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Dempsey, C; Battel-Kirk, B; Barry, MM
The CompHP Core Competencies Framework for Health Promotion Handbook
International Union Of Health Promotion And Education (IUHPE),
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INTRODUCTION The core competencies presented in this Handbook were developed as part of a European project entitled ‘Developing Competencies and Professional Standards for Health Promotion Capacity Building in Europe’ (CompHP) , which is funded by the Executive Agency for Health and Consumers. This is the first in a series of three Handbooks to be produced by the CompHP project and will be followed by Handbooks on Professional Standards and a Pan-European Accreditation Framework for Health Promotion. The CompHP Project will also publish reports on the processes undertaken in developing the core competencies, professional standards and accreditation framework and their testing in academic and practice settings. The CompHP Handbooks and reports will be widely disseminated throughout the European Union (EU) member states and candidate countries and will be available on the CompHP website1. The CompHP Project The aim of the CompHP project is to develop competency-based standards and an accreditation system for health promotion practice, education and training that will have a positive impact on workforce capacity to deliver public health improvement in Europe. The CompHP Project brings together 24 European partners from the professional development, policy, practice and academic sectors in health promotion. The work of CompHP is also supported by an International Advisory Group of experts with experience of the development of health promotion competencies at a global level (see Appendix 1 for a full list of CompHP partners and members of the International Advisory Group). The CompHP Project employs a consensus building process based on consultation with key stakeholders in health promotion across Europe and builds on existing European and global competency frameworks for health promotion. In particular, it is informed by work undertaken by the European Regional Sub Committee on Training, Accreditation and Professional Standards of the International Union for Health Promotion and Education (IUHPE), which developed and supported the groundwork for the CompHP Project, including undertaking a feasibility study (1). Context and Rationale for Developing Core Competencies for Health Promotion A competent workforce that has the necessary knowledge, skills and abilities in translating policy, theory and research into effective action is recognised as being critical to the future growth and development of global health promotion (2, 3, 4, 5). Identifying and agreeing the core competencies for effective health promotion practice, education and training is acknowledged as being an essential component of developing and strengthening workforce capacity to improve global health in the 21st century (6, 7, 8). 1 EAHC Project number 20081209 1 The CompHP Core Competencies Framework for Health Promotion Within the pan-European context, health promotion goals are clearly identified in EU strategies but, there has been no agreement to date on Europe-wide competencies, standards or accreditation systems to assure quality standards in reaching those goals. The development of the CompHP Project was driven by recognition of the need for a coherent competency based framework that would build on related national and international developments. Other key drivers for the project included: freedom of employment policies highlighting the need for agreed standards to facilitate employment across the EU; quality assurance issues for practice, education and training identified within all health fields in Europe; and clarity on workforce capacity required for promoting health and addressing inequalities as identified in EU strategies. It was also recognised that health promotion is an evolving field in Europe with a diverse and growing workforce drawn from a range of disciplines, and operating in a variety of settings and across a wide range of political, economic and social contexts. Given this diversity, there is a need for core competencies which delineate the specific body of skills, knowledge and expertise that represents, and is distinctive to, health promotion practice (7, 8) to unify and strengthen health promotion workforce capacity across Europe. What are Core Competencies? The definition of competencies used in this Handbook is: ‘a combination of the essential knowledge, abilities, skills and values necessary for the practice of health promotion,’ (adapted from Shilton et al. 2001) (9). Core competencies are defined as the minimum set of competencies that constitute a common baseline for all health promotion roles i.e. ; ‘they are what all health promotion practitioners are expected to be capable of doing to work efficiently, effectively and appropriately in the field’ (10). How were the CompHP Core Competencies developed? The key elements in the development process for the CompHP Core Competency Framework for Health Promotion were: • • • • 2 A review of the international and European literature on health promotion competencies (11) An initial draft framework of core competencies based on findings from the literature review and consultation with project partners A Delphi survey on the draft core competencies undertaken with health promotion experts from across Europe to reach consensus2 Focus groups with health promotion experts and other key stakeholders from across Europe The sample for the two rounds of the Delphi Survey comprised six representatives from a total of 34 European countries, two from each of the areas of practice, policy, and academia selected on, in order of priority: national role in health promotion, experience in health promotion, and experience in the competency approach. 2 EAHC Project number 20081209 The CompHP Core Competencies Framework for Health Promotion • Consultation with health promotion stakeholders across Europe using a web based consultation process. The CompHP project partners and the International Expert Advisory Group advised on each stage of the development process. The CompHP core competencies are, therefore, the result of a wide- ranging consultation process and draw on the international and European literature, in particular: The domains of core competencies outlined in the Galway Consensus Statement (7), together with the modifications to the statement suggested in a global consultation process The core competencies for health promotion developed in Australia (10), Canada (12), New Zealand (13) and the UK (14) Core competencies developed in related fields such as public health (15, 16) and health education (17). Who are the CompHP Core Competencies for? The CompHP core competencies are primarily designed for use by health promotion practitioners whose main role and function is health promotion and who hold a graduate or post graduate qualification in health promotion or a related discipline3,4. A health promotion practitioner is defined as a person who works to promote health and reduce health inequities using the actions described by the Ottawa Charter (18): building healthy public policy creating supportive environments strengthening community action developing personal skills reorienting health services. While job titles and academic course titles in different countries across Europe may not always include the term ‘health promotion’, the core competencies are designed to be relevant to all practitioners whose main role reflects the definition and principles of health promotion defined in the Ottawa Charter (18). Health promotion practitioners require specific education and training together with ongoing professional development to maintain the particular combination of knowledge and skills required to ensure quality health promotion practice. 3 Including, for example, public health, health education, social sciences including psychology, epidemiology, sociology, education, communication, environmental health, community, urban or rural development, political science. This is not an exclusive list as other academic qualifications may also be deemed as appropriate. 4 While a formal qualification in health promotion or related discipline is the general required minimum standard for entry into the profession, it is recognised that there are practitioners who entered the field without a formal qualification. For this group, these competencies provide a frame- work for assessing and helping achieve formal recognition for relevant past experience. EAHC Project number 20081209 3 The CompHP Core Competencies Framework for Health Promotion While the competencies articulated in this Handbook are aimed at entry level practitioners, acquiring a competency is not viewed as a one-time event, but rather an ongoing process. Formal training is one means of acquiring entry level competencies, however, ongoing learning, through experience, coaching, feedback and individual learning activities, is required to develop advanced competencies and maintain the knowledge and skills required by changing practice and policy (19). Much discussion has centred on the appropriate level for these core competencies and it has been agreed that they are at ‘entry level’ i.e. the level at which a practitioner enters practice. This does not imply that all health promotion practitioners are limited to that level. The core competencies can, for example, provide the basis for developing more advanced competencies for practitioners working at senior management level in health promotion or inform the development of specialised competencies for those who work in specific settings. It is also recognised that those using the CompHP Core Competencies may wish to identify different levels of expertise for some or all of the competencies or to emphasise some competencies to a greater degree than others. However, as these are core competencies, all should be addressed if they are to be used as the basis for consistent, quality health promotion practice which can be recognised internationally and be accredited though a pan-European accreditation system. While these competencies were developed within a Pan-European context they may also be useful for health promotion competency development in other countries globally. The competencies can also be useful to those working in other professional areas whose role includes health promotion (e.g., community health, health education) or those in the other sectors who are involved in partnerships to promote health or create healthy environments5. The matrix presented in Appendix 2 illustrates how the competencies can be used by health promotion practitioners at different levels of seniority or experience and also by other professionals whose role includes health promotion. How can the CompHP Core Competencies be used? The purpose of health promotion competencies is to provide a description of the essential knowledge, abilities, skills and values that are needed to inform effective practice. In this context some countries or organisations may use the Framework as a standalone document. However, within the context of the CompHP Project the core competencies are designed to provide a base of knowledge and skills for practice that will inform the development of Professional Standards for Health Promotion and a pan-European Accreditation Framework. An effective competency framework can provide a solid base for workforce development and has a wide range of potential useful applications across many areas. 5 For example, teachers, community development workers. 4 EAHC Project number 20081209 The CompHP Core Competencies Framework for Health Promotion Core Competencies have a key role to play in developing health promotion by (adapted from PHAC, 2008) (16): Underpinning future developments in health promotion training and course development Continuing professional development Providing a basis for systems of accreditation and development of professional standards Consolidation of health promotion as a specialised field of practice Accountability to the public for the standards of health promotion practice. Core Competencies may promote the health of the public by: Contributing to a more effective workforce Encouraging service delivery that is evidence based, population-focused, ethical, equitable, standardised and client-centred Forming the basis for accountable practice and quality assurance. Core Competencies can benefit health promotion practitioners by: Ensuring that there are clear guidelines for the knowledge, skills and values needed to practice effectively and ethically Informing education, training and qualification frameworks to ensure that they are relevant to practice and workplace needs Assisting in career planning and identifying professional development and training needs Facilitating movement across roles, organisations, regions and countries through the use of shared understandings, qualifications and, where appropriate, accreditation systems based on the competencies Promoting better communication and team work in multidisciplinary and multisectoral settings by providing a common language and shared understanding of the key concepts and practices used in health promotion Helping to create a more unified workforce by providing a shared understanding of key concepts and practices Contributing to greater recognition and validation of health promotion and the work done by health promotion practitioners. EAHC Project number 20081209 5 The CompHP Core Competencies Framework for Health Promotion Core Competencies can benefit health promotion organisations by: Identifying staff development and training needs Providing a basis for job descriptions, interview questions and frameworks for evaluation and quality assurance Identifying the appropriate numbers and mix of health promotion workers in a given setting Assisting employers and managers to gain a better understanding of health promotion roles in individual workplaces and develop appropriate job descriptions. In developing the CompHP Project it was recognised that for some countries and regions the core competencies may be all that is useful or appropriate for their specific practice or policy context. In these instances The CompHP Core Competencies for Health Promotion Handbook may be used as a ‘standalone’ document. However, within the context of the overall Project, the core competencies are designed to form the basis for the development of Professional Standards and a pan-European Accreditation Framework for Health Promotion as additional tools for health promotion workforce capacity development across Europe. Core Concepts and Principles Underpinning the CompHP Core Competencies The competencies are based on the core concepts and principles of health promotion outlined in the Ottawa Charter (18) and successive World Health Organisation (WHO) charters and declarations on health promotion (5, 20-24). Health promotion is, therefore, understood to be ‘the process of enabling people to increase control over, and to improve, their health’ (18). Health promotion is viewed as representing a comprehensive social and political process which not only embraces action directed at strengthening the skills and capabilities of individuals, but also actions directed toward changing social, environmental and economic conditions which impact on health (25). Health is defined as ‘a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity’ (26). Health is further conceptualised as a resource for everyday life, emphasising social and personal resources, as well as physical capacities (18). The CompHP Core Competencies are underpinned by an understanding that health promotion has been shown to be an ethical, principled, effective and evidence-based discipline (27, 28) and that there are well-developed theories, strategies, evidence and values that underpin good practice in health promotion (29). The term ‘health promotion action’ is used in the core competencies to describe programmes, policies and other organised health promotion interventions that are empowering, participatory, holistic, intersectoral, equitable, sustainable and multi-strategy in nature (22) which aim to improve health and reduce health inequities.
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