Health by Design: Interweaving Health Promotion into Environments and Settings

Abstract

The important influence of the environmental context on health and health behavior—which includes place, settings, and the multiple environments within place and settings—has directed health promotion planners from a focus solely on changing individuals, toward a focus on harnessing and changing context for individual and community health promotion. Health promotion planning frameworks such as Intervention Mapping provide helpful guidance in addressing various facets of the environmental context in health intervention design, including the environmental factors that influence a given health condition or behavior, environmental agents that can influence a population’s health, and environmental change methods. In further exploring how to harness the environmental context for health promotion, we examine in this paper the concept of interweaving of health promotion into context, defined as weaving or blending together health promotion strategies, practices, programs, and policies to fit within, complement, and build from existing settings and environments. Health promotion interweaving stems from current perspectives in health intervention planning, improvement science and complex systems thinking by guiding practitioners from a conceptualization of context as a backdrop to intervention, to one that recognizes context as integral to the intervention design and to the potential to directly influence health outcomes. In exploring the general approach of health promotion interweaving, we examine selected theoretical and practice-based interweaving concepts in relation to four key environments (the policy environment, the information environment, the social/cultural/organizational environment, and the physical environment), followed by evidence-based and practice-based examples of health promotion interweaving from the literature. Interweaving of health promotion into context is a common practice for health planners in designing health promotion interventions, yet one which merits further intentionality as a specific health promotion planning design approach.

Intervention Mapping: Theory- and Evidence-Based Health Promotion Program Planning: Perspective and Examples

“…IM addresses the growing body of evidence on the influence of the environmental context on health and health behavior [e.g., (47)] by providing a robust framework for planning health interventions that considers various facets of the environment. Springer et al (48) explore how health planners and practitioners can further incorporate the environmental context of health intervention design through the concept of health promotion interweaving . Building from theoretical perspectives rooted in social-ecological models, improvement science, and systems thinking, this paper advances an indigenous health intervention development approach that takes into account the environmental context, to designing interventions.…”

Improving Environmental Capacities for Health Promotion in Support Settings for People with Intellectual Disabilities: Inclusive Design of the DIHASID Tool

“…Therefore, we advise anyone who wants to apply the DIHASID tool in another country to conduct a pilot to see whether adaptations are needed for that context. Future studies could use the DIHASID tool to (1) provide insight into how people with ID are currently supported by ID support organizations to live healthily, (2) enhance intervention effectiveness in specific settings by identifying assets that can support the intervention in that particular setting and/or interweave the intervention in the setting [53], and (3) gain insight into contextual factors that might influence the outcomes and successes of health promotion interventions applied in that particular setting [54].…”

Active Learning Norwegian Preschool(er)s (ACTNOW) – Design of a Cluster Randomized Controlled Trial of Staff Professional Development to Promote Physical Activity, Motor Skills, and Cognition in Preschoolers

“…Alongside the involvement of directors and teachers in the professional development, the research group will work in partnership with each preschool and its entire staff to ensure support and commitment, not only among those enrolled in the professional development. As recommended by the literature on health promotion assessment and interweaving (Springer et al, 2017), the process among staff will begin by involving all in an analysis of the preschool's existing PA policies and practices as well as an assessment of staff and children's needs and resources related to PA, and thus their readiness for change. Based on the assessment, staff will develop a written PA policy with set priorities and objectives, which will incorporate both intervention levels, including the four core components for children.…”