A Global Participatory Process to Structuring the Field of Health Promotion Research: An Introduction

Abstract

While health promotion has developed mainly as professional and advocacy practices, a growing number of research contributes to the health promotion knowledge base. To support further professional development of health promotion, there is a need to structure health promotion research as a distinct field. Global Handbook of Health Promotion Research aims to map the various health promotion research practices, to provide a usable resource for health promotion research and to contribute to the creation of a shared identity for health promotion researchers. Designed as a collaborative project, this handbook is mainly composed of chapters written by individuals and groups in response to an open call for contributions. The chapters illustrate research practices and reflect on their epistemological and ethical dimensions. The final product comprises three distinct volumes. Volume 1, Mapping Health Promotion Research, offers an overview on the diversity of health promotion research practices conducted around the world. Volume 2, Framing Health Promotion Research, written by the editors, proposes a framework for a distinct field of health promotion research. Volume 3, Doing Health Promotion Research, provides introductory-level presentations of paradigms, strategies of inquiry and methods associated with, and contributing to, health promotion research.

Reprinted by permission from Springer Nature: Springer, with slight modifications. A Global Participatory Process for Structuring the Field of Health Promotion Research: An Introduction by L. Potvin and D. Jourdan. In: Potvin, L., Jourdan, D. (eds), Global Handbook of Health Promotion Research, Vol. 1: Mapping Health Promotion Research. Copyright © 2022.

With the exception of the Bangkok Charter, which calls to anchor health promotion practice on the best available evidence (WHO, 2005), there is no mention of research and of relevant scientific knowledge in health promotion founding documents. These documents frame health promotion mostly as a discourse and a professional practice based on a set of values and principles that promotes changes at the individual, community and global levels (Potvin & Jones, 2011). There is no well-defined knowledge base and no distinctive, widely agreed knowledge production approach for health promotion research. Nevertheless, during the past decades, health promotion research has developed and gained recognition as witnessed through various signs of scientific institutionalisation (scientific journals, graduate research-oriented programmes, departments in higher education institutions and research units in universities). In many knowledge institutions, health promotion research has gained the status of ‘a name on the door’ (Potvin & McQueen, 2007).

Like all other research domains related to a professional practice, health promotion research has started its development following what we would call a potluck model. Researchers from various disciplinary backgrounds, attracted to the values and transformative vision underpinning the health promotion discourse, have used their disciplinary-based theories and methods to conduct studies about the various practices associated with health promotion (MacDonald & Bunton, 2002; Jourdan, 2013). The question arises as to whether health promotion research is still at the potluck stage or is it now a constituted, distinctive field of scientific enquiry. In other words, is health promotion research simply a crossroads where researchers from different disciplines temporarily meet, or is it a constituted field of research on its own with its specific objects, epistemological frameworks, methods and specialists? This question has been raised in all research fields founded on social practices (see, for example, Fischer & Miller, 2007, on political science or Wyse et al., 2016, on education science) and not on a specific approach to reality (physics, sociology and so on). We created this Global Handbook of Health Promotion Research project to make visible that health promotion research has come of age and has become a distinct field of scientific enquiry. It can be distinguished from other fields through its distinctive objects and a unique configuration of ethical and epistemological perspectives that shape the research practice of those who identify as health promotion researchers.

However, as of yet, these ethical and epistemological foundations have not been explicitly formulated and articulated into a coherent structuring framework for health promotion research. This is the project of this global handbook, for which the process of achieving the framework itself was a stepping stone for structuring the field, mobilizing a community of health promotion researchers and contributing to the capacity building of the newly minted researchers.

To our knowledge, there exist only a couple of books entirely dedicated to presenting health promotion research (Goodson, 2009; Salazar et al., 2015). Both these references discuss health promotion research mostly from the point of view of researching health behaviour changes and are blind to researching health promoting systems and policies. Neither makes extensive references to the broader perspective on health promotion as a practice aimed at influencing the social, political, environmental and economic determinants of health. Although there is room in health promotion research for researching individual practices and heath behaviours, we conceive of health promotion research as a much broader field of enquiry. To contribute to the sustainability of health promotion, health promotion research needs to encompass the entire transformative agenda proposed in the Ottawa Charter (WHO, 1986).

Developing knowledge on such a broad range of practices involving a diversity of social actors requires a pluralist view of science that makes room for and integrates diverse relevant paradigms. With this handbook, our ambition is threefold.

• 1. To map the various health promotion research practices, to make visible their diversity and distinctive characteristics

• 2. To provide a reference tool and a usable resource for researchers, practitioners and students to navigate and conduct health promotion research

• 3. To contribute to the creation of a shared and recognised identity for health promotion researchers

1.1 The Need for a Solid and Relevant Knowledge Base

Health promotion was institutionalised in the mid-1980s through a WHO-EURO effort to operationalise the goal of ‘achieving health for all in 2000’ (Kickbusch, 2003). With the recognition towards the end of the twentieth century that non-communicable diseases and modifiable lifestyle risk factors were major causes of disease and mortality in high but also low- and middle-income countries (Murray & Lopez, 1994), health promotion has become global. The Bangkok Charter for Health Promotion in a Globalised World (WHO, 2005) made this explicit. However, to survive and thrive as an intervention and political framework as well as a global professional activity, health promotion must develop a solid and relevant knowledge base to buttress other elements of professional sustainability such as training programmes, accreditation process and competency frameworks.

Parallel to this geographical expansion, health promotion has also penetrated the academic domain. The fact that a growing number of scientific journals, research infrastructure and specialised academic degrees include health promotion in their titles is a sure sign of a thriving scientific enterprise. While research teams are capable of producing scientific knowledge, the field of health promotion research is yet to be recognised as distinct and associated with a coherent body of knowledge anchored in shared paradigms, approaches and methods (Jourdan, 2019). In comparison to well-established theory-based fields of research such as psychology, sociology or epidemiology, for example, health promotion research could appear to be weak from an epistemological point of view: its objects are somewhat ill-defined and the epistemic boundaries with established fields of research are blurred (Jourdan et al., 2012). The field is still in search of a proper niche as witnessed by the fact that health promotion research infrastructure and academic degrees are associated with various scientific disciplines that range from psychology, education, social work and various allied health sciences such as public health, nutrition and others, depending on university traditions (Van den Broucke, 2017).

The key questions are then: what are the criteria to define a research field and does health promotion research meet these criteria? In reference to Bourdieu’s notion of social field (Bourdieu, 1980), a field of research is a structured space of relationships for social actors, both individual and institutional (in our case, people and organisations involved in health promotion research). It is defined by its boundaries with other related fields (such as public health research, political science or health psychology) and it defines an identity for those within. Actors in the field struggle to obtain significant shares of various types of capital from which they can position themselves favourably within this space. In the case of a science field, these capitals are mainly peer recognition, role in scientific journals or funding organisations or other authoritative instances for knowledge production and dissemination (Jourdan et al., 2012). On the basis of the volume of scientific publications, journals, research teams, graduate degrees and other metric indicators of scientific activity, we consider that health promotion research has many of the attributes of a distinct research field. What is missing is an explicit and shared structuring framework that will facilitate the development of other attributes such as a clear identity of health promotion researchers, recognition and assessment of the value of their work in their academic careers, funding processes, scholarly associations. Developing such a framework for health promotion research is the next step that will support the maturing of health promotion research and the sustainability of health promotion. Working towards a framework for the field of health promotion research does not mean imposing a universal standard. It is a matter of identifying the anchoring points that characterise research in all its diversity on the basis of existing practices and in a collaborative approach. Doing so will make visible the specific characteristics of the field. This work could only be done by mobilising the forces of the health promotion research at a global level. This is why we launched the initiative of the creation of a global handbook.

1.2 A Collaborative Process to Structuring Health Promotion Research

The overarching ambition of this global handbook is to contribute to structuring the field of health promotion research based on the actual research practices. From the work of Ludwig Fleck (2005) in the early twentieth century to that of Thomas Kuhn (1962) and Bruno Latour (1989), empirical investigations of the scientific knowledge production activity have demonstrated that science is a sociological enterprise. Over and above philosophical considerations about the thinking process foundational to all knowledge, scientific knowledge is the product of the social practices of researchers whose work cannot be reduced to applying methods. Science is a social activity. Researchers are social actors whose behaviours are shaped by structuring forces related to a community of researchers to which they belong. Scientific activity is rooted in the worldviews, paradigms, methods and tools elaborated by those recognised as contributing to the discipline in which the activity is embedded and, conversely, that shapes the discipline. Although every research project is a singular, original activity, it is related to an identifiable scientific field through a configuration of characteristics that are shared by the community of researchers in the discipline.

To structure the field of health promotion research, we opted to work from the bottom-up, i.e. to start by taking stock of the research practices of those who compose the field and who identify as health promotion researchers. After having carefully mapped these practices, their analysis should allow the identification of what underlies them and their organisation into a coherent framework. This is the first objective of the handbook.

A second objective is to help structure a distinctive community of health promotion researchers and to support its expansion by providing the next generation of researchers with a tool to situate their own contributions to the field. We also want to expose these future researchers with a coherent framework to organise the breadth and depth of valid health promotion research practices. Coming from a variety of disciplinary perspectives, those involve in health promotion research often operate at the margin of their own discipline. Providing a structured and recognised space in the form of a scientific field will strengthen and legitimate the label ‘health promotion researcher’ and will provide criteria and directions to further develop tools (journals, graduate programmes, funding mechanisms) adapted to the specificities of the practices of health promotion researchers. In order to ensure the relevance of the proposed structuring framework for the global community of health promotion researchers, we framed the project as a participatory enterprise in which those who identify as health promotion researchers contribute to creating the framework through sharing and discussing their own research practices. The intent is to base the handbook on the collective experience of health promotion researchers globally about how they create and share health promotion knowledge.

This is why a call for contributions was launched in February 2020. It was open to the global community of health promotion researchers, defined as individuals and groups interested in advancing health promotion research by reflecting and sharing their practices. To reach these researchers, we associated with the International Union for Health Promotion and Education (IUHPE), the only NGO with a global membership composed of decision-makers, practitioners and researchers in the field of health promotion, and posted our call on their website and in their journal Global Health Promotion. The call was also sent through the community of the UNESCO chair Global Health and Education. Finally, we issued personalised invitations to a number of prominent colleagues and researchers in health promotion. The call asked for outlines of potential chapters detailing research practices as implemented in specific research projects or in more comprehensive research programmes. We provided the following headings for guidance.

• 1. The specific health promotion practices investigated: Who were the actors? What were they doing? For what purposes?

• 2. The purpose of the research project or programme: What were the objectives? In which context were they defined? Who participated in their definition? Were values other than knowledge production pursued through this research? Which ones? Who defined them?

• 3. The research framework: Which research paradigm was framing the research and why? Which theories were used, and how?

• 4. The relationship with those whose practices were investigated: How were research participants involved in the planning and conduct of the research? Were research results shared with non-researchers? If yes, how and for what purpose?

• 5. The methods used: What kind of data were collected? How was it collected and analysed?

• 6. Specific challenges of health promotion research enlightened by the project or programme: How does the research contribute to advancing health promotion research?

We received 108 outlines from all continents encompassing a wide range of research practices and methods reporting on research that were clearly about issues related to health promotion. Authors were diverse as well, with some of them just graduating from a doctorate programme and some being seasoned researchers. We interpreted this very positive response to our call as a real need of the field to reflect on research practices and as a genuine willingness from researchers to contribute to shaping and structuring health promotion research. We invited 79 groups to contribute a full chapter, excluding outlines that did not report on research nor on the dissemination of research results. Concerning research objects, only outlines clearly linked to the health promotion discourse and practice as delineated by the Ottawa Charter of Health Promotion (WHO, 1986) or related documents were selected.

At this very early stage, we noted two types of outlines. The majority of outlines described a research project or programme and discussed the ways in which it contributed to address distinctive challenges in health promotion research. Taken together, these contributions would constitute the first part of the handbook aiming to answer the question: how is health promotion research conducted globally? To further guide authors in their reflexive task, we asked them to organise their chapter in a way that would provide evidence to answer four questions.

• 1. How are the research objects distinctive of health promotion?

• 2. What kind of knowledge does the research generate?

• 3. What makes this research approach distinctive of health promotion research?

• 4. How does this research contribute to advancing and structuring the field of health promotion research?

There was a second type of outline. Mostly written by more seasoned researchers, these contributions presented a high-level reflection on how a specific research approach or method, which authors had championed either as developer or main adapter from another field, was contributing to shaping health promotion research because it addresses fundamental challenges in health promotion research. We asked these authors to write a chapter for didactic purposes. These chapters would provide an overview of approaches, strategies of inquiry and methods for generating knowledge about health promotion practices. To complement these chapters, we also issued more personalised invitations to colleagues who are known for their work in a specific area. All these contributions would constitute the third part of the handbook aiming to guide researchers on doing health promotion research. This part would be more akin to a textbook in which junior researchers and graduate students could find accurate introductions to approaches used in health promotion research and to innovative practices in health promotion research. We asked authors to structure these contributions around these following questions.

• 1. Which general health promotion research issues does this approach address?

• 2. How does this approach solve that issue?

• 3. What are the approach’s fundamentals and key references?

• 4. How does this approach structure the field of health promotion research?

Based on our experience with similar projects, we expected that about half the number of invitations we issued would lead to full chapters. To our amazement, almost all authors and groups of authors invited produced a full-fledged chapter. It was more than 79 complete chapters that we reviewed and commented! The chapters have gone through several exchanges between the authors and the editors. In addition to describing research practices, all of them include an epistemological and ethical analysis that contributes to the construction of the field of health promotion research. A genuine process of maturation occurred which enabled the authors to make more explicit the foundations of their work and the editors to acquire a global vision of health promotion research practices in all their diversity. Finally, although this is not a systematic collection, the topics, approaches, strategies of inquiry and practices, disciplines and research setting presented and discussed in this wide selection of chapters offer a valid and realist perspective on the breadth and variety of health promotion research globally. Figure 1.1 provides a schematic representation of the process.

Fig. 1.1

The Collaborative process of creating the Global Handbook of Health Promotion Research. (Potvin & Jourdan, 2022a)

1.3 The Content of the Global Handbook: An Open Project

Given the number of contributions received, the handbook comprises three distinct volumes. Each volume has a unique scope and format providing a unique perspective to structuring the field of health promotion research. The mapping of practices is the first phase of our work. It has led to the publication of the first volume of the handbook. Based on this material, the second part of the work consists of a systematic description of the epistemological and ethical framework of health promotion research. It constitutes the second volume of the handbook. Finally, the present book or third volume, proposes a systematic collection of approaches, strategies of inquiry and methods. Figure 1.2 illustrates the overall architecture of the Handbook.

Fig. 1.2

Structure of the Global Handbook of Health Promotion Research. (Potvin & Jourdan, 2022a)

Volume 1, subtitled ‘Mapping Health Promotion Research’, is composed of 53 contributions that reflect on research projects or programmes that aimed at producing knowledge about health promotion practices. These chapters offer an overview on the range of health promotion practices studied by health promotion researchers on the one hand and on the research practices enacted to do so on the other hand. Chapters are organised in four parts according to the health promotion practices studied since it is a fundamental dimension for structuring the research field. The fifth part is composed of four chapters that correspond to our analysis of this material to derive some shared elements from the actual practice in health promotion research that will inform our effort to structure the field.

Volume 2 is subtitled: ‘Framing Health Promotion Research’. It is entirely written by Jourdan and Potvin and proposes our view of what makes health promotion research a distinct field. It is composed of short chapters with a didactic aim that describe and discuss what we consider as the fundamental elements for structuring the field and their specific configurations that make this field of research distinct. The argument is organised in four parts. The first part defines what constitutes a research field and why it is relevant and useful to distinguish health promotion research from other related research fields. The second part discusses the values and the ethical framework that we consider is a main characteristic of health promotion research. The third part proposes a comprehensive epistemological framework for health promotion research. The fourth part discusses the objects that delineate the range of health promotion practices studied in health promotion research.

Volume 3 (this volume) is subtitled: ‘Doing Health Promotion Research’. It is composed of short chapters written by authors who have developed a recognised expertise with regard to either an approach, a paradigm, a research design or a method associated with health promotion research. These chapters are written as introductions to these approaches in relation to the specific health promotion research challenge they address. The book is organised in six parts. The first part presents seven examples of research approaches based on various paradigms that are prisms for understanding the mechanisms at work in health promotion practices. The second through fifth parts propose 16 examples of heuristic research designs and methods designed or adapted to address methodological and ethical challenges in health promotion research. The sixth part is the conclusion of the volume.

Recognizing that: (1) we cannot pretend to have an exhaustive coverage of all relevant paradigms, strategies of inquiry and methods for health promotion research, and (2) the field is evolving rapidly, the handbook, especially this third volume, is conceived of as an opening for the future and a stepping stone for an ongoing global initiative. In collaboration with the Editorial Board of Global Health Promotion, the official journal of the International Union for Health Promotion and Education, we have created a section in the journal entitled ‘Doing health promotion research’ (Potvin & Jourdan, 2022b). This section publishes introductory-level presentations of paradigms, approaches and methods relevant for health promotion research and written by health promotion researchers.