Acknowledgments

Introduction

History and Background of the Report

Scope of the Inventory

Overview of the Report

General Course Information

Student and Teacher Demographics

Teaching and Evaluation Methods

Teacher/Teaching Resources

Issues in Health Promotion Teaching

Key Challenges Facing Teachers of Health Promotion in Canada

Health Promotion Programs

Summary and Analysis

Recommendations

References

The authors would like to acknowledge the contributions of the authors of the original research report; Joan Feather, Douglas Wilson, Kathryn Green, Michael Sharratt, Eric Roy, Jim Frankish, Irv Rootman and Michael Goodstadt. This project was funded by Health Canada

In 1997, the Canadian Consortium for Health Promotion Research Working Group on Education and Training conducted a study to determined the status of education in health promotion in Canada. Specifically, the Working Group was interested in examining the scope of formal post-secondary health promotion training in Canada and the key issues in teaching health promotion.

As part of that survey, 53 Canadian university teachers of health promotion courses were interviewed, by telephone and by questionnaire. The information derived from these interviews along with descriptions of degree programs in health promotion, was complied in a report to Health Canada. The following is a summary of that report.

The Canadian Consortium for Health Promotion Research established a Working Group on Health Promotion Education and Training in 1995 to obtain needed information about the status of education and training in the area of health promotion in Canada. The Group was asked to undertake three tasks:

• to assess options for improved coordination of planning for summer schools/institutes,
• to make recommendations for testing the feasibility of a proposed case study fellowship program; and,
• to examine the current status of formal health promotion training in courses and programs at Canadian universities.

A subcommittee of the Working Group was formed to address this third task, beginning with the teacher/course survey and the report of it, described in this chapter.

Funding was received from Health Canada to conduct an survey of Canadian universities. The intent was to obtain an accurate and current inventory of information of health promotion courses and programs in Canada. Such an inventory was seen to be a valuable resource for faculty affiliated with health promotion programs and for prospective students of health promotion. In addition, this inventory would provide a starting point for discussions about such issues as: the relevance of formal training to practice competencies; the availability of appropriate teaching resources; innovative teaching methods; and the role of formal training in the professional development of the field of health promotion practice. It was expected that discussions of this nature would take place among teachers identified at universities across Canada, and between teachers and key representatives of health promotion practice.

The subcommittee initially asked representatives of the Canadian Consortium for Health Promotion Research Centres to identify contact people involved in teaching health promotion at their affiliated institutions. In order to increase the comprehensiveness of the inventory, this approach was subsequently supplemented by surveying the calendars of the universities listed in the 1996 AUUC Directory of Canadian Universities (community colleges were not surveyed) for the term "health promotion" in course titles or course descriptions.

From the initial contacts and the calendars survey, 23 of the 36 listed universities were identified as having either courses in health promotion or courses with significant health promotion content. A total of 84 such classes (26 graduate and 58 undergraduate) taught by about 70 teachers were located. The subcommittee decided to include in the survey all teachers named by the initial contacts who had indicated that they taught one or more courses in health promotion, by their own definition. The majority were taught in schools or faculties of nursing with the remainder in programs of health education and health promotion, community health and epidemiology, physical education, gerontology, family health, psychology and nutrition.

The health promotion teachers who had been located were sent a letter that explained the survey and requested that course outlines and reading lists be sent to the subcommittee. Also included was alist of questions to assist them in preparing for a telephone interview. Follow up telephone calls were made to the teachers to arrange interview times. A few teachers preferred to answer the questions in writing.

Fifty-three teachers were interviewed or mailed in responses to the questions and 37 course outlines were received. A summary of the teachers' responses is presented in this chapter. Additional information on particular courses is located in the original report (CCHPR Working Group on Education and Training, 1997).

The interviews were designed to obtain specific information about the courses, the students who enrolled in them, and the instructors who taught them, as well as to solicit subjective comments and concerns. The report contains the acquired data on the courses generally, on student and teacher demographics and on teaching methodologies and resources. It also summarizes the teachers' many comments about the concerns and difficulties and issues that they face in their roles as health promotion teachers. The teacher questionnaire, the calendar course descriptions and a directory of the teachers and institutions are contained in appendices to the report (CCHPR Working Group on Education & Training, 1997).

This section of the report summarizes general course information including data on the year that the courses were first offered; course length and timing within the academic year; course status as elective, required or recommended; team teaching; and currency of the course (whether and when it was changed since its inception). Respondents teaching more than one health promotion course were questioned separately.

Twenty-four of the 53 teachers interviewed had taught their classes for the first time in the 1995/96 or 1996/97 school year. Another 24 had begun teaching from 1990 to 1995. The remainder had begun their teaching in the 1980s with one instructor teaching since 1977.

The majority of classes are offered once a year with 11 offered twice a year (mostly nursing classes) and two in alternate years. Five classes are given through distance education mechanisms.

Most classes are required for the degrees under the appropriate faculty; some are restricted to admission from the degree granting faculty while others may be taken as electives by students from other faculties. Sixteen classes are elective and are usually open to any interested student; a few are "highly recommended" for students within the faculty.

About half of the teachers are the sole teacher for the class while the rest share the teaching with other faculty members. This sharing occurs primarily where there are large enrollments in undergraduate classes, requiring a number of sections. It also occurs in a few cases where teaching modules are used as the primary instruction method, with one instructor responsible for one module. When conducting the interviews for these classes, the primary instructor or coordinator was contacted.

Slightly more than half of the teachers indicated that they had not made significant changes to their courses or teaching methods since they began teaching them. Most of these, however, had begun teaching the course within the past year or two; they indicated that they would evaluate and make changes as necessary in the future. Among those teachers who indicated that they had made changes, many indicated that they regularly changed reading materials for the classes.

Student Populations

Class sizes ranged from under 10 to 350. The enrollment in the classes appeared to be stable. Only four teachers indicated that their enrollment has been declining, while five reported that their enrollment has been increasing. The class size data is presented in Table 1

Table 1: Class Size

As indicated in Table 2, the majority of students taking health promotion course were in the nursing field. In addition to those represented in Table 2, a few students were enrolled in sociology, administration, education, occupational therapy/rehabilitation medicine, human ecology, communications, and general arts and sciences.

Table 2: Distribution of Students in Health Promotion Courses by Discipline

The teachers reported a range of experience of students in both undergraduate and graduate classes. In undergraduate classes, most students were studying for their first degree, however, up to 20 percent of undergraduates were found to be mature students who were returning to study in a new area or to upgrade their skills. Similarly, in graduate programs, a number of students were continuing from their undergraduate degree, while others were mature students who were returning for further education and training. The mature students come from similar fields as those listed above (Table 2) with the majority coming from a nursing background.

Only 14 of the teachers estimated that 95 to 100 percent of their students were full time while four teachers indicated that fewer than 20 percent were full time. Full time attendance was mostly in the 60 to 80% range. Students who were learning by a distance education format (off campus) were found to be studying almost exclusively part time. With some institutions planning to add a distance education option to their classes, it is likely that part-time studies will become even more prevalent. One institution that had offered a graduate program that required full time attendance had recently dropped this requirement.

The majority of teachers interviewed had a doctoral degree (33 of 53); 14 had master's degrees, of these, four were doctoral candidates; one had a medical degree; and one a bachelor's degree. Thirteen had obtained their degrees in the United States, two in other countries and the remainder at Canadian institutions. A few of the respondents had certifications in addition to their academic degrees, mostly in the field of psychology.

With regard to work experience in health promotion, 27 respondents indicated that they worked primarily in the academic settings, with practical experience obtained primarily through consulting activities. Another 21 respondents had more extensive community-based experience acquired in such areas as public and mental health nursing, and public health nutrition.

Other settings in which respondents had experience included; the Victorian Order of Nurses, CUSO, hospitals, community development, government work, environmental health and occupational health. Nine respondents reported working with community-based volunteer organizations. A number also mentioned that they had active research programs in health promotion and a number also were continuing to carry out consulting in the community.

The respondents belonged to a vast number of professional organizations, local, provincial, national and international. The most commonly mentioned organizations were Registered Nursing Associations (both provincial and national), the Canadian Public Health Association and its provincial counterparts and the American Public Health Association. Also mentioned by several people were the Canadian Association of Teachers of Community Health and the Canadian Nursing Research Group. Many people belonged to associations related to their field of interest or training, including psychology, physical education, epidemiology, health education, behavioural medicine, sociology, aging, gerontology, women's health, nutrition, family health and services, mental health, community health, sports and exercise, and health planning.

The teachers described 18 different learning activities used in their classes, the10 most common are listed in Table 3. In addition, individual teachers mentioned using: self study modules, computer based modules, surveys, preparation of audio and video tapes of community projects, simulation games, storytelling, review of newspaper articles and panel discussions. Graduate courses tended to involve the smallest amount of lecture time.

Table 3: Learning Activities Used by Teachers

Teachers reported using a total of 17 different forms of student evaluations. The most common are reported in Table 4. Other methods mentioned were; audio or video tapes of a project, analyses of a novel, critiques of journal or newspaper articles, Internet surveys, literature reviews, draft resolutions for presentation at a health promotion conference, draft letters to a newspaper on a health promotion issue and draft grant proposals for a health promotion project.

Table 4: Evaluation Methods Used by Teachers

Respondents were asked about the resources that they used in their teaching as well as the resources that they used to keep themselves current with the field of health promotion. They were also questioned about resources that they would have liked but which were unavailable to them. The questions and answers generated considerable information about each category.

Teaching Resources Used

For teaching purposes, 20 different resources were mentioned, those listed in Table 5 plus individual reports of booklets developed from previous classes as part of class projects, games, bibliographies, teaching modules, general media, computer software, novels and audiotapes.

Table 5: Teaching Resources Used by Teachers

Resources Used by Teachers to Keep Themselves Current

Academic journals are the primary resource that teachers use for staying current in the area of health promotion, cited by 39 respondents. Conferences were mentioned by 24 teachers, with the qualification by a number of them that they are attending fewer conferences than in the past because of limited travel resources. Twenty-four teachers indicated that they use the Internet to search for materials and information such as discussion topics and government documents and statistics, for use in their classes. Some stated that they are just beginning to use this resource and anticipate that they will use it more in the future. Discussions with colleagues, in person, at meetings and by email were used by 15 respondents. Texts and books were used by about one quarter of the teachers and workshops by eight. Other resources mentioned included government documents and reports, personal research, community agencies and non-profit groups, Canadian Public Health Association, clinical practice, consulting practice, university seminars, librarians, videos and CD ROM sources.

Desired Resources That Were Not Accessible or Available to Instructors

Several instructors mentioned that they would like to have a mechanism by which they could be in touch with other instructors. One suggested video-conferencing as a mechanism; others suggested an Internet site, specific workshops for teachers in health promotion and interest groups which could meet at conferences.

Infrastructural Requirements

With the change from traditional didactic teaching to more group activities, a number of respondents indicated that they would like better classrooms for group teaching. Many reported that the standard lecture room format is not conducive to group work and yet it is often all that is available. Also, classroom access computer systems is required if teachers are to incorporate these new sources of information into their teaching. Only one university, Acadia, has prepared for this new technology for its students. At the beginning of the 1997-98 term, all incoming students were provided with lap-top computers and computer access as part of the Acadia Advantage program.

Some instructors were finding it more difficult to obtain current information in the field because of the declining resources for teaching and the reduced availability of journals due to library cutbacks in. In addition, some teachers reported having less access to teaching assistants who could provide help in leading discussions for larger groups, and for searching out useful class information. This leads to time pressure for teachers who are attempting to keep current in the field.

Instructional Materials and Opportunities

A large number of respondents mentioned that they would like materials that were geared towards teaching, not just field practice of health promotion. The kinds of materials they mentioned were: class exercises specifically for graduate and undergraduate classes; information on rural population health promotion, women's health and aging; health promotion information applied specifically to nursing; and information on how to work with the various levels of government. The most frequently mentioned need was for Canadian information and materials based on Canadian programs and experience (both English and French). These materials include texts, books, and videos as well as computer based methods such as CD ROM and Internet.

Computer Access to Information

Some instructors mentioned that they would like to obtain information through computer sources, including a central compilation of health promotion information and materials, federal and provincial government documents (policy statements, statistics), new resources as they become available and interactive exercises. It was also noted that both teachers and students need better access to the Internet and email.

Videotape Materials

A number of respondents commented on the usefulness of videotapes. However, a few noted that since the change in copyright laws, it was not as easy to use some video materials for class presentations. For example, one instructor had had students view commercial videos to analyze the health implications of the movie's plot, but that option was no longer available because of the copyright changes.

Other instructors indicated that they would like a variety of materials available on video, for example, role plays, debates, descriptions of community-based health promotion programs and master lectures. One instructor stated that it would be helpful to have access to equipment for students to videotape their community-based projects so that they could be used later by other students.

The survey solicited teachers' opinions on two specific issues: the roles of community-based learning and interdisciplinarity in health promotion teaching. Following this they were asked their perceptions of the key challenges facing health promotion teachers in Canada.

Role for Community-Based Learning for Students of Health Promotion

When asked what role they saw for community-based learning, most teachers responded that it is "important", "valuable", or essential". Teachers felt that community-based learning, through guest speakers or activities in the community, enriched the didactic and theory components of their courses, provided a reality based perspective to students, and gave them a more practical/applied focus. It also allowed the students to mature in their knowledge, to network with practitioners in the community, and to expose themselves to real practice activities.

Guest speakers and community-based projects and/or practice were the most common methods of introducing students to health promotion in the community. Another strategy mentioned, especially graduate classes, was students discussing their previous work experiences.

Many teachers commented on the difficulties of providing community-based experiences, such as a practicum. The limited availability of sites in the community was reported as a problem for instructors. When only a small number of sites are available, the risk of "burn out" for the preceptors in the community was perceived as a problem. It was noted that a great deal of time and coordination are needed to set up and maintain community-based practical experiences, and with reduced teaching resources this was becoming more difficult for some institutions. Locating appropriate practicum placements is especially problematic when dealing with large student numbers in a class. Furthermore, respondents recognized that practitioners in the field who are working with students need to be as up-to-date as possible for the the practicum experience to be of maximum benefit to students. They noted the difficulty in monitoring this aspect of the practicum experience.

Two instructors mentioned the challenge teaching of health promotion to students based in institutions, for example, nursing students who are primarily focussed on tertiary care. One instructor felt that the community-based practicum was more useful for upper year students rather than those in first or second year, who are just learning about the field.

Role for Interdisciplinarity in the Teaching of Health Promotion

This question of whether there is a role for interdisciplinarity in the teaching of health promotion generated a variety of opinions, most positive, many with qualifications. Remarks of teachers of graduate and undergraduate classes were generally similar. Ten institutions reported the substantial use of interdisciplinary teaching for their programs. This occurred for both graduate and undergraduate programs.

Most teachers expressed positive comments such as "important", "vital", "key", and "essential" to describe the role of interdisciplinarity in teaching. Several others indicated that interdisciplinarity is the basis of health promotion, bringing together the many perspectives and broad areas that are part of the field of health promotion. Others indicated that interdisciplinarity was where the future of health promotion teaching was headed and felt that it offered many opportunities to improve teaching.

The breadth and varying perspectives of health promotion were considered by many to be both a benefit and a challenge for teaching. One major consideration was the amount of time and resources available for teaching classes, the majority of which were one semester (13 weeks) in length. Many teachers find it difficult to incorporate the many different areas concerning health promotion into this time frame. This is particularly problematic for teachers who offer the only health promotion course in the faculty and so they feel compelled to cover as much as possible. An interdisciplinary teaching approach might well require additional time and resources.

Several respondents mentioned the difficulties posed by administrative barriers to interdisciplinarity in some institutions, such as assigning teaching credit, territoriality, and protectionism. This latter situation was mentioned in two cases where cutbacks in universities are resulting in teachers ensuring that they have adequate levels of teaching not considered redundant by administration.

The respondents described many challenges. Since the comments made by teachers of graduate and undergraduate classes did not differ greatly, they are reported together. These challenges fell into the following areas.

Keeping Current with Health Promotion Information

Those surveyed reported finding it difficult to keep current with the field, especially because of the breadth of health promotion and the rapid changes that are occurring in the field. Those who were new to teaching in health promotion and those who had been in the field but were not as active as they used to be found currency a particular challenge. To address this challenge some respondents suggested mentoring of new faculty by "big names" in the field and resource sharing through computer access.

The Scope and Definition of Health Promotion

Some confusion was expressed about the concept of health promotion. A number of respondents indicated uncertainty about what health promotion encompasses, whether it can be considered a discipline or a way of approaching health problems, its limits, the distinction between prevention and health promotion, and whether population health is replacing health promotion. Identification of health promotion as separate from public health and as a legitimate practice was also mentioned.

This lack of consensus of on the meaning of health promotion was evident in various comments, as well as the range of course considered by teachers to be about health promotion. Some noted that their colleagues have difficulty in understanding the role of health promotion and consequently, do not see the need for, and priority of, health promotion in teaching.

Health Promotion as a Profession

Concern about the future of health promotion was expressed by several of the teachers interviewed. This concern was expressed in relation to the problem of governmental support for health promotion as opposed to acute care/institutional funding. There was a general sense that government rhetoric about health promotion did not match government practice as reflected by funding. How to interpret the apparent lack of government support to students who were studying health promotion was also expressed as a concern.

In addition, some programs were experiencing a reduction in the number of student placements in the community. The feeling among some teachers was that students might perceive health promotion as not having a future as an area for employment and that they would move away from taking these kinds of courses. However, as noted earlier, teachers reported that their class sizes had remained stable over the years they had been teaching, with a few actually increasing in enrolment.

Two teachers mentioned that one cannot obtain a degree in health promotion in their universities. Most of the programs which have a significant health promotion component or emphasis fall under community health or nursing faculties.

The Value of Health Promotion

Many teachers of health promotion expressed concern that students do not seem to value the concept of health promotion. They indicated that they have a challenge to move student thinking from "hi-tech" acute, institutional care to community-based health promotion. In general, they noted that students tend to think in terms of the individual and "lifestyle" when they first encounter health promotion, and the challenge is to make a change to critical thinking regarding the broader issues of health, including economics, subtle policies, politics, and the social, psychological and environmental determinants of health. Teachers were looking for ways to make health promotion meaningful for students.

Nine teachers (6 of graduate classes, 3 of undergraduates) emphasized the need for evidence-based confirmation that health promotion "works". They felt this was a key issue underlying the difficulty in justifying and valuing health promotion as a legitimate field of study.

Political Climate

The lack of support for health promotion from governments was mentioned by teachers in different parts of the country. One concern expressed was the political move to neo-conservatism whereby funding was being moved away from the community to support primarily acute care. Several people commented on the loss of the Health Promotion Directorate within Health Canada and of the Health Promotion journal, published by Health Canada. Both were viewed as useful resources that no longer existed.

Teaching Issues

The breadth of the field of health promotion was considered by most to be both a strength and a drawback. It was viewed as a strength because it provides many different perspectives from which to approach health. The converse of this is the difficulty of exploring all the different perspectives, making the different points of view clear to students and describing the complexities of the field, including policies, politics and practice.

Several teachers described the challenge of changing students' ways of thinking from individual, lifestyle and treatment points of view to a more holistic socio-ecolological view. A number of teachers mentioned that it took time to bring about this change of focus which was difficult with limited class time. One teacher suggested that health promotion concepts should be introduced from the first year, instead of at the third and fourth years where they mostly occur. Another teacher felt that the practical components of health promotion experience should be left to the upper years so that the students could get a grounding in the theoretical areas first.

On several occasions, resources for teaching came up as a challenge. Comments included the lack of Canadian information in both English and French, with most texts, books and journals coming from the United States and Europe. Also, few teachers had access to teaching assistants. In addition, with the increasing use of computer-based learning, access to computers by students was a concern. Also in relation to computer-based information, several people mentioned the need to have a centralized collection or data base of health promotion materials. In addition, teachers wanted a mechanism for sharing information and resources with colleagues across the country. Francophone teachers who had reported the same difficulty, have initiated project to provide a central information point for information, education and training available in the French language. This project is being undertaken by faculty at Universitie de Laval in Quebec city.

Identifying a core curriculum in health promotion was a challenge to some teachers. Recognizing the difference between health promotion research and practice for teaching purposes was also mentioned by several teachers. They found that much of the material available in the area of health promotion available was research oriented and that practice-based information, particularly in the Canadian setting, was much more difficult to obtain.

Finding ways to equip students with the necessary skills to become competent health promotion practitioners was noted as a challenge for several teachers. The limited number of classes in health promotion that are available to students was seen as a major barrier to developing the necessary knowledge and skills to practice health promotion. Furthermore, it was reported that this limited availability of courses was not sufficient to teach students to be aware of what skills they will need to acquire themselves in their practice. The challenge of obtaining and maintaining appropriate community sites and agencies for practical training was common to many teachers. A few teachers commented that they had slowly built up good relationships with many agencies over the years, and that a key to maintaining these relationships was ensuring that any student activity benefited that agency or community group, as well as the student and the teaching institution.

Respondents raised other concerns about collaboration including finding ways to work together with colleagues in other departments or faculties, overcoming administrative barriers interdisciplinary teaching and addressing the insecurity felt by faculty because of current economic realities.

The following Universities were identified in the survey as having a major focus in health Promotion. There programs are described briefly below.

This Centre provides Postgraduate Diploma and Master of Science Degree programs in Health Promotion that was initiated in September 1996. The diploma is a one year program and the masters degree is a two year program with a thesis component. In the current year, 1998-99, seventy graduate students (full and part time) are registered in these programs.

The Centre for Health Promotion Studies is committed to making the diploma and masters degree programs accessible to students from all parts of Alberta by distance delivery. In September 1997, the four core courses were offered for distance learning using primarily internet-based computer conferencing. Two additional graduate courses, including one from the University of Calgary, will be offered in 1998/99 for twenty distance students.

The Department of Community Health at Laval offers a Masters Degree in Community Health with a Health Promotion stream. In 1989 the professional Masters Degree program, a two year program, was instituted. In 1996, a research stream with thesis was added. The department anticipates that a doctoral degree program will be available in one to two years.

The University of Montreal offers Masters and Doctoral level degrees in Public Health with an option in Health Promotion. The description of the Masters program is as follows:

Ler futur intervenant en promotion de la santé devra connaître et maîtrises fontes les habiletés nécessaires à l'intervention en promotion de la santé. De façon spécifique, il devra être capable de: déterminer les besoins d'intervention en promotion de la santé auprès des individus et des communautés; planifier, implanter et évaluer un programme de promotion de la santé; communiquer avec les ressources du milieu.

The doctoral program description is as follows:

Emanant d'une pluralité de disciplines des sciences sociales et de la santé, le champ de la promotion de la santé propose un vaste agenda de recherche et d'intervention visant la prise en charge de leur santé et de ses déterminants par les individus et les communautés. Sans la poursuite de cet objectif, le mouvement de promotion de la santé reconnaît la complémentarité des approches basées sur les changements individuels avec cells qui ciblent les changements structurels. Reflet de ses fondements pluridisciplinaires, le chanmp et de concepts et se trouve à la jonction d'un programme de recherche fondemental et appliqué qui regroupe trois domaines de préoccupation: 1) les développements theoretiques fondamentaux concevant les changements individuels, les interactions entre les personnes et leur milleu de vie, et les interactions entre la santéet els environnements; 2) le développement de modéles theoretique d'intervention; et 3) I' évaluation de programmes en promotion de la sante.

University of Toronto. Graduate Department of Community Health

The mission of the academic field of Community Health at the University of Toronto is "to provide programs of excellence in education, research, and service aimed at: the analysis, understanding, and evaluation of factors affecting the health of people and communities and the development of policies, programs and systems which promote health, prevent disease, and support the effective and well-managed use of available resources for health."

The Department of Behavioural Science within the Graduate Department of Community Health offers a Master of Health Science degree in which students may specialize in one of six areas, one of which is Health Promotion. All students in the M.H.Sc. program learn basic theoretical and methodological approaches used in community health and are able to pursue areas of specific personal interest. The degree program has a practicum component in the chosen area of study. In addition, a doctoral degree in behavioural science with a sub-specialization in health promotion is offered through this department. These programs are multi-disciplinary and interdepartmental in their instruction and the Department participates in a broad range of multi-disciplinary, inter-faculty and community-linked academic initiatives.

Although not initially identified in the original survey, it was discovered subsequent to the completion of the report that one undergraduate nursing program, the Collaborative Nursing program of British Columbia, uses health promotion as a framework for its entire curriculum. The purpose of this program is to educate nurses to work with individuals, families, groups and/or communities from a health promotion perspective and with an ethic of caring (Hills et al, 1994). This health promotion nursing curriculum is offered at ten institutions throughout British Columbia and is responsible for graduating over 75% (N= 750/per year)of all nurses that graduate in British Columbia. Approximately 250 faculty teach in this curriculum. Faculty teaching in this curriculum are currently completing the original questionnaire in order to update the Canadian report.

The Collaborative nursing program focusses on people and their experiences of health and healing rather than the more typical focus of nursing programs on medical diagnosis or clinical settings (Hills & Lindsey, 1994). Each semester is organized around a health promotion theme and the courses and practice experiences reflect this focus (Hills et al, 1994). Students have practica experiences in both community and institutional settings throughout the program. Health promotion principles and philosophy guide students practice and learning in both community and institutional settings. The program includes courses as such as health, prevention, health teaching, family health, community development, and societal health, including political action and transformative change (Hills et al, 1994). Furthermore, all course are highly interactive and seek to reduce the power differential between learners an teachers.

In addition to its on campus offerings, this program is available in Distance Education format to registered nurses wishing to complete their degree. This option is currently available to students throughout Canada and plans are in progress to allow access to students throughout the world.

With a report of this nature, it is difficult to be sure that all courses currently being taught in all Canadian Universities were included in the survey. Some courses and programs that were not captured in the initial survey have subsequently been identified and the field is likely to continue to evolve. Thus the costs, benefits and feasibility of keeping such an inventory current must be assessed.

Teachers identified several critical issues that need to be addressed. For example, it is clear that resource materials that are relevant to the Canadian context are needed and that they should be available in both French and English. Further, mechanisms need to be established to facilitate communication among teachers of health promotion. Such communication might assist in addressing some of the resource issues by making it easier for teachers to at least share the resources that they are currently using.

The perceived lack of government support for Health Promotion is disconcerting. For health promotion to be viable it needs not only support, but also leadership, from Central and provincial governments. In the past, Canada has been recognized as a leader in health promotion but in recent years the lack of government support has raised questions about the viability of this field in Canada. We are encouraged, however, by the recent support from Health Canada for the Canadian Consortium for Health Promotion Research. This Consortium consists of 15 centres engaged in health promotion research, education and practice across Canada.. Support for the activities of these centres is hopefully a sign of renewed interest in health promotion by the Canadian government.

In this survey, health promotion was not defined a priori but rather participants were encouraged to self-select and self-define courses that they considered to be about health promotion. This lack of consensus on the scope and definition noted in the report also makes it difficult to interpret the information given by respondents about their courses and their concerns. This problem is not new and the reasons for this confusion are discussed extensively throughout the literature. Perhaps it is time for us to be more articulate about what we mean by health promotion. Raeburn & Rootman (1998) have made an excellent contribution towards clarifying the meaning of health promotion and assist us in making important distinctions between people centred health promotion and other types of health promotion.

Several recommendations were made to Health Canada as a result of conducting this survey. The following reflect the highest priorities:

That the report be circulated to the survey respondents, Canadian Health Promotion Centres, the Canadian Public Health Association, provincial ministries of health and education, the Ontario Provincial Clearinghouse, and the provincial medical officers of health.

• That the report be made available through the Health Canada website.
• That Health Canada organize a group of key health promotion teachers, practitioners and students for the purposes of validating the information contained in the report and further developing the some of the issues identified.
• That Health Canada facilitate the development of a listserv for health promotion teachers.
• That opportunities be provided for health promotion teachers to meet (perhaps in conjunction with another National meeting).
• That core Health Promotion competencies be identified in order to examine current programs & practice in relation to these core competencies.
• That International Collaboration occur on the development of health promotion teaching strategies.

Action on many of these recommendations has already begun. The report has been widely distributed and invitations to submit additional information have been extended to those who were not included in the initial report. Plans are being developed for teachers of health promotion to participate in a day long pre-conference workshop to discuss issues of pedagogy related to teaching health promotion. It is envisioned that this will include time to consider the issues raised in the report about teaching health promotion. In addition, international collaboration with the International Union for Health Promotion and Education has begun under the leadership of Michel O'Neill from Laval University. Health Canada has responded positively to the recommendations and has indicated that they will collaborate with the Consortium in taking action on them.

A survey of this nature inevitably becomes out of date almost before it is printed. However, the issues identified by the respondents provide a starting point for the enhancement of health promotion teaching in Canada. The initial report and provides a useful basis upon which to continue to develop our knowledge education in health promotion in the Canadian context.

Hills, M., & Lindsey, E., (1994). Health promotion: A viable curriculum framework for nursing education. Nursing Outlook, 42(4), 158-162.

Hills, M., Lindsey, E., Chisamore, M., Bassett-Smith, J., Abbot, K., & Fournier-Chalmers, J. (1994). University-College collaboration: Rethinking curriculum development. Journal of Nursing Education, 33(5), 220-225.

Working Group on Health Promotion Education and Training (1997). Health Promotion Courses and Programs in Canadian Colleges and Universities: An Inventory. Ottawa: Health Canada

Raeburn, J., & Rootman, I. (1998). People-Centred Health Promotion. Toronto: John Wiley & Sons.

      

Last updated: December 4, 1999