Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av. Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain.
Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
Int J Equity Health. 2017 Jun 13;16(1):99. doi: 10.1186/s12939-017-0590-2.
Although some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention.
A descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out.
Health-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants' profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having implemented some change to promote their health. The most powerful motivators to change lifestyles are having a disease, fear of becoming ill and taking care of oneself to maintain health. Health-care users believe that the main difficulties are associated with the physical, social, working and family environment, as well as lack of determination and motivation. They also highlight the need for more information. In relation to the assets and deficits of the neighbourhood, each group identifies those closer to their role.
Generally, participants showed a holistic and positive concept of health and a more traditional, individual approach to health promotion. We consider therefore crucial to depart from the model of health services that focuses on the individual and the disease toward a socio-ecological health model that substantially increases the participation of health-care users and emphasizes health promotion, wellbeing and community participation.
虽然有些文章从医疗保健使用者和医疗保健专业人员的角度分析了健康和健康促进的定义，但没有发表的研究同时包括医疗保健使用者、初级卫生保健专业人员和主要社区知情人的参与。了解这些不同利益相关者对健康和健康促进的看法对于设计和实施成功、公平和可持续的措施至关重要，这些措施可以改善人口的健康和福祉。此外，不同的信息提供者对不同的健康资产和缺陷的识别将产生新的证据，以促进健康行为、改善社区健康和福祉以及减少可预防的不平等。本研究的目的是探讨健康和健康促进的概念，并比较医疗保健使用者、主要社区知情人和初级卫生保健工作者确定的健康资产和缺陷，最终目的是收集必要的数据，以设计和实施成功的健康促进干预措施。
采用描述性解释性定性研究，对来自西班牙 7 个地区 14 个初级保健中心的 276 名参与者进行了研究。采用理论抽样进行选择。我们组织了 11 个讨论小组和 2 个三角小组，参与者为医疗保健使用者；对 30 名主要社区知情人进行了 30 次半结构化访谈；对 14 名初级卫生保健工作者进行了 14 次讨论小组。进行了主题内容分析。
医疗保健使用者和主要社区知情人都认为健康是一个复杂、广泛、多因素的概念，包含几个相互关联的维度（身体、心理-情绪、社会、职业、智力、精神和环境）。这三个参与者的概况认为健康促进是不可或缺的，尽管他们将其定义为复杂和模糊的。事实上，大多数医疗保健使用者承认已经采取了一些措施来促进自己的健康。改变生活方式的最强大动力是患有疾病、害怕生病和照顾自己以保持健康。医疗保健使用者认为主要的困难与身体、社会、工作和家庭环境有关，还与缺乏决心和动力有关。他们还强调需要更多的信息。关于邻里的资产和缺陷，每个群体都确定了与他们角色更接近的资产和缺陷。
一般来说，参与者表现出了对健康的整体和积极的概念，以及对健康促进的更传统、个人的方法。因此，我们认为至关重要的是要从关注个体和疾病的卫生服务模式转向社会生态健康模式，大幅增加医疗保健使用者的参与，并强调健康促进、福祉和社区参与。
