There is a major assumption underly

There is a major assumption underlying our consideration
of the identification and implementation of best
practices in health promotion. This assumption is that
the quality and value of practice depends on the awareness,
articulation, clarity, and reflection associated with
each of the domains included in the IDM (Figure 1); in
combination, this awareness, articulation, clarity, and
reflection constitute a critically reflective approach.
• Awareness: Without awareness, ideas, feelings,
actions, and conditions cannot be scrutinized or
addressed. Without awareness, they remain unrecognized
and unnamed; if they change, it is by accident rather than design. Practitioners are often unaware of
the beliefs and assumptions underlying health promotion
practice, even though practice is extremely
sensitive to these issues. Best practices in health promotion
are only attainable if practitioners are conscious
and aware of their own (and their society’s) values,
ideas, beliefs, and understandings.
• Articulation: Articulation is an essential precondition
for dialogue about ideas and feelings related to health
promotion practice; this dialogue, with its interchange
of thoughts and feelings, increases synergy among
health promotion practitioners and helps to define areas
of convergence and divergence. Inadequate articulation
of health promotion domains (and subdomains) has its
origins in a number of factors, including lack of awareness
(see above), failure to recognize the importance of
the health promotion domains, and fear of conflict.
• Clarity: Without clarity, confusion reigns, resulting in a
shallow understanding of the domains (and subdomains),
their interrelationships, their relative importance,
and their long- and short-term implications and
consequences for practice. In addition, lack of clarity
impedes discussions because in the absence of clearly
articulated assumptions, it is difficult to determine
where genuine agreement or disagreement lies.
Although health promotion practitioners may employ a
common language (i.e., use similar words), the meanings
they attach to words such as equity and empowerment
vary widely; this can result in the selection and
implementation of inappropriate practice responses,
thereby reducing health promotion’s potential impact
(Israel, Checkoway, Schultz, & Zimmerman, 1994;
Rissel, 1994; Stevenson & Burke, 1992).
• Reflection: Without reflection, there can be little
awareness or clarity. Reflection is the mirror that
reveals things otherwise left hidden; it is the means by
which concepts can be critically examined and revised,
and by which internal contradictions can be recognized
and eliminated. Reflection allows people to make judgments
about what works and what is consistent with
their values, and to apply what they have learned to current
and future practice (Eakin & Maclean, 1992). Concerning
reflection, Evans et al. (1994) wrote, “Rather
than close our eyes to perceived failure, we should
embrace experience as an effective form of learning
and be willing to adapt future practice accordingly.
Equally we should reflect on our successes to transfer
the lessons to other situations which arise in the continuing
development of health promotion services (p.12).”
Using violence against women as a concrete example,
effective policies and actions are dependent on (a)
being aware of the nature of violence against women
and the extent to which it exists, so that appropriate
action can be taken (in contrast to keeping the issue of
violence against women hidden, and therefore ignored,
as in the past); (b) articulating the issue in a way that
brings it into the public realm, where it can be fully discussed
(resulting in increased awareness of the issue
and reduced inhibitions against speaking about violence
against women); (c) achieving clarity, thereby
enhancing our understanding and articulation of the
issue, its impact, and how to address it—for example,
women will no longer be blamed for the violence they
suffer; and (d) reflecting on the nature and impact of
our thoughts, words, and actions concerning violence
against women in an effort to improve services, programs,
and policies. In our example, this critically
reflective approach (which does not necessarily occur
in the linear fashion presented here) would be explicitly
applied to each element of the IDM, that is, with respect
to the values underlying the identification of violence
against women as an issue worthy of attention, the theories
and beliefs associated with the issue (e.g., “the
cycle of violence”), the evidence supporting specific
strategies to decrease the incidence of violence against
women, an understanding of the environment with
respect to this issue, and practice choices.
In conclusion, making a habit of fostering awareness,
articulation, clarity, and reflection with respect to
the various domains outlined in the IDM approach to
best practices provides a solid basis for effective health
promotion practice.