Building health promotion capacity in a primary health care workforce in the Northern Territory: some lessons from practiceJenni Judd A B E and Helen Keleher C D
A Faculty of Medicine Health and Molecular Science, James Cook University, Townsville, Qld 4814, Australia.
B School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Qld 4059, Australia.
C School of Public Health and Preventive Medicine, Monash University (Alfred Campus), Melbourne, Vic. 3004, Australia.
D Frankston Mornington Peninsula Medicare Local, Mornington, Vic. 3193, Australia.
E Corresponding author. Email: email@example.com
Health Promotion Journal of Australia 24(3) 163-169 http://dx.doi.org/10.1071/HE13082
Submitted: 27 September 2013 Accepted: 25 November 2013 Published: 19 December 2013
Issues addressed: Reorientation of the workforce in primary health care is a complex process and requires specific strategies and interventions. Primary health care providers are a key health care workforce that is expected to deliver tangible outcomes from disease prevention and health promotion strategies. This paper describes a training intervention that occurred as part of a broader participatory action research process for building health promotion capacity in the primary health care workforce.
Methods: Participatory action research (PAR) was conducted over six action and reflection cycles in a two-year period (2001–02) in an urban community health setting in the Northern Territory. One of the PAR cycles was a training intervention that was identified as a need from a survey in the first action and reflection cycle. This training was facilitated by a health promotion specialist, face-to-face and comprised five 3.5-h sessions over a 5-month period. A pre-post questionnaire was used to measure the knowledge and skills components of the training intervention.
Results: The results reinforced the importance of using a participatory approach that involved the primary health care providers themselves. Multiple strategies such as workforce development within capacity building frameworks assisted in shifting work practice more upstream. Additionally, these strategies encouraged more reflective practice and built social capital within the primary health care workforce.
Conclusion: Lessons from practice reinforce that workforce development influenced work practice change and is an important element in building the health promotion capacity of primary health care centres.
So what?: Workforce development is critical for reorienting health services. Health promotion specialists play an important role in reorienting practice, which is only effective when combined with other strategies, and driven and led by the primary health care workforce.
Key words: capacity building, participatory action research, primary health care, reorienting health services, workforce development.
References World Health Organization. Declaration of Alma Ata. Geneva: World Health Organization; 1978.
 World Health Organization. Ottawa Charter for Health Promotion. Geneva: World Health Organization; 1986.
 World Health Organization. Jakarta Declaration on Leading Health Promotion into the 21st Century. Geneva: World Health Organization; 1997.
 Frankish CJ, Moulton G, Rootman I, Cole C, Gray D (2006) Setting a foundation: underlying values and structures of health promotion in primary health care settings. Prim Health Care Res Dev 7, 172–82.
 Moulton G, Frankish J, Rootman I, Cole C, Gray D (2006) Building on a foundation: strategies, processes and outcomes of health promotion in primary health care settings. Prim Health Care Res Dev 7, 269–77.
 Keleher H (2001) Why primary health care offers a more comprehensive approach for tackling health inequalities than primary care. Aust J Primary Health 7, 57–61.
| Why primary health care offers a more comprehensive approach for tackling health inequalities than primary care.CrossRef |
 Wass A. Promoting health: the primary health care approach. 2nd edn. Sydney: Harcourt Saunders; 2000.
 Baum FE, Legge DG, Freeman T, Lawless A, Labonte R, Jolley GM (2013) The potential for multidisciplinary primary health care services to take action on the social determinants of health: actions and constraints. Biomed Central. BMC Public Health 13, 460
| The potential for multidisciplinary primary health care services to take action on the social determinants of health: actions and constraints.CrossRef |
 NSW Health. How to apply capacity building to health promotion action-framework. Sydney: Health Promotion Strategies Unit; 1997.
 Hawe P, Noort M, King L, Jordens C (1997) Multiplying health gains: the critical role of capacity building within health promotion programs. Health Policy 39, 29–42.
| Multiplying health gains: the critical role of capacity building within health promotion programs.CrossRef | 1:STN:280:DyaK2s7ptFykug%3D%3D&md5=bb6579b0586a6d0b1c6ba571d25562bdCAS | 10164903PubMed |
 King L, Ritchie J. Promoting health in the Northern Territory: a review. Sydney: WHO Regional Training Centre for Health Development School of Medical Education, Faculty of Medicine, and University of NSW; 1999.
 Judd J, Keleher H. Reorienting health services in the Northern Territory of Australia: a conceptual model for building health promotion capacity in the workforce. Global Health Promotion 2013; 20: 53.
 National Health and Hospital Reform Commission. A healthier future for all Australians – final report of the National Health and Hospitals Reform Commission. Commonwealth of Australia; 2009.
 Murphy B, Keleher H. Framework for health promotion action: a discussion paper for course development. Melbourne: School of Health Development, Deakin University; 2003.
 Judd J. Building health promotion capacity in the workforce: participatory action research. Thesis. Melbourne: Deakin University; 2005.
 Australian Bureau of Statistics. Northern Territory in focus. Australia: Australian Bureau of Statistics.; 2001.
 Northern Territory Health Services. Aboriginal public health strategy. Darwin: Territory Health Services; 1998.
 Marmot M, Wilkinson R. Social determinants of health, 2nd edn. Oxford: Oxford University Press; 2006.
 Wright L. In Perkins ER, Simnett I, Wright L, editors. Evidence-based health promotion. (pp. 91–98.) Chichester: John Wiley and Sons: 1999;
 Connor Fleming M, Parker E, Oldenburg B (2000) Health Promotion Workforce Development in Australia’. Health Promot J Austr 10, 140–7.
 NSW Health. A framework for building capacity to improve health. North Sydney: Health Promotion Strategies Unit, NSW Health; 2000.
 Patton MQ. Qualitative research and evaluation methods, 3rd edn. Thousand Oaks, CA: SAGE; 2002.
 Miles MB, Huberman AM. Qualitative data analysis. Thousand Oaks, CA: SAGE; 1994.
 Wadsworth Y. What is participatory action research? Action Research International. 1998 Paper 2. Available from: http://www.aral.com.au/ari/p-ywadsworth98.html [Verified 8 December 2013]
 Greenwood W, Harkary I (1993) Participatory action research as a process and a goal. Hum Relat 46, 175–92.
| Participatory action research as a process and a goal.CrossRef |
 Green L, George MA, Daniel M, Frankish CJ, Herbert CJ, Bowies WR. et al. Study of participatory health research in health promotion: review and recommendations for the development of participatory research in health promotion in Canada. Canada: The Royal Society of Canada; 1995.
 Minkler M, Wallerstein N, eds. Community based participatory research in health. San Francisco, CA: Jossey-Bass; 2003.
 Wallerstein N, Duran B (2006) Using community based participatory research to address health disparities. Health Promot Pract 7, 312–23.
| Using community based participatory research to address health disparities.CrossRef | 16760238PubMed |
 Cargo M, Mercer SL (2008) The value and challenges of participatory research: strengthening its practice. Annu Rev Public Health 29, 325–50.
| The value and challenges of participatory research: strengthening its practice.CrossRef | 18173388PubMed |
 National Health and Medical Research Council. National statement on ethical conduct in human research. Australia: Australian Government; 2007.
 Northern Territory Training Authority, Brief Intervention and Sharing Health Information accredited courses, Department of Business, NT; 1999.
 Nutbeam D (2000) Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int 15, 259–67.
| Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century.CrossRef |
 Coulter A, Ellins J (2007) Effectiveness of strategies for informing, educating and involving patients. BMJ 335, 24–7.
| Effectiveness of strategies for informing, educating and involving patients.CrossRef | 17615222PubMed |
 Community Health Services and Health Industry Skills Council. Population health training packages. Australian Government, Department of Industries. Available from: http://www.cshisc.com.au/discover/industries-a-z-directory/population-health/ [Verified 3 December 2013]
 Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT The alcohol use disorders identification test: guidelines for use in primary care. Geneva: World Health Organization; 2001.
 Prochaska JO, DiClemente CC (1983) Stages and processes of self change of smoking: toward an integrative model of change. J Consult Clin Psychol 51, 390–5.
| Stages and processes of self change of smoking: toward an integrative model of change.CrossRef | 1:STN:280:DyaL3s3jvFaksw%3D%3D&md5=1bac32cfff3f5b1a570f0ff853cdb1b3CAS | 6863699PubMed |
 Australian National Preventative Health Agency. The role of Australian primary health care in the prevention of chronic disease. Australian Government; September 2012.
 Hawe P, Shiell A (2000) Social capital and health promotion: a review. Soc Sci Med 51, 871–885.
| Social capital and health promotion: a review.CrossRef | 1:STN:280:DC%2BD3M7gvFegsw%3D%3D&md5=0d384f61be1ad4c0f0d70541e4e13f06CAS | 10972431PubMed |
 Fleming P. Enhancing the empowerment agenda in health promotion through reflective practice. Reflective Practice 2000; 8: 315–30.
 Australian Health Promotion Association. Health promotion: Workforce development: A snapshot of practice in Australia. Melbourne: Australian Health Promotion Association; 2001.