The challenges of developing health promotion in health care : investigating the process of learning and change

Traditional views on the spread of knowledge and learning in health care have been criticized as being overly linear, simplified and rational, leading to a slow progress of clinical praxis. Accelerating change in health promotion is a special challenge. The objective of the study was to examine learning and change processes in a countywide multi-professional, multi-organizational health promoting program for children, named Salut. The involved county council facilitators used an improvement approach built on theory regarding how to accomplish change in complex systems. The program involved active cooperation between researchers, process facilitators and professionals in a pilot area process. Interviews, observations, survey and archival data were used in analyses of the program's progress (2004-2008) and the actors' views on the learning and change processes introduced. Results indicate differences in perspectives, focus, aims and understanding between groups of actors, and between steering and operational levels of the project organization. The facilitators' views differed most compared to the others regarding aspects of learning and process focus. The views on learning changed as the program progressed and were at the end of 2008 under new strategic consideration. A model of development and learning, from medical knowledge to health improvements, was developed, describing several sub-processes. It also illustrates different scientific focuses on health intervention and change. A main conclusion is the importance of including intermediate processes when designing health promoting programs and acknowledgement of relations between evidence based medical knowledge, the processes of producing and selecting interventions, intervention design, type of implementation process and its effects on sustainability; the learning-in-context by professionals and parent/child and its connection to sustainability; the cognitive processes involved in learning and behavioral change; life-style changes and their effects on health. A good pilot example can hardly spread without a strategic change plan and an understanding of the dynamics of context and processes over time. The model has become a central tool in continuing the process of the Salut program and might also be of aid to other development projects.Godkänd; 2009; 20091110 (rick_g