公共卫生教育和促进的重大挑战

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Introduction

The Section Public Health Education and Promotion aims to advance the scientific basis of knowledge and action for current and future health education and promotion researchers and professionals, including those working with lay audiences. The section seeks to foster research on a broad range of health education, health promotion and disease prevention approaches operating at individual, organizational, community and society level. The Ottawa Charter (1) has provided a basis for addressing public health challenges in fundamentally new ways with building public policy, creating supportive environments for health, strengthening community action, developing personal skills and reorienting health services. However since the Charter has been launched many social and economic changes have occurred and globalization as well as digitization have had strong impacts on systems, governance structures, economies and therewith on the daily lives of people. Therefore, the conference on health promotion in 2016 has released the Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development (2), which suggests that health promotion methods and strategies play a key role to achieve the UN Sustainable Development Goals (SDGs) (3) and the Declaration puts Healthy Cities, improved governance for health and health literacy in the focus of actions. More recently, the COVID-19 pandemic has reminded us that health is multi-faceted and that there are multiple and interacting impacts of the pandemic in the settings of our everyday lives (4). Therefore, the Section Public Health Education and Promotion aims to foster innovative research, education and practice that can help individuals to better deal with the challenges of rapidly changing environments and make better personal health choices, health education and promotion professionals more effectively engage in evidence-based practices, and societies enhance programmatic efforts and policy initiatives to protect and promote population health. In order to support the goals of the Ottawa Charter and the Shanghai Declaration, the following eight topics and themes should be addressed in future research to create better evidence for tackling the present and future public health challenges effectively.

Health Promotion in Settings

The importance of settings as “.. a place or context in which people engage in daily activities in which environmental, organizational and personal factors interact to affect health and wellbeing” (5) for sustainable health and wellbeing has been expressed in many different WHO documents since the Ottawa Charter has shed the light on the settings-based approach to health promotion in 1986. The importance of settings is presently re-affirmed, because the recovery from COVID-19 will to a large extent be determined by and experienced in the settings in which we live our lives, and a settings approach is thus needed to mitigate the negative impacts of COVID-19 (6). Whitelaw et al. (7) have distinguished different types of setting based approaches and provided a better understanding of how setting-based health promotion is implemented in current practice. The types range from the passive model, where the setting provides access to population groups or individuals to address health behavior change and development of personal skills, to the organic model requiring active engagement of the community and the comprehensive model, where health promotion is the central component of the setting development. In the settings-based approach to health promotion participation and empowerment of both individuals and communities is key. However, more research is needed to investigate the effectiveness of the different types of health promotion within settings on health and wellbeing of the members of the setting and the wider communities with which settings are deeply interconnected (8).

Health Literacy With Focus on the Health Literacy Environment

The last two decades have seen an extraordinary increase in published papers on the subject of health literacy showing the growth in interest in this topic. Health literacy has been described as the ability to assess, understand, appraise and apply health-related information in the domains of health promotion, prevention and health care (9). There is a body of research showing that health literacy has influence on behavioral choices and the use of health services, which in turn creates an impact on health outcomes and health service costs (10–12). Given the relevance of health literacy to improve population health there is still a lack of research both in terms of measuring the level of health literacy as well as to improve health literacy in diverse populations. The focus of the majority of studies has been on interventions providing information, effective communications and structured education in clinical settings and directed toward improving functional health literacy, while implementation of national policies and programs still seems to be lacking behind (13). In addition, more research is needed on health literacy environment approaches encompassing programmes, interventions and policies to make health services more user-friendly and to reduce communication barriers.

Digital Health Education and Promotion

Since technology is shaping nearly every aspect of our lives in information societies health education and health promotion is also transitioning into a new technological and digital era and digital health promotion is evolving (14, 15). While the technology is rapidly developing and improving and the connectivity and adoption of devices is increasing world-wide, there are many new options to reach out to hard-to-access populations and communities in better and more affordable ways. Another advantage is the potential use of new ways to communicate digitally with tailored and even individually personalized health information and messages, health promotion services. With the decreasing costs of digital technologies reaching out to large populations with digital health promotion seems to be possible even in low- and middle income countries. However, successful digital health promotion needs to take some environmental factors into account that are minimizing still existing digital divides in terms of access, the need to develop applications that are easy to use across generations and age groups, to incorporate interactivity and gamification elements, to deliver incentives for use in real time and to establish trust in terms of high standards of data protection (15). A scoping review has shown that digital health promotion uses a variety of technologies ranging from computer- and web-based programs to mobile devices/smartphone apps and telemonitoring in form of sensors (14). However, the authors also conclude that there is still a lack of research of environmental and structural approaches in the field of digital health promotion and that most applications and programs operating with digital technologies focus on individual behavior change (15). In addition, more research is needed to address key challenges of digital health promotion and education in terms of privacy control, appropriate use of data including secondary usage beyond the original intention and the appropriate limits of nudging vs. the free choice (15).

Co-Creation in Intervention Development and Stakeholder Engagement

It is widely accepted that co-creation of new interventions and stakeholder involvement has the potential to develop more effective interventions with strong and enduring impact on health outcomes (16) and to speed up the application in practice (17). Co-creation has emerged from the participatory design paradigm (18) and ensures that programs are designed with those that are ultimately the recipients of a health intervention (19). While Co-creation has been initially used in developing health care services (20) it may also be a promising strategy to adopt to address other complex health behaviors (19). Interventions and programmes developed in co-creation with stakeholders, users and recipients of programmes have thus demonstrated value for researchers, users and society at large (21). In addition, the need to include wider stakeholder groups during the intervention development process has been identified more recently in order to ensure that user generated ideas are feasible and applicable in practice (22). Co-creation processes ensure that emphasis is placed on empowering participants and that all solutions emerging from co-design are user centered and stakeholder supported. The participation and engagement of stakeholders and/or programme recipients in various stages of the intervention development process, has different origins but shares important assumptions and operating principals (16, 23). While collaboration and engagement with users and stakeholders during intervention development processes are considered vital, clear articulation of procedures and considerations for various co-creation methodologies warrants further research attention (19).

Social Marketing Approaches

Health education and health promotion build to a large extent on research and approaches developed within social marketing. Co-creation e.g., has its roots in participatory action research, but also in co- design originating from service design thinking in marketing (19). Moreover, social norms approaches are widely used to shift risk-taking behavior toward more responsible health behavior, which have their origin in social marketing. While social marketing approaches and techniques are of high value and relevance for health promotion practitioners and researchers, the sharing of knowledge and practices between these fields of science should be intensified. Thus, more social marketing research should be published in the Section Public Health Education and Promotion in order to make innovative social marketing approaches more visible for public health scientists and practitioners.

Health Communication and Risk Communication

Significant communication components are involved in the management of public health issues. This became even more urgent during the COVID-19 pandemic. Communication strategies are needed to effectively prompt warnings about risks, increase self-efficacy of individuals for behavioral change, and inform about symptomatology and medical treatment. Risk communication is a science-based approach for communicating effectively in such high concern situations than in a pandemic, and it is based on a multi-level process of interactive exchange of information between public government and citizens (24). More research is needed to fully understand how multiple messages about the nature of the risk and about the legal and the institutional arrangements for risk management can be effectively communicated to broad and diverse audiences in times of fake news and misinformation.

New Ways to Evaluate Health Education and Promotion Programmes

The last decades have seen an increasing emphasis on evidence-based programmes and actions in the field of health promotion and prevention. However, developing such evidence is still a challenge given the complex nature of many of the community or settings-based interventions with multiple intervention strategies and the diversity of the outcomes on both behavioral and structural level. Since the randomized-controlled trial (RCT) as the gold standard in intervention evaluation is often too restrictive to fit to the diverse types of interventions, the research methods to evaluate their success need to vary according to the type of intervention including qualitative, quantitative, economic and participative methods (25). In addition, new ways to evaluate the effectiveness of digital health tools are needed that allow for capturing dynamic changes of digital health interventions over time (26). Additionally, more research is needed in developing evaluation strategies to tackle the lengthy and costly nature of RCTs.

Innovative Teaching and Learning in Health Education and Promotion

The multiple and rapid societal end environmental changes in the context of globalization and digitisation require also adaptations and responses in how we teach and learn in the field of health education and promotion. Moreover, the COVID-19 pandemic has changed the way we teach and learn fundamentally with the rapid enforcement of online teaching in many countries. Research addressing the short-, mid- and long-term consequences of distance learning practices on learning outcomes and social interaction among peers and between educators and students are needed. In addition, research about new ways to teach and learn interactively via distance, hybrid or classroom teaching is also warranted.

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介绍

公共卫生教育和促进部分旨在为当前和未来的健康教育和促进研究人员和专业人员（包括与非专业观众一起工作的人员）推进知识和行动的科学基础。该部分旨在促进对在个人、组织、社区和社会层面开展的广泛健康教育、健康促进和疾病预防方法的研究。渥太华宪章 ( 1) 为以全新方式应对公共卫生挑战提供了基础，包括制定公共政策、为健康创造支持性环境、加强社区行动、发展个人技能和重新定位卫生服务。然而，自《宪章》发布以来，社会和经济发生了许多变化，全球化和数字化对系统、治理结构、经济以及人们的日常生活产生了强烈影响。因此，2016年健康促进大会发布了《2030年可持续发展议程促进健康上海宣言》（2），提出健康促进方法和战略对实现联合国可持续发展目标（SDGs）具有关键作用。( 3) 和宣言将健康城市、改进的健康治理和健康素养置于行动的重点。最近，COVID-19 大流行提醒我们，健康是多方面的，大流行对我们日常生活的环境有多重和相互作用的影响（4）。因此，公共卫生教育和促进科旨在促进创新的研究、教育和实践，以帮助个人更好地应对快速变化的环境带来的挑战，做出更好的个人健康选择，健康教育和促进专业人员更有效地参与证据-基于实践和社会加强保护和促进人口健康的计划努力和政策举措。为了支持《渥太华宪章》和《上海宣言》的目标，未来的研究应解决以下八个主题和主题，以便为有效应对当前和未来的公共卫生挑战创造更好的证据。

环境中的健康促进

环境作为“..人们从事日常活动的场所或环境，环境、组织和个人因素相互作用以影响健康和福祉”（5）对于可持续健康和福祉的重要性已在许多不同的世卫组织文件中得到体现自 1986 年《渥太华宪章》阐明了以环境为基础的健康促进方法以来。环境的重要性目前得到了重新肯定，因为从 COVID-19 中恢复过来在很大程度上取决于环境并在环境中经历我们生活在其中，因此需要一种环境方法来减轻 COVID-19 的负面影响 ( 6 )。怀特劳等人。( 7) 区分了不同类型的基于环境的方法，并提供了对当前实践中如何实施基于环境的健康促进的更好理解。类型包括从被动模式到需要社区积极参与的有机模式和以健康促进为中心的综合模式设置开发的组成部分。在基于环境的健康促进方法中，个人和社区的参与和赋权是关键。然而，8 ).

注重健康素养环境的健康素养

在过去的二十年中，关于健康素养主题的已发表论文数量显着增加，这表明人们对该主题的兴趣正在增长。健康素养被描述为在健康促进、预防和保健领域评估、理解、评价和应用健康相关信息的能力 ( 9 )。有大量研究表明，健康素养对行为选择和卫生服务的使用产生影响，进而对健康结果和卫生服务成本产生影响（10 - 12）。鉴于健康素养与改善人口健康的相关性，在衡量健康素养水平以及提高不同人群的健康素养方面仍然缺乏研究。大多数研究的重点是在临床环境中提供信息、有效沟通和结构化教育的干预措施，旨在提高功能性健康素养，而国家政策和计划的实施似乎仍然落后（13）。此外，需要对包括计划、干预措施和政策在内的健康素养环境方法进行更多研究，以使卫生服务更加用户友好并减少沟通障碍。

数字健康教育与推广

由于技术在信息社会中几乎影响着我们生活的方方面面，健康教育和健康促进也正在过渡到一个新的技术和数字时代，而数字健康促进也在不断发展 ( 14 , 15 )）。尽管该技术正在迅速发展和改进，并且全球范围内设备的连接性和采用率正在增加，但仍有许多新的选择可以以更好、更实惠的方式接触到难以进入的人群和社区。另一个优势是可能使用新的方式与量身定制的甚至个性化的健康信息和信息、健康促进服务进行数字通信。随着数字技术成本的降低，即使在中低收入国家，通过数字健康促进向大量人群普及似乎也是可能的。然而，成功的数字健康促进需要考虑一些环境因素，这些因素正在最大限度地减少仍然存在的数字鸿沟，15 )。范围审查表明，数字健康促进使用各种技术，从基于计算机和网络的程序到移动设备/智能手机应用程序和传感器形式的远程监控 ( 14 )。然而，作者还得出结论，在数字健康促进领域仍然缺乏对环境和结构方法的研究，并且大多数使用数字技术的应用程序和程序都侧重于个人行为改变（15）。此外，还需要更多的研究来解决数字健康促进和教育在隐私控制、数据的适当使用（包括超出原意的二次使用）以及轻推与自由选择的适当限制方面的关键挑战（15）。

干预发展和利益相关者参与的共同创造

人们普遍认为，共同创造新的干预措施和利益相关者参与有可能开发更有效的干预措施，对健康结果产生强烈和持久的影响 ( 16 ) 并加快实践中的应用 ( 17 )。共同创造源于参与式设计范式 ( 18 )，并确保项目的设计与那些最终成为健康干预接受者的人一起设计 ( 19 )。虽然共同创造最初被用于开发医疗保健服务 ( 20 )，但它也可能是一种有前途的策略，可用于解决其他复杂的健康行为 ( 19 )）。因此，与利益相关者、用户和项目接受者共同开发的干预措施和项目已经证明了对研究人员、用户和整个社会的价值（21）。此外，为了确保用户产生的想法在实践中可行和适用，最近已经确定在干预开发过程中需要包括更广泛的利益相关者群体（22）。共同创造过程确保重点放在赋予参与者权力上，并确保从共同设计中出现的所有解决方案都以用户为中心并支持利益相关者。利益相关者和/或计划接受者在干预开发过程的各个阶段的参与和参与，有不同的起源，但具有重要的假设和操作原则 ( 16 , 23 )。虽然在干预开发过程中与用户和利益相关者的合作和参与被认为是至关重要的，但对各种共同创造方法的程序和考虑因素的清晰表述值得进一步研究关注 ( 19 )。

社会营销方法

健康教育和健康促进在很大程度上建立在社会营销中开发的研究和方法之上。例如，共同创造源于参与式行动研究，但也源于源于营销中的服务设计思维的协同设计（19）。此外，社会规范方法被广泛用于将冒险行为转变为更负责任的健康行为，这源于社会营销。虽然社会营销方法和技术对健康促进从业者和研究人员具有很高的价值和相关性，但应加强这些科学领域之间的知识和实践共享。因此，应该在公共卫生教育和促进部分发表更多的社会营销研究，以使创新的社会营销方法对公共卫生科学家和从业者来说更加明显。

健康沟通和风险沟通

重要的通信组件涉及公共卫生问题的管理。在 COVID-19 大流行期间，这变得更加紧迫。需要沟通策略来有效地提示风险警告，提高个人行为改变的自我效能，并告知症状学和医疗。风险沟通是一种以科学为基础的方法，可以在比大流行病更受关注的情况下进行有效沟通，它基于公共政府和公民之间的多层次信息交互交流过程（24）。需要进行更多研究，以充分了解在虚假新闻和错误信息出现时，如何将有关风险性质以及风险管理的法律和制度安排的多种信息有效地传达给广泛而多样的受众。

评估健康教育和促进计划的新方法

在过去的几十年里，人们越来越重视健康促进和预防领域的循证计划和行动。然而，鉴于许多基于社区或环境的干预措施具有多种干预策略的复杂性，以及行为和结构层面结果的多样性，开发此类证据仍然是一项挑战。由于作为干预评估金标准的随机对照试验 (RCT) 通常过于局限，无法适应不同类型的干预，因此评估其成功的研究方法需要根据干预类型而有所不同，包括定性、定量、经济和参与方法（25）。此外，需要新的方法来评估数字健康工具的有效性，以便捕捉数字健康干预措施随时间的动态变化 ( 26 )。此外，需要更多的研究来制定评估策略，以解决 RCT 的冗长和昂贵的性质。

健康教育与促进的创新教学

在全球化和数字化的背景下，多重和快速的社会环境变化也要求我们在健康教育和促进领域的教学方式上进行调整和应对。此外，随着许多国家在线教学的迅速实施，COVID-19 大流行从根本上改变了我们的教学方式。需要研究解决远程学习实践对学习成果和同伴之间以及教育工作者和学生之间的社会互动的短期、中期和长期影响。此外，还需要研究通过远程、混合或课堂教学进行交互式教学和学习的新方法。

THE

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