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Healthpromotion involves social and environmental interventions designed to benefit and protecthealth. It often harmfully impacts the environment through air and water pollution, medical waste, g...

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This article considers the extent to whichhealthpromotion strategies pose a threat to individual freedom. It begins by taking a look athealthpromotion strategies and at the historical development ofhealthpromotion in Britain. A theoretical context is then developed in which Berlin’s distinction between negative and positive liberty is used alongside the ideas of John Stuart Mill, Charles Taylor and T.H. Green to discuss the politics ofhealthpromotion and (...) to identify the implications of conflicting perspectives on freedom. The final section looks at currenthealthpromotion policy in Britain and beyond and argues that, if freedom is seen in terms of empowerment,healthpromotion can enhance individual freedom. (shrink)

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A consideration of current debates in the philosophy of medicine andhealth care regarding the nature ofhealth andhealthpromotion, concepts and measurements of mentalhealth problems, phenomenological conceptions ofhealth and illness, allocation ofhealth care resources and medical ethics.

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R S Downie;HealthPromotion andHealth Education, Journal of Philosophy of Education, Volume 22, Issue 1, 30 May 2006, Pages 3–11, https://doi.org/10.1111/j.14.

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Health-promoting nudges have been put into practice by different agents, in different contexts and with different aims. This article formulates a set of criteria that enables a thorough ethical evaluation of such nudges. As such, it bridges the gap between the abstract, theoretical debates among academics and the actual behavioral interventions being implemented in practice. The criteria are derived from arguments against nudges, which allegedly disrespect nudgees, as these would impose values on nudgees and/or violate their rationality and autonomy. (...) Instead of interpreting these objections as knock-down arguments, I take them as expressing legitimate worries that can often be addressed. I analyze six prototypical nudge cases, such as Google’s rearrangement of fridges and the use of defaults in organ donation registration. I show how the ethical criteria listed are satisfied by most—but not all—nudges in most—but not all—circumstances. (shrink)

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'Healthpromotion' has unfortunately come to mean different things to different people. Interpretations have frequently been left implicit and where spelt out have often been too diffuse or too limited to be useful. Nevertheless the term can be usefully employed to define a set ofhealth-enhancing activities in which the focus is deflected from current disease- and cure-oriented power bases. Used in this wayhealthpromotion can come to include the best of the developing theory (...) and practice from a wide range of 'experts' but can also place due emphasis on community involvement. To rejecthealthpromotion on the basis of selected, inadequate interpretations is to discard past successes, current developments and future possibilities in important fields of activity and to preserve an inappropriate status quo. (shrink)

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The relationship between pleasure and asceticism has been at the core of debates on western subjectivity at least since Nietzsche. Addressing this theme, this article explores the emergence of ‘non-authoritarian’health campaigns, which do not propagate abstention from harmful substances but intend to foster a ‘well-balanced subject’ straddling pleasure and asceticism. The article seeks to develop the Foucauldian analytical framework by foregrounding a strategy of subjectivation that integrates desire, pleasure and enjoyment intohealthpromotion. The point of (...) departure is the overwhelming emphasis in the governmentality literature on ‘prudence’, ‘self-responsibility’ or ‘risk calculation’, such that pleasure and desire remain largely absent from the framework. Some insights from Žižek’s work are introduced to help us obtain a firmer grasp on the problematic of ‘the well-balanced subject’. The article argues that, in order to analyse the transformation of interpellation in recenthealthpromotion, we must recognize the mechanism of self-distance or dis-identification as an integral part of the procedure of subjectification. (shrink)

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Healthpromotion efforts are commonly directed towards encouraging people to discard ‘unhealthy’ and adopt ‘healthy’ behaviours in order to tackle chronic disease. Typical targets for behaviour change interventions include diet, physical activity, smoking and alcohol consumption, sometimes described as ‘lifestyle behaviours.’ In this paper, I discuss how efforts to raise awareness of the impact of lifestyles onhealth, in seeking to communicate the need for people to change their behaviour, can contribute to a climate of ‘healthism’ and (...) promote the moralisation of people’s lifestyles. I begin by summarising recent trends inhealthpromotion and introducing the notion of healthism, as described by Robert Crawford in the 1980s. One aspect of healthism is moralisation, which I outline and suggest is facilitated by efforts to promotehealth via information provision and educational strategies. I propose that perceived responsibility plays a role in mediating the tendency to moralise abouthealth and behaviour. Since I argue that states ought to avoid direct and indirect moralisation of people’shealth-related behaviour, this suggests states must be cautious with regard to the use of responsibility-indicating interventions to promotehealth. (shrink)

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There is a large literature exploring the concept of ‘healthpromotion’. However, the meaning of the term remains unclear and contested. This is for at least two reasons. First, any definition of ‘healthpromotion’ is going to have to outline and defend an account of the notoriously controversial concept of ‘health’, and then suggest how (and why) we should promote it. Second,healthpromotion clearly has some overlap with ‘publichealth’, but it (...) is far from clear how they are related. Ishealthpromotion part of publichealth or ishealthpromotion a radically different type of activity from publichealth? Answering this question requires engaging with tricky professional as well as contentious conceptual issues. Some advocates ofhealthpromotion talk as though publichealth is problematic: seen as medical, physiological in focus and reductionist in approach, whereashealthpromotion, on this view, is focused on the whole person in a social environment. However, to an outsider this looks more like an attempt to artificially (and rather crudely) define and protect professional boundaries, rather than a contribution to conceptual analysis. There seems no good reason why publichealth cannot take into account the role of social, political, economic and cultural factors and their impact onhealth. Indeed, much work in publichealth does precisely this, and uses a wide range of methodologies drawn from non-medical disciplines such as geography, sociology and psychology, not just epidemiology. It seems much more sensible to seehealthpromotion as being one vitally important aspect of the work of publichealth, rather than something markedly distinct. We will assume here that this is the case and focus instead on the first issue: what ishealthpromotion? (shrink)

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Healthpromotion is a key element of publichealth practice. Among strategies aiming to deal with publichealth problems,healthpromotion purports to help people achieve betterhealth.Healthpromotion can significantly alter people’s lifestyles, and three main ethical issues relate to it: ( i ) what are the ultimate goals for publichealth practice, i.e. what ‘good’ should be achieved? ( ii ) how should this good be distributed in (...) the population? and ( iii ) what means may we use to try to achieve and distribute this good? The last question is the subject of this article. Concerns raised abouthealthpromotion can be divided into two groups: ( i ) efficacy-based considerations – are they cost-effective or cost-ineffective? and ( ii ) autonomy-based concerns – (to what extent) do they interfere with free choice, i.e. do they attempt to direct social values and lifestyles? Ways in which an individual’s autonomy may be compromised by means of influencing behaviour change are considered. This article has been retracted: See RETRACTION NOTICE. (shrink)

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Employeehealth is not only positively related to the employee well-being and family happiness, but also impacts organizations, and society as a whole. We searched thehealth-promoting leadership literature in the following databases: Web of Science, ProQuest, EBSCO, and a Chinese local database. Based on this research, we clarify the concept ofhealth-promoting leadership, propose a definition ofhealth-promoting leadership, and examine measurement scales for this type of leadership. We also suggest a research framework for (...) class='Hi'>health-promoting leadership, demonstrating its potential outcomes at both the individual level and the organizational level ; the mechanisms for its development based on conservation of resources theory, the job demands–resources model, social learning theory, and social exchange theory; and antecedents. Finally, we identify six potential research areas: Research level, performance, the impacts ofhealth-promoting leaders on themselves, moderators, research methods, and intervention effects onhealth-promoting leadership. (shrink)

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There is an increasing tendency for administrators and government to expect both thehealth services and the education service to 'show results' for the investment of public money in them. One response to this has been the growing commitment to 'healthpromotion', where measurable objectives may be set in terms of desired behaviour (stopping smoking, breast self-examination, child immunisation etc) and where evaluation can be made on the evidence of statistical improvement.Health workers use the term (...) 'promotion' in a variety of ways which seem to be as confusing to them as they are to their clients --the general public. Since successfulpromotion is likely to depend on the 'hard sell' (and since the methodology and aims of this may be incompatible with those ofhealth education) this paper looks at some of the questions which the customer might wish to ask the salesman before deciding whether or not to buy. (shrink)

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The terms “healthpromotion” and “disease prevention” refer to professional activities. But a “health promoter” has also come to denote a profession, with an alternative agenda compared to that of traditional publichealth work, work that by some is seen to be too medically oriented, too reliant upon prevention, risk-elimination andhealth-care. But is there really a sharp distinction between these activities and professions? The main aim of the paper is to investigate if these concepts (...) are logically different, or if they are just two extremes of one dimension. The central concepts,healthpromotion and disease prevention, are defined, and it is concluded thathealthpromotion and disease prevention are logically distinct concepts, although they are conceptually related through a causal connection. Thus, logically, it is possible to promotehealth without preventing disease, even if this is not so common, in practice, but it is not possible to prevent disease without promotinghealth. Finally, mosthealth promoting interventions target basichealth, not manifesthealth, and often also thereby reduce future disease. (shrink)

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STAJDUHAR K, FUNK L, JAKOBSSON E and ÖHLÉN J. Nursing Inquiry 2010; 17: 221–230A critical analysis ofhealthpromotion and ‘empowerment’ in the context of palliative family care-givingTraditionally viewed as in opposition to palliative care, newer ideas about ‘health-promoting palliative care’ increasingly infuse the practices and philosophies of healthcare professionals, often invoking ideals of empowerment and participation in care and decision-making. The general tendency is to assume that empowerment, participation, and self-care are universally beneficial for and welcomed (...) by all individuals. But does this assumption hold for everyone, and do we fully understand the implications ofhealth-promoting palliative care for family caregivers in particular? In this study, we draw on existing literature to highlight potential challenges arising from the application of ‘family empowerment’ strategies in palliative home-care nursing practice. In particular, there is a risk that empowerment may be operationalized as transferring technical and medical-care tasks to family caregivers at home. Yet, for some family caregivers, a sense of security and support, as well as trust in professionals, may be equally if not more important than empowerment. Relational and role concerns may also at times take precedence over a desire for empowerment. The potential implications of ‘family empowerment’ are explored in this regard. ‘Family empowerment’ approaches need to be accompanied by a strong understanding of how to best support individual palliative family caregivers. (shrink)

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Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention orhealthpromotion may differ. Following Antonovsky’s salutogenic framework, different perspectives between professionals and clients on the (...) pathways that lead tohealthpromotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and herhealth and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others’ perspective, and have a dialogue with each other, taking the life narrative of clients into account. (shrink)

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Whilehealthpromotion is widely acknowledged as a practice field where multidisciplinary teamwork is important, within nursing's discipline‐specific literature, a strong argument can be discerned regarding the profession's belief that it has a clear and unique role to play in that field. Yet rarely is this unique role, how it arises, and specifically how its effects are to be demarcated, attended to within the discipline‐specific literature. Two philosophical perspectives on science are presented and we demonstrate the extent to (...) which these two perspectives influence nursing scholarship, including nursing practice within the field ofhealthpromotion. We then go on to argue that, for nurses to sustain their claim to a unique and important contribution withinhealthpromotion, clear articulation of the philosophical premises underpinning practice methodologies is warranted. Specifically we argue the importance of such clarity within the context of an analysis of the discourse of multidisciplinary practice as a strategy for avoiding confronting the ways in which bio‐medical authority has already significantly demarcated howhealthpromotion practice can proceed. (shrink)

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It appears that there are two distinct practices within publichealth, namelyhealthpromotion and disease prevention, leading to different goals. But does the distinction hold? Can we promotehealth without preventing disease, and vice versa? The aim of the paper is to answer these questions. First, the central concepts are defined and the logical relations between them are spelt out. A preliminary conclusion is that there is a logical difference betweenhealth and disease, which (...) makeshealthpromotion and disease prevention two distinct endeavours. However, since disease is defined in relation tohealth, as those kinds of internal processes and states that typically lead to illhealth, the difference is smaller than it might appear. Second, in order to answer the practical question whether it is possible to promotehealth without preventing disease, and vice versa, several kinds of publichealth interventions are discussed. The conclusion is that whilehealthpromotion and disease prevention can be distinguished conceptually, they can hardly be distinguished in practice. Most general measures do both at the same time. (shrink)

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This article claims thathealthpromotion is best practised in the light of an Aristotelian conception of the good life for humans and of the place ofhealth within it.

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Over time, there has been a steady increase of workplacehealthpromotion programs that aim to promote employees’health and fitness. Previous research has focused on such program’s effectiveness, cost-savings, and barriers to engaging in workplacehealthpromotion. The present research focuses on a downside of workplacehealthpromotion programs that to date has not been examined before, namely the possibility that they, due to a focus on individual responsibility for one’shealth, (...) inadvertently facilitate stigmatization and discrimination of people with overweight in the workplace. Study 1 shows that the presence of workplacehealthpromotion programs is associated with increased attributions of weight controllability. Study 2 experimentally demonstrates that workplacehealthpromotion programs emphasizing individual rather than organizational responsibility elicit weight stigma. Study 3, which was pre-registered, showed that workplacehealthpromotion programs emphasizing individual responsibility induced weight-based discrimination in the context ofpromotion decisions in the workplace. Moreover, focusing on people with obesity who frequently experience weight stigma and discrimination, Study 3 showed that workplacehealthpromotion programs highlighting individual responsibility induced employees with obesity to feel individually responsible for theirhealth, but at the same time made them perceive weight as less controllable. Together, our research identifies workplacehealthpromotion programs as potent catalysts of weight stigma and weight-based discrimination, especially when they emphasize individual responsibility forhealth outcomes. As such, we offer valuable insights for organizations who aim to design and implement workplacehealthpromotion programs in an inclusive, non-discriminatory way that benefits all employees. (shrink)

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(2011). Theory inHealthPromotion Research and Practice: Thinking outside the Box. Patricia Goodson. Boston, MA: Jones and Bartlett. 2010. 245, pp. $78.95. Educational Studies: Vol. 47, No. 6, pp. 583-588.

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It is generally wrong to manipulate. One leading reason is because manipulation interferes with autonomy, in particular the component of autonomy called ‘independence’, that is, freedom from intentional control by others. Manipulativehealthpromotion would therefore seem wrong. However, manipulative techniques could be used to counter-manipulation, for example, playing on male fears of impotence to counter ‘smoking is sexy’ advertisements. What difference does it make to the ethics of manipulation when it is counter-manipulation? This article distinguishes two powerful (...) defences of counter-manipulativehealthpromotion: that the counter-manipulation would prevent manipulation occurring, leaving people unmanipulated; and that the counter-manipulation would make people healthier without being any more manipulated than they would otherwise be. The article explains how counter-manipulation might work and the limits to its scope. The upshot is that counter-manipulativehealthpromotion could respect the independence people are owed in virtue of their autonomy. However, autonomy is not the only consideration, and the article discusses further potential problems. Counter-manipulativehealthpromotion might be misapplied, it might undermine trust, it might infringe on some norms for role behaviour and it might encourage a regrettable social practice. These objections are likely to be decisive against the counter-manipulation in some but not all cases. (shrink)

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In order to maximize human performance, defence forces continue to explore, develop, and apply human performance enhancement (HPE) methods, ranging from pharmaceuticals to (bio)technological enhancement. This raises ethical, legal, and societal concerns and requires organizing a careful reflection and deliberation process, with relevant stakeholders. We discuss a range of ethical, legal, and societal aspects (ELSA), which people involved in the development and deployment of HPE can use for such reflection and deliberation. A realistic military scenario with proposed HPE application can (...) serve as a starting point for such an iterative and participatory process. Stakeholders can discuss this application, modify its features, and design appropriate processes around it – for instance, procedures for informed consent. We propose that organizing aspects into these three categories – ethical, legal, and societal – can help involve appropriate interlocutors at different moments: legal aspects with people in strategy or management roles, from the start of a project; ethical aspects with people in operations and medical roles, during development; and societal aspects with people in communication and personnel roles, during deployment. Notably, we developed and discussed this framework and the three aspects in close collaboration with personnel from the military. (shrink)

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In this manuscript, we explore the potential therapeutic use of helminths. After analyzing helminths’ role in connection with humanhealth from the perspective of their symbiotic and evolutionary relationship, we critically examine some studies on their therapeutic applications. In doing so, we focus on some prominent mechanisms of action and potential benefits, but also on the exaggerations and theoretical and methodological difficulties of such proposals. We conclude that further studies are needed to fully explore the potential benefits of this (...) perspective, and we encourage the scientific community in doing so. (shrink)

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Background: Since presenteeism is related to numerous negativehealth and work-related effects, measures are required to reduce it. There are initial indications that how an organization deals withhealth has a decisive influence on employees’ presenteeism behavior.Aims: The concept ofhealth-promoting collaboration was developed on the basis of these indications. As an extension of healthy leadership it includes not only the leader but also co-workers. In modern forms of collaboration, leaders cannot be assigned sole responsibility for employees’ (...)health, since the leader is often hardly visible or there is no longer a clear leader. The study examines the concept ofhealth-promoting collaboration in relation to presenteeism. Relationships betweenhealth-promoting collaboration, well-being and work ability are also in focus, regarding presenteeism as a mediator.Methods: The data comprise the findings of a quantitative survey of 308 employees at a German university of applied sciences. Correlation and mediator analyses were conducted.Results: The results show a significant negative relationship betweenhealth-promoting collaboration and presenteeism. Significant positive relationships were found betweenhealth-promoting collaboration and both well-being and work ability. Presenteeism was identified as a mediator of these relationships.Conclusion: The relevance ofhealth-promoting collaboration in reducing presenteeism was demonstrated and various starting points for practice were proposed. Future studies should investigate further this newly developed concept in relation to presenteeism. (shrink)

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In this paper I provide a critique of a set of assumptions relating to agency, choice and the legitimacy of actions impactinghealth that can be seen in some approaches tohealthpromotion. After a brief discussion about the definition ofhealthpromotion, I outline two contrasting approaches to this area ofhealth care practice. The first is focused on the provision of information and the second is concerned with seeking to change people’s preferences (...) in a particular way. It has been argued by a number of critics ofhealthpromotion that only the first approach is ethical, as it is for individuals to make their own lifestyle choices and adopt their own conception of the good life. I argue against this ‘information’ approach tohealthpromotion on two grounds. First, I suggest that given the aims ofhealthpromotion, the provision of information is, as a matter of fact, of limited effectiveness in achieving these aims. Second, I argue that we have good reasons to question the appropriateness of respecting many of the preferences that individuals happen to have, given the origins and quality of such preferences. I then go on to argue, that by contrast we have good reasons to focus on changing at least some of the preferences that people have related to their lifestyle choices. This involves a commitment to both paternalism and a defence of a certain conception of the good life, but both can be defended. I use the example of potential responses to the growing problem of obesity to illustrate my argument, arguing that only policy that, at least sometimes, aims at preference change will be both effective and ethical. (shrink)

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In this paper two fears abouthealthpromotion are identified. The first concerns the ability to choose between proliferating expert advice, and the second concerns the fear of government interference in personal life. The paper goes on to outline the current place ofhealthpromotion in Britishhealth policy, and to discuss the relevance of recent research onhealth beliefs. The paper argues that work on ‘lay epidemiology’ has been overlooked by both critics and (...) supporters ofhealthpromotion. From this vantage point the fears abouthealthpromotion can be seen to be exaggerated. (shrink)

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In this article, we provide a description of the good inhealthpromotion based on an empirical study ofhealthpromotion practices in New South Wales, the most populous state in Australia. We found that practitioners were unified by a vision of the good inhealthpromotion that had substantive and procedural dimensions. Substantively, the good inhealthpromotion was teleological: it inhered in meliorism, an intention to promotehealth, which was (...) understood holistically and situated in places and environments, a commitment to primary rather than secondary prevention and engagement with communities more than individuals. Procedurally, the good inhealthpromotion arose from qualities of practices that they developed over time in respectful relationships, were flexible and responsive to communities, built capabilities in communities and were sustainable. We discuss our findings with reference to Martha Nussbaum’s normative list of functional capabilities for a good human life, David Buchanan’s vision forhealthpromotion ethics and common concerns inhealthpromotion ethics regarding the relationship between paternalism and freedom. Our thick, vague conception of the good inhealthpromotion, founded in the values and practical reason of people engaged daily inhealthpromotion work, contributes to the development of a more complete theory ofhealthpromotion ethics. (shrink)

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Nordenfelt has presented a very useful philosophical analysis of the nature and ethics ofhealthpromotion. The first section of this paper is a response to the starting point of that analysis—the equation ofhealthpromotion withhealthpromotion action. It is argued that this starting point leads to a serious ambiguity, and that this ambiguity is characteristic of other writing abouthealthpromotion, including that of the WHO. The second section of (...) this paper explores the implications of this ambiguity, as it appears in the widerhealthpromotion literature, for drawing the borders ofhealthpromotion. (shrink)

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In this systematic review, we summarized and evaluated the evidence for effects of, and associations between, immersive nature-experience on mental, physical and socialhealthpromotion outcomes. Immersive nature-experience was operationalized as non-competitive activities, both sedentary and active, occurring in natural environments removed from everyday environments. We definedhealth according to the WorldHealth Organization’s holistic and positive definition ofhealth and included steady-state, intermediate, andhealthpromotion outcomes. An electronic search was performed for (...) Danish, English, German, Norwegian, and Swedish articles published between January 2004 and May 2017. Manual approaches, e.g., bibliographies from experts, supplemented the literature search. Data were extracted from 461 publications that met the inclusion criteria. To assess the status and quality of the evidence forhealthpromotion effects of immersive nature-experience, we focused on the subset of studies based on controlled designs (n = 133). Outcome level quality of the evidence was assessed narratively. Interventions most often involved adventure-based activities, short-termed walking, and seated relaxation in natural environments. We found positive effects on a range ofhealthpromotion outcomes grouped under psychological wellbeing (n = 97; ≈55% positive; ≈13% mixed; ≈29% non-significant; 2% negative); psychosocial function (n = 67; ≈61% positive; ≈9% mixed; ≈30% non-significant); psychophysiological stress response (n = 50; ≈58% positive; ≈18% mixed; ≈24% non-significant), and cognitive performance (n = 36; ≈58% positive; ≈6% mixed; ≈33% non-significant; 3% negative); and social skills and relationships (n = 34; ≈70% positive; ≈7% mixed; ≈22% non-significant). Findings related to outcomes categorized under physicalhealth, e.g., risk of cardiovascular disease, were less consistent (n = 51; ≈37% positive; ≈28% mixed; ≈35% non-significant). Across the types of interventions and outcomes, the quality of the evidence was deemed low and occasionally moderate. In the review, we identify, discuss, and present possible solutions to four core methodological challenges associated with investigating immersive nature-experience andhealth outcomes: 1) intervention and program complexity; 2) feasibility and desirability of randomization; 3) blinding of participants and researchers; and 4) transferability and generalizability. The results of the review have been published as a popular-scientific report and a scientific research overview, both in Danish language. (shrink)

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Companies increasingly offer their employees the opportunity to participate in voluntary WorkplaceHealthPromotion programmes. Although such programmes have come into focus through national and regional regulation throughout much of the Western world, their ethical implications remain largely unexamined. This article maps the territory of the ethical issues that have arisen in relation to voluntaryhealthpromotion in the workplace against the background of asymmetric relationships between employers and employees. It addresses questions of autonomy and voluntariness, (...) discrimination and distributive justice, as well as privacy and responsibility. Following this analysis, we highlight the inadequacy of currently established ethical frameworks to sufficiently cover all aspects of workplacehealthpromotion. Thus, we recommend the consideration of principles from all such frameworks in combination, in a joint reflection of an Ethics of WorkplaceHealthPromotion. (shrink)

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Health communication researchers and practitioners continue to debate about the types of influence that are appropriate inhealthpromotion. A widely held assumption is thathealth campaigns and communicators should respect the autonomy of their audiences, and that the most appropriate way to do so is to persuade them by means of truthful substantive information. This approach to ethical persuasion, though, suffers from certain blind spots. To account for circumstances when respecting autonomy might take a back (...) seat to other ethical considerations, a comprehensive framework for the ethics ofhealth communication needs to acknowledge types of communication that aim to do something other than provide substantive information (disclosive and directive communication), and subjective circumstances when people are not motivated to process information or make active choices (low processing motivation and decision aversion). (shrink)

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Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention orhealthpromotion may differ. Following Antonovsky’s salutogenic framework, different perspectives between professionals and clients on the (...) pathways that lead tohealthpromotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and herhealth and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others’ perspective, and have a dialogue with each other, taking the life narrative of clients into account. (shrink)

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