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The Five Major Strategies for Health Promotion Identified in The Ottawa Charter

Introduction to Health Promotion in Primary Care

Diabetes mellitus has become a notable health issue worldwide and is prevalent due to a surge in the rates of obesity and an ageing population (Agide & Shakibazadeh, 2018). Additionally, its life-long nature and challenging epidemiology have contributed towards it being a global concern. The Ottawa Charter for Health Promotion is a response to the blooming expectations of the health sector for a paradigm shift to health promotion and health education. The aim of this essay is to discuss the role of nurses in health promotion through the five main strategies identified in the Ottawa Charter for Health Promotion.

Discussion on Health Promotion in Primary Care

The three fundamentals as per the Ottawa Charter for Health Promotion are enabling, mediating and advocacy (WHO, 2020). The health promotion is possible through “enabling" by building a supportive and health-promoting environment, “mediating” efficiently between different sectors and different groups of health department and government to achieve the pursuit of health and “advocacy” as a medium to ensure inception of favourable conditions for better health. The five major strategies for health promotion include building healthy public policy, creating a supportive environment, strengthening of community action, developing personal skills and re-orienting health services (WHO, 2020).

Strengthening Community Action: The Australian Health System has two tiers, the first tier being the Federal Government which is involved in health planning activities at the national level and the second tier which is responsible for the public hospital administration with both, community and acute, health services which includes health-promoting activities (Roden et al., 2016). Community nurses work at the forefront of the healthcare system and play an essential role in both, the community and aged care sectors. Hence, the government are prompted to invest increasingly in the education and training of community nurses. The nurses can play important role in diabetes prevention by efficient and substantial community action in decision-making, planning policies as well as strategies along with implementing them and setting priorities to achieve improved health.

Developing personal skills: Promotion of health is a vital aspect of nursing and the identification of nurses as a front figure in the expansion of health promotion makes it more essential to focus on their training and education (Pham & Ziegart, 2016). According to the study carried out by Pham and Ziegart (2016), nurses perceived and executed health promotion for patients with type 2 diabetes through a positive relation and the nurses gave importance to the social aspects of the patients as a vital context in health-promoting activities. The nurses also described how developing a close positive relationship with the patients turned out to be a resource for health promotion. Nurses explained that they promoted awareness and healthy habits to prevent and control diabetes by answering the patient’s questions, educating and explaining the patients along with their relatives. Several barriers to health promotion were also mentioned by them (Pham & Ziegart, 2016). Lack of knowledge about strategies to promote health, as well as health promotion in general, was indicated as the primary barrier for health promotion in type 2 diabetes patients. The nurses due to their close association with the patients can reach out to them and explain the importance of adopting healthy practices and making changes in their diet and lifestyle. This way the nurses can empower the patients to be able to manage their condition in a better way. Efforts should be made to empower the nurses to work independently, incorporate health-promoting activities in the daily work of the nurses and allow a dedicated time for the same.

Building healthy public policy: In diabetes mellitus, health-promoting strategies may include one or more programs targeting self-management, health and dietary education, psychological management and may consist of initiatives and policies that target healthcare professional or community stakeholders, and also intend to increase partnership across different sectors (Sorenson et al., 2015). The Ottawa Charter for health promotion instructs the practice of health promotion which includes strategies at various levels including individual, system and community in order to achieve sustainable changes and address complex health issues.

Indicators of health promotion for diabetes mellitus pay attention to socio-economic factors, different levels of the determinants of disease, health literacy and the organization of health care (Sorenson et al., 2015). This helps take into consideration the representativeness of the context and setting of the target population. All of this can help increase the validity of the interventions and give concrete advises to the program initiator and policymakers when developing strategies to improve the health of the community or the nation. The nurses can play an active role in both, helping understand these various indicators as well as engaging in health promotion activities that encompass the different aspects of these indicators.

Creating a supportive environment: Holism as a concept is fundamental in both, nursing and health promotion (Povlsen & Borup, 2011). A ‘holistic view on health’ was recognised as one of the main principles of the Ottawa Charter for health promotion. “In health promotion, holism is based on the recognition of inextricable links between social and economic conditions, the physical environment, individual lifestyles and health and that effective and equitable healthcare, therefore, requires an understanding of the social ecology of health. While holistic aspects of nursing care primarily included health education and when related to chronic diseases, patient-centred and tailored measures to support and facilitate patients’ self-care management” (Povlsen & Borup, 2011). These strategies call for a close alliance between the patient and the nurse to help recognise the patient’s needs and strengthen the healthcare system which enables the patient to actively participate in the treatment and decision-making. This helps create an environment conducive for better health-promoting strategies and helps gain a better approach to understand, prevent and combat diseases like diabetes mellitus right from the grass-root level.

Diabetes mellitus being a long-term complex condition requires the patient to better understand the condition as well as adopt a watchful approach for self-management and self-care to achieve the best results (Stiles, 2011). This can be brought about by increasing the patient’s health literacy. Health literacy entails elements like motivation, empowerment, culture and the person’s experiences and exchanges within the health system. Comprehension of health literacy by the nurse is vital for enabling patients to attain self-management of the life-long conditions. The strategies for health literacy should focus on enhancing the communication between diabetes mellitus patients and the healthcare providers (especially the nurses as they are more approachable and a constant in the patient’s treatment), providing the information in various formats and seeking to enhance the access to the various healthcare services. 

Reorienting health services: A vast group of healthcare providers is constituted by the nurses in the Australian health sector, however, nursing is not being given enough preparation and efforts for training in health promotion or primary health care (Keleher & Parker, 2013). Undoubtedly, nurses are efficient in both primary care as well as community care, yet there is enormous scope to optimize their skills for broader spectrum and effective health care delivery by enhancing the proficiencies of the nurses in health promoting-activities. Practising health promotion with the actions and principles as per the Ottawa Charter requires procurement knowledge, competencies and skills that equip and prepare the healthcare providers (Joss and Keleher, 2011). This can enable the nurses who have been meticulously educated and trained in acute care knowledge and skills, to work towards health promotion and prevention of disease. According to Caldron (2011), strengthening of the primary care systems has substantial capacity for improving the opportunities and potential of the nurses for health-promoting activities which is in line with the National Primary Health Care Strategy (Australian Government Department of Health and Ageing, 2010).

One might think that nurses being healthcare professionals providing healthcare services must naturally be a part of health promotion activities but this is not the case. Their engagement in health education activities, that is providing information related to diabetes mellitus and other diseases, is more likely than in health promotion activities, that involves empowerment of the patients, families and communities. Even though health education is a part of health promotion, these two terms are not interchangeable and efforts should be made to reorient the health services provided by the nurses.

Conclusion on Health Promotion in Primary Care

Nurses bear the potential to engage in health promotion activities and bring out the positive outcome for diabetes mellitus. Addressing the populations’ needs and queries can help build a path to enable and empower the patients to better manage their condition as well as help in prevention for the healthy. The nurses work in close association with the patients and are likely to develop a positive relationship with patients especially in case of long term diseases like diabetes mellitus. This positive relationship can then be used to promote healthy habits and various methods to prevent and control diabetes, though the lack of education and training of the nurses for health-promoting activities can prove to be a hurdle. Nurses being the frontline figures in health promotion can propagate control and prevention of diabetes mellitus better than the other healthcare providers. However, there is a dearth of funds, policies and strategies that focus on the engagement of the nurses in health promotion. Diabetes mellitus being a global concern requires interventions at various levels and the nurses can prove to be the pioneers to execute the interventions. It is essential to shift the focus of the nurses from just health education to health education and promotion.

References for Health Promotion in Primary Care

Agide, F. D. & Shakibazadeh, E. (2018). Contextualizing Ottawa Charter frameworks for type 2 diabetes prevention: A professional perspective as a review. Ethiopian Journal of Health Sciences, 28(3), 355. doi:10.4314/ejhs.v28i3.14

Calderon, C., Balague, L., Cortada, J. & Sánchez, A. (2011). Health promotion in primary care: How should we intervene? A qualitative study involving both physicians and patients. BMC Health Services Research, 11(62).

Common Wealth of Australia. (2010). National primary health care strategic framework. Retrieved from:

Joss, N. & Keleher, H. (2011). Competencies for public health and health promotion: Build your own career! Understanding health. South Melbourne: Oxford University Press.

Keleher, H. & Parker, R. (2013). Health promotion by primary care nurses in Australian general practice. Collegian, 20(4), 215–221. doi:10.1016/j.colegn.2012.09.001

Pham, L. & Ziegert, K. (2016). Ways of promoting health to patients with diabetes and chronic kidney disease from a nursing perspective in Vietnam: A phenomenographic study. International Journal of Qualitative Studies on Health and Well-Being, 11(1), 30722.

Povlsen, L. & Borup, I. K. (2011). Holism in nursing and health promotion: Distinct or related perspectives? A literature review. Scandinavian Journal of Caring Sciences, 25(4), 798–805. doi:10.1111/j.1471-6712.2011.00885.x

Roden, J., Jarvis, L., Campbell-Crofts, S. & Whitehead, D. (2016). Australian rural, remote and urban community nurses' health promotion role and function. Health Promotion International, 31(3), 704–714.

Sorensen, M., Korsmo-Haugen, H., Maggini, M., Kuske, S., Icks, A., Rothe, U., Lindström, J. & Zalete, J. (2015). Health promotion interventions in type 2 diabetes. Ann Ist Super Sanità, 51(3), 192-198.

Stiles, E. (2011). Promoting health literacy in patients with diabetes. Nursing Standard, 28(8), 35-40.

World Health Organization. (2020). The Ottawa Charter for health promotion. Retrieved from:

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