research work on health promotion

Doing Health Promotion Research: Approaches, Paradigms, Designs and Methods to Produce Knowledge

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• Didier Jourdan 3 &
• Louise Potvin 4 , 5  

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Our aim in this volume is to present solutions used by researchers to advance the knowledge base and solve epistemological difficulties linked to the practice of health promotion research. In the introduction to this volume, we first describe the characteristics of the knowledge base in health promotion research. Although the database is gradually constructed through the production of new knowledge, it is not primarily built on a cumulative basis. Research weaves networks of knowledge resulting from diversified research approaches. These networks of questions, concepts, methods and results are what structures research in health promotion beyond their diversity. Then we present the two main ways of advancing knowledge in our field. The first of these ways is through the development of research approaches rooted in various conceptual frameworks (new starting points) that shed new light on practice and thus advance knowledge. We propose seven examples of such approaches based on various paradigms (critical theories, political science, economics, etc.) which are all relevant frameworks for understanding the mechanisms at work in health promotion practices. The second way is by increasingly advanced innovations in the implementation of research. We thus propose 16 examples of heuristic research designs and methods likely to complete the toolbox of health promotion researchers.

Reprinted by permission from Springer Nature: Springer. Conclusion: Characterising the Field of Health Promotion Research by D. Jourdan and L. Potvin. Fig. 53.2. In: Potvin, L., Jourdan, D. (eds), Global Handbook of Health Promotion Research, Vol. 1: Mapping Health Promotion Research . Copyright © 2022.

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Jourdan, D., & Potvin, L. (2022). Conclusion: Characterising the field of health promotion research. In L. Potvin & D. Jourdan (Eds.), Global handbook of health promotion research, Vol. 1: Mapping health promotion research . Springer. https://doi.org/10.1007/978-3-030-97212-7_53

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Potvin, L., & Jourdan, D. (2022). Markers of an epistemological framework in health promotion research. In L. Potvin & D. Jourdan (Eds.), Global handbook of health promotion research, Vol 1: Mapping health promotion research (pp. 801–812). Springer. https://doi.org/10.1007/978-3-030-97212-7_52

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UNESCO Chair and WHO Collaborating Centre in Global Health & Education, University of Clermont Auvergne, Clermont-Ferrand, France

Didier Jourdan

School of Public Health, University of Montreal, Montreal, QC, Canada

Louise Potvin

Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, Canada

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Jourdan, D., Potvin, L. (2023). Doing Health Promotion Research: Approaches, Paradigms, Designs and Methods to Produce Knowledge. In: Jourdan, D., Potvin, L. (eds) Global Handbook of Health Promotion Research, Vol. 3. Springer, Cham. https://doi.org/10.1007/978-3-031-20401-2_2

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Decades of workplace health promotion research: marginal gains or a bright future ahead

Affiliation.

• 1 Suzan Robroek, Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. [email protected].
• PMID: 34655223
• PMCID: PMC9058620
• DOI: 10.5271/sjweh.3995

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An employer-based training program to improve the health of participating employers and certified trainers, with an emphasis on reducing chronic disease and injury risk and improving worker productivity.

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Putting science to work for the health of women

Advancing Women’s Health Research: From Policy to Action

Advancing women’s health research: from policy to action , by dr. janine a. clayton.

White House Actions to Advance Women’s Health Research

On March 18, 2024, President Joe Biden signed a new Executive Order (EO) that builds upon the White House Initiative on Women’s Health Research . The EO outlined strategies to improve women’s health research by integrating women’s health across the federal research portfolio, prioritizing funding, galvanizing new research on women’s midlife health, and assessing areas needing further support. ORWH Deputy Director Vivian Ota Wang, Ph.D., and I were honored to attend the historic signing, alongside NIH Director Monica Bertagnolli, M.D., and Deputy Director for Program Coordination, Planning, and Strategic Initiatives Tara A. Schwetz, Ph.D., and other NIH leaders. A key aspect of this initiative was the announcement of a new NIH-wide effort to invest $200 million in Fiscal Year 2025 specifically for interdisciplinary women’s health research. This substantial investment is aligned with the administration’s commitment to advancing our understanding of women’s health issues and developing targeted interventions and treatments.  

As part of the White House Initiative on Women’s Health Research, First Lady Dr. Jill Biden and I visited Research Triangle Park, home to North Carolina State University, Duke University, and the University of North Carolina at Chapel Hill, to promote the EO, specifically focusing on challenges women face in midlife like menopause and heart disease. Our collaborative efforts with renowned institutions and health care professionals emphasized the need to address disparities in health care, advocating for innovative research and health care solutions that prioritize women’s health.

Moreover, in alignment with the White House Initiative on Women’s Health Research, ORWH issued a NIH-wide Notice of Special Interest to highlight interest in receiving research applications focused on diseases and health conditions that predominantly affect women (e.g., autoimmune diseases, depressive disorders, Alzheimer’s disease and Alzheimer’s disease-related dementias, gender-based violence), present and progress differently in women (e.g., cardiovascular disease, HIV, reproductive aging and its implications), or are female specific (e.g., uterine fibroids, endometriosis, menopause). I strongly encourage applications incorporate an intersectional and/or multidimensional approach to gender-related social and structural variables, including race, ethnicity, socioeconomic status, and state and federal policies.  

Dr. Elizabeth Barr Named Associate Director for Interdisciplinary Research

Congratulations to Elizabeth Barr, Ph.D. on being named Associate Director for Interdisciplinary Research at ORWH. Dr. Barr joined ORWH in 2019, where she has coordinated efforts to advance intersectional health research on gender as a social and structural variable, managed the ORWH interprofessional education program, and led efforts to advance HIV research for women. Dr. Barr’s background is in gender and women’s studies, community-led HIV research, and reproductive justice. Dr. Barr completed her Ph.D. in communications, with training in science and technology studies, at the University of Wisconsin–Madison and her M.S. in women’s and gender studies at Towson University. Prior to joining ORWH, Dr. Barr led interdisciplinary, cross-sector projects to increase women’s engagement in clinical research and served on the faculties of Towson University and the University of Maryland, Baltimore County. Dr. Barr is widely respected in the field of interdisciplinary research as demonstrated by her accomplishments above, and we look forward to her continued contributions to ORWH!

Advisory Committee on Research on Women’s Health  

The 60th Meeting of the NIH Advisory Committee on Research on Women's Health (ACRWH), held on April 12, 2024, provided a forum for ACRWH members to give guidance and make recommendations on priority issues affecting women's health and sex differences research. Carolyn Mazure, Ph.D., White House Initiative on Women’s Health Research chair, provided an insightful update on the White House Women’s Health Research Initiative. Dawn Corbett, M.P.H., NIH inclusion policy officer, Office of Extramural Research, presented a comprehensive inclusion update on NIH clinical research. The event hosted a robust panel titled Middle-Life Health of Women and Menopause, of expert researchers that discussed how menopause can affect the health of women. The Office of Disease Prevention will host a Pathways to Prevention (P2P) workshop in 2025 to identify research gaps in the menopausal tradition and to promote well-being through midlife and beyond. Visit the ACRWH event page for the videocast recording.

HIV & Women Scientific Workshop

In March 2024, the NIH Office of AIDS Research (OAR) and ORWH hosted a two-day virtual workshop to review the state of the science on HIV and women and inform the future research agenda. The workshop, which is part of the OAR-ORWH joint HIV and Women Signature Program , featured a diverse array of HIV-related topics of relevance to women, girls, and gender-diverse people, including prevention, treatment, cure, and social and structural determinants of health. Aligned with the signature program’s focus on intersectional, data-driven, and equity-informed approaches to HIV and women, the workshop included community members on the organizing committee and community speakers on every panel. We were also happy to feature work from established and emerging investigators, highlighting opportunities for ongoing collaborations and connections. Over 700 people watched the workshop live, and it is archived via videocast for viewing on-demand.

National Minority Health Month

April marks National Minority Health Month (NMHM), a time to raise awareness about the importance of improving the health of racial and ethnic minority communities and reducing health disparities. The National Institute on Minority Health and Health Disparities celebrated this month with a series of events, including a Minority Health Walk, Run, Roll 5K and a Fireside Chat featuring the Honorable Louis W. Sullivan, M.D. Additionally, the Health and Human Services Office of Minority Health (OMH) has emphasized this year’s theme, “Be the Source for Better Health: Improving Health Outcomes Through Our Cultures, Communities, and Connections,” focusing on understanding how the unique environments, cultures, histories, and circumstances (known as social determinants of health) of racial and ethnic minority and American Indian and Alaska Native populations impact their overall health. I encourage you to learn more about health equity by using the resources made available online by OMH.

As we commemorate NMHM, I look forward to the upcoming release of the Health of Women of U3 Populations Data Book. This resource holds immense promise in offering valuable insights into the complex interplay of cultural, racial, socioeconomic, and geographical factors that can influence the health status of women. By highlighting the challenges these communities face, this data book emphasizes the urgent need for equitable health care practices to promote health equity for all.

Black Maternal Health Week

This year, we observed Black Maternal Health Week from April 11 to 17. This week serves as a crucial platform to spotlight and address the disparities in health outcomes experienced by Black mothers. Research and data have consistently shown stark racial and ethnic disparities in maternal mortality rates, with Non-Hispanic Native Hawaiian and Pacific Islander, Black or African American, American Indian, and Alaska Native women facing mortality rates two to four times higher than Non-Hispanic White women in pregnancy-related causes. Recognizing the urgent need for action, the Health Resources and Services Administration Maternal and Child Health Bureau has spearheaded a comprehensive campaign during Black Maternal Health Week aimed at raising awareness, fostering meaningful action, and advocating for positive change in Black maternal health. In response to the disparate maternal mortality rates, the IMPROVE initiative was developed to support research on how to reduce preventable maternal mortality, decrease severe maternal morbidity, and promote health equity. Central to this effort is a toolkit featuring a range of resources strategically designed to empower individuals and organizations, providing them with the tools necessary to amplify their initiatives, forge collaborations, and celebrate achievements in the ongoing quest for equitable maternal health care for Black mothers. It is imperative these efforts continue beyond this designated week, fostering sustained awareness, advocacy, and policy changes to ensure lasting improvements in Black maternal health outcomes.

Looking Forward

In line with ORWH’s mission to advance women in science careers, we launched a prize competition aimed at enhancing gender diversity among faculty members in higher education. This initiative underscores our commitment to breaking down barriers and fostering transformative change. The resulting NIH Prize for Enhancing Faculty Gender Diversity in Biomedical and Behavioral Science has not only encouraged innovative strategies but has also led to the development of a toolkit. This toolkit highlights best practices and links them with evidence of their impact, fostering a culture of accountability and innovation. For more information on how the toolkit was developed, click here .

Looking ahead, ORWH is excited to celebrate National Women’s Health Week by hosting the 8th Annual Vivian W. Pinn Symposium and the first ever NIH Women’s Health Roundtable event. The Vivian W. Pinn Symposium honors the first full-time director of the office, Vivian W. Pinn, M.D., and serves as a critical forum for experts across sectors to communicate and collaborate for the advancement of women’s health. The roundtable “ Future Directions in Menopause Research: Optimizing Midlife Health of Women ,” is scheduled for May 16, 2024, from 11 a.m. to 1 p.m. EDT. This event serves as the launch for the NIH Women’s Health Roundtable Series as part of the White House Women’s Health Research Initiative. The series will engage the extramural research community to bring greater awareness to female-specific health conditions, as well as diseases and conditions that present differently in women. I encourage all researchers, health care professionals, policymakers, and advocates to join us at this impactful roundtable as we collaborate to foster transformative discoveries and interventions in women's health. Your participation and insights are invaluable in driving positive change and advancing our collective mission to shape the future of women’s health research and improve outcomes for women.

The recent initiatives and collaborative efforts serve as a catalyst for continuous dialogue, innovation, and enhancing research. As we navigate the intricate landscape of health care disparities and societal complexities, ORWH’s commitment remains unwavering—to expand and accelerate women’s health research initiatives that generate new data and discoveries which will promote health equity. Together, we strive to create a future where health outcomes are improved for all populations of women, paving the way for more equitable, inclusive health care for everyone.

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Workshop: Promoting Mental Health for Sexual and Gender Minority Youth: Evidence-Based Developmental Perspectives

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This two-day virtual workshop will convene researchers, youth advocates, and federal officials to review the state of the science on developmental trajectories of gender identity and sexuality with a focus on research aimed at the promotion of mental health for sexual and gender minority youth. Session themes include epidemiological and population health studies of developmental trends, social determinants of health that drive mental health outcomes at multiple levels (i.e., national, community, interpersonal, and individual), and preventive and treatment interventions to ensure healthy futures for all youth. The workshop is free and open to the scientific community and the public.

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Researchers review findings and clinical messages from the Women’s Health Initiative 30 years after launch

Data from influential study underscore the importance of personalized and shared decision-making to support the health of postmenopausal women

WHAT: A new review in JAMA highlights key findings and clinical messages from the Women’s Health Initiative (WHI), the largest women’s health study in the United States. The WHI is supported by the National Institutes of Health’s National Heart, Lung, and Blood Institute (NHLBI), and was created to study factors that may reduce risks for cardiovascular disease, cancer, hip fractures, and other conditions in postmenopausal women. More than 68,000 women enrolled in clinical trials between 1993 and 1998 and were followed for up to 20 years.

After reviewing these long-term data, the researchers explain the primary findings:

Hormone therapy and menopause. The WHI study found that estrogen or a combination of estrogen and progestin, two types of hormone replacement therapies, had varying outcomes with chronic conditions, and the evidence does not support the use of these therapies to reduce risks for chronic diseases, such as heart disease, stroke, cancer, and dementia. The study was not designed to assess the effects of FDA-approved hormone therapies for treating menopausal symptoms, the benefits of which had been established before the WHI study began.

The authors reinforce the importance of women making shared decisions with physicians about the benefits or risks of taking hormone therapy during menopause. For example, women younger than age 60 with low-to-average risk for cardiovascular disease and breast cancer who want to take hormone therapy may experience greater health benefits than risks during early menopause to treat moderate-to-severe symptoms, such as bothersome hot flashes or night sweats.

Calcium and vitamin D supplements and bone fractures. A combined calcium and vitamin D supplement was not associated with reduced risks for hip fractures among postmenopausal women at average risk for osteoporosis, according to the study. However, the authors note that supplements can help fill nutrient gaps among women who do not meet the daily recommended intake for these nutrients . Therefore, women with questions about adequate intake and levels should consult with their healthcare provider.

Low-fat diets and cancer. A low-fat dietary pattern with at least five daily servings of fruits and vegetables and increased grains did not reduce the risk of breast or colorectal cancer. However, upon subsequent analyses during the follow-up period, researchers found that this type of eating pattern was associated with a reduced risk of death from breast cancer.

Findings from the clinical trials and study observations can vary based on multiple factors, such as age and underlying cardiovascular disease risks, so women ages 50 and older should work with their clinicians to make individualized and shared medical decisions, the researchers noted.

STUDY: Manson, JE, Crandall CJ, Rossouw JE, et al. The Women’s Health Initiative randomized trials and clinical practice: A review. JAMA ; 2024. Doi: 10.1001/jama.2024.6542.

WHO: Candice A. Price, Ph.D., program director of the epidemiology branch, located within the Division of Cardiovascular Sciences at NHLBI, is available to discuss this review.

About the National Heart, Lung, and Blood Institute (NHLBI):  NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit  www.nhlbi.nih.gov .

About the National Institutes of Health (NIH):  NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit  www.nih.gov .

The Future of Work: more evidence, less drama

By Bernard Magenhann, JRC Acting Director-General

Profound transformations have swept through our workplaces in recent years. Digital tools, automation and algorithmic management are increasingly widespread across various economic sectors. Algorithmically-driven automation tools, initially used for task allocation and workers’ monitoring in digital labour platforms, are increasingly adopted in traditional workplaces as well, and for a wider range of tasks.

Labour Day is a fitting moment to consider how this new wave of technological change is reshaping our labour markets.  What impact will it have on the composition of the labour force, and what are the potential risks and opportunities for workers and businesses? Most importantly, how can we be best prepared for these changes?

Amid rapid technological advancement, concerns about the future of work are natural.  Understanding how automation, digitalisation and algorithmic management are reshaping employment dynamics in the digital age is crucial. The research agenda on the changing nature of work carried out by the European Commission’s Joint Research Centre in collaboration with the Commission’s Directorate-General for Employment, Social Affairs & Inclusion helps us better understand how we can anticipate challenges and seize opportunities, while still protecting the wellbeing of workers and ensuring the best possible working environments.

So, what is the expected impact on work and workers of these technological advancements?

Don't panic!

Contrary to apocalyptic narratives, the future of work is not a doomsday scenario that will render human labour obsolete. From the research conducted so far, automation has been and will likely continue to be a gradual, incremental process. We are witnessing the integration of digital technologies to complement existing automation technologies, improving workflows and processes. For example, in manufacturing, robots equipped with AI-driven sensors enhance precision and efficiency, leading to more productive and efficient production lines.

Indeed, the advent of automation is not synonymous with large-scale job destruction. Any employment reduction linked to technological upgrading is often mitigated by increases in productivity, volumes produced, and the emergence of new types of jobs. Instead of replacing workers ‘ en masse’ , automation often alters the nature of tasks and quality of jobs overall, with the tasks reassigned and workers redeployed to new roles. The share of maintenance staff and engineers, for example, is likely to increase in a more automated world. Investing in education and training and embracing life-long learning is crucial for workers and employers to adapt to these shifts.

Lending a (metallic) hand

Automation of repetitive and arduous tasks can reduce physical strain, fatigue and stress levels resulting in safer, more comfortable working environments and allowing some workers to focus on more fulfilling tasks. For example, in the healthcare sector digital technologies could improve work coordination processes, freeing up time for caregiving activities.

From ergonomics to mental health

Nevertheless, our research also suggests increased pressure and pace due to automation and algorithmic management, which can offset the positive impacts and take a toll on mental health and job quality. This underscores the need for proactive measures to safeguard worker wellbeing.

Additionally, concerns about digital monitoring and surveillance of workers must be addressed. The rise of algorithmic management, characterised by algorithms organising, monitoring and optimising work processes, is transforming traditional employment dynamics. While research conducted so far suggests that the current institutional and regulatory frameworks still seem to mitigate major impacts, concerns about workers’ rights and privacy remain valid.

The reduction of workers’ autonomy is another concern, as tasks become more standardised, potentially leading to workers losing agency. There is also a risk of increased discrimination, as the algorithms dictating work assignments and schedules could replicate biases and inequalities. However, human decisions can also be discriminatory, and automation can be used to reduce human biases. The dynamics in this evolving landscape need to be closely monitored so that EU institutions and European governments have robust evidence to support future policy decisions to grasp the benefits of these technologies and protect workers. 

Losing the middle?

Contrary to fears of a disappearing middle, research indicates that there is no universal pattern of job polarisation as a result of technical change. Instead, we observe continuous occupational upgrading, with a growing demand for high-skilled occupations. However, in some countries and periods, workers with middle and particularly low levels of skills face increasing difficulties in the labour market. Recent research suggests that advanced tools, such as generative AI, may decrease disparities within occupations, increasing productivity, particularly among less-experienced and lower-skilled workers.

Keeping up with change: the real challenge?

Adapting to change remains the real challenge. As digitalisation, automation and algorithmic management become a reality across all workplaces, leaders in both the public and private sectors must stay alert to their human impact.

Ultimately, it is about understanding the direction of future changes, boosting productivity and fostering innovation, while protecting workers' rights and ensuring a fair and inclusive labour market for all. We hope our research contributes to this objective.

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Studying the role of postsecondary policies in shaping families’ financial health

A college degree provides substantial benefits, including lower unemployment, higher wages, and increased social mobility. However, as the price of a degree has risen, families increasingly use debt to finance a college education, with parents shouldering a larger share of the burden. For example, originations of federal “Parent PLUS” loans rose from $2.2 billion in 1991-1992 to $15.2 billion in 2017-2018 (Ma and Pender 2023). Parent PLUS loans are just one of many ways in which a child’s college decisions affect parents, leading to articles that declare parents as the “ Hidden Causalities of the Student Debt Crisis ” (Granville 2022). 

Motivated by these trends, Dr. Gurantz has begun to engage in a number of projects that look at how attending college affects family finances. Surprisingly there is very little research on this topic, in large part as there is rarely the ability to observe parent-student linked data at any reasonable scale. As a result, prior studies typically focus on how attending college impacts just the finances of the individual student (e.g., Scott-Clayton & Zafar, 2019 ), which paints an incomplete picture of how the costs of higher education are affecting society. 

With funding from the Spencer Foundation and Arnold Ventures, we have begun to answer these questions, with a research team that includes Palaash Bhargava and Dr. Sandra Black from Columbia University, Dr. Jeffrey Denning from Notre Dame, and Dr. Robert Fairlie from UCLA. These results rely on a newly-available, confidential, restricted-access administrative dataset that captures the universe of Free Application for Federal Student Aid (FAFSA) filers in California, which is then linked at the individual-level to detailed credit data records from a large credit bureau. These FAFSA data have an innovative feature: for students who are still dependents – which is most 18 and 19 year olds but can continue as long as students are not yet 26 – we can link applicants to their parents and consider how the child’s college experience affects their parent’s financial health. Although credit data do not capture many important outcomes, we can observe debt balances and default rates on a variety of loan types, such as educational loans, credit cards, and other forms of credit.  Impacts of state grant aid on financial health

The first project using these data focuses on how families react to changes in the price of college as a result of receiving state aid; we anticipate releasing this working paper in 2024. In our data we can observe families who just met the criteria to become eligible for state aid receipt and compare to them to essentially identical families who are just ineligible for state aid. As a result, these luckier families receive about $17,500 in additional aid over the following six years, which induces their children to be slightly more likely to enroll in a broad access, four-year California State University instead of a two-year community college. Even though state grant aid induces a small increase in more expensive, four-year college enrollment, we find that parents reduce the educational loan balances they take out on behalf of their students by about 10%. We also find reductions in HELOC balances (Home Equity Lines of Credit). These reductions vary by household wealth, with families that have mortgages showing larger reductions in HELOCs, whereas families who do not own a home having larger reductions in educational loan balances. Grant aid also reduces the chance that parents are delinquent on their debt but only for parents with a prior history of delinquency, with no effect on parents without prior delinquencies.

Interestingly, we do not find any evidence that receiving grant aid reduces student borrowing. This project demonstrates that, at least in this case, focusing just on student outcomes would have missed all of the positive financial effects of aid receipt on families.

Future Work

The paper described above is just the first in a sequence of topics that we hope to investigate over the coming years. A second paper, just underway, will examine the complex role of federal Parent PLUS loans. These loans are only available to parents if their child has exhausted their own available federal credit and have become an increasingly important source of financial support. There has been considerable controversy over the benefits of Parent PLUS loans and who should have access to them. As with other educational loans, the primary benefit is that they could enable students to attend college who otherwise could not. However, parents may become overextended by these sizeable loans, which could create adverse financial consequences if it causes them to miss mortgage, credit card, or other necessary payments.  

For most of recent history, PLUS loans could be originated through the Department of Education’s Direct Loan (DL) program or the Federal Family Education Loan (FFEL) program, which were bank-issued loans backed by the federal government. However, after the federal government became the sole provider of federal loans via the Direct Loan Program, they chose to synthesize policies and tighten loan standards, which had the effect of denying PLUS access to some families with adverse credit histories. This change led to significant public outcry, particularly from HBCUs and other colleges that enrolled more Black students who were negatively impacted by these adverse credit history standards (Stratford 2014). As a result, the federal government changed the eligibility criteria yet again in 2014, thus increasing access for a subset of parents. 

Using the same data listed above – FAFSA applicants linked to their credit histories – we will examine whether changes in access to Parent PLUS loans impacted whether students attended college. More importantly, we can examine whether access to Parent PLUS loans changed how parents finance their child’s education, potentially forcing them into riskier types of credit with higher interest payments, such as credit cards. Thus we will determine whether losing or gaining access to this program had financial implications for these families with worse credit histories. 

We hope the two papers described above are just the beginning of an avenue for producing policy relevant research that touches on some of the most important factors facing higher education today.