ABSTRACT
Quality assurance can, on the one hand, be oriented towards a search for excellence; on the other, focus on improving performance in general health promotion work. Health promotion encompasses a philosophy, democratic values, policy structures and individual behaviours, and also a variety of methods. Since health promotion activities are rarely repeated, but are normally unique in terms of place, time and people, they have more in common with dynamic process development than regular service provision. This means that quality in health promotion must be assured even when activities are being designed and planned, so that the creation of optimal conditions for successful outcomes is facilitated. The importance of sharing experiences from local projects in a standardised and systematic way was stressed at the Third International Conference on Health Promotion in Sundsvall, Sweden, in 1991. A specific questionnaire, based on the Supportive Environments Action Model (SESAME), which is a stepwise action model with a focus on quality aspects, was used to build a database comprising more than 1,000 local health promotion projects worldwide. The 20-item questionnaire covered project planning, processes and outcomes. It has since been tested and revised, and now has six dimensions covering different aspects of quality: organisational quality; strategic quality; quality in approaching inequalities; quality of methods; and quality of monitoring and outcome measurement and quality improvement. Its use in local health promotion projects has demonstrated the instrument. So far, it has been employed in several health promotion settings, including healthy school development. The instrument has also been used (for training purposes) in health promotion courses at Masters level (MPH) and for experienced practitioners (in-service training) at the Karolinska Institute in Sweden.
