title: Determinants of health promotion action in primary health care: comparative study of health and home care personnel in four municipalities in Finland.
abstract: OBJECTIVE
  The purpose of this paper is to contribute to understanding which factors influence health promotion action in primary health care (PHC) on the municipal, i.e. local, level.
  
  
  METHODS
  A cross-sectional mail survey of all PHC personnel in four municipalities in Finland in 2002. The data were analysed by descriptive statistics, and univariate and multivariate logistic regression analyses.
  
  
  RESULTS
  A total of 417 (response rate 57%) healthcare professionals participated in the study; 65% of the personnel working in ambulatory care, 52% working in home care and 44% working in inpatient care were engaged in health promotion action (=higher than median engagement). Factors independently associated with engagement in health promotion were organizational values, reflected in perceived skill discretion and social support from coworkers, and the personnel's competence, reflected in knowledge about the health and living conditions of the population served. Further, the opportunities, reflected in cooperation with partners outside the organization were strongly associated with engagement in health promotion action.
  
  
  CONCLUSIONS
  The results suggest that working conditions such as possibilities for skill usage, reflection and development as well as collegial support enable higher engagement in health promotion action in PHC. However, access to data on the local population's health and living conditions, in addition to opportunities to cooperate with decision makers and partners in the community turned out to be as important. This should be taken into consideration when striving to reorient health services to health promotion.
authors.affiliation: Department of Public Health, University of Helsinki, Finland, and Folkhälsan Research Center, Helsinki, Finland. nina.simonsen-rehn@helsinki.fi
authors.forename: Nina
authors.initials: N
authors.lastname: Simonsen-Rehn
authors.forename: Ritva
authors.initials: R
authors.lastname: Laamanen
authors.forename: Jari
authors.initials: J
authors.lastname: Sundell
authors.forename: Mats
authors.initials: M
authors.lastname: Brommels
authors.forename: Sakari
authors.initials: S
authors.lastname: Suominen
mesh_terms: D000328:Adult; D003153:Community Health Services; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D005387:Finland; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D011320:Primary Health Care; D011361:Professional Competence; D011634:Public Health; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D000078329:Workforce; D016526:Workload