An international Delphi study examining health promotion and health education in nursing practice, education and policy


  • Dean Whitehead MSc, RN

    1. Senior Lecturer, College of Humanities and Social Sciences, School of Health Sciences, Massey University, Palmerston North, New Zealand
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Dean Whitehead
College of Humanities and Social Sciences
School of Health Sciences
Massey University
Turitea Campus
Private Bag 11 222
Palmerston North
New Zealand
Telephone: +64 (06) 356 9099 – ext 7227


Aim.  To arrive at an expert consensus in relation to health promotion and health education constructs as they apply to nursing practice, education and policy.

Background.  Nursing has often been maligned and criticized, both inside and outside of the profession, for its ability to understand and conduct effective health promotion and health education-related activities. In the absence of an expert-based consensus, nurses may find it difficult to progress beyond the current situation. In the absence of any previously published nursing-related consensus research, this study seeks to fill that knowledge-gap.

Design.  A two-round Delphi technique via email correspondence.

Methods.  A first-round qualitative questionnaire used open-ended questions for defining health promotion and health education. This was both in general terms and as participants believed these concepts related to the clinical, theoretical (academic/educational) and the policy (political) setting in nursing. Line-by-line qualitative content and thematic analysis of the first-round data generated 13 specific categories. These categories contained 134 statement items. The second-round questionnaire comprised the identified 134 statements. Using a five-point Likert scale (ranging from 1 = strongly disagree to 5 = strongly agree) participants scored and rated their level of agreement/disagreement against the listed items. Data from the second-round was descriptively analysed according to distribution and central tendency measures.

Results.  An expert consensus was reached on 65 of the original 134 statements. While some minor contradiction was demonstrated, strong consensus emerged around the issues of defining health promotion and health education and the emergence of a wider health promotion and health education role for nursing. No consensus was reached on only one of the 13 identified topic categories – that of ‘nurses working with other disciplines and agencies in a health education and health promotion role.’

Conclusions.  This study provides a hitherto previously absent expert consensus on the current position of health promotion and health education, in nursing and predictions for their future course. Its findings represent an important step for nurses as they seek to become increasingly active and influential within wider health promotion and health education arenas.

Relevance to clinical practice.  Delphi studies do not necessarily offer indisputable fact. This study, however, with its strong consensus on the majority of original statements is a good indicator as to how nursing experts currently view health promotion and health education constructs. Expert consensus offers a useful form of measure against current and future clinical practice and helps to build a firm foundation for change. Nurses, then, are advised here to refer to the findings presented, that they remain contextually and conceptually clear, as they embark on current and future health promotion-related activities.