Ethics and health promotion practice: exploring attitudes and practices in Western Australian health organisations
T. Reilly A B , G. Crawford A , R. Lobo A , J. Leavy A and J. Jancey AA Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, GPO Box U1987, WA 6845, Australia.
B Corresponding author. Email: tegan.reilly1@gmail.com
Health Promotion Journal of Australia 27(1) 54-60 https://doi.org/10.1071/HE15059
Submitted: 5 June 2015 Accepted: 12 February 2016 Published: 4 April 2016
Abstract
Issue addressed: Evidence-informed practice underpinned by ethics is fundamental to developing the science of health promotion. Knowledge and application of ethical principles are competencies required for health promotion practice. However, these competencies are often inconsistently understood and applied. This research explored attitudes, practices, enablers and barriers related to ethics in practice in Western Australian health organisations.
Methods: Semistructured, in-depth interviews were conducted with 10 health promotion practitioners, purposefully selected to provide a cross-section of government and non-government organisations. Interviews were recorded, transcribed and then themed.
Results: The majority of participants reported consideration of ethics in their practice; however, only half reported seeking Human Research Ethics Committee (HREC) approval for projects in the past 12 months. Enablers identified as supporting ethics in practice and disseminating findings included: support preparing ethics applications; resources and training about ethical practice; ability to access HRECs for ethics approval; and a supportive organisational culture. Barriers included: limited time; insufficient resourcing and capacity; ethics approval not seen as part of core business; and concerns about academic writing.
Conclusion: The majority of participants were aware of the importance of ethics in practice and the dissemination of findings. However, participants reported barriers to engaging in formal ethics processes and to publishing findings.
So what?: Alignment of evidence-informed and ethics-based practice is critical. Resources and information about ethics may be required to support practice and encourage dissemination of findings, including in the peer-reviewed literature. Investigating the role of community-based ethics boards may be valuable to bridging the ethics–evidence gap.
Key words: ethics, practitioners, evidence-informed, barriers, enablers, dissemination.
References
[1] Carter SM, Rychetnik L, Lloyd B, Kerridge I, Baur L, Bauman A, Hooker C, Zask A (2011) Evidence, ethics, and values: a framework for health promotion. Am J Public Health 101, 465–72.| Evidence, ethics, and values: a framework for health promotion.Crossref | GoogleScholarGoogle Scholar | 21233436PubMed |
[2] Speller V, Parish R, Davison H, Zilnyk A, the CompHP Project Partners. The ComHP Professional Standards for Health Promotion Handbook (Short version). International Union for Health Promotion and Education, Paris. 2012. Available from: http://www.iuhpe.org/images/PROJECTS/ACCREDITATION/CompHP_Professional_standards_Short_ENG.pdf [Verified 6 December 2015].
[3] Carter S, Klinner C, Kerridge I, Rychetnik L, Li V, Fry D (2012) The ethical commitments of health promotion practitioners: an empirical study from New South Wales, Australia. Public Health Ethics 5, 128–39.
| The ethical commitments of health promotion practitioners: an empirical study from New South Wales, Australia.Crossref | GoogleScholarGoogle Scholar |
[4] Seedhouse D (2001) Health promotion’s ethical challenge. Health Promot J Austr 11, 135–8.
[5] Gregg J, O’Hara L (2007) Values and principles evident in current health promotion practice. Health Promot J Austr 18, 7–11.
[6] National Health and Medical Research Council. National statement on ethical conduct in human research. Canberra: Commonwealth of Australia. 2007. Available from: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/e72_national_statement_may_2015_150514_a.pdf [Verified 6 December 2015].
[7] National Health and Medical Research Council. Australian code for the responsible conduct of research. Canberra: Commonweath of Australia. 2007. Available from: http://www.nhmrc.gov.au/_files_nhmrc/file/research/research-integrity/r39_australian_code_responsible_conduct_research_150811.pdf [Verified 6 December 2015].
[8] Sainsbury P (2015) Development and oversight of ethical health promotion quality assurance and evaluation activities involving human participants. Health Promot J Austr 26, 176–81.
| Development and oversight of ethical health promotion quality assurance and evaluation activities involving human participants.Crossref | GoogleScholarGoogle Scholar |
[9] Newson AJ, Lipworth W (2015) Why should ethics approval be required prior to publication of health promotion research? Health Promot J Austr 26, 170–75.
| Why should ethics approval be required prior to publication of health promotion research?Crossref | GoogleScholarGoogle Scholar |
[10] James EL, Talbot L (2005) Conducting research in general practice: lessons learnt from experience. Health Promot J Austr 16, 41–6.
[11] Pierce M (1998) Doing research in general practice: advice for the uninitiated. Diabet Med 15, S25–8.
| Doing research in general practice: advice for the uninitiated.Crossref | GoogleScholarGoogle Scholar | 9829765PubMed |
[12] National Health and Medical Research Council. Human research ethics committees. Canberra: Commonweath of Australia. 2015. Available from: https://www.nhmrc.gov.au/health-ethics/human-research-ethics-committees-hrecs [Verified 6 December 2015].
[13] Community Research Ethics Network. Community Research Ethic Office – Our Services. 2012. Available from: http://www.communityresearchethics.com/creo-services/ [Verified 6 December 2015].
[14] Harris A, Mortimer D (2009) Funding illness prevention and health promotion in Australia: a way forward. Aust New Zealand Health Policy 6, 25
| Funding illness prevention and health promotion in Australia: a way forward.Crossref | GoogleScholarGoogle Scholar | 19909519PubMed |
[15] Green LW (2014) Closing the chasm between research and practice: evidence of and for change. Health Promot J Austr 25, 25–9.
| Closing the chasm between research and practice: evidence of and for change.Crossref | GoogleScholarGoogle Scholar | 24666557PubMed |
[16] O’Hara BJ, Phongsavan P, King L, Develin E, Milat A, Eggins D, King E, Smith J, Bauman AE (2014) Translation formative evaluation: critical in up-scaling public health programs. Health Promot Int 29, 38–46.
| Translation formative evaluation: critical in up-scaling public health programs.Crossref | GoogleScholarGoogle Scholar | 23630131PubMed |
[17] Carter SM (2012) What is health promotion ethics? Health Promot J Austr 23, 4
| What is health promotion ethics?Crossref | GoogleScholarGoogle Scholar | 22730937PubMed |
[18] Carter S, Cribb A, Allegrante J (2012) How to think about health promotion ethics. Public Health Rev 34, 122–45.
[19] Parker E, Gould T, Fleming M (2007) Ethics in health promotion – reflections in practice. Health Promot J Austr 18, 69–72.
[20] Raphael D (2000) The question of evidence in health promotion. Health Promot Int 15, 355–67.
| The question of evidence in health promotion.Crossref | GoogleScholarGoogle Scholar |
[21] Ryan G, Bernard H (2003) Techniques to identify themes. Field Methods 15, 85–109.
| Techniques to identify themes.Crossref | GoogleScholarGoogle Scholar |
[22] Sindall C (2002) Does health promotion need a code of ethics? Health Promot Int 17, 201–3.
| Does health promotion need a code of ethics?Crossref | GoogleScholarGoogle Scholar | 12147634PubMed |
[23] World Health Organization. Ethical issues in patient safety research: interpreting existing guidance. 2013. Available from: http://apps.who.int/iris/bitstream/10665/85371/1/9789241505475_eng.pdf [Verified 6 December 2015].
[24] Carter SM (2014) Health promotion: an ethical analysis. Health Promot J Austr 25, 19–24.
| Health promotion: an ethical analysis.Crossref | GoogleScholarGoogle Scholar | 24739775PubMed |
[25] Upshur RE (2002) Principles for the justification of public health intervention. Can J Public Health 93, 101–3.
[26] Brown LJ, McIntyre E (2014) The contribution of primary health care research, evaluation and development-supported research to primary health care policy and practice. Aust J Prim Health 20, 47–55.
| The contribution of primary health care research, evaluation and development-supported research to primary health care policy and practice.Crossref | GoogleScholarGoogle Scholar | 23092638PubMed |