The Journal in 1977 published a seminal article by Larry Green highlighting an array of challenges associated with the evaluation and measurement of health promotion research (http://am.ajph.link/LGreen_1977). In what we might consider as déjà vu, today, more than 40 years later, we are still grappling with strategies to enhance the rigor and relevance and overcome the complexities associated with health promotion research.
Originally, the field of health promotion placed an emphasis on personal “lifestyle” behaviors. In addition to focusing on individuals’ behavior, more contemporaneous definitions of “lifestyle” have included the social and cultural circumstances that condition and constrain behavior. Regardless of the definition, the Institute of Medicine recognizes health promotion research as critical for identifying new and innovative strategies to improve the nation’s health. By enhancing the science base of health promotion, new insights, both on the determinants of health and disease and on the relative effectiveness of innovative approaches to improving population health can be quantified and integrated into sustainable interventions.
Historically, efficacious health promotion interventions were guided by traditional public health theories and models. Today, there is growing recognition of the complexity of public health threats. Effectively addressing contemporary public health challenges requires multiple frameworks, models, and theories. Thus, complementing traditional health promotion theories with nontraditional theories, such as systems theory, social network theory, and critical race theory, can provide a broader theoretical foundation for developing interventions to reduce health disparities.
A cornerstone of health promotion research has been developing evidence-based individual-level interventions. To enhance the breadth and impact of these interventions, it may be beneficial to link interventions across different socio-ecological levels optimizing their synergy. Recent advances in intervention design combine individual-level interventions with higher-level interventions (e.g., neighborhood-level interventions) to create multilevel interventions that may be more effective in promoting health behaviors and, more importantly, population health.
Health promotion is recognized for its strengths in community partnerships, engaging diverse public health professionals and public health academics. However, to maximize the effectiveness and sustainability of health promotion interventions requires a transdisciplinary approach. Collaboratively leveraging the experience, strengths, and expertise across different fields is the hallmark of team science and creates opportunities for innovation. Furthermore, linkages with social media and marketing agencies could be cost-effective, enhancing the dissemination, reach, and scale up of interventions. Additionally, the innovation offered by design thinking, a human-being–centered model of thinking that considers inspiration, ideation, and implementation as stages in product development may facilitate intervention design, implementation, and sustainability.
Research methods are also at the core of health promotion. However, more recent methodologic advances, such as pragmatic trial designs, may create “real-world” evidence for health promotion interventions. Technological advances allow integrating minimally invasive biosensors and biomarkers that measure physiologic changes as a complement to self-reported behavioral outcomes, primarily used for evaluating health promotion interventions. Today researchers employ novel analytic approaches including agent-based modeling and geographical information systems. The emergence of data visualization, storytelling and other health communication techniques could enhance communication of findings in health promotion research. These methodologic approaches could be powerful tools in the health promotion armamentarium.
The field of health promotion continues to evolve. To accelerate its evolution and impact requires continued and renewed emphasis on both, its traditional core elements and adopting and applying new theories and methods. Ultimately, a commitment to improving the science base of health promotion is vital for informed and sustained progress.
15 Years Ago
A New Pathway for Occupational Health Research
[I] call for a revised occupational health research paradigm in developing countries that focuses less on the workplace and more on the workers in their social contexts. A contextual, social justice orientation of occupational health research, as opposed to the narrow traditional approach, places occupational health researchers in tandem with other stakeholders in the call for a just and healthy society. . . . [O]nly by becoming a tool for social change . . . can occupational health research effectively understand the hazards of work and its effects on workers and the community in developing countries. . . . [S]taying with the prevailing paradigm means a prolongation of neglect, ineffectiveness, and professional stagnation.
From AJPH, November 2004, p. 1940
61 Years Ago
Operations Research in Public Health
Operations research . . . sets up a representative model of the situation and then extrapolates from this model to high probability predictions that certain events will occur if recommendations are followed. . . . [T]hrough this technic . . . the use of the scientific method [can be] extended further into the realm of administrative decision. . . . Operations research has also contributed greatly to public health research in that it recognizes the need to assign quantitative status to certain human values. . . . Any research which succeeds in defining these values in quantitative terms similar to those we use to explain the epidemiology of disease will indeed contribute much to the practice of public health.
From AJPH, March 1958, p. 355–356
Biography
Contributor Information
Gina M. Wingood, Columbia University New York, NY.
Ralph J. DiClemente, New York University New York, NY.