Kemppainen et al. found, in an integrative review, that before 1998, the nurse’s role in health promotion had been one mainly linked to disease prevention through health education and behaviour change directed toward individuals.[5] However, nurses can provide evidence-based health promotion to communities as well as to individuals. The Ottawa Charter for Health Promotion can be used to guide and inform nursing practice, policy development, and research.[6] For example:
- Build healthy public policy: nurses have a role in promoting effective public policy as well as advocating to policy-makers on behalf of clients and communities.[7]
- Create supportive environments: nurses in the HIV sector establish and foster partnerships between services and individuals and also between clinical services and HIV health promotion agencies, peer-based organisations and community groups. One such example may be ensuring services are accessible to the target population by providing a safe location, opening hours that allow users to access the service, minimising barriers to access such as financial constraints and creating a professional and non-judgmental environment for those who may engage or may contemplate engaging with the service.
In subsequent years, health promotion advocates emphasised greater social responsibility for health, investment, and infrastructure[8] and later strong political action.[9] Three principal models for promoting health are:
- Biomedical model – emphasises risk behaviours and healthy lifestyles, individual responsibility
- Social model – seeks to:
- address broader determinants of health
- empower individuals and communities
- act to reduce social inequities and enable access to health care and involve intersectoral collaboration
- Ecological model
In the HIV sector, nurses, while mostly familiar with, and expert in the biomedical model of health, draw from social and ecological models as well. In Australia, HIV nursing models of care incorporate strong health promotion components: notably, community health nurses, primary care nurses and district nurses in Australia and in the region have very broad, well-developed roles in HIV health promotion. For example, nurses are involved in:
- capacity building initiatives such as training volunteers through HIV organisations including AIDS Councils and peer-support agencies[12]
- outreach to peer-based organisations to facilitate harm reduction, health education, HIV prevention and engagement in care[13]
- social marketing through participation in community events (such as World AIDS Day)
- participation in policy development including national and state HIV, sexually transmissible infections (STIs) and blood-borne virus (BBV) strategies
- action research projects.[14] [15].