ABSTRACT
The field of health promotions faces considerable ethical and programmatic challenge - and we believe opportunity - in addressing the relative normativity of the concept(s) of health and its professional handling. To date, distinctions of objective and subjective indicants of "health" have fostered normative tension(s) within the utilitarian ethics of health promotions, which we opine to be anathema to the ultimate goal(s) of attaining and sustaining healthy individuals and societies. Objective and subjective metrics and values should be reconciled, as reciprocal and complementary on both idiosyncratic and systemic levels. In this light, we propose that a philosophical and ethical approach, based primarily upon Schmitz's New Phenomenology and its specific understanding of subjectivity could afford epistemological bases for non-normative engagement of health promotion within a structural-functional framework of ethics. We dialectically address its potential benefit, limitations and value for health promotion and health care ethics and present an approach which points towards a more substantial encouragement of diversity through the legitimation of subjectivity.
Subject(s)
Bioethics , Humans , Health Promotion , Benchmarking , Health Status , KnowledgeABSTRACT
Background: Pulmonary vascular disease and pulmonary hypertension (PH) belong to the most relevant complications of congenital heart disease (CHD) in the long-term course. Although PH might lead to a severely impaired quality of life (QOL), there are no current studies comparing QOL in adults with CHD (ACHD) with and without PH. Therefore, this study aimed to systematically examine QOL in ACHD with and without PH in order to generate a more differentiated understanding of their overall health-status and to employ newly gained findings into general care of this particular patient population. Methods: In this comparative cross-sectional study, a representative sample of 803 adults with various forms of CHD with or without PH was analyzed. Data collection took place between September 2017 until February 2018 in a tertiary care center for ACHD. Medical data was retrieved from medical records. QOL was assessed using the EQ-5D-5L questionnaire. Descriptive methods, chi-square and t-tests were used to compare QOL of patients with and without PH. Results: Of 803 patients, 752 patients had no PH [93.6%; 47.3% female; mean age: 34.9±11.83 (range, 18-86) years], 51 were identified with manifest PH [6.4%; 55.8% female; mean age: 41.9±12.17 (range, 21-69) years]. PH patients showed significantly worse overall QOL [mean no PH: 86.78±13.30 (8.2-100) vs. mean PH: 81.79±12.77 (43.6-100); 95% confidence interval (CI): 1.43 to 9.46; P=0.013], worse crosswalk index [mean no PH: 93.29±12.86 (-11, 100) vs. mean PH: 89.73±11.77 (47-100); 95% CI: 0.08 to 7.56; P=0.043], and worse VAS [mean no PH: 80.12±16.50 (15-100) vs. mean PH: 72.56±16.80 (40-100); 95% CI: 3.29 to 12.17; P=0.004]. However, after adjusting for age, only the VAS stayed significant (P=0.039). The QOL within the dimensions mobility (P<0.001), self-care (P=0.002), and usual activities (P=0.007), were significantly decreased in PH patients. Overall, anxiety and depression (11.08%) as well as pain and discomfort (11.03%) were the most impaired dimensions in both patient groups. Conclusions: Since QOL is a significant predictor of outcome, PH-CHD patients need an early provision of psychosocial, health promoting support in addition to dedicated care and targeted PH treatment. It is therefore pivotal to timely identify unique psychosocial impairments in order to enhance quantity and QOL in this particularly vulnerable patient population.
ABSTRACT
Health promotion provides a complementary scientific and practical approach to medicine, which may help to create, maintain and restore wellness even in the presence of disease and illness. Salutogenesis, as key concept, focuses upon the emergence of health and thus, leads to fortifying individuals' and communities' health determinants and resources. The potential integration of health promotion and medicine can contribute to a more person-centred focus of integrative care to address and realize individuals' health potential and needs, rather than merely an emphasis upon the underlying disease, such as congenital heart diseases. We posit that it is possible-and advisable-to address lifestyle modification aspects, and to change the focus of therapeutic encounters and health care programs to be more tailored to and aligned with individual needs, demands and expectations. By adopting a health promotional approach to the individual patient as person, their subjective biography, narrative and lifeworld can serve as resources for developing more beneficial coping styles, resilience and trajectories for personal growth over the life span, despite the occurrence and durability of chronic conditions, such as long-term cardiovascular disease. Implications, important contingencies and requirements for education and training of health-care professionals are addressed, as they are key issues that may affect the successful development and engagement of health promotion programs within health care systems at-large.
ABSTRACT
HINTERGRUND: Das Projekt "Gesunde Südstadt" hat den Schwerpunkt Gesundheitsförderung in der Lebenswelt Kommune. Es wurde im Rahmen des "Präventionsgesetzes" (SGB V §20a) initiiert und zielt ab auf die Verringerung der gesundheitlichen Ungleichheit in der Stadt Nürnberg. Die Maßnahmen der kommunalen Gesundheitsförderung im Handlungsfeld Ernährung wurden durch eine externe multiperspektivische, multimethodische Prozess- und Ergebnisevaluation begleitend untersucht. METHODEN: 55 Maßnahmenberichte, 8 Interviews mit Teilnehmenden sowie 3 Interviews mit Maßnahmendurchführenden wurden mit qualitativer Inhaltsanalyse ausgewertet. Eine Teilnehmendenbefragung (n=35) mittels Fragebögen wurde quantitativ-statistisch ausgewertet. ERGEBNISSE: Die Ergebnisse zeigen, dass die Gesundheitsförderungsmaßnahmen durch die Teilnehmenden eine hohe Akzeptanz erfuhren und ein ausgeprägtes Maß an Partizipation ermöglicht wurde. Weiterhin zeigen die Ergebnisse, dass die Maßnahmen die interaktive sowie die funktionale Gesundheitskompetenz förderten. Ein empirisches Pfadmodell für kommunale Gesundheitsförderungsprojekte wurde abgeleitet. SCHLUSSFOLGERUNG: Die Ergebnisse belegen gesundheitsförderliche Effekte eines verhältnis- und verhaltensbasierten, kommunalen Ansatzes zur Gesundheitsförderung bei Teilnehmenden an Maßnahmen im Handlungsfeld Ernährung. Das Projekt "Gesunde Südstadt" stellt einen systematischen, lebensweltrelevanten und niedrigschwelligen Ansatz der soziallagenbezogenen Gesundheitsförderung im kommunalen Setting dar. Methodische Einschränkungen, wie das Querschnittsdesign der Studie, werden diskutiert. BACKGROUND AND OBJECTIVES: The Project "Gesunde Südstadt" is focused on community-based health promotion interventions. It was initiated as part of the "Prevention Act" (SGB V §20a) and aims to reduce health inequalities in the city of Nuremberg. The community-based health promotion interventions focussing on nutrition were evaluated with an external multi-perspective, multi-method evaluation approach with a focus both on process and outcome results. METHODS: 55 reports on activities, 8 interviews with participants and 3 interviews with trainers were coded using qualitative content analysis. Statistical analyses were conducted on a participant survey (n=35). RESULTS: Results showed that the community-based health promotion interventions were not only widely accepted by the participants but also enabled them to participate in health-related activities. Additionally, health promotion interventions in the community were found to promote interactive and functional health competences. An empirically derived path model for community-based health promotion interventions was statistically tested. CONCLUSIONS: Results show health promotion effects of community-based nutrition-related health promotion interventions on participants. The project "Gesunde Südstadt" thus represents a systematic, relevant and low-threshold approach to health promotion in a communal setting. Methodological limitations such as the cross-sectional design are discussed.
