Operative links: the importance of combining perspectives in municipal strategies aimed at children's and adolescents' health.
OBJECTIVE
The subject of investigation is the ways in which the Danish municipalities organize prevention and health-promotion efforts for children and adolescents. The aim is to examine how health managerial ideas have been combined with health professional ideals concerning different health educational approaches.


METHODS
Mixed qualitative design: survey based on telephone interviews with health managers (n=72), personal and focus group interviews with health professionals (n=84) and pupils (n=108) from 18 school classes, and comparative case studies in five selected municipalities of various size and geographical location. The theoretical framework has three positions combining a public management perspective with a pedagogical perspective on health promotion.


RESULTS
The municipalities give high priority to prevention and health promotion directed toward children and adolescents and face a number of challenges at the management, collaboration, and knowledge levels. Missing links is one of the main points. Health managers and health professionals are preoccupied with some educational consequences of the health interventions, but they do not focus to the same extent on explicit health educational goals, learning content, or value clarification. Health pedagogy is often a matter of retrospective rationalization rather than the starting point of planning. Health and risk behaviour approaches override health educational approaches.


CONCLUSIONS
Operational links between health education, health professionalism, and management strategies pose the foremost challenge. Operational links indicates cooperative levels that facilitate a creative and innovative effort across traditional professional boundaries. It is proposed that such links are supported by network structures, shared semantics, and situated pedagogical means of intervention.
Department of Education, University of Aarhus, Copenhagen Campus, Tuborgvej 164, Copenhagen, Denmark. kawi@dpu.dk
Karen
K
Wistoft
Holger
H
Højlund
D000293:Adolescent; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003718:Denmark; D017144:Focus Groups; D006266:Health Education / Q000379:methods* / Q000458:organization & administration; D006293:Health Promotion / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D011314:Preventive Health Services / Q000379:methods* / Q000458:organization & administration; D036301:Qualitative Research; D012574:Schools; D013334:Students