428818

2012
GHP19110.1177/1757975911428818W. Madsen and T. BellGlobal Health Promotion

Original Article

Using health promotion competencies

for curriculum development in higher education
Wendy Madsen1 and Tanya Bell1

Abstract: Health promotion core competencies are used for a variety of reasons. Recently there have
been moves to gain international consensus regarding core competencies within health promotion.
One of the main reasons put forward for having core competencies is to guide curriculum development
within higher education institutions. This article outlines the endeavours of one institution to develop
undergraduate and postgraduate curricula around the Australian core competencies for health
promotion practitioners. It argues that until core competencies have been agreed upon internationally,
basing curricula on these carries a risk associated with change. However, delaying curricula until such
risks are ameliorated decreases opportunities to deliver dynamic and current health promotion education
within higher institutions. (Global Health Promotion, 2012; 19(1): 43–49)

Keywords: education, health promotion

Introduction as the discipline grows and matures within a praxis

context rather than one that is strictly theoretical
Although various aspects of what we now or academic. This raises questions for those teaching
understand as health promotion have been evident into health promotion programs at undergraduate
in different guises for a number of centuries, health or postgraduate levels regarding how to prepare
promotion has been emerging as a distinct discipline the curricula for these programs: what is to be
since 1986 as heralded by the Ottawa Charter. As included? How is it to be taught? How can theory
such, there is still debate as to what constitutes inform practice? How is practice driving theoretical
health promotion in a way that is not seen in older, developments? This article explores how one higher
more established discipline areas such as medicine educational institution has approached these
or law. One of the consequences of this ongoing challenges using national core competencies for
debate is a lack of certainty for those teaching the health promotion practitioners as the basis of
new generation of health promotion practitioners. curricula. A brief outline of the development of core
Traditionally, academia has provided the nurturing competencies will be offered as the context within
grounds for new professionals, steeping novices in which the curricula were constructed, followed by
the culture of the professional discipline area, a presentation of the curricula models and a
feeding their minds with the concepts and knowledge discussion of the limitations of taking this approach.
needed to emerge as graduates and take up their Throughout this article, it will be argued that while
positions in society and the profession. Tradition there are risks associated with using core
and research formed the basis of such nurturing competencies as the foundation of curricula in a
grounds. However, for emerging fields of study and climate of ongoing change, the benefits of keeping
disciplines such as health promotion, there is more the curricula dynamic and relevant to health
of a ‘chicken-and-egg’ situation within academia promotion outweigh the concerns.

1. CQ University, Bundaberg, Australia. Correspondence to: Wendy Madsen, CQ University, Locked Bag 3333, Bundaberg,
Qld. 4670, Australia. Email: w.madsen@cqu.edu.au

(This manuscript was submitted on September 5, 2010. Following blind peer review, it was accepted for publication
on May 26, 2011)

Global Health Promotion 1757-9759; Vol 19(1): 43­ –49; 428818 Copyright © The Author(s) 2012, Reprints and permissions:
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44 W. Madsen and T. Bell
Background
The concept of constructing core competencies for
health promotion professionals has been around some
time (1,2), but has gained ascendancy since the
Galway Consensus Conference in 2008 that instigated
the process of compiling a set of internationally
agreed upon competencies. This conference needs to
be seen in the context of health promotion as an
emerging discipline. Indeed, in their outline of the
conference outcomes, Barry et al. (3) highlight the
various meanings associated with terminology used
to depict health promotion and health education.
Other papers published from this conference provide
a clear picture of how health promotion has evolved;
the cultural variations within health promotion’s
history; and the diverse workforce within health
promotion (4,5). Bennett et al.’s (6) analysis of public
health education in Australia also illustrates health
promotion has emerged from the broader discipline
area of public health with a Masters of Public Health
being taken by disparate professionals as the
traditional pathway into this field. Thus, the health
promotion workforce is perceived as ‘ill-defined’,
with professional development often ‘ad hoc’ (7).
The collection of papers that came out of the
Galway Consensus Conference offers a useful history
of the development of core competencies within
health promotion. A number of authors outline the
credentialing moves within the USA and the UK over
the past three decades (8–10) and the status quo
within Europe (5). Battel-Kirk et al. (11) provide a
literature review of competencies, including the
arguments for and against going down this path,
suggesting that one of the main problems with core
competencies is that they are often backward looking
rather than forward looking. Amidst this literature
and that offered by others, such as Wright (12), issues
related to core competencies as setting the entry level
into health promotion as a discipline are raised. In
particular, as Bennett et al. (6) indicate, there are a
number of entry points into health promotion now:
via undergraduate programs; specific health
promotion postgraduate programs; as well as the
more traditional Masters in Public Health. Is it
appropriate, therefore, for all of these entry points
into the practice of health promotion to have the
same entry level expectations? In Australia, core
competencies for health promotion practitioners have
been available for a number of years. These were
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initially devised with course development in mind
across a range of academic levels, from undergraduate
to postgraduate degree programs (13) and have
recently been updated (14). Like others, these core
competencies outline entry level criteria for beginning
health promotion practitioners. As such, one of their
primary purposes is to provide a framework for
health promotion curricula.
A number of the reasons put forward at the Galway
Consensus Conference for developing competencies
relate to curricula development and building the
capacity of the health promotion workforce (3–5,11).
The International Union for Health Promotion and
Education (IUHPE) in its 2007 Shaping the future of
health promotion statement considers that core
competencies ‘define the field and provide common
direction for curriculum development’ (15). Indeed,
Barry’s commentary (16) regarding the work of the
IUHPE Global Vice-President for Capacity Building,
Education and Training highlights the challenges for
curricula development including: multiple levels of
qualifications to suit at least two levels of practitioners;
and the responsiveness of curricula to the needs of
practitioners working in diverse social and political
contexts. However, there is an emerging consensus
within the literature that, despite such challenges, the
development of core competencies for health promotion
practitioners is useful for curriculum developers and
provides frameworks and direction that has been
previously missing. Where programs may have once
been based on a compilation of multidisciplinary
courses, particularly those relevant to public health,
with the occasional health promotion specific course
(6), programs are now becoming more prevalent that
have been intentionally constructed for the specific
needs of health promotion practitioners. Core
competencies help provide coherence to such curricula.
Alongside discussion of competencies within
curricula, and not just those related to health promotion,
is the question of how to show a curriculum is addressing
the competencies. This is often done by ‘mapping’ across
the curriculum. This has become increasingly popular
as generic skills have been introduced into higher
education institutions and there are now a number of
computer programs that allow mapping of various
competencies (17,18). However, such mapping is often
retrospective in that its aim is to identify components
within an established curriculum. Howat et al. (19)
outline a much more prospective process whereby
identified health promotion competencies were used to
 Original Article
construct the curricula at undergraduate and
postgraduate levels. It is this latter approach that has
been used to construct the curricula models outlined in
this article.
Using core competencies as the basis
of curricula
In their argument about the need to bring curricula
into higher education debates on teaching and learning,
Barnett and Coate (20) suggest the silence surrounding
curriculum issues has resulted in a stealthy sliding of
curriculum towards a ‘skills, standards and outcomes
model’ rather than a ‘reflexive, collective, developmental
and process-oriented model’. That is, that attention
has drifted towards skills rather than knowledge and
understanding. Such concerns need to be considered
carefully when using core competencies as the
foundation of health promotion curricula as there is
a danger that these will be viewed as a set of ‘skills’
rather than broader competencies based on knowledge
and understanding. The Australian Health Promotion
Association’s (AHPA) core competencies for health
promotion practitioners (14) indicate the competencies
relate to knowledge, skills, attitudes and values that
‘constitute a common baseline for all health promotion
roles’. Thus, while skills certainly feature within these
competencies, they are placed within a broader context
based on health promotion program planning,
implementation and evaluation; partnership building;
communication and report writing; technology; and
knowledge competencies. It is these core competencies
that have been used in the curricula outlined here, with
the understanding that these competencies need to be
considered within their broader contexts.
In addition to the core competencies for health
promotion practitioners, many universities across the
globe also want to see evidence of ‘generic’ attributes
embedded into curricula. This is in response to a
shifting role of universities within society and a need
to better prepare graduates for the workplace (20,21).
Interestingly, many of these graduate attributes
correspond with the core competencies for health
promotion practitioners as outlined by the AHPA and
others internationally. However, there is some
divergence around the areas of developing the student
(and graduate) as a ‘person’. While graduate attributes
across institutions vary, some do articulate a number
of personal qualities as being a valued part of completing
a degree from that particular institution. For example,
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45
the University of Tasmania includes global perspective
and social responsibility among the more common
attributes of ‘knowledge’, ‘communication skills’ and
‘problem-solving skills’ (21). The graduate attributes
needed to be considered within the curricula outlined
in this article include: communication, problem solving,
critical thinking, information literacy, team work,
information technology competence, cross cultural
competence, and ethical practice. The inclusion of so
many ‘personal’ attributes confirms the three domains
of curricula put forward by Barnett and Coate (20) of:
knowing, acting, and being. That is, any curriculum
can be considered as containing elements that relate to
the knowledge and the manipulation of knowledge; to
acting out and conducting certain skills; and to personal
development of learning to engage with knowledge
and practice in an authentic and meaningful way and
developing an open mind towards other viewpoints.
The AHPA core competencies for health promotion
practitioners relate very well to the knowing and
acting domains as outlined by Barnett and Coate (20).
However, there is little in the way of being. Indeed, a
criticism of these core competencies would be the lack
of attention paid to articulating the need to be a
reflective practitioner as the basis of professional (and
personal) development. While this attribute is often
implied within the core competencies and in the spirit
in which they were developed whereby they do attach
importance to attitudes and values, including cultural
competencies, there is no explicit competency related
to reflective practice. Yet, it could be argued that
reflective practice is fundamental to many of the
AHPA competencies and of the domains outlined by
Barry et al. (3) that are being considered as the basis
of international competencies for health promotion
practitioners. This can be seen in earlier attempts to
develop a European core curriculum for health
promotion (22) and in the application of competencies
to the development of a portfolio within the Masters
of health promotion program at the National
University of Galway, in Ireland, both of which place
a great deal of emphasis on developing reflective
practice (23). Indeed, Chiu (24) argues that critical
reflection and conscientization processes are very
useful in health promotion practice that is focused on
social transformation. It is acknowledged that the
concept of reflective practice within health promotion
is contested as outlined by Issitt (25) and Cronin and
Connolly (26) whereas there seems to be a greater
acceptance of critical reflection and reflective practice
IUHPE – Global Health Promotion Vol. 19, No. 1 2012
46 W. Madsen and T. Bell
Figure 1.  Curriculum model for Bachelor of Health
Promotion
in other health disciplines such as nursing and social
work. Despite this, from the basis of incorporating
being elements into the health promotion curricula
outlined here, the curriculum design team included
reflective practice strategies in both the undergraduate
and postgraduate programs.
The previous undergraduate curriculum was loosely
based on the AHPA 2005 core competencies as
outlined by Shilton et al. (13). It was certainly possible
to map most of these competencies across the program.
However, in 2009 as part of a major program review,
it was decided there needed to be a greater level of
focus on the Ottawa Charter and the core competencies
within the program, and rather than fit these concepts
into certain courses, it was necessary to allow these
fundamental concepts to ‘drive’ the curriculum. A
curriculum model was created based on these
fundamental concepts to provide a visual representation
of the importance they played in dictating what was
included in the intended and taught curriculum. This
curriculum model is illustrated in Figure 1. Barnett
and Coate (20) warn that such diagrammatic
representations of curricula need to be understood
from a teacher’s perspective (what is intended and
actually taught) rather than a representation of the
student’s experience of the curriculum (often termed
‘received’ curriculum). Thus, the curriculum models
presented in this article are intended to outline what
IUHPE – Global Health Promotion Vol. 19, No. 1 2012
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was in the minds of those designing the curriculum of
the program as a whole. The models were used as the
basis for their decision making of how to piece together
various courses and what may be contained within
these courses. Thus the core competencies were woven
into the curriculum from the beginning and while these
competencies are mapped across the curriculum — that
is, constructed in a matrix that identifies which
competencies are introduced and developed in which
courses — the process was prospective.
The Masters program in health promotion will be
offered for the first time in 2011. The process of
designing the curriculum for this program followed a
similar pathway to that outlined above and the model
produced had similar purposes. The difficulty presented
here was that the AHPA core competencies are written
for entry level practitioners. In a traditional discipline,
these would be conceptualized as appropriate for
graduates of an undergraduate program. However,
because of the multiple entry levels within the health
promotion workforce, this creates some difficulty for
developing curriculum at a postgraduate level. To
overcome this difficulty, the core competencies were
integrated into a curriculum model that was also based
on Transformative Learning principles. In particular,
elements of alternative perspectives, centrality of
experience, critical reflection, collaboration, learner-
centred approach, peer review, reflective dialogue and
self-assessment (27) were incorporated. As students
of this program need to be working in the field of
health promotion as a prerequisite (but do not have
to have any extensive health promotion experience),
taking this approach to the curriculum allows core
competencies to be extended beyond the entry level
to better meet the learning needs of these students.
Evidently, this approach relies heavily on self-reflective
strategies as the basis of extending the core competencies
as students need to critique their own practices,
uncovering unquestioned assumptions and using each
others’ experiences to construct a new collective
understanding. However, the extensive literature
surrounding transformative learning principles
provides a reasonable level of confidence in this
approach (28,29). Such an approach may not solve
all problems of using entry level competencies for
postgraduate studies as outlined in the literature (6,16),
but in the absence of any alternatives, this may provide
one approach to address the dilemma. The curriculum
model for the Masters program is illustrated in
Figure 2.
 Original Article 47

cultural background to health, before moving to more

Figure 2.  Curriculum model for Masters of Health
Promotion
Integrating core competencies into a curriculum
model is probably the easy part of curriculum design.
The visual representations can be seen as pretty
pictures, but unless the ideas contained in these
models are distilled down to course structure, content,
delivery and assessment levels, they remain simply as
ideas. Furthermore, competencies need to be
developed and woven across the entire program,
although some courses are likely to have a stronger
focus on one or two competencies. For example, the
undergraduate course community needs assessment
relates quite specifically to the AHPA Core
Competency 1.1 needs (or situational) assessment
competencies. The process used by the teaching team
for the programs outlined here starts by providing
students with the historical, political, social and
knowledge based courses that picked up specific health
promotion theories and procedural competencies. This
means competencies are developed across a number
of courses, from a fundamental level in first year
courses, to a more complex understanding and
application in higher level courses. For instance, first
year students are introduced to working in teams as
part of the learning activities and assessment for
health promotion concepts, but are required to work
in partnership with someone from industry in third
year as part of health promotion in practice A & B
assessment. Some aspects of the AHPA core
competencies are more readily divided across various
courses. For example, the competency related to
communication outlines a number of genres of
writing and these were simply allocated a particular
assessment item or activity within a particular course.
There was no precise science involved in this, but
rather a movement around of the various components
to come up with a course-of-best-fit that stayed true
to the overall curriculum model and that collectively
accounted for all the components. A broad outline
of how the core competencies have been mapped
across a number of central courses within the Bachelor
of health promotion is contained in Table 1.
Health promotion is not an accredited program in
Australia, nor is there any regulation of programs by
a regulatory or credentialing body. There are no checks

Table 1.  Map of Australian core competencies across Bachelor of Health Promotion central courses

Program planning, Partnership Communication Technology Knowledge

implementation and building and report writing competencies competencies
evaluation competencies competencies competencies

Foundations of √ √ √
health promotion
Health promotion √ √ √ √
concepts
Health √ √ √ √
communications
Community needs √ √ √ √ √
assessment
Health promotion √ √ √ √ √
strategies
Health promotion √ √ √ √ √
in practice A & B
Population health √ √ √
epidemiology

IUHPE – Global Health Promotion Vol. 19, No. 1 2012

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48 W. Madsen and T. Bell
and balances in place to ensure prospective students
or the public at large that programs being offered
through higher education institutions are appropriate
for the health promotion workforce. Many universities
have industry advisory committees to help guide their
decision making in regards to curricula matters, and
this was the process used to guide the curriculum
development for the programs outlined in this article.
However, much is expected from these industry
representatives, including having an understanding
of curriculum issues as well as being cognisant of
the broader industry. Integrating the AHPA core
competencies into the curriculum models for the
undergraduate and Masters level programs has kept
the knowledge, skills, attitudes and values of health
promotion practitioners in the foreground throughout
the decision making process of constructing program
outcomes and subsequent course outcomes, teaching
strategies and assessments. Models have not replaced
the need for industry consultation, but have perhaps
eased the pressure on these representatives to be all-
knowing, and reduced the ‘guess work’ involved. The
models also assisted in constructing more coherent
curricula, although it is not until the programs have
actually been taught in their entirety and evaluated
through the university systems that these impressions
will be confirmed or challenged.
Limitations of using core competencies
in curricula
At this point in time there are no internationally
agreed upon core competencies for health promotion
practitioners. The literature outlines moves towards
this goal and the experiences of a handful of countries
that have competencies that have been formally
adopted as part of accreditation processes. Placing
core competencies at the very foundation of curricula
when these have not been confirmed at an international
level can be seen as somewhat risky. Even the AHPA
core competencies changed quite dramatically between
2005 and 2009 raising questions of whether further
changes would undermine curricula that have been
based on these competencies; and given the glacial
speed most university processes operate, would faculty
be able to move quickly enough to adapt to changes
that do occur to ensure the curricula remains
appropriate to the needs of students? Placing the
competencies at the core of the curriculum does mean
that changes do have a potentially greater effect than
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simply mapping competencies in retrospect. However,
as indicated by Allegrante et al. (8), there do seem to
be sufficient commonalities regarding what health
promotion is to take the risk of basing curricula on
these ideas. Furthermore, constructing a curriculum
that is based on the current and prospective competencies
breathes life into the teaching and learning plans for
delivering health promotion programs, knowing the
content and strategies are up to date and relevant to
health promotion practitioners now and when students
graduate. Yes, changes that occur at national and
international levels may mean significant changes also
need to happen in the curriculum but rather than seeing
this as a problem, such changes can be welcomed as
opportunities to keep the curriculum dynamic and
fresh. Indeed, Barnett and Coate (20) argue a
curriculum should be dynamic as it responds to
consistent internal and external influences.
Conclusion
Constructing curricula within the higher education
sector is fraught with challenges and competing
tensions. There are internal and external factors that
need to be taken into consideration: industry concerns;
national and international expectations; graduate
attributes; student cohort characteristics; delivery
opportunities and constraints; staffing profiles
and workload issues. In the absence of an external
accrediting body to oversee curricula and determine
content and processes, as with health promotion, using
core competencies for health promotion practitioners
as the fundamental basis of curriculum models is one
way of trying to keep curricula coherent and relevant
while juggling these internal and external factors. This
article has outlined how the AHPA core competencies
have been used to guide curriculum development in
one institution. Taking this approach is not without
risks as the international health promotion community
progress towards developing agreed upon core
competencies that may not be the same as those
used to build the curriculum models outlined here,
necessitating significant revision. However, rather
than seeing this as a threat to the curricula, curriculum
developers should be prepared to view all changes as
opportunities to keep the teaching and learning within
programs dynamic and responsive to the ‘real world’
of health promotion. Core competencies are not a
panacea, but they do provide a framework, along with
research, of further engaging the tertiary sector with
 Original Article
the health promotion industry to help ensure higher
education institutions provide an appropriate nurturing
ground for health promotion graduates.
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IUHPE – Global Health Promotion Vol. 19, No. 1 2012
78 Résumés

Utiliser les compétences essentielles de la promotion de la santé pour développer

les cursus de l’enseignement supérieur
W. Madsen et T. Bell
Les compétences essentielles de la promotion de la santé sont utilisées pour diverses raisons. On a assisté
récemment à des mouvements pour parvenir à un consensus international sur les compétences essentielles
dans le domaine de la promotion de la santé. L’une des principales raisons avancées pour avoir des compétences
essentielles est de pouvoir orienter l’élaboration des cursus de l’enseignement supérieur. Cet article décrit les
efforts déployés par une institution pour développer un programme d’études autour des compétences
essentielles en Australie pour des praticiens de la promotion de la santé. Il soutient que tant qu’il n’y aura pas
eu un accord international sur les compétences essentielles en fondant les cursus sur ces compétences on
prend un risque associé à des changements potentiels. Cependant, en reportant le développement des cursus
jusqu’à ce que de tels risques aient été réduits, on diminue les opportunités de délivrer un enseignement
dynamique et actuel en matière de promotion de la santé dans les institutions d’enseignement supérieur.
(Global Health Promotion, 2012; 19(1): 43-49)

Les comportements liés à la consommation associée de substances psychoactives

chez les jeunes : l’environnement scolaire a-t-il un impact ?
M. J. E. Costello, S. T. Leatherdale, R. Ahmed, D. L. Church et J. A. Cunningham
Contexte. La consommation de substances psychoactives est courante chez les jeunes ; cependant, on a une
connaissance limité de la consommation associée de tabac, d’alcool et de marijuana. L’environnement scolaire
peut jouer un rôle important dans la probabilité pour un jeune de se livrer à des comportements à risque en
matière de consommation de substances psychoactives, et notamment de consommation associée. Objectif.
Cette étude vise à : (i) décrire la prévalence de la consommation associée de substances psychoactives chez les
jeunes ; (ii) identifier et comparer les caractéristiques des jeunes qui consomment régulièrement l’une de ces
substances, deux d’entre elles ou les trois ; (iii) examiner si la probabilité de consommation associée varie en
fonction de l’établissement scolaire ; et (iv) examiner quels facteurs sont liés à une consommation associée.
Méthodes. Cette étude a utilisé des données représentatives recueillies à l’échelle nationale auprès de lycéens,
agés de 14 à 18 ans approximativement, (n = 41886) dans le cadre de l’Enquête canadienne 2006-2007 sur
le Tabagisme chez les Jeunes. Des données démographiques et comportementales ont été recueillies parmi
lesquelles la consommation actuelle de cigarettes, d’alcool et de marijuana. Résultats. 6,5% (n = 107000) ont
rapporté une consommation courante des trois substances et 20,3% (n = 333000) de deux d’entre elles. Une
analyse multi-niveaux a révélé des variations significatives entre les écoles en ce qui concerne les probabilités
pour un lycéen de consommer l’ensemble des trois substances et deux des trois ; ce qui représente respectivement
16,9% et 13,5% de la variabilité. La consommation associée variait en fonction du sexe, de la classe, du
montant d’argent de poche disponible et de la performance scolaire perçue. Conclusions. La consommation
associée de substances psychoactives est élevée chez les jeunes. Cependant, toutes les écoles ne connaissent
pas la même prévalence. Il est important de connaître les caractéristiques du milieu scolaire qui font que
certains établissements sont plus à risques que d’autres en ce qui concerne la consommation de substances
nocives par les jeunes. Cela devrait permettre d’adapter les programmes d’éducation sur la consommation de
drogue et d’alcool. Des interventions ciblant la prévention de la consommation associée de substances
psychoactives sont nécessaires. (Global Health Promotion, 2012; 19(1): 50-59)

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Para llegar a ser una Escuela Promotora de Salud: elementos clave de la planificación
E. Senior
Este trabajo contempla los aspectos prácticos de la ejecución del marco de la Escuela Promotora de Salud (EPS),
entre ellos, la realización de una auditoria en toda la institución a fin de lograr que una escuela primaria adopte
con éxito los principios de las EPS. Se firmó un acuerdo de colaboración entre EACH Social and Community
Health, que es un Centro de Salud Comunitaria local, y una escuela primaria de las afueras de la zona este de
Melbourne (Australia). Se llevó a cabo una auditoria de la comunidad escolar para la cual se hizo el seguimiento
de 4 grupos foco de alumnos entre 8 y 11 años de edad, del 3º al 6º año. Los datos cuantitativos fueron facilitados
por veinte profesores de la escuela a lo largo de una jornada de desarrollo profesional organizada por el personal
de promoción de la salud del Centro de Salud Comunitaria. Los resultados de la auditoria escolar reflejan que
tanto los estudiantes de los cursos 3º a 6º como los padres valoraban por encima de todo el entorno exterior de
la escuela. El personal de la escuela valoraba por encima de todo los atributos del personal. Entre las sugerencias
de los alumnos figuraba la de mejorar el comedor y el entorno exterior. El personal de la escuela estaba más
preocupado por la forma física tanto propia como de los alumnos. Una de las preocupaciones de los padres era
la ausencia de una dieta sana. La comunidad escolar reconoce el valor de adoptar el marco de la EPS, pero se
constata la necesidad de prestarle un apoyo estructurado y continuado para que pueda aplicar con éxito el
enfoque de la EPS. Es necesario que la comunidad escolar entienda que la transición hacia un cambio cultural y
medioambiental es lenta. Para que el modelo de EPS se aplique con éxito se necesita tiempo y colaboración.
Habría que hacer hincapié en prestar apoyo a los profesores para que cambien la escuela desde dentro. Las
relaciones son importantes. (Global Health Promotion, 2012; 19(1): 23-31)

Relación causal entre el sentido de la coherencia y el entorno laboral psicosocial

a partir de datos de seguimiento de trabajadores japoneses adultos durante un año
T.Togari y Y.Yamakazi
El objetivo de este estudio era utilizar datos longitudinales e investigar las siguientes cuatro hipótesis en torno
a la relación entre el sentido de la coherencia (SC) y el entorno laboral (EL) en razón de los sexos: (1) Existe
una relación causa efecto bidireccional entre SC y EL; 2) el EL es la causa y el SC es el efecto; 3) el SC es la
causa y el EL es el efecto; y 4) no existe relación causa efecto entre SC y EL. Se realizó un muestreo aleatorio
estratificado en dos fases con sujetos masculinos y femeninos de edades comprendidas entre los 20 y los
40 años, residentes en Japón, y se les envió por correo unos cuestionarios autoadministrados entre enero y
marzo 2007 (Etapa 1). Se llevó a cabo un seguimiento del mismo modo de enero a marzo de 2008 (Etapa 2).
Se recibieron respuestas de 3.965 personas (ratio de seguimiento: 82,6%). Este estudio analizó las respuestas
de 1.291 varones y 933 mujeres con una edad mínima de 25 años en la Etapa 1 y que permanecieron en el
mismo trabajo en los dos periodos de tiempo. El análisis se realizó empleando un modelo de correlación de
retardos cruzado bajo modelización de ecuaciones estructurales. Se eligió la segunda hipótesis tanto para
varones como para mujeres en base al resultado de las comparaciones anidadas. Es decir, se constató una
relación temporal causa-efecto entre SC y EL tanto en los varones como en las mujeres, en el que el EL era la
causa y el SC era el efecto. (Global Health Promotion, 2012; 19(1): 32-42)

Utilizar las competencias de promoción de la salud para el desarrollo curricular

de la enseñanza superior
W. Madsen y T. Bell
Las competencias básicas de la promoción de la salud se utilizan para diversos fines. Recientemente, se han
dado pasos para lograr un consenso internacional respecto de las competencias que se consideran esenciales

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92 Resúmenes

para el ejercicio de la promoción de la salud. Una de las principales razones que se argumenta para formular
competencias básicas es que sirvan de orientación para el desarrollo curricular en las instituciones de
enseñanza superior. Este artículo describe un intento institucional de desarrollar un programa de estudios
para estudiantes universitarios y de posgrado en base a las competencias básicas definidas en Australia para
los profesionales de promoción de la salud. Explica que si se incorporan las competencias básicas a los
programas de estudios antes de lograr un consenso internacional al respecto, se corre el riesgo de que luego
cambien. No obstante, aplazar la elaboración de los programas de estudios hasta que desaparezca este riesgo
reduce las oportunidades de impartir la enseñanza de promoción de la salud de manera dinámica y actualizada
en las instituciones universitarias. (Global Health Promotion, 2012; 19(1): 43-49)

Consumo comórbido de sustancias entre los jóvenes: ¿Influye el entorno escolar?

M. J. E. Costello, S. T. Leatherdale, R. Ahmed, D. L. Church y J. A. Cunningham
Antecedentes. El consumo de sustancias es corriente entre los jóvenes; no obstante, seguimos teniendo un
conocimiento limitado del consumo comórbido de tabaco, alcohol y marihuana. El entorno escolar puede
desempeñar un importante papel en la probabilidad de que un alumno se inicie en el consumo de sustancias
de alto riesgo, incluido el consumo comórbido. Objetivo. Este estudio pretende: (1) describir la prevalencia
de las conductas de consumo comórbido de sustancias en los jóvenes; (2 ) identificar y comparar las
características de los jóvenes que actualmente consumen una sola sustancia, dos o las tres; (3) investigar si la
probabilidad del consumo comórbido varia de una escuela a otra; y (4) examinar qué factores se asocian al
consumo comórbido. Métodos. Este estudio utilizó datos representativos a escala nacional de alumnos en los
cursos 9º a 12º, entre 14 y 18 años de edad aproximadamente, (n=41.886) recogidos en el Canadian Youth
Smoking Survey (YSS) (Estudio sobre el tabaco en los jóvenes canadienses) realizado en 2006-2007. Se
recogieron datos demográficos y conductuales, entre ellos, el consumo de cigarrillos, alcohol y marihuana en
aquel momento. Resultados. 6,5% (n=107.000) de los encuestados admitían consumir las tres sustancias y
20,3% (n=333.000) dos de ellas. El análisis de los diferentes niveles reveló la importancia de la escuela en las
probabilidades de que el alumno consumiera las tres sustancias o dos de ellas, lo que representó el 6,9% y
13,5% de la variabilidad respectivamente. El consumo comórbido tiene relación con el sexo, el curso escolar,
la cantidad de dinero disponible y la percepción del rendimiento escolar. Conclusiones. El consumo comórbido
de sustancias entre los jóvenes es elevado; no obstante, no en todas las escuelas se constata la misma
prevalencia. Algunas características de las escuelas las colocan en situación de especial riesgo de que el
alumno consuma sustancias. Por ello es importante conocer estas características, para que los programas
educativos sobre drogas y alcohol se ajusten a las necesidades de cada escuela. Se constata la necesidad de
impulsar intervenciones cuyo objetivo sea prevenir el consumo comórbido de sustancias. (Global Health
Promotion, 2012: 19(1): 50-59)

Reflexiones sobre la diversidad cultural en la promoción y la prevención en

materia de salud buco-dental
E. Riggs, C. van Gemert, M. Gussy, E. Waters y N. Kilpatrick
La caries dental es una enfermedad sumamente debilitadora cuyas consecuencias se padecen de por vida. En
casi todos los países desarrollados existen desigualdades importantes en materia de salud buco-dental en las
comunidades menos favorecidas, que incluyen la población refugiada y emigrante. Abordar estas desigualdades
se está convirtiendo en un desafío cada vez mayor, puesto que las comunidades son cada vez más diversas
culturalmente. El conocimiento de las prácticas tradicionales de salud bucodental permitiría a los profesionales
de este campo y del campo de la salud en general entender mejor estas diferencias y, en consecuencia, responder

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