To our knowledge, this is the first cross-mapping study covering Europe which shows how the themes of health promotion and disease prevention are addressed in the educational programs of different health and nursing professions. health care. Information was obtained on 186 educational programs, targeting 17 different health professions. Health promotion and disease prevention were integrated into the three levels of education studied (initial training, postgraduate training and CPD) for a wide range of professionals. Accreditation of these educational programs is common and the use of a multidisciplinary approach appears widespread. Some programs also targeted multiple health professionals. Traditional teaching methods, such as lectures (97%) and homework (81%), were dominant, while online learning was less frequently used (46%). Epidemiology, evidence-based medicine, health policy and communication skills were covered the most, while digitalization in health promotion, digital health coaching, health economics and health inequalities were the least frequently addressed.
Furthermore, the results indicate that educational programs aim to address knowledge, skills and behaviors that may limit the activity of health professionals in effective health promotion and disease prevention, both at the institutional and interpersonal, as previous studies have revealed (7, 8). This contrasts with previous findings in the United States, where current training of health professionals appears to lack emphasis on health promotion and disease prevention (6).
While this is encouraging and carries a positive message regarding the growing burden of NCDs, the findings also highlight future challenges for education and health policy development. The healthcare and education environment is being disrupted as new health threats, such as the climate crisis and the ongoing COVID-19 pandemic, will impact the (digital) skills needed by professionals (12). Furthermore, the digitalization of services constitutes a challenge for health professionals (13). This paradigm shift requires new skills and attitudes from healthcare professionals. Skills are developed through practice and active participation, while multi-method teaching enhances skill development (14), so it is worrying that only half of programs report building skills in health behavior change techniques and only 15% in digital environments. Understanding the factors influencing the abilities of individuals and their social environment to adapt to change affects the attitudes of professionals considered as an obstacle to patient compliance with lifestyle changes and treatments (15). Therefore, educational programs need to pay more attention to health literacy, digital health coaching and digitalization in health promotion and disease prevention, in order to equip professionals with the necessary skills and attitudes to fully benefit from care and patients’ abilities to implement it. Additionally, it requires investment by educational programs to apply new teaching techniques, including online learning modules, above the traditional methods that were found to be most common in this study.
We believe that to increase health promotion and disease prevention in health systems, common health professional skills and context-based implementation strategies are needed across the EU and Europe. A similar need was recognized in the United States (16,17,18) and in previous studies in Europe (9, 13). Our findings could be used as a starting point to develop a common framework for the implementation of health promotion and disease prevention skills by health professions in the EU, complementing the recently updated framework (19). Such an initiative could be timely amid other challenges such as changing demographics, digitalization and the current COVID-19 pandemic, which has revised and expanded the roles of professionals in healthcare and promotion of health (20, 21). However, the existing multidisciplinary approach can favor the development process, and the EU provides a context for collaboration and dissemination of new standards through accreditation systems: universities and other establishments have already collaborated in coordination of education, for example the Bologna Process, for undergraduate education (22) and the 2005 European directive relating to the recognition of professional qualifications in CDP (23), and in the establishment of skills benchmarks (examples: PHARMINE for pharmacists (24) and MEDINE for doctors (25)). Likewise, lifestyle medicine is growing (26,27,28). To support people with NCDs by promoting healthy behaviors, common skills could lay the foundation for results-oriented education (29), reduce barriers between different professions and promote collaboration among health professionals (30).
Limitations of the study
Our study has several limitations. It only provides an overview of the current situation, as changes are likely over time, particularly given the move of teaching online due to the current COVID-19 pandemic. As no single or defined source of information was available for all levels of education (e.g. curriculum mapping could have been used only for undergraduate education), the snowball method was used. This is a non-random sampling method, which limits the generalizability of the results. Counting only educational programs covering the topics of health promotion and disease prevention increased the possibility of systematic bias. Therefore, this study cannot provide a complete picture of the proportion of health promotion and disease prevention in the training of health professionals in Europe. This gap implies a risk of selection bias, as educational institutions that implemented health promotion into their programs, i.e. the pioneers, may have been more inclined to respond than those that are less active. Finally, the data was self-reported through a survey and there may be information bias, as anyone could have completed the survey on behalf of the program and respondents might be more positive about with regard to their own programs.
