In response to global public health challenges and increasing demands for skilled practitioners, this study explores professionalisation and competency-based approaches among health promotion specialists in local governments in Estonia. The aim was to identify priority areas for competency enhancement and examine opportunities and barriers to additional training.
Semi-structured interviews with local government leaders (N = 10) and health promotion specialists (N = 9) were conducted. The sample consisted of interviewees recruited in 2022‒2023 and represented three groups: local governments that had created or updated their health and well-being profile, those currently working on it, and those that had not yet begun updating the profile. Thematic analysis identified themes related to the role of health promotion specialists, training needs, awareness of learning opportunities, and the development of core competencies.
The findings revealed considerable variation in how the role of health promotion specialists is understood, alongside limited awareness of the competency framework guiding the profession. Key challenges included inconsistent role definitions, resource constraints, and uneven institutional support for training. Priority areas for competency development were identified in needs assessment, planning, evaluation, and communication. Major barriers to professional development included lack of time, funding, organisational support, and awareness of training opportunities, while employer encouragement, flexible learning formats, and perceived relevance to daily work emerged as important enabling factors.
Battel-Kirk, B. and Barry, M. M. 2019. Has the development of health promotion competencies made a difference? A scoping review of the literature. Health Education & Behavior, 46(5), 824‒842.
https://doi.org/10.1177/1090198119846935
Battel-Kirk, B. and Sendall, M. C. 2022. Core competencies for health promotion: development and experience in pedagogy. In International Handbook of Teaching and Learning in Health Promotion (Akerman, M. and Germani, A. C. C. G., eds). Springer, Cham, 563–583.
https://doi.org/10.1007/978-3-030-96005-6_35
Battel-Kirk, B., Barry, M. M., Taub, A. and Lysoby, L. 2009. A review of the international literature on health promotion competencies: identifying frameworks and core competencies. Global Health Promotion, 16(2), 12–20.
https://doi.org/10.1177/1757975909104100
Battel-Kirk, B., Barry, M. M., van der Zanden, G., Contu, P., Gallardo, C., Martinez, A. et al. 2015. Operationalising and piloting the IUHPE European accreditation system for health promotion. Global Health Promotion, 22(3), 25–34.
https://doi.org/10.1177/1757975914545386
Czabanowska, K. and Middleton, J. 2022. Professionalism of the public health workforce ‒ how to make it happen? Journal of Public Health, 44(1), i54–i59.
https://doi.org/10.1093/pubmed/fdac091
Czabanowska, K., Rodriguez Feria, P., Kuhlmann, E., Kostoulas, P., Middleton, J., Magana, L. et al. 2024. Professionalization of the public health workforce: scoping review and call to action. European Journal of Public Health, 34(1), 52–58.
https://doi.org/10.1093/eurpub/ckad171
Dempsey, C., Barry, M. M., Battel-Kirk, B. and the CompHP Project Partners. 2011a. Literature review: developing competencies for health promotion.IUHPE, Paris, France.
http://www.iuhpe.org/images/PROJECTS/ACCREDITATION/CompHP_LiteratureReview Part1.pdf (accessed 2025-07-02).
Dempsey, C., Barry, M. M., Battel-Kirk, B. and the CompHP Project Partners. 2011b. Developing consensus on core competencies for health promotion.IUHPE, Paris, France.
http://www.iuhpe.org/images/PROJECTS/ACCREDITATION/European_Consensus_on_Core_Competencies_for_HP.pdf (accessed 2025-07-02).
Dempsey, C., Barry, M. M., Battel-Kirk, B. and the CompHP Project Partners. 2011c. The CompHP core competencies framework for health promotion.IUHPE, Paris, France.
http://www.iuhpe.org/images/PROJECTS/ACCREDITATION/CompHP_Competencies_Handbook.pdf (accessed 2025-07-02).
ETÜ (Eesti Tervisedenduse Ühing) (Health Promotion Union of Estonia). 2013. Ajaloost (History).
https://www.tervis.ee/uhingust/ajaloost/ (accessed 2025-07-02).
Ezzy, D. 2002. Qualitative Analysis: Practice and Innovation. Routledge, London. https://doi.org/10.4324/9781315015484
Fattahi, H., Abolghasem Gorji, H. and Bayat, M. 2020. Core competencies for health headquarters: a systematic review and meta-synthesis. BMC Public Health, 20(1), 891.
https://doi.org/10.1186/s12889-020-08884-2
Fosse, E. and Helgesen, M. K. 2015. How can local governments level the social gradient in health among families with children? The case of Norway. International Journal of Child, Youth and Family Studies, 6(2), 328–346.
https://doi.org/10.18357/ijcyfs.62201513505
Gabrhelik, R., Foxcroft, D., Mifsud, J., Dimech, A. M., Pischke, C., Steenbock, B. et al. 2015. Quality plan for prevention science education and training in Europe. Science for prevention academic network ‒ SPAN, Oxford.
Hagen, S., Overgård, K. I., Helgesen, M., Fosse, E. and Torp, S. 2018. Health promotion at local level in Norway: the use of public health coordinators and health overviews to promote fair distribution among social groups. International Journal of Health Policy and Management, 7(9), 807–817.
https://doi.org/10.15171/ijhpm.2018.22
IUHPE (International Union for Health Promotion and Education). 2016. IUHPE core competencies and professional standards for health promotion.
https://www.ukphr.org/wp-content/uploads/2017/02/Core_Competencies_Standards_linkE.pdf (accessed 2025-07-09).
Kookla, M. and Purru, T. 2024. Rahvatervishoid ja turvalisus kohalikes omavalitsustes. Uuringuaruanne 2023 (Public health and safety in local governments. Survey report 2023). Tervise Arengu Instituut (The National Institute for Health Development).
https://tai.ee/sites/default/files/2024-05/Rahvatervishoid_ja_turvalisus_KOV_2023-2.pdf (accessed 2025-07-02).
Krasna, H., Czabanowska, K., Jiang, S., Khadka, S., Morita, H., Kornfeld, J. et al. 2020. The future of careers at the intersection of climate change and public health: what can job postings and an employer survey tell us? International Journal of Environmental Research and Public Health, 17(4), 1310.
https://doi.org/10.3390/ijerph17041310
Kutsekoda (Estonian Qualifications Authority). 2024a. Awarding Bodies.
https://www.kutseregister.ee/ctrl/en/KAO/vaata/10086683 (accessed 2025-07-02).
Kutsekoda (Estonian Qualifications Authority). 2024b. Occupational Qualification Standards: Health promoter, level 6.
https://www.kutseregister.ee/ctrl/en/Standardid/vaata/11252737 (accessed 2025-07-09).
Meresman, S., Colomer, C., Barry, M., Davies, J. K., Lindstrom, B., Loureiro, I. et al. 2006. Review of professional competencies in health promotion: European perspectives. International Journal of Health Promotion and Education, 44(3), 113–120.
https://doi.org/10.1080/14635240.2006.10708081
Mereu, A., Sotgiu, A., Buja, A., Casuccio, A., Cecconi, R., Fabiani, L. et al. 2015. Professional competencies in health promotion and public health: what is common and what is specific? Review of the European debate and perspectives for professional development. Epidemiologia e Prevenzione, 39(4), 33–38.
PHANZ (Public Health Association of New Zealand). 2024. Generic competencies for public health in Aotearoa-New Zealand.
https://hpfnz.org.nz/assets/Uploads/Generic-Competencies-for-Public-Health-in-Aotearoa-NZ-v2.pdf (accessed 2025-07-09).
Purru, T. and Seema, K. 2021. Rahvatervis ja turvalisus kohalikes omavalitsustes. Uuringuaruanne 2020 (Public health and safety in local governments. Survey report 2020). Tervise Arengu Instituut (National Institute for Health Development).
https://www.tai.ee/sites/default/files/2021-10/Rahvatervis_ja_turvalisus_koh_omavalitsustes_web.pdf (accessed 2025-07-02).
Saboga-Nunes, L., Levin-Zamir, D., Bittlingmayer, U., Contu, P., Pinheiro, P., Ivassenko, V. et al. 2020. A health promotion focus on COVID-19: keep the Trojan horse out of our health systems. Promote health for ALL in times of crisis and beyond! EUPHA-HP, IUHPE, UNESCO Chair Global Health & Education.
Shephard, R., Uy, J., Otterman, V., Betker, C., Sandhu, H., Tjaden, L. et al. 2024. The core competencies for public health in Canada: opportunities and recommendations for modernization. Journal of Public Health Management and Practice, 30(3), 432–441.
https://doi.org/10.1097/PHH.0000000000001884
Speller, V., Parish, R., Davison, H., Zilnyk, A. and the CompHP Project Partners. 2012. Report: Developing a European consensus on professional standards for health promotion. IUHPE, Paris.
https://doi.org/10.1177/1090198112467802
TAI (Tervise Arengu Instituut) (The National Institute for Health Development). 2022. TAI asub Eestis rakendama ühtset ennetuse õppekava. (NIHD is starting to implement a unified prevention curriculum in Estonia).
https://www.tai.ee/et/uudised/tai-asub-eestis-rakendama-uhtset-ennetuse-oppekava (accessed 2025-07-02).
THUAS (Tallinn Health University of Applied Sciences). Curriculum of health promotion.
https://www.ttk.ee/en/curriculum-health-promotion (accessed 2025-07-02).
Van den Broucke, S. 2017. Strengthening public health capacity through a health promotion lens. Health Promotion International, 32(5), 763–767.
https://doi.org/10.1093/heapro/dax064
WHO (World Health Organization). 2014. Helsinki Statement on health in all policies.
https://iris.who.int/bitstream/handle/10665/112636/9789241506908_eng.pdf
WHO (World Health Organization. Regional Office for Europe). 2022. Roadmap to professionalizing the public health workforce in the European Region.
https://iris.who.int/handle/10665/351526
WHO/SEARO (World Health Organization. South-East Asia Regional Office). 2010. Developing health promotion competencies and standards for countries in WHO South-East Asia region.
http://apps.who.int/iris/bitstream/handle/10665/204957/B4465.pdf?sequence=1&isAllowed=y