Post on 09-Mar-2021
Health promotion and disease prevention including lifestyle
medicine in health and educational settings
Mapping results and analysis to be presented at the
International Conference ldquoPromoting healthy lifestyles
in Europe from education to practicerdquo September 24th
2020
Written by ECORYS Nederland BV June 2020
Third
EU Health
Programme
EUROPEAN COMMISSION
Directorate-General for Health and Food Safety Directorate C mdash Public health country knowledge crisis management
Unit C4 mdash Health determinants and international relations
E-mail sante-consult-c4eceuropaeu
European Commission
L-2920 Luxembourg
ldquoThis document has been prepared for the European Commission however it reflects the
views only of the authors and the Commission cannot be held responsible for any use
which may be made of the information contained thereinrdquo
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to your questions about the European Union
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00 800 6 7 8 9 10 11
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
4
Table of Contents
Preface 5
Executive summary 7
1 Introduction 11
11 Research questions 14
2 Theoretical background 15
21 Societal needs for health promotion and disease prevention 15
22 Health profession competencies 16
23 Educational systems for health professions in Europe 19
24 Relevant educational settings for health promotion 19
25 Theoretical framework for this study 21
3 Methodology 22
31 Mapping of health educational programmes in the EU 22
311 Online survey 22
312 Desk research 26
32 Long list of good practices 27
4 Mapping of the current situation IN health promotion training in the EU 29
41 Overview of educational programmes in the EU 29
411 Summary of the main findings in the survey 29
412 Detailed results of the survey 29
42 Overview of competency profiles of health professionals in the EU 44
5 Long list of good practices 45
51 Results 45
52 Analysis of good practices 48
6 Conclusions 53
Annex 1 Survey results by country 57
Annex 2 Competency profiles per professions 71
Annex 3 Online survey 89
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
5
PREFACE
ECORYS Nederland BV is pleased to present the reader to support Member States in
mainstreaming health promotion and disease prevention including lifestyle medicine in
education of health professionals The reader gives a general overview of professional
training initiatives in the European Union (EU)
The study comes at a time when it is well known that lifestyle factors are important
determinants for most non-communicable diseases These diseases have a major impact
on the health of European citizens At the same time an increasing proportion of aged
population poses demands on health systems and stresses the need to sustain the work -
abilities of the working age population Therefore health promotion disease prevention
and a healthy lifestyle are essential for patients and the general population Health
professionals play an essential role here This is not an easy task as dealing with lifestyle
factors requires different strategies at a population level or for targeted patient groups with
eg type II diabetes or cardiovascular risks Health professionals need to be prepared for
this task in their education either during their study period or as part of continuous
professional development Though widely acknowledged it remained unclear to what
extent and how Member States address this challenge
In the context of this project we collected practices how EU Member States include health
promotion disease prevention and lifestyle medicine in health professional education This
report presents a mapping of the current situation across different countries and health
professions Without pretending to be complete it provides a unique baseline of the way
professionals are currently prepared to implement health promotion disease prevention
and lifestyle medicine in EU countries With this baseline Chafea created an important
starting point for the exchange of experiences and mutual learning Hope is that this will
boost developments in the near future so as to prepare health professionals to adequately
address the challenges that healthcare systems in the EU face and implement the paradigm
shift from treatment of diseases among patients to promotion of health among the entire
population
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
7
EXECUTIVE SUMMARY
Background
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices and unhealthy diets Tobacco use harmful
use of alcohol and physical inactivity have been identified as the top risk factors for non-
communicable diseases (NCDs) in the European Union In recognition of this important
public health challenge investing in effective health promotion and disease prevention of
NCDs is critical to improve the quality of life and well-being of European citizens
Healthcare professionals such as doctors (especially general practitioners) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs However while
many policy statements and NCDs practice guidelines call for behavioural change as the
first line of prevention and management professionals often do not include behavioural
change counselling in their care yet While most health professionals acknowledge the need
for lifestyle advice there seems to be a mismatch between the roles and competencies for
which health professionals are trained and the action required This underscores the need
to develop and strengthen lifestyle medicine as a component of health professionalsrsquo
education defined as lsquothe integration of lifestyle practices into the modern practice of
medicine both to lower risk factors for chronic disease andor if diseases are already
present to serve as an adjunct in therapy Lifestyle medicine brings together sound
scientific evidence in diverse health related fields to assist the clinician in the process of not
only treating disease but also promoting good healthrsquo
Objective of the study
This study seeks to provide a mapping of the current situation how health professionals are
trained in health promotion in the EU To that end this study aims to answer the following
research questions
1 How are health professionals in the EU countries being trained in health promotion
prevention and lifestyle medicine in graduate post-graduate and continuous
professional education
2 What are good practices on knowledge capacity and competency building and
advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Scope of the study
Classically public health targets at activity levels can be described in operational models
like the Friedenacutes pyramid model It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of health
like socioeconomic status We use this model as a substructure to investigate health
professionalsrsquo education as they contribute to public health at all these levels
Methodology
In order to provide a general overview on how health professionals are trained in health
promotion and disease prevention and lifestyle medicine in the EU we conducted an online
survey We identified potential organisations in the EU to take part in the survey and asked
those organisations to spread the survey among other organisations or stakeholders in their
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
8
network We contacted 24 EU associations that represent entire professions or part of the
professions (like post-graduates) in all EU countries and have major networks in the fields
of graduate post-graduate and continuous professional development for their support We
aimed to cover all professions within the scope of this study physicians physiotherapists
occupational therapists psychologists nurses social workers dentists pharmacies
dietitians Also national health associations and national educational organisations were
approached to fill in the survey Among other topics the survey contained questions on the
training programme type of health professional targeted implementation in the
curriculum description of the health promotion component funding accreditation and
partnerships
In addition to the online survey a desk research was conducted including both scientific
and grey literature to establish an overview of the competency profiles of health
professionals in the field of health promotion and disease prevention Based on the
identified literature we described the competency profiles for each of the following
healthcare professions (undergraduate) medicine medical specialists dentists nurses
nurse specialists occupational therapists pharmacists physiotherapists psychologists
and social workers
Results were tabulated and described Good practices were selected on the basis of four
pre-established criteria These practices were analysed more in-depth with an analytical
tool aligning Friedenrsquos pyramid of public health needs and Kraigerrsquos Learning Typology This
in-depth analysis was used to define a short list of 10 good practices representing a variety
of professions and countries
Results
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades1there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional However there is room for improvement many competency
profiles leave room for interpretation the described competences are not ranked in order
of importance and it is often not explained how the competences should be applied in
practice ie in a pro-active preventive way (always assessing lifestyle within the
treatment) or a more curative reactive way (only included in the treatment when there is
a clear lifestyle component related to the disease)
As for the inclusion in educational programmes a high percentage (93) of respondents
(n=197) indicate that health promotion and disease prevention is implemented in their
educational programmes or modules The high share may reflect a selection bias as those
who have implemented health promotion within the education may have been more inclined
to fill in the questionnaire In the survey we explored how health promotion and disease
prevention is implemented in the educational setting In summary this provided the
following results
1 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
9
bull More than half of the respondents indicated that they filled in the questionnaire for
practices in undergraduate educational settings Throughout Europe these
numbers were relatively similar
bull Physiotherapists are the professional group most actively involved in health
promotion training activities The vast majority applies multidisciplinary
approaches and thus brings other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within training programmes In continuous professional development on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion especially target knowledge skills
and behaviour of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for continuous professional
development (33) compared to undergraduate and postgraduate education
where the topic is covered in most modules (15 and 6) Funding was more
often obtained in Northern and Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) Regarding full modules high percentages indicated
that this is mandatory and that there is an exam at the end of the module (81
70 respectively)
Conclusions
The present study provides an overview of current practice on health promotion disease
prevention and lifestyle medicine in the education of health professionals in EU countries
This is an important need-assessment for the exchange of knowledge and expertise among
EU countries All professions have versatile competency profiles in health promotion giving
a good ground for further development As the study results reveal some unbalance in
competencies addressed and methods used a next step could be to support further
development of educational practices in lifestyle medicine and adoption of new
technologies There is room for improvement as well as encouraging volition to share
expertise across professions professional associations universities and countries in the EU
The body of knowledge generated in this study can serve as a basis for further analysis and
contribute to the enhance effectiveness of educational practices of health promotion
disease prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
11
1 INTRODUCTION
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices2 In Europe such chronic diseases as
cancer cardiovascular diseases diabetes and chronic respiratory diseases are giving the
greatest disease burden3 The Global Burden of Disease (GBD) 2016 study estimates that
over 91 of deaths and over 87 of DALYs in the European Union (EU) are the result of
non-communicable diseases (NCDs) of which 61 and 43 respectively can be attributed
to modifiable risk factors4 To a large extent lifestyle factors unhealthy diets tobacco use
harmful use of alcohol and physical inactivity have been identified as the top risk factors
for NCDs in the EU5 The last non-communicable diseases progress monitor 2017 of the
WHO underlines that ldquoNCDs share key modifiable behavioural risk factors like tobacco
use unhealthy diet lack of physical activity and the harmful use of alcohol which in turn
lead to overweight and obesity raised blood pressure raised cholesterol and ultimately
diseaserdquo6 Since NCDs share many related modifiable risk factors and often do not occur in
isolation7 prevention must be integrated into population approaches to combat NCDs as a
group8 In recognition of this important public health challenge investing in effective health
promotion and disease prevention is critical to improve the quality of life and well- being of
European citizens910 as well as their productivity and NCDrsquos burden on health systems and
economy of European societies11
Strengthening the investments in health promotion and disease prevention is key to delay
the onset and reduce the burden of NCDs in Europe12 As there is a great need for chronic
disease management the healthcare setting is crucial for health promotion in both primary
and secondary prevention of NCDs13 For example obesity is a major modifiable risk factor
2 Chopra M et al (2002) A global response to a global problem the epidemic of overnutrition
httpswwwncbinlmnihgovpmcarticlesPMC2567699pdf12571723pdf 3 WHO (2006) Gaining Health The European strategy for the prevention and control of noncommunicable
diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf 4 EU burden from non-communicable diseases and key risk factors httpseceuropaeujrcenhealth-
knowledge-gatewaysocietal-impactsburden 5 WHO (2014) Prevention and control of noncommunicable diseases in the European Region a progress report
httpwwweurowhoint__dataassetspdf_file0004235975Prevention-and-control-of-noncommunicable-diseases-in-the-European-Region-A-progress-report-Engpdf
6 WHO (2017) Noncommunicable diseases progress monitor 2017 httpappswhointirisbitstream handle106652589409789241513029-engpdfjsessionid=0613BF26D66A7DA9D1C91AD325E0A75Dsequence=1
7 httpsacels-cdncomS00917435150028321-s20-S0091743515002832-mainpdf_tid=88fea2bf-946a-44c2-be59-0edbabc2c2e8ampacdnat=1541511066_feedfb33968e2ac2f5b47a3452254a9f
8 Integrated approach to prevent noncommunicable diseases httpwwweurowhointenhealth-topicsnoncommunicable-diseasescanceractivitiesintegrated-approach-to-prevent-noncommunicable-diseases
9 WHO (2006) Gaining Health The European Strategy for the prevention and control of noncommunicable diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf
10 Scriven A (2017) Promoting Health a Practical Guide Seventh Edition httpsbooksgooglenl
bookshl=nlamplr=ampid=fJwqDwAAQBAJampoi=fndamppg=PP1ampdq=importance+health+ promotion+and+disease+prevention+European+Commissionampots=jcXZvCYJIQampsig=8D8Yqa9wKa_DlaaYUky_EtUxd_gv=onepageampq=importance20health20promotion20and20disease20prevention20European20Commissionampf=false
11 Tender 12 Chrodis (2015) Health promotion and primary prevention in 14 European countries a comparative overview
of key policies approaches gaps and needs httpchrodiseuwp-contentuploads 201507 FinalFinalSummaryofWP5CountryReportspdf
13 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
12
for type II diabetes (DM II) and thus efficacy of the intervention matters In economic
modelling for eight European countries a body-mass index reduction in the adult population
of 5 compared to 1 resulted a three-fold reduction in the incidence of DM II14 Apart
from the health losses caused directly by NCDs underlying conditions may also increase
susceptibility for other diseases Patients with diabetes and serious heart conditions eg
were identified as risk populations for COVID-1915 New health threats like climate crisis
will have an impact on healthcare systems and need for adaptation options including
training of health care workers integrated heatwave early warning systems especially for
the most vulnerable populations and supporting lifestyle changes toward healthy choices
that are at the same time climate and health friendly16
Healthcare providers such as doctors especially general practitioners (GPs) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs17 Health
promotion is collaborative work where professionals strengthen the message and help
patients to choose and implement healthier behaviours Counselling on and prescription of
a healthy lifestyle is particularly important to socioeconomically vulnerable and
disadvantaged population groups which are disproportionally affected by unhealthy
lifestyles and are more difficult to reach18 Secondary and tertiary prevention in chronic
diseases is embedded into good quality care since good nutrition status decreases the risk
of reinfarction as does smoking cessation For these reasons health promotion was
explicitly recognized as an integral part of the professional role of the GP in several policy
statements at both the European and the national level19 While many policy statements
and NCDs practice guidelines include a call for behavioural change as the first line of
prevention and management providers often do not provide behavioural change
counselling in their care20
A recently published report by the European Commission and WHO Europe (2018) identified
barriers for prescribing and counselling on exercise schemes and on promoting physical
activity in the health sector These were the lack of confidence and knowledge and skills by
health professionals on providing effective counselling21 For example Koutoukidis et al
(2017) performed a qualitative study on the perspective of healthcare professionals on
lifestyle advice to cancer survivors Health professional-centred barriers to provision of
lifestyle advice were a lack of knowledge on healthy lifestyle guidelines the feeling that
14 Webber L Divajeva D Marsh T McPherson K Brown M Galea G et al The future burden of obesity-related
diseases in the 53 WHO European-Region countries and the impact of effective interventions A modelling study BMJ Open 2014
15 Centre for Disease Control and Prevention (2020) Coronavirus disease 2019 Groups at higher risk for severe illness httpswwwcdcgovcoronavirus2019-ncovneed-extra-precautionsgroups-at-higher-riskhtml
16 Drummond P Ekins P Grubb M Lott MSEng M Byass P Nilsson M et al The Lancet Commissions Institute for Sustainable Resources (P Health and climate change policy responses to protect public health thelancetcom 2015
17 Catapano AL et al (2007) Averting a pandemic health crisis in Europeby 2020 what physicians need to know regarding cholesterol management httpswwwncbinlmnihgovpubmed17446817
18 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
19 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20 European20General20Practicepdf
20 httpswwwncbinlmnihgovpmcarticlesPMC4561845pdf101177_1559827615580307pdf 21 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the
European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
13
they were not the right person to provide advice and lack of time and resources22
Additional barriers mentioned in the World Book of Family Medicine ndash European Edition
2015 are perceived as lack of time or competing work load insufficient reimbursement
doubts about patientsrsquo acceptance and willingness to receive lifestyle counselling low self-
efficacy insufficient skills and training doubts about effectiveness of interventions and
health promotion perceived as outside professional role2324 Therefore while most health
professionals seem to acknowledge the need for lifestyle advice there seems to be a
mismatch between roles competencies training and possibilities among health
professionals and action25 Factors causing this mismatch differ from individual and
organizational context wherefore strategies to address these barriers will also vary26
These findings underline the need for developing and strengthening lifestyle medicine in
health professionalsrsquo education27 defined as lsquothe integration of lifestyle practices into the
modern practice of medicine both to lower the risk factors for chronic disease andor if
disease already present serve as an adjunct in its therapy Lifestyle medicine brings
together sound scientific evidence in diverse health-related fields to assist the clinician in
the process of not only treating disease but also promoting good healthrsquo28 Hence lifestyle
medicine covers the systematised approach for prevention and management of chronic
disease addressing eg diet physical activity behaviour change stress and coping and
tobaccosubstance abuse29 Health professionals need to learn how to overcome the
identified barriers mentioned above30 and how to effectively and efficiently counsel their
patients towards adopting and sustaining healthier behaviours31
Moreover digitalization is changing the scenery for lifestyle medicine and chronic disease
management Patient engagement can be enhanced with applications self-monitoring or
self-management tools To successfully embed these new forms of care professionals must
develop new skills32 However studies have shown that medical students are not formally
trained in major concepts known to influence health33 Philips et al (2014) states that
including lifestyle medicine in undergraduate medical curricula would have important public
health implications by efficiently promoting the prevention and treatment of NCDs34 A
study by Dacey et al (2012) states that face-to-face continuing medical education formats
22 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 23 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20
European20General20Practicepdf 24 Geense WW van de Glind IM Visscher TL van Achterberg T Barriers facilitators and attitudes influencing
health promotion activities in general practice an explorative pilot study BMC-family practice 2013 1420 25 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 26
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
27 Polak R et al (2015) Lifestyle Medicine Education httpswwwncbinlmnihgov pmcarticles PMC4561845
28 Rippe JM (2019) Lifestyle Medicine Third Edition CRC Press 29 Kushner RF and Webb Sorensen K (2013) Lifestyle medicine the future of chronic disease management
Obesity and nutrition 201320 30 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 31 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) The impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 32 Eg Richard A A amp Shea K (2011) Delineation of Self-Care and Associated Concepts Journal of Nursing
Scholarship 43(3) no-no httpdoiorg101111j1547-5069201101404x 33 httpscdnymawscomwwwacpmorgresourceresmgrlifestylemedicine-filesajpm-lmcommentarypdf 34 Philips E Pojednic R Polak R Bush J amp Trilk J (2014) including lifestyle medicine in undergraduate
medical curricula Medical education online
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
14
have a positive impact on physician behaviour toward health promotion and disease
prevention by increasing their knowledge confidence and practices that help patients to
adopt healthy behaviours35 Similar results can be expected among other health
professionals as well
The World Book of Family Medicine ndash European Edition 2015 states that the shared aim to
integrate health promotion disease prevention and lifestyle medicine has not been fully
achieved Future activities as to how lifestyle interventions can be better integrated need
collaborative approaches36 As a starting point for more collaborative action this study
seeks to provide a mapping of the current situation on health professionals training in health
promotion in the EU
11 Research questions
To that end this study seeks to answers to the following research questions
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and continuous
professional education
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
35 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) the impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 36
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
15
2 THEORETICAL BACKGROUND
21 Societal needs for health promotion and disease prevention
Classically public health targets at activity levels can be described in operational models
like Friedenacutes pyramid model37 It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of
health like socioeconomic status6 We use this model as a substructure in looking into
health professionalsrsquo education as they contribute to public health in these levels (Figure
21) Society needs to evaluate cost-effectiveness of public health efforts and find a balance
between the levels of actions at each level We use this framework to enable us to present
the needs of societies in general for different health professionals and their roles and
competencies in public health
Figure 21 Frieden Pyramid of health impact of health professional activities at the different levels of society (T Frieden 2010 CDC)
Healthcare services can contribute in mitigating the burden of disease by socioeconomic
disadvantages Health professionals have a key role in developing health services so their
competency to take account of differences in abilities of people to benefit from health
services is vital But more is needed Traditionally health professionals have been managing
the individual risk factors and provision of services That is not enough For example in
cardiovascular diseases the ldquoperfect treatment approachrdquo fails to prevent almost half of the
disease burden37 In cancer diseases individual health behaviours like smoking contribute
in more direct manner Therefore we need to develop educational systems that support
health professionals to take part in new public health approaches by planning interventions
that change the environmental context to make healthy options the default choice
37 Frieden TR A framework for public health action The health impact pyramid American Journal of Public
Health 2010
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
16
regardless of education income service provision or other societal factors37 These are
equally needed in out-of-health contexts like climate change where socio-economic
inequalities and (health) behavioural choices are among major drivers of climate changes38
Policies can influence environments to support healthier choices and we need health
professionals in policy development and execution Still health behaviour changes happen
at the individual level We need more efficient skills in personalized health coaching of
individuals to increase the cost-effectiveness of treatment of NCDs39 An ageing population
and increasing rates of chronic disease as well as advances in medical science and health
information technology to make care safer and more efficient require a rethinking of how
care is delivered Digitalization of services will challenge healthcare professionals and
collaborative care models have become more common40 Instead of requiring compliance
from patients patient-centred approaches are required from professionals This means that
clinical interventions need to be complemented by counselling and education to achieve
long-lasting protective measures Health coaching is aiming to empower patients in co-
management of their disease41 and emphasize and support patientsrsquo autonomy instead of
merely compliance It is based on shared decision-making and collaborative goal setting
facilitated by motivational interviewing42 Health coaching is already happening in digital
environments This paradigm shift requires new skills and attitudes from health
professionals too
New approaches to public health on societal level the paradigm shift to health coaching on
patient level and new forms of healthcare delivery pose a big challenge to the educational
system of health professionals It needs to prepare new professionals and train health
professionals already working in the healthcare system to master a wider scope of
knowledge and develop new skills and attitudes to implement these new approaches in a
safe effective and efficient way
22 Health profession competencies
Healthcare service is a complex and interconnected network of professionals There are
common professional competencies needed in health care and health promotion
(communication collaboration) but they are applied to meet the learning aims of each
profession or level of education If we want to increase the implementation of lifestyle
counselling or systemwide changes we need to evaluate knowledge skills and attitudes
required for the changes and to define the competencies needed to support this change
Professional competencies sum the elements of abilities (knowledge skills attitudes and
behaviours) that enable a professional to accomplish the activities described in a task
statement that outlines what the professional is expected to do43
38 Watts Nick Amann Markus Arnell Nigel et al (66 more authors) (2019) Report of The Lancet Countdown
on Health and Climate Change The Lancet ISSN 0140-6736 httpsdoiorg101016S0140-6736(19)32596-6)
39 Hale R Giese J Cost-Effectiveness of Health Coaching Prof Case Manag 2017 40 Falconer E Kho D Docherty JP Use of technology for care coordination initiatives for patients with mental
health issues A systematic literature review Neuropsychiatric Disease and Treatment 2018 41 Hayes E McCahon C Panahi MR Hamre T Pohlman K Alliance not compliance Coaching strategies to
improve type 2 diabetes outcomes J Am Acad Nurse Pract 2008 42 Olsen JM Health Coaching A Concept Analysis Nurs Forum 2014 43 Kraiger etal 1993 Application of cognitive skill-based and affective theories of learning outcomes to new
methods of training evaluation
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
17
Learning Outcome Typology by Kraiger is a widely used descriptive model for setting targets
and learning outcomes in education43 It comprises cognitive (knowledge) psychomotor
(skill-based) affective and behavioural (attitudes) components This classification scheme
for learning outcomes is based on Bloomrsquos work (1956) of three learning domains including
cognitive domain the affective domain and psychomotor44 45Knowledge can be factual and
declarative knowledge information and concepts or processes and organizations or
metacognitive strategies like allocation and regulation of professional performance Skills
include simple routine development and procedures needed at work and more complex
skills needed for the ability to monitor the performance along other tasks Attitudes are
linked with professionalsrsquo perceptions on learning self-efficacy at work perception about
ability to perform and ability to goal setting It has domains on professionalism Knowledge
can be obtained in reading or e-Learning modules skills require active teaching methods
and attitudes develop over time Behaviours then are complex situations where knowledge
skills and attitudes are utilised in professional manners In education planning outcomes
are defined by these elements
Competency frameworks are an effective method for achieving outcome-based education46
They provide a tool for capturing the elements and abilities (knowledge skills attitudes
and behaviours) needed in effective and safe patient work47They can serve in evaluating
the components of different specialities or societal needs like in this report public health
needs Competencies define an acceptable and feasible description of professional
behaviours used in relation to health promotion Competency building is at the basis in
developing similar programmes in the US4849 Meaningful assessment of competencies
developed is critical for the implementation of effective competency-based medical
education (CBME)50
The International Union for Health Promotion and Education (IUHPE) published an
extensive list of core competencies and professional standards for health promotion in
201651 It defines acuteHealth Promotion actionrsquo in the context of these competencies and
standards to describe programmes policies and other organised Health Promotion
interventions that are empowering participatory holistic inter-sectoral equitable
sustainable and multi-strategy in nature and aim to improve health and reduce health
inequities51
44 Bloom BS (1956) Taxonomy of educational objectives The classification of educational goals New York NY
Longmans Green 45 Cruz-Cunha MM (2012) Handbook of Research on Serious Games as Educational Business and Research Tools 46 Frank JR Danoff D The CanMEDS initiative Implementing an outcomes-based framework of physician
competencies Med Teach 200729(7)642ndash7 47 Cooke M Irby DM Sullivan W Ludmerer KM Medical education American medical education 100 years after
the flexner report N Engl J Med [Internet] 2006355(13)1339-1344+1306 Available from httpwww
scopuscominwardrecordurleid=2-s20-33749062559amppartnerID=40ampmd5=d949feb 758c984c732a419 cada174c85
48 Alaranta A Alaranta H Patja K Palmu P Praumlttaumllauml R Martelin T et alSnuff use and smoking in Finnish Olympic athletes Int J Sports Med 200627(7)
49 Van Horn L Lenders CM Pratt CA Beech B Carney PA Dietz W et al Advancing Nutrition Education Training and Research for Medical Students Residents Fellows Attending Physicians and Other Clinicians Building Competencies and Interdisciplinary Coordination Adv Nutr 2019
50 Lockyer J Carraccio C Chan MK Hart D Smee S Touchie C et al Core principles of assessment in competency-based medical education Med Teach 201739(6)609ndash16
51 IUHPE (2016) Core competencies and professional standards for health promotion full version httpwwwukphrorgwp-contentuploads201702Core_Competencies_Standards_linkEpdf )
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
18
We present CanMEDS as an example of a framework that includes content-specific
competencies (Table 21) CanMEDS was developed for medical experts but most
competencies are applicable to all health professionals
Table 21 CanMEDS in short form52 original version53
Competency Short description
Medical Expert Apply clinical skills and knowledge of the biomedical sciences to fulfil your scope of practice
Collaborate with patients and families for patient-centred care and management
Contribute to health care quality and patient safety
Communicator Build rapport and empathy in all interactions with patients and include families (with the patientrsquos consent)
Understand the patientrsquos perspectives expectations and socio-economic issues
Use active listening patient-centred interviewing skills and culturally safe communication
Share information in plain language to promote patientsrsquo understanding
Clearly document and share information with patients and others on the care team
Collaborator Collaborate by sharing knowledge and perspectives sharing responsibilities learning together
Collaborate in care education advocacy administration and scholarship
Leader Take responsibility for the ongoing operation evolution and continuous
improvement of the healthcare system
Expand beyond a clinical or technical role to take on administrative teaching and scholarly roles and responsibilities
Exercise efficient use of resources to achieve cost-effective care
Contribute to improvements in personal practice team organization and system
Health Advocate
Understand and address the determinants of health that affect patients and support patients to navigate through the health care system
Collaborate with communities and populations to influence change in the health
care system
Contribute to health promotion and disease prevention Understand determinants and needs speak on behalf of others increase awareness
Scholar Plan for and engage in life-long learning
Teach others
Evaluate and apply evidence to day-to-day practice
Contribute to research including creation dissemination and translation into
practice
Professional Commit to patients society profession and ldquoselfrdquo Patients ndash maintain clinical competency and adhere to ethical standard Society ndash demonstrate social accountability by responding to societal needs and
expectations Profession ndash peer assessment mentorship supporting others setting standards Self ndash participate in self-assessment and reflection build self-awareness and manage own well-being
52 Michener Institute No Title CanMEDS framework in short [Internet] Available from httpsmichenercawp-
contentuploads201805CanMEDS-Framework-Summarypdf 53 Frank JR Snell L Sherbino J E CanMEDs 2015 Physician Competency Framework [Internet] CanMEDS 2015
Physician Competency Framework Ottawa Royal College of Physicians and Surgeons of Canada 2015 p 1ndash30 Available from httpwwwroyalcollegecaportalpageportalrccanmedsresourcespublications
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
19
23 Educational systems for health professions in Europe
According to the EU Treaty European citizens have a virtue of rights of free movement as
workers freedom of establishment and freedom of service providers54 Directives on the
requirements of professional qualifications in EU their recognition and Regulation55
facilitate the mobility of health personnel Each member state will apply this directive in
the national legislation on health professional qualifications There is a system of automatic
recognition based on harmonised minimum training requirements This system depends on
the timely notification of new or changed evidence of formal qualifications by MS and their
publication by the Commission Otherwise holders of such qualifications have no
guarantees that they can benefit from automatic recognition
The undergraduate education in Europe is coordinated through the Bologna Process which
is an intergovernmental cooperation of 48 European countries in the field of higher
education It guides the collective effort of public authorities universities teachers and
students together with stakeholder associations employers quality assurance agencies
international organizations and institutions including the EC to bring more coherence to
higher education systems across Europe56 Under the Bologna Process all 48 participating
European countries agreed to ensure mutual recognition of qualifications and learning
periods abroad completed at other universities Nonetheless it should be noted that across
Europe healthcare systems and educations may still significantly differ
While professional activity is regulated by national law in individual member states57
faculties and other academic institutions have collaborated in the establishment of a
framework of competencies based on the scientific advances and new methodologies in
education In fact EU Directives of the European Parliament and Council on the recognition
of professional qualifications have consolidated a system of mutual recognition between
MS58 Examples include the PHARMINE for pharmacists and MEDINE for medical doctors59
This collaboration is in line with the Bologna Process
24 Relevant educational settings for health promotion
Inclusion of health promotion and lifestyle medicine in undergraduate medical curricula is
expected to have important public health implications However in current medical
education this subject is minimal to nonexistent60 This is a global problem In 2016 the
American associations around NCDs launched a joint programme called lsquoThe Lifestyle
54 Treaty on the Functioning of the European Union (TFEU) Articles 45 49-62 55 European Parliament C of the EU Directive 200536EC on the recognition of professional qualifications and
Regulation [Internet] 2013 Available from httpseur-lexeuropaeulegal-
contentENALLuri=celex3A32013L0055 56 The Bologna process and the European Higher Education Area httpseceuropaeu education policies
higher-educationbologna-process-and-european-higher-education-area_en 57 UEMS (2017) Charter on training of medical specialists in the EU httpswwwuemseu
dataassetspdf_file001943561ETR-Psychiatry-201703pdf 58 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 59 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 60 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
20
Medicine Education Collaborativerdquo for improvement of health promotion education among
health professionals and in medical schools61 This initiative will a) work for high-quality
curricular material on an easily navigable website b) provide support for medical schools
to advocate for and implement lifestyle medicine curricula into their own institutions c)
aim to increase awareness and legislative initiatives that encourage adoption of lifestyle
medicine into medical school education d) develop and conduct assessment in the
following areas Student Health Student Knowledge and Programme Effectiveness and
e) train and support medical students as effective champions of lifestyle medicine whose
engagement with the curriculum lead to increased adoption within medical schools and
enhanced collaboration nationallyError Bookmark not defined This need has been acknowledged
in Europe as well62
Besides education in medical schools continuous professional development (CPD) is an
essential component in health education to ensure that professionals graduated in past
decades keep their competencies up to date and acquire new competencies needed for
health promotion disease prevention and lifestyle medicine It is important to encourage
further strengthening of CPD for those professions that benefit from automatic recognition
of their professional qualifications Member states should in particular encourage CPD for
physicians medical specialists general practitioners nurses responsible for general are
dental practitioners specialized dental practitioners veterinary surgeons midwives
pharmacists and architects63 Given the rapid developments in societal needs and
approaches towards health promotion and disease prevention and spectacular increase in
technological support facilities lifelong learning is imperative for health professionals and
should be oriented towards the competencies required to best serve their population and
society
Figure 22 Lifelong learning is an iterative process where learners build knowledge skills
attitudes and behaviours on top of their current professional competency
61 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019 62 European Lifestyle Medicine organisation httpswwweulmorg 63 Lim SS Vos T Flaxman AD Danaei G Shibuya K Adair-Rohani H et al A comparative risk assessment of
burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions 1990-2010 A systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
21
25 Theoretical framework for this study
In this study we touch upon the existing levels of health promotion disease prevention
and lifestyle medicine in health and educational settings in the EU and make a preliminary
assessment of its relevance
As right now health professional competencies seem more practical we approached the
mapping of competencies in health education through professions rather than with an
overall theoretical framework Thus we aim to create a general picture for different health
professions at different levels of education
For the assessment of relevance of the existing levels of health promotion in education we
aligned the competency framework of Kraiger with Friedenrsquos public health framework We
used three components64 of Kraigerrsquos Learning Typology
bull Knowledge cognitive and mental abilities
bull Skills psychomotor manual and physical abilities to perform tasks
bull Attitude (or self) perceptions growth in feelings or emotional areas
We used the integrated framework as an analytical tool to classify content areas covered
and their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future
This study is an important first step as we know little about present practices However
more detailed research will obviously be needed
64 Given the limitations of the study behaviour ndash the fourth component ndash is not included Behaviour refers to
practices to utilise knowledge skills and attitude in work environment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
22
3 METHODOLOGY
31 Mapping of health educational programmes in the EU
The first aim was to provide a general overview on how health professionals are trained in
health promotion and disease prevention and lifestyle medicine in the EU To that end we
conducted an online survey to map the educational programmes of health professionals in
the EU In addition to the proposed methodology we also conducted desk research to
create an overview of competency profiles of health professionals in the EU
311 Online survey
This study looks at undergraduate education postgraduate education and CPD courses in
all healthcare professions across the EU Within the EU different organisations are
responsible for the education of healthcare professionals
bull The undergraduate education programmes are organised by universities in each
country
bull The post-graduate education programmes are organised differently in each
country This includes a set of European organisations that run the guidelines
and portfolioacutes for each profession or specialty within this profession (like in
medicine)
bull CPD programmes are even more diverse between countries and can be accredited
both by European organisations and universities
Due to the wide scope of the study and the different levels of healthcare educational
programmes no country correspondents could be found with a full overview of educational
programmes addressing health promotion and disease prevention in their country
Therefore we chose for a snowball methodology to obtain information on all levels of health
professional education The snowball methodology consists of two steps First we identified
potential organisations in the EU to take part in the survey Second we asked those
organisations to recruit other organisations or stakeholders in their national andor
international network of colleagues and spread the survey among those This method
required more effort and time in the beginning but once the lsquoballrsquo was rolling it provided
us with a growing dataset including the perspectives from healthcare educators healthcare
professional associations and healthcare students and residents The snowball method
implies a risk of selection bias as educational institutions that have implemented health
promotion within their programmes ie the front-runners may have been more inclined
to respond than those who have not
In addition this recruitment process served as a communication and dissemination vehicle
and increased the engagement to the mapping Many organisations expressed their interest
to join the workshop as well as willingness to disseminate the results to their members and
collaborators Because of the growing interest we decided to extend the deadline after the
workshop organised on 13 February so attendees could spread the survey among their
national andor international networks
Our original workplan included an Excel worksheet to be sent to the national health
coordinators in each EU country but as we chose a different strategy it was necessary to
develop a more user-friendly and flexible method Therefore an online survey was
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
23
developed This enabled refinement of questions to each level of education with core sets
of questions Survey links proved to be easy to use and shared within educational facilities
or associations which led to higher response
In this section we discuss in more detail how the survey was developed and how relevant
international organisations were recruited
Development of an online survey
First we developed a mapping tool (stand-alone Excel document) to map the current
situation of professionals trained in health promotion This mapping tool was validated by
both Chafea and DG SANTE and by the external experts in the core research team After a
pilot phase an online survey was developed for all healthcare professions based on the
content of the mapping tool This was a necessary step to boost response as the online
survey proved to be more user-friendly and easier to share among educational facilities or
associations than the mapping tool in Excel
Among other topics the survey contained questions on the
bull Training programme for which the respondent is filling in the survey (which
(educational) institute and health profession portfolio etc)
bull Type of training programme (undergraduate education postgraduate education or
continues professionalrsquos development
bull Type of health professional targeted (eg GPrsquos physiotherapists etc)
bull Implementation in the curriculum
bull Description of the health promotion component in the programme (eg teaching
methods monodisciplinary approach or multidisciplinary approach expected
outcomes in knowledge skills and attitude)
bull Targeted funding
bull Accreditation
bull Partnerships
The questions in the survey correspond with the information requested in the Tender
Specifications Note that the survey maps the educational offer effectiveness of education
is outside the scope of this study The complete questionnaire used in the survey can be
found in Annex 3
Recruitment of relevant international organisations EU and national medical and
non-medical associations medical faculties national and international institutes
networks and organisations
As we used a snowball method it is not possible to provide the exact number of persons
who received the survey and response rates Instead we present each of the steps taken
to approach respondents and final response obtained
Recruitment of European associations
First we connected with major networks in the fields of graduate post-graduate and
continuous professional development for their support as these organisations have an
overview of the three levels of health professional education These associations represent
entire professions or part of the professions (like post-graduates) in all European countries
National professional organisations are members of these umbrella organisations For
example the Union of Medical Specialists (UEMS) represents 16 million medical specialists
It has 40 full member associations (Member States of the EU amp Member States of the
European Economic Area) associate member associations (Member States of the Council
of Europe) and observer member associations (other countries eg the United States)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
24
The UEMS represents more than 50 medical disciplines through various bodies
and structures The most important ones are the 43 Specialist Sections which represent
independently recognised specialties All health professionals health professional students
and post-graduates are organised in a similar manner These organisations are in a good
position to provide information and disseminate it across EU countries
Overall 24 EU associations were approached by email to spread the survey among their
networks (see Table 31 for a complete overview) We aimed to cover all professions within
the scope of this study ie physicians physiotherapists occupational therapists
psychologists nurses social workers dentists pharmacies dietitians throughout Europe
Therefore European associations with focus on educational programmes for these specific
professions were approached
Table 31 Approached European Associations
No European Associations
1 European Medical Association (EMANET)
2 The European Union of General Practitioners (UEMO)
3 European Union of medical specialists (UEMS)
4 European Medical Students Association EMSA)
5 European Forum of Medical associations (EFMA)
6 European Federation of Nurses Associations (EFN)
7 European Association of schools of social work
8 European Network of Physiotherapy in Higher Education
9 European Region ndash World Confederation of Physical Therapy (ER-WCPT)
10 European Network of Occupational Therapy in Higher Education (ENOTHE)
11 Council of Occupational therapists of European Countries (COTEC) part of the World
12 Federation of Occupational Therapists (WFOT)
13 Federation of National Psychologists Associations
14 European federation of nurse educators (FINE) association
15 Association for Dental Education in Europe
16 Council of European Dentists
17 Association for Medical Education in Europe (AMEE)
18 Pharmaceutical group of the European Union (PGEU)
19 European Pharmacists Forum (EPF)
20 European Association of faculties of pharmacy (EAFP)
21 European network of medical residents in Public health
22 The Association of Medical Schools Europe (AMSE)
23 The European Society of Preventive Medicine (ESPREV)
24 The European Lifestyle Medicine Organisation (ELMO)
Recruitment of national associations
Second national health associations for all Member States and all professions were
approached to fill in the survey This step was crucial to increase the response National
health associations were selected using the member list of European organisations Table
32 shows the European organisations used to identify national health associations that
were invited to participate in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
25
Table 32 Examples of the approached national associations
Profession European Association Examples of approached national associations (1 out of 28)
Medical doctors Standing committee of European Doctors (CPME)
Czech Medical Chamber
Physiotherapists World confederation for physical therapy (WCPT)
Swedish Association of Physiotherapists
Social workers International federation of
social workers
German professional
association for social work
Psychologists European Federation of psychologistsrsquo association (EFPA)
Croatian psychological association
Occupational therapists Council of occupational
therapists for the European Countries (COTEC)
Association of Bulgarian
Ergotherapists
Dietitians The European Federation of the associations of dieticians
(EFAD)
French Association of Nutritionist Dietitians
Dentists Council of European Dentists Irish dental association
Nurses European Federation of Nurses
Association (EFN)
Polish Nurse Association
Pharmacists Pharmaceutical group of European Union (PGEU)
Malta Chamber of Pharmacists
Recruitment of national educational organisations
Last the list of the selected associations was used to identify relevant national educational
organisations These national educational organisations (eg University of Maastricht
Faculty of Health Medicine and Life Sciences Kaunas University Medical School Lifestyle
Medicine University of Helsinki Faculty of Medicine) were approached individually and
asked to fill in the survey and spread it throughout their network
Table 33 Number of national educational organisations approached
Profession Number of approached national education organisations
Medical schools 298
Schools of physiotherapy 29
School of social work 31
School of dietitians 40
School of Occupational therapists 45
School of dentists 85
School of pharmacists 56
Response obtained
In total we received information on 176 educational practices till mid-February The
workshop organized in Luxembourg65 gave an additional boost and resulted in 32 more
practices reported in the survey In total this mapping exercise is based on information on
208 practices of health promotion in educational settings
65 Workshop ldquoPromoting lifestyle medicine competencies and education of health professionals in the EU todayrdquo
13th February 2020 Luxembourg Organized by Chafea and DG SANTE
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
26
312 Desk research
Desk research was conducted on both scientific and grey literature with the main purpose
to establish an overview of the competency profiles of health professionals in the field of
health promotion and disease prevention This overview was created to gain insight to what
extent competency profiles related to health promotion and disease prevention are covered
in the educational standards of different health professions in the EU We have made use
of reports published online and scientific articles on competency profiles or educational
standards set at EU level (eg European standards in medical training (UEMS) as the EU
Directives of the European Parliament and Council on the recognition of professional
qualifications have consolidated a system of mutual recognition between Member States3
When reports on EU level could not be identified we selected articles on global standards
such as for the profession of social work (ie global standards for the education and training
of the social work profession)
Based on the identified literature we have described the competency profiles for each of
the following healthcare professions
bull (undergraduate) Medicine
bull Medical specialists
- sports medicine specialists
- public health specialists
- internists
- cardiologists
- psychiatrists
- general practitioners
bull Dentists
bull Nurses
bull Nurse specialists
bull Occupational therapists
bull Pharmacists
bull Physiotherapists
bull Psychologists
bull Social workers
The selection of healthcare professions included in the desk research was made in
consultation with Chafea DG SANTE and the experts
The assessment of the competency profiles was based on the three Domains of Learning
KSAs as described in Chapter 2
bull Cognitive mental skills (knowledge)
bull Psychomotor manual or physical skills (skills)
bull Affective growth in feelings or emotional areas (attitude or self)
This method was chosen as especially ldquolack of confidence and knowledge and skills by
health professionals on providing effective counsellingrdquo was identified as a barrier for
prescribing and counselling on promoting physical activity in the healthcare sector66 In
Chapter 4 the results are described in detail
66 httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
27
32 Long list of good practices
From the survey results we have drawn a long list of good practices As agreed with Chafea
and DG SANTE these good practices were selected using the following four selection criteria
bull The programme contains a multidisciplinary approach
bull The education is mandatory (including an exam)
bull The education covers the following topics digitalisation in health eHealth and
digital health coaching
bull The expected outcome includes change in skills and or behaviour
Several variables were included in the longlist country name of the programme name of
the institute whether there is a focus on knowledge skills and behaviour the type of
professionals who are being trained the theories that are covered by the education (eg
human cognition and behaviour health behaviour change techniques communication skills
etc) education methods used year since the education is provided the time spend in the
modules in hours and lastly in case of one full module the duration of this module To
enable comparison between good practices based on different variables the preliminary
longlist can be found in a separate Excel document Chapter 5 includes an overview of the
coverage and content of the long list of good practices
After closing of the online survey we analysed the longlist of good practices along the
following research questions
bull What content items of health promotion disease prevention and lifestyle
counseling do programmes consist of
bull What kinds of learning aims do they have
bull How do they distribute in Friedens model of levels of health promotion
bull Are there differences between professional groups
First we analysed the distribution of the learning skills separately by the levels of education
(undergraduate postgraduate and CPD) We expected that adult learning will be more
directed towards skills (learning by doing) than the undergraduate and postgraduate
programmes Secondly we analysed the educational methods and tools used in the good
practices
Good practices can be submitted to the European Commissionrsquos Best Practice Portal to be
assessed by external evaluators against criteria adopted by the Steering Group on Health
Promotion Disease Prevention and Management of NCDs Practices rated as best against
these criteria will be published on the European Commissionrsquos Best Practice Portal67
67 httpswebgateeceuropaeudynabp-portal
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
28
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
29
4 MAPPING OF THE CURRENT SITUATION IN HEALTH PROMOTION TRAINING IN THE EU
41 Overview of educational programmes in the EU
411 Summary of the main findings in the survey
A high percentage (93) of respondents (n=197) indicated that health promotion and
disease prevention are implemented in their educational programmes or modules For
undergraduate education postgraduate education and CPD these percentages were 95
93 and 83 respectively Other results include
bull More than half of the respondents indicated that they filled in the questionnaire
based on undergraduate educational settings Throughout Europe these numbers
were relatively similar
bull Physiotherapists seem to be the professional group most actively involved in
health promotion training activities The vast majority applies multidisciplinary
approaches and thus bring other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within the undergraduate and postgraduate programmes In CPD on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion target knowledge skills and
attitudes of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for CPD (33) compared to
undergraduate and postgraduate education (15 and 6) when the topic is
covered in most modules Funding was more often obtained in Northern and
Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) With regard to full modules high percentages
indicated that these are mandatory and that there is an exam at the end of the
module (81 70 respectively)
412 Detailed results of the survey
Respondents
In the following section we provide a detailed description of the survey results The survey
targeted undergraduate education postgraduate education and CPD programmes in all
Member States Overall 208 respondents filled in the questionnaire about their educational
practice Note the results presented in the remainder of this report are exclusively based
on the answers respondents provided in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
30
Table 41 and Figure 41 provide an overview of the number of practices reported per
European countries A detailed overview of the educational programmes collected
throughout Europe can be found in Annex 1
Figure 41 Practices collected in the survey by European countries (n=208)
Table 41 Number of respondents per European Member State 2019-2020 (n=208)
Abbreviations EU Member State Number of respondents
AT Austria 12
BE Belgium 23
BG Bulgaria 4
CY Cyprus 1
CZ Czech Republic 7
DE Germany 1
DK Denmark 8
EE Estonia 2
ES Spain 22
FI Finland 6
FR France 15
GB United Kingdom 6
GR Greece 10
HR Croatia 0
HU Hungary 3
IE Ireland 8
IT Italy 10
LT Lithuania 1
LU Luxembourg 0
LV Latvia 5
MT Malta 6
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
31
Abbreviations EU Member State Number of respondents
NL Netherlands 2
PO Poland 0
PT Portugal 14
RO Romania 3
SE Sweden 4
SI Slovenia 14
SK Slovakia 2
Additional countries 19
TOT 208 the UK is included as a Member State in this study as the results were obtained before Brexit
For mapping purposes we made a breakdown of results by region ie Northern Europe
Eastern Southern and Western Europe (based on United Nations Regional Groups)
Furthermore we compare results of individual countries for which at least 10 practices have
been reported in the survey These are Austria Belgium France Greece Italy Portugal
Slovenia and Spain
Table 42 European countries per region
Region European countries
West Austria Belgium France Ireland Germany
Luxembourg Netherlands United Kingdom Switzerland
North Denmark Sweden Estonia Finland Lithuania Latvia Norway
East Bulgaria Czech Republic Hungary Romania Slovakia Poland Georgia Kazakhstan
South Italy Spain Cyprus Portugal Greece Malta Slovenia Croatia Bosnia Kosovo Serbia
Type of education
We asked the respondents to indicate the type of educational setting As shown in Figure
42 more than half of the practices (60) refer to undergraduate educational settings and
approximately one third to postgraduate educational settings Only twelve percent of the
reported educational settings is related to CPD
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
32
Figure 42 Practices by educational level (n=199 in percentages)
Figure 43 and Figure 44 show the distribution in type of education per region and on
country level respectively For Western Southern and Northern Europe distribution is in
line with the overall results In Eastern Europe practices reported are more evenly
distributed over undergraduate and postgraduate education Also the share of CPD
practices is high in comparison with other regions and overall results
Figure 43 Practices by type of education per region (n=204 in percentages)
64
42
62
60
29
37
27
30
7
21
12
10
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Undergraduate education Postgraduate education Continuous professional development
60
29
12
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
33
Figure 44 Practices by type of education per country (in percentages)
Type of health professions
An overview of the type of health professional trained in the educational practices is
provided in figure 45 Remarkably over one third (35) of the educational practices
reported are oriented to physical therapists Note that multiple answers could be provided
Figure 45 Type of health professional being trained (n=208 in percentages)
Medical specialists refer to doctors with an extra expertise in one type of medicine eg including sports
medicine public health internal medicine cardiology psychiatry and the general practitioner68 General
practitioners refers to doctors working within General Practice or Family Medicine (GPFM)69 Medical doctors refers
to doctors without any specialization
68 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 69 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
83
70
27
50
30
62
71
71
8
22
60
30
60
23
14
19
8
9
13
20
10
15
14
10
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Undergraduate education Postgraduate education Continuous professional development
116
15
35
1417
7 8 5
29
0
10
20
30
40
50
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
34
Health professionals involved as educators in health promotion and disease prevention are
shown in Figure 46 Physical therapists are most often active as teachers of health
promotion (36) which coincides with the high share of practices oriented to this
profession Some professions like medical specialists nurses and psychologists are
represented more often as teacher then as trainee of the educational practices This implies
they are involved in programmes oriented towards other health professions and is in line
with a multidisciplinary approach that is applied by the vast majority of practices ( 81
n=148)
Figure 46 Health professionals teaching contents of health promotion (n=90 in
percentages)
Methods of education
Survey results show that traditional methods ie lectures and assignments are most often
used (Figure 47) Assignment refers to home school projects such as writing papers In
CPD eLearning methods are more often used (67) compared to undergraduate (45)
and post graduate education (39) The use of field training is relatively similar for the
different levels of education
Figure 47 Teaching methods applied (n=145 in percentages)
8
27 26
36
14
24 23
6 7
37
0
10
20
30
40
50
97
81
74
46
0 10 20 30 40 50 60 70 80 90 100
Lectures
Assignments
Field training in real environments
eLearning modules
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
35
Knowledge skills and behaviour
As for the outcome of the education respectively 99 94 and 89 of all practices
indicate knowledge skills and behaviour as expected outcomes (Figure 48) There are no
significant differences between types of education
Figure 48 Knowledge skills and behaviour (n=142 in percentages)
Accreditation
Overall 39 of the educational practices is accredited on European or international level
53 is accredited at a national level and only 5 lacks accreditation (n=179) Comparing
the different levels of education the rate of accreditation at a European or nation level
varies At a European level these are 46 33 22 at the national level 47 58
67 for undergraduate education postgraduate education and CPD respectively
Throughout Europe the level of accreditation of education is high in Northern Eastern
Southern and Western countries the share of practices without accreditation is 11 0
5 and 3 respectively (n=197) Eastern European countries have regulated their
accreditation more often on a national level compared to the other countries
Theories covered
Figure 49 shows that health behaviour human cognition and behaviour and population
health are covered in most educational practices to a high or at least limited extent
99
0 1
94
4 2
89
6 4
0
20
40
60
80
100
Yes No Unknown Yes No Unknown Yes No Unknown
Knowledge Skills Behavior
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
36
Figure 49 Theories covered by the education (n=137 (in percentages)
Figure 410 provides a more detailed overview of contents covered in the educational
programmes and shows that communications skills ethics and methods of evidence-based
medicine are mostly covered within the education Contents least covered are digital health
coaching digitalisation health economics
Funding and partnerships
Figure 411 provides an overview of the practices that a) obtained targeted funding to
incorporate health promotion and disease prevention in the curriculum b) for which a
partnership is set up for execution of teaching activities on health promotion or c) built on
existing partnerships to incorporate health promotion in the curriculum of the whole
educational programme This overview only includes educational practices where health
promotion and disease is incorporated in most modules
Funding differed between level of education 15 6 and 33 of the undergraduate
education postgraduate education and CPD received targeted funding to incorporate health
promotion in the curriculum Hence funding seems to play a more important role for CPD
than for undergraduate and postgraduate education
66
54
65
31
42
32
1
1
2
3
1
0 20 40 60 80 100
Population health
Human cognition and behavior
Health behaviour
Yes very much Yes but limited No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
37
Figure 410 Theories that are included within education on health promotion (n=137 in percentages)
Figure 411 Funding and partnerships when health promotion is covered in most modules of the educational programme (n=123 in percentages)
Figure 412 provides a comparison of funding obtained by European region Remarkably
in Western Europe the share of practices with targeted funding to incorporate health
promotion is much lower than in the other EU regions
48
69
40
16
54
48
20
34
37
41
49
64
9
44
24
55
51
42
47
50
50
48
44
42
31
43
7
6
4
4
3
4
25
25
9
9
5
2
42
1
1
1
1
1
1
5
5
5
6
4
3
6
0 20 40 60 80 100
Epidemiology and bio-statistics (research capacity)
Methods of evidence-based medicine
Health policies and regulation
Health economics
Ethics
Health care systems
Digitalisation in health promotion
Health inequalities
Disease prevention in teams
Health literacy
Health behavior change techniques
Communication skills
Digital health coaching
Yes very much Yes but limited No Unknown
52
61
15
0 20 40 60 80 100
Partnerships in incorporating it in the curriculum of thewhole educational programme
Partnerships for execution of teaching activities
Funding to incorporate health promotion in curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
38
Figure 412 Funding to incorporate health promotion for programmes covering health promotion in most modules by region (n=119 in percentages)
Comparing individual countries figure 413 shows that funding is obtained for the
educational programmes reported in Slovenia Italy and France while this is not the case
or unknown in Portugal Belgium and Austria
Figure 413 Funding to incorporate health promotion when health promotion is covered in
most modules of the educational programme by country (n=71 in percentages)
Dedicated modules to health promotion
In a majority of practices (63) health promotion disease prevention and lifestyle
medicine are covered in all modules of the educational programme as opposed to coverage
in one module primarily dedicated to health promotion (37) Undergraduate and
postgraduate education show a similar pattern while in CPD programmes full modules
primarily dedicated to health promotion are relatively restricted namely 15 (Figure 414)
Both options have the potential to be effective depending on context implementation and
other factors The data gathered in this study do not allow any statement on effectiveness
of each option
20
12
21
3
80
82
70
85
6
9
13
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Yes No Unknown
13
29
0
9
30
89
100
38
71
40
100
73
70
11
50
18
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Yes No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
39
Figure 414 Share of practices with one full module primarily dedicated to health promotion
(n=140 in percentages)
Visibility of health promotion in CPD
In CPD health promotion is often integrated into disease-oriented or risk behaviour-
based contents making it harder to identify the subject in events available The
Union of European Medical Specialists (UEMS) has an electronic database for
accrediting continuous medical education This data set contains keywords Using
health promotion public health or lifestyle as keywords 37 educational events were
found in the years 2017-19 (Table 415) There were 6 events in year 2017 3 in
year 2018 and 8 in year 2019 Average number of credits (1 ECMEC equals 1 hour
maximum 6 per day) was 296 average length of events 45 days This illustrates
availability of international training on health promotion and public health for
medical professions In other events these themes may have been touched upon
as well but are not the main subject So there might be a need to make health
promotion more visible in CPD events Competency-based education could provide
a solution if health promotion disease prevention and lifestyle medicine are defined
as competencies
Table 415 CPD events with health promotion public health or lifestyle as keyword 2017-
2019 (n=37)70
Title ECMEC Year Location Website
Control of multidrug-
resistant micro-organisms in health care settings
20 2017 Stockholm
Sweden
httpwwwecdceuropaeu
Epidemiology and public health microbiology for facilitators
30 2017 Spetses Greece
httpwwwecdceuropaeu
Fellowship (EPIET amp EUPHEM) introductory course
86 2017 Spetses Greece
httpwwwecdceuropaeu
International Society for Quality in Health Care 34th International Conference
23 2017 London United Kingdom
httpisquaorgEventslondon-2017
DOHaD 2017 10th World Congress DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE
25 2017 Rotterdam Netherlands
httpwwwdohad2017org
70 Source UEMS database of accredited events 2017-2019
4035
150
20
40
60
80
100
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
40
Title ECMEC Year Location Website
10th European Public Health Conference
23 2017 Stockholm Sweden
httpsephconferenceeu
Methods and tools for evidence-based practice
and decision-making in Public Health with special emphasis on communicable disease
22 2018 Stockholm Sweden
httpwwwecdceuropaeu
ESCMID Workshop on
Migrants Health
15 2018 Muscat
Oman
httpsescmidpulselinksco
mevent14833
Control of multidrug-resistant micro-organisms in health care settings
17 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventscourse-control-multidrug-resistant-micro-organisms-mdros-health-
care-settings
ECDC Summer School 2018 23 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventsecdc-summer-school-2018
3rd International Conference of the European Network for Smoking and Tobacco Prevention
15 2018 Madrid Spain
httpsenspconferenceorg
European Observatory Venice Summer School 2018
25 2018 San Servolo Italy
wwwtheobservatorysummerschoolorg
Letrsquos talk about nutrition (NESG)
4 2018 Madrid Spain
httpespencongresscomprogrammelll-courses
Epidemiology and public health microbiology for
facilitators
28 2018 Spetses Greece
httpsecdceuropaeuenepiet-euphemaboutintro
International Society for
Quality in Health Care 35th International Conference
22 2018 Kuala
Lumpur Malaysia
httpsisquaorgEventsmal
aysia-2018
Fellowship (EPIET amp EUPHEM) introductory course
93 2018 Spetses Greece
wwwecdceuropaeu
EGEA 2018 ndash ldquoNutrition and health from science to practicerdquo
16 2018 Lyon France httpswwwegeaconferencecom
1st EUROPEAN LIFESTYLE MEDICINE CONGRESS
13 2018 Geneva Switzerland
wwwelmocongresscom
11th European Public Health Conference
24 2018 Ljubljana Slovenia
wwwephconferenceeu
Fellowship Multivariable
Analysis
25 2019 Madrid
Spain
Rapid Assessment and Survey methods (RAS)
module
35 2019 Zagreb Croatia
ECDC Summer School 2019 28 2019 Stockholm Sweden
httpswwwecdceuropaeuennews-eventsecdc-summer-school-2019
Fellowship Vaccinology Module
29 2019 Rome Italy
Programme Planning and Implementationrdquo Training Program for Resolve to
Prevent Epidemics Initiative
39 2019 Butaro Rwanda
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
41
Title ECMEC Year Location Website
Skill-mix innovation in primary and chronic care mobilizing the health workforce
28 2019 Venice Italy wwwtheobservatorysummerschoolorg
Evolutionary Medicine Conference 2019 5th international meeting of the International Society for Evolution Medicine and Public Health
15 2019 Zurich Switzerland
httpsisemphorg2019-Meeting
Fellowship (EPIET amp EUPHEM) introductory course
85 2019 Spetses Greece
Project Management for Emergency Preparedness Budget and Finance Management
20 2019 Butaro Rwanda
Autumn School on Medical
Education
19 2019 Chernivtsi
Ukraine
httpswwwfacebookcome
vents531981117209981
Project Management for Emergency Preparedness Practical Leadership Skills
24 2019 Butaro Rwanda
International Society for Quality in Health Care 36th International Conference Cape Town 20102019 - 23102019
18 2019 Cape Town South Africa
httpswwwisquaorgeventscp2019html
Public Health Genomics an
introduction
11 2019 Stockholm
Sweden
httpsecdceuropaeuenne
ws-eventspublic-health-genomics-introduction
ENSP Tobacco treatment
specialistsrsquo training
5 2019 Paris France httpenspnetwork
World Health Summit 2019 16 2019 Berlin Germany
wwwworldhealthsummitorg
Time Series Analysis 28 2019 Bilthoven
Netherlands
httpsecdceuropaeuenep
iet-euphemaboutexperience
12th European Public Health Conference
16 2019 Marseille France
wwwephconferenceeu
Outbreak Investigation Module
30 2019 Nicosia Cyprus
httpswwwecdceuropaeuenepiet-euphemaboutexperience
Source UEMS database of accredited events 2017-2019
Looking at the regional level we found that in most regions a majority of practices cover
the topic in all (or most) modules of the educational programme (Figure 416) In Northern
Europe this is most pronounced with as much as 76 of the practices reported covering
health promotion in all modules whereas in Eastern Europe this applies for 55 of
practices A similar analysis for individual countries shows that only in Spain health
promotion is covered in a dedicated module in the majority (62) of educational practices
reported while in all other countries the topic is mostly covered in all (or most) modules of
the programme Percentages vary from 56 (Austria) to 86 (Greece Figure 417)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
42
Figure 416 How is health promotion implemented in education by region (n=148 in percentages)
Figure 417 How is health promotion implemented in education by country (n=120 in
percentages)
55 participants answered specific questions on the full module dedicated to health
promotion 81 of them indicated that the education is mandatory As figure 418 shows
in Northern and Eastern Europe all dedicated module on health promotion form part of
mandatory education In Western Europe one out of three modules is optional for students
24
4537
42
76
5563
58
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
4439
36
14
22
38
18
6256
6164
86
78
63
82
38
0
20
40
60
80
100
Austria Belgium France Greece Italy Portugal Slovenia Spain
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
43
Figure 418 Full modules on health promotion that are part of mandatory education by region (n=47 in percentages)
An exam is taken at the end of the module in 70 of the cases Between regions
percentages do not differ much (Figure 419) Please note that results are based on a
limited number of practices as response for this question was low
Figure 419 Exam at the end of dedicated module by region (n=47 in percentages)
When asked whether the module on health promotion and disease prevention was
accredited separately 15 indicate that this is the case 30 report that the module is
provided at multiple locations
Figure 420 provides an overview of respondents who indicate that funding was obtained
to set up the module as well as the use of partnerships for implementation of teaching
activities on health promotion or in setting up the module Lastly it was indicated that
mostly lsquootherrsquo professionals are teaching these modules
100 100
82
67
12
22
611
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
Yes No Unknown
2518
2225
12 11
75 7571
67
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
No Unknown Yes
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
44
Figure 420 Funding and partnerships for dedicated modules (n=47 in percentages)
42 Overview of competency profiles of health professionals in the EU
A detailed description of the competency profiles per healthcare profession as obtained
from the desk research can be found in Annex 2 Competency profiles per professions
These profiles provide a solid basis for health promotion and disease prevention
Most competency profiles mention health promotion andor disease prevention Overall
the competencies of medical specialists are most comprehensively described including the
competencies for health promotion Although there are many similarities between the
different competency profiles we have identified differences in the coverage of domains of
learning ie knowledge skills and attitudes (see chapter 23) Knowledge refers to
cognitive or mental competencies skills to competencies to perform tasks or activities and
attitudes to competencies related to beliefs or values An example of an attitude
competency is ldquoexemplify appropriate lifestyle in personal behaviourrdquo In professions that
are less physically oriented emphasis is on knowledge and attitude rather than on skills
related to health promotiondisease prevention This mainly holds for psychiatry and social
workers For professions in which lifestyle is an essential component ie sports medicine
and public health emphasis is on skills rather than attitudesOnly for cardiology nurses
nurse specialists and pharmacists competency profiles describe competences in all
domains of learning ieknowledge skills and attitudes
Many competency profiles leave room for interpretation and competencies described are
not ranked in order of importance In addition profiles do not state whether competencies
should be practised in a pro-active (within every treatment) or reactive way (only when
treating diseases with a clear lifestyle component
43
53
11
0 20 40 60 80 100
Partnerships in setting up module
Partnerships for execution of teachingactivities
Funding to set up module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
45
5 LONG LIST OF GOOD PRACTICES
In this chapter we present the coverage and content of the long list of good practices The
list is also available in an Excel-file that provides the opportunity to easily make selections
by different variables such as country type of programme (undergraduate postgraduate
CPD) or the characteristics of the education programme
We also provide an analysis of content areas covered and their weight in educational
programmes learning objectives learning typology and educational methodology using
Kraigerrsquos typology and Friedenrsquos pyramid as analytical tools
51 Results
From the survey results we have drawn a long list of good practices In agreement with
Chafea and DG SANTE good practices were selected based on four criteria
1 The programme contains a multidisciplinary approach
2 The education is mandatory (including an exam)
3 The education covers the following topics digitalisation in health eHealth and digital
health coaching
4 The expected outcome includes change in skills andor behaviour
This resulted in a long list of 70 good practices that meet all criteria Educational practices
cover all regions of Europe and originate from 20 Member States (Figure 51 and Table
51)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
46
Figure 51 Number of good practices selected for long list by country 2019-2020
Table 51 Number of good practices selected based on the four selection criteria per European Member State 2019-2020
Abbreviations EU Member State Number of good
practices
AT Austria 6
BE Belgium 11
BG Bulgaria 2
CY Cyprus 1
CZ Czech Republic 2
DE Germany 0
DK Denmark 5
EE Estonia 1
ES Spain 7
FI Finland 2
FR France 6
GR Greece 7
HR Croatia 0
HU Hungary 1
IE Ireland 3
IT Italy 2
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
47
Abbreviations EU Member State Number of good practices
LT Lithuania 1
LU Luxembourg 0
LV Latvia 1
MT Malta 0
NL Netherlands 0
PO Poland 0
PT Portugal 2
RO Romania 1
SE Sweden 2
SI Slovenia 7
SK Slovakia 0
TOT 70
Of all selected good practices of healthcare educational programmes 16 practices (23)
cover health promotion and disease prevention in one full module primarily dedicated to
the subject In 54 good practices (77) the educational programmes incorporate the topic
of health promotion and disease prevention in all or most modules (Figure 52)
Figure 52 How is health promotion covered in selected good practices (n=70 in percentages)
When dividing good practices by type of education programme we see that all types
educational programmes are represented (Figure 53) The highest share of good practices
is focused on undergraduate education (60 n=42) Two practices are focused on both
undergraduate and postgraduate education
Figure 53 Type of education () represented by selected good practices (n=70)
77 23
All modules One module
6026
113
Undergraduate education
Post graduate education
Continuous professionaldevelopment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
48
Figure 54 presents the absolute number of selected good practices by type of profession
trained The absolute number sums up till 128 as multiple professions can be trained within
one programme This shows a good variation of health professionals Most good practices
focus on nurses (17 n=22) and medical doctors (13 n=17)
Figure 54 Good practices by profession being trained (n=70 in absolute numbers)
In addition to those described above other variables are included in the separate Excel file
mentioned above These include the name of the programme and the institute focus on
knowledge skills and behaviour type of professionals being trained theories covered in
the education (eg human cognition and behaviour health behaviour change techniques
communication skills etc) education methods used when the education started time
spent on the modules in study hours (ECDEC) and in case of one full module the duration
of this module This Excel file allows to make cross comparisons between different variables
52 Analysis of good practices
In this section good practices are analysed more in detail Figure 55 presents the
distribution of content areas in health promotion and their weight in educational
programmes Methodological training like evidence-based methods (EBM) varies in
programmes but has a strong position Lifestyle intervention skills are widely taught
however new technologies are still on their way in becoming part of health promotion
education Interestingly health economics rate less in these practices in spite of its close
link with health promotion as part of public health policies
30
4
4
11
17
15
15
22
10
Other
Social workers
Dentists
Occupational therapists
Medical doctors
Medical specialists
Psychologists
Nurses
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
49
Figure 55 Results for good practices(n=70) ldquoDoes the education of the initiative includerdquo
Numbers refer to Frieden model in levels of health promotion with exception of methodological contents marked
as tools (1) counselling and education (2) clinical interventions (4) changing the context to make individualrsquos
default decisions healthy (5) socioeconomic factors (6) methods in studying and evaluating health promotion
and public health
We used Friedenrsquos pyramid of levels of health promotion (Frieden 2010) and Kraigerrsquos
typology of learning (Kraiger et al 1993) to describe the abilities that professionals are
expected to acquire Based on their description learning objectives move in a knowledge
level skill building or into attitudinal objectives Figure 56 gives a graphical visualization
of the results of our analysis The dark blue green and light blue rectangles represent the
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
50
Figure 56 Learning objectives categorised into Friedenrsquos levels and learning typology
(knowledge skills attitudes) of good practices (n=70)
different domains of learning knowledge skills and attitudes The size of the rectangles is
proportional to their share in all domains in the educational practice
Within each domain of learning contents are categorized Their vertical order reflects the
order of impact levels of Frieden (from individual patient to society level) and again size
corresponds to share in the curriculums content
This analysis provides a general picture of educational practices in health promotion
disease prevention and lifestyle medicine The graph shows that practices are
predominantly oriented towards knowledge-based competencies (around 60 of the
curriculum) Roughly one third of the programme has skills-oriented learning objectives
while competencies regarding attitudes are addressed in around 10 percent of the
programmersquos content
Looking into knowledge-based competencies the broad spectrum of individual to societal
levels of impact is addressed On a societal level social and medical aspects are widely
represented while the economic angle is scarcely present Technological developments like
digitalisation are present to a modest extent
Skill-oriented learning objectives focus in communicative competences like communication
skills behaviour change techniques and teamwork Health coaching is covered in a small
number of practices Interestingly in methodological contents the aim of skills-oriented
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
51
education is to provide mainly knowledge like in EBM Few practices include practical skills
for communication and coaching in their objectives
Competence-building in the domain of attitudes form a minimal part of educational
practices They are reflected in eg health literacy and ethics However these are also
taught in a hidden curriculum as well
Educational methodologies in the survey include lectures assignments e-Learning and
real-world field assignments As these are the selected good practices it was to be expected
that multiple methods are used in most of these programmes (given selection criterium 3)
In 37 programmes all methods are in use E-Learning is used in 41 programmes
Figure 57 Educational methods used in good practices (n=70 in percentages) ()
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
53
6 CONCLUSIONS
The competency profiles as well as information on a large number of educational practices
in health promotion disease prevention and lifestyle medicine for health professionals in
the EU allow us to formulate answers to the research questions that guided this study
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and
continuous professional education
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades71there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional The educational practices collected show that this is true for all
regions of the EU However there is no overall body that has responsibility for quality
assuring standards of training and professional practice at the European level
The information on around 200 practices from 25 EU Member States (including UK) shows
that the majority of educational practices take place in undergraduate settings while
training events on health promotion for health professionals active in the field are relatively
scarce in continuous professional development (CPD) a limited number of practices on
health promotion are reported and indeed few courses or training events on health
promotion are available in the CPD calendar of the UEMS database of accredited events
Education on health promotion aims at developing competencies in knowledge skills and
attitude and most often has a multidisciplinary character Especially medical doctors nurses
and psychologists are often involved in educating other disciplines on health promotion
Health behaviour human cognition and behaviour as well as population health are part of
educational practices for all professions A majority also include communication skills
methods of EBM and ethics
The most common way to teach health professionals on health promotion disease
prevention and lifestyle medicine is the integration of the subject in most of all modules of
the curriculum Dedicated modules on health promotion are developed in undergraduate
and postgraduate education but are scarce in CPD This may contribute to the invisibility of
the subject in training for professionals active in the field
Four out of ten educational practices on health promotion are accredited on the European
(or international) level half of them have national accreditation
71 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
54
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Based on in-depth analysis of a selection of 70 good practices knowledge proves to be the
predominant domain of learning Theories covered relate to different levels of impact of
Friedenrsquos pyramid but emphasis is on the individual patient level with a predominant
position for evidence-based medicine Health economics receive remarkably little attention
This may be disadvantageous for advocacy of health promotion which requires influencing
decision-making on public funding
Around one third of educational contents are dedicated to competencies in the domain of
skills and mainly target communicative skills Interestingly they provide mainly knowledge
rather than practical training Competencies in the domain of attitude are addressed least
Ethics and health literacy are theories are the most common examples of attitude-oriented
contents When looking at the competencies defined by health professionals advocacy has
a solid role in all of them with defined skills It was represented in only few domains like
health economics so it may well be that educating advocacy skills are more common than
found in this study
Good practices use a mix of educational methods including lectures assignments real-
world practices and digital study methods
In conclusion this study is a first step in gaining knowledge and insights in the state of
affairs of health professionalsrsquo education in health promotion disease prevention and
lifestyle medicine in the EU It is an important step as we know little about present
practices However more detailed research will obviously be needed
The results of our in-depth analysis of good practices provide qualitative information We
used the integrated framework as an analytical tool to classify content areas covered and
their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future The information supplied by the
respondents show the culture of describing health promotion and education objectives
Therefore no lsquohardrsquo conclusions can be drawn However some cautious notions are
worthwhile to mention as they flag opportunities for learning and improving by collaborative
action
First it is worthwhile to stress the progress made While 20 years ago health professionals
were hardly trained in health promotion and lifestyle medicine and at best received some
instruction on specific disease-related unhealthy habits (like smoking for lung diseases) it
is now part of standard education for most health professionals That is an important
development and essential for collaboration across professions
However more can be done Health promotion education should respond to societyrsquos needs
and therefore educational needs are constantly changing and providers of education need
to follow needs in the field Increasing recognition of societal impact on health inequalities
the paradigm shift from treating to coaching patients changes in the way care is delivered
the digital revolution and the need to contain the cost of our healthcare systems represent
a multitude of challenges and relentless educational efforts in health promotion disease
prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
55
To name a few the balance between domains of learning in curricula will have to redefined
as in health coaching skills attitudes and knowledge are equally important Health
professionals will have to manage health economics to speak the language of policy makers
Teaching methodologies have gained from the technological revolution and there is
potential in utilising them even more Also there is a necessity to do so in order to provide
for effective health promotion Health literacy has got alongside data literacy Therefore
education needs to respond to in using more technologies as well as teaching adaptation of
technologies into care This is not common practice yet The constant development in needs
also stresses the need for continuous professional development in health promotion
disease prevention and lifestyle medicine To date CPD seems to be underrepresented in
educational practices on health promotion and more heavily dependent on external funding
than in undergraduate and postgraduate courses
The experience developed in the good practices collected in the survey represents a
valuable body of knowledge skills and attitudes among health educators With collaborative
efforts this can serve as an important capital to promote continuous development and
improvement of educational practices in health promotion disease prevention and lifestyle
medicine in all European countries
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
57
ANNEX 1 SURVEY RESULTS BY COUNTRY
In this annex we provide the names of all educational programmes by country filled in in
the survey In addition the following variables of the educational programmes are
provided the name of the educational institution type of education and type of health
professionals being trained This information is based on the information provided by the
respondents from each country If certain boxes are not filled in this means that only
partial information of this educational programme is provided
Austria
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Bachelorstudiengang Physiotherapie
FH JOANEUM GmbH Undergraduate education
Physical therapists
Dietetics Health University of
Applied Sciences
Undergraduate
education
Dieticians
Physiotherapy University of Applied Sciences St Polten
Undergraduate education
Physical therapists
Bachelorrsquos Degree Programme Physiotherapy
FH Campus Wien Undergraduate education
Physical therapists
Dietetics and Nutrition FH Joanneum Undergraduate education
Medical Doctors Non-specialized dietitians
Bachelor Programme Physiotherapy
University of Applied Sciences Upper Austria
Undergraduate education
Physical therapists
Degree Programme Dietetics
(Bachelor of Science)
University of Applied
Sciences Upper Austria
Undergraduate
education
Dietitians
Midwifes Speak and language therapists Biomedical scientists Radiological
technologists Physical therapists Occupational therapists Nurses
Bachelor in Health Studies
Physiotherapy
FH Kaernten Undergraduate
education
Physical therapists
Nursing Science Medical University of Graz
Postgraduate education
Nurses
Public Health Medical University of Vienna
Continuous professional development
Medical doctors
Belgium
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Drug Development KU Leuven Undergraduate education
Pharmacists
Bachelor and master Rehabilitation Sciences and
Physiotherapy
University of Antwerp Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
58
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Motor Sciences Physiotherapy
Universiteacute Libre de Bruxelles
Undergraduate education
Physical therapists
Nutrition amp Dietetics Thomas More University College
Undergraduate education
Dietitians
Adad Adad Undergraduate education
Physical therapists
Master Physiotherapy and
Rehabilitation Science
KU Leuven Postgraduate
education
Physical
therapists
Occupational therapist HE Vinci Parnasse ISEI Undergraduate education
Occupational therapists
Master in Physical therapy and Rehabilitation
Universiteacute Libre de Bruxelles
Postgraduate education
Physical therapists
Master in Physical therapy Universiteacute Libre de Bruxelles
Postgraduate education
Medical specialists Physical
therapists (Sport medicine)
Nutrition and dietetics Thomas More University College
Continuous professional
education
Medical doctors Dieticians
psychologists
Information not provided Information not provided
Undergraduate education
Pharmacists
The European Certificate in
Lifestyle Medicine
The European Lifestyle
medicine organisation (ELMO) together with the Belgian Lifestyle
Medicine Organisation (BELMO)
Continuous
professional education
Medical doctors
Medical specialists (lifestyle
medicine) Physical therapists
Occupational therapists Nurses Psychologists General practitioners
Nutrition and Dietetics Erasmus Hogeschool Brussels
Undergraduate education
Dieticians
Master in Nursing and Midwifery
University of Antwerp Postgraduate education
Nurses
Bachelor amp Master Rehabilitation Sciences amp
Physiotherapy
KU Leuven Undergraduate education
Physical therapists
Bachelor Nursing University of Applied
Sciences Gent HOGENT
Undergraduate
education
Nurses
Professional Bachelor in Nutrition and Dietetics
University colleges Leuven Limburg
Undergraduate education
Dieticians
Nutrition and Dietetics University College Ghent
Undergraduate education
Dieticians
Bachelor in Applied Health Science
Howest University College
Undergraduate education
Lifestyle coaches
Physiotherapist Universiteacute Libre de Bruxelles
Postgraduate education
Osteopathy Physical therapists
Bachelor in Medicine Hasselt University Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
59
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor of Nutrition and Dietetics
University of Applied Sciences of Gent
Undergraduate education
Dieticians
Bulgaria
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor programme in Social Work
Plovdiv University Department of Social work
Undergraduate education
Social workers
Rhinology Bulgarian Rhinologic
Society
Postgraduate
education
ENT doctors
Kinesitherapy Medical University Undergraduate education
Physical therapists
TRS rehabilitator Medical College Medical University
Continuous professional
education
Medical specialists
Cyprus
Name of educational
programme
Name of
educational
institution
Type of
education
Type of
health
professionals
being trained
Physiotherapy
programme
Nicosia University Undergraduate
education
Physical
therapists
Czech Republic
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy Universities Undergraduate education
Physical therapists
Physiotherapy Charles University first
faculty of Medicine
Undergraduate
education
Physical
therapists
Physiotherapy Faculty of Medicine Masaryk University Brno
Undergraduate education
Physical therapists
Physiotherapy Palackyacute University Faculty of Physical Culture Department of Physiotherapy
Postgraduate education
Physical therapists
General Nursing Masaryk University Undergraduate education
Nurses
Prakticky zubni lekar (Practical Dentist)
Czech Dental Chamber Continuous professional education
Medical specialists
Health Promotion Ministry of Health Czech Republic
Continuous professional education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
60
Denmark
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Musculoskeletal physiotherapy
Aalborg University Postgraduate education
Physical therapists
Master in Physiotherapy University of Southern Denmark
Postgraduate education
Physical therapists
The Fairstart Foundation The Fairstart Foundation
Continuous professional education
Orphanage staff (each orphanage has
professional staff such as psychologists social workers
andor therapists
These staff members are responsible to work with each child on an individual basis) School
teachers Psychologists Social workers
Bachelor in Physiotherapy University College North Denmark
Undergraduate education
Occupational therapists
Nurses
Bachelorrsquos degree Programme of Physiotherapy
VIA University college Postgraduate education
Physical therapists
Master of Public Health Aalborg University Undergraduate education
Midwives Nurses Therapists Psychologists Medical Specialists
Estonia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Nursing (general nursing) Tartu Health Care College
Undergraduate education
Nurses
Psychology University of Tarty Institute of Psychology
Undergraduate education
Psychologists
Finland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
NutritionNutrition therapy University of Eastern Finland
Postgraduate education
Clinical nutriontinists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
61
Masterrsquos programme of Human Nutrition and food-related behaviour
University of Helsinki Undergraduate education
Nutrition experts who work in eg community
health promotion
Master of Healthcare advanced practice ndash supporting self-care and
care of non-communicable diseases
Savonia University of Applied Sciences
Postgraduate education
Physical therapists Occupational
therapists Nurses
Public Health Nursing Metropolia University of Applied Sciences
Postgraduate education
Public Health nurse
Medical doctors training programme
University of Helsinki medical faculty
Undergraduate education
Medical doctors Nursing
Master degree in Health Management Psychologists
Dentists
Dental education University of Helsinki Faculty of Medicine Department of Oral and Maxillofacial Diseases
Undergraduate education
Dentists
France
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Occupational therapy school Croix Rouge Franccediloise Postgraduate education
Occupational therapists
Institut Reacutegional de Formation en Ergotheacuterapie
Association Saint Franccedilois dAssise
Postgraduate education
Occupational therapists
Occupational therapy Institut de formation en Ergotheacuterapie de Berck-sur-Mer site de Loos
Postgraduate education
Occupational therapists
Occupational therapy IFE Assas Undergraduate education
Occupational therapists
Arrecircteacute du 5 juillet 2010
relatif au diplocircme drsquoEacutetat drsquoergotheacuterapeute
Institut de Formation
en Ergotheacuterapie du CHU Rouen Normandie
Undergraduate
education
Occupational
therapists
Occupational therapy school Croix Rouge Francaise Postgraduate education
Occupational therapists
Occupational therapy UPEC Postgraduate
education
Occupational
therapists
Diplocircme de Dieacuteteacuteticien IUT biologie ou BTS dieacuteteacutetique
Postgraduate education
Dietitians
Programme deacuteducation et de promotion agrave la santeacute
CoDEPS 13 Continuous professional education
Nurses Psychologists Dentists Social workers
Public health Universiteacute de Bourgogne
Postgraduate education
Medical doctors
Public health Lyon University Undergraduate education
Medical specialists
Public health residency Faculty of medicine University of Nantes
Undergraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
62
Name of educational programme
Name of educational institution
Type of education
Type of health professionals being trained
Master in Public Health Karolinska Institute Postgraduate education
Occupational therapists Social Workers
Public health and social
medicine
Universiteacute Versailles
Saint Quentin en Yveline
Continuous
professional education
Medical doctors
Public health UFR sciences de santeacute - Universiteacute de Bourgogne
Postgraduate education
Medical doctors Medical specialists
Midwives Physical therapists
Nurses General practitioners
Germany
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Visceral Surgery Augsburg University Continuous professional education
Medical specialist Physical therapists
Occupational therapists
Nurses Social workers
Human Medicine ndash The
cologne model study course (human medicine)
University of Cologne
Medical faculty
Undergraduate
education
Medical
specialists
Greece
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy University of Thessaly Undergraduate education
Physical therapists
Oral education programme
for children via experiential learning
Hellenic Dental
Association-Dental School of Athens-Hellenic Society of Paediatric Dentistry
Continuous
professional education
Psychologists
Dentists
Sports Nutrition International Hellenic University
Postgraduate education
Dieticians
Preventive Dentistry National and
kapodistrian University of Athens school of dentistry
Undergraduate
education
Undergraduate
students
Nutrition amp Dietetics International Hellenic University
Postgraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
63
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicine ndash under and post graduate studies
School of health sciences University of Patras
Undergraduate education
Medical doctors
Pharmacy diploma Aristotle University of
Thessaloniki
Undergraduate
education
Pharmacists
Hungary
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Public Health and Preventive
Medicine
Semmelweis University
Budapest Faculty of
Medicine Department of Public Health
Undergraduate
education
Medical doctors
Academic programme of Medicine
Semmelweis University Faculty of Medicine
Undergraduate education
Medical doctors
Residency in Preventive Medicine and Public Health
Semmelweis University Postgraduate education
Medical specialists
Ireland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Social Science in
Social Work
Maynooth University
(national University of Ireland Maynooth)
Postgraduate
education
Social workers
Information not provided Information not provided
Undergraduate education
Physical therapists
Professional Master of Physiotherapy
University College Dublin
Postgraduate education
Physical therapists
Bachelor Physiotherapy University College Dublin
Undergraduate education
Physical therapists
Bachelor Physiotherapy RCSI Undergraduate education
Physical therapists
Irish Dental Association Irish dental association Continuous professional
development
Dentists
Public Health Medicine Royal College of Physicians in Ireland
Postgraduate education
Medical specialists
Higher specialist training in Public Health Medicine
Royal College of Physicians in Ireland
Postgraduate education
Medical doctors Medical specialists General practitioners
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
64
Italy
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Healthy Lifestyles CNAI ndash Italian Nurses association
Continuous professional education
Nurses
Management for Health Professionals
University of Rome Postgraduate education
Midwifes Physical therapists Nurses
Corso di laurea in Terapia occupazionale (Bachelor in Occupational therapy)
Universitagrave degli Studi di Milano (State University of Milan)
Undergraduate education
Occupational therapists
Life Sciences University of Catania
School of Medicine
Continuous
professional
education
Medical doctors
Medical
specialists Physical therapists Occupational therapists Nurses
Dentists
Health promotion University of pavia Undergraduate education
Nurses
Corso di Laurea Magistrale
in Odontoiatria e Protesi Dentaria
Universitagrave di Parma Undergraduate
education
Dentists
Hygiene preventive medicine and public health
Universitagrave Cattolica del Sacro Cuore
Postgraduate education
Medical doctors Medical
specialists
general practicioners
Igiene e Medicina Preventiva Universitagrave degli Studi dellrsquoAquila
Postgraduate education
Medical doctors non-specialized
Post graduate school of Public Health
University of Sienna Postgraduate education
Medical doctors
Hygiene and Public Health University of Bari Aldo Moro
Postgraduate education
Medical doctors
School of specialization in Hygiene and Preventive Medicine
University of Milan Postgraduate education
Medical doctors
Lithuania
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Health Education and Promotion
Klaipeda State University of Applied sciences
Undergraduate education
Dietitians Physical therapists Nurses Dentists Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
65
Latvia
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Dentistry Riga Stradins University Undergraduate education
Dentists General practicioners
Professional Bachelor programme Physiotherapy
LASE Postgraduate education
Physical therapists
Physiotherapy Riga Stradins University Undergraduate education
Physical therapists
Malta
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Bachelor in Nursing Studies University of Malta Faculty of Health Sciences department of Nursing
Undergraduate education
Nurses
FHs University of Malta Undergraduate education
General practitioners
Netherlands
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Occupational Therapy Information not provided
Undergraduate education
Occupational therapists
Lifestyle and Healthcare Amsterdam University Medical Centre
Undergraduate education
Medical students
Portugal
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
PhD in Social Work ISCTE University Institute of Lisbon
Postgraduate education
Social workers
Bachelor degree in
Physiotherapy
Escola Superior de
Sauacutede de Santa Maria
Undergraduate
education
Physical
therapists
Physiotherapy IPC ESTeSC Coimbra Health school
Undergraduate education
Physical therapists
Licenciatura em Fisioterapia Escola Superior de Sauacutede - Instituto Politeacutecnico do Porto
Undergraduate education
Physical therapists
Degree in Physical therapy Instituto Piaget ndash Vila Nova de Gaia
Undergraduate education
Physical therapists
Degree in Physical therapy ESSATLA Continuous professional development
Physical therapists
Curso Licenciatura em Fisioterapia
Instituto Politeacutecnico de Sauacutede do Norte Escola Superior de Sauacutede do Vale do Ave CESPU
Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
66
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Clinical Education University Fernando Pessoa- Faculty of Health Sciences
Continuous professional development
Workers factory
Physiotherapy (Bachelor) School of healthy-
polytechnic institute of Setubal
Undergraduate
education
Physical
therapists
Physiotherapy Escola Superior De Sauacutede Do Vale Do Sousa do Instituto
Politeacutecnico De Sauacutede Do Norte
Undergraduate education
Physical therapists Nurses
Psychologists Dentists
Public Health ARSLVT Postgraduate
education
Medical
specialists
Information not provided Information not provided
Postgraduate education
Physical therapists
Information not provided Information not provided
Undergraduate education
General practicioners
Romania
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Nursing Education University Lucian Blaga Postgraduate education
Nurses
MedicinePharmacy - Health University of Oradea Faculty of medicine and
pharmacy Oradea
Postgraduation education
Medical doctors Medical
specialists Pharmacists Physical therapists Nurses
Dentists General practicioners
Slovakia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Social Work Constantine the philosopher University in Nitra
Postgraduate education
Social workers
Specialisation study in Clinical Psychology
Comenius University in Bratislava Faculty of
Arts
Continuous professional
development
Medical specialists
psychologists
Slovenia
Name of educational
programme
Name of educational
institution
Type of
education
Type of health
professionals being trained
Physiotherapy Alma Mater Europaea Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
67
Physiotherapy University of Novo mesto Faculty of Health sciences
Undergraduate education
Physical therapists
Faculty of health sciences University of Primorska Continuous professional education
Dietetics Physical therapists Occupational therapists Nurses
Nursing Applied Kinesiology Physiotherapy and Nutritional counselling ndash dietetics
University of Primorska Faculty of Health Sciences Slovenia
Undergraduate education
Nutrional counselling Kinesiologists Physical therapists Nurses
Professional higher education study programme 1st cycle degree occupational
therapy
University of Ljubljana faculty of health sciences
Undergraduate education
Occupational therapists
Applied Kinesiology UP FVZ Undergraduate
education
Kinesiology
Physiotherapy Alma mater Europaea ndash Evropski center Maribor
Undergraduate education
Physical therapists
Bachelor in Physiotherapy University of Ljubliana Faculty of health sciences
Undergraduate education
Physical therapists
Health Promotion Angela Boskin Faculty of healthcare
Postgraduate education
Physical therapists Occupational
therapists nurses
1st Bologna cycle study programme Physiotherapy
Angela Boskin Faculty of healthcare
Undergraduate education
Physical therapists
Public Health Medical
Residency
Medical chamber of
Slovenia
Continuous
professional development
Medical doctors
Public Health National institute of public health of the
Republic of Slovenia
Postgraduate education
Medical doctors
Psychology Faculty of arts University of Maribor
Postgraduate education
Psychologists
Spain
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Human Nutrition and Dietetics
University of Zaragoza Undergraduate education
Dieticians
Continuous professional
education
Nurses
Physiotherapy University of Coruna Undergraduate education
Physical therapists
EHEA Degree in Human Nutrition and Dietetics
Blanquerna School of Health Sciences ndash Universitad Ramon Lull
Undergraduate education
Dietitians
Bachelor in Pharmacy Universidad de Sevilla Undergraduate
education
Pharmacists
Continuous professional development
Spanish General Council of Social Work
Continuous professional education
Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
68
Bachelor in Pharmacy Universidad de Alcala Undergraduate education
Pharmacists
Bachelor in Medicine Faculty of medicine University of Cadiz Spain
Undergraduate education
Medical doctors General practitioners
Residency in Preventive Medicine and Public Health
Hospital Clinic de Barcelona
Postgraduate education
Nurses
Bachelor in Medicine Information not provided
Undergraduate education
Medical doctors
MasterBachelor in Pharmacy
University of Navarra Undergraduate education
Postgraduate education
Pharmacists
Human Nutrition and Dietetics
Univeristy of Navarra Undergraduate education
Nutritionists amp Dietitians
Pharmacy Universitad Ramon Lull
Undergraduate education
Pharmacists
Pharmacy IQS ndash FCSB Undergraduate education
Pharmacists
Master in Advanced Therapies and Innovation in Biotechnology
Universidad de Francisco de Vitoria
Postgraduate education
Pharmacists
Pharmacy Universidad of the Basque County
Undergraduate education
Pharmacists
Sweden
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master programme in Public Health
Karolinska institute Postgraduate education
Occupational therapists
Social workers
Dietetics programme Department of food and Nutrition
Undergraduate education
Dietician
Dietetics programme Department of food studies dietetics and nutrition
Undergraduate education
Dietician
Programme in Dietetics University of Gothenburg
Sahlgrenska Academy
Undergraduate education
Dietician
Master of Public Health Department of public health and caring sciences Uppsala University
Postgraduate education
Medical doctors Bachelor of science Physical
therapists Nurses Psychologists Dentists Social workers
United Kingdom
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor (Hons) Occupational Therapy
Northumbria University Undergraduate education
Occupational therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
69
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master (pre reg) Occupational Therapy
Master in Occupational Therapy
Leeds Beckett University
Postgraduate education
Occupational therapists
Bachelor (Hons) Occupational Therapy
St Georgersquos University of London
Undergraduate education
Medical doctors Medical specialists Physical therapists
Occupational therapists
Bachelor (Hons)
Occupational Therapy
Caterburry Christ
Church University
Undergraduate
education
Occupational
therapists
Bachelor (Hons) Occupational Therapy Master in (pre-reg) Occupation Therapy Occupational Therapy degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Public Health speciality training
Health education England -north west
Postgraduate education
Medical doctors Medical specialists Researchers Nurses
Bachelor in (Hons) Occupational Therapy Master in (Pre-reg)
Occupational Therapy Occupational Therapy
Degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Additional countries
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Bachelor of Physiotherapy University of Prishtina Kosovo Albania
Postgraduate education
Physical therapists
Physiotherapy Faculty of health studies University of Sarajevo Bosnia-Herzegovina
Undergraduate education
Physical therapists
Fysioterapeututdanning NTNU Norway Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy BFH
Berner Fachhochschule BFH Bern University of Applied Sciences Swiss
Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy
ZHAW Zurich University of applied sciences Swiss
Undergraduate education
Physical therapists
Physical Therapy Sciences University of Iceland
School of Health Sciences
Undergraduate
education
Physical
therapists
Medicine International school of medicine Kazachstan
Undergraduate education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
70
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicinesingle-cycle degree programme
University of Georgia Republic of Georgia
Medical doctors Psychologists General practicioners
Medicine Akaki tsereteli state University Republic of Georgia
Postgraduate education
Medical doctors Medical specialists Physical therapists Psychologists
Dentists General
practicioners
Public Health and Epidemiology
David tvildiani medical University Republic of
Georgia
Postgraduate education
Medical doctors
Biomedical and Healthcare Science doctoral programme
David tvildiani medical University Republic of Georgia
Postgraduate education
Medical doctors Biomedical Science master degree holders
Medicinesingle-cyle degree programme
University of Georgia Republic of Georgie
Undergraduate education
Medical doctors
Public Health Tbilisi State Medical University (TSMU)
Republic of Georgia
Undergraduate education
Medical doctors and public
health specialists
David tvildiani Medical
University
David tvildiani Medical
University Republic of Georgia
Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
71
ANNEX 2 COMPETENCY PROFILES PER PROFESSIONS
Undergraduate medicine
The CanMEDS framework is worldwide the most commonly used and adapted model that
identifies and describes the abilities physicians require in order to effectively meet the
health care needs of the people they serve72 Within European Member States modifications
of this model are used within health and educational settings (for example in the
Netherlands and Finland) for undergraduate medicine and medical specialisations The
CanMEDS model defines seven roles of the physician namely (1) medical expert (the
integrating role) (2) communicator (3) collaborator (4) leader (5) health advocate (6)
scholar and (7) professional73 The role of health advocate is defined as physicians
contributing their expertise and influence as they work with communities or patient
populations to improve health ldquoimproving health is not limited to mitigating illness or
trauma but also involves disease prevention health promotion and health protection
Improving health also includes promoting health equity whereby individuals and
populations reach their full health potential without being disadvantaged by for example
race ethnicity religion gender sexual orientation age social class economic status or
level of educationrdquo Within this role two key competencies are defined74
1 Respond to an individual patientrsquos health needs by advocating with the patient within
and beyond the clinical environment
a Work with patients to address determinants of health that affect them and their access
to needed health services or resources
b Work with patients and their families to increase opportunities to adopt healthy
behaviours
c Incorporate disease prevention health promotion and health surveillance into
interactions with individual patients
2 Respond to the needs of the communities or populations they serve by advocating with
them for system-level change in a socially accountable manner
d Work with a community or population to identify the determinants of health that affect
them
e Improve clinical practice by applying a process of continuous quality improvement to
disease prevention health promotion and health surveillance activities
f Contribute to a process to improve health in the community or population they serve
In addition the European Thematic Network project MEDINE (2004-2007) and Tuning
Project (Medicine) under its auspice (MEDINE) have generated and gained widespread
consensus on a set of competences for primary medical degree qualifications in Europe
(ie undergraduate medicine)75 Within this project it is stated that graduates in medicine
72 httpwwwroyalcollegecarcsitecanmedscanmeds-framework-e 73 httpwwwroyalcollegecarcsitecanmedsabout-canmeds-e 74 httpwwwroyalcollegecarcsitecanmedsframeworkcanmeds-role-scholar-e 75 httptuningacademyorgmedine-medicinelang=en
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
72
would need the ability to ldquopromote health engage with population health issues and work
effectively in a health care systemrdquo76 The following points define health promotion
bull provide patient care which minimises the risk of harm to patients
bull apply measures to prevent the spread of infection
bull recognise own health needs and ensure own health does not interfere with
professional responsibilities
bull conform with professional regulation and certification to practise
bull receive and provide professional appraisal
bull make informed career choices
bull engage in health promotion at individual and population levels
Medical specialist
The European Union of Medical Specialists (UEMS) contributed significantly to the
improvement of post-graduate training through the development of a European Curriculum
in each medical speciality as well as the elaboration of training standards77 Within this
section we provide a detailed description of the European training requirements for a
selection of medical specialists including sports medicine public health internal medicine
cardiology psychiatry and the general practitioner78 This selection was based on the fact
that within these specialities lifestyle might be an essential component or important part of
the treatment of chronically ill patients
1) Medical specialist sports medicine
Sports medicine is defined by the European Commission as a ldquomultidisciplinary clinical and
academic speciality of medicine dealing with health promotion for the general population
by stimulating a physically active lifestyle and diagnosis treatment prevention and
rehabilitation following injuries or illnesses from participation to physical activities
exercises and sport at all levelsrdquo79 As health promotion and prevention are both
incorporated in the definition of sports medicine these topics are included throughout the
whole curriculum of sports medicine The curriculum of sports medicine aimed to provide
theoretical understanding and practical skills to provide first line clinical services80 Within
the training requirements for the speciality of sports medicine it is stated that sports
medicine does not solely take care for sporting elite athletes but as well for its important
role to promote exercise as a medical tool meant for patients with chronic diseases81
bull Theoretical knowledge aims to provide theoretical understanding and practical skills to
provide first line clinical services
- Clinical To provide pre-participation clinical screening and examination before
exercise and competition as well as medical assistance to the athletes engaged in all
sports
76
httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNLearning_Outcomes_Competences_for_Undergraduate_Medical_Education_in_Europepdf
77 httpswwwuemseu__dataassetspdf_file00111415906pdf 78 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 79 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 80 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 81 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
73
- Public health
bull As part of a multi-disciplinary team to encourage and promote physical activity as
a lever for healthy living
bull To identify impediments to an active lifestyle and work within a multi-disciplinary
framework to remove those impediments or minimize their impact
bull To work alongside local health authoritiespublic health clinicians developing
exercise opportunities for the general public for health gain
bull To liaise with public (local authoritieseducationvoluntary) and private sector to
advise on the health aspects of exercise programmes for physical activity of special
groups like women children adolescents and aging population
bull Practical and clinical skills
bull To foster the integration of knowledge and practical skills acquired during the
cardiology orthopaedics physical amp rehabilitation medicine general practice
medicine and physiology internships
bull To learn to put into practice information gained in the relevant course work
bull To extend and deepen their knowledge in the assessment of fitness such as
isokinetic and functional muscle performance cycle ergometry and treadmill
ergometry
bull To gain experience in the use of such test results in the decision making with regard
to diagnosis recommendations and therapy for people of both gender and in
different age groups and performance levels
bull With regard to elite sport trainees will learn how to diagnose treat and prevent
overtraining and overexertion
bull To become proficient in activities related to for example hygiene and nutrition
and will work closely with trainers athletes physiotherapists officials etc
bull Competencies
bull Clinical and instrumental assessment to determine the pathophysiology
mechanisms and the underlying diagnosis of the patientrsquos condition
bull Trainees are expected to complete evidence of reflective practice through case
reports and other experiences in their training record
bull Other self-directed work will be planning data collection analysis and presentation
of audit and research work
bull The mandatory training record (hand written diary or preferably electronic
logbook) will contain evidence of academic pursuits and should be checked and
documented regularly by the Supervisor
bull Trainees will take part and be able to lead in teaching and will be expected to
develop skills to teach undergraduates postgraduates and non-medical staff in
small groups and formal lectures making personal presentations using a variety of
audiovisual methods
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
74
bull They will be expected to present at journal clubs and make case presentations at
grand rounds or similar settings
bull They will be expected to undertake personal audit and research and make
presentations of their findings at clinical meetings
bull Prescription as much evidence-based as possible of medical and physical
treatments (including drug treatment physical modalities innovative
technologies natural factors and others) as well as of technical aids
bull Prevention and management of complications
bull Skill to perform and participate in research
2) Medical specialist public health
The European Commission defines public health ldquoas the science and art of preventing
disease prolonging life and promoting mental and physical health and efficiency through
organized community effort Public health may be considered as structures and processes
by which the Health of the population is understood safeguarded and promoted through
the organized efforts of societyrdquo82 Public health specialists aim to improve populationrsquos
health by using the following skills and competencies
bull Theoretical knowledge on a range of fields including epidemiology prevention health
promotion public health research behavioural sciences health programme evaluations
health need assessments and quality and safety in healthcare
bull Practical and clinical skills
- Surveillance and evaluation of the health of the population (trained in epidemiology)
- Planning and evaluation of health services and public health control
- Analysing the health of the population (analysing determinants on individual and
community levels)
- Plan participate in or evaluate preventive and control programmes (public health
assessments)
- Participate in multidisciplinary health impact assessment
- Inform decision-makers about potential impacts and to identify appropriate and
sustainable actions to manage those effects (including environmental determinants
of health)
- Organisational issues in healthcare (participating in policy and strategic development
quality and safety management)
- Generate and share new evidence on the ways in which social determinants influence
population health and health equity
- Sufficient linguistic ability to communicate with hisher public health colleagues
82 httpswwwuemseu__dataassetspdf_file001198435UEMS-201924-European-Training-
Requirements-for-Public-Healthpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
75
- Develop high professional ethical standard including respect towards human rights
participants in public health programmes colleges and other professionals in the
team
bull Competencies
- Establish the expertise role as a Public Health Physician
bull Function as public health leaders and consultants to health services and other
organizations and institutions in order to provide safe appropriate cost effective
and equal health care to groups communities and populations
bull Establish and maintain medical knowledge skills and attitudes appropriate to their
practice including the organization and financing of health care public health
control and public health law
- Perform expertise analyses of the health of the population
bull Apply and combine medical and epidemiological competencies for the surveillance
and evaluation of the health of the population
bull Identify the determinants of health of populations and risks for public health and
implications for interventions and policy
bull Evaluate health problems biopsychosocial mechanisms andor health care issues
for different population groups and their implications for the community
bull Critically evaluate epidemiological demographic health statistical and
environmental pollution data and their sources and apply them appropriately to
public health issues
bull Identify community health needs and advise about their implications for public
health and medical care services
- Lead and supervise public health interventions
bull Select develop implement and monitor public health surveillance and
interventions namely in the areas of human behaviour social and physical
environment food safety and nutrition health care associated risks and working
life related health
bull Promote the health of individuals communities and populations through health
programming
bull Contribute to the organization and evaluation of societal and health care
programmes aiming to promote health and social functioning among individuals
with long-term diseases and disabilities
bull Contribute to the planning organization supervision of and evaluation of societal
and health care programmes promoting the health of specific target groups such
as children elderly and vulnerable and underserved groups in society
bull Contribute to the organization of and evaluate primary and secondary medical
prevention programmes
bull Contribute to strengthening regulatory frameworks for protecting and improving
health
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
76
- Function as expertise in planning and evaluation of Public Health and Medical Care
bull Evaluate Public Health and other service programmes concerning processes and
outputs from the different perspectives of care seekers professional health care
workers and health managers
bull Analyse and differentiate between need demand and supply and assess the health
of a defined population and identify areas for improvement including the allocation
of health care resources delivery
bull Evaluate the outcome quality and safety of care and promote quality development
systems based on evidence and public health principles
bull Apply health economic principles and methods such as cost-effectiveness cost-
utility and cost-benefits considering the strengths and weaknesses of different
methods
bull Use methods to determine priorities and their strengths and weaknesses and
promote awareness of the competing and conflicting influences on public and
political perceptions of the need for health care and the resulting constraints on
action
bull Promote and evaluate collaboration between health services and other welfare
organizations in society
bull Evaluate and contribute to the policy and strategic development in health care
planning
bull Contribute to the planning and evaluation of different sectors of society by health
impact assessments and public health medical reports and consultations
- Communicate and develop public health medical expertise
bull Lead supervise and participate in an interprofessional health care team
bull Consult other (health) professionals and policymakers and recognise the
advantages and limits of their expertise
bull Effectively convey oral and written information about public health issues including
adequate public health reporting and effective interaction with media
bull Stimulate and motivate others so that they recognise the importance of the public
health population perspective
bull Maintain and enhance professional activities through ongoing learning and
research and contribute appropriately to the generation dissemination application
and translation of new public health knowledge and practices
3) Medical specialist internal medicine
The UEMS defines an internist as ldquoa physician trained in the scientific basis of medicine
who specialises in the assessment diagnosis and management of general medical
problems atypical presentations multiple problems and consequential complex health
issues and system disorders (Professional) The physician is skilled in the management of
acute unselected medical emergencies and the management of patients in a holistic and
ethical way considering all psychosocial as well as medical factors for enhancing quality of
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
77
life The physician values the continuing care of all patients irrespective of the nature of the
patients complaint and is committed to lifelong continued professional development
(Scholar) The physician practices clinical audit and evidence-based medicine The
physician functions in a number of roles including clinical counselling educating leading
and managingrdquo83
Internists have a fundamental role in modern healthcare systems Within the definition of
the internist the shift towards a preventive strategy focusing on health promotion is
highlighted by the acknowledgement of the high prevalence of chronic and complex
diseases that are associated with the lifestyle of ageing western societies The role of
healthcare advocate (a role defined in the CanMED framework) is an important part of the
internistrsquos function and forms the generic competencies of an internist (see section 11)
However lifestyle promotion and disease prevention is not a specific area of expertise
Specific areas of the internist include multi-morbidity and ageing acute care medical
consultation shared-decision-making collaborative care transition in care vulnerable
adult patient safety and quality of care and medical leadership
4) Medical specialist cardiology
According to the training requirements for the speciality of cardiology84 training in
cardiology should be based on the syllabus of the ESC core Curriculum for the general
cardiologist part 2 ldquothe core curriculum per topicrdquo85 The necessary core cardiology
competencies are set out as cardiology learning objectives with the knowledge skills
attitudes and competencies needed to fulfil the objectives One of the core cardiology
competences is cardiovascular prevention aiming to
bull Assess and manage patients with risk factors for cardiovascular disease
bull Understand the mode of action of different prevention methods
bull Describe cardiovascular disease and risk factors in the local community
bull Contribute to the global efforts in reducing cardiovascular morbidity and mortality
by communicating the prevention message to the public
bull To approach prevention in a holistic way understanding the potentiation of
cardiovascular risk by clustering of risk factors
bull
Knowledge
bull Epidemiology of cardiovascular disease in the local community incidence
prevalence survival
bull Risk factors in the local community
83 httpswwwuemseu__dataassetspdf_file001744450UEMS-201613-European-Training-
Requirements-Internal-Medicinepdf 84 httpswwwuemseu__dataassetspdf_file001119577UEMS-201324-SECTIONS-AND-BOARDS-
Cardiology-European-Training-Requirements-20131019pdf 85 httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_
9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
78
bull Risk assessment in primary prevention multifactorial risk interaction and use of
risk scoring charts
bull The impact of lifestyle on people at risk of and patients with cardiovascular
disease
bull The potential of lifestyle changes to prevent and ameliorate cardiovascular
disease diet and nutrition toxic habits (smoking alcohol and others) physical
activity
bull Emerging risk factors (social economic stress depression and personality type)
bull Treatmentprevention strategies for major risk factors and changes in lifestyle
including corresponding pharmacologic therapies
bull The comprehensive approach required for multiple risk factors
bull Patient compliance
In addition the main objectives and knowledge competence are further specified by
hypertension dyslipidaemia diabetes and lifestyle
Skills
bull obtain a relevant history and perform an appropriate clinical examination
bull evaluate cardiovascular risk and assess global cardiovascular risk at the individual
level
bull evaluate cardiovascular risk at population level (mortality morbidity disability)
bull evaluate the benefit of prevention at individual and population levels
bull manage risk factors appropriately including pharmacological and non-
pharmacological therapies
bull communicate their importance to patients their families and the wider
community including smoking cessation diet and exercise
bull communicate the importance of patient compliance and behaviour
bull motivate patients and families to change lifestyles and be compliant with
prescriptionsrecommendations
bull monitor patient compliance and behaviour
bull evaluate the benefit of risk factor intervention for the individual patient
Behaviours and attitudes
bull Non-judgemental attitude to patients regarding their lifestyle (eg smoking diet
etc)
bull Exemplify appropriate lifestyle in personal behaviour
bull Team working with other physicians including general practitioners
diabetologists nephrologists and elderly care physicians for the management of
specific risk factors
bull Team working with all professionals with a role in primary and secondary
prevention (nurses dieticians teachers and politicians)
Another core competency is the physical activity and sport in primary and secondary
prevention Further defined in sports cardiology and cardiac rehabilitation
Sports cardiology aiming86
86
httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
79
bull To conduct strategies to implement healthy lifestyle in particular physical and
sports activities in the general population (primary prevention)
bull To evaluate cardiovascular risk and exercise capacity (see Chapters 22 and
271)
bull To recognize the characteristics of the athletersquos heart
bull To appropriately detect contraindications to exercisecompetition and
appropriately provide non-contraindication certificates
Knowledge
bull Exercise and sports physiology
bull Benefits of exercise training
bull Safety issues in exercise and sport
bull Diagnostic criteria and appropriate investigations in athletes with cardiovascular
disease
bull Risk factors for and mechanisms of sudden cardiac death (SCD) during and after
strenuous exercise
bull Specific population challenges and exercise programmes in appropriate settings
bull Recommendations for professional and recreational sports participation
bull SCD in patients athletes and in the population at large and
bull Mechanisms of action of illicit drugs
Skills
bull perform an individual CVD risk assessment using appropriate information from
history laboratory assessment including full lipid profile and clinical data
bull recognize pathological cardiovascular changes and differentiate them from the
characteristic features of lsquoathletersquos heartrsquo and
bull use prevailing recommendations for eligibility for participation in competitive
sports
Behaviours and attitudes
bull Recognition of the role of active lifestyle exercise and sport in the promotion of
health and in the prevention of the most threatening diseases including
cardiovascular diseases
Cardiac rehabilitation aiming
bull To evaluate and manage cardiovascular risk
bull To evaluate exercise capacity and causes of exercise intolerance
bull To provide appropriate rehabilitation and secondary prevention to patients with
cardiovascular diseases
7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
80
Knowledge
bull Multi-disciplinary risk factor intervention
bull Definition of comprehensive cardiovascular prevention and rehabilitation
bull Effects of behavioural change including physical activity nutrition education and
psychosocial risk factors on quality of life cardiovascular risk and outcome
bull Rehabilitation as a component of cardiac care and a promoter of secondary
prevention
bull Target populations and risk stratification of patients
bull Psychological aspects of rehabilitation and exercise practice
Skills
bull take a relevant history and perform an appropriate clinical examination including
the specific evaluation of the elderly patient
bull perform and interpret risk stratification using indicated tests
bull interpret a cardiopulmonary exercise test and distinguish different causes of
exercise limitation
bull prescribe exercise-based rehabilitation programmes and other lifestyle
interventions according to the patientrsquos condition in collaboration with other
specialists when necessary and
bull motivate the patient to ensure long-term adherence to lifestyle changes and
continuing exercise programmes
Behaviours and attitudes
bull rehabilitation as a component of cardiac care
bull the importance of rehabilitation and secondary prevention for professional
personal and social life among patients with heart disease
bull the interplay of physical and psychological aspects of heart disease and the
positive influence of exercise on cardiovascular risk factors
bull the role of other professionals including nurse specialists physiotherapists ergo
physiologists psychologists dieticians and general practitioners in rehabilitation
and secondary prevention and
bull the importance of patient and family education and the role of other professionals
in rehabilitation
5) Medical specialist psychiatry
The UEMS has issued a charter of requirements for the training in psychiatry in 2000 with
an additional European Framework for Competencies in Psychiatry in 2009 The learning
outcomes in the European Framework for Competencies in Psychiatry (EFCP) are arranged
under the seven physician roles derived from the CanMEDS framework87 Within the EFCP
it is stated that ldquopsychiatrists recognise the importance of advocacy and health promotion
in responding to the challenges represented by those social environmental and biological
factors that determine the mental health and well-being of patients and society They
recognise advocacy as an essential and fundamental component of mental health promotion
that occurs at the level of the individual patient the practice population and the broader
communityrdquo
Competencies
87 httpuemspsychiatryorgwp-contentuploads2013092009-Oct-EFCPpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
81
bull identify the determinants of mental disorder as well as the factors that may
contribute to positive mental health so as to be able to prevent disorder and
promote mental health
- recognise the determinants of mental health of populations and how public
policy including legislation impacts on mental health
- promote positive mental and physical health in patients particularly in those
with severe mental disorder based on best evidence
- recognise the impact of mental disorder on families and carers and take
remedial measures
- collaborate with other community sectors to promote mental health and
prevent mental disorder at all levels focusing particularly on family school and
workplace
- identify and address barriers and inequity in access to care particularly for
vulnerable or marginalised populations
bull Identify and address issues and circumstances when advocacy on behalf of
patients professions or society is necessary
- respect and promote the human rights of people with mental disorders and
collaborate with user and carer associations and advocacy groups
- empower people with mental disorders and their carers
- recognise and address prejudice stigma and discrimination associated with
mental disorder and its treatment
- use strategies to enhance patientrsquos self-management and autonomy
- actively oppose the use of psychiatry for political repression
- recognise the possibility of conflict inherent in their role as a health advocate
for a patient or community with that of manager or gatekeeper
6) General practitioner
The European training requirements for General PracticeFamily Medicine (GPFM) specialist
training88 defined twelve central characteristics of the practice before determining the core
competences Related to health promotion and disease prevention two of these
characteristics are as following ldquopromotes health and well-being both by appropriate and
effective interventionrdquo and ldquohas a specific responsibility for the health of the communityrdquo
The twelve characteristics are clustered into six core competences primary care
management person-centred care specific problem solving skills comprehensive
approach community orientation holistic modelling Under comprehensive approach the
following abilities relate to health promotion and disease prevention
bull to promote health and wellbeing by applying health promotion and disease
prevention strategies appropriately
bull to manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
Furthermore community orientation includes the ability
bull to reconcile the health needs of individual patients and the health needs of the
community in which they live in balance with available resources
88 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
82
In the more comprehensive assessment of GPrsquos performance in daily practice by the
European Academy of Teachers in General PracticeFamily Medicine (EURACT)89 these
abilities are further defined as following
bull To promote health and wellbeing by applying health promotion and disease
prevention strategies appropriate
- Identifies opportunity for health promotion intervention
- Makes use of structured medical record as reminder of preventive activities
- Makes use of teamwork
- Uses communication skills
- Is aware of any personal prejudices which might influence negatively
preventive advice
- Makes recommendations which are feasible in the context of patientrsquos lifestyle
and home situation
- Acts as suitable role model
bull To manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
- Provides appropriate medical management
- Involves members of practice team eg through case conference
- Performsarranges home visit (consider relevant team members) ndash needs
assessment eg cause of falls
- Involves relatives
- Facilitates communication (two-way) with hospital
- Involves external community resources (eg home help etc)
Dentist
According to the profile and competences for the graduating European dentist one of the
major competences for dentists is to improve oral health of individuals families and groups
in the community On graduation a dentist must be competent at promoting and improving
the oral health of individuals families and groups in the community90 Furthermore with
regard to health promotion and disease prevention a dentist
bull Must be competent at
- Applying the principles of health promotion and disease prevention via
comprehensive preventive measures to individuals and the community
according to their risk assessment status
- Understanding the complex interactions between oral health nutrition general
health drugs and diseases that can have an impact on oral health care and
oral diseases
- Providing appropriate dietary advice
bull Have knowledge of
- The organisation and provision of health care in the community and in the
specialist hospital service in the country of training
- The prevalence of the common dental conditions in the country of
trainingpractice
- The social cultural and environmental factors which contribute to health or
illness
- The strategies to overcome barriers to dental care for disabled elderly
socially deprived and ethnic minority groups
- Training auxiliaries in basic skills of oral health promotion
89httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-
documentseuractperformanceagendadC3BCsseldorf2014-openaccessebookversionpdf 90 httpwwwdentuoagrfileadmindentuoagruploadsusefull_filesADEE-competences-2009_enpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
83
In 2017 a new updated framework was published for undergraduate education for dentists
including a revised structure of the educational domains and their areas of competence In
the revised framework health promotion and disease prevention compromises one of the
areas of competence in the domain ldquodentistry in societyrdquo in the educational strategy of a
dentist91 Note Dentists can also specialise in public health in a similar programme as
physicians
Nurses
The training for nurses responsible for general care shall following the Directive
201355EU include a set of eight competences 92 The training for nurses should provide
assurance that the ability of the following knowledge and skills
1 comprehensive knowledge of the sciences on which general nursing is based including
sufficient understanding of the structure physiological functions and behaviour of
healthy and sick persons and of the relationship between the state of health and the
physical and social environment of the human being
2 sufficient knowledge of the nature and ethics of the profession and of the general
principles of health and nursing
3 adequate clinical experience such experience should be gained under the supervision
of qualified nursing staff and in places where the number of qualified staff and equipment
are appropriate for the nursing care of the patient
4 the ability to participate in the practical training of health personnel and experience of
working with such personnel
5 experience of working with members of other professions in the health sector
Competencies 93
6 Competency to independently diagnose the nursing care required using current
theoretical and clinical knowledge as well as to plan organise and implement nursing
care when treating patients on the basis of page the knowledge and skills acquired in
accordance with points (1) (2) and (3) in order to improve professional practice
7 Competency to work together effectively with other players in the health sector including
participation in the practical training of health personnel on the basis of the knowledge
and skills acquired in accordance with points (4) and (5)
8 Competency to empower individuals families and groups towards healthy lifestyles and
self-care on the basis of the knowledge and skills acquired in accordance with points (1)
and (2)
9 Competency to independently initiate immediate measures to pre- serve life and to carry
out measures in crisis and disaster situations
9191 Field JC Cowpe JG Walmsley AD The Graduating European Dentist A New Undergraduate Curriculum
Framework Eur J Dent Educ 201721(Suppl 1)2-10 httpsdoiorg101111eje12307 92 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf 93 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
84
10 Competency to independently advise instruct and support individuals needing care
and their attachment figures
11 Competency to independently ensure the quality of nursing care and assess it
12 Competency to communicate comprehensively and professionally and to cooperate
with members of other professions in the health sector
13 Competency to analyse the quality of care in order to improve their own professional
practice as general care nurses
The competences included in Directive 201355EU are different from the competences
contained in the EFN Competency Framework These competences contain the following
competences on health promotion and disease prevention guidance and teaching
bull To promote healthy lifestyles preventive measures and self-care by strengthening
empowerment promoting health and enhancing behaviours and therapeutic
compliance
bull To independently protect the health and well-being of individuals families or
groups being cared for ensuring their safety and promoting their autonomy
bull To integrate promote and apply theoretical methodological and practical
knowledge This enables the promotion and the development of nursing care in
long term care co-morbidity and in situations of dependency in order to maintain
an individualrsquos personal autonomy and hisher relationships with the environment
in every moment of the healthillness process
Nurse specialist
The European Specialist Nurses Organisation (ESNO) defines the nurse specialist as follows
ldquoThe Nurse Specialist (NS) is an advanced practice Nurse prepared as a specialist within a
clinical specialty at the masterrsquos post masterrsquos or doctoral levelrdquo94 Following the ESNO the
competencies should be considered as a reference template and guidelines for the different
specialities in which each speciality can define its own knowledge skills and attitudes
Generic competencies are the clinical role patient relationship patient teachingcoaching
mentoring research organisation and management communication and teamwork ethic
and decision making leadership and policy making and prevention The competency of
prevention is based on the case for investing in public health from the World Health
Organization95 The competency of prevention is based on the ability of promoting health
and prevent disease by the capacity to develop and put in place intervention in
bull Surveillance of population health and wellbeing
bull Disease prevention at the 3 levels of prevention (primary secondary)
bull Ability to promote health and prevent disease
bull Monitoring and response to health hazards and emergencies
bull Health promotion including actions to address social determinants and healthy
inequities
bull Advocacy communication and social mobilization for health advancing public
health
bull Research to inform policy and practice96
94 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf 95 httpwwweurowhoint__dataassetspdf_file0009278073Case-Investing-Public-Healthpdfua=1 96 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
85
Occupational therapist
The World Federation of Occupational Therapists (WFOT) provided minimum standards for
the education of occupational therapists97 One of the settings in which occupational
therapists work is defined as following ldquoCommunity or group approaches such as health
promotion community development community based rehabilitation injury prevention
environmental design disaster preparation and recoveryrdquo Furthermore under essential
knowledge skills amp attitudes for competent practice the following (could) relate to health
promotion and disease prevention
bull Knowledge about
- The relationship between occupation and human development over the life
course including healthy ageing
- The relationship between psychological social and economic factors and
occupation (eg stress adjustment to life changes including disability
societal disruption natural or man-made disaster displacement)
- Early identification and functional interventions focusing on somatosensory
stimulation and performance mechanisms mitigating early developmental and
environmental factors impacting negatively on behaviour and learning
- How activity limitations and participation in occupation affect health This
includes the ability to maintain a healthy environment and personal factors
such as adjustment interpersonal relationships and social networks
- How health conditions and threats to health affect participation in work
bull Skills in
- Inter-sectoral collaboration in public health initiatives
- Assessing health in relation to occupation
In addition the Tuning programme described the reference points for the design and
delivery degree programmes in occupational therapy98 in which they first ranked subject
specific competency One of the highest ranked included
bull Enable individualsgroupsorganisationscommunities to be engaged in occupation
through health promotion prevention rehabilitation treatment and
coachingtraining
In the final set of subject specific competences however this is mentioned less explicitly
and only the following are related to health promotion and disease prevention
bull Knowledge the occupational therapist is able to
- Work in partnership with individuals and groups using occupation in
prevention rehabilitation and treatment in order to promote participation
health and well-being
- Explain the relationship between occupational performance health and well-
being
- Collaborate with communities to promote and develop the health and well-
being of their members through their participation in occupation
- Develop new knowledge of occupation and occupational therapy practice
particularly in relation to local andor emerging health and social challenges
97 httpswwwwfotorgassetsresourcesCOPYRIGHTED-World-Federation-of-Occupational-Therapists-
Minimum-Standards-for-the-Education-of-Occupational-Therapists-2016apdf 98 httptuningacademyorgwp-contentuploads201402RefOccupationalTherapy_EU_ENpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
86
Pharmacists
In a two-stage large-scale Delphi process fifty competences of pharmacy practice were
ranked and the Quality Assurance in European Pharmacy Education and Training (PHAR-
QA) framework was harmonized and validated99 Of these fifty competences the following
relate to health promotion and disease prevention
bull Ability to promote public health in collaboration with other professionals within the
healthcare system
bull Ability to provide appropriate lifestyle advice to improve patient outcomes
bull (eg advice on smoking obesity etc)
bull Ability to use pharmaceutical knowledge and provide evidence-based advice on
public health issues involving medicines
Physiotherapists
According to the World Confederation for Physical Therapy (WCPT) the scope of physical
therapists practices includes (among others) public health strategies and advocating for
patientsclients and for health100 Furthermore it is described that physical therapists may
have the following purposes
bull promoting the health and wellbeing of individuals and the general publicsociety
emphasising the importance of physical activity and exercise
bull preventing impairments activity limitations participatory restrictions and
disabilities in individuals at risk of altered movement behaviours due to health
factors socio-economic stressors environmental factors and lifestyle factors
The European Network of Physiotherapy in Higher Education (ENPHE) also described
professional competencies of physiotherapists101 According to the ENPHE one of the roles
of a physiotherapist is to be a
bull Health care promotor
- Advocate on health and wellbeing promotion and disease or injury prevention
on behalf of patientclients and the profession to enhance individual
community and public health
- Promote adherence to local regional national and EU health and safety
policies guidelines and protocols
Psychologist
The European Federation of Psychologistsrsquo Associations developed the European Certificate
in Psychology ndash the EuroPsy102 The Tuning programme also published lsquoReference points for
the design and delivery of degree programmes in Psychologyrsquo103 in which they state that
the Tuning programme and the EuroPsy programme have experienced a parallel
development over the last ten years In fact the Tuning document presents a reference
99 httpswwwncbinlmnihgovpmcarticlesPMC5419365 100 httpswwwwcptorgpolicyps-descriptionPT 101 httpwwwenpheorgwp-
contentuploads201910ESCO_report_ENPHE_recommendations_April_2017pdf 102 httpwwwinpa-europsyitmoduliEuroPsy20Regulations20July202011pdf 103httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNPsychology_reference_points
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
87
point for the design and delivery of degree programmes in psychology on the basis of the
EuroPsy programme
Based on the definition of the key role of the professional psychologist health promotion
and disease prevention could be part of the profession as this has been described as
follows to develop and apply psychological principles knowledge models and methods in
an ethical and scientific way in order to promote the development well-being and
effectiveness of individuals groups organisations and society However no specific
competences related to health promotion and disease prevention are now described in the
documents It is plausible though that psychologist do act to promote health as the core
of their profession is to help others to understand behaviour to improve performance and
well-being or to alleviate problems and distress As these emergent specialisms develop in
response to new demands there is a tendency to develop education and training
programmes thus increasing the specialisation and the requirement for specialist skills of
professional psychology
Social worker
Global standards for the education and training of the social work profession are developed
by the International Association of Schools of Social Work (IASSW)104 The IASSW
worldwide association of schools of social work other tertiary level social work educational
programmes and social work educators These global standards include for example
standards regarding the schoolrsquos core purpose or mission statement standards regarding
programme objectives and outcomes standards with regard to programme curricula
including field education The standards with regard to the core curricula are organised into
four conceptual components domain of the social work profession domain of the social
work professional methods of social work practice and paradigm of the social work
profession under which several sub-domains are described which mainly relate to aspects
such as inadequacies discrimination tradition and culture social stability and ethical
principles The following touch upon the field of health promotion and disease prevention
bull Knowledge of human behaviour and development and of the social environment
with particular emphasis on the person-in-environment transaction life-span
development and the interaction among biological psychological socio-structural
economic political cultural and spiritual factors in shaping human development
and behaviour (domain of the social work profession)
bull Sufficient practice skills in and knowledge of assessment relationship building
and helping processes to achieve the identified goals of the programme for the
purposes of social support and developmental protective preventive andor
therapeutic intervention ndash depending on the particular focus of the programme or
professional practice orientation (methods of social work practice)
bull The application of social work values ethical principles knowledge and skills to
promote care mutual respect and mutual responsibility amongst members of a
society (methods of social work practice)
bull Problem-solving and anticipatory socialisation through an understanding of the
normative developmental life cycle and expected life tasks and crises in relation
to age-related influences with due consideration to socio-cultural expectations
(paradigm of the social work profession)
104 httpswwwiassw-aietsorgwp-contentuploads201808Global-standards-for-the-education-and-training-
of-the-social-work-professionpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
88
The European Social Network (ESN) investigated the social services workforce throughout
Europe and provided an overview of qualifications and skills in different Member States in
their research report showing that qualification and skills for social care workers differ per
country105 In fact in some countries there are specific training routes for social care
workers including specialised training courses or apprenticeships and the content of these
trainings depends on the service user group and is generally defined at a local or authority
level A questionnaire was set out in which essential components of social care workers
were identified which showed that health and safety is seen as an important component
of social work
105 httpswwwesn-euorgsitesdefaultfilespublicationsInvesting_in_the_social_service_workforce_WEBpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
89
ANNEX 3 ONLINE SURVEY
Survey Health promotion and disease prevention in health and educational
settings
Health promotion and disease prevention in health and educational settings -
medical schools The European Union has commissioned Ecorys an international
research and consultancy agency to conduct a project on health promotion and
disease prevention in health and educational settings In order to provide an EU
wide overview and to better support national governments we would like to ask
for your cooperation The project will develop an EU wide overview of the
educationtraining programmes for basic education postgraduate education as
well as continuous professional development with regard to education on health
promotion Your help will therefore be key in the collection of information and
data on public health initiatives in medical and non-medical education The survey
will take approximately 20 minutes of your time You do not need to complete this
survey at once You may leave the survey and continue at a later moment in
time Questions can be saved by clicking on the pauze button (below the
questionnaire) When doing so a new URL link will be provided We would be
pleased if you could provide this information by means of an online questionnaire
to Ecorys who is also available in case you have questions or you would like
additional information bull Ms Emalie Hurkmans (Project Coordinator) tel +31
(0)6 280 579 21 email emaliehurkmansecoryscom bull Ms Tessa Huis in lsquot
Veld tel +31 6 29 22 10 58 email tessahuisintveldecoryscom
What is the name of your education
What are the website details of the educationPlease enter the link of the website
with information of the education
Can you give a brief description of the education
What type of health professionals are trained in the education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
90
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
What type of medical specialist
Is the education
Undergraduate education
Postgraduate education
Continuous professional development
Is the course accreditated
Yes
No
Unknown
Does the course cover the topic health promotion and disease prevention
Yes
No
Is the education accreditated
Yes
No
Unknown
Does the education cover the topic health promotion and disease prevention
Yes
No
How is the topic health promotion and disease prevention incorporated in the
curriculum
In a seperate module
Topic incorporated into curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
91
Who is (are) the contact person(s) of the module health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Was there any partnerships in setting up the module health promotion and disease
prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Has the education obtained any funding to set up the module on health promotion
and disease prevention EU funding national public funding local public funding
or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
92
Since when is the module on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the module Eg is it a two weeks one month or one
year programme
What is the typical quantity in hours spend at health promotion and disease
prevention by participants The amount of hours spent on attendence and
homework
Is the module health promotion and disease prevention accreditated separately
No
Unknown
Yes please specify how many points are given
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
93
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the module
No
Unknown
Yes please specify what type of exam
Is the module also provided at other locations For example at other universities
Yes
No
Unknown
Is there a contact person(s)expert for the topic health promotion and disease
prevention
Was there any partnerships in incorporating it in the curriculum
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
94
Has the education obtained funding to incorporate health promotion and disease
prevention into the curriculum EU funding national public funding local public
funding or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is health promotion and disease prevention incorporated into the whole
curriculum eg since September 2017
What is the typical quantity in hours (approximately) spend at health promotion
and disease prevention by participants The amount of hours spent on attendence
and homework
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
95
In what way are knowledge and skills with regard to health promotion and disease
prevention tested in the curriculum For example incorporated into a written exam
Who is (are) the contact person(s) of the course on health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Were there any partnerships in setting up the course on health promotion and
disease prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
business NGOs individual citizens governmental agencies who have a role fill in
yes and add by the partnership in place
No
Yes please specify
Has the education obtained any funding to set up the course on health promotion
and disease prevention
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
96
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is the course on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the course eg two weeks one month or one year
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
97
What is typical quantity in hours spend at health promotion and disease prevention
by participants The amount of hours spent on attendence and homework
Is the course on health promotion and disease prevention accreditated separately
No
Unknown
Yes how many points are given
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the course
No
Unknown
Yes what type of exam
Is the course provided at multiple locations For example at other universities
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
98
What are the general objectives of the teaching activities on health promotion and
disease prevention eg arise awareness among Medical Doctors on the
importance of physical activity within the elderly population with a high risk of
heart failure
Which stakeholders were involved in developing the teaching activities on health
promotion and disease prevention
Is there made use of a mono- or multidisciplinary approach
Monodisciplinairy approach
Multidisciplinary approach
Unknown
Does the education include theories of
1
Yes
2
No
3
Unknown
Population health
Human cognition
and behaviour
Health behaviour
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
99
Does the education include
1
Yes
2
No
3
Unknown
Epidemiology and
bio-statistics
(research
capacity)
Methods of
evidence-based
medicine
Health policies
and regulation
Health economics
Ethics
Health care
systems
Digitalisation in
health promotion
Health inequalities
Disease
prevention in
teams
Health literacy
Health behaviour
change
techniques
Communication
skills
Digital health
coaching
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
100
Concerning teaching methods of health promotion and disease prevention which
methods are used
1
Yes
2
No
3
Unknown
Lectures
Assignments
Field training in real environments
eLearning modules
Other please specify
Concerning covered competencys or capacities of health promotion and disease
prevention the main focus is on
What are the expected outcomes
1
Yes
2
No
3
Unknown
Knowledge
Skills
Behaviour
attitudes
Relevant output (if available) eg number of students following the module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
101
Do you think it is likely you will apply the learned knowledge and skills (on health
promotion and disease prevention) in daily practice after completion of this
education
Yes please specify
No please specify
Not sure please specify
Is there a reason why this education might be a good example for other
educational settings with regard to the way that health promotion and disease
prevention is covered in the education
Are there any remarks Please feel free to give overall remarks or initiative-specific
remarks
Your responses have been registered Thank you for taking the time to complete
the survey your input is valuable to us
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
102
HOW TO OBTAIN EU PUBLICATIONS
Free publications
bull one copy via EU Bookshop (httpbookshopeuropaeu)
bull more than one copy or postersmaps from the European Unionrsquos representations (httpeceuropaeurepresent_enhtm) from the delegations in non-EU countries (httpeeaseuropaeudelegationsindex_enhtm) by contacting the Europe Direct service (httpeuropaeueuropedirectindex_enhtm) or calling 00 800 6 7 8 9 10 11 (freephone number from anywhere in the EU) () () The information given is free as are most calls (though some operators phone boxes or hotels may charge you)
Priced publications
bull via EU Bookshop (httpbookshopeuropaeu)
EUROPEAN COMMISSION
Directorate-General for Health and Food Safety Directorate C mdash Public health country knowledge crisis management
Unit C4 mdash Health determinants and international relations
E-mail sante-consult-c4eceuropaeu
European Commission
L-2920 Luxembourg
ldquoThis document has been prepared for the European Commission however it reflects the
views only of the authors and the Commission cannot be held responsible for any use
which may be made of the information contained thereinrdquo
Europe Direct is a service to help you find answers
to your questions about the European Union
Freephone number ()
00 800 6 7 8 9 10 11
() The information given is free as are most calls (though some
operators phone boxes or hotels may charge you)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
4
Table of Contents
Preface 5
Executive summary 7
1 Introduction 11
11 Research questions 14
2 Theoretical background 15
21 Societal needs for health promotion and disease prevention 15
22 Health profession competencies 16
23 Educational systems for health professions in Europe 19
24 Relevant educational settings for health promotion 19
25 Theoretical framework for this study 21
3 Methodology 22
31 Mapping of health educational programmes in the EU 22
311 Online survey 22
312 Desk research 26
32 Long list of good practices 27
4 Mapping of the current situation IN health promotion training in the EU 29
41 Overview of educational programmes in the EU 29
411 Summary of the main findings in the survey 29
412 Detailed results of the survey 29
42 Overview of competency profiles of health professionals in the EU 44
5 Long list of good practices 45
51 Results 45
52 Analysis of good practices 48
6 Conclusions 53
Annex 1 Survey results by country 57
Annex 2 Competency profiles per professions 71
Annex 3 Online survey 89
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
5
PREFACE
ECORYS Nederland BV is pleased to present the reader to support Member States in
mainstreaming health promotion and disease prevention including lifestyle medicine in
education of health professionals The reader gives a general overview of professional
training initiatives in the European Union (EU)
The study comes at a time when it is well known that lifestyle factors are important
determinants for most non-communicable diseases These diseases have a major impact
on the health of European citizens At the same time an increasing proportion of aged
population poses demands on health systems and stresses the need to sustain the work -
abilities of the working age population Therefore health promotion disease prevention
and a healthy lifestyle are essential for patients and the general population Health
professionals play an essential role here This is not an easy task as dealing with lifestyle
factors requires different strategies at a population level or for targeted patient groups with
eg type II diabetes or cardiovascular risks Health professionals need to be prepared for
this task in their education either during their study period or as part of continuous
professional development Though widely acknowledged it remained unclear to what
extent and how Member States address this challenge
In the context of this project we collected practices how EU Member States include health
promotion disease prevention and lifestyle medicine in health professional education This
report presents a mapping of the current situation across different countries and health
professions Without pretending to be complete it provides a unique baseline of the way
professionals are currently prepared to implement health promotion disease prevention
and lifestyle medicine in EU countries With this baseline Chafea created an important
starting point for the exchange of experiences and mutual learning Hope is that this will
boost developments in the near future so as to prepare health professionals to adequately
address the challenges that healthcare systems in the EU face and implement the paradigm
shift from treatment of diseases among patients to promotion of health among the entire
population
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
7
EXECUTIVE SUMMARY
Background
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices and unhealthy diets Tobacco use harmful
use of alcohol and physical inactivity have been identified as the top risk factors for non-
communicable diseases (NCDs) in the European Union In recognition of this important
public health challenge investing in effective health promotion and disease prevention of
NCDs is critical to improve the quality of life and well-being of European citizens
Healthcare professionals such as doctors (especially general practitioners) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs However while
many policy statements and NCDs practice guidelines call for behavioural change as the
first line of prevention and management professionals often do not include behavioural
change counselling in their care yet While most health professionals acknowledge the need
for lifestyle advice there seems to be a mismatch between the roles and competencies for
which health professionals are trained and the action required This underscores the need
to develop and strengthen lifestyle medicine as a component of health professionalsrsquo
education defined as lsquothe integration of lifestyle practices into the modern practice of
medicine both to lower risk factors for chronic disease andor if diseases are already
present to serve as an adjunct in therapy Lifestyle medicine brings together sound
scientific evidence in diverse health related fields to assist the clinician in the process of not
only treating disease but also promoting good healthrsquo
Objective of the study
This study seeks to provide a mapping of the current situation how health professionals are
trained in health promotion in the EU To that end this study aims to answer the following
research questions
1 How are health professionals in the EU countries being trained in health promotion
prevention and lifestyle medicine in graduate post-graduate and continuous
professional education
2 What are good practices on knowledge capacity and competency building and
advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Scope of the study
Classically public health targets at activity levels can be described in operational models
like the Friedenacutes pyramid model It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of health
like socioeconomic status We use this model as a substructure to investigate health
professionalsrsquo education as they contribute to public health at all these levels
Methodology
In order to provide a general overview on how health professionals are trained in health
promotion and disease prevention and lifestyle medicine in the EU we conducted an online
survey We identified potential organisations in the EU to take part in the survey and asked
those organisations to spread the survey among other organisations or stakeholders in their
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
8
network We contacted 24 EU associations that represent entire professions or part of the
professions (like post-graduates) in all EU countries and have major networks in the fields
of graduate post-graduate and continuous professional development for their support We
aimed to cover all professions within the scope of this study physicians physiotherapists
occupational therapists psychologists nurses social workers dentists pharmacies
dietitians Also national health associations and national educational organisations were
approached to fill in the survey Among other topics the survey contained questions on the
training programme type of health professional targeted implementation in the
curriculum description of the health promotion component funding accreditation and
partnerships
In addition to the online survey a desk research was conducted including both scientific
and grey literature to establish an overview of the competency profiles of health
professionals in the field of health promotion and disease prevention Based on the
identified literature we described the competency profiles for each of the following
healthcare professions (undergraduate) medicine medical specialists dentists nurses
nurse specialists occupational therapists pharmacists physiotherapists psychologists
and social workers
Results were tabulated and described Good practices were selected on the basis of four
pre-established criteria These practices were analysed more in-depth with an analytical
tool aligning Friedenrsquos pyramid of public health needs and Kraigerrsquos Learning Typology This
in-depth analysis was used to define a short list of 10 good practices representing a variety
of professions and countries
Results
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades1there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional However there is room for improvement many competency
profiles leave room for interpretation the described competences are not ranked in order
of importance and it is often not explained how the competences should be applied in
practice ie in a pro-active preventive way (always assessing lifestyle within the
treatment) or a more curative reactive way (only included in the treatment when there is
a clear lifestyle component related to the disease)
As for the inclusion in educational programmes a high percentage (93) of respondents
(n=197) indicate that health promotion and disease prevention is implemented in their
educational programmes or modules The high share may reflect a selection bias as those
who have implemented health promotion within the education may have been more inclined
to fill in the questionnaire In the survey we explored how health promotion and disease
prevention is implemented in the educational setting In summary this provided the
following results
1 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
9
bull More than half of the respondents indicated that they filled in the questionnaire for
practices in undergraduate educational settings Throughout Europe these
numbers were relatively similar
bull Physiotherapists are the professional group most actively involved in health
promotion training activities The vast majority applies multidisciplinary
approaches and thus brings other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within training programmes In continuous professional development on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion especially target knowledge skills
and behaviour of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for continuous professional
development (33) compared to undergraduate and postgraduate education
where the topic is covered in most modules (15 and 6) Funding was more
often obtained in Northern and Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) Regarding full modules high percentages indicated
that this is mandatory and that there is an exam at the end of the module (81
70 respectively)
Conclusions
The present study provides an overview of current practice on health promotion disease
prevention and lifestyle medicine in the education of health professionals in EU countries
This is an important need-assessment for the exchange of knowledge and expertise among
EU countries All professions have versatile competency profiles in health promotion giving
a good ground for further development As the study results reveal some unbalance in
competencies addressed and methods used a next step could be to support further
development of educational practices in lifestyle medicine and adoption of new
technologies There is room for improvement as well as encouraging volition to share
expertise across professions professional associations universities and countries in the EU
The body of knowledge generated in this study can serve as a basis for further analysis and
contribute to the enhance effectiveness of educational practices of health promotion
disease prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
11
1 INTRODUCTION
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices2 In Europe such chronic diseases as
cancer cardiovascular diseases diabetes and chronic respiratory diseases are giving the
greatest disease burden3 The Global Burden of Disease (GBD) 2016 study estimates that
over 91 of deaths and over 87 of DALYs in the European Union (EU) are the result of
non-communicable diseases (NCDs) of which 61 and 43 respectively can be attributed
to modifiable risk factors4 To a large extent lifestyle factors unhealthy diets tobacco use
harmful use of alcohol and physical inactivity have been identified as the top risk factors
for NCDs in the EU5 The last non-communicable diseases progress monitor 2017 of the
WHO underlines that ldquoNCDs share key modifiable behavioural risk factors like tobacco
use unhealthy diet lack of physical activity and the harmful use of alcohol which in turn
lead to overweight and obesity raised blood pressure raised cholesterol and ultimately
diseaserdquo6 Since NCDs share many related modifiable risk factors and often do not occur in
isolation7 prevention must be integrated into population approaches to combat NCDs as a
group8 In recognition of this important public health challenge investing in effective health
promotion and disease prevention is critical to improve the quality of life and well- being of
European citizens910 as well as their productivity and NCDrsquos burden on health systems and
economy of European societies11
Strengthening the investments in health promotion and disease prevention is key to delay
the onset and reduce the burden of NCDs in Europe12 As there is a great need for chronic
disease management the healthcare setting is crucial for health promotion in both primary
and secondary prevention of NCDs13 For example obesity is a major modifiable risk factor
2 Chopra M et al (2002) A global response to a global problem the epidemic of overnutrition
httpswwwncbinlmnihgovpmcarticlesPMC2567699pdf12571723pdf 3 WHO (2006) Gaining Health The European strategy for the prevention and control of noncommunicable
diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf 4 EU burden from non-communicable diseases and key risk factors httpseceuropaeujrcenhealth-
knowledge-gatewaysocietal-impactsburden 5 WHO (2014) Prevention and control of noncommunicable diseases in the European Region a progress report
httpwwweurowhoint__dataassetspdf_file0004235975Prevention-and-control-of-noncommunicable-diseases-in-the-European-Region-A-progress-report-Engpdf
6 WHO (2017) Noncommunicable diseases progress monitor 2017 httpappswhointirisbitstream handle106652589409789241513029-engpdfjsessionid=0613BF26D66A7DA9D1C91AD325E0A75Dsequence=1
7 httpsacels-cdncomS00917435150028321-s20-S0091743515002832-mainpdf_tid=88fea2bf-946a-44c2-be59-0edbabc2c2e8ampacdnat=1541511066_feedfb33968e2ac2f5b47a3452254a9f
8 Integrated approach to prevent noncommunicable diseases httpwwweurowhointenhealth-topicsnoncommunicable-diseasescanceractivitiesintegrated-approach-to-prevent-noncommunicable-diseases
9 WHO (2006) Gaining Health The European Strategy for the prevention and control of noncommunicable diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf
10 Scriven A (2017) Promoting Health a Practical Guide Seventh Edition httpsbooksgooglenl
bookshl=nlamplr=ampid=fJwqDwAAQBAJampoi=fndamppg=PP1ampdq=importance+health+ promotion+and+disease+prevention+European+Commissionampots=jcXZvCYJIQampsig=8D8Yqa9wKa_DlaaYUky_EtUxd_gv=onepageampq=importance20health20promotion20and20disease20prevention20European20Commissionampf=false
11 Tender 12 Chrodis (2015) Health promotion and primary prevention in 14 European countries a comparative overview
of key policies approaches gaps and needs httpchrodiseuwp-contentuploads 201507 FinalFinalSummaryofWP5CountryReportspdf
13 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
12
for type II diabetes (DM II) and thus efficacy of the intervention matters In economic
modelling for eight European countries a body-mass index reduction in the adult population
of 5 compared to 1 resulted a three-fold reduction in the incidence of DM II14 Apart
from the health losses caused directly by NCDs underlying conditions may also increase
susceptibility for other diseases Patients with diabetes and serious heart conditions eg
were identified as risk populations for COVID-1915 New health threats like climate crisis
will have an impact on healthcare systems and need for adaptation options including
training of health care workers integrated heatwave early warning systems especially for
the most vulnerable populations and supporting lifestyle changes toward healthy choices
that are at the same time climate and health friendly16
Healthcare providers such as doctors especially general practitioners (GPs) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs17 Health
promotion is collaborative work where professionals strengthen the message and help
patients to choose and implement healthier behaviours Counselling on and prescription of
a healthy lifestyle is particularly important to socioeconomically vulnerable and
disadvantaged population groups which are disproportionally affected by unhealthy
lifestyles and are more difficult to reach18 Secondary and tertiary prevention in chronic
diseases is embedded into good quality care since good nutrition status decreases the risk
of reinfarction as does smoking cessation For these reasons health promotion was
explicitly recognized as an integral part of the professional role of the GP in several policy
statements at both the European and the national level19 While many policy statements
and NCDs practice guidelines include a call for behavioural change as the first line of
prevention and management providers often do not provide behavioural change
counselling in their care20
A recently published report by the European Commission and WHO Europe (2018) identified
barriers for prescribing and counselling on exercise schemes and on promoting physical
activity in the health sector These were the lack of confidence and knowledge and skills by
health professionals on providing effective counselling21 For example Koutoukidis et al
(2017) performed a qualitative study on the perspective of healthcare professionals on
lifestyle advice to cancer survivors Health professional-centred barriers to provision of
lifestyle advice were a lack of knowledge on healthy lifestyle guidelines the feeling that
14 Webber L Divajeva D Marsh T McPherson K Brown M Galea G et al The future burden of obesity-related
diseases in the 53 WHO European-Region countries and the impact of effective interventions A modelling study BMJ Open 2014
15 Centre for Disease Control and Prevention (2020) Coronavirus disease 2019 Groups at higher risk for severe illness httpswwwcdcgovcoronavirus2019-ncovneed-extra-precautionsgroups-at-higher-riskhtml
16 Drummond P Ekins P Grubb M Lott MSEng M Byass P Nilsson M et al The Lancet Commissions Institute for Sustainable Resources (P Health and climate change policy responses to protect public health thelancetcom 2015
17 Catapano AL et al (2007) Averting a pandemic health crisis in Europeby 2020 what physicians need to know regarding cholesterol management httpswwwncbinlmnihgovpubmed17446817
18 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
19 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20 European20General20Practicepdf
20 httpswwwncbinlmnihgovpmcarticlesPMC4561845pdf101177_1559827615580307pdf 21 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the
European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
13
they were not the right person to provide advice and lack of time and resources22
Additional barriers mentioned in the World Book of Family Medicine ndash European Edition
2015 are perceived as lack of time or competing work load insufficient reimbursement
doubts about patientsrsquo acceptance and willingness to receive lifestyle counselling low self-
efficacy insufficient skills and training doubts about effectiveness of interventions and
health promotion perceived as outside professional role2324 Therefore while most health
professionals seem to acknowledge the need for lifestyle advice there seems to be a
mismatch between roles competencies training and possibilities among health
professionals and action25 Factors causing this mismatch differ from individual and
organizational context wherefore strategies to address these barriers will also vary26
These findings underline the need for developing and strengthening lifestyle medicine in
health professionalsrsquo education27 defined as lsquothe integration of lifestyle practices into the
modern practice of medicine both to lower the risk factors for chronic disease andor if
disease already present serve as an adjunct in its therapy Lifestyle medicine brings
together sound scientific evidence in diverse health-related fields to assist the clinician in
the process of not only treating disease but also promoting good healthrsquo28 Hence lifestyle
medicine covers the systematised approach for prevention and management of chronic
disease addressing eg diet physical activity behaviour change stress and coping and
tobaccosubstance abuse29 Health professionals need to learn how to overcome the
identified barriers mentioned above30 and how to effectively and efficiently counsel their
patients towards adopting and sustaining healthier behaviours31
Moreover digitalization is changing the scenery for lifestyle medicine and chronic disease
management Patient engagement can be enhanced with applications self-monitoring or
self-management tools To successfully embed these new forms of care professionals must
develop new skills32 However studies have shown that medical students are not formally
trained in major concepts known to influence health33 Philips et al (2014) states that
including lifestyle medicine in undergraduate medical curricula would have important public
health implications by efficiently promoting the prevention and treatment of NCDs34 A
study by Dacey et al (2012) states that face-to-face continuing medical education formats
22 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 23 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20
European20General20Practicepdf 24 Geense WW van de Glind IM Visscher TL van Achterberg T Barriers facilitators and attitudes influencing
health promotion activities in general practice an explorative pilot study BMC-family practice 2013 1420 25 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 26
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
27 Polak R et al (2015) Lifestyle Medicine Education httpswwwncbinlmnihgov pmcarticles PMC4561845
28 Rippe JM (2019) Lifestyle Medicine Third Edition CRC Press 29 Kushner RF and Webb Sorensen K (2013) Lifestyle medicine the future of chronic disease management
Obesity and nutrition 201320 30 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 31 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) The impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 32 Eg Richard A A amp Shea K (2011) Delineation of Self-Care and Associated Concepts Journal of Nursing
Scholarship 43(3) no-no httpdoiorg101111j1547-5069201101404x 33 httpscdnymawscomwwwacpmorgresourceresmgrlifestylemedicine-filesajpm-lmcommentarypdf 34 Philips E Pojednic R Polak R Bush J amp Trilk J (2014) including lifestyle medicine in undergraduate
medical curricula Medical education online
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
14
have a positive impact on physician behaviour toward health promotion and disease
prevention by increasing their knowledge confidence and practices that help patients to
adopt healthy behaviours35 Similar results can be expected among other health
professionals as well
The World Book of Family Medicine ndash European Edition 2015 states that the shared aim to
integrate health promotion disease prevention and lifestyle medicine has not been fully
achieved Future activities as to how lifestyle interventions can be better integrated need
collaborative approaches36 As a starting point for more collaborative action this study
seeks to provide a mapping of the current situation on health professionals training in health
promotion in the EU
11 Research questions
To that end this study seeks to answers to the following research questions
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and continuous
professional education
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
35 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) the impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 36
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
15
2 THEORETICAL BACKGROUND
21 Societal needs for health promotion and disease prevention
Classically public health targets at activity levels can be described in operational models
like Friedenacutes pyramid model37 It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of
health like socioeconomic status6 We use this model as a substructure in looking into
health professionalsrsquo education as they contribute to public health in these levels (Figure
21) Society needs to evaluate cost-effectiveness of public health efforts and find a balance
between the levels of actions at each level We use this framework to enable us to present
the needs of societies in general for different health professionals and their roles and
competencies in public health
Figure 21 Frieden Pyramid of health impact of health professional activities at the different levels of society (T Frieden 2010 CDC)
Healthcare services can contribute in mitigating the burden of disease by socioeconomic
disadvantages Health professionals have a key role in developing health services so their
competency to take account of differences in abilities of people to benefit from health
services is vital But more is needed Traditionally health professionals have been managing
the individual risk factors and provision of services That is not enough For example in
cardiovascular diseases the ldquoperfect treatment approachrdquo fails to prevent almost half of the
disease burden37 In cancer diseases individual health behaviours like smoking contribute
in more direct manner Therefore we need to develop educational systems that support
health professionals to take part in new public health approaches by planning interventions
that change the environmental context to make healthy options the default choice
37 Frieden TR A framework for public health action The health impact pyramid American Journal of Public
Health 2010
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
16
regardless of education income service provision or other societal factors37 These are
equally needed in out-of-health contexts like climate change where socio-economic
inequalities and (health) behavioural choices are among major drivers of climate changes38
Policies can influence environments to support healthier choices and we need health
professionals in policy development and execution Still health behaviour changes happen
at the individual level We need more efficient skills in personalized health coaching of
individuals to increase the cost-effectiveness of treatment of NCDs39 An ageing population
and increasing rates of chronic disease as well as advances in medical science and health
information technology to make care safer and more efficient require a rethinking of how
care is delivered Digitalization of services will challenge healthcare professionals and
collaborative care models have become more common40 Instead of requiring compliance
from patients patient-centred approaches are required from professionals This means that
clinical interventions need to be complemented by counselling and education to achieve
long-lasting protective measures Health coaching is aiming to empower patients in co-
management of their disease41 and emphasize and support patientsrsquo autonomy instead of
merely compliance It is based on shared decision-making and collaborative goal setting
facilitated by motivational interviewing42 Health coaching is already happening in digital
environments This paradigm shift requires new skills and attitudes from health
professionals too
New approaches to public health on societal level the paradigm shift to health coaching on
patient level and new forms of healthcare delivery pose a big challenge to the educational
system of health professionals It needs to prepare new professionals and train health
professionals already working in the healthcare system to master a wider scope of
knowledge and develop new skills and attitudes to implement these new approaches in a
safe effective and efficient way
22 Health profession competencies
Healthcare service is a complex and interconnected network of professionals There are
common professional competencies needed in health care and health promotion
(communication collaboration) but they are applied to meet the learning aims of each
profession or level of education If we want to increase the implementation of lifestyle
counselling or systemwide changes we need to evaluate knowledge skills and attitudes
required for the changes and to define the competencies needed to support this change
Professional competencies sum the elements of abilities (knowledge skills attitudes and
behaviours) that enable a professional to accomplish the activities described in a task
statement that outlines what the professional is expected to do43
38 Watts Nick Amann Markus Arnell Nigel et al (66 more authors) (2019) Report of The Lancet Countdown
on Health and Climate Change The Lancet ISSN 0140-6736 httpsdoiorg101016S0140-6736(19)32596-6)
39 Hale R Giese J Cost-Effectiveness of Health Coaching Prof Case Manag 2017 40 Falconer E Kho D Docherty JP Use of technology for care coordination initiatives for patients with mental
health issues A systematic literature review Neuropsychiatric Disease and Treatment 2018 41 Hayes E McCahon C Panahi MR Hamre T Pohlman K Alliance not compliance Coaching strategies to
improve type 2 diabetes outcomes J Am Acad Nurse Pract 2008 42 Olsen JM Health Coaching A Concept Analysis Nurs Forum 2014 43 Kraiger etal 1993 Application of cognitive skill-based and affective theories of learning outcomes to new
methods of training evaluation
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
17
Learning Outcome Typology by Kraiger is a widely used descriptive model for setting targets
and learning outcomes in education43 It comprises cognitive (knowledge) psychomotor
(skill-based) affective and behavioural (attitudes) components This classification scheme
for learning outcomes is based on Bloomrsquos work (1956) of three learning domains including
cognitive domain the affective domain and psychomotor44 45Knowledge can be factual and
declarative knowledge information and concepts or processes and organizations or
metacognitive strategies like allocation and regulation of professional performance Skills
include simple routine development and procedures needed at work and more complex
skills needed for the ability to monitor the performance along other tasks Attitudes are
linked with professionalsrsquo perceptions on learning self-efficacy at work perception about
ability to perform and ability to goal setting It has domains on professionalism Knowledge
can be obtained in reading or e-Learning modules skills require active teaching methods
and attitudes develop over time Behaviours then are complex situations where knowledge
skills and attitudes are utilised in professional manners In education planning outcomes
are defined by these elements
Competency frameworks are an effective method for achieving outcome-based education46
They provide a tool for capturing the elements and abilities (knowledge skills attitudes
and behaviours) needed in effective and safe patient work47They can serve in evaluating
the components of different specialities or societal needs like in this report public health
needs Competencies define an acceptable and feasible description of professional
behaviours used in relation to health promotion Competency building is at the basis in
developing similar programmes in the US4849 Meaningful assessment of competencies
developed is critical for the implementation of effective competency-based medical
education (CBME)50
The International Union for Health Promotion and Education (IUHPE) published an
extensive list of core competencies and professional standards for health promotion in
201651 It defines acuteHealth Promotion actionrsquo in the context of these competencies and
standards to describe programmes policies and other organised Health Promotion
interventions that are empowering participatory holistic inter-sectoral equitable
sustainable and multi-strategy in nature and aim to improve health and reduce health
inequities51
44 Bloom BS (1956) Taxonomy of educational objectives The classification of educational goals New York NY
Longmans Green 45 Cruz-Cunha MM (2012) Handbook of Research on Serious Games as Educational Business and Research Tools 46 Frank JR Danoff D The CanMEDS initiative Implementing an outcomes-based framework of physician
competencies Med Teach 200729(7)642ndash7 47 Cooke M Irby DM Sullivan W Ludmerer KM Medical education American medical education 100 years after
the flexner report N Engl J Med [Internet] 2006355(13)1339-1344+1306 Available from httpwww
scopuscominwardrecordurleid=2-s20-33749062559amppartnerID=40ampmd5=d949feb 758c984c732a419 cada174c85
48 Alaranta A Alaranta H Patja K Palmu P Praumlttaumllauml R Martelin T et alSnuff use and smoking in Finnish Olympic athletes Int J Sports Med 200627(7)
49 Van Horn L Lenders CM Pratt CA Beech B Carney PA Dietz W et al Advancing Nutrition Education Training and Research for Medical Students Residents Fellows Attending Physicians and Other Clinicians Building Competencies and Interdisciplinary Coordination Adv Nutr 2019
50 Lockyer J Carraccio C Chan MK Hart D Smee S Touchie C et al Core principles of assessment in competency-based medical education Med Teach 201739(6)609ndash16
51 IUHPE (2016) Core competencies and professional standards for health promotion full version httpwwwukphrorgwp-contentuploads201702Core_Competencies_Standards_linkEpdf )
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
18
We present CanMEDS as an example of a framework that includes content-specific
competencies (Table 21) CanMEDS was developed for medical experts but most
competencies are applicable to all health professionals
Table 21 CanMEDS in short form52 original version53
Competency Short description
Medical Expert Apply clinical skills and knowledge of the biomedical sciences to fulfil your scope of practice
Collaborate with patients and families for patient-centred care and management
Contribute to health care quality and patient safety
Communicator Build rapport and empathy in all interactions with patients and include families (with the patientrsquos consent)
Understand the patientrsquos perspectives expectations and socio-economic issues
Use active listening patient-centred interviewing skills and culturally safe communication
Share information in plain language to promote patientsrsquo understanding
Clearly document and share information with patients and others on the care team
Collaborator Collaborate by sharing knowledge and perspectives sharing responsibilities learning together
Collaborate in care education advocacy administration and scholarship
Leader Take responsibility for the ongoing operation evolution and continuous
improvement of the healthcare system
Expand beyond a clinical or technical role to take on administrative teaching and scholarly roles and responsibilities
Exercise efficient use of resources to achieve cost-effective care
Contribute to improvements in personal practice team organization and system
Health Advocate
Understand and address the determinants of health that affect patients and support patients to navigate through the health care system
Collaborate with communities and populations to influence change in the health
care system
Contribute to health promotion and disease prevention Understand determinants and needs speak on behalf of others increase awareness
Scholar Plan for and engage in life-long learning
Teach others
Evaluate and apply evidence to day-to-day practice
Contribute to research including creation dissemination and translation into
practice
Professional Commit to patients society profession and ldquoselfrdquo Patients ndash maintain clinical competency and adhere to ethical standard Society ndash demonstrate social accountability by responding to societal needs and
expectations Profession ndash peer assessment mentorship supporting others setting standards Self ndash participate in self-assessment and reflection build self-awareness and manage own well-being
52 Michener Institute No Title CanMEDS framework in short [Internet] Available from httpsmichenercawp-
contentuploads201805CanMEDS-Framework-Summarypdf 53 Frank JR Snell L Sherbino J E CanMEDs 2015 Physician Competency Framework [Internet] CanMEDS 2015
Physician Competency Framework Ottawa Royal College of Physicians and Surgeons of Canada 2015 p 1ndash30 Available from httpwwwroyalcollegecaportalpageportalrccanmedsresourcespublications
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
19
23 Educational systems for health professions in Europe
According to the EU Treaty European citizens have a virtue of rights of free movement as
workers freedom of establishment and freedom of service providers54 Directives on the
requirements of professional qualifications in EU their recognition and Regulation55
facilitate the mobility of health personnel Each member state will apply this directive in
the national legislation on health professional qualifications There is a system of automatic
recognition based on harmonised minimum training requirements This system depends on
the timely notification of new or changed evidence of formal qualifications by MS and their
publication by the Commission Otherwise holders of such qualifications have no
guarantees that they can benefit from automatic recognition
The undergraduate education in Europe is coordinated through the Bologna Process which
is an intergovernmental cooperation of 48 European countries in the field of higher
education It guides the collective effort of public authorities universities teachers and
students together with stakeholder associations employers quality assurance agencies
international organizations and institutions including the EC to bring more coherence to
higher education systems across Europe56 Under the Bologna Process all 48 participating
European countries agreed to ensure mutual recognition of qualifications and learning
periods abroad completed at other universities Nonetheless it should be noted that across
Europe healthcare systems and educations may still significantly differ
While professional activity is regulated by national law in individual member states57
faculties and other academic institutions have collaborated in the establishment of a
framework of competencies based on the scientific advances and new methodologies in
education In fact EU Directives of the European Parliament and Council on the recognition
of professional qualifications have consolidated a system of mutual recognition between
MS58 Examples include the PHARMINE for pharmacists and MEDINE for medical doctors59
This collaboration is in line with the Bologna Process
24 Relevant educational settings for health promotion
Inclusion of health promotion and lifestyle medicine in undergraduate medical curricula is
expected to have important public health implications However in current medical
education this subject is minimal to nonexistent60 This is a global problem In 2016 the
American associations around NCDs launched a joint programme called lsquoThe Lifestyle
54 Treaty on the Functioning of the European Union (TFEU) Articles 45 49-62 55 European Parliament C of the EU Directive 200536EC on the recognition of professional qualifications and
Regulation [Internet] 2013 Available from httpseur-lexeuropaeulegal-
contentENALLuri=celex3A32013L0055 56 The Bologna process and the European Higher Education Area httpseceuropaeu education policies
higher-educationbologna-process-and-european-higher-education-area_en 57 UEMS (2017) Charter on training of medical specialists in the EU httpswwwuemseu
dataassetspdf_file001943561ETR-Psychiatry-201703pdf 58 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 59 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 60 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
20
Medicine Education Collaborativerdquo for improvement of health promotion education among
health professionals and in medical schools61 This initiative will a) work for high-quality
curricular material on an easily navigable website b) provide support for medical schools
to advocate for and implement lifestyle medicine curricula into their own institutions c)
aim to increase awareness and legislative initiatives that encourage adoption of lifestyle
medicine into medical school education d) develop and conduct assessment in the
following areas Student Health Student Knowledge and Programme Effectiveness and
e) train and support medical students as effective champions of lifestyle medicine whose
engagement with the curriculum lead to increased adoption within medical schools and
enhanced collaboration nationallyError Bookmark not defined This need has been acknowledged
in Europe as well62
Besides education in medical schools continuous professional development (CPD) is an
essential component in health education to ensure that professionals graduated in past
decades keep their competencies up to date and acquire new competencies needed for
health promotion disease prevention and lifestyle medicine It is important to encourage
further strengthening of CPD for those professions that benefit from automatic recognition
of their professional qualifications Member states should in particular encourage CPD for
physicians medical specialists general practitioners nurses responsible for general are
dental practitioners specialized dental practitioners veterinary surgeons midwives
pharmacists and architects63 Given the rapid developments in societal needs and
approaches towards health promotion and disease prevention and spectacular increase in
technological support facilities lifelong learning is imperative for health professionals and
should be oriented towards the competencies required to best serve their population and
society
Figure 22 Lifelong learning is an iterative process where learners build knowledge skills
attitudes and behaviours on top of their current professional competency
61 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019 62 European Lifestyle Medicine organisation httpswwweulmorg 63 Lim SS Vos T Flaxman AD Danaei G Shibuya K Adair-Rohani H et al A comparative risk assessment of
burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions 1990-2010 A systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
21
25 Theoretical framework for this study
In this study we touch upon the existing levels of health promotion disease prevention
and lifestyle medicine in health and educational settings in the EU and make a preliminary
assessment of its relevance
As right now health professional competencies seem more practical we approached the
mapping of competencies in health education through professions rather than with an
overall theoretical framework Thus we aim to create a general picture for different health
professions at different levels of education
For the assessment of relevance of the existing levels of health promotion in education we
aligned the competency framework of Kraiger with Friedenrsquos public health framework We
used three components64 of Kraigerrsquos Learning Typology
bull Knowledge cognitive and mental abilities
bull Skills psychomotor manual and physical abilities to perform tasks
bull Attitude (or self) perceptions growth in feelings or emotional areas
We used the integrated framework as an analytical tool to classify content areas covered
and their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future
This study is an important first step as we know little about present practices However
more detailed research will obviously be needed
64 Given the limitations of the study behaviour ndash the fourth component ndash is not included Behaviour refers to
practices to utilise knowledge skills and attitude in work environment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
22
3 METHODOLOGY
31 Mapping of health educational programmes in the EU
The first aim was to provide a general overview on how health professionals are trained in
health promotion and disease prevention and lifestyle medicine in the EU To that end we
conducted an online survey to map the educational programmes of health professionals in
the EU In addition to the proposed methodology we also conducted desk research to
create an overview of competency profiles of health professionals in the EU
311 Online survey
This study looks at undergraduate education postgraduate education and CPD courses in
all healthcare professions across the EU Within the EU different organisations are
responsible for the education of healthcare professionals
bull The undergraduate education programmes are organised by universities in each
country
bull The post-graduate education programmes are organised differently in each
country This includes a set of European organisations that run the guidelines
and portfolioacutes for each profession or specialty within this profession (like in
medicine)
bull CPD programmes are even more diverse between countries and can be accredited
both by European organisations and universities
Due to the wide scope of the study and the different levels of healthcare educational
programmes no country correspondents could be found with a full overview of educational
programmes addressing health promotion and disease prevention in their country
Therefore we chose for a snowball methodology to obtain information on all levels of health
professional education The snowball methodology consists of two steps First we identified
potential organisations in the EU to take part in the survey Second we asked those
organisations to recruit other organisations or stakeholders in their national andor
international network of colleagues and spread the survey among those This method
required more effort and time in the beginning but once the lsquoballrsquo was rolling it provided
us with a growing dataset including the perspectives from healthcare educators healthcare
professional associations and healthcare students and residents The snowball method
implies a risk of selection bias as educational institutions that have implemented health
promotion within their programmes ie the front-runners may have been more inclined
to respond than those who have not
In addition this recruitment process served as a communication and dissemination vehicle
and increased the engagement to the mapping Many organisations expressed their interest
to join the workshop as well as willingness to disseminate the results to their members and
collaborators Because of the growing interest we decided to extend the deadline after the
workshop organised on 13 February so attendees could spread the survey among their
national andor international networks
Our original workplan included an Excel worksheet to be sent to the national health
coordinators in each EU country but as we chose a different strategy it was necessary to
develop a more user-friendly and flexible method Therefore an online survey was
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
23
developed This enabled refinement of questions to each level of education with core sets
of questions Survey links proved to be easy to use and shared within educational facilities
or associations which led to higher response
In this section we discuss in more detail how the survey was developed and how relevant
international organisations were recruited
Development of an online survey
First we developed a mapping tool (stand-alone Excel document) to map the current
situation of professionals trained in health promotion This mapping tool was validated by
both Chafea and DG SANTE and by the external experts in the core research team After a
pilot phase an online survey was developed for all healthcare professions based on the
content of the mapping tool This was a necessary step to boost response as the online
survey proved to be more user-friendly and easier to share among educational facilities or
associations than the mapping tool in Excel
Among other topics the survey contained questions on the
bull Training programme for which the respondent is filling in the survey (which
(educational) institute and health profession portfolio etc)
bull Type of training programme (undergraduate education postgraduate education or
continues professionalrsquos development
bull Type of health professional targeted (eg GPrsquos physiotherapists etc)
bull Implementation in the curriculum
bull Description of the health promotion component in the programme (eg teaching
methods monodisciplinary approach or multidisciplinary approach expected
outcomes in knowledge skills and attitude)
bull Targeted funding
bull Accreditation
bull Partnerships
The questions in the survey correspond with the information requested in the Tender
Specifications Note that the survey maps the educational offer effectiveness of education
is outside the scope of this study The complete questionnaire used in the survey can be
found in Annex 3
Recruitment of relevant international organisations EU and national medical and
non-medical associations medical faculties national and international institutes
networks and organisations
As we used a snowball method it is not possible to provide the exact number of persons
who received the survey and response rates Instead we present each of the steps taken
to approach respondents and final response obtained
Recruitment of European associations
First we connected with major networks in the fields of graduate post-graduate and
continuous professional development for their support as these organisations have an
overview of the three levels of health professional education These associations represent
entire professions or part of the professions (like post-graduates) in all European countries
National professional organisations are members of these umbrella organisations For
example the Union of Medical Specialists (UEMS) represents 16 million medical specialists
It has 40 full member associations (Member States of the EU amp Member States of the
European Economic Area) associate member associations (Member States of the Council
of Europe) and observer member associations (other countries eg the United States)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
24
The UEMS represents more than 50 medical disciplines through various bodies
and structures The most important ones are the 43 Specialist Sections which represent
independently recognised specialties All health professionals health professional students
and post-graduates are organised in a similar manner These organisations are in a good
position to provide information and disseminate it across EU countries
Overall 24 EU associations were approached by email to spread the survey among their
networks (see Table 31 for a complete overview) We aimed to cover all professions within
the scope of this study ie physicians physiotherapists occupational therapists
psychologists nurses social workers dentists pharmacies dietitians throughout Europe
Therefore European associations with focus on educational programmes for these specific
professions were approached
Table 31 Approached European Associations
No European Associations
1 European Medical Association (EMANET)
2 The European Union of General Practitioners (UEMO)
3 European Union of medical specialists (UEMS)
4 European Medical Students Association EMSA)
5 European Forum of Medical associations (EFMA)
6 European Federation of Nurses Associations (EFN)
7 European Association of schools of social work
8 European Network of Physiotherapy in Higher Education
9 European Region ndash World Confederation of Physical Therapy (ER-WCPT)
10 European Network of Occupational Therapy in Higher Education (ENOTHE)
11 Council of Occupational therapists of European Countries (COTEC) part of the World
12 Federation of Occupational Therapists (WFOT)
13 Federation of National Psychologists Associations
14 European federation of nurse educators (FINE) association
15 Association for Dental Education in Europe
16 Council of European Dentists
17 Association for Medical Education in Europe (AMEE)
18 Pharmaceutical group of the European Union (PGEU)
19 European Pharmacists Forum (EPF)
20 European Association of faculties of pharmacy (EAFP)
21 European network of medical residents in Public health
22 The Association of Medical Schools Europe (AMSE)
23 The European Society of Preventive Medicine (ESPREV)
24 The European Lifestyle Medicine Organisation (ELMO)
Recruitment of national associations
Second national health associations for all Member States and all professions were
approached to fill in the survey This step was crucial to increase the response National
health associations were selected using the member list of European organisations Table
32 shows the European organisations used to identify national health associations that
were invited to participate in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
25
Table 32 Examples of the approached national associations
Profession European Association Examples of approached national associations (1 out of 28)
Medical doctors Standing committee of European Doctors (CPME)
Czech Medical Chamber
Physiotherapists World confederation for physical therapy (WCPT)
Swedish Association of Physiotherapists
Social workers International federation of
social workers
German professional
association for social work
Psychologists European Federation of psychologistsrsquo association (EFPA)
Croatian psychological association
Occupational therapists Council of occupational
therapists for the European Countries (COTEC)
Association of Bulgarian
Ergotherapists
Dietitians The European Federation of the associations of dieticians
(EFAD)
French Association of Nutritionist Dietitians
Dentists Council of European Dentists Irish dental association
Nurses European Federation of Nurses
Association (EFN)
Polish Nurse Association
Pharmacists Pharmaceutical group of European Union (PGEU)
Malta Chamber of Pharmacists
Recruitment of national educational organisations
Last the list of the selected associations was used to identify relevant national educational
organisations These national educational organisations (eg University of Maastricht
Faculty of Health Medicine and Life Sciences Kaunas University Medical School Lifestyle
Medicine University of Helsinki Faculty of Medicine) were approached individually and
asked to fill in the survey and spread it throughout their network
Table 33 Number of national educational organisations approached
Profession Number of approached national education organisations
Medical schools 298
Schools of physiotherapy 29
School of social work 31
School of dietitians 40
School of Occupational therapists 45
School of dentists 85
School of pharmacists 56
Response obtained
In total we received information on 176 educational practices till mid-February The
workshop organized in Luxembourg65 gave an additional boost and resulted in 32 more
practices reported in the survey In total this mapping exercise is based on information on
208 practices of health promotion in educational settings
65 Workshop ldquoPromoting lifestyle medicine competencies and education of health professionals in the EU todayrdquo
13th February 2020 Luxembourg Organized by Chafea and DG SANTE
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
26
312 Desk research
Desk research was conducted on both scientific and grey literature with the main purpose
to establish an overview of the competency profiles of health professionals in the field of
health promotion and disease prevention This overview was created to gain insight to what
extent competency profiles related to health promotion and disease prevention are covered
in the educational standards of different health professions in the EU We have made use
of reports published online and scientific articles on competency profiles or educational
standards set at EU level (eg European standards in medical training (UEMS) as the EU
Directives of the European Parliament and Council on the recognition of professional
qualifications have consolidated a system of mutual recognition between Member States3
When reports on EU level could not be identified we selected articles on global standards
such as for the profession of social work (ie global standards for the education and training
of the social work profession)
Based on the identified literature we have described the competency profiles for each of
the following healthcare professions
bull (undergraduate) Medicine
bull Medical specialists
- sports medicine specialists
- public health specialists
- internists
- cardiologists
- psychiatrists
- general practitioners
bull Dentists
bull Nurses
bull Nurse specialists
bull Occupational therapists
bull Pharmacists
bull Physiotherapists
bull Psychologists
bull Social workers
The selection of healthcare professions included in the desk research was made in
consultation with Chafea DG SANTE and the experts
The assessment of the competency profiles was based on the three Domains of Learning
KSAs as described in Chapter 2
bull Cognitive mental skills (knowledge)
bull Psychomotor manual or physical skills (skills)
bull Affective growth in feelings or emotional areas (attitude or self)
This method was chosen as especially ldquolack of confidence and knowledge and skills by
health professionals on providing effective counsellingrdquo was identified as a barrier for
prescribing and counselling on promoting physical activity in the healthcare sector66 In
Chapter 4 the results are described in detail
66 httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
27
32 Long list of good practices
From the survey results we have drawn a long list of good practices As agreed with Chafea
and DG SANTE these good practices were selected using the following four selection criteria
bull The programme contains a multidisciplinary approach
bull The education is mandatory (including an exam)
bull The education covers the following topics digitalisation in health eHealth and
digital health coaching
bull The expected outcome includes change in skills and or behaviour
Several variables were included in the longlist country name of the programme name of
the institute whether there is a focus on knowledge skills and behaviour the type of
professionals who are being trained the theories that are covered by the education (eg
human cognition and behaviour health behaviour change techniques communication skills
etc) education methods used year since the education is provided the time spend in the
modules in hours and lastly in case of one full module the duration of this module To
enable comparison between good practices based on different variables the preliminary
longlist can be found in a separate Excel document Chapter 5 includes an overview of the
coverage and content of the long list of good practices
After closing of the online survey we analysed the longlist of good practices along the
following research questions
bull What content items of health promotion disease prevention and lifestyle
counseling do programmes consist of
bull What kinds of learning aims do they have
bull How do they distribute in Friedens model of levels of health promotion
bull Are there differences between professional groups
First we analysed the distribution of the learning skills separately by the levels of education
(undergraduate postgraduate and CPD) We expected that adult learning will be more
directed towards skills (learning by doing) than the undergraduate and postgraduate
programmes Secondly we analysed the educational methods and tools used in the good
practices
Good practices can be submitted to the European Commissionrsquos Best Practice Portal to be
assessed by external evaluators against criteria adopted by the Steering Group on Health
Promotion Disease Prevention and Management of NCDs Practices rated as best against
these criteria will be published on the European Commissionrsquos Best Practice Portal67
67 httpswebgateeceuropaeudynabp-portal
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
28
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
29
4 MAPPING OF THE CURRENT SITUATION IN HEALTH PROMOTION TRAINING IN THE EU
41 Overview of educational programmes in the EU
411 Summary of the main findings in the survey
A high percentage (93) of respondents (n=197) indicated that health promotion and
disease prevention are implemented in their educational programmes or modules For
undergraduate education postgraduate education and CPD these percentages were 95
93 and 83 respectively Other results include
bull More than half of the respondents indicated that they filled in the questionnaire
based on undergraduate educational settings Throughout Europe these numbers
were relatively similar
bull Physiotherapists seem to be the professional group most actively involved in
health promotion training activities The vast majority applies multidisciplinary
approaches and thus bring other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within the undergraduate and postgraduate programmes In CPD on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion target knowledge skills and
attitudes of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for CPD (33) compared to
undergraduate and postgraduate education (15 and 6) when the topic is
covered in most modules Funding was more often obtained in Northern and
Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) With regard to full modules high percentages
indicated that these are mandatory and that there is an exam at the end of the
module (81 70 respectively)
412 Detailed results of the survey
Respondents
In the following section we provide a detailed description of the survey results The survey
targeted undergraduate education postgraduate education and CPD programmes in all
Member States Overall 208 respondents filled in the questionnaire about their educational
practice Note the results presented in the remainder of this report are exclusively based
on the answers respondents provided in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
30
Table 41 and Figure 41 provide an overview of the number of practices reported per
European countries A detailed overview of the educational programmes collected
throughout Europe can be found in Annex 1
Figure 41 Practices collected in the survey by European countries (n=208)
Table 41 Number of respondents per European Member State 2019-2020 (n=208)
Abbreviations EU Member State Number of respondents
AT Austria 12
BE Belgium 23
BG Bulgaria 4
CY Cyprus 1
CZ Czech Republic 7
DE Germany 1
DK Denmark 8
EE Estonia 2
ES Spain 22
FI Finland 6
FR France 15
GB United Kingdom 6
GR Greece 10
HR Croatia 0
HU Hungary 3
IE Ireland 8
IT Italy 10
LT Lithuania 1
LU Luxembourg 0
LV Latvia 5
MT Malta 6
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
31
Abbreviations EU Member State Number of respondents
NL Netherlands 2
PO Poland 0
PT Portugal 14
RO Romania 3
SE Sweden 4
SI Slovenia 14
SK Slovakia 2
Additional countries 19
TOT 208 the UK is included as a Member State in this study as the results were obtained before Brexit
For mapping purposes we made a breakdown of results by region ie Northern Europe
Eastern Southern and Western Europe (based on United Nations Regional Groups)
Furthermore we compare results of individual countries for which at least 10 practices have
been reported in the survey These are Austria Belgium France Greece Italy Portugal
Slovenia and Spain
Table 42 European countries per region
Region European countries
West Austria Belgium France Ireland Germany
Luxembourg Netherlands United Kingdom Switzerland
North Denmark Sweden Estonia Finland Lithuania Latvia Norway
East Bulgaria Czech Republic Hungary Romania Slovakia Poland Georgia Kazakhstan
South Italy Spain Cyprus Portugal Greece Malta Slovenia Croatia Bosnia Kosovo Serbia
Type of education
We asked the respondents to indicate the type of educational setting As shown in Figure
42 more than half of the practices (60) refer to undergraduate educational settings and
approximately one third to postgraduate educational settings Only twelve percent of the
reported educational settings is related to CPD
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
32
Figure 42 Practices by educational level (n=199 in percentages)
Figure 43 and Figure 44 show the distribution in type of education per region and on
country level respectively For Western Southern and Northern Europe distribution is in
line with the overall results In Eastern Europe practices reported are more evenly
distributed over undergraduate and postgraduate education Also the share of CPD
practices is high in comparison with other regions and overall results
Figure 43 Practices by type of education per region (n=204 in percentages)
64
42
62
60
29
37
27
30
7
21
12
10
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Undergraduate education Postgraduate education Continuous professional development
60
29
12
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
33
Figure 44 Practices by type of education per country (in percentages)
Type of health professions
An overview of the type of health professional trained in the educational practices is
provided in figure 45 Remarkably over one third (35) of the educational practices
reported are oriented to physical therapists Note that multiple answers could be provided
Figure 45 Type of health professional being trained (n=208 in percentages)
Medical specialists refer to doctors with an extra expertise in one type of medicine eg including sports
medicine public health internal medicine cardiology psychiatry and the general practitioner68 General
practitioners refers to doctors working within General Practice or Family Medicine (GPFM)69 Medical doctors refers
to doctors without any specialization
68 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 69 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
83
70
27
50
30
62
71
71
8
22
60
30
60
23
14
19
8
9
13
20
10
15
14
10
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Undergraduate education Postgraduate education Continuous professional development
116
15
35
1417
7 8 5
29
0
10
20
30
40
50
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
34
Health professionals involved as educators in health promotion and disease prevention are
shown in Figure 46 Physical therapists are most often active as teachers of health
promotion (36) which coincides with the high share of practices oriented to this
profession Some professions like medical specialists nurses and psychologists are
represented more often as teacher then as trainee of the educational practices This implies
they are involved in programmes oriented towards other health professions and is in line
with a multidisciplinary approach that is applied by the vast majority of practices ( 81
n=148)
Figure 46 Health professionals teaching contents of health promotion (n=90 in
percentages)
Methods of education
Survey results show that traditional methods ie lectures and assignments are most often
used (Figure 47) Assignment refers to home school projects such as writing papers In
CPD eLearning methods are more often used (67) compared to undergraduate (45)
and post graduate education (39) The use of field training is relatively similar for the
different levels of education
Figure 47 Teaching methods applied (n=145 in percentages)
8
27 26
36
14
24 23
6 7
37
0
10
20
30
40
50
97
81
74
46
0 10 20 30 40 50 60 70 80 90 100
Lectures
Assignments
Field training in real environments
eLearning modules
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
35
Knowledge skills and behaviour
As for the outcome of the education respectively 99 94 and 89 of all practices
indicate knowledge skills and behaviour as expected outcomes (Figure 48) There are no
significant differences between types of education
Figure 48 Knowledge skills and behaviour (n=142 in percentages)
Accreditation
Overall 39 of the educational practices is accredited on European or international level
53 is accredited at a national level and only 5 lacks accreditation (n=179) Comparing
the different levels of education the rate of accreditation at a European or nation level
varies At a European level these are 46 33 22 at the national level 47 58
67 for undergraduate education postgraduate education and CPD respectively
Throughout Europe the level of accreditation of education is high in Northern Eastern
Southern and Western countries the share of practices without accreditation is 11 0
5 and 3 respectively (n=197) Eastern European countries have regulated their
accreditation more often on a national level compared to the other countries
Theories covered
Figure 49 shows that health behaviour human cognition and behaviour and population
health are covered in most educational practices to a high or at least limited extent
99
0 1
94
4 2
89
6 4
0
20
40
60
80
100
Yes No Unknown Yes No Unknown Yes No Unknown
Knowledge Skills Behavior
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
36
Figure 49 Theories covered by the education (n=137 (in percentages)
Figure 410 provides a more detailed overview of contents covered in the educational
programmes and shows that communications skills ethics and methods of evidence-based
medicine are mostly covered within the education Contents least covered are digital health
coaching digitalisation health economics
Funding and partnerships
Figure 411 provides an overview of the practices that a) obtained targeted funding to
incorporate health promotion and disease prevention in the curriculum b) for which a
partnership is set up for execution of teaching activities on health promotion or c) built on
existing partnerships to incorporate health promotion in the curriculum of the whole
educational programme This overview only includes educational practices where health
promotion and disease is incorporated in most modules
Funding differed between level of education 15 6 and 33 of the undergraduate
education postgraduate education and CPD received targeted funding to incorporate health
promotion in the curriculum Hence funding seems to play a more important role for CPD
than for undergraduate and postgraduate education
66
54
65
31
42
32
1
1
2
3
1
0 20 40 60 80 100
Population health
Human cognition and behavior
Health behaviour
Yes very much Yes but limited No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
37
Figure 410 Theories that are included within education on health promotion (n=137 in percentages)
Figure 411 Funding and partnerships when health promotion is covered in most modules of the educational programme (n=123 in percentages)
Figure 412 provides a comparison of funding obtained by European region Remarkably
in Western Europe the share of practices with targeted funding to incorporate health
promotion is much lower than in the other EU regions
48
69
40
16
54
48
20
34
37
41
49
64
9
44
24
55
51
42
47
50
50
48
44
42
31
43
7
6
4
4
3
4
25
25
9
9
5
2
42
1
1
1
1
1
1
5
5
5
6
4
3
6
0 20 40 60 80 100
Epidemiology and bio-statistics (research capacity)
Methods of evidence-based medicine
Health policies and regulation
Health economics
Ethics
Health care systems
Digitalisation in health promotion
Health inequalities
Disease prevention in teams
Health literacy
Health behavior change techniques
Communication skills
Digital health coaching
Yes very much Yes but limited No Unknown
52
61
15
0 20 40 60 80 100
Partnerships in incorporating it in the curriculum of thewhole educational programme
Partnerships for execution of teaching activities
Funding to incorporate health promotion in curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
38
Figure 412 Funding to incorporate health promotion for programmes covering health promotion in most modules by region (n=119 in percentages)
Comparing individual countries figure 413 shows that funding is obtained for the
educational programmes reported in Slovenia Italy and France while this is not the case
or unknown in Portugal Belgium and Austria
Figure 413 Funding to incorporate health promotion when health promotion is covered in
most modules of the educational programme by country (n=71 in percentages)
Dedicated modules to health promotion
In a majority of practices (63) health promotion disease prevention and lifestyle
medicine are covered in all modules of the educational programme as opposed to coverage
in one module primarily dedicated to health promotion (37) Undergraduate and
postgraduate education show a similar pattern while in CPD programmes full modules
primarily dedicated to health promotion are relatively restricted namely 15 (Figure 414)
Both options have the potential to be effective depending on context implementation and
other factors The data gathered in this study do not allow any statement on effectiveness
of each option
20
12
21
3
80
82
70
85
6
9
13
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Yes No Unknown
13
29
0
9
30
89
100
38
71
40
100
73
70
11
50
18
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Yes No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
39
Figure 414 Share of practices with one full module primarily dedicated to health promotion
(n=140 in percentages)
Visibility of health promotion in CPD
In CPD health promotion is often integrated into disease-oriented or risk behaviour-
based contents making it harder to identify the subject in events available The
Union of European Medical Specialists (UEMS) has an electronic database for
accrediting continuous medical education This data set contains keywords Using
health promotion public health or lifestyle as keywords 37 educational events were
found in the years 2017-19 (Table 415) There were 6 events in year 2017 3 in
year 2018 and 8 in year 2019 Average number of credits (1 ECMEC equals 1 hour
maximum 6 per day) was 296 average length of events 45 days This illustrates
availability of international training on health promotion and public health for
medical professions In other events these themes may have been touched upon
as well but are not the main subject So there might be a need to make health
promotion more visible in CPD events Competency-based education could provide
a solution if health promotion disease prevention and lifestyle medicine are defined
as competencies
Table 415 CPD events with health promotion public health or lifestyle as keyword 2017-
2019 (n=37)70
Title ECMEC Year Location Website
Control of multidrug-
resistant micro-organisms in health care settings
20 2017 Stockholm
Sweden
httpwwwecdceuropaeu
Epidemiology and public health microbiology for facilitators
30 2017 Spetses Greece
httpwwwecdceuropaeu
Fellowship (EPIET amp EUPHEM) introductory course
86 2017 Spetses Greece
httpwwwecdceuropaeu
International Society for Quality in Health Care 34th International Conference
23 2017 London United Kingdom
httpisquaorgEventslondon-2017
DOHaD 2017 10th World Congress DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE
25 2017 Rotterdam Netherlands
httpwwwdohad2017org
70 Source UEMS database of accredited events 2017-2019
4035
150
20
40
60
80
100
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
40
Title ECMEC Year Location Website
10th European Public Health Conference
23 2017 Stockholm Sweden
httpsephconferenceeu
Methods and tools for evidence-based practice
and decision-making in Public Health with special emphasis on communicable disease
22 2018 Stockholm Sweden
httpwwwecdceuropaeu
ESCMID Workshop on
Migrants Health
15 2018 Muscat
Oman
httpsescmidpulselinksco
mevent14833
Control of multidrug-resistant micro-organisms in health care settings
17 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventscourse-control-multidrug-resistant-micro-organisms-mdros-health-
care-settings
ECDC Summer School 2018 23 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventsecdc-summer-school-2018
3rd International Conference of the European Network for Smoking and Tobacco Prevention
15 2018 Madrid Spain
httpsenspconferenceorg
European Observatory Venice Summer School 2018
25 2018 San Servolo Italy
wwwtheobservatorysummerschoolorg
Letrsquos talk about nutrition (NESG)
4 2018 Madrid Spain
httpespencongresscomprogrammelll-courses
Epidemiology and public health microbiology for
facilitators
28 2018 Spetses Greece
httpsecdceuropaeuenepiet-euphemaboutintro
International Society for
Quality in Health Care 35th International Conference
22 2018 Kuala
Lumpur Malaysia
httpsisquaorgEventsmal
aysia-2018
Fellowship (EPIET amp EUPHEM) introductory course
93 2018 Spetses Greece
wwwecdceuropaeu
EGEA 2018 ndash ldquoNutrition and health from science to practicerdquo
16 2018 Lyon France httpswwwegeaconferencecom
1st EUROPEAN LIFESTYLE MEDICINE CONGRESS
13 2018 Geneva Switzerland
wwwelmocongresscom
11th European Public Health Conference
24 2018 Ljubljana Slovenia
wwwephconferenceeu
Fellowship Multivariable
Analysis
25 2019 Madrid
Spain
Rapid Assessment and Survey methods (RAS)
module
35 2019 Zagreb Croatia
ECDC Summer School 2019 28 2019 Stockholm Sweden
httpswwwecdceuropaeuennews-eventsecdc-summer-school-2019
Fellowship Vaccinology Module
29 2019 Rome Italy
Programme Planning and Implementationrdquo Training Program for Resolve to
Prevent Epidemics Initiative
39 2019 Butaro Rwanda
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
41
Title ECMEC Year Location Website
Skill-mix innovation in primary and chronic care mobilizing the health workforce
28 2019 Venice Italy wwwtheobservatorysummerschoolorg
Evolutionary Medicine Conference 2019 5th international meeting of the International Society for Evolution Medicine and Public Health
15 2019 Zurich Switzerland
httpsisemphorg2019-Meeting
Fellowship (EPIET amp EUPHEM) introductory course
85 2019 Spetses Greece
Project Management for Emergency Preparedness Budget and Finance Management
20 2019 Butaro Rwanda
Autumn School on Medical
Education
19 2019 Chernivtsi
Ukraine
httpswwwfacebookcome
vents531981117209981
Project Management for Emergency Preparedness Practical Leadership Skills
24 2019 Butaro Rwanda
International Society for Quality in Health Care 36th International Conference Cape Town 20102019 - 23102019
18 2019 Cape Town South Africa
httpswwwisquaorgeventscp2019html
Public Health Genomics an
introduction
11 2019 Stockholm
Sweden
httpsecdceuropaeuenne
ws-eventspublic-health-genomics-introduction
ENSP Tobacco treatment
specialistsrsquo training
5 2019 Paris France httpenspnetwork
World Health Summit 2019 16 2019 Berlin Germany
wwwworldhealthsummitorg
Time Series Analysis 28 2019 Bilthoven
Netherlands
httpsecdceuropaeuenep
iet-euphemaboutexperience
12th European Public Health Conference
16 2019 Marseille France
wwwephconferenceeu
Outbreak Investigation Module
30 2019 Nicosia Cyprus
httpswwwecdceuropaeuenepiet-euphemaboutexperience
Source UEMS database of accredited events 2017-2019
Looking at the regional level we found that in most regions a majority of practices cover
the topic in all (or most) modules of the educational programme (Figure 416) In Northern
Europe this is most pronounced with as much as 76 of the practices reported covering
health promotion in all modules whereas in Eastern Europe this applies for 55 of
practices A similar analysis for individual countries shows that only in Spain health
promotion is covered in a dedicated module in the majority (62) of educational practices
reported while in all other countries the topic is mostly covered in all (or most) modules of
the programme Percentages vary from 56 (Austria) to 86 (Greece Figure 417)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
42
Figure 416 How is health promotion implemented in education by region (n=148 in percentages)
Figure 417 How is health promotion implemented in education by country (n=120 in
percentages)
55 participants answered specific questions on the full module dedicated to health
promotion 81 of them indicated that the education is mandatory As figure 418 shows
in Northern and Eastern Europe all dedicated module on health promotion form part of
mandatory education In Western Europe one out of three modules is optional for students
24
4537
42
76
5563
58
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
4439
36
14
22
38
18
6256
6164
86
78
63
82
38
0
20
40
60
80
100
Austria Belgium France Greece Italy Portugal Slovenia Spain
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
43
Figure 418 Full modules on health promotion that are part of mandatory education by region (n=47 in percentages)
An exam is taken at the end of the module in 70 of the cases Between regions
percentages do not differ much (Figure 419) Please note that results are based on a
limited number of practices as response for this question was low
Figure 419 Exam at the end of dedicated module by region (n=47 in percentages)
When asked whether the module on health promotion and disease prevention was
accredited separately 15 indicate that this is the case 30 report that the module is
provided at multiple locations
Figure 420 provides an overview of respondents who indicate that funding was obtained
to set up the module as well as the use of partnerships for implementation of teaching
activities on health promotion or in setting up the module Lastly it was indicated that
mostly lsquootherrsquo professionals are teaching these modules
100 100
82
67
12
22
611
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
Yes No Unknown
2518
2225
12 11
75 7571
67
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
No Unknown Yes
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
44
Figure 420 Funding and partnerships for dedicated modules (n=47 in percentages)
42 Overview of competency profiles of health professionals in the EU
A detailed description of the competency profiles per healthcare profession as obtained
from the desk research can be found in Annex 2 Competency profiles per professions
These profiles provide a solid basis for health promotion and disease prevention
Most competency profiles mention health promotion andor disease prevention Overall
the competencies of medical specialists are most comprehensively described including the
competencies for health promotion Although there are many similarities between the
different competency profiles we have identified differences in the coverage of domains of
learning ie knowledge skills and attitudes (see chapter 23) Knowledge refers to
cognitive or mental competencies skills to competencies to perform tasks or activities and
attitudes to competencies related to beliefs or values An example of an attitude
competency is ldquoexemplify appropriate lifestyle in personal behaviourrdquo In professions that
are less physically oriented emphasis is on knowledge and attitude rather than on skills
related to health promotiondisease prevention This mainly holds for psychiatry and social
workers For professions in which lifestyle is an essential component ie sports medicine
and public health emphasis is on skills rather than attitudesOnly for cardiology nurses
nurse specialists and pharmacists competency profiles describe competences in all
domains of learning ieknowledge skills and attitudes
Many competency profiles leave room for interpretation and competencies described are
not ranked in order of importance In addition profiles do not state whether competencies
should be practised in a pro-active (within every treatment) or reactive way (only when
treating diseases with a clear lifestyle component
43
53
11
0 20 40 60 80 100
Partnerships in setting up module
Partnerships for execution of teachingactivities
Funding to set up module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
45
5 LONG LIST OF GOOD PRACTICES
In this chapter we present the coverage and content of the long list of good practices The
list is also available in an Excel-file that provides the opportunity to easily make selections
by different variables such as country type of programme (undergraduate postgraduate
CPD) or the characteristics of the education programme
We also provide an analysis of content areas covered and their weight in educational
programmes learning objectives learning typology and educational methodology using
Kraigerrsquos typology and Friedenrsquos pyramid as analytical tools
51 Results
From the survey results we have drawn a long list of good practices In agreement with
Chafea and DG SANTE good practices were selected based on four criteria
1 The programme contains a multidisciplinary approach
2 The education is mandatory (including an exam)
3 The education covers the following topics digitalisation in health eHealth and digital
health coaching
4 The expected outcome includes change in skills andor behaviour
This resulted in a long list of 70 good practices that meet all criteria Educational practices
cover all regions of Europe and originate from 20 Member States (Figure 51 and Table
51)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
46
Figure 51 Number of good practices selected for long list by country 2019-2020
Table 51 Number of good practices selected based on the four selection criteria per European Member State 2019-2020
Abbreviations EU Member State Number of good
practices
AT Austria 6
BE Belgium 11
BG Bulgaria 2
CY Cyprus 1
CZ Czech Republic 2
DE Germany 0
DK Denmark 5
EE Estonia 1
ES Spain 7
FI Finland 2
FR France 6
GR Greece 7
HR Croatia 0
HU Hungary 1
IE Ireland 3
IT Italy 2
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
47
Abbreviations EU Member State Number of good practices
LT Lithuania 1
LU Luxembourg 0
LV Latvia 1
MT Malta 0
NL Netherlands 0
PO Poland 0
PT Portugal 2
RO Romania 1
SE Sweden 2
SI Slovenia 7
SK Slovakia 0
TOT 70
Of all selected good practices of healthcare educational programmes 16 practices (23)
cover health promotion and disease prevention in one full module primarily dedicated to
the subject In 54 good practices (77) the educational programmes incorporate the topic
of health promotion and disease prevention in all or most modules (Figure 52)
Figure 52 How is health promotion covered in selected good practices (n=70 in percentages)
When dividing good practices by type of education programme we see that all types
educational programmes are represented (Figure 53) The highest share of good practices
is focused on undergraduate education (60 n=42) Two practices are focused on both
undergraduate and postgraduate education
Figure 53 Type of education () represented by selected good practices (n=70)
77 23
All modules One module
6026
113
Undergraduate education
Post graduate education
Continuous professionaldevelopment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
48
Figure 54 presents the absolute number of selected good practices by type of profession
trained The absolute number sums up till 128 as multiple professions can be trained within
one programme This shows a good variation of health professionals Most good practices
focus on nurses (17 n=22) and medical doctors (13 n=17)
Figure 54 Good practices by profession being trained (n=70 in absolute numbers)
In addition to those described above other variables are included in the separate Excel file
mentioned above These include the name of the programme and the institute focus on
knowledge skills and behaviour type of professionals being trained theories covered in
the education (eg human cognition and behaviour health behaviour change techniques
communication skills etc) education methods used when the education started time
spent on the modules in study hours (ECDEC) and in case of one full module the duration
of this module This Excel file allows to make cross comparisons between different variables
52 Analysis of good practices
In this section good practices are analysed more in detail Figure 55 presents the
distribution of content areas in health promotion and their weight in educational
programmes Methodological training like evidence-based methods (EBM) varies in
programmes but has a strong position Lifestyle intervention skills are widely taught
however new technologies are still on their way in becoming part of health promotion
education Interestingly health economics rate less in these practices in spite of its close
link with health promotion as part of public health policies
30
4
4
11
17
15
15
22
10
Other
Social workers
Dentists
Occupational therapists
Medical doctors
Medical specialists
Psychologists
Nurses
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
49
Figure 55 Results for good practices(n=70) ldquoDoes the education of the initiative includerdquo
Numbers refer to Frieden model in levels of health promotion with exception of methodological contents marked
as tools (1) counselling and education (2) clinical interventions (4) changing the context to make individualrsquos
default decisions healthy (5) socioeconomic factors (6) methods in studying and evaluating health promotion
and public health
We used Friedenrsquos pyramid of levels of health promotion (Frieden 2010) and Kraigerrsquos
typology of learning (Kraiger et al 1993) to describe the abilities that professionals are
expected to acquire Based on their description learning objectives move in a knowledge
level skill building or into attitudinal objectives Figure 56 gives a graphical visualization
of the results of our analysis The dark blue green and light blue rectangles represent the
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
50
Figure 56 Learning objectives categorised into Friedenrsquos levels and learning typology
(knowledge skills attitudes) of good practices (n=70)
different domains of learning knowledge skills and attitudes The size of the rectangles is
proportional to their share in all domains in the educational practice
Within each domain of learning contents are categorized Their vertical order reflects the
order of impact levels of Frieden (from individual patient to society level) and again size
corresponds to share in the curriculums content
This analysis provides a general picture of educational practices in health promotion
disease prevention and lifestyle medicine The graph shows that practices are
predominantly oriented towards knowledge-based competencies (around 60 of the
curriculum) Roughly one third of the programme has skills-oriented learning objectives
while competencies regarding attitudes are addressed in around 10 percent of the
programmersquos content
Looking into knowledge-based competencies the broad spectrum of individual to societal
levels of impact is addressed On a societal level social and medical aspects are widely
represented while the economic angle is scarcely present Technological developments like
digitalisation are present to a modest extent
Skill-oriented learning objectives focus in communicative competences like communication
skills behaviour change techniques and teamwork Health coaching is covered in a small
number of practices Interestingly in methodological contents the aim of skills-oriented
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
51
education is to provide mainly knowledge like in EBM Few practices include practical skills
for communication and coaching in their objectives
Competence-building in the domain of attitudes form a minimal part of educational
practices They are reflected in eg health literacy and ethics However these are also
taught in a hidden curriculum as well
Educational methodologies in the survey include lectures assignments e-Learning and
real-world field assignments As these are the selected good practices it was to be expected
that multiple methods are used in most of these programmes (given selection criterium 3)
In 37 programmes all methods are in use E-Learning is used in 41 programmes
Figure 57 Educational methods used in good practices (n=70 in percentages) ()
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
53
6 CONCLUSIONS
The competency profiles as well as information on a large number of educational practices
in health promotion disease prevention and lifestyle medicine for health professionals in
the EU allow us to formulate answers to the research questions that guided this study
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and
continuous professional education
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades71there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional The educational practices collected show that this is true for all
regions of the EU However there is no overall body that has responsibility for quality
assuring standards of training and professional practice at the European level
The information on around 200 practices from 25 EU Member States (including UK) shows
that the majority of educational practices take place in undergraduate settings while
training events on health promotion for health professionals active in the field are relatively
scarce in continuous professional development (CPD) a limited number of practices on
health promotion are reported and indeed few courses or training events on health
promotion are available in the CPD calendar of the UEMS database of accredited events
Education on health promotion aims at developing competencies in knowledge skills and
attitude and most often has a multidisciplinary character Especially medical doctors nurses
and psychologists are often involved in educating other disciplines on health promotion
Health behaviour human cognition and behaviour as well as population health are part of
educational practices for all professions A majority also include communication skills
methods of EBM and ethics
The most common way to teach health professionals on health promotion disease
prevention and lifestyle medicine is the integration of the subject in most of all modules of
the curriculum Dedicated modules on health promotion are developed in undergraduate
and postgraduate education but are scarce in CPD This may contribute to the invisibility of
the subject in training for professionals active in the field
Four out of ten educational practices on health promotion are accredited on the European
(or international) level half of them have national accreditation
71 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
54
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Based on in-depth analysis of a selection of 70 good practices knowledge proves to be the
predominant domain of learning Theories covered relate to different levels of impact of
Friedenrsquos pyramid but emphasis is on the individual patient level with a predominant
position for evidence-based medicine Health economics receive remarkably little attention
This may be disadvantageous for advocacy of health promotion which requires influencing
decision-making on public funding
Around one third of educational contents are dedicated to competencies in the domain of
skills and mainly target communicative skills Interestingly they provide mainly knowledge
rather than practical training Competencies in the domain of attitude are addressed least
Ethics and health literacy are theories are the most common examples of attitude-oriented
contents When looking at the competencies defined by health professionals advocacy has
a solid role in all of them with defined skills It was represented in only few domains like
health economics so it may well be that educating advocacy skills are more common than
found in this study
Good practices use a mix of educational methods including lectures assignments real-
world practices and digital study methods
In conclusion this study is a first step in gaining knowledge and insights in the state of
affairs of health professionalsrsquo education in health promotion disease prevention and
lifestyle medicine in the EU It is an important step as we know little about present
practices However more detailed research will obviously be needed
The results of our in-depth analysis of good practices provide qualitative information We
used the integrated framework as an analytical tool to classify content areas covered and
their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future The information supplied by the
respondents show the culture of describing health promotion and education objectives
Therefore no lsquohardrsquo conclusions can be drawn However some cautious notions are
worthwhile to mention as they flag opportunities for learning and improving by collaborative
action
First it is worthwhile to stress the progress made While 20 years ago health professionals
were hardly trained in health promotion and lifestyle medicine and at best received some
instruction on specific disease-related unhealthy habits (like smoking for lung diseases) it
is now part of standard education for most health professionals That is an important
development and essential for collaboration across professions
However more can be done Health promotion education should respond to societyrsquos needs
and therefore educational needs are constantly changing and providers of education need
to follow needs in the field Increasing recognition of societal impact on health inequalities
the paradigm shift from treating to coaching patients changes in the way care is delivered
the digital revolution and the need to contain the cost of our healthcare systems represent
a multitude of challenges and relentless educational efforts in health promotion disease
prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
55
To name a few the balance between domains of learning in curricula will have to redefined
as in health coaching skills attitudes and knowledge are equally important Health
professionals will have to manage health economics to speak the language of policy makers
Teaching methodologies have gained from the technological revolution and there is
potential in utilising them even more Also there is a necessity to do so in order to provide
for effective health promotion Health literacy has got alongside data literacy Therefore
education needs to respond to in using more technologies as well as teaching adaptation of
technologies into care This is not common practice yet The constant development in needs
also stresses the need for continuous professional development in health promotion
disease prevention and lifestyle medicine To date CPD seems to be underrepresented in
educational practices on health promotion and more heavily dependent on external funding
than in undergraduate and postgraduate courses
The experience developed in the good practices collected in the survey represents a
valuable body of knowledge skills and attitudes among health educators With collaborative
efforts this can serve as an important capital to promote continuous development and
improvement of educational practices in health promotion disease prevention and lifestyle
medicine in all European countries
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
57
ANNEX 1 SURVEY RESULTS BY COUNTRY
In this annex we provide the names of all educational programmes by country filled in in
the survey In addition the following variables of the educational programmes are
provided the name of the educational institution type of education and type of health
professionals being trained This information is based on the information provided by the
respondents from each country If certain boxes are not filled in this means that only
partial information of this educational programme is provided
Austria
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Bachelorstudiengang Physiotherapie
FH JOANEUM GmbH Undergraduate education
Physical therapists
Dietetics Health University of
Applied Sciences
Undergraduate
education
Dieticians
Physiotherapy University of Applied Sciences St Polten
Undergraduate education
Physical therapists
Bachelorrsquos Degree Programme Physiotherapy
FH Campus Wien Undergraduate education
Physical therapists
Dietetics and Nutrition FH Joanneum Undergraduate education
Medical Doctors Non-specialized dietitians
Bachelor Programme Physiotherapy
University of Applied Sciences Upper Austria
Undergraduate education
Physical therapists
Degree Programme Dietetics
(Bachelor of Science)
University of Applied
Sciences Upper Austria
Undergraduate
education
Dietitians
Midwifes Speak and language therapists Biomedical scientists Radiological
technologists Physical therapists Occupational therapists Nurses
Bachelor in Health Studies
Physiotherapy
FH Kaernten Undergraduate
education
Physical therapists
Nursing Science Medical University of Graz
Postgraduate education
Nurses
Public Health Medical University of Vienna
Continuous professional development
Medical doctors
Belgium
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Drug Development KU Leuven Undergraduate education
Pharmacists
Bachelor and master Rehabilitation Sciences and
Physiotherapy
University of Antwerp Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
58
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Motor Sciences Physiotherapy
Universiteacute Libre de Bruxelles
Undergraduate education
Physical therapists
Nutrition amp Dietetics Thomas More University College
Undergraduate education
Dietitians
Adad Adad Undergraduate education
Physical therapists
Master Physiotherapy and
Rehabilitation Science
KU Leuven Postgraduate
education
Physical
therapists
Occupational therapist HE Vinci Parnasse ISEI Undergraduate education
Occupational therapists
Master in Physical therapy and Rehabilitation
Universiteacute Libre de Bruxelles
Postgraduate education
Physical therapists
Master in Physical therapy Universiteacute Libre de Bruxelles
Postgraduate education
Medical specialists Physical
therapists (Sport medicine)
Nutrition and dietetics Thomas More University College
Continuous professional
education
Medical doctors Dieticians
psychologists
Information not provided Information not provided
Undergraduate education
Pharmacists
The European Certificate in
Lifestyle Medicine
The European Lifestyle
medicine organisation (ELMO) together with the Belgian Lifestyle
Medicine Organisation (BELMO)
Continuous
professional education
Medical doctors
Medical specialists (lifestyle
medicine) Physical therapists
Occupational therapists Nurses Psychologists General practitioners
Nutrition and Dietetics Erasmus Hogeschool Brussels
Undergraduate education
Dieticians
Master in Nursing and Midwifery
University of Antwerp Postgraduate education
Nurses
Bachelor amp Master Rehabilitation Sciences amp
Physiotherapy
KU Leuven Undergraduate education
Physical therapists
Bachelor Nursing University of Applied
Sciences Gent HOGENT
Undergraduate
education
Nurses
Professional Bachelor in Nutrition and Dietetics
University colleges Leuven Limburg
Undergraduate education
Dieticians
Nutrition and Dietetics University College Ghent
Undergraduate education
Dieticians
Bachelor in Applied Health Science
Howest University College
Undergraduate education
Lifestyle coaches
Physiotherapist Universiteacute Libre de Bruxelles
Postgraduate education
Osteopathy Physical therapists
Bachelor in Medicine Hasselt University Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
59
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor of Nutrition and Dietetics
University of Applied Sciences of Gent
Undergraduate education
Dieticians
Bulgaria
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor programme in Social Work
Plovdiv University Department of Social work
Undergraduate education
Social workers
Rhinology Bulgarian Rhinologic
Society
Postgraduate
education
ENT doctors
Kinesitherapy Medical University Undergraduate education
Physical therapists
TRS rehabilitator Medical College Medical University
Continuous professional
education
Medical specialists
Cyprus
Name of educational
programme
Name of
educational
institution
Type of
education
Type of
health
professionals
being trained
Physiotherapy
programme
Nicosia University Undergraduate
education
Physical
therapists
Czech Republic
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy Universities Undergraduate education
Physical therapists
Physiotherapy Charles University first
faculty of Medicine
Undergraduate
education
Physical
therapists
Physiotherapy Faculty of Medicine Masaryk University Brno
Undergraduate education
Physical therapists
Physiotherapy Palackyacute University Faculty of Physical Culture Department of Physiotherapy
Postgraduate education
Physical therapists
General Nursing Masaryk University Undergraduate education
Nurses
Prakticky zubni lekar (Practical Dentist)
Czech Dental Chamber Continuous professional education
Medical specialists
Health Promotion Ministry of Health Czech Republic
Continuous professional education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
60
Denmark
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Musculoskeletal physiotherapy
Aalborg University Postgraduate education
Physical therapists
Master in Physiotherapy University of Southern Denmark
Postgraduate education
Physical therapists
The Fairstart Foundation The Fairstart Foundation
Continuous professional education
Orphanage staff (each orphanage has
professional staff such as psychologists social workers
andor therapists
These staff members are responsible to work with each child on an individual basis) School
teachers Psychologists Social workers
Bachelor in Physiotherapy University College North Denmark
Undergraduate education
Occupational therapists
Nurses
Bachelorrsquos degree Programme of Physiotherapy
VIA University college Postgraduate education
Physical therapists
Master of Public Health Aalborg University Undergraduate education
Midwives Nurses Therapists Psychologists Medical Specialists
Estonia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Nursing (general nursing) Tartu Health Care College
Undergraduate education
Nurses
Psychology University of Tarty Institute of Psychology
Undergraduate education
Psychologists
Finland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
NutritionNutrition therapy University of Eastern Finland
Postgraduate education
Clinical nutriontinists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
61
Masterrsquos programme of Human Nutrition and food-related behaviour
University of Helsinki Undergraduate education
Nutrition experts who work in eg community
health promotion
Master of Healthcare advanced practice ndash supporting self-care and
care of non-communicable diseases
Savonia University of Applied Sciences
Postgraduate education
Physical therapists Occupational
therapists Nurses
Public Health Nursing Metropolia University of Applied Sciences
Postgraduate education
Public Health nurse
Medical doctors training programme
University of Helsinki medical faculty
Undergraduate education
Medical doctors Nursing
Master degree in Health Management Psychologists
Dentists
Dental education University of Helsinki Faculty of Medicine Department of Oral and Maxillofacial Diseases
Undergraduate education
Dentists
France
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Occupational therapy school Croix Rouge Franccediloise Postgraduate education
Occupational therapists
Institut Reacutegional de Formation en Ergotheacuterapie
Association Saint Franccedilois dAssise
Postgraduate education
Occupational therapists
Occupational therapy Institut de formation en Ergotheacuterapie de Berck-sur-Mer site de Loos
Postgraduate education
Occupational therapists
Occupational therapy IFE Assas Undergraduate education
Occupational therapists
Arrecircteacute du 5 juillet 2010
relatif au diplocircme drsquoEacutetat drsquoergotheacuterapeute
Institut de Formation
en Ergotheacuterapie du CHU Rouen Normandie
Undergraduate
education
Occupational
therapists
Occupational therapy school Croix Rouge Francaise Postgraduate education
Occupational therapists
Occupational therapy UPEC Postgraduate
education
Occupational
therapists
Diplocircme de Dieacuteteacuteticien IUT biologie ou BTS dieacuteteacutetique
Postgraduate education
Dietitians
Programme deacuteducation et de promotion agrave la santeacute
CoDEPS 13 Continuous professional education
Nurses Psychologists Dentists Social workers
Public health Universiteacute de Bourgogne
Postgraduate education
Medical doctors
Public health Lyon University Undergraduate education
Medical specialists
Public health residency Faculty of medicine University of Nantes
Undergraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
62
Name of educational programme
Name of educational institution
Type of education
Type of health professionals being trained
Master in Public Health Karolinska Institute Postgraduate education
Occupational therapists Social Workers
Public health and social
medicine
Universiteacute Versailles
Saint Quentin en Yveline
Continuous
professional education
Medical doctors
Public health UFR sciences de santeacute - Universiteacute de Bourgogne
Postgraduate education
Medical doctors Medical specialists
Midwives Physical therapists
Nurses General practitioners
Germany
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Visceral Surgery Augsburg University Continuous professional education
Medical specialist Physical therapists
Occupational therapists
Nurses Social workers
Human Medicine ndash The
cologne model study course (human medicine)
University of Cologne
Medical faculty
Undergraduate
education
Medical
specialists
Greece
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy University of Thessaly Undergraduate education
Physical therapists
Oral education programme
for children via experiential learning
Hellenic Dental
Association-Dental School of Athens-Hellenic Society of Paediatric Dentistry
Continuous
professional education
Psychologists
Dentists
Sports Nutrition International Hellenic University
Postgraduate education
Dieticians
Preventive Dentistry National and
kapodistrian University of Athens school of dentistry
Undergraduate
education
Undergraduate
students
Nutrition amp Dietetics International Hellenic University
Postgraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
63
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicine ndash under and post graduate studies
School of health sciences University of Patras
Undergraduate education
Medical doctors
Pharmacy diploma Aristotle University of
Thessaloniki
Undergraduate
education
Pharmacists
Hungary
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Public Health and Preventive
Medicine
Semmelweis University
Budapest Faculty of
Medicine Department of Public Health
Undergraduate
education
Medical doctors
Academic programme of Medicine
Semmelweis University Faculty of Medicine
Undergraduate education
Medical doctors
Residency in Preventive Medicine and Public Health
Semmelweis University Postgraduate education
Medical specialists
Ireland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Social Science in
Social Work
Maynooth University
(national University of Ireland Maynooth)
Postgraduate
education
Social workers
Information not provided Information not provided
Undergraduate education
Physical therapists
Professional Master of Physiotherapy
University College Dublin
Postgraduate education
Physical therapists
Bachelor Physiotherapy University College Dublin
Undergraduate education
Physical therapists
Bachelor Physiotherapy RCSI Undergraduate education
Physical therapists
Irish Dental Association Irish dental association Continuous professional
development
Dentists
Public Health Medicine Royal College of Physicians in Ireland
Postgraduate education
Medical specialists
Higher specialist training in Public Health Medicine
Royal College of Physicians in Ireland
Postgraduate education
Medical doctors Medical specialists General practitioners
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
64
Italy
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Healthy Lifestyles CNAI ndash Italian Nurses association
Continuous professional education
Nurses
Management for Health Professionals
University of Rome Postgraduate education
Midwifes Physical therapists Nurses
Corso di laurea in Terapia occupazionale (Bachelor in Occupational therapy)
Universitagrave degli Studi di Milano (State University of Milan)
Undergraduate education
Occupational therapists
Life Sciences University of Catania
School of Medicine
Continuous
professional
education
Medical doctors
Medical
specialists Physical therapists Occupational therapists Nurses
Dentists
Health promotion University of pavia Undergraduate education
Nurses
Corso di Laurea Magistrale
in Odontoiatria e Protesi Dentaria
Universitagrave di Parma Undergraduate
education
Dentists
Hygiene preventive medicine and public health
Universitagrave Cattolica del Sacro Cuore
Postgraduate education
Medical doctors Medical
specialists
general practicioners
Igiene e Medicina Preventiva Universitagrave degli Studi dellrsquoAquila
Postgraduate education
Medical doctors non-specialized
Post graduate school of Public Health
University of Sienna Postgraduate education
Medical doctors
Hygiene and Public Health University of Bari Aldo Moro
Postgraduate education
Medical doctors
School of specialization in Hygiene and Preventive Medicine
University of Milan Postgraduate education
Medical doctors
Lithuania
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Health Education and Promotion
Klaipeda State University of Applied sciences
Undergraduate education
Dietitians Physical therapists Nurses Dentists Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
65
Latvia
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Dentistry Riga Stradins University Undergraduate education
Dentists General practicioners
Professional Bachelor programme Physiotherapy
LASE Postgraduate education
Physical therapists
Physiotherapy Riga Stradins University Undergraduate education
Physical therapists
Malta
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Bachelor in Nursing Studies University of Malta Faculty of Health Sciences department of Nursing
Undergraduate education
Nurses
FHs University of Malta Undergraduate education
General practitioners
Netherlands
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Occupational Therapy Information not provided
Undergraduate education
Occupational therapists
Lifestyle and Healthcare Amsterdam University Medical Centre
Undergraduate education
Medical students
Portugal
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
PhD in Social Work ISCTE University Institute of Lisbon
Postgraduate education
Social workers
Bachelor degree in
Physiotherapy
Escola Superior de
Sauacutede de Santa Maria
Undergraduate
education
Physical
therapists
Physiotherapy IPC ESTeSC Coimbra Health school
Undergraduate education
Physical therapists
Licenciatura em Fisioterapia Escola Superior de Sauacutede - Instituto Politeacutecnico do Porto
Undergraduate education
Physical therapists
Degree in Physical therapy Instituto Piaget ndash Vila Nova de Gaia
Undergraduate education
Physical therapists
Degree in Physical therapy ESSATLA Continuous professional development
Physical therapists
Curso Licenciatura em Fisioterapia
Instituto Politeacutecnico de Sauacutede do Norte Escola Superior de Sauacutede do Vale do Ave CESPU
Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
66
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Clinical Education University Fernando Pessoa- Faculty of Health Sciences
Continuous professional development
Workers factory
Physiotherapy (Bachelor) School of healthy-
polytechnic institute of Setubal
Undergraduate
education
Physical
therapists
Physiotherapy Escola Superior De Sauacutede Do Vale Do Sousa do Instituto
Politeacutecnico De Sauacutede Do Norte
Undergraduate education
Physical therapists Nurses
Psychologists Dentists
Public Health ARSLVT Postgraduate
education
Medical
specialists
Information not provided Information not provided
Postgraduate education
Physical therapists
Information not provided Information not provided
Undergraduate education
General practicioners
Romania
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Nursing Education University Lucian Blaga Postgraduate education
Nurses
MedicinePharmacy - Health University of Oradea Faculty of medicine and
pharmacy Oradea
Postgraduation education
Medical doctors Medical
specialists Pharmacists Physical therapists Nurses
Dentists General practicioners
Slovakia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Social Work Constantine the philosopher University in Nitra
Postgraduate education
Social workers
Specialisation study in Clinical Psychology
Comenius University in Bratislava Faculty of
Arts
Continuous professional
development
Medical specialists
psychologists
Slovenia
Name of educational
programme
Name of educational
institution
Type of
education
Type of health
professionals being trained
Physiotherapy Alma Mater Europaea Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
67
Physiotherapy University of Novo mesto Faculty of Health sciences
Undergraduate education
Physical therapists
Faculty of health sciences University of Primorska Continuous professional education
Dietetics Physical therapists Occupational therapists Nurses
Nursing Applied Kinesiology Physiotherapy and Nutritional counselling ndash dietetics
University of Primorska Faculty of Health Sciences Slovenia
Undergraduate education
Nutrional counselling Kinesiologists Physical therapists Nurses
Professional higher education study programme 1st cycle degree occupational
therapy
University of Ljubljana faculty of health sciences
Undergraduate education
Occupational therapists
Applied Kinesiology UP FVZ Undergraduate
education
Kinesiology
Physiotherapy Alma mater Europaea ndash Evropski center Maribor
Undergraduate education
Physical therapists
Bachelor in Physiotherapy University of Ljubliana Faculty of health sciences
Undergraduate education
Physical therapists
Health Promotion Angela Boskin Faculty of healthcare
Postgraduate education
Physical therapists Occupational
therapists nurses
1st Bologna cycle study programme Physiotherapy
Angela Boskin Faculty of healthcare
Undergraduate education
Physical therapists
Public Health Medical
Residency
Medical chamber of
Slovenia
Continuous
professional development
Medical doctors
Public Health National institute of public health of the
Republic of Slovenia
Postgraduate education
Medical doctors
Psychology Faculty of arts University of Maribor
Postgraduate education
Psychologists
Spain
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Human Nutrition and Dietetics
University of Zaragoza Undergraduate education
Dieticians
Continuous professional
education
Nurses
Physiotherapy University of Coruna Undergraduate education
Physical therapists
EHEA Degree in Human Nutrition and Dietetics
Blanquerna School of Health Sciences ndash Universitad Ramon Lull
Undergraduate education
Dietitians
Bachelor in Pharmacy Universidad de Sevilla Undergraduate
education
Pharmacists
Continuous professional development
Spanish General Council of Social Work
Continuous professional education
Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
68
Bachelor in Pharmacy Universidad de Alcala Undergraduate education
Pharmacists
Bachelor in Medicine Faculty of medicine University of Cadiz Spain
Undergraduate education
Medical doctors General practitioners
Residency in Preventive Medicine and Public Health
Hospital Clinic de Barcelona
Postgraduate education
Nurses
Bachelor in Medicine Information not provided
Undergraduate education
Medical doctors
MasterBachelor in Pharmacy
University of Navarra Undergraduate education
Postgraduate education
Pharmacists
Human Nutrition and Dietetics
Univeristy of Navarra Undergraduate education
Nutritionists amp Dietitians
Pharmacy Universitad Ramon Lull
Undergraduate education
Pharmacists
Pharmacy IQS ndash FCSB Undergraduate education
Pharmacists
Master in Advanced Therapies and Innovation in Biotechnology
Universidad de Francisco de Vitoria
Postgraduate education
Pharmacists
Pharmacy Universidad of the Basque County
Undergraduate education
Pharmacists
Sweden
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master programme in Public Health
Karolinska institute Postgraduate education
Occupational therapists
Social workers
Dietetics programme Department of food and Nutrition
Undergraduate education
Dietician
Dietetics programme Department of food studies dietetics and nutrition
Undergraduate education
Dietician
Programme in Dietetics University of Gothenburg
Sahlgrenska Academy
Undergraduate education
Dietician
Master of Public Health Department of public health and caring sciences Uppsala University
Postgraduate education
Medical doctors Bachelor of science Physical
therapists Nurses Psychologists Dentists Social workers
United Kingdom
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor (Hons) Occupational Therapy
Northumbria University Undergraduate education
Occupational therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
69
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master (pre reg) Occupational Therapy
Master in Occupational Therapy
Leeds Beckett University
Postgraduate education
Occupational therapists
Bachelor (Hons) Occupational Therapy
St Georgersquos University of London
Undergraduate education
Medical doctors Medical specialists Physical therapists
Occupational therapists
Bachelor (Hons)
Occupational Therapy
Caterburry Christ
Church University
Undergraduate
education
Occupational
therapists
Bachelor (Hons) Occupational Therapy Master in (pre-reg) Occupation Therapy Occupational Therapy degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Public Health speciality training
Health education England -north west
Postgraduate education
Medical doctors Medical specialists Researchers Nurses
Bachelor in (Hons) Occupational Therapy Master in (Pre-reg)
Occupational Therapy Occupational Therapy
Degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Additional countries
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Bachelor of Physiotherapy University of Prishtina Kosovo Albania
Postgraduate education
Physical therapists
Physiotherapy Faculty of health studies University of Sarajevo Bosnia-Herzegovina
Undergraduate education
Physical therapists
Fysioterapeututdanning NTNU Norway Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy BFH
Berner Fachhochschule BFH Bern University of Applied Sciences Swiss
Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy
ZHAW Zurich University of applied sciences Swiss
Undergraduate education
Physical therapists
Physical Therapy Sciences University of Iceland
School of Health Sciences
Undergraduate
education
Physical
therapists
Medicine International school of medicine Kazachstan
Undergraduate education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
70
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicinesingle-cycle degree programme
University of Georgia Republic of Georgia
Medical doctors Psychologists General practicioners
Medicine Akaki tsereteli state University Republic of Georgia
Postgraduate education
Medical doctors Medical specialists Physical therapists Psychologists
Dentists General
practicioners
Public Health and Epidemiology
David tvildiani medical University Republic of
Georgia
Postgraduate education
Medical doctors
Biomedical and Healthcare Science doctoral programme
David tvildiani medical University Republic of Georgia
Postgraduate education
Medical doctors Biomedical Science master degree holders
Medicinesingle-cyle degree programme
University of Georgia Republic of Georgie
Undergraduate education
Medical doctors
Public Health Tbilisi State Medical University (TSMU)
Republic of Georgia
Undergraduate education
Medical doctors and public
health specialists
David tvildiani Medical
University
David tvildiani Medical
University Republic of Georgia
Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
71
ANNEX 2 COMPETENCY PROFILES PER PROFESSIONS
Undergraduate medicine
The CanMEDS framework is worldwide the most commonly used and adapted model that
identifies and describes the abilities physicians require in order to effectively meet the
health care needs of the people they serve72 Within European Member States modifications
of this model are used within health and educational settings (for example in the
Netherlands and Finland) for undergraduate medicine and medical specialisations The
CanMEDS model defines seven roles of the physician namely (1) medical expert (the
integrating role) (2) communicator (3) collaborator (4) leader (5) health advocate (6)
scholar and (7) professional73 The role of health advocate is defined as physicians
contributing their expertise and influence as they work with communities or patient
populations to improve health ldquoimproving health is not limited to mitigating illness or
trauma but also involves disease prevention health promotion and health protection
Improving health also includes promoting health equity whereby individuals and
populations reach their full health potential without being disadvantaged by for example
race ethnicity religion gender sexual orientation age social class economic status or
level of educationrdquo Within this role two key competencies are defined74
1 Respond to an individual patientrsquos health needs by advocating with the patient within
and beyond the clinical environment
a Work with patients to address determinants of health that affect them and their access
to needed health services or resources
b Work with patients and their families to increase opportunities to adopt healthy
behaviours
c Incorporate disease prevention health promotion and health surveillance into
interactions with individual patients
2 Respond to the needs of the communities or populations they serve by advocating with
them for system-level change in a socially accountable manner
d Work with a community or population to identify the determinants of health that affect
them
e Improve clinical practice by applying a process of continuous quality improvement to
disease prevention health promotion and health surveillance activities
f Contribute to a process to improve health in the community or population they serve
In addition the European Thematic Network project MEDINE (2004-2007) and Tuning
Project (Medicine) under its auspice (MEDINE) have generated and gained widespread
consensus on a set of competences for primary medical degree qualifications in Europe
(ie undergraduate medicine)75 Within this project it is stated that graduates in medicine
72 httpwwwroyalcollegecarcsitecanmedscanmeds-framework-e 73 httpwwwroyalcollegecarcsitecanmedsabout-canmeds-e 74 httpwwwroyalcollegecarcsitecanmedsframeworkcanmeds-role-scholar-e 75 httptuningacademyorgmedine-medicinelang=en
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
72
would need the ability to ldquopromote health engage with population health issues and work
effectively in a health care systemrdquo76 The following points define health promotion
bull provide patient care which minimises the risk of harm to patients
bull apply measures to prevent the spread of infection
bull recognise own health needs and ensure own health does not interfere with
professional responsibilities
bull conform with professional regulation and certification to practise
bull receive and provide professional appraisal
bull make informed career choices
bull engage in health promotion at individual and population levels
Medical specialist
The European Union of Medical Specialists (UEMS) contributed significantly to the
improvement of post-graduate training through the development of a European Curriculum
in each medical speciality as well as the elaboration of training standards77 Within this
section we provide a detailed description of the European training requirements for a
selection of medical specialists including sports medicine public health internal medicine
cardiology psychiatry and the general practitioner78 This selection was based on the fact
that within these specialities lifestyle might be an essential component or important part of
the treatment of chronically ill patients
1) Medical specialist sports medicine
Sports medicine is defined by the European Commission as a ldquomultidisciplinary clinical and
academic speciality of medicine dealing with health promotion for the general population
by stimulating a physically active lifestyle and diagnosis treatment prevention and
rehabilitation following injuries or illnesses from participation to physical activities
exercises and sport at all levelsrdquo79 As health promotion and prevention are both
incorporated in the definition of sports medicine these topics are included throughout the
whole curriculum of sports medicine The curriculum of sports medicine aimed to provide
theoretical understanding and practical skills to provide first line clinical services80 Within
the training requirements for the speciality of sports medicine it is stated that sports
medicine does not solely take care for sporting elite athletes but as well for its important
role to promote exercise as a medical tool meant for patients with chronic diseases81
bull Theoretical knowledge aims to provide theoretical understanding and practical skills to
provide first line clinical services
- Clinical To provide pre-participation clinical screening and examination before
exercise and competition as well as medical assistance to the athletes engaged in all
sports
76
httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNLearning_Outcomes_Competences_for_Undergraduate_Medical_Education_in_Europepdf
77 httpswwwuemseu__dataassetspdf_file00111415906pdf 78 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 79 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 80 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 81 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
73
- Public health
bull As part of a multi-disciplinary team to encourage and promote physical activity as
a lever for healthy living
bull To identify impediments to an active lifestyle and work within a multi-disciplinary
framework to remove those impediments or minimize their impact
bull To work alongside local health authoritiespublic health clinicians developing
exercise opportunities for the general public for health gain
bull To liaise with public (local authoritieseducationvoluntary) and private sector to
advise on the health aspects of exercise programmes for physical activity of special
groups like women children adolescents and aging population
bull Practical and clinical skills
bull To foster the integration of knowledge and practical skills acquired during the
cardiology orthopaedics physical amp rehabilitation medicine general practice
medicine and physiology internships
bull To learn to put into practice information gained in the relevant course work
bull To extend and deepen their knowledge in the assessment of fitness such as
isokinetic and functional muscle performance cycle ergometry and treadmill
ergometry
bull To gain experience in the use of such test results in the decision making with regard
to diagnosis recommendations and therapy for people of both gender and in
different age groups and performance levels
bull With regard to elite sport trainees will learn how to diagnose treat and prevent
overtraining and overexertion
bull To become proficient in activities related to for example hygiene and nutrition
and will work closely with trainers athletes physiotherapists officials etc
bull Competencies
bull Clinical and instrumental assessment to determine the pathophysiology
mechanisms and the underlying diagnosis of the patientrsquos condition
bull Trainees are expected to complete evidence of reflective practice through case
reports and other experiences in their training record
bull Other self-directed work will be planning data collection analysis and presentation
of audit and research work
bull The mandatory training record (hand written diary or preferably electronic
logbook) will contain evidence of academic pursuits and should be checked and
documented regularly by the Supervisor
bull Trainees will take part and be able to lead in teaching and will be expected to
develop skills to teach undergraduates postgraduates and non-medical staff in
small groups and formal lectures making personal presentations using a variety of
audiovisual methods
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
74
bull They will be expected to present at journal clubs and make case presentations at
grand rounds or similar settings
bull They will be expected to undertake personal audit and research and make
presentations of their findings at clinical meetings
bull Prescription as much evidence-based as possible of medical and physical
treatments (including drug treatment physical modalities innovative
technologies natural factors and others) as well as of technical aids
bull Prevention and management of complications
bull Skill to perform and participate in research
2) Medical specialist public health
The European Commission defines public health ldquoas the science and art of preventing
disease prolonging life and promoting mental and physical health and efficiency through
organized community effort Public health may be considered as structures and processes
by which the Health of the population is understood safeguarded and promoted through
the organized efforts of societyrdquo82 Public health specialists aim to improve populationrsquos
health by using the following skills and competencies
bull Theoretical knowledge on a range of fields including epidemiology prevention health
promotion public health research behavioural sciences health programme evaluations
health need assessments and quality and safety in healthcare
bull Practical and clinical skills
- Surveillance and evaluation of the health of the population (trained in epidemiology)
- Planning and evaluation of health services and public health control
- Analysing the health of the population (analysing determinants on individual and
community levels)
- Plan participate in or evaluate preventive and control programmes (public health
assessments)
- Participate in multidisciplinary health impact assessment
- Inform decision-makers about potential impacts and to identify appropriate and
sustainable actions to manage those effects (including environmental determinants
of health)
- Organisational issues in healthcare (participating in policy and strategic development
quality and safety management)
- Generate and share new evidence on the ways in which social determinants influence
population health and health equity
- Sufficient linguistic ability to communicate with hisher public health colleagues
82 httpswwwuemseu__dataassetspdf_file001198435UEMS-201924-European-Training-
Requirements-for-Public-Healthpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
75
- Develop high professional ethical standard including respect towards human rights
participants in public health programmes colleges and other professionals in the
team
bull Competencies
- Establish the expertise role as a Public Health Physician
bull Function as public health leaders and consultants to health services and other
organizations and institutions in order to provide safe appropriate cost effective
and equal health care to groups communities and populations
bull Establish and maintain medical knowledge skills and attitudes appropriate to their
practice including the organization and financing of health care public health
control and public health law
- Perform expertise analyses of the health of the population
bull Apply and combine medical and epidemiological competencies for the surveillance
and evaluation of the health of the population
bull Identify the determinants of health of populations and risks for public health and
implications for interventions and policy
bull Evaluate health problems biopsychosocial mechanisms andor health care issues
for different population groups and their implications for the community
bull Critically evaluate epidemiological demographic health statistical and
environmental pollution data and their sources and apply them appropriately to
public health issues
bull Identify community health needs and advise about their implications for public
health and medical care services
- Lead and supervise public health interventions
bull Select develop implement and monitor public health surveillance and
interventions namely in the areas of human behaviour social and physical
environment food safety and nutrition health care associated risks and working
life related health
bull Promote the health of individuals communities and populations through health
programming
bull Contribute to the organization and evaluation of societal and health care
programmes aiming to promote health and social functioning among individuals
with long-term diseases and disabilities
bull Contribute to the planning organization supervision of and evaluation of societal
and health care programmes promoting the health of specific target groups such
as children elderly and vulnerable and underserved groups in society
bull Contribute to the organization of and evaluate primary and secondary medical
prevention programmes
bull Contribute to strengthening regulatory frameworks for protecting and improving
health
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
76
- Function as expertise in planning and evaluation of Public Health and Medical Care
bull Evaluate Public Health and other service programmes concerning processes and
outputs from the different perspectives of care seekers professional health care
workers and health managers
bull Analyse and differentiate between need demand and supply and assess the health
of a defined population and identify areas for improvement including the allocation
of health care resources delivery
bull Evaluate the outcome quality and safety of care and promote quality development
systems based on evidence and public health principles
bull Apply health economic principles and methods such as cost-effectiveness cost-
utility and cost-benefits considering the strengths and weaknesses of different
methods
bull Use methods to determine priorities and their strengths and weaknesses and
promote awareness of the competing and conflicting influences on public and
political perceptions of the need for health care and the resulting constraints on
action
bull Promote and evaluate collaboration between health services and other welfare
organizations in society
bull Evaluate and contribute to the policy and strategic development in health care
planning
bull Contribute to the planning and evaluation of different sectors of society by health
impact assessments and public health medical reports and consultations
- Communicate and develop public health medical expertise
bull Lead supervise and participate in an interprofessional health care team
bull Consult other (health) professionals and policymakers and recognise the
advantages and limits of their expertise
bull Effectively convey oral and written information about public health issues including
adequate public health reporting and effective interaction with media
bull Stimulate and motivate others so that they recognise the importance of the public
health population perspective
bull Maintain and enhance professional activities through ongoing learning and
research and contribute appropriately to the generation dissemination application
and translation of new public health knowledge and practices
3) Medical specialist internal medicine
The UEMS defines an internist as ldquoa physician trained in the scientific basis of medicine
who specialises in the assessment diagnosis and management of general medical
problems atypical presentations multiple problems and consequential complex health
issues and system disorders (Professional) The physician is skilled in the management of
acute unselected medical emergencies and the management of patients in a holistic and
ethical way considering all psychosocial as well as medical factors for enhancing quality of
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
77
life The physician values the continuing care of all patients irrespective of the nature of the
patients complaint and is committed to lifelong continued professional development
(Scholar) The physician practices clinical audit and evidence-based medicine The
physician functions in a number of roles including clinical counselling educating leading
and managingrdquo83
Internists have a fundamental role in modern healthcare systems Within the definition of
the internist the shift towards a preventive strategy focusing on health promotion is
highlighted by the acknowledgement of the high prevalence of chronic and complex
diseases that are associated with the lifestyle of ageing western societies The role of
healthcare advocate (a role defined in the CanMED framework) is an important part of the
internistrsquos function and forms the generic competencies of an internist (see section 11)
However lifestyle promotion and disease prevention is not a specific area of expertise
Specific areas of the internist include multi-morbidity and ageing acute care medical
consultation shared-decision-making collaborative care transition in care vulnerable
adult patient safety and quality of care and medical leadership
4) Medical specialist cardiology
According to the training requirements for the speciality of cardiology84 training in
cardiology should be based on the syllabus of the ESC core Curriculum for the general
cardiologist part 2 ldquothe core curriculum per topicrdquo85 The necessary core cardiology
competencies are set out as cardiology learning objectives with the knowledge skills
attitudes and competencies needed to fulfil the objectives One of the core cardiology
competences is cardiovascular prevention aiming to
bull Assess and manage patients with risk factors for cardiovascular disease
bull Understand the mode of action of different prevention methods
bull Describe cardiovascular disease and risk factors in the local community
bull Contribute to the global efforts in reducing cardiovascular morbidity and mortality
by communicating the prevention message to the public
bull To approach prevention in a holistic way understanding the potentiation of
cardiovascular risk by clustering of risk factors
bull
Knowledge
bull Epidemiology of cardiovascular disease in the local community incidence
prevalence survival
bull Risk factors in the local community
83 httpswwwuemseu__dataassetspdf_file001744450UEMS-201613-European-Training-
Requirements-Internal-Medicinepdf 84 httpswwwuemseu__dataassetspdf_file001119577UEMS-201324-SECTIONS-AND-BOARDS-
Cardiology-European-Training-Requirements-20131019pdf 85 httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_
9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
78
bull Risk assessment in primary prevention multifactorial risk interaction and use of
risk scoring charts
bull The impact of lifestyle on people at risk of and patients with cardiovascular
disease
bull The potential of lifestyle changes to prevent and ameliorate cardiovascular
disease diet and nutrition toxic habits (smoking alcohol and others) physical
activity
bull Emerging risk factors (social economic stress depression and personality type)
bull Treatmentprevention strategies for major risk factors and changes in lifestyle
including corresponding pharmacologic therapies
bull The comprehensive approach required for multiple risk factors
bull Patient compliance
In addition the main objectives and knowledge competence are further specified by
hypertension dyslipidaemia diabetes and lifestyle
Skills
bull obtain a relevant history and perform an appropriate clinical examination
bull evaluate cardiovascular risk and assess global cardiovascular risk at the individual
level
bull evaluate cardiovascular risk at population level (mortality morbidity disability)
bull evaluate the benefit of prevention at individual and population levels
bull manage risk factors appropriately including pharmacological and non-
pharmacological therapies
bull communicate their importance to patients their families and the wider
community including smoking cessation diet and exercise
bull communicate the importance of patient compliance and behaviour
bull motivate patients and families to change lifestyles and be compliant with
prescriptionsrecommendations
bull monitor patient compliance and behaviour
bull evaluate the benefit of risk factor intervention for the individual patient
Behaviours and attitudes
bull Non-judgemental attitude to patients regarding their lifestyle (eg smoking diet
etc)
bull Exemplify appropriate lifestyle in personal behaviour
bull Team working with other physicians including general practitioners
diabetologists nephrologists and elderly care physicians for the management of
specific risk factors
bull Team working with all professionals with a role in primary and secondary
prevention (nurses dieticians teachers and politicians)
Another core competency is the physical activity and sport in primary and secondary
prevention Further defined in sports cardiology and cardiac rehabilitation
Sports cardiology aiming86
86
httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
79
bull To conduct strategies to implement healthy lifestyle in particular physical and
sports activities in the general population (primary prevention)
bull To evaluate cardiovascular risk and exercise capacity (see Chapters 22 and
271)
bull To recognize the characteristics of the athletersquos heart
bull To appropriately detect contraindications to exercisecompetition and
appropriately provide non-contraindication certificates
Knowledge
bull Exercise and sports physiology
bull Benefits of exercise training
bull Safety issues in exercise and sport
bull Diagnostic criteria and appropriate investigations in athletes with cardiovascular
disease
bull Risk factors for and mechanisms of sudden cardiac death (SCD) during and after
strenuous exercise
bull Specific population challenges and exercise programmes in appropriate settings
bull Recommendations for professional and recreational sports participation
bull SCD in patients athletes and in the population at large and
bull Mechanisms of action of illicit drugs
Skills
bull perform an individual CVD risk assessment using appropriate information from
history laboratory assessment including full lipid profile and clinical data
bull recognize pathological cardiovascular changes and differentiate them from the
characteristic features of lsquoathletersquos heartrsquo and
bull use prevailing recommendations for eligibility for participation in competitive
sports
Behaviours and attitudes
bull Recognition of the role of active lifestyle exercise and sport in the promotion of
health and in the prevention of the most threatening diseases including
cardiovascular diseases
Cardiac rehabilitation aiming
bull To evaluate and manage cardiovascular risk
bull To evaluate exercise capacity and causes of exercise intolerance
bull To provide appropriate rehabilitation and secondary prevention to patients with
cardiovascular diseases
7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
80
Knowledge
bull Multi-disciplinary risk factor intervention
bull Definition of comprehensive cardiovascular prevention and rehabilitation
bull Effects of behavioural change including physical activity nutrition education and
psychosocial risk factors on quality of life cardiovascular risk and outcome
bull Rehabilitation as a component of cardiac care and a promoter of secondary
prevention
bull Target populations and risk stratification of patients
bull Psychological aspects of rehabilitation and exercise practice
Skills
bull take a relevant history and perform an appropriate clinical examination including
the specific evaluation of the elderly patient
bull perform and interpret risk stratification using indicated tests
bull interpret a cardiopulmonary exercise test and distinguish different causes of
exercise limitation
bull prescribe exercise-based rehabilitation programmes and other lifestyle
interventions according to the patientrsquos condition in collaboration with other
specialists when necessary and
bull motivate the patient to ensure long-term adherence to lifestyle changes and
continuing exercise programmes
Behaviours and attitudes
bull rehabilitation as a component of cardiac care
bull the importance of rehabilitation and secondary prevention for professional
personal and social life among patients with heart disease
bull the interplay of physical and psychological aspects of heart disease and the
positive influence of exercise on cardiovascular risk factors
bull the role of other professionals including nurse specialists physiotherapists ergo
physiologists psychologists dieticians and general practitioners in rehabilitation
and secondary prevention and
bull the importance of patient and family education and the role of other professionals
in rehabilitation
5) Medical specialist psychiatry
The UEMS has issued a charter of requirements for the training in psychiatry in 2000 with
an additional European Framework for Competencies in Psychiatry in 2009 The learning
outcomes in the European Framework for Competencies in Psychiatry (EFCP) are arranged
under the seven physician roles derived from the CanMEDS framework87 Within the EFCP
it is stated that ldquopsychiatrists recognise the importance of advocacy and health promotion
in responding to the challenges represented by those social environmental and biological
factors that determine the mental health and well-being of patients and society They
recognise advocacy as an essential and fundamental component of mental health promotion
that occurs at the level of the individual patient the practice population and the broader
communityrdquo
Competencies
87 httpuemspsychiatryorgwp-contentuploads2013092009-Oct-EFCPpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
81
bull identify the determinants of mental disorder as well as the factors that may
contribute to positive mental health so as to be able to prevent disorder and
promote mental health
- recognise the determinants of mental health of populations and how public
policy including legislation impacts on mental health
- promote positive mental and physical health in patients particularly in those
with severe mental disorder based on best evidence
- recognise the impact of mental disorder on families and carers and take
remedial measures
- collaborate with other community sectors to promote mental health and
prevent mental disorder at all levels focusing particularly on family school and
workplace
- identify and address barriers and inequity in access to care particularly for
vulnerable or marginalised populations
bull Identify and address issues and circumstances when advocacy on behalf of
patients professions or society is necessary
- respect and promote the human rights of people with mental disorders and
collaborate with user and carer associations and advocacy groups
- empower people with mental disorders and their carers
- recognise and address prejudice stigma and discrimination associated with
mental disorder and its treatment
- use strategies to enhance patientrsquos self-management and autonomy
- actively oppose the use of psychiatry for political repression
- recognise the possibility of conflict inherent in their role as a health advocate
for a patient or community with that of manager or gatekeeper
6) General practitioner
The European training requirements for General PracticeFamily Medicine (GPFM) specialist
training88 defined twelve central characteristics of the practice before determining the core
competences Related to health promotion and disease prevention two of these
characteristics are as following ldquopromotes health and well-being both by appropriate and
effective interventionrdquo and ldquohas a specific responsibility for the health of the communityrdquo
The twelve characteristics are clustered into six core competences primary care
management person-centred care specific problem solving skills comprehensive
approach community orientation holistic modelling Under comprehensive approach the
following abilities relate to health promotion and disease prevention
bull to promote health and wellbeing by applying health promotion and disease
prevention strategies appropriately
bull to manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
Furthermore community orientation includes the ability
bull to reconcile the health needs of individual patients and the health needs of the
community in which they live in balance with available resources
88 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
82
In the more comprehensive assessment of GPrsquos performance in daily practice by the
European Academy of Teachers in General PracticeFamily Medicine (EURACT)89 these
abilities are further defined as following
bull To promote health and wellbeing by applying health promotion and disease
prevention strategies appropriate
- Identifies opportunity for health promotion intervention
- Makes use of structured medical record as reminder of preventive activities
- Makes use of teamwork
- Uses communication skills
- Is aware of any personal prejudices which might influence negatively
preventive advice
- Makes recommendations which are feasible in the context of patientrsquos lifestyle
and home situation
- Acts as suitable role model
bull To manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
- Provides appropriate medical management
- Involves members of practice team eg through case conference
- Performsarranges home visit (consider relevant team members) ndash needs
assessment eg cause of falls
- Involves relatives
- Facilitates communication (two-way) with hospital
- Involves external community resources (eg home help etc)
Dentist
According to the profile and competences for the graduating European dentist one of the
major competences for dentists is to improve oral health of individuals families and groups
in the community On graduation a dentist must be competent at promoting and improving
the oral health of individuals families and groups in the community90 Furthermore with
regard to health promotion and disease prevention a dentist
bull Must be competent at
- Applying the principles of health promotion and disease prevention via
comprehensive preventive measures to individuals and the community
according to their risk assessment status
- Understanding the complex interactions between oral health nutrition general
health drugs and diseases that can have an impact on oral health care and
oral diseases
- Providing appropriate dietary advice
bull Have knowledge of
- The organisation and provision of health care in the community and in the
specialist hospital service in the country of training
- The prevalence of the common dental conditions in the country of
trainingpractice
- The social cultural and environmental factors which contribute to health or
illness
- The strategies to overcome barriers to dental care for disabled elderly
socially deprived and ethnic minority groups
- Training auxiliaries in basic skills of oral health promotion
89httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-
documentseuractperformanceagendadC3BCsseldorf2014-openaccessebookversionpdf 90 httpwwwdentuoagrfileadmindentuoagruploadsusefull_filesADEE-competences-2009_enpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
83
In 2017 a new updated framework was published for undergraduate education for dentists
including a revised structure of the educational domains and their areas of competence In
the revised framework health promotion and disease prevention compromises one of the
areas of competence in the domain ldquodentistry in societyrdquo in the educational strategy of a
dentist91 Note Dentists can also specialise in public health in a similar programme as
physicians
Nurses
The training for nurses responsible for general care shall following the Directive
201355EU include a set of eight competences 92 The training for nurses should provide
assurance that the ability of the following knowledge and skills
1 comprehensive knowledge of the sciences on which general nursing is based including
sufficient understanding of the structure physiological functions and behaviour of
healthy and sick persons and of the relationship between the state of health and the
physical and social environment of the human being
2 sufficient knowledge of the nature and ethics of the profession and of the general
principles of health and nursing
3 adequate clinical experience such experience should be gained under the supervision
of qualified nursing staff and in places where the number of qualified staff and equipment
are appropriate for the nursing care of the patient
4 the ability to participate in the practical training of health personnel and experience of
working with such personnel
5 experience of working with members of other professions in the health sector
Competencies 93
6 Competency to independently diagnose the nursing care required using current
theoretical and clinical knowledge as well as to plan organise and implement nursing
care when treating patients on the basis of page the knowledge and skills acquired in
accordance with points (1) (2) and (3) in order to improve professional practice
7 Competency to work together effectively with other players in the health sector including
participation in the practical training of health personnel on the basis of the knowledge
and skills acquired in accordance with points (4) and (5)
8 Competency to empower individuals families and groups towards healthy lifestyles and
self-care on the basis of the knowledge and skills acquired in accordance with points (1)
and (2)
9 Competency to independently initiate immediate measures to pre- serve life and to carry
out measures in crisis and disaster situations
9191 Field JC Cowpe JG Walmsley AD The Graduating European Dentist A New Undergraduate Curriculum
Framework Eur J Dent Educ 201721(Suppl 1)2-10 httpsdoiorg101111eje12307 92 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf 93 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
84
10 Competency to independently advise instruct and support individuals needing care
and their attachment figures
11 Competency to independently ensure the quality of nursing care and assess it
12 Competency to communicate comprehensively and professionally and to cooperate
with members of other professions in the health sector
13 Competency to analyse the quality of care in order to improve their own professional
practice as general care nurses
The competences included in Directive 201355EU are different from the competences
contained in the EFN Competency Framework These competences contain the following
competences on health promotion and disease prevention guidance and teaching
bull To promote healthy lifestyles preventive measures and self-care by strengthening
empowerment promoting health and enhancing behaviours and therapeutic
compliance
bull To independently protect the health and well-being of individuals families or
groups being cared for ensuring their safety and promoting their autonomy
bull To integrate promote and apply theoretical methodological and practical
knowledge This enables the promotion and the development of nursing care in
long term care co-morbidity and in situations of dependency in order to maintain
an individualrsquos personal autonomy and hisher relationships with the environment
in every moment of the healthillness process
Nurse specialist
The European Specialist Nurses Organisation (ESNO) defines the nurse specialist as follows
ldquoThe Nurse Specialist (NS) is an advanced practice Nurse prepared as a specialist within a
clinical specialty at the masterrsquos post masterrsquos or doctoral levelrdquo94 Following the ESNO the
competencies should be considered as a reference template and guidelines for the different
specialities in which each speciality can define its own knowledge skills and attitudes
Generic competencies are the clinical role patient relationship patient teachingcoaching
mentoring research organisation and management communication and teamwork ethic
and decision making leadership and policy making and prevention The competency of
prevention is based on the case for investing in public health from the World Health
Organization95 The competency of prevention is based on the ability of promoting health
and prevent disease by the capacity to develop and put in place intervention in
bull Surveillance of population health and wellbeing
bull Disease prevention at the 3 levels of prevention (primary secondary)
bull Ability to promote health and prevent disease
bull Monitoring and response to health hazards and emergencies
bull Health promotion including actions to address social determinants and healthy
inequities
bull Advocacy communication and social mobilization for health advancing public
health
bull Research to inform policy and practice96
94 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf 95 httpwwweurowhoint__dataassetspdf_file0009278073Case-Investing-Public-Healthpdfua=1 96 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
85
Occupational therapist
The World Federation of Occupational Therapists (WFOT) provided minimum standards for
the education of occupational therapists97 One of the settings in which occupational
therapists work is defined as following ldquoCommunity or group approaches such as health
promotion community development community based rehabilitation injury prevention
environmental design disaster preparation and recoveryrdquo Furthermore under essential
knowledge skills amp attitudes for competent practice the following (could) relate to health
promotion and disease prevention
bull Knowledge about
- The relationship between occupation and human development over the life
course including healthy ageing
- The relationship between psychological social and economic factors and
occupation (eg stress adjustment to life changes including disability
societal disruption natural or man-made disaster displacement)
- Early identification and functional interventions focusing on somatosensory
stimulation and performance mechanisms mitigating early developmental and
environmental factors impacting negatively on behaviour and learning
- How activity limitations and participation in occupation affect health This
includes the ability to maintain a healthy environment and personal factors
such as adjustment interpersonal relationships and social networks
- How health conditions and threats to health affect participation in work
bull Skills in
- Inter-sectoral collaboration in public health initiatives
- Assessing health in relation to occupation
In addition the Tuning programme described the reference points for the design and
delivery degree programmes in occupational therapy98 in which they first ranked subject
specific competency One of the highest ranked included
bull Enable individualsgroupsorganisationscommunities to be engaged in occupation
through health promotion prevention rehabilitation treatment and
coachingtraining
In the final set of subject specific competences however this is mentioned less explicitly
and only the following are related to health promotion and disease prevention
bull Knowledge the occupational therapist is able to
- Work in partnership with individuals and groups using occupation in
prevention rehabilitation and treatment in order to promote participation
health and well-being
- Explain the relationship between occupational performance health and well-
being
- Collaborate with communities to promote and develop the health and well-
being of their members through their participation in occupation
- Develop new knowledge of occupation and occupational therapy practice
particularly in relation to local andor emerging health and social challenges
97 httpswwwwfotorgassetsresourcesCOPYRIGHTED-World-Federation-of-Occupational-Therapists-
Minimum-Standards-for-the-Education-of-Occupational-Therapists-2016apdf 98 httptuningacademyorgwp-contentuploads201402RefOccupationalTherapy_EU_ENpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
86
Pharmacists
In a two-stage large-scale Delphi process fifty competences of pharmacy practice were
ranked and the Quality Assurance in European Pharmacy Education and Training (PHAR-
QA) framework was harmonized and validated99 Of these fifty competences the following
relate to health promotion and disease prevention
bull Ability to promote public health in collaboration with other professionals within the
healthcare system
bull Ability to provide appropriate lifestyle advice to improve patient outcomes
bull (eg advice on smoking obesity etc)
bull Ability to use pharmaceutical knowledge and provide evidence-based advice on
public health issues involving medicines
Physiotherapists
According to the World Confederation for Physical Therapy (WCPT) the scope of physical
therapists practices includes (among others) public health strategies and advocating for
patientsclients and for health100 Furthermore it is described that physical therapists may
have the following purposes
bull promoting the health and wellbeing of individuals and the general publicsociety
emphasising the importance of physical activity and exercise
bull preventing impairments activity limitations participatory restrictions and
disabilities in individuals at risk of altered movement behaviours due to health
factors socio-economic stressors environmental factors and lifestyle factors
The European Network of Physiotherapy in Higher Education (ENPHE) also described
professional competencies of physiotherapists101 According to the ENPHE one of the roles
of a physiotherapist is to be a
bull Health care promotor
- Advocate on health and wellbeing promotion and disease or injury prevention
on behalf of patientclients and the profession to enhance individual
community and public health
- Promote adherence to local regional national and EU health and safety
policies guidelines and protocols
Psychologist
The European Federation of Psychologistsrsquo Associations developed the European Certificate
in Psychology ndash the EuroPsy102 The Tuning programme also published lsquoReference points for
the design and delivery of degree programmes in Psychologyrsquo103 in which they state that
the Tuning programme and the EuroPsy programme have experienced a parallel
development over the last ten years In fact the Tuning document presents a reference
99 httpswwwncbinlmnihgovpmcarticlesPMC5419365 100 httpswwwwcptorgpolicyps-descriptionPT 101 httpwwwenpheorgwp-
contentuploads201910ESCO_report_ENPHE_recommendations_April_2017pdf 102 httpwwwinpa-europsyitmoduliEuroPsy20Regulations20July202011pdf 103httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNPsychology_reference_points
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
87
point for the design and delivery of degree programmes in psychology on the basis of the
EuroPsy programme
Based on the definition of the key role of the professional psychologist health promotion
and disease prevention could be part of the profession as this has been described as
follows to develop and apply psychological principles knowledge models and methods in
an ethical and scientific way in order to promote the development well-being and
effectiveness of individuals groups organisations and society However no specific
competences related to health promotion and disease prevention are now described in the
documents It is plausible though that psychologist do act to promote health as the core
of their profession is to help others to understand behaviour to improve performance and
well-being or to alleviate problems and distress As these emergent specialisms develop in
response to new demands there is a tendency to develop education and training
programmes thus increasing the specialisation and the requirement for specialist skills of
professional psychology
Social worker
Global standards for the education and training of the social work profession are developed
by the International Association of Schools of Social Work (IASSW)104 The IASSW
worldwide association of schools of social work other tertiary level social work educational
programmes and social work educators These global standards include for example
standards regarding the schoolrsquos core purpose or mission statement standards regarding
programme objectives and outcomes standards with regard to programme curricula
including field education The standards with regard to the core curricula are organised into
four conceptual components domain of the social work profession domain of the social
work professional methods of social work practice and paradigm of the social work
profession under which several sub-domains are described which mainly relate to aspects
such as inadequacies discrimination tradition and culture social stability and ethical
principles The following touch upon the field of health promotion and disease prevention
bull Knowledge of human behaviour and development and of the social environment
with particular emphasis on the person-in-environment transaction life-span
development and the interaction among biological psychological socio-structural
economic political cultural and spiritual factors in shaping human development
and behaviour (domain of the social work profession)
bull Sufficient practice skills in and knowledge of assessment relationship building
and helping processes to achieve the identified goals of the programme for the
purposes of social support and developmental protective preventive andor
therapeutic intervention ndash depending on the particular focus of the programme or
professional practice orientation (methods of social work practice)
bull The application of social work values ethical principles knowledge and skills to
promote care mutual respect and mutual responsibility amongst members of a
society (methods of social work practice)
bull Problem-solving and anticipatory socialisation through an understanding of the
normative developmental life cycle and expected life tasks and crises in relation
to age-related influences with due consideration to socio-cultural expectations
(paradigm of the social work profession)
104 httpswwwiassw-aietsorgwp-contentuploads201808Global-standards-for-the-education-and-training-
of-the-social-work-professionpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
88
The European Social Network (ESN) investigated the social services workforce throughout
Europe and provided an overview of qualifications and skills in different Member States in
their research report showing that qualification and skills for social care workers differ per
country105 In fact in some countries there are specific training routes for social care
workers including specialised training courses or apprenticeships and the content of these
trainings depends on the service user group and is generally defined at a local or authority
level A questionnaire was set out in which essential components of social care workers
were identified which showed that health and safety is seen as an important component
of social work
105 httpswwwesn-euorgsitesdefaultfilespublicationsInvesting_in_the_social_service_workforce_WEBpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
89
ANNEX 3 ONLINE SURVEY
Survey Health promotion and disease prevention in health and educational
settings
Health promotion and disease prevention in health and educational settings -
medical schools The European Union has commissioned Ecorys an international
research and consultancy agency to conduct a project on health promotion and
disease prevention in health and educational settings In order to provide an EU
wide overview and to better support national governments we would like to ask
for your cooperation The project will develop an EU wide overview of the
educationtraining programmes for basic education postgraduate education as
well as continuous professional development with regard to education on health
promotion Your help will therefore be key in the collection of information and
data on public health initiatives in medical and non-medical education The survey
will take approximately 20 minutes of your time You do not need to complete this
survey at once You may leave the survey and continue at a later moment in
time Questions can be saved by clicking on the pauze button (below the
questionnaire) When doing so a new URL link will be provided We would be
pleased if you could provide this information by means of an online questionnaire
to Ecorys who is also available in case you have questions or you would like
additional information bull Ms Emalie Hurkmans (Project Coordinator) tel +31
(0)6 280 579 21 email emaliehurkmansecoryscom bull Ms Tessa Huis in lsquot
Veld tel +31 6 29 22 10 58 email tessahuisintveldecoryscom
What is the name of your education
What are the website details of the educationPlease enter the link of the website
with information of the education
Can you give a brief description of the education
What type of health professionals are trained in the education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
90
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
What type of medical specialist
Is the education
Undergraduate education
Postgraduate education
Continuous professional development
Is the course accreditated
Yes
No
Unknown
Does the course cover the topic health promotion and disease prevention
Yes
No
Is the education accreditated
Yes
No
Unknown
Does the education cover the topic health promotion and disease prevention
Yes
No
How is the topic health promotion and disease prevention incorporated in the
curriculum
In a seperate module
Topic incorporated into curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
91
Who is (are) the contact person(s) of the module health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Was there any partnerships in setting up the module health promotion and disease
prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Has the education obtained any funding to set up the module on health promotion
and disease prevention EU funding national public funding local public funding
or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
92
Since when is the module on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the module Eg is it a two weeks one month or one
year programme
What is the typical quantity in hours spend at health promotion and disease
prevention by participants The amount of hours spent on attendence and
homework
Is the module health promotion and disease prevention accreditated separately
No
Unknown
Yes please specify how many points are given
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
93
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the module
No
Unknown
Yes please specify what type of exam
Is the module also provided at other locations For example at other universities
Yes
No
Unknown
Is there a contact person(s)expert for the topic health promotion and disease
prevention
Was there any partnerships in incorporating it in the curriculum
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
94
Has the education obtained funding to incorporate health promotion and disease
prevention into the curriculum EU funding national public funding local public
funding or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is health promotion and disease prevention incorporated into the whole
curriculum eg since September 2017
What is the typical quantity in hours (approximately) spend at health promotion
and disease prevention by participants The amount of hours spent on attendence
and homework
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
95
In what way are knowledge and skills with regard to health promotion and disease
prevention tested in the curriculum For example incorporated into a written exam
Who is (are) the contact person(s) of the course on health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Were there any partnerships in setting up the course on health promotion and
disease prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
business NGOs individual citizens governmental agencies who have a role fill in
yes and add by the partnership in place
No
Yes please specify
Has the education obtained any funding to set up the course on health promotion
and disease prevention
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
96
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is the course on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the course eg two weeks one month or one year
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
97
What is typical quantity in hours spend at health promotion and disease prevention
by participants The amount of hours spent on attendence and homework
Is the course on health promotion and disease prevention accreditated separately
No
Unknown
Yes how many points are given
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the course
No
Unknown
Yes what type of exam
Is the course provided at multiple locations For example at other universities
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
98
What are the general objectives of the teaching activities on health promotion and
disease prevention eg arise awareness among Medical Doctors on the
importance of physical activity within the elderly population with a high risk of
heart failure
Which stakeholders were involved in developing the teaching activities on health
promotion and disease prevention
Is there made use of a mono- or multidisciplinary approach
Monodisciplinairy approach
Multidisciplinary approach
Unknown
Does the education include theories of
1
Yes
2
No
3
Unknown
Population health
Human cognition
and behaviour
Health behaviour
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
99
Does the education include
1
Yes
2
No
3
Unknown
Epidemiology and
bio-statistics
(research
capacity)
Methods of
evidence-based
medicine
Health policies
and regulation
Health economics
Ethics
Health care
systems
Digitalisation in
health promotion
Health inequalities
Disease
prevention in
teams
Health literacy
Health behaviour
change
techniques
Communication
skills
Digital health
coaching
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
100
Concerning teaching methods of health promotion and disease prevention which
methods are used
1
Yes
2
No
3
Unknown
Lectures
Assignments
Field training in real environments
eLearning modules
Other please specify
Concerning covered competencys or capacities of health promotion and disease
prevention the main focus is on
What are the expected outcomes
1
Yes
2
No
3
Unknown
Knowledge
Skills
Behaviour
attitudes
Relevant output (if available) eg number of students following the module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
101
Do you think it is likely you will apply the learned knowledge and skills (on health
promotion and disease prevention) in daily practice after completion of this
education
Yes please specify
No please specify
Not sure please specify
Is there a reason why this education might be a good example for other
educational settings with regard to the way that health promotion and disease
prevention is covered in the education
Are there any remarks Please feel free to give overall remarks or initiative-specific
remarks
Your responses have been registered Thank you for taking the time to complete
the survey your input is valuable to us
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
102
HOW TO OBTAIN EU PUBLICATIONS
Free publications
bull one copy via EU Bookshop (httpbookshopeuropaeu)
bull more than one copy or postersmaps from the European Unionrsquos representations (httpeceuropaeurepresent_enhtm) from the delegations in non-EU countries (httpeeaseuropaeudelegationsindex_enhtm) by contacting the Europe Direct service (httpeuropaeueuropedirectindex_enhtm) or calling 00 800 6 7 8 9 10 11 (freephone number from anywhere in the EU) () () The information given is free as are most calls (though some operators phone boxes or hotels may charge you)
Priced publications
bull via EU Bookshop (httpbookshopeuropaeu)
ldquoThis document has been prepared for the European Commission however it reflects the
views only of the authors and the Commission cannot be held responsible for any use
which may be made of the information contained thereinrdquo
Europe Direct is a service to help you find answers
to your questions about the European Union
Freephone number ()
00 800 6 7 8 9 10 11
() The information given is free as are most calls (though some
operators phone boxes or hotels may charge you)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
4
Table of Contents
Preface 5
Executive summary 7
1 Introduction 11
11 Research questions 14
2 Theoretical background 15
21 Societal needs for health promotion and disease prevention 15
22 Health profession competencies 16
23 Educational systems for health professions in Europe 19
24 Relevant educational settings for health promotion 19
25 Theoretical framework for this study 21
3 Methodology 22
31 Mapping of health educational programmes in the EU 22
311 Online survey 22
312 Desk research 26
32 Long list of good practices 27
4 Mapping of the current situation IN health promotion training in the EU 29
41 Overview of educational programmes in the EU 29
411 Summary of the main findings in the survey 29
412 Detailed results of the survey 29
42 Overview of competency profiles of health professionals in the EU 44
5 Long list of good practices 45
51 Results 45
52 Analysis of good practices 48
6 Conclusions 53
Annex 1 Survey results by country 57
Annex 2 Competency profiles per professions 71
Annex 3 Online survey 89
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
5
PREFACE
ECORYS Nederland BV is pleased to present the reader to support Member States in
mainstreaming health promotion and disease prevention including lifestyle medicine in
education of health professionals The reader gives a general overview of professional
training initiatives in the European Union (EU)
The study comes at a time when it is well known that lifestyle factors are important
determinants for most non-communicable diseases These diseases have a major impact
on the health of European citizens At the same time an increasing proportion of aged
population poses demands on health systems and stresses the need to sustain the work -
abilities of the working age population Therefore health promotion disease prevention
and a healthy lifestyle are essential for patients and the general population Health
professionals play an essential role here This is not an easy task as dealing with lifestyle
factors requires different strategies at a population level or for targeted patient groups with
eg type II diabetes or cardiovascular risks Health professionals need to be prepared for
this task in their education either during their study period or as part of continuous
professional development Though widely acknowledged it remained unclear to what
extent and how Member States address this challenge
In the context of this project we collected practices how EU Member States include health
promotion disease prevention and lifestyle medicine in health professional education This
report presents a mapping of the current situation across different countries and health
professions Without pretending to be complete it provides a unique baseline of the way
professionals are currently prepared to implement health promotion disease prevention
and lifestyle medicine in EU countries With this baseline Chafea created an important
starting point for the exchange of experiences and mutual learning Hope is that this will
boost developments in the near future so as to prepare health professionals to adequately
address the challenges that healthcare systems in the EU face and implement the paradigm
shift from treatment of diseases among patients to promotion of health among the entire
population
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
7
EXECUTIVE SUMMARY
Background
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices and unhealthy diets Tobacco use harmful
use of alcohol and physical inactivity have been identified as the top risk factors for non-
communicable diseases (NCDs) in the European Union In recognition of this important
public health challenge investing in effective health promotion and disease prevention of
NCDs is critical to improve the quality of life and well-being of European citizens
Healthcare professionals such as doctors (especially general practitioners) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs However while
many policy statements and NCDs practice guidelines call for behavioural change as the
first line of prevention and management professionals often do not include behavioural
change counselling in their care yet While most health professionals acknowledge the need
for lifestyle advice there seems to be a mismatch between the roles and competencies for
which health professionals are trained and the action required This underscores the need
to develop and strengthen lifestyle medicine as a component of health professionalsrsquo
education defined as lsquothe integration of lifestyle practices into the modern practice of
medicine both to lower risk factors for chronic disease andor if diseases are already
present to serve as an adjunct in therapy Lifestyle medicine brings together sound
scientific evidence in diverse health related fields to assist the clinician in the process of not
only treating disease but also promoting good healthrsquo
Objective of the study
This study seeks to provide a mapping of the current situation how health professionals are
trained in health promotion in the EU To that end this study aims to answer the following
research questions
1 How are health professionals in the EU countries being trained in health promotion
prevention and lifestyle medicine in graduate post-graduate and continuous
professional education
2 What are good practices on knowledge capacity and competency building and
advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Scope of the study
Classically public health targets at activity levels can be described in operational models
like the Friedenacutes pyramid model It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of health
like socioeconomic status We use this model as a substructure to investigate health
professionalsrsquo education as they contribute to public health at all these levels
Methodology
In order to provide a general overview on how health professionals are trained in health
promotion and disease prevention and lifestyle medicine in the EU we conducted an online
survey We identified potential organisations in the EU to take part in the survey and asked
those organisations to spread the survey among other organisations or stakeholders in their
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
8
network We contacted 24 EU associations that represent entire professions or part of the
professions (like post-graduates) in all EU countries and have major networks in the fields
of graduate post-graduate and continuous professional development for their support We
aimed to cover all professions within the scope of this study physicians physiotherapists
occupational therapists psychologists nurses social workers dentists pharmacies
dietitians Also national health associations and national educational organisations were
approached to fill in the survey Among other topics the survey contained questions on the
training programme type of health professional targeted implementation in the
curriculum description of the health promotion component funding accreditation and
partnerships
In addition to the online survey a desk research was conducted including both scientific
and grey literature to establish an overview of the competency profiles of health
professionals in the field of health promotion and disease prevention Based on the
identified literature we described the competency profiles for each of the following
healthcare professions (undergraduate) medicine medical specialists dentists nurses
nurse specialists occupational therapists pharmacists physiotherapists psychologists
and social workers
Results were tabulated and described Good practices were selected on the basis of four
pre-established criteria These practices were analysed more in-depth with an analytical
tool aligning Friedenrsquos pyramid of public health needs and Kraigerrsquos Learning Typology This
in-depth analysis was used to define a short list of 10 good practices representing a variety
of professions and countries
Results
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades1there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional However there is room for improvement many competency
profiles leave room for interpretation the described competences are not ranked in order
of importance and it is often not explained how the competences should be applied in
practice ie in a pro-active preventive way (always assessing lifestyle within the
treatment) or a more curative reactive way (only included in the treatment when there is
a clear lifestyle component related to the disease)
As for the inclusion in educational programmes a high percentage (93) of respondents
(n=197) indicate that health promotion and disease prevention is implemented in their
educational programmes or modules The high share may reflect a selection bias as those
who have implemented health promotion within the education may have been more inclined
to fill in the questionnaire In the survey we explored how health promotion and disease
prevention is implemented in the educational setting In summary this provided the
following results
1 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
9
bull More than half of the respondents indicated that they filled in the questionnaire for
practices in undergraduate educational settings Throughout Europe these
numbers were relatively similar
bull Physiotherapists are the professional group most actively involved in health
promotion training activities The vast majority applies multidisciplinary
approaches and thus brings other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within training programmes In continuous professional development on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion especially target knowledge skills
and behaviour of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for continuous professional
development (33) compared to undergraduate and postgraduate education
where the topic is covered in most modules (15 and 6) Funding was more
often obtained in Northern and Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) Regarding full modules high percentages indicated
that this is mandatory and that there is an exam at the end of the module (81
70 respectively)
Conclusions
The present study provides an overview of current practice on health promotion disease
prevention and lifestyle medicine in the education of health professionals in EU countries
This is an important need-assessment for the exchange of knowledge and expertise among
EU countries All professions have versatile competency profiles in health promotion giving
a good ground for further development As the study results reveal some unbalance in
competencies addressed and methods used a next step could be to support further
development of educational practices in lifestyle medicine and adoption of new
technologies There is room for improvement as well as encouraging volition to share
expertise across professions professional associations universities and countries in the EU
The body of knowledge generated in this study can serve as a basis for further analysis and
contribute to the enhance effectiveness of educational practices of health promotion
disease prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
11
1 INTRODUCTION
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices2 In Europe such chronic diseases as
cancer cardiovascular diseases diabetes and chronic respiratory diseases are giving the
greatest disease burden3 The Global Burden of Disease (GBD) 2016 study estimates that
over 91 of deaths and over 87 of DALYs in the European Union (EU) are the result of
non-communicable diseases (NCDs) of which 61 and 43 respectively can be attributed
to modifiable risk factors4 To a large extent lifestyle factors unhealthy diets tobacco use
harmful use of alcohol and physical inactivity have been identified as the top risk factors
for NCDs in the EU5 The last non-communicable diseases progress monitor 2017 of the
WHO underlines that ldquoNCDs share key modifiable behavioural risk factors like tobacco
use unhealthy diet lack of physical activity and the harmful use of alcohol which in turn
lead to overweight and obesity raised blood pressure raised cholesterol and ultimately
diseaserdquo6 Since NCDs share many related modifiable risk factors and often do not occur in
isolation7 prevention must be integrated into population approaches to combat NCDs as a
group8 In recognition of this important public health challenge investing in effective health
promotion and disease prevention is critical to improve the quality of life and well- being of
European citizens910 as well as their productivity and NCDrsquos burden on health systems and
economy of European societies11
Strengthening the investments in health promotion and disease prevention is key to delay
the onset and reduce the burden of NCDs in Europe12 As there is a great need for chronic
disease management the healthcare setting is crucial for health promotion in both primary
and secondary prevention of NCDs13 For example obesity is a major modifiable risk factor
2 Chopra M et al (2002) A global response to a global problem the epidemic of overnutrition
httpswwwncbinlmnihgovpmcarticlesPMC2567699pdf12571723pdf 3 WHO (2006) Gaining Health The European strategy for the prevention and control of noncommunicable
diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf 4 EU burden from non-communicable diseases and key risk factors httpseceuropaeujrcenhealth-
knowledge-gatewaysocietal-impactsburden 5 WHO (2014) Prevention and control of noncommunicable diseases in the European Region a progress report
httpwwweurowhoint__dataassetspdf_file0004235975Prevention-and-control-of-noncommunicable-diseases-in-the-European-Region-A-progress-report-Engpdf
6 WHO (2017) Noncommunicable diseases progress monitor 2017 httpappswhointirisbitstream handle106652589409789241513029-engpdfjsessionid=0613BF26D66A7DA9D1C91AD325E0A75Dsequence=1
7 httpsacels-cdncomS00917435150028321-s20-S0091743515002832-mainpdf_tid=88fea2bf-946a-44c2-be59-0edbabc2c2e8ampacdnat=1541511066_feedfb33968e2ac2f5b47a3452254a9f
8 Integrated approach to prevent noncommunicable diseases httpwwweurowhointenhealth-topicsnoncommunicable-diseasescanceractivitiesintegrated-approach-to-prevent-noncommunicable-diseases
9 WHO (2006) Gaining Health The European Strategy for the prevention and control of noncommunicable diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf
10 Scriven A (2017) Promoting Health a Practical Guide Seventh Edition httpsbooksgooglenl
bookshl=nlamplr=ampid=fJwqDwAAQBAJampoi=fndamppg=PP1ampdq=importance+health+ promotion+and+disease+prevention+European+Commissionampots=jcXZvCYJIQampsig=8D8Yqa9wKa_DlaaYUky_EtUxd_gv=onepageampq=importance20health20promotion20and20disease20prevention20European20Commissionampf=false
11 Tender 12 Chrodis (2015) Health promotion and primary prevention in 14 European countries a comparative overview
of key policies approaches gaps and needs httpchrodiseuwp-contentuploads 201507 FinalFinalSummaryofWP5CountryReportspdf
13 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
12
for type II diabetes (DM II) and thus efficacy of the intervention matters In economic
modelling for eight European countries a body-mass index reduction in the adult population
of 5 compared to 1 resulted a three-fold reduction in the incidence of DM II14 Apart
from the health losses caused directly by NCDs underlying conditions may also increase
susceptibility for other diseases Patients with diabetes and serious heart conditions eg
were identified as risk populations for COVID-1915 New health threats like climate crisis
will have an impact on healthcare systems and need for adaptation options including
training of health care workers integrated heatwave early warning systems especially for
the most vulnerable populations and supporting lifestyle changes toward healthy choices
that are at the same time climate and health friendly16
Healthcare providers such as doctors especially general practitioners (GPs) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs17 Health
promotion is collaborative work where professionals strengthen the message and help
patients to choose and implement healthier behaviours Counselling on and prescription of
a healthy lifestyle is particularly important to socioeconomically vulnerable and
disadvantaged population groups which are disproportionally affected by unhealthy
lifestyles and are more difficult to reach18 Secondary and tertiary prevention in chronic
diseases is embedded into good quality care since good nutrition status decreases the risk
of reinfarction as does smoking cessation For these reasons health promotion was
explicitly recognized as an integral part of the professional role of the GP in several policy
statements at both the European and the national level19 While many policy statements
and NCDs practice guidelines include a call for behavioural change as the first line of
prevention and management providers often do not provide behavioural change
counselling in their care20
A recently published report by the European Commission and WHO Europe (2018) identified
barriers for prescribing and counselling on exercise schemes and on promoting physical
activity in the health sector These were the lack of confidence and knowledge and skills by
health professionals on providing effective counselling21 For example Koutoukidis et al
(2017) performed a qualitative study on the perspective of healthcare professionals on
lifestyle advice to cancer survivors Health professional-centred barriers to provision of
lifestyle advice were a lack of knowledge on healthy lifestyle guidelines the feeling that
14 Webber L Divajeva D Marsh T McPherson K Brown M Galea G et al The future burden of obesity-related
diseases in the 53 WHO European-Region countries and the impact of effective interventions A modelling study BMJ Open 2014
15 Centre for Disease Control and Prevention (2020) Coronavirus disease 2019 Groups at higher risk for severe illness httpswwwcdcgovcoronavirus2019-ncovneed-extra-precautionsgroups-at-higher-riskhtml
16 Drummond P Ekins P Grubb M Lott MSEng M Byass P Nilsson M et al The Lancet Commissions Institute for Sustainable Resources (P Health and climate change policy responses to protect public health thelancetcom 2015
17 Catapano AL et al (2007) Averting a pandemic health crisis in Europeby 2020 what physicians need to know regarding cholesterol management httpswwwncbinlmnihgovpubmed17446817
18 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
19 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20 European20General20Practicepdf
20 httpswwwncbinlmnihgovpmcarticlesPMC4561845pdf101177_1559827615580307pdf 21 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the
European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
13
they were not the right person to provide advice and lack of time and resources22
Additional barriers mentioned in the World Book of Family Medicine ndash European Edition
2015 are perceived as lack of time or competing work load insufficient reimbursement
doubts about patientsrsquo acceptance and willingness to receive lifestyle counselling low self-
efficacy insufficient skills and training doubts about effectiveness of interventions and
health promotion perceived as outside professional role2324 Therefore while most health
professionals seem to acknowledge the need for lifestyle advice there seems to be a
mismatch between roles competencies training and possibilities among health
professionals and action25 Factors causing this mismatch differ from individual and
organizational context wherefore strategies to address these barriers will also vary26
These findings underline the need for developing and strengthening lifestyle medicine in
health professionalsrsquo education27 defined as lsquothe integration of lifestyle practices into the
modern practice of medicine both to lower the risk factors for chronic disease andor if
disease already present serve as an adjunct in its therapy Lifestyle medicine brings
together sound scientific evidence in diverse health-related fields to assist the clinician in
the process of not only treating disease but also promoting good healthrsquo28 Hence lifestyle
medicine covers the systematised approach for prevention and management of chronic
disease addressing eg diet physical activity behaviour change stress and coping and
tobaccosubstance abuse29 Health professionals need to learn how to overcome the
identified barriers mentioned above30 and how to effectively and efficiently counsel their
patients towards adopting and sustaining healthier behaviours31
Moreover digitalization is changing the scenery for lifestyle medicine and chronic disease
management Patient engagement can be enhanced with applications self-monitoring or
self-management tools To successfully embed these new forms of care professionals must
develop new skills32 However studies have shown that medical students are not formally
trained in major concepts known to influence health33 Philips et al (2014) states that
including lifestyle medicine in undergraduate medical curricula would have important public
health implications by efficiently promoting the prevention and treatment of NCDs34 A
study by Dacey et al (2012) states that face-to-face continuing medical education formats
22 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 23 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20
European20General20Practicepdf 24 Geense WW van de Glind IM Visscher TL van Achterberg T Barriers facilitators and attitudes influencing
health promotion activities in general practice an explorative pilot study BMC-family practice 2013 1420 25 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 26
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
27 Polak R et al (2015) Lifestyle Medicine Education httpswwwncbinlmnihgov pmcarticles PMC4561845
28 Rippe JM (2019) Lifestyle Medicine Third Edition CRC Press 29 Kushner RF and Webb Sorensen K (2013) Lifestyle medicine the future of chronic disease management
Obesity and nutrition 201320 30 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 31 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) The impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 32 Eg Richard A A amp Shea K (2011) Delineation of Self-Care and Associated Concepts Journal of Nursing
Scholarship 43(3) no-no httpdoiorg101111j1547-5069201101404x 33 httpscdnymawscomwwwacpmorgresourceresmgrlifestylemedicine-filesajpm-lmcommentarypdf 34 Philips E Pojednic R Polak R Bush J amp Trilk J (2014) including lifestyle medicine in undergraduate
medical curricula Medical education online
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
14
have a positive impact on physician behaviour toward health promotion and disease
prevention by increasing their knowledge confidence and practices that help patients to
adopt healthy behaviours35 Similar results can be expected among other health
professionals as well
The World Book of Family Medicine ndash European Edition 2015 states that the shared aim to
integrate health promotion disease prevention and lifestyle medicine has not been fully
achieved Future activities as to how lifestyle interventions can be better integrated need
collaborative approaches36 As a starting point for more collaborative action this study
seeks to provide a mapping of the current situation on health professionals training in health
promotion in the EU
11 Research questions
To that end this study seeks to answers to the following research questions
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and continuous
professional education
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
35 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) the impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 36
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
15
2 THEORETICAL BACKGROUND
21 Societal needs for health promotion and disease prevention
Classically public health targets at activity levels can be described in operational models
like Friedenacutes pyramid model37 It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of
health like socioeconomic status6 We use this model as a substructure in looking into
health professionalsrsquo education as they contribute to public health in these levels (Figure
21) Society needs to evaluate cost-effectiveness of public health efforts and find a balance
between the levels of actions at each level We use this framework to enable us to present
the needs of societies in general for different health professionals and their roles and
competencies in public health
Figure 21 Frieden Pyramid of health impact of health professional activities at the different levels of society (T Frieden 2010 CDC)
Healthcare services can contribute in mitigating the burden of disease by socioeconomic
disadvantages Health professionals have a key role in developing health services so their
competency to take account of differences in abilities of people to benefit from health
services is vital But more is needed Traditionally health professionals have been managing
the individual risk factors and provision of services That is not enough For example in
cardiovascular diseases the ldquoperfect treatment approachrdquo fails to prevent almost half of the
disease burden37 In cancer diseases individual health behaviours like smoking contribute
in more direct manner Therefore we need to develop educational systems that support
health professionals to take part in new public health approaches by planning interventions
that change the environmental context to make healthy options the default choice
37 Frieden TR A framework for public health action The health impact pyramid American Journal of Public
Health 2010
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
16
regardless of education income service provision or other societal factors37 These are
equally needed in out-of-health contexts like climate change where socio-economic
inequalities and (health) behavioural choices are among major drivers of climate changes38
Policies can influence environments to support healthier choices and we need health
professionals in policy development and execution Still health behaviour changes happen
at the individual level We need more efficient skills in personalized health coaching of
individuals to increase the cost-effectiveness of treatment of NCDs39 An ageing population
and increasing rates of chronic disease as well as advances in medical science and health
information technology to make care safer and more efficient require a rethinking of how
care is delivered Digitalization of services will challenge healthcare professionals and
collaborative care models have become more common40 Instead of requiring compliance
from patients patient-centred approaches are required from professionals This means that
clinical interventions need to be complemented by counselling and education to achieve
long-lasting protective measures Health coaching is aiming to empower patients in co-
management of their disease41 and emphasize and support patientsrsquo autonomy instead of
merely compliance It is based on shared decision-making and collaborative goal setting
facilitated by motivational interviewing42 Health coaching is already happening in digital
environments This paradigm shift requires new skills and attitudes from health
professionals too
New approaches to public health on societal level the paradigm shift to health coaching on
patient level and new forms of healthcare delivery pose a big challenge to the educational
system of health professionals It needs to prepare new professionals and train health
professionals already working in the healthcare system to master a wider scope of
knowledge and develop new skills and attitudes to implement these new approaches in a
safe effective and efficient way
22 Health profession competencies
Healthcare service is a complex and interconnected network of professionals There are
common professional competencies needed in health care and health promotion
(communication collaboration) but they are applied to meet the learning aims of each
profession or level of education If we want to increase the implementation of lifestyle
counselling or systemwide changes we need to evaluate knowledge skills and attitudes
required for the changes and to define the competencies needed to support this change
Professional competencies sum the elements of abilities (knowledge skills attitudes and
behaviours) that enable a professional to accomplish the activities described in a task
statement that outlines what the professional is expected to do43
38 Watts Nick Amann Markus Arnell Nigel et al (66 more authors) (2019) Report of The Lancet Countdown
on Health and Climate Change The Lancet ISSN 0140-6736 httpsdoiorg101016S0140-6736(19)32596-6)
39 Hale R Giese J Cost-Effectiveness of Health Coaching Prof Case Manag 2017 40 Falconer E Kho D Docherty JP Use of technology for care coordination initiatives for patients with mental
health issues A systematic literature review Neuropsychiatric Disease and Treatment 2018 41 Hayes E McCahon C Panahi MR Hamre T Pohlman K Alliance not compliance Coaching strategies to
improve type 2 diabetes outcomes J Am Acad Nurse Pract 2008 42 Olsen JM Health Coaching A Concept Analysis Nurs Forum 2014 43 Kraiger etal 1993 Application of cognitive skill-based and affective theories of learning outcomes to new
methods of training evaluation
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
17
Learning Outcome Typology by Kraiger is a widely used descriptive model for setting targets
and learning outcomes in education43 It comprises cognitive (knowledge) psychomotor
(skill-based) affective and behavioural (attitudes) components This classification scheme
for learning outcomes is based on Bloomrsquos work (1956) of three learning domains including
cognitive domain the affective domain and psychomotor44 45Knowledge can be factual and
declarative knowledge information and concepts or processes and organizations or
metacognitive strategies like allocation and regulation of professional performance Skills
include simple routine development and procedures needed at work and more complex
skills needed for the ability to monitor the performance along other tasks Attitudes are
linked with professionalsrsquo perceptions on learning self-efficacy at work perception about
ability to perform and ability to goal setting It has domains on professionalism Knowledge
can be obtained in reading or e-Learning modules skills require active teaching methods
and attitudes develop over time Behaviours then are complex situations where knowledge
skills and attitudes are utilised in professional manners In education planning outcomes
are defined by these elements
Competency frameworks are an effective method for achieving outcome-based education46
They provide a tool for capturing the elements and abilities (knowledge skills attitudes
and behaviours) needed in effective and safe patient work47They can serve in evaluating
the components of different specialities or societal needs like in this report public health
needs Competencies define an acceptable and feasible description of professional
behaviours used in relation to health promotion Competency building is at the basis in
developing similar programmes in the US4849 Meaningful assessment of competencies
developed is critical for the implementation of effective competency-based medical
education (CBME)50
The International Union for Health Promotion and Education (IUHPE) published an
extensive list of core competencies and professional standards for health promotion in
201651 It defines acuteHealth Promotion actionrsquo in the context of these competencies and
standards to describe programmes policies and other organised Health Promotion
interventions that are empowering participatory holistic inter-sectoral equitable
sustainable and multi-strategy in nature and aim to improve health and reduce health
inequities51
44 Bloom BS (1956) Taxonomy of educational objectives The classification of educational goals New York NY
Longmans Green 45 Cruz-Cunha MM (2012) Handbook of Research on Serious Games as Educational Business and Research Tools 46 Frank JR Danoff D The CanMEDS initiative Implementing an outcomes-based framework of physician
competencies Med Teach 200729(7)642ndash7 47 Cooke M Irby DM Sullivan W Ludmerer KM Medical education American medical education 100 years after
the flexner report N Engl J Med [Internet] 2006355(13)1339-1344+1306 Available from httpwww
scopuscominwardrecordurleid=2-s20-33749062559amppartnerID=40ampmd5=d949feb 758c984c732a419 cada174c85
48 Alaranta A Alaranta H Patja K Palmu P Praumlttaumllauml R Martelin T et alSnuff use and smoking in Finnish Olympic athletes Int J Sports Med 200627(7)
49 Van Horn L Lenders CM Pratt CA Beech B Carney PA Dietz W et al Advancing Nutrition Education Training and Research for Medical Students Residents Fellows Attending Physicians and Other Clinicians Building Competencies and Interdisciplinary Coordination Adv Nutr 2019
50 Lockyer J Carraccio C Chan MK Hart D Smee S Touchie C et al Core principles of assessment in competency-based medical education Med Teach 201739(6)609ndash16
51 IUHPE (2016) Core competencies and professional standards for health promotion full version httpwwwukphrorgwp-contentuploads201702Core_Competencies_Standards_linkEpdf )
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
18
We present CanMEDS as an example of a framework that includes content-specific
competencies (Table 21) CanMEDS was developed for medical experts but most
competencies are applicable to all health professionals
Table 21 CanMEDS in short form52 original version53
Competency Short description
Medical Expert Apply clinical skills and knowledge of the biomedical sciences to fulfil your scope of practice
Collaborate with patients and families for patient-centred care and management
Contribute to health care quality and patient safety
Communicator Build rapport and empathy in all interactions with patients and include families (with the patientrsquos consent)
Understand the patientrsquos perspectives expectations and socio-economic issues
Use active listening patient-centred interviewing skills and culturally safe communication
Share information in plain language to promote patientsrsquo understanding
Clearly document and share information with patients and others on the care team
Collaborator Collaborate by sharing knowledge and perspectives sharing responsibilities learning together
Collaborate in care education advocacy administration and scholarship
Leader Take responsibility for the ongoing operation evolution and continuous
improvement of the healthcare system
Expand beyond a clinical or technical role to take on administrative teaching and scholarly roles and responsibilities
Exercise efficient use of resources to achieve cost-effective care
Contribute to improvements in personal practice team organization and system
Health Advocate
Understand and address the determinants of health that affect patients and support patients to navigate through the health care system
Collaborate with communities and populations to influence change in the health
care system
Contribute to health promotion and disease prevention Understand determinants and needs speak on behalf of others increase awareness
Scholar Plan for and engage in life-long learning
Teach others
Evaluate and apply evidence to day-to-day practice
Contribute to research including creation dissemination and translation into
practice
Professional Commit to patients society profession and ldquoselfrdquo Patients ndash maintain clinical competency and adhere to ethical standard Society ndash demonstrate social accountability by responding to societal needs and
expectations Profession ndash peer assessment mentorship supporting others setting standards Self ndash participate in self-assessment and reflection build self-awareness and manage own well-being
52 Michener Institute No Title CanMEDS framework in short [Internet] Available from httpsmichenercawp-
contentuploads201805CanMEDS-Framework-Summarypdf 53 Frank JR Snell L Sherbino J E CanMEDs 2015 Physician Competency Framework [Internet] CanMEDS 2015
Physician Competency Framework Ottawa Royal College of Physicians and Surgeons of Canada 2015 p 1ndash30 Available from httpwwwroyalcollegecaportalpageportalrccanmedsresourcespublications
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
19
23 Educational systems for health professions in Europe
According to the EU Treaty European citizens have a virtue of rights of free movement as
workers freedom of establishment and freedom of service providers54 Directives on the
requirements of professional qualifications in EU their recognition and Regulation55
facilitate the mobility of health personnel Each member state will apply this directive in
the national legislation on health professional qualifications There is a system of automatic
recognition based on harmonised minimum training requirements This system depends on
the timely notification of new or changed evidence of formal qualifications by MS and their
publication by the Commission Otherwise holders of such qualifications have no
guarantees that they can benefit from automatic recognition
The undergraduate education in Europe is coordinated through the Bologna Process which
is an intergovernmental cooperation of 48 European countries in the field of higher
education It guides the collective effort of public authorities universities teachers and
students together with stakeholder associations employers quality assurance agencies
international organizations and institutions including the EC to bring more coherence to
higher education systems across Europe56 Under the Bologna Process all 48 participating
European countries agreed to ensure mutual recognition of qualifications and learning
periods abroad completed at other universities Nonetheless it should be noted that across
Europe healthcare systems and educations may still significantly differ
While professional activity is regulated by national law in individual member states57
faculties and other academic institutions have collaborated in the establishment of a
framework of competencies based on the scientific advances and new methodologies in
education In fact EU Directives of the European Parliament and Council on the recognition
of professional qualifications have consolidated a system of mutual recognition between
MS58 Examples include the PHARMINE for pharmacists and MEDINE for medical doctors59
This collaboration is in line with the Bologna Process
24 Relevant educational settings for health promotion
Inclusion of health promotion and lifestyle medicine in undergraduate medical curricula is
expected to have important public health implications However in current medical
education this subject is minimal to nonexistent60 This is a global problem In 2016 the
American associations around NCDs launched a joint programme called lsquoThe Lifestyle
54 Treaty on the Functioning of the European Union (TFEU) Articles 45 49-62 55 European Parliament C of the EU Directive 200536EC on the recognition of professional qualifications and
Regulation [Internet] 2013 Available from httpseur-lexeuropaeulegal-
contentENALLuri=celex3A32013L0055 56 The Bologna process and the European Higher Education Area httpseceuropaeu education policies
higher-educationbologna-process-and-european-higher-education-area_en 57 UEMS (2017) Charter on training of medical specialists in the EU httpswwwuemseu
dataassetspdf_file001943561ETR-Psychiatry-201703pdf 58 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 59 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 60 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
20
Medicine Education Collaborativerdquo for improvement of health promotion education among
health professionals and in medical schools61 This initiative will a) work for high-quality
curricular material on an easily navigable website b) provide support for medical schools
to advocate for and implement lifestyle medicine curricula into their own institutions c)
aim to increase awareness and legislative initiatives that encourage adoption of lifestyle
medicine into medical school education d) develop and conduct assessment in the
following areas Student Health Student Knowledge and Programme Effectiveness and
e) train and support medical students as effective champions of lifestyle medicine whose
engagement with the curriculum lead to increased adoption within medical schools and
enhanced collaboration nationallyError Bookmark not defined This need has been acknowledged
in Europe as well62
Besides education in medical schools continuous professional development (CPD) is an
essential component in health education to ensure that professionals graduated in past
decades keep their competencies up to date and acquire new competencies needed for
health promotion disease prevention and lifestyle medicine It is important to encourage
further strengthening of CPD for those professions that benefit from automatic recognition
of their professional qualifications Member states should in particular encourage CPD for
physicians medical specialists general practitioners nurses responsible for general are
dental practitioners specialized dental practitioners veterinary surgeons midwives
pharmacists and architects63 Given the rapid developments in societal needs and
approaches towards health promotion and disease prevention and spectacular increase in
technological support facilities lifelong learning is imperative for health professionals and
should be oriented towards the competencies required to best serve their population and
society
Figure 22 Lifelong learning is an iterative process where learners build knowledge skills
attitudes and behaviours on top of their current professional competency
61 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019 62 European Lifestyle Medicine organisation httpswwweulmorg 63 Lim SS Vos T Flaxman AD Danaei G Shibuya K Adair-Rohani H et al A comparative risk assessment of
burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions 1990-2010 A systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
21
25 Theoretical framework for this study
In this study we touch upon the existing levels of health promotion disease prevention
and lifestyle medicine in health and educational settings in the EU and make a preliminary
assessment of its relevance
As right now health professional competencies seem more practical we approached the
mapping of competencies in health education through professions rather than with an
overall theoretical framework Thus we aim to create a general picture for different health
professions at different levels of education
For the assessment of relevance of the existing levels of health promotion in education we
aligned the competency framework of Kraiger with Friedenrsquos public health framework We
used three components64 of Kraigerrsquos Learning Typology
bull Knowledge cognitive and mental abilities
bull Skills psychomotor manual and physical abilities to perform tasks
bull Attitude (or self) perceptions growth in feelings or emotional areas
We used the integrated framework as an analytical tool to classify content areas covered
and their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future
This study is an important first step as we know little about present practices However
more detailed research will obviously be needed
64 Given the limitations of the study behaviour ndash the fourth component ndash is not included Behaviour refers to
practices to utilise knowledge skills and attitude in work environment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
22
3 METHODOLOGY
31 Mapping of health educational programmes in the EU
The first aim was to provide a general overview on how health professionals are trained in
health promotion and disease prevention and lifestyle medicine in the EU To that end we
conducted an online survey to map the educational programmes of health professionals in
the EU In addition to the proposed methodology we also conducted desk research to
create an overview of competency profiles of health professionals in the EU
311 Online survey
This study looks at undergraduate education postgraduate education and CPD courses in
all healthcare professions across the EU Within the EU different organisations are
responsible for the education of healthcare professionals
bull The undergraduate education programmes are organised by universities in each
country
bull The post-graduate education programmes are organised differently in each
country This includes a set of European organisations that run the guidelines
and portfolioacutes for each profession or specialty within this profession (like in
medicine)
bull CPD programmes are even more diverse between countries and can be accredited
both by European organisations and universities
Due to the wide scope of the study and the different levels of healthcare educational
programmes no country correspondents could be found with a full overview of educational
programmes addressing health promotion and disease prevention in their country
Therefore we chose for a snowball methodology to obtain information on all levels of health
professional education The snowball methodology consists of two steps First we identified
potential organisations in the EU to take part in the survey Second we asked those
organisations to recruit other organisations or stakeholders in their national andor
international network of colleagues and spread the survey among those This method
required more effort and time in the beginning but once the lsquoballrsquo was rolling it provided
us with a growing dataset including the perspectives from healthcare educators healthcare
professional associations and healthcare students and residents The snowball method
implies a risk of selection bias as educational institutions that have implemented health
promotion within their programmes ie the front-runners may have been more inclined
to respond than those who have not
In addition this recruitment process served as a communication and dissemination vehicle
and increased the engagement to the mapping Many organisations expressed their interest
to join the workshop as well as willingness to disseminate the results to their members and
collaborators Because of the growing interest we decided to extend the deadline after the
workshop organised on 13 February so attendees could spread the survey among their
national andor international networks
Our original workplan included an Excel worksheet to be sent to the national health
coordinators in each EU country but as we chose a different strategy it was necessary to
develop a more user-friendly and flexible method Therefore an online survey was
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
23
developed This enabled refinement of questions to each level of education with core sets
of questions Survey links proved to be easy to use and shared within educational facilities
or associations which led to higher response
In this section we discuss in more detail how the survey was developed and how relevant
international organisations were recruited
Development of an online survey
First we developed a mapping tool (stand-alone Excel document) to map the current
situation of professionals trained in health promotion This mapping tool was validated by
both Chafea and DG SANTE and by the external experts in the core research team After a
pilot phase an online survey was developed for all healthcare professions based on the
content of the mapping tool This was a necessary step to boost response as the online
survey proved to be more user-friendly and easier to share among educational facilities or
associations than the mapping tool in Excel
Among other topics the survey contained questions on the
bull Training programme for which the respondent is filling in the survey (which
(educational) institute and health profession portfolio etc)
bull Type of training programme (undergraduate education postgraduate education or
continues professionalrsquos development
bull Type of health professional targeted (eg GPrsquos physiotherapists etc)
bull Implementation in the curriculum
bull Description of the health promotion component in the programme (eg teaching
methods monodisciplinary approach or multidisciplinary approach expected
outcomes in knowledge skills and attitude)
bull Targeted funding
bull Accreditation
bull Partnerships
The questions in the survey correspond with the information requested in the Tender
Specifications Note that the survey maps the educational offer effectiveness of education
is outside the scope of this study The complete questionnaire used in the survey can be
found in Annex 3
Recruitment of relevant international organisations EU and national medical and
non-medical associations medical faculties national and international institutes
networks and organisations
As we used a snowball method it is not possible to provide the exact number of persons
who received the survey and response rates Instead we present each of the steps taken
to approach respondents and final response obtained
Recruitment of European associations
First we connected with major networks in the fields of graduate post-graduate and
continuous professional development for their support as these organisations have an
overview of the three levels of health professional education These associations represent
entire professions or part of the professions (like post-graduates) in all European countries
National professional organisations are members of these umbrella organisations For
example the Union of Medical Specialists (UEMS) represents 16 million medical specialists
It has 40 full member associations (Member States of the EU amp Member States of the
European Economic Area) associate member associations (Member States of the Council
of Europe) and observer member associations (other countries eg the United States)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
24
The UEMS represents more than 50 medical disciplines through various bodies
and structures The most important ones are the 43 Specialist Sections which represent
independently recognised specialties All health professionals health professional students
and post-graduates are organised in a similar manner These organisations are in a good
position to provide information and disseminate it across EU countries
Overall 24 EU associations were approached by email to spread the survey among their
networks (see Table 31 for a complete overview) We aimed to cover all professions within
the scope of this study ie physicians physiotherapists occupational therapists
psychologists nurses social workers dentists pharmacies dietitians throughout Europe
Therefore European associations with focus on educational programmes for these specific
professions were approached
Table 31 Approached European Associations
No European Associations
1 European Medical Association (EMANET)
2 The European Union of General Practitioners (UEMO)
3 European Union of medical specialists (UEMS)
4 European Medical Students Association EMSA)
5 European Forum of Medical associations (EFMA)
6 European Federation of Nurses Associations (EFN)
7 European Association of schools of social work
8 European Network of Physiotherapy in Higher Education
9 European Region ndash World Confederation of Physical Therapy (ER-WCPT)
10 European Network of Occupational Therapy in Higher Education (ENOTHE)
11 Council of Occupational therapists of European Countries (COTEC) part of the World
12 Federation of Occupational Therapists (WFOT)
13 Federation of National Psychologists Associations
14 European federation of nurse educators (FINE) association
15 Association for Dental Education in Europe
16 Council of European Dentists
17 Association for Medical Education in Europe (AMEE)
18 Pharmaceutical group of the European Union (PGEU)
19 European Pharmacists Forum (EPF)
20 European Association of faculties of pharmacy (EAFP)
21 European network of medical residents in Public health
22 The Association of Medical Schools Europe (AMSE)
23 The European Society of Preventive Medicine (ESPREV)
24 The European Lifestyle Medicine Organisation (ELMO)
Recruitment of national associations
Second national health associations for all Member States and all professions were
approached to fill in the survey This step was crucial to increase the response National
health associations were selected using the member list of European organisations Table
32 shows the European organisations used to identify national health associations that
were invited to participate in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
25
Table 32 Examples of the approached national associations
Profession European Association Examples of approached national associations (1 out of 28)
Medical doctors Standing committee of European Doctors (CPME)
Czech Medical Chamber
Physiotherapists World confederation for physical therapy (WCPT)
Swedish Association of Physiotherapists
Social workers International federation of
social workers
German professional
association for social work
Psychologists European Federation of psychologistsrsquo association (EFPA)
Croatian psychological association
Occupational therapists Council of occupational
therapists for the European Countries (COTEC)
Association of Bulgarian
Ergotherapists
Dietitians The European Federation of the associations of dieticians
(EFAD)
French Association of Nutritionist Dietitians
Dentists Council of European Dentists Irish dental association
Nurses European Federation of Nurses
Association (EFN)
Polish Nurse Association
Pharmacists Pharmaceutical group of European Union (PGEU)
Malta Chamber of Pharmacists
Recruitment of national educational organisations
Last the list of the selected associations was used to identify relevant national educational
organisations These national educational organisations (eg University of Maastricht
Faculty of Health Medicine and Life Sciences Kaunas University Medical School Lifestyle
Medicine University of Helsinki Faculty of Medicine) were approached individually and
asked to fill in the survey and spread it throughout their network
Table 33 Number of national educational organisations approached
Profession Number of approached national education organisations
Medical schools 298
Schools of physiotherapy 29
School of social work 31
School of dietitians 40
School of Occupational therapists 45
School of dentists 85
School of pharmacists 56
Response obtained
In total we received information on 176 educational practices till mid-February The
workshop organized in Luxembourg65 gave an additional boost and resulted in 32 more
practices reported in the survey In total this mapping exercise is based on information on
208 practices of health promotion in educational settings
65 Workshop ldquoPromoting lifestyle medicine competencies and education of health professionals in the EU todayrdquo
13th February 2020 Luxembourg Organized by Chafea and DG SANTE
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
26
312 Desk research
Desk research was conducted on both scientific and grey literature with the main purpose
to establish an overview of the competency profiles of health professionals in the field of
health promotion and disease prevention This overview was created to gain insight to what
extent competency profiles related to health promotion and disease prevention are covered
in the educational standards of different health professions in the EU We have made use
of reports published online and scientific articles on competency profiles or educational
standards set at EU level (eg European standards in medical training (UEMS) as the EU
Directives of the European Parliament and Council on the recognition of professional
qualifications have consolidated a system of mutual recognition between Member States3
When reports on EU level could not be identified we selected articles on global standards
such as for the profession of social work (ie global standards for the education and training
of the social work profession)
Based on the identified literature we have described the competency profiles for each of
the following healthcare professions
bull (undergraduate) Medicine
bull Medical specialists
- sports medicine specialists
- public health specialists
- internists
- cardiologists
- psychiatrists
- general practitioners
bull Dentists
bull Nurses
bull Nurse specialists
bull Occupational therapists
bull Pharmacists
bull Physiotherapists
bull Psychologists
bull Social workers
The selection of healthcare professions included in the desk research was made in
consultation with Chafea DG SANTE and the experts
The assessment of the competency profiles was based on the three Domains of Learning
KSAs as described in Chapter 2
bull Cognitive mental skills (knowledge)
bull Psychomotor manual or physical skills (skills)
bull Affective growth in feelings or emotional areas (attitude or self)
This method was chosen as especially ldquolack of confidence and knowledge and skills by
health professionals on providing effective counsellingrdquo was identified as a barrier for
prescribing and counselling on promoting physical activity in the healthcare sector66 In
Chapter 4 the results are described in detail
66 httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
27
32 Long list of good practices
From the survey results we have drawn a long list of good practices As agreed with Chafea
and DG SANTE these good practices were selected using the following four selection criteria
bull The programme contains a multidisciplinary approach
bull The education is mandatory (including an exam)
bull The education covers the following topics digitalisation in health eHealth and
digital health coaching
bull The expected outcome includes change in skills and or behaviour
Several variables were included in the longlist country name of the programme name of
the institute whether there is a focus on knowledge skills and behaviour the type of
professionals who are being trained the theories that are covered by the education (eg
human cognition and behaviour health behaviour change techniques communication skills
etc) education methods used year since the education is provided the time spend in the
modules in hours and lastly in case of one full module the duration of this module To
enable comparison between good practices based on different variables the preliminary
longlist can be found in a separate Excel document Chapter 5 includes an overview of the
coverage and content of the long list of good practices
After closing of the online survey we analysed the longlist of good practices along the
following research questions
bull What content items of health promotion disease prevention and lifestyle
counseling do programmes consist of
bull What kinds of learning aims do they have
bull How do they distribute in Friedens model of levels of health promotion
bull Are there differences between professional groups
First we analysed the distribution of the learning skills separately by the levels of education
(undergraduate postgraduate and CPD) We expected that adult learning will be more
directed towards skills (learning by doing) than the undergraduate and postgraduate
programmes Secondly we analysed the educational methods and tools used in the good
practices
Good practices can be submitted to the European Commissionrsquos Best Practice Portal to be
assessed by external evaluators against criteria adopted by the Steering Group on Health
Promotion Disease Prevention and Management of NCDs Practices rated as best against
these criteria will be published on the European Commissionrsquos Best Practice Portal67
67 httpswebgateeceuropaeudynabp-portal
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
28
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
29
4 MAPPING OF THE CURRENT SITUATION IN HEALTH PROMOTION TRAINING IN THE EU
41 Overview of educational programmes in the EU
411 Summary of the main findings in the survey
A high percentage (93) of respondents (n=197) indicated that health promotion and
disease prevention are implemented in their educational programmes or modules For
undergraduate education postgraduate education and CPD these percentages were 95
93 and 83 respectively Other results include
bull More than half of the respondents indicated that they filled in the questionnaire
based on undergraduate educational settings Throughout Europe these numbers
were relatively similar
bull Physiotherapists seem to be the professional group most actively involved in
health promotion training activities The vast majority applies multidisciplinary
approaches and thus bring other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within the undergraduate and postgraduate programmes In CPD on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion target knowledge skills and
attitudes of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for CPD (33) compared to
undergraduate and postgraduate education (15 and 6) when the topic is
covered in most modules Funding was more often obtained in Northern and
Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) With regard to full modules high percentages
indicated that these are mandatory and that there is an exam at the end of the
module (81 70 respectively)
412 Detailed results of the survey
Respondents
In the following section we provide a detailed description of the survey results The survey
targeted undergraduate education postgraduate education and CPD programmes in all
Member States Overall 208 respondents filled in the questionnaire about their educational
practice Note the results presented in the remainder of this report are exclusively based
on the answers respondents provided in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
30
Table 41 and Figure 41 provide an overview of the number of practices reported per
European countries A detailed overview of the educational programmes collected
throughout Europe can be found in Annex 1
Figure 41 Practices collected in the survey by European countries (n=208)
Table 41 Number of respondents per European Member State 2019-2020 (n=208)
Abbreviations EU Member State Number of respondents
AT Austria 12
BE Belgium 23
BG Bulgaria 4
CY Cyprus 1
CZ Czech Republic 7
DE Germany 1
DK Denmark 8
EE Estonia 2
ES Spain 22
FI Finland 6
FR France 15
GB United Kingdom 6
GR Greece 10
HR Croatia 0
HU Hungary 3
IE Ireland 8
IT Italy 10
LT Lithuania 1
LU Luxembourg 0
LV Latvia 5
MT Malta 6
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
31
Abbreviations EU Member State Number of respondents
NL Netherlands 2
PO Poland 0
PT Portugal 14
RO Romania 3
SE Sweden 4
SI Slovenia 14
SK Slovakia 2
Additional countries 19
TOT 208 the UK is included as a Member State in this study as the results were obtained before Brexit
For mapping purposes we made a breakdown of results by region ie Northern Europe
Eastern Southern and Western Europe (based on United Nations Regional Groups)
Furthermore we compare results of individual countries for which at least 10 practices have
been reported in the survey These are Austria Belgium France Greece Italy Portugal
Slovenia and Spain
Table 42 European countries per region
Region European countries
West Austria Belgium France Ireland Germany
Luxembourg Netherlands United Kingdom Switzerland
North Denmark Sweden Estonia Finland Lithuania Latvia Norway
East Bulgaria Czech Republic Hungary Romania Slovakia Poland Georgia Kazakhstan
South Italy Spain Cyprus Portugal Greece Malta Slovenia Croatia Bosnia Kosovo Serbia
Type of education
We asked the respondents to indicate the type of educational setting As shown in Figure
42 more than half of the practices (60) refer to undergraduate educational settings and
approximately one third to postgraduate educational settings Only twelve percent of the
reported educational settings is related to CPD
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
32
Figure 42 Practices by educational level (n=199 in percentages)
Figure 43 and Figure 44 show the distribution in type of education per region and on
country level respectively For Western Southern and Northern Europe distribution is in
line with the overall results In Eastern Europe practices reported are more evenly
distributed over undergraduate and postgraduate education Also the share of CPD
practices is high in comparison with other regions and overall results
Figure 43 Practices by type of education per region (n=204 in percentages)
64
42
62
60
29
37
27
30
7
21
12
10
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Undergraduate education Postgraduate education Continuous professional development
60
29
12
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
33
Figure 44 Practices by type of education per country (in percentages)
Type of health professions
An overview of the type of health professional trained in the educational practices is
provided in figure 45 Remarkably over one third (35) of the educational practices
reported are oriented to physical therapists Note that multiple answers could be provided
Figure 45 Type of health professional being trained (n=208 in percentages)
Medical specialists refer to doctors with an extra expertise in one type of medicine eg including sports
medicine public health internal medicine cardiology psychiatry and the general practitioner68 General
practitioners refers to doctors working within General Practice or Family Medicine (GPFM)69 Medical doctors refers
to doctors without any specialization
68 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 69 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
83
70
27
50
30
62
71
71
8
22
60
30
60
23
14
19
8
9
13
20
10
15
14
10
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Undergraduate education Postgraduate education Continuous professional development
116
15
35
1417
7 8 5
29
0
10
20
30
40
50
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
34
Health professionals involved as educators in health promotion and disease prevention are
shown in Figure 46 Physical therapists are most often active as teachers of health
promotion (36) which coincides with the high share of practices oriented to this
profession Some professions like medical specialists nurses and psychologists are
represented more often as teacher then as trainee of the educational practices This implies
they are involved in programmes oriented towards other health professions and is in line
with a multidisciplinary approach that is applied by the vast majority of practices ( 81
n=148)
Figure 46 Health professionals teaching contents of health promotion (n=90 in
percentages)
Methods of education
Survey results show that traditional methods ie lectures and assignments are most often
used (Figure 47) Assignment refers to home school projects such as writing papers In
CPD eLearning methods are more often used (67) compared to undergraduate (45)
and post graduate education (39) The use of field training is relatively similar for the
different levels of education
Figure 47 Teaching methods applied (n=145 in percentages)
8
27 26
36
14
24 23
6 7
37
0
10
20
30
40
50
97
81
74
46
0 10 20 30 40 50 60 70 80 90 100
Lectures
Assignments
Field training in real environments
eLearning modules
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
35
Knowledge skills and behaviour
As for the outcome of the education respectively 99 94 and 89 of all practices
indicate knowledge skills and behaviour as expected outcomes (Figure 48) There are no
significant differences between types of education
Figure 48 Knowledge skills and behaviour (n=142 in percentages)
Accreditation
Overall 39 of the educational practices is accredited on European or international level
53 is accredited at a national level and only 5 lacks accreditation (n=179) Comparing
the different levels of education the rate of accreditation at a European or nation level
varies At a European level these are 46 33 22 at the national level 47 58
67 for undergraduate education postgraduate education and CPD respectively
Throughout Europe the level of accreditation of education is high in Northern Eastern
Southern and Western countries the share of practices without accreditation is 11 0
5 and 3 respectively (n=197) Eastern European countries have regulated their
accreditation more often on a national level compared to the other countries
Theories covered
Figure 49 shows that health behaviour human cognition and behaviour and population
health are covered in most educational practices to a high or at least limited extent
99
0 1
94
4 2
89
6 4
0
20
40
60
80
100
Yes No Unknown Yes No Unknown Yes No Unknown
Knowledge Skills Behavior
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
36
Figure 49 Theories covered by the education (n=137 (in percentages)
Figure 410 provides a more detailed overview of contents covered in the educational
programmes and shows that communications skills ethics and methods of evidence-based
medicine are mostly covered within the education Contents least covered are digital health
coaching digitalisation health economics
Funding and partnerships
Figure 411 provides an overview of the practices that a) obtained targeted funding to
incorporate health promotion and disease prevention in the curriculum b) for which a
partnership is set up for execution of teaching activities on health promotion or c) built on
existing partnerships to incorporate health promotion in the curriculum of the whole
educational programme This overview only includes educational practices where health
promotion and disease is incorporated in most modules
Funding differed between level of education 15 6 and 33 of the undergraduate
education postgraduate education and CPD received targeted funding to incorporate health
promotion in the curriculum Hence funding seems to play a more important role for CPD
than for undergraduate and postgraduate education
66
54
65
31
42
32
1
1
2
3
1
0 20 40 60 80 100
Population health
Human cognition and behavior
Health behaviour
Yes very much Yes but limited No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
37
Figure 410 Theories that are included within education on health promotion (n=137 in percentages)
Figure 411 Funding and partnerships when health promotion is covered in most modules of the educational programme (n=123 in percentages)
Figure 412 provides a comparison of funding obtained by European region Remarkably
in Western Europe the share of practices with targeted funding to incorporate health
promotion is much lower than in the other EU regions
48
69
40
16
54
48
20
34
37
41
49
64
9
44
24
55
51
42
47
50
50
48
44
42
31
43
7
6
4
4
3
4
25
25
9
9
5
2
42
1
1
1
1
1
1
5
5
5
6
4
3
6
0 20 40 60 80 100
Epidemiology and bio-statistics (research capacity)
Methods of evidence-based medicine
Health policies and regulation
Health economics
Ethics
Health care systems
Digitalisation in health promotion
Health inequalities
Disease prevention in teams
Health literacy
Health behavior change techniques
Communication skills
Digital health coaching
Yes very much Yes but limited No Unknown
52
61
15
0 20 40 60 80 100
Partnerships in incorporating it in the curriculum of thewhole educational programme
Partnerships for execution of teaching activities
Funding to incorporate health promotion in curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
38
Figure 412 Funding to incorporate health promotion for programmes covering health promotion in most modules by region (n=119 in percentages)
Comparing individual countries figure 413 shows that funding is obtained for the
educational programmes reported in Slovenia Italy and France while this is not the case
or unknown in Portugal Belgium and Austria
Figure 413 Funding to incorporate health promotion when health promotion is covered in
most modules of the educational programme by country (n=71 in percentages)
Dedicated modules to health promotion
In a majority of practices (63) health promotion disease prevention and lifestyle
medicine are covered in all modules of the educational programme as opposed to coverage
in one module primarily dedicated to health promotion (37) Undergraduate and
postgraduate education show a similar pattern while in CPD programmes full modules
primarily dedicated to health promotion are relatively restricted namely 15 (Figure 414)
Both options have the potential to be effective depending on context implementation and
other factors The data gathered in this study do not allow any statement on effectiveness
of each option
20
12
21
3
80
82
70
85
6
9
13
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Yes No Unknown
13
29
0
9
30
89
100
38
71
40
100
73
70
11
50
18
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Yes No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
39
Figure 414 Share of practices with one full module primarily dedicated to health promotion
(n=140 in percentages)
Visibility of health promotion in CPD
In CPD health promotion is often integrated into disease-oriented or risk behaviour-
based contents making it harder to identify the subject in events available The
Union of European Medical Specialists (UEMS) has an electronic database for
accrediting continuous medical education This data set contains keywords Using
health promotion public health or lifestyle as keywords 37 educational events were
found in the years 2017-19 (Table 415) There were 6 events in year 2017 3 in
year 2018 and 8 in year 2019 Average number of credits (1 ECMEC equals 1 hour
maximum 6 per day) was 296 average length of events 45 days This illustrates
availability of international training on health promotion and public health for
medical professions In other events these themes may have been touched upon
as well but are not the main subject So there might be a need to make health
promotion more visible in CPD events Competency-based education could provide
a solution if health promotion disease prevention and lifestyle medicine are defined
as competencies
Table 415 CPD events with health promotion public health or lifestyle as keyword 2017-
2019 (n=37)70
Title ECMEC Year Location Website
Control of multidrug-
resistant micro-organisms in health care settings
20 2017 Stockholm
Sweden
httpwwwecdceuropaeu
Epidemiology and public health microbiology for facilitators
30 2017 Spetses Greece
httpwwwecdceuropaeu
Fellowship (EPIET amp EUPHEM) introductory course
86 2017 Spetses Greece
httpwwwecdceuropaeu
International Society for Quality in Health Care 34th International Conference
23 2017 London United Kingdom
httpisquaorgEventslondon-2017
DOHaD 2017 10th World Congress DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE
25 2017 Rotterdam Netherlands
httpwwwdohad2017org
70 Source UEMS database of accredited events 2017-2019
4035
150
20
40
60
80
100
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
40
Title ECMEC Year Location Website
10th European Public Health Conference
23 2017 Stockholm Sweden
httpsephconferenceeu
Methods and tools for evidence-based practice
and decision-making in Public Health with special emphasis on communicable disease
22 2018 Stockholm Sweden
httpwwwecdceuropaeu
ESCMID Workshop on
Migrants Health
15 2018 Muscat
Oman
httpsescmidpulselinksco
mevent14833
Control of multidrug-resistant micro-organisms in health care settings
17 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventscourse-control-multidrug-resistant-micro-organisms-mdros-health-
care-settings
ECDC Summer School 2018 23 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventsecdc-summer-school-2018
3rd International Conference of the European Network for Smoking and Tobacco Prevention
15 2018 Madrid Spain
httpsenspconferenceorg
European Observatory Venice Summer School 2018
25 2018 San Servolo Italy
wwwtheobservatorysummerschoolorg
Letrsquos talk about nutrition (NESG)
4 2018 Madrid Spain
httpespencongresscomprogrammelll-courses
Epidemiology and public health microbiology for
facilitators
28 2018 Spetses Greece
httpsecdceuropaeuenepiet-euphemaboutintro
International Society for
Quality in Health Care 35th International Conference
22 2018 Kuala
Lumpur Malaysia
httpsisquaorgEventsmal
aysia-2018
Fellowship (EPIET amp EUPHEM) introductory course
93 2018 Spetses Greece
wwwecdceuropaeu
EGEA 2018 ndash ldquoNutrition and health from science to practicerdquo
16 2018 Lyon France httpswwwegeaconferencecom
1st EUROPEAN LIFESTYLE MEDICINE CONGRESS
13 2018 Geneva Switzerland
wwwelmocongresscom
11th European Public Health Conference
24 2018 Ljubljana Slovenia
wwwephconferenceeu
Fellowship Multivariable
Analysis
25 2019 Madrid
Spain
Rapid Assessment and Survey methods (RAS)
module
35 2019 Zagreb Croatia
ECDC Summer School 2019 28 2019 Stockholm Sweden
httpswwwecdceuropaeuennews-eventsecdc-summer-school-2019
Fellowship Vaccinology Module
29 2019 Rome Italy
Programme Planning and Implementationrdquo Training Program for Resolve to
Prevent Epidemics Initiative
39 2019 Butaro Rwanda
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
41
Title ECMEC Year Location Website
Skill-mix innovation in primary and chronic care mobilizing the health workforce
28 2019 Venice Italy wwwtheobservatorysummerschoolorg
Evolutionary Medicine Conference 2019 5th international meeting of the International Society for Evolution Medicine and Public Health
15 2019 Zurich Switzerland
httpsisemphorg2019-Meeting
Fellowship (EPIET amp EUPHEM) introductory course
85 2019 Spetses Greece
Project Management for Emergency Preparedness Budget and Finance Management
20 2019 Butaro Rwanda
Autumn School on Medical
Education
19 2019 Chernivtsi
Ukraine
httpswwwfacebookcome
vents531981117209981
Project Management for Emergency Preparedness Practical Leadership Skills
24 2019 Butaro Rwanda
International Society for Quality in Health Care 36th International Conference Cape Town 20102019 - 23102019
18 2019 Cape Town South Africa
httpswwwisquaorgeventscp2019html
Public Health Genomics an
introduction
11 2019 Stockholm
Sweden
httpsecdceuropaeuenne
ws-eventspublic-health-genomics-introduction
ENSP Tobacco treatment
specialistsrsquo training
5 2019 Paris France httpenspnetwork
World Health Summit 2019 16 2019 Berlin Germany
wwwworldhealthsummitorg
Time Series Analysis 28 2019 Bilthoven
Netherlands
httpsecdceuropaeuenep
iet-euphemaboutexperience
12th European Public Health Conference
16 2019 Marseille France
wwwephconferenceeu
Outbreak Investigation Module
30 2019 Nicosia Cyprus
httpswwwecdceuropaeuenepiet-euphemaboutexperience
Source UEMS database of accredited events 2017-2019
Looking at the regional level we found that in most regions a majority of practices cover
the topic in all (or most) modules of the educational programme (Figure 416) In Northern
Europe this is most pronounced with as much as 76 of the practices reported covering
health promotion in all modules whereas in Eastern Europe this applies for 55 of
practices A similar analysis for individual countries shows that only in Spain health
promotion is covered in a dedicated module in the majority (62) of educational practices
reported while in all other countries the topic is mostly covered in all (or most) modules of
the programme Percentages vary from 56 (Austria) to 86 (Greece Figure 417)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
42
Figure 416 How is health promotion implemented in education by region (n=148 in percentages)
Figure 417 How is health promotion implemented in education by country (n=120 in
percentages)
55 participants answered specific questions on the full module dedicated to health
promotion 81 of them indicated that the education is mandatory As figure 418 shows
in Northern and Eastern Europe all dedicated module on health promotion form part of
mandatory education In Western Europe one out of three modules is optional for students
24
4537
42
76
5563
58
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
4439
36
14
22
38
18
6256
6164
86
78
63
82
38
0
20
40
60
80
100
Austria Belgium France Greece Italy Portugal Slovenia Spain
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
43
Figure 418 Full modules on health promotion that are part of mandatory education by region (n=47 in percentages)
An exam is taken at the end of the module in 70 of the cases Between regions
percentages do not differ much (Figure 419) Please note that results are based on a
limited number of practices as response for this question was low
Figure 419 Exam at the end of dedicated module by region (n=47 in percentages)
When asked whether the module on health promotion and disease prevention was
accredited separately 15 indicate that this is the case 30 report that the module is
provided at multiple locations
Figure 420 provides an overview of respondents who indicate that funding was obtained
to set up the module as well as the use of partnerships for implementation of teaching
activities on health promotion or in setting up the module Lastly it was indicated that
mostly lsquootherrsquo professionals are teaching these modules
100 100
82
67
12
22
611
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
Yes No Unknown
2518
2225
12 11
75 7571
67
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
No Unknown Yes
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
44
Figure 420 Funding and partnerships for dedicated modules (n=47 in percentages)
42 Overview of competency profiles of health professionals in the EU
A detailed description of the competency profiles per healthcare profession as obtained
from the desk research can be found in Annex 2 Competency profiles per professions
These profiles provide a solid basis for health promotion and disease prevention
Most competency profiles mention health promotion andor disease prevention Overall
the competencies of medical specialists are most comprehensively described including the
competencies for health promotion Although there are many similarities between the
different competency profiles we have identified differences in the coverage of domains of
learning ie knowledge skills and attitudes (see chapter 23) Knowledge refers to
cognitive or mental competencies skills to competencies to perform tasks or activities and
attitudes to competencies related to beliefs or values An example of an attitude
competency is ldquoexemplify appropriate lifestyle in personal behaviourrdquo In professions that
are less physically oriented emphasis is on knowledge and attitude rather than on skills
related to health promotiondisease prevention This mainly holds for psychiatry and social
workers For professions in which lifestyle is an essential component ie sports medicine
and public health emphasis is on skills rather than attitudesOnly for cardiology nurses
nurse specialists and pharmacists competency profiles describe competences in all
domains of learning ieknowledge skills and attitudes
Many competency profiles leave room for interpretation and competencies described are
not ranked in order of importance In addition profiles do not state whether competencies
should be practised in a pro-active (within every treatment) or reactive way (only when
treating diseases with a clear lifestyle component
43
53
11
0 20 40 60 80 100
Partnerships in setting up module
Partnerships for execution of teachingactivities
Funding to set up module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
45
5 LONG LIST OF GOOD PRACTICES
In this chapter we present the coverage and content of the long list of good practices The
list is also available in an Excel-file that provides the opportunity to easily make selections
by different variables such as country type of programme (undergraduate postgraduate
CPD) or the characteristics of the education programme
We also provide an analysis of content areas covered and their weight in educational
programmes learning objectives learning typology and educational methodology using
Kraigerrsquos typology and Friedenrsquos pyramid as analytical tools
51 Results
From the survey results we have drawn a long list of good practices In agreement with
Chafea and DG SANTE good practices were selected based on four criteria
1 The programme contains a multidisciplinary approach
2 The education is mandatory (including an exam)
3 The education covers the following topics digitalisation in health eHealth and digital
health coaching
4 The expected outcome includes change in skills andor behaviour
This resulted in a long list of 70 good practices that meet all criteria Educational practices
cover all regions of Europe and originate from 20 Member States (Figure 51 and Table
51)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
46
Figure 51 Number of good practices selected for long list by country 2019-2020
Table 51 Number of good practices selected based on the four selection criteria per European Member State 2019-2020
Abbreviations EU Member State Number of good
practices
AT Austria 6
BE Belgium 11
BG Bulgaria 2
CY Cyprus 1
CZ Czech Republic 2
DE Germany 0
DK Denmark 5
EE Estonia 1
ES Spain 7
FI Finland 2
FR France 6
GR Greece 7
HR Croatia 0
HU Hungary 1
IE Ireland 3
IT Italy 2
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
47
Abbreviations EU Member State Number of good practices
LT Lithuania 1
LU Luxembourg 0
LV Latvia 1
MT Malta 0
NL Netherlands 0
PO Poland 0
PT Portugal 2
RO Romania 1
SE Sweden 2
SI Slovenia 7
SK Slovakia 0
TOT 70
Of all selected good practices of healthcare educational programmes 16 practices (23)
cover health promotion and disease prevention in one full module primarily dedicated to
the subject In 54 good practices (77) the educational programmes incorporate the topic
of health promotion and disease prevention in all or most modules (Figure 52)
Figure 52 How is health promotion covered in selected good practices (n=70 in percentages)
When dividing good practices by type of education programme we see that all types
educational programmes are represented (Figure 53) The highest share of good practices
is focused on undergraduate education (60 n=42) Two practices are focused on both
undergraduate and postgraduate education
Figure 53 Type of education () represented by selected good practices (n=70)
77 23
All modules One module
6026
113
Undergraduate education
Post graduate education
Continuous professionaldevelopment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
48
Figure 54 presents the absolute number of selected good practices by type of profession
trained The absolute number sums up till 128 as multiple professions can be trained within
one programme This shows a good variation of health professionals Most good practices
focus on nurses (17 n=22) and medical doctors (13 n=17)
Figure 54 Good practices by profession being trained (n=70 in absolute numbers)
In addition to those described above other variables are included in the separate Excel file
mentioned above These include the name of the programme and the institute focus on
knowledge skills and behaviour type of professionals being trained theories covered in
the education (eg human cognition and behaviour health behaviour change techniques
communication skills etc) education methods used when the education started time
spent on the modules in study hours (ECDEC) and in case of one full module the duration
of this module This Excel file allows to make cross comparisons between different variables
52 Analysis of good practices
In this section good practices are analysed more in detail Figure 55 presents the
distribution of content areas in health promotion and their weight in educational
programmes Methodological training like evidence-based methods (EBM) varies in
programmes but has a strong position Lifestyle intervention skills are widely taught
however new technologies are still on their way in becoming part of health promotion
education Interestingly health economics rate less in these practices in spite of its close
link with health promotion as part of public health policies
30
4
4
11
17
15
15
22
10
Other
Social workers
Dentists
Occupational therapists
Medical doctors
Medical specialists
Psychologists
Nurses
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
49
Figure 55 Results for good practices(n=70) ldquoDoes the education of the initiative includerdquo
Numbers refer to Frieden model in levels of health promotion with exception of methodological contents marked
as tools (1) counselling and education (2) clinical interventions (4) changing the context to make individualrsquos
default decisions healthy (5) socioeconomic factors (6) methods in studying and evaluating health promotion
and public health
We used Friedenrsquos pyramid of levels of health promotion (Frieden 2010) and Kraigerrsquos
typology of learning (Kraiger et al 1993) to describe the abilities that professionals are
expected to acquire Based on their description learning objectives move in a knowledge
level skill building or into attitudinal objectives Figure 56 gives a graphical visualization
of the results of our analysis The dark blue green and light blue rectangles represent the
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
50
Figure 56 Learning objectives categorised into Friedenrsquos levels and learning typology
(knowledge skills attitudes) of good practices (n=70)
different domains of learning knowledge skills and attitudes The size of the rectangles is
proportional to their share in all domains in the educational practice
Within each domain of learning contents are categorized Their vertical order reflects the
order of impact levels of Frieden (from individual patient to society level) and again size
corresponds to share in the curriculums content
This analysis provides a general picture of educational practices in health promotion
disease prevention and lifestyle medicine The graph shows that practices are
predominantly oriented towards knowledge-based competencies (around 60 of the
curriculum) Roughly one third of the programme has skills-oriented learning objectives
while competencies regarding attitudes are addressed in around 10 percent of the
programmersquos content
Looking into knowledge-based competencies the broad spectrum of individual to societal
levels of impact is addressed On a societal level social and medical aspects are widely
represented while the economic angle is scarcely present Technological developments like
digitalisation are present to a modest extent
Skill-oriented learning objectives focus in communicative competences like communication
skills behaviour change techniques and teamwork Health coaching is covered in a small
number of practices Interestingly in methodological contents the aim of skills-oriented
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
51
education is to provide mainly knowledge like in EBM Few practices include practical skills
for communication and coaching in their objectives
Competence-building in the domain of attitudes form a minimal part of educational
practices They are reflected in eg health literacy and ethics However these are also
taught in a hidden curriculum as well
Educational methodologies in the survey include lectures assignments e-Learning and
real-world field assignments As these are the selected good practices it was to be expected
that multiple methods are used in most of these programmes (given selection criterium 3)
In 37 programmes all methods are in use E-Learning is used in 41 programmes
Figure 57 Educational methods used in good practices (n=70 in percentages) ()
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
53
6 CONCLUSIONS
The competency profiles as well as information on a large number of educational practices
in health promotion disease prevention and lifestyle medicine for health professionals in
the EU allow us to formulate answers to the research questions that guided this study
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and
continuous professional education
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades71there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional The educational practices collected show that this is true for all
regions of the EU However there is no overall body that has responsibility for quality
assuring standards of training and professional practice at the European level
The information on around 200 practices from 25 EU Member States (including UK) shows
that the majority of educational practices take place in undergraduate settings while
training events on health promotion for health professionals active in the field are relatively
scarce in continuous professional development (CPD) a limited number of practices on
health promotion are reported and indeed few courses or training events on health
promotion are available in the CPD calendar of the UEMS database of accredited events
Education on health promotion aims at developing competencies in knowledge skills and
attitude and most often has a multidisciplinary character Especially medical doctors nurses
and psychologists are often involved in educating other disciplines on health promotion
Health behaviour human cognition and behaviour as well as population health are part of
educational practices for all professions A majority also include communication skills
methods of EBM and ethics
The most common way to teach health professionals on health promotion disease
prevention and lifestyle medicine is the integration of the subject in most of all modules of
the curriculum Dedicated modules on health promotion are developed in undergraduate
and postgraduate education but are scarce in CPD This may contribute to the invisibility of
the subject in training for professionals active in the field
Four out of ten educational practices on health promotion are accredited on the European
(or international) level half of them have national accreditation
71 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
54
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Based on in-depth analysis of a selection of 70 good practices knowledge proves to be the
predominant domain of learning Theories covered relate to different levels of impact of
Friedenrsquos pyramid but emphasis is on the individual patient level with a predominant
position for evidence-based medicine Health economics receive remarkably little attention
This may be disadvantageous for advocacy of health promotion which requires influencing
decision-making on public funding
Around one third of educational contents are dedicated to competencies in the domain of
skills and mainly target communicative skills Interestingly they provide mainly knowledge
rather than practical training Competencies in the domain of attitude are addressed least
Ethics and health literacy are theories are the most common examples of attitude-oriented
contents When looking at the competencies defined by health professionals advocacy has
a solid role in all of them with defined skills It was represented in only few domains like
health economics so it may well be that educating advocacy skills are more common than
found in this study
Good practices use a mix of educational methods including lectures assignments real-
world practices and digital study methods
In conclusion this study is a first step in gaining knowledge and insights in the state of
affairs of health professionalsrsquo education in health promotion disease prevention and
lifestyle medicine in the EU It is an important step as we know little about present
practices However more detailed research will obviously be needed
The results of our in-depth analysis of good practices provide qualitative information We
used the integrated framework as an analytical tool to classify content areas covered and
their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future The information supplied by the
respondents show the culture of describing health promotion and education objectives
Therefore no lsquohardrsquo conclusions can be drawn However some cautious notions are
worthwhile to mention as they flag opportunities for learning and improving by collaborative
action
First it is worthwhile to stress the progress made While 20 years ago health professionals
were hardly trained in health promotion and lifestyle medicine and at best received some
instruction on specific disease-related unhealthy habits (like smoking for lung diseases) it
is now part of standard education for most health professionals That is an important
development and essential for collaboration across professions
However more can be done Health promotion education should respond to societyrsquos needs
and therefore educational needs are constantly changing and providers of education need
to follow needs in the field Increasing recognition of societal impact on health inequalities
the paradigm shift from treating to coaching patients changes in the way care is delivered
the digital revolution and the need to contain the cost of our healthcare systems represent
a multitude of challenges and relentless educational efforts in health promotion disease
prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
55
To name a few the balance between domains of learning in curricula will have to redefined
as in health coaching skills attitudes and knowledge are equally important Health
professionals will have to manage health economics to speak the language of policy makers
Teaching methodologies have gained from the technological revolution and there is
potential in utilising them even more Also there is a necessity to do so in order to provide
for effective health promotion Health literacy has got alongside data literacy Therefore
education needs to respond to in using more technologies as well as teaching adaptation of
technologies into care This is not common practice yet The constant development in needs
also stresses the need for continuous professional development in health promotion
disease prevention and lifestyle medicine To date CPD seems to be underrepresented in
educational practices on health promotion and more heavily dependent on external funding
than in undergraduate and postgraduate courses
The experience developed in the good practices collected in the survey represents a
valuable body of knowledge skills and attitudes among health educators With collaborative
efforts this can serve as an important capital to promote continuous development and
improvement of educational practices in health promotion disease prevention and lifestyle
medicine in all European countries
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
57
ANNEX 1 SURVEY RESULTS BY COUNTRY
In this annex we provide the names of all educational programmes by country filled in in
the survey In addition the following variables of the educational programmes are
provided the name of the educational institution type of education and type of health
professionals being trained This information is based on the information provided by the
respondents from each country If certain boxes are not filled in this means that only
partial information of this educational programme is provided
Austria
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Bachelorstudiengang Physiotherapie
FH JOANEUM GmbH Undergraduate education
Physical therapists
Dietetics Health University of
Applied Sciences
Undergraduate
education
Dieticians
Physiotherapy University of Applied Sciences St Polten
Undergraduate education
Physical therapists
Bachelorrsquos Degree Programme Physiotherapy
FH Campus Wien Undergraduate education
Physical therapists
Dietetics and Nutrition FH Joanneum Undergraduate education
Medical Doctors Non-specialized dietitians
Bachelor Programme Physiotherapy
University of Applied Sciences Upper Austria
Undergraduate education
Physical therapists
Degree Programme Dietetics
(Bachelor of Science)
University of Applied
Sciences Upper Austria
Undergraduate
education
Dietitians
Midwifes Speak and language therapists Biomedical scientists Radiological
technologists Physical therapists Occupational therapists Nurses
Bachelor in Health Studies
Physiotherapy
FH Kaernten Undergraduate
education
Physical therapists
Nursing Science Medical University of Graz
Postgraduate education
Nurses
Public Health Medical University of Vienna
Continuous professional development
Medical doctors
Belgium
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Drug Development KU Leuven Undergraduate education
Pharmacists
Bachelor and master Rehabilitation Sciences and
Physiotherapy
University of Antwerp Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
58
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Motor Sciences Physiotherapy
Universiteacute Libre de Bruxelles
Undergraduate education
Physical therapists
Nutrition amp Dietetics Thomas More University College
Undergraduate education
Dietitians
Adad Adad Undergraduate education
Physical therapists
Master Physiotherapy and
Rehabilitation Science
KU Leuven Postgraduate
education
Physical
therapists
Occupational therapist HE Vinci Parnasse ISEI Undergraduate education
Occupational therapists
Master in Physical therapy and Rehabilitation
Universiteacute Libre de Bruxelles
Postgraduate education
Physical therapists
Master in Physical therapy Universiteacute Libre de Bruxelles
Postgraduate education
Medical specialists Physical
therapists (Sport medicine)
Nutrition and dietetics Thomas More University College
Continuous professional
education
Medical doctors Dieticians
psychologists
Information not provided Information not provided
Undergraduate education
Pharmacists
The European Certificate in
Lifestyle Medicine
The European Lifestyle
medicine organisation (ELMO) together with the Belgian Lifestyle
Medicine Organisation (BELMO)
Continuous
professional education
Medical doctors
Medical specialists (lifestyle
medicine) Physical therapists
Occupational therapists Nurses Psychologists General practitioners
Nutrition and Dietetics Erasmus Hogeschool Brussels
Undergraduate education
Dieticians
Master in Nursing and Midwifery
University of Antwerp Postgraduate education
Nurses
Bachelor amp Master Rehabilitation Sciences amp
Physiotherapy
KU Leuven Undergraduate education
Physical therapists
Bachelor Nursing University of Applied
Sciences Gent HOGENT
Undergraduate
education
Nurses
Professional Bachelor in Nutrition and Dietetics
University colleges Leuven Limburg
Undergraduate education
Dieticians
Nutrition and Dietetics University College Ghent
Undergraduate education
Dieticians
Bachelor in Applied Health Science
Howest University College
Undergraduate education
Lifestyle coaches
Physiotherapist Universiteacute Libre de Bruxelles
Postgraduate education
Osteopathy Physical therapists
Bachelor in Medicine Hasselt University Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
59
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor of Nutrition and Dietetics
University of Applied Sciences of Gent
Undergraduate education
Dieticians
Bulgaria
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor programme in Social Work
Plovdiv University Department of Social work
Undergraduate education
Social workers
Rhinology Bulgarian Rhinologic
Society
Postgraduate
education
ENT doctors
Kinesitherapy Medical University Undergraduate education
Physical therapists
TRS rehabilitator Medical College Medical University
Continuous professional
education
Medical specialists
Cyprus
Name of educational
programme
Name of
educational
institution
Type of
education
Type of
health
professionals
being trained
Physiotherapy
programme
Nicosia University Undergraduate
education
Physical
therapists
Czech Republic
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy Universities Undergraduate education
Physical therapists
Physiotherapy Charles University first
faculty of Medicine
Undergraduate
education
Physical
therapists
Physiotherapy Faculty of Medicine Masaryk University Brno
Undergraduate education
Physical therapists
Physiotherapy Palackyacute University Faculty of Physical Culture Department of Physiotherapy
Postgraduate education
Physical therapists
General Nursing Masaryk University Undergraduate education
Nurses
Prakticky zubni lekar (Practical Dentist)
Czech Dental Chamber Continuous professional education
Medical specialists
Health Promotion Ministry of Health Czech Republic
Continuous professional education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
60
Denmark
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Musculoskeletal physiotherapy
Aalborg University Postgraduate education
Physical therapists
Master in Physiotherapy University of Southern Denmark
Postgraduate education
Physical therapists
The Fairstart Foundation The Fairstart Foundation
Continuous professional education
Orphanage staff (each orphanage has
professional staff such as psychologists social workers
andor therapists
These staff members are responsible to work with each child on an individual basis) School
teachers Psychologists Social workers
Bachelor in Physiotherapy University College North Denmark
Undergraduate education
Occupational therapists
Nurses
Bachelorrsquos degree Programme of Physiotherapy
VIA University college Postgraduate education
Physical therapists
Master of Public Health Aalborg University Undergraduate education
Midwives Nurses Therapists Psychologists Medical Specialists
Estonia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Nursing (general nursing) Tartu Health Care College
Undergraduate education
Nurses
Psychology University of Tarty Institute of Psychology
Undergraduate education
Psychologists
Finland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
NutritionNutrition therapy University of Eastern Finland
Postgraduate education
Clinical nutriontinists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
61
Masterrsquos programme of Human Nutrition and food-related behaviour
University of Helsinki Undergraduate education
Nutrition experts who work in eg community
health promotion
Master of Healthcare advanced practice ndash supporting self-care and
care of non-communicable diseases
Savonia University of Applied Sciences
Postgraduate education
Physical therapists Occupational
therapists Nurses
Public Health Nursing Metropolia University of Applied Sciences
Postgraduate education
Public Health nurse
Medical doctors training programme
University of Helsinki medical faculty
Undergraduate education
Medical doctors Nursing
Master degree in Health Management Psychologists
Dentists
Dental education University of Helsinki Faculty of Medicine Department of Oral and Maxillofacial Diseases
Undergraduate education
Dentists
France
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Occupational therapy school Croix Rouge Franccediloise Postgraduate education
Occupational therapists
Institut Reacutegional de Formation en Ergotheacuterapie
Association Saint Franccedilois dAssise
Postgraduate education
Occupational therapists
Occupational therapy Institut de formation en Ergotheacuterapie de Berck-sur-Mer site de Loos
Postgraduate education
Occupational therapists
Occupational therapy IFE Assas Undergraduate education
Occupational therapists
Arrecircteacute du 5 juillet 2010
relatif au diplocircme drsquoEacutetat drsquoergotheacuterapeute
Institut de Formation
en Ergotheacuterapie du CHU Rouen Normandie
Undergraduate
education
Occupational
therapists
Occupational therapy school Croix Rouge Francaise Postgraduate education
Occupational therapists
Occupational therapy UPEC Postgraduate
education
Occupational
therapists
Diplocircme de Dieacuteteacuteticien IUT biologie ou BTS dieacuteteacutetique
Postgraduate education
Dietitians
Programme deacuteducation et de promotion agrave la santeacute
CoDEPS 13 Continuous professional education
Nurses Psychologists Dentists Social workers
Public health Universiteacute de Bourgogne
Postgraduate education
Medical doctors
Public health Lyon University Undergraduate education
Medical specialists
Public health residency Faculty of medicine University of Nantes
Undergraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
62
Name of educational programme
Name of educational institution
Type of education
Type of health professionals being trained
Master in Public Health Karolinska Institute Postgraduate education
Occupational therapists Social Workers
Public health and social
medicine
Universiteacute Versailles
Saint Quentin en Yveline
Continuous
professional education
Medical doctors
Public health UFR sciences de santeacute - Universiteacute de Bourgogne
Postgraduate education
Medical doctors Medical specialists
Midwives Physical therapists
Nurses General practitioners
Germany
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Visceral Surgery Augsburg University Continuous professional education
Medical specialist Physical therapists
Occupational therapists
Nurses Social workers
Human Medicine ndash The
cologne model study course (human medicine)
University of Cologne
Medical faculty
Undergraduate
education
Medical
specialists
Greece
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy University of Thessaly Undergraduate education
Physical therapists
Oral education programme
for children via experiential learning
Hellenic Dental
Association-Dental School of Athens-Hellenic Society of Paediatric Dentistry
Continuous
professional education
Psychologists
Dentists
Sports Nutrition International Hellenic University
Postgraduate education
Dieticians
Preventive Dentistry National and
kapodistrian University of Athens school of dentistry
Undergraduate
education
Undergraduate
students
Nutrition amp Dietetics International Hellenic University
Postgraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
63
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicine ndash under and post graduate studies
School of health sciences University of Patras
Undergraduate education
Medical doctors
Pharmacy diploma Aristotle University of
Thessaloniki
Undergraduate
education
Pharmacists
Hungary
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Public Health and Preventive
Medicine
Semmelweis University
Budapest Faculty of
Medicine Department of Public Health
Undergraduate
education
Medical doctors
Academic programme of Medicine
Semmelweis University Faculty of Medicine
Undergraduate education
Medical doctors
Residency in Preventive Medicine and Public Health
Semmelweis University Postgraduate education
Medical specialists
Ireland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Social Science in
Social Work
Maynooth University
(national University of Ireland Maynooth)
Postgraduate
education
Social workers
Information not provided Information not provided
Undergraduate education
Physical therapists
Professional Master of Physiotherapy
University College Dublin
Postgraduate education
Physical therapists
Bachelor Physiotherapy University College Dublin
Undergraduate education
Physical therapists
Bachelor Physiotherapy RCSI Undergraduate education
Physical therapists
Irish Dental Association Irish dental association Continuous professional
development
Dentists
Public Health Medicine Royal College of Physicians in Ireland
Postgraduate education
Medical specialists
Higher specialist training in Public Health Medicine
Royal College of Physicians in Ireland
Postgraduate education
Medical doctors Medical specialists General practitioners
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
64
Italy
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Healthy Lifestyles CNAI ndash Italian Nurses association
Continuous professional education
Nurses
Management for Health Professionals
University of Rome Postgraduate education
Midwifes Physical therapists Nurses
Corso di laurea in Terapia occupazionale (Bachelor in Occupational therapy)
Universitagrave degli Studi di Milano (State University of Milan)
Undergraduate education
Occupational therapists
Life Sciences University of Catania
School of Medicine
Continuous
professional
education
Medical doctors
Medical
specialists Physical therapists Occupational therapists Nurses
Dentists
Health promotion University of pavia Undergraduate education
Nurses
Corso di Laurea Magistrale
in Odontoiatria e Protesi Dentaria
Universitagrave di Parma Undergraduate
education
Dentists
Hygiene preventive medicine and public health
Universitagrave Cattolica del Sacro Cuore
Postgraduate education
Medical doctors Medical
specialists
general practicioners
Igiene e Medicina Preventiva Universitagrave degli Studi dellrsquoAquila
Postgraduate education
Medical doctors non-specialized
Post graduate school of Public Health
University of Sienna Postgraduate education
Medical doctors
Hygiene and Public Health University of Bari Aldo Moro
Postgraduate education
Medical doctors
School of specialization in Hygiene and Preventive Medicine
University of Milan Postgraduate education
Medical doctors
Lithuania
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Health Education and Promotion
Klaipeda State University of Applied sciences
Undergraduate education
Dietitians Physical therapists Nurses Dentists Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
65
Latvia
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Dentistry Riga Stradins University Undergraduate education
Dentists General practicioners
Professional Bachelor programme Physiotherapy
LASE Postgraduate education
Physical therapists
Physiotherapy Riga Stradins University Undergraduate education
Physical therapists
Malta
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Bachelor in Nursing Studies University of Malta Faculty of Health Sciences department of Nursing
Undergraduate education
Nurses
FHs University of Malta Undergraduate education
General practitioners
Netherlands
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Occupational Therapy Information not provided
Undergraduate education
Occupational therapists
Lifestyle and Healthcare Amsterdam University Medical Centre
Undergraduate education
Medical students
Portugal
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
PhD in Social Work ISCTE University Institute of Lisbon
Postgraduate education
Social workers
Bachelor degree in
Physiotherapy
Escola Superior de
Sauacutede de Santa Maria
Undergraduate
education
Physical
therapists
Physiotherapy IPC ESTeSC Coimbra Health school
Undergraduate education
Physical therapists
Licenciatura em Fisioterapia Escola Superior de Sauacutede - Instituto Politeacutecnico do Porto
Undergraduate education
Physical therapists
Degree in Physical therapy Instituto Piaget ndash Vila Nova de Gaia
Undergraduate education
Physical therapists
Degree in Physical therapy ESSATLA Continuous professional development
Physical therapists
Curso Licenciatura em Fisioterapia
Instituto Politeacutecnico de Sauacutede do Norte Escola Superior de Sauacutede do Vale do Ave CESPU
Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
66
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Clinical Education University Fernando Pessoa- Faculty of Health Sciences
Continuous professional development
Workers factory
Physiotherapy (Bachelor) School of healthy-
polytechnic institute of Setubal
Undergraduate
education
Physical
therapists
Physiotherapy Escola Superior De Sauacutede Do Vale Do Sousa do Instituto
Politeacutecnico De Sauacutede Do Norte
Undergraduate education
Physical therapists Nurses
Psychologists Dentists
Public Health ARSLVT Postgraduate
education
Medical
specialists
Information not provided Information not provided
Postgraduate education
Physical therapists
Information not provided Information not provided
Undergraduate education
General practicioners
Romania
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Nursing Education University Lucian Blaga Postgraduate education
Nurses
MedicinePharmacy - Health University of Oradea Faculty of medicine and
pharmacy Oradea
Postgraduation education
Medical doctors Medical
specialists Pharmacists Physical therapists Nurses
Dentists General practicioners
Slovakia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Social Work Constantine the philosopher University in Nitra
Postgraduate education
Social workers
Specialisation study in Clinical Psychology
Comenius University in Bratislava Faculty of
Arts
Continuous professional
development
Medical specialists
psychologists
Slovenia
Name of educational
programme
Name of educational
institution
Type of
education
Type of health
professionals being trained
Physiotherapy Alma Mater Europaea Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
67
Physiotherapy University of Novo mesto Faculty of Health sciences
Undergraduate education
Physical therapists
Faculty of health sciences University of Primorska Continuous professional education
Dietetics Physical therapists Occupational therapists Nurses
Nursing Applied Kinesiology Physiotherapy and Nutritional counselling ndash dietetics
University of Primorska Faculty of Health Sciences Slovenia
Undergraduate education
Nutrional counselling Kinesiologists Physical therapists Nurses
Professional higher education study programme 1st cycle degree occupational
therapy
University of Ljubljana faculty of health sciences
Undergraduate education
Occupational therapists
Applied Kinesiology UP FVZ Undergraduate
education
Kinesiology
Physiotherapy Alma mater Europaea ndash Evropski center Maribor
Undergraduate education
Physical therapists
Bachelor in Physiotherapy University of Ljubliana Faculty of health sciences
Undergraduate education
Physical therapists
Health Promotion Angela Boskin Faculty of healthcare
Postgraduate education
Physical therapists Occupational
therapists nurses
1st Bologna cycle study programme Physiotherapy
Angela Boskin Faculty of healthcare
Undergraduate education
Physical therapists
Public Health Medical
Residency
Medical chamber of
Slovenia
Continuous
professional development
Medical doctors
Public Health National institute of public health of the
Republic of Slovenia
Postgraduate education
Medical doctors
Psychology Faculty of arts University of Maribor
Postgraduate education
Psychologists
Spain
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Human Nutrition and Dietetics
University of Zaragoza Undergraduate education
Dieticians
Continuous professional
education
Nurses
Physiotherapy University of Coruna Undergraduate education
Physical therapists
EHEA Degree in Human Nutrition and Dietetics
Blanquerna School of Health Sciences ndash Universitad Ramon Lull
Undergraduate education
Dietitians
Bachelor in Pharmacy Universidad de Sevilla Undergraduate
education
Pharmacists
Continuous professional development
Spanish General Council of Social Work
Continuous professional education
Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
68
Bachelor in Pharmacy Universidad de Alcala Undergraduate education
Pharmacists
Bachelor in Medicine Faculty of medicine University of Cadiz Spain
Undergraduate education
Medical doctors General practitioners
Residency in Preventive Medicine and Public Health
Hospital Clinic de Barcelona
Postgraduate education
Nurses
Bachelor in Medicine Information not provided
Undergraduate education
Medical doctors
MasterBachelor in Pharmacy
University of Navarra Undergraduate education
Postgraduate education
Pharmacists
Human Nutrition and Dietetics
Univeristy of Navarra Undergraduate education
Nutritionists amp Dietitians
Pharmacy Universitad Ramon Lull
Undergraduate education
Pharmacists
Pharmacy IQS ndash FCSB Undergraduate education
Pharmacists
Master in Advanced Therapies and Innovation in Biotechnology
Universidad de Francisco de Vitoria
Postgraduate education
Pharmacists
Pharmacy Universidad of the Basque County
Undergraduate education
Pharmacists
Sweden
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master programme in Public Health
Karolinska institute Postgraduate education
Occupational therapists
Social workers
Dietetics programme Department of food and Nutrition
Undergraduate education
Dietician
Dietetics programme Department of food studies dietetics and nutrition
Undergraduate education
Dietician
Programme in Dietetics University of Gothenburg
Sahlgrenska Academy
Undergraduate education
Dietician
Master of Public Health Department of public health and caring sciences Uppsala University
Postgraduate education
Medical doctors Bachelor of science Physical
therapists Nurses Psychologists Dentists Social workers
United Kingdom
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor (Hons) Occupational Therapy
Northumbria University Undergraduate education
Occupational therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
69
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master (pre reg) Occupational Therapy
Master in Occupational Therapy
Leeds Beckett University
Postgraduate education
Occupational therapists
Bachelor (Hons) Occupational Therapy
St Georgersquos University of London
Undergraduate education
Medical doctors Medical specialists Physical therapists
Occupational therapists
Bachelor (Hons)
Occupational Therapy
Caterburry Christ
Church University
Undergraduate
education
Occupational
therapists
Bachelor (Hons) Occupational Therapy Master in (pre-reg) Occupation Therapy Occupational Therapy degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Public Health speciality training
Health education England -north west
Postgraduate education
Medical doctors Medical specialists Researchers Nurses
Bachelor in (Hons) Occupational Therapy Master in (Pre-reg)
Occupational Therapy Occupational Therapy
Degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Additional countries
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Bachelor of Physiotherapy University of Prishtina Kosovo Albania
Postgraduate education
Physical therapists
Physiotherapy Faculty of health studies University of Sarajevo Bosnia-Herzegovina
Undergraduate education
Physical therapists
Fysioterapeututdanning NTNU Norway Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy BFH
Berner Fachhochschule BFH Bern University of Applied Sciences Swiss
Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy
ZHAW Zurich University of applied sciences Swiss
Undergraduate education
Physical therapists
Physical Therapy Sciences University of Iceland
School of Health Sciences
Undergraduate
education
Physical
therapists
Medicine International school of medicine Kazachstan
Undergraduate education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
70
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicinesingle-cycle degree programme
University of Georgia Republic of Georgia
Medical doctors Psychologists General practicioners
Medicine Akaki tsereteli state University Republic of Georgia
Postgraduate education
Medical doctors Medical specialists Physical therapists Psychologists
Dentists General
practicioners
Public Health and Epidemiology
David tvildiani medical University Republic of
Georgia
Postgraduate education
Medical doctors
Biomedical and Healthcare Science doctoral programme
David tvildiani medical University Republic of Georgia
Postgraduate education
Medical doctors Biomedical Science master degree holders
Medicinesingle-cyle degree programme
University of Georgia Republic of Georgie
Undergraduate education
Medical doctors
Public Health Tbilisi State Medical University (TSMU)
Republic of Georgia
Undergraduate education
Medical doctors and public
health specialists
David tvildiani Medical
University
David tvildiani Medical
University Republic of Georgia
Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
71
ANNEX 2 COMPETENCY PROFILES PER PROFESSIONS
Undergraduate medicine
The CanMEDS framework is worldwide the most commonly used and adapted model that
identifies and describes the abilities physicians require in order to effectively meet the
health care needs of the people they serve72 Within European Member States modifications
of this model are used within health and educational settings (for example in the
Netherlands and Finland) for undergraduate medicine and medical specialisations The
CanMEDS model defines seven roles of the physician namely (1) medical expert (the
integrating role) (2) communicator (3) collaborator (4) leader (5) health advocate (6)
scholar and (7) professional73 The role of health advocate is defined as physicians
contributing their expertise and influence as they work with communities or patient
populations to improve health ldquoimproving health is not limited to mitigating illness or
trauma but also involves disease prevention health promotion and health protection
Improving health also includes promoting health equity whereby individuals and
populations reach their full health potential without being disadvantaged by for example
race ethnicity religion gender sexual orientation age social class economic status or
level of educationrdquo Within this role two key competencies are defined74
1 Respond to an individual patientrsquos health needs by advocating with the patient within
and beyond the clinical environment
a Work with patients to address determinants of health that affect them and their access
to needed health services or resources
b Work with patients and their families to increase opportunities to adopt healthy
behaviours
c Incorporate disease prevention health promotion and health surveillance into
interactions with individual patients
2 Respond to the needs of the communities or populations they serve by advocating with
them for system-level change in a socially accountable manner
d Work with a community or population to identify the determinants of health that affect
them
e Improve clinical practice by applying a process of continuous quality improvement to
disease prevention health promotion and health surveillance activities
f Contribute to a process to improve health in the community or population they serve
In addition the European Thematic Network project MEDINE (2004-2007) and Tuning
Project (Medicine) under its auspice (MEDINE) have generated and gained widespread
consensus on a set of competences for primary medical degree qualifications in Europe
(ie undergraduate medicine)75 Within this project it is stated that graduates in medicine
72 httpwwwroyalcollegecarcsitecanmedscanmeds-framework-e 73 httpwwwroyalcollegecarcsitecanmedsabout-canmeds-e 74 httpwwwroyalcollegecarcsitecanmedsframeworkcanmeds-role-scholar-e 75 httptuningacademyorgmedine-medicinelang=en
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
72
would need the ability to ldquopromote health engage with population health issues and work
effectively in a health care systemrdquo76 The following points define health promotion
bull provide patient care which minimises the risk of harm to patients
bull apply measures to prevent the spread of infection
bull recognise own health needs and ensure own health does not interfere with
professional responsibilities
bull conform with professional regulation and certification to practise
bull receive and provide professional appraisal
bull make informed career choices
bull engage in health promotion at individual and population levels
Medical specialist
The European Union of Medical Specialists (UEMS) contributed significantly to the
improvement of post-graduate training through the development of a European Curriculum
in each medical speciality as well as the elaboration of training standards77 Within this
section we provide a detailed description of the European training requirements for a
selection of medical specialists including sports medicine public health internal medicine
cardiology psychiatry and the general practitioner78 This selection was based on the fact
that within these specialities lifestyle might be an essential component or important part of
the treatment of chronically ill patients
1) Medical specialist sports medicine
Sports medicine is defined by the European Commission as a ldquomultidisciplinary clinical and
academic speciality of medicine dealing with health promotion for the general population
by stimulating a physically active lifestyle and diagnosis treatment prevention and
rehabilitation following injuries or illnesses from participation to physical activities
exercises and sport at all levelsrdquo79 As health promotion and prevention are both
incorporated in the definition of sports medicine these topics are included throughout the
whole curriculum of sports medicine The curriculum of sports medicine aimed to provide
theoretical understanding and practical skills to provide first line clinical services80 Within
the training requirements for the speciality of sports medicine it is stated that sports
medicine does not solely take care for sporting elite athletes but as well for its important
role to promote exercise as a medical tool meant for patients with chronic diseases81
bull Theoretical knowledge aims to provide theoretical understanding and practical skills to
provide first line clinical services
- Clinical To provide pre-participation clinical screening and examination before
exercise and competition as well as medical assistance to the athletes engaged in all
sports
76
httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNLearning_Outcomes_Competences_for_Undergraduate_Medical_Education_in_Europepdf
77 httpswwwuemseu__dataassetspdf_file00111415906pdf 78 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 79 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 80 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 81 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
73
- Public health
bull As part of a multi-disciplinary team to encourage and promote physical activity as
a lever for healthy living
bull To identify impediments to an active lifestyle and work within a multi-disciplinary
framework to remove those impediments or minimize their impact
bull To work alongside local health authoritiespublic health clinicians developing
exercise opportunities for the general public for health gain
bull To liaise with public (local authoritieseducationvoluntary) and private sector to
advise on the health aspects of exercise programmes for physical activity of special
groups like women children adolescents and aging population
bull Practical and clinical skills
bull To foster the integration of knowledge and practical skills acquired during the
cardiology orthopaedics physical amp rehabilitation medicine general practice
medicine and physiology internships
bull To learn to put into practice information gained in the relevant course work
bull To extend and deepen their knowledge in the assessment of fitness such as
isokinetic and functional muscle performance cycle ergometry and treadmill
ergometry
bull To gain experience in the use of such test results in the decision making with regard
to diagnosis recommendations and therapy for people of both gender and in
different age groups and performance levels
bull With regard to elite sport trainees will learn how to diagnose treat and prevent
overtraining and overexertion
bull To become proficient in activities related to for example hygiene and nutrition
and will work closely with trainers athletes physiotherapists officials etc
bull Competencies
bull Clinical and instrumental assessment to determine the pathophysiology
mechanisms and the underlying diagnosis of the patientrsquos condition
bull Trainees are expected to complete evidence of reflective practice through case
reports and other experiences in their training record
bull Other self-directed work will be planning data collection analysis and presentation
of audit and research work
bull The mandatory training record (hand written diary or preferably electronic
logbook) will contain evidence of academic pursuits and should be checked and
documented regularly by the Supervisor
bull Trainees will take part and be able to lead in teaching and will be expected to
develop skills to teach undergraduates postgraduates and non-medical staff in
small groups and formal lectures making personal presentations using a variety of
audiovisual methods
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
74
bull They will be expected to present at journal clubs and make case presentations at
grand rounds or similar settings
bull They will be expected to undertake personal audit and research and make
presentations of their findings at clinical meetings
bull Prescription as much evidence-based as possible of medical and physical
treatments (including drug treatment physical modalities innovative
technologies natural factors and others) as well as of technical aids
bull Prevention and management of complications
bull Skill to perform and participate in research
2) Medical specialist public health
The European Commission defines public health ldquoas the science and art of preventing
disease prolonging life and promoting mental and physical health and efficiency through
organized community effort Public health may be considered as structures and processes
by which the Health of the population is understood safeguarded and promoted through
the organized efforts of societyrdquo82 Public health specialists aim to improve populationrsquos
health by using the following skills and competencies
bull Theoretical knowledge on a range of fields including epidemiology prevention health
promotion public health research behavioural sciences health programme evaluations
health need assessments and quality and safety in healthcare
bull Practical and clinical skills
- Surveillance and evaluation of the health of the population (trained in epidemiology)
- Planning and evaluation of health services and public health control
- Analysing the health of the population (analysing determinants on individual and
community levels)
- Plan participate in or evaluate preventive and control programmes (public health
assessments)
- Participate in multidisciplinary health impact assessment
- Inform decision-makers about potential impacts and to identify appropriate and
sustainable actions to manage those effects (including environmental determinants
of health)
- Organisational issues in healthcare (participating in policy and strategic development
quality and safety management)
- Generate and share new evidence on the ways in which social determinants influence
population health and health equity
- Sufficient linguistic ability to communicate with hisher public health colleagues
82 httpswwwuemseu__dataassetspdf_file001198435UEMS-201924-European-Training-
Requirements-for-Public-Healthpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
75
- Develop high professional ethical standard including respect towards human rights
participants in public health programmes colleges and other professionals in the
team
bull Competencies
- Establish the expertise role as a Public Health Physician
bull Function as public health leaders and consultants to health services and other
organizations and institutions in order to provide safe appropriate cost effective
and equal health care to groups communities and populations
bull Establish and maintain medical knowledge skills and attitudes appropriate to their
practice including the organization and financing of health care public health
control and public health law
- Perform expertise analyses of the health of the population
bull Apply and combine medical and epidemiological competencies for the surveillance
and evaluation of the health of the population
bull Identify the determinants of health of populations and risks for public health and
implications for interventions and policy
bull Evaluate health problems biopsychosocial mechanisms andor health care issues
for different population groups and their implications for the community
bull Critically evaluate epidemiological demographic health statistical and
environmental pollution data and their sources and apply them appropriately to
public health issues
bull Identify community health needs and advise about their implications for public
health and medical care services
- Lead and supervise public health interventions
bull Select develop implement and monitor public health surveillance and
interventions namely in the areas of human behaviour social and physical
environment food safety and nutrition health care associated risks and working
life related health
bull Promote the health of individuals communities and populations through health
programming
bull Contribute to the organization and evaluation of societal and health care
programmes aiming to promote health and social functioning among individuals
with long-term diseases and disabilities
bull Contribute to the planning organization supervision of and evaluation of societal
and health care programmes promoting the health of specific target groups such
as children elderly and vulnerable and underserved groups in society
bull Contribute to the organization of and evaluate primary and secondary medical
prevention programmes
bull Contribute to strengthening regulatory frameworks for protecting and improving
health
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
76
- Function as expertise in planning and evaluation of Public Health and Medical Care
bull Evaluate Public Health and other service programmes concerning processes and
outputs from the different perspectives of care seekers professional health care
workers and health managers
bull Analyse and differentiate between need demand and supply and assess the health
of a defined population and identify areas for improvement including the allocation
of health care resources delivery
bull Evaluate the outcome quality and safety of care and promote quality development
systems based on evidence and public health principles
bull Apply health economic principles and methods such as cost-effectiveness cost-
utility and cost-benefits considering the strengths and weaknesses of different
methods
bull Use methods to determine priorities and their strengths and weaknesses and
promote awareness of the competing and conflicting influences on public and
political perceptions of the need for health care and the resulting constraints on
action
bull Promote and evaluate collaboration between health services and other welfare
organizations in society
bull Evaluate and contribute to the policy and strategic development in health care
planning
bull Contribute to the planning and evaluation of different sectors of society by health
impact assessments and public health medical reports and consultations
- Communicate and develop public health medical expertise
bull Lead supervise and participate in an interprofessional health care team
bull Consult other (health) professionals and policymakers and recognise the
advantages and limits of their expertise
bull Effectively convey oral and written information about public health issues including
adequate public health reporting and effective interaction with media
bull Stimulate and motivate others so that they recognise the importance of the public
health population perspective
bull Maintain and enhance professional activities through ongoing learning and
research and contribute appropriately to the generation dissemination application
and translation of new public health knowledge and practices
3) Medical specialist internal medicine
The UEMS defines an internist as ldquoa physician trained in the scientific basis of medicine
who specialises in the assessment diagnosis and management of general medical
problems atypical presentations multiple problems and consequential complex health
issues and system disorders (Professional) The physician is skilled in the management of
acute unselected medical emergencies and the management of patients in a holistic and
ethical way considering all psychosocial as well as medical factors for enhancing quality of
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
77
life The physician values the continuing care of all patients irrespective of the nature of the
patients complaint and is committed to lifelong continued professional development
(Scholar) The physician practices clinical audit and evidence-based medicine The
physician functions in a number of roles including clinical counselling educating leading
and managingrdquo83
Internists have a fundamental role in modern healthcare systems Within the definition of
the internist the shift towards a preventive strategy focusing on health promotion is
highlighted by the acknowledgement of the high prevalence of chronic and complex
diseases that are associated with the lifestyle of ageing western societies The role of
healthcare advocate (a role defined in the CanMED framework) is an important part of the
internistrsquos function and forms the generic competencies of an internist (see section 11)
However lifestyle promotion and disease prevention is not a specific area of expertise
Specific areas of the internist include multi-morbidity and ageing acute care medical
consultation shared-decision-making collaborative care transition in care vulnerable
adult patient safety and quality of care and medical leadership
4) Medical specialist cardiology
According to the training requirements for the speciality of cardiology84 training in
cardiology should be based on the syllabus of the ESC core Curriculum for the general
cardiologist part 2 ldquothe core curriculum per topicrdquo85 The necessary core cardiology
competencies are set out as cardiology learning objectives with the knowledge skills
attitudes and competencies needed to fulfil the objectives One of the core cardiology
competences is cardiovascular prevention aiming to
bull Assess and manage patients with risk factors for cardiovascular disease
bull Understand the mode of action of different prevention methods
bull Describe cardiovascular disease and risk factors in the local community
bull Contribute to the global efforts in reducing cardiovascular morbidity and mortality
by communicating the prevention message to the public
bull To approach prevention in a holistic way understanding the potentiation of
cardiovascular risk by clustering of risk factors
bull
Knowledge
bull Epidemiology of cardiovascular disease in the local community incidence
prevalence survival
bull Risk factors in the local community
83 httpswwwuemseu__dataassetspdf_file001744450UEMS-201613-European-Training-
Requirements-Internal-Medicinepdf 84 httpswwwuemseu__dataassetspdf_file001119577UEMS-201324-SECTIONS-AND-BOARDS-
Cardiology-European-Training-Requirements-20131019pdf 85 httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_
9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
78
bull Risk assessment in primary prevention multifactorial risk interaction and use of
risk scoring charts
bull The impact of lifestyle on people at risk of and patients with cardiovascular
disease
bull The potential of lifestyle changes to prevent and ameliorate cardiovascular
disease diet and nutrition toxic habits (smoking alcohol and others) physical
activity
bull Emerging risk factors (social economic stress depression and personality type)
bull Treatmentprevention strategies for major risk factors and changes in lifestyle
including corresponding pharmacologic therapies
bull The comprehensive approach required for multiple risk factors
bull Patient compliance
In addition the main objectives and knowledge competence are further specified by
hypertension dyslipidaemia diabetes and lifestyle
Skills
bull obtain a relevant history and perform an appropriate clinical examination
bull evaluate cardiovascular risk and assess global cardiovascular risk at the individual
level
bull evaluate cardiovascular risk at population level (mortality morbidity disability)
bull evaluate the benefit of prevention at individual and population levels
bull manage risk factors appropriately including pharmacological and non-
pharmacological therapies
bull communicate their importance to patients their families and the wider
community including smoking cessation diet and exercise
bull communicate the importance of patient compliance and behaviour
bull motivate patients and families to change lifestyles and be compliant with
prescriptionsrecommendations
bull monitor patient compliance and behaviour
bull evaluate the benefit of risk factor intervention for the individual patient
Behaviours and attitudes
bull Non-judgemental attitude to patients regarding their lifestyle (eg smoking diet
etc)
bull Exemplify appropriate lifestyle in personal behaviour
bull Team working with other physicians including general practitioners
diabetologists nephrologists and elderly care physicians for the management of
specific risk factors
bull Team working with all professionals with a role in primary and secondary
prevention (nurses dieticians teachers and politicians)
Another core competency is the physical activity and sport in primary and secondary
prevention Further defined in sports cardiology and cardiac rehabilitation
Sports cardiology aiming86
86
httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
79
bull To conduct strategies to implement healthy lifestyle in particular physical and
sports activities in the general population (primary prevention)
bull To evaluate cardiovascular risk and exercise capacity (see Chapters 22 and
271)
bull To recognize the characteristics of the athletersquos heart
bull To appropriately detect contraindications to exercisecompetition and
appropriately provide non-contraindication certificates
Knowledge
bull Exercise and sports physiology
bull Benefits of exercise training
bull Safety issues in exercise and sport
bull Diagnostic criteria and appropriate investigations in athletes with cardiovascular
disease
bull Risk factors for and mechanisms of sudden cardiac death (SCD) during and after
strenuous exercise
bull Specific population challenges and exercise programmes in appropriate settings
bull Recommendations for professional and recreational sports participation
bull SCD in patients athletes and in the population at large and
bull Mechanisms of action of illicit drugs
Skills
bull perform an individual CVD risk assessment using appropriate information from
history laboratory assessment including full lipid profile and clinical data
bull recognize pathological cardiovascular changes and differentiate them from the
characteristic features of lsquoathletersquos heartrsquo and
bull use prevailing recommendations for eligibility for participation in competitive
sports
Behaviours and attitudes
bull Recognition of the role of active lifestyle exercise and sport in the promotion of
health and in the prevention of the most threatening diseases including
cardiovascular diseases
Cardiac rehabilitation aiming
bull To evaluate and manage cardiovascular risk
bull To evaluate exercise capacity and causes of exercise intolerance
bull To provide appropriate rehabilitation and secondary prevention to patients with
cardiovascular diseases
7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
80
Knowledge
bull Multi-disciplinary risk factor intervention
bull Definition of comprehensive cardiovascular prevention and rehabilitation
bull Effects of behavioural change including physical activity nutrition education and
psychosocial risk factors on quality of life cardiovascular risk and outcome
bull Rehabilitation as a component of cardiac care and a promoter of secondary
prevention
bull Target populations and risk stratification of patients
bull Psychological aspects of rehabilitation and exercise practice
Skills
bull take a relevant history and perform an appropriate clinical examination including
the specific evaluation of the elderly patient
bull perform and interpret risk stratification using indicated tests
bull interpret a cardiopulmonary exercise test and distinguish different causes of
exercise limitation
bull prescribe exercise-based rehabilitation programmes and other lifestyle
interventions according to the patientrsquos condition in collaboration with other
specialists when necessary and
bull motivate the patient to ensure long-term adherence to lifestyle changes and
continuing exercise programmes
Behaviours and attitudes
bull rehabilitation as a component of cardiac care
bull the importance of rehabilitation and secondary prevention for professional
personal and social life among patients with heart disease
bull the interplay of physical and psychological aspects of heart disease and the
positive influence of exercise on cardiovascular risk factors
bull the role of other professionals including nurse specialists physiotherapists ergo
physiologists psychologists dieticians and general practitioners in rehabilitation
and secondary prevention and
bull the importance of patient and family education and the role of other professionals
in rehabilitation
5) Medical specialist psychiatry
The UEMS has issued a charter of requirements for the training in psychiatry in 2000 with
an additional European Framework for Competencies in Psychiatry in 2009 The learning
outcomes in the European Framework for Competencies in Psychiatry (EFCP) are arranged
under the seven physician roles derived from the CanMEDS framework87 Within the EFCP
it is stated that ldquopsychiatrists recognise the importance of advocacy and health promotion
in responding to the challenges represented by those social environmental and biological
factors that determine the mental health and well-being of patients and society They
recognise advocacy as an essential and fundamental component of mental health promotion
that occurs at the level of the individual patient the practice population and the broader
communityrdquo
Competencies
87 httpuemspsychiatryorgwp-contentuploads2013092009-Oct-EFCPpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
81
bull identify the determinants of mental disorder as well as the factors that may
contribute to positive mental health so as to be able to prevent disorder and
promote mental health
- recognise the determinants of mental health of populations and how public
policy including legislation impacts on mental health
- promote positive mental and physical health in patients particularly in those
with severe mental disorder based on best evidence
- recognise the impact of mental disorder on families and carers and take
remedial measures
- collaborate with other community sectors to promote mental health and
prevent mental disorder at all levels focusing particularly on family school and
workplace
- identify and address barriers and inequity in access to care particularly for
vulnerable or marginalised populations
bull Identify and address issues and circumstances when advocacy on behalf of
patients professions or society is necessary
- respect and promote the human rights of people with mental disorders and
collaborate with user and carer associations and advocacy groups
- empower people with mental disorders and their carers
- recognise and address prejudice stigma and discrimination associated with
mental disorder and its treatment
- use strategies to enhance patientrsquos self-management and autonomy
- actively oppose the use of psychiatry for political repression
- recognise the possibility of conflict inherent in their role as a health advocate
for a patient or community with that of manager or gatekeeper
6) General practitioner
The European training requirements for General PracticeFamily Medicine (GPFM) specialist
training88 defined twelve central characteristics of the practice before determining the core
competences Related to health promotion and disease prevention two of these
characteristics are as following ldquopromotes health and well-being both by appropriate and
effective interventionrdquo and ldquohas a specific responsibility for the health of the communityrdquo
The twelve characteristics are clustered into six core competences primary care
management person-centred care specific problem solving skills comprehensive
approach community orientation holistic modelling Under comprehensive approach the
following abilities relate to health promotion and disease prevention
bull to promote health and wellbeing by applying health promotion and disease
prevention strategies appropriately
bull to manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
Furthermore community orientation includes the ability
bull to reconcile the health needs of individual patients and the health needs of the
community in which they live in balance with available resources
88 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
82
In the more comprehensive assessment of GPrsquos performance in daily practice by the
European Academy of Teachers in General PracticeFamily Medicine (EURACT)89 these
abilities are further defined as following
bull To promote health and wellbeing by applying health promotion and disease
prevention strategies appropriate
- Identifies opportunity for health promotion intervention
- Makes use of structured medical record as reminder of preventive activities
- Makes use of teamwork
- Uses communication skills
- Is aware of any personal prejudices which might influence negatively
preventive advice
- Makes recommendations which are feasible in the context of patientrsquos lifestyle
and home situation
- Acts as suitable role model
bull To manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
- Provides appropriate medical management
- Involves members of practice team eg through case conference
- Performsarranges home visit (consider relevant team members) ndash needs
assessment eg cause of falls
- Involves relatives
- Facilitates communication (two-way) with hospital
- Involves external community resources (eg home help etc)
Dentist
According to the profile and competences for the graduating European dentist one of the
major competences for dentists is to improve oral health of individuals families and groups
in the community On graduation a dentist must be competent at promoting and improving
the oral health of individuals families and groups in the community90 Furthermore with
regard to health promotion and disease prevention a dentist
bull Must be competent at
- Applying the principles of health promotion and disease prevention via
comprehensive preventive measures to individuals and the community
according to their risk assessment status
- Understanding the complex interactions between oral health nutrition general
health drugs and diseases that can have an impact on oral health care and
oral diseases
- Providing appropriate dietary advice
bull Have knowledge of
- The organisation and provision of health care in the community and in the
specialist hospital service in the country of training
- The prevalence of the common dental conditions in the country of
trainingpractice
- The social cultural and environmental factors which contribute to health or
illness
- The strategies to overcome barriers to dental care for disabled elderly
socially deprived and ethnic minority groups
- Training auxiliaries in basic skills of oral health promotion
89httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-
documentseuractperformanceagendadC3BCsseldorf2014-openaccessebookversionpdf 90 httpwwwdentuoagrfileadmindentuoagruploadsusefull_filesADEE-competences-2009_enpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
83
In 2017 a new updated framework was published for undergraduate education for dentists
including a revised structure of the educational domains and their areas of competence In
the revised framework health promotion and disease prevention compromises one of the
areas of competence in the domain ldquodentistry in societyrdquo in the educational strategy of a
dentist91 Note Dentists can also specialise in public health in a similar programme as
physicians
Nurses
The training for nurses responsible for general care shall following the Directive
201355EU include a set of eight competences 92 The training for nurses should provide
assurance that the ability of the following knowledge and skills
1 comprehensive knowledge of the sciences on which general nursing is based including
sufficient understanding of the structure physiological functions and behaviour of
healthy and sick persons and of the relationship between the state of health and the
physical and social environment of the human being
2 sufficient knowledge of the nature and ethics of the profession and of the general
principles of health and nursing
3 adequate clinical experience such experience should be gained under the supervision
of qualified nursing staff and in places where the number of qualified staff and equipment
are appropriate for the nursing care of the patient
4 the ability to participate in the practical training of health personnel and experience of
working with such personnel
5 experience of working with members of other professions in the health sector
Competencies 93
6 Competency to independently diagnose the nursing care required using current
theoretical and clinical knowledge as well as to plan organise and implement nursing
care when treating patients on the basis of page the knowledge and skills acquired in
accordance with points (1) (2) and (3) in order to improve professional practice
7 Competency to work together effectively with other players in the health sector including
participation in the practical training of health personnel on the basis of the knowledge
and skills acquired in accordance with points (4) and (5)
8 Competency to empower individuals families and groups towards healthy lifestyles and
self-care on the basis of the knowledge and skills acquired in accordance with points (1)
and (2)
9 Competency to independently initiate immediate measures to pre- serve life and to carry
out measures in crisis and disaster situations
9191 Field JC Cowpe JG Walmsley AD The Graduating European Dentist A New Undergraduate Curriculum
Framework Eur J Dent Educ 201721(Suppl 1)2-10 httpsdoiorg101111eje12307 92 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf 93 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
84
10 Competency to independently advise instruct and support individuals needing care
and their attachment figures
11 Competency to independently ensure the quality of nursing care and assess it
12 Competency to communicate comprehensively and professionally and to cooperate
with members of other professions in the health sector
13 Competency to analyse the quality of care in order to improve their own professional
practice as general care nurses
The competences included in Directive 201355EU are different from the competences
contained in the EFN Competency Framework These competences contain the following
competences on health promotion and disease prevention guidance and teaching
bull To promote healthy lifestyles preventive measures and self-care by strengthening
empowerment promoting health and enhancing behaviours and therapeutic
compliance
bull To independently protect the health and well-being of individuals families or
groups being cared for ensuring their safety and promoting their autonomy
bull To integrate promote and apply theoretical methodological and practical
knowledge This enables the promotion and the development of nursing care in
long term care co-morbidity and in situations of dependency in order to maintain
an individualrsquos personal autonomy and hisher relationships with the environment
in every moment of the healthillness process
Nurse specialist
The European Specialist Nurses Organisation (ESNO) defines the nurse specialist as follows
ldquoThe Nurse Specialist (NS) is an advanced practice Nurse prepared as a specialist within a
clinical specialty at the masterrsquos post masterrsquos or doctoral levelrdquo94 Following the ESNO the
competencies should be considered as a reference template and guidelines for the different
specialities in which each speciality can define its own knowledge skills and attitudes
Generic competencies are the clinical role patient relationship patient teachingcoaching
mentoring research organisation and management communication and teamwork ethic
and decision making leadership and policy making and prevention The competency of
prevention is based on the case for investing in public health from the World Health
Organization95 The competency of prevention is based on the ability of promoting health
and prevent disease by the capacity to develop and put in place intervention in
bull Surveillance of population health and wellbeing
bull Disease prevention at the 3 levels of prevention (primary secondary)
bull Ability to promote health and prevent disease
bull Monitoring and response to health hazards and emergencies
bull Health promotion including actions to address social determinants and healthy
inequities
bull Advocacy communication and social mobilization for health advancing public
health
bull Research to inform policy and practice96
94 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf 95 httpwwweurowhoint__dataassetspdf_file0009278073Case-Investing-Public-Healthpdfua=1 96 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
85
Occupational therapist
The World Federation of Occupational Therapists (WFOT) provided minimum standards for
the education of occupational therapists97 One of the settings in which occupational
therapists work is defined as following ldquoCommunity or group approaches such as health
promotion community development community based rehabilitation injury prevention
environmental design disaster preparation and recoveryrdquo Furthermore under essential
knowledge skills amp attitudes for competent practice the following (could) relate to health
promotion and disease prevention
bull Knowledge about
- The relationship between occupation and human development over the life
course including healthy ageing
- The relationship between psychological social and economic factors and
occupation (eg stress adjustment to life changes including disability
societal disruption natural or man-made disaster displacement)
- Early identification and functional interventions focusing on somatosensory
stimulation and performance mechanisms mitigating early developmental and
environmental factors impacting negatively on behaviour and learning
- How activity limitations and participation in occupation affect health This
includes the ability to maintain a healthy environment and personal factors
such as adjustment interpersonal relationships and social networks
- How health conditions and threats to health affect participation in work
bull Skills in
- Inter-sectoral collaboration in public health initiatives
- Assessing health in relation to occupation
In addition the Tuning programme described the reference points for the design and
delivery degree programmes in occupational therapy98 in which they first ranked subject
specific competency One of the highest ranked included
bull Enable individualsgroupsorganisationscommunities to be engaged in occupation
through health promotion prevention rehabilitation treatment and
coachingtraining
In the final set of subject specific competences however this is mentioned less explicitly
and only the following are related to health promotion and disease prevention
bull Knowledge the occupational therapist is able to
- Work in partnership with individuals and groups using occupation in
prevention rehabilitation and treatment in order to promote participation
health and well-being
- Explain the relationship between occupational performance health and well-
being
- Collaborate with communities to promote and develop the health and well-
being of their members through their participation in occupation
- Develop new knowledge of occupation and occupational therapy practice
particularly in relation to local andor emerging health and social challenges
97 httpswwwwfotorgassetsresourcesCOPYRIGHTED-World-Federation-of-Occupational-Therapists-
Minimum-Standards-for-the-Education-of-Occupational-Therapists-2016apdf 98 httptuningacademyorgwp-contentuploads201402RefOccupationalTherapy_EU_ENpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
86
Pharmacists
In a two-stage large-scale Delphi process fifty competences of pharmacy practice were
ranked and the Quality Assurance in European Pharmacy Education and Training (PHAR-
QA) framework was harmonized and validated99 Of these fifty competences the following
relate to health promotion and disease prevention
bull Ability to promote public health in collaboration with other professionals within the
healthcare system
bull Ability to provide appropriate lifestyle advice to improve patient outcomes
bull (eg advice on smoking obesity etc)
bull Ability to use pharmaceutical knowledge and provide evidence-based advice on
public health issues involving medicines
Physiotherapists
According to the World Confederation for Physical Therapy (WCPT) the scope of physical
therapists practices includes (among others) public health strategies and advocating for
patientsclients and for health100 Furthermore it is described that physical therapists may
have the following purposes
bull promoting the health and wellbeing of individuals and the general publicsociety
emphasising the importance of physical activity and exercise
bull preventing impairments activity limitations participatory restrictions and
disabilities in individuals at risk of altered movement behaviours due to health
factors socio-economic stressors environmental factors and lifestyle factors
The European Network of Physiotherapy in Higher Education (ENPHE) also described
professional competencies of physiotherapists101 According to the ENPHE one of the roles
of a physiotherapist is to be a
bull Health care promotor
- Advocate on health and wellbeing promotion and disease or injury prevention
on behalf of patientclients and the profession to enhance individual
community and public health
- Promote adherence to local regional national and EU health and safety
policies guidelines and protocols
Psychologist
The European Federation of Psychologistsrsquo Associations developed the European Certificate
in Psychology ndash the EuroPsy102 The Tuning programme also published lsquoReference points for
the design and delivery of degree programmes in Psychologyrsquo103 in which they state that
the Tuning programme and the EuroPsy programme have experienced a parallel
development over the last ten years In fact the Tuning document presents a reference
99 httpswwwncbinlmnihgovpmcarticlesPMC5419365 100 httpswwwwcptorgpolicyps-descriptionPT 101 httpwwwenpheorgwp-
contentuploads201910ESCO_report_ENPHE_recommendations_April_2017pdf 102 httpwwwinpa-europsyitmoduliEuroPsy20Regulations20July202011pdf 103httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNPsychology_reference_points
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
87
point for the design and delivery of degree programmes in psychology on the basis of the
EuroPsy programme
Based on the definition of the key role of the professional psychologist health promotion
and disease prevention could be part of the profession as this has been described as
follows to develop and apply psychological principles knowledge models and methods in
an ethical and scientific way in order to promote the development well-being and
effectiveness of individuals groups organisations and society However no specific
competences related to health promotion and disease prevention are now described in the
documents It is plausible though that psychologist do act to promote health as the core
of their profession is to help others to understand behaviour to improve performance and
well-being or to alleviate problems and distress As these emergent specialisms develop in
response to new demands there is a tendency to develop education and training
programmes thus increasing the specialisation and the requirement for specialist skills of
professional psychology
Social worker
Global standards for the education and training of the social work profession are developed
by the International Association of Schools of Social Work (IASSW)104 The IASSW
worldwide association of schools of social work other tertiary level social work educational
programmes and social work educators These global standards include for example
standards regarding the schoolrsquos core purpose or mission statement standards regarding
programme objectives and outcomes standards with regard to programme curricula
including field education The standards with regard to the core curricula are organised into
four conceptual components domain of the social work profession domain of the social
work professional methods of social work practice and paradigm of the social work
profession under which several sub-domains are described which mainly relate to aspects
such as inadequacies discrimination tradition and culture social stability and ethical
principles The following touch upon the field of health promotion and disease prevention
bull Knowledge of human behaviour and development and of the social environment
with particular emphasis on the person-in-environment transaction life-span
development and the interaction among biological psychological socio-structural
economic political cultural and spiritual factors in shaping human development
and behaviour (domain of the social work profession)
bull Sufficient practice skills in and knowledge of assessment relationship building
and helping processes to achieve the identified goals of the programme for the
purposes of social support and developmental protective preventive andor
therapeutic intervention ndash depending on the particular focus of the programme or
professional practice orientation (methods of social work practice)
bull The application of social work values ethical principles knowledge and skills to
promote care mutual respect and mutual responsibility amongst members of a
society (methods of social work practice)
bull Problem-solving and anticipatory socialisation through an understanding of the
normative developmental life cycle and expected life tasks and crises in relation
to age-related influences with due consideration to socio-cultural expectations
(paradigm of the social work profession)
104 httpswwwiassw-aietsorgwp-contentuploads201808Global-standards-for-the-education-and-training-
of-the-social-work-professionpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
88
The European Social Network (ESN) investigated the social services workforce throughout
Europe and provided an overview of qualifications and skills in different Member States in
their research report showing that qualification and skills for social care workers differ per
country105 In fact in some countries there are specific training routes for social care
workers including specialised training courses or apprenticeships and the content of these
trainings depends on the service user group and is generally defined at a local or authority
level A questionnaire was set out in which essential components of social care workers
were identified which showed that health and safety is seen as an important component
of social work
105 httpswwwesn-euorgsitesdefaultfilespublicationsInvesting_in_the_social_service_workforce_WEBpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
89
ANNEX 3 ONLINE SURVEY
Survey Health promotion and disease prevention in health and educational
settings
Health promotion and disease prevention in health and educational settings -
medical schools The European Union has commissioned Ecorys an international
research and consultancy agency to conduct a project on health promotion and
disease prevention in health and educational settings In order to provide an EU
wide overview and to better support national governments we would like to ask
for your cooperation The project will develop an EU wide overview of the
educationtraining programmes for basic education postgraduate education as
well as continuous professional development with regard to education on health
promotion Your help will therefore be key in the collection of information and
data on public health initiatives in medical and non-medical education The survey
will take approximately 20 minutes of your time You do not need to complete this
survey at once You may leave the survey and continue at a later moment in
time Questions can be saved by clicking on the pauze button (below the
questionnaire) When doing so a new URL link will be provided We would be
pleased if you could provide this information by means of an online questionnaire
to Ecorys who is also available in case you have questions or you would like
additional information bull Ms Emalie Hurkmans (Project Coordinator) tel +31
(0)6 280 579 21 email emaliehurkmansecoryscom bull Ms Tessa Huis in lsquot
Veld tel +31 6 29 22 10 58 email tessahuisintveldecoryscom
What is the name of your education
What are the website details of the educationPlease enter the link of the website
with information of the education
Can you give a brief description of the education
What type of health professionals are trained in the education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
90
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
What type of medical specialist
Is the education
Undergraduate education
Postgraduate education
Continuous professional development
Is the course accreditated
Yes
No
Unknown
Does the course cover the topic health promotion and disease prevention
Yes
No
Is the education accreditated
Yes
No
Unknown
Does the education cover the topic health promotion and disease prevention
Yes
No
How is the topic health promotion and disease prevention incorporated in the
curriculum
In a seperate module
Topic incorporated into curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
91
Who is (are) the contact person(s) of the module health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Was there any partnerships in setting up the module health promotion and disease
prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Has the education obtained any funding to set up the module on health promotion
and disease prevention EU funding national public funding local public funding
or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
92
Since when is the module on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the module Eg is it a two weeks one month or one
year programme
What is the typical quantity in hours spend at health promotion and disease
prevention by participants The amount of hours spent on attendence and
homework
Is the module health promotion and disease prevention accreditated separately
No
Unknown
Yes please specify how many points are given
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
93
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the module
No
Unknown
Yes please specify what type of exam
Is the module also provided at other locations For example at other universities
Yes
No
Unknown
Is there a contact person(s)expert for the topic health promotion and disease
prevention
Was there any partnerships in incorporating it in the curriculum
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
94
Has the education obtained funding to incorporate health promotion and disease
prevention into the curriculum EU funding national public funding local public
funding or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is health promotion and disease prevention incorporated into the whole
curriculum eg since September 2017
What is the typical quantity in hours (approximately) spend at health promotion
and disease prevention by participants The amount of hours spent on attendence
and homework
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
95
In what way are knowledge and skills with regard to health promotion and disease
prevention tested in the curriculum For example incorporated into a written exam
Who is (are) the contact person(s) of the course on health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Were there any partnerships in setting up the course on health promotion and
disease prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
business NGOs individual citizens governmental agencies who have a role fill in
yes and add by the partnership in place
No
Yes please specify
Has the education obtained any funding to set up the course on health promotion
and disease prevention
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
96
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is the course on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the course eg two weeks one month or one year
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
97
What is typical quantity in hours spend at health promotion and disease prevention
by participants The amount of hours spent on attendence and homework
Is the course on health promotion and disease prevention accreditated separately
No
Unknown
Yes how many points are given
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the course
No
Unknown
Yes what type of exam
Is the course provided at multiple locations For example at other universities
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
98
What are the general objectives of the teaching activities on health promotion and
disease prevention eg arise awareness among Medical Doctors on the
importance of physical activity within the elderly population with a high risk of
heart failure
Which stakeholders were involved in developing the teaching activities on health
promotion and disease prevention
Is there made use of a mono- or multidisciplinary approach
Monodisciplinairy approach
Multidisciplinary approach
Unknown
Does the education include theories of
1
Yes
2
No
3
Unknown
Population health
Human cognition
and behaviour
Health behaviour
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
99
Does the education include
1
Yes
2
No
3
Unknown
Epidemiology and
bio-statistics
(research
capacity)
Methods of
evidence-based
medicine
Health policies
and regulation
Health economics
Ethics
Health care
systems
Digitalisation in
health promotion
Health inequalities
Disease
prevention in
teams
Health literacy
Health behaviour
change
techniques
Communication
skills
Digital health
coaching
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
100
Concerning teaching methods of health promotion and disease prevention which
methods are used
1
Yes
2
No
3
Unknown
Lectures
Assignments
Field training in real environments
eLearning modules
Other please specify
Concerning covered competencys or capacities of health promotion and disease
prevention the main focus is on
What are the expected outcomes
1
Yes
2
No
3
Unknown
Knowledge
Skills
Behaviour
attitudes
Relevant output (if available) eg number of students following the module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
101
Do you think it is likely you will apply the learned knowledge and skills (on health
promotion and disease prevention) in daily practice after completion of this
education
Yes please specify
No please specify
Not sure please specify
Is there a reason why this education might be a good example for other
educational settings with regard to the way that health promotion and disease
prevention is covered in the education
Are there any remarks Please feel free to give overall remarks or initiative-specific
remarks
Your responses have been registered Thank you for taking the time to complete
the survey your input is valuable to us
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
102
HOW TO OBTAIN EU PUBLICATIONS
Free publications
bull one copy via EU Bookshop (httpbookshopeuropaeu)
bull more than one copy or postersmaps from the European Unionrsquos representations (httpeceuropaeurepresent_enhtm) from the delegations in non-EU countries (httpeeaseuropaeudelegationsindex_enhtm) by contacting the Europe Direct service (httpeuropaeueuropedirectindex_enhtm) or calling 00 800 6 7 8 9 10 11 (freephone number from anywhere in the EU) () () The information given is free as are most calls (though some operators phone boxes or hotels may charge you)
Priced publications
bull via EU Bookshop (httpbookshopeuropaeu)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
4
Table of Contents
Preface 5
Executive summary 7
1 Introduction 11
11 Research questions 14
2 Theoretical background 15
21 Societal needs for health promotion and disease prevention 15
22 Health profession competencies 16
23 Educational systems for health professions in Europe 19
24 Relevant educational settings for health promotion 19
25 Theoretical framework for this study 21
3 Methodology 22
31 Mapping of health educational programmes in the EU 22
311 Online survey 22
312 Desk research 26
32 Long list of good practices 27
4 Mapping of the current situation IN health promotion training in the EU 29
41 Overview of educational programmes in the EU 29
411 Summary of the main findings in the survey 29
412 Detailed results of the survey 29
42 Overview of competency profiles of health professionals in the EU 44
5 Long list of good practices 45
51 Results 45
52 Analysis of good practices 48
6 Conclusions 53
Annex 1 Survey results by country 57
Annex 2 Competency profiles per professions 71
Annex 3 Online survey 89
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
5
PREFACE
ECORYS Nederland BV is pleased to present the reader to support Member States in
mainstreaming health promotion and disease prevention including lifestyle medicine in
education of health professionals The reader gives a general overview of professional
training initiatives in the European Union (EU)
The study comes at a time when it is well known that lifestyle factors are important
determinants for most non-communicable diseases These diseases have a major impact
on the health of European citizens At the same time an increasing proportion of aged
population poses demands on health systems and stresses the need to sustain the work -
abilities of the working age population Therefore health promotion disease prevention
and a healthy lifestyle are essential for patients and the general population Health
professionals play an essential role here This is not an easy task as dealing with lifestyle
factors requires different strategies at a population level or for targeted patient groups with
eg type II diabetes or cardiovascular risks Health professionals need to be prepared for
this task in their education either during their study period or as part of continuous
professional development Though widely acknowledged it remained unclear to what
extent and how Member States address this challenge
In the context of this project we collected practices how EU Member States include health
promotion disease prevention and lifestyle medicine in health professional education This
report presents a mapping of the current situation across different countries and health
professions Without pretending to be complete it provides a unique baseline of the way
professionals are currently prepared to implement health promotion disease prevention
and lifestyle medicine in EU countries With this baseline Chafea created an important
starting point for the exchange of experiences and mutual learning Hope is that this will
boost developments in the near future so as to prepare health professionals to adequately
address the challenges that healthcare systems in the EU face and implement the paradigm
shift from treatment of diseases among patients to promotion of health among the entire
population
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
7
EXECUTIVE SUMMARY
Background
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices and unhealthy diets Tobacco use harmful
use of alcohol and physical inactivity have been identified as the top risk factors for non-
communicable diseases (NCDs) in the European Union In recognition of this important
public health challenge investing in effective health promotion and disease prevention of
NCDs is critical to improve the quality of life and well-being of European citizens
Healthcare professionals such as doctors (especially general practitioners) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs However while
many policy statements and NCDs practice guidelines call for behavioural change as the
first line of prevention and management professionals often do not include behavioural
change counselling in their care yet While most health professionals acknowledge the need
for lifestyle advice there seems to be a mismatch between the roles and competencies for
which health professionals are trained and the action required This underscores the need
to develop and strengthen lifestyle medicine as a component of health professionalsrsquo
education defined as lsquothe integration of lifestyle practices into the modern practice of
medicine both to lower risk factors for chronic disease andor if diseases are already
present to serve as an adjunct in therapy Lifestyle medicine brings together sound
scientific evidence in diverse health related fields to assist the clinician in the process of not
only treating disease but also promoting good healthrsquo
Objective of the study
This study seeks to provide a mapping of the current situation how health professionals are
trained in health promotion in the EU To that end this study aims to answer the following
research questions
1 How are health professionals in the EU countries being trained in health promotion
prevention and lifestyle medicine in graduate post-graduate and continuous
professional education
2 What are good practices on knowledge capacity and competency building and
advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Scope of the study
Classically public health targets at activity levels can be described in operational models
like the Friedenacutes pyramid model It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of health
like socioeconomic status We use this model as a substructure to investigate health
professionalsrsquo education as they contribute to public health at all these levels
Methodology
In order to provide a general overview on how health professionals are trained in health
promotion and disease prevention and lifestyle medicine in the EU we conducted an online
survey We identified potential organisations in the EU to take part in the survey and asked
those organisations to spread the survey among other organisations or stakeholders in their
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
8
network We contacted 24 EU associations that represent entire professions or part of the
professions (like post-graduates) in all EU countries and have major networks in the fields
of graduate post-graduate and continuous professional development for their support We
aimed to cover all professions within the scope of this study physicians physiotherapists
occupational therapists psychologists nurses social workers dentists pharmacies
dietitians Also national health associations and national educational organisations were
approached to fill in the survey Among other topics the survey contained questions on the
training programme type of health professional targeted implementation in the
curriculum description of the health promotion component funding accreditation and
partnerships
In addition to the online survey a desk research was conducted including both scientific
and grey literature to establish an overview of the competency profiles of health
professionals in the field of health promotion and disease prevention Based on the
identified literature we described the competency profiles for each of the following
healthcare professions (undergraduate) medicine medical specialists dentists nurses
nurse specialists occupational therapists pharmacists physiotherapists psychologists
and social workers
Results were tabulated and described Good practices were selected on the basis of four
pre-established criteria These practices were analysed more in-depth with an analytical
tool aligning Friedenrsquos pyramid of public health needs and Kraigerrsquos Learning Typology This
in-depth analysis was used to define a short list of 10 good practices representing a variety
of professions and countries
Results
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades1there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional However there is room for improvement many competency
profiles leave room for interpretation the described competences are not ranked in order
of importance and it is often not explained how the competences should be applied in
practice ie in a pro-active preventive way (always assessing lifestyle within the
treatment) or a more curative reactive way (only included in the treatment when there is
a clear lifestyle component related to the disease)
As for the inclusion in educational programmes a high percentage (93) of respondents
(n=197) indicate that health promotion and disease prevention is implemented in their
educational programmes or modules The high share may reflect a selection bias as those
who have implemented health promotion within the education may have been more inclined
to fill in the questionnaire In the survey we explored how health promotion and disease
prevention is implemented in the educational setting In summary this provided the
following results
1 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
9
bull More than half of the respondents indicated that they filled in the questionnaire for
practices in undergraduate educational settings Throughout Europe these
numbers were relatively similar
bull Physiotherapists are the professional group most actively involved in health
promotion training activities The vast majority applies multidisciplinary
approaches and thus brings other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within training programmes In continuous professional development on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion especially target knowledge skills
and behaviour of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for continuous professional
development (33) compared to undergraduate and postgraduate education
where the topic is covered in most modules (15 and 6) Funding was more
often obtained in Northern and Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) Regarding full modules high percentages indicated
that this is mandatory and that there is an exam at the end of the module (81
70 respectively)
Conclusions
The present study provides an overview of current practice on health promotion disease
prevention and lifestyle medicine in the education of health professionals in EU countries
This is an important need-assessment for the exchange of knowledge and expertise among
EU countries All professions have versatile competency profiles in health promotion giving
a good ground for further development As the study results reveal some unbalance in
competencies addressed and methods used a next step could be to support further
development of educational practices in lifestyle medicine and adoption of new
technologies There is room for improvement as well as encouraging volition to share
expertise across professions professional associations universities and countries in the EU
The body of knowledge generated in this study can serve as a basis for further analysis and
contribute to the enhance effectiveness of educational practices of health promotion
disease prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
11
1 INTRODUCTION
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices2 In Europe such chronic diseases as
cancer cardiovascular diseases diabetes and chronic respiratory diseases are giving the
greatest disease burden3 The Global Burden of Disease (GBD) 2016 study estimates that
over 91 of deaths and over 87 of DALYs in the European Union (EU) are the result of
non-communicable diseases (NCDs) of which 61 and 43 respectively can be attributed
to modifiable risk factors4 To a large extent lifestyle factors unhealthy diets tobacco use
harmful use of alcohol and physical inactivity have been identified as the top risk factors
for NCDs in the EU5 The last non-communicable diseases progress monitor 2017 of the
WHO underlines that ldquoNCDs share key modifiable behavioural risk factors like tobacco
use unhealthy diet lack of physical activity and the harmful use of alcohol which in turn
lead to overweight and obesity raised blood pressure raised cholesterol and ultimately
diseaserdquo6 Since NCDs share many related modifiable risk factors and often do not occur in
isolation7 prevention must be integrated into population approaches to combat NCDs as a
group8 In recognition of this important public health challenge investing in effective health
promotion and disease prevention is critical to improve the quality of life and well- being of
European citizens910 as well as their productivity and NCDrsquos burden on health systems and
economy of European societies11
Strengthening the investments in health promotion and disease prevention is key to delay
the onset and reduce the burden of NCDs in Europe12 As there is a great need for chronic
disease management the healthcare setting is crucial for health promotion in both primary
and secondary prevention of NCDs13 For example obesity is a major modifiable risk factor
2 Chopra M et al (2002) A global response to a global problem the epidemic of overnutrition
httpswwwncbinlmnihgovpmcarticlesPMC2567699pdf12571723pdf 3 WHO (2006) Gaining Health The European strategy for the prevention and control of noncommunicable
diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf 4 EU burden from non-communicable diseases and key risk factors httpseceuropaeujrcenhealth-
knowledge-gatewaysocietal-impactsburden 5 WHO (2014) Prevention and control of noncommunicable diseases in the European Region a progress report
httpwwweurowhoint__dataassetspdf_file0004235975Prevention-and-control-of-noncommunicable-diseases-in-the-European-Region-A-progress-report-Engpdf
6 WHO (2017) Noncommunicable diseases progress monitor 2017 httpappswhointirisbitstream handle106652589409789241513029-engpdfjsessionid=0613BF26D66A7DA9D1C91AD325E0A75Dsequence=1
7 httpsacels-cdncomS00917435150028321-s20-S0091743515002832-mainpdf_tid=88fea2bf-946a-44c2-be59-0edbabc2c2e8ampacdnat=1541511066_feedfb33968e2ac2f5b47a3452254a9f
8 Integrated approach to prevent noncommunicable diseases httpwwweurowhointenhealth-topicsnoncommunicable-diseasescanceractivitiesintegrated-approach-to-prevent-noncommunicable-diseases
9 WHO (2006) Gaining Health The European Strategy for the prevention and control of noncommunicable diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf
10 Scriven A (2017) Promoting Health a Practical Guide Seventh Edition httpsbooksgooglenl
bookshl=nlamplr=ampid=fJwqDwAAQBAJampoi=fndamppg=PP1ampdq=importance+health+ promotion+and+disease+prevention+European+Commissionampots=jcXZvCYJIQampsig=8D8Yqa9wKa_DlaaYUky_EtUxd_gv=onepageampq=importance20health20promotion20and20disease20prevention20European20Commissionampf=false
11 Tender 12 Chrodis (2015) Health promotion and primary prevention in 14 European countries a comparative overview
of key policies approaches gaps and needs httpchrodiseuwp-contentuploads 201507 FinalFinalSummaryofWP5CountryReportspdf
13 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
12
for type II diabetes (DM II) and thus efficacy of the intervention matters In economic
modelling for eight European countries a body-mass index reduction in the adult population
of 5 compared to 1 resulted a three-fold reduction in the incidence of DM II14 Apart
from the health losses caused directly by NCDs underlying conditions may also increase
susceptibility for other diseases Patients with diabetes and serious heart conditions eg
were identified as risk populations for COVID-1915 New health threats like climate crisis
will have an impact on healthcare systems and need for adaptation options including
training of health care workers integrated heatwave early warning systems especially for
the most vulnerable populations and supporting lifestyle changes toward healthy choices
that are at the same time climate and health friendly16
Healthcare providers such as doctors especially general practitioners (GPs) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs17 Health
promotion is collaborative work where professionals strengthen the message and help
patients to choose and implement healthier behaviours Counselling on and prescription of
a healthy lifestyle is particularly important to socioeconomically vulnerable and
disadvantaged population groups which are disproportionally affected by unhealthy
lifestyles and are more difficult to reach18 Secondary and tertiary prevention in chronic
diseases is embedded into good quality care since good nutrition status decreases the risk
of reinfarction as does smoking cessation For these reasons health promotion was
explicitly recognized as an integral part of the professional role of the GP in several policy
statements at both the European and the national level19 While many policy statements
and NCDs practice guidelines include a call for behavioural change as the first line of
prevention and management providers often do not provide behavioural change
counselling in their care20
A recently published report by the European Commission and WHO Europe (2018) identified
barriers for prescribing and counselling on exercise schemes and on promoting physical
activity in the health sector These were the lack of confidence and knowledge and skills by
health professionals on providing effective counselling21 For example Koutoukidis et al
(2017) performed a qualitative study on the perspective of healthcare professionals on
lifestyle advice to cancer survivors Health professional-centred barriers to provision of
lifestyle advice were a lack of knowledge on healthy lifestyle guidelines the feeling that
14 Webber L Divajeva D Marsh T McPherson K Brown M Galea G et al The future burden of obesity-related
diseases in the 53 WHO European-Region countries and the impact of effective interventions A modelling study BMJ Open 2014
15 Centre for Disease Control and Prevention (2020) Coronavirus disease 2019 Groups at higher risk for severe illness httpswwwcdcgovcoronavirus2019-ncovneed-extra-precautionsgroups-at-higher-riskhtml
16 Drummond P Ekins P Grubb M Lott MSEng M Byass P Nilsson M et al The Lancet Commissions Institute for Sustainable Resources (P Health and climate change policy responses to protect public health thelancetcom 2015
17 Catapano AL et al (2007) Averting a pandemic health crisis in Europeby 2020 what physicians need to know regarding cholesterol management httpswwwncbinlmnihgovpubmed17446817
18 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
19 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20 European20General20Practicepdf
20 httpswwwncbinlmnihgovpmcarticlesPMC4561845pdf101177_1559827615580307pdf 21 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the
European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
13
they were not the right person to provide advice and lack of time and resources22
Additional barriers mentioned in the World Book of Family Medicine ndash European Edition
2015 are perceived as lack of time or competing work load insufficient reimbursement
doubts about patientsrsquo acceptance and willingness to receive lifestyle counselling low self-
efficacy insufficient skills and training doubts about effectiveness of interventions and
health promotion perceived as outside professional role2324 Therefore while most health
professionals seem to acknowledge the need for lifestyle advice there seems to be a
mismatch between roles competencies training and possibilities among health
professionals and action25 Factors causing this mismatch differ from individual and
organizational context wherefore strategies to address these barriers will also vary26
These findings underline the need for developing and strengthening lifestyle medicine in
health professionalsrsquo education27 defined as lsquothe integration of lifestyle practices into the
modern practice of medicine both to lower the risk factors for chronic disease andor if
disease already present serve as an adjunct in its therapy Lifestyle medicine brings
together sound scientific evidence in diverse health-related fields to assist the clinician in
the process of not only treating disease but also promoting good healthrsquo28 Hence lifestyle
medicine covers the systematised approach for prevention and management of chronic
disease addressing eg diet physical activity behaviour change stress and coping and
tobaccosubstance abuse29 Health professionals need to learn how to overcome the
identified barriers mentioned above30 and how to effectively and efficiently counsel their
patients towards adopting and sustaining healthier behaviours31
Moreover digitalization is changing the scenery for lifestyle medicine and chronic disease
management Patient engagement can be enhanced with applications self-monitoring or
self-management tools To successfully embed these new forms of care professionals must
develop new skills32 However studies have shown that medical students are not formally
trained in major concepts known to influence health33 Philips et al (2014) states that
including lifestyle medicine in undergraduate medical curricula would have important public
health implications by efficiently promoting the prevention and treatment of NCDs34 A
study by Dacey et al (2012) states that face-to-face continuing medical education formats
22 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 23 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20
European20General20Practicepdf 24 Geense WW van de Glind IM Visscher TL van Achterberg T Barriers facilitators and attitudes influencing
health promotion activities in general practice an explorative pilot study BMC-family practice 2013 1420 25 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 26
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
27 Polak R et al (2015) Lifestyle Medicine Education httpswwwncbinlmnihgov pmcarticles PMC4561845
28 Rippe JM (2019) Lifestyle Medicine Third Edition CRC Press 29 Kushner RF and Webb Sorensen K (2013) Lifestyle medicine the future of chronic disease management
Obesity and nutrition 201320 30 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 31 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) The impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 32 Eg Richard A A amp Shea K (2011) Delineation of Self-Care and Associated Concepts Journal of Nursing
Scholarship 43(3) no-no httpdoiorg101111j1547-5069201101404x 33 httpscdnymawscomwwwacpmorgresourceresmgrlifestylemedicine-filesajpm-lmcommentarypdf 34 Philips E Pojednic R Polak R Bush J amp Trilk J (2014) including lifestyle medicine in undergraduate
medical curricula Medical education online
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
14
have a positive impact on physician behaviour toward health promotion and disease
prevention by increasing their knowledge confidence and practices that help patients to
adopt healthy behaviours35 Similar results can be expected among other health
professionals as well
The World Book of Family Medicine ndash European Edition 2015 states that the shared aim to
integrate health promotion disease prevention and lifestyle medicine has not been fully
achieved Future activities as to how lifestyle interventions can be better integrated need
collaborative approaches36 As a starting point for more collaborative action this study
seeks to provide a mapping of the current situation on health professionals training in health
promotion in the EU
11 Research questions
To that end this study seeks to answers to the following research questions
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and continuous
professional education
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
35 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) the impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 36
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
15
2 THEORETICAL BACKGROUND
21 Societal needs for health promotion and disease prevention
Classically public health targets at activity levels can be described in operational models
like Friedenacutes pyramid model37 It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of
health like socioeconomic status6 We use this model as a substructure in looking into
health professionalsrsquo education as they contribute to public health in these levels (Figure
21) Society needs to evaluate cost-effectiveness of public health efforts and find a balance
between the levels of actions at each level We use this framework to enable us to present
the needs of societies in general for different health professionals and their roles and
competencies in public health
Figure 21 Frieden Pyramid of health impact of health professional activities at the different levels of society (T Frieden 2010 CDC)
Healthcare services can contribute in mitigating the burden of disease by socioeconomic
disadvantages Health professionals have a key role in developing health services so their
competency to take account of differences in abilities of people to benefit from health
services is vital But more is needed Traditionally health professionals have been managing
the individual risk factors and provision of services That is not enough For example in
cardiovascular diseases the ldquoperfect treatment approachrdquo fails to prevent almost half of the
disease burden37 In cancer diseases individual health behaviours like smoking contribute
in more direct manner Therefore we need to develop educational systems that support
health professionals to take part in new public health approaches by planning interventions
that change the environmental context to make healthy options the default choice
37 Frieden TR A framework for public health action The health impact pyramid American Journal of Public
Health 2010
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
16
regardless of education income service provision or other societal factors37 These are
equally needed in out-of-health contexts like climate change where socio-economic
inequalities and (health) behavioural choices are among major drivers of climate changes38
Policies can influence environments to support healthier choices and we need health
professionals in policy development and execution Still health behaviour changes happen
at the individual level We need more efficient skills in personalized health coaching of
individuals to increase the cost-effectiveness of treatment of NCDs39 An ageing population
and increasing rates of chronic disease as well as advances in medical science and health
information technology to make care safer and more efficient require a rethinking of how
care is delivered Digitalization of services will challenge healthcare professionals and
collaborative care models have become more common40 Instead of requiring compliance
from patients patient-centred approaches are required from professionals This means that
clinical interventions need to be complemented by counselling and education to achieve
long-lasting protective measures Health coaching is aiming to empower patients in co-
management of their disease41 and emphasize and support patientsrsquo autonomy instead of
merely compliance It is based on shared decision-making and collaborative goal setting
facilitated by motivational interviewing42 Health coaching is already happening in digital
environments This paradigm shift requires new skills and attitudes from health
professionals too
New approaches to public health on societal level the paradigm shift to health coaching on
patient level and new forms of healthcare delivery pose a big challenge to the educational
system of health professionals It needs to prepare new professionals and train health
professionals already working in the healthcare system to master a wider scope of
knowledge and develop new skills and attitudes to implement these new approaches in a
safe effective and efficient way
22 Health profession competencies
Healthcare service is a complex and interconnected network of professionals There are
common professional competencies needed in health care and health promotion
(communication collaboration) but they are applied to meet the learning aims of each
profession or level of education If we want to increase the implementation of lifestyle
counselling or systemwide changes we need to evaluate knowledge skills and attitudes
required for the changes and to define the competencies needed to support this change
Professional competencies sum the elements of abilities (knowledge skills attitudes and
behaviours) that enable a professional to accomplish the activities described in a task
statement that outlines what the professional is expected to do43
38 Watts Nick Amann Markus Arnell Nigel et al (66 more authors) (2019) Report of The Lancet Countdown
on Health and Climate Change The Lancet ISSN 0140-6736 httpsdoiorg101016S0140-6736(19)32596-6)
39 Hale R Giese J Cost-Effectiveness of Health Coaching Prof Case Manag 2017 40 Falconer E Kho D Docherty JP Use of technology for care coordination initiatives for patients with mental
health issues A systematic literature review Neuropsychiatric Disease and Treatment 2018 41 Hayes E McCahon C Panahi MR Hamre T Pohlman K Alliance not compliance Coaching strategies to
improve type 2 diabetes outcomes J Am Acad Nurse Pract 2008 42 Olsen JM Health Coaching A Concept Analysis Nurs Forum 2014 43 Kraiger etal 1993 Application of cognitive skill-based and affective theories of learning outcomes to new
methods of training evaluation
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
17
Learning Outcome Typology by Kraiger is a widely used descriptive model for setting targets
and learning outcomes in education43 It comprises cognitive (knowledge) psychomotor
(skill-based) affective and behavioural (attitudes) components This classification scheme
for learning outcomes is based on Bloomrsquos work (1956) of three learning domains including
cognitive domain the affective domain and psychomotor44 45Knowledge can be factual and
declarative knowledge information and concepts or processes and organizations or
metacognitive strategies like allocation and regulation of professional performance Skills
include simple routine development and procedures needed at work and more complex
skills needed for the ability to monitor the performance along other tasks Attitudes are
linked with professionalsrsquo perceptions on learning self-efficacy at work perception about
ability to perform and ability to goal setting It has domains on professionalism Knowledge
can be obtained in reading or e-Learning modules skills require active teaching methods
and attitudes develop over time Behaviours then are complex situations where knowledge
skills and attitudes are utilised in professional manners In education planning outcomes
are defined by these elements
Competency frameworks are an effective method for achieving outcome-based education46
They provide a tool for capturing the elements and abilities (knowledge skills attitudes
and behaviours) needed in effective and safe patient work47They can serve in evaluating
the components of different specialities or societal needs like in this report public health
needs Competencies define an acceptable and feasible description of professional
behaviours used in relation to health promotion Competency building is at the basis in
developing similar programmes in the US4849 Meaningful assessment of competencies
developed is critical for the implementation of effective competency-based medical
education (CBME)50
The International Union for Health Promotion and Education (IUHPE) published an
extensive list of core competencies and professional standards for health promotion in
201651 It defines acuteHealth Promotion actionrsquo in the context of these competencies and
standards to describe programmes policies and other organised Health Promotion
interventions that are empowering participatory holistic inter-sectoral equitable
sustainable and multi-strategy in nature and aim to improve health and reduce health
inequities51
44 Bloom BS (1956) Taxonomy of educational objectives The classification of educational goals New York NY
Longmans Green 45 Cruz-Cunha MM (2012) Handbook of Research on Serious Games as Educational Business and Research Tools 46 Frank JR Danoff D The CanMEDS initiative Implementing an outcomes-based framework of physician
competencies Med Teach 200729(7)642ndash7 47 Cooke M Irby DM Sullivan W Ludmerer KM Medical education American medical education 100 years after
the flexner report N Engl J Med [Internet] 2006355(13)1339-1344+1306 Available from httpwww
scopuscominwardrecordurleid=2-s20-33749062559amppartnerID=40ampmd5=d949feb 758c984c732a419 cada174c85
48 Alaranta A Alaranta H Patja K Palmu P Praumlttaumllauml R Martelin T et alSnuff use and smoking in Finnish Olympic athletes Int J Sports Med 200627(7)
49 Van Horn L Lenders CM Pratt CA Beech B Carney PA Dietz W et al Advancing Nutrition Education Training and Research for Medical Students Residents Fellows Attending Physicians and Other Clinicians Building Competencies and Interdisciplinary Coordination Adv Nutr 2019
50 Lockyer J Carraccio C Chan MK Hart D Smee S Touchie C et al Core principles of assessment in competency-based medical education Med Teach 201739(6)609ndash16
51 IUHPE (2016) Core competencies and professional standards for health promotion full version httpwwwukphrorgwp-contentuploads201702Core_Competencies_Standards_linkEpdf )
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
18
We present CanMEDS as an example of a framework that includes content-specific
competencies (Table 21) CanMEDS was developed for medical experts but most
competencies are applicable to all health professionals
Table 21 CanMEDS in short form52 original version53
Competency Short description
Medical Expert Apply clinical skills and knowledge of the biomedical sciences to fulfil your scope of practice
Collaborate with patients and families for patient-centred care and management
Contribute to health care quality and patient safety
Communicator Build rapport and empathy in all interactions with patients and include families (with the patientrsquos consent)
Understand the patientrsquos perspectives expectations and socio-economic issues
Use active listening patient-centred interviewing skills and culturally safe communication
Share information in plain language to promote patientsrsquo understanding
Clearly document and share information with patients and others on the care team
Collaborator Collaborate by sharing knowledge and perspectives sharing responsibilities learning together
Collaborate in care education advocacy administration and scholarship
Leader Take responsibility for the ongoing operation evolution and continuous
improvement of the healthcare system
Expand beyond a clinical or technical role to take on administrative teaching and scholarly roles and responsibilities
Exercise efficient use of resources to achieve cost-effective care
Contribute to improvements in personal practice team organization and system
Health Advocate
Understand and address the determinants of health that affect patients and support patients to navigate through the health care system
Collaborate with communities and populations to influence change in the health
care system
Contribute to health promotion and disease prevention Understand determinants and needs speak on behalf of others increase awareness
Scholar Plan for and engage in life-long learning
Teach others
Evaluate and apply evidence to day-to-day practice
Contribute to research including creation dissemination and translation into
practice
Professional Commit to patients society profession and ldquoselfrdquo Patients ndash maintain clinical competency and adhere to ethical standard Society ndash demonstrate social accountability by responding to societal needs and
expectations Profession ndash peer assessment mentorship supporting others setting standards Self ndash participate in self-assessment and reflection build self-awareness and manage own well-being
52 Michener Institute No Title CanMEDS framework in short [Internet] Available from httpsmichenercawp-
contentuploads201805CanMEDS-Framework-Summarypdf 53 Frank JR Snell L Sherbino J E CanMEDs 2015 Physician Competency Framework [Internet] CanMEDS 2015
Physician Competency Framework Ottawa Royal College of Physicians and Surgeons of Canada 2015 p 1ndash30 Available from httpwwwroyalcollegecaportalpageportalrccanmedsresourcespublications
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
19
23 Educational systems for health professions in Europe
According to the EU Treaty European citizens have a virtue of rights of free movement as
workers freedom of establishment and freedom of service providers54 Directives on the
requirements of professional qualifications in EU their recognition and Regulation55
facilitate the mobility of health personnel Each member state will apply this directive in
the national legislation on health professional qualifications There is a system of automatic
recognition based on harmonised minimum training requirements This system depends on
the timely notification of new or changed evidence of formal qualifications by MS and their
publication by the Commission Otherwise holders of such qualifications have no
guarantees that they can benefit from automatic recognition
The undergraduate education in Europe is coordinated through the Bologna Process which
is an intergovernmental cooperation of 48 European countries in the field of higher
education It guides the collective effort of public authorities universities teachers and
students together with stakeholder associations employers quality assurance agencies
international organizations and institutions including the EC to bring more coherence to
higher education systems across Europe56 Under the Bologna Process all 48 participating
European countries agreed to ensure mutual recognition of qualifications and learning
periods abroad completed at other universities Nonetheless it should be noted that across
Europe healthcare systems and educations may still significantly differ
While professional activity is regulated by national law in individual member states57
faculties and other academic institutions have collaborated in the establishment of a
framework of competencies based on the scientific advances and new methodologies in
education In fact EU Directives of the European Parliament and Council on the recognition
of professional qualifications have consolidated a system of mutual recognition between
MS58 Examples include the PHARMINE for pharmacists and MEDINE for medical doctors59
This collaboration is in line with the Bologna Process
24 Relevant educational settings for health promotion
Inclusion of health promotion and lifestyle medicine in undergraduate medical curricula is
expected to have important public health implications However in current medical
education this subject is minimal to nonexistent60 This is a global problem In 2016 the
American associations around NCDs launched a joint programme called lsquoThe Lifestyle
54 Treaty on the Functioning of the European Union (TFEU) Articles 45 49-62 55 European Parliament C of the EU Directive 200536EC on the recognition of professional qualifications and
Regulation [Internet] 2013 Available from httpseur-lexeuropaeulegal-
contentENALLuri=celex3A32013L0055 56 The Bologna process and the European Higher Education Area httpseceuropaeu education policies
higher-educationbologna-process-and-european-higher-education-area_en 57 UEMS (2017) Charter on training of medical specialists in the EU httpswwwuemseu
dataassetspdf_file001943561ETR-Psychiatry-201703pdf 58 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 59 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 60 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
20
Medicine Education Collaborativerdquo for improvement of health promotion education among
health professionals and in medical schools61 This initiative will a) work for high-quality
curricular material on an easily navigable website b) provide support for medical schools
to advocate for and implement lifestyle medicine curricula into their own institutions c)
aim to increase awareness and legislative initiatives that encourage adoption of lifestyle
medicine into medical school education d) develop and conduct assessment in the
following areas Student Health Student Knowledge and Programme Effectiveness and
e) train and support medical students as effective champions of lifestyle medicine whose
engagement with the curriculum lead to increased adoption within medical schools and
enhanced collaboration nationallyError Bookmark not defined This need has been acknowledged
in Europe as well62
Besides education in medical schools continuous professional development (CPD) is an
essential component in health education to ensure that professionals graduated in past
decades keep their competencies up to date and acquire new competencies needed for
health promotion disease prevention and lifestyle medicine It is important to encourage
further strengthening of CPD for those professions that benefit from automatic recognition
of their professional qualifications Member states should in particular encourage CPD for
physicians medical specialists general practitioners nurses responsible for general are
dental practitioners specialized dental practitioners veterinary surgeons midwives
pharmacists and architects63 Given the rapid developments in societal needs and
approaches towards health promotion and disease prevention and spectacular increase in
technological support facilities lifelong learning is imperative for health professionals and
should be oriented towards the competencies required to best serve their population and
society
Figure 22 Lifelong learning is an iterative process where learners build knowledge skills
attitudes and behaviours on top of their current professional competency
61 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019 62 European Lifestyle Medicine organisation httpswwweulmorg 63 Lim SS Vos T Flaxman AD Danaei G Shibuya K Adair-Rohani H et al A comparative risk assessment of
burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions 1990-2010 A systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
21
25 Theoretical framework for this study
In this study we touch upon the existing levels of health promotion disease prevention
and lifestyle medicine in health and educational settings in the EU and make a preliminary
assessment of its relevance
As right now health professional competencies seem more practical we approached the
mapping of competencies in health education through professions rather than with an
overall theoretical framework Thus we aim to create a general picture for different health
professions at different levels of education
For the assessment of relevance of the existing levels of health promotion in education we
aligned the competency framework of Kraiger with Friedenrsquos public health framework We
used three components64 of Kraigerrsquos Learning Typology
bull Knowledge cognitive and mental abilities
bull Skills psychomotor manual and physical abilities to perform tasks
bull Attitude (or self) perceptions growth in feelings or emotional areas
We used the integrated framework as an analytical tool to classify content areas covered
and their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future
This study is an important first step as we know little about present practices However
more detailed research will obviously be needed
64 Given the limitations of the study behaviour ndash the fourth component ndash is not included Behaviour refers to
practices to utilise knowledge skills and attitude in work environment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
22
3 METHODOLOGY
31 Mapping of health educational programmes in the EU
The first aim was to provide a general overview on how health professionals are trained in
health promotion and disease prevention and lifestyle medicine in the EU To that end we
conducted an online survey to map the educational programmes of health professionals in
the EU In addition to the proposed methodology we also conducted desk research to
create an overview of competency profiles of health professionals in the EU
311 Online survey
This study looks at undergraduate education postgraduate education and CPD courses in
all healthcare professions across the EU Within the EU different organisations are
responsible for the education of healthcare professionals
bull The undergraduate education programmes are organised by universities in each
country
bull The post-graduate education programmes are organised differently in each
country This includes a set of European organisations that run the guidelines
and portfolioacutes for each profession or specialty within this profession (like in
medicine)
bull CPD programmes are even more diverse between countries and can be accredited
both by European organisations and universities
Due to the wide scope of the study and the different levels of healthcare educational
programmes no country correspondents could be found with a full overview of educational
programmes addressing health promotion and disease prevention in their country
Therefore we chose for a snowball methodology to obtain information on all levels of health
professional education The snowball methodology consists of two steps First we identified
potential organisations in the EU to take part in the survey Second we asked those
organisations to recruit other organisations or stakeholders in their national andor
international network of colleagues and spread the survey among those This method
required more effort and time in the beginning but once the lsquoballrsquo was rolling it provided
us with a growing dataset including the perspectives from healthcare educators healthcare
professional associations and healthcare students and residents The snowball method
implies a risk of selection bias as educational institutions that have implemented health
promotion within their programmes ie the front-runners may have been more inclined
to respond than those who have not
In addition this recruitment process served as a communication and dissemination vehicle
and increased the engagement to the mapping Many organisations expressed their interest
to join the workshop as well as willingness to disseminate the results to their members and
collaborators Because of the growing interest we decided to extend the deadline after the
workshop organised on 13 February so attendees could spread the survey among their
national andor international networks
Our original workplan included an Excel worksheet to be sent to the national health
coordinators in each EU country but as we chose a different strategy it was necessary to
develop a more user-friendly and flexible method Therefore an online survey was
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
23
developed This enabled refinement of questions to each level of education with core sets
of questions Survey links proved to be easy to use and shared within educational facilities
or associations which led to higher response
In this section we discuss in more detail how the survey was developed and how relevant
international organisations were recruited
Development of an online survey
First we developed a mapping tool (stand-alone Excel document) to map the current
situation of professionals trained in health promotion This mapping tool was validated by
both Chafea and DG SANTE and by the external experts in the core research team After a
pilot phase an online survey was developed for all healthcare professions based on the
content of the mapping tool This was a necessary step to boost response as the online
survey proved to be more user-friendly and easier to share among educational facilities or
associations than the mapping tool in Excel
Among other topics the survey contained questions on the
bull Training programme for which the respondent is filling in the survey (which
(educational) institute and health profession portfolio etc)
bull Type of training programme (undergraduate education postgraduate education or
continues professionalrsquos development
bull Type of health professional targeted (eg GPrsquos physiotherapists etc)
bull Implementation in the curriculum
bull Description of the health promotion component in the programme (eg teaching
methods monodisciplinary approach or multidisciplinary approach expected
outcomes in knowledge skills and attitude)
bull Targeted funding
bull Accreditation
bull Partnerships
The questions in the survey correspond with the information requested in the Tender
Specifications Note that the survey maps the educational offer effectiveness of education
is outside the scope of this study The complete questionnaire used in the survey can be
found in Annex 3
Recruitment of relevant international organisations EU and national medical and
non-medical associations medical faculties national and international institutes
networks and organisations
As we used a snowball method it is not possible to provide the exact number of persons
who received the survey and response rates Instead we present each of the steps taken
to approach respondents and final response obtained
Recruitment of European associations
First we connected with major networks in the fields of graduate post-graduate and
continuous professional development for their support as these organisations have an
overview of the three levels of health professional education These associations represent
entire professions or part of the professions (like post-graduates) in all European countries
National professional organisations are members of these umbrella organisations For
example the Union of Medical Specialists (UEMS) represents 16 million medical specialists
It has 40 full member associations (Member States of the EU amp Member States of the
European Economic Area) associate member associations (Member States of the Council
of Europe) and observer member associations (other countries eg the United States)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
24
The UEMS represents more than 50 medical disciplines through various bodies
and structures The most important ones are the 43 Specialist Sections which represent
independently recognised specialties All health professionals health professional students
and post-graduates are organised in a similar manner These organisations are in a good
position to provide information and disseminate it across EU countries
Overall 24 EU associations were approached by email to spread the survey among their
networks (see Table 31 for a complete overview) We aimed to cover all professions within
the scope of this study ie physicians physiotherapists occupational therapists
psychologists nurses social workers dentists pharmacies dietitians throughout Europe
Therefore European associations with focus on educational programmes for these specific
professions were approached
Table 31 Approached European Associations
No European Associations
1 European Medical Association (EMANET)
2 The European Union of General Practitioners (UEMO)
3 European Union of medical specialists (UEMS)
4 European Medical Students Association EMSA)
5 European Forum of Medical associations (EFMA)
6 European Federation of Nurses Associations (EFN)
7 European Association of schools of social work
8 European Network of Physiotherapy in Higher Education
9 European Region ndash World Confederation of Physical Therapy (ER-WCPT)
10 European Network of Occupational Therapy in Higher Education (ENOTHE)
11 Council of Occupational therapists of European Countries (COTEC) part of the World
12 Federation of Occupational Therapists (WFOT)
13 Federation of National Psychologists Associations
14 European federation of nurse educators (FINE) association
15 Association for Dental Education in Europe
16 Council of European Dentists
17 Association for Medical Education in Europe (AMEE)
18 Pharmaceutical group of the European Union (PGEU)
19 European Pharmacists Forum (EPF)
20 European Association of faculties of pharmacy (EAFP)
21 European network of medical residents in Public health
22 The Association of Medical Schools Europe (AMSE)
23 The European Society of Preventive Medicine (ESPREV)
24 The European Lifestyle Medicine Organisation (ELMO)
Recruitment of national associations
Second national health associations for all Member States and all professions were
approached to fill in the survey This step was crucial to increase the response National
health associations were selected using the member list of European organisations Table
32 shows the European organisations used to identify national health associations that
were invited to participate in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
25
Table 32 Examples of the approached national associations
Profession European Association Examples of approached national associations (1 out of 28)
Medical doctors Standing committee of European Doctors (CPME)
Czech Medical Chamber
Physiotherapists World confederation for physical therapy (WCPT)
Swedish Association of Physiotherapists
Social workers International federation of
social workers
German professional
association for social work
Psychologists European Federation of psychologistsrsquo association (EFPA)
Croatian psychological association
Occupational therapists Council of occupational
therapists for the European Countries (COTEC)
Association of Bulgarian
Ergotherapists
Dietitians The European Federation of the associations of dieticians
(EFAD)
French Association of Nutritionist Dietitians
Dentists Council of European Dentists Irish dental association
Nurses European Federation of Nurses
Association (EFN)
Polish Nurse Association
Pharmacists Pharmaceutical group of European Union (PGEU)
Malta Chamber of Pharmacists
Recruitment of national educational organisations
Last the list of the selected associations was used to identify relevant national educational
organisations These national educational organisations (eg University of Maastricht
Faculty of Health Medicine and Life Sciences Kaunas University Medical School Lifestyle
Medicine University of Helsinki Faculty of Medicine) were approached individually and
asked to fill in the survey and spread it throughout their network
Table 33 Number of national educational organisations approached
Profession Number of approached national education organisations
Medical schools 298
Schools of physiotherapy 29
School of social work 31
School of dietitians 40
School of Occupational therapists 45
School of dentists 85
School of pharmacists 56
Response obtained
In total we received information on 176 educational practices till mid-February The
workshop organized in Luxembourg65 gave an additional boost and resulted in 32 more
practices reported in the survey In total this mapping exercise is based on information on
208 practices of health promotion in educational settings
65 Workshop ldquoPromoting lifestyle medicine competencies and education of health professionals in the EU todayrdquo
13th February 2020 Luxembourg Organized by Chafea and DG SANTE
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
26
312 Desk research
Desk research was conducted on both scientific and grey literature with the main purpose
to establish an overview of the competency profiles of health professionals in the field of
health promotion and disease prevention This overview was created to gain insight to what
extent competency profiles related to health promotion and disease prevention are covered
in the educational standards of different health professions in the EU We have made use
of reports published online and scientific articles on competency profiles or educational
standards set at EU level (eg European standards in medical training (UEMS) as the EU
Directives of the European Parliament and Council on the recognition of professional
qualifications have consolidated a system of mutual recognition between Member States3
When reports on EU level could not be identified we selected articles on global standards
such as for the profession of social work (ie global standards for the education and training
of the social work profession)
Based on the identified literature we have described the competency profiles for each of
the following healthcare professions
bull (undergraduate) Medicine
bull Medical specialists
- sports medicine specialists
- public health specialists
- internists
- cardiologists
- psychiatrists
- general practitioners
bull Dentists
bull Nurses
bull Nurse specialists
bull Occupational therapists
bull Pharmacists
bull Physiotherapists
bull Psychologists
bull Social workers
The selection of healthcare professions included in the desk research was made in
consultation with Chafea DG SANTE and the experts
The assessment of the competency profiles was based on the three Domains of Learning
KSAs as described in Chapter 2
bull Cognitive mental skills (knowledge)
bull Psychomotor manual or physical skills (skills)
bull Affective growth in feelings or emotional areas (attitude or self)
This method was chosen as especially ldquolack of confidence and knowledge and skills by
health professionals on providing effective counsellingrdquo was identified as a barrier for
prescribing and counselling on promoting physical activity in the healthcare sector66 In
Chapter 4 the results are described in detail
66 httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
27
32 Long list of good practices
From the survey results we have drawn a long list of good practices As agreed with Chafea
and DG SANTE these good practices were selected using the following four selection criteria
bull The programme contains a multidisciplinary approach
bull The education is mandatory (including an exam)
bull The education covers the following topics digitalisation in health eHealth and
digital health coaching
bull The expected outcome includes change in skills and or behaviour
Several variables were included in the longlist country name of the programme name of
the institute whether there is a focus on knowledge skills and behaviour the type of
professionals who are being trained the theories that are covered by the education (eg
human cognition and behaviour health behaviour change techniques communication skills
etc) education methods used year since the education is provided the time spend in the
modules in hours and lastly in case of one full module the duration of this module To
enable comparison between good practices based on different variables the preliminary
longlist can be found in a separate Excel document Chapter 5 includes an overview of the
coverage and content of the long list of good practices
After closing of the online survey we analysed the longlist of good practices along the
following research questions
bull What content items of health promotion disease prevention and lifestyle
counseling do programmes consist of
bull What kinds of learning aims do they have
bull How do they distribute in Friedens model of levels of health promotion
bull Are there differences between professional groups
First we analysed the distribution of the learning skills separately by the levels of education
(undergraduate postgraduate and CPD) We expected that adult learning will be more
directed towards skills (learning by doing) than the undergraduate and postgraduate
programmes Secondly we analysed the educational methods and tools used in the good
practices
Good practices can be submitted to the European Commissionrsquos Best Practice Portal to be
assessed by external evaluators against criteria adopted by the Steering Group on Health
Promotion Disease Prevention and Management of NCDs Practices rated as best against
these criteria will be published on the European Commissionrsquos Best Practice Portal67
67 httpswebgateeceuropaeudynabp-portal
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
28
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
29
4 MAPPING OF THE CURRENT SITUATION IN HEALTH PROMOTION TRAINING IN THE EU
41 Overview of educational programmes in the EU
411 Summary of the main findings in the survey
A high percentage (93) of respondents (n=197) indicated that health promotion and
disease prevention are implemented in their educational programmes or modules For
undergraduate education postgraduate education and CPD these percentages were 95
93 and 83 respectively Other results include
bull More than half of the respondents indicated that they filled in the questionnaire
based on undergraduate educational settings Throughout Europe these numbers
were relatively similar
bull Physiotherapists seem to be the professional group most actively involved in
health promotion training activities The vast majority applies multidisciplinary
approaches and thus bring other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within the undergraduate and postgraduate programmes In CPD on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion target knowledge skills and
attitudes of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for CPD (33) compared to
undergraduate and postgraduate education (15 and 6) when the topic is
covered in most modules Funding was more often obtained in Northern and
Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) With regard to full modules high percentages
indicated that these are mandatory and that there is an exam at the end of the
module (81 70 respectively)
412 Detailed results of the survey
Respondents
In the following section we provide a detailed description of the survey results The survey
targeted undergraduate education postgraduate education and CPD programmes in all
Member States Overall 208 respondents filled in the questionnaire about their educational
practice Note the results presented in the remainder of this report are exclusively based
on the answers respondents provided in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
30
Table 41 and Figure 41 provide an overview of the number of practices reported per
European countries A detailed overview of the educational programmes collected
throughout Europe can be found in Annex 1
Figure 41 Practices collected in the survey by European countries (n=208)
Table 41 Number of respondents per European Member State 2019-2020 (n=208)
Abbreviations EU Member State Number of respondents
AT Austria 12
BE Belgium 23
BG Bulgaria 4
CY Cyprus 1
CZ Czech Republic 7
DE Germany 1
DK Denmark 8
EE Estonia 2
ES Spain 22
FI Finland 6
FR France 15
GB United Kingdom 6
GR Greece 10
HR Croatia 0
HU Hungary 3
IE Ireland 8
IT Italy 10
LT Lithuania 1
LU Luxembourg 0
LV Latvia 5
MT Malta 6
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
31
Abbreviations EU Member State Number of respondents
NL Netherlands 2
PO Poland 0
PT Portugal 14
RO Romania 3
SE Sweden 4
SI Slovenia 14
SK Slovakia 2
Additional countries 19
TOT 208 the UK is included as a Member State in this study as the results were obtained before Brexit
For mapping purposes we made a breakdown of results by region ie Northern Europe
Eastern Southern and Western Europe (based on United Nations Regional Groups)
Furthermore we compare results of individual countries for which at least 10 practices have
been reported in the survey These are Austria Belgium France Greece Italy Portugal
Slovenia and Spain
Table 42 European countries per region
Region European countries
West Austria Belgium France Ireland Germany
Luxembourg Netherlands United Kingdom Switzerland
North Denmark Sweden Estonia Finland Lithuania Latvia Norway
East Bulgaria Czech Republic Hungary Romania Slovakia Poland Georgia Kazakhstan
South Italy Spain Cyprus Portugal Greece Malta Slovenia Croatia Bosnia Kosovo Serbia
Type of education
We asked the respondents to indicate the type of educational setting As shown in Figure
42 more than half of the practices (60) refer to undergraduate educational settings and
approximately one third to postgraduate educational settings Only twelve percent of the
reported educational settings is related to CPD
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
32
Figure 42 Practices by educational level (n=199 in percentages)
Figure 43 and Figure 44 show the distribution in type of education per region and on
country level respectively For Western Southern and Northern Europe distribution is in
line with the overall results In Eastern Europe practices reported are more evenly
distributed over undergraduate and postgraduate education Also the share of CPD
practices is high in comparison with other regions and overall results
Figure 43 Practices by type of education per region (n=204 in percentages)
64
42
62
60
29
37
27
30
7
21
12
10
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Undergraduate education Postgraduate education Continuous professional development
60
29
12
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
33
Figure 44 Practices by type of education per country (in percentages)
Type of health professions
An overview of the type of health professional trained in the educational practices is
provided in figure 45 Remarkably over one third (35) of the educational practices
reported are oriented to physical therapists Note that multiple answers could be provided
Figure 45 Type of health professional being trained (n=208 in percentages)
Medical specialists refer to doctors with an extra expertise in one type of medicine eg including sports
medicine public health internal medicine cardiology psychiatry and the general practitioner68 General
practitioners refers to doctors working within General Practice or Family Medicine (GPFM)69 Medical doctors refers
to doctors without any specialization
68 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 69 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
83
70
27
50
30
62
71
71
8
22
60
30
60
23
14
19
8
9
13
20
10
15
14
10
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Undergraduate education Postgraduate education Continuous professional development
116
15
35
1417
7 8 5
29
0
10
20
30
40
50
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
34
Health professionals involved as educators in health promotion and disease prevention are
shown in Figure 46 Physical therapists are most often active as teachers of health
promotion (36) which coincides with the high share of practices oriented to this
profession Some professions like medical specialists nurses and psychologists are
represented more often as teacher then as trainee of the educational practices This implies
they are involved in programmes oriented towards other health professions and is in line
with a multidisciplinary approach that is applied by the vast majority of practices ( 81
n=148)
Figure 46 Health professionals teaching contents of health promotion (n=90 in
percentages)
Methods of education
Survey results show that traditional methods ie lectures and assignments are most often
used (Figure 47) Assignment refers to home school projects such as writing papers In
CPD eLearning methods are more often used (67) compared to undergraduate (45)
and post graduate education (39) The use of field training is relatively similar for the
different levels of education
Figure 47 Teaching methods applied (n=145 in percentages)
8
27 26
36
14
24 23
6 7
37
0
10
20
30
40
50
97
81
74
46
0 10 20 30 40 50 60 70 80 90 100
Lectures
Assignments
Field training in real environments
eLearning modules
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
35
Knowledge skills and behaviour
As for the outcome of the education respectively 99 94 and 89 of all practices
indicate knowledge skills and behaviour as expected outcomes (Figure 48) There are no
significant differences between types of education
Figure 48 Knowledge skills and behaviour (n=142 in percentages)
Accreditation
Overall 39 of the educational practices is accredited on European or international level
53 is accredited at a national level and only 5 lacks accreditation (n=179) Comparing
the different levels of education the rate of accreditation at a European or nation level
varies At a European level these are 46 33 22 at the national level 47 58
67 for undergraduate education postgraduate education and CPD respectively
Throughout Europe the level of accreditation of education is high in Northern Eastern
Southern and Western countries the share of practices without accreditation is 11 0
5 and 3 respectively (n=197) Eastern European countries have regulated their
accreditation more often on a national level compared to the other countries
Theories covered
Figure 49 shows that health behaviour human cognition and behaviour and population
health are covered in most educational practices to a high or at least limited extent
99
0 1
94
4 2
89
6 4
0
20
40
60
80
100
Yes No Unknown Yes No Unknown Yes No Unknown
Knowledge Skills Behavior
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
36
Figure 49 Theories covered by the education (n=137 (in percentages)
Figure 410 provides a more detailed overview of contents covered in the educational
programmes and shows that communications skills ethics and methods of evidence-based
medicine are mostly covered within the education Contents least covered are digital health
coaching digitalisation health economics
Funding and partnerships
Figure 411 provides an overview of the practices that a) obtained targeted funding to
incorporate health promotion and disease prevention in the curriculum b) for which a
partnership is set up for execution of teaching activities on health promotion or c) built on
existing partnerships to incorporate health promotion in the curriculum of the whole
educational programme This overview only includes educational practices where health
promotion and disease is incorporated in most modules
Funding differed between level of education 15 6 and 33 of the undergraduate
education postgraduate education and CPD received targeted funding to incorporate health
promotion in the curriculum Hence funding seems to play a more important role for CPD
than for undergraduate and postgraduate education
66
54
65
31
42
32
1
1
2
3
1
0 20 40 60 80 100
Population health
Human cognition and behavior
Health behaviour
Yes very much Yes but limited No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
37
Figure 410 Theories that are included within education on health promotion (n=137 in percentages)
Figure 411 Funding and partnerships when health promotion is covered in most modules of the educational programme (n=123 in percentages)
Figure 412 provides a comparison of funding obtained by European region Remarkably
in Western Europe the share of practices with targeted funding to incorporate health
promotion is much lower than in the other EU regions
48
69
40
16
54
48
20
34
37
41
49
64
9
44
24
55
51
42
47
50
50
48
44
42
31
43
7
6
4
4
3
4
25
25
9
9
5
2
42
1
1
1
1
1
1
5
5
5
6
4
3
6
0 20 40 60 80 100
Epidemiology and bio-statistics (research capacity)
Methods of evidence-based medicine
Health policies and regulation
Health economics
Ethics
Health care systems
Digitalisation in health promotion
Health inequalities
Disease prevention in teams
Health literacy
Health behavior change techniques
Communication skills
Digital health coaching
Yes very much Yes but limited No Unknown
52
61
15
0 20 40 60 80 100
Partnerships in incorporating it in the curriculum of thewhole educational programme
Partnerships for execution of teaching activities
Funding to incorporate health promotion in curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
38
Figure 412 Funding to incorporate health promotion for programmes covering health promotion in most modules by region (n=119 in percentages)
Comparing individual countries figure 413 shows that funding is obtained for the
educational programmes reported in Slovenia Italy and France while this is not the case
or unknown in Portugal Belgium and Austria
Figure 413 Funding to incorporate health promotion when health promotion is covered in
most modules of the educational programme by country (n=71 in percentages)
Dedicated modules to health promotion
In a majority of practices (63) health promotion disease prevention and lifestyle
medicine are covered in all modules of the educational programme as opposed to coverage
in one module primarily dedicated to health promotion (37) Undergraduate and
postgraduate education show a similar pattern while in CPD programmes full modules
primarily dedicated to health promotion are relatively restricted namely 15 (Figure 414)
Both options have the potential to be effective depending on context implementation and
other factors The data gathered in this study do not allow any statement on effectiveness
of each option
20
12
21
3
80
82
70
85
6
9
13
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Yes No Unknown
13
29
0
9
30
89
100
38
71
40
100
73
70
11
50
18
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Yes No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
39
Figure 414 Share of practices with one full module primarily dedicated to health promotion
(n=140 in percentages)
Visibility of health promotion in CPD
In CPD health promotion is often integrated into disease-oriented or risk behaviour-
based contents making it harder to identify the subject in events available The
Union of European Medical Specialists (UEMS) has an electronic database for
accrediting continuous medical education This data set contains keywords Using
health promotion public health or lifestyle as keywords 37 educational events were
found in the years 2017-19 (Table 415) There were 6 events in year 2017 3 in
year 2018 and 8 in year 2019 Average number of credits (1 ECMEC equals 1 hour
maximum 6 per day) was 296 average length of events 45 days This illustrates
availability of international training on health promotion and public health for
medical professions In other events these themes may have been touched upon
as well but are not the main subject So there might be a need to make health
promotion more visible in CPD events Competency-based education could provide
a solution if health promotion disease prevention and lifestyle medicine are defined
as competencies
Table 415 CPD events with health promotion public health or lifestyle as keyword 2017-
2019 (n=37)70
Title ECMEC Year Location Website
Control of multidrug-
resistant micro-organisms in health care settings
20 2017 Stockholm
Sweden
httpwwwecdceuropaeu
Epidemiology and public health microbiology for facilitators
30 2017 Spetses Greece
httpwwwecdceuropaeu
Fellowship (EPIET amp EUPHEM) introductory course
86 2017 Spetses Greece
httpwwwecdceuropaeu
International Society for Quality in Health Care 34th International Conference
23 2017 London United Kingdom
httpisquaorgEventslondon-2017
DOHaD 2017 10th World Congress DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE
25 2017 Rotterdam Netherlands
httpwwwdohad2017org
70 Source UEMS database of accredited events 2017-2019
4035
150
20
40
60
80
100
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
40
Title ECMEC Year Location Website
10th European Public Health Conference
23 2017 Stockholm Sweden
httpsephconferenceeu
Methods and tools for evidence-based practice
and decision-making in Public Health with special emphasis on communicable disease
22 2018 Stockholm Sweden
httpwwwecdceuropaeu
ESCMID Workshop on
Migrants Health
15 2018 Muscat
Oman
httpsescmidpulselinksco
mevent14833
Control of multidrug-resistant micro-organisms in health care settings
17 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventscourse-control-multidrug-resistant-micro-organisms-mdros-health-
care-settings
ECDC Summer School 2018 23 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventsecdc-summer-school-2018
3rd International Conference of the European Network for Smoking and Tobacco Prevention
15 2018 Madrid Spain
httpsenspconferenceorg
European Observatory Venice Summer School 2018
25 2018 San Servolo Italy
wwwtheobservatorysummerschoolorg
Letrsquos talk about nutrition (NESG)
4 2018 Madrid Spain
httpespencongresscomprogrammelll-courses
Epidemiology and public health microbiology for
facilitators
28 2018 Spetses Greece
httpsecdceuropaeuenepiet-euphemaboutintro
International Society for
Quality in Health Care 35th International Conference
22 2018 Kuala
Lumpur Malaysia
httpsisquaorgEventsmal
aysia-2018
Fellowship (EPIET amp EUPHEM) introductory course
93 2018 Spetses Greece
wwwecdceuropaeu
EGEA 2018 ndash ldquoNutrition and health from science to practicerdquo
16 2018 Lyon France httpswwwegeaconferencecom
1st EUROPEAN LIFESTYLE MEDICINE CONGRESS
13 2018 Geneva Switzerland
wwwelmocongresscom
11th European Public Health Conference
24 2018 Ljubljana Slovenia
wwwephconferenceeu
Fellowship Multivariable
Analysis
25 2019 Madrid
Spain
Rapid Assessment and Survey methods (RAS)
module
35 2019 Zagreb Croatia
ECDC Summer School 2019 28 2019 Stockholm Sweden
httpswwwecdceuropaeuennews-eventsecdc-summer-school-2019
Fellowship Vaccinology Module
29 2019 Rome Italy
Programme Planning and Implementationrdquo Training Program for Resolve to
Prevent Epidemics Initiative
39 2019 Butaro Rwanda
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
41
Title ECMEC Year Location Website
Skill-mix innovation in primary and chronic care mobilizing the health workforce
28 2019 Venice Italy wwwtheobservatorysummerschoolorg
Evolutionary Medicine Conference 2019 5th international meeting of the International Society for Evolution Medicine and Public Health
15 2019 Zurich Switzerland
httpsisemphorg2019-Meeting
Fellowship (EPIET amp EUPHEM) introductory course
85 2019 Spetses Greece
Project Management for Emergency Preparedness Budget and Finance Management
20 2019 Butaro Rwanda
Autumn School on Medical
Education
19 2019 Chernivtsi
Ukraine
httpswwwfacebookcome
vents531981117209981
Project Management for Emergency Preparedness Practical Leadership Skills
24 2019 Butaro Rwanda
International Society for Quality in Health Care 36th International Conference Cape Town 20102019 - 23102019
18 2019 Cape Town South Africa
httpswwwisquaorgeventscp2019html
Public Health Genomics an
introduction
11 2019 Stockholm
Sweden
httpsecdceuropaeuenne
ws-eventspublic-health-genomics-introduction
ENSP Tobacco treatment
specialistsrsquo training
5 2019 Paris France httpenspnetwork
World Health Summit 2019 16 2019 Berlin Germany
wwwworldhealthsummitorg
Time Series Analysis 28 2019 Bilthoven
Netherlands
httpsecdceuropaeuenep
iet-euphemaboutexperience
12th European Public Health Conference
16 2019 Marseille France
wwwephconferenceeu
Outbreak Investigation Module
30 2019 Nicosia Cyprus
httpswwwecdceuropaeuenepiet-euphemaboutexperience
Source UEMS database of accredited events 2017-2019
Looking at the regional level we found that in most regions a majority of practices cover
the topic in all (or most) modules of the educational programme (Figure 416) In Northern
Europe this is most pronounced with as much as 76 of the practices reported covering
health promotion in all modules whereas in Eastern Europe this applies for 55 of
practices A similar analysis for individual countries shows that only in Spain health
promotion is covered in a dedicated module in the majority (62) of educational practices
reported while in all other countries the topic is mostly covered in all (or most) modules of
the programme Percentages vary from 56 (Austria) to 86 (Greece Figure 417)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
42
Figure 416 How is health promotion implemented in education by region (n=148 in percentages)
Figure 417 How is health promotion implemented in education by country (n=120 in
percentages)
55 participants answered specific questions on the full module dedicated to health
promotion 81 of them indicated that the education is mandatory As figure 418 shows
in Northern and Eastern Europe all dedicated module on health promotion form part of
mandatory education In Western Europe one out of three modules is optional for students
24
4537
42
76
5563
58
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
4439
36
14
22
38
18
6256
6164
86
78
63
82
38
0
20
40
60
80
100
Austria Belgium France Greece Italy Portugal Slovenia Spain
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
43
Figure 418 Full modules on health promotion that are part of mandatory education by region (n=47 in percentages)
An exam is taken at the end of the module in 70 of the cases Between regions
percentages do not differ much (Figure 419) Please note that results are based on a
limited number of practices as response for this question was low
Figure 419 Exam at the end of dedicated module by region (n=47 in percentages)
When asked whether the module on health promotion and disease prevention was
accredited separately 15 indicate that this is the case 30 report that the module is
provided at multiple locations
Figure 420 provides an overview of respondents who indicate that funding was obtained
to set up the module as well as the use of partnerships for implementation of teaching
activities on health promotion or in setting up the module Lastly it was indicated that
mostly lsquootherrsquo professionals are teaching these modules
100 100
82
67
12
22
611
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
Yes No Unknown
2518
2225
12 11
75 7571
67
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
No Unknown Yes
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
44
Figure 420 Funding and partnerships for dedicated modules (n=47 in percentages)
42 Overview of competency profiles of health professionals in the EU
A detailed description of the competency profiles per healthcare profession as obtained
from the desk research can be found in Annex 2 Competency profiles per professions
These profiles provide a solid basis for health promotion and disease prevention
Most competency profiles mention health promotion andor disease prevention Overall
the competencies of medical specialists are most comprehensively described including the
competencies for health promotion Although there are many similarities between the
different competency profiles we have identified differences in the coverage of domains of
learning ie knowledge skills and attitudes (see chapter 23) Knowledge refers to
cognitive or mental competencies skills to competencies to perform tasks or activities and
attitudes to competencies related to beliefs or values An example of an attitude
competency is ldquoexemplify appropriate lifestyle in personal behaviourrdquo In professions that
are less physically oriented emphasis is on knowledge and attitude rather than on skills
related to health promotiondisease prevention This mainly holds for psychiatry and social
workers For professions in which lifestyle is an essential component ie sports medicine
and public health emphasis is on skills rather than attitudesOnly for cardiology nurses
nurse specialists and pharmacists competency profiles describe competences in all
domains of learning ieknowledge skills and attitudes
Many competency profiles leave room for interpretation and competencies described are
not ranked in order of importance In addition profiles do not state whether competencies
should be practised in a pro-active (within every treatment) or reactive way (only when
treating diseases with a clear lifestyle component
43
53
11
0 20 40 60 80 100
Partnerships in setting up module
Partnerships for execution of teachingactivities
Funding to set up module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
45
5 LONG LIST OF GOOD PRACTICES
In this chapter we present the coverage and content of the long list of good practices The
list is also available in an Excel-file that provides the opportunity to easily make selections
by different variables such as country type of programme (undergraduate postgraduate
CPD) or the characteristics of the education programme
We also provide an analysis of content areas covered and their weight in educational
programmes learning objectives learning typology and educational methodology using
Kraigerrsquos typology and Friedenrsquos pyramid as analytical tools
51 Results
From the survey results we have drawn a long list of good practices In agreement with
Chafea and DG SANTE good practices were selected based on four criteria
1 The programme contains a multidisciplinary approach
2 The education is mandatory (including an exam)
3 The education covers the following topics digitalisation in health eHealth and digital
health coaching
4 The expected outcome includes change in skills andor behaviour
This resulted in a long list of 70 good practices that meet all criteria Educational practices
cover all regions of Europe and originate from 20 Member States (Figure 51 and Table
51)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
46
Figure 51 Number of good practices selected for long list by country 2019-2020
Table 51 Number of good practices selected based on the four selection criteria per European Member State 2019-2020
Abbreviations EU Member State Number of good
practices
AT Austria 6
BE Belgium 11
BG Bulgaria 2
CY Cyprus 1
CZ Czech Republic 2
DE Germany 0
DK Denmark 5
EE Estonia 1
ES Spain 7
FI Finland 2
FR France 6
GR Greece 7
HR Croatia 0
HU Hungary 1
IE Ireland 3
IT Italy 2
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
47
Abbreviations EU Member State Number of good practices
LT Lithuania 1
LU Luxembourg 0
LV Latvia 1
MT Malta 0
NL Netherlands 0
PO Poland 0
PT Portugal 2
RO Romania 1
SE Sweden 2
SI Slovenia 7
SK Slovakia 0
TOT 70
Of all selected good practices of healthcare educational programmes 16 practices (23)
cover health promotion and disease prevention in one full module primarily dedicated to
the subject In 54 good practices (77) the educational programmes incorporate the topic
of health promotion and disease prevention in all or most modules (Figure 52)
Figure 52 How is health promotion covered in selected good practices (n=70 in percentages)
When dividing good practices by type of education programme we see that all types
educational programmes are represented (Figure 53) The highest share of good practices
is focused on undergraduate education (60 n=42) Two practices are focused on both
undergraduate and postgraduate education
Figure 53 Type of education () represented by selected good practices (n=70)
77 23
All modules One module
6026
113
Undergraduate education
Post graduate education
Continuous professionaldevelopment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
48
Figure 54 presents the absolute number of selected good practices by type of profession
trained The absolute number sums up till 128 as multiple professions can be trained within
one programme This shows a good variation of health professionals Most good practices
focus on nurses (17 n=22) and medical doctors (13 n=17)
Figure 54 Good practices by profession being trained (n=70 in absolute numbers)
In addition to those described above other variables are included in the separate Excel file
mentioned above These include the name of the programme and the institute focus on
knowledge skills and behaviour type of professionals being trained theories covered in
the education (eg human cognition and behaviour health behaviour change techniques
communication skills etc) education methods used when the education started time
spent on the modules in study hours (ECDEC) and in case of one full module the duration
of this module This Excel file allows to make cross comparisons between different variables
52 Analysis of good practices
In this section good practices are analysed more in detail Figure 55 presents the
distribution of content areas in health promotion and their weight in educational
programmes Methodological training like evidence-based methods (EBM) varies in
programmes but has a strong position Lifestyle intervention skills are widely taught
however new technologies are still on their way in becoming part of health promotion
education Interestingly health economics rate less in these practices in spite of its close
link with health promotion as part of public health policies
30
4
4
11
17
15
15
22
10
Other
Social workers
Dentists
Occupational therapists
Medical doctors
Medical specialists
Psychologists
Nurses
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
49
Figure 55 Results for good practices(n=70) ldquoDoes the education of the initiative includerdquo
Numbers refer to Frieden model in levels of health promotion with exception of methodological contents marked
as tools (1) counselling and education (2) clinical interventions (4) changing the context to make individualrsquos
default decisions healthy (5) socioeconomic factors (6) methods in studying and evaluating health promotion
and public health
We used Friedenrsquos pyramid of levels of health promotion (Frieden 2010) and Kraigerrsquos
typology of learning (Kraiger et al 1993) to describe the abilities that professionals are
expected to acquire Based on their description learning objectives move in a knowledge
level skill building or into attitudinal objectives Figure 56 gives a graphical visualization
of the results of our analysis The dark blue green and light blue rectangles represent the
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
50
Figure 56 Learning objectives categorised into Friedenrsquos levels and learning typology
(knowledge skills attitudes) of good practices (n=70)
different domains of learning knowledge skills and attitudes The size of the rectangles is
proportional to their share in all domains in the educational practice
Within each domain of learning contents are categorized Their vertical order reflects the
order of impact levels of Frieden (from individual patient to society level) and again size
corresponds to share in the curriculums content
This analysis provides a general picture of educational practices in health promotion
disease prevention and lifestyle medicine The graph shows that practices are
predominantly oriented towards knowledge-based competencies (around 60 of the
curriculum) Roughly one third of the programme has skills-oriented learning objectives
while competencies regarding attitudes are addressed in around 10 percent of the
programmersquos content
Looking into knowledge-based competencies the broad spectrum of individual to societal
levels of impact is addressed On a societal level social and medical aspects are widely
represented while the economic angle is scarcely present Technological developments like
digitalisation are present to a modest extent
Skill-oriented learning objectives focus in communicative competences like communication
skills behaviour change techniques and teamwork Health coaching is covered in a small
number of practices Interestingly in methodological contents the aim of skills-oriented
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
51
education is to provide mainly knowledge like in EBM Few practices include practical skills
for communication and coaching in their objectives
Competence-building in the domain of attitudes form a minimal part of educational
practices They are reflected in eg health literacy and ethics However these are also
taught in a hidden curriculum as well
Educational methodologies in the survey include lectures assignments e-Learning and
real-world field assignments As these are the selected good practices it was to be expected
that multiple methods are used in most of these programmes (given selection criterium 3)
In 37 programmes all methods are in use E-Learning is used in 41 programmes
Figure 57 Educational methods used in good practices (n=70 in percentages) ()
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
53
6 CONCLUSIONS
The competency profiles as well as information on a large number of educational practices
in health promotion disease prevention and lifestyle medicine for health professionals in
the EU allow us to formulate answers to the research questions that guided this study
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and
continuous professional education
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades71there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional The educational practices collected show that this is true for all
regions of the EU However there is no overall body that has responsibility for quality
assuring standards of training and professional practice at the European level
The information on around 200 practices from 25 EU Member States (including UK) shows
that the majority of educational practices take place in undergraduate settings while
training events on health promotion for health professionals active in the field are relatively
scarce in continuous professional development (CPD) a limited number of practices on
health promotion are reported and indeed few courses or training events on health
promotion are available in the CPD calendar of the UEMS database of accredited events
Education on health promotion aims at developing competencies in knowledge skills and
attitude and most often has a multidisciplinary character Especially medical doctors nurses
and psychologists are often involved in educating other disciplines on health promotion
Health behaviour human cognition and behaviour as well as population health are part of
educational practices for all professions A majority also include communication skills
methods of EBM and ethics
The most common way to teach health professionals on health promotion disease
prevention and lifestyle medicine is the integration of the subject in most of all modules of
the curriculum Dedicated modules on health promotion are developed in undergraduate
and postgraduate education but are scarce in CPD This may contribute to the invisibility of
the subject in training for professionals active in the field
Four out of ten educational practices on health promotion are accredited on the European
(or international) level half of them have national accreditation
71 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
54
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Based on in-depth analysis of a selection of 70 good practices knowledge proves to be the
predominant domain of learning Theories covered relate to different levels of impact of
Friedenrsquos pyramid but emphasis is on the individual patient level with a predominant
position for evidence-based medicine Health economics receive remarkably little attention
This may be disadvantageous for advocacy of health promotion which requires influencing
decision-making on public funding
Around one third of educational contents are dedicated to competencies in the domain of
skills and mainly target communicative skills Interestingly they provide mainly knowledge
rather than practical training Competencies in the domain of attitude are addressed least
Ethics and health literacy are theories are the most common examples of attitude-oriented
contents When looking at the competencies defined by health professionals advocacy has
a solid role in all of them with defined skills It was represented in only few domains like
health economics so it may well be that educating advocacy skills are more common than
found in this study
Good practices use a mix of educational methods including lectures assignments real-
world practices and digital study methods
In conclusion this study is a first step in gaining knowledge and insights in the state of
affairs of health professionalsrsquo education in health promotion disease prevention and
lifestyle medicine in the EU It is an important step as we know little about present
practices However more detailed research will obviously be needed
The results of our in-depth analysis of good practices provide qualitative information We
used the integrated framework as an analytical tool to classify content areas covered and
their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future The information supplied by the
respondents show the culture of describing health promotion and education objectives
Therefore no lsquohardrsquo conclusions can be drawn However some cautious notions are
worthwhile to mention as they flag opportunities for learning and improving by collaborative
action
First it is worthwhile to stress the progress made While 20 years ago health professionals
were hardly trained in health promotion and lifestyle medicine and at best received some
instruction on specific disease-related unhealthy habits (like smoking for lung diseases) it
is now part of standard education for most health professionals That is an important
development and essential for collaboration across professions
However more can be done Health promotion education should respond to societyrsquos needs
and therefore educational needs are constantly changing and providers of education need
to follow needs in the field Increasing recognition of societal impact on health inequalities
the paradigm shift from treating to coaching patients changes in the way care is delivered
the digital revolution and the need to contain the cost of our healthcare systems represent
a multitude of challenges and relentless educational efforts in health promotion disease
prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
55
To name a few the balance between domains of learning in curricula will have to redefined
as in health coaching skills attitudes and knowledge are equally important Health
professionals will have to manage health economics to speak the language of policy makers
Teaching methodologies have gained from the technological revolution and there is
potential in utilising them even more Also there is a necessity to do so in order to provide
for effective health promotion Health literacy has got alongside data literacy Therefore
education needs to respond to in using more technologies as well as teaching adaptation of
technologies into care This is not common practice yet The constant development in needs
also stresses the need for continuous professional development in health promotion
disease prevention and lifestyle medicine To date CPD seems to be underrepresented in
educational practices on health promotion and more heavily dependent on external funding
than in undergraduate and postgraduate courses
The experience developed in the good practices collected in the survey represents a
valuable body of knowledge skills and attitudes among health educators With collaborative
efforts this can serve as an important capital to promote continuous development and
improvement of educational practices in health promotion disease prevention and lifestyle
medicine in all European countries
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
57
ANNEX 1 SURVEY RESULTS BY COUNTRY
In this annex we provide the names of all educational programmes by country filled in in
the survey In addition the following variables of the educational programmes are
provided the name of the educational institution type of education and type of health
professionals being trained This information is based on the information provided by the
respondents from each country If certain boxes are not filled in this means that only
partial information of this educational programme is provided
Austria
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Bachelorstudiengang Physiotherapie
FH JOANEUM GmbH Undergraduate education
Physical therapists
Dietetics Health University of
Applied Sciences
Undergraduate
education
Dieticians
Physiotherapy University of Applied Sciences St Polten
Undergraduate education
Physical therapists
Bachelorrsquos Degree Programme Physiotherapy
FH Campus Wien Undergraduate education
Physical therapists
Dietetics and Nutrition FH Joanneum Undergraduate education
Medical Doctors Non-specialized dietitians
Bachelor Programme Physiotherapy
University of Applied Sciences Upper Austria
Undergraduate education
Physical therapists
Degree Programme Dietetics
(Bachelor of Science)
University of Applied
Sciences Upper Austria
Undergraduate
education
Dietitians
Midwifes Speak and language therapists Biomedical scientists Radiological
technologists Physical therapists Occupational therapists Nurses
Bachelor in Health Studies
Physiotherapy
FH Kaernten Undergraduate
education
Physical therapists
Nursing Science Medical University of Graz
Postgraduate education
Nurses
Public Health Medical University of Vienna
Continuous professional development
Medical doctors
Belgium
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Drug Development KU Leuven Undergraduate education
Pharmacists
Bachelor and master Rehabilitation Sciences and
Physiotherapy
University of Antwerp Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
58
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Motor Sciences Physiotherapy
Universiteacute Libre de Bruxelles
Undergraduate education
Physical therapists
Nutrition amp Dietetics Thomas More University College
Undergraduate education
Dietitians
Adad Adad Undergraduate education
Physical therapists
Master Physiotherapy and
Rehabilitation Science
KU Leuven Postgraduate
education
Physical
therapists
Occupational therapist HE Vinci Parnasse ISEI Undergraduate education
Occupational therapists
Master in Physical therapy and Rehabilitation
Universiteacute Libre de Bruxelles
Postgraduate education
Physical therapists
Master in Physical therapy Universiteacute Libre de Bruxelles
Postgraduate education
Medical specialists Physical
therapists (Sport medicine)
Nutrition and dietetics Thomas More University College
Continuous professional
education
Medical doctors Dieticians
psychologists
Information not provided Information not provided
Undergraduate education
Pharmacists
The European Certificate in
Lifestyle Medicine
The European Lifestyle
medicine organisation (ELMO) together with the Belgian Lifestyle
Medicine Organisation (BELMO)
Continuous
professional education
Medical doctors
Medical specialists (lifestyle
medicine) Physical therapists
Occupational therapists Nurses Psychologists General practitioners
Nutrition and Dietetics Erasmus Hogeschool Brussels
Undergraduate education
Dieticians
Master in Nursing and Midwifery
University of Antwerp Postgraduate education
Nurses
Bachelor amp Master Rehabilitation Sciences amp
Physiotherapy
KU Leuven Undergraduate education
Physical therapists
Bachelor Nursing University of Applied
Sciences Gent HOGENT
Undergraduate
education
Nurses
Professional Bachelor in Nutrition and Dietetics
University colleges Leuven Limburg
Undergraduate education
Dieticians
Nutrition and Dietetics University College Ghent
Undergraduate education
Dieticians
Bachelor in Applied Health Science
Howest University College
Undergraduate education
Lifestyle coaches
Physiotherapist Universiteacute Libre de Bruxelles
Postgraduate education
Osteopathy Physical therapists
Bachelor in Medicine Hasselt University Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
59
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor of Nutrition and Dietetics
University of Applied Sciences of Gent
Undergraduate education
Dieticians
Bulgaria
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor programme in Social Work
Plovdiv University Department of Social work
Undergraduate education
Social workers
Rhinology Bulgarian Rhinologic
Society
Postgraduate
education
ENT doctors
Kinesitherapy Medical University Undergraduate education
Physical therapists
TRS rehabilitator Medical College Medical University
Continuous professional
education
Medical specialists
Cyprus
Name of educational
programme
Name of
educational
institution
Type of
education
Type of
health
professionals
being trained
Physiotherapy
programme
Nicosia University Undergraduate
education
Physical
therapists
Czech Republic
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy Universities Undergraduate education
Physical therapists
Physiotherapy Charles University first
faculty of Medicine
Undergraduate
education
Physical
therapists
Physiotherapy Faculty of Medicine Masaryk University Brno
Undergraduate education
Physical therapists
Physiotherapy Palackyacute University Faculty of Physical Culture Department of Physiotherapy
Postgraduate education
Physical therapists
General Nursing Masaryk University Undergraduate education
Nurses
Prakticky zubni lekar (Practical Dentist)
Czech Dental Chamber Continuous professional education
Medical specialists
Health Promotion Ministry of Health Czech Republic
Continuous professional education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
60
Denmark
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Musculoskeletal physiotherapy
Aalborg University Postgraduate education
Physical therapists
Master in Physiotherapy University of Southern Denmark
Postgraduate education
Physical therapists
The Fairstart Foundation The Fairstart Foundation
Continuous professional education
Orphanage staff (each orphanage has
professional staff such as psychologists social workers
andor therapists
These staff members are responsible to work with each child on an individual basis) School
teachers Psychologists Social workers
Bachelor in Physiotherapy University College North Denmark
Undergraduate education
Occupational therapists
Nurses
Bachelorrsquos degree Programme of Physiotherapy
VIA University college Postgraduate education
Physical therapists
Master of Public Health Aalborg University Undergraduate education
Midwives Nurses Therapists Psychologists Medical Specialists
Estonia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Nursing (general nursing) Tartu Health Care College
Undergraduate education
Nurses
Psychology University of Tarty Institute of Psychology
Undergraduate education
Psychologists
Finland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
NutritionNutrition therapy University of Eastern Finland
Postgraduate education
Clinical nutriontinists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
61
Masterrsquos programme of Human Nutrition and food-related behaviour
University of Helsinki Undergraduate education
Nutrition experts who work in eg community
health promotion
Master of Healthcare advanced practice ndash supporting self-care and
care of non-communicable diseases
Savonia University of Applied Sciences
Postgraduate education
Physical therapists Occupational
therapists Nurses
Public Health Nursing Metropolia University of Applied Sciences
Postgraduate education
Public Health nurse
Medical doctors training programme
University of Helsinki medical faculty
Undergraduate education
Medical doctors Nursing
Master degree in Health Management Psychologists
Dentists
Dental education University of Helsinki Faculty of Medicine Department of Oral and Maxillofacial Diseases
Undergraduate education
Dentists
France
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Occupational therapy school Croix Rouge Franccediloise Postgraduate education
Occupational therapists
Institut Reacutegional de Formation en Ergotheacuterapie
Association Saint Franccedilois dAssise
Postgraduate education
Occupational therapists
Occupational therapy Institut de formation en Ergotheacuterapie de Berck-sur-Mer site de Loos
Postgraduate education
Occupational therapists
Occupational therapy IFE Assas Undergraduate education
Occupational therapists
Arrecircteacute du 5 juillet 2010
relatif au diplocircme drsquoEacutetat drsquoergotheacuterapeute
Institut de Formation
en Ergotheacuterapie du CHU Rouen Normandie
Undergraduate
education
Occupational
therapists
Occupational therapy school Croix Rouge Francaise Postgraduate education
Occupational therapists
Occupational therapy UPEC Postgraduate
education
Occupational
therapists
Diplocircme de Dieacuteteacuteticien IUT biologie ou BTS dieacuteteacutetique
Postgraduate education
Dietitians
Programme deacuteducation et de promotion agrave la santeacute
CoDEPS 13 Continuous professional education
Nurses Psychologists Dentists Social workers
Public health Universiteacute de Bourgogne
Postgraduate education
Medical doctors
Public health Lyon University Undergraduate education
Medical specialists
Public health residency Faculty of medicine University of Nantes
Undergraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
62
Name of educational programme
Name of educational institution
Type of education
Type of health professionals being trained
Master in Public Health Karolinska Institute Postgraduate education
Occupational therapists Social Workers
Public health and social
medicine
Universiteacute Versailles
Saint Quentin en Yveline
Continuous
professional education
Medical doctors
Public health UFR sciences de santeacute - Universiteacute de Bourgogne
Postgraduate education
Medical doctors Medical specialists
Midwives Physical therapists
Nurses General practitioners
Germany
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Visceral Surgery Augsburg University Continuous professional education
Medical specialist Physical therapists
Occupational therapists
Nurses Social workers
Human Medicine ndash The
cologne model study course (human medicine)
University of Cologne
Medical faculty
Undergraduate
education
Medical
specialists
Greece
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy University of Thessaly Undergraduate education
Physical therapists
Oral education programme
for children via experiential learning
Hellenic Dental
Association-Dental School of Athens-Hellenic Society of Paediatric Dentistry
Continuous
professional education
Psychologists
Dentists
Sports Nutrition International Hellenic University
Postgraduate education
Dieticians
Preventive Dentistry National and
kapodistrian University of Athens school of dentistry
Undergraduate
education
Undergraduate
students
Nutrition amp Dietetics International Hellenic University
Postgraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
63
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicine ndash under and post graduate studies
School of health sciences University of Patras
Undergraduate education
Medical doctors
Pharmacy diploma Aristotle University of
Thessaloniki
Undergraduate
education
Pharmacists
Hungary
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Public Health and Preventive
Medicine
Semmelweis University
Budapest Faculty of
Medicine Department of Public Health
Undergraduate
education
Medical doctors
Academic programme of Medicine
Semmelweis University Faculty of Medicine
Undergraduate education
Medical doctors
Residency in Preventive Medicine and Public Health
Semmelweis University Postgraduate education
Medical specialists
Ireland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Social Science in
Social Work
Maynooth University
(national University of Ireland Maynooth)
Postgraduate
education
Social workers
Information not provided Information not provided
Undergraduate education
Physical therapists
Professional Master of Physiotherapy
University College Dublin
Postgraduate education
Physical therapists
Bachelor Physiotherapy University College Dublin
Undergraduate education
Physical therapists
Bachelor Physiotherapy RCSI Undergraduate education
Physical therapists
Irish Dental Association Irish dental association Continuous professional
development
Dentists
Public Health Medicine Royal College of Physicians in Ireland
Postgraduate education
Medical specialists
Higher specialist training in Public Health Medicine
Royal College of Physicians in Ireland
Postgraduate education
Medical doctors Medical specialists General practitioners
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
64
Italy
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Healthy Lifestyles CNAI ndash Italian Nurses association
Continuous professional education
Nurses
Management for Health Professionals
University of Rome Postgraduate education
Midwifes Physical therapists Nurses
Corso di laurea in Terapia occupazionale (Bachelor in Occupational therapy)
Universitagrave degli Studi di Milano (State University of Milan)
Undergraduate education
Occupational therapists
Life Sciences University of Catania
School of Medicine
Continuous
professional
education
Medical doctors
Medical
specialists Physical therapists Occupational therapists Nurses
Dentists
Health promotion University of pavia Undergraduate education
Nurses
Corso di Laurea Magistrale
in Odontoiatria e Protesi Dentaria
Universitagrave di Parma Undergraduate
education
Dentists
Hygiene preventive medicine and public health
Universitagrave Cattolica del Sacro Cuore
Postgraduate education
Medical doctors Medical
specialists
general practicioners
Igiene e Medicina Preventiva Universitagrave degli Studi dellrsquoAquila
Postgraduate education
Medical doctors non-specialized
Post graduate school of Public Health
University of Sienna Postgraduate education
Medical doctors
Hygiene and Public Health University of Bari Aldo Moro
Postgraduate education
Medical doctors
School of specialization in Hygiene and Preventive Medicine
University of Milan Postgraduate education
Medical doctors
Lithuania
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Health Education and Promotion
Klaipeda State University of Applied sciences
Undergraduate education
Dietitians Physical therapists Nurses Dentists Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
65
Latvia
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Dentistry Riga Stradins University Undergraduate education
Dentists General practicioners
Professional Bachelor programme Physiotherapy
LASE Postgraduate education
Physical therapists
Physiotherapy Riga Stradins University Undergraduate education
Physical therapists
Malta
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Bachelor in Nursing Studies University of Malta Faculty of Health Sciences department of Nursing
Undergraduate education
Nurses
FHs University of Malta Undergraduate education
General practitioners
Netherlands
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Occupational Therapy Information not provided
Undergraduate education
Occupational therapists
Lifestyle and Healthcare Amsterdam University Medical Centre
Undergraduate education
Medical students
Portugal
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
PhD in Social Work ISCTE University Institute of Lisbon
Postgraduate education
Social workers
Bachelor degree in
Physiotherapy
Escola Superior de
Sauacutede de Santa Maria
Undergraduate
education
Physical
therapists
Physiotherapy IPC ESTeSC Coimbra Health school
Undergraduate education
Physical therapists
Licenciatura em Fisioterapia Escola Superior de Sauacutede - Instituto Politeacutecnico do Porto
Undergraduate education
Physical therapists
Degree in Physical therapy Instituto Piaget ndash Vila Nova de Gaia
Undergraduate education
Physical therapists
Degree in Physical therapy ESSATLA Continuous professional development
Physical therapists
Curso Licenciatura em Fisioterapia
Instituto Politeacutecnico de Sauacutede do Norte Escola Superior de Sauacutede do Vale do Ave CESPU
Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
66
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Clinical Education University Fernando Pessoa- Faculty of Health Sciences
Continuous professional development
Workers factory
Physiotherapy (Bachelor) School of healthy-
polytechnic institute of Setubal
Undergraduate
education
Physical
therapists
Physiotherapy Escola Superior De Sauacutede Do Vale Do Sousa do Instituto
Politeacutecnico De Sauacutede Do Norte
Undergraduate education
Physical therapists Nurses
Psychologists Dentists
Public Health ARSLVT Postgraduate
education
Medical
specialists
Information not provided Information not provided
Postgraduate education
Physical therapists
Information not provided Information not provided
Undergraduate education
General practicioners
Romania
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Nursing Education University Lucian Blaga Postgraduate education
Nurses
MedicinePharmacy - Health University of Oradea Faculty of medicine and
pharmacy Oradea
Postgraduation education
Medical doctors Medical
specialists Pharmacists Physical therapists Nurses
Dentists General practicioners
Slovakia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Social Work Constantine the philosopher University in Nitra
Postgraduate education
Social workers
Specialisation study in Clinical Psychology
Comenius University in Bratislava Faculty of
Arts
Continuous professional
development
Medical specialists
psychologists
Slovenia
Name of educational
programme
Name of educational
institution
Type of
education
Type of health
professionals being trained
Physiotherapy Alma Mater Europaea Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
67
Physiotherapy University of Novo mesto Faculty of Health sciences
Undergraduate education
Physical therapists
Faculty of health sciences University of Primorska Continuous professional education
Dietetics Physical therapists Occupational therapists Nurses
Nursing Applied Kinesiology Physiotherapy and Nutritional counselling ndash dietetics
University of Primorska Faculty of Health Sciences Slovenia
Undergraduate education
Nutrional counselling Kinesiologists Physical therapists Nurses
Professional higher education study programme 1st cycle degree occupational
therapy
University of Ljubljana faculty of health sciences
Undergraduate education
Occupational therapists
Applied Kinesiology UP FVZ Undergraduate
education
Kinesiology
Physiotherapy Alma mater Europaea ndash Evropski center Maribor
Undergraduate education
Physical therapists
Bachelor in Physiotherapy University of Ljubliana Faculty of health sciences
Undergraduate education
Physical therapists
Health Promotion Angela Boskin Faculty of healthcare
Postgraduate education
Physical therapists Occupational
therapists nurses
1st Bologna cycle study programme Physiotherapy
Angela Boskin Faculty of healthcare
Undergraduate education
Physical therapists
Public Health Medical
Residency
Medical chamber of
Slovenia
Continuous
professional development
Medical doctors
Public Health National institute of public health of the
Republic of Slovenia
Postgraduate education
Medical doctors
Psychology Faculty of arts University of Maribor
Postgraduate education
Psychologists
Spain
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Human Nutrition and Dietetics
University of Zaragoza Undergraduate education
Dieticians
Continuous professional
education
Nurses
Physiotherapy University of Coruna Undergraduate education
Physical therapists
EHEA Degree in Human Nutrition and Dietetics
Blanquerna School of Health Sciences ndash Universitad Ramon Lull
Undergraduate education
Dietitians
Bachelor in Pharmacy Universidad de Sevilla Undergraduate
education
Pharmacists
Continuous professional development
Spanish General Council of Social Work
Continuous professional education
Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
68
Bachelor in Pharmacy Universidad de Alcala Undergraduate education
Pharmacists
Bachelor in Medicine Faculty of medicine University of Cadiz Spain
Undergraduate education
Medical doctors General practitioners
Residency in Preventive Medicine and Public Health
Hospital Clinic de Barcelona
Postgraduate education
Nurses
Bachelor in Medicine Information not provided
Undergraduate education
Medical doctors
MasterBachelor in Pharmacy
University of Navarra Undergraduate education
Postgraduate education
Pharmacists
Human Nutrition and Dietetics
Univeristy of Navarra Undergraduate education
Nutritionists amp Dietitians
Pharmacy Universitad Ramon Lull
Undergraduate education
Pharmacists
Pharmacy IQS ndash FCSB Undergraduate education
Pharmacists
Master in Advanced Therapies and Innovation in Biotechnology
Universidad de Francisco de Vitoria
Postgraduate education
Pharmacists
Pharmacy Universidad of the Basque County
Undergraduate education
Pharmacists
Sweden
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master programme in Public Health
Karolinska institute Postgraduate education
Occupational therapists
Social workers
Dietetics programme Department of food and Nutrition
Undergraduate education
Dietician
Dietetics programme Department of food studies dietetics and nutrition
Undergraduate education
Dietician
Programme in Dietetics University of Gothenburg
Sahlgrenska Academy
Undergraduate education
Dietician
Master of Public Health Department of public health and caring sciences Uppsala University
Postgraduate education
Medical doctors Bachelor of science Physical
therapists Nurses Psychologists Dentists Social workers
United Kingdom
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor (Hons) Occupational Therapy
Northumbria University Undergraduate education
Occupational therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
69
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master (pre reg) Occupational Therapy
Master in Occupational Therapy
Leeds Beckett University
Postgraduate education
Occupational therapists
Bachelor (Hons) Occupational Therapy
St Georgersquos University of London
Undergraduate education
Medical doctors Medical specialists Physical therapists
Occupational therapists
Bachelor (Hons)
Occupational Therapy
Caterburry Christ
Church University
Undergraduate
education
Occupational
therapists
Bachelor (Hons) Occupational Therapy Master in (pre-reg) Occupation Therapy Occupational Therapy degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Public Health speciality training
Health education England -north west
Postgraduate education
Medical doctors Medical specialists Researchers Nurses
Bachelor in (Hons) Occupational Therapy Master in (Pre-reg)
Occupational Therapy Occupational Therapy
Degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Additional countries
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Bachelor of Physiotherapy University of Prishtina Kosovo Albania
Postgraduate education
Physical therapists
Physiotherapy Faculty of health studies University of Sarajevo Bosnia-Herzegovina
Undergraduate education
Physical therapists
Fysioterapeututdanning NTNU Norway Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy BFH
Berner Fachhochschule BFH Bern University of Applied Sciences Swiss
Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy
ZHAW Zurich University of applied sciences Swiss
Undergraduate education
Physical therapists
Physical Therapy Sciences University of Iceland
School of Health Sciences
Undergraduate
education
Physical
therapists
Medicine International school of medicine Kazachstan
Undergraduate education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
70
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicinesingle-cycle degree programme
University of Georgia Republic of Georgia
Medical doctors Psychologists General practicioners
Medicine Akaki tsereteli state University Republic of Georgia
Postgraduate education
Medical doctors Medical specialists Physical therapists Psychologists
Dentists General
practicioners
Public Health and Epidemiology
David tvildiani medical University Republic of
Georgia
Postgraduate education
Medical doctors
Biomedical and Healthcare Science doctoral programme
David tvildiani medical University Republic of Georgia
Postgraduate education
Medical doctors Biomedical Science master degree holders
Medicinesingle-cyle degree programme
University of Georgia Republic of Georgie
Undergraduate education
Medical doctors
Public Health Tbilisi State Medical University (TSMU)
Republic of Georgia
Undergraduate education
Medical doctors and public
health specialists
David tvildiani Medical
University
David tvildiani Medical
University Republic of Georgia
Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
71
ANNEX 2 COMPETENCY PROFILES PER PROFESSIONS
Undergraduate medicine
The CanMEDS framework is worldwide the most commonly used and adapted model that
identifies and describes the abilities physicians require in order to effectively meet the
health care needs of the people they serve72 Within European Member States modifications
of this model are used within health and educational settings (for example in the
Netherlands and Finland) for undergraduate medicine and medical specialisations The
CanMEDS model defines seven roles of the physician namely (1) medical expert (the
integrating role) (2) communicator (3) collaborator (4) leader (5) health advocate (6)
scholar and (7) professional73 The role of health advocate is defined as physicians
contributing their expertise and influence as they work with communities or patient
populations to improve health ldquoimproving health is not limited to mitigating illness or
trauma but also involves disease prevention health promotion and health protection
Improving health also includes promoting health equity whereby individuals and
populations reach their full health potential without being disadvantaged by for example
race ethnicity religion gender sexual orientation age social class economic status or
level of educationrdquo Within this role two key competencies are defined74
1 Respond to an individual patientrsquos health needs by advocating with the patient within
and beyond the clinical environment
a Work with patients to address determinants of health that affect them and their access
to needed health services or resources
b Work with patients and their families to increase opportunities to adopt healthy
behaviours
c Incorporate disease prevention health promotion and health surveillance into
interactions with individual patients
2 Respond to the needs of the communities or populations they serve by advocating with
them for system-level change in a socially accountable manner
d Work with a community or population to identify the determinants of health that affect
them
e Improve clinical practice by applying a process of continuous quality improvement to
disease prevention health promotion and health surveillance activities
f Contribute to a process to improve health in the community or population they serve
In addition the European Thematic Network project MEDINE (2004-2007) and Tuning
Project (Medicine) under its auspice (MEDINE) have generated and gained widespread
consensus on a set of competences for primary medical degree qualifications in Europe
(ie undergraduate medicine)75 Within this project it is stated that graduates in medicine
72 httpwwwroyalcollegecarcsitecanmedscanmeds-framework-e 73 httpwwwroyalcollegecarcsitecanmedsabout-canmeds-e 74 httpwwwroyalcollegecarcsitecanmedsframeworkcanmeds-role-scholar-e 75 httptuningacademyorgmedine-medicinelang=en
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
72
would need the ability to ldquopromote health engage with population health issues and work
effectively in a health care systemrdquo76 The following points define health promotion
bull provide patient care which minimises the risk of harm to patients
bull apply measures to prevent the spread of infection
bull recognise own health needs and ensure own health does not interfere with
professional responsibilities
bull conform with professional regulation and certification to practise
bull receive and provide professional appraisal
bull make informed career choices
bull engage in health promotion at individual and population levels
Medical specialist
The European Union of Medical Specialists (UEMS) contributed significantly to the
improvement of post-graduate training through the development of a European Curriculum
in each medical speciality as well as the elaboration of training standards77 Within this
section we provide a detailed description of the European training requirements for a
selection of medical specialists including sports medicine public health internal medicine
cardiology psychiatry and the general practitioner78 This selection was based on the fact
that within these specialities lifestyle might be an essential component or important part of
the treatment of chronically ill patients
1) Medical specialist sports medicine
Sports medicine is defined by the European Commission as a ldquomultidisciplinary clinical and
academic speciality of medicine dealing with health promotion for the general population
by stimulating a physically active lifestyle and diagnosis treatment prevention and
rehabilitation following injuries or illnesses from participation to physical activities
exercises and sport at all levelsrdquo79 As health promotion and prevention are both
incorporated in the definition of sports medicine these topics are included throughout the
whole curriculum of sports medicine The curriculum of sports medicine aimed to provide
theoretical understanding and practical skills to provide first line clinical services80 Within
the training requirements for the speciality of sports medicine it is stated that sports
medicine does not solely take care for sporting elite athletes but as well for its important
role to promote exercise as a medical tool meant for patients with chronic diseases81
bull Theoretical knowledge aims to provide theoretical understanding and practical skills to
provide first line clinical services
- Clinical To provide pre-participation clinical screening and examination before
exercise and competition as well as medical assistance to the athletes engaged in all
sports
76
httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNLearning_Outcomes_Competences_for_Undergraduate_Medical_Education_in_Europepdf
77 httpswwwuemseu__dataassetspdf_file00111415906pdf 78 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 79 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 80 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 81 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
73
- Public health
bull As part of a multi-disciplinary team to encourage and promote physical activity as
a lever for healthy living
bull To identify impediments to an active lifestyle and work within a multi-disciplinary
framework to remove those impediments or minimize their impact
bull To work alongside local health authoritiespublic health clinicians developing
exercise opportunities for the general public for health gain
bull To liaise with public (local authoritieseducationvoluntary) and private sector to
advise on the health aspects of exercise programmes for physical activity of special
groups like women children adolescents and aging population
bull Practical and clinical skills
bull To foster the integration of knowledge and practical skills acquired during the
cardiology orthopaedics physical amp rehabilitation medicine general practice
medicine and physiology internships
bull To learn to put into practice information gained in the relevant course work
bull To extend and deepen their knowledge in the assessment of fitness such as
isokinetic and functional muscle performance cycle ergometry and treadmill
ergometry
bull To gain experience in the use of such test results in the decision making with regard
to diagnosis recommendations and therapy for people of both gender and in
different age groups and performance levels
bull With regard to elite sport trainees will learn how to diagnose treat and prevent
overtraining and overexertion
bull To become proficient in activities related to for example hygiene and nutrition
and will work closely with trainers athletes physiotherapists officials etc
bull Competencies
bull Clinical and instrumental assessment to determine the pathophysiology
mechanisms and the underlying diagnosis of the patientrsquos condition
bull Trainees are expected to complete evidence of reflective practice through case
reports and other experiences in their training record
bull Other self-directed work will be planning data collection analysis and presentation
of audit and research work
bull The mandatory training record (hand written diary or preferably electronic
logbook) will contain evidence of academic pursuits and should be checked and
documented regularly by the Supervisor
bull Trainees will take part and be able to lead in teaching and will be expected to
develop skills to teach undergraduates postgraduates and non-medical staff in
small groups and formal lectures making personal presentations using a variety of
audiovisual methods
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
74
bull They will be expected to present at journal clubs and make case presentations at
grand rounds or similar settings
bull They will be expected to undertake personal audit and research and make
presentations of their findings at clinical meetings
bull Prescription as much evidence-based as possible of medical and physical
treatments (including drug treatment physical modalities innovative
technologies natural factors and others) as well as of technical aids
bull Prevention and management of complications
bull Skill to perform and participate in research
2) Medical specialist public health
The European Commission defines public health ldquoas the science and art of preventing
disease prolonging life and promoting mental and physical health and efficiency through
organized community effort Public health may be considered as structures and processes
by which the Health of the population is understood safeguarded and promoted through
the organized efforts of societyrdquo82 Public health specialists aim to improve populationrsquos
health by using the following skills and competencies
bull Theoretical knowledge on a range of fields including epidemiology prevention health
promotion public health research behavioural sciences health programme evaluations
health need assessments and quality and safety in healthcare
bull Practical and clinical skills
- Surveillance and evaluation of the health of the population (trained in epidemiology)
- Planning and evaluation of health services and public health control
- Analysing the health of the population (analysing determinants on individual and
community levels)
- Plan participate in or evaluate preventive and control programmes (public health
assessments)
- Participate in multidisciplinary health impact assessment
- Inform decision-makers about potential impacts and to identify appropriate and
sustainable actions to manage those effects (including environmental determinants
of health)
- Organisational issues in healthcare (participating in policy and strategic development
quality and safety management)
- Generate and share new evidence on the ways in which social determinants influence
population health and health equity
- Sufficient linguistic ability to communicate with hisher public health colleagues
82 httpswwwuemseu__dataassetspdf_file001198435UEMS-201924-European-Training-
Requirements-for-Public-Healthpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
75
- Develop high professional ethical standard including respect towards human rights
participants in public health programmes colleges and other professionals in the
team
bull Competencies
- Establish the expertise role as a Public Health Physician
bull Function as public health leaders and consultants to health services and other
organizations and institutions in order to provide safe appropriate cost effective
and equal health care to groups communities and populations
bull Establish and maintain medical knowledge skills and attitudes appropriate to their
practice including the organization and financing of health care public health
control and public health law
- Perform expertise analyses of the health of the population
bull Apply and combine medical and epidemiological competencies for the surveillance
and evaluation of the health of the population
bull Identify the determinants of health of populations and risks for public health and
implications for interventions and policy
bull Evaluate health problems biopsychosocial mechanisms andor health care issues
for different population groups and their implications for the community
bull Critically evaluate epidemiological demographic health statistical and
environmental pollution data and their sources and apply them appropriately to
public health issues
bull Identify community health needs and advise about their implications for public
health and medical care services
- Lead and supervise public health interventions
bull Select develop implement and monitor public health surveillance and
interventions namely in the areas of human behaviour social and physical
environment food safety and nutrition health care associated risks and working
life related health
bull Promote the health of individuals communities and populations through health
programming
bull Contribute to the organization and evaluation of societal and health care
programmes aiming to promote health and social functioning among individuals
with long-term diseases and disabilities
bull Contribute to the planning organization supervision of and evaluation of societal
and health care programmes promoting the health of specific target groups such
as children elderly and vulnerable and underserved groups in society
bull Contribute to the organization of and evaluate primary and secondary medical
prevention programmes
bull Contribute to strengthening regulatory frameworks for protecting and improving
health
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
76
- Function as expertise in planning and evaluation of Public Health and Medical Care
bull Evaluate Public Health and other service programmes concerning processes and
outputs from the different perspectives of care seekers professional health care
workers and health managers
bull Analyse and differentiate between need demand and supply and assess the health
of a defined population and identify areas for improvement including the allocation
of health care resources delivery
bull Evaluate the outcome quality and safety of care and promote quality development
systems based on evidence and public health principles
bull Apply health economic principles and methods such as cost-effectiveness cost-
utility and cost-benefits considering the strengths and weaknesses of different
methods
bull Use methods to determine priorities and their strengths and weaknesses and
promote awareness of the competing and conflicting influences on public and
political perceptions of the need for health care and the resulting constraints on
action
bull Promote and evaluate collaboration between health services and other welfare
organizations in society
bull Evaluate and contribute to the policy and strategic development in health care
planning
bull Contribute to the planning and evaluation of different sectors of society by health
impact assessments and public health medical reports and consultations
- Communicate and develop public health medical expertise
bull Lead supervise and participate in an interprofessional health care team
bull Consult other (health) professionals and policymakers and recognise the
advantages and limits of their expertise
bull Effectively convey oral and written information about public health issues including
adequate public health reporting and effective interaction with media
bull Stimulate and motivate others so that they recognise the importance of the public
health population perspective
bull Maintain and enhance professional activities through ongoing learning and
research and contribute appropriately to the generation dissemination application
and translation of new public health knowledge and practices
3) Medical specialist internal medicine
The UEMS defines an internist as ldquoa physician trained in the scientific basis of medicine
who specialises in the assessment diagnosis and management of general medical
problems atypical presentations multiple problems and consequential complex health
issues and system disorders (Professional) The physician is skilled in the management of
acute unselected medical emergencies and the management of patients in a holistic and
ethical way considering all psychosocial as well as medical factors for enhancing quality of
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
77
life The physician values the continuing care of all patients irrespective of the nature of the
patients complaint and is committed to lifelong continued professional development
(Scholar) The physician practices clinical audit and evidence-based medicine The
physician functions in a number of roles including clinical counselling educating leading
and managingrdquo83
Internists have a fundamental role in modern healthcare systems Within the definition of
the internist the shift towards a preventive strategy focusing on health promotion is
highlighted by the acknowledgement of the high prevalence of chronic and complex
diseases that are associated with the lifestyle of ageing western societies The role of
healthcare advocate (a role defined in the CanMED framework) is an important part of the
internistrsquos function and forms the generic competencies of an internist (see section 11)
However lifestyle promotion and disease prevention is not a specific area of expertise
Specific areas of the internist include multi-morbidity and ageing acute care medical
consultation shared-decision-making collaborative care transition in care vulnerable
adult patient safety and quality of care and medical leadership
4) Medical specialist cardiology
According to the training requirements for the speciality of cardiology84 training in
cardiology should be based on the syllabus of the ESC core Curriculum for the general
cardiologist part 2 ldquothe core curriculum per topicrdquo85 The necessary core cardiology
competencies are set out as cardiology learning objectives with the knowledge skills
attitudes and competencies needed to fulfil the objectives One of the core cardiology
competences is cardiovascular prevention aiming to
bull Assess and manage patients with risk factors for cardiovascular disease
bull Understand the mode of action of different prevention methods
bull Describe cardiovascular disease and risk factors in the local community
bull Contribute to the global efforts in reducing cardiovascular morbidity and mortality
by communicating the prevention message to the public
bull To approach prevention in a holistic way understanding the potentiation of
cardiovascular risk by clustering of risk factors
bull
Knowledge
bull Epidemiology of cardiovascular disease in the local community incidence
prevalence survival
bull Risk factors in the local community
83 httpswwwuemseu__dataassetspdf_file001744450UEMS-201613-European-Training-
Requirements-Internal-Medicinepdf 84 httpswwwuemseu__dataassetspdf_file001119577UEMS-201324-SECTIONS-AND-BOARDS-
Cardiology-European-Training-Requirements-20131019pdf 85 httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_
9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
78
bull Risk assessment in primary prevention multifactorial risk interaction and use of
risk scoring charts
bull The impact of lifestyle on people at risk of and patients with cardiovascular
disease
bull The potential of lifestyle changes to prevent and ameliorate cardiovascular
disease diet and nutrition toxic habits (smoking alcohol and others) physical
activity
bull Emerging risk factors (social economic stress depression and personality type)
bull Treatmentprevention strategies for major risk factors and changes in lifestyle
including corresponding pharmacologic therapies
bull The comprehensive approach required for multiple risk factors
bull Patient compliance
In addition the main objectives and knowledge competence are further specified by
hypertension dyslipidaemia diabetes and lifestyle
Skills
bull obtain a relevant history and perform an appropriate clinical examination
bull evaluate cardiovascular risk and assess global cardiovascular risk at the individual
level
bull evaluate cardiovascular risk at population level (mortality morbidity disability)
bull evaluate the benefit of prevention at individual and population levels
bull manage risk factors appropriately including pharmacological and non-
pharmacological therapies
bull communicate their importance to patients their families and the wider
community including smoking cessation diet and exercise
bull communicate the importance of patient compliance and behaviour
bull motivate patients and families to change lifestyles and be compliant with
prescriptionsrecommendations
bull monitor patient compliance and behaviour
bull evaluate the benefit of risk factor intervention for the individual patient
Behaviours and attitudes
bull Non-judgemental attitude to patients regarding their lifestyle (eg smoking diet
etc)
bull Exemplify appropriate lifestyle in personal behaviour
bull Team working with other physicians including general practitioners
diabetologists nephrologists and elderly care physicians for the management of
specific risk factors
bull Team working with all professionals with a role in primary and secondary
prevention (nurses dieticians teachers and politicians)
Another core competency is the physical activity and sport in primary and secondary
prevention Further defined in sports cardiology and cardiac rehabilitation
Sports cardiology aiming86
86
httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
79
bull To conduct strategies to implement healthy lifestyle in particular physical and
sports activities in the general population (primary prevention)
bull To evaluate cardiovascular risk and exercise capacity (see Chapters 22 and
271)
bull To recognize the characteristics of the athletersquos heart
bull To appropriately detect contraindications to exercisecompetition and
appropriately provide non-contraindication certificates
Knowledge
bull Exercise and sports physiology
bull Benefits of exercise training
bull Safety issues in exercise and sport
bull Diagnostic criteria and appropriate investigations in athletes with cardiovascular
disease
bull Risk factors for and mechanisms of sudden cardiac death (SCD) during and after
strenuous exercise
bull Specific population challenges and exercise programmes in appropriate settings
bull Recommendations for professional and recreational sports participation
bull SCD in patients athletes and in the population at large and
bull Mechanisms of action of illicit drugs
Skills
bull perform an individual CVD risk assessment using appropriate information from
history laboratory assessment including full lipid profile and clinical data
bull recognize pathological cardiovascular changes and differentiate them from the
characteristic features of lsquoathletersquos heartrsquo and
bull use prevailing recommendations for eligibility for participation in competitive
sports
Behaviours and attitudes
bull Recognition of the role of active lifestyle exercise and sport in the promotion of
health and in the prevention of the most threatening diseases including
cardiovascular diseases
Cardiac rehabilitation aiming
bull To evaluate and manage cardiovascular risk
bull To evaluate exercise capacity and causes of exercise intolerance
bull To provide appropriate rehabilitation and secondary prevention to patients with
cardiovascular diseases
7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
80
Knowledge
bull Multi-disciplinary risk factor intervention
bull Definition of comprehensive cardiovascular prevention and rehabilitation
bull Effects of behavioural change including physical activity nutrition education and
psychosocial risk factors on quality of life cardiovascular risk and outcome
bull Rehabilitation as a component of cardiac care and a promoter of secondary
prevention
bull Target populations and risk stratification of patients
bull Psychological aspects of rehabilitation and exercise practice
Skills
bull take a relevant history and perform an appropriate clinical examination including
the specific evaluation of the elderly patient
bull perform and interpret risk stratification using indicated tests
bull interpret a cardiopulmonary exercise test and distinguish different causes of
exercise limitation
bull prescribe exercise-based rehabilitation programmes and other lifestyle
interventions according to the patientrsquos condition in collaboration with other
specialists when necessary and
bull motivate the patient to ensure long-term adherence to lifestyle changes and
continuing exercise programmes
Behaviours and attitudes
bull rehabilitation as a component of cardiac care
bull the importance of rehabilitation and secondary prevention for professional
personal and social life among patients with heart disease
bull the interplay of physical and psychological aspects of heart disease and the
positive influence of exercise on cardiovascular risk factors
bull the role of other professionals including nurse specialists physiotherapists ergo
physiologists psychologists dieticians and general practitioners in rehabilitation
and secondary prevention and
bull the importance of patient and family education and the role of other professionals
in rehabilitation
5) Medical specialist psychiatry
The UEMS has issued a charter of requirements for the training in psychiatry in 2000 with
an additional European Framework for Competencies in Psychiatry in 2009 The learning
outcomes in the European Framework for Competencies in Psychiatry (EFCP) are arranged
under the seven physician roles derived from the CanMEDS framework87 Within the EFCP
it is stated that ldquopsychiatrists recognise the importance of advocacy and health promotion
in responding to the challenges represented by those social environmental and biological
factors that determine the mental health and well-being of patients and society They
recognise advocacy as an essential and fundamental component of mental health promotion
that occurs at the level of the individual patient the practice population and the broader
communityrdquo
Competencies
87 httpuemspsychiatryorgwp-contentuploads2013092009-Oct-EFCPpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
81
bull identify the determinants of mental disorder as well as the factors that may
contribute to positive mental health so as to be able to prevent disorder and
promote mental health
- recognise the determinants of mental health of populations and how public
policy including legislation impacts on mental health
- promote positive mental and physical health in patients particularly in those
with severe mental disorder based on best evidence
- recognise the impact of mental disorder on families and carers and take
remedial measures
- collaborate with other community sectors to promote mental health and
prevent mental disorder at all levels focusing particularly on family school and
workplace
- identify and address barriers and inequity in access to care particularly for
vulnerable or marginalised populations
bull Identify and address issues and circumstances when advocacy on behalf of
patients professions or society is necessary
- respect and promote the human rights of people with mental disorders and
collaborate with user and carer associations and advocacy groups
- empower people with mental disorders and their carers
- recognise and address prejudice stigma and discrimination associated with
mental disorder and its treatment
- use strategies to enhance patientrsquos self-management and autonomy
- actively oppose the use of psychiatry for political repression
- recognise the possibility of conflict inherent in their role as a health advocate
for a patient or community with that of manager or gatekeeper
6) General practitioner
The European training requirements for General PracticeFamily Medicine (GPFM) specialist
training88 defined twelve central characteristics of the practice before determining the core
competences Related to health promotion and disease prevention two of these
characteristics are as following ldquopromotes health and well-being both by appropriate and
effective interventionrdquo and ldquohas a specific responsibility for the health of the communityrdquo
The twelve characteristics are clustered into six core competences primary care
management person-centred care specific problem solving skills comprehensive
approach community orientation holistic modelling Under comprehensive approach the
following abilities relate to health promotion and disease prevention
bull to promote health and wellbeing by applying health promotion and disease
prevention strategies appropriately
bull to manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
Furthermore community orientation includes the ability
bull to reconcile the health needs of individual patients and the health needs of the
community in which they live in balance with available resources
88 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
82
In the more comprehensive assessment of GPrsquos performance in daily practice by the
European Academy of Teachers in General PracticeFamily Medicine (EURACT)89 these
abilities are further defined as following
bull To promote health and wellbeing by applying health promotion and disease
prevention strategies appropriate
- Identifies opportunity for health promotion intervention
- Makes use of structured medical record as reminder of preventive activities
- Makes use of teamwork
- Uses communication skills
- Is aware of any personal prejudices which might influence negatively
preventive advice
- Makes recommendations which are feasible in the context of patientrsquos lifestyle
and home situation
- Acts as suitable role model
bull To manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
- Provides appropriate medical management
- Involves members of practice team eg through case conference
- Performsarranges home visit (consider relevant team members) ndash needs
assessment eg cause of falls
- Involves relatives
- Facilitates communication (two-way) with hospital
- Involves external community resources (eg home help etc)
Dentist
According to the profile and competences for the graduating European dentist one of the
major competences for dentists is to improve oral health of individuals families and groups
in the community On graduation a dentist must be competent at promoting and improving
the oral health of individuals families and groups in the community90 Furthermore with
regard to health promotion and disease prevention a dentist
bull Must be competent at
- Applying the principles of health promotion and disease prevention via
comprehensive preventive measures to individuals and the community
according to their risk assessment status
- Understanding the complex interactions between oral health nutrition general
health drugs and diseases that can have an impact on oral health care and
oral diseases
- Providing appropriate dietary advice
bull Have knowledge of
- The organisation and provision of health care in the community and in the
specialist hospital service in the country of training
- The prevalence of the common dental conditions in the country of
trainingpractice
- The social cultural and environmental factors which contribute to health or
illness
- The strategies to overcome barriers to dental care for disabled elderly
socially deprived and ethnic minority groups
- Training auxiliaries in basic skills of oral health promotion
89httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-
documentseuractperformanceagendadC3BCsseldorf2014-openaccessebookversionpdf 90 httpwwwdentuoagrfileadmindentuoagruploadsusefull_filesADEE-competences-2009_enpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
83
In 2017 a new updated framework was published for undergraduate education for dentists
including a revised structure of the educational domains and their areas of competence In
the revised framework health promotion and disease prevention compromises one of the
areas of competence in the domain ldquodentistry in societyrdquo in the educational strategy of a
dentist91 Note Dentists can also specialise in public health in a similar programme as
physicians
Nurses
The training for nurses responsible for general care shall following the Directive
201355EU include a set of eight competences 92 The training for nurses should provide
assurance that the ability of the following knowledge and skills
1 comprehensive knowledge of the sciences on which general nursing is based including
sufficient understanding of the structure physiological functions and behaviour of
healthy and sick persons and of the relationship between the state of health and the
physical and social environment of the human being
2 sufficient knowledge of the nature and ethics of the profession and of the general
principles of health and nursing
3 adequate clinical experience such experience should be gained under the supervision
of qualified nursing staff and in places where the number of qualified staff and equipment
are appropriate for the nursing care of the patient
4 the ability to participate in the practical training of health personnel and experience of
working with such personnel
5 experience of working with members of other professions in the health sector
Competencies 93
6 Competency to independently diagnose the nursing care required using current
theoretical and clinical knowledge as well as to plan organise and implement nursing
care when treating patients on the basis of page the knowledge and skills acquired in
accordance with points (1) (2) and (3) in order to improve professional practice
7 Competency to work together effectively with other players in the health sector including
participation in the practical training of health personnel on the basis of the knowledge
and skills acquired in accordance with points (4) and (5)
8 Competency to empower individuals families and groups towards healthy lifestyles and
self-care on the basis of the knowledge and skills acquired in accordance with points (1)
and (2)
9 Competency to independently initiate immediate measures to pre- serve life and to carry
out measures in crisis and disaster situations
9191 Field JC Cowpe JG Walmsley AD The Graduating European Dentist A New Undergraduate Curriculum
Framework Eur J Dent Educ 201721(Suppl 1)2-10 httpsdoiorg101111eje12307 92 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf 93 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
84
10 Competency to independently advise instruct and support individuals needing care
and their attachment figures
11 Competency to independently ensure the quality of nursing care and assess it
12 Competency to communicate comprehensively and professionally and to cooperate
with members of other professions in the health sector
13 Competency to analyse the quality of care in order to improve their own professional
practice as general care nurses
The competences included in Directive 201355EU are different from the competences
contained in the EFN Competency Framework These competences contain the following
competences on health promotion and disease prevention guidance and teaching
bull To promote healthy lifestyles preventive measures and self-care by strengthening
empowerment promoting health and enhancing behaviours and therapeutic
compliance
bull To independently protect the health and well-being of individuals families or
groups being cared for ensuring their safety and promoting their autonomy
bull To integrate promote and apply theoretical methodological and practical
knowledge This enables the promotion and the development of nursing care in
long term care co-morbidity and in situations of dependency in order to maintain
an individualrsquos personal autonomy and hisher relationships with the environment
in every moment of the healthillness process
Nurse specialist
The European Specialist Nurses Organisation (ESNO) defines the nurse specialist as follows
ldquoThe Nurse Specialist (NS) is an advanced practice Nurse prepared as a specialist within a
clinical specialty at the masterrsquos post masterrsquos or doctoral levelrdquo94 Following the ESNO the
competencies should be considered as a reference template and guidelines for the different
specialities in which each speciality can define its own knowledge skills and attitudes
Generic competencies are the clinical role patient relationship patient teachingcoaching
mentoring research organisation and management communication and teamwork ethic
and decision making leadership and policy making and prevention The competency of
prevention is based on the case for investing in public health from the World Health
Organization95 The competency of prevention is based on the ability of promoting health
and prevent disease by the capacity to develop and put in place intervention in
bull Surveillance of population health and wellbeing
bull Disease prevention at the 3 levels of prevention (primary secondary)
bull Ability to promote health and prevent disease
bull Monitoring and response to health hazards and emergencies
bull Health promotion including actions to address social determinants and healthy
inequities
bull Advocacy communication and social mobilization for health advancing public
health
bull Research to inform policy and practice96
94 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf 95 httpwwweurowhoint__dataassetspdf_file0009278073Case-Investing-Public-Healthpdfua=1 96 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
85
Occupational therapist
The World Federation of Occupational Therapists (WFOT) provided minimum standards for
the education of occupational therapists97 One of the settings in which occupational
therapists work is defined as following ldquoCommunity or group approaches such as health
promotion community development community based rehabilitation injury prevention
environmental design disaster preparation and recoveryrdquo Furthermore under essential
knowledge skills amp attitudes for competent practice the following (could) relate to health
promotion and disease prevention
bull Knowledge about
- The relationship between occupation and human development over the life
course including healthy ageing
- The relationship between psychological social and economic factors and
occupation (eg stress adjustment to life changes including disability
societal disruption natural or man-made disaster displacement)
- Early identification and functional interventions focusing on somatosensory
stimulation and performance mechanisms mitigating early developmental and
environmental factors impacting negatively on behaviour and learning
- How activity limitations and participation in occupation affect health This
includes the ability to maintain a healthy environment and personal factors
such as adjustment interpersonal relationships and social networks
- How health conditions and threats to health affect participation in work
bull Skills in
- Inter-sectoral collaboration in public health initiatives
- Assessing health in relation to occupation
In addition the Tuning programme described the reference points for the design and
delivery degree programmes in occupational therapy98 in which they first ranked subject
specific competency One of the highest ranked included
bull Enable individualsgroupsorganisationscommunities to be engaged in occupation
through health promotion prevention rehabilitation treatment and
coachingtraining
In the final set of subject specific competences however this is mentioned less explicitly
and only the following are related to health promotion and disease prevention
bull Knowledge the occupational therapist is able to
- Work in partnership with individuals and groups using occupation in
prevention rehabilitation and treatment in order to promote participation
health and well-being
- Explain the relationship between occupational performance health and well-
being
- Collaborate with communities to promote and develop the health and well-
being of their members through their participation in occupation
- Develop new knowledge of occupation and occupational therapy practice
particularly in relation to local andor emerging health and social challenges
97 httpswwwwfotorgassetsresourcesCOPYRIGHTED-World-Federation-of-Occupational-Therapists-
Minimum-Standards-for-the-Education-of-Occupational-Therapists-2016apdf 98 httptuningacademyorgwp-contentuploads201402RefOccupationalTherapy_EU_ENpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
86
Pharmacists
In a two-stage large-scale Delphi process fifty competences of pharmacy practice were
ranked and the Quality Assurance in European Pharmacy Education and Training (PHAR-
QA) framework was harmonized and validated99 Of these fifty competences the following
relate to health promotion and disease prevention
bull Ability to promote public health in collaboration with other professionals within the
healthcare system
bull Ability to provide appropriate lifestyle advice to improve patient outcomes
bull (eg advice on smoking obesity etc)
bull Ability to use pharmaceutical knowledge and provide evidence-based advice on
public health issues involving medicines
Physiotherapists
According to the World Confederation for Physical Therapy (WCPT) the scope of physical
therapists practices includes (among others) public health strategies and advocating for
patientsclients and for health100 Furthermore it is described that physical therapists may
have the following purposes
bull promoting the health and wellbeing of individuals and the general publicsociety
emphasising the importance of physical activity and exercise
bull preventing impairments activity limitations participatory restrictions and
disabilities in individuals at risk of altered movement behaviours due to health
factors socio-economic stressors environmental factors and lifestyle factors
The European Network of Physiotherapy in Higher Education (ENPHE) also described
professional competencies of physiotherapists101 According to the ENPHE one of the roles
of a physiotherapist is to be a
bull Health care promotor
- Advocate on health and wellbeing promotion and disease or injury prevention
on behalf of patientclients and the profession to enhance individual
community and public health
- Promote adherence to local regional national and EU health and safety
policies guidelines and protocols
Psychologist
The European Federation of Psychologistsrsquo Associations developed the European Certificate
in Psychology ndash the EuroPsy102 The Tuning programme also published lsquoReference points for
the design and delivery of degree programmes in Psychologyrsquo103 in which they state that
the Tuning programme and the EuroPsy programme have experienced a parallel
development over the last ten years In fact the Tuning document presents a reference
99 httpswwwncbinlmnihgovpmcarticlesPMC5419365 100 httpswwwwcptorgpolicyps-descriptionPT 101 httpwwwenpheorgwp-
contentuploads201910ESCO_report_ENPHE_recommendations_April_2017pdf 102 httpwwwinpa-europsyitmoduliEuroPsy20Regulations20July202011pdf 103httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNPsychology_reference_points
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
87
point for the design and delivery of degree programmes in psychology on the basis of the
EuroPsy programme
Based on the definition of the key role of the professional psychologist health promotion
and disease prevention could be part of the profession as this has been described as
follows to develop and apply psychological principles knowledge models and methods in
an ethical and scientific way in order to promote the development well-being and
effectiveness of individuals groups organisations and society However no specific
competences related to health promotion and disease prevention are now described in the
documents It is plausible though that psychologist do act to promote health as the core
of their profession is to help others to understand behaviour to improve performance and
well-being or to alleviate problems and distress As these emergent specialisms develop in
response to new demands there is a tendency to develop education and training
programmes thus increasing the specialisation and the requirement for specialist skills of
professional psychology
Social worker
Global standards for the education and training of the social work profession are developed
by the International Association of Schools of Social Work (IASSW)104 The IASSW
worldwide association of schools of social work other tertiary level social work educational
programmes and social work educators These global standards include for example
standards regarding the schoolrsquos core purpose or mission statement standards regarding
programme objectives and outcomes standards with regard to programme curricula
including field education The standards with regard to the core curricula are organised into
four conceptual components domain of the social work profession domain of the social
work professional methods of social work practice and paradigm of the social work
profession under which several sub-domains are described which mainly relate to aspects
such as inadequacies discrimination tradition and culture social stability and ethical
principles The following touch upon the field of health promotion and disease prevention
bull Knowledge of human behaviour and development and of the social environment
with particular emphasis on the person-in-environment transaction life-span
development and the interaction among biological psychological socio-structural
economic political cultural and spiritual factors in shaping human development
and behaviour (domain of the social work profession)
bull Sufficient practice skills in and knowledge of assessment relationship building
and helping processes to achieve the identified goals of the programme for the
purposes of social support and developmental protective preventive andor
therapeutic intervention ndash depending on the particular focus of the programme or
professional practice orientation (methods of social work practice)
bull The application of social work values ethical principles knowledge and skills to
promote care mutual respect and mutual responsibility amongst members of a
society (methods of social work practice)
bull Problem-solving and anticipatory socialisation through an understanding of the
normative developmental life cycle and expected life tasks and crises in relation
to age-related influences with due consideration to socio-cultural expectations
(paradigm of the social work profession)
104 httpswwwiassw-aietsorgwp-contentuploads201808Global-standards-for-the-education-and-training-
of-the-social-work-professionpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
88
The European Social Network (ESN) investigated the social services workforce throughout
Europe and provided an overview of qualifications and skills in different Member States in
their research report showing that qualification and skills for social care workers differ per
country105 In fact in some countries there are specific training routes for social care
workers including specialised training courses or apprenticeships and the content of these
trainings depends on the service user group and is generally defined at a local or authority
level A questionnaire was set out in which essential components of social care workers
were identified which showed that health and safety is seen as an important component
of social work
105 httpswwwesn-euorgsitesdefaultfilespublicationsInvesting_in_the_social_service_workforce_WEBpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
89
ANNEX 3 ONLINE SURVEY
Survey Health promotion and disease prevention in health and educational
settings
Health promotion and disease prevention in health and educational settings -
medical schools The European Union has commissioned Ecorys an international
research and consultancy agency to conduct a project on health promotion and
disease prevention in health and educational settings In order to provide an EU
wide overview and to better support national governments we would like to ask
for your cooperation The project will develop an EU wide overview of the
educationtraining programmes for basic education postgraduate education as
well as continuous professional development with regard to education on health
promotion Your help will therefore be key in the collection of information and
data on public health initiatives in medical and non-medical education The survey
will take approximately 20 minutes of your time You do not need to complete this
survey at once You may leave the survey and continue at a later moment in
time Questions can be saved by clicking on the pauze button (below the
questionnaire) When doing so a new URL link will be provided We would be
pleased if you could provide this information by means of an online questionnaire
to Ecorys who is also available in case you have questions or you would like
additional information bull Ms Emalie Hurkmans (Project Coordinator) tel +31
(0)6 280 579 21 email emaliehurkmansecoryscom bull Ms Tessa Huis in lsquot
Veld tel +31 6 29 22 10 58 email tessahuisintveldecoryscom
What is the name of your education
What are the website details of the educationPlease enter the link of the website
with information of the education
Can you give a brief description of the education
What type of health professionals are trained in the education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
90
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
What type of medical specialist
Is the education
Undergraduate education
Postgraduate education
Continuous professional development
Is the course accreditated
Yes
No
Unknown
Does the course cover the topic health promotion and disease prevention
Yes
No
Is the education accreditated
Yes
No
Unknown
Does the education cover the topic health promotion and disease prevention
Yes
No
How is the topic health promotion and disease prevention incorporated in the
curriculum
In a seperate module
Topic incorporated into curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
91
Who is (are) the contact person(s) of the module health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Was there any partnerships in setting up the module health promotion and disease
prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Has the education obtained any funding to set up the module on health promotion
and disease prevention EU funding national public funding local public funding
or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
92
Since when is the module on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the module Eg is it a two weeks one month or one
year programme
What is the typical quantity in hours spend at health promotion and disease
prevention by participants The amount of hours spent on attendence and
homework
Is the module health promotion and disease prevention accreditated separately
No
Unknown
Yes please specify how many points are given
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
93
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the module
No
Unknown
Yes please specify what type of exam
Is the module also provided at other locations For example at other universities
Yes
No
Unknown
Is there a contact person(s)expert for the topic health promotion and disease
prevention
Was there any partnerships in incorporating it in the curriculum
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
94
Has the education obtained funding to incorporate health promotion and disease
prevention into the curriculum EU funding national public funding local public
funding or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is health promotion and disease prevention incorporated into the whole
curriculum eg since September 2017
What is the typical quantity in hours (approximately) spend at health promotion
and disease prevention by participants The amount of hours spent on attendence
and homework
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
95
In what way are knowledge and skills with regard to health promotion and disease
prevention tested in the curriculum For example incorporated into a written exam
Who is (are) the contact person(s) of the course on health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Were there any partnerships in setting up the course on health promotion and
disease prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
business NGOs individual citizens governmental agencies who have a role fill in
yes and add by the partnership in place
No
Yes please specify
Has the education obtained any funding to set up the course on health promotion
and disease prevention
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
96
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is the course on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the course eg two weeks one month or one year
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
97
What is typical quantity in hours spend at health promotion and disease prevention
by participants The amount of hours spent on attendence and homework
Is the course on health promotion and disease prevention accreditated separately
No
Unknown
Yes how many points are given
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the course
No
Unknown
Yes what type of exam
Is the course provided at multiple locations For example at other universities
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
98
What are the general objectives of the teaching activities on health promotion and
disease prevention eg arise awareness among Medical Doctors on the
importance of physical activity within the elderly population with a high risk of
heart failure
Which stakeholders were involved in developing the teaching activities on health
promotion and disease prevention
Is there made use of a mono- or multidisciplinary approach
Monodisciplinairy approach
Multidisciplinary approach
Unknown
Does the education include theories of
1
Yes
2
No
3
Unknown
Population health
Human cognition
and behaviour
Health behaviour
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
99
Does the education include
1
Yes
2
No
3
Unknown
Epidemiology and
bio-statistics
(research
capacity)
Methods of
evidence-based
medicine
Health policies
and regulation
Health economics
Ethics
Health care
systems
Digitalisation in
health promotion
Health inequalities
Disease
prevention in
teams
Health literacy
Health behaviour
change
techniques
Communication
skills
Digital health
coaching
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
100
Concerning teaching methods of health promotion and disease prevention which
methods are used
1
Yes
2
No
3
Unknown
Lectures
Assignments
Field training in real environments
eLearning modules
Other please specify
Concerning covered competencys or capacities of health promotion and disease
prevention the main focus is on
What are the expected outcomes
1
Yes
2
No
3
Unknown
Knowledge
Skills
Behaviour
attitudes
Relevant output (if available) eg number of students following the module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
101
Do you think it is likely you will apply the learned knowledge and skills (on health
promotion and disease prevention) in daily practice after completion of this
education
Yes please specify
No please specify
Not sure please specify
Is there a reason why this education might be a good example for other
educational settings with regard to the way that health promotion and disease
prevention is covered in the education
Are there any remarks Please feel free to give overall remarks or initiative-specific
remarks
Your responses have been registered Thank you for taking the time to complete
the survey your input is valuable to us
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
102
HOW TO OBTAIN EU PUBLICATIONS
Free publications
bull one copy via EU Bookshop (httpbookshopeuropaeu)
bull more than one copy or postersmaps from the European Unionrsquos representations (httpeceuropaeurepresent_enhtm) from the delegations in non-EU countries (httpeeaseuropaeudelegationsindex_enhtm) by contacting the Europe Direct service (httpeuropaeueuropedirectindex_enhtm) or calling 00 800 6 7 8 9 10 11 (freephone number from anywhere in the EU) () () The information given is free as are most calls (though some operators phone boxes or hotels may charge you)
Priced publications
bull via EU Bookshop (httpbookshopeuropaeu)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
5
PREFACE
ECORYS Nederland BV is pleased to present the reader to support Member States in
mainstreaming health promotion and disease prevention including lifestyle medicine in
education of health professionals The reader gives a general overview of professional
training initiatives in the European Union (EU)
The study comes at a time when it is well known that lifestyle factors are important
determinants for most non-communicable diseases These diseases have a major impact
on the health of European citizens At the same time an increasing proportion of aged
population poses demands on health systems and stresses the need to sustain the work -
abilities of the working age population Therefore health promotion disease prevention
and a healthy lifestyle are essential for patients and the general population Health
professionals play an essential role here This is not an easy task as dealing with lifestyle
factors requires different strategies at a population level or for targeted patient groups with
eg type II diabetes or cardiovascular risks Health professionals need to be prepared for
this task in their education either during their study period or as part of continuous
professional development Though widely acknowledged it remained unclear to what
extent and how Member States address this challenge
In the context of this project we collected practices how EU Member States include health
promotion disease prevention and lifestyle medicine in health professional education This
report presents a mapping of the current situation across different countries and health
professions Without pretending to be complete it provides a unique baseline of the way
professionals are currently prepared to implement health promotion disease prevention
and lifestyle medicine in EU countries With this baseline Chafea created an important
starting point for the exchange of experiences and mutual learning Hope is that this will
boost developments in the near future so as to prepare health professionals to adequately
address the challenges that healthcare systems in the EU face and implement the paradigm
shift from treatment of diseases among patients to promotion of health among the entire
population
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
7
EXECUTIVE SUMMARY
Background
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices and unhealthy diets Tobacco use harmful
use of alcohol and physical inactivity have been identified as the top risk factors for non-
communicable diseases (NCDs) in the European Union In recognition of this important
public health challenge investing in effective health promotion and disease prevention of
NCDs is critical to improve the quality of life and well-being of European citizens
Healthcare professionals such as doctors (especially general practitioners) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs However while
many policy statements and NCDs practice guidelines call for behavioural change as the
first line of prevention and management professionals often do not include behavioural
change counselling in their care yet While most health professionals acknowledge the need
for lifestyle advice there seems to be a mismatch between the roles and competencies for
which health professionals are trained and the action required This underscores the need
to develop and strengthen lifestyle medicine as a component of health professionalsrsquo
education defined as lsquothe integration of lifestyle practices into the modern practice of
medicine both to lower risk factors for chronic disease andor if diseases are already
present to serve as an adjunct in therapy Lifestyle medicine brings together sound
scientific evidence in diverse health related fields to assist the clinician in the process of not
only treating disease but also promoting good healthrsquo
Objective of the study
This study seeks to provide a mapping of the current situation how health professionals are
trained in health promotion in the EU To that end this study aims to answer the following
research questions
1 How are health professionals in the EU countries being trained in health promotion
prevention and lifestyle medicine in graduate post-graduate and continuous
professional education
2 What are good practices on knowledge capacity and competency building and
advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Scope of the study
Classically public health targets at activity levels can be described in operational models
like the Friedenacutes pyramid model It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of health
like socioeconomic status We use this model as a substructure to investigate health
professionalsrsquo education as they contribute to public health at all these levels
Methodology
In order to provide a general overview on how health professionals are trained in health
promotion and disease prevention and lifestyle medicine in the EU we conducted an online
survey We identified potential organisations in the EU to take part in the survey and asked
those organisations to spread the survey among other organisations or stakeholders in their
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
8
network We contacted 24 EU associations that represent entire professions or part of the
professions (like post-graduates) in all EU countries and have major networks in the fields
of graduate post-graduate and continuous professional development for their support We
aimed to cover all professions within the scope of this study physicians physiotherapists
occupational therapists psychologists nurses social workers dentists pharmacies
dietitians Also national health associations and national educational organisations were
approached to fill in the survey Among other topics the survey contained questions on the
training programme type of health professional targeted implementation in the
curriculum description of the health promotion component funding accreditation and
partnerships
In addition to the online survey a desk research was conducted including both scientific
and grey literature to establish an overview of the competency profiles of health
professionals in the field of health promotion and disease prevention Based on the
identified literature we described the competency profiles for each of the following
healthcare professions (undergraduate) medicine medical specialists dentists nurses
nurse specialists occupational therapists pharmacists physiotherapists psychologists
and social workers
Results were tabulated and described Good practices were selected on the basis of four
pre-established criteria These practices were analysed more in-depth with an analytical
tool aligning Friedenrsquos pyramid of public health needs and Kraigerrsquos Learning Typology This
in-depth analysis was used to define a short list of 10 good practices representing a variety
of professions and countries
Results
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades1there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional However there is room for improvement many competency
profiles leave room for interpretation the described competences are not ranked in order
of importance and it is often not explained how the competences should be applied in
practice ie in a pro-active preventive way (always assessing lifestyle within the
treatment) or a more curative reactive way (only included in the treatment when there is
a clear lifestyle component related to the disease)
As for the inclusion in educational programmes a high percentage (93) of respondents
(n=197) indicate that health promotion and disease prevention is implemented in their
educational programmes or modules The high share may reflect a selection bias as those
who have implemented health promotion within the education may have been more inclined
to fill in the questionnaire In the survey we explored how health promotion and disease
prevention is implemented in the educational setting In summary this provided the
following results
1 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
9
bull More than half of the respondents indicated that they filled in the questionnaire for
practices in undergraduate educational settings Throughout Europe these
numbers were relatively similar
bull Physiotherapists are the professional group most actively involved in health
promotion training activities The vast majority applies multidisciplinary
approaches and thus brings other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within training programmes In continuous professional development on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion especially target knowledge skills
and behaviour of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for continuous professional
development (33) compared to undergraduate and postgraduate education
where the topic is covered in most modules (15 and 6) Funding was more
often obtained in Northern and Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) Regarding full modules high percentages indicated
that this is mandatory and that there is an exam at the end of the module (81
70 respectively)
Conclusions
The present study provides an overview of current practice on health promotion disease
prevention and lifestyle medicine in the education of health professionals in EU countries
This is an important need-assessment for the exchange of knowledge and expertise among
EU countries All professions have versatile competency profiles in health promotion giving
a good ground for further development As the study results reveal some unbalance in
competencies addressed and methods used a next step could be to support further
development of educational practices in lifestyle medicine and adoption of new
technologies There is room for improvement as well as encouraging volition to share
expertise across professions professional associations universities and countries in the EU
The body of knowledge generated in this study can serve as a basis for further analysis and
contribute to the enhance effectiveness of educational practices of health promotion
disease prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
11
1 INTRODUCTION
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices2 In Europe such chronic diseases as
cancer cardiovascular diseases diabetes and chronic respiratory diseases are giving the
greatest disease burden3 The Global Burden of Disease (GBD) 2016 study estimates that
over 91 of deaths and over 87 of DALYs in the European Union (EU) are the result of
non-communicable diseases (NCDs) of which 61 and 43 respectively can be attributed
to modifiable risk factors4 To a large extent lifestyle factors unhealthy diets tobacco use
harmful use of alcohol and physical inactivity have been identified as the top risk factors
for NCDs in the EU5 The last non-communicable diseases progress monitor 2017 of the
WHO underlines that ldquoNCDs share key modifiable behavioural risk factors like tobacco
use unhealthy diet lack of physical activity and the harmful use of alcohol which in turn
lead to overweight and obesity raised blood pressure raised cholesterol and ultimately
diseaserdquo6 Since NCDs share many related modifiable risk factors and often do not occur in
isolation7 prevention must be integrated into population approaches to combat NCDs as a
group8 In recognition of this important public health challenge investing in effective health
promotion and disease prevention is critical to improve the quality of life and well- being of
European citizens910 as well as their productivity and NCDrsquos burden on health systems and
economy of European societies11
Strengthening the investments in health promotion and disease prevention is key to delay
the onset and reduce the burden of NCDs in Europe12 As there is a great need for chronic
disease management the healthcare setting is crucial for health promotion in both primary
and secondary prevention of NCDs13 For example obesity is a major modifiable risk factor
2 Chopra M et al (2002) A global response to a global problem the epidemic of overnutrition
httpswwwncbinlmnihgovpmcarticlesPMC2567699pdf12571723pdf 3 WHO (2006) Gaining Health The European strategy for the prevention and control of noncommunicable
diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf 4 EU burden from non-communicable diseases and key risk factors httpseceuropaeujrcenhealth-
knowledge-gatewaysocietal-impactsburden 5 WHO (2014) Prevention and control of noncommunicable diseases in the European Region a progress report
httpwwweurowhoint__dataassetspdf_file0004235975Prevention-and-control-of-noncommunicable-diseases-in-the-European-Region-A-progress-report-Engpdf
6 WHO (2017) Noncommunicable diseases progress monitor 2017 httpappswhointirisbitstream handle106652589409789241513029-engpdfjsessionid=0613BF26D66A7DA9D1C91AD325E0A75Dsequence=1
7 httpsacels-cdncomS00917435150028321-s20-S0091743515002832-mainpdf_tid=88fea2bf-946a-44c2-be59-0edbabc2c2e8ampacdnat=1541511066_feedfb33968e2ac2f5b47a3452254a9f
8 Integrated approach to prevent noncommunicable diseases httpwwweurowhointenhealth-topicsnoncommunicable-diseasescanceractivitiesintegrated-approach-to-prevent-noncommunicable-diseases
9 WHO (2006) Gaining Health The European Strategy for the prevention and control of noncommunicable diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf
10 Scriven A (2017) Promoting Health a Practical Guide Seventh Edition httpsbooksgooglenl
bookshl=nlamplr=ampid=fJwqDwAAQBAJampoi=fndamppg=PP1ampdq=importance+health+ promotion+and+disease+prevention+European+Commissionampots=jcXZvCYJIQampsig=8D8Yqa9wKa_DlaaYUky_EtUxd_gv=onepageampq=importance20health20promotion20and20disease20prevention20European20Commissionampf=false
11 Tender 12 Chrodis (2015) Health promotion and primary prevention in 14 European countries a comparative overview
of key policies approaches gaps and needs httpchrodiseuwp-contentuploads 201507 FinalFinalSummaryofWP5CountryReportspdf
13 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
12
for type II diabetes (DM II) and thus efficacy of the intervention matters In economic
modelling for eight European countries a body-mass index reduction in the adult population
of 5 compared to 1 resulted a three-fold reduction in the incidence of DM II14 Apart
from the health losses caused directly by NCDs underlying conditions may also increase
susceptibility for other diseases Patients with diabetes and serious heart conditions eg
were identified as risk populations for COVID-1915 New health threats like climate crisis
will have an impact on healthcare systems and need for adaptation options including
training of health care workers integrated heatwave early warning systems especially for
the most vulnerable populations and supporting lifestyle changes toward healthy choices
that are at the same time climate and health friendly16
Healthcare providers such as doctors especially general practitioners (GPs) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs17 Health
promotion is collaborative work where professionals strengthen the message and help
patients to choose and implement healthier behaviours Counselling on and prescription of
a healthy lifestyle is particularly important to socioeconomically vulnerable and
disadvantaged population groups which are disproportionally affected by unhealthy
lifestyles and are more difficult to reach18 Secondary and tertiary prevention in chronic
diseases is embedded into good quality care since good nutrition status decreases the risk
of reinfarction as does smoking cessation For these reasons health promotion was
explicitly recognized as an integral part of the professional role of the GP in several policy
statements at both the European and the national level19 While many policy statements
and NCDs practice guidelines include a call for behavioural change as the first line of
prevention and management providers often do not provide behavioural change
counselling in their care20
A recently published report by the European Commission and WHO Europe (2018) identified
barriers for prescribing and counselling on exercise schemes and on promoting physical
activity in the health sector These were the lack of confidence and knowledge and skills by
health professionals on providing effective counselling21 For example Koutoukidis et al
(2017) performed a qualitative study on the perspective of healthcare professionals on
lifestyle advice to cancer survivors Health professional-centred barriers to provision of
lifestyle advice were a lack of knowledge on healthy lifestyle guidelines the feeling that
14 Webber L Divajeva D Marsh T McPherson K Brown M Galea G et al The future burden of obesity-related
diseases in the 53 WHO European-Region countries and the impact of effective interventions A modelling study BMJ Open 2014
15 Centre for Disease Control and Prevention (2020) Coronavirus disease 2019 Groups at higher risk for severe illness httpswwwcdcgovcoronavirus2019-ncovneed-extra-precautionsgroups-at-higher-riskhtml
16 Drummond P Ekins P Grubb M Lott MSEng M Byass P Nilsson M et al The Lancet Commissions Institute for Sustainable Resources (P Health and climate change policy responses to protect public health thelancetcom 2015
17 Catapano AL et al (2007) Averting a pandemic health crisis in Europeby 2020 what physicians need to know regarding cholesterol management httpswwwncbinlmnihgovpubmed17446817
18 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
19 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20 European20General20Practicepdf
20 httpswwwncbinlmnihgovpmcarticlesPMC4561845pdf101177_1559827615580307pdf 21 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the
European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
13
they were not the right person to provide advice and lack of time and resources22
Additional barriers mentioned in the World Book of Family Medicine ndash European Edition
2015 are perceived as lack of time or competing work load insufficient reimbursement
doubts about patientsrsquo acceptance and willingness to receive lifestyle counselling low self-
efficacy insufficient skills and training doubts about effectiveness of interventions and
health promotion perceived as outside professional role2324 Therefore while most health
professionals seem to acknowledge the need for lifestyle advice there seems to be a
mismatch between roles competencies training and possibilities among health
professionals and action25 Factors causing this mismatch differ from individual and
organizational context wherefore strategies to address these barriers will also vary26
These findings underline the need for developing and strengthening lifestyle medicine in
health professionalsrsquo education27 defined as lsquothe integration of lifestyle practices into the
modern practice of medicine both to lower the risk factors for chronic disease andor if
disease already present serve as an adjunct in its therapy Lifestyle medicine brings
together sound scientific evidence in diverse health-related fields to assist the clinician in
the process of not only treating disease but also promoting good healthrsquo28 Hence lifestyle
medicine covers the systematised approach for prevention and management of chronic
disease addressing eg diet physical activity behaviour change stress and coping and
tobaccosubstance abuse29 Health professionals need to learn how to overcome the
identified barriers mentioned above30 and how to effectively and efficiently counsel their
patients towards adopting and sustaining healthier behaviours31
Moreover digitalization is changing the scenery for lifestyle medicine and chronic disease
management Patient engagement can be enhanced with applications self-monitoring or
self-management tools To successfully embed these new forms of care professionals must
develop new skills32 However studies have shown that medical students are not formally
trained in major concepts known to influence health33 Philips et al (2014) states that
including lifestyle medicine in undergraduate medical curricula would have important public
health implications by efficiently promoting the prevention and treatment of NCDs34 A
study by Dacey et al (2012) states that face-to-face continuing medical education formats
22 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 23 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20
European20General20Practicepdf 24 Geense WW van de Glind IM Visscher TL van Achterberg T Barriers facilitators and attitudes influencing
health promotion activities in general practice an explorative pilot study BMC-family practice 2013 1420 25 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 26
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
27 Polak R et al (2015) Lifestyle Medicine Education httpswwwncbinlmnihgov pmcarticles PMC4561845
28 Rippe JM (2019) Lifestyle Medicine Third Edition CRC Press 29 Kushner RF and Webb Sorensen K (2013) Lifestyle medicine the future of chronic disease management
Obesity and nutrition 201320 30 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 31 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) The impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 32 Eg Richard A A amp Shea K (2011) Delineation of Self-Care and Associated Concepts Journal of Nursing
Scholarship 43(3) no-no httpdoiorg101111j1547-5069201101404x 33 httpscdnymawscomwwwacpmorgresourceresmgrlifestylemedicine-filesajpm-lmcommentarypdf 34 Philips E Pojednic R Polak R Bush J amp Trilk J (2014) including lifestyle medicine in undergraduate
medical curricula Medical education online
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
14
have a positive impact on physician behaviour toward health promotion and disease
prevention by increasing their knowledge confidence and practices that help patients to
adopt healthy behaviours35 Similar results can be expected among other health
professionals as well
The World Book of Family Medicine ndash European Edition 2015 states that the shared aim to
integrate health promotion disease prevention and lifestyle medicine has not been fully
achieved Future activities as to how lifestyle interventions can be better integrated need
collaborative approaches36 As a starting point for more collaborative action this study
seeks to provide a mapping of the current situation on health professionals training in health
promotion in the EU
11 Research questions
To that end this study seeks to answers to the following research questions
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and continuous
professional education
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
35 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) the impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 36
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
15
2 THEORETICAL BACKGROUND
21 Societal needs for health promotion and disease prevention
Classically public health targets at activity levels can be described in operational models
like Friedenacutes pyramid model37 It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of
health like socioeconomic status6 We use this model as a substructure in looking into
health professionalsrsquo education as they contribute to public health in these levels (Figure
21) Society needs to evaluate cost-effectiveness of public health efforts and find a balance
between the levels of actions at each level We use this framework to enable us to present
the needs of societies in general for different health professionals and their roles and
competencies in public health
Figure 21 Frieden Pyramid of health impact of health professional activities at the different levels of society (T Frieden 2010 CDC)
Healthcare services can contribute in mitigating the burden of disease by socioeconomic
disadvantages Health professionals have a key role in developing health services so their
competency to take account of differences in abilities of people to benefit from health
services is vital But more is needed Traditionally health professionals have been managing
the individual risk factors and provision of services That is not enough For example in
cardiovascular diseases the ldquoperfect treatment approachrdquo fails to prevent almost half of the
disease burden37 In cancer diseases individual health behaviours like smoking contribute
in more direct manner Therefore we need to develop educational systems that support
health professionals to take part in new public health approaches by planning interventions
that change the environmental context to make healthy options the default choice
37 Frieden TR A framework for public health action The health impact pyramid American Journal of Public
Health 2010
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
16
regardless of education income service provision or other societal factors37 These are
equally needed in out-of-health contexts like climate change where socio-economic
inequalities and (health) behavioural choices are among major drivers of climate changes38
Policies can influence environments to support healthier choices and we need health
professionals in policy development and execution Still health behaviour changes happen
at the individual level We need more efficient skills in personalized health coaching of
individuals to increase the cost-effectiveness of treatment of NCDs39 An ageing population
and increasing rates of chronic disease as well as advances in medical science and health
information technology to make care safer and more efficient require a rethinking of how
care is delivered Digitalization of services will challenge healthcare professionals and
collaborative care models have become more common40 Instead of requiring compliance
from patients patient-centred approaches are required from professionals This means that
clinical interventions need to be complemented by counselling and education to achieve
long-lasting protective measures Health coaching is aiming to empower patients in co-
management of their disease41 and emphasize and support patientsrsquo autonomy instead of
merely compliance It is based on shared decision-making and collaborative goal setting
facilitated by motivational interviewing42 Health coaching is already happening in digital
environments This paradigm shift requires new skills and attitudes from health
professionals too
New approaches to public health on societal level the paradigm shift to health coaching on
patient level and new forms of healthcare delivery pose a big challenge to the educational
system of health professionals It needs to prepare new professionals and train health
professionals already working in the healthcare system to master a wider scope of
knowledge and develop new skills and attitudes to implement these new approaches in a
safe effective and efficient way
22 Health profession competencies
Healthcare service is a complex and interconnected network of professionals There are
common professional competencies needed in health care and health promotion
(communication collaboration) but they are applied to meet the learning aims of each
profession or level of education If we want to increase the implementation of lifestyle
counselling or systemwide changes we need to evaluate knowledge skills and attitudes
required for the changes and to define the competencies needed to support this change
Professional competencies sum the elements of abilities (knowledge skills attitudes and
behaviours) that enable a professional to accomplish the activities described in a task
statement that outlines what the professional is expected to do43
38 Watts Nick Amann Markus Arnell Nigel et al (66 more authors) (2019) Report of The Lancet Countdown
on Health and Climate Change The Lancet ISSN 0140-6736 httpsdoiorg101016S0140-6736(19)32596-6)
39 Hale R Giese J Cost-Effectiveness of Health Coaching Prof Case Manag 2017 40 Falconer E Kho D Docherty JP Use of technology for care coordination initiatives for patients with mental
health issues A systematic literature review Neuropsychiatric Disease and Treatment 2018 41 Hayes E McCahon C Panahi MR Hamre T Pohlman K Alliance not compliance Coaching strategies to
improve type 2 diabetes outcomes J Am Acad Nurse Pract 2008 42 Olsen JM Health Coaching A Concept Analysis Nurs Forum 2014 43 Kraiger etal 1993 Application of cognitive skill-based and affective theories of learning outcomes to new
methods of training evaluation
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
17
Learning Outcome Typology by Kraiger is a widely used descriptive model for setting targets
and learning outcomes in education43 It comprises cognitive (knowledge) psychomotor
(skill-based) affective and behavioural (attitudes) components This classification scheme
for learning outcomes is based on Bloomrsquos work (1956) of three learning domains including
cognitive domain the affective domain and psychomotor44 45Knowledge can be factual and
declarative knowledge information and concepts or processes and organizations or
metacognitive strategies like allocation and regulation of professional performance Skills
include simple routine development and procedures needed at work and more complex
skills needed for the ability to monitor the performance along other tasks Attitudes are
linked with professionalsrsquo perceptions on learning self-efficacy at work perception about
ability to perform and ability to goal setting It has domains on professionalism Knowledge
can be obtained in reading or e-Learning modules skills require active teaching methods
and attitudes develop over time Behaviours then are complex situations where knowledge
skills and attitudes are utilised in professional manners In education planning outcomes
are defined by these elements
Competency frameworks are an effective method for achieving outcome-based education46
They provide a tool for capturing the elements and abilities (knowledge skills attitudes
and behaviours) needed in effective and safe patient work47They can serve in evaluating
the components of different specialities or societal needs like in this report public health
needs Competencies define an acceptable and feasible description of professional
behaviours used in relation to health promotion Competency building is at the basis in
developing similar programmes in the US4849 Meaningful assessment of competencies
developed is critical for the implementation of effective competency-based medical
education (CBME)50
The International Union for Health Promotion and Education (IUHPE) published an
extensive list of core competencies and professional standards for health promotion in
201651 It defines acuteHealth Promotion actionrsquo in the context of these competencies and
standards to describe programmes policies and other organised Health Promotion
interventions that are empowering participatory holistic inter-sectoral equitable
sustainable and multi-strategy in nature and aim to improve health and reduce health
inequities51
44 Bloom BS (1956) Taxonomy of educational objectives The classification of educational goals New York NY
Longmans Green 45 Cruz-Cunha MM (2012) Handbook of Research on Serious Games as Educational Business and Research Tools 46 Frank JR Danoff D The CanMEDS initiative Implementing an outcomes-based framework of physician
competencies Med Teach 200729(7)642ndash7 47 Cooke M Irby DM Sullivan W Ludmerer KM Medical education American medical education 100 years after
the flexner report N Engl J Med [Internet] 2006355(13)1339-1344+1306 Available from httpwww
scopuscominwardrecordurleid=2-s20-33749062559amppartnerID=40ampmd5=d949feb 758c984c732a419 cada174c85
48 Alaranta A Alaranta H Patja K Palmu P Praumlttaumllauml R Martelin T et alSnuff use and smoking in Finnish Olympic athletes Int J Sports Med 200627(7)
49 Van Horn L Lenders CM Pratt CA Beech B Carney PA Dietz W et al Advancing Nutrition Education Training and Research for Medical Students Residents Fellows Attending Physicians and Other Clinicians Building Competencies and Interdisciplinary Coordination Adv Nutr 2019
50 Lockyer J Carraccio C Chan MK Hart D Smee S Touchie C et al Core principles of assessment in competency-based medical education Med Teach 201739(6)609ndash16
51 IUHPE (2016) Core competencies and professional standards for health promotion full version httpwwwukphrorgwp-contentuploads201702Core_Competencies_Standards_linkEpdf )
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
18
We present CanMEDS as an example of a framework that includes content-specific
competencies (Table 21) CanMEDS was developed for medical experts but most
competencies are applicable to all health professionals
Table 21 CanMEDS in short form52 original version53
Competency Short description
Medical Expert Apply clinical skills and knowledge of the biomedical sciences to fulfil your scope of practice
Collaborate with patients and families for patient-centred care and management
Contribute to health care quality and patient safety
Communicator Build rapport and empathy in all interactions with patients and include families (with the patientrsquos consent)
Understand the patientrsquos perspectives expectations and socio-economic issues
Use active listening patient-centred interviewing skills and culturally safe communication
Share information in plain language to promote patientsrsquo understanding
Clearly document and share information with patients and others on the care team
Collaborator Collaborate by sharing knowledge and perspectives sharing responsibilities learning together
Collaborate in care education advocacy administration and scholarship
Leader Take responsibility for the ongoing operation evolution and continuous
improvement of the healthcare system
Expand beyond a clinical or technical role to take on administrative teaching and scholarly roles and responsibilities
Exercise efficient use of resources to achieve cost-effective care
Contribute to improvements in personal practice team organization and system
Health Advocate
Understand and address the determinants of health that affect patients and support patients to navigate through the health care system
Collaborate with communities and populations to influence change in the health
care system
Contribute to health promotion and disease prevention Understand determinants and needs speak on behalf of others increase awareness
Scholar Plan for and engage in life-long learning
Teach others
Evaluate and apply evidence to day-to-day practice
Contribute to research including creation dissemination and translation into
practice
Professional Commit to patients society profession and ldquoselfrdquo Patients ndash maintain clinical competency and adhere to ethical standard Society ndash demonstrate social accountability by responding to societal needs and
expectations Profession ndash peer assessment mentorship supporting others setting standards Self ndash participate in self-assessment and reflection build self-awareness and manage own well-being
52 Michener Institute No Title CanMEDS framework in short [Internet] Available from httpsmichenercawp-
contentuploads201805CanMEDS-Framework-Summarypdf 53 Frank JR Snell L Sherbino J E CanMEDs 2015 Physician Competency Framework [Internet] CanMEDS 2015
Physician Competency Framework Ottawa Royal College of Physicians and Surgeons of Canada 2015 p 1ndash30 Available from httpwwwroyalcollegecaportalpageportalrccanmedsresourcespublications
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
19
23 Educational systems for health professions in Europe
According to the EU Treaty European citizens have a virtue of rights of free movement as
workers freedom of establishment and freedom of service providers54 Directives on the
requirements of professional qualifications in EU their recognition and Regulation55
facilitate the mobility of health personnel Each member state will apply this directive in
the national legislation on health professional qualifications There is a system of automatic
recognition based on harmonised minimum training requirements This system depends on
the timely notification of new or changed evidence of formal qualifications by MS and their
publication by the Commission Otherwise holders of such qualifications have no
guarantees that they can benefit from automatic recognition
The undergraduate education in Europe is coordinated through the Bologna Process which
is an intergovernmental cooperation of 48 European countries in the field of higher
education It guides the collective effort of public authorities universities teachers and
students together with stakeholder associations employers quality assurance agencies
international organizations and institutions including the EC to bring more coherence to
higher education systems across Europe56 Under the Bologna Process all 48 participating
European countries agreed to ensure mutual recognition of qualifications and learning
periods abroad completed at other universities Nonetheless it should be noted that across
Europe healthcare systems and educations may still significantly differ
While professional activity is regulated by national law in individual member states57
faculties and other academic institutions have collaborated in the establishment of a
framework of competencies based on the scientific advances and new methodologies in
education In fact EU Directives of the European Parliament and Council on the recognition
of professional qualifications have consolidated a system of mutual recognition between
MS58 Examples include the PHARMINE for pharmacists and MEDINE for medical doctors59
This collaboration is in line with the Bologna Process
24 Relevant educational settings for health promotion
Inclusion of health promotion and lifestyle medicine in undergraduate medical curricula is
expected to have important public health implications However in current medical
education this subject is minimal to nonexistent60 This is a global problem In 2016 the
American associations around NCDs launched a joint programme called lsquoThe Lifestyle
54 Treaty on the Functioning of the European Union (TFEU) Articles 45 49-62 55 European Parliament C of the EU Directive 200536EC on the recognition of professional qualifications and
Regulation [Internet] 2013 Available from httpseur-lexeuropaeulegal-
contentENALLuri=celex3A32013L0055 56 The Bologna process and the European Higher Education Area httpseceuropaeu education policies
higher-educationbologna-process-and-european-higher-education-area_en 57 UEMS (2017) Charter on training of medical specialists in the EU httpswwwuemseu
dataassetspdf_file001943561ETR-Psychiatry-201703pdf 58 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 59 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 60 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
20
Medicine Education Collaborativerdquo for improvement of health promotion education among
health professionals and in medical schools61 This initiative will a) work for high-quality
curricular material on an easily navigable website b) provide support for medical schools
to advocate for and implement lifestyle medicine curricula into their own institutions c)
aim to increase awareness and legislative initiatives that encourage adoption of lifestyle
medicine into medical school education d) develop and conduct assessment in the
following areas Student Health Student Knowledge and Programme Effectiveness and
e) train and support medical students as effective champions of lifestyle medicine whose
engagement with the curriculum lead to increased adoption within medical schools and
enhanced collaboration nationallyError Bookmark not defined This need has been acknowledged
in Europe as well62
Besides education in medical schools continuous professional development (CPD) is an
essential component in health education to ensure that professionals graduated in past
decades keep their competencies up to date and acquire new competencies needed for
health promotion disease prevention and lifestyle medicine It is important to encourage
further strengthening of CPD for those professions that benefit from automatic recognition
of their professional qualifications Member states should in particular encourage CPD for
physicians medical specialists general practitioners nurses responsible for general are
dental practitioners specialized dental practitioners veterinary surgeons midwives
pharmacists and architects63 Given the rapid developments in societal needs and
approaches towards health promotion and disease prevention and spectacular increase in
technological support facilities lifelong learning is imperative for health professionals and
should be oriented towards the competencies required to best serve their population and
society
Figure 22 Lifelong learning is an iterative process where learners build knowledge skills
attitudes and behaviours on top of their current professional competency
61 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019 62 European Lifestyle Medicine organisation httpswwweulmorg 63 Lim SS Vos T Flaxman AD Danaei G Shibuya K Adair-Rohani H et al A comparative risk assessment of
burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions 1990-2010 A systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
21
25 Theoretical framework for this study
In this study we touch upon the existing levels of health promotion disease prevention
and lifestyle medicine in health and educational settings in the EU and make a preliminary
assessment of its relevance
As right now health professional competencies seem more practical we approached the
mapping of competencies in health education through professions rather than with an
overall theoretical framework Thus we aim to create a general picture for different health
professions at different levels of education
For the assessment of relevance of the existing levels of health promotion in education we
aligned the competency framework of Kraiger with Friedenrsquos public health framework We
used three components64 of Kraigerrsquos Learning Typology
bull Knowledge cognitive and mental abilities
bull Skills psychomotor manual and physical abilities to perform tasks
bull Attitude (or self) perceptions growth in feelings or emotional areas
We used the integrated framework as an analytical tool to classify content areas covered
and their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future
This study is an important first step as we know little about present practices However
more detailed research will obviously be needed
64 Given the limitations of the study behaviour ndash the fourth component ndash is not included Behaviour refers to
practices to utilise knowledge skills and attitude in work environment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
22
3 METHODOLOGY
31 Mapping of health educational programmes in the EU
The first aim was to provide a general overview on how health professionals are trained in
health promotion and disease prevention and lifestyle medicine in the EU To that end we
conducted an online survey to map the educational programmes of health professionals in
the EU In addition to the proposed methodology we also conducted desk research to
create an overview of competency profiles of health professionals in the EU
311 Online survey
This study looks at undergraduate education postgraduate education and CPD courses in
all healthcare professions across the EU Within the EU different organisations are
responsible for the education of healthcare professionals
bull The undergraduate education programmes are organised by universities in each
country
bull The post-graduate education programmes are organised differently in each
country This includes a set of European organisations that run the guidelines
and portfolioacutes for each profession or specialty within this profession (like in
medicine)
bull CPD programmes are even more diverse between countries and can be accredited
both by European organisations and universities
Due to the wide scope of the study and the different levels of healthcare educational
programmes no country correspondents could be found with a full overview of educational
programmes addressing health promotion and disease prevention in their country
Therefore we chose for a snowball methodology to obtain information on all levels of health
professional education The snowball methodology consists of two steps First we identified
potential organisations in the EU to take part in the survey Second we asked those
organisations to recruit other organisations or stakeholders in their national andor
international network of colleagues and spread the survey among those This method
required more effort and time in the beginning but once the lsquoballrsquo was rolling it provided
us with a growing dataset including the perspectives from healthcare educators healthcare
professional associations and healthcare students and residents The snowball method
implies a risk of selection bias as educational institutions that have implemented health
promotion within their programmes ie the front-runners may have been more inclined
to respond than those who have not
In addition this recruitment process served as a communication and dissemination vehicle
and increased the engagement to the mapping Many organisations expressed their interest
to join the workshop as well as willingness to disseminate the results to their members and
collaborators Because of the growing interest we decided to extend the deadline after the
workshop organised on 13 February so attendees could spread the survey among their
national andor international networks
Our original workplan included an Excel worksheet to be sent to the national health
coordinators in each EU country but as we chose a different strategy it was necessary to
develop a more user-friendly and flexible method Therefore an online survey was
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
23
developed This enabled refinement of questions to each level of education with core sets
of questions Survey links proved to be easy to use and shared within educational facilities
or associations which led to higher response
In this section we discuss in more detail how the survey was developed and how relevant
international organisations were recruited
Development of an online survey
First we developed a mapping tool (stand-alone Excel document) to map the current
situation of professionals trained in health promotion This mapping tool was validated by
both Chafea and DG SANTE and by the external experts in the core research team After a
pilot phase an online survey was developed for all healthcare professions based on the
content of the mapping tool This was a necessary step to boost response as the online
survey proved to be more user-friendly and easier to share among educational facilities or
associations than the mapping tool in Excel
Among other topics the survey contained questions on the
bull Training programme for which the respondent is filling in the survey (which
(educational) institute and health profession portfolio etc)
bull Type of training programme (undergraduate education postgraduate education or
continues professionalrsquos development
bull Type of health professional targeted (eg GPrsquos physiotherapists etc)
bull Implementation in the curriculum
bull Description of the health promotion component in the programme (eg teaching
methods monodisciplinary approach or multidisciplinary approach expected
outcomes in knowledge skills and attitude)
bull Targeted funding
bull Accreditation
bull Partnerships
The questions in the survey correspond with the information requested in the Tender
Specifications Note that the survey maps the educational offer effectiveness of education
is outside the scope of this study The complete questionnaire used in the survey can be
found in Annex 3
Recruitment of relevant international organisations EU and national medical and
non-medical associations medical faculties national and international institutes
networks and organisations
As we used a snowball method it is not possible to provide the exact number of persons
who received the survey and response rates Instead we present each of the steps taken
to approach respondents and final response obtained
Recruitment of European associations
First we connected with major networks in the fields of graduate post-graduate and
continuous professional development for their support as these organisations have an
overview of the three levels of health professional education These associations represent
entire professions or part of the professions (like post-graduates) in all European countries
National professional organisations are members of these umbrella organisations For
example the Union of Medical Specialists (UEMS) represents 16 million medical specialists
It has 40 full member associations (Member States of the EU amp Member States of the
European Economic Area) associate member associations (Member States of the Council
of Europe) and observer member associations (other countries eg the United States)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
24
The UEMS represents more than 50 medical disciplines through various bodies
and structures The most important ones are the 43 Specialist Sections which represent
independently recognised specialties All health professionals health professional students
and post-graduates are organised in a similar manner These organisations are in a good
position to provide information and disseminate it across EU countries
Overall 24 EU associations were approached by email to spread the survey among their
networks (see Table 31 for a complete overview) We aimed to cover all professions within
the scope of this study ie physicians physiotherapists occupational therapists
psychologists nurses social workers dentists pharmacies dietitians throughout Europe
Therefore European associations with focus on educational programmes for these specific
professions were approached
Table 31 Approached European Associations
No European Associations
1 European Medical Association (EMANET)
2 The European Union of General Practitioners (UEMO)
3 European Union of medical specialists (UEMS)
4 European Medical Students Association EMSA)
5 European Forum of Medical associations (EFMA)
6 European Federation of Nurses Associations (EFN)
7 European Association of schools of social work
8 European Network of Physiotherapy in Higher Education
9 European Region ndash World Confederation of Physical Therapy (ER-WCPT)
10 European Network of Occupational Therapy in Higher Education (ENOTHE)
11 Council of Occupational therapists of European Countries (COTEC) part of the World
12 Federation of Occupational Therapists (WFOT)
13 Federation of National Psychologists Associations
14 European federation of nurse educators (FINE) association
15 Association for Dental Education in Europe
16 Council of European Dentists
17 Association for Medical Education in Europe (AMEE)
18 Pharmaceutical group of the European Union (PGEU)
19 European Pharmacists Forum (EPF)
20 European Association of faculties of pharmacy (EAFP)
21 European network of medical residents in Public health
22 The Association of Medical Schools Europe (AMSE)
23 The European Society of Preventive Medicine (ESPREV)
24 The European Lifestyle Medicine Organisation (ELMO)
Recruitment of national associations
Second national health associations for all Member States and all professions were
approached to fill in the survey This step was crucial to increase the response National
health associations were selected using the member list of European organisations Table
32 shows the European organisations used to identify national health associations that
were invited to participate in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
25
Table 32 Examples of the approached national associations
Profession European Association Examples of approached national associations (1 out of 28)
Medical doctors Standing committee of European Doctors (CPME)
Czech Medical Chamber
Physiotherapists World confederation for physical therapy (WCPT)
Swedish Association of Physiotherapists
Social workers International federation of
social workers
German professional
association for social work
Psychologists European Federation of psychologistsrsquo association (EFPA)
Croatian psychological association
Occupational therapists Council of occupational
therapists for the European Countries (COTEC)
Association of Bulgarian
Ergotherapists
Dietitians The European Federation of the associations of dieticians
(EFAD)
French Association of Nutritionist Dietitians
Dentists Council of European Dentists Irish dental association
Nurses European Federation of Nurses
Association (EFN)
Polish Nurse Association
Pharmacists Pharmaceutical group of European Union (PGEU)
Malta Chamber of Pharmacists
Recruitment of national educational organisations
Last the list of the selected associations was used to identify relevant national educational
organisations These national educational organisations (eg University of Maastricht
Faculty of Health Medicine and Life Sciences Kaunas University Medical School Lifestyle
Medicine University of Helsinki Faculty of Medicine) were approached individually and
asked to fill in the survey and spread it throughout their network
Table 33 Number of national educational organisations approached
Profession Number of approached national education organisations
Medical schools 298
Schools of physiotherapy 29
School of social work 31
School of dietitians 40
School of Occupational therapists 45
School of dentists 85
School of pharmacists 56
Response obtained
In total we received information on 176 educational practices till mid-February The
workshop organized in Luxembourg65 gave an additional boost and resulted in 32 more
practices reported in the survey In total this mapping exercise is based on information on
208 practices of health promotion in educational settings
65 Workshop ldquoPromoting lifestyle medicine competencies and education of health professionals in the EU todayrdquo
13th February 2020 Luxembourg Organized by Chafea and DG SANTE
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
26
312 Desk research
Desk research was conducted on both scientific and grey literature with the main purpose
to establish an overview of the competency profiles of health professionals in the field of
health promotion and disease prevention This overview was created to gain insight to what
extent competency profiles related to health promotion and disease prevention are covered
in the educational standards of different health professions in the EU We have made use
of reports published online and scientific articles on competency profiles or educational
standards set at EU level (eg European standards in medical training (UEMS) as the EU
Directives of the European Parliament and Council on the recognition of professional
qualifications have consolidated a system of mutual recognition between Member States3
When reports on EU level could not be identified we selected articles on global standards
such as for the profession of social work (ie global standards for the education and training
of the social work profession)
Based on the identified literature we have described the competency profiles for each of
the following healthcare professions
bull (undergraduate) Medicine
bull Medical specialists
- sports medicine specialists
- public health specialists
- internists
- cardiologists
- psychiatrists
- general practitioners
bull Dentists
bull Nurses
bull Nurse specialists
bull Occupational therapists
bull Pharmacists
bull Physiotherapists
bull Psychologists
bull Social workers
The selection of healthcare professions included in the desk research was made in
consultation with Chafea DG SANTE and the experts
The assessment of the competency profiles was based on the three Domains of Learning
KSAs as described in Chapter 2
bull Cognitive mental skills (knowledge)
bull Psychomotor manual or physical skills (skills)
bull Affective growth in feelings or emotional areas (attitude or self)
This method was chosen as especially ldquolack of confidence and knowledge and skills by
health professionals on providing effective counsellingrdquo was identified as a barrier for
prescribing and counselling on promoting physical activity in the healthcare sector66 In
Chapter 4 the results are described in detail
66 httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
27
32 Long list of good practices
From the survey results we have drawn a long list of good practices As agreed with Chafea
and DG SANTE these good practices were selected using the following four selection criteria
bull The programme contains a multidisciplinary approach
bull The education is mandatory (including an exam)
bull The education covers the following topics digitalisation in health eHealth and
digital health coaching
bull The expected outcome includes change in skills and or behaviour
Several variables were included in the longlist country name of the programme name of
the institute whether there is a focus on knowledge skills and behaviour the type of
professionals who are being trained the theories that are covered by the education (eg
human cognition and behaviour health behaviour change techniques communication skills
etc) education methods used year since the education is provided the time spend in the
modules in hours and lastly in case of one full module the duration of this module To
enable comparison between good practices based on different variables the preliminary
longlist can be found in a separate Excel document Chapter 5 includes an overview of the
coverage and content of the long list of good practices
After closing of the online survey we analysed the longlist of good practices along the
following research questions
bull What content items of health promotion disease prevention and lifestyle
counseling do programmes consist of
bull What kinds of learning aims do they have
bull How do they distribute in Friedens model of levels of health promotion
bull Are there differences between professional groups
First we analysed the distribution of the learning skills separately by the levels of education
(undergraduate postgraduate and CPD) We expected that adult learning will be more
directed towards skills (learning by doing) than the undergraduate and postgraduate
programmes Secondly we analysed the educational methods and tools used in the good
practices
Good practices can be submitted to the European Commissionrsquos Best Practice Portal to be
assessed by external evaluators against criteria adopted by the Steering Group on Health
Promotion Disease Prevention and Management of NCDs Practices rated as best against
these criteria will be published on the European Commissionrsquos Best Practice Portal67
67 httpswebgateeceuropaeudynabp-portal
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
28
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
29
4 MAPPING OF THE CURRENT SITUATION IN HEALTH PROMOTION TRAINING IN THE EU
41 Overview of educational programmes in the EU
411 Summary of the main findings in the survey
A high percentage (93) of respondents (n=197) indicated that health promotion and
disease prevention are implemented in their educational programmes or modules For
undergraduate education postgraduate education and CPD these percentages were 95
93 and 83 respectively Other results include
bull More than half of the respondents indicated that they filled in the questionnaire
based on undergraduate educational settings Throughout Europe these numbers
were relatively similar
bull Physiotherapists seem to be the professional group most actively involved in
health promotion training activities The vast majority applies multidisciplinary
approaches and thus bring other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within the undergraduate and postgraduate programmes In CPD on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion target knowledge skills and
attitudes of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for CPD (33) compared to
undergraduate and postgraduate education (15 and 6) when the topic is
covered in most modules Funding was more often obtained in Northern and
Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) With regard to full modules high percentages
indicated that these are mandatory and that there is an exam at the end of the
module (81 70 respectively)
412 Detailed results of the survey
Respondents
In the following section we provide a detailed description of the survey results The survey
targeted undergraduate education postgraduate education and CPD programmes in all
Member States Overall 208 respondents filled in the questionnaire about their educational
practice Note the results presented in the remainder of this report are exclusively based
on the answers respondents provided in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
30
Table 41 and Figure 41 provide an overview of the number of practices reported per
European countries A detailed overview of the educational programmes collected
throughout Europe can be found in Annex 1
Figure 41 Practices collected in the survey by European countries (n=208)
Table 41 Number of respondents per European Member State 2019-2020 (n=208)
Abbreviations EU Member State Number of respondents
AT Austria 12
BE Belgium 23
BG Bulgaria 4
CY Cyprus 1
CZ Czech Republic 7
DE Germany 1
DK Denmark 8
EE Estonia 2
ES Spain 22
FI Finland 6
FR France 15
GB United Kingdom 6
GR Greece 10
HR Croatia 0
HU Hungary 3
IE Ireland 8
IT Italy 10
LT Lithuania 1
LU Luxembourg 0
LV Latvia 5
MT Malta 6
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
31
Abbreviations EU Member State Number of respondents
NL Netherlands 2
PO Poland 0
PT Portugal 14
RO Romania 3
SE Sweden 4
SI Slovenia 14
SK Slovakia 2
Additional countries 19
TOT 208 the UK is included as a Member State in this study as the results were obtained before Brexit
For mapping purposes we made a breakdown of results by region ie Northern Europe
Eastern Southern and Western Europe (based on United Nations Regional Groups)
Furthermore we compare results of individual countries for which at least 10 practices have
been reported in the survey These are Austria Belgium France Greece Italy Portugal
Slovenia and Spain
Table 42 European countries per region
Region European countries
West Austria Belgium France Ireland Germany
Luxembourg Netherlands United Kingdom Switzerland
North Denmark Sweden Estonia Finland Lithuania Latvia Norway
East Bulgaria Czech Republic Hungary Romania Slovakia Poland Georgia Kazakhstan
South Italy Spain Cyprus Portugal Greece Malta Slovenia Croatia Bosnia Kosovo Serbia
Type of education
We asked the respondents to indicate the type of educational setting As shown in Figure
42 more than half of the practices (60) refer to undergraduate educational settings and
approximately one third to postgraduate educational settings Only twelve percent of the
reported educational settings is related to CPD
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
32
Figure 42 Practices by educational level (n=199 in percentages)
Figure 43 and Figure 44 show the distribution in type of education per region and on
country level respectively For Western Southern and Northern Europe distribution is in
line with the overall results In Eastern Europe practices reported are more evenly
distributed over undergraduate and postgraduate education Also the share of CPD
practices is high in comparison with other regions and overall results
Figure 43 Practices by type of education per region (n=204 in percentages)
64
42
62
60
29
37
27
30
7
21
12
10
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Undergraduate education Postgraduate education Continuous professional development
60
29
12
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
33
Figure 44 Practices by type of education per country (in percentages)
Type of health professions
An overview of the type of health professional trained in the educational practices is
provided in figure 45 Remarkably over one third (35) of the educational practices
reported are oriented to physical therapists Note that multiple answers could be provided
Figure 45 Type of health professional being trained (n=208 in percentages)
Medical specialists refer to doctors with an extra expertise in one type of medicine eg including sports
medicine public health internal medicine cardiology psychiatry and the general practitioner68 General
practitioners refers to doctors working within General Practice or Family Medicine (GPFM)69 Medical doctors refers
to doctors without any specialization
68 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 69 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
83
70
27
50
30
62
71
71
8
22
60
30
60
23
14
19
8
9
13
20
10
15
14
10
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Undergraduate education Postgraduate education Continuous professional development
116
15
35
1417
7 8 5
29
0
10
20
30
40
50
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
34
Health professionals involved as educators in health promotion and disease prevention are
shown in Figure 46 Physical therapists are most often active as teachers of health
promotion (36) which coincides with the high share of practices oriented to this
profession Some professions like medical specialists nurses and psychologists are
represented more often as teacher then as trainee of the educational practices This implies
they are involved in programmes oriented towards other health professions and is in line
with a multidisciplinary approach that is applied by the vast majority of practices ( 81
n=148)
Figure 46 Health professionals teaching contents of health promotion (n=90 in
percentages)
Methods of education
Survey results show that traditional methods ie lectures and assignments are most often
used (Figure 47) Assignment refers to home school projects such as writing papers In
CPD eLearning methods are more often used (67) compared to undergraduate (45)
and post graduate education (39) The use of field training is relatively similar for the
different levels of education
Figure 47 Teaching methods applied (n=145 in percentages)
8
27 26
36
14
24 23
6 7
37
0
10
20
30
40
50
97
81
74
46
0 10 20 30 40 50 60 70 80 90 100
Lectures
Assignments
Field training in real environments
eLearning modules
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
35
Knowledge skills and behaviour
As for the outcome of the education respectively 99 94 and 89 of all practices
indicate knowledge skills and behaviour as expected outcomes (Figure 48) There are no
significant differences between types of education
Figure 48 Knowledge skills and behaviour (n=142 in percentages)
Accreditation
Overall 39 of the educational practices is accredited on European or international level
53 is accredited at a national level and only 5 lacks accreditation (n=179) Comparing
the different levels of education the rate of accreditation at a European or nation level
varies At a European level these are 46 33 22 at the national level 47 58
67 for undergraduate education postgraduate education and CPD respectively
Throughout Europe the level of accreditation of education is high in Northern Eastern
Southern and Western countries the share of practices without accreditation is 11 0
5 and 3 respectively (n=197) Eastern European countries have regulated their
accreditation more often on a national level compared to the other countries
Theories covered
Figure 49 shows that health behaviour human cognition and behaviour and population
health are covered in most educational practices to a high or at least limited extent
99
0 1
94
4 2
89
6 4
0
20
40
60
80
100
Yes No Unknown Yes No Unknown Yes No Unknown
Knowledge Skills Behavior
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
36
Figure 49 Theories covered by the education (n=137 (in percentages)
Figure 410 provides a more detailed overview of contents covered in the educational
programmes and shows that communications skills ethics and methods of evidence-based
medicine are mostly covered within the education Contents least covered are digital health
coaching digitalisation health economics
Funding and partnerships
Figure 411 provides an overview of the practices that a) obtained targeted funding to
incorporate health promotion and disease prevention in the curriculum b) for which a
partnership is set up for execution of teaching activities on health promotion or c) built on
existing partnerships to incorporate health promotion in the curriculum of the whole
educational programme This overview only includes educational practices where health
promotion and disease is incorporated in most modules
Funding differed between level of education 15 6 and 33 of the undergraduate
education postgraduate education and CPD received targeted funding to incorporate health
promotion in the curriculum Hence funding seems to play a more important role for CPD
than for undergraduate and postgraduate education
66
54
65
31
42
32
1
1
2
3
1
0 20 40 60 80 100
Population health
Human cognition and behavior
Health behaviour
Yes very much Yes but limited No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
37
Figure 410 Theories that are included within education on health promotion (n=137 in percentages)
Figure 411 Funding and partnerships when health promotion is covered in most modules of the educational programme (n=123 in percentages)
Figure 412 provides a comparison of funding obtained by European region Remarkably
in Western Europe the share of practices with targeted funding to incorporate health
promotion is much lower than in the other EU regions
48
69
40
16
54
48
20
34
37
41
49
64
9
44
24
55
51
42
47
50
50
48
44
42
31
43
7
6
4
4
3
4
25
25
9
9
5
2
42
1
1
1
1
1
1
5
5
5
6
4
3
6
0 20 40 60 80 100
Epidemiology and bio-statistics (research capacity)
Methods of evidence-based medicine
Health policies and regulation
Health economics
Ethics
Health care systems
Digitalisation in health promotion
Health inequalities
Disease prevention in teams
Health literacy
Health behavior change techniques
Communication skills
Digital health coaching
Yes very much Yes but limited No Unknown
52
61
15
0 20 40 60 80 100
Partnerships in incorporating it in the curriculum of thewhole educational programme
Partnerships for execution of teaching activities
Funding to incorporate health promotion in curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
38
Figure 412 Funding to incorporate health promotion for programmes covering health promotion in most modules by region (n=119 in percentages)
Comparing individual countries figure 413 shows that funding is obtained for the
educational programmes reported in Slovenia Italy and France while this is not the case
or unknown in Portugal Belgium and Austria
Figure 413 Funding to incorporate health promotion when health promotion is covered in
most modules of the educational programme by country (n=71 in percentages)
Dedicated modules to health promotion
In a majority of practices (63) health promotion disease prevention and lifestyle
medicine are covered in all modules of the educational programme as opposed to coverage
in one module primarily dedicated to health promotion (37) Undergraduate and
postgraduate education show a similar pattern while in CPD programmes full modules
primarily dedicated to health promotion are relatively restricted namely 15 (Figure 414)
Both options have the potential to be effective depending on context implementation and
other factors The data gathered in this study do not allow any statement on effectiveness
of each option
20
12
21
3
80
82
70
85
6
9
13
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Yes No Unknown
13
29
0
9
30
89
100
38
71
40
100
73
70
11
50
18
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Yes No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
39
Figure 414 Share of practices with one full module primarily dedicated to health promotion
(n=140 in percentages)
Visibility of health promotion in CPD
In CPD health promotion is often integrated into disease-oriented or risk behaviour-
based contents making it harder to identify the subject in events available The
Union of European Medical Specialists (UEMS) has an electronic database for
accrediting continuous medical education This data set contains keywords Using
health promotion public health or lifestyle as keywords 37 educational events were
found in the years 2017-19 (Table 415) There were 6 events in year 2017 3 in
year 2018 and 8 in year 2019 Average number of credits (1 ECMEC equals 1 hour
maximum 6 per day) was 296 average length of events 45 days This illustrates
availability of international training on health promotion and public health for
medical professions In other events these themes may have been touched upon
as well but are not the main subject So there might be a need to make health
promotion more visible in CPD events Competency-based education could provide
a solution if health promotion disease prevention and lifestyle medicine are defined
as competencies
Table 415 CPD events with health promotion public health or lifestyle as keyword 2017-
2019 (n=37)70
Title ECMEC Year Location Website
Control of multidrug-
resistant micro-organisms in health care settings
20 2017 Stockholm
Sweden
httpwwwecdceuropaeu
Epidemiology and public health microbiology for facilitators
30 2017 Spetses Greece
httpwwwecdceuropaeu
Fellowship (EPIET amp EUPHEM) introductory course
86 2017 Spetses Greece
httpwwwecdceuropaeu
International Society for Quality in Health Care 34th International Conference
23 2017 London United Kingdom
httpisquaorgEventslondon-2017
DOHaD 2017 10th World Congress DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE
25 2017 Rotterdam Netherlands
httpwwwdohad2017org
70 Source UEMS database of accredited events 2017-2019
4035
150
20
40
60
80
100
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
40
Title ECMEC Year Location Website
10th European Public Health Conference
23 2017 Stockholm Sweden
httpsephconferenceeu
Methods and tools for evidence-based practice
and decision-making in Public Health with special emphasis on communicable disease
22 2018 Stockholm Sweden
httpwwwecdceuropaeu
ESCMID Workshop on
Migrants Health
15 2018 Muscat
Oman
httpsescmidpulselinksco
mevent14833
Control of multidrug-resistant micro-organisms in health care settings
17 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventscourse-control-multidrug-resistant-micro-organisms-mdros-health-
care-settings
ECDC Summer School 2018 23 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventsecdc-summer-school-2018
3rd International Conference of the European Network for Smoking and Tobacco Prevention
15 2018 Madrid Spain
httpsenspconferenceorg
European Observatory Venice Summer School 2018
25 2018 San Servolo Italy
wwwtheobservatorysummerschoolorg
Letrsquos talk about nutrition (NESG)
4 2018 Madrid Spain
httpespencongresscomprogrammelll-courses
Epidemiology and public health microbiology for
facilitators
28 2018 Spetses Greece
httpsecdceuropaeuenepiet-euphemaboutintro
International Society for
Quality in Health Care 35th International Conference
22 2018 Kuala
Lumpur Malaysia
httpsisquaorgEventsmal
aysia-2018
Fellowship (EPIET amp EUPHEM) introductory course
93 2018 Spetses Greece
wwwecdceuropaeu
EGEA 2018 ndash ldquoNutrition and health from science to practicerdquo
16 2018 Lyon France httpswwwegeaconferencecom
1st EUROPEAN LIFESTYLE MEDICINE CONGRESS
13 2018 Geneva Switzerland
wwwelmocongresscom
11th European Public Health Conference
24 2018 Ljubljana Slovenia
wwwephconferenceeu
Fellowship Multivariable
Analysis
25 2019 Madrid
Spain
Rapid Assessment and Survey methods (RAS)
module
35 2019 Zagreb Croatia
ECDC Summer School 2019 28 2019 Stockholm Sweden
httpswwwecdceuropaeuennews-eventsecdc-summer-school-2019
Fellowship Vaccinology Module
29 2019 Rome Italy
Programme Planning and Implementationrdquo Training Program for Resolve to
Prevent Epidemics Initiative
39 2019 Butaro Rwanda
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
41
Title ECMEC Year Location Website
Skill-mix innovation in primary and chronic care mobilizing the health workforce
28 2019 Venice Italy wwwtheobservatorysummerschoolorg
Evolutionary Medicine Conference 2019 5th international meeting of the International Society for Evolution Medicine and Public Health
15 2019 Zurich Switzerland
httpsisemphorg2019-Meeting
Fellowship (EPIET amp EUPHEM) introductory course
85 2019 Spetses Greece
Project Management for Emergency Preparedness Budget and Finance Management
20 2019 Butaro Rwanda
Autumn School on Medical
Education
19 2019 Chernivtsi
Ukraine
httpswwwfacebookcome
vents531981117209981
Project Management for Emergency Preparedness Practical Leadership Skills
24 2019 Butaro Rwanda
International Society for Quality in Health Care 36th International Conference Cape Town 20102019 - 23102019
18 2019 Cape Town South Africa
httpswwwisquaorgeventscp2019html
Public Health Genomics an
introduction
11 2019 Stockholm
Sweden
httpsecdceuropaeuenne
ws-eventspublic-health-genomics-introduction
ENSP Tobacco treatment
specialistsrsquo training
5 2019 Paris France httpenspnetwork
World Health Summit 2019 16 2019 Berlin Germany
wwwworldhealthsummitorg
Time Series Analysis 28 2019 Bilthoven
Netherlands
httpsecdceuropaeuenep
iet-euphemaboutexperience
12th European Public Health Conference
16 2019 Marseille France
wwwephconferenceeu
Outbreak Investigation Module
30 2019 Nicosia Cyprus
httpswwwecdceuropaeuenepiet-euphemaboutexperience
Source UEMS database of accredited events 2017-2019
Looking at the regional level we found that in most regions a majority of practices cover
the topic in all (or most) modules of the educational programme (Figure 416) In Northern
Europe this is most pronounced with as much as 76 of the practices reported covering
health promotion in all modules whereas in Eastern Europe this applies for 55 of
practices A similar analysis for individual countries shows that only in Spain health
promotion is covered in a dedicated module in the majority (62) of educational practices
reported while in all other countries the topic is mostly covered in all (or most) modules of
the programme Percentages vary from 56 (Austria) to 86 (Greece Figure 417)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
42
Figure 416 How is health promotion implemented in education by region (n=148 in percentages)
Figure 417 How is health promotion implemented in education by country (n=120 in
percentages)
55 participants answered specific questions on the full module dedicated to health
promotion 81 of them indicated that the education is mandatory As figure 418 shows
in Northern and Eastern Europe all dedicated module on health promotion form part of
mandatory education In Western Europe one out of three modules is optional for students
24
4537
42
76
5563
58
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
4439
36
14
22
38
18
6256
6164
86
78
63
82
38
0
20
40
60
80
100
Austria Belgium France Greece Italy Portugal Slovenia Spain
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
43
Figure 418 Full modules on health promotion that are part of mandatory education by region (n=47 in percentages)
An exam is taken at the end of the module in 70 of the cases Between regions
percentages do not differ much (Figure 419) Please note that results are based on a
limited number of practices as response for this question was low
Figure 419 Exam at the end of dedicated module by region (n=47 in percentages)
When asked whether the module on health promotion and disease prevention was
accredited separately 15 indicate that this is the case 30 report that the module is
provided at multiple locations
Figure 420 provides an overview of respondents who indicate that funding was obtained
to set up the module as well as the use of partnerships for implementation of teaching
activities on health promotion or in setting up the module Lastly it was indicated that
mostly lsquootherrsquo professionals are teaching these modules
100 100
82
67
12
22
611
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
Yes No Unknown
2518
2225
12 11
75 7571
67
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
No Unknown Yes
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
44
Figure 420 Funding and partnerships for dedicated modules (n=47 in percentages)
42 Overview of competency profiles of health professionals in the EU
A detailed description of the competency profiles per healthcare profession as obtained
from the desk research can be found in Annex 2 Competency profiles per professions
These profiles provide a solid basis for health promotion and disease prevention
Most competency profiles mention health promotion andor disease prevention Overall
the competencies of medical specialists are most comprehensively described including the
competencies for health promotion Although there are many similarities between the
different competency profiles we have identified differences in the coverage of domains of
learning ie knowledge skills and attitudes (see chapter 23) Knowledge refers to
cognitive or mental competencies skills to competencies to perform tasks or activities and
attitudes to competencies related to beliefs or values An example of an attitude
competency is ldquoexemplify appropriate lifestyle in personal behaviourrdquo In professions that
are less physically oriented emphasis is on knowledge and attitude rather than on skills
related to health promotiondisease prevention This mainly holds for psychiatry and social
workers For professions in which lifestyle is an essential component ie sports medicine
and public health emphasis is on skills rather than attitudesOnly for cardiology nurses
nurse specialists and pharmacists competency profiles describe competences in all
domains of learning ieknowledge skills and attitudes
Many competency profiles leave room for interpretation and competencies described are
not ranked in order of importance In addition profiles do not state whether competencies
should be practised in a pro-active (within every treatment) or reactive way (only when
treating diseases with a clear lifestyle component
43
53
11
0 20 40 60 80 100
Partnerships in setting up module
Partnerships for execution of teachingactivities
Funding to set up module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
45
5 LONG LIST OF GOOD PRACTICES
In this chapter we present the coverage and content of the long list of good practices The
list is also available in an Excel-file that provides the opportunity to easily make selections
by different variables such as country type of programme (undergraduate postgraduate
CPD) or the characteristics of the education programme
We also provide an analysis of content areas covered and their weight in educational
programmes learning objectives learning typology and educational methodology using
Kraigerrsquos typology and Friedenrsquos pyramid as analytical tools
51 Results
From the survey results we have drawn a long list of good practices In agreement with
Chafea and DG SANTE good practices were selected based on four criteria
1 The programme contains a multidisciplinary approach
2 The education is mandatory (including an exam)
3 The education covers the following topics digitalisation in health eHealth and digital
health coaching
4 The expected outcome includes change in skills andor behaviour
This resulted in a long list of 70 good practices that meet all criteria Educational practices
cover all regions of Europe and originate from 20 Member States (Figure 51 and Table
51)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
46
Figure 51 Number of good practices selected for long list by country 2019-2020
Table 51 Number of good practices selected based on the four selection criteria per European Member State 2019-2020
Abbreviations EU Member State Number of good
practices
AT Austria 6
BE Belgium 11
BG Bulgaria 2
CY Cyprus 1
CZ Czech Republic 2
DE Germany 0
DK Denmark 5
EE Estonia 1
ES Spain 7
FI Finland 2
FR France 6
GR Greece 7
HR Croatia 0
HU Hungary 1
IE Ireland 3
IT Italy 2
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
47
Abbreviations EU Member State Number of good practices
LT Lithuania 1
LU Luxembourg 0
LV Latvia 1
MT Malta 0
NL Netherlands 0
PO Poland 0
PT Portugal 2
RO Romania 1
SE Sweden 2
SI Slovenia 7
SK Slovakia 0
TOT 70
Of all selected good practices of healthcare educational programmes 16 practices (23)
cover health promotion and disease prevention in one full module primarily dedicated to
the subject In 54 good practices (77) the educational programmes incorporate the topic
of health promotion and disease prevention in all or most modules (Figure 52)
Figure 52 How is health promotion covered in selected good practices (n=70 in percentages)
When dividing good practices by type of education programme we see that all types
educational programmes are represented (Figure 53) The highest share of good practices
is focused on undergraduate education (60 n=42) Two practices are focused on both
undergraduate and postgraduate education
Figure 53 Type of education () represented by selected good practices (n=70)
77 23
All modules One module
6026
113
Undergraduate education
Post graduate education
Continuous professionaldevelopment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
48
Figure 54 presents the absolute number of selected good practices by type of profession
trained The absolute number sums up till 128 as multiple professions can be trained within
one programme This shows a good variation of health professionals Most good practices
focus on nurses (17 n=22) and medical doctors (13 n=17)
Figure 54 Good practices by profession being trained (n=70 in absolute numbers)
In addition to those described above other variables are included in the separate Excel file
mentioned above These include the name of the programme and the institute focus on
knowledge skills and behaviour type of professionals being trained theories covered in
the education (eg human cognition and behaviour health behaviour change techniques
communication skills etc) education methods used when the education started time
spent on the modules in study hours (ECDEC) and in case of one full module the duration
of this module This Excel file allows to make cross comparisons between different variables
52 Analysis of good practices
In this section good practices are analysed more in detail Figure 55 presents the
distribution of content areas in health promotion and their weight in educational
programmes Methodological training like evidence-based methods (EBM) varies in
programmes but has a strong position Lifestyle intervention skills are widely taught
however new technologies are still on their way in becoming part of health promotion
education Interestingly health economics rate less in these practices in spite of its close
link with health promotion as part of public health policies
30
4
4
11
17
15
15
22
10
Other
Social workers
Dentists
Occupational therapists
Medical doctors
Medical specialists
Psychologists
Nurses
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
49
Figure 55 Results for good practices(n=70) ldquoDoes the education of the initiative includerdquo
Numbers refer to Frieden model in levels of health promotion with exception of methodological contents marked
as tools (1) counselling and education (2) clinical interventions (4) changing the context to make individualrsquos
default decisions healthy (5) socioeconomic factors (6) methods in studying and evaluating health promotion
and public health
We used Friedenrsquos pyramid of levels of health promotion (Frieden 2010) and Kraigerrsquos
typology of learning (Kraiger et al 1993) to describe the abilities that professionals are
expected to acquire Based on their description learning objectives move in a knowledge
level skill building or into attitudinal objectives Figure 56 gives a graphical visualization
of the results of our analysis The dark blue green and light blue rectangles represent the
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
50
Figure 56 Learning objectives categorised into Friedenrsquos levels and learning typology
(knowledge skills attitudes) of good practices (n=70)
different domains of learning knowledge skills and attitudes The size of the rectangles is
proportional to their share in all domains in the educational practice
Within each domain of learning contents are categorized Their vertical order reflects the
order of impact levels of Frieden (from individual patient to society level) and again size
corresponds to share in the curriculums content
This analysis provides a general picture of educational practices in health promotion
disease prevention and lifestyle medicine The graph shows that practices are
predominantly oriented towards knowledge-based competencies (around 60 of the
curriculum) Roughly one third of the programme has skills-oriented learning objectives
while competencies regarding attitudes are addressed in around 10 percent of the
programmersquos content
Looking into knowledge-based competencies the broad spectrum of individual to societal
levels of impact is addressed On a societal level social and medical aspects are widely
represented while the economic angle is scarcely present Technological developments like
digitalisation are present to a modest extent
Skill-oriented learning objectives focus in communicative competences like communication
skills behaviour change techniques and teamwork Health coaching is covered in a small
number of practices Interestingly in methodological contents the aim of skills-oriented
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
51
education is to provide mainly knowledge like in EBM Few practices include practical skills
for communication and coaching in their objectives
Competence-building in the domain of attitudes form a minimal part of educational
practices They are reflected in eg health literacy and ethics However these are also
taught in a hidden curriculum as well
Educational methodologies in the survey include lectures assignments e-Learning and
real-world field assignments As these are the selected good practices it was to be expected
that multiple methods are used in most of these programmes (given selection criterium 3)
In 37 programmes all methods are in use E-Learning is used in 41 programmes
Figure 57 Educational methods used in good practices (n=70 in percentages) ()
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
53
6 CONCLUSIONS
The competency profiles as well as information on a large number of educational practices
in health promotion disease prevention and lifestyle medicine for health professionals in
the EU allow us to formulate answers to the research questions that guided this study
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and
continuous professional education
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades71there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional The educational practices collected show that this is true for all
regions of the EU However there is no overall body that has responsibility for quality
assuring standards of training and professional practice at the European level
The information on around 200 practices from 25 EU Member States (including UK) shows
that the majority of educational practices take place in undergraduate settings while
training events on health promotion for health professionals active in the field are relatively
scarce in continuous professional development (CPD) a limited number of practices on
health promotion are reported and indeed few courses or training events on health
promotion are available in the CPD calendar of the UEMS database of accredited events
Education on health promotion aims at developing competencies in knowledge skills and
attitude and most often has a multidisciplinary character Especially medical doctors nurses
and psychologists are often involved in educating other disciplines on health promotion
Health behaviour human cognition and behaviour as well as population health are part of
educational practices for all professions A majority also include communication skills
methods of EBM and ethics
The most common way to teach health professionals on health promotion disease
prevention and lifestyle medicine is the integration of the subject in most of all modules of
the curriculum Dedicated modules on health promotion are developed in undergraduate
and postgraduate education but are scarce in CPD This may contribute to the invisibility of
the subject in training for professionals active in the field
Four out of ten educational practices on health promotion are accredited on the European
(or international) level half of them have national accreditation
71 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
54
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Based on in-depth analysis of a selection of 70 good practices knowledge proves to be the
predominant domain of learning Theories covered relate to different levels of impact of
Friedenrsquos pyramid but emphasis is on the individual patient level with a predominant
position for evidence-based medicine Health economics receive remarkably little attention
This may be disadvantageous for advocacy of health promotion which requires influencing
decision-making on public funding
Around one third of educational contents are dedicated to competencies in the domain of
skills and mainly target communicative skills Interestingly they provide mainly knowledge
rather than practical training Competencies in the domain of attitude are addressed least
Ethics and health literacy are theories are the most common examples of attitude-oriented
contents When looking at the competencies defined by health professionals advocacy has
a solid role in all of them with defined skills It was represented in only few domains like
health economics so it may well be that educating advocacy skills are more common than
found in this study
Good practices use a mix of educational methods including lectures assignments real-
world practices and digital study methods
In conclusion this study is a first step in gaining knowledge and insights in the state of
affairs of health professionalsrsquo education in health promotion disease prevention and
lifestyle medicine in the EU It is an important step as we know little about present
practices However more detailed research will obviously be needed
The results of our in-depth analysis of good practices provide qualitative information We
used the integrated framework as an analytical tool to classify content areas covered and
their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future The information supplied by the
respondents show the culture of describing health promotion and education objectives
Therefore no lsquohardrsquo conclusions can be drawn However some cautious notions are
worthwhile to mention as they flag opportunities for learning and improving by collaborative
action
First it is worthwhile to stress the progress made While 20 years ago health professionals
were hardly trained in health promotion and lifestyle medicine and at best received some
instruction on specific disease-related unhealthy habits (like smoking for lung diseases) it
is now part of standard education for most health professionals That is an important
development and essential for collaboration across professions
However more can be done Health promotion education should respond to societyrsquos needs
and therefore educational needs are constantly changing and providers of education need
to follow needs in the field Increasing recognition of societal impact on health inequalities
the paradigm shift from treating to coaching patients changes in the way care is delivered
the digital revolution and the need to contain the cost of our healthcare systems represent
a multitude of challenges and relentless educational efforts in health promotion disease
prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
55
To name a few the balance between domains of learning in curricula will have to redefined
as in health coaching skills attitudes and knowledge are equally important Health
professionals will have to manage health economics to speak the language of policy makers
Teaching methodologies have gained from the technological revolution and there is
potential in utilising them even more Also there is a necessity to do so in order to provide
for effective health promotion Health literacy has got alongside data literacy Therefore
education needs to respond to in using more technologies as well as teaching adaptation of
technologies into care This is not common practice yet The constant development in needs
also stresses the need for continuous professional development in health promotion
disease prevention and lifestyle medicine To date CPD seems to be underrepresented in
educational practices on health promotion and more heavily dependent on external funding
than in undergraduate and postgraduate courses
The experience developed in the good practices collected in the survey represents a
valuable body of knowledge skills and attitudes among health educators With collaborative
efforts this can serve as an important capital to promote continuous development and
improvement of educational practices in health promotion disease prevention and lifestyle
medicine in all European countries
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
57
ANNEX 1 SURVEY RESULTS BY COUNTRY
In this annex we provide the names of all educational programmes by country filled in in
the survey In addition the following variables of the educational programmes are
provided the name of the educational institution type of education and type of health
professionals being trained This information is based on the information provided by the
respondents from each country If certain boxes are not filled in this means that only
partial information of this educational programme is provided
Austria
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Bachelorstudiengang Physiotherapie
FH JOANEUM GmbH Undergraduate education
Physical therapists
Dietetics Health University of
Applied Sciences
Undergraduate
education
Dieticians
Physiotherapy University of Applied Sciences St Polten
Undergraduate education
Physical therapists
Bachelorrsquos Degree Programme Physiotherapy
FH Campus Wien Undergraduate education
Physical therapists
Dietetics and Nutrition FH Joanneum Undergraduate education
Medical Doctors Non-specialized dietitians
Bachelor Programme Physiotherapy
University of Applied Sciences Upper Austria
Undergraduate education
Physical therapists
Degree Programme Dietetics
(Bachelor of Science)
University of Applied
Sciences Upper Austria
Undergraduate
education
Dietitians
Midwifes Speak and language therapists Biomedical scientists Radiological
technologists Physical therapists Occupational therapists Nurses
Bachelor in Health Studies
Physiotherapy
FH Kaernten Undergraduate
education
Physical therapists
Nursing Science Medical University of Graz
Postgraduate education
Nurses
Public Health Medical University of Vienna
Continuous professional development
Medical doctors
Belgium
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Drug Development KU Leuven Undergraduate education
Pharmacists
Bachelor and master Rehabilitation Sciences and
Physiotherapy
University of Antwerp Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
58
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Motor Sciences Physiotherapy
Universiteacute Libre de Bruxelles
Undergraduate education
Physical therapists
Nutrition amp Dietetics Thomas More University College
Undergraduate education
Dietitians
Adad Adad Undergraduate education
Physical therapists
Master Physiotherapy and
Rehabilitation Science
KU Leuven Postgraduate
education
Physical
therapists
Occupational therapist HE Vinci Parnasse ISEI Undergraduate education
Occupational therapists
Master in Physical therapy and Rehabilitation
Universiteacute Libre de Bruxelles
Postgraduate education
Physical therapists
Master in Physical therapy Universiteacute Libre de Bruxelles
Postgraduate education
Medical specialists Physical
therapists (Sport medicine)
Nutrition and dietetics Thomas More University College
Continuous professional
education
Medical doctors Dieticians
psychologists
Information not provided Information not provided
Undergraduate education
Pharmacists
The European Certificate in
Lifestyle Medicine
The European Lifestyle
medicine organisation (ELMO) together with the Belgian Lifestyle
Medicine Organisation (BELMO)
Continuous
professional education
Medical doctors
Medical specialists (lifestyle
medicine) Physical therapists
Occupational therapists Nurses Psychologists General practitioners
Nutrition and Dietetics Erasmus Hogeschool Brussels
Undergraduate education
Dieticians
Master in Nursing and Midwifery
University of Antwerp Postgraduate education
Nurses
Bachelor amp Master Rehabilitation Sciences amp
Physiotherapy
KU Leuven Undergraduate education
Physical therapists
Bachelor Nursing University of Applied
Sciences Gent HOGENT
Undergraduate
education
Nurses
Professional Bachelor in Nutrition and Dietetics
University colleges Leuven Limburg
Undergraduate education
Dieticians
Nutrition and Dietetics University College Ghent
Undergraduate education
Dieticians
Bachelor in Applied Health Science
Howest University College
Undergraduate education
Lifestyle coaches
Physiotherapist Universiteacute Libre de Bruxelles
Postgraduate education
Osteopathy Physical therapists
Bachelor in Medicine Hasselt University Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
59
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor of Nutrition and Dietetics
University of Applied Sciences of Gent
Undergraduate education
Dieticians
Bulgaria
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor programme in Social Work
Plovdiv University Department of Social work
Undergraduate education
Social workers
Rhinology Bulgarian Rhinologic
Society
Postgraduate
education
ENT doctors
Kinesitherapy Medical University Undergraduate education
Physical therapists
TRS rehabilitator Medical College Medical University
Continuous professional
education
Medical specialists
Cyprus
Name of educational
programme
Name of
educational
institution
Type of
education
Type of
health
professionals
being trained
Physiotherapy
programme
Nicosia University Undergraduate
education
Physical
therapists
Czech Republic
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy Universities Undergraduate education
Physical therapists
Physiotherapy Charles University first
faculty of Medicine
Undergraduate
education
Physical
therapists
Physiotherapy Faculty of Medicine Masaryk University Brno
Undergraduate education
Physical therapists
Physiotherapy Palackyacute University Faculty of Physical Culture Department of Physiotherapy
Postgraduate education
Physical therapists
General Nursing Masaryk University Undergraduate education
Nurses
Prakticky zubni lekar (Practical Dentist)
Czech Dental Chamber Continuous professional education
Medical specialists
Health Promotion Ministry of Health Czech Republic
Continuous professional education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
60
Denmark
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Musculoskeletal physiotherapy
Aalborg University Postgraduate education
Physical therapists
Master in Physiotherapy University of Southern Denmark
Postgraduate education
Physical therapists
The Fairstart Foundation The Fairstart Foundation
Continuous professional education
Orphanage staff (each orphanage has
professional staff such as psychologists social workers
andor therapists
These staff members are responsible to work with each child on an individual basis) School
teachers Psychologists Social workers
Bachelor in Physiotherapy University College North Denmark
Undergraduate education
Occupational therapists
Nurses
Bachelorrsquos degree Programme of Physiotherapy
VIA University college Postgraduate education
Physical therapists
Master of Public Health Aalborg University Undergraduate education
Midwives Nurses Therapists Psychologists Medical Specialists
Estonia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Nursing (general nursing) Tartu Health Care College
Undergraduate education
Nurses
Psychology University of Tarty Institute of Psychology
Undergraduate education
Psychologists
Finland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
NutritionNutrition therapy University of Eastern Finland
Postgraduate education
Clinical nutriontinists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
61
Masterrsquos programme of Human Nutrition and food-related behaviour
University of Helsinki Undergraduate education
Nutrition experts who work in eg community
health promotion
Master of Healthcare advanced practice ndash supporting self-care and
care of non-communicable diseases
Savonia University of Applied Sciences
Postgraduate education
Physical therapists Occupational
therapists Nurses
Public Health Nursing Metropolia University of Applied Sciences
Postgraduate education
Public Health nurse
Medical doctors training programme
University of Helsinki medical faculty
Undergraduate education
Medical doctors Nursing
Master degree in Health Management Psychologists
Dentists
Dental education University of Helsinki Faculty of Medicine Department of Oral and Maxillofacial Diseases
Undergraduate education
Dentists
France
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Occupational therapy school Croix Rouge Franccediloise Postgraduate education
Occupational therapists
Institut Reacutegional de Formation en Ergotheacuterapie
Association Saint Franccedilois dAssise
Postgraduate education
Occupational therapists
Occupational therapy Institut de formation en Ergotheacuterapie de Berck-sur-Mer site de Loos
Postgraduate education
Occupational therapists
Occupational therapy IFE Assas Undergraduate education
Occupational therapists
Arrecircteacute du 5 juillet 2010
relatif au diplocircme drsquoEacutetat drsquoergotheacuterapeute
Institut de Formation
en Ergotheacuterapie du CHU Rouen Normandie
Undergraduate
education
Occupational
therapists
Occupational therapy school Croix Rouge Francaise Postgraduate education
Occupational therapists
Occupational therapy UPEC Postgraduate
education
Occupational
therapists
Diplocircme de Dieacuteteacuteticien IUT biologie ou BTS dieacuteteacutetique
Postgraduate education
Dietitians
Programme deacuteducation et de promotion agrave la santeacute
CoDEPS 13 Continuous professional education
Nurses Psychologists Dentists Social workers
Public health Universiteacute de Bourgogne
Postgraduate education
Medical doctors
Public health Lyon University Undergraduate education
Medical specialists
Public health residency Faculty of medicine University of Nantes
Undergraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
62
Name of educational programme
Name of educational institution
Type of education
Type of health professionals being trained
Master in Public Health Karolinska Institute Postgraduate education
Occupational therapists Social Workers
Public health and social
medicine
Universiteacute Versailles
Saint Quentin en Yveline
Continuous
professional education
Medical doctors
Public health UFR sciences de santeacute - Universiteacute de Bourgogne
Postgraduate education
Medical doctors Medical specialists
Midwives Physical therapists
Nurses General practitioners
Germany
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Visceral Surgery Augsburg University Continuous professional education
Medical specialist Physical therapists
Occupational therapists
Nurses Social workers
Human Medicine ndash The
cologne model study course (human medicine)
University of Cologne
Medical faculty
Undergraduate
education
Medical
specialists
Greece
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy University of Thessaly Undergraduate education
Physical therapists
Oral education programme
for children via experiential learning
Hellenic Dental
Association-Dental School of Athens-Hellenic Society of Paediatric Dentistry
Continuous
professional education
Psychologists
Dentists
Sports Nutrition International Hellenic University
Postgraduate education
Dieticians
Preventive Dentistry National and
kapodistrian University of Athens school of dentistry
Undergraduate
education
Undergraduate
students
Nutrition amp Dietetics International Hellenic University
Postgraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
63
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicine ndash under and post graduate studies
School of health sciences University of Patras
Undergraduate education
Medical doctors
Pharmacy diploma Aristotle University of
Thessaloniki
Undergraduate
education
Pharmacists
Hungary
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Public Health and Preventive
Medicine
Semmelweis University
Budapest Faculty of
Medicine Department of Public Health
Undergraduate
education
Medical doctors
Academic programme of Medicine
Semmelweis University Faculty of Medicine
Undergraduate education
Medical doctors
Residency in Preventive Medicine and Public Health
Semmelweis University Postgraduate education
Medical specialists
Ireland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Social Science in
Social Work
Maynooth University
(national University of Ireland Maynooth)
Postgraduate
education
Social workers
Information not provided Information not provided
Undergraduate education
Physical therapists
Professional Master of Physiotherapy
University College Dublin
Postgraduate education
Physical therapists
Bachelor Physiotherapy University College Dublin
Undergraduate education
Physical therapists
Bachelor Physiotherapy RCSI Undergraduate education
Physical therapists
Irish Dental Association Irish dental association Continuous professional
development
Dentists
Public Health Medicine Royal College of Physicians in Ireland
Postgraduate education
Medical specialists
Higher specialist training in Public Health Medicine
Royal College of Physicians in Ireland
Postgraduate education
Medical doctors Medical specialists General practitioners
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
64
Italy
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Healthy Lifestyles CNAI ndash Italian Nurses association
Continuous professional education
Nurses
Management for Health Professionals
University of Rome Postgraduate education
Midwifes Physical therapists Nurses
Corso di laurea in Terapia occupazionale (Bachelor in Occupational therapy)
Universitagrave degli Studi di Milano (State University of Milan)
Undergraduate education
Occupational therapists
Life Sciences University of Catania
School of Medicine
Continuous
professional
education
Medical doctors
Medical
specialists Physical therapists Occupational therapists Nurses
Dentists
Health promotion University of pavia Undergraduate education
Nurses
Corso di Laurea Magistrale
in Odontoiatria e Protesi Dentaria
Universitagrave di Parma Undergraduate
education
Dentists
Hygiene preventive medicine and public health
Universitagrave Cattolica del Sacro Cuore
Postgraduate education
Medical doctors Medical
specialists
general practicioners
Igiene e Medicina Preventiva Universitagrave degli Studi dellrsquoAquila
Postgraduate education
Medical doctors non-specialized
Post graduate school of Public Health
University of Sienna Postgraduate education
Medical doctors
Hygiene and Public Health University of Bari Aldo Moro
Postgraduate education
Medical doctors
School of specialization in Hygiene and Preventive Medicine
University of Milan Postgraduate education
Medical doctors
Lithuania
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Health Education and Promotion
Klaipeda State University of Applied sciences
Undergraduate education
Dietitians Physical therapists Nurses Dentists Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
65
Latvia
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Dentistry Riga Stradins University Undergraduate education
Dentists General practicioners
Professional Bachelor programme Physiotherapy
LASE Postgraduate education
Physical therapists
Physiotherapy Riga Stradins University Undergraduate education
Physical therapists
Malta
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Bachelor in Nursing Studies University of Malta Faculty of Health Sciences department of Nursing
Undergraduate education
Nurses
FHs University of Malta Undergraduate education
General practitioners
Netherlands
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Occupational Therapy Information not provided
Undergraduate education
Occupational therapists
Lifestyle and Healthcare Amsterdam University Medical Centre
Undergraduate education
Medical students
Portugal
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
PhD in Social Work ISCTE University Institute of Lisbon
Postgraduate education
Social workers
Bachelor degree in
Physiotherapy
Escola Superior de
Sauacutede de Santa Maria
Undergraduate
education
Physical
therapists
Physiotherapy IPC ESTeSC Coimbra Health school
Undergraduate education
Physical therapists
Licenciatura em Fisioterapia Escola Superior de Sauacutede - Instituto Politeacutecnico do Porto
Undergraduate education
Physical therapists
Degree in Physical therapy Instituto Piaget ndash Vila Nova de Gaia
Undergraduate education
Physical therapists
Degree in Physical therapy ESSATLA Continuous professional development
Physical therapists
Curso Licenciatura em Fisioterapia
Instituto Politeacutecnico de Sauacutede do Norte Escola Superior de Sauacutede do Vale do Ave CESPU
Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
66
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Clinical Education University Fernando Pessoa- Faculty of Health Sciences
Continuous professional development
Workers factory
Physiotherapy (Bachelor) School of healthy-
polytechnic institute of Setubal
Undergraduate
education
Physical
therapists
Physiotherapy Escola Superior De Sauacutede Do Vale Do Sousa do Instituto
Politeacutecnico De Sauacutede Do Norte
Undergraduate education
Physical therapists Nurses
Psychologists Dentists
Public Health ARSLVT Postgraduate
education
Medical
specialists
Information not provided Information not provided
Postgraduate education
Physical therapists
Information not provided Information not provided
Undergraduate education
General practicioners
Romania
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Nursing Education University Lucian Blaga Postgraduate education
Nurses
MedicinePharmacy - Health University of Oradea Faculty of medicine and
pharmacy Oradea
Postgraduation education
Medical doctors Medical
specialists Pharmacists Physical therapists Nurses
Dentists General practicioners
Slovakia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Social Work Constantine the philosopher University in Nitra
Postgraduate education
Social workers
Specialisation study in Clinical Psychology
Comenius University in Bratislava Faculty of
Arts
Continuous professional
development
Medical specialists
psychologists
Slovenia
Name of educational
programme
Name of educational
institution
Type of
education
Type of health
professionals being trained
Physiotherapy Alma Mater Europaea Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
67
Physiotherapy University of Novo mesto Faculty of Health sciences
Undergraduate education
Physical therapists
Faculty of health sciences University of Primorska Continuous professional education
Dietetics Physical therapists Occupational therapists Nurses
Nursing Applied Kinesiology Physiotherapy and Nutritional counselling ndash dietetics
University of Primorska Faculty of Health Sciences Slovenia
Undergraduate education
Nutrional counselling Kinesiologists Physical therapists Nurses
Professional higher education study programme 1st cycle degree occupational
therapy
University of Ljubljana faculty of health sciences
Undergraduate education
Occupational therapists
Applied Kinesiology UP FVZ Undergraduate
education
Kinesiology
Physiotherapy Alma mater Europaea ndash Evropski center Maribor
Undergraduate education
Physical therapists
Bachelor in Physiotherapy University of Ljubliana Faculty of health sciences
Undergraduate education
Physical therapists
Health Promotion Angela Boskin Faculty of healthcare
Postgraduate education
Physical therapists Occupational
therapists nurses
1st Bologna cycle study programme Physiotherapy
Angela Boskin Faculty of healthcare
Undergraduate education
Physical therapists
Public Health Medical
Residency
Medical chamber of
Slovenia
Continuous
professional development
Medical doctors
Public Health National institute of public health of the
Republic of Slovenia
Postgraduate education
Medical doctors
Psychology Faculty of arts University of Maribor
Postgraduate education
Psychologists
Spain
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Human Nutrition and Dietetics
University of Zaragoza Undergraduate education
Dieticians
Continuous professional
education
Nurses
Physiotherapy University of Coruna Undergraduate education
Physical therapists
EHEA Degree in Human Nutrition and Dietetics
Blanquerna School of Health Sciences ndash Universitad Ramon Lull
Undergraduate education
Dietitians
Bachelor in Pharmacy Universidad de Sevilla Undergraduate
education
Pharmacists
Continuous professional development
Spanish General Council of Social Work
Continuous professional education
Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
68
Bachelor in Pharmacy Universidad de Alcala Undergraduate education
Pharmacists
Bachelor in Medicine Faculty of medicine University of Cadiz Spain
Undergraduate education
Medical doctors General practitioners
Residency in Preventive Medicine and Public Health
Hospital Clinic de Barcelona
Postgraduate education
Nurses
Bachelor in Medicine Information not provided
Undergraduate education
Medical doctors
MasterBachelor in Pharmacy
University of Navarra Undergraduate education
Postgraduate education
Pharmacists
Human Nutrition and Dietetics
Univeristy of Navarra Undergraduate education
Nutritionists amp Dietitians
Pharmacy Universitad Ramon Lull
Undergraduate education
Pharmacists
Pharmacy IQS ndash FCSB Undergraduate education
Pharmacists
Master in Advanced Therapies and Innovation in Biotechnology
Universidad de Francisco de Vitoria
Postgraduate education
Pharmacists
Pharmacy Universidad of the Basque County
Undergraduate education
Pharmacists
Sweden
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master programme in Public Health
Karolinska institute Postgraduate education
Occupational therapists
Social workers
Dietetics programme Department of food and Nutrition
Undergraduate education
Dietician
Dietetics programme Department of food studies dietetics and nutrition
Undergraduate education
Dietician
Programme in Dietetics University of Gothenburg
Sahlgrenska Academy
Undergraduate education
Dietician
Master of Public Health Department of public health and caring sciences Uppsala University
Postgraduate education
Medical doctors Bachelor of science Physical
therapists Nurses Psychologists Dentists Social workers
United Kingdom
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor (Hons) Occupational Therapy
Northumbria University Undergraduate education
Occupational therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
69
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master (pre reg) Occupational Therapy
Master in Occupational Therapy
Leeds Beckett University
Postgraduate education
Occupational therapists
Bachelor (Hons) Occupational Therapy
St Georgersquos University of London
Undergraduate education
Medical doctors Medical specialists Physical therapists
Occupational therapists
Bachelor (Hons)
Occupational Therapy
Caterburry Christ
Church University
Undergraduate
education
Occupational
therapists
Bachelor (Hons) Occupational Therapy Master in (pre-reg) Occupation Therapy Occupational Therapy degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Public Health speciality training
Health education England -north west
Postgraduate education
Medical doctors Medical specialists Researchers Nurses
Bachelor in (Hons) Occupational Therapy Master in (Pre-reg)
Occupational Therapy Occupational Therapy
Degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Additional countries
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Bachelor of Physiotherapy University of Prishtina Kosovo Albania
Postgraduate education
Physical therapists
Physiotherapy Faculty of health studies University of Sarajevo Bosnia-Herzegovina
Undergraduate education
Physical therapists
Fysioterapeututdanning NTNU Norway Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy BFH
Berner Fachhochschule BFH Bern University of Applied Sciences Swiss
Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy
ZHAW Zurich University of applied sciences Swiss
Undergraduate education
Physical therapists
Physical Therapy Sciences University of Iceland
School of Health Sciences
Undergraduate
education
Physical
therapists
Medicine International school of medicine Kazachstan
Undergraduate education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
70
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicinesingle-cycle degree programme
University of Georgia Republic of Georgia
Medical doctors Psychologists General practicioners
Medicine Akaki tsereteli state University Republic of Georgia
Postgraduate education
Medical doctors Medical specialists Physical therapists Psychologists
Dentists General
practicioners
Public Health and Epidemiology
David tvildiani medical University Republic of
Georgia
Postgraduate education
Medical doctors
Biomedical and Healthcare Science doctoral programme
David tvildiani medical University Republic of Georgia
Postgraduate education
Medical doctors Biomedical Science master degree holders
Medicinesingle-cyle degree programme
University of Georgia Republic of Georgie
Undergraduate education
Medical doctors
Public Health Tbilisi State Medical University (TSMU)
Republic of Georgia
Undergraduate education
Medical doctors and public
health specialists
David tvildiani Medical
University
David tvildiani Medical
University Republic of Georgia
Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
71
ANNEX 2 COMPETENCY PROFILES PER PROFESSIONS
Undergraduate medicine
The CanMEDS framework is worldwide the most commonly used and adapted model that
identifies and describes the abilities physicians require in order to effectively meet the
health care needs of the people they serve72 Within European Member States modifications
of this model are used within health and educational settings (for example in the
Netherlands and Finland) for undergraduate medicine and medical specialisations The
CanMEDS model defines seven roles of the physician namely (1) medical expert (the
integrating role) (2) communicator (3) collaborator (4) leader (5) health advocate (6)
scholar and (7) professional73 The role of health advocate is defined as physicians
contributing their expertise and influence as they work with communities or patient
populations to improve health ldquoimproving health is not limited to mitigating illness or
trauma but also involves disease prevention health promotion and health protection
Improving health also includes promoting health equity whereby individuals and
populations reach their full health potential without being disadvantaged by for example
race ethnicity religion gender sexual orientation age social class economic status or
level of educationrdquo Within this role two key competencies are defined74
1 Respond to an individual patientrsquos health needs by advocating with the patient within
and beyond the clinical environment
a Work with patients to address determinants of health that affect them and their access
to needed health services or resources
b Work with patients and their families to increase opportunities to adopt healthy
behaviours
c Incorporate disease prevention health promotion and health surveillance into
interactions with individual patients
2 Respond to the needs of the communities or populations they serve by advocating with
them for system-level change in a socially accountable manner
d Work with a community or population to identify the determinants of health that affect
them
e Improve clinical practice by applying a process of continuous quality improvement to
disease prevention health promotion and health surveillance activities
f Contribute to a process to improve health in the community or population they serve
In addition the European Thematic Network project MEDINE (2004-2007) and Tuning
Project (Medicine) under its auspice (MEDINE) have generated and gained widespread
consensus on a set of competences for primary medical degree qualifications in Europe
(ie undergraduate medicine)75 Within this project it is stated that graduates in medicine
72 httpwwwroyalcollegecarcsitecanmedscanmeds-framework-e 73 httpwwwroyalcollegecarcsitecanmedsabout-canmeds-e 74 httpwwwroyalcollegecarcsitecanmedsframeworkcanmeds-role-scholar-e 75 httptuningacademyorgmedine-medicinelang=en
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
72
would need the ability to ldquopromote health engage with population health issues and work
effectively in a health care systemrdquo76 The following points define health promotion
bull provide patient care which minimises the risk of harm to patients
bull apply measures to prevent the spread of infection
bull recognise own health needs and ensure own health does not interfere with
professional responsibilities
bull conform with professional regulation and certification to practise
bull receive and provide professional appraisal
bull make informed career choices
bull engage in health promotion at individual and population levels
Medical specialist
The European Union of Medical Specialists (UEMS) contributed significantly to the
improvement of post-graduate training through the development of a European Curriculum
in each medical speciality as well as the elaboration of training standards77 Within this
section we provide a detailed description of the European training requirements for a
selection of medical specialists including sports medicine public health internal medicine
cardiology psychiatry and the general practitioner78 This selection was based on the fact
that within these specialities lifestyle might be an essential component or important part of
the treatment of chronically ill patients
1) Medical specialist sports medicine
Sports medicine is defined by the European Commission as a ldquomultidisciplinary clinical and
academic speciality of medicine dealing with health promotion for the general population
by stimulating a physically active lifestyle and diagnosis treatment prevention and
rehabilitation following injuries or illnesses from participation to physical activities
exercises and sport at all levelsrdquo79 As health promotion and prevention are both
incorporated in the definition of sports medicine these topics are included throughout the
whole curriculum of sports medicine The curriculum of sports medicine aimed to provide
theoretical understanding and practical skills to provide first line clinical services80 Within
the training requirements for the speciality of sports medicine it is stated that sports
medicine does not solely take care for sporting elite athletes but as well for its important
role to promote exercise as a medical tool meant for patients with chronic diseases81
bull Theoretical knowledge aims to provide theoretical understanding and practical skills to
provide first line clinical services
- Clinical To provide pre-participation clinical screening and examination before
exercise and competition as well as medical assistance to the athletes engaged in all
sports
76
httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNLearning_Outcomes_Competences_for_Undergraduate_Medical_Education_in_Europepdf
77 httpswwwuemseu__dataassetspdf_file00111415906pdf 78 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 79 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 80 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 81 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
73
- Public health
bull As part of a multi-disciplinary team to encourage and promote physical activity as
a lever for healthy living
bull To identify impediments to an active lifestyle and work within a multi-disciplinary
framework to remove those impediments or minimize their impact
bull To work alongside local health authoritiespublic health clinicians developing
exercise opportunities for the general public for health gain
bull To liaise with public (local authoritieseducationvoluntary) and private sector to
advise on the health aspects of exercise programmes for physical activity of special
groups like women children adolescents and aging population
bull Practical and clinical skills
bull To foster the integration of knowledge and practical skills acquired during the
cardiology orthopaedics physical amp rehabilitation medicine general practice
medicine and physiology internships
bull To learn to put into practice information gained in the relevant course work
bull To extend and deepen their knowledge in the assessment of fitness such as
isokinetic and functional muscle performance cycle ergometry and treadmill
ergometry
bull To gain experience in the use of such test results in the decision making with regard
to diagnosis recommendations and therapy for people of both gender and in
different age groups and performance levels
bull With regard to elite sport trainees will learn how to diagnose treat and prevent
overtraining and overexertion
bull To become proficient in activities related to for example hygiene and nutrition
and will work closely with trainers athletes physiotherapists officials etc
bull Competencies
bull Clinical and instrumental assessment to determine the pathophysiology
mechanisms and the underlying diagnosis of the patientrsquos condition
bull Trainees are expected to complete evidence of reflective practice through case
reports and other experiences in their training record
bull Other self-directed work will be planning data collection analysis and presentation
of audit and research work
bull The mandatory training record (hand written diary or preferably electronic
logbook) will contain evidence of academic pursuits and should be checked and
documented regularly by the Supervisor
bull Trainees will take part and be able to lead in teaching and will be expected to
develop skills to teach undergraduates postgraduates and non-medical staff in
small groups and formal lectures making personal presentations using a variety of
audiovisual methods
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
74
bull They will be expected to present at journal clubs and make case presentations at
grand rounds or similar settings
bull They will be expected to undertake personal audit and research and make
presentations of their findings at clinical meetings
bull Prescription as much evidence-based as possible of medical and physical
treatments (including drug treatment physical modalities innovative
technologies natural factors and others) as well as of technical aids
bull Prevention and management of complications
bull Skill to perform and participate in research
2) Medical specialist public health
The European Commission defines public health ldquoas the science and art of preventing
disease prolonging life and promoting mental and physical health and efficiency through
organized community effort Public health may be considered as structures and processes
by which the Health of the population is understood safeguarded and promoted through
the organized efforts of societyrdquo82 Public health specialists aim to improve populationrsquos
health by using the following skills and competencies
bull Theoretical knowledge on a range of fields including epidemiology prevention health
promotion public health research behavioural sciences health programme evaluations
health need assessments and quality and safety in healthcare
bull Practical and clinical skills
- Surveillance and evaluation of the health of the population (trained in epidemiology)
- Planning and evaluation of health services and public health control
- Analysing the health of the population (analysing determinants on individual and
community levels)
- Plan participate in or evaluate preventive and control programmes (public health
assessments)
- Participate in multidisciplinary health impact assessment
- Inform decision-makers about potential impacts and to identify appropriate and
sustainable actions to manage those effects (including environmental determinants
of health)
- Organisational issues in healthcare (participating in policy and strategic development
quality and safety management)
- Generate and share new evidence on the ways in which social determinants influence
population health and health equity
- Sufficient linguistic ability to communicate with hisher public health colleagues
82 httpswwwuemseu__dataassetspdf_file001198435UEMS-201924-European-Training-
Requirements-for-Public-Healthpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
75
- Develop high professional ethical standard including respect towards human rights
participants in public health programmes colleges and other professionals in the
team
bull Competencies
- Establish the expertise role as a Public Health Physician
bull Function as public health leaders and consultants to health services and other
organizations and institutions in order to provide safe appropriate cost effective
and equal health care to groups communities and populations
bull Establish and maintain medical knowledge skills and attitudes appropriate to their
practice including the organization and financing of health care public health
control and public health law
- Perform expertise analyses of the health of the population
bull Apply and combine medical and epidemiological competencies for the surveillance
and evaluation of the health of the population
bull Identify the determinants of health of populations and risks for public health and
implications for interventions and policy
bull Evaluate health problems biopsychosocial mechanisms andor health care issues
for different population groups and their implications for the community
bull Critically evaluate epidemiological demographic health statistical and
environmental pollution data and their sources and apply them appropriately to
public health issues
bull Identify community health needs and advise about their implications for public
health and medical care services
- Lead and supervise public health interventions
bull Select develop implement and monitor public health surveillance and
interventions namely in the areas of human behaviour social and physical
environment food safety and nutrition health care associated risks and working
life related health
bull Promote the health of individuals communities and populations through health
programming
bull Contribute to the organization and evaluation of societal and health care
programmes aiming to promote health and social functioning among individuals
with long-term diseases and disabilities
bull Contribute to the planning organization supervision of and evaluation of societal
and health care programmes promoting the health of specific target groups such
as children elderly and vulnerable and underserved groups in society
bull Contribute to the organization of and evaluate primary and secondary medical
prevention programmes
bull Contribute to strengthening regulatory frameworks for protecting and improving
health
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
76
- Function as expertise in planning and evaluation of Public Health and Medical Care
bull Evaluate Public Health and other service programmes concerning processes and
outputs from the different perspectives of care seekers professional health care
workers and health managers
bull Analyse and differentiate between need demand and supply and assess the health
of a defined population and identify areas for improvement including the allocation
of health care resources delivery
bull Evaluate the outcome quality and safety of care and promote quality development
systems based on evidence and public health principles
bull Apply health economic principles and methods such as cost-effectiveness cost-
utility and cost-benefits considering the strengths and weaknesses of different
methods
bull Use methods to determine priorities and their strengths and weaknesses and
promote awareness of the competing and conflicting influences on public and
political perceptions of the need for health care and the resulting constraints on
action
bull Promote and evaluate collaboration between health services and other welfare
organizations in society
bull Evaluate and contribute to the policy and strategic development in health care
planning
bull Contribute to the planning and evaluation of different sectors of society by health
impact assessments and public health medical reports and consultations
- Communicate and develop public health medical expertise
bull Lead supervise and participate in an interprofessional health care team
bull Consult other (health) professionals and policymakers and recognise the
advantages and limits of their expertise
bull Effectively convey oral and written information about public health issues including
adequate public health reporting and effective interaction with media
bull Stimulate and motivate others so that they recognise the importance of the public
health population perspective
bull Maintain and enhance professional activities through ongoing learning and
research and contribute appropriately to the generation dissemination application
and translation of new public health knowledge and practices
3) Medical specialist internal medicine
The UEMS defines an internist as ldquoa physician trained in the scientific basis of medicine
who specialises in the assessment diagnosis and management of general medical
problems atypical presentations multiple problems and consequential complex health
issues and system disorders (Professional) The physician is skilled in the management of
acute unselected medical emergencies and the management of patients in a holistic and
ethical way considering all psychosocial as well as medical factors for enhancing quality of
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
77
life The physician values the continuing care of all patients irrespective of the nature of the
patients complaint and is committed to lifelong continued professional development
(Scholar) The physician practices clinical audit and evidence-based medicine The
physician functions in a number of roles including clinical counselling educating leading
and managingrdquo83
Internists have a fundamental role in modern healthcare systems Within the definition of
the internist the shift towards a preventive strategy focusing on health promotion is
highlighted by the acknowledgement of the high prevalence of chronic and complex
diseases that are associated with the lifestyle of ageing western societies The role of
healthcare advocate (a role defined in the CanMED framework) is an important part of the
internistrsquos function and forms the generic competencies of an internist (see section 11)
However lifestyle promotion and disease prevention is not a specific area of expertise
Specific areas of the internist include multi-morbidity and ageing acute care medical
consultation shared-decision-making collaborative care transition in care vulnerable
adult patient safety and quality of care and medical leadership
4) Medical specialist cardiology
According to the training requirements for the speciality of cardiology84 training in
cardiology should be based on the syllabus of the ESC core Curriculum for the general
cardiologist part 2 ldquothe core curriculum per topicrdquo85 The necessary core cardiology
competencies are set out as cardiology learning objectives with the knowledge skills
attitudes and competencies needed to fulfil the objectives One of the core cardiology
competences is cardiovascular prevention aiming to
bull Assess and manage patients with risk factors for cardiovascular disease
bull Understand the mode of action of different prevention methods
bull Describe cardiovascular disease and risk factors in the local community
bull Contribute to the global efforts in reducing cardiovascular morbidity and mortality
by communicating the prevention message to the public
bull To approach prevention in a holistic way understanding the potentiation of
cardiovascular risk by clustering of risk factors
bull
Knowledge
bull Epidemiology of cardiovascular disease in the local community incidence
prevalence survival
bull Risk factors in the local community
83 httpswwwuemseu__dataassetspdf_file001744450UEMS-201613-European-Training-
Requirements-Internal-Medicinepdf 84 httpswwwuemseu__dataassetspdf_file001119577UEMS-201324-SECTIONS-AND-BOARDS-
Cardiology-European-Training-Requirements-20131019pdf 85 httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_
9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
78
bull Risk assessment in primary prevention multifactorial risk interaction and use of
risk scoring charts
bull The impact of lifestyle on people at risk of and patients with cardiovascular
disease
bull The potential of lifestyle changes to prevent and ameliorate cardiovascular
disease diet and nutrition toxic habits (smoking alcohol and others) physical
activity
bull Emerging risk factors (social economic stress depression and personality type)
bull Treatmentprevention strategies for major risk factors and changes in lifestyle
including corresponding pharmacologic therapies
bull The comprehensive approach required for multiple risk factors
bull Patient compliance
In addition the main objectives and knowledge competence are further specified by
hypertension dyslipidaemia diabetes and lifestyle
Skills
bull obtain a relevant history and perform an appropriate clinical examination
bull evaluate cardiovascular risk and assess global cardiovascular risk at the individual
level
bull evaluate cardiovascular risk at population level (mortality morbidity disability)
bull evaluate the benefit of prevention at individual and population levels
bull manage risk factors appropriately including pharmacological and non-
pharmacological therapies
bull communicate their importance to patients their families and the wider
community including smoking cessation diet and exercise
bull communicate the importance of patient compliance and behaviour
bull motivate patients and families to change lifestyles and be compliant with
prescriptionsrecommendations
bull monitor patient compliance and behaviour
bull evaluate the benefit of risk factor intervention for the individual patient
Behaviours and attitudes
bull Non-judgemental attitude to patients regarding their lifestyle (eg smoking diet
etc)
bull Exemplify appropriate lifestyle in personal behaviour
bull Team working with other physicians including general practitioners
diabetologists nephrologists and elderly care physicians for the management of
specific risk factors
bull Team working with all professionals with a role in primary and secondary
prevention (nurses dieticians teachers and politicians)
Another core competency is the physical activity and sport in primary and secondary
prevention Further defined in sports cardiology and cardiac rehabilitation
Sports cardiology aiming86
86
httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
79
bull To conduct strategies to implement healthy lifestyle in particular physical and
sports activities in the general population (primary prevention)
bull To evaluate cardiovascular risk and exercise capacity (see Chapters 22 and
271)
bull To recognize the characteristics of the athletersquos heart
bull To appropriately detect contraindications to exercisecompetition and
appropriately provide non-contraindication certificates
Knowledge
bull Exercise and sports physiology
bull Benefits of exercise training
bull Safety issues in exercise and sport
bull Diagnostic criteria and appropriate investigations in athletes with cardiovascular
disease
bull Risk factors for and mechanisms of sudden cardiac death (SCD) during and after
strenuous exercise
bull Specific population challenges and exercise programmes in appropriate settings
bull Recommendations for professional and recreational sports participation
bull SCD in patients athletes and in the population at large and
bull Mechanisms of action of illicit drugs
Skills
bull perform an individual CVD risk assessment using appropriate information from
history laboratory assessment including full lipid profile and clinical data
bull recognize pathological cardiovascular changes and differentiate them from the
characteristic features of lsquoathletersquos heartrsquo and
bull use prevailing recommendations for eligibility for participation in competitive
sports
Behaviours and attitudes
bull Recognition of the role of active lifestyle exercise and sport in the promotion of
health and in the prevention of the most threatening diseases including
cardiovascular diseases
Cardiac rehabilitation aiming
bull To evaluate and manage cardiovascular risk
bull To evaluate exercise capacity and causes of exercise intolerance
bull To provide appropriate rehabilitation and secondary prevention to patients with
cardiovascular diseases
7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
80
Knowledge
bull Multi-disciplinary risk factor intervention
bull Definition of comprehensive cardiovascular prevention and rehabilitation
bull Effects of behavioural change including physical activity nutrition education and
psychosocial risk factors on quality of life cardiovascular risk and outcome
bull Rehabilitation as a component of cardiac care and a promoter of secondary
prevention
bull Target populations and risk stratification of patients
bull Psychological aspects of rehabilitation and exercise practice
Skills
bull take a relevant history and perform an appropriate clinical examination including
the specific evaluation of the elderly patient
bull perform and interpret risk stratification using indicated tests
bull interpret a cardiopulmonary exercise test and distinguish different causes of
exercise limitation
bull prescribe exercise-based rehabilitation programmes and other lifestyle
interventions according to the patientrsquos condition in collaboration with other
specialists when necessary and
bull motivate the patient to ensure long-term adherence to lifestyle changes and
continuing exercise programmes
Behaviours and attitudes
bull rehabilitation as a component of cardiac care
bull the importance of rehabilitation and secondary prevention for professional
personal and social life among patients with heart disease
bull the interplay of physical and psychological aspects of heart disease and the
positive influence of exercise on cardiovascular risk factors
bull the role of other professionals including nurse specialists physiotherapists ergo
physiologists psychologists dieticians and general practitioners in rehabilitation
and secondary prevention and
bull the importance of patient and family education and the role of other professionals
in rehabilitation
5) Medical specialist psychiatry
The UEMS has issued a charter of requirements for the training in psychiatry in 2000 with
an additional European Framework for Competencies in Psychiatry in 2009 The learning
outcomes in the European Framework for Competencies in Psychiatry (EFCP) are arranged
under the seven physician roles derived from the CanMEDS framework87 Within the EFCP
it is stated that ldquopsychiatrists recognise the importance of advocacy and health promotion
in responding to the challenges represented by those social environmental and biological
factors that determine the mental health and well-being of patients and society They
recognise advocacy as an essential and fundamental component of mental health promotion
that occurs at the level of the individual patient the practice population and the broader
communityrdquo
Competencies
87 httpuemspsychiatryorgwp-contentuploads2013092009-Oct-EFCPpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
81
bull identify the determinants of mental disorder as well as the factors that may
contribute to positive mental health so as to be able to prevent disorder and
promote mental health
- recognise the determinants of mental health of populations and how public
policy including legislation impacts on mental health
- promote positive mental and physical health in patients particularly in those
with severe mental disorder based on best evidence
- recognise the impact of mental disorder on families and carers and take
remedial measures
- collaborate with other community sectors to promote mental health and
prevent mental disorder at all levels focusing particularly on family school and
workplace
- identify and address barriers and inequity in access to care particularly for
vulnerable or marginalised populations
bull Identify and address issues and circumstances when advocacy on behalf of
patients professions or society is necessary
- respect and promote the human rights of people with mental disorders and
collaborate with user and carer associations and advocacy groups
- empower people with mental disorders and their carers
- recognise and address prejudice stigma and discrimination associated with
mental disorder and its treatment
- use strategies to enhance patientrsquos self-management and autonomy
- actively oppose the use of psychiatry for political repression
- recognise the possibility of conflict inherent in their role as a health advocate
for a patient or community with that of manager or gatekeeper
6) General practitioner
The European training requirements for General PracticeFamily Medicine (GPFM) specialist
training88 defined twelve central characteristics of the practice before determining the core
competences Related to health promotion and disease prevention two of these
characteristics are as following ldquopromotes health and well-being both by appropriate and
effective interventionrdquo and ldquohas a specific responsibility for the health of the communityrdquo
The twelve characteristics are clustered into six core competences primary care
management person-centred care specific problem solving skills comprehensive
approach community orientation holistic modelling Under comprehensive approach the
following abilities relate to health promotion and disease prevention
bull to promote health and wellbeing by applying health promotion and disease
prevention strategies appropriately
bull to manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
Furthermore community orientation includes the ability
bull to reconcile the health needs of individual patients and the health needs of the
community in which they live in balance with available resources
88 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
82
In the more comprehensive assessment of GPrsquos performance in daily practice by the
European Academy of Teachers in General PracticeFamily Medicine (EURACT)89 these
abilities are further defined as following
bull To promote health and wellbeing by applying health promotion and disease
prevention strategies appropriate
- Identifies opportunity for health promotion intervention
- Makes use of structured medical record as reminder of preventive activities
- Makes use of teamwork
- Uses communication skills
- Is aware of any personal prejudices which might influence negatively
preventive advice
- Makes recommendations which are feasible in the context of patientrsquos lifestyle
and home situation
- Acts as suitable role model
bull To manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
- Provides appropriate medical management
- Involves members of practice team eg through case conference
- Performsarranges home visit (consider relevant team members) ndash needs
assessment eg cause of falls
- Involves relatives
- Facilitates communication (two-way) with hospital
- Involves external community resources (eg home help etc)
Dentist
According to the profile and competences for the graduating European dentist one of the
major competences for dentists is to improve oral health of individuals families and groups
in the community On graduation a dentist must be competent at promoting and improving
the oral health of individuals families and groups in the community90 Furthermore with
regard to health promotion and disease prevention a dentist
bull Must be competent at
- Applying the principles of health promotion and disease prevention via
comprehensive preventive measures to individuals and the community
according to their risk assessment status
- Understanding the complex interactions between oral health nutrition general
health drugs and diseases that can have an impact on oral health care and
oral diseases
- Providing appropriate dietary advice
bull Have knowledge of
- The organisation and provision of health care in the community and in the
specialist hospital service in the country of training
- The prevalence of the common dental conditions in the country of
trainingpractice
- The social cultural and environmental factors which contribute to health or
illness
- The strategies to overcome barriers to dental care for disabled elderly
socially deprived and ethnic minority groups
- Training auxiliaries in basic skills of oral health promotion
89httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-
documentseuractperformanceagendadC3BCsseldorf2014-openaccessebookversionpdf 90 httpwwwdentuoagrfileadmindentuoagruploadsusefull_filesADEE-competences-2009_enpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
83
In 2017 a new updated framework was published for undergraduate education for dentists
including a revised structure of the educational domains and their areas of competence In
the revised framework health promotion and disease prevention compromises one of the
areas of competence in the domain ldquodentistry in societyrdquo in the educational strategy of a
dentist91 Note Dentists can also specialise in public health in a similar programme as
physicians
Nurses
The training for nurses responsible for general care shall following the Directive
201355EU include a set of eight competences 92 The training for nurses should provide
assurance that the ability of the following knowledge and skills
1 comprehensive knowledge of the sciences on which general nursing is based including
sufficient understanding of the structure physiological functions and behaviour of
healthy and sick persons and of the relationship between the state of health and the
physical and social environment of the human being
2 sufficient knowledge of the nature and ethics of the profession and of the general
principles of health and nursing
3 adequate clinical experience such experience should be gained under the supervision
of qualified nursing staff and in places where the number of qualified staff and equipment
are appropriate for the nursing care of the patient
4 the ability to participate in the practical training of health personnel and experience of
working with such personnel
5 experience of working with members of other professions in the health sector
Competencies 93
6 Competency to independently diagnose the nursing care required using current
theoretical and clinical knowledge as well as to plan organise and implement nursing
care when treating patients on the basis of page the knowledge and skills acquired in
accordance with points (1) (2) and (3) in order to improve professional practice
7 Competency to work together effectively with other players in the health sector including
participation in the practical training of health personnel on the basis of the knowledge
and skills acquired in accordance with points (4) and (5)
8 Competency to empower individuals families and groups towards healthy lifestyles and
self-care on the basis of the knowledge and skills acquired in accordance with points (1)
and (2)
9 Competency to independently initiate immediate measures to pre- serve life and to carry
out measures in crisis and disaster situations
9191 Field JC Cowpe JG Walmsley AD The Graduating European Dentist A New Undergraduate Curriculum
Framework Eur J Dent Educ 201721(Suppl 1)2-10 httpsdoiorg101111eje12307 92 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf 93 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
84
10 Competency to independently advise instruct and support individuals needing care
and their attachment figures
11 Competency to independently ensure the quality of nursing care and assess it
12 Competency to communicate comprehensively and professionally and to cooperate
with members of other professions in the health sector
13 Competency to analyse the quality of care in order to improve their own professional
practice as general care nurses
The competences included in Directive 201355EU are different from the competences
contained in the EFN Competency Framework These competences contain the following
competences on health promotion and disease prevention guidance and teaching
bull To promote healthy lifestyles preventive measures and self-care by strengthening
empowerment promoting health and enhancing behaviours and therapeutic
compliance
bull To independently protect the health and well-being of individuals families or
groups being cared for ensuring their safety and promoting their autonomy
bull To integrate promote and apply theoretical methodological and practical
knowledge This enables the promotion and the development of nursing care in
long term care co-morbidity and in situations of dependency in order to maintain
an individualrsquos personal autonomy and hisher relationships with the environment
in every moment of the healthillness process
Nurse specialist
The European Specialist Nurses Organisation (ESNO) defines the nurse specialist as follows
ldquoThe Nurse Specialist (NS) is an advanced practice Nurse prepared as a specialist within a
clinical specialty at the masterrsquos post masterrsquos or doctoral levelrdquo94 Following the ESNO the
competencies should be considered as a reference template and guidelines for the different
specialities in which each speciality can define its own knowledge skills and attitudes
Generic competencies are the clinical role patient relationship patient teachingcoaching
mentoring research organisation and management communication and teamwork ethic
and decision making leadership and policy making and prevention The competency of
prevention is based on the case for investing in public health from the World Health
Organization95 The competency of prevention is based on the ability of promoting health
and prevent disease by the capacity to develop and put in place intervention in
bull Surveillance of population health and wellbeing
bull Disease prevention at the 3 levels of prevention (primary secondary)
bull Ability to promote health and prevent disease
bull Monitoring and response to health hazards and emergencies
bull Health promotion including actions to address social determinants and healthy
inequities
bull Advocacy communication and social mobilization for health advancing public
health
bull Research to inform policy and practice96
94 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf 95 httpwwweurowhoint__dataassetspdf_file0009278073Case-Investing-Public-Healthpdfua=1 96 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
85
Occupational therapist
The World Federation of Occupational Therapists (WFOT) provided minimum standards for
the education of occupational therapists97 One of the settings in which occupational
therapists work is defined as following ldquoCommunity or group approaches such as health
promotion community development community based rehabilitation injury prevention
environmental design disaster preparation and recoveryrdquo Furthermore under essential
knowledge skills amp attitudes for competent practice the following (could) relate to health
promotion and disease prevention
bull Knowledge about
- The relationship between occupation and human development over the life
course including healthy ageing
- The relationship between psychological social and economic factors and
occupation (eg stress adjustment to life changes including disability
societal disruption natural or man-made disaster displacement)
- Early identification and functional interventions focusing on somatosensory
stimulation and performance mechanisms mitigating early developmental and
environmental factors impacting negatively on behaviour and learning
- How activity limitations and participation in occupation affect health This
includes the ability to maintain a healthy environment and personal factors
such as adjustment interpersonal relationships and social networks
- How health conditions and threats to health affect participation in work
bull Skills in
- Inter-sectoral collaboration in public health initiatives
- Assessing health in relation to occupation
In addition the Tuning programme described the reference points for the design and
delivery degree programmes in occupational therapy98 in which they first ranked subject
specific competency One of the highest ranked included
bull Enable individualsgroupsorganisationscommunities to be engaged in occupation
through health promotion prevention rehabilitation treatment and
coachingtraining
In the final set of subject specific competences however this is mentioned less explicitly
and only the following are related to health promotion and disease prevention
bull Knowledge the occupational therapist is able to
- Work in partnership with individuals and groups using occupation in
prevention rehabilitation and treatment in order to promote participation
health and well-being
- Explain the relationship between occupational performance health and well-
being
- Collaborate with communities to promote and develop the health and well-
being of their members through their participation in occupation
- Develop new knowledge of occupation and occupational therapy practice
particularly in relation to local andor emerging health and social challenges
97 httpswwwwfotorgassetsresourcesCOPYRIGHTED-World-Federation-of-Occupational-Therapists-
Minimum-Standards-for-the-Education-of-Occupational-Therapists-2016apdf 98 httptuningacademyorgwp-contentuploads201402RefOccupationalTherapy_EU_ENpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
86
Pharmacists
In a two-stage large-scale Delphi process fifty competences of pharmacy practice were
ranked and the Quality Assurance in European Pharmacy Education and Training (PHAR-
QA) framework was harmonized and validated99 Of these fifty competences the following
relate to health promotion and disease prevention
bull Ability to promote public health in collaboration with other professionals within the
healthcare system
bull Ability to provide appropriate lifestyle advice to improve patient outcomes
bull (eg advice on smoking obesity etc)
bull Ability to use pharmaceutical knowledge and provide evidence-based advice on
public health issues involving medicines
Physiotherapists
According to the World Confederation for Physical Therapy (WCPT) the scope of physical
therapists practices includes (among others) public health strategies and advocating for
patientsclients and for health100 Furthermore it is described that physical therapists may
have the following purposes
bull promoting the health and wellbeing of individuals and the general publicsociety
emphasising the importance of physical activity and exercise
bull preventing impairments activity limitations participatory restrictions and
disabilities in individuals at risk of altered movement behaviours due to health
factors socio-economic stressors environmental factors and lifestyle factors
The European Network of Physiotherapy in Higher Education (ENPHE) also described
professional competencies of physiotherapists101 According to the ENPHE one of the roles
of a physiotherapist is to be a
bull Health care promotor
- Advocate on health and wellbeing promotion and disease or injury prevention
on behalf of patientclients and the profession to enhance individual
community and public health
- Promote adherence to local regional national and EU health and safety
policies guidelines and protocols
Psychologist
The European Federation of Psychologistsrsquo Associations developed the European Certificate
in Psychology ndash the EuroPsy102 The Tuning programme also published lsquoReference points for
the design and delivery of degree programmes in Psychologyrsquo103 in which they state that
the Tuning programme and the EuroPsy programme have experienced a parallel
development over the last ten years In fact the Tuning document presents a reference
99 httpswwwncbinlmnihgovpmcarticlesPMC5419365 100 httpswwwwcptorgpolicyps-descriptionPT 101 httpwwwenpheorgwp-
contentuploads201910ESCO_report_ENPHE_recommendations_April_2017pdf 102 httpwwwinpa-europsyitmoduliEuroPsy20Regulations20July202011pdf 103httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNPsychology_reference_points
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
87
point for the design and delivery of degree programmes in psychology on the basis of the
EuroPsy programme
Based on the definition of the key role of the professional psychologist health promotion
and disease prevention could be part of the profession as this has been described as
follows to develop and apply psychological principles knowledge models and methods in
an ethical and scientific way in order to promote the development well-being and
effectiveness of individuals groups organisations and society However no specific
competences related to health promotion and disease prevention are now described in the
documents It is plausible though that psychologist do act to promote health as the core
of their profession is to help others to understand behaviour to improve performance and
well-being or to alleviate problems and distress As these emergent specialisms develop in
response to new demands there is a tendency to develop education and training
programmes thus increasing the specialisation and the requirement for specialist skills of
professional psychology
Social worker
Global standards for the education and training of the social work profession are developed
by the International Association of Schools of Social Work (IASSW)104 The IASSW
worldwide association of schools of social work other tertiary level social work educational
programmes and social work educators These global standards include for example
standards regarding the schoolrsquos core purpose or mission statement standards regarding
programme objectives and outcomes standards with regard to programme curricula
including field education The standards with regard to the core curricula are organised into
four conceptual components domain of the social work profession domain of the social
work professional methods of social work practice and paradigm of the social work
profession under which several sub-domains are described which mainly relate to aspects
such as inadequacies discrimination tradition and culture social stability and ethical
principles The following touch upon the field of health promotion and disease prevention
bull Knowledge of human behaviour and development and of the social environment
with particular emphasis on the person-in-environment transaction life-span
development and the interaction among biological psychological socio-structural
economic political cultural and spiritual factors in shaping human development
and behaviour (domain of the social work profession)
bull Sufficient practice skills in and knowledge of assessment relationship building
and helping processes to achieve the identified goals of the programme for the
purposes of social support and developmental protective preventive andor
therapeutic intervention ndash depending on the particular focus of the programme or
professional practice orientation (methods of social work practice)
bull The application of social work values ethical principles knowledge and skills to
promote care mutual respect and mutual responsibility amongst members of a
society (methods of social work practice)
bull Problem-solving and anticipatory socialisation through an understanding of the
normative developmental life cycle and expected life tasks and crises in relation
to age-related influences with due consideration to socio-cultural expectations
(paradigm of the social work profession)
104 httpswwwiassw-aietsorgwp-contentuploads201808Global-standards-for-the-education-and-training-
of-the-social-work-professionpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
88
The European Social Network (ESN) investigated the social services workforce throughout
Europe and provided an overview of qualifications and skills in different Member States in
their research report showing that qualification and skills for social care workers differ per
country105 In fact in some countries there are specific training routes for social care
workers including specialised training courses or apprenticeships and the content of these
trainings depends on the service user group and is generally defined at a local or authority
level A questionnaire was set out in which essential components of social care workers
were identified which showed that health and safety is seen as an important component
of social work
105 httpswwwesn-euorgsitesdefaultfilespublicationsInvesting_in_the_social_service_workforce_WEBpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
89
ANNEX 3 ONLINE SURVEY
Survey Health promotion and disease prevention in health and educational
settings
Health promotion and disease prevention in health and educational settings -
medical schools The European Union has commissioned Ecorys an international
research and consultancy agency to conduct a project on health promotion and
disease prevention in health and educational settings In order to provide an EU
wide overview and to better support national governments we would like to ask
for your cooperation The project will develop an EU wide overview of the
educationtraining programmes for basic education postgraduate education as
well as continuous professional development with regard to education on health
promotion Your help will therefore be key in the collection of information and
data on public health initiatives in medical and non-medical education The survey
will take approximately 20 minutes of your time You do not need to complete this
survey at once You may leave the survey and continue at a later moment in
time Questions can be saved by clicking on the pauze button (below the
questionnaire) When doing so a new URL link will be provided We would be
pleased if you could provide this information by means of an online questionnaire
to Ecorys who is also available in case you have questions or you would like
additional information bull Ms Emalie Hurkmans (Project Coordinator) tel +31
(0)6 280 579 21 email emaliehurkmansecoryscom bull Ms Tessa Huis in lsquot
Veld tel +31 6 29 22 10 58 email tessahuisintveldecoryscom
What is the name of your education
What are the website details of the educationPlease enter the link of the website
with information of the education
Can you give a brief description of the education
What type of health professionals are trained in the education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
90
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
What type of medical specialist
Is the education
Undergraduate education
Postgraduate education
Continuous professional development
Is the course accreditated
Yes
No
Unknown
Does the course cover the topic health promotion and disease prevention
Yes
No
Is the education accreditated
Yes
No
Unknown
Does the education cover the topic health promotion and disease prevention
Yes
No
How is the topic health promotion and disease prevention incorporated in the
curriculum
In a seperate module
Topic incorporated into curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
91
Who is (are) the contact person(s) of the module health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Was there any partnerships in setting up the module health promotion and disease
prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Has the education obtained any funding to set up the module on health promotion
and disease prevention EU funding national public funding local public funding
or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
92
Since when is the module on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the module Eg is it a two weeks one month or one
year programme
What is the typical quantity in hours spend at health promotion and disease
prevention by participants The amount of hours spent on attendence and
homework
Is the module health promotion and disease prevention accreditated separately
No
Unknown
Yes please specify how many points are given
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
93
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the module
No
Unknown
Yes please specify what type of exam
Is the module also provided at other locations For example at other universities
Yes
No
Unknown
Is there a contact person(s)expert for the topic health promotion and disease
prevention
Was there any partnerships in incorporating it in the curriculum
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
94
Has the education obtained funding to incorporate health promotion and disease
prevention into the curriculum EU funding national public funding local public
funding or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is health promotion and disease prevention incorporated into the whole
curriculum eg since September 2017
What is the typical quantity in hours (approximately) spend at health promotion
and disease prevention by participants The amount of hours spent on attendence
and homework
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
95
In what way are knowledge and skills with regard to health promotion and disease
prevention tested in the curriculum For example incorporated into a written exam
Who is (are) the contact person(s) of the course on health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Were there any partnerships in setting up the course on health promotion and
disease prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
business NGOs individual citizens governmental agencies who have a role fill in
yes and add by the partnership in place
No
Yes please specify
Has the education obtained any funding to set up the course on health promotion
and disease prevention
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
96
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is the course on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the course eg two weeks one month or one year
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
97
What is typical quantity in hours spend at health promotion and disease prevention
by participants The amount of hours spent on attendence and homework
Is the course on health promotion and disease prevention accreditated separately
No
Unknown
Yes how many points are given
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the course
No
Unknown
Yes what type of exam
Is the course provided at multiple locations For example at other universities
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
98
What are the general objectives of the teaching activities on health promotion and
disease prevention eg arise awareness among Medical Doctors on the
importance of physical activity within the elderly population with a high risk of
heart failure
Which stakeholders were involved in developing the teaching activities on health
promotion and disease prevention
Is there made use of a mono- or multidisciplinary approach
Monodisciplinairy approach
Multidisciplinary approach
Unknown
Does the education include theories of
1
Yes
2
No
3
Unknown
Population health
Human cognition
and behaviour
Health behaviour
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
99
Does the education include
1
Yes
2
No
3
Unknown
Epidemiology and
bio-statistics
(research
capacity)
Methods of
evidence-based
medicine
Health policies
and regulation
Health economics
Ethics
Health care
systems
Digitalisation in
health promotion
Health inequalities
Disease
prevention in
teams
Health literacy
Health behaviour
change
techniques
Communication
skills
Digital health
coaching
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
100
Concerning teaching methods of health promotion and disease prevention which
methods are used
1
Yes
2
No
3
Unknown
Lectures
Assignments
Field training in real environments
eLearning modules
Other please specify
Concerning covered competencys or capacities of health promotion and disease
prevention the main focus is on
What are the expected outcomes
1
Yes
2
No
3
Unknown
Knowledge
Skills
Behaviour
attitudes
Relevant output (if available) eg number of students following the module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
101
Do you think it is likely you will apply the learned knowledge and skills (on health
promotion and disease prevention) in daily practice after completion of this
education
Yes please specify
No please specify
Not sure please specify
Is there a reason why this education might be a good example for other
educational settings with regard to the way that health promotion and disease
prevention is covered in the education
Are there any remarks Please feel free to give overall remarks or initiative-specific
remarks
Your responses have been registered Thank you for taking the time to complete
the survey your input is valuable to us
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
102
HOW TO OBTAIN EU PUBLICATIONS
Free publications
bull one copy via EU Bookshop (httpbookshopeuropaeu)
bull more than one copy or postersmaps from the European Unionrsquos representations (httpeceuropaeurepresent_enhtm) from the delegations in non-EU countries (httpeeaseuropaeudelegationsindex_enhtm) by contacting the Europe Direct service (httpeuropaeueuropedirectindex_enhtm) or calling 00 800 6 7 8 9 10 11 (freephone number from anywhere in the EU) () () The information given is free as are most calls (though some operators phone boxes or hotels may charge you)
Priced publications
bull via EU Bookshop (httpbookshopeuropaeu)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
7
EXECUTIVE SUMMARY
Background
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices and unhealthy diets Tobacco use harmful
use of alcohol and physical inactivity have been identified as the top risk factors for non-
communicable diseases (NCDs) in the European Union In recognition of this important
public health challenge investing in effective health promotion and disease prevention of
NCDs is critical to improve the quality of life and well-being of European citizens
Healthcare professionals such as doctors (especially general practitioners) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs However while
many policy statements and NCDs practice guidelines call for behavioural change as the
first line of prevention and management professionals often do not include behavioural
change counselling in their care yet While most health professionals acknowledge the need
for lifestyle advice there seems to be a mismatch between the roles and competencies for
which health professionals are trained and the action required This underscores the need
to develop and strengthen lifestyle medicine as a component of health professionalsrsquo
education defined as lsquothe integration of lifestyle practices into the modern practice of
medicine both to lower risk factors for chronic disease andor if diseases are already
present to serve as an adjunct in therapy Lifestyle medicine brings together sound
scientific evidence in diverse health related fields to assist the clinician in the process of not
only treating disease but also promoting good healthrsquo
Objective of the study
This study seeks to provide a mapping of the current situation how health professionals are
trained in health promotion in the EU To that end this study aims to answer the following
research questions
1 How are health professionals in the EU countries being trained in health promotion
prevention and lifestyle medicine in graduate post-graduate and continuous
professional education
2 What are good practices on knowledge capacity and competency building and
advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Scope of the study
Classically public health targets at activity levels can be described in operational models
like the Friedenacutes pyramid model It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of health
like socioeconomic status We use this model as a substructure to investigate health
professionalsrsquo education as they contribute to public health at all these levels
Methodology
In order to provide a general overview on how health professionals are trained in health
promotion and disease prevention and lifestyle medicine in the EU we conducted an online
survey We identified potential organisations in the EU to take part in the survey and asked
those organisations to spread the survey among other organisations or stakeholders in their
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
8
network We contacted 24 EU associations that represent entire professions or part of the
professions (like post-graduates) in all EU countries and have major networks in the fields
of graduate post-graduate and continuous professional development for their support We
aimed to cover all professions within the scope of this study physicians physiotherapists
occupational therapists psychologists nurses social workers dentists pharmacies
dietitians Also national health associations and national educational organisations were
approached to fill in the survey Among other topics the survey contained questions on the
training programme type of health professional targeted implementation in the
curriculum description of the health promotion component funding accreditation and
partnerships
In addition to the online survey a desk research was conducted including both scientific
and grey literature to establish an overview of the competency profiles of health
professionals in the field of health promotion and disease prevention Based on the
identified literature we described the competency profiles for each of the following
healthcare professions (undergraduate) medicine medical specialists dentists nurses
nurse specialists occupational therapists pharmacists physiotherapists psychologists
and social workers
Results were tabulated and described Good practices were selected on the basis of four
pre-established criteria These practices were analysed more in-depth with an analytical
tool aligning Friedenrsquos pyramid of public health needs and Kraigerrsquos Learning Typology This
in-depth analysis was used to define a short list of 10 good practices representing a variety
of professions and countries
Results
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades1there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional However there is room for improvement many competency
profiles leave room for interpretation the described competences are not ranked in order
of importance and it is often not explained how the competences should be applied in
practice ie in a pro-active preventive way (always assessing lifestyle within the
treatment) or a more curative reactive way (only included in the treatment when there is
a clear lifestyle component related to the disease)
As for the inclusion in educational programmes a high percentage (93) of respondents
(n=197) indicate that health promotion and disease prevention is implemented in their
educational programmes or modules The high share may reflect a selection bias as those
who have implemented health promotion within the education may have been more inclined
to fill in the questionnaire In the survey we explored how health promotion and disease
prevention is implemented in the educational setting In summary this provided the
following results
1 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
9
bull More than half of the respondents indicated that they filled in the questionnaire for
practices in undergraduate educational settings Throughout Europe these
numbers were relatively similar
bull Physiotherapists are the professional group most actively involved in health
promotion training activities The vast majority applies multidisciplinary
approaches and thus brings other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within training programmes In continuous professional development on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion especially target knowledge skills
and behaviour of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for continuous professional
development (33) compared to undergraduate and postgraduate education
where the topic is covered in most modules (15 and 6) Funding was more
often obtained in Northern and Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) Regarding full modules high percentages indicated
that this is mandatory and that there is an exam at the end of the module (81
70 respectively)
Conclusions
The present study provides an overview of current practice on health promotion disease
prevention and lifestyle medicine in the education of health professionals in EU countries
This is an important need-assessment for the exchange of knowledge and expertise among
EU countries All professions have versatile competency profiles in health promotion giving
a good ground for further development As the study results reveal some unbalance in
competencies addressed and methods used a next step could be to support further
development of educational practices in lifestyle medicine and adoption of new
technologies There is room for improvement as well as encouraging volition to share
expertise across professions professional associations universities and countries in the EU
The body of knowledge generated in this study can serve as a basis for further analysis and
contribute to the enhance effectiveness of educational practices of health promotion
disease prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
11
1 INTRODUCTION
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices2 In Europe such chronic diseases as
cancer cardiovascular diseases diabetes and chronic respiratory diseases are giving the
greatest disease burden3 The Global Burden of Disease (GBD) 2016 study estimates that
over 91 of deaths and over 87 of DALYs in the European Union (EU) are the result of
non-communicable diseases (NCDs) of which 61 and 43 respectively can be attributed
to modifiable risk factors4 To a large extent lifestyle factors unhealthy diets tobacco use
harmful use of alcohol and physical inactivity have been identified as the top risk factors
for NCDs in the EU5 The last non-communicable diseases progress monitor 2017 of the
WHO underlines that ldquoNCDs share key modifiable behavioural risk factors like tobacco
use unhealthy diet lack of physical activity and the harmful use of alcohol which in turn
lead to overweight and obesity raised blood pressure raised cholesterol and ultimately
diseaserdquo6 Since NCDs share many related modifiable risk factors and often do not occur in
isolation7 prevention must be integrated into population approaches to combat NCDs as a
group8 In recognition of this important public health challenge investing in effective health
promotion and disease prevention is critical to improve the quality of life and well- being of
European citizens910 as well as their productivity and NCDrsquos burden on health systems and
economy of European societies11
Strengthening the investments in health promotion and disease prevention is key to delay
the onset and reduce the burden of NCDs in Europe12 As there is a great need for chronic
disease management the healthcare setting is crucial for health promotion in both primary
and secondary prevention of NCDs13 For example obesity is a major modifiable risk factor
2 Chopra M et al (2002) A global response to a global problem the epidemic of overnutrition
httpswwwncbinlmnihgovpmcarticlesPMC2567699pdf12571723pdf 3 WHO (2006) Gaining Health The European strategy for the prevention and control of noncommunicable
diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf 4 EU burden from non-communicable diseases and key risk factors httpseceuropaeujrcenhealth-
knowledge-gatewaysocietal-impactsburden 5 WHO (2014) Prevention and control of noncommunicable diseases in the European Region a progress report
httpwwweurowhoint__dataassetspdf_file0004235975Prevention-and-control-of-noncommunicable-diseases-in-the-European-Region-A-progress-report-Engpdf
6 WHO (2017) Noncommunicable diseases progress monitor 2017 httpappswhointirisbitstream handle106652589409789241513029-engpdfjsessionid=0613BF26D66A7DA9D1C91AD325E0A75Dsequence=1
7 httpsacels-cdncomS00917435150028321-s20-S0091743515002832-mainpdf_tid=88fea2bf-946a-44c2-be59-0edbabc2c2e8ampacdnat=1541511066_feedfb33968e2ac2f5b47a3452254a9f
8 Integrated approach to prevent noncommunicable diseases httpwwweurowhointenhealth-topicsnoncommunicable-diseasescanceractivitiesintegrated-approach-to-prevent-noncommunicable-diseases
9 WHO (2006) Gaining Health The European Strategy for the prevention and control of noncommunicable diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf
10 Scriven A (2017) Promoting Health a Practical Guide Seventh Edition httpsbooksgooglenl
bookshl=nlamplr=ampid=fJwqDwAAQBAJampoi=fndamppg=PP1ampdq=importance+health+ promotion+and+disease+prevention+European+Commissionampots=jcXZvCYJIQampsig=8D8Yqa9wKa_DlaaYUky_EtUxd_gv=onepageampq=importance20health20promotion20and20disease20prevention20European20Commissionampf=false
11 Tender 12 Chrodis (2015) Health promotion and primary prevention in 14 European countries a comparative overview
of key policies approaches gaps and needs httpchrodiseuwp-contentuploads 201507 FinalFinalSummaryofWP5CountryReportspdf
13 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
12
for type II diabetes (DM II) and thus efficacy of the intervention matters In economic
modelling for eight European countries a body-mass index reduction in the adult population
of 5 compared to 1 resulted a three-fold reduction in the incidence of DM II14 Apart
from the health losses caused directly by NCDs underlying conditions may also increase
susceptibility for other diseases Patients with diabetes and serious heart conditions eg
were identified as risk populations for COVID-1915 New health threats like climate crisis
will have an impact on healthcare systems and need for adaptation options including
training of health care workers integrated heatwave early warning systems especially for
the most vulnerable populations and supporting lifestyle changes toward healthy choices
that are at the same time climate and health friendly16
Healthcare providers such as doctors especially general practitioners (GPs) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs17 Health
promotion is collaborative work where professionals strengthen the message and help
patients to choose and implement healthier behaviours Counselling on and prescription of
a healthy lifestyle is particularly important to socioeconomically vulnerable and
disadvantaged population groups which are disproportionally affected by unhealthy
lifestyles and are more difficult to reach18 Secondary and tertiary prevention in chronic
diseases is embedded into good quality care since good nutrition status decreases the risk
of reinfarction as does smoking cessation For these reasons health promotion was
explicitly recognized as an integral part of the professional role of the GP in several policy
statements at both the European and the national level19 While many policy statements
and NCDs practice guidelines include a call for behavioural change as the first line of
prevention and management providers often do not provide behavioural change
counselling in their care20
A recently published report by the European Commission and WHO Europe (2018) identified
barriers for prescribing and counselling on exercise schemes and on promoting physical
activity in the health sector These were the lack of confidence and knowledge and skills by
health professionals on providing effective counselling21 For example Koutoukidis et al
(2017) performed a qualitative study on the perspective of healthcare professionals on
lifestyle advice to cancer survivors Health professional-centred barriers to provision of
lifestyle advice were a lack of knowledge on healthy lifestyle guidelines the feeling that
14 Webber L Divajeva D Marsh T McPherson K Brown M Galea G et al The future burden of obesity-related
diseases in the 53 WHO European-Region countries and the impact of effective interventions A modelling study BMJ Open 2014
15 Centre for Disease Control and Prevention (2020) Coronavirus disease 2019 Groups at higher risk for severe illness httpswwwcdcgovcoronavirus2019-ncovneed-extra-precautionsgroups-at-higher-riskhtml
16 Drummond P Ekins P Grubb M Lott MSEng M Byass P Nilsson M et al The Lancet Commissions Institute for Sustainable Resources (P Health and climate change policy responses to protect public health thelancetcom 2015
17 Catapano AL et al (2007) Averting a pandemic health crisis in Europeby 2020 what physicians need to know regarding cholesterol management httpswwwncbinlmnihgovpubmed17446817
18 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
19 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20 European20General20Practicepdf
20 httpswwwncbinlmnihgovpmcarticlesPMC4561845pdf101177_1559827615580307pdf 21 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the
European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
13
they were not the right person to provide advice and lack of time and resources22
Additional barriers mentioned in the World Book of Family Medicine ndash European Edition
2015 are perceived as lack of time or competing work load insufficient reimbursement
doubts about patientsrsquo acceptance and willingness to receive lifestyle counselling low self-
efficacy insufficient skills and training doubts about effectiveness of interventions and
health promotion perceived as outside professional role2324 Therefore while most health
professionals seem to acknowledge the need for lifestyle advice there seems to be a
mismatch between roles competencies training and possibilities among health
professionals and action25 Factors causing this mismatch differ from individual and
organizational context wherefore strategies to address these barriers will also vary26
These findings underline the need for developing and strengthening lifestyle medicine in
health professionalsrsquo education27 defined as lsquothe integration of lifestyle practices into the
modern practice of medicine both to lower the risk factors for chronic disease andor if
disease already present serve as an adjunct in its therapy Lifestyle medicine brings
together sound scientific evidence in diverse health-related fields to assist the clinician in
the process of not only treating disease but also promoting good healthrsquo28 Hence lifestyle
medicine covers the systematised approach for prevention and management of chronic
disease addressing eg diet physical activity behaviour change stress and coping and
tobaccosubstance abuse29 Health professionals need to learn how to overcome the
identified barriers mentioned above30 and how to effectively and efficiently counsel their
patients towards adopting and sustaining healthier behaviours31
Moreover digitalization is changing the scenery for lifestyle medicine and chronic disease
management Patient engagement can be enhanced with applications self-monitoring or
self-management tools To successfully embed these new forms of care professionals must
develop new skills32 However studies have shown that medical students are not formally
trained in major concepts known to influence health33 Philips et al (2014) states that
including lifestyle medicine in undergraduate medical curricula would have important public
health implications by efficiently promoting the prevention and treatment of NCDs34 A
study by Dacey et al (2012) states that face-to-face continuing medical education formats
22 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 23 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20
European20General20Practicepdf 24 Geense WW van de Glind IM Visscher TL van Achterberg T Barriers facilitators and attitudes influencing
health promotion activities in general practice an explorative pilot study BMC-family practice 2013 1420 25 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 26
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
27 Polak R et al (2015) Lifestyle Medicine Education httpswwwncbinlmnihgov pmcarticles PMC4561845
28 Rippe JM (2019) Lifestyle Medicine Third Edition CRC Press 29 Kushner RF and Webb Sorensen K (2013) Lifestyle medicine the future of chronic disease management
Obesity and nutrition 201320 30 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 31 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) The impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 32 Eg Richard A A amp Shea K (2011) Delineation of Self-Care and Associated Concepts Journal of Nursing
Scholarship 43(3) no-no httpdoiorg101111j1547-5069201101404x 33 httpscdnymawscomwwwacpmorgresourceresmgrlifestylemedicine-filesajpm-lmcommentarypdf 34 Philips E Pojednic R Polak R Bush J amp Trilk J (2014) including lifestyle medicine in undergraduate
medical curricula Medical education online
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
14
have a positive impact on physician behaviour toward health promotion and disease
prevention by increasing their knowledge confidence and practices that help patients to
adopt healthy behaviours35 Similar results can be expected among other health
professionals as well
The World Book of Family Medicine ndash European Edition 2015 states that the shared aim to
integrate health promotion disease prevention and lifestyle medicine has not been fully
achieved Future activities as to how lifestyle interventions can be better integrated need
collaborative approaches36 As a starting point for more collaborative action this study
seeks to provide a mapping of the current situation on health professionals training in health
promotion in the EU
11 Research questions
To that end this study seeks to answers to the following research questions
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and continuous
professional education
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
35 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) the impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 36
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
15
2 THEORETICAL BACKGROUND
21 Societal needs for health promotion and disease prevention
Classically public health targets at activity levels can be described in operational models
like Friedenacutes pyramid model37 It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of
health like socioeconomic status6 We use this model as a substructure in looking into
health professionalsrsquo education as they contribute to public health in these levels (Figure
21) Society needs to evaluate cost-effectiveness of public health efforts and find a balance
between the levels of actions at each level We use this framework to enable us to present
the needs of societies in general for different health professionals and their roles and
competencies in public health
Figure 21 Frieden Pyramid of health impact of health professional activities at the different levels of society (T Frieden 2010 CDC)
Healthcare services can contribute in mitigating the burden of disease by socioeconomic
disadvantages Health professionals have a key role in developing health services so their
competency to take account of differences in abilities of people to benefit from health
services is vital But more is needed Traditionally health professionals have been managing
the individual risk factors and provision of services That is not enough For example in
cardiovascular diseases the ldquoperfect treatment approachrdquo fails to prevent almost half of the
disease burden37 In cancer diseases individual health behaviours like smoking contribute
in more direct manner Therefore we need to develop educational systems that support
health professionals to take part in new public health approaches by planning interventions
that change the environmental context to make healthy options the default choice
37 Frieden TR A framework for public health action The health impact pyramid American Journal of Public
Health 2010
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
16
regardless of education income service provision or other societal factors37 These are
equally needed in out-of-health contexts like climate change where socio-economic
inequalities and (health) behavioural choices are among major drivers of climate changes38
Policies can influence environments to support healthier choices and we need health
professionals in policy development and execution Still health behaviour changes happen
at the individual level We need more efficient skills in personalized health coaching of
individuals to increase the cost-effectiveness of treatment of NCDs39 An ageing population
and increasing rates of chronic disease as well as advances in medical science and health
information technology to make care safer and more efficient require a rethinking of how
care is delivered Digitalization of services will challenge healthcare professionals and
collaborative care models have become more common40 Instead of requiring compliance
from patients patient-centred approaches are required from professionals This means that
clinical interventions need to be complemented by counselling and education to achieve
long-lasting protective measures Health coaching is aiming to empower patients in co-
management of their disease41 and emphasize and support patientsrsquo autonomy instead of
merely compliance It is based on shared decision-making and collaborative goal setting
facilitated by motivational interviewing42 Health coaching is already happening in digital
environments This paradigm shift requires new skills and attitudes from health
professionals too
New approaches to public health on societal level the paradigm shift to health coaching on
patient level and new forms of healthcare delivery pose a big challenge to the educational
system of health professionals It needs to prepare new professionals and train health
professionals already working in the healthcare system to master a wider scope of
knowledge and develop new skills and attitudes to implement these new approaches in a
safe effective and efficient way
22 Health profession competencies
Healthcare service is a complex and interconnected network of professionals There are
common professional competencies needed in health care and health promotion
(communication collaboration) but they are applied to meet the learning aims of each
profession or level of education If we want to increase the implementation of lifestyle
counselling or systemwide changes we need to evaluate knowledge skills and attitudes
required for the changes and to define the competencies needed to support this change
Professional competencies sum the elements of abilities (knowledge skills attitudes and
behaviours) that enable a professional to accomplish the activities described in a task
statement that outlines what the professional is expected to do43
38 Watts Nick Amann Markus Arnell Nigel et al (66 more authors) (2019) Report of The Lancet Countdown
on Health and Climate Change The Lancet ISSN 0140-6736 httpsdoiorg101016S0140-6736(19)32596-6)
39 Hale R Giese J Cost-Effectiveness of Health Coaching Prof Case Manag 2017 40 Falconer E Kho D Docherty JP Use of technology for care coordination initiatives for patients with mental
health issues A systematic literature review Neuropsychiatric Disease and Treatment 2018 41 Hayes E McCahon C Panahi MR Hamre T Pohlman K Alliance not compliance Coaching strategies to
improve type 2 diabetes outcomes J Am Acad Nurse Pract 2008 42 Olsen JM Health Coaching A Concept Analysis Nurs Forum 2014 43 Kraiger etal 1993 Application of cognitive skill-based and affective theories of learning outcomes to new
methods of training evaluation
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
17
Learning Outcome Typology by Kraiger is a widely used descriptive model for setting targets
and learning outcomes in education43 It comprises cognitive (knowledge) psychomotor
(skill-based) affective and behavioural (attitudes) components This classification scheme
for learning outcomes is based on Bloomrsquos work (1956) of three learning domains including
cognitive domain the affective domain and psychomotor44 45Knowledge can be factual and
declarative knowledge information and concepts or processes and organizations or
metacognitive strategies like allocation and regulation of professional performance Skills
include simple routine development and procedures needed at work and more complex
skills needed for the ability to monitor the performance along other tasks Attitudes are
linked with professionalsrsquo perceptions on learning self-efficacy at work perception about
ability to perform and ability to goal setting It has domains on professionalism Knowledge
can be obtained in reading or e-Learning modules skills require active teaching methods
and attitudes develop over time Behaviours then are complex situations where knowledge
skills and attitudes are utilised in professional manners In education planning outcomes
are defined by these elements
Competency frameworks are an effective method for achieving outcome-based education46
They provide a tool for capturing the elements and abilities (knowledge skills attitudes
and behaviours) needed in effective and safe patient work47They can serve in evaluating
the components of different specialities or societal needs like in this report public health
needs Competencies define an acceptable and feasible description of professional
behaviours used in relation to health promotion Competency building is at the basis in
developing similar programmes in the US4849 Meaningful assessment of competencies
developed is critical for the implementation of effective competency-based medical
education (CBME)50
The International Union for Health Promotion and Education (IUHPE) published an
extensive list of core competencies and professional standards for health promotion in
201651 It defines acuteHealth Promotion actionrsquo in the context of these competencies and
standards to describe programmes policies and other organised Health Promotion
interventions that are empowering participatory holistic inter-sectoral equitable
sustainable and multi-strategy in nature and aim to improve health and reduce health
inequities51
44 Bloom BS (1956) Taxonomy of educational objectives The classification of educational goals New York NY
Longmans Green 45 Cruz-Cunha MM (2012) Handbook of Research on Serious Games as Educational Business and Research Tools 46 Frank JR Danoff D The CanMEDS initiative Implementing an outcomes-based framework of physician
competencies Med Teach 200729(7)642ndash7 47 Cooke M Irby DM Sullivan W Ludmerer KM Medical education American medical education 100 years after
the flexner report N Engl J Med [Internet] 2006355(13)1339-1344+1306 Available from httpwww
scopuscominwardrecordurleid=2-s20-33749062559amppartnerID=40ampmd5=d949feb 758c984c732a419 cada174c85
48 Alaranta A Alaranta H Patja K Palmu P Praumlttaumllauml R Martelin T et alSnuff use and smoking in Finnish Olympic athletes Int J Sports Med 200627(7)
49 Van Horn L Lenders CM Pratt CA Beech B Carney PA Dietz W et al Advancing Nutrition Education Training and Research for Medical Students Residents Fellows Attending Physicians and Other Clinicians Building Competencies and Interdisciplinary Coordination Adv Nutr 2019
50 Lockyer J Carraccio C Chan MK Hart D Smee S Touchie C et al Core principles of assessment in competency-based medical education Med Teach 201739(6)609ndash16
51 IUHPE (2016) Core competencies and professional standards for health promotion full version httpwwwukphrorgwp-contentuploads201702Core_Competencies_Standards_linkEpdf )
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
18
We present CanMEDS as an example of a framework that includes content-specific
competencies (Table 21) CanMEDS was developed for medical experts but most
competencies are applicable to all health professionals
Table 21 CanMEDS in short form52 original version53
Competency Short description
Medical Expert Apply clinical skills and knowledge of the biomedical sciences to fulfil your scope of practice
Collaborate with patients and families for patient-centred care and management
Contribute to health care quality and patient safety
Communicator Build rapport and empathy in all interactions with patients and include families (with the patientrsquos consent)
Understand the patientrsquos perspectives expectations and socio-economic issues
Use active listening patient-centred interviewing skills and culturally safe communication
Share information in plain language to promote patientsrsquo understanding
Clearly document and share information with patients and others on the care team
Collaborator Collaborate by sharing knowledge and perspectives sharing responsibilities learning together
Collaborate in care education advocacy administration and scholarship
Leader Take responsibility for the ongoing operation evolution and continuous
improvement of the healthcare system
Expand beyond a clinical or technical role to take on administrative teaching and scholarly roles and responsibilities
Exercise efficient use of resources to achieve cost-effective care
Contribute to improvements in personal practice team organization and system
Health Advocate
Understand and address the determinants of health that affect patients and support patients to navigate through the health care system
Collaborate with communities and populations to influence change in the health
care system
Contribute to health promotion and disease prevention Understand determinants and needs speak on behalf of others increase awareness
Scholar Plan for and engage in life-long learning
Teach others
Evaluate and apply evidence to day-to-day practice
Contribute to research including creation dissemination and translation into
practice
Professional Commit to patients society profession and ldquoselfrdquo Patients ndash maintain clinical competency and adhere to ethical standard Society ndash demonstrate social accountability by responding to societal needs and
expectations Profession ndash peer assessment mentorship supporting others setting standards Self ndash participate in self-assessment and reflection build self-awareness and manage own well-being
52 Michener Institute No Title CanMEDS framework in short [Internet] Available from httpsmichenercawp-
contentuploads201805CanMEDS-Framework-Summarypdf 53 Frank JR Snell L Sherbino J E CanMEDs 2015 Physician Competency Framework [Internet] CanMEDS 2015
Physician Competency Framework Ottawa Royal College of Physicians and Surgeons of Canada 2015 p 1ndash30 Available from httpwwwroyalcollegecaportalpageportalrccanmedsresourcespublications
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
19
23 Educational systems for health professions in Europe
According to the EU Treaty European citizens have a virtue of rights of free movement as
workers freedom of establishment and freedom of service providers54 Directives on the
requirements of professional qualifications in EU their recognition and Regulation55
facilitate the mobility of health personnel Each member state will apply this directive in
the national legislation on health professional qualifications There is a system of automatic
recognition based on harmonised minimum training requirements This system depends on
the timely notification of new or changed evidence of formal qualifications by MS and their
publication by the Commission Otherwise holders of such qualifications have no
guarantees that they can benefit from automatic recognition
The undergraduate education in Europe is coordinated through the Bologna Process which
is an intergovernmental cooperation of 48 European countries in the field of higher
education It guides the collective effort of public authorities universities teachers and
students together with stakeholder associations employers quality assurance agencies
international organizations and institutions including the EC to bring more coherence to
higher education systems across Europe56 Under the Bologna Process all 48 participating
European countries agreed to ensure mutual recognition of qualifications and learning
periods abroad completed at other universities Nonetheless it should be noted that across
Europe healthcare systems and educations may still significantly differ
While professional activity is regulated by national law in individual member states57
faculties and other academic institutions have collaborated in the establishment of a
framework of competencies based on the scientific advances and new methodologies in
education In fact EU Directives of the European Parliament and Council on the recognition
of professional qualifications have consolidated a system of mutual recognition between
MS58 Examples include the PHARMINE for pharmacists and MEDINE for medical doctors59
This collaboration is in line with the Bologna Process
24 Relevant educational settings for health promotion
Inclusion of health promotion and lifestyle medicine in undergraduate medical curricula is
expected to have important public health implications However in current medical
education this subject is minimal to nonexistent60 This is a global problem In 2016 the
American associations around NCDs launched a joint programme called lsquoThe Lifestyle
54 Treaty on the Functioning of the European Union (TFEU) Articles 45 49-62 55 European Parliament C of the EU Directive 200536EC on the recognition of professional qualifications and
Regulation [Internet] 2013 Available from httpseur-lexeuropaeulegal-
contentENALLuri=celex3A32013L0055 56 The Bologna process and the European Higher Education Area httpseceuropaeu education policies
higher-educationbologna-process-and-european-higher-education-area_en 57 UEMS (2017) Charter on training of medical specialists in the EU httpswwwuemseu
dataassetspdf_file001943561ETR-Psychiatry-201703pdf 58 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 59 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 60 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
20
Medicine Education Collaborativerdquo for improvement of health promotion education among
health professionals and in medical schools61 This initiative will a) work for high-quality
curricular material on an easily navigable website b) provide support for medical schools
to advocate for and implement lifestyle medicine curricula into their own institutions c)
aim to increase awareness and legislative initiatives that encourage adoption of lifestyle
medicine into medical school education d) develop and conduct assessment in the
following areas Student Health Student Knowledge and Programme Effectiveness and
e) train and support medical students as effective champions of lifestyle medicine whose
engagement with the curriculum lead to increased adoption within medical schools and
enhanced collaboration nationallyError Bookmark not defined This need has been acknowledged
in Europe as well62
Besides education in medical schools continuous professional development (CPD) is an
essential component in health education to ensure that professionals graduated in past
decades keep their competencies up to date and acquire new competencies needed for
health promotion disease prevention and lifestyle medicine It is important to encourage
further strengthening of CPD for those professions that benefit from automatic recognition
of their professional qualifications Member states should in particular encourage CPD for
physicians medical specialists general practitioners nurses responsible for general are
dental practitioners specialized dental practitioners veterinary surgeons midwives
pharmacists and architects63 Given the rapid developments in societal needs and
approaches towards health promotion and disease prevention and spectacular increase in
technological support facilities lifelong learning is imperative for health professionals and
should be oriented towards the competencies required to best serve their population and
society
Figure 22 Lifelong learning is an iterative process where learners build knowledge skills
attitudes and behaviours on top of their current professional competency
61 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019 62 European Lifestyle Medicine organisation httpswwweulmorg 63 Lim SS Vos T Flaxman AD Danaei G Shibuya K Adair-Rohani H et al A comparative risk assessment of
burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions 1990-2010 A systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
21
25 Theoretical framework for this study
In this study we touch upon the existing levels of health promotion disease prevention
and lifestyle medicine in health and educational settings in the EU and make a preliminary
assessment of its relevance
As right now health professional competencies seem more practical we approached the
mapping of competencies in health education through professions rather than with an
overall theoretical framework Thus we aim to create a general picture for different health
professions at different levels of education
For the assessment of relevance of the existing levels of health promotion in education we
aligned the competency framework of Kraiger with Friedenrsquos public health framework We
used three components64 of Kraigerrsquos Learning Typology
bull Knowledge cognitive and mental abilities
bull Skills psychomotor manual and physical abilities to perform tasks
bull Attitude (or self) perceptions growth in feelings or emotional areas
We used the integrated framework as an analytical tool to classify content areas covered
and their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future
This study is an important first step as we know little about present practices However
more detailed research will obviously be needed
64 Given the limitations of the study behaviour ndash the fourth component ndash is not included Behaviour refers to
practices to utilise knowledge skills and attitude in work environment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
22
3 METHODOLOGY
31 Mapping of health educational programmes in the EU
The first aim was to provide a general overview on how health professionals are trained in
health promotion and disease prevention and lifestyle medicine in the EU To that end we
conducted an online survey to map the educational programmes of health professionals in
the EU In addition to the proposed methodology we also conducted desk research to
create an overview of competency profiles of health professionals in the EU
311 Online survey
This study looks at undergraduate education postgraduate education and CPD courses in
all healthcare professions across the EU Within the EU different organisations are
responsible for the education of healthcare professionals
bull The undergraduate education programmes are organised by universities in each
country
bull The post-graduate education programmes are organised differently in each
country This includes a set of European organisations that run the guidelines
and portfolioacutes for each profession or specialty within this profession (like in
medicine)
bull CPD programmes are even more diverse between countries and can be accredited
both by European organisations and universities
Due to the wide scope of the study and the different levels of healthcare educational
programmes no country correspondents could be found with a full overview of educational
programmes addressing health promotion and disease prevention in their country
Therefore we chose for a snowball methodology to obtain information on all levels of health
professional education The snowball methodology consists of two steps First we identified
potential organisations in the EU to take part in the survey Second we asked those
organisations to recruit other organisations or stakeholders in their national andor
international network of colleagues and spread the survey among those This method
required more effort and time in the beginning but once the lsquoballrsquo was rolling it provided
us with a growing dataset including the perspectives from healthcare educators healthcare
professional associations and healthcare students and residents The snowball method
implies a risk of selection bias as educational institutions that have implemented health
promotion within their programmes ie the front-runners may have been more inclined
to respond than those who have not
In addition this recruitment process served as a communication and dissemination vehicle
and increased the engagement to the mapping Many organisations expressed their interest
to join the workshop as well as willingness to disseminate the results to their members and
collaborators Because of the growing interest we decided to extend the deadline after the
workshop organised on 13 February so attendees could spread the survey among their
national andor international networks
Our original workplan included an Excel worksheet to be sent to the national health
coordinators in each EU country but as we chose a different strategy it was necessary to
develop a more user-friendly and flexible method Therefore an online survey was
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
23
developed This enabled refinement of questions to each level of education with core sets
of questions Survey links proved to be easy to use and shared within educational facilities
or associations which led to higher response
In this section we discuss in more detail how the survey was developed and how relevant
international organisations were recruited
Development of an online survey
First we developed a mapping tool (stand-alone Excel document) to map the current
situation of professionals trained in health promotion This mapping tool was validated by
both Chafea and DG SANTE and by the external experts in the core research team After a
pilot phase an online survey was developed for all healthcare professions based on the
content of the mapping tool This was a necessary step to boost response as the online
survey proved to be more user-friendly and easier to share among educational facilities or
associations than the mapping tool in Excel
Among other topics the survey contained questions on the
bull Training programme for which the respondent is filling in the survey (which
(educational) institute and health profession portfolio etc)
bull Type of training programme (undergraduate education postgraduate education or
continues professionalrsquos development
bull Type of health professional targeted (eg GPrsquos physiotherapists etc)
bull Implementation in the curriculum
bull Description of the health promotion component in the programme (eg teaching
methods monodisciplinary approach or multidisciplinary approach expected
outcomes in knowledge skills and attitude)
bull Targeted funding
bull Accreditation
bull Partnerships
The questions in the survey correspond with the information requested in the Tender
Specifications Note that the survey maps the educational offer effectiveness of education
is outside the scope of this study The complete questionnaire used in the survey can be
found in Annex 3
Recruitment of relevant international organisations EU and national medical and
non-medical associations medical faculties national and international institutes
networks and organisations
As we used a snowball method it is not possible to provide the exact number of persons
who received the survey and response rates Instead we present each of the steps taken
to approach respondents and final response obtained
Recruitment of European associations
First we connected with major networks in the fields of graduate post-graduate and
continuous professional development for their support as these organisations have an
overview of the three levels of health professional education These associations represent
entire professions or part of the professions (like post-graduates) in all European countries
National professional organisations are members of these umbrella organisations For
example the Union of Medical Specialists (UEMS) represents 16 million medical specialists
It has 40 full member associations (Member States of the EU amp Member States of the
European Economic Area) associate member associations (Member States of the Council
of Europe) and observer member associations (other countries eg the United States)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
24
The UEMS represents more than 50 medical disciplines through various bodies
and structures The most important ones are the 43 Specialist Sections which represent
independently recognised specialties All health professionals health professional students
and post-graduates are organised in a similar manner These organisations are in a good
position to provide information and disseminate it across EU countries
Overall 24 EU associations were approached by email to spread the survey among their
networks (see Table 31 for a complete overview) We aimed to cover all professions within
the scope of this study ie physicians physiotherapists occupational therapists
psychologists nurses social workers dentists pharmacies dietitians throughout Europe
Therefore European associations with focus on educational programmes for these specific
professions were approached
Table 31 Approached European Associations
No European Associations
1 European Medical Association (EMANET)
2 The European Union of General Practitioners (UEMO)
3 European Union of medical specialists (UEMS)
4 European Medical Students Association EMSA)
5 European Forum of Medical associations (EFMA)
6 European Federation of Nurses Associations (EFN)
7 European Association of schools of social work
8 European Network of Physiotherapy in Higher Education
9 European Region ndash World Confederation of Physical Therapy (ER-WCPT)
10 European Network of Occupational Therapy in Higher Education (ENOTHE)
11 Council of Occupational therapists of European Countries (COTEC) part of the World
12 Federation of Occupational Therapists (WFOT)
13 Federation of National Psychologists Associations
14 European federation of nurse educators (FINE) association
15 Association for Dental Education in Europe
16 Council of European Dentists
17 Association for Medical Education in Europe (AMEE)
18 Pharmaceutical group of the European Union (PGEU)
19 European Pharmacists Forum (EPF)
20 European Association of faculties of pharmacy (EAFP)
21 European network of medical residents in Public health
22 The Association of Medical Schools Europe (AMSE)
23 The European Society of Preventive Medicine (ESPREV)
24 The European Lifestyle Medicine Organisation (ELMO)
Recruitment of national associations
Second national health associations for all Member States and all professions were
approached to fill in the survey This step was crucial to increase the response National
health associations were selected using the member list of European organisations Table
32 shows the European organisations used to identify national health associations that
were invited to participate in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
25
Table 32 Examples of the approached national associations
Profession European Association Examples of approached national associations (1 out of 28)
Medical doctors Standing committee of European Doctors (CPME)
Czech Medical Chamber
Physiotherapists World confederation for physical therapy (WCPT)
Swedish Association of Physiotherapists
Social workers International federation of
social workers
German professional
association for social work
Psychologists European Federation of psychologistsrsquo association (EFPA)
Croatian psychological association
Occupational therapists Council of occupational
therapists for the European Countries (COTEC)
Association of Bulgarian
Ergotherapists
Dietitians The European Federation of the associations of dieticians
(EFAD)
French Association of Nutritionist Dietitians
Dentists Council of European Dentists Irish dental association
Nurses European Federation of Nurses
Association (EFN)
Polish Nurse Association
Pharmacists Pharmaceutical group of European Union (PGEU)
Malta Chamber of Pharmacists
Recruitment of national educational organisations
Last the list of the selected associations was used to identify relevant national educational
organisations These national educational organisations (eg University of Maastricht
Faculty of Health Medicine and Life Sciences Kaunas University Medical School Lifestyle
Medicine University of Helsinki Faculty of Medicine) were approached individually and
asked to fill in the survey and spread it throughout their network
Table 33 Number of national educational organisations approached
Profession Number of approached national education organisations
Medical schools 298
Schools of physiotherapy 29
School of social work 31
School of dietitians 40
School of Occupational therapists 45
School of dentists 85
School of pharmacists 56
Response obtained
In total we received information on 176 educational practices till mid-February The
workshop organized in Luxembourg65 gave an additional boost and resulted in 32 more
practices reported in the survey In total this mapping exercise is based on information on
208 practices of health promotion in educational settings
65 Workshop ldquoPromoting lifestyle medicine competencies and education of health professionals in the EU todayrdquo
13th February 2020 Luxembourg Organized by Chafea and DG SANTE
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
26
312 Desk research
Desk research was conducted on both scientific and grey literature with the main purpose
to establish an overview of the competency profiles of health professionals in the field of
health promotion and disease prevention This overview was created to gain insight to what
extent competency profiles related to health promotion and disease prevention are covered
in the educational standards of different health professions in the EU We have made use
of reports published online and scientific articles on competency profiles or educational
standards set at EU level (eg European standards in medical training (UEMS) as the EU
Directives of the European Parliament and Council on the recognition of professional
qualifications have consolidated a system of mutual recognition between Member States3
When reports on EU level could not be identified we selected articles on global standards
such as for the profession of social work (ie global standards for the education and training
of the social work profession)
Based on the identified literature we have described the competency profiles for each of
the following healthcare professions
bull (undergraduate) Medicine
bull Medical specialists
- sports medicine specialists
- public health specialists
- internists
- cardiologists
- psychiatrists
- general practitioners
bull Dentists
bull Nurses
bull Nurse specialists
bull Occupational therapists
bull Pharmacists
bull Physiotherapists
bull Psychologists
bull Social workers
The selection of healthcare professions included in the desk research was made in
consultation with Chafea DG SANTE and the experts
The assessment of the competency profiles was based on the three Domains of Learning
KSAs as described in Chapter 2
bull Cognitive mental skills (knowledge)
bull Psychomotor manual or physical skills (skills)
bull Affective growth in feelings or emotional areas (attitude or self)
This method was chosen as especially ldquolack of confidence and knowledge and skills by
health professionals on providing effective counsellingrdquo was identified as a barrier for
prescribing and counselling on promoting physical activity in the healthcare sector66 In
Chapter 4 the results are described in detail
66 httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
27
32 Long list of good practices
From the survey results we have drawn a long list of good practices As agreed with Chafea
and DG SANTE these good practices were selected using the following four selection criteria
bull The programme contains a multidisciplinary approach
bull The education is mandatory (including an exam)
bull The education covers the following topics digitalisation in health eHealth and
digital health coaching
bull The expected outcome includes change in skills and or behaviour
Several variables were included in the longlist country name of the programme name of
the institute whether there is a focus on knowledge skills and behaviour the type of
professionals who are being trained the theories that are covered by the education (eg
human cognition and behaviour health behaviour change techniques communication skills
etc) education methods used year since the education is provided the time spend in the
modules in hours and lastly in case of one full module the duration of this module To
enable comparison between good practices based on different variables the preliminary
longlist can be found in a separate Excel document Chapter 5 includes an overview of the
coverage and content of the long list of good practices
After closing of the online survey we analysed the longlist of good practices along the
following research questions
bull What content items of health promotion disease prevention and lifestyle
counseling do programmes consist of
bull What kinds of learning aims do they have
bull How do they distribute in Friedens model of levels of health promotion
bull Are there differences between professional groups
First we analysed the distribution of the learning skills separately by the levels of education
(undergraduate postgraduate and CPD) We expected that adult learning will be more
directed towards skills (learning by doing) than the undergraduate and postgraduate
programmes Secondly we analysed the educational methods and tools used in the good
practices
Good practices can be submitted to the European Commissionrsquos Best Practice Portal to be
assessed by external evaluators against criteria adopted by the Steering Group on Health
Promotion Disease Prevention and Management of NCDs Practices rated as best against
these criteria will be published on the European Commissionrsquos Best Practice Portal67
67 httpswebgateeceuropaeudynabp-portal
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
28
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
29
4 MAPPING OF THE CURRENT SITUATION IN HEALTH PROMOTION TRAINING IN THE EU
41 Overview of educational programmes in the EU
411 Summary of the main findings in the survey
A high percentage (93) of respondents (n=197) indicated that health promotion and
disease prevention are implemented in their educational programmes or modules For
undergraduate education postgraduate education and CPD these percentages were 95
93 and 83 respectively Other results include
bull More than half of the respondents indicated that they filled in the questionnaire
based on undergraduate educational settings Throughout Europe these numbers
were relatively similar
bull Physiotherapists seem to be the professional group most actively involved in
health promotion training activities The vast majority applies multidisciplinary
approaches and thus bring other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within the undergraduate and postgraduate programmes In CPD on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion target knowledge skills and
attitudes of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for CPD (33) compared to
undergraduate and postgraduate education (15 and 6) when the topic is
covered in most modules Funding was more often obtained in Northern and
Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) With regard to full modules high percentages
indicated that these are mandatory and that there is an exam at the end of the
module (81 70 respectively)
412 Detailed results of the survey
Respondents
In the following section we provide a detailed description of the survey results The survey
targeted undergraduate education postgraduate education and CPD programmes in all
Member States Overall 208 respondents filled in the questionnaire about their educational
practice Note the results presented in the remainder of this report are exclusively based
on the answers respondents provided in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
30
Table 41 and Figure 41 provide an overview of the number of practices reported per
European countries A detailed overview of the educational programmes collected
throughout Europe can be found in Annex 1
Figure 41 Practices collected in the survey by European countries (n=208)
Table 41 Number of respondents per European Member State 2019-2020 (n=208)
Abbreviations EU Member State Number of respondents
AT Austria 12
BE Belgium 23
BG Bulgaria 4
CY Cyprus 1
CZ Czech Republic 7
DE Germany 1
DK Denmark 8
EE Estonia 2
ES Spain 22
FI Finland 6
FR France 15
GB United Kingdom 6
GR Greece 10
HR Croatia 0
HU Hungary 3
IE Ireland 8
IT Italy 10
LT Lithuania 1
LU Luxembourg 0
LV Latvia 5
MT Malta 6
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
31
Abbreviations EU Member State Number of respondents
NL Netherlands 2
PO Poland 0
PT Portugal 14
RO Romania 3
SE Sweden 4
SI Slovenia 14
SK Slovakia 2
Additional countries 19
TOT 208 the UK is included as a Member State in this study as the results were obtained before Brexit
For mapping purposes we made a breakdown of results by region ie Northern Europe
Eastern Southern and Western Europe (based on United Nations Regional Groups)
Furthermore we compare results of individual countries for which at least 10 practices have
been reported in the survey These are Austria Belgium France Greece Italy Portugal
Slovenia and Spain
Table 42 European countries per region
Region European countries
West Austria Belgium France Ireland Germany
Luxembourg Netherlands United Kingdom Switzerland
North Denmark Sweden Estonia Finland Lithuania Latvia Norway
East Bulgaria Czech Republic Hungary Romania Slovakia Poland Georgia Kazakhstan
South Italy Spain Cyprus Portugal Greece Malta Slovenia Croatia Bosnia Kosovo Serbia
Type of education
We asked the respondents to indicate the type of educational setting As shown in Figure
42 more than half of the practices (60) refer to undergraduate educational settings and
approximately one third to postgraduate educational settings Only twelve percent of the
reported educational settings is related to CPD
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
32
Figure 42 Practices by educational level (n=199 in percentages)
Figure 43 and Figure 44 show the distribution in type of education per region and on
country level respectively For Western Southern and Northern Europe distribution is in
line with the overall results In Eastern Europe practices reported are more evenly
distributed over undergraduate and postgraduate education Also the share of CPD
practices is high in comparison with other regions and overall results
Figure 43 Practices by type of education per region (n=204 in percentages)
64
42
62
60
29
37
27
30
7
21
12
10
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Undergraduate education Postgraduate education Continuous professional development
60
29
12
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
33
Figure 44 Practices by type of education per country (in percentages)
Type of health professions
An overview of the type of health professional trained in the educational practices is
provided in figure 45 Remarkably over one third (35) of the educational practices
reported are oriented to physical therapists Note that multiple answers could be provided
Figure 45 Type of health professional being trained (n=208 in percentages)
Medical specialists refer to doctors with an extra expertise in one type of medicine eg including sports
medicine public health internal medicine cardiology psychiatry and the general practitioner68 General
practitioners refers to doctors working within General Practice or Family Medicine (GPFM)69 Medical doctors refers
to doctors without any specialization
68 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 69 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
83
70
27
50
30
62
71
71
8
22
60
30
60
23
14
19
8
9
13
20
10
15
14
10
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Undergraduate education Postgraduate education Continuous professional development
116
15
35
1417
7 8 5
29
0
10
20
30
40
50
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
34
Health professionals involved as educators in health promotion and disease prevention are
shown in Figure 46 Physical therapists are most often active as teachers of health
promotion (36) which coincides with the high share of practices oriented to this
profession Some professions like medical specialists nurses and psychologists are
represented more often as teacher then as trainee of the educational practices This implies
they are involved in programmes oriented towards other health professions and is in line
with a multidisciplinary approach that is applied by the vast majority of practices ( 81
n=148)
Figure 46 Health professionals teaching contents of health promotion (n=90 in
percentages)
Methods of education
Survey results show that traditional methods ie lectures and assignments are most often
used (Figure 47) Assignment refers to home school projects such as writing papers In
CPD eLearning methods are more often used (67) compared to undergraduate (45)
and post graduate education (39) The use of field training is relatively similar for the
different levels of education
Figure 47 Teaching methods applied (n=145 in percentages)
8
27 26
36
14
24 23
6 7
37
0
10
20
30
40
50
97
81
74
46
0 10 20 30 40 50 60 70 80 90 100
Lectures
Assignments
Field training in real environments
eLearning modules
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
35
Knowledge skills and behaviour
As for the outcome of the education respectively 99 94 and 89 of all practices
indicate knowledge skills and behaviour as expected outcomes (Figure 48) There are no
significant differences between types of education
Figure 48 Knowledge skills and behaviour (n=142 in percentages)
Accreditation
Overall 39 of the educational practices is accredited on European or international level
53 is accredited at a national level and only 5 lacks accreditation (n=179) Comparing
the different levels of education the rate of accreditation at a European or nation level
varies At a European level these are 46 33 22 at the national level 47 58
67 for undergraduate education postgraduate education and CPD respectively
Throughout Europe the level of accreditation of education is high in Northern Eastern
Southern and Western countries the share of practices without accreditation is 11 0
5 and 3 respectively (n=197) Eastern European countries have regulated their
accreditation more often on a national level compared to the other countries
Theories covered
Figure 49 shows that health behaviour human cognition and behaviour and population
health are covered in most educational practices to a high or at least limited extent
99
0 1
94
4 2
89
6 4
0
20
40
60
80
100
Yes No Unknown Yes No Unknown Yes No Unknown
Knowledge Skills Behavior
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
36
Figure 49 Theories covered by the education (n=137 (in percentages)
Figure 410 provides a more detailed overview of contents covered in the educational
programmes and shows that communications skills ethics and methods of evidence-based
medicine are mostly covered within the education Contents least covered are digital health
coaching digitalisation health economics
Funding and partnerships
Figure 411 provides an overview of the practices that a) obtained targeted funding to
incorporate health promotion and disease prevention in the curriculum b) for which a
partnership is set up for execution of teaching activities on health promotion or c) built on
existing partnerships to incorporate health promotion in the curriculum of the whole
educational programme This overview only includes educational practices where health
promotion and disease is incorporated in most modules
Funding differed between level of education 15 6 and 33 of the undergraduate
education postgraduate education and CPD received targeted funding to incorporate health
promotion in the curriculum Hence funding seems to play a more important role for CPD
than for undergraduate and postgraduate education
66
54
65
31
42
32
1
1
2
3
1
0 20 40 60 80 100
Population health
Human cognition and behavior
Health behaviour
Yes very much Yes but limited No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
37
Figure 410 Theories that are included within education on health promotion (n=137 in percentages)
Figure 411 Funding and partnerships when health promotion is covered in most modules of the educational programme (n=123 in percentages)
Figure 412 provides a comparison of funding obtained by European region Remarkably
in Western Europe the share of practices with targeted funding to incorporate health
promotion is much lower than in the other EU regions
48
69
40
16
54
48
20
34
37
41
49
64
9
44
24
55
51
42
47
50
50
48
44
42
31
43
7
6
4
4
3
4
25
25
9
9
5
2
42
1
1
1
1
1
1
5
5
5
6
4
3
6
0 20 40 60 80 100
Epidemiology and bio-statistics (research capacity)
Methods of evidence-based medicine
Health policies and regulation
Health economics
Ethics
Health care systems
Digitalisation in health promotion
Health inequalities
Disease prevention in teams
Health literacy
Health behavior change techniques
Communication skills
Digital health coaching
Yes very much Yes but limited No Unknown
52
61
15
0 20 40 60 80 100
Partnerships in incorporating it in the curriculum of thewhole educational programme
Partnerships for execution of teaching activities
Funding to incorporate health promotion in curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
38
Figure 412 Funding to incorporate health promotion for programmes covering health promotion in most modules by region (n=119 in percentages)
Comparing individual countries figure 413 shows that funding is obtained for the
educational programmes reported in Slovenia Italy and France while this is not the case
or unknown in Portugal Belgium and Austria
Figure 413 Funding to incorporate health promotion when health promotion is covered in
most modules of the educational programme by country (n=71 in percentages)
Dedicated modules to health promotion
In a majority of practices (63) health promotion disease prevention and lifestyle
medicine are covered in all modules of the educational programme as opposed to coverage
in one module primarily dedicated to health promotion (37) Undergraduate and
postgraduate education show a similar pattern while in CPD programmes full modules
primarily dedicated to health promotion are relatively restricted namely 15 (Figure 414)
Both options have the potential to be effective depending on context implementation and
other factors The data gathered in this study do not allow any statement on effectiveness
of each option
20
12
21
3
80
82
70
85
6
9
13
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Yes No Unknown
13
29
0
9
30
89
100
38
71
40
100
73
70
11
50
18
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Yes No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
39
Figure 414 Share of practices with one full module primarily dedicated to health promotion
(n=140 in percentages)
Visibility of health promotion in CPD
In CPD health promotion is often integrated into disease-oriented or risk behaviour-
based contents making it harder to identify the subject in events available The
Union of European Medical Specialists (UEMS) has an electronic database for
accrediting continuous medical education This data set contains keywords Using
health promotion public health or lifestyle as keywords 37 educational events were
found in the years 2017-19 (Table 415) There were 6 events in year 2017 3 in
year 2018 and 8 in year 2019 Average number of credits (1 ECMEC equals 1 hour
maximum 6 per day) was 296 average length of events 45 days This illustrates
availability of international training on health promotion and public health for
medical professions In other events these themes may have been touched upon
as well but are not the main subject So there might be a need to make health
promotion more visible in CPD events Competency-based education could provide
a solution if health promotion disease prevention and lifestyle medicine are defined
as competencies
Table 415 CPD events with health promotion public health or lifestyle as keyword 2017-
2019 (n=37)70
Title ECMEC Year Location Website
Control of multidrug-
resistant micro-organisms in health care settings
20 2017 Stockholm
Sweden
httpwwwecdceuropaeu
Epidemiology and public health microbiology for facilitators
30 2017 Spetses Greece
httpwwwecdceuropaeu
Fellowship (EPIET amp EUPHEM) introductory course
86 2017 Spetses Greece
httpwwwecdceuropaeu
International Society for Quality in Health Care 34th International Conference
23 2017 London United Kingdom
httpisquaorgEventslondon-2017
DOHaD 2017 10th World Congress DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE
25 2017 Rotterdam Netherlands
httpwwwdohad2017org
70 Source UEMS database of accredited events 2017-2019
4035
150
20
40
60
80
100
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
40
Title ECMEC Year Location Website
10th European Public Health Conference
23 2017 Stockholm Sweden
httpsephconferenceeu
Methods and tools for evidence-based practice
and decision-making in Public Health with special emphasis on communicable disease
22 2018 Stockholm Sweden
httpwwwecdceuropaeu
ESCMID Workshop on
Migrants Health
15 2018 Muscat
Oman
httpsescmidpulselinksco
mevent14833
Control of multidrug-resistant micro-organisms in health care settings
17 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventscourse-control-multidrug-resistant-micro-organisms-mdros-health-
care-settings
ECDC Summer School 2018 23 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventsecdc-summer-school-2018
3rd International Conference of the European Network for Smoking and Tobacco Prevention
15 2018 Madrid Spain
httpsenspconferenceorg
European Observatory Venice Summer School 2018
25 2018 San Servolo Italy
wwwtheobservatorysummerschoolorg
Letrsquos talk about nutrition (NESG)
4 2018 Madrid Spain
httpespencongresscomprogrammelll-courses
Epidemiology and public health microbiology for
facilitators
28 2018 Spetses Greece
httpsecdceuropaeuenepiet-euphemaboutintro
International Society for
Quality in Health Care 35th International Conference
22 2018 Kuala
Lumpur Malaysia
httpsisquaorgEventsmal
aysia-2018
Fellowship (EPIET amp EUPHEM) introductory course
93 2018 Spetses Greece
wwwecdceuropaeu
EGEA 2018 ndash ldquoNutrition and health from science to practicerdquo
16 2018 Lyon France httpswwwegeaconferencecom
1st EUROPEAN LIFESTYLE MEDICINE CONGRESS
13 2018 Geneva Switzerland
wwwelmocongresscom
11th European Public Health Conference
24 2018 Ljubljana Slovenia
wwwephconferenceeu
Fellowship Multivariable
Analysis
25 2019 Madrid
Spain
Rapid Assessment and Survey methods (RAS)
module
35 2019 Zagreb Croatia
ECDC Summer School 2019 28 2019 Stockholm Sweden
httpswwwecdceuropaeuennews-eventsecdc-summer-school-2019
Fellowship Vaccinology Module
29 2019 Rome Italy
Programme Planning and Implementationrdquo Training Program for Resolve to
Prevent Epidemics Initiative
39 2019 Butaro Rwanda
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
41
Title ECMEC Year Location Website
Skill-mix innovation in primary and chronic care mobilizing the health workforce
28 2019 Venice Italy wwwtheobservatorysummerschoolorg
Evolutionary Medicine Conference 2019 5th international meeting of the International Society for Evolution Medicine and Public Health
15 2019 Zurich Switzerland
httpsisemphorg2019-Meeting
Fellowship (EPIET amp EUPHEM) introductory course
85 2019 Spetses Greece
Project Management for Emergency Preparedness Budget and Finance Management
20 2019 Butaro Rwanda
Autumn School on Medical
Education
19 2019 Chernivtsi
Ukraine
httpswwwfacebookcome
vents531981117209981
Project Management for Emergency Preparedness Practical Leadership Skills
24 2019 Butaro Rwanda
International Society for Quality in Health Care 36th International Conference Cape Town 20102019 - 23102019
18 2019 Cape Town South Africa
httpswwwisquaorgeventscp2019html
Public Health Genomics an
introduction
11 2019 Stockholm
Sweden
httpsecdceuropaeuenne
ws-eventspublic-health-genomics-introduction
ENSP Tobacco treatment
specialistsrsquo training
5 2019 Paris France httpenspnetwork
World Health Summit 2019 16 2019 Berlin Germany
wwwworldhealthsummitorg
Time Series Analysis 28 2019 Bilthoven
Netherlands
httpsecdceuropaeuenep
iet-euphemaboutexperience
12th European Public Health Conference
16 2019 Marseille France
wwwephconferenceeu
Outbreak Investigation Module
30 2019 Nicosia Cyprus
httpswwwecdceuropaeuenepiet-euphemaboutexperience
Source UEMS database of accredited events 2017-2019
Looking at the regional level we found that in most regions a majority of practices cover
the topic in all (or most) modules of the educational programme (Figure 416) In Northern
Europe this is most pronounced with as much as 76 of the practices reported covering
health promotion in all modules whereas in Eastern Europe this applies for 55 of
practices A similar analysis for individual countries shows that only in Spain health
promotion is covered in a dedicated module in the majority (62) of educational practices
reported while in all other countries the topic is mostly covered in all (or most) modules of
the programme Percentages vary from 56 (Austria) to 86 (Greece Figure 417)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
42
Figure 416 How is health promotion implemented in education by region (n=148 in percentages)
Figure 417 How is health promotion implemented in education by country (n=120 in
percentages)
55 participants answered specific questions on the full module dedicated to health
promotion 81 of them indicated that the education is mandatory As figure 418 shows
in Northern and Eastern Europe all dedicated module on health promotion form part of
mandatory education In Western Europe one out of three modules is optional for students
24
4537
42
76
5563
58
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
4439
36
14
22
38
18
6256
6164
86
78
63
82
38
0
20
40
60
80
100
Austria Belgium France Greece Italy Portugal Slovenia Spain
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
43
Figure 418 Full modules on health promotion that are part of mandatory education by region (n=47 in percentages)
An exam is taken at the end of the module in 70 of the cases Between regions
percentages do not differ much (Figure 419) Please note that results are based on a
limited number of practices as response for this question was low
Figure 419 Exam at the end of dedicated module by region (n=47 in percentages)
When asked whether the module on health promotion and disease prevention was
accredited separately 15 indicate that this is the case 30 report that the module is
provided at multiple locations
Figure 420 provides an overview of respondents who indicate that funding was obtained
to set up the module as well as the use of partnerships for implementation of teaching
activities on health promotion or in setting up the module Lastly it was indicated that
mostly lsquootherrsquo professionals are teaching these modules
100 100
82
67
12
22
611
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
Yes No Unknown
2518
2225
12 11
75 7571
67
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
No Unknown Yes
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
44
Figure 420 Funding and partnerships for dedicated modules (n=47 in percentages)
42 Overview of competency profiles of health professionals in the EU
A detailed description of the competency profiles per healthcare profession as obtained
from the desk research can be found in Annex 2 Competency profiles per professions
These profiles provide a solid basis for health promotion and disease prevention
Most competency profiles mention health promotion andor disease prevention Overall
the competencies of medical specialists are most comprehensively described including the
competencies for health promotion Although there are many similarities between the
different competency profiles we have identified differences in the coverage of domains of
learning ie knowledge skills and attitudes (see chapter 23) Knowledge refers to
cognitive or mental competencies skills to competencies to perform tasks or activities and
attitudes to competencies related to beliefs or values An example of an attitude
competency is ldquoexemplify appropriate lifestyle in personal behaviourrdquo In professions that
are less physically oriented emphasis is on knowledge and attitude rather than on skills
related to health promotiondisease prevention This mainly holds for psychiatry and social
workers For professions in which lifestyle is an essential component ie sports medicine
and public health emphasis is on skills rather than attitudesOnly for cardiology nurses
nurse specialists and pharmacists competency profiles describe competences in all
domains of learning ieknowledge skills and attitudes
Many competency profiles leave room for interpretation and competencies described are
not ranked in order of importance In addition profiles do not state whether competencies
should be practised in a pro-active (within every treatment) or reactive way (only when
treating diseases with a clear lifestyle component
43
53
11
0 20 40 60 80 100
Partnerships in setting up module
Partnerships for execution of teachingactivities
Funding to set up module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
45
5 LONG LIST OF GOOD PRACTICES
In this chapter we present the coverage and content of the long list of good practices The
list is also available in an Excel-file that provides the opportunity to easily make selections
by different variables such as country type of programme (undergraduate postgraduate
CPD) or the characteristics of the education programme
We also provide an analysis of content areas covered and their weight in educational
programmes learning objectives learning typology and educational methodology using
Kraigerrsquos typology and Friedenrsquos pyramid as analytical tools
51 Results
From the survey results we have drawn a long list of good practices In agreement with
Chafea and DG SANTE good practices were selected based on four criteria
1 The programme contains a multidisciplinary approach
2 The education is mandatory (including an exam)
3 The education covers the following topics digitalisation in health eHealth and digital
health coaching
4 The expected outcome includes change in skills andor behaviour
This resulted in a long list of 70 good practices that meet all criteria Educational practices
cover all regions of Europe and originate from 20 Member States (Figure 51 and Table
51)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
46
Figure 51 Number of good practices selected for long list by country 2019-2020
Table 51 Number of good practices selected based on the four selection criteria per European Member State 2019-2020
Abbreviations EU Member State Number of good
practices
AT Austria 6
BE Belgium 11
BG Bulgaria 2
CY Cyprus 1
CZ Czech Republic 2
DE Germany 0
DK Denmark 5
EE Estonia 1
ES Spain 7
FI Finland 2
FR France 6
GR Greece 7
HR Croatia 0
HU Hungary 1
IE Ireland 3
IT Italy 2
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
47
Abbreviations EU Member State Number of good practices
LT Lithuania 1
LU Luxembourg 0
LV Latvia 1
MT Malta 0
NL Netherlands 0
PO Poland 0
PT Portugal 2
RO Romania 1
SE Sweden 2
SI Slovenia 7
SK Slovakia 0
TOT 70
Of all selected good practices of healthcare educational programmes 16 practices (23)
cover health promotion and disease prevention in one full module primarily dedicated to
the subject In 54 good practices (77) the educational programmes incorporate the topic
of health promotion and disease prevention in all or most modules (Figure 52)
Figure 52 How is health promotion covered in selected good practices (n=70 in percentages)
When dividing good practices by type of education programme we see that all types
educational programmes are represented (Figure 53) The highest share of good practices
is focused on undergraduate education (60 n=42) Two practices are focused on both
undergraduate and postgraduate education
Figure 53 Type of education () represented by selected good practices (n=70)
77 23
All modules One module
6026
113
Undergraduate education
Post graduate education
Continuous professionaldevelopment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
48
Figure 54 presents the absolute number of selected good practices by type of profession
trained The absolute number sums up till 128 as multiple professions can be trained within
one programme This shows a good variation of health professionals Most good practices
focus on nurses (17 n=22) and medical doctors (13 n=17)
Figure 54 Good practices by profession being trained (n=70 in absolute numbers)
In addition to those described above other variables are included in the separate Excel file
mentioned above These include the name of the programme and the institute focus on
knowledge skills and behaviour type of professionals being trained theories covered in
the education (eg human cognition and behaviour health behaviour change techniques
communication skills etc) education methods used when the education started time
spent on the modules in study hours (ECDEC) and in case of one full module the duration
of this module This Excel file allows to make cross comparisons between different variables
52 Analysis of good practices
In this section good practices are analysed more in detail Figure 55 presents the
distribution of content areas in health promotion and their weight in educational
programmes Methodological training like evidence-based methods (EBM) varies in
programmes but has a strong position Lifestyle intervention skills are widely taught
however new technologies are still on their way in becoming part of health promotion
education Interestingly health economics rate less in these practices in spite of its close
link with health promotion as part of public health policies
30
4
4
11
17
15
15
22
10
Other
Social workers
Dentists
Occupational therapists
Medical doctors
Medical specialists
Psychologists
Nurses
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
49
Figure 55 Results for good practices(n=70) ldquoDoes the education of the initiative includerdquo
Numbers refer to Frieden model in levels of health promotion with exception of methodological contents marked
as tools (1) counselling and education (2) clinical interventions (4) changing the context to make individualrsquos
default decisions healthy (5) socioeconomic factors (6) methods in studying and evaluating health promotion
and public health
We used Friedenrsquos pyramid of levels of health promotion (Frieden 2010) and Kraigerrsquos
typology of learning (Kraiger et al 1993) to describe the abilities that professionals are
expected to acquire Based on their description learning objectives move in a knowledge
level skill building or into attitudinal objectives Figure 56 gives a graphical visualization
of the results of our analysis The dark blue green and light blue rectangles represent the
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
50
Figure 56 Learning objectives categorised into Friedenrsquos levels and learning typology
(knowledge skills attitudes) of good practices (n=70)
different domains of learning knowledge skills and attitudes The size of the rectangles is
proportional to their share in all domains in the educational practice
Within each domain of learning contents are categorized Their vertical order reflects the
order of impact levels of Frieden (from individual patient to society level) and again size
corresponds to share in the curriculums content
This analysis provides a general picture of educational practices in health promotion
disease prevention and lifestyle medicine The graph shows that practices are
predominantly oriented towards knowledge-based competencies (around 60 of the
curriculum) Roughly one third of the programme has skills-oriented learning objectives
while competencies regarding attitudes are addressed in around 10 percent of the
programmersquos content
Looking into knowledge-based competencies the broad spectrum of individual to societal
levels of impact is addressed On a societal level social and medical aspects are widely
represented while the economic angle is scarcely present Technological developments like
digitalisation are present to a modest extent
Skill-oriented learning objectives focus in communicative competences like communication
skills behaviour change techniques and teamwork Health coaching is covered in a small
number of practices Interestingly in methodological contents the aim of skills-oriented
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
51
education is to provide mainly knowledge like in EBM Few practices include practical skills
for communication and coaching in their objectives
Competence-building in the domain of attitudes form a minimal part of educational
practices They are reflected in eg health literacy and ethics However these are also
taught in a hidden curriculum as well
Educational methodologies in the survey include lectures assignments e-Learning and
real-world field assignments As these are the selected good practices it was to be expected
that multiple methods are used in most of these programmes (given selection criterium 3)
In 37 programmes all methods are in use E-Learning is used in 41 programmes
Figure 57 Educational methods used in good practices (n=70 in percentages) ()
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
53
6 CONCLUSIONS
The competency profiles as well as information on a large number of educational practices
in health promotion disease prevention and lifestyle medicine for health professionals in
the EU allow us to formulate answers to the research questions that guided this study
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and
continuous professional education
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades71there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional The educational practices collected show that this is true for all
regions of the EU However there is no overall body that has responsibility for quality
assuring standards of training and professional practice at the European level
The information on around 200 practices from 25 EU Member States (including UK) shows
that the majority of educational practices take place in undergraduate settings while
training events on health promotion for health professionals active in the field are relatively
scarce in continuous professional development (CPD) a limited number of practices on
health promotion are reported and indeed few courses or training events on health
promotion are available in the CPD calendar of the UEMS database of accredited events
Education on health promotion aims at developing competencies in knowledge skills and
attitude and most often has a multidisciplinary character Especially medical doctors nurses
and psychologists are often involved in educating other disciplines on health promotion
Health behaviour human cognition and behaviour as well as population health are part of
educational practices for all professions A majority also include communication skills
methods of EBM and ethics
The most common way to teach health professionals on health promotion disease
prevention and lifestyle medicine is the integration of the subject in most of all modules of
the curriculum Dedicated modules on health promotion are developed in undergraduate
and postgraduate education but are scarce in CPD This may contribute to the invisibility of
the subject in training for professionals active in the field
Four out of ten educational practices on health promotion are accredited on the European
(or international) level half of them have national accreditation
71 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
54
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Based on in-depth analysis of a selection of 70 good practices knowledge proves to be the
predominant domain of learning Theories covered relate to different levels of impact of
Friedenrsquos pyramid but emphasis is on the individual patient level with a predominant
position for evidence-based medicine Health economics receive remarkably little attention
This may be disadvantageous for advocacy of health promotion which requires influencing
decision-making on public funding
Around one third of educational contents are dedicated to competencies in the domain of
skills and mainly target communicative skills Interestingly they provide mainly knowledge
rather than practical training Competencies in the domain of attitude are addressed least
Ethics and health literacy are theories are the most common examples of attitude-oriented
contents When looking at the competencies defined by health professionals advocacy has
a solid role in all of them with defined skills It was represented in only few domains like
health economics so it may well be that educating advocacy skills are more common than
found in this study
Good practices use a mix of educational methods including lectures assignments real-
world practices and digital study methods
In conclusion this study is a first step in gaining knowledge and insights in the state of
affairs of health professionalsrsquo education in health promotion disease prevention and
lifestyle medicine in the EU It is an important step as we know little about present
practices However more detailed research will obviously be needed
The results of our in-depth analysis of good practices provide qualitative information We
used the integrated framework as an analytical tool to classify content areas covered and
their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future The information supplied by the
respondents show the culture of describing health promotion and education objectives
Therefore no lsquohardrsquo conclusions can be drawn However some cautious notions are
worthwhile to mention as they flag opportunities for learning and improving by collaborative
action
First it is worthwhile to stress the progress made While 20 years ago health professionals
were hardly trained in health promotion and lifestyle medicine and at best received some
instruction on specific disease-related unhealthy habits (like smoking for lung diseases) it
is now part of standard education for most health professionals That is an important
development and essential for collaboration across professions
However more can be done Health promotion education should respond to societyrsquos needs
and therefore educational needs are constantly changing and providers of education need
to follow needs in the field Increasing recognition of societal impact on health inequalities
the paradigm shift from treating to coaching patients changes in the way care is delivered
the digital revolution and the need to contain the cost of our healthcare systems represent
a multitude of challenges and relentless educational efforts in health promotion disease
prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
55
To name a few the balance between domains of learning in curricula will have to redefined
as in health coaching skills attitudes and knowledge are equally important Health
professionals will have to manage health economics to speak the language of policy makers
Teaching methodologies have gained from the technological revolution and there is
potential in utilising them even more Also there is a necessity to do so in order to provide
for effective health promotion Health literacy has got alongside data literacy Therefore
education needs to respond to in using more technologies as well as teaching adaptation of
technologies into care This is not common practice yet The constant development in needs
also stresses the need for continuous professional development in health promotion
disease prevention and lifestyle medicine To date CPD seems to be underrepresented in
educational practices on health promotion and more heavily dependent on external funding
than in undergraduate and postgraduate courses
The experience developed in the good practices collected in the survey represents a
valuable body of knowledge skills and attitudes among health educators With collaborative
efforts this can serve as an important capital to promote continuous development and
improvement of educational practices in health promotion disease prevention and lifestyle
medicine in all European countries
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
57
ANNEX 1 SURVEY RESULTS BY COUNTRY
In this annex we provide the names of all educational programmes by country filled in in
the survey In addition the following variables of the educational programmes are
provided the name of the educational institution type of education and type of health
professionals being trained This information is based on the information provided by the
respondents from each country If certain boxes are not filled in this means that only
partial information of this educational programme is provided
Austria
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Bachelorstudiengang Physiotherapie
FH JOANEUM GmbH Undergraduate education
Physical therapists
Dietetics Health University of
Applied Sciences
Undergraduate
education
Dieticians
Physiotherapy University of Applied Sciences St Polten
Undergraduate education
Physical therapists
Bachelorrsquos Degree Programme Physiotherapy
FH Campus Wien Undergraduate education
Physical therapists
Dietetics and Nutrition FH Joanneum Undergraduate education
Medical Doctors Non-specialized dietitians
Bachelor Programme Physiotherapy
University of Applied Sciences Upper Austria
Undergraduate education
Physical therapists
Degree Programme Dietetics
(Bachelor of Science)
University of Applied
Sciences Upper Austria
Undergraduate
education
Dietitians
Midwifes Speak and language therapists Biomedical scientists Radiological
technologists Physical therapists Occupational therapists Nurses
Bachelor in Health Studies
Physiotherapy
FH Kaernten Undergraduate
education
Physical therapists
Nursing Science Medical University of Graz
Postgraduate education
Nurses
Public Health Medical University of Vienna
Continuous professional development
Medical doctors
Belgium
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Drug Development KU Leuven Undergraduate education
Pharmacists
Bachelor and master Rehabilitation Sciences and
Physiotherapy
University of Antwerp Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
58
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Motor Sciences Physiotherapy
Universiteacute Libre de Bruxelles
Undergraduate education
Physical therapists
Nutrition amp Dietetics Thomas More University College
Undergraduate education
Dietitians
Adad Adad Undergraduate education
Physical therapists
Master Physiotherapy and
Rehabilitation Science
KU Leuven Postgraduate
education
Physical
therapists
Occupational therapist HE Vinci Parnasse ISEI Undergraduate education
Occupational therapists
Master in Physical therapy and Rehabilitation
Universiteacute Libre de Bruxelles
Postgraduate education
Physical therapists
Master in Physical therapy Universiteacute Libre de Bruxelles
Postgraduate education
Medical specialists Physical
therapists (Sport medicine)
Nutrition and dietetics Thomas More University College
Continuous professional
education
Medical doctors Dieticians
psychologists
Information not provided Information not provided
Undergraduate education
Pharmacists
The European Certificate in
Lifestyle Medicine
The European Lifestyle
medicine organisation (ELMO) together with the Belgian Lifestyle
Medicine Organisation (BELMO)
Continuous
professional education
Medical doctors
Medical specialists (lifestyle
medicine) Physical therapists
Occupational therapists Nurses Psychologists General practitioners
Nutrition and Dietetics Erasmus Hogeschool Brussels
Undergraduate education
Dieticians
Master in Nursing and Midwifery
University of Antwerp Postgraduate education
Nurses
Bachelor amp Master Rehabilitation Sciences amp
Physiotherapy
KU Leuven Undergraduate education
Physical therapists
Bachelor Nursing University of Applied
Sciences Gent HOGENT
Undergraduate
education
Nurses
Professional Bachelor in Nutrition and Dietetics
University colleges Leuven Limburg
Undergraduate education
Dieticians
Nutrition and Dietetics University College Ghent
Undergraduate education
Dieticians
Bachelor in Applied Health Science
Howest University College
Undergraduate education
Lifestyle coaches
Physiotherapist Universiteacute Libre de Bruxelles
Postgraduate education
Osteopathy Physical therapists
Bachelor in Medicine Hasselt University Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
59
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor of Nutrition and Dietetics
University of Applied Sciences of Gent
Undergraduate education
Dieticians
Bulgaria
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor programme in Social Work
Plovdiv University Department of Social work
Undergraduate education
Social workers
Rhinology Bulgarian Rhinologic
Society
Postgraduate
education
ENT doctors
Kinesitherapy Medical University Undergraduate education
Physical therapists
TRS rehabilitator Medical College Medical University
Continuous professional
education
Medical specialists
Cyprus
Name of educational
programme
Name of
educational
institution
Type of
education
Type of
health
professionals
being trained
Physiotherapy
programme
Nicosia University Undergraduate
education
Physical
therapists
Czech Republic
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy Universities Undergraduate education
Physical therapists
Physiotherapy Charles University first
faculty of Medicine
Undergraduate
education
Physical
therapists
Physiotherapy Faculty of Medicine Masaryk University Brno
Undergraduate education
Physical therapists
Physiotherapy Palackyacute University Faculty of Physical Culture Department of Physiotherapy
Postgraduate education
Physical therapists
General Nursing Masaryk University Undergraduate education
Nurses
Prakticky zubni lekar (Practical Dentist)
Czech Dental Chamber Continuous professional education
Medical specialists
Health Promotion Ministry of Health Czech Republic
Continuous professional education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
60
Denmark
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Musculoskeletal physiotherapy
Aalborg University Postgraduate education
Physical therapists
Master in Physiotherapy University of Southern Denmark
Postgraduate education
Physical therapists
The Fairstart Foundation The Fairstart Foundation
Continuous professional education
Orphanage staff (each orphanage has
professional staff such as psychologists social workers
andor therapists
These staff members are responsible to work with each child on an individual basis) School
teachers Psychologists Social workers
Bachelor in Physiotherapy University College North Denmark
Undergraduate education
Occupational therapists
Nurses
Bachelorrsquos degree Programme of Physiotherapy
VIA University college Postgraduate education
Physical therapists
Master of Public Health Aalborg University Undergraduate education
Midwives Nurses Therapists Psychologists Medical Specialists
Estonia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Nursing (general nursing) Tartu Health Care College
Undergraduate education
Nurses
Psychology University of Tarty Institute of Psychology
Undergraduate education
Psychologists
Finland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
NutritionNutrition therapy University of Eastern Finland
Postgraduate education
Clinical nutriontinists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
61
Masterrsquos programme of Human Nutrition and food-related behaviour
University of Helsinki Undergraduate education
Nutrition experts who work in eg community
health promotion
Master of Healthcare advanced practice ndash supporting self-care and
care of non-communicable diseases
Savonia University of Applied Sciences
Postgraduate education
Physical therapists Occupational
therapists Nurses
Public Health Nursing Metropolia University of Applied Sciences
Postgraduate education
Public Health nurse
Medical doctors training programme
University of Helsinki medical faculty
Undergraduate education
Medical doctors Nursing
Master degree in Health Management Psychologists
Dentists
Dental education University of Helsinki Faculty of Medicine Department of Oral and Maxillofacial Diseases
Undergraduate education
Dentists
France
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Occupational therapy school Croix Rouge Franccediloise Postgraduate education
Occupational therapists
Institut Reacutegional de Formation en Ergotheacuterapie
Association Saint Franccedilois dAssise
Postgraduate education
Occupational therapists
Occupational therapy Institut de formation en Ergotheacuterapie de Berck-sur-Mer site de Loos
Postgraduate education
Occupational therapists
Occupational therapy IFE Assas Undergraduate education
Occupational therapists
Arrecircteacute du 5 juillet 2010
relatif au diplocircme drsquoEacutetat drsquoergotheacuterapeute
Institut de Formation
en Ergotheacuterapie du CHU Rouen Normandie
Undergraduate
education
Occupational
therapists
Occupational therapy school Croix Rouge Francaise Postgraduate education
Occupational therapists
Occupational therapy UPEC Postgraduate
education
Occupational
therapists
Diplocircme de Dieacuteteacuteticien IUT biologie ou BTS dieacuteteacutetique
Postgraduate education
Dietitians
Programme deacuteducation et de promotion agrave la santeacute
CoDEPS 13 Continuous professional education
Nurses Psychologists Dentists Social workers
Public health Universiteacute de Bourgogne
Postgraduate education
Medical doctors
Public health Lyon University Undergraduate education
Medical specialists
Public health residency Faculty of medicine University of Nantes
Undergraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
62
Name of educational programme
Name of educational institution
Type of education
Type of health professionals being trained
Master in Public Health Karolinska Institute Postgraduate education
Occupational therapists Social Workers
Public health and social
medicine
Universiteacute Versailles
Saint Quentin en Yveline
Continuous
professional education
Medical doctors
Public health UFR sciences de santeacute - Universiteacute de Bourgogne
Postgraduate education
Medical doctors Medical specialists
Midwives Physical therapists
Nurses General practitioners
Germany
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Visceral Surgery Augsburg University Continuous professional education
Medical specialist Physical therapists
Occupational therapists
Nurses Social workers
Human Medicine ndash The
cologne model study course (human medicine)
University of Cologne
Medical faculty
Undergraduate
education
Medical
specialists
Greece
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy University of Thessaly Undergraduate education
Physical therapists
Oral education programme
for children via experiential learning
Hellenic Dental
Association-Dental School of Athens-Hellenic Society of Paediatric Dentistry
Continuous
professional education
Psychologists
Dentists
Sports Nutrition International Hellenic University
Postgraduate education
Dieticians
Preventive Dentistry National and
kapodistrian University of Athens school of dentistry
Undergraduate
education
Undergraduate
students
Nutrition amp Dietetics International Hellenic University
Postgraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
63
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicine ndash under and post graduate studies
School of health sciences University of Patras
Undergraduate education
Medical doctors
Pharmacy diploma Aristotle University of
Thessaloniki
Undergraduate
education
Pharmacists
Hungary
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Public Health and Preventive
Medicine
Semmelweis University
Budapest Faculty of
Medicine Department of Public Health
Undergraduate
education
Medical doctors
Academic programme of Medicine
Semmelweis University Faculty of Medicine
Undergraduate education
Medical doctors
Residency in Preventive Medicine and Public Health
Semmelweis University Postgraduate education
Medical specialists
Ireland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Social Science in
Social Work
Maynooth University
(national University of Ireland Maynooth)
Postgraduate
education
Social workers
Information not provided Information not provided
Undergraduate education
Physical therapists
Professional Master of Physiotherapy
University College Dublin
Postgraduate education
Physical therapists
Bachelor Physiotherapy University College Dublin
Undergraduate education
Physical therapists
Bachelor Physiotherapy RCSI Undergraduate education
Physical therapists
Irish Dental Association Irish dental association Continuous professional
development
Dentists
Public Health Medicine Royal College of Physicians in Ireland
Postgraduate education
Medical specialists
Higher specialist training in Public Health Medicine
Royal College of Physicians in Ireland
Postgraduate education
Medical doctors Medical specialists General practitioners
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
64
Italy
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Healthy Lifestyles CNAI ndash Italian Nurses association
Continuous professional education
Nurses
Management for Health Professionals
University of Rome Postgraduate education
Midwifes Physical therapists Nurses
Corso di laurea in Terapia occupazionale (Bachelor in Occupational therapy)
Universitagrave degli Studi di Milano (State University of Milan)
Undergraduate education
Occupational therapists
Life Sciences University of Catania
School of Medicine
Continuous
professional
education
Medical doctors
Medical
specialists Physical therapists Occupational therapists Nurses
Dentists
Health promotion University of pavia Undergraduate education
Nurses
Corso di Laurea Magistrale
in Odontoiatria e Protesi Dentaria
Universitagrave di Parma Undergraduate
education
Dentists
Hygiene preventive medicine and public health
Universitagrave Cattolica del Sacro Cuore
Postgraduate education
Medical doctors Medical
specialists
general practicioners
Igiene e Medicina Preventiva Universitagrave degli Studi dellrsquoAquila
Postgraduate education
Medical doctors non-specialized
Post graduate school of Public Health
University of Sienna Postgraduate education
Medical doctors
Hygiene and Public Health University of Bari Aldo Moro
Postgraduate education
Medical doctors
School of specialization in Hygiene and Preventive Medicine
University of Milan Postgraduate education
Medical doctors
Lithuania
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Health Education and Promotion
Klaipeda State University of Applied sciences
Undergraduate education
Dietitians Physical therapists Nurses Dentists Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
65
Latvia
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Dentistry Riga Stradins University Undergraduate education
Dentists General practicioners
Professional Bachelor programme Physiotherapy
LASE Postgraduate education
Physical therapists
Physiotherapy Riga Stradins University Undergraduate education
Physical therapists
Malta
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Bachelor in Nursing Studies University of Malta Faculty of Health Sciences department of Nursing
Undergraduate education
Nurses
FHs University of Malta Undergraduate education
General practitioners
Netherlands
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Occupational Therapy Information not provided
Undergraduate education
Occupational therapists
Lifestyle and Healthcare Amsterdam University Medical Centre
Undergraduate education
Medical students
Portugal
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
PhD in Social Work ISCTE University Institute of Lisbon
Postgraduate education
Social workers
Bachelor degree in
Physiotherapy
Escola Superior de
Sauacutede de Santa Maria
Undergraduate
education
Physical
therapists
Physiotherapy IPC ESTeSC Coimbra Health school
Undergraduate education
Physical therapists
Licenciatura em Fisioterapia Escola Superior de Sauacutede - Instituto Politeacutecnico do Porto
Undergraduate education
Physical therapists
Degree in Physical therapy Instituto Piaget ndash Vila Nova de Gaia
Undergraduate education
Physical therapists
Degree in Physical therapy ESSATLA Continuous professional development
Physical therapists
Curso Licenciatura em Fisioterapia
Instituto Politeacutecnico de Sauacutede do Norte Escola Superior de Sauacutede do Vale do Ave CESPU
Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
66
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Clinical Education University Fernando Pessoa- Faculty of Health Sciences
Continuous professional development
Workers factory
Physiotherapy (Bachelor) School of healthy-
polytechnic institute of Setubal
Undergraduate
education
Physical
therapists
Physiotherapy Escola Superior De Sauacutede Do Vale Do Sousa do Instituto
Politeacutecnico De Sauacutede Do Norte
Undergraduate education
Physical therapists Nurses
Psychologists Dentists
Public Health ARSLVT Postgraduate
education
Medical
specialists
Information not provided Information not provided
Postgraduate education
Physical therapists
Information not provided Information not provided
Undergraduate education
General practicioners
Romania
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Nursing Education University Lucian Blaga Postgraduate education
Nurses
MedicinePharmacy - Health University of Oradea Faculty of medicine and
pharmacy Oradea
Postgraduation education
Medical doctors Medical
specialists Pharmacists Physical therapists Nurses
Dentists General practicioners
Slovakia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Social Work Constantine the philosopher University in Nitra
Postgraduate education
Social workers
Specialisation study in Clinical Psychology
Comenius University in Bratislava Faculty of
Arts
Continuous professional
development
Medical specialists
psychologists
Slovenia
Name of educational
programme
Name of educational
institution
Type of
education
Type of health
professionals being trained
Physiotherapy Alma Mater Europaea Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
67
Physiotherapy University of Novo mesto Faculty of Health sciences
Undergraduate education
Physical therapists
Faculty of health sciences University of Primorska Continuous professional education
Dietetics Physical therapists Occupational therapists Nurses
Nursing Applied Kinesiology Physiotherapy and Nutritional counselling ndash dietetics
University of Primorska Faculty of Health Sciences Slovenia
Undergraduate education
Nutrional counselling Kinesiologists Physical therapists Nurses
Professional higher education study programme 1st cycle degree occupational
therapy
University of Ljubljana faculty of health sciences
Undergraduate education
Occupational therapists
Applied Kinesiology UP FVZ Undergraduate
education
Kinesiology
Physiotherapy Alma mater Europaea ndash Evropski center Maribor
Undergraduate education
Physical therapists
Bachelor in Physiotherapy University of Ljubliana Faculty of health sciences
Undergraduate education
Physical therapists
Health Promotion Angela Boskin Faculty of healthcare
Postgraduate education
Physical therapists Occupational
therapists nurses
1st Bologna cycle study programme Physiotherapy
Angela Boskin Faculty of healthcare
Undergraduate education
Physical therapists
Public Health Medical
Residency
Medical chamber of
Slovenia
Continuous
professional development
Medical doctors
Public Health National institute of public health of the
Republic of Slovenia
Postgraduate education
Medical doctors
Psychology Faculty of arts University of Maribor
Postgraduate education
Psychologists
Spain
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Human Nutrition and Dietetics
University of Zaragoza Undergraduate education
Dieticians
Continuous professional
education
Nurses
Physiotherapy University of Coruna Undergraduate education
Physical therapists
EHEA Degree in Human Nutrition and Dietetics
Blanquerna School of Health Sciences ndash Universitad Ramon Lull
Undergraduate education
Dietitians
Bachelor in Pharmacy Universidad de Sevilla Undergraduate
education
Pharmacists
Continuous professional development
Spanish General Council of Social Work
Continuous professional education
Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
68
Bachelor in Pharmacy Universidad de Alcala Undergraduate education
Pharmacists
Bachelor in Medicine Faculty of medicine University of Cadiz Spain
Undergraduate education
Medical doctors General practitioners
Residency in Preventive Medicine and Public Health
Hospital Clinic de Barcelona
Postgraduate education
Nurses
Bachelor in Medicine Information not provided
Undergraduate education
Medical doctors
MasterBachelor in Pharmacy
University of Navarra Undergraduate education
Postgraduate education
Pharmacists
Human Nutrition and Dietetics
Univeristy of Navarra Undergraduate education
Nutritionists amp Dietitians
Pharmacy Universitad Ramon Lull
Undergraduate education
Pharmacists
Pharmacy IQS ndash FCSB Undergraduate education
Pharmacists
Master in Advanced Therapies and Innovation in Biotechnology
Universidad de Francisco de Vitoria
Postgraduate education
Pharmacists
Pharmacy Universidad of the Basque County
Undergraduate education
Pharmacists
Sweden
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master programme in Public Health
Karolinska institute Postgraduate education
Occupational therapists
Social workers
Dietetics programme Department of food and Nutrition
Undergraduate education
Dietician
Dietetics programme Department of food studies dietetics and nutrition
Undergraduate education
Dietician
Programme in Dietetics University of Gothenburg
Sahlgrenska Academy
Undergraduate education
Dietician
Master of Public Health Department of public health and caring sciences Uppsala University
Postgraduate education
Medical doctors Bachelor of science Physical
therapists Nurses Psychologists Dentists Social workers
United Kingdom
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor (Hons) Occupational Therapy
Northumbria University Undergraduate education
Occupational therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
69
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master (pre reg) Occupational Therapy
Master in Occupational Therapy
Leeds Beckett University
Postgraduate education
Occupational therapists
Bachelor (Hons) Occupational Therapy
St Georgersquos University of London
Undergraduate education
Medical doctors Medical specialists Physical therapists
Occupational therapists
Bachelor (Hons)
Occupational Therapy
Caterburry Christ
Church University
Undergraduate
education
Occupational
therapists
Bachelor (Hons) Occupational Therapy Master in (pre-reg) Occupation Therapy Occupational Therapy degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Public Health speciality training
Health education England -north west
Postgraduate education
Medical doctors Medical specialists Researchers Nurses
Bachelor in (Hons) Occupational Therapy Master in (Pre-reg)
Occupational Therapy Occupational Therapy
Degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Additional countries
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Bachelor of Physiotherapy University of Prishtina Kosovo Albania
Postgraduate education
Physical therapists
Physiotherapy Faculty of health studies University of Sarajevo Bosnia-Herzegovina
Undergraduate education
Physical therapists
Fysioterapeututdanning NTNU Norway Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy BFH
Berner Fachhochschule BFH Bern University of Applied Sciences Swiss
Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy
ZHAW Zurich University of applied sciences Swiss
Undergraduate education
Physical therapists
Physical Therapy Sciences University of Iceland
School of Health Sciences
Undergraduate
education
Physical
therapists
Medicine International school of medicine Kazachstan
Undergraduate education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
70
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicinesingle-cycle degree programme
University of Georgia Republic of Georgia
Medical doctors Psychologists General practicioners
Medicine Akaki tsereteli state University Republic of Georgia
Postgraduate education
Medical doctors Medical specialists Physical therapists Psychologists
Dentists General
practicioners
Public Health and Epidemiology
David tvildiani medical University Republic of
Georgia
Postgraduate education
Medical doctors
Biomedical and Healthcare Science doctoral programme
David tvildiani medical University Republic of Georgia
Postgraduate education
Medical doctors Biomedical Science master degree holders
Medicinesingle-cyle degree programme
University of Georgia Republic of Georgie
Undergraduate education
Medical doctors
Public Health Tbilisi State Medical University (TSMU)
Republic of Georgia
Undergraduate education
Medical doctors and public
health specialists
David tvildiani Medical
University
David tvildiani Medical
University Republic of Georgia
Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
71
ANNEX 2 COMPETENCY PROFILES PER PROFESSIONS
Undergraduate medicine
The CanMEDS framework is worldwide the most commonly used and adapted model that
identifies and describes the abilities physicians require in order to effectively meet the
health care needs of the people they serve72 Within European Member States modifications
of this model are used within health and educational settings (for example in the
Netherlands and Finland) for undergraduate medicine and medical specialisations The
CanMEDS model defines seven roles of the physician namely (1) medical expert (the
integrating role) (2) communicator (3) collaborator (4) leader (5) health advocate (6)
scholar and (7) professional73 The role of health advocate is defined as physicians
contributing their expertise and influence as they work with communities or patient
populations to improve health ldquoimproving health is not limited to mitigating illness or
trauma but also involves disease prevention health promotion and health protection
Improving health also includes promoting health equity whereby individuals and
populations reach their full health potential without being disadvantaged by for example
race ethnicity religion gender sexual orientation age social class economic status or
level of educationrdquo Within this role two key competencies are defined74
1 Respond to an individual patientrsquos health needs by advocating with the patient within
and beyond the clinical environment
a Work with patients to address determinants of health that affect them and their access
to needed health services or resources
b Work with patients and their families to increase opportunities to adopt healthy
behaviours
c Incorporate disease prevention health promotion and health surveillance into
interactions with individual patients
2 Respond to the needs of the communities or populations they serve by advocating with
them for system-level change in a socially accountable manner
d Work with a community or population to identify the determinants of health that affect
them
e Improve clinical practice by applying a process of continuous quality improvement to
disease prevention health promotion and health surveillance activities
f Contribute to a process to improve health in the community or population they serve
In addition the European Thematic Network project MEDINE (2004-2007) and Tuning
Project (Medicine) under its auspice (MEDINE) have generated and gained widespread
consensus on a set of competences for primary medical degree qualifications in Europe
(ie undergraduate medicine)75 Within this project it is stated that graduates in medicine
72 httpwwwroyalcollegecarcsitecanmedscanmeds-framework-e 73 httpwwwroyalcollegecarcsitecanmedsabout-canmeds-e 74 httpwwwroyalcollegecarcsitecanmedsframeworkcanmeds-role-scholar-e 75 httptuningacademyorgmedine-medicinelang=en
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
72
would need the ability to ldquopromote health engage with population health issues and work
effectively in a health care systemrdquo76 The following points define health promotion
bull provide patient care which minimises the risk of harm to patients
bull apply measures to prevent the spread of infection
bull recognise own health needs and ensure own health does not interfere with
professional responsibilities
bull conform with professional regulation and certification to practise
bull receive and provide professional appraisal
bull make informed career choices
bull engage in health promotion at individual and population levels
Medical specialist
The European Union of Medical Specialists (UEMS) contributed significantly to the
improvement of post-graduate training through the development of a European Curriculum
in each medical speciality as well as the elaboration of training standards77 Within this
section we provide a detailed description of the European training requirements for a
selection of medical specialists including sports medicine public health internal medicine
cardiology psychiatry and the general practitioner78 This selection was based on the fact
that within these specialities lifestyle might be an essential component or important part of
the treatment of chronically ill patients
1) Medical specialist sports medicine
Sports medicine is defined by the European Commission as a ldquomultidisciplinary clinical and
academic speciality of medicine dealing with health promotion for the general population
by stimulating a physically active lifestyle and diagnosis treatment prevention and
rehabilitation following injuries or illnesses from participation to physical activities
exercises and sport at all levelsrdquo79 As health promotion and prevention are both
incorporated in the definition of sports medicine these topics are included throughout the
whole curriculum of sports medicine The curriculum of sports medicine aimed to provide
theoretical understanding and practical skills to provide first line clinical services80 Within
the training requirements for the speciality of sports medicine it is stated that sports
medicine does not solely take care for sporting elite athletes but as well for its important
role to promote exercise as a medical tool meant for patients with chronic diseases81
bull Theoretical knowledge aims to provide theoretical understanding and practical skills to
provide first line clinical services
- Clinical To provide pre-participation clinical screening and examination before
exercise and competition as well as medical assistance to the athletes engaged in all
sports
76
httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNLearning_Outcomes_Competences_for_Undergraduate_Medical_Education_in_Europepdf
77 httpswwwuemseu__dataassetspdf_file00111415906pdf 78 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 79 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 80 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 81 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
73
- Public health
bull As part of a multi-disciplinary team to encourage and promote physical activity as
a lever for healthy living
bull To identify impediments to an active lifestyle and work within a multi-disciplinary
framework to remove those impediments or minimize their impact
bull To work alongside local health authoritiespublic health clinicians developing
exercise opportunities for the general public for health gain
bull To liaise with public (local authoritieseducationvoluntary) and private sector to
advise on the health aspects of exercise programmes for physical activity of special
groups like women children adolescents and aging population
bull Practical and clinical skills
bull To foster the integration of knowledge and practical skills acquired during the
cardiology orthopaedics physical amp rehabilitation medicine general practice
medicine and physiology internships
bull To learn to put into practice information gained in the relevant course work
bull To extend and deepen their knowledge in the assessment of fitness such as
isokinetic and functional muscle performance cycle ergometry and treadmill
ergometry
bull To gain experience in the use of such test results in the decision making with regard
to diagnosis recommendations and therapy for people of both gender and in
different age groups and performance levels
bull With regard to elite sport trainees will learn how to diagnose treat and prevent
overtraining and overexertion
bull To become proficient in activities related to for example hygiene and nutrition
and will work closely with trainers athletes physiotherapists officials etc
bull Competencies
bull Clinical and instrumental assessment to determine the pathophysiology
mechanisms and the underlying diagnosis of the patientrsquos condition
bull Trainees are expected to complete evidence of reflective practice through case
reports and other experiences in their training record
bull Other self-directed work will be planning data collection analysis and presentation
of audit and research work
bull The mandatory training record (hand written diary or preferably electronic
logbook) will contain evidence of academic pursuits and should be checked and
documented regularly by the Supervisor
bull Trainees will take part and be able to lead in teaching and will be expected to
develop skills to teach undergraduates postgraduates and non-medical staff in
small groups and formal lectures making personal presentations using a variety of
audiovisual methods
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
74
bull They will be expected to present at journal clubs and make case presentations at
grand rounds or similar settings
bull They will be expected to undertake personal audit and research and make
presentations of their findings at clinical meetings
bull Prescription as much evidence-based as possible of medical and physical
treatments (including drug treatment physical modalities innovative
technologies natural factors and others) as well as of technical aids
bull Prevention and management of complications
bull Skill to perform and participate in research
2) Medical specialist public health
The European Commission defines public health ldquoas the science and art of preventing
disease prolonging life and promoting mental and physical health and efficiency through
organized community effort Public health may be considered as structures and processes
by which the Health of the population is understood safeguarded and promoted through
the organized efforts of societyrdquo82 Public health specialists aim to improve populationrsquos
health by using the following skills and competencies
bull Theoretical knowledge on a range of fields including epidemiology prevention health
promotion public health research behavioural sciences health programme evaluations
health need assessments and quality and safety in healthcare
bull Practical and clinical skills
- Surveillance and evaluation of the health of the population (trained in epidemiology)
- Planning and evaluation of health services and public health control
- Analysing the health of the population (analysing determinants on individual and
community levels)
- Plan participate in or evaluate preventive and control programmes (public health
assessments)
- Participate in multidisciplinary health impact assessment
- Inform decision-makers about potential impacts and to identify appropriate and
sustainable actions to manage those effects (including environmental determinants
of health)
- Organisational issues in healthcare (participating in policy and strategic development
quality and safety management)
- Generate and share new evidence on the ways in which social determinants influence
population health and health equity
- Sufficient linguistic ability to communicate with hisher public health colleagues
82 httpswwwuemseu__dataassetspdf_file001198435UEMS-201924-European-Training-
Requirements-for-Public-Healthpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
75
- Develop high professional ethical standard including respect towards human rights
participants in public health programmes colleges and other professionals in the
team
bull Competencies
- Establish the expertise role as a Public Health Physician
bull Function as public health leaders and consultants to health services and other
organizations and institutions in order to provide safe appropriate cost effective
and equal health care to groups communities and populations
bull Establish and maintain medical knowledge skills and attitudes appropriate to their
practice including the organization and financing of health care public health
control and public health law
- Perform expertise analyses of the health of the population
bull Apply and combine medical and epidemiological competencies for the surveillance
and evaluation of the health of the population
bull Identify the determinants of health of populations and risks for public health and
implications for interventions and policy
bull Evaluate health problems biopsychosocial mechanisms andor health care issues
for different population groups and their implications for the community
bull Critically evaluate epidemiological demographic health statistical and
environmental pollution data and their sources and apply them appropriately to
public health issues
bull Identify community health needs and advise about their implications for public
health and medical care services
- Lead and supervise public health interventions
bull Select develop implement and monitor public health surveillance and
interventions namely in the areas of human behaviour social and physical
environment food safety and nutrition health care associated risks and working
life related health
bull Promote the health of individuals communities and populations through health
programming
bull Contribute to the organization and evaluation of societal and health care
programmes aiming to promote health and social functioning among individuals
with long-term diseases and disabilities
bull Contribute to the planning organization supervision of and evaluation of societal
and health care programmes promoting the health of specific target groups such
as children elderly and vulnerable and underserved groups in society
bull Contribute to the organization of and evaluate primary and secondary medical
prevention programmes
bull Contribute to strengthening regulatory frameworks for protecting and improving
health
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
76
- Function as expertise in planning and evaluation of Public Health and Medical Care
bull Evaluate Public Health and other service programmes concerning processes and
outputs from the different perspectives of care seekers professional health care
workers and health managers
bull Analyse and differentiate between need demand and supply and assess the health
of a defined population and identify areas for improvement including the allocation
of health care resources delivery
bull Evaluate the outcome quality and safety of care and promote quality development
systems based on evidence and public health principles
bull Apply health economic principles and methods such as cost-effectiveness cost-
utility and cost-benefits considering the strengths and weaknesses of different
methods
bull Use methods to determine priorities and their strengths and weaknesses and
promote awareness of the competing and conflicting influences on public and
political perceptions of the need for health care and the resulting constraints on
action
bull Promote and evaluate collaboration between health services and other welfare
organizations in society
bull Evaluate and contribute to the policy and strategic development in health care
planning
bull Contribute to the planning and evaluation of different sectors of society by health
impact assessments and public health medical reports and consultations
- Communicate and develop public health medical expertise
bull Lead supervise and participate in an interprofessional health care team
bull Consult other (health) professionals and policymakers and recognise the
advantages and limits of their expertise
bull Effectively convey oral and written information about public health issues including
adequate public health reporting and effective interaction with media
bull Stimulate and motivate others so that they recognise the importance of the public
health population perspective
bull Maintain and enhance professional activities through ongoing learning and
research and contribute appropriately to the generation dissemination application
and translation of new public health knowledge and practices
3) Medical specialist internal medicine
The UEMS defines an internist as ldquoa physician trained in the scientific basis of medicine
who specialises in the assessment diagnosis and management of general medical
problems atypical presentations multiple problems and consequential complex health
issues and system disorders (Professional) The physician is skilled in the management of
acute unselected medical emergencies and the management of patients in a holistic and
ethical way considering all psychosocial as well as medical factors for enhancing quality of
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
77
life The physician values the continuing care of all patients irrespective of the nature of the
patients complaint and is committed to lifelong continued professional development
(Scholar) The physician practices clinical audit and evidence-based medicine The
physician functions in a number of roles including clinical counselling educating leading
and managingrdquo83
Internists have a fundamental role in modern healthcare systems Within the definition of
the internist the shift towards a preventive strategy focusing on health promotion is
highlighted by the acknowledgement of the high prevalence of chronic and complex
diseases that are associated with the lifestyle of ageing western societies The role of
healthcare advocate (a role defined in the CanMED framework) is an important part of the
internistrsquos function and forms the generic competencies of an internist (see section 11)
However lifestyle promotion and disease prevention is not a specific area of expertise
Specific areas of the internist include multi-morbidity and ageing acute care medical
consultation shared-decision-making collaborative care transition in care vulnerable
adult patient safety and quality of care and medical leadership
4) Medical specialist cardiology
According to the training requirements for the speciality of cardiology84 training in
cardiology should be based on the syllabus of the ESC core Curriculum for the general
cardiologist part 2 ldquothe core curriculum per topicrdquo85 The necessary core cardiology
competencies are set out as cardiology learning objectives with the knowledge skills
attitudes and competencies needed to fulfil the objectives One of the core cardiology
competences is cardiovascular prevention aiming to
bull Assess and manage patients with risk factors for cardiovascular disease
bull Understand the mode of action of different prevention methods
bull Describe cardiovascular disease and risk factors in the local community
bull Contribute to the global efforts in reducing cardiovascular morbidity and mortality
by communicating the prevention message to the public
bull To approach prevention in a holistic way understanding the potentiation of
cardiovascular risk by clustering of risk factors
bull
Knowledge
bull Epidemiology of cardiovascular disease in the local community incidence
prevalence survival
bull Risk factors in the local community
83 httpswwwuemseu__dataassetspdf_file001744450UEMS-201613-European-Training-
Requirements-Internal-Medicinepdf 84 httpswwwuemseu__dataassetspdf_file001119577UEMS-201324-SECTIONS-AND-BOARDS-
Cardiology-European-Training-Requirements-20131019pdf 85 httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_
9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
78
bull Risk assessment in primary prevention multifactorial risk interaction and use of
risk scoring charts
bull The impact of lifestyle on people at risk of and patients with cardiovascular
disease
bull The potential of lifestyle changes to prevent and ameliorate cardiovascular
disease diet and nutrition toxic habits (smoking alcohol and others) physical
activity
bull Emerging risk factors (social economic stress depression and personality type)
bull Treatmentprevention strategies for major risk factors and changes in lifestyle
including corresponding pharmacologic therapies
bull The comprehensive approach required for multiple risk factors
bull Patient compliance
In addition the main objectives and knowledge competence are further specified by
hypertension dyslipidaemia diabetes and lifestyle
Skills
bull obtain a relevant history and perform an appropriate clinical examination
bull evaluate cardiovascular risk and assess global cardiovascular risk at the individual
level
bull evaluate cardiovascular risk at population level (mortality morbidity disability)
bull evaluate the benefit of prevention at individual and population levels
bull manage risk factors appropriately including pharmacological and non-
pharmacological therapies
bull communicate their importance to patients their families and the wider
community including smoking cessation diet and exercise
bull communicate the importance of patient compliance and behaviour
bull motivate patients and families to change lifestyles and be compliant with
prescriptionsrecommendations
bull monitor patient compliance and behaviour
bull evaluate the benefit of risk factor intervention for the individual patient
Behaviours and attitudes
bull Non-judgemental attitude to patients regarding their lifestyle (eg smoking diet
etc)
bull Exemplify appropriate lifestyle in personal behaviour
bull Team working with other physicians including general practitioners
diabetologists nephrologists and elderly care physicians for the management of
specific risk factors
bull Team working with all professionals with a role in primary and secondary
prevention (nurses dieticians teachers and politicians)
Another core competency is the physical activity and sport in primary and secondary
prevention Further defined in sports cardiology and cardiac rehabilitation
Sports cardiology aiming86
86
httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
79
bull To conduct strategies to implement healthy lifestyle in particular physical and
sports activities in the general population (primary prevention)
bull To evaluate cardiovascular risk and exercise capacity (see Chapters 22 and
271)
bull To recognize the characteristics of the athletersquos heart
bull To appropriately detect contraindications to exercisecompetition and
appropriately provide non-contraindication certificates
Knowledge
bull Exercise and sports physiology
bull Benefits of exercise training
bull Safety issues in exercise and sport
bull Diagnostic criteria and appropriate investigations in athletes with cardiovascular
disease
bull Risk factors for and mechanisms of sudden cardiac death (SCD) during and after
strenuous exercise
bull Specific population challenges and exercise programmes in appropriate settings
bull Recommendations for professional and recreational sports participation
bull SCD in patients athletes and in the population at large and
bull Mechanisms of action of illicit drugs
Skills
bull perform an individual CVD risk assessment using appropriate information from
history laboratory assessment including full lipid profile and clinical data
bull recognize pathological cardiovascular changes and differentiate them from the
characteristic features of lsquoathletersquos heartrsquo and
bull use prevailing recommendations for eligibility for participation in competitive
sports
Behaviours and attitudes
bull Recognition of the role of active lifestyle exercise and sport in the promotion of
health and in the prevention of the most threatening diseases including
cardiovascular diseases
Cardiac rehabilitation aiming
bull To evaluate and manage cardiovascular risk
bull To evaluate exercise capacity and causes of exercise intolerance
bull To provide appropriate rehabilitation and secondary prevention to patients with
cardiovascular diseases
7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
80
Knowledge
bull Multi-disciplinary risk factor intervention
bull Definition of comprehensive cardiovascular prevention and rehabilitation
bull Effects of behavioural change including physical activity nutrition education and
psychosocial risk factors on quality of life cardiovascular risk and outcome
bull Rehabilitation as a component of cardiac care and a promoter of secondary
prevention
bull Target populations and risk stratification of patients
bull Psychological aspects of rehabilitation and exercise practice
Skills
bull take a relevant history and perform an appropriate clinical examination including
the specific evaluation of the elderly patient
bull perform and interpret risk stratification using indicated tests
bull interpret a cardiopulmonary exercise test and distinguish different causes of
exercise limitation
bull prescribe exercise-based rehabilitation programmes and other lifestyle
interventions according to the patientrsquos condition in collaboration with other
specialists when necessary and
bull motivate the patient to ensure long-term adherence to lifestyle changes and
continuing exercise programmes
Behaviours and attitudes
bull rehabilitation as a component of cardiac care
bull the importance of rehabilitation and secondary prevention for professional
personal and social life among patients with heart disease
bull the interplay of physical and psychological aspects of heart disease and the
positive influence of exercise on cardiovascular risk factors
bull the role of other professionals including nurse specialists physiotherapists ergo
physiologists psychologists dieticians and general practitioners in rehabilitation
and secondary prevention and
bull the importance of patient and family education and the role of other professionals
in rehabilitation
5) Medical specialist psychiatry
The UEMS has issued a charter of requirements for the training in psychiatry in 2000 with
an additional European Framework for Competencies in Psychiatry in 2009 The learning
outcomes in the European Framework for Competencies in Psychiatry (EFCP) are arranged
under the seven physician roles derived from the CanMEDS framework87 Within the EFCP
it is stated that ldquopsychiatrists recognise the importance of advocacy and health promotion
in responding to the challenges represented by those social environmental and biological
factors that determine the mental health and well-being of patients and society They
recognise advocacy as an essential and fundamental component of mental health promotion
that occurs at the level of the individual patient the practice population and the broader
communityrdquo
Competencies
87 httpuemspsychiatryorgwp-contentuploads2013092009-Oct-EFCPpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
81
bull identify the determinants of mental disorder as well as the factors that may
contribute to positive mental health so as to be able to prevent disorder and
promote mental health
- recognise the determinants of mental health of populations and how public
policy including legislation impacts on mental health
- promote positive mental and physical health in patients particularly in those
with severe mental disorder based on best evidence
- recognise the impact of mental disorder on families and carers and take
remedial measures
- collaborate with other community sectors to promote mental health and
prevent mental disorder at all levels focusing particularly on family school and
workplace
- identify and address barriers and inequity in access to care particularly for
vulnerable or marginalised populations
bull Identify and address issues and circumstances when advocacy on behalf of
patients professions or society is necessary
- respect and promote the human rights of people with mental disorders and
collaborate with user and carer associations and advocacy groups
- empower people with mental disorders and their carers
- recognise and address prejudice stigma and discrimination associated with
mental disorder and its treatment
- use strategies to enhance patientrsquos self-management and autonomy
- actively oppose the use of psychiatry for political repression
- recognise the possibility of conflict inherent in their role as a health advocate
for a patient or community with that of manager or gatekeeper
6) General practitioner
The European training requirements for General PracticeFamily Medicine (GPFM) specialist
training88 defined twelve central characteristics of the practice before determining the core
competences Related to health promotion and disease prevention two of these
characteristics are as following ldquopromotes health and well-being both by appropriate and
effective interventionrdquo and ldquohas a specific responsibility for the health of the communityrdquo
The twelve characteristics are clustered into six core competences primary care
management person-centred care specific problem solving skills comprehensive
approach community orientation holistic modelling Under comprehensive approach the
following abilities relate to health promotion and disease prevention
bull to promote health and wellbeing by applying health promotion and disease
prevention strategies appropriately
bull to manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
Furthermore community orientation includes the ability
bull to reconcile the health needs of individual patients and the health needs of the
community in which they live in balance with available resources
88 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
82
In the more comprehensive assessment of GPrsquos performance in daily practice by the
European Academy of Teachers in General PracticeFamily Medicine (EURACT)89 these
abilities are further defined as following
bull To promote health and wellbeing by applying health promotion and disease
prevention strategies appropriate
- Identifies opportunity for health promotion intervention
- Makes use of structured medical record as reminder of preventive activities
- Makes use of teamwork
- Uses communication skills
- Is aware of any personal prejudices which might influence negatively
preventive advice
- Makes recommendations which are feasible in the context of patientrsquos lifestyle
and home situation
- Acts as suitable role model
bull To manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
- Provides appropriate medical management
- Involves members of practice team eg through case conference
- Performsarranges home visit (consider relevant team members) ndash needs
assessment eg cause of falls
- Involves relatives
- Facilitates communication (two-way) with hospital
- Involves external community resources (eg home help etc)
Dentist
According to the profile and competences for the graduating European dentist one of the
major competences for dentists is to improve oral health of individuals families and groups
in the community On graduation a dentist must be competent at promoting and improving
the oral health of individuals families and groups in the community90 Furthermore with
regard to health promotion and disease prevention a dentist
bull Must be competent at
- Applying the principles of health promotion and disease prevention via
comprehensive preventive measures to individuals and the community
according to their risk assessment status
- Understanding the complex interactions between oral health nutrition general
health drugs and diseases that can have an impact on oral health care and
oral diseases
- Providing appropriate dietary advice
bull Have knowledge of
- The organisation and provision of health care in the community and in the
specialist hospital service in the country of training
- The prevalence of the common dental conditions in the country of
trainingpractice
- The social cultural and environmental factors which contribute to health or
illness
- The strategies to overcome barriers to dental care for disabled elderly
socially deprived and ethnic minority groups
- Training auxiliaries in basic skills of oral health promotion
89httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-
documentseuractperformanceagendadC3BCsseldorf2014-openaccessebookversionpdf 90 httpwwwdentuoagrfileadmindentuoagruploadsusefull_filesADEE-competences-2009_enpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
83
In 2017 a new updated framework was published for undergraduate education for dentists
including a revised structure of the educational domains and their areas of competence In
the revised framework health promotion and disease prevention compromises one of the
areas of competence in the domain ldquodentistry in societyrdquo in the educational strategy of a
dentist91 Note Dentists can also specialise in public health in a similar programme as
physicians
Nurses
The training for nurses responsible for general care shall following the Directive
201355EU include a set of eight competences 92 The training for nurses should provide
assurance that the ability of the following knowledge and skills
1 comprehensive knowledge of the sciences on which general nursing is based including
sufficient understanding of the structure physiological functions and behaviour of
healthy and sick persons and of the relationship between the state of health and the
physical and social environment of the human being
2 sufficient knowledge of the nature and ethics of the profession and of the general
principles of health and nursing
3 adequate clinical experience such experience should be gained under the supervision
of qualified nursing staff and in places where the number of qualified staff and equipment
are appropriate for the nursing care of the patient
4 the ability to participate in the practical training of health personnel and experience of
working with such personnel
5 experience of working with members of other professions in the health sector
Competencies 93
6 Competency to independently diagnose the nursing care required using current
theoretical and clinical knowledge as well as to plan organise and implement nursing
care when treating patients on the basis of page the knowledge and skills acquired in
accordance with points (1) (2) and (3) in order to improve professional practice
7 Competency to work together effectively with other players in the health sector including
participation in the practical training of health personnel on the basis of the knowledge
and skills acquired in accordance with points (4) and (5)
8 Competency to empower individuals families and groups towards healthy lifestyles and
self-care on the basis of the knowledge and skills acquired in accordance with points (1)
and (2)
9 Competency to independently initiate immediate measures to pre- serve life and to carry
out measures in crisis and disaster situations
9191 Field JC Cowpe JG Walmsley AD The Graduating European Dentist A New Undergraduate Curriculum
Framework Eur J Dent Educ 201721(Suppl 1)2-10 httpsdoiorg101111eje12307 92 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf 93 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
84
10 Competency to independently advise instruct and support individuals needing care
and their attachment figures
11 Competency to independently ensure the quality of nursing care and assess it
12 Competency to communicate comprehensively and professionally and to cooperate
with members of other professions in the health sector
13 Competency to analyse the quality of care in order to improve their own professional
practice as general care nurses
The competences included in Directive 201355EU are different from the competences
contained in the EFN Competency Framework These competences contain the following
competences on health promotion and disease prevention guidance and teaching
bull To promote healthy lifestyles preventive measures and self-care by strengthening
empowerment promoting health and enhancing behaviours and therapeutic
compliance
bull To independently protect the health and well-being of individuals families or
groups being cared for ensuring their safety and promoting their autonomy
bull To integrate promote and apply theoretical methodological and practical
knowledge This enables the promotion and the development of nursing care in
long term care co-morbidity and in situations of dependency in order to maintain
an individualrsquos personal autonomy and hisher relationships with the environment
in every moment of the healthillness process
Nurse specialist
The European Specialist Nurses Organisation (ESNO) defines the nurse specialist as follows
ldquoThe Nurse Specialist (NS) is an advanced practice Nurse prepared as a specialist within a
clinical specialty at the masterrsquos post masterrsquos or doctoral levelrdquo94 Following the ESNO the
competencies should be considered as a reference template and guidelines for the different
specialities in which each speciality can define its own knowledge skills and attitudes
Generic competencies are the clinical role patient relationship patient teachingcoaching
mentoring research organisation and management communication and teamwork ethic
and decision making leadership and policy making and prevention The competency of
prevention is based on the case for investing in public health from the World Health
Organization95 The competency of prevention is based on the ability of promoting health
and prevent disease by the capacity to develop and put in place intervention in
bull Surveillance of population health and wellbeing
bull Disease prevention at the 3 levels of prevention (primary secondary)
bull Ability to promote health and prevent disease
bull Monitoring and response to health hazards and emergencies
bull Health promotion including actions to address social determinants and healthy
inequities
bull Advocacy communication and social mobilization for health advancing public
health
bull Research to inform policy and practice96
94 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf 95 httpwwweurowhoint__dataassetspdf_file0009278073Case-Investing-Public-Healthpdfua=1 96 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
85
Occupational therapist
The World Federation of Occupational Therapists (WFOT) provided minimum standards for
the education of occupational therapists97 One of the settings in which occupational
therapists work is defined as following ldquoCommunity or group approaches such as health
promotion community development community based rehabilitation injury prevention
environmental design disaster preparation and recoveryrdquo Furthermore under essential
knowledge skills amp attitudes for competent practice the following (could) relate to health
promotion and disease prevention
bull Knowledge about
- The relationship between occupation and human development over the life
course including healthy ageing
- The relationship between psychological social and economic factors and
occupation (eg stress adjustment to life changes including disability
societal disruption natural or man-made disaster displacement)
- Early identification and functional interventions focusing on somatosensory
stimulation and performance mechanisms mitigating early developmental and
environmental factors impacting negatively on behaviour and learning
- How activity limitations and participation in occupation affect health This
includes the ability to maintain a healthy environment and personal factors
such as adjustment interpersonal relationships and social networks
- How health conditions and threats to health affect participation in work
bull Skills in
- Inter-sectoral collaboration in public health initiatives
- Assessing health in relation to occupation
In addition the Tuning programme described the reference points for the design and
delivery degree programmes in occupational therapy98 in which they first ranked subject
specific competency One of the highest ranked included
bull Enable individualsgroupsorganisationscommunities to be engaged in occupation
through health promotion prevention rehabilitation treatment and
coachingtraining
In the final set of subject specific competences however this is mentioned less explicitly
and only the following are related to health promotion and disease prevention
bull Knowledge the occupational therapist is able to
- Work in partnership with individuals and groups using occupation in
prevention rehabilitation and treatment in order to promote participation
health and well-being
- Explain the relationship between occupational performance health and well-
being
- Collaborate with communities to promote and develop the health and well-
being of their members through their participation in occupation
- Develop new knowledge of occupation and occupational therapy practice
particularly in relation to local andor emerging health and social challenges
97 httpswwwwfotorgassetsresourcesCOPYRIGHTED-World-Federation-of-Occupational-Therapists-
Minimum-Standards-for-the-Education-of-Occupational-Therapists-2016apdf 98 httptuningacademyorgwp-contentuploads201402RefOccupationalTherapy_EU_ENpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
86
Pharmacists
In a two-stage large-scale Delphi process fifty competences of pharmacy practice were
ranked and the Quality Assurance in European Pharmacy Education and Training (PHAR-
QA) framework was harmonized and validated99 Of these fifty competences the following
relate to health promotion and disease prevention
bull Ability to promote public health in collaboration with other professionals within the
healthcare system
bull Ability to provide appropriate lifestyle advice to improve patient outcomes
bull (eg advice on smoking obesity etc)
bull Ability to use pharmaceutical knowledge and provide evidence-based advice on
public health issues involving medicines
Physiotherapists
According to the World Confederation for Physical Therapy (WCPT) the scope of physical
therapists practices includes (among others) public health strategies and advocating for
patientsclients and for health100 Furthermore it is described that physical therapists may
have the following purposes
bull promoting the health and wellbeing of individuals and the general publicsociety
emphasising the importance of physical activity and exercise
bull preventing impairments activity limitations participatory restrictions and
disabilities in individuals at risk of altered movement behaviours due to health
factors socio-economic stressors environmental factors and lifestyle factors
The European Network of Physiotherapy in Higher Education (ENPHE) also described
professional competencies of physiotherapists101 According to the ENPHE one of the roles
of a physiotherapist is to be a
bull Health care promotor
- Advocate on health and wellbeing promotion and disease or injury prevention
on behalf of patientclients and the profession to enhance individual
community and public health
- Promote adherence to local regional national and EU health and safety
policies guidelines and protocols
Psychologist
The European Federation of Psychologistsrsquo Associations developed the European Certificate
in Psychology ndash the EuroPsy102 The Tuning programme also published lsquoReference points for
the design and delivery of degree programmes in Psychologyrsquo103 in which they state that
the Tuning programme and the EuroPsy programme have experienced a parallel
development over the last ten years In fact the Tuning document presents a reference
99 httpswwwncbinlmnihgovpmcarticlesPMC5419365 100 httpswwwwcptorgpolicyps-descriptionPT 101 httpwwwenpheorgwp-
contentuploads201910ESCO_report_ENPHE_recommendations_April_2017pdf 102 httpwwwinpa-europsyitmoduliEuroPsy20Regulations20July202011pdf 103httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNPsychology_reference_points
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
87
point for the design and delivery of degree programmes in psychology on the basis of the
EuroPsy programme
Based on the definition of the key role of the professional psychologist health promotion
and disease prevention could be part of the profession as this has been described as
follows to develop and apply psychological principles knowledge models and methods in
an ethical and scientific way in order to promote the development well-being and
effectiveness of individuals groups organisations and society However no specific
competences related to health promotion and disease prevention are now described in the
documents It is plausible though that psychologist do act to promote health as the core
of their profession is to help others to understand behaviour to improve performance and
well-being or to alleviate problems and distress As these emergent specialisms develop in
response to new demands there is a tendency to develop education and training
programmes thus increasing the specialisation and the requirement for specialist skills of
professional psychology
Social worker
Global standards for the education and training of the social work profession are developed
by the International Association of Schools of Social Work (IASSW)104 The IASSW
worldwide association of schools of social work other tertiary level social work educational
programmes and social work educators These global standards include for example
standards regarding the schoolrsquos core purpose or mission statement standards regarding
programme objectives and outcomes standards with regard to programme curricula
including field education The standards with regard to the core curricula are organised into
four conceptual components domain of the social work profession domain of the social
work professional methods of social work practice and paradigm of the social work
profession under which several sub-domains are described which mainly relate to aspects
such as inadequacies discrimination tradition and culture social stability and ethical
principles The following touch upon the field of health promotion and disease prevention
bull Knowledge of human behaviour and development and of the social environment
with particular emphasis on the person-in-environment transaction life-span
development and the interaction among biological psychological socio-structural
economic political cultural and spiritual factors in shaping human development
and behaviour (domain of the social work profession)
bull Sufficient practice skills in and knowledge of assessment relationship building
and helping processes to achieve the identified goals of the programme for the
purposes of social support and developmental protective preventive andor
therapeutic intervention ndash depending on the particular focus of the programme or
professional practice orientation (methods of social work practice)
bull The application of social work values ethical principles knowledge and skills to
promote care mutual respect and mutual responsibility amongst members of a
society (methods of social work practice)
bull Problem-solving and anticipatory socialisation through an understanding of the
normative developmental life cycle and expected life tasks and crises in relation
to age-related influences with due consideration to socio-cultural expectations
(paradigm of the social work profession)
104 httpswwwiassw-aietsorgwp-contentuploads201808Global-standards-for-the-education-and-training-
of-the-social-work-professionpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
88
The European Social Network (ESN) investigated the social services workforce throughout
Europe and provided an overview of qualifications and skills in different Member States in
their research report showing that qualification and skills for social care workers differ per
country105 In fact in some countries there are specific training routes for social care
workers including specialised training courses or apprenticeships and the content of these
trainings depends on the service user group and is generally defined at a local or authority
level A questionnaire was set out in which essential components of social care workers
were identified which showed that health and safety is seen as an important component
of social work
105 httpswwwesn-euorgsitesdefaultfilespublicationsInvesting_in_the_social_service_workforce_WEBpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
89
ANNEX 3 ONLINE SURVEY
Survey Health promotion and disease prevention in health and educational
settings
Health promotion and disease prevention in health and educational settings -
medical schools The European Union has commissioned Ecorys an international
research and consultancy agency to conduct a project on health promotion and
disease prevention in health and educational settings In order to provide an EU
wide overview and to better support national governments we would like to ask
for your cooperation The project will develop an EU wide overview of the
educationtraining programmes for basic education postgraduate education as
well as continuous professional development with regard to education on health
promotion Your help will therefore be key in the collection of information and
data on public health initiatives in medical and non-medical education The survey
will take approximately 20 minutes of your time You do not need to complete this
survey at once You may leave the survey and continue at a later moment in
time Questions can be saved by clicking on the pauze button (below the
questionnaire) When doing so a new URL link will be provided We would be
pleased if you could provide this information by means of an online questionnaire
to Ecorys who is also available in case you have questions or you would like
additional information bull Ms Emalie Hurkmans (Project Coordinator) tel +31
(0)6 280 579 21 email emaliehurkmansecoryscom bull Ms Tessa Huis in lsquot
Veld tel +31 6 29 22 10 58 email tessahuisintveldecoryscom
What is the name of your education
What are the website details of the educationPlease enter the link of the website
with information of the education
Can you give a brief description of the education
What type of health professionals are trained in the education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
90
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
What type of medical specialist
Is the education
Undergraduate education
Postgraduate education
Continuous professional development
Is the course accreditated
Yes
No
Unknown
Does the course cover the topic health promotion and disease prevention
Yes
No
Is the education accreditated
Yes
No
Unknown
Does the education cover the topic health promotion and disease prevention
Yes
No
How is the topic health promotion and disease prevention incorporated in the
curriculum
In a seperate module
Topic incorporated into curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
91
Who is (are) the contact person(s) of the module health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Was there any partnerships in setting up the module health promotion and disease
prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Has the education obtained any funding to set up the module on health promotion
and disease prevention EU funding national public funding local public funding
or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
92
Since when is the module on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the module Eg is it a two weeks one month or one
year programme
What is the typical quantity in hours spend at health promotion and disease
prevention by participants The amount of hours spent on attendence and
homework
Is the module health promotion and disease prevention accreditated separately
No
Unknown
Yes please specify how many points are given
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
93
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the module
No
Unknown
Yes please specify what type of exam
Is the module also provided at other locations For example at other universities
Yes
No
Unknown
Is there a contact person(s)expert for the topic health promotion and disease
prevention
Was there any partnerships in incorporating it in the curriculum
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
94
Has the education obtained funding to incorporate health promotion and disease
prevention into the curriculum EU funding national public funding local public
funding or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is health promotion and disease prevention incorporated into the whole
curriculum eg since September 2017
What is the typical quantity in hours (approximately) spend at health promotion
and disease prevention by participants The amount of hours spent on attendence
and homework
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
95
In what way are knowledge and skills with regard to health promotion and disease
prevention tested in the curriculum For example incorporated into a written exam
Who is (are) the contact person(s) of the course on health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Were there any partnerships in setting up the course on health promotion and
disease prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
business NGOs individual citizens governmental agencies who have a role fill in
yes and add by the partnership in place
No
Yes please specify
Has the education obtained any funding to set up the course on health promotion
and disease prevention
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
96
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is the course on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the course eg two weeks one month or one year
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
97
What is typical quantity in hours spend at health promotion and disease prevention
by participants The amount of hours spent on attendence and homework
Is the course on health promotion and disease prevention accreditated separately
No
Unknown
Yes how many points are given
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the course
No
Unknown
Yes what type of exam
Is the course provided at multiple locations For example at other universities
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
98
What are the general objectives of the teaching activities on health promotion and
disease prevention eg arise awareness among Medical Doctors on the
importance of physical activity within the elderly population with a high risk of
heart failure
Which stakeholders were involved in developing the teaching activities on health
promotion and disease prevention
Is there made use of a mono- or multidisciplinary approach
Monodisciplinairy approach
Multidisciplinary approach
Unknown
Does the education include theories of
1
Yes
2
No
3
Unknown
Population health
Human cognition
and behaviour
Health behaviour
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
99
Does the education include
1
Yes
2
No
3
Unknown
Epidemiology and
bio-statistics
(research
capacity)
Methods of
evidence-based
medicine
Health policies
and regulation
Health economics
Ethics
Health care
systems
Digitalisation in
health promotion
Health inequalities
Disease
prevention in
teams
Health literacy
Health behaviour
change
techniques
Communication
skills
Digital health
coaching
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
100
Concerning teaching methods of health promotion and disease prevention which
methods are used
1
Yes
2
No
3
Unknown
Lectures
Assignments
Field training in real environments
eLearning modules
Other please specify
Concerning covered competencys or capacities of health promotion and disease
prevention the main focus is on
What are the expected outcomes
1
Yes
2
No
3
Unknown
Knowledge
Skills
Behaviour
attitudes
Relevant output (if available) eg number of students following the module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
101
Do you think it is likely you will apply the learned knowledge and skills (on health
promotion and disease prevention) in daily practice after completion of this
education
Yes please specify
No please specify
Not sure please specify
Is there a reason why this education might be a good example for other
educational settings with regard to the way that health promotion and disease
prevention is covered in the education
Are there any remarks Please feel free to give overall remarks or initiative-specific
remarks
Your responses have been registered Thank you for taking the time to complete
the survey your input is valuable to us
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
102
HOW TO OBTAIN EU PUBLICATIONS
Free publications
bull one copy via EU Bookshop (httpbookshopeuropaeu)
bull more than one copy or postersmaps from the European Unionrsquos representations (httpeceuropaeurepresent_enhtm) from the delegations in non-EU countries (httpeeaseuropaeudelegationsindex_enhtm) by contacting the Europe Direct service (httpeuropaeueuropedirectindex_enhtm) or calling 00 800 6 7 8 9 10 11 (freephone number from anywhere in the EU) () () The information given is free as are most calls (though some operators phone boxes or hotels may charge you)
Priced publications
bull via EU Bookshop (httpbookshopeuropaeu)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
8
network We contacted 24 EU associations that represent entire professions or part of the
professions (like post-graduates) in all EU countries and have major networks in the fields
of graduate post-graduate and continuous professional development for their support We
aimed to cover all professions within the scope of this study physicians physiotherapists
occupational therapists psychologists nurses social workers dentists pharmacies
dietitians Also national health associations and national educational organisations were
approached to fill in the survey Among other topics the survey contained questions on the
training programme type of health professional targeted implementation in the
curriculum description of the health promotion component funding accreditation and
partnerships
In addition to the online survey a desk research was conducted including both scientific
and grey literature to establish an overview of the competency profiles of health
professionals in the field of health promotion and disease prevention Based on the
identified literature we described the competency profiles for each of the following
healthcare professions (undergraduate) medicine medical specialists dentists nurses
nurse specialists occupational therapists pharmacists physiotherapists psychologists
and social workers
Results were tabulated and described Good practices were selected on the basis of four
pre-established criteria These practices were analysed more in-depth with an analytical
tool aligning Friedenrsquos pyramid of public health needs and Kraigerrsquos Learning Typology This
in-depth analysis was used to define a short list of 10 good practices representing a variety
of professions and countries
Results
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades1there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional However there is room for improvement many competency
profiles leave room for interpretation the described competences are not ranked in order
of importance and it is often not explained how the competences should be applied in
practice ie in a pro-active preventive way (always assessing lifestyle within the
treatment) or a more curative reactive way (only included in the treatment when there is
a clear lifestyle component related to the disease)
As for the inclusion in educational programmes a high percentage (93) of respondents
(n=197) indicate that health promotion and disease prevention is implemented in their
educational programmes or modules The high share may reflect a selection bias as those
who have implemented health promotion within the education may have been more inclined
to fill in the questionnaire In the survey we explored how health promotion and disease
prevention is implemented in the educational setting In summary this provided the
following results
1 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
9
bull More than half of the respondents indicated that they filled in the questionnaire for
practices in undergraduate educational settings Throughout Europe these
numbers were relatively similar
bull Physiotherapists are the professional group most actively involved in health
promotion training activities The vast majority applies multidisciplinary
approaches and thus brings other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within training programmes In continuous professional development on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion especially target knowledge skills
and behaviour of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for continuous professional
development (33) compared to undergraduate and postgraduate education
where the topic is covered in most modules (15 and 6) Funding was more
often obtained in Northern and Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) Regarding full modules high percentages indicated
that this is mandatory and that there is an exam at the end of the module (81
70 respectively)
Conclusions
The present study provides an overview of current practice on health promotion disease
prevention and lifestyle medicine in the education of health professionals in EU countries
This is an important need-assessment for the exchange of knowledge and expertise among
EU countries All professions have versatile competency profiles in health promotion giving
a good ground for further development As the study results reveal some unbalance in
competencies addressed and methods used a next step could be to support further
development of educational practices in lifestyle medicine and adoption of new
technologies There is room for improvement as well as encouraging volition to share
expertise across professions professional associations universities and countries in the EU
The body of knowledge generated in this study can serve as a basis for further analysis and
contribute to the enhance effectiveness of educational practices of health promotion
disease prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
11
1 INTRODUCTION
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices2 In Europe such chronic diseases as
cancer cardiovascular diseases diabetes and chronic respiratory diseases are giving the
greatest disease burden3 The Global Burden of Disease (GBD) 2016 study estimates that
over 91 of deaths and over 87 of DALYs in the European Union (EU) are the result of
non-communicable diseases (NCDs) of which 61 and 43 respectively can be attributed
to modifiable risk factors4 To a large extent lifestyle factors unhealthy diets tobacco use
harmful use of alcohol and physical inactivity have been identified as the top risk factors
for NCDs in the EU5 The last non-communicable diseases progress monitor 2017 of the
WHO underlines that ldquoNCDs share key modifiable behavioural risk factors like tobacco
use unhealthy diet lack of physical activity and the harmful use of alcohol which in turn
lead to overweight and obesity raised blood pressure raised cholesterol and ultimately
diseaserdquo6 Since NCDs share many related modifiable risk factors and often do not occur in
isolation7 prevention must be integrated into population approaches to combat NCDs as a
group8 In recognition of this important public health challenge investing in effective health
promotion and disease prevention is critical to improve the quality of life and well- being of
European citizens910 as well as their productivity and NCDrsquos burden on health systems and
economy of European societies11
Strengthening the investments in health promotion and disease prevention is key to delay
the onset and reduce the burden of NCDs in Europe12 As there is a great need for chronic
disease management the healthcare setting is crucial for health promotion in both primary
and secondary prevention of NCDs13 For example obesity is a major modifiable risk factor
2 Chopra M et al (2002) A global response to a global problem the epidemic of overnutrition
httpswwwncbinlmnihgovpmcarticlesPMC2567699pdf12571723pdf 3 WHO (2006) Gaining Health The European strategy for the prevention and control of noncommunicable
diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf 4 EU burden from non-communicable diseases and key risk factors httpseceuropaeujrcenhealth-
knowledge-gatewaysocietal-impactsburden 5 WHO (2014) Prevention and control of noncommunicable diseases in the European Region a progress report
httpwwweurowhoint__dataassetspdf_file0004235975Prevention-and-control-of-noncommunicable-diseases-in-the-European-Region-A-progress-report-Engpdf
6 WHO (2017) Noncommunicable diseases progress monitor 2017 httpappswhointirisbitstream handle106652589409789241513029-engpdfjsessionid=0613BF26D66A7DA9D1C91AD325E0A75Dsequence=1
7 httpsacels-cdncomS00917435150028321-s20-S0091743515002832-mainpdf_tid=88fea2bf-946a-44c2-be59-0edbabc2c2e8ampacdnat=1541511066_feedfb33968e2ac2f5b47a3452254a9f
8 Integrated approach to prevent noncommunicable diseases httpwwweurowhointenhealth-topicsnoncommunicable-diseasescanceractivitiesintegrated-approach-to-prevent-noncommunicable-diseases
9 WHO (2006) Gaining Health The European Strategy for the prevention and control of noncommunicable diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf
10 Scriven A (2017) Promoting Health a Practical Guide Seventh Edition httpsbooksgooglenl
bookshl=nlamplr=ampid=fJwqDwAAQBAJampoi=fndamppg=PP1ampdq=importance+health+ promotion+and+disease+prevention+European+Commissionampots=jcXZvCYJIQampsig=8D8Yqa9wKa_DlaaYUky_EtUxd_gv=onepageampq=importance20health20promotion20and20disease20prevention20European20Commissionampf=false
11 Tender 12 Chrodis (2015) Health promotion and primary prevention in 14 European countries a comparative overview
of key policies approaches gaps and needs httpchrodiseuwp-contentuploads 201507 FinalFinalSummaryofWP5CountryReportspdf
13 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
12
for type II diabetes (DM II) and thus efficacy of the intervention matters In economic
modelling for eight European countries a body-mass index reduction in the adult population
of 5 compared to 1 resulted a three-fold reduction in the incidence of DM II14 Apart
from the health losses caused directly by NCDs underlying conditions may also increase
susceptibility for other diseases Patients with diabetes and serious heart conditions eg
were identified as risk populations for COVID-1915 New health threats like climate crisis
will have an impact on healthcare systems and need for adaptation options including
training of health care workers integrated heatwave early warning systems especially for
the most vulnerable populations and supporting lifestyle changes toward healthy choices
that are at the same time climate and health friendly16
Healthcare providers such as doctors especially general practitioners (GPs) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs17 Health
promotion is collaborative work where professionals strengthen the message and help
patients to choose and implement healthier behaviours Counselling on and prescription of
a healthy lifestyle is particularly important to socioeconomically vulnerable and
disadvantaged population groups which are disproportionally affected by unhealthy
lifestyles and are more difficult to reach18 Secondary and tertiary prevention in chronic
diseases is embedded into good quality care since good nutrition status decreases the risk
of reinfarction as does smoking cessation For these reasons health promotion was
explicitly recognized as an integral part of the professional role of the GP in several policy
statements at both the European and the national level19 While many policy statements
and NCDs practice guidelines include a call for behavioural change as the first line of
prevention and management providers often do not provide behavioural change
counselling in their care20
A recently published report by the European Commission and WHO Europe (2018) identified
barriers for prescribing and counselling on exercise schemes and on promoting physical
activity in the health sector These were the lack of confidence and knowledge and skills by
health professionals on providing effective counselling21 For example Koutoukidis et al
(2017) performed a qualitative study on the perspective of healthcare professionals on
lifestyle advice to cancer survivors Health professional-centred barriers to provision of
lifestyle advice were a lack of knowledge on healthy lifestyle guidelines the feeling that
14 Webber L Divajeva D Marsh T McPherson K Brown M Galea G et al The future burden of obesity-related
diseases in the 53 WHO European-Region countries and the impact of effective interventions A modelling study BMJ Open 2014
15 Centre for Disease Control and Prevention (2020) Coronavirus disease 2019 Groups at higher risk for severe illness httpswwwcdcgovcoronavirus2019-ncovneed-extra-precautionsgroups-at-higher-riskhtml
16 Drummond P Ekins P Grubb M Lott MSEng M Byass P Nilsson M et al The Lancet Commissions Institute for Sustainable Resources (P Health and climate change policy responses to protect public health thelancetcom 2015
17 Catapano AL et al (2007) Averting a pandemic health crisis in Europeby 2020 what physicians need to know regarding cholesterol management httpswwwncbinlmnihgovpubmed17446817
18 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
19 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20 European20General20Practicepdf
20 httpswwwncbinlmnihgovpmcarticlesPMC4561845pdf101177_1559827615580307pdf 21 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the
European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
13
they were not the right person to provide advice and lack of time and resources22
Additional barriers mentioned in the World Book of Family Medicine ndash European Edition
2015 are perceived as lack of time or competing work load insufficient reimbursement
doubts about patientsrsquo acceptance and willingness to receive lifestyle counselling low self-
efficacy insufficient skills and training doubts about effectiveness of interventions and
health promotion perceived as outside professional role2324 Therefore while most health
professionals seem to acknowledge the need for lifestyle advice there seems to be a
mismatch between roles competencies training and possibilities among health
professionals and action25 Factors causing this mismatch differ from individual and
organizational context wherefore strategies to address these barriers will also vary26
These findings underline the need for developing and strengthening lifestyle medicine in
health professionalsrsquo education27 defined as lsquothe integration of lifestyle practices into the
modern practice of medicine both to lower the risk factors for chronic disease andor if
disease already present serve as an adjunct in its therapy Lifestyle medicine brings
together sound scientific evidence in diverse health-related fields to assist the clinician in
the process of not only treating disease but also promoting good healthrsquo28 Hence lifestyle
medicine covers the systematised approach for prevention and management of chronic
disease addressing eg diet physical activity behaviour change stress and coping and
tobaccosubstance abuse29 Health professionals need to learn how to overcome the
identified barriers mentioned above30 and how to effectively and efficiently counsel their
patients towards adopting and sustaining healthier behaviours31
Moreover digitalization is changing the scenery for lifestyle medicine and chronic disease
management Patient engagement can be enhanced with applications self-monitoring or
self-management tools To successfully embed these new forms of care professionals must
develop new skills32 However studies have shown that medical students are not formally
trained in major concepts known to influence health33 Philips et al (2014) states that
including lifestyle medicine in undergraduate medical curricula would have important public
health implications by efficiently promoting the prevention and treatment of NCDs34 A
study by Dacey et al (2012) states that face-to-face continuing medical education formats
22 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 23 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20
European20General20Practicepdf 24 Geense WW van de Glind IM Visscher TL van Achterberg T Barriers facilitators and attitudes influencing
health promotion activities in general practice an explorative pilot study BMC-family practice 2013 1420 25 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 26
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
27 Polak R et al (2015) Lifestyle Medicine Education httpswwwncbinlmnihgov pmcarticles PMC4561845
28 Rippe JM (2019) Lifestyle Medicine Third Edition CRC Press 29 Kushner RF and Webb Sorensen K (2013) Lifestyle medicine the future of chronic disease management
Obesity and nutrition 201320 30 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 31 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) The impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 32 Eg Richard A A amp Shea K (2011) Delineation of Self-Care and Associated Concepts Journal of Nursing
Scholarship 43(3) no-no httpdoiorg101111j1547-5069201101404x 33 httpscdnymawscomwwwacpmorgresourceresmgrlifestylemedicine-filesajpm-lmcommentarypdf 34 Philips E Pojednic R Polak R Bush J amp Trilk J (2014) including lifestyle medicine in undergraduate
medical curricula Medical education online
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
14
have a positive impact on physician behaviour toward health promotion and disease
prevention by increasing their knowledge confidence and practices that help patients to
adopt healthy behaviours35 Similar results can be expected among other health
professionals as well
The World Book of Family Medicine ndash European Edition 2015 states that the shared aim to
integrate health promotion disease prevention and lifestyle medicine has not been fully
achieved Future activities as to how lifestyle interventions can be better integrated need
collaborative approaches36 As a starting point for more collaborative action this study
seeks to provide a mapping of the current situation on health professionals training in health
promotion in the EU
11 Research questions
To that end this study seeks to answers to the following research questions
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and continuous
professional education
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
35 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) the impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 36
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
15
2 THEORETICAL BACKGROUND
21 Societal needs for health promotion and disease prevention
Classically public health targets at activity levels can be described in operational models
like Friedenacutes pyramid model37 It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of
health like socioeconomic status6 We use this model as a substructure in looking into
health professionalsrsquo education as they contribute to public health in these levels (Figure
21) Society needs to evaluate cost-effectiveness of public health efforts and find a balance
between the levels of actions at each level We use this framework to enable us to present
the needs of societies in general for different health professionals and their roles and
competencies in public health
Figure 21 Frieden Pyramid of health impact of health professional activities at the different levels of society (T Frieden 2010 CDC)
Healthcare services can contribute in mitigating the burden of disease by socioeconomic
disadvantages Health professionals have a key role in developing health services so their
competency to take account of differences in abilities of people to benefit from health
services is vital But more is needed Traditionally health professionals have been managing
the individual risk factors and provision of services That is not enough For example in
cardiovascular diseases the ldquoperfect treatment approachrdquo fails to prevent almost half of the
disease burden37 In cancer diseases individual health behaviours like smoking contribute
in more direct manner Therefore we need to develop educational systems that support
health professionals to take part in new public health approaches by planning interventions
that change the environmental context to make healthy options the default choice
37 Frieden TR A framework for public health action The health impact pyramid American Journal of Public
Health 2010
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
16
regardless of education income service provision or other societal factors37 These are
equally needed in out-of-health contexts like climate change where socio-economic
inequalities and (health) behavioural choices are among major drivers of climate changes38
Policies can influence environments to support healthier choices and we need health
professionals in policy development and execution Still health behaviour changes happen
at the individual level We need more efficient skills in personalized health coaching of
individuals to increase the cost-effectiveness of treatment of NCDs39 An ageing population
and increasing rates of chronic disease as well as advances in medical science and health
information technology to make care safer and more efficient require a rethinking of how
care is delivered Digitalization of services will challenge healthcare professionals and
collaborative care models have become more common40 Instead of requiring compliance
from patients patient-centred approaches are required from professionals This means that
clinical interventions need to be complemented by counselling and education to achieve
long-lasting protective measures Health coaching is aiming to empower patients in co-
management of their disease41 and emphasize and support patientsrsquo autonomy instead of
merely compliance It is based on shared decision-making and collaborative goal setting
facilitated by motivational interviewing42 Health coaching is already happening in digital
environments This paradigm shift requires new skills and attitudes from health
professionals too
New approaches to public health on societal level the paradigm shift to health coaching on
patient level and new forms of healthcare delivery pose a big challenge to the educational
system of health professionals It needs to prepare new professionals and train health
professionals already working in the healthcare system to master a wider scope of
knowledge and develop new skills and attitudes to implement these new approaches in a
safe effective and efficient way
22 Health profession competencies
Healthcare service is a complex and interconnected network of professionals There are
common professional competencies needed in health care and health promotion
(communication collaboration) but they are applied to meet the learning aims of each
profession or level of education If we want to increase the implementation of lifestyle
counselling or systemwide changes we need to evaluate knowledge skills and attitudes
required for the changes and to define the competencies needed to support this change
Professional competencies sum the elements of abilities (knowledge skills attitudes and
behaviours) that enable a professional to accomplish the activities described in a task
statement that outlines what the professional is expected to do43
38 Watts Nick Amann Markus Arnell Nigel et al (66 more authors) (2019) Report of The Lancet Countdown
on Health and Climate Change The Lancet ISSN 0140-6736 httpsdoiorg101016S0140-6736(19)32596-6)
39 Hale R Giese J Cost-Effectiveness of Health Coaching Prof Case Manag 2017 40 Falconer E Kho D Docherty JP Use of technology for care coordination initiatives for patients with mental
health issues A systematic literature review Neuropsychiatric Disease and Treatment 2018 41 Hayes E McCahon C Panahi MR Hamre T Pohlman K Alliance not compliance Coaching strategies to
improve type 2 diabetes outcomes J Am Acad Nurse Pract 2008 42 Olsen JM Health Coaching A Concept Analysis Nurs Forum 2014 43 Kraiger etal 1993 Application of cognitive skill-based and affective theories of learning outcomes to new
methods of training evaluation
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
17
Learning Outcome Typology by Kraiger is a widely used descriptive model for setting targets
and learning outcomes in education43 It comprises cognitive (knowledge) psychomotor
(skill-based) affective and behavioural (attitudes) components This classification scheme
for learning outcomes is based on Bloomrsquos work (1956) of three learning domains including
cognitive domain the affective domain and psychomotor44 45Knowledge can be factual and
declarative knowledge information and concepts or processes and organizations or
metacognitive strategies like allocation and regulation of professional performance Skills
include simple routine development and procedures needed at work and more complex
skills needed for the ability to monitor the performance along other tasks Attitudes are
linked with professionalsrsquo perceptions on learning self-efficacy at work perception about
ability to perform and ability to goal setting It has domains on professionalism Knowledge
can be obtained in reading or e-Learning modules skills require active teaching methods
and attitudes develop over time Behaviours then are complex situations where knowledge
skills and attitudes are utilised in professional manners In education planning outcomes
are defined by these elements
Competency frameworks are an effective method for achieving outcome-based education46
They provide a tool for capturing the elements and abilities (knowledge skills attitudes
and behaviours) needed in effective and safe patient work47They can serve in evaluating
the components of different specialities or societal needs like in this report public health
needs Competencies define an acceptable and feasible description of professional
behaviours used in relation to health promotion Competency building is at the basis in
developing similar programmes in the US4849 Meaningful assessment of competencies
developed is critical for the implementation of effective competency-based medical
education (CBME)50
The International Union for Health Promotion and Education (IUHPE) published an
extensive list of core competencies and professional standards for health promotion in
201651 It defines acuteHealth Promotion actionrsquo in the context of these competencies and
standards to describe programmes policies and other organised Health Promotion
interventions that are empowering participatory holistic inter-sectoral equitable
sustainable and multi-strategy in nature and aim to improve health and reduce health
inequities51
44 Bloom BS (1956) Taxonomy of educational objectives The classification of educational goals New York NY
Longmans Green 45 Cruz-Cunha MM (2012) Handbook of Research on Serious Games as Educational Business and Research Tools 46 Frank JR Danoff D The CanMEDS initiative Implementing an outcomes-based framework of physician
competencies Med Teach 200729(7)642ndash7 47 Cooke M Irby DM Sullivan W Ludmerer KM Medical education American medical education 100 years after
the flexner report N Engl J Med [Internet] 2006355(13)1339-1344+1306 Available from httpwww
scopuscominwardrecordurleid=2-s20-33749062559amppartnerID=40ampmd5=d949feb 758c984c732a419 cada174c85
48 Alaranta A Alaranta H Patja K Palmu P Praumlttaumllauml R Martelin T et alSnuff use and smoking in Finnish Olympic athletes Int J Sports Med 200627(7)
49 Van Horn L Lenders CM Pratt CA Beech B Carney PA Dietz W et al Advancing Nutrition Education Training and Research for Medical Students Residents Fellows Attending Physicians and Other Clinicians Building Competencies and Interdisciplinary Coordination Adv Nutr 2019
50 Lockyer J Carraccio C Chan MK Hart D Smee S Touchie C et al Core principles of assessment in competency-based medical education Med Teach 201739(6)609ndash16
51 IUHPE (2016) Core competencies and professional standards for health promotion full version httpwwwukphrorgwp-contentuploads201702Core_Competencies_Standards_linkEpdf )
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
18
We present CanMEDS as an example of a framework that includes content-specific
competencies (Table 21) CanMEDS was developed for medical experts but most
competencies are applicable to all health professionals
Table 21 CanMEDS in short form52 original version53
Competency Short description
Medical Expert Apply clinical skills and knowledge of the biomedical sciences to fulfil your scope of practice
Collaborate with patients and families for patient-centred care and management
Contribute to health care quality and patient safety
Communicator Build rapport and empathy in all interactions with patients and include families (with the patientrsquos consent)
Understand the patientrsquos perspectives expectations and socio-economic issues
Use active listening patient-centred interviewing skills and culturally safe communication
Share information in plain language to promote patientsrsquo understanding
Clearly document and share information with patients and others on the care team
Collaborator Collaborate by sharing knowledge and perspectives sharing responsibilities learning together
Collaborate in care education advocacy administration and scholarship
Leader Take responsibility for the ongoing operation evolution and continuous
improvement of the healthcare system
Expand beyond a clinical or technical role to take on administrative teaching and scholarly roles and responsibilities
Exercise efficient use of resources to achieve cost-effective care
Contribute to improvements in personal practice team organization and system
Health Advocate
Understand and address the determinants of health that affect patients and support patients to navigate through the health care system
Collaborate with communities and populations to influence change in the health
care system
Contribute to health promotion and disease prevention Understand determinants and needs speak on behalf of others increase awareness
Scholar Plan for and engage in life-long learning
Teach others
Evaluate and apply evidence to day-to-day practice
Contribute to research including creation dissemination and translation into
practice
Professional Commit to patients society profession and ldquoselfrdquo Patients ndash maintain clinical competency and adhere to ethical standard Society ndash demonstrate social accountability by responding to societal needs and
expectations Profession ndash peer assessment mentorship supporting others setting standards Self ndash participate in self-assessment and reflection build self-awareness and manage own well-being
52 Michener Institute No Title CanMEDS framework in short [Internet] Available from httpsmichenercawp-
contentuploads201805CanMEDS-Framework-Summarypdf 53 Frank JR Snell L Sherbino J E CanMEDs 2015 Physician Competency Framework [Internet] CanMEDS 2015
Physician Competency Framework Ottawa Royal College of Physicians and Surgeons of Canada 2015 p 1ndash30 Available from httpwwwroyalcollegecaportalpageportalrccanmedsresourcespublications
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
19
23 Educational systems for health professions in Europe
According to the EU Treaty European citizens have a virtue of rights of free movement as
workers freedom of establishment and freedom of service providers54 Directives on the
requirements of professional qualifications in EU their recognition and Regulation55
facilitate the mobility of health personnel Each member state will apply this directive in
the national legislation on health professional qualifications There is a system of automatic
recognition based on harmonised minimum training requirements This system depends on
the timely notification of new or changed evidence of formal qualifications by MS and their
publication by the Commission Otherwise holders of such qualifications have no
guarantees that they can benefit from automatic recognition
The undergraduate education in Europe is coordinated through the Bologna Process which
is an intergovernmental cooperation of 48 European countries in the field of higher
education It guides the collective effort of public authorities universities teachers and
students together with stakeholder associations employers quality assurance agencies
international organizations and institutions including the EC to bring more coherence to
higher education systems across Europe56 Under the Bologna Process all 48 participating
European countries agreed to ensure mutual recognition of qualifications and learning
periods abroad completed at other universities Nonetheless it should be noted that across
Europe healthcare systems and educations may still significantly differ
While professional activity is regulated by national law in individual member states57
faculties and other academic institutions have collaborated in the establishment of a
framework of competencies based on the scientific advances and new methodologies in
education In fact EU Directives of the European Parliament and Council on the recognition
of professional qualifications have consolidated a system of mutual recognition between
MS58 Examples include the PHARMINE for pharmacists and MEDINE for medical doctors59
This collaboration is in line with the Bologna Process
24 Relevant educational settings for health promotion
Inclusion of health promotion and lifestyle medicine in undergraduate medical curricula is
expected to have important public health implications However in current medical
education this subject is minimal to nonexistent60 This is a global problem In 2016 the
American associations around NCDs launched a joint programme called lsquoThe Lifestyle
54 Treaty on the Functioning of the European Union (TFEU) Articles 45 49-62 55 European Parliament C of the EU Directive 200536EC on the recognition of professional qualifications and
Regulation [Internet] 2013 Available from httpseur-lexeuropaeulegal-
contentENALLuri=celex3A32013L0055 56 The Bologna process and the European Higher Education Area httpseceuropaeu education policies
higher-educationbologna-process-and-european-higher-education-area_en 57 UEMS (2017) Charter on training of medical specialists in the EU httpswwwuemseu
dataassetspdf_file001943561ETR-Psychiatry-201703pdf 58 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 59 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 60 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
20
Medicine Education Collaborativerdquo for improvement of health promotion education among
health professionals and in medical schools61 This initiative will a) work for high-quality
curricular material on an easily navigable website b) provide support for medical schools
to advocate for and implement lifestyle medicine curricula into their own institutions c)
aim to increase awareness and legislative initiatives that encourage adoption of lifestyle
medicine into medical school education d) develop and conduct assessment in the
following areas Student Health Student Knowledge and Programme Effectiveness and
e) train and support medical students as effective champions of lifestyle medicine whose
engagement with the curriculum lead to increased adoption within medical schools and
enhanced collaboration nationallyError Bookmark not defined This need has been acknowledged
in Europe as well62
Besides education in medical schools continuous professional development (CPD) is an
essential component in health education to ensure that professionals graduated in past
decades keep their competencies up to date and acquire new competencies needed for
health promotion disease prevention and lifestyle medicine It is important to encourage
further strengthening of CPD for those professions that benefit from automatic recognition
of their professional qualifications Member states should in particular encourage CPD for
physicians medical specialists general practitioners nurses responsible for general are
dental practitioners specialized dental practitioners veterinary surgeons midwives
pharmacists and architects63 Given the rapid developments in societal needs and
approaches towards health promotion and disease prevention and spectacular increase in
technological support facilities lifelong learning is imperative for health professionals and
should be oriented towards the competencies required to best serve their population and
society
Figure 22 Lifelong learning is an iterative process where learners build knowledge skills
attitudes and behaviours on top of their current professional competency
61 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019 62 European Lifestyle Medicine organisation httpswwweulmorg 63 Lim SS Vos T Flaxman AD Danaei G Shibuya K Adair-Rohani H et al A comparative risk assessment of
burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions 1990-2010 A systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
21
25 Theoretical framework for this study
In this study we touch upon the existing levels of health promotion disease prevention
and lifestyle medicine in health and educational settings in the EU and make a preliminary
assessment of its relevance
As right now health professional competencies seem more practical we approached the
mapping of competencies in health education through professions rather than with an
overall theoretical framework Thus we aim to create a general picture for different health
professions at different levels of education
For the assessment of relevance of the existing levels of health promotion in education we
aligned the competency framework of Kraiger with Friedenrsquos public health framework We
used three components64 of Kraigerrsquos Learning Typology
bull Knowledge cognitive and mental abilities
bull Skills psychomotor manual and physical abilities to perform tasks
bull Attitude (or self) perceptions growth in feelings or emotional areas
We used the integrated framework as an analytical tool to classify content areas covered
and their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future
This study is an important first step as we know little about present practices However
more detailed research will obviously be needed
64 Given the limitations of the study behaviour ndash the fourth component ndash is not included Behaviour refers to
practices to utilise knowledge skills and attitude in work environment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
22
3 METHODOLOGY
31 Mapping of health educational programmes in the EU
The first aim was to provide a general overview on how health professionals are trained in
health promotion and disease prevention and lifestyle medicine in the EU To that end we
conducted an online survey to map the educational programmes of health professionals in
the EU In addition to the proposed methodology we also conducted desk research to
create an overview of competency profiles of health professionals in the EU
311 Online survey
This study looks at undergraduate education postgraduate education and CPD courses in
all healthcare professions across the EU Within the EU different organisations are
responsible for the education of healthcare professionals
bull The undergraduate education programmes are organised by universities in each
country
bull The post-graduate education programmes are organised differently in each
country This includes a set of European organisations that run the guidelines
and portfolioacutes for each profession or specialty within this profession (like in
medicine)
bull CPD programmes are even more diverse between countries and can be accredited
both by European organisations and universities
Due to the wide scope of the study and the different levels of healthcare educational
programmes no country correspondents could be found with a full overview of educational
programmes addressing health promotion and disease prevention in their country
Therefore we chose for a snowball methodology to obtain information on all levels of health
professional education The snowball methodology consists of two steps First we identified
potential organisations in the EU to take part in the survey Second we asked those
organisations to recruit other organisations or stakeholders in their national andor
international network of colleagues and spread the survey among those This method
required more effort and time in the beginning but once the lsquoballrsquo was rolling it provided
us with a growing dataset including the perspectives from healthcare educators healthcare
professional associations and healthcare students and residents The snowball method
implies a risk of selection bias as educational institutions that have implemented health
promotion within their programmes ie the front-runners may have been more inclined
to respond than those who have not
In addition this recruitment process served as a communication and dissemination vehicle
and increased the engagement to the mapping Many organisations expressed their interest
to join the workshop as well as willingness to disseminate the results to their members and
collaborators Because of the growing interest we decided to extend the deadline after the
workshop organised on 13 February so attendees could spread the survey among their
national andor international networks
Our original workplan included an Excel worksheet to be sent to the national health
coordinators in each EU country but as we chose a different strategy it was necessary to
develop a more user-friendly and flexible method Therefore an online survey was
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
23
developed This enabled refinement of questions to each level of education with core sets
of questions Survey links proved to be easy to use and shared within educational facilities
or associations which led to higher response
In this section we discuss in more detail how the survey was developed and how relevant
international organisations were recruited
Development of an online survey
First we developed a mapping tool (stand-alone Excel document) to map the current
situation of professionals trained in health promotion This mapping tool was validated by
both Chafea and DG SANTE and by the external experts in the core research team After a
pilot phase an online survey was developed for all healthcare professions based on the
content of the mapping tool This was a necessary step to boost response as the online
survey proved to be more user-friendly and easier to share among educational facilities or
associations than the mapping tool in Excel
Among other topics the survey contained questions on the
bull Training programme for which the respondent is filling in the survey (which
(educational) institute and health profession portfolio etc)
bull Type of training programme (undergraduate education postgraduate education or
continues professionalrsquos development
bull Type of health professional targeted (eg GPrsquos physiotherapists etc)
bull Implementation in the curriculum
bull Description of the health promotion component in the programme (eg teaching
methods monodisciplinary approach or multidisciplinary approach expected
outcomes in knowledge skills and attitude)
bull Targeted funding
bull Accreditation
bull Partnerships
The questions in the survey correspond with the information requested in the Tender
Specifications Note that the survey maps the educational offer effectiveness of education
is outside the scope of this study The complete questionnaire used in the survey can be
found in Annex 3
Recruitment of relevant international organisations EU and national medical and
non-medical associations medical faculties national and international institutes
networks and organisations
As we used a snowball method it is not possible to provide the exact number of persons
who received the survey and response rates Instead we present each of the steps taken
to approach respondents and final response obtained
Recruitment of European associations
First we connected with major networks in the fields of graduate post-graduate and
continuous professional development for their support as these organisations have an
overview of the three levels of health professional education These associations represent
entire professions or part of the professions (like post-graduates) in all European countries
National professional organisations are members of these umbrella organisations For
example the Union of Medical Specialists (UEMS) represents 16 million medical specialists
It has 40 full member associations (Member States of the EU amp Member States of the
European Economic Area) associate member associations (Member States of the Council
of Europe) and observer member associations (other countries eg the United States)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
24
The UEMS represents more than 50 medical disciplines through various bodies
and structures The most important ones are the 43 Specialist Sections which represent
independently recognised specialties All health professionals health professional students
and post-graduates are organised in a similar manner These organisations are in a good
position to provide information and disseminate it across EU countries
Overall 24 EU associations were approached by email to spread the survey among their
networks (see Table 31 for a complete overview) We aimed to cover all professions within
the scope of this study ie physicians physiotherapists occupational therapists
psychologists nurses social workers dentists pharmacies dietitians throughout Europe
Therefore European associations with focus on educational programmes for these specific
professions were approached
Table 31 Approached European Associations
No European Associations
1 European Medical Association (EMANET)
2 The European Union of General Practitioners (UEMO)
3 European Union of medical specialists (UEMS)
4 European Medical Students Association EMSA)
5 European Forum of Medical associations (EFMA)
6 European Federation of Nurses Associations (EFN)
7 European Association of schools of social work
8 European Network of Physiotherapy in Higher Education
9 European Region ndash World Confederation of Physical Therapy (ER-WCPT)
10 European Network of Occupational Therapy in Higher Education (ENOTHE)
11 Council of Occupational therapists of European Countries (COTEC) part of the World
12 Federation of Occupational Therapists (WFOT)
13 Federation of National Psychologists Associations
14 European federation of nurse educators (FINE) association
15 Association for Dental Education in Europe
16 Council of European Dentists
17 Association for Medical Education in Europe (AMEE)
18 Pharmaceutical group of the European Union (PGEU)
19 European Pharmacists Forum (EPF)
20 European Association of faculties of pharmacy (EAFP)
21 European network of medical residents in Public health
22 The Association of Medical Schools Europe (AMSE)
23 The European Society of Preventive Medicine (ESPREV)
24 The European Lifestyle Medicine Organisation (ELMO)
Recruitment of national associations
Second national health associations for all Member States and all professions were
approached to fill in the survey This step was crucial to increase the response National
health associations were selected using the member list of European organisations Table
32 shows the European organisations used to identify national health associations that
were invited to participate in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
25
Table 32 Examples of the approached national associations
Profession European Association Examples of approached national associations (1 out of 28)
Medical doctors Standing committee of European Doctors (CPME)
Czech Medical Chamber
Physiotherapists World confederation for physical therapy (WCPT)
Swedish Association of Physiotherapists
Social workers International federation of
social workers
German professional
association for social work
Psychologists European Federation of psychologistsrsquo association (EFPA)
Croatian psychological association
Occupational therapists Council of occupational
therapists for the European Countries (COTEC)
Association of Bulgarian
Ergotherapists
Dietitians The European Federation of the associations of dieticians
(EFAD)
French Association of Nutritionist Dietitians
Dentists Council of European Dentists Irish dental association
Nurses European Federation of Nurses
Association (EFN)
Polish Nurse Association
Pharmacists Pharmaceutical group of European Union (PGEU)
Malta Chamber of Pharmacists
Recruitment of national educational organisations
Last the list of the selected associations was used to identify relevant national educational
organisations These national educational organisations (eg University of Maastricht
Faculty of Health Medicine and Life Sciences Kaunas University Medical School Lifestyle
Medicine University of Helsinki Faculty of Medicine) were approached individually and
asked to fill in the survey and spread it throughout their network
Table 33 Number of national educational organisations approached
Profession Number of approached national education organisations
Medical schools 298
Schools of physiotherapy 29
School of social work 31
School of dietitians 40
School of Occupational therapists 45
School of dentists 85
School of pharmacists 56
Response obtained
In total we received information on 176 educational practices till mid-February The
workshop organized in Luxembourg65 gave an additional boost and resulted in 32 more
practices reported in the survey In total this mapping exercise is based on information on
208 practices of health promotion in educational settings
65 Workshop ldquoPromoting lifestyle medicine competencies and education of health professionals in the EU todayrdquo
13th February 2020 Luxembourg Organized by Chafea and DG SANTE
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
26
312 Desk research
Desk research was conducted on both scientific and grey literature with the main purpose
to establish an overview of the competency profiles of health professionals in the field of
health promotion and disease prevention This overview was created to gain insight to what
extent competency profiles related to health promotion and disease prevention are covered
in the educational standards of different health professions in the EU We have made use
of reports published online and scientific articles on competency profiles or educational
standards set at EU level (eg European standards in medical training (UEMS) as the EU
Directives of the European Parliament and Council on the recognition of professional
qualifications have consolidated a system of mutual recognition between Member States3
When reports on EU level could not be identified we selected articles on global standards
such as for the profession of social work (ie global standards for the education and training
of the social work profession)
Based on the identified literature we have described the competency profiles for each of
the following healthcare professions
bull (undergraduate) Medicine
bull Medical specialists
- sports medicine specialists
- public health specialists
- internists
- cardiologists
- psychiatrists
- general practitioners
bull Dentists
bull Nurses
bull Nurse specialists
bull Occupational therapists
bull Pharmacists
bull Physiotherapists
bull Psychologists
bull Social workers
The selection of healthcare professions included in the desk research was made in
consultation with Chafea DG SANTE and the experts
The assessment of the competency profiles was based on the three Domains of Learning
KSAs as described in Chapter 2
bull Cognitive mental skills (knowledge)
bull Psychomotor manual or physical skills (skills)
bull Affective growth in feelings or emotional areas (attitude or self)
This method was chosen as especially ldquolack of confidence and knowledge and skills by
health professionals on providing effective counsellingrdquo was identified as a barrier for
prescribing and counselling on promoting physical activity in the healthcare sector66 In
Chapter 4 the results are described in detail
66 httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
27
32 Long list of good practices
From the survey results we have drawn a long list of good practices As agreed with Chafea
and DG SANTE these good practices were selected using the following four selection criteria
bull The programme contains a multidisciplinary approach
bull The education is mandatory (including an exam)
bull The education covers the following topics digitalisation in health eHealth and
digital health coaching
bull The expected outcome includes change in skills and or behaviour
Several variables were included in the longlist country name of the programme name of
the institute whether there is a focus on knowledge skills and behaviour the type of
professionals who are being trained the theories that are covered by the education (eg
human cognition and behaviour health behaviour change techniques communication skills
etc) education methods used year since the education is provided the time spend in the
modules in hours and lastly in case of one full module the duration of this module To
enable comparison between good practices based on different variables the preliminary
longlist can be found in a separate Excel document Chapter 5 includes an overview of the
coverage and content of the long list of good practices
After closing of the online survey we analysed the longlist of good practices along the
following research questions
bull What content items of health promotion disease prevention and lifestyle
counseling do programmes consist of
bull What kinds of learning aims do they have
bull How do they distribute in Friedens model of levels of health promotion
bull Are there differences between professional groups
First we analysed the distribution of the learning skills separately by the levels of education
(undergraduate postgraduate and CPD) We expected that adult learning will be more
directed towards skills (learning by doing) than the undergraduate and postgraduate
programmes Secondly we analysed the educational methods and tools used in the good
practices
Good practices can be submitted to the European Commissionrsquos Best Practice Portal to be
assessed by external evaluators against criteria adopted by the Steering Group on Health
Promotion Disease Prevention and Management of NCDs Practices rated as best against
these criteria will be published on the European Commissionrsquos Best Practice Portal67
67 httpswebgateeceuropaeudynabp-portal
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
28
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
29
4 MAPPING OF THE CURRENT SITUATION IN HEALTH PROMOTION TRAINING IN THE EU
41 Overview of educational programmes in the EU
411 Summary of the main findings in the survey
A high percentage (93) of respondents (n=197) indicated that health promotion and
disease prevention are implemented in their educational programmes or modules For
undergraduate education postgraduate education and CPD these percentages were 95
93 and 83 respectively Other results include
bull More than half of the respondents indicated that they filled in the questionnaire
based on undergraduate educational settings Throughout Europe these numbers
were relatively similar
bull Physiotherapists seem to be the professional group most actively involved in
health promotion training activities The vast majority applies multidisciplinary
approaches and thus bring other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within the undergraduate and postgraduate programmes In CPD on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion target knowledge skills and
attitudes of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for CPD (33) compared to
undergraduate and postgraduate education (15 and 6) when the topic is
covered in most modules Funding was more often obtained in Northern and
Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) With regard to full modules high percentages
indicated that these are mandatory and that there is an exam at the end of the
module (81 70 respectively)
412 Detailed results of the survey
Respondents
In the following section we provide a detailed description of the survey results The survey
targeted undergraduate education postgraduate education and CPD programmes in all
Member States Overall 208 respondents filled in the questionnaire about their educational
practice Note the results presented in the remainder of this report are exclusively based
on the answers respondents provided in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
30
Table 41 and Figure 41 provide an overview of the number of practices reported per
European countries A detailed overview of the educational programmes collected
throughout Europe can be found in Annex 1
Figure 41 Practices collected in the survey by European countries (n=208)
Table 41 Number of respondents per European Member State 2019-2020 (n=208)
Abbreviations EU Member State Number of respondents
AT Austria 12
BE Belgium 23
BG Bulgaria 4
CY Cyprus 1
CZ Czech Republic 7
DE Germany 1
DK Denmark 8
EE Estonia 2
ES Spain 22
FI Finland 6
FR France 15
GB United Kingdom 6
GR Greece 10
HR Croatia 0
HU Hungary 3
IE Ireland 8
IT Italy 10
LT Lithuania 1
LU Luxembourg 0
LV Latvia 5
MT Malta 6
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
31
Abbreviations EU Member State Number of respondents
NL Netherlands 2
PO Poland 0
PT Portugal 14
RO Romania 3
SE Sweden 4
SI Slovenia 14
SK Slovakia 2
Additional countries 19
TOT 208 the UK is included as a Member State in this study as the results were obtained before Brexit
For mapping purposes we made a breakdown of results by region ie Northern Europe
Eastern Southern and Western Europe (based on United Nations Regional Groups)
Furthermore we compare results of individual countries for which at least 10 practices have
been reported in the survey These are Austria Belgium France Greece Italy Portugal
Slovenia and Spain
Table 42 European countries per region
Region European countries
West Austria Belgium France Ireland Germany
Luxembourg Netherlands United Kingdom Switzerland
North Denmark Sweden Estonia Finland Lithuania Latvia Norway
East Bulgaria Czech Republic Hungary Romania Slovakia Poland Georgia Kazakhstan
South Italy Spain Cyprus Portugal Greece Malta Slovenia Croatia Bosnia Kosovo Serbia
Type of education
We asked the respondents to indicate the type of educational setting As shown in Figure
42 more than half of the practices (60) refer to undergraduate educational settings and
approximately one third to postgraduate educational settings Only twelve percent of the
reported educational settings is related to CPD
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
32
Figure 42 Practices by educational level (n=199 in percentages)
Figure 43 and Figure 44 show the distribution in type of education per region and on
country level respectively For Western Southern and Northern Europe distribution is in
line with the overall results In Eastern Europe practices reported are more evenly
distributed over undergraduate and postgraduate education Also the share of CPD
practices is high in comparison with other regions and overall results
Figure 43 Practices by type of education per region (n=204 in percentages)
64
42
62
60
29
37
27
30
7
21
12
10
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Undergraduate education Postgraduate education Continuous professional development
60
29
12
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
33
Figure 44 Practices by type of education per country (in percentages)
Type of health professions
An overview of the type of health professional trained in the educational practices is
provided in figure 45 Remarkably over one third (35) of the educational practices
reported are oriented to physical therapists Note that multiple answers could be provided
Figure 45 Type of health professional being trained (n=208 in percentages)
Medical specialists refer to doctors with an extra expertise in one type of medicine eg including sports
medicine public health internal medicine cardiology psychiatry and the general practitioner68 General
practitioners refers to doctors working within General Practice or Family Medicine (GPFM)69 Medical doctors refers
to doctors without any specialization
68 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 69 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
83
70
27
50
30
62
71
71
8
22
60
30
60
23
14
19
8
9
13
20
10
15
14
10
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Undergraduate education Postgraduate education Continuous professional development
116
15
35
1417
7 8 5
29
0
10
20
30
40
50
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
34
Health professionals involved as educators in health promotion and disease prevention are
shown in Figure 46 Physical therapists are most often active as teachers of health
promotion (36) which coincides with the high share of practices oriented to this
profession Some professions like medical specialists nurses and psychologists are
represented more often as teacher then as trainee of the educational practices This implies
they are involved in programmes oriented towards other health professions and is in line
with a multidisciplinary approach that is applied by the vast majority of practices ( 81
n=148)
Figure 46 Health professionals teaching contents of health promotion (n=90 in
percentages)
Methods of education
Survey results show that traditional methods ie lectures and assignments are most often
used (Figure 47) Assignment refers to home school projects such as writing papers In
CPD eLearning methods are more often used (67) compared to undergraduate (45)
and post graduate education (39) The use of field training is relatively similar for the
different levels of education
Figure 47 Teaching methods applied (n=145 in percentages)
8
27 26
36
14
24 23
6 7
37
0
10
20
30
40
50
97
81
74
46
0 10 20 30 40 50 60 70 80 90 100
Lectures
Assignments
Field training in real environments
eLearning modules
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
35
Knowledge skills and behaviour
As for the outcome of the education respectively 99 94 and 89 of all practices
indicate knowledge skills and behaviour as expected outcomes (Figure 48) There are no
significant differences between types of education
Figure 48 Knowledge skills and behaviour (n=142 in percentages)
Accreditation
Overall 39 of the educational practices is accredited on European or international level
53 is accredited at a national level and only 5 lacks accreditation (n=179) Comparing
the different levels of education the rate of accreditation at a European or nation level
varies At a European level these are 46 33 22 at the national level 47 58
67 for undergraduate education postgraduate education and CPD respectively
Throughout Europe the level of accreditation of education is high in Northern Eastern
Southern and Western countries the share of practices without accreditation is 11 0
5 and 3 respectively (n=197) Eastern European countries have regulated their
accreditation more often on a national level compared to the other countries
Theories covered
Figure 49 shows that health behaviour human cognition and behaviour and population
health are covered in most educational practices to a high or at least limited extent
99
0 1
94
4 2
89
6 4
0
20
40
60
80
100
Yes No Unknown Yes No Unknown Yes No Unknown
Knowledge Skills Behavior
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
36
Figure 49 Theories covered by the education (n=137 (in percentages)
Figure 410 provides a more detailed overview of contents covered in the educational
programmes and shows that communications skills ethics and methods of evidence-based
medicine are mostly covered within the education Contents least covered are digital health
coaching digitalisation health economics
Funding and partnerships
Figure 411 provides an overview of the practices that a) obtained targeted funding to
incorporate health promotion and disease prevention in the curriculum b) for which a
partnership is set up for execution of teaching activities on health promotion or c) built on
existing partnerships to incorporate health promotion in the curriculum of the whole
educational programme This overview only includes educational practices where health
promotion and disease is incorporated in most modules
Funding differed between level of education 15 6 and 33 of the undergraduate
education postgraduate education and CPD received targeted funding to incorporate health
promotion in the curriculum Hence funding seems to play a more important role for CPD
than for undergraduate and postgraduate education
66
54
65
31
42
32
1
1
2
3
1
0 20 40 60 80 100
Population health
Human cognition and behavior
Health behaviour
Yes very much Yes but limited No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
37
Figure 410 Theories that are included within education on health promotion (n=137 in percentages)
Figure 411 Funding and partnerships when health promotion is covered in most modules of the educational programme (n=123 in percentages)
Figure 412 provides a comparison of funding obtained by European region Remarkably
in Western Europe the share of practices with targeted funding to incorporate health
promotion is much lower than in the other EU regions
48
69
40
16
54
48
20
34
37
41
49
64
9
44
24
55
51
42
47
50
50
48
44
42
31
43
7
6
4
4
3
4
25
25
9
9
5
2
42
1
1
1
1
1
1
5
5
5
6
4
3
6
0 20 40 60 80 100
Epidemiology and bio-statistics (research capacity)
Methods of evidence-based medicine
Health policies and regulation
Health economics
Ethics
Health care systems
Digitalisation in health promotion
Health inequalities
Disease prevention in teams
Health literacy
Health behavior change techniques
Communication skills
Digital health coaching
Yes very much Yes but limited No Unknown
52
61
15
0 20 40 60 80 100
Partnerships in incorporating it in the curriculum of thewhole educational programme
Partnerships for execution of teaching activities
Funding to incorporate health promotion in curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
38
Figure 412 Funding to incorporate health promotion for programmes covering health promotion in most modules by region (n=119 in percentages)
Comparing individual countries figure 413 shows that funding is obtained for the
educational programmes reported in Slovenia Italy and France while this is not the case
or unknown in Portugal Belgium and Austria
Figure 413 Funding to incorporate health promotion when health promotion is covered in
most modules of the educational programme by country (n=71 in percentages)
Dedicated modules to health promotion
In a majority of practices (63) health promotion disease prevention and lifestyle
medicine are covered in all modules of the educational programme as opposed to coverage
in one module primarily dedicated to health promotion (37) Undergraduate and
postgraduate education show a similar pattern while in CPD programmes full modules
primarily dedicated to health promotion are relatively restricted namely 15 (Figure 414)
Both options have the potential to be effective depending on context implementation and
other factors The data gathered in this study do not allow any statement on effectiveness
of each option
20
12
21
3
80
82
70
85
6
9
13
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Yes No Unknown
13
29
0
9
30
89
100
38
71
40
100
73
70
11
50
18
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Yes No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
39
Figure 414 Share of practices with one full module primarily dedicated to health promotion
(n=140 in percentages)
Visibility of health promotion in CPD
In CPD health promotion is often integrated into disease-oriented or risk behaviour-
based contents making it harder to identify the subject in events available The
Union of European Medical Specialists (UEMS) has an electronic database for
accrediting continuous medical education This data set contains keywords Using
health promotion public health or lifestyle as keywords 37 educational events were
found in the years 2017-19 (Table 415) There were 6 events in year 2017 3 in
year 2018 and 8 in year 2019 Average number of credits (1 ECMEC equals 1 hour
maximum 6 per day) was 296 average length of events 45 days This illustrates
availability of international training on health promotion and public health for
medical professions In other events these themes may have been touched upon
as well but are not the main subject So there might be a need to make health
promotion more visible in CPD events Competency-based education could provide
a solution if health promotion disease prevention and lifestyle medicine are defined
as competencies
Table 415 CPD events with health promotion public health or lifestyle as keyword 2017-
2019 (n=37)70
Title ECMEC Year Location Website
Control of multidrug-
resistant micro-organisms in health care settings
20 2017 Stockholm
Sweden
httpwwwecdceuropaeu
Epidemiology and public health microbiology for facilitators
30 2017 Spetses Greece
httpwwwecdceuropaeu
Fellowship (EPIET amp EUPHEM) introductory course
86 2017 Spetses Greece
httpwwwecdceuropaeu
International Society for Quality in Health Care 34th International Conference
23 2017 London United Kingdom
httpisquaorgEventslondon-2017
DOHaD 2017 10th World Congress DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE
25 2017 Rotterdam Netherlands
httpwwwdohad2017org
70 Source UEMS database of accredited events 2017-2019
4035
150
20
40
60
80
100
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
40
Title ECMEC Year Location Website
10th European Public Health Conference
23 2017 Stockholm Sweden
httpsephconferenceeu
Methods and tools for evidence-based practice
and decision-making in Public Health with special emphasis on communicable disease
22 2018 Stockholm Sweden
httpwwwecdceuropaeu
ESCMID Workshop on
Migrants Health
15 2018 Muscat
Oman
httpsescmidpulselinksco
mevent14833
Control of multidrug-resistant micro-organisms in health care settings
17 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventscourse-control-multidrug-resistant-micro-organisms-mdros-health-
care-settings
ECDC Summer School 2018 23 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventsecdc-summer-school-2018
3rd International Conference of the European Network for Smoking and Tobacco Prevention
15 2018 Madrid Spain
httpsenspconferenceorg
European Observatory Venice Summer School 2018
25 2018 San Servolo Italy
wwwtheobservatorysummerschoolorg
Letrsquos talk about nutrition (NESG)
4 2018 Madrid Spain
httpespencongresscomprogrammelll-courses
Epidemiology and public health microbiology for
facilitators
28 2018 Spetses Greece
httpsecdceuropaeuenepiet-euphemaboutintro
International Society for
Quality in Health Care 35th International Conference
22 2018 Kuala
Lumpur Malaysia
httpsisquaorgEventsmal
aysia-2018
Fellowship (EPIET amp EUPHEM) introductory course
93 2018 Spetses Greece
wwwecdceuropaeu
EGEA 2018 ndash ldquoNutrition and health from science to practicerdquo
16 2018 Lyon France httpswwwegeaconferencecom
1st EUROPEAN LIFESTYLE MEDICINE CONGRESS
13 2018 Geneva Switzerland
wwwelmocongresscom
11th European Public Health Conference
24 2018 Ljubljana Slovenia
wwwephconferenceeu
Fellowship Multivariable
Analysis
25 2019 Madrid
Spain
Rapid Assessment and Survey methods (RAS)
module
35 2019 Zagreb Croatia
ECDC Summer School 2019 28 2019 Stockholm Sweden
httpswwwecdceuropaeuennews-eventsecdc-summer-school-2019
Fellowship Vaccinology Module
29 2019 Rome Italy
Programme Planning and Implementationrdquo Training Program for Resolve to
Prevent Epidemics Initiative
39 2019 Butaro Rwanda
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
41
Title ECMEC Year Location Website
Skill-mix innovation in primary and chronic care mobilizing the health workforce
28 2019 Venice Italy wwwtheobservatorysummerschoolorg
Evolutionary Medicine Conference 2019 5th international meeting of the International Society for Evolution Medicine and Public Health
15 2019 Zurich Switzerland
httpsisemphorg2019-Meeting
Fellowship (EPIET amp EUPHEM) introductory course
85 2019 Spetses Greece
Project Management for Emergency Preparedness Budget and Finance Management
20 2019 Butaro Rwanda
Autumn School on Medical
Education
19 2019 Chernivtsi
Ukraine
httpswwwfacebookcome
vents531981117209981
Project Management for Emergency Preparedness Practical Leadership Skills
24 2019 Butaro Rwanda
International Society for Quality in Health Care 36th International Conference Cape Town 20102019 - 23102019
18 2019 Cape Town South Africa
httpswwwisquaorgeventscp2019html
Public Health Genomics an
introduction
11 2019 Stockholm
Sweden
httpsecdceuropaeuenne
ws-eventspublic-health-genomics-introduction
ENSP Tobacco treatment
specialistsrsquo training
5 2019 Paris France httpenspnetwork
World Health Summit 2019 16 2019 Berlin Germany
wwwworldhealthsummitorg
Time Series Analysis 28 2019 Bilthoven
Netherlands
httpsecdceuropaeuenep
iet-euphemaboutexperience
12th European Public Health Conference
16 2019 Marseille France
wwwephconferenceeu
Outbreak Investigation Module
30 2019 Nicosia Cyprus
httpswwwecdceuropaeuenepiet-euphemaboutexperience
Source UEMS database of accredited events 2017-2019
Looking at the regional level we found that in most regions a majority of practices cover
the topic in all (or most) modules of the educational programme (Figure 416) In Northern
Europe this is most pronounced with as much as 76 of the practices reported covering
health promotion in all modules whereas in Eastern Europe this applies for 55 of
practices A similar analysis for individual countries shows that only in Spain health
promotion is covered in a dedicated module in the majority (62) of educational practices
reported while in all other countries the topic is mostly covered in all (or most) modules of
the programme Percentages vary from 56 (Austria) to 86 (Greece Figure 417)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
42
Figure 416 How is health promotion implemented in education by region (n=148 in percentages)
Figure 417 How is health promotion implemented in education by country (n=120 in
percentages)
55 participants answered specific questions on the full module dedicated to health
promotion 81 of them indicated that the education is mandatory As figure 418 shows
in Northern and Eastern Europe all dedicated module on health promotion form part of
mandatory education In Western Europe one out of three modules is optional for students
24
4537
42
76
5563
58
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
4439
36
14
22
38
18
6256
6164
86
78
63
82
38
0
20
40
60
80
100
Austria Belgium France Greece Italy Portugal Slovenia Spain
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
43
Figure 418 Full modules on health promotion that are part of mandatory education by region (n=47 in percentages)
An exam is taken at the end of the module in 70 of the cases Between regions
percentages do not differ much (Figure 419) Please note that results are based on a
limited number of practices as response for this question was low
Figure 419 Exam at the end of dedicated module by region (n=47 in percentages)
When asked whether the module on health promotion and disease prevention was
accredited separately 15 indicate that this is the case 30 report that the module is
provided at multiple locations
Figure 420 provides an overview of respondents who indicate that funding was obtained
to set up the module as well as the use of partnerships for implementation of teaching
activities on health promotion or in setting up the module Lastly it was indicated that
mostly lsquootherrsquo professionals are teaching these modules
100 100
82
67
12
22
611
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
Yes No Unknown
2518
2225
12 11
75 7571
67
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
No Unknown Yes
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
44
Figure 420 Funding and partnerships for dedicated modules (n=47 in percentages)
42 Overview of competency profiles of health professionals in the EU
A detailed description of the competency profiles per healthcare profession as obtained
from the desk research can be found in Annex 2 Competency profiles per professions
These profiles provide a solid basis for health promotion and disease prevention
Most competency profiles mention health promotion andor disease prevention Overall
the competencies of medical specialists are most comprehensively described including the
competencies for health promotion Although there are many similarities between the
different competency profiles we have identified differences in the coverage of domains of
learning ie knowledge skills and attitudes (see chapter 23) Knowledge refers to
cognitive or mental competencies skills to competencies to perform tasks or activities and
attitudes to competencies related to beliefs or values An example of an attitude
competency is ldquoexemplify appropriate lifestyle in personal behaviourrdquo In professions that
are less physically oriented emphasis is on knowledge and attitude rather than on skills
related to health promotiondisease prevention This mainly holds for psychiatry and social
workers For professions in which lifestyle is an essential component ie sports medicine
and public health emphasis is on skills rather than attitudesOnly for cardiology nurses
nurse specialists and pharmacists competency profiles describe competences in all
domains of learning ieknowledge skills and attitudes
Many competency profiles leave room for interpretation and competencies described are
not ranked in order of importance In addition profiles do not state whether competencies
should be practised in a pro-active (within every treatment) or reactive way (only when
treating diseases with a clear lifestyle component
43
53
11
0 20 40 60 80 100
Partnerships in setting up module
Partnerships for execution of teachingactivities
Funding to set up module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
45
5 LONG LIST OF GOOD PRACTICES
In this chapter we present the coverage and content of the long list of good practices The
list is also available in an Excel-file that provides the opportunity to easily make selections
by different variables such as country type of programme (undergraduate postgraduate
CPD) or the characteristics of the education programme
We also provide an analysis of content areas covered and their weight in educational
programmes learning objectives learning typology and educational methodology using
Kraigerrsquos typology and Friedenrsquos pyramid as analytical tools
51 Results
From the survey results we have drawn a long list of good practices In agreement with
Chafea and DG SANTE good practices were selected based on four criteria
1 The programme contains a multidisciplinary approach
2 The education is mandatory (including an exam)
3 The education covers the following topics digitalisation in health eHealth and digital
health coaching
4 The expected outcome includes change in skills andor behaviour
This resulted in a long list of 70 good practices that meet all criteria Educational practices
cover all regions of Europe and originate from 20 Member States (Figure 51 and Table
51)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
46
Figure 51 Number of good practices selected for long list by country 2019-2020
Table 51 Number of good practices selected based on the four selection criteria per European Member State 2019-2020
Abbreviations EU Member State Number of good
practices
AT Austria 6
BE Belgium 11
BG Bulgaria 2
CY Cyprus 1
CZ Czech Republic 2
DE Germany 0
DK Denmark 5
EE Estonia 1
ES Spain 7
FI Finland 2
FR France 6
GR Greece 7
HR Croatia 0
HU Hungary 1
IE Ireland 3
IT Italy 2
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
47
Abbreviations EU Member State Number of good practices
LT Lithuania 1
LU Luxembourg 0
LV Latvia 1
MT Malta 0
NL Netherlands 0
PO Poland 0
PT Portugal 2
RO Romania 1
SE Sweden 2
SI Slovenia 7
SK Slovakia 0
TOT 70
Of all selected good practices of healthcare educational programmes 16 practices (23)
cover health promotion and disease prevention in one full module primarily dedicated to
the subject In 54 good practices (77) the educational programmes incorporate the topic
of health promotion and disease prevention in all or most modules (Figure 52)
Figure 52 How is health promotion covered in selected good practices (n=70 in percentages)
When dividing good practices by type of education programme we see that all types
educational programmes are represented (Figure 53) The highest share of good practices
is focused on undergraduate education (60 n=42) Two practices are focused on both
undergraduate and postgraduate education
Figure 53 Type of education () represented by selected good practices (n=70)
77 23
All modules One module
6026
113
Undergraduate education
Post graduate education
Continuous professionaldevelopment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
48
Figure 54 presents the absolute number of selected good practices by type of profession
trained The absolute number sums up till 128 as multiple professions can be trained within
one programme This shows a good variation of health professionals Most good practices
focus on nurses (17 n=22) and medical doctors (13 n=17)
Figure 54 Good practices by profession being trained (n=70 in absolute numbers)
In addition to those described above other variables are included in the separate Excel file
mentioned above These include the name of the programme and the institute focus on
knowledge skills and behaviour type of professionals being trained theories covered in
the education (eg human cognition and behaviour health behaviour change techniques
communication skills etc) education methods used when the education started time
spent on the modules in study hours (ECDEC) and in case of one full module the duration
of this module This Excel file allows to make cross comparisons between different variables
52 Analysis of good practices
In this section good practices are analysed more in detail Figure 55 presents the
distribution of content areas in health promotion and their weight in educational
programmes Methodological training like evidence-based methods (EBM) varies in
programmes but has a strong position Lifestyle intervention skills are widely taught
however new technologies are still on their way in becoming part of health promotion
education Interestingly health economics rate less in these practices in spite of its close
link with health promotion as part of public health policies
30
4
4
11
17
15
15
22
10
Other
Social workers
Dentists
Occupational therapists
Medical doctors
Medical specialists
Psychologists
Nurses
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
49
Figure 55 Results for good practices(n=70) ldquoDoes the education of the initiative includerdquo
Numbers refer to Frieden model in levels of health promotion with exception of methodological contents marked
as tools (1) counselling and education (2) clinical interventions (4) changing the context to make individualrsquos
default decisions healthy (5) socioeconomic factors (6) methods in studying and evaluating health promotion
and public health
We used Friedenrsquos pyramid of levels of health promotion (Frieden 2010) and Kraigerrsquos
typology of learning (Kraiger et al 1993) to describe the abilities that professionals are
expected to acquire Based on their description learning objectives move in a knowledge
level skill building or into attitudinal objectives Figure 56 gives a graphical visualization
of the results of our analysis The dark blue green and light blue rectangles represent the
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
50
Figure 56 Learning objectives categorised into Friedenrsquos levels and learning typology
(knowledge skills attitudes) of good practices (n=70)
different domains of learning knowledge skills and attitudes The size of the rectangles is
proportional to their share in all domains in the educational practice
Within each domain of learning contents are categorized Their vertical order reflects the
order of impact levels of Frieden (from individual patient to society level) and again size
corresponds to share in the curriculums content
This analysis provides a general picture of educational practices in health promotion
disease prevention and lifestyle medicine The graph shows that practices are
predominantly oriented towards knowledge-based competencies (around 60 of the
curriculum) Roughly one third of the programme has skills-oriented learning objectives
while competencies regarding attitudes are addressed in around 10 percent of the
programmersquos content
Looking into knowledge-based competencies the broad spectrum of individual to societal
levels of impact is addressed On a societal level social and medical aspects are widely
represented while the economic angle is scarcely present Technological developments like
digitalisation are present to a modest extent
Skill-oriented learning objectives focus in communicative competences like communication
skills behaviour change techniques and teamwork Health coaching is covered in a small
number of practices Interestingly in methodological contents the aim of skills-oriented
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
51
education is to provide mainly knowledge like in EBM Few practices include practical skills
for communication and coaching in their objectives
Competence-building in the domain of attitudes form a minimal part of educational
practices They are reflected in eg health literacy and ethics However these are also
taught in a hidden curriculum as well
Educational methodologies in the survey include lectures assignments e-Learning and
real-world field assignments As these are the selected good practices it was to be expected
that multiple methods are used in most of these programmes (given selection criterium 3)
In 37 programmes all methods are in use E-Learning is used in 41 programmes
Figure 57 Educational methods used in good practices (n=70 in percentages) ()
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
53
6 CONCLUSIONS
The competency profiles as well as information on a large number of educational practices
in health promotion disease prevention and lifestyle medicine for health professionals in
the EU allow us to formulate answers to the research questions that guided this study
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and
continuous professional education
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades71there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional The educational practices collected show that this is true for all
regions of the EU However there is no overall body that has responsibility for quality
assuring standards of training and professional practice at the European level
The information on around 200 practices from 25 EU Member States (including UK) shows
that the majority of educational practices take place in undergraduate settings while
training events on health promotion for health professionals active in the field are relatively
scarce in continuous professional development (CPD) a limited number of practices on
health promotion are reported and indeed few courses or training events on health
promotion are available in the CPD calendar of the UEMS database of accredited events
Education on health promotion aims at developing competencies in knowledge skills and
attitude and most often has a multidisciplinary character Especially medical doctors nurses
and psychologists are often involved in educating other disciplines on health promotion
Health behaviour human cognition and behaviour as well as population health are part of
educational practices for all professions A majority also include communication skills
methods of EBM and ethics
The most common way to teach health professionals on health promotion disease
prevention and lifestyle medicine is the integration of the subject in most of all modules of
the curriculum Dedicated modules on health promotion are developed in undergraduate
and postgraduate education but are scarce in CPD This may contribute to the invisibility of
the subject in training for professionals active in the field
Four out of ten educational practices on health promotion are accredited on the European
(or international) level half of them have national accreditation
71 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
54
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Based on in-depth analysis of a selection of 70 good practices knowledge proves to be the
predominant domain of learning Theories covered relate to different levels of impact of
Friedenrsquos pyramid but emphasis is on the individual patient level with a predominant
position for evidence-based medicine Health economics receive remarkably little attention
This may be disadvantageous for advocacy of health promotion which requires influencing
decision-making on public funding
Around one third of educational contents are dedicated to competencies in the domain of
skills and mainly target communicative skills Interestingly they provide mainly knowledge
rather than practical training Competencies in the domain of attitude are addressed least
Ethics and health literacy are theories are the most common examples of attitude-oriented
contents When looking at the competencies defined by health professionals advocacy has
a solid role in all of them with defined skills It was represented in only few domains like
health economics so it may well be that educating advocacy skills are more common than
found in this study
Good practices use a mix of educational methods including lectures assignments real-
world practices and digital study methods
In conclusion this study is a first step in gaining knowledge and insights in the state of
affairs of health professionalsrsquo education in health promotion disease prevention and
lifestyle medicine in the EU It is an important step as we know little about present
practices However more detailed research will obviously be needed
The results of our in-depth analysis of good practices provide qualitative information We
used the integrated framework as an analytical tool to classify content areas covered and
their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future The information supplied by the
respondents show the culture of describing health promotion and education objectives
Therefore no lsquohardrsquo conclusions can be drawn However some cautious notions are
worthwhile to mention as they flag opportunities for learning and improving by collaborative
action
First it is worthwhile to stress the progress made While 20 years ago health professionals
were hardly trained in health promotion and lifestyle medicine and at best received some
instruction on specific disease-related unhealthy habits (like smoking for lung diseases) it
is now part of standard education for most health professionals That is an important
development and essential for collaboration across professions
However more can be done Health promotion education should respond to societyrsquos needs
and therefore educational needs are constantly changing and providers of education need
to follow needs in the field Increasing recognition of societal impact on health inequalities
the paradigm shift from treating to coaching patients changes in the way care is delivered
the digital revolution and the need to contain the cost of our healthcare systems represent
a multitude of challenges and relentless educational efforts in health promotion disease
prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
55
To name a few the balance between domains of learning in curricula will have to redefined
as in health coaching skills attitudes and knowledge are equally important Health
professionals will have to manage health economics to speak the language of policy makers
Teaching methodologies have gained from the technological revolution and there is
potential in utilising them even more Also there is a necessity to do so in order to provide
for effective health promotion Health literacy has got alongside data literacy Therefore
education needs to respond to in using more technologies as well as teaching adaptation of
technologies into care This is not common practice yet The constant development in needs
also stresses the need for continuous professional development in health promotion
disease prevention and lifestyle medicine To date CPD seems to be underrepresented in
educational practices on health promotion and more heavily dependent on external funding
than in undergraduate and postgraduate courses
The experience developed in the good practices collected in the survey represents a
valuable body of knowledge skills and attitudes among health educators With collaborative
efforts this can serve as an important capital to promote continuous development and
improvement of educational practices in health promotion disease prevention and lifestyle
medicine in all European countries
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
57
ANNEX 1 SURVEY RESULTS BY COUNTRY
In this annex we provide the names of all educational programmes by country filled in in
the survey In addition the following variables of the educational programmes are
provided the name of the educational institution type of education and type of health
professionals being trained This information is based on the information provided by the
respondents from each country If certain boxes are not filled in this means that only
partial information of this educational programme is provided
Austria
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Bachelorstudiengang Physiotherapie
FH JOANEUM GmbH Undergraduate education
Physical therapists
Dietetics Health University of
Applied Sciences
Undergraduate
education
Dieticians
Physiotherapy University of Applied Sciences St Polten
Undergraduate education
Physical therapists
Bachelorrsquos Degree Programme Physiotherapy
FH Campus Wien Undergraduate education
Physical therapists
Dietetics and Nutrition FH Joanneum Undergraduate education
Medical Doctors Non-specialized dietitians
Bachelor Programme Physiotherapy
University of Applied Sciences Upper Austria
Undergraduate education
Physical therapists
Degree Programme Dietetics
(Bachelor of Science)
University of Applied
Sciences Upper Austria
Undergraduate
education
Dietitians
Midwifes Speak and language therapists Biomedical scientists Radiological
technologists Physical therapists Occupational therapists Nurses
Bachelor in Health Studies
Physiotherapy
FH Kaernten Undergraduate
education
Physical therapists
Nursing Science Medical University of Graz
Postgraduate education
Nurses
Public Health Medical University of Vienna
Continuous professional development
Medical doctors
Belgium
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Drug Development KU Leuven Undergraduate education
Pharmacists
Bachelor and master Rehabilitation Sciences and
Physiotherapy
University of Antwerp Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
58
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Motor Sciences Physiotherapy
Universiteacute Libre de Bruxelles
Undergraduate education
Physical therapists
Nutrition amp Dietetics Thomas More University College
Undergraduate education
Dietitians
Adad Adad Undergraduate education
Physical therapists
Master Physiotherapy and
Rehabilitation Science
KU Leuven Postgraduate
education
Physical
therapists
Occupational therapist HE Vinci Parnasse ISEI Undergraduate education
Occupational therapists
Master in Physical therapy and Rehabilitation
Universiteacute Libre de Bruxelles
Postgraduate education
Physical therapists
Master in Physical therapy Universiteacute Libre de Bruxelles
Postgraduate education
Medical specialists Physical
therapists (Sport medicine)
Nutrition and dietetics Thomas More University College
Continuous professional
education
Medical doctors Dieticians
psychologists
Information not provided Information not provided
Undergraduate education
Pharmacists
The European Certificate in
Lifestyle Medicine
The European Lifestyle
medicine organisation (ELMO) together with the Belgian Lifestyle
Medicine Organisation (BELMO)
Continuous
professional education
Medical doctors
Medical specialists (lifestyle
medicine) Physical therapists
Occupational therapists Nurses Psychologists General practitioners
Nutrition and Dietetics Erasmus Hogeschool Brussels
Undergraduate education
Dieticians
Master in Nursing and Midwifery
University of Antwerp Postgraduate education
Nurses
Bachelor amp Master Rehabilitation Sciences amp
Physiotherapy
KU Leuven Undergraduate education
Physical therapists
Bachelor Nursing University of Applied
Sciences Gent HOGENT
Undergraduate
education
Nurses
Professional Bachelor in Nutrition and Dietetics
University colleges Leuven Limburg
Undergraduate education
Dieticians
Nutrition and Dietetics University College Ghent
Undergraduate education
Dieticians
Bachelor in Applied Health Science
Howest University College
Undergraduate education
Lifestyle coaches
Physiotherapist Universiteacute Libre de Bruxelles
Postgraduate education
Osteopathy Physical therapists
Bachelor in Medicine Hasselt University Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
59
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor of Nutrition and Dietetics
University of Applied Sciences of Gent
Undergraduate education
Dieticians
Bulgaria
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor programme in Social Work
Plovdiv University Department of Social work
Undergraduate education
Social workers
Rhinology Bulgarian Rhinologic
Society
Postgraduate
education
ENT doctors
Kinesitherapy Medical University Undergraduate education
Physical therapists
TRS rehabilitator Medical College Medical University
Continuous professional
education
Medical specialists
Cyprus
Name of educational
programme
Name of
educational
institution
Type of
education
Type of
health
professionals
being trained
Physiotherapy
programme
Nicosia University Undergraduate
education
Physical
therapists
Czech Republic
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy Universities Undergraduate education
Physical therapists
Physiotherapy Charles University first
faculty of Medicine
Undergraduate
education
Physical
therapists
Physiotherapy Faculty of Medicine Masaryk University Brno
Undergraduate education
Physical therapists
Physiotherapy Palackyacute University Faculty of Physical Culture Department of Physiotherapy
Postgraduate education
Physical therapists
General Nursing Masaryk University Undergraduate education
Nurses
Prakticky zubni lekar (Practical Dentist)
Czech Dental Chamber Continuous professional education
Medical specialists
Health Promotion Ministry of Health Czech Republic
Continuous professional education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
60
Denmark
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Musculoskeletal physiotherapy
Aalborg University Postgraduate education
Physical therapists
Master in Physiotherapy University of Southern Denmark
Postgraduate education
Physical therapists
The Fairstart Foundation The Fairstart Foundation
Continuous professional education
Orphanage staff (each orphanage has
professional staff such as psychologists social workers
andor therapists
These staff members are responsible to work with each child on an individual basis) School
teachers Psychologists Social workers
Bachelor in Physiotherapy University College North Denmark
Undergraduate education
Occupational therapists
Nurses
Bachelorrsquos degree Programme of Physiotherapy
VIA University college Postgraduate education
Physical therapists
Master of Public Health Aalborg University Undergraduate education
Midwives Nurses Therapists Psychologists Medical Specialists
Estonia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Nursing (general nursing) Tartu Health Care College
Undergraduate education
Nurses
Psychology University of Tarty Institute of Psychology
Undergraduate education
Psychologists
Finland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
NutritionNutrition therapy University of Eastern Finland
Postgraduate education
Clinical nutriontinists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
61
Masterrsquos programme of Human Nutrition and food-related behaviour
University of Helsinki Undergraduate education
Nutrition experts who work in eg community
health promotion
Master of Healthcare advanced practice ndash supporting self-care and
care of non-communicable diseases
Savonia University of Applied Sciences
Postgraduate education
Physical therapists Occupational
therapists Nurses
Public Health Nursing Metropolia University of Applied Sciences
Postgraduate education
Public Health nurse
Medical doctors training programme
University of Helsinki medical faculty
Undergraduate education
Medical doctors Nursing
Master degree in Health Management Psychologists
Dentists
Dental education University of Helsinki Faculty of Medicine Department of Oral and Maxillofacial Diseases
Undergraduate education
Dentists
France
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Occupational therapy school Croix Rouge Franccediloise Postgraduate education
Occupational therapists
Institut Reacutegional de Formation en Ergotheacuterapie
Association Saint Franccedilois dAssise
Postgraduate education
Occupational therapists
Occupational therapy Institut de formation en Ergotheacuterapie de Berck-sur-Mer site de Loos
Postgraduate education
Occupational therapists
Occupational therapy IFE Assas Undergraduate education
Occupational therapists
Arrecircteacute du 5 juillet 2010
relatif au diplocircme drsquoEacutetat drsquoergotheacuterapeute
Institut de Formation
en Ergotheacuterapie du CHU Rouen Normandie
Undergraduate
education
Occupational
therapists
Occupational therapy school Croix Rouge Francaise Postgraduate education
Occupational therapists
Occupational therapy UPEC Postgraduate
education
Occupational
therapists
Diplocircme de Dieacuteteacuteticien IUT biologie ou BTS dieacuteteacutetique
Postgraduate education
Dietitians
Programme deacuteducation et de promotion agrave la santeacute
CoDEPS 13 Continuous professional education
Nurses Psychologists Dentists Social workers
Public health Universiteacute de Bourgogne
Postgraduate education
Medical doctors
Public health Lyon University Undergraduate education
Medical specialists
Public health residency Faculty of medicine University of Nantes
Undergraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
62
Name of educational programme
Name of educational institution
Type of education
Type of health professionals being trained
Master in Public Health Karolinska Institute Postgraduate education
Occupational therapists Social Workers
Public health and social
medicine
Universiteacute Versailles
Saint Quentin en Yveline
Continuous
professional education
Medical doctors
Public health UFR sciences de santeacute - Universiteacute de Bourgogne
Postgraduate education
Medical doctors Medical specialists
Midwives Physical therapists
Nurses General practitioners
Germany
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Visceral Surgery Augsburg University Continuous professional education
Medical specialist Physical therapists
Occupational therapists
Nurses Social workers
Human Medicine ndash The
cologne model study course (human medicine)
University of Cologne
Medical faculty
Undergraduate
education
Medical
specialists
Greece
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy University of Thessaly Undergraduate education
Physical therapists
Oral education programme
for children via experiential learning
Hellenic Dental
Association-Dental School of Athens-Hellenic Society of Paediatric Dentistry
Continuous
professional education
Psychologists
Dentists
Sports Nutrition International Hellenic University
Postgraduate education
Dieticians
Preventive Dentistry National and
kapodistrian University of Athens school of dentistry
Undergraduate
education
Undergraduate
students
Nutrition amp Dietetics International Hellenic University
Postgraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
63
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicine ndash under and post graduate studies
School of health sciences University of Patras
Undergraduate education
Medical doctors
Pharmacy diploma Aristotle University of
Thessaloniki
Undergraduate
education
Pharmacists
Hungary
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Public Health and Preventive
Medicine
Semmelweis University
Budapest Faculty of
Medicine Department of Public Health
Undergraduate
education
Medical doctors
Academic programme of Medicine
Semmelweis University Faculty of Medicine
Undergraduate education
Medical doctors
Residency in Preventive Medicine and Public Health
Semmelweis University Postgraduate education
Medical specialists
Ireland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Social Science in
Social Work
Maynooth University
(national University of Ireland Maynooth)
Postgraduate
education
Social workers
Information not provided Information not provided
Undergraduate education
Physical therapists
Professional Master of Physiotherapy
University College Dublin
Postgraduate education
Physical therapists
Bachelor Physiotherapy University College Dublin
Undergraduate education
Physical therapists
Bachelor Physiotherapy RCSI Undergraduate education
Physical therapists
Irish Dental Association Irish dental association Continuous professional
development
Dentists
Public Health Medicine Royal College of Physicians in Ireland
Postgraduate education
Medical specialists
Higher specialist training in Public Health Medicine
Royal College of Physicians in Ireland
Postgraduate education
Medical doctors Medical specialists General practitioners
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
64
Italy
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Healthy Lifestyles CNAI ndash Italian Nurses association
Continuous professional education
Nurses
Management for Health Professionals
University of Rome Postgraduate education
Midwifes Physical therapists Nurses
Corso di laurea in Terapia occupazionale (Bachelor in Occupational therapy)
Universitagrave degli Studi di Milano (State University of Milan)
Undergraduate education
Occupational therapists
Life Sciences University of Catania
School of Medicine
Continuous
professional
education
Medical doctors
Medical
specialists Physical therapists Occupational therapists Nurses
Dentists
Health promotion University of pavia Undergraduate education
Nurses
Corso di Laurea Magistrale
in Odontoiatria e Protesi Dentaria
Universitagrave di Parma Undergraduate
education
Dentists
Hygiene preventive medicine and public health
Universitagrave Cattolica del Sacro Cuore
Postgraduate education
Medical doctors Medical
specialists
general practicioners
Igiene e Medicina Preventiva Universitagrave degli Studi dellrsquoAquila
Postgraduate education
Medical doctors non-specialized
Post graduate school of Public Health
University of Sienna Postgraduate education
Medical doctors
Hygiene and Public Health University of Bari Aldo Moro
Postgraduate education
Medical doctors
School of specialization in Hygiene and Preventive Medicine
University of Milan Postgraduate education
Medical doctors
Lithuania
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Health Education and Promotion
Klaipeda State University of Applied sciences
Undergraduate education
Dietitians Physical therapists Nurses Dentists Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
65
Latvia
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Dentistry Riga Stradins University Undergraduate education
Dentists General practicioners
Professional Bachelor programme Physiotherapy
LASE Postgraduate education
Physical therapists
Physiotherapy Riga Stradins University Undergraduate education
Physical therapists
Malta
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Bachelor in Nursing Studies University of Malta Faculty of Health Sciences department of Nursing
Undergraduate education
Nurses
FHs University of Malta Undergraduate education
General practitioners
Netherlands
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Occupational Therapy Information not provided
Undergraduate education
Occupational therapists
Lifestyle and Healthcare Amsterdam University Medical Centre
Undergraduate education
Medical students
Portugal
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
PhD in Social Work ISCTE University Institute of Lisbon
Postgraduate education
Social workers
Bachelor degree in
Physiotherapy
Escola Superior de
Sauacutede de Santa Maria
Undergraduate
education
Physical
therapists
Physiotherapy IPC ESTeSC Coimbra Health school
Undergraduate education
Physical therapists
Licenciatura em Fisioterapia Escola Superior de Sauacutede - Instituto Politeacutecnico do Porto
Undergraduate education
Physical therapists
Degree in Physical therapy Instituto Piaget ndash Vila Nova de Gaia
Undergraduate education
Physical therapists
Degree in Physical therapy ESSATLA Continuous professional development
Physical therapists
Curso Licenciatura em Fisioterapia
Instituto Politeacutecnico de Sauacutede do Norte Escola Superior de Sauacutede do Vale do Ave CESPU
Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
66
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Clinical Education University Fernando Pessoa- Faculty of Health Sciences
Continuous professional development
Workers factory
Physiotherapy (Bachelor) School of healthy-
polytechnic institute of Setubal
Undergraduate
education
Physical
therapists
Physiotherapy Escola Superior De Sauacutede Do Vale Do Sousa do Instituto
Politeacutecnico De Sauacutede Do Norte
Undergraduate education
Physical therapists Nurses
Psychologists Dentists
Public Health ARSLVT Postgraduate
education
Medical
specialists
Information not provided Information not provided
Postgraduate education
Physical therapists
Information not provided Information not provided
Undergraduate education
General practicioners
Romania
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Nursing Education University Lucian Blaga Postgraduate education
Nurses
MedicinePharmacy - Health University of Oradea Faculty of medicine and
pharmacy Oradea
Postgraduation education
Medical doctors Medical
specialists Pharmacists Physical therapists Nurses
Dentists General practicioners
Slovakia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Social Work Constantine the philosopher University in Nitra
Postgraduate education
Social workers
Specialisation study in Clinical Psychology
Comenius University in Bratislava Faculty of
Arts
Continuous professional
development
Medical specialists
psychologists
Slovenia
Name of educational
programme
Name of educational
institution
Type of
education
Type of health
professionals being trained
Physiotherapy Alma Mater Europaea Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
67
Physiotherapy University of Novo mesto Faculty of Health sciences
Undergraduate education
Physical therapists
Faculty of health sciences University of Primorska Continuous professional education
Dietetics Physical therapists Occupational therapists Nurses
Nursing Applied Kinesiology Physiotherapy and Nutritional counselling ndash dietetics
University of Primorska Faculty of Health Sciences Slovenia
Undergraduate education
Nutrional counselling Kinesiologists Physical therapists Nurses
Professional higher education study programme 1st cycle degree occupational
therapy
University of Ljubljana faculty of health sciences
Undergraduate education
Occupational therapists
Applied Kinesiology UP FVZ Undergraduate
education
Kinesiology
Physiotherapy Alma mater Europaea ndash Evropski center Maribor
Undergraduate education
Physical therapists
Bachelor in Physiotherapy University of Ljubliana Faculty of health sciences
Undergraduate education
Physical therapists
Health Promotion Angela Boskin Faculty of healthcare
Postgraduate education
Physical therapists Occupational
therapists nurses
1st Bologna cycle study programme Physiotherapy
Angela Boskin Faculty of healthcare
Undergraduate education
Physical therapists
Public Health Medical
Residency
Medical chamber of
Slovenia
Continuous
professional development
Medical doctors
Public Health National institute of public health of the
Republic of Slovenia
Postgraduate education
Medical doctors
Psychology Faculty of arts University of Maribor
Postgraduate education
Psychologists
Spain
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Human Nutrition and Dietetics
University of Zaragoza Undergraduate education
Dieticians
Continuous professional
education
Nurses
Physiotherapy University of Coruna Undergraduate education
Physical therapists
EHEA Degree in Human Nutrition and Dietetics
Blanquerna School of Health Sciences ndash Universitad Ramon Lull
Undergraduate education
Dietitians
Bachelor in Pharmacy Universidad de Sevilla Undergraduate
education
Pharmacists
Continuous professional development
Spanish General Council of Social Work
Continuous professional education
Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
68
Bachelor in Pharmacy Universidad de Alcala Undergraduate education
Pharmacists
Bachelor in Medicine Faculty of medicine University of Cadiz Spain
Undergraduate education
Medical doctors General practitioners
Residency in Preventive Medicine and Public Health
Hospital Clinic de Barcelona
Postgraduate education
Nurses
Bachelor in Medicine Information not provided
Undergraduate education
Medical doctors
MasterBachelor in Pharmacy
University of Navarra Undergraduate education
Postgraduate education
Pharmacists
Human Nutrition and Dietetics
Univeristy of Navarra Undergraduate education
Nutritionists amp Dietitians
Pharmacy Universitad Ramon Lull
Undergraduate education
Pharmacists
Pharmacy IQS ndash FCSB Undergraduate education
Pharmacists
Master in Advanced Therapies and Innovation in Biotechnology
Universidad de Francisco de Vitoria
Postgraduate education
Pharmacists
Pharmacy Universidad of the Basque County
Undergraduate education
Pharmacists
Sweden
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master programme in Public Health
Karolinska institute Postgraduate education
Occupational therapists
Social workers
Dietetics programme Department of food and Nutrition
Undergraduate education
Dietician
Dietetics programme Department of food studies dietetics and nutrition
Undergraduate education
Dietician
Programme in Dietetics University of Gothenburg
Sahlgrenska Academy
Undergraduate education
Dietician
Master of Public Health Department of public health and caring sciences Uppsala University
Postgraduate education
Medical doctors Bachelor of science Physical
therapists Nurses Psychologists Dentists Social workers
United Kingdom
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor (Hons) Occupational Therapy
Northumbria University Undergraduate education
Occupational therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
69
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master (pre reg) Occupational Therapy
Master in Occupational Therapy
Leeds Beckett University
Postgraduate education
Occupational therapists
Bachelor (Hons) Occupational Therapy
St Georgersquos University of London
Undergraduate education
Medical doctors Medical specialists Physical therapists
Occupational therapists
Bachelor (Hons)
Occupational Therapy
Caterburry Christ
Church University
Undergraduate
education
Occupational
therapists
Bachelor (Hons) Occupational Therapy Master in (pre-reg) Occupation Therapy Occupational Therapy degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Public Health speciality training
Health education England -north west
Postgraduate education
Medical doctors Medical specialists Researchers Nurses
Bachelor in (Hons) Occupational Therapy Master in (Pre-reg)
Occupational Therapy Occupational Therapy
Degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Additional countries
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Bachelor of Physiotherapy University of Prishtina Kosovo Albania
Postgraduate education
Physical therapists
Physiotherapy Faculty of health studies University of Sarajevo Bosnia-Herzegovina
Undergraduate education
Physical therapists
Fysioterapeututdanning NTNU Norway Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy BFH
Berner Fachhochschule BFH Bern University of Applied Sciences Swiss
Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy
ZHAW Zurich University of applied sciences Swiss
Undergraduate education
Physical therapists
Physical Therapy Sciences University of Iceland
School of Health Sciences
Undergraduate
education
Physical
therapists
Medicine International school of medicine Kazachstan
Undergraduate education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
70
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicinesingle-cycle degree programme
University of Georgia Republic of Georgia
Medical doctors Psychologists General practicioners
Medicine Akaki tsereteli state University Republic of Georgia
Postgraduate education
Medical doctors Medical specialists Physical therapists Psychologists
Dentists General
practicioners
Public Health and Epidemiology
David tvildiani medical University Republic of
Georgia
Postgraduate education
Medical doctors
Biomedical and Healthcare Science doctoral programme
David tvildiani medical University Republic of Georgia
Postgraduate education
Medical doctors Biomedical Science master degree holders
Medicinesingle-cyle degree programme
University of Georgia Republic of Georgie
Undergraduate education
Medical doctors
Public Health Tbilisi State Medical University (TSMU)
Republic of Georgia
Undergraduate education
Medical doctors and public
health specialists
David tvildiani Medical
University
David tvildiani Medical
University Republic of Georgia
Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
71
ANNEX 2 COMPETENCY PROFILES PER PROFESSIONS
Undergraduate medicine
The CanMEDS framework is worldwide the most commonly used and adapted model that
identifies and describes the abilities physicians require in order to effectively meet the
health care needs of the people they serve72 Within European Member States modifications
of this model are used within health and educational settings (for example in the
Netherlands and Finland) for undergraduate medicine and medical specialisations The
CanMEDS model defines seven roles of the physician namely (1) medical expert (the
integrating role) (2) communicator (3) collaborator (4) leader (5) health advocate (6)
scholar and (7) professional73 The role of health advocate is defined as physicians
contributing their expertise and influence as they work with communities or patient
populations to improve health ldquoimproving health is not limited to mitigating illness or
trauma but also involves disease prevention health promotion and health protection
Improving health also includes promoting health equity whereby individuals and
populations reach their full health potential without being disadvantaged by for example
race ethnicity religion gender sexual orientation age social class economic status or
level of educationrdquo Within this role two key competencies are defined74
1 Respond to an individual patientrsquos health needs by advocating with the patient within
and beyond the clinical environment
a Work with patients to address determinants of health that affect them and their access
to needed health services or resources
b Work with patients and their families to increase opportunities to adopt healthy
behaviours
c Incorporate disease prevention health promotion and health surveillance into
interactions with individual patients
2 Respond to the needs of the communities or populations they serve by advocating with
them for system-level change in a socially accountable manner
d Work with a community or population to identify the determinants of health that affect
them
e Improve clinical practice by applying a process of continuous quality improvement to
disease prevention health promotion and health surveillance activities
f Contribute to a process to improve health in the community or population they serve
In addition the European Thematic Network project MEDINE (2004-2007) and Tuning
Project (Medicine) under its auspice (MEDINE) have generated and gained widespread
consensus on a set of competences for primary medical degree qualifications in Europe
(ie undergraduate medicine)75 Within this project it is stated that graduates in medicine
72 httpwwwroyalcollegecarcsitecanmedscanmeds-framework-e 73 httpwwwroyalcollegecarcsitecanmedsabout-canmeds-e 74 httpwwwroyalcollegecarcsitecanmedsframeworkcanmeds-role-scholar-e 75 httptuningacademyorgmedine-medicinelang=en
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
72
would need the ability to ldquopromote health engage with population health issues and work
effectively in a health care systemrdquo76 The following points define health promotion
bull provide patient care which minimises the risk of harm to patients
bull apply measures to prevent the spread of infection
bull recognise own health needs and ensure own health does not interfere with
professional responsibilities
bull conform with professional regulation and certification to practise
bull receive and provide professional appraisal
bull make informed career choices
bull engage in health promotion at individual and population levels
Medical specialist
The European Union of Medical Specialists (UEMS) contributed significantly to the
improvement of post-graduate training through the development of a European Curriculum
in each medical speciality as well as the elaboration of training standards77 Within this
section we provide a detailed description of the European training requirements for a
selection of medical specialists including sports medicine public health internal medicine
cardiology psychiatry and the general practitioner78 This selection was based on the fact
that within these specialities lifestyle might be an essential component or important part of
the treatment of chronically ill patients
1) Medical specialist sports medicine
Sports medicine is defined by the European Commission as a ldquomultidisciplinary clinical and
academic speciality of medicine dealing with health promotion for the general population
by stimulating a physically active lifestyle and diagnosis treatment prevention and
rehabilitation following injuries or illnesses from participation to physical activities
exercises and sport at all levelsrdquo79 As health promotion and prevention are both
incorporated in the definition of sports medicine these topics are included throughout the
whole curriculum of sports medicine The curriculum of sports medicine aimed to provide
theoretical understanding and practical skills to provide first line clinical services80 Within
the training requirements for the speciality of sports medicine it is stated that sports
medicine does not solely take care for sporting elite athletes but as well for its important
role to promote exercise as a medical tool meant for patients with chronic diseases81
bull Theoretical knowledge aims to provide theoretical understanding and practical skills to
provide first line clinical services
- Clinical To provide pre-participation clinical screening and examination before
exercise and competition as well as medical assistance to the athletes engaged in all
sports
76
httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNLearning_Outcomes_Competences_for_Undergraduate_Medical_Education_in_Europepdf
77 httpswwwuemseu__dataassetspdf_file00111415906pdf 78 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 79 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 80 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 81 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
73
- Public health
bull As part of a multi-disciplinary team to encourage and promote physical activity as
a lever for healthy living
bull To identify impediments to an active lifestyle and work within a multi-disciplinary
framework to remove those impediments or minimize their impact
bull To work alongside local health authoritiespublic health clinicians developing
exercise opportunities for the general public for health gain
bull To liaise with public (local authoritieseducationvoluntary) and private sector to
advise on the health aspects of exercise programmes for physical activity of special
groups like women children adolescents and aging population
bull Practical and clinical skills
bull To foster the integration of knowledge and practical skills acquired during the
cardiology orthopaedics physical amp rehabilitation medicine general practice
medicine and physiology internships
bull To learn to put into practice information gained in the relevant course work
bull To extend and deepen their knowledge in the assessment of fitness such as
isokinetic and functional muscle performance cycle ergometry and treadmill
ergometry
bull To gain experience in the use of such test results in the decision making with regard
to diagnosis recommendations and therapy for people of both gender and in
different age groups and performance levels
bull With regard to elite sport trainees will learn how to diagnose treat and prevent
overtraining and overexertion
bull To become proficient in activities related to for example hygiene and nutrition
and will work closely with trainers athletes physiotherapists officials etc
bull Competencies
bull Clinical and instrumental assessment to determine the pathophysiology
mechanisms and the underlying diagnosis of the patientrsquos condition
bull Trainees are expected to complete evidence of reflective practice through case
reports and other experiences in their training record
bull Other self-directed work will be planning data collection analysis and presentation
of audit and research work
bull The mandatory training record (hand written diary or preferably electronic
logbook) will contain evidence of academic pursuits and should be checked and
documented regularly by the Supervisor
bull Trainees will take part and be able to lead in teaching and will be expected to
develop skills to teach undergraduates postgraduates and non-medical staff in
small groups and formal lectures making personal presentations using a variety of
audiovisual methods
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
74
bull They will be expected to present at journal clubs and make case presentations at
grand rounds or similar settings
bull They will be expected to undertake personal audit and research and make
presentations of their findings at clinical meetings
bull Prescription as much evidence-based as possible of medical and physical
treatments (including drug treatment physical modalities innovative
technologies natural factors and others) as well as of technical aids
bull Prevention and management of complications
bull Skill to perform and participate in research
2) Medical specialist public health
The European Commission defines public health ldquoas the science and art of preventing
disease prolonging life and promoting mental and physical health and efficiency through
organized community effort Public health may be considered as structures and processes
by which the Health of the population is understood safeguarded and promoted through
the organized efforts of societyrdquo82 Public health specialists aim to improve populationrsquos
health by using the following skills and competencies
bull Theoretical knowledge on a range of fields including epidemiology prevention health
promotion public health research behavioural sciences health programme evaluations
health need assessments and quality and safety in healthcare
bull Practical and clinical skills
- Surveillance and evaluation of the health of the population (trained in epidemiology)
- Planning and evaluation of health services and public health control
- Analysing the health of the population (analysing determinants on individual and
community levels)
- Plan participate in or evaluate preventive and control programmes (public health
assessments)
- Participate in multidisciplinary health impact assessment
- Inform decision-makers about potential impacts and to identify appropriate and
sustainable actions to manage those effects (including environmental determinants
of health)
- Organisational issues in healthcare (participating in policy and strategic development
quality and safety management)
- Generate and share new evidence on the ways in which social determinants influence
population health and health equity
- Sufficient linguistic ability to communicate with hisher public health colleagues
82 httpswwwuemseu__dataassetspdf_file001198435UEMS-201924-European-Training-
Requirements-for-Public-Healthpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
75
- Develop high professional ethical standard including respect towards human rights
participants in public health programmes colleges and other professionals in the
team
bull Competencies
- Establish the expertise role as a Public Health Physician
bull Function as public health leaders and consultants to health services and other
organizations and institutions in order to provide safe appropriate cost effective
and equal health care to groups communities and populations
bull Establish and maintain medical knowledge skills and attitudes appropriate to their
practice including the organization and financing of health care public health
control and public health law
- Perform expertise analyses of the health of the population
bull Apply and combine medical and epidemiological competencies for the surveillance
and evaluation of the health of the population
bull Identify the determinants of health of populations and risks for public health and
implications for interventions and policy
bull Evaluate health problems biopsychosocial mechanisms andor health care issues
for different population groups and their implications for the community
bull Critically evaluate epidemiological demographic health statistical and
environmental pollution data and their sources and apply them appropriately to
public health issues
bull Identify community health needs and advise about their implications for public
health and medical care services
- Lead and supervise public health interventions
bull Select develop implement and monitor public health surveillance and
interventions namely in the areas of human behaviour social and physical
environment food safety and nutrition health care associated risks and working
life related health
bull Promote the health of individuals communities and populations through health
programming
bull Contribute to the organization and evaluation of societal and health care
programmes aiming to promote health and social functioning among individuals
with long-term diseases and disabilities
bull Contribute to the planning organization supervision of and evaluation of societal
and health care programmes promoting the health of specific target groups such
as children elderly and vulnerable and underserved groups in society
bull Contribute to the organization of and evaluate primary and secondary medical
prevention programmes
bull Contribute to strengthening regulatory frameworks for protecting and improving
health
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
76
- Function as expertise in planning and evaluation of Public Health and Medical Care
bull Evaluate Public Health and other service programmes concerning processes and
outputs from the different perspectives of care seekers professional health care
workers and health managers
bull Analyse and differentiate between need demand and supply and assess the health
of a defined population and identify areas for improvement including the allocation
of health care resources delivery
bull Evaluate the outcome quality and safety of care and promote quality development
systems based on evidence and public health principles
bull Apply health economic principles and methods such as cost-effectiveness cost-
utility and cost-benefits considering the strengths and weaknesses of different
methods
bull Use methods to determine priorities and their strengths and weaknesses and
promote awareness of the competing and conflicting influences on public and
political perceptions of the need for health care and the resulting constraints on
action
bull Promote and evaluate collaboration between health services and other welfare
organizations in society
bull Evaluate and contribute to the policy and strategic development in health care
planning
bull Contribute to the planning and evaluation of different sectors of society by health
impact assessments and public health medical reports and consultations
- Communicate and develop public health medical expertise
bull Lead supervise and participate in an interprofessional health care team
bull Consult other (health) professionals and policymakers and recognise the
advantages and limits of their expertise
bull Effectively convey oral and written information about public health issues including
adequate public health reporting and effective interaction with media
bull Stimulate and motivate others so that they recognise the importance of the public
health population perspective
bull Maintain and enhance professional activities through ongoing learning and
research and contribute appropriately to the generation dissemination application
and translation of new public health knowledge and practices
3) Medical specialist internal medicine
The UEMS defines an internist as ldquoa physician trained in the scientific basis of medicine
who specialises in the assessment diagnosis and management of general medical
problems atypical presentations multiple problems and consequential complex health
issues and system disorders (Professional) The physician is skilled in the management of
acute unselected medical emergencies and the management of patients in a holistic and
ethical way considering all psychosocial as well as medical factors for enhancing quality of
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
77
life The physician values the continuing care of all patients irrespective of the nature of the
patients complaint and is committed to lifelong continued professional development
(Scholar) The physician practices clinical audit and evidence-based medicine The
physician functions in a number of roles including clinical counselling educating leading
and managingrdquo83
Internists have a fundamental role in modern healthcare systems Within the definition of
the internist the shift towards a preventive strategy focusing on health promotion is
highlighted by the acknowledgement of the high prevalence of chronic and complex
diseases that are associated with the lifestyle of ageing western societies The role of
healthcare advocate (a role defined in the CanMED framework) is an important part of the
internistrsquos function and forms the generic competencies of an internist (see section 11)
However lifestyle promotion and disease prevention is not a specific area of expertise
Specific areas of the internist include multi-morbidity and ageing acute care medical
consultation shared-decision-making collaborative care transition in care vulnerable
adult patient safety and quality of care and medical leadership
4) Medical specialist cardiology
According to the training requirements for the speciality of cardiology84 training in
cardiology should be based on the syllabus of the ESC core Curriculum for the general
cardiologist part 2 ldquothe core curriculum per topicrdquo85 The necessary core cardiology
competencies are set out as cardiology learning objectives with the knowledge skills
attitudes and competencies needed to fulfil the objectives One of the core cardiology
competences is cardiovascular prevention aiming to
bull Assess and manage patients with risk factors for cardiovascular disease
bull Understand the mode of action of different prevention methods
bull Describe cardiovascular disease and risk factors in the local community
bull Contribute to the global efforts in reducing cardiovascular morbidity and mortality
by communicating the prevention message to the public
bull To approach prevention in a holistic way understanding the potentiation of
cardiovascular risk by clustering of risk factors
bull
Knowledge
bull Epidemiology of cardiovascular disease in the local community incidence
prevalence survival
bull Risk factors in the local community
83 httpswwwuemseu__dataassetspdf_file001744450UEMS-201613-European-Training-
Requirements-Internal-Medicinepdf 84 httpswwwuemseu__dataassetspdf_file001119577UEMS-201324-SECTIONS-AND-BOARDS-
Cardiology-European-Training-Requirements-20131019pdf 85 httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_
9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
78
bull Risk assessment in primary prevention multifactorial risk interaction and use of
risk scoring charts
bull The impact of lifestyle on people at risk of and patients with cardiovascular
disease
bull The potential of lifestyle changes to prevent and ameliorate cardiovascular
disease diet and nutrition toxic habits (smoking alcohol and others) physical
activity
bull Emerging risk factors (social economic stress depression and personality type)
bull Treatmentprevention strategies for major risk factors and changes in lifestyle
including corresponding pharmacologic therapies
bull The comprehensive approach required for multiple risk factors
bull Patient compliance
In addition the main objectives and knowledge competence are further specified by
hypertension dyslipidaemia diabetes and lifestyle
Skills
bull obtain a relevant history and perform an appropriate clinical examination
bull evaluate cardiovascular risk and assess global cardiovascular risk at the individual
level
bull evaluate cardiovascular risk at population level (mortality morbidity disability)
bull evaluate the benefit of prevention at individual and population levels
bull manage risk factors appropriately including pharmacological and non-
pharmacological therapies
bull communicate their importance to patients their families and the wider
community including smoking cessation diet and exercise
bull communicate the importance of patient compliance and behaviour
bull motivate patients and families to change lifestyles and be compliant with
prescriptionsrecommendations
bull monitor patient compliance and behaviour
bull evaluate the benefit of risk factor intervention for the individual patient
Behaviours and attitudes
bull Non-judgemental attitude to patients regarding their lifestyle (eg smoking diet
etc)
bull Exemplify appropriate lifestyle in personal behaviour
bull Team working with other physicians including general practitioners
diabetologists nephrologists and elderly care physicians for the management of
specific risk factors
bull Team working with all professionals with a role in primary and secondary
prevention (nurses dieticians teachers and politicians)
Another core competency is the physical activity and sport in primary and secondary
prevention Further defined in sports cardiology and cardiac rehabilitation
Sports cardiology aiming86
86
httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
79
bull To conduct strategies to implement healthy lifestyle in particular physical and
sports activities in the general population (primary prevention)
bull To evaluate cardiovascular risk and exercise capacity (see Chapters 22 and
271)
bull To recognize the characteristics of the athletersquos heart
bull To appropriately detect contraindications to exercisecompetition and
appropriately provide non-contraindication certificates
Knowledge
bull Exercise and sports physiology
bull Benefits of exercise training
bull Safety issues in exercise and sport
bull Diagnostic criteria and appropriate investigations in athletes with cardiovascular
disease
bull Risk factors for and mechanisms of sudden cardiac death (SCD) during and after
strenuous exercise
bull Specific population challenges and exercise programmes in appropriate settings
bull Recommendations for professional and recreational sports participation
bull SCD in patients athletes and in the population at large and
bull Mechanisms of action of illicit drugs
Skills
bull perform an individual CVD risk assessment using appropriate information from
history laboratory assessment including full lipid profile and clinical data
bull recognize pathological cardiovascular changes and differentiate them from the
characteristic features of lsquoathletersquos heartrsquo and
bull use prevailing recommendations for eligibility for participation in competitive
sports
Behaviours and attitudes
bull Recognition of the role of active lifestyle exercise and sport in the promotion of
health and in the prevention of the most threatening diseases including
cardiovascular diseases
Cardiac rehabilitation aiming
bull To evaluate and manage cardiovascular risk
bull To evaluate exercise capacity and causes of exercise intolerance
bull To provide appropriate rehabilitation and secondary prevention to patients with
cardiovascular diseases
7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
80
Knowledge
bull Multi-disciplinary risk factor intervention
bull Definition of comprehensive cardiovascular prevention and rehabilitation
bull Effects of behavioural change including physical activity nutrition education and
psychosocial risk factors on quality of life cardiovascular risk and outcome
bull Rehabilitation as a component of cardiac care and a promoter of secondary
prevention
bull Target populations and risk stratification of patients
bull Psychological aspects of rehabilitation and exercise practice
Skills
bull take a relevant history and perform an appropriate clinical examination including
the specific evaluation of the elderly patient
bull perform and interpret risk stratification using indicated tests
bull interpret a cardiopulmonary exercise test and distinguish different causes of
exercise limitation
bull prescribe exercise-based rehabilitation programmes and other lifestyle
interventions according to the patientrsquos condition in collaboration with other
specialists when necessary and
bull motivate the patient to ensure long-term adherence to lifestyle changes and
continuing exercise programmes
Behaviours and attitudes
bull rehabilitation as a component of cardiac care
bull the importance of rehabilitation and secondary prevention for professional
personal and social life among patients with heart disease
bull the interplay of physical and psychological aspects of heart disease and the
positive influence of exercise on cardiovascular risk factors
bull the role of other professionals including nurse specialists physiotherapists ergo
physiologists psychologists dieticians and general practitioners in rehabilitation
and secondary prevention and
bull the importance of patient and family education and the role of other professionals
in rehabilitation
5) Medical specialist psychiatry
The UEMS has issued a charter of requirements for the training in psychiatry in 2000 with
an additional European Framework for Competencies in Psychiatry in 2009 The learning
outcomes in the European Framework for Competencies in Psychiatry (EFCP) are arranged
under the seven physician roles derived from the CanMEDS framework87 Within the EFCP
it is stated that ldquopsychiatrists recognise the importance of advocacy and health promotion
in responding to the challenges represented by those social environmental and biological
factors that determine the mental health and well-being of patients and society They
recognise advocacy as an essential and fundamental component of mental health promotion
that occurs at the level of the individual patient the practice population and the broader
communityrdquo
Competencies
87 httpuemspsychiatryorgwp-contentuploads2013092009-Oct-EFCPpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
81
bull identify the determinants of mental disorder as well as the factors that may
contribute to positive mental health so as to be able to prevent disorder and
promote mental health
- recognise the determinants of mental health of populations and how public
policy including legislation impacts on mental health
- promote positive mental and physical health in patients particularly in those
with severe mental disorder based on best evidence
- recognise the impact of mental disorder on families and carers and take
remedial measures
- collaborate with other community sectors to promote mental health and
prevent mental disorder at all levels focusing particularly on family school and
workplace
- identify and address barriers and inequity in access to care particularly for
vulnerable or marginalised populations
bull Identify and address issues and circumstances when advocacy on behalf of
patients professions or society is necessary
- respect and promote the human rights of people with mental disorders and
collaborate with user and carer associations and advocacy groups
- empower people with mental disorders and their carers
- recognise and address prejudice stigma and discrimination associated with
mental disorder and its treatment
- use strategies to enhance patientrsquos self-management and autonomy
- actively oppose the use of psychiatry for political repression
- recognise the possibility of conflict inherent in their role as a health advocate
for a patient or community with that of manager or gatekeeper
6) General practitioner
The European training requirements for General PracticeFamily Medicine (GPFM) specialist
training88 defined twelve central characteristics of the practice before determining the core
competences Related to health promotion and disease prevention two of these
characteristics are as following ldquopromotes health and well-being both by appropriate and
effective interventionrdquo and ldquohas a specific responsibility for the health of the communityrdquo
The twelve characteristics are clustered into six core competences primary care
management person-centred care specific problem solving skills comprehensive
approach community orientation holistic modelling Under comprehensive approach the
following abilities relate to health promotion and disease prevention
bull to promote health and wellbeing by applying health promotion and disease
prevention strategies appropriately
bull to manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
Furthermore community orientation includes the ability
bull to reconcile the health needs of individual patients and the health needs of the
community in which they live in balance with available resources
88 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
82
In the more comprehensive assessment of GPrsquos performance in daily practice by the
European Academy of Teachers in General PracticeFamily Medicine (EURACT)89 these
abilities are further defined as following
bull To promote health and wellbeing by applying health promotion and disease
prevention strategies appropriate
- Identifies opportunity for health promotion intervention
- Makes use of structured medical record as reminder of preventive activities
- Makes use of teamwork
- Uses communication skills
- Is aware of any personal prejudices which might influence negatively
preventive advice
- Makes recommendations which are feasible in the context of patientrsquos lifestyle
and home situation
- Acts as suitable role model
bull To manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
- Provides appropriate medical management
- Involves members of practice team eg through case conference
- Performsarranges home visit (consider relevant team members) ndash needs
assessment eg cause of falls
- Involves relatives
- Facilitates communication (two-way) with hospital
- Involves external community resources (eg home help etc)
Dentist
According to the profile and competences for the graduating European dentist one of the
major competences for dentists is to improve oral health of individuals families and groups
in the community On graduation a dentist must be competent at promoting and improving
the oral health of individuals families and groups in the community90 Furthermore with
regard to health promotion and disease prevention a dentist
bull Must be competent at
- Applying the principles of health promotion and disease prevention via
comprehensive preventive measures to individuals and the community
according to their risk assessment status
- Understanding the complex interactions between oral health nutrition general
health drugs and diseases that can have an impact on oral health care and
oral diseases
- Providing appropriate dietary advice
bull Have knowledge of
- The organisation and provision of health care in the community and in the
specialist hospital service in the country of training
- The prevalence of the common dental conditions in the country of
trainingpractice
- The social cultural and environmental factors which contribute to health or
illness
- The strategies to overcome barriers to dental care for disabled elderly
socially deprived and ethnic minority groups
- Training auxiliaries in basic skills of oral health promotion
89httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-
documentseuractperformanceagendadC3BCsseldorf2014-openaccessebookversionpdf 90 httpwwwdentuoagrfileadmindentuoagruploadsusefull_filesADEE-competences-2009_enpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
83
In 2017 a new updated framework was published for undergraduate education for dentists
including a revised structure of the educational domains and their areas of competence In
the revised framework health promotion and disease prevention compromises one of the
areas of competence in the domain ldquodentistry in societyrdquo in the educational strategy of a
dentist91 Note Dentists can also specialise in public health in a similar programme as
physicians
Nurses
The training for nurses responsible for general care shall following the Directive
201355EU include a set of eight competences 92 The training for nurses should provide
assurance that the ability of the following knowledge and skills
1 comprehensive knowledge of the sciences on which general nursing is based including
sufficient understanding of the structure physiological functions and behaviour of
healthy and sick persons and of the relationship between the state of health and the
physical and social environment of the human being
2 sufficient knowledge of the nature and ethics of the profession and of the general
principles of health and nursing
3 adequate clinical experience such experience should be gained under the supervision
of qualified nursing staff and in places where the number of qualified staff and equipment
are appropriate for the nursing care of the patient
4 the ability to participate in the practical training of health personnel and experience of
working with such personnel
5 experience of working with members of other professions in the health sector
Competencies 93
6 Competency to independently diagnose the nursing care required using current
theoretical and clinical knowledge as well as to plan organise and implement nursing
care when treating patients on the basis of page the knowledge and skills acquired in
accordance with points (1) (2) and (3) in order to improve professional practice
7 Competency to work together effectively with other players in the health sector including
participation in the practical training of health personnel on the basis of the knowledge
and skills acquired in accordance with points (4) and (5)
8 Competency to empower individuals families and groups towards healthy lifestyles and
self-care on the basis of the knowledge and skills acquired in accordance with points (1)
and (2)
9 Competency to independently initiate immediate measures to pre- serve life and to carry
out measures in crisis and disaster situations
9191 Field JC Cowpe JG Walmsley AD The Graduating European Dentist A New Undergraduate Curriculum
Framework Eur J Dent Educ 201721(Suppl 1)2-10 httpsdoiorg101111eje12307 92 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf 93 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
84
10 Competency to independently advise instruct and support individuals needing care
and their attachment figures
11 Competency to independently ensure the quality of nursing care and assess it
12 Competency to communicate comprehensively and professionally and to cooperate
with members of other professions in the health sector
13 Competency to analyse the quality of care in order to improve their own professional
practice as general care nurses
The competences included in Directive 201355EU are different from the competences
contained in the EFN Competency Framework These competences contain the following
competences on health promotion and disease prevention guidance and teaching
bull To promote healthy lifestyles preventive measures and self-care by strengthening
empowerment promoting health and enhancing behaviours and therapeutic
compliance
bull To independently protect the health and well-being of individuals families or
groups being cared for ensuring their safety and promoting their autonomy
bull To integrate promote and apply theoretical methodological and practical
knowledge This enables the promotion and the development of nursing care in
long term care co-morbidity and in situations of dependency in order to maintain
an individualrsquos personal autonomy and hisher relationships with the environment
in every moment of the healthillness process
Nurse specialist
The European Specialist Nurses Organisation (ESNO) defines the nurse specialist as follows
ldquoThe Nurse Specialist (NS) is an advanced practice Nurse prepared as a specialist within a
clinical specialty at the masterrsquos post masterrsquos or doctoral levelrdquo94 Following the ESNO the
competencies should be considered as a reference template and guidelines for the different
specialities in which each speciality can define its own knowledge skills and attitudes
Generic competencies are the clinical role patient relationship patient teachingcoaching
mentoring research organisation and management communication and teamwork ethic
and decision making leadership and policy making and prevention The competency of
prevention is based on the case for investing in public health from the World Health
Organization95 The competency of prevention is based on the ability of promoting health
and prevent disease by the capacity to develop and put in place intervention in
bull Surveillance of population health and wellbeing
bull Disease prevention at the 3 levels of prevention (primary secondary)
bull Ability to promote health and prevent disease
bull Monitoring and response to health hazards and emergencies
bull Health promotion including actions to address social determinants and healthy
inequities
bull Advocacy communication and social mobilization for health advancing public
health
bull Research to inform policy and practice96
94 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf 95 httpwwweurowhoint__dataassetspdf_file0009278073Case-Investing-Public-Healthpdfua=1 96 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
85
Occupational therapist
The World Federation of Occupational Therapists (WFOT) provided minimum standards for
the education of occupational therapists97 One of the settings in which occupational
therapists work is defined as following ldquoCommunity or group approaches such as health
promotion community development community based rehabilitation injury prevention
environmental design disaster preparation and recoveryrdquo Furthermore under essential
knowledge skills amp attitudes for competent practice the following (could) relate to health
promotion and disease prevention
bull Knowledge about
- The relationship between occupation and human development over the life
course including healthy ageing
- The relationship between psychological social and economic factors and
occupation (eg stress adjustment to life changes including disability
societal disruption natural or man-made disaster displacement)
- Early identification and functional interventions focusing on somatosensory
stimulation and performance mechanisms mitigating early developmental and
environmental factors impacting negatively on behaviour and learning
- How activity limitations and participation in occupation affect health This
includes the ability to maintain a healthy environment and personal factors
such as adjustment interpersonal relationships and social networks
- How health conditions and threats to health affect participation in work
bull Skills in
- Inter-sectoral collaboration in public health initiatives
- Assessing health in relation to occupation
In addition the Tuning programme described the reference points for the design and
delivery degree programmes in occupational therapy98 in which they first ranked subject
specific competency One of the highest ranked included
bull Enable individualsgroupsorganisationscommunities to be engaged in occupation
through health promotion prevention rehabilitation treatment and
coachingtraining
In the final set of subject specific competences however this is mentioned less explicitly
and only the following are related to health promotion and disease prevention
bull Knowledge the occupational therapist is able to
- Work in partnership with individuals and groups using occupation in
prevention rehabilitation and treatment in order to promote participation
health and well-being
- Explain the relationship between occupational performance health and well-
being
- Collaborate with communities to promote and develop the health and well-
being of their members through their participation in occupation
- Develop new knowledge of occupation and occupational therapy practice
particularly in relation to local andor emerging health and social challenges
97 httpswwwwfotorgassetsresourcesCOPYRIGHTED-World-Federation-of-Occupational-Therapists-
Minimum-Standards-for-the-Education-of-Occupational-Therapists-2016apdf 98 httptuningacademyorgwp-contentuploads201402RefOccupationalTherapy_EU_ENpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
86
Pharmacists
In a two-stage large-scale Delphi process fifty competences of pharmacy practice were
ranked and the Quality Assurance in European Pharmacy Education and Training (PHAR-
QA) framework was harmonized and validated99 Of these fifty competences the following
relate to health promotion and disease prevention
bull Ability to promote public health in collaboration with other professionals within the
healthcare system
bull Ability to provide appropriate lifestyle advice to improve patient outcomes
bull (eg advice on smoking obesity etc)
bull Ability to use pharmaceutical knowledge and provide evidence-based advice on
public health issues involving medicines
Physiotherapists
According to the World Confederation for Physical Therapy (WCPT) the scope of physical
therapists practices includes (among others) public health strategies and advocating for
patientsclients and for health100 Furthermore it is described that physical therapists may
have the following purposes
bull promoting the health and wellbeing of individuals and the general publicsociety
emphasising the importance of physical activity and exercise
bull preventing impairments activity limitations participatory restrictions and
disabilities in individuals at risk of altered movement behaviours due to health
factors socio-economic stressors environmental factors and lifestyle factors
The European Network of Physiotherapy in Higher Education (ENPHE) also described
professional competencies of physiotherapists101 According to the ENPHE one of the roles
of a physiotherapist is to be a
bull Health care promotor
- Advocate on health and wellbeing promotion and disease or injury prevention
on behalf of patientclients and the profession to enhance individual
community and public health
- Promote adherence to local regional national and EU health and safety
policies guidelines and protocols
Psychologist
The European Federation of Psychologistsrsquo Associations developed the European Certificate
in Psychology ndash the EuroPsy102 The Tuning programme also published lsquoReference points for
the design and delivery of degree programmes in Psychologyrsquo103 in which they state that
the Tuning programme and the EuroPsy programme have experienced a parallel
development over the last ten years In fact the Tuning document presents a reference
99 httpswwwncbinlmnihgovpmcarticlesPMC5419365 100 httpswwwwcptorgpolicyps-descriptionPT 101 httpwwwenpheorgwp-
contentuploads201910ESCO_report_ENPHE_recommendations_April_2017pdf 102 httpwwwinpa-europsyitmoduliEuroPsy20Regulations20July202011pdf 103httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNPsychology_reference_points
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
87
point for the design and delivery of degree programmes in psychology on the basis of the
EuroPsy programme
Based on the definition of the key role of the professional psychologist health promotion
and disease prevention could be part of the profession as this has been described as
follows to develop and apply psychological principles knowledge models and methods in
an ethical and scientific way in order to promote the development well-being and
effectiveness of individuals groups organisations and society However no specific
competences related to health promotion and disease prevention are now described in the
documents It is plausible though that psychologist do act to promote health as the core
of their profession is to help others to understand behaviour to improve performance and
well-being or to alleviate problems and distress As these emergent specialisms develop in
response to new demands there is a tendency to develop education and training
programmes thus increasing the specialisation and the requirement for specialist skills of
professional psychology
Social worker
Global standards for the education and training of the social work profession are developed
by the International Association of Schools of Social Work (IASSW)104 The IASSW
worldwide association of schools of social work other tertiary level social work educational
programmes and social work educators These global standards include for example
standards regarding the schoolrsquos core purpose or mission statement standards regarding
programme objectives and outcomes standards with regard to programme curricula
including field education The standards with regard to the core curricula are organised into
four conceptual components domain of the social work profession domain of the social
work professional methods of social work practice and paradigm of the social work
profession under which several sub-domains are described which mainly relate to aspects
such as inadequacies discrimination tradition and culture social stability and ethical
principles The following touch upon the field of health promotion and disease prevention
bull Knowledge of human behaviour and development and of the social environment
with particular emphasis on the person-in-environment transaction life-span
development and the interaction among biological psychological socio-structural
economic political cultural and spiritual factors in shaping human development
and behaviour (domain of the social work profession)
bull Sufficient practice skills in and knowledge of assessment relationship building
and helping processes to achieve the identified goals of the programme for the
purposes of social support and developmental protective preventive andor
therapeutic intervention ndash depending on the particular focus of the programme or
professional practice orientation (methods of social work practice)
bull The application of social work values ethical principles knowledge and skills to
promote care mutual respect and mutual responsibility amongst members of a
society (methods of social work practice)
bull Problem-solving and anticipatory socialisation through an understanding of the
normative developmental life cycle and expected life tasks and crises in relation
to age-related influences with due consideration to socio-cultural expectations
(paradigm of the social work profession)
104 httpswwwiassw-aietsorgwp-contentuploads201808Global-standards-for-the-education-and-training-
of-the-social-work-professionpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
88
The European Social Network (ESN) investigated the social services workforce throughout
Europe and provided an overview of qualifications and skills in different Member States in
their research report showing that qualification and skills for social care workers differ per
country105 In fact in some countries there are specific training routes for social care
workers including specialised training courses or apprenticeships and the content of these
trainings depends on the service user group and is generally defined at a local or authority
level A questionnaire was set out in which essential components of social care workers
were identified which showed that health and safety is seen as an important component
of social work
105 httpswwwesn-euorgsitesdefaultfilespublicationsInvesting_in_the_social_service_workforce_WEBpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
89
ANNEX 3 ONLINE SURVEY
Survey Health promotion and disease prevention in health and educational
settings
Health promotion and disease prevention in health and educational settings -
medical schools The European Union has commissioned Ecorys an international
research and consultancy agency to conduct a project on health promotion and
disease prevention in health and educational settings In order to provide an EU
wide overview and to better support national governments we would like to ask
for your cooperation The project will develop an EU wide overview of the
educationtraining programmes for basic education postgraduate education as
well as continuous professional development with regard to education on health
promotion Your help will therefore be key in the collection of information and
data on public health initiatives in medical and non-medical education The survey
will take approximately 20 minutes of your time You do not need to complete this
survey at once You may leave the survey and continue at a later moment in
time Questions can be saved by clicking on the pauze button (below the
questionnaire) When doing so a new URL link will be provided We would be
pleased if you could provide this information by means of an online questionnaire
to Ecorys who is also available in case you have questions or you would like
additional information bull Ms Emalie Hurkmans (Project Coordinator) tel +31
(0)6 280 579 21 email emaliehurkmansecoryscom bull Ms Tessa Huis in lsquot
Veld tel +31 6 29 22 10 58 email tessahuisintveldecoryscom
What is the name of your education
What are the website details of the educationPlease enter the link of the website
with information of the education
Can you give a brief description of the education
What type of health professionals are trained in the education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
90
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
What type of medical specialist
Is the education
Undergraduate education
Postgraduate education
Continuous professional development
Is the course accreditated
Yes
No
Unknown
Does the course cover the topic health promotion and disease prevention
Yes
No
Is the education accreditated
Yes
No
Unknown
Does the education cover the topic health promotion and disease prevention
Yes
No
How is the topic health promotion and disease prevention incorporated in the
curriculum
In a seperate module
Topic incorporated into curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
91
Who is (are) the contact person(s) of the module health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Was there any partnerships in setting up the module health promotion and disease
prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Has the education obtained any funding to set up the module on health promotion
and disease prevention EU funding national public funding local public funding
or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
92
Since when is the module on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the module Eg is it a two weeks one month or one
year programme
What is the typical quantity in hours spend at health promotion and disease
prevention by participants The amount of hours spent on attendence and
homework
Is the module health promotion and disease prevention accreditated separately
No
Unknown
Yes please specify how many points are given
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
93
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the module
No
Unknown
Yes please specify what type of exam
Is the module also provided at other locations For example at other universities
Yes
No
Unknown
Is there a contact person(s)expert for the topic health promotion and disease
prevention
Was there any partnerships in incorporating it in the curriculum
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
94
Has the education obtained funding to incorporate health promotion and disease
prevention into the curriculum EU funding national public funding local public
funding or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is health promotion and disease prevention incorporated into the whole
curriculum eg since September 2017
What is the typical quantity in hours (approximately) spend at health promotion
and disease prevention by participants The amount of hours spent on attendence
and homework
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
95
In what way are knowledge and skills with regard to health promotion and disease
prevention tested in the curriculum For example incorporated into a written exam
Who is (are) the contact person(s) of the course on health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Were there any partnerships in setting up the course on health promotion and
disease prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
business NGOs individual citizens governmental agencies who have a role fill in
yes and add by the partnership in place
No
Yes please specify
Has the education obtained any funding to set up the course on health promotion
and disease prevention
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
96
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is the course on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the course eg two weeks one month or one year
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
97
What is typical quantity in hours spend at health promotion and disease prevention
by participants The amount of hours spent on attendence and homework
Is the course on health promotion and disease prevention accreditated separately
No
Unknown
Yes how many points are given
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the course
No
Unknown
Yes what type of exam
Is the course provided at multiple locations For example at other universities
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
98
What are the general objectives of the teaching activities on health promotion and
disease prevention eg arise awareness among Medical Doctors on the
importance of physical activity within the elderly population with a high risk of
heart failure
Which stakeholders were involved in developing the teaching activities on health
promotion and disease prevention
Is there made use of a mono- or multidisciplinary approach
Monodisciplinairy approach
Multidisciplinary approach
Unknown
Does the education include theories of
1
Yes
2
No
3
Unknown
Population health
Human cognition
and behaviour
Health behaviour
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
99
Does the education include
1
Yes
2
No
3
Unknown
Epidemiology and
bio-statistics
(research
capacity)
Methods of
evidence-based
medicine
Health policies
and regulation
Health economics
Ethics
Health care
systems
Digitalisation in
health promotion
Health inequalities
Disease
prevention in
teams
Health literacy
Health behaviour
change
techniques
Communication
skills
Digital health
coaching
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
100
Concerning teaching methods of health promotion and disease prevention which
methods are used
1
Yes
2
No
3
Unknown
Lectures
Assignments
Field training in real environments
eLearning modules
Other please specify
Concerning covered competencys or capacities of health promotion and disease
prevention the main focus is on
What are the expected outcomes
1
Yes
2
No
3
Unknown
Knowledge
Skills
Behaviour
attitudes
Relevant output (if available) eg number of students following the module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
101
Do you think it is likely you will apply the learned knowledge and skills (on health
promotion and disease prevention) in daily practice after completion of this
education
Yes please specify
No please specify
Not sure please specify
Is there a reason why this education might be a good example for other
educational settings with regard to the way that health promotion and disease
prevention is covered in the education
Are there any remarks Please feel free to give overall remarks or initiative-specific
remarks
Your responses have been registered Thank you for taking the time to complete
the survey your input is valuable to us
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
102
HOW TO OBTAIN EU PUBLICATIONS
Free publications
bull one copy via EU Bookshop (httpbookshopeuropaeu)
bull more than one copy or postersmaps from the European Unionrsquos representations (httpeceuropaeurepresent_enhtm) from the delegations in non-EU countries (httpeeaseuropaeudelegationsindex_enhtm) by contacting the Europe Direct service (httpeuropaeueuropedirectindex_enhtm) or calling 00 800 6 7 8 9 10 11 (freephone number from anywhere in the EU) () () The information given is free as are most calls (though some operators phone boxes or hotels may charge you)
Priced publications
bull via EU Bookshop (httpbookshopeuropaeu)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
9
bull More than half of the respondents indicated that they filled in the questionnaire for
practices in undergraduate educational settings Throughout Europe these
numbers were relatively similar
bull Physiotherapists are the professional group most actively involved in health
promotion training activities The vast majority applies multidisciplinary
approaches and thus brings other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within training programmes In continuous professional development on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion especially target knowledge skills
and behaviour of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for continuous professional
development (33) compared to undergraduate and postgraduate education
where the topic is covered in most modules (15 and 6) Funding was more
often obtained in Northern and Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) Regarding full modules high percentages indicated
that this is mandatory and that there is an exam at the end of the module (81
70 respectively)
Conclusions
The present study provides an overview of current practice on health promotion disease
prevention and lifestyle medicine in the education of health professionals in EU countries
This is an important need-assessment for the exchange of knowledge and expertise among
EU countries All professions have versatile competency profiles in health promotion giving
a good ground for further development As the study results reveal some unbalance in
competencies addressed and methods used a next step could be to support further
development of educational practices in lifestyle medicine and adoption of new
technologies There is room for improvement as well as encouraging volition to share
expertise across professions professional associations universities and countries in the EU
The body of knowledge generated in this study can serve as a basis for further analysis and
contribute to the enhance effectiveness of educational practices of health promotion
disease prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
11
1 INTRODUCTION
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices2 In Europe such chronic diseases as
cancer cardiovascular diseases diabetes and chronic respiratory diseases are giving the
greatest disease burden3 The Global Burden of Disease (GBD) 2016 study estimates that
over 91 of deaths and over 87 of DALYs in the European Union (EU) are the result of
non-communicable diseases (NCDs) of which 61 and 43 respectively can be attributed
to modifiable risk factors4 To a large extent lifestyle factors unhealthy diets tobacco use
harmful use of alcohol and physical inactivity have been identified as the top risk factors
for NCDs in the EU5 The last non-communicable diseases progress monitor 2017 of the
WHO underlines that ldquoNCDs share key modifiable behavioural risk factors like tobacco
use unhealthy diet lack of physical activity and the harmful use of alcohol which in turn
lead to overweight and obesity raised blood pressure raised cholesterol and ultimately
diseaserdquo6 Since NCDs share many related modifiable risk factors and often do not occur in
isolation7 prevention must be integrated into population approaches to combat NCDs as a
group8 In recognition of this important public health challenge investing in effective health
promotion and disease prevention is critical to improve the quality of life and well- being of
European citizens910 as well as their productivity and NCDrsquos burden on health systems and
economy of European societies11
Strengthening the investments in health promotion and disease prevention is key to delay
the onset and reduce the burden of NCDs in Europe12 As there is a great need for chronic
disease management the healthcare setting is crucial for health promotion in both primary
and secondary prevention of NCDs13 For example obesity is a major modifiable risk factor
2 Chopra M et al (2002) A global response to a global problem the epidemic of overnutrition
httpswwwncbinlmnihgovpmcarticlesPMC2567699pdf12571723pdf 3 WHO (2006) Gaining Health The European strategy for the prevention and control of noncommunicable
diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf 4 EU burden from non-communicable diseases and key risk factors httpseceuropaeujrcenhealth-
knowledge-gatewaysocietal-impactsburden 5 WHO (2014) Prevention and control of noncommunicable diseases in the European Region a progress report
httpwwweurowhoint__dataassetspdf_file0004235975Prevention-and-control-of-noncommunicable-diseases-in-the-European-Region-A-progress-report-Engpdf
6 WHO (2017) Noncommunicable diseases progress monitor 2017 httpappswhointirisbitstream handle106652589409789241513029-engpdfjsessionid=0613BF26D66A7DA9D1C91AD325E0A75Dsequence=1
7 httpsacels-cdncomS00917435150028321-s20-S0091743515002832-mainpdf_tid=88fea2bf-946a-44c2-be59-0edbabc2c2e8ampacdnat=1541511066_feedfb33968e2ac2f5b47a3452254a9f
8 Integrated approach to prevent noncommunicable diseases httpwwweurowhointenhealth-topicsnoncommunicable-diseasescanceractivitiesintegrated-approach-to-prevent-noncommunicable-diseases
9 WHO (2006) Gaining Health The European Strategy for the prevention and control of noncommunicable diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf
10 Scriven A (2017) Promoting Health a Practical Guide Seventh Edition httpsbooksgooglenl
bookshl=nlamplr=ampid=fJwqDwAAQBAJampoi=fndamppg=PP1ampdq=importance+health+ promotion+and+disease+prevention+European+Commissionampots=jcXZvCYJIQampsig=8D8Yqa9wKa_DlaaYUky_EtUxd_gv=onepageampq=importance20health20promotion20and20disease20prevention20European20Commissionampf=false
11 Tender 12 Chrodis (2015) Health promotion and primary prevention in 14 European countries a comparative overview
of key policies approaches gaps and needs httpchrodiseuwp-contentuploads 201507 FinalFinalSummaryofWP5CountryReportspdf
13 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
12
for type II diabetes (DM II) and thus efficacy of the intervention matters In economic
modelling for eight European countries a body-mass index reduction in the adult population
of 5 compared to 1 resulted a three-fold reduction in the incidence of DM II14 Apart
from the health losses caused directly by NCDs underlying conditions may also increase
susceptibility for other diseases Patients with diabetes and serious heart conditions eg
were identified as risk populations for COVID-1915 New health threats like climate crisis
will have an impact on healthcare systems and need for adaptation options including
training of health care workers integrated heatwave early warning systems especially for
the most vulnerable populations and supporting lifestyle changes toward healthy choices
that are at the same time climate and health friendly16
Healthcare providers such as doctors especially general practitioners (GPs) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs17 Health
promotion is collaborative work where professionals strengthen the message and help
patients to choose and implement healthier behaviours Counselling on and prescription of
a healthy lifestyle is particularly important to socioeconomically vulnerable and
disadvantaged population groups which are disproportionally affected by unhealthy
lifestyles and are more difficult to reach18 Secondary and tertiary prevention in chronic
diseases is embedded into good quality care since good nutrition status decreases the risk
of reinfarction as does smoking cessation For these reasons health promotion was
explicitly recognized as an integral part of the professional role of the GP in several policy
statements at both the European and the national level19 While many policy statements
and NCDs practice guidelines include a call for behavioural change as the first line of
prevention and management providers often do not provide behavioural change
counselling in their care20
A recently published report by the European Commission and WHO Europe (2018) identified
barriers for prescribing and counselling on exercise schemes and on promoting physical
activity in the health sector These were the lack of confidence and knowledge and skills by
health professionals on providing effective counselling21 For example Koutoukidis et al
(2017) performed a qualitative study on the perspective of healthcare professionals on
lifestyle advice to cancer survivors Health professional-centred barriers to provision of
lifestyle advice were a lack of knowledge on healthy lifestyle guidelines the feeling that
14 Webber L Divajeva D Marsh T McPherson K Brown M Galea G et al The future burden of obesity-related
diseases in the 53 WHO European-Region countries and the impact of effective interventions A modelling study BMJ Open 2014
15 Centre for Disease Control and Prevention (2020) Coronavirus disease 2019 Groups at higher risk for severe illness httpswwwcdcgovcoronavirus2019-ncovneed-extra-precautionsgroups-at-higher-riskhtml
16 Drummond P Ekins P Grubb M Lott MSEng M Byass P Nilsson M et al The Lancet Commissions Institute for Sustainable Resources (P Health and climate change policy responses to protect public health thelancetcom 2015
17 Catapano AL et al (2007) Averting a pandemic health crisis in Europeby 2020 what physicians need to know regarding cholesterol management httpswwwncbinlmnihgovpubmed17446817
18 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
19 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20 European20General20Practicepdf
20 httpswwwncbinlmnihgovpmcarticlesPMC4561845pdf101177_1559827615580307pdf 21 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the
European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
13
they were not the right person to provide advice and lack of time and resources22
Additional barriers mentioned in the World Book of Family Medicine ndash European Edition
2015 are perceived as lack of time or competing work load insufficient reimbursement
doubts about patientsrsquo acceptance and willingness to receive lifestyle counselling low self-
efficacy insufficient skills and training doubts about effectiveness of interventions and
health promotion perceived as outside professional role2324 Therefore while most health
professionals seem to acknowledge the need for lifestyle advice there seems to be a
mismatch between roles competencies training and possibilities among health
professionals and action25 Factors causing this mismatch differ from individual and
organizational context wherefore strategies to address these barriers will also vary26
These findings underline the need for developing and strengthening lifestyle medicine in
health professionalsrsquo education27 defined as lsquothe integration of lifestyle practices into the
modern practice of medicine both to lower the risk factors for chronic disease andor if
disease already present serve as an adjunct in its therapy Lifestyle medicine brings
together sound scientific evidence in diverse health-related fields to assist the clinician in
the process of not only treating disease but also promoting good healthrsquo28 Hence lifestyle
medicine covers the systematised approach for prevention and management of chronic
disease addressing eg diet physical activity behaviour change stress and coping and
tobaccosubstance abuse29 Health professionals need to learn how to overcome the
identified barriers mentioned above30 and how to effectively and efficiently counsel their
patients towards adopting and sustaining healthier behaviours31
Moreover digitalization is changing the scenery for lifestyle medicine and chronic disease
management Patient engagement can be enhanced with applications self-monitoring or
self-management tools To successfully embed these new forms of care professionals must
develop new skills32 However studies have shown that medical students are not formally
trained in major concepts known to influence health33 Philips et al (2014) states that
including lifestyle medicine in undergraduate medical curricula would have important public
health implications by efficiently promoting the prevention and treatment of NCDs34 A
study by Dacey et al (2012) states that face-to-face continuing medical education formats
22 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 23 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20
European20General20Practicepdf 24 Geense WW van de Glind IM Visscher TL van Achterberg T Barriers facilitators and attitudes influencing
health promotion activities in general practice an explorative pilot study BMC-family practice 2013 1420 25 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 26
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
27 Polak R et al (2015) Lifestyle Medicine Education httpswwwncbinlmnihgov pmcarticles PMC4561845
28 Rippe JM (2019) Lifestyle Medicine Third Edition CRC Press 29 Kushner RF and Webb Sorensen K (2013) Lifestyle medicine the future of chronic disease management
Obesity and nutrition 201320 30 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 31 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) The impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 32 Eg Richard A A amp Shea K (2011) Delineation of Self-Care and Associated Concepts Journal of Nursing
Scholarship 43(3) no-no httpdoiorg101111j1547-5069201101404x 33 httpscdnymawscomwwwacpmorgresourceresmgrlifestylemedicine-filesajpm-lmcommentarypdf 34 Philips E Pojednic R Polak R Bush J amp Trilk J (2014) including lifestyle medicine in undergraduate
medical curricula Medical education online
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
14
have a positive impact on physician behaviour toward health promotion and disease
prevention by increasing their knowledge confidence and practices that help patients to
adopt healthy behaviours35 Similar results can be expected among other health
professionals as well
The World Book of Family Medicine ndash European Edition 2015 states that the shared aim to
integrate health promotion disease prevention and lifestyle medicine has not been fully
achieved Future activities as to how lifestyle interventions can be better integrated need
collaborative approaches36 As a starting point for more collaborative action this study
seeks to provide a mapping of the current situation on health professionals training in health
promotion in the EU
11 Research questions
To that end this study seeks to answers to the following research questions
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and continuous
professional education
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
35 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) the impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 36
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
15
2 THEORETICAL BACKGROUND
21 Societal needs for health promotion and disease prevention
Classically public health targets at activity levels can be described in operational models
like Friedenacutes pyramid model37 It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of
health like socioeconomic status6 We use this model as a substructure in looking into
health professionalsrsquo education as they contribute to public health in these levels (Figure
21) Society needs to evaluate cost-effectiveness of public health efforts and find a balance
between the levels of actions at each level We use this framework to enable us to present
the needs of societies in general for different health professionals and their roles and
competencies in public health
Figure 21 Frieden Pyramid of health impact of health professional activities at the different levels of society (T Frieden 2010 CDC)
Healthcare services can contribute in mitigating the burden of disease by socioeconomic
disadvantages Health professionals have a key role in developing health services so their
competency to take account of differences in abilities of people to benefit from health
services is vital But more is needed Traditionally health professionals have been managing
the individual risk factors and provision of services That is not enough For example in
cardiovascular diseases the ldquoperfect treatment approachrdquo fails to prevent almost half of the
disease burden37 In cancer diseases individual health behaviours like smoking contribute
in more direct manner Therefore we need to develop educational systems that support
health professionals to take part in new public health approaches by planning interventions
that change the environmental context to make healthy options the default choice
37 Frieden TR A framework for public health action The health impact pyramid American Journal of Public
Health 2010
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
16
regardless of education income service provision or other societal factors37 These are
equally needed in out-of-health contexts like climate change where socio-economic
inequalities and (health) behavioural choices are among major drivers of climate changes38
Policies can influence environments to support healthier choices and we need health
professionals in policy development and execution Still health behaviour changes happen
at the individual level We need more efficient skills in personalized health coaching of
individuals to increase the cost-effectiveness of treatment of NCDs39 An ageing population
and increasing rates of chronic disease as well as advances in medical science and health
information technology to make care safer and more efficient require a rethinking of how
care is delivered Digitalization of services will challenge healthcare professionals and
collaborative care models have become more common40 Instead of requiring compliance
from patients patient-centred approaches are required from professionals This means that
clinical interventions need to be complemented by counselling and education to achieve
long-lasting protective measures Health coaching is aiming to empower patients in co-
management of their disease41 and emphasize and support patientsrsquo autonomy instead of
merely compliance It is based on shared decision-making and collaborative goal setting
facilitated by motivational interviewing42 Health coaching is already happening in digital
environments This paradigm shift requires new skills and attitudes from health
professionals too
New approaches to public health on societal level the paradigm shift to health coaching on
patient level and new forms of healthcare delivery pose a big challenge to the educational
system of health professionals It needs to prepare new professionals and train health
professionals already working in the healthcare system to master a wider scope of
knowledge and develop new skills and attitudes to implement these new approaches in a
safe effective and efficient way
22 Health profession competencies
Healthcare service is a complex and interconnected network of professionals There are
common professional competencies needed in health care and health promotion
(communication collaboration) but they are applied to meet the learning aims of each
profession or level of education If we want to increase the implementation of lifestyle
counselling or systemwide changes we need to evaluate knowledge skills and attitudes
required for the changes and to define the competencies needed to support this change
Professional competencies sum the elements of abilities (knowledge skills attitudes and
behaviours) that enable a professional to accomplish the activities described in a task
statement that outlines what the professional is expected to do43
38 Watts Nick Amann Markus Arnell Nigel et al (66 more authors) (2019) Report of The Lancet Countdown
on Health and Climate Change The Lancet ISSN 0140-6736 httpsdoiorg101016S0140-6736(19)32596-6)
39 Hale R Giese J Cost-Effectiveness of Health Coaching Prof Case Manag 2017 40 Falconer E Kho D Docherty JP Use of technology for care coordination initiatives for patients with mental
health issues A systematic literature review Neuropsychiatric Disease and Treatment 2018 41 Hayes E McCahon C Panahi MR Hamre T Pohlman K Alliance not compliance Coaching strategies to
improve type 2 diabetes outcomes J Am Acad Nurse Pract 2008 42 Olsen JM Health Coaching A Concept Analysis Nurs Forum 2014 43 Kraiger etal 1993 Application of cognitive skill-based and affective theories of learning outcomes to new
methods of training evaluation
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
17
Learning Outcome Typology by Kraiger is a widely used descriptive model for setting targets
and learning outcomes in education43 It comprises cognitive (knowledge) psychomotor
(skill-based) affective and behavioural (attitudes) components This classification scheme
for learning outcomes is based on Bloomrsquos work (1956) of three learning domains including
cognitive domain the affective domain and psychomotor44 45Knowledge can be factual and
declarative knowledge information and concepts or processes and organizations or
metacognitive strategies like allocation and regulation of professional performance Skills
include simple routine development and procedures needed at work and more complex
skills needed for the ability to monitor the performance along other tasks Attitudes are
linked with professionalsrsquo perceptions on learning self-efficacy at work perception about
ability to perform and ability to goal setting It has domains on professionalism Knowledge
can be obtained in reading or e-Learning modules skills require active teaching methods
and attitudes develop over time Behaviours then are complex situations where knowledge
skills and attitudes are utilised in professional manners In education planning outcomes
are defined by these elements
Competency frameworks are an effective method for achieving outcome-based education46
They provide a tool for capturing the elements and abilities (knowledge skills attitudes
and behaviours) needed in effective and safe patient work47They can serve in evaluating
the components of different specialities or societal needs like in this report public health
needs Competencies define an acceptable and feasible description of professional
behaviours used in relation to health promotion Competency building is at the basis in
developing similar programmes in the US4849 Meaningful assessment of competencies
developed is critical for the implementation of effective competency-based medical
education (CBME)50
The International Union for Health Promotion and Education (IUHPE) published an
extensive list of core competencies and professional standards for health promotion in
201651 It defines acuteHealth Promotion actionrsquo in the context of these competencies and
standards to describe programmes policies and other organised Health Promotion
interventions that are empowering participatory holistic inter-sectoral equitable
sustainable and multi-strategy in nature and aim to improve health and reduce health
inequities51
44 Bloom BS (1956) Taxonomy of educational objectives The classification of educational goals New York NY
Longmans Green 45 Cruz-Cunha MM (2012) Handbook of Research on Serious Games as Educational Business and Research Tools 46 Frank JR Danoff D The CanMEDS initiative Implementing an outcomes-based framework of physician
competencies Med Teach 200729(7)642ndash7 47 Cooke M Irby DM Sullivan W Ludmerer KM Medical education American medical education 100 years after
the flexner report N Engl J Med [Internet] 2006355(13)1339-1344+1306 Available from httpwww
scopuscominwardrecordurleid=2-s20-33749062559amppartnerID=40ampmd5=d949feb 758c984c732a419 cada174c85
48 Alaranta A Alaranta H Patja K Palmu P Praumlttaumllauml R Martelin T et alSnuff use and smoking in Finnish Olympic athletes Int J Sports Med 200627(7)
49 Van Horn L Lenders CM Pratt CA Beech B Carney PA Dietz W et al Advancing Nutrition Education Training and Research for Medical Students Residents Fellows Attending Physicians and Other Clinicians Building Competencies and Interdisciplinary Coordination Adv Nutr 2019
50 Lockyer J Carraccio C Chan MK Hart D Smee S Touchie C et al Core principles of assessment in competency-based medical education Med Teach 201739(6)609ndash16
51 IUHPE (2016) Core competencies and professional standards for health promotion full version httpwwwukphrorgwp-contentuploads201702Core_Competencies_Standards_linkEpdf )
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
18
We present CanMEDS as an example of a framework that includes content-specific
competencies (Table 21) CanMEDS was developed for medical experts but most
competencies are applicable to all health professionals
Table 21 CanMEDS in short form52 original version53
Competency Short description
Medical Expert Apply clinical skills and knowledge of the biomedical sciences to fulfil your scope of practice
Collaborate with patients and families for patient-centred care and management
Contribute to health care quality and patient safety
Communicator Build rapport and empathy in all interactions with patients and include families (with the patientrsquos consent)
Understand the patientrsquos perspectives expectations and socio-economic issues
Use active listening patient-centred interviewing skills and culturally safe communication
Share information in plain language to promote patientsrsquo understanding
Clearly document and share information with patients and others on the care team
Collaborator Collaborate by sharing knowledge and perspectives sharing responsibilities learning together
Collaborate in care education advocacy administration and scholarship
Leader Take responsibility for the ongoing operation evolution and continuous
improvement of the healthcare system
Expand beyond a clinical or technical role to take on administrative teaching and scholarly roles and responsibilities
Exercise efficient use of resources to achieve cost-effective care
Contribute to improvements in personal practice team organization and system
Health Advocate
Understand and address the determinants of health that affect patients and support patients to navigate through the health care system
Collaborate with communities and populations to influence change in the health
care system
Contribute to health promotion and disease prevention Understand determinants and needs speak on behalf of others increase awareness
Scholar Plan for and engage in life-long learning
Teach others
Evaluate and apply evidence to day-to-day practice
Contribute to research including creation dissemination and translation into
practice
Professional Commit to patients society profession and ldquoselfrdquo Patients ndash maintain clinical competency and adhere to ethical standard Society ndash demonstrate social accountability by responding to societal needs and
expectations Profession ndash peer assessment mentorship supporting others setting standards Self ndash participate in self-assessment and reflection build self-awareness and manage own well-being
52 Michener Institute No Title CanMEDS framework in short [Internet] Available from httpsmichenercawp-
contentuploads201805CanMEDS-Framework-Summarypdf 53 Frank JR Snell L Sherbino J E CanMEDs 2015 Physician Competency Framework [Internet] CanMEDS 2015
Physician Competency Framework Ottawa Royal College of Physicians and Surgeons of Canada 2015 p 1ndash30 Available from httpwwwroyalcollegecaportalpageportalrccanmedsresourcespublications
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
19
23 Educational systems for health professions in Europe
According to the EU Treaty European citizens have a virtue of rights of free movement as
workers freedom of establishment and freedom of service providers54 Directives on the
requirements of professional qualifications in EU their recognition and Regulation55
facilitate the mobility of health personnel Each member state will apply this directive in
the national legislation on health professional qualifications There is a system of automatic
recognition based on harmonised minimum training requirements This system depends on
the timely notification of new or changed evidence of formal qualifications by MS and their
publication by the Commission Otherwise holders of such qualifications have no
guarantees that they can benefit from automatic recognition
The undergraduate education in Europe is coordinated through the Bologna Process which
is an intergovernmental cooperation of 48 European countries in the field of higher
education It guides the collective effort of public authorities universities teachers and
students together with stakeholder associations employers quality assurance agencies
international organizations and institutions including the EC to bring more coherence to
higher education systems across Europe56 Under the Bologna Process all 48 participating
European countries agreed to ensure mutual recognition of qualifications and learning
periods abroad completed at other universities Nonetheless it should be noted that across
Europe healthcare systems and educations may still significantly differ
While professional activity is regulated by national law in individual member states57
faculties and other academic institutions have collaborated in the establishment of a
framework of competencies based on the scientific advances and new methodologies in
education In fact EU Directives of the European Parliament and Council on the recognition
of professional qualifications have consolidated a system of mutual recognition between
MS58 Examples include the PHARMINE for pharmacists and MEDINE for medical doctors59
This collaboration is in line with the Bologna Process
24 Relevant educational settings for health promotion
Inclusion of health promotion and lifestyle medicine in undergraduate medical curricula is
expected to have important public health implications However in current medical
education this subject is minimal to nonexistent60 This is a global problem In 2016 the
American associations around NCDs launched a joint programme called lsquoThe Lifestyle
54 Treaty on the Functioning of the European Union (TFEU) Articles 45 49-62 55 European Parliament C of the EU Directive 200536EC on the recognition of professional qualifications and
Regulation [Internet] 2013 Available from httpseur-lexeuropaeulegal-
contentENALLuri=celex3A32013L0055 56 The Bologna process and the European Higher Education Area httpseceuropaeu education policies
higher-educationbologna-process-and-european-higher-education-area_en 57 UEMS (2017) Charter on training of medical specialists in the EU httpswwwuemseu
dataassetspdf_file001943561ETR-Psychiatry-201703pdf 58 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 59 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 60 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
20
Medicine Education Collaborativerdquo for improvement of health promotion education among
health professionals and in medical schools61 This initiative will a) work for high-quality
curricular material on an easily navigable website b) provide support for medical schools
to advocate for and implement lifestyle medicine curricula into their own institutions c)
aim to increase awareness and legislative initiatives that encourage adoption of lifestyle
medicine into medical school education d) develop and conduct assessment in the
following areas Student Health Student Knowledge and Programme Effectiveness and
e) train and support medical students as effective champions of lifestyle medicine whose
engagement with the curriculum lead to increased adoption within medical schools and
enhanced collaboration nationallyError Bookmark not defined This need has been acknowledged
in Europe as well62
Besides education in medical schools continuous professional development (CPD) is an
essential component in health education to ensure that professionals graduated in past
decades keep their competencies up to date and acquire new competencies needed for
health promotion disease prevention and lifestyle medicine It is important to encourage
further strengthening of CPD for those professions that benefit from automatic recognition
of their professional qualifications Member states should in particular encourage CPD for
physicians medical specialists general practitioners nurses responsible for general are
dental practitioners specialized dental practitioners veterinary surgeons midwives
pharmacists and architects63 Given the rapid developments in societal needs and
approaches towards health promotion and disease prevention and spectacular increase in
technological support facilities lifelong learning is imperative for health professionals and
should be oriented towards the competencies required to best serve their population and
society
Figure 22 Lifelong learning is an iterative process where learners build knowledge skills
attitudes and behaviours on top of their current professional competency
61 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019 62 European Lifestyle Medicine organisation httpswwweulmorg 63 Lim SS Vos T Flaxman AD Danaei G Shibuya K Adair-Rohani H et al A comparative risk assessment of
burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions 1990-2010 A systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
21
25 Theoretical framework for this study
In this study we touch upon the existing levels of health promotion disease prevention
and lifestyle medicine in health and educational settings in the EU and make a preliminary
assessment of its relevance
As right now health professional competencies seem more practical we approached the
mapping of competencies in health education through professions rather than with an
overall theoretical framework Thus we aim to create a general picture for different health
professions at different levels of education
For the assessment of relevance of the existing levels of health promotion in education we
aligned the competency framework of Kraiger with Friedenrsquos public health framework We
used three components64 of Kraigerrsquos Learning Typology
bull Knowledge cognitive and mental abilities
bull Skills psychomotor manual and physical abilities to perform tasks
bull Attitude (or self) perceptions growth in feelings or emotional areas
We used the integrated framework as an analytical tool to classify content areas covered
and their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future
This study is an important first step as we know little about present practices However
more detailed research will obviously be needed
64 Given the limitations of the study behaviour ndash the fourth component ndash is not included Behaviour refers to
practices to utilise knowledge skills and attitude in work environment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
22
3 METHODOLOGY
31 Mapping of health educational programmes in the EU
The first aim was to provide a general overview on how health professionals are trained in
health promotion and disease prevention and lifestyle medicine in the EU To that end we
conducted an online survey to map the educational programmes of health professionals in
the EU In addition to the proposed methodology we also conducted desk research to
create an overview of competency profiles of health professionals in the EU
311 Online survey
This study looks at undergraduate education postgraduate education and CPD courses in
all healthcare professions across the EU Within the EU different organisations are
responsible for the education of healthcare professionals
bull The undergraduate education programmes are organised by universities in each
country
bull The post-graduate education programmes are organised differently in each
country This includes a set of European organisations that run the guidelines
and portfolioacutes for each profession or specialty within this profession (like in
medicine)
bull CPD programmes are even more diverse between countries and can be accredited
both by European organisations and universities
Due to the wide scope of the study and the different levels of healthcare educational
programmes no country correspondents could be found with a full overview of educational
programmes addressing health promotion and disease prevention in their country
Therefore we chose for a snowball methodology to obtain information on all levels of health
professional education The snowball methodology consists of two steps First we identified
potential organisations in the EU to take part in the survey Second we asked those
organisations to recruit other organisations or stakeholders in their national andor
international network of colleagues and spread the survey among those This method
required more effort and time in the beginning but once the lsquoballrsquo was rolling it provided
us with a growing dataset including the perspectives from healthcare educators healthcare
professional associations and healthcare students and residents The snowball method
implies a risk of selection bias as educational institutions that have implemented health
promotion within their programmes ie the front-runners may have been more inclined
to respond than those who have not
In addition this recruitment process served as a communication and dissemination vehicle
and increased the engagement to the mapping Many organisations expressed their interest
to join the workshop as well as willingness to disseminate the results to their members and
collaborators Because of the growing interest we decided to extend the deadline after the
workshop organised on 13 February so attendees could spread the survey among their
national andor international networks
Our original workplan included an Excel worksheet to be sent to the national health
coordinators in each EU country but as we chose a different strategy it was necessary to
develop a more user-friendly and flexible method Therefore an online survey was
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
23
developed This enabled refinement of questions to each level of education with core sets
of questions Survey links proved to be easy to use and shared within educational facilities
or associations which led to higher response
In this section we discuss in more detail how the survey was developed and how relevant
international organisations were recruited
Development of an online survey
First we developed a mapping tool (stand-alone Excel document) to map the current
situation of professionals trained in health promotion This mapping tool was validated by
both Chafea and DG SANTE and by the external experts in the core research team After a
pilot phase an online survey was developed for all healthcare professions based on the
content of the mapping tool This was a necessary step to boost response as the online
survey proved to be more user-friendly and easier to share among educational facilities or
associations than the mapping tool in Excel
Among other topics the survey contained questions on the
bull Training programme for which the respondent is filling in the survey (which
(educational) institute and health profession portfolio etc)
bull Type of training programme (undergraduate education postgraduate education or
continues professionalrsquos development
bull Type of health professional targeted (eg GPrsquos physiotherapists etc)
bull Implementation in the curriculum
bull Description of the health promotion component in the programme (eg teaching
methods monodisciplinary approach or multidisciplinary approach expected
outcomes in knowledge skills and attitude)
bull Targeted funding
bull Accreditation
bull Partnerships
The questions in the survey correspond with the information requested in the Tender
Specifications Note that the survey maps the educational offer effectiveness of education
is outside the scope of this study The complete questionnaire used in the survey can be
found in Annex 3
Recruitment of relevant international organisations EU and national medical and
non-medical associations medical faculties national and international institutes
networks and organisations
As we used a snowball method it is not possible to provide the exact number of persons
who received the survey and response rates Instead we present each of the steps taken
to approach respondents and final response obtained
Recruitment of European associations
First we connected with major networks in the fields of graduate post-graduate and
continuous professional development for their support as these organisations have an
overview of the three levels of health professional education These associations represent
entire professions or part of the professions (like post-graduates) in all European countries
National professional organisations are members of these umbrella organisations For
example the Union of Medical Specialists (UEMS) represents 16 million medical specialists
It has 40 full member associations (Member States of the EU amp Member States of the
European Economic Area) associate member associations (Member States of the Council
of Europe) and observer member associations (other countries eg the United States)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
24
The UEMS represents more than 50 medical disciplines through various bodies
and structures The most important ones are the 43 Specialist Sections which represent
independently recognised specialties All health professionals health professional students
and post-graduates are organised in a similar manner These organisations are in a good
position to provide information and disseminate it across EU countries
Overall 24 EU associations were approached by email to spread the survey among their
networks (see Table 31 for a complete overview) We aimed to cover all professions within
the scope of this study ie physicians physiotherapists occupational therapists
psychologists nurses social workers dentists pharmacies dietitians throughout Europe
Therefore European associations with focus on educational programmes for these specific
professions were approached
Table 31 Approached European Associations
No European Associations
1 European Medical Association (EMANET)
2 The European Union of General Practitioners (UEMO)
3 European Union of medical specialists (UEMS)
4 European Medical Students Association EMSA)
5 European Forum of Medical associations (EFMA)
6 European Federation of Nurses Associations (EFN)
7 European Association of schools of social work
8 European Network of Physiotherapy in Higher Education
9 European Region ndash World Confederation of Physical Therapy (ER-WCPT)
10 European Network of Occupational Therapy in Higher Education (ENOTHE)
11 Council of Occupational therapists of European Countries (COTEC) part of the World
12 Federation of Occupational Therapists (WFOT)
13 Federation of National Psychologists Associations
14 European federation of nurse educators (FINE) association
15 Association for Dental Education in Europe
16 Council of European Dentists
17 Association for Medical Education in Europe (AMEE)
18 Pharmaceutical group of the European Union (PGEU)
19 European Pharmacists Forum (EPF)
20 European Association of faculties of pharmacy (EAFP)
21 European network of medical residents in Public health
22 The Association of Medical Schools Europe (AMSE)
23 The European Society of Preventive Medicine (ESPREV)
24 The European Lifestyle Medicine Organisation (ELMO)
Recruitment of national associations
Second national health associations for all Member States and all professions were
approached to fill in the survey This step was crucial to increase the response National
health associations were selected using the member list of European organisations Table
32 shows the European organisations used to identify national health associations that
were invited to participate in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
25
Table 32 Examples of the approached national associations
Profession European Association Examples of approached national associations (1 out of 28)
Medical doctors Standing committee of European Doctors (CPME)
Czech Medical Chamber
Physiotherapists World confederation for physical therapy (WCPT)
Swedish Association of Physiotherapists
Social workers International federation of
social workers
German professional
association for social work
Psychologists European Federation of psychologistsrsquo association (EFPA)
Croatian psychological association
Occupational therapists Council of occupational
therapists for the European Countries (COTEC)
Association of Bulgarian
Ergotherapists
Dietitians The European Federation of the associations of dieticians
(EFAD)
French Association of Nutritionist Dietitians
Dentists Council of European Dentists Irish dental association
Nurses European Federation of Nurses
Association (EFN)
Polish Nurse Association
Pharmacists Pharmaceutical group of European Union (PGEU)
Malta Chamber of Pharmacists
Recruitment of national educational organisations
Last the list of the selected associations was used to identify relevant national educational
organisations These national educational organisations (eg University of Maastricht
Faculty of Health Medicine and Life Sciences Kaunas University Medical School Lifestyle
Medicine University of Helsinki Faculty of Medicine) were approached individually and
asked to fill in the survey and spread it throughout their network
Table 33 Number of national educational organisations approached
Profession Number of approached national education organisations
Medical schools 298
Schools of physiotherapy 29
School of social work 31
School of dietitians 40
School of Occupational therapists 45
School of dentists 85
School of pharmacists 56
Response obtained
In total we received information on 176 educational practices till mid-February The
workshop organized in Luxembourg65 gave an additional boost and resulted in 32 more
practices reported in the survey In total this mapping exercise is based on information on
208 practices of health promotion in educational settings
65 Workshop ldquoPromoting lifestyle medicine competencies and education of health professionals in the EU todayrdquo
13th February 2020 Luxembourg Organized by Chafea and DG SANTE
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
26
312 Desk research
Desk research was conducted on both scientific and grey literature with the main purpose
to establish an overview of the competency profiles of health professionals in the field of
health promotion and disease prevention This overview was created to gain insight to what
extent competency profiles related to health promotion and disease prevention are covered
in the educational standards of different health professions in the EU We have made use
of reports published online and scientific articles on competency profiles or educational
standards set at EU level (eg European standards in medical training (UEMS) as the EU
Directives of the European Parliament and Council on the recognition of professional
qualifications have consolidated a system of mutual recognition between Member States3
When reports on EU level could not be identified we selected articles on global standards
such as for the profession of social work (ie global standards for the education and training
of the social work profession)
Based on the identified literature we have described the competency profiles for each of
the following healthcare professions
bull (undergraduate) Medicine
bull Medical specialists
- sports medicine specialists
- public health specialists
- internists
- cardiologists
- psychiatrists
- general practitioners
bull Dentists
bull Nurses
bull Nurse specialists
bull Occupational therapists
bull Pharmacists
bull Physiotherapists
bull Psychologists
bull Social workers
The selection of healthcare professions included in the desk research was made in
consultation with Chafea DG SANTE and the experts
The assessment of the competency profiles was based on the three Domains of Learning
KSAs as described in Chapter 2
bull Cognitive mental skills (knowledge)
bull Psychomotor manual or physical skills (skills)
bull Affective growth in feelings or emotional areas (attitude or self)
This method was chosen as especially ldquolack of confidence and knowledge and skills by
health professionals on providing effective counsellingrdquo was identified as a barrier for
prescribing and counselling on promoting physical activity in the healthcare sector66 In
Chapter 4 the results are described in detail
66 httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
27
32 Long list of good practices
From the survey results we have drawn a long list of good practices As agreed with Chafea
and DG SANTE these good practices were selected using the following four selection criteria
bull The programme contains a multidisciplinary approach
bull The education is mandatory (including an exam)
bull The education covers the following topics digitalisation in health eHealth and
digital health coaching
bull The expected outcome includes change in skills and or behaviour
Several variables were included in the longlist country name of the programme name of
the institute whether there is a focus on knowledge skills and behaviour the type of
professionals who are being trained the theories that are covered by the education (eg
human cognition and behaviour health behaviour change techniques communication skills
etc) education methods used year since the education is provided the time spend in the
modules in hours and lastly in case of one full module the duration of this module To
enable comparison between good practices based on different variables the preliminary
longlist can be found in a separate Excel document Chapter 5 includes an overview of the
coverage and content of the long list of good practices
After closing of the online survey we analysed the longlist of good practices along the
following research questions
bull What content items of health promotion disease prevention and lifestyle
counseling do programmes consist of
bull What kinds of learning aims do they have
bull How do they distribute in Friedens model of levels of health promotion
bull Are there differences between professional groups
First we analysed the distribution of the learning skills separately by the levels of education
(undergraduate postgraduate and CPD) We expected that adult learning will be more
directed towards skills (learning by doing) than the undergraduate and postgraduate
programmes Secondly we analysed the educational methods and tools used in the good
practices
Good practices can be submitted to the European Commissionrsquos Best Practice Portal to be
assessed by external evaluators against criteria adopted by the Steering Group on Health
Promotion Disease Prevention and Management of NCDs Practices rated as best against
these criteria will be published on the European Commissionrsquos Best Practice Portal67
67 httpswebgateeceuropaeudynabp-portal
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
28
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
29
4 MAPPING OF THE CURRENT SITUATION IN HEALTH PROMOTION TRAINING IN THE EU
41 Overview of educational programmes in the EU
411 Summary of the main findings in the survey
A high percentage (93) of respondents (n=197) indicated that health promotion and
disease prevention are implemented in their educational programmes or modules For
undergraduate education postgraduate education and CPD these percentages were 95
93 and 83 respectively Other results include
bull More than half of the respondents indicated that they filled in the questionnaire
based on undergraduate educational settings Throughout Europe these numbers
were relatively similar
bull Physiotherapists seem to be the professional group most actively involved in
health promotion training activities The vast majority applies multidisciplinary
approaches and thus bring other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within the undergraduate and postgraduate programmes In CPD on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion target knowledge skills and
attitudes of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for CPD (33) compared to
undergraduate and postgraduate education (15 and 6) when the topic is
covered in most modules Funding was more often obtained in Northern and
Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) With regard to full modules high percentages
indicated that these are mandatory and that there is an exam at the end of the
module (81 70 respectively)
412 Detailed results of the survey
Respondents
In the following section we provide a detailed description of the survey results The survey
targeted undergraduate education postgraduate education and CPD programmes in all
Member States Overall 208 respondents filled in the questionnaire about their educational
practice Note the results presented in the remainder of this report are exclusively based
on the answers respondents provided in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
30
Table 41 and Figure 41 provide an overview of the number of practices reported per
European countries A detailed overview of the educational programmes collected
throughout Europe can be found in Annex 1
Figure 41 Practices collected in the survey by European countries (n=208)
Table 41 Number of respondents per European Member State 2019-2020 (n=208)
Abbreviations EU Member State Number of respondents
AT Austria 12
BE Belgium 23
BG Bulgaria 4
CY Cyprus 1
CZ Czech Republic 7
DE Germany 1
DK Denmark 8
EE Estonia 2
ES Spain 22
FI Finland 6
FR France 15
GB United Kingdom 6
GR Greece 10
HR Croatia 0
HU Hungary 3
IE Ireland 8
IT Italy 10
LT Lithuania 1
LU Luxembourg 0
LV Latvia 5
MT Malta 6
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
31
Abbreviations EU Member State Number of respondents
NL Netherlands 2
PO Poland 0
PT Portugal 14
RO Romania 3
SE Sweden 4
SI Slovenia 14
SK Slovakia 2
Additional countries 19
TOT 208 the UK is included as a Member State in this study as the results were obtained before Brexit
For mapping purposes we made a breakdown of results by region ie Northern Europe
Eastern Southern and Western Europe (based on United Nations Regional Groups)
Furthermore we compare results of individual countries for which at least 10 practices have
been reported in the survey These are Austria Belgium France Greece Italy Portugal
Slovenia and Spain
Table 42 European countries per region
Region European countries
West Austria Belgium France Ireland Germany
Luxembourg Netherlands United Kingdom Switzerland
North Denmark Sweden Estonia Finland Lithuania Latvia Norway
East Bulgaria Czech Republic Hungary Romania Slovakia Poland Georgia Kazakhstan
South Italy Spain Cyprus Portugal Greece Malta Slovenia Croatia Bosnia Kosovo Serbia
Type of education
We asked the respondents to indicate the type of educational setting As shown in Figure
42 more than half of the practices (60) refer to undergraduate educational settings and
approximately one third to postgraduate educational settings Only twelve percent of the
reported educational settings is related to CPD
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
32
Figure 42 Practices by educational level (n=199 in percentages)
Figure 43 and Figure 44 show the distribution in type of education per region and on
country level respectively For Western Southern and Northern Europe distribution is in
line with the overall results In Eastern Europe practices reported are more evenly
distributed over undergraduate and postgraduate education Also the share of CPD
practices is high in comparison with other regions and overall results
Figure 43 Practices by type of education per region (n=204 in percentages)
64
42
62
60
29
37
27
30
7
21
12
10
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Undergraduate education Postgraduate education Continuous professional development
60
29
12
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
33
Figure 44 Practices by type of education per country (in percentages)
Type of health professions
An overview of the type of health professional trained in the educational practices is
provided in figure 45 Remarkably over one third (35) of the educational practices
reported are oriented to physical therapists Note that multiple answers could be provided
Figure 45 Type of health professional being trained (n=208 in percentages)
Medical specialists refer to doctors with an extra expertise in one type of medicine eg including sports
medicine public health internal medicine cardiology psychiatry and the general practitioner68 General
practitioners refers to doctors working within General Practice or Family Medicine (GPFM)69 Medical doctors refers
to doctors without any specialization
68 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 69 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
83
70
27
50
30
62
71
71
8
22
60
30
60
23
14
19
8
9
13
20
10
15
14
10
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Undergraduate education Postgraduate education Continuous professional development
116
15
35
1417
7 8 5
29
0
10
20
30
40
50
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
34
Health professionals involved as educators in health promotion and disease prevention are
shown in Figure 46 Physical therapists are most often active as teachers of health
promotion (36) which coincides with the high share of practices oriented to this
profession Some professions like medical specialists nurses and psychologists are
represented more often as teacher then as trainee of the educational practices This implies
they are involved in programmes oriented towards other health professions and is in line
with a multidisciplinary approach that is applied by the vast majority of practices ( 81
n=148)
Figure 46 Health professionals teaching contents of health promotion (n=90 in
percentages)
Methods of education
Survey results show that traditional methods ie lectures and assignments are most often
used (Figure 47) Assignment refers to home school projects such as writing papers In
CPD eLearning methods are more often used (67) compared to undergraduate (45)
and post graduate education (39) The use of field training is relatively similar for the
different levels of education
Figure 47 Teaching methods applied (n=145 in percentages)
8
27 26
36
14
24 23
6 7
37
0
10
20
30
40
50
97
81
74
46
0 10 20 30 40 50 60 70 80 90 100
Lectures
Assignments
Field training in real environments
eLearning modules
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
35
Knowledge skills and behaviour
As for the outcome of the education respectively 99 94 and 89 of all practices
indicate knowledge skills and behaviour as expected outcomes (Figure 48) There are no
significant differences between types of education
Figure 48 Knowledge skills and behaviour (n=142 in percentages)
Accreditation
Overall 39 of the educational practices is accredited on European or international level
53 is accredited at a national level and only 5 lacks accreditation (n=179) Comparing
the different levels of education the rate of accreditation at a European or nation level
varies At a European level these are 46 33 22 at the national level 47 58
67 for undergraduate education postgraduate education and CPD respectively
Throughout Europe the level of accreditation of education is high in Northern Eastern
Southern and Western countries the share of practices without accreditation is 11 0
5 and 3 respectively (n=197) Eastern European countries have regulated their
accreditation more often on a national level compared to the other countries
Theories covered
Figure 49 shows that health behaviour human cognition and behaviour and population
health are covered in most educational practices to a high or at least limited extent
99
0 1
94
4 2
89
6 4
0
20
40
60
80
100
Yes No Unknown Yes No Unknown Yes No Unknown
Knowledge Skills Behavior
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
36
Figure 49 Theories covered by the education (n=137 (in percentages)
Figure 410 provides a more detailed overview of contents covered in the educational
programmes and shows that communications skills ethics and methods of evidence-based
medicine are mostly covered within the education Contents least covered are digital health
coaching digitalisation health economics
Funding and partnerships
Figure 411 provides an overview of the practices that a) obtained targeted funding to
incorporate health promotion and disease prevention in the curriculum b) for which a
partnership is set up for execution of teaching activities on health promotion or c) built on
existing partnerships to incorporate health promotion in the curriculum of the whole
educational programme This overview only includes educational practices where health
promotion and disease is incorporated in most modules
Funding differed between level of education 15 6 and 33 of the undergraduate
education postgraduate education and CPD received targeted funding to incorporate health
promotion in the curriculum Hence funding seems to play a more important role for CPD
than for undergraduate and postgraduate education
66
54
65
31
42
32
1
1
2
3
1
0 20 40 60 80 100
Population health
Human cognition and behavior
Health behaviour
Yes very much Yes but limited No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
37
Figure 410 Theories that are included within education on health promotion (n=137 in percentages)
Figure 411 Funding and partnerships when health promotion is covered in most modules of the educational programme (n=123 in percentages)
Figure 412 provides a comparison of funding obtained by European region Remarkably
in Western Europe the share of practices with targeted funding to incorporate health
promotion is much lower than in the other EU regions
48
69
40
16
54
48
20
34
37
41
49
64
9
44
24
55
51
42
47
50
50
48
44
42
31
43
7
6
4
4
3
4
25
25
9
9
5
2
42
1
1
1
1
1
1
5
5
5
6
4
3
6
0 20 40 60 80 100
Epidemiology and bio-statistics (research capacity)
Methods of evidence-based medicine
Health policies and regulation
Health economics
Ethics
Health care systems
Digitalisation in health promotion
Health inequalities
Disease prevention in teams
Health literacy
Health behavior change techniques
Communication skills
Digital health coaching
Yes very much Yes but limited No Unknown
52
61
15
0 20 40 60 80 100
Partnerships in incorporating it in the curriculum of thewhole educational programme
Partnerships for execution of teaching activities
Funding to incorporate health promotion in curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
38
Figure 412 Funding to incorporate health promotion for programmes covering health promotion in most modules by region (n=119 in percentages)
Comparing individual countries figure 413 shows that funding is obtained for the
educational programmes reported in Slovenia Italy and France while this is not the case
or unknown in Portugal Belgium and Austria
Figure 413 Funding to incorporate health promotion when health promotion is covered in
most modules of the educational programme by country (n=71 in percentages)
Dedicated modules to health promotion
In a majority of practices (63) health promotion disease prevention and lifestyle
medicine are covered in all modules of the educational programme as opposed to coverage
in one module primarily dedicated to health promotion (37) Undergraduate and
postgraduate education show a similar pattern while in CPD programmes full modules
primarily dedicated to health promotion are relatively restricted namely 15 (Figure 414)
Both options have the potential to be effective depending on context implementation and
other factors The data gathered in this study do not allow any statement on effectiveness
of each option
20
12
21
3
80
82
70
85
6
9
13
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Yes No Unknown
13
29
0
9
30
89
100
38
71
40
100
73
70
11
50
18
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Yes No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
39
Figure 414 Share of practices with one full module primarily dedicated to health promotion
(n=140 in percentages)
Visibility of health promotion in CPD
In CPD health promotion is often integrated into disease-oriented or risk behaviour-
based contents making it harder to identify the subject in events available The
Union of European Medical Specialists (UEMS) has an electronic database for
accrediting continuous medical education This data set contains keywords Using
health promotion public health or lifestyle as keywords 37 educational events were
found in the years 2017-19 (Table 415) There were 6 events in year 2017 3 in
year 2018 and 8 in year 2019 Average number of credits (1 ECMEC equals 1 hour
maximum 6 per day) was 296 average length of events 45 days This illustrates
availability of international training on health promotion and public health for
medical professions In other events these themes may have been touched upon
as well but are not the main subject So there might be a need to make health
promotion more visible in CPD events Competency-based education could provide
a solution if health promotion disease prevention and lifestyle medicine are defined
as competencies
Table 415 CPD events with health promotion public health or lifestyle as keyword 2017-
2019 (n=37)70
Title ECMEC Year Location Website
Control of multidrug-
resistant micro-organisms in health care settings
20 2017 Stockholm
Sweden
httpwwwecdceuropaeu
Epidemiology and public health microbiology for facilitators
30 2017 Spetses Greece
httpwwwecdceuropaeu
Fellowship (EPIET amp EUPHEM) introductory course
86 2017 Spetses Greece
httpwwwecdceuropaeu
International Society for Quality in Health Care 34th International Conference
23 2017 London United Kingdom
httpisquaorgEventslondon-2017
DOHaD 2017 10th World Congress DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE
25 2017 Rotterdam Netherlands
httpwwwdohad2017org
70 Source UEMS database of accredited events 2017-2019
4035
150
20
40
60
80
100
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
40
Title ECMEC Year Location Website
10th European Public Health Conference
23 2017 Stockholm Sweden
httpsephconferenceeu
Methods and tools for evidence-based practice
and decision-making in Public Health with special emphasis on communicable disease
22 2018 Stockholm Sweden
httpwwwecdceuropaeu
ESCMID Workshop on
Migrants Health
15 2018 Muscat
Oman
httpsescmidpulselinksco
mevent14833
Control of multidrug-resistant micro-organisms in health care settings
17 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventscourse-control-multidrug-resistant-micro-organisms-mdros-health-
care-settings
ECDC Summer School 2018 23 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventsecdc-summer-school-2018
3rd International Conference of the European Network for Smoking and Tobacco Prevention
15 2018 Madrid Spain
httpsenspconferenceorg
European Observatory Venice Summer School 2018
25 2018 San Servolo Italy
wwwtheobservatorysummerschoolorg
Letrsquos talk about nutrition (NESG)
4 2018 Madrid Spain
httpespencongresscomprogrammelll-courses
Epidemiology and public health microbiology for
facilitators
28 2018 Spetses Greece
httpsecdceuropaeuenepiet-euphemaboutintro
International Society for
Quality in Health Care 35th International Conference
22 2018 Kuala
Lumpur Malaysia
httpsisquaorgEventsmal
aysia-2018
Fellowship (EPIET amp EUPHEM) introductory course
93 2018 Spetses Greece
wwwecdceuropaeu
EGEA 2018 ndash ldquoNutrition and health from science to practicerdquo
16 2018 Lyon France httpswwwegeaconferencecom
1st EUROPEAN LIFESTYLE MEDICINE CONGRESS
13 2018 Geneva Switzerland
wwwelmocongresscom
11th European Public Health Conference
24 2018 Ljubljana Slovenia
wwwephconferenceeu
Fellowship Multivariable
Analysis
25 2019 Madrid
Spain
Rapid Assessment and Survey methods (RAS)
module
35 2019 Zagreb Croatia
ECDC Summer School 2019 28 2019 Stockholm Sweden
httpswwwecdceuropaeuennews-eventsecdc-summer-school-2019
Fellowship Vaccinology Module
29 2019 Rome Italy
Programme Planning and Implementationrdquo Training Program for Resolve to
Prevent Epidemics Initiative
39 2019 Butaro Rwanda
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
41
Title ECMEC Year Location Website
Skill-mix innovation in primary and chronic care mobilizing the health workforce
28 2019 Venice Italy wwwtheobservatorysummerschoolorg
Evolutionary Medicine Conference 2019 5th international meeting of the International Society for Evolution Medicine and Public Health
15 2019 Zurich Switzerland
httpsisemphorg2019-Meeting
Fellowship (EPIET amp EUPHEM) introductory course
85 2019 Spetses Greece
Project Management for Emergency Preparedness Budget and Finance Management
20 2019 Butaro Rwanda
Autumn School on Medical
Education
19 2019 Chernivtsi
Ukraine
httpswwwfacebookcome
vents531981117209981
Project Management for Emergency Preparedness Practical Leadership Skills
24 2019 Butaro Rwanda
International Society for Quality in Health Care 36th International Conference Cape Town 20102019 - 23102019
18 2019 Cape Town South Africa
httpswwwisquaorgeventscp2019html
Public Health Genomics an
introduction
11 2019 Stockholm
Sweden
httpsecdceuropaeuenne
ws-eventspublic-health-genomics-introduction
ENSP Tobacco treatment
specialistsrsquo training
5 2019 Paris France httpenspnetwork
World Health Summit 2019 16 2019 Berlin Germany
wwwworldhealthsummitorg
Time Series Analysis 28 2019 Bilthoven
Netherlands
httpsecdceuropaeuenep
iet-euphemaboutexperience
12th European Public Health Conference
16 2019 Marseille France
wwwephconferenceeu
Outbreak Investigation Module
30 2019 Nicosia Cyprus
httpswwwecdceuropaeuenepiet-euphemaboutexperience
Source UEMS database of accredited events 2017-2019
Looking at the regional level we found that in most regions a majority of practices cover
the topic in all (or most) modules of the educational programme (Figure 416) In Northern
Europe this is most pronounced with as much as 76 of the practices reported covering
health promotion in all modules whereas in Eastern Europe this applies for 55 of
practices A similar analysis for individual countries shows that only in Spain health
promotion is covered in a dedicated module in the majority (62) of educational practices
reported while in all other countries the topic is mostly covered in all (or most) modules of
the programme Percentages vary from 56 (Austria) to 86 (Greece Figure 417)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
42
Figure 416 How is health promotion implemented in education by region (n=148 in percentages)
Figure 417 How is health promotion implemented in education by country (n=120 in
percentages)
55 participants answered specific questions on the full module dedicated to health
promotion 81 of them indicated that the education is mandatory As figure 418 shows
in Northern and Eastern Europe all dedicated module on health promotion form part of
mandatory education In Western Europe one out of three modules is optional for students
24
4537
42
76
5563
58
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
4439
36
14
22
38
18
6256
6164
86
78
63
82
38
0
20
40
60
80
100
Austria Belgium France Greece Italy Portugal Slovenia Spain
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
43
Figure 418 Full modules on health promotion that are part of mandatory education by region (n=47 in percentages)
An exam is taken at the end of the module in 70 of the cases Between regions
percentages do not differ much (Figure 419) Please note that results are based on a
limited number of practices as response for this question was low
Figure 419 Exam at the end of dedicated module by region (n=47 in percentages)
When asked whether the module on health promotion and disease prevention was
accredited separately 15 indicate that this is the case 30 report that the module is
provided at multiple locations
Figure 420 provides an overview of respondents who indicate that funding was obtained
to set up the module as well as the use of partnerships for implementation of teaching
activities on health promotion or in setting up the module Lastly it was indicated that
mostly lsquootherrsquo professionals are teaching these modules
100 100
82
67
12
22
611
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
Yes No Unknown
2518
2225
12 11
75 7571
67
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
No Unknown Yes
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
44
Figure 420 Funding and partnerships for dedicated modules (n=47 in percentages)
42 Overview of competency profiles of health professionals in the EU
A detailed description of the competency profiles per healthcare profession as obtained
from the desk research can be found in Annex 2 Competency profiles per professions
These profiles provide a solid basis for health promotion and disease prevention
Most competency profiles mention health promotion andor disease prevention Overall
the competencies of medical specialists are most comprehensively described including the
competencies for health promotion Although there are many similarities between the
different competency profiles we have identified differences in the coverage of domains of
learning ie knowledge skills and attitudes (see chapter 23) Knowledge refers to
cognitive or mental competencies skills to competencies to perform tasks or activities and
attitudes to competencies related to beliefs or values An example of an attitude
competency is ldquoexemplify appropriate lifestyle in personal behaviourrdquo In professions that
are less physically oriented emphasis is on knowledge and attitude rather than on skills
related to health promotiondisease prevention This mainly holds for psychiatry and social
workers For professions in which lifestyle is an essential component ie sports medicine
and public health emphasis is on skills rather than attitudesOnly for cardiology nurses
nurse specialists and pharmacists competency profiles describe competences in all
domains of learning ieknowledge skills and attitudes
Many competency profiles leave room for interpretation and competencies described are
not ranked in order of importance In addition profiles do not state whether competencies
should be practised in a pro-active (within every treatment) or reactive way (only when
treating diseases with a clear lifestyle component
43
53
11
0 20 40 60 80 100
Partnerships in setting up module
Partnerships for execution of teachingactivities
Funding to set up module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
45
5 LONG LIST OF GOOD PRACTICES
In this chapter we present the coverage and content of the long list of good practices The
list is also available in an Excel-file that provides the opportunity to easily make selections
by different variables such as country type of programme (undergraduate postgraduate
CPD) or the characteristics of the education programme
We also provide an analysis of content areas covered and their weight in educational
programmes learning objectives learning typology and educational methodology using
Kraigerrsquos typology and Friedenrsquos pyramid as analytical tools
51 Results
From the survey results we have drawn a long list of good practices In agreement with
Chafea and DG SANTE good practices were selected based on four criteria
1 The programme contains a multidisciplinary approach
2 The education is mandatory (including an exam)
3 The education covers the following topics digitalisation in health eHealth and digital
health coaching
4 The expected outcome includes change in skills andor behaviour
This resulted in a long list of 70 good practices that meet all criteria Educational practices
cover all regions of Europe and originate from 20 Member States (Figure 51 and Table
51)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
46
Figure 51 Number of good practices selected for long list by country 2019-2020
Table 51 Number of good practices selected based on the four selection criteria per European Member State 2019-2020
Abbreviations EU Member State Number of good
practices
AT Austria 6
BE Belgium 11
BG Bulgaria 2
CY Cyprus 1
CZ Czech Republic 2
DE Germany 0
DK Denmark 5
EE Estonia 1
ES Spain 7
FI Finland 2
FR France 6
GR Greece 7
HR Croatia 0
HU Hungary 1
IE Ireland 3
IT Italy 2
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
47
Abbreviations EU Member State Number of good practices
LT Lithuania 1
LU Luxembourg 0
LV Latvia 1
MT Malta 0
NL Netherlands 0
PO Poland 0
PT Portugal 2
RO Romania 1
SE Sweden 2
SI Slovenia 7
SK Slovakia 0
TOT 70
Of all selected good practices of healthcare educational programmes 16 practices (23)
cover health promotion and disease prevention in one full module primarily dedicated to
the subject In 54 good practices (77) the educational programmes incorporate the topic
of health promotion and disease prevention in all or most modules (Figure 52)
Figure 52 How is health promotion covered in selected good practices (n=70 in percentages)
When dividing good practices by type of education programme we see that all types
educational programmes are represented (Figure 53) The highest share of good practices
is focused on undergraduate education (60 n=42) Two practices are focused on both
undergraduate and postgraduate education
Figure 53 Type of education () represented by selected good practices (n=70)
77 23
All modules One module
6026
113
Undergraduate education
Post graduate education
Continuous professionaldevelopment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
48
Figure 54 presents the absolute number of selected good practices by type of profession
trained The absolute number sums up till 128 as multiple professions can be trained within
one programme This shows a good variation of health professionals Most good practices
focus on nurses (17 n=22) and medical doctors (13 n=17)
Figure 54 Good practices by profession being trained (n=70 in absolute numbers)
In addition to those described above other variables are included in the separate Excel file
mentioned above These include the name of the programme and the institute focus on
knowledge skills and behaviour type of professionals being trained theories covered in
the education (eg human cognition and behaviour health behaviour change techniques
communication skills etc) education methods used when the education started time
spent on the modules in study hours (ECDEC) and in case of one full module the duration
of this module This Excel file allows to make cross comparisons between different variables
52 Analysis of good practices
In this section good practices are analysed more in detail Figure 55 presents the
distribution of content areas in health promotion and their weight in educational
programmes Methodological training like evidence-based methods (EBM) varies in
programmes but has a strong position Lifestyle intervention skills are widely taught
however new technologies are still on their way in becoming part of health promotion
education Interestingly health economics rate less in these practices in spite of its close
link with health promotion as part of public health policies
30
4
4
11
17
15
15
22
10
Other
Social workers
Dentists
Occupational therapists
Medical doctors
Medical specialists
Psychologists
Nurses
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
49
Figure 55 Results for good practices(n=70) ldquoDoes the education of the initiative includerdquo
Numbers refer to Frieden model in levels of health promotion with exception of methodological contents marked
as tools (1) counselling and education (2) clinical interventions (4) changing the context to make individualrsquos
default decisions healthy (5) socioeconomic factors (6) methods in studying and evaluating health promotion
and public health
We used Friedenrsquos pyramid of levels of health promotion (Frieden 2010) and Kraigerrsquos
typology of learning (Kraiger et al 1993) to describe the abilities that professionals are
expected to acquire Based on their description learning objectives move in a knowledge
level skill building or into attitudinal objectives Figure 56 gives a graphical visualization
of the results of our analysis The dark blue green and light blue rectangles represent the
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
50
Figure 56 Learning objectives categorised into Friedenrsquos levels and learning typology
(knowledge skills attitudes) of good practices (n=70)
different domains of learning knowledge skills and attitudes The size of the rectangles is
proportional to their share in all domains in the educational practice
Within each domain of learning contents are categorized Their vertical order reflects the
order of impact levels of Frieden (from individual patient to society level) and again size
corresponds to share in the curriculums content
This analysis provides a general picture of educational practices in health promotion
disease prevention and lifestyle medicine The graph shows that practices are
predominantly oriented towards knowledge-based competencies (around 60 of the
curriculum) Roughly one third of the programme has skills-oriented learning objectives
while competencies regarding attitudes are addressed in around 10 percent of the
programmersquos content
Looking into knowledge-based competencies the broad spectrum of individual to societal
levels of impact is addressed On a societal level social and medical aspects are widely
represented while the economic angle is scarcely present Technological developments like
digitalisation are present to a modest extent
Skill-oriented learning objectives focus in communicative competences like communication
skills behaviour change techniques and teamwork Health coaching is covered in a small
number of practices Interestingly in methodological contents the aim of skills-oriented
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
51
education is to provide mainly knowledge like in EBM Few practices include practical skills
for communication and coaching in their objectives
Competence-building in the domain of attitudes form a minimal part of educational
practices They are reflected in eg health literacy and ethics However these are also
taught in a hidden curriculum as well
Educational methodologies in the survey include lectures assignments e-Learning and
real-world field assignments As these are the selected good practices it was to be expected
that multiple methods are used in most of these programmes (given selection criterium 3)
In 37 programmes all methods are in use E-Learning is used in 41 programmes
Figure 57 Educational methods used in good practices (n=70 in percentages) ()
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
53
6 CONCLUSIONS
The competency profiles as well as information on a large number of educational practices
in health promotion disease prevention and lifestyle medicine for health professionals in
the EU allow us to formulate answers to the research questions that guided this study
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and
continuous professional education
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades71there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional The educational practices collected show that this is true for all
regions of the EU However there is no overall body that has responsibility for quality
assuring standards of training and professional practice at the European level
The information on around 200 practices from 25 EU Member States (including UK) shows
that the majority of educational practices take place in undergraduate settings while
training events on health promotion for health professionals active in the field are relatively
scarce in continuous professional development (CPD) a limited number of practices on
health promotion are reported and indeed few courses or training events on health
promotion are available in the CPD calendar of the UEMS database of accredited events
Education on health promotion aims at developing competencies in knowledge skills and
attitude and most often has a multidisciplinary character Especially medical doctors nurses
and psychologists are often involved in educating other disciplines on health promotion
Health behaviour human cognition and behaviour as well as population health are part of
educational practices for all professions A majority also include communication skills
methods of EBM and ethics
The most common way to teach health professionals on health promotion disease
prevention and lifestyle medicine is the integration of the subject in most of all modules of
the curriculum Dedicated modules on health promotion are developed in undergraduate
and postgraduate education but are scarce in CPD This may contribute to the invisibility of
the subject in training for professionals active in the field
Four out of ten educational practices on health promotion are accredited on the European
(or international) level half of them have national accreditation
71 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
54
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Based on in-depth analysis of a selection of 70 good practices knowledge proves to be the
predominant domain of learning Theories covered relate to different levels of impact of
Friedenrsquos pyramid but emphasis is on the individual patient level with a predominant
position for evidence-based medicine Health economics receive remarkably little attention
This may be disadvantageous for advocacy of health promotion which requires influencing
decision-making on public funding
Around one third of educational contents are dedicated to competencies in the domain of
skills and mainly target communicative skills Interestingly they provide mainly knowledge
rather than practical training Competencies in the domain of attitude are addressed least
Ethics and health literacy are theories are the most common examples of attitude-oriented
contents When looking at the competencies defined by health professionals advocacy has
a solid role in all of them with defined skills It was represented in only few domains like
health economics so it may well be that educating advocacy skills are more common than
found in this study
Good practices use a mix of educational methods including lectures assignments real-
world practices and digital study methods
In conclusion this study is a first step in gaining knowledge and insights in the state of
affairs of health professionalsrsquo education in health promotion disease prevention and
lifestyle medicine in the EU It is an important step as we know little about present
practices However more detailed research will obviously be needed
The results of our in-depth analysis of good practices provide qualitative information We
used the integrated framework as an analytical tool to classify content areas covered and
their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future The information supplied by the
respondents show the culture of describing health promotion and education objectives
Therefore no lsquohardrsquo conclusions can be drawn However some cautious notions are
worthwhile to mention as they flag opportunities for learning and improving by collaborative
action
First it is worthwhile to stress the progress made While 20 years ago health professionals
were hardly trained in health promotion and lifestyle medicine and at best received some
instruction on specific disease-related unhealthy habits (like smoking for lung diseases) it
is now part of standard education for most health professionals That is an important
development and essential for collaboration across professions
However more can be done Health promotion education should respond to societyrsquos needs
and therefore educational needs are constantly changing and providers of education need
to follow needs in the field Increasing recognition of societal impact on health inequalities
the paradigm shift from treating to coaching patients changes in the way care is delivered
the digital revolution and the need to contain the cost of our healthcare systems represent
a multitude of challenges and relentless educational efforts in health promotion disease
prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
55
To name a few the balance between domains of learning in curricula will have to redefined
as in health coaching skills attitudes and knowledge are equally important Health
professionals will have to manage health economics to speak the language of policy makers
Teaching methodologies have gained from the technological revolution and there is
potential in utilising them even more Also there is a necessity to do so in order to provide
for effective health promotion Health literacy has got alongside data literacy Therefore
education needs to respond to in using more technologies as well as teaching adaptation of
technologies into care This is not common practice yet The constant development in needs
also stresses the need for continuous professional development in health promotion
disease prevention and lifestyle medicine To date CPD seems to be underrepresented in
educational practices on health promotion and more heavily dependent on external funding
than in undergraduate and postgraduate courses
The experience developed in the good practices collected in the survey represents a
valuable body of knowledge skills and attitudes among health educators With collaborative
efforts this can serve as an important capital to promote continuous development and
improvement of educational practices in health promotion disease prevention and lifestyle
medicine in all European countries
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
57
ANNEX 1 SURVEY RESULTS BY COUNTRY
In this annex we provide the names of all educational programmes by country filled in in
the survey In addition the following variables of the educational programmes are
provided the name of the educational institution type of education and type of health
professionals being trained This information is based on the information provided by the
respondents from each country If certain boxes are not filled in this means that only
partial information of this educational programme is provided
Austria
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Bachelorstudiengang Physiotherapie
FH JOANEUM GmbH Undergraduate education
Physical therapists
Dietetics Health University of
Applied Sciences
Undergraduate
education
Dieticians
Physiotherapy University of Applied Sciences St Polten
Undergraduate education
Physical therapists
Bachelorrsquos Degree Programme Physiotherapy
FH Campus Wien Undergraduate education
Physical therapists
Dietetics and Nutrition FH Joanneum Undergraduate education
Medical Doctors Non-specialized dietitians
Bachelor Programme Physiotherapy
University of Applied Sciences Upper Austria
Undergraduate education
Physical therapists
Degree Programme Dietetics
(Bachelor of Science)
University of Applied
Sciences Upper Austria
Undergraduate
education
Dietitians
Midwifes Speak and language therapists Biomedical scientists Radiological
technologists Physical therapists Occupational therapists Nurses
Bachelor in Health Studies
Physiotherapy
FH Kaernten Undergraduate
education
Physical therapists
Nursing Science Medical University of Graz
Postgraduate education
Nurses
Public Health Medical University of Vienna
Continuous professional development
Medical doctors
Belgium
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Drug Development KU Leuven Undergraduate education
Pharmacists
Bachelor and master Rehabilitation Sciences and
Physiotherapy
University of Antwerp Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
58
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Motor Sciences Physiotherapy
Universiteacute Libre de Bruxelles
Undergraduate education
Physical therapists
Nutrition amp Dietetics Thomas More University College
Undergraduate education
Dietitians
Adad Adad Undergraduate education
Physical therapists
Master Physiotherapy and
Rehabilitation Science
KU Leuven Postgraduate
education
Physical
therapists
Occupational therapist HE Vinci Parnasse ISEI Undergraduate education
Occupational therapists
Master in Physical therapy and Rehabilitation
Universiteacute Libre de Bruxelles
Postgraduate education
Physical therapists
Master in Physical therapy Universiteacute Libre de Bruxelles
Postgraduate education
Medical specialists Physical
therapists (Sport medicine)
Nutrition and dietetics Thomas More University College
Continuous professional
education
Medical doctors Dieticians
psychologists
Information not provided Information not provided
Undergraduate education
Pharmacists
The European Certificate in
Lifestyle Medicine
The European Lifestyle
medicine organisation (ELMO) together with the Belgian Lifestyle
Medicine Organisation (BELMO)
Continuous
professional education
Medical doctors
Medical specialists (lifestyle
medicine) Physical therapists
Occupational therapists Nurses Psychologists General practitioners
Nutrition and Dietetics Erasmus Hogeschool Brussels
Undergraduate education
Dieticians
Master in Nursing and Midwifery
University of Antwerp Postgraduate education
Nurses
Bachelor amp Master Rehabilitation Sciences amp
Physiotherapy
KU Leuven Undergraduate education
Physical therapists
Bachelor Nursing University of Applied
Sciences Gent HOGENT
Undergraduate
education
Nurses
Professional Bachelor in Nutrition and Dietetics
University colleges Leuven Limburg
Undergraduate education
Dieticians
Nutrition and Dietetics University College Ghent
Undergraduate education
Dieticians
Bachelor in Applied Health Science
Howest University College
Undergraduate education
Lifestyle coaches
Physiotherapist Universiteacute Libre de Bruxelles
Postgraduate education
Osteopathy Physical therapists
Bachelor in Medicine Hasselt University Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
59
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor of Nutrition and Dietetics
University of Applied Sciences of Gent
Undergraduate education
Dieticians
Bulgaria
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor programme in Social Work
Plovdiv University Department of Social work
Undergraduate education
Social workers
Rhinology Bulgarian Rhinologic
Society
Postgraduate
education
ENT doctors
Kinesitherapy Medical University Undergraduate education
Physical therapists
TRS rehabilitator Medical College Medical University
Continuous professional
education
Medical specialists
Cyprus
Name of educational
programme
Name of
educational
institution
Type of
education
Type of
health
professionals
being trained
Physiotherapy
programme
Nicosia University Undergraduate
education
Physical
therapists
Czech Republic
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy Universities Undergraduate education
Physical therapists
Physiotherapy Charles University first
faculty of Medicine
Undergraduate
education
Physical
therapists
Physiotherapy Faculty of Medicine Masaryk University Brno
Undergraduate education
Physical therapists
Physiotherapy Palackyacute University Faculty of Physical Culture Department of Physiotherapy
Postgraduate education
Physical therapists
General Nursing Masaryk University Undergraduate education
Nurses
Prakticky zubni lekar (Practical Dentist)
Czech Dental Chamber Continuous professional education
Medical specialists
Health Promotion Ministry of Health Czech Republic
Continuous professional education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
60
Denmark
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Musculoskeletal physiotherapy
Aalborg University Postgraduate education
Physical therapists
Master in Physiotherapy University of Southern Denmark
Postgraduate education
Physical therapists
The Fairstart Foundation The Fairstart Foundation
Continuous professional education
Orphanage staff (each orphanage has
professional staff such as psychologists social workers
andor therapists
These staff members are responsible to work with each child on an individual basis) School
teachers Psychologists Social workers
Bachelor in Physiotherapy University College North Denmark
Undergraduate education
Occupational therapists
Nurses
Bachelorrsquos degree Programme of Physiotherapy
VIA University college Postgraduate education
Physical therapists
Master of Public Health Aalborg University Undergraduate education
Midwives Nurses Therapists Psychologists Medical Specialists
Estonia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Nursing (general nursing) Tartu Health Care College
Undergraduate education
Nurses
Psychology University of Tarty Institute of Psychology
Undergraduate education
Psychologists
Finland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
NutritionNutrition therapy University of Eastern Finland
Postgraduate education
Clinical nutriontinists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
61
Masterrsquos programme of Human Nutrition and food-related behaviour
University of Helsinki Undergraduate education
Nutrition experts who work in eg community
health promotion
Master of Healthcare advanced practice ndash supporting self-care and
care of non-communicable diseases
Savonia University of Applied Sciences
Postgraduate education
Physical therapists Occupational
therapists Nurses
Public Health Nursing Metropolia University of Applied Sciences
Postgraduate education
Public Health nurse
Medical doctors training programme
University of Helsinki medical faculty
Undergraduate education
Medical doctors Nursing
Master degree in Health Management Psychologists
Dentists
Dental education University of Helsinki Faculty of Medicine Department of Oral and Maxillofacial Diseases
Undergraduate education
Dentists
France
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Occupational therapy school Croix Rouge Franccediloise Postgraduate education
Occupational therapists
Institut Reacutegional de Formation en Ergotheacuterapie
Association Saint Franccedilois dAssise
Postgraduate education
Occupational therapists
Occupational therapy Institut de formation en Ergotheacuterapie de Berck-sur-Mer site de Loos
Postgraduate education
Occupational therapists
Occupational therapy IFE Assas Undergraduate education
Occupational therapists
Arrecircteacute du 5 juillet 2010
relatif au diplocircme drsquoEacutetat drsquoergotheacuterapeute
Institut de Formation
en Ergotheacuterapie du CHU Rouen Normandie
Undergraduate
education
Occupational
therapists
Occupational therapy school Croix Rouge Francaise Postgraduate education
Occupational therapists
Occupational therapy UPEC Postgraduate
education
Occupational
therapists
Diplocircme de Dieacuteteacuteticien IUT biologie ou BTS dieacuteteacutetique
Postgraduate education
Dietitians
Programme deacuteducation et de promotion agrave la santeacute
CoDEPS 13 Continuous professional education
Nurses Psychologists Dentists Social workers
Public health Universiteacute de Bourgogne
Postgraduate education
Medical doctors
Public health Lyon University Undergraduate education
Medical specialists
Public health residency Faculty of medicine University of Nantes
Undergraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
62
Name of educational programme
Name of educational institution
Type of education
Type of health professionals being trained
Master in Public Health Karolinska Institute Postgraduate education
Occupational therapists Social Workers
Public health and social
medicine
Universiteacute Versailles
Saint Quentin en Yveline
Continuous
professional education
Medical doctors
Public health UFR sciences de santeacute - Universiteacute de Bourgogne
Postgraduate education
Medical doctors Medical specialists
Midwives Physical therapists
Nurses General practitioners
Germany
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Visceral Surgery Augsburg University Continuous professional education
Medical specialist Physical therapists
Occupational therapists
Nurses Social workers
Human Medicine ndash The
cologne model study course (human medicine)
University of Cologne
Medical faculty
Undergraduate
education
Medical
specialists
Greece
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy University of Thessaly Undergraduate education
Physical therapists
Oral education programme
for children via experiential learning
Hellenic Dental
Association-Dental School of Athens-Hellenic Society of Paediatric Dentistry
Continuous
professional education
Psychologists
Dentists
Sports Nutrition International Hellenic University
Postgraduate education
Dieticians
Preventive Dentistry National and
kapodistrian University of Athens school of dentistry
Undergraduate
education
Undergraduate
students
Nutrition amp Dietetics International Hellenic University
Postgraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
63
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicine ndash under and post graduate studies
School of health sciences University of Patras
Undergraduate education
Medical doctors
Pharmacy diploma Aristotle University of
Thessaloniki
Undergraduate
education
Pharmacists
Hungary
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Public Health and Preventive
Medicine
Semmelweis University
Budapest Faculty of
Medicine Department of Public Health
Undergraduate
education
Medical doctors
Academic programme of Medicine
Semmelweis University Faculty of Medicine
Undergraduate education
Medical doctors
Residency in Preventive Medicine and Public Health
Semmelweis University Postgraduate education
Medical specialists
Ireland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Social Science in
Social Work
Maynooth University
(national University of Ireland Maynooth)
Postgraduate
education
Social workers
Information not provided Information not provided
Undergraduate education
Physical therapists
Professional Master of Physiotherapy
University College Dublin
Postgraduate education
Physical therapists
Bachelor Physiotherapy University College Dublin
Undergraduate education
Physical therapists
Bachelor Physiotherapy RCSI Undergraduate education
Physical therapists
Irish Dental Association Irish dental association Continuous professional
development
Dentists
Public Health Medicine Royal College of Physicians in Ireland
Postgraduate education
Medical specialists
Higher specialist training in Public Health Medicine
Royal College of Physicians in Ireland
Postgraduate education
Medical doctors Medical specialists General practitioners
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
64
Italy
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Healthy Lifestyles CNAI ndash Italian Nurses association
Continuous professional education
Nurses
Management for Health Professionals
University of Rome Postgraduate education
Midwifes Physical therapists Nurses
Corso di laurea in Terapia occupazionale (Bachelor in Occupational therapy)
Universitagrave degli Studi di Milano (State University of Milan)
Undergraduate education
Occupational therapists
Life Sciences University of Catania
School of Medicine
Continuous
professional
education
Medical doctors
Medical
specialists Physical therapists Occupational therapists Nurses
Dentists
Health promotion University of pavia Undergraduate education
Nurses
Corso di Laurea Magistrale
in Odontoiatria e Protesi Dentaria
Universitagrave di Parma Undergraduate
education
Dentists
Hygiene preventive medicine and public health
Universitagrave Cattolica del Sacro Cuore
Postgraduate education
Medical doctors Medical
specialists
general practicioners
Igiene e Medicina Preventiva Universitagrave degli Studi dellrsquoAquila
Postgraduate education
Medical doctors non-specialized
Post graduate school of Public Health
University of Sienna Postgraduate education
Medical doctors
Hygiene and Public Health University of Bari Aldo Moro
Postgraduate education
Medical doctors
School of specialization in Hygiene and Preventive Medicine
University of Milan Postgraduate education
Medical doctors
Lithuania
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Health Education and Promotion
Klaipeda State University of Applied sciences
Undergraduate education
Dietitians Physical therapists Nurses Dentists Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
65
Latvia
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Dentistry Riga Stradins University Undergraduate education
Dentists General practicioners
Professional Bachelor programme Physiotherapy
LASE Postgraduate education
Physical therapists
Physiotherapy Riga Stradins University Undergraduate education
Physical therapists
Malta
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Bachelor in Nursing Studies University of Malta Faculty of Health Sciences department of Nursing
Undergraduate education
Nurses
FHs University of Malta Undergraduate education
General practitioners
Netherlands
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Occupational Therapy Information not provided
Undergraduate education
Occupational therapists
Lifestyle and Healthcare Amsterdam University Medical Centre
Undergraduate education
Medical students
Portugal
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
PhD in Social Work ISCTE University Institute of Lisbon
Postgraduate education
Social workers
Bachelor degree in
Physiotherapy
Escola Superior de
Sauacutede de Santa Maria
Undergraduate
education
Physical
therapists
Physiotherapy IPC ESTeSC Coimbra Health school
Undergraduate education
Physical therapists
Licenciatura em Fisioterapia Escola Superior de Sauacutede - Instituto Politeacutecnico do Porto
Undergraduate education
Physical therapists
Degree in Physical therapy Instituto Piaget ndash Vila Nova de Gaia
Undergraduate education
Physical therapists
Degree in Physical therapy ESSATLA Continuous professional development
Physical therapists
Curso Licenciatura em Fisioterapia
Instituto Politeacutecnico de Sauacutede do Norte Escola Superior de Sauacutede do Vale do Ave CESPU
Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
66
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Clinical Education University Fernando Pessoa- Faculty of Health Sciences
Continuous professional development
Workers factory
Physiotherapy (Bachelor) School of healthy-
polytechnic institute of Setubal
Undergraduate
education
Physical
therapists
Physiotherapy Escola Superior De Sauacutede Do Vale Do Sousa do Instituto
Politeacutecnico De Sauacutede Do Norte
Undergraduate education
Physical therapists Nurses
Psychologists Dentists
Public Health ARSLVT Postgraduate
education
Medical
specialists
Information not provided Information not provided
Postgraduate education
Physical therapists
Information not provided Information not provided
Undergraduate education
General practicioners
Romania
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Nursing Education University Lucian Blaga Postgraduate education
Nurses
MedicinePharmacy - Health University of Oradea Faculty of medicine and
pharmacy Oradea
Postgraduation education
Medical doctors Medical
specialists Pharmacists Physical therapists Nurses
Dentists General practicioners
Slovakia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Social Work Constantine the philosopher University in Nitra
Postgraduate education
Social workers
Specialisation study in Clinical Psychology
Comenius University in Bratislava Faculty of
Arts
Continuous professional
development
Medical specialists
psychologists
Slovenia
Name of educational
programme
Name of educational
institution
Type of
education
Type of health
professionals being trained
Physiotherapy Alma Mater Europaea Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
67
Physiotherapy University of Novo mesto Faculty of Health sciences
Undergraduate education
Physical therapists
Faculty of health sciences University of Primorska Continuous professional education
Dietetics Physical therapists Occupational therapists Nurses
Nursing Applied Kinesiology Physiotherapy and Nutritional counselling ndash dietetics
University of Primorska Faculty of Health Sciences Slovenia
Undergraduate education
Nutrional counselling Kinesiologists Physical therapists Nurses
Professional higher education study programme 1st cycle degree occupational
therapy
University of Ljubljana faculty of health sciences
Undergraduate education
Occupational therapists
Applied Kinesiology UP FVZ Undergraduate
education
Kinesiology
Physiotherapy Alma mater Europaea ndash Evropski center Maribor
Undergraduate education
Physical therapists
Bachelor in Physiotherapy University of Ljubliana Faculty of health sciences
Undergraduate education
Physical therapists
Health Promotion Angela Boskin Faculty of healthcare
Postgraduate education
Physical therapists Occupational
therapists nurses
1st Bologna cycle study programme Physiotherapy
Angela Boskin Faculty of healthcare
Undergraduate education
Physical therapists
Public Health Medical
Residency
Medical chamber of
Slovenia
Continuous
professional development
Medical doctors
Public Health National institute of public health of the
Republic of Slovenia
Postgraduate education
Medical doctors
Psychology Faculty of arts University of Maribor
Postgraduate education
Psychologists
Spain
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Human Nutrition and Dietetics
University of Zaragoza Undergraduate education
Dieticians
Continuous professional
education
Nurses
Physiotherapy University of Coruna Undergraduate education
Physical therapists
EHEA Degree in Human Nutrition and Dietetics
Blanquerna School of Health Sciences ndash Universitad Ramon Lull
Undergraduate education
Dietitians
Bachelor in Pharmacy Universidad de Sevilla Undergraduate
education
Pharmacists
Continuous professional development
Spanish General Council of Social Work
Continuous professional education
Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
68
Bachelor in Pharmacy Universidad de Alcala Undergraduate education
Pharmacists
Bachelor in Medicine Faculty of medicine University of Cadiz Spain
Undergraduate education
Medical doctors General practitioners
Residency in Preventive Medicine and Public Health
Hospital Clinic de Barcelona
Postgraduate education
Nurses
Bachelor in Medicine Information not provided
Undergraduate education
Medical doctors
MasterBachelor in Pharmacy
University of Navarra Undergraduate education
Postgraduate education
Pharmacists
Human Nutrition and Dietetics
Univeristy of Navarra Undergraduate education
Nutritionists amp Dietitians
Pharmacy Universitad Ramon Lull
Undergraduate education
Pharmacists
Pharmacy IQS ndash FCSB Undergraduate education
Pharmacists
Master in Advanced Therapies and Innovation in Biotechnology
Universidad de Francisco de Vitoria
Postgraduate education
Pharmacists
Pharmacy Universidad of the Basque County
Undergraduate education
Pharmacists
Sweden
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master programme in Public Health
Karolinska institute Postgraduate education
Occupational therapists
Social workers
Dietetics programme Department of food and Nutrition
Undergraduate education
Dietician
Dietetics programme Department of food studies dietetics and nutrition
Undergraduate education
Dietician
Programme in Dietetics University of Gothenburg
Sahlgrenska Academy
Undergraduate education
Dietician
Master of Public Health Department of public health and caring sciences Uppsala University
Postgraduate education
Medical doctors Bachelor of science Physical
therapists Nurses Psychologists Dentists Social workers
United Kingdom
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor (Hons) Occupational Therapy
Northumbria University Undergraduate education
Occupational therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
69
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master (pre reg) Occupational Therapy
Master in Occupational Therapy
Leeds Beckett University
Postgraduate education
Occupational therapists
Bachelor (Hons) Occupational Therapy
St Georgersquos University of London
Undergraduate education
Medical doctors Medical specialists Physical therapists
Occupational therapists
Bachelor (Hons)
Occupational Therapy
Caterburry Christ
Church University
Undergraduate
education
Occupational
therapists
Bachelor (Hons) Occupational Therapy Master in (pre-reg) Occupation Therapy Occupational Therapy degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Public Health speciality training
Health education England -north west
Postgraduate education
Medical doctors Medical specialists Researchers Nurses
Bachelor in (Hons) Occupational Therapy Master in (Pre-reg)
Occupational Therapy Occupational Therapy
Degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Additional countries
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Bachelor of Physiotherapy University of Prishtina Kosovo Albania
Postgraduate education
Physical therapists
Physiotherapy Faculty of health studies University of Sarajevo Bosnia-Herzegovina
Undergraduate education
Physical therapists
Fysioterapeututdanning NTNU Norway Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy BFH
Berner Fachhochschule BFH Bern University of Applied Sciences Swiss
Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy
ZHAW Zurich University of applied sciences Swiss
Undergraduate education
Physical therapists
Physical Therapy Sciences University of Iceland
School of Health Sciences
Undergraduate
education
Physical
therapists
Medicine International school of medicine Kazachstan
Undergraduate education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
70
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicinesingle-cycle degree programme
University of Georgia Republic of Georgia
Medical doctors Psychologists General practicioners
Medicine Akaki tsereteli state University Republic of Georgia
Postgraduate education
Medical doctors Medical specialists Physical therapists Psychologists
Dentists General
practicioners
Public Health and Epidemiology
David tvildiani medical University Republic of
Georgia
Postgraduate education
Medical doctors
Biomedical and Healthcare Science doctoral programme
David tvildiani medical University Republic of Georgia
Postgraduate education
Medical doctors Biomedical Science master degree holders
Medicinesingle-cyle degree programme
University of Georgia Republic of Georgie
Undergraduate education
Medical doctors
Public Health Tbilisi State Medical University (TSMU)
Republic of Georgia
Undergraduate education
Medical doctors and public
health specialists
David tvildiani Medical
University
David tvildiani Medical
University Republic of Georgia
Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
71
ANNEX 2 COMPETENCY PROFILES PER PROFESSIONS
Undergraduate medicine
The CanMEDS framework is worldwide the most commonly used and adapted model that
identifies and describes the abilities physicians require in order to effectively meet the
health care needs of the people they serve72 Within European Member States modifications
of this model are used within health and educational settings (for example in the
Netherlands and Finland) for undergraduate medicine and medical specialisations The
CanMEDS model defines seven roles of the physician namely (1) medical expert (the
integrating role) (2) communicator (3) collaborator (4) leader (5) health advocate (6)
scholar and (7) professional73 The role of health advocate is defined as physicians
contributing their expertise and influence as they work with communities or patient
populations to improve health ldquoimproving health is not limited to mitigating illness or
trauma but also involves disease prevention health promotion and health protection
Improving health also includes promoting health equity whereby individuals and
populations reach their full health potential without being disadvantaged by for example
race ethnicity religion gender sexual orientation age social class economic status or
level of educationrdquo Within this role two key competencies are defined74
1 Respond to an individual patientrsquos health needs by advocating with the patient within
and beyond the clinical environment
a Work with patients to address determinants of health that affect them and their access
to needed health services or resources
b Work with patients and their families to increase opportunities to adopt healthy
behaviours
c Incorporate disease prevention health promotion and health surveillance into
interactions with individual patients
2 Respond to the needs of the communities or populations they serve by advocating with
them for system-level change in a socially accountable manner
d Work with a community or population to identify the determinants of health that affect
them
e Improve clinical practice by applying a process of continuous quality improvement to
disease prevention health promotion and health surveillance activities
f Contribute to a process to improve health in the community or population they serve
In addition the European Thematic Network project MEDINE (2004-2007) and Tuning
Project (Medicine) under its auspice (MEDINE) have generated and gained widespread
consensus on a set of competences for primary medical degree qualifications in Europe
(ie undergraduate medicine)75 Within this project it is stated that graduates in medicine
72 httpwwwroyalcollegecarcsitecanmedscanmeds-framework-e 73 httpwwwroyalcollegecarcsitecanmedsabout-canmeds-e 74 httpwwwroyalcollegecarcsitecanmedsframeworkcanmeds-role-scholar-e 75 httptuningacademyorgmedine-medicinelang=en
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
72
would need the ability to ldquopromote health engage with population health issues and work
effectively in a health care systemrdquo76 The following points define health promotion
bull provide patient care which minimises the risk of harm to patients
bull apply measures to prevent the spread of infection
bull recognise own health needs and ensure own health does not interfere with
professional responsibilities
bull conform with professional regulation and certification to practise
bull receive and provide professional appraisal
bull make informed career choices
bull engage in health promotion at individual and population levels
Medical specialist
The European Union of Medical Specialists (UEMS) contributed significantly to the
improvement of post-graduate training through the development of a European Curriculum
in each medical speciality as well as the elaboration of training standards77 Within this
section we provide a detailed description of the European training requirements for a
selection of medical specialists including sports medicine public health internal medicine
cardiology psychiatry and the general practitioner78 This selection was based on the fact
that within these specialities lifestyle might be an essential component or important part of
the treatment of chronically ill patients
1) Medical specialist sports medicine
Sports medicine is defined by the European Commission as a ldquomultidisciplinary clinical and
academic speciality of medicine dealing with health promotion for the general population
by stimulating a physically active lifestyle and diagnosis treatment prevention and
rehabilitation following injuries or illnesses from participation to physical activities
exercises and sport at all levelsrdquo79 As health promotion and prevention are both
incorporated in the definition of sports medicine these topics are included throughout the
whole curriculum of sports medicine The curriculum of sports medicine aimed to provide
theoretical understanding and practical skills to provide first line clinical services80 Within
the training requirements for the speciality of sports medicine it is stated that sports
medicine does not solely take care for sporting elite athletes but as well for its important
role to promote exercise as a medical tool meant for patients with chronic diseases81
bull Theoretical knowledge aims to provide theoretical understanding and practical skills to
provide first line clinical services
- Clinical To provide pre-participation clinical screening and examination before
exercise and competition as well as medical assistance to the athletes engaged in all
sports
76
httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNLearning_Outcomes_Competences_for_Undergraduate_Medical_Education_in_Europepdf
77 httpswwwuemseu__dataassetspdf_file00111415906pdf 78 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 79 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 80 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 81 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
73
- Public health
bull As part of a multi-disciplinary team to encourage and promote physical activity as
a lever for healthy living
bull To identify impediments to an active lifestyle and work within a multi-disciplinary
framework to remove those impediments or minimize their impact
bull To work alongside local health authoritiespublic health clinicians developing
exercise opportunities for the general public for health gain
bull To liaise with public (local authoritieseducationvoluntary) and private sector to
advise on the health aspects of exercise programmes for physical activity of special
groups like women children adolescents and aging population
bull Practical and clinical skills
bull To foster the integration of knowledge and practical skills acquired during the
cardiology orthopaedics physical amp rehabilitation medicine general practice
medicine and physiology internships
bull To learn to put into practice information gained in the relevant course work
bull To extend and deepen their knowledge in the assessment of fitness such as
isokinetic and functional muscle performance cycle ergometry and treadmill
ergometry
bull To gain experience in the use of such test results in the decision making with regard
to diagnosis recommendations and therapy for people of both gender and in
different age groups and performance levels
bull With regard to elite sport trainees will learn how to diagnose treat and prevent
overtraining and overexertion
bull To become proficient in activities related to for example hygiene and nutrition
and will work closely with trainers athletes physiotherapists officials etc
bull Competencies
bull Clinical and instrumental assessment to determine the pathophysiology
mechanisms and the underlying diagnosis of the patientrsquos condition
bull Trainees are expected to complete evidence of reflective practice through case
reports and other experiences in their training record
bull Other self-directed work will be planning data collection analysis and presentation
of audit and research work
bull The mandatory training record (hand written diary or preferably electronic
logbook) will contain evidence of academic pursuits and should be checked and
documented regularly by the Supervisor
bull Trainees will take part and be able to lead in teaching and will be expected to
develop skills to teach undergraduates postgraduates and non-medical staff in
small groups and formal lectures making personal presentations using a variety of
audiovisual methods
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
74
bull They will be expected to present at journal clubs and make case presentations at
grand rounds or similar settings
bull They will be expected to undertake personal audit and research and make
presentations of their findings at clinical meetings
bull Prescription as much evidence-based as possible of medical and physical
treatments (including drug treatment physical modalities innovative
technologies natural factors and others) as well as of technical aids
bull Prevention and management of complications
bull Skill to perform and participate in research
2) Medical specialist public health
The European Commission defines public health ldquoas the science and art of preventing
disease prolonging life and promoting mental and physical health and efficiency through
organized community effort Public health may be considered as structures and processes
by which the Health of the population is understood safeguarded and promoted through
the organized efforts of societyrdquo82 Public health specialists aim to improve populationrsquos
health by using the following skills and competencies
bull Theoretical knowledge on a range of fields including epidemiology prevention health
promotion public health research behavioural sciences health programme evaluations
health need assessments and quality and safety in healthcare
bull Practical and clinical skills
- Surveillance and evaluation of the health of the population (trained in epidemiology)
- Planning and evaluation of health services and public health control
- Analysing the health of the population (analysing determinants on individual and
community levels)
- Plan participate in or evaluate preventive and control programmes (public health
assessments)
- Participate in multidisciplinary health impact assessment
- Inform decision-makers about potential impacts and to identify appropriate and
sustainable actions to manage those effects (including environmental determinants
of health)
- Organisational issues in healthcare (participating in policy and strategic development
quality and safety management)
- Generate and share new evidence on the ways in which social determinants influence
population health and health equity
- Sufficient linguistic ability to communicate with hisher public health colleagues
82 httpswwwuemseu__dataassetspdf_file001198435UEMS-201924-European-Training-
Requirements-for-Public-Healthpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
75
- Develop high professional ethical standard including respect towards human rights
participants in public health programmes colleges and other professionals in the
team
bull Competencies
- Establish the expertise role as a Public Health Physician
bull Function as public health leaders and consultants to health services and other
organizations and institutions in order to provide safe appropriate cost effective
and equal health care to groups communities and populations
bull Establish and maintain medical knowledge skills and attitudes appropriate to their
practice including the organization and financing of health care public health
control and public health law
- Perform expertise analyses of the health of the population
bull Apply and combine medical and epidemiological competencies for the surveillance
and evaluation of the health of the population
bull Identify the determinants of health of populations and risks for public health and
implications for interventions and policy
bull Evaluate health problems biopsychosocial mechanisms andor health care issues
for different population groups and their implications for the community
bull Critically evaluate epidemiological demographic health statistical and
environmental pollution data and their sources and apply them appropriately to
public health issues
bull Identify community health needs and advise about their implications for public
health and medical care services
- Lead and supervise public health interventions
bull Select develop implement and monitor public health surveillance and
interventions namely in the areas of human behaviour social and physical
environment food safety and nutrition health care associated risks and working
life related health
bull Promote the health of individuals communities and populations through health
programming
bull Contribute to the organization and evaluation of societal and health care
programmes aiming to promote health and social functioning among individuals
with long-term diseases and disabilities
bull Contribute to the planning organization supervision of and evaluation of societal
and health care programmes promoting the health of specific target groups such
as children elderly and vulnerable and underserved groups in society
bull Contribute to the organization of and evaluate primary and secondary medical
prevention programmes
bull Contribute to strengthening regulatory frameworks for protecting and improving
health
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
76
- Function as expertise in planning and evaluation of Public Health and Medical Care
bull Evaluate Public Health and other service programmes concerning processes and
outputs from the different perspectives of care seekers professional health care
workers and health managers
bull Analyse and differentiate between need demand and supply and assess the health
of a defined population and identify areas for improvement including the allocation
of health care resources delivery
bull Evaluate the outcome quality and safety of care and promote quality development
systems based on evidence and public health principles
bull Apply health economic principles and methods such as cost-effectiveness cost-
utility and cost-benefits considering the strengths and weaknesses of different
methods
bull Use methods to determine priorities and their strengths and weaknesses and
promote awareness of the competing and conflicting influences on public and
political perceptions of the need for health care and the resulting constraints on
action
bull Promote and evaluate collaboration between health services and other welfare
organizations in society
bull Evaluate and contribute to the policy and strategic development in health care
planning
bull Contribute to the planning and evaluation of different sectors of society by health
impact assessments and public health medical reports and consultations
- Communicate and develop public health medical expertise
bull Lead supervise and participate in an interprofessional health care team
bull Consult other (health) professionals and policymakers and recognise the
advantages and limits of their expertise
bull Effectively convey oral and written information about public health issues including
adequate public health reporting and effective interaction with media
bull Stimulate and motivate others so that they recognise the importance of the public
health population perspective
bull Maintain and enhance professional activities through ongoing learning and
research and contribute appropriately to the generation dissemination application
and translation of new public health knowledge and practices
3) Medical specialist internal medicine
The UEMS defines an internist as ldquoa physician trained in the scientific basis of medicine
who specialises in the assessment diagnosis and management of general medical
problems atypical presentations multiple problems and consequential complex health
issues and system disorders (Professional) The physician is skilled in the management of
acute unselected medical emergencies and the management of patients in a holistic and
ethical way considering all psychosocial as well as medical factors for enhancing quality of
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
77
life The physician values the continuing care of all patients irrespective of the nature of the
patients complaint and is committed to lifelong continued professional development
(Scholar) The physician practices clinical audit and evidence-based medicine The
physician functions in a number of roles including clinical counselling educating leading
and managingrdquo83
Internists have a fundamental role in modern healthcare systems Within the definition of
the internist the shift towards a preventive strategy focusing on health promotion is
highlighted by the acknowledgement of the high prevalence of chronic and complex
diseases that are associated with the lifestyle of ageing western societies The role of
healthcare advocate (a role defined in the CanMED framework) is an important part of the
internistrsquos function and forms the generic competencies of an internist (see section 11)
However lifestyle promotion and disease prevention is not a specific area of expertise
Specific areas of the internist include multi-morbidity and ageing acute care medical
consultation shared-decision-making collaborative care transition in care vulnerable
adult patient safety and quality of care and medical leadership
4) Medical specialist cardiology
According to the training requirements for the speciality of cardiology84 training in
cardiology should be based on the syllabus of the ESC core Curriculum for the general
cardiologist part 2 ldquothe core curriculum per topicrdquo85 The necessary core cardiology
competencies are set out as cardiology learning objectives with the knowledge skills
attitudes and competencies needed to fulfil the objectives One of the core cardiology
competences is cardiovascular prevention aiming to
bull Assess and manage patients with risk factors for cardiovascular disease
bull Understand the mode of action of different prevention methods
bull Describe cardiovascular disease and risk factors in the local community
bull Contribute to the global efforts in reducing cardiovascular morbidity and mortality
by communicating the prevention message to the public
bull To approach prevention in a holistic way understanding the potentiation of
cardiovascular risk by clustering of risk factors
bull
Knowledge
bull Epidemiology of cardiovascular disease in the local community incidence
prevalence survival
bull Risk factors in the local community
83 httpswwwuemseu__dataassetspdf_file001744450UEMS-201613-European-Training-
Requirements-Internal-Medicinepdf 84 httpswwwuemseu__dataassetspdf_file001119577UEMS-201324-SECTIONS-AND-BOARDS-
Cardiology-European-Training-Requirements-20131019pdf 85 httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_
9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
78
bull Risk assessment in primary prevention multifactorial risk interaction and use of
risk scoring charts
bull The impact of lifestyle on people at risk of and patients with cardiovascular
disease
bull The potential of lifestyle changes to prevent and ameliorate cardiovascular
disease diet and nutrition toxic habits (smoking alcohol and others) physical
activity
bull Emerging risk factors (social economic stress depression and personality type)
bull Treatmentprevention strategies for major risk factors and changes in lifestyle
including corresponding pharmacologic therapies
bull The comprehensive approach required for multiple risk factors
bull Patient compliance
In addition the main objectives and knowledge competence are further specified by
hypertension dyslipidaemia diabetes and lifestyle
Skills
bull obtain a relevant history and perform an appropriate clinical examination
bull evaluate cardiovascular risk and assess global cardiovascular risk at the individual
level
bull evaluate cardiovascular risk at population level (mortality morbidity disability)
bull evaluate the benefit of prevention at individual and population levels
bull manage risk factors appropriately including pharmacological and non-
pharmacological therapies
bull communicate their importance to patients their families and the wider
community including smoking cessation diet and exercise
bull communicate the importance of patient compliance and behaviour
bull motivate patients and families to change lifestyles and be compliant with
prescriptionsrecommendations
bull monitor patient compliance and behaviour
bull evaluate the benefit of risk factor intervention for the individual patient
Behaviours and attitudes
bull Non-judgemental attitude to patients regarding their lifestyle (eg smoking diet
etc)
bull Exemplify appropriate lifestyle in personal behaviour
bull Team working with other physicians including general practitioners
diabetologists nephrologists and elderly care physicians for the management of
specific risk factors
bull Team working with all professionals with a role in primary and secondary
prevention (nurses dieticians teachers and politicians)
Another core competency is the physical activity and sport in primary and secondary
prevention Further defined in sports cardiology and cardiac rehabilitation
Sports cardiology aiming86
86
httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
79
bull To conduct strategies to implement healthy lifestyle in particular physical and
sports activities in the general population (primary prevention)
bull To evaluate cardiovascular risk and exercise capacity (see Chapters 22 and
271)
bull To recognize the characteristics of the athletersquos heart
bull To appropriately detect contraindications to exercisecompetition and
appropriately provide non-contraindication certificates
Knowledge
bull Exercise and sports physiology
bull Benefits of exercise training
bull Safety issues in exercise and sport
bull Diagnostic criteria and appropriate investigations in athletes with cardiovascular
disease
bull Risk factors for and mechanisms of sudden cardiac death (SCD) during and after
strenuous exercise
bull Specific population challenges and exercise programmes in appropriate settings
bull Recommendations for professional and recreational sports participation
bull SCD in patients athletes and in the population at large and
bull Mechanisms of action of illicit drugs
Skills
bull perform an individual CVD risk assessment using appropriate information from
history laboratory assessment including full lipid profile and clinical data
bull recognize pathological cardiovascular changes and differentiate them from the
characteristic features of lsquoathletersquos heartrsquo and
bull use prevailing recommendations for eligibility for participation in competitive
sports
Behaviours and attitudes
bull Recognition of the role of active lifestyle exercise and sport in the promotion of
health and in the prevention of the most threatening diseases including
cardiovascular diseases
Cardiac rehabilitation aiming
bull To evaluate and manage cardiovascular risk
bull To evaluate exercise capacity and causes of exercise intolerance
bull To provide appropriate rehabilitation and secondary prevention to patients with
cardiovascular diseases
7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
80
Knowledge
bull Multi-disciplinary risk factor intervention
bull Definition of comprehensive cardiovascular prevention and rehabilitation
bull Effects of behavioural change including physical activity nutrition education and
psychosocial risk factors on quality of life cardiovascular risk and outcome
bull Rehabilitation as a component of cardiac care and a promoter of secondary
prevention
bull Target populations and risk stratification of patients
bull Psychological aspects of rehabilitation and exercise practice
Skills
bull take a relevant history and perform an appropriate clinical examination including
the specific evaluation of the elderly patient
bull perform and interpret risk stratification using indicated tests
bull interpret a cardiopulmonary exercise test and distinguish different causes of
exercise limitation
bull prescribe exercise-based rehabilitation programmes and other lifestyle
interventions according to the patientrsquos condition in collaboration with other
specialists when necessary and
bull motivate the patient to ensure long-term adherence to lifestyle changes and
continuing exercise programmes
Behaviours and attitudes
bull rehabilitation as a component of cardiac care
bull the importance of rehabilitation and secondary prevention for professional
personal and social life among patients with heart disease
bull the interplay of physical and psychological aspects of heart disease and the
positive influence of exercise on cardiovascular risk factors
bull the role of other professionals including nurse specialists physiotherapists ergo
physiologists psychologists dieticians and general practitioners in rehabilitation
and secondary prevention and
bull the importance of patient and family education and the role of other professionals
in rehabilitation
5) Medical specialist psychiatry
The UEMS has issued a charter of requirements for the training in psychiatry in 2000 with
an additional European Framework for Competencies in Psychiatry in 2009 The learning
outcomes in the European Framework for Competencies in Psychiatry (EFCP) are arranged
under the seven physician roles derived from the CanMEDS framework87 Within the EFCP
it is stated that ldquopsychiatrists recognise the importance of advocacy and health promotion
in responding to the challenges represented by those social environmental and biological
factors that determine the mental health and well-being of patients and society They
recognise advocacy as an essential and fundamental component of mental health promotion
that occurs at the level of the individual patient the practice population and the broader
communityrdquo
Competencies
87 httpuemspsychiatryorgwp-contentuploads2013092009-Oct-EFCPpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
81
bull identify the determinants of mental disorder as well as the factors that may
contribute to positive mental health so as to be able to prevent disorder and
promote mental health
- recognise the determinants of mental health of populations and how public
policy including legislation impacts on mental health
- promote positive mental and physical health in patients particularly in those
with severe mental disorder based on best evidence
- recognise the impact of mental disorder on families and carers and take
remedial measures
- collaborate with other community sectors to promote mental health and
prevent mental disorder at all levels focusing particularly on family school and
workplace
- identify and address barriers and inequity in access to care particularly for
vulnerable or marginalised populations
bull Identify and address issues and circumstances when advocacy on behalf of
patients professions or society is necessary
- respect and promote the human rights of people with mental disorders and
collaborate with user and carer associations and advocacy groups
- empower people with mental disorders and their carers
- recognise and address prejudice stigma and discrimination associated with
mental disorder and its treatment
- use strategies to enhance patientrsquos self-management and autonomy
- actively oppose the use of psychiatry for political repression
- recognise the possibility of conflict inherent in their role as a health advocate
for a patient or community with that of manager or gatekeeper
6) General practitioner
The European training requirements for General PracticeFamily Medicine (GPFM) specialist
training88 defined twelve central characteristics of the practice before determining the core
competences Related to health promotion and disease prevention two of these
characteristics are as following ldquopromotes health and well-being both by appropriate and
effective interventionrdquo and ldquohas a specific responsibility for the health of the communityrdquo
The twelve characteristics are clustered into six core competences primary care
management person-centred care specific problem solving skills comprehensive
approach community orientation holistic modelling Under comprehensive approach the
following abilities relate to health promotion and disease prevention
bull to promote health and wellbeing by applying health promotion and disease
prevention strategies appropriately
bull to manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
Furthermore community orientation includes the ability
bull to reconcile the health needs of individual patients and the health needs of the
community in which they live in balance with available resources
88 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
82
In the more comprehensive assessment of GPrsquos performance in daily practice by the
European Academy of Teachers in General PracticeFamily Medicine (EURACT)89 these
abilities are further defined as following
bull To promote health and wellbeing by applying health promotion and disease
prevention strategies appropriate
- Identifies opportunity for health promotion intervention
- Makes use of structured medical record as reminder of preventive activities
- Makes use of teamwork
- Uses communication skills
- Is aware of any personal prejudices which might influence negatively
preventive advice
- Makes recommendations which are feasible in the context of patientrsquos lifestyle
and home situation
- Acts as suitable role model
bull To manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
- Provides appropriate medical management
- Involves members of practice team eg through case conference
- Performsarranges home visit (consider relevant team members) ndash needs
assessment eg cause of falls
- Involves relatives
- Facilitates communication (two-way) with hospital
- Involves external community resources (eg home help etc)
Dentist
According to the profile and competences for the graduating European dentist one of the
major competences for dentists is to improve oral health of individuals families and groups
in the community On graduation a dentist must be competent at promoting and improving
the oral health of individuals families and groups in the community90 Furthermore with
regard to health promotion and disease prevention a dentist
bull Must be competent at
- Applying the principles of health promotion and disease prevention via
comprehensive preventive measures to individuals and the community
according to their risk assessment status
- Understanding the complex interactions between oral health nutrition general
health drugs and diseases that can have an impact on oral health care and
oral diseases
- Providing appropriate dietary advice
bull Have knowledge of
- The organisation and provision of health care in the community and in the
specialist hospital service in the country of training
- The prevalence of the common dental conditions in the country of
trainingpractice
- The social cultural and environmental factors which contribute to health or
illness
- The strategies to overcome barriers to dental care for disabled elderly
socially deprived and ethnic minority groups
- Training auxiliaries in basic skills of oral health promotion
89httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-
documentseuractperformanceagendadC3BCsseldorf2014-openaccessebookversionpdf 90 httpwwwdentuoagrfileadmindentuoagruploadsusefull_filesADEE-competences-2009_enpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
83
In 2017 a new updated framework was published for undergraduate education for dentists
including a revised structure of the educational domains and their areas of competence In
the revised framework health promotion and disease prevention compromises one of the
areas of competence in the domain ldquodentistry in societyrdquo in the educational strategy of a
dentist91 Note Dentists can also specialise in public health in a similar programme as
physicians
Nurses
The training for nurses responsible for general care shall following the Directive
201355EU include a set of eight competences 92 The training for nurses should provide
assurance that the ability of the following knowledge and skills
1 comprehensive knowledge of the sciences on which general nursing is based including
sufficient understanding of the structure physiological functions and behaviour of
healthy and sick persons and of the relationship between the state of health and the
physical and social environment of the human being
2 sufficient knowledge of the nature and ethics of the profession and of the general
principles of health and nursing
3 adequate clinical experience such experience should be gained under the supervision
of qualified nursing staff and in places where the number of qualified staff and equipment
are appropriate for the nursing care of the patient
4 the ability to participate in the practical training of health personnel and experience of
working with such personnel
5 experience of working with members of other professions in the health sector
Competencies 93
6 Competency to independently diagnose the nursing care required using current
theoretical and clinical knowledge as well as to plan organise and implement nursing
care when treating patients on the basis of page the knowledge and skills acquired in
accordance with points (1) (2) and (3) in order to improve professional practice
7 Competency to work together effectively with other players in the health sector including
participation in the practical training of health personnel on the basis of the knowledge
and skills acquired in accordance with points (4) and (5)
8 Competency to empower individuals families and groups towards healthy lifestyles and
self-care on the basis of the knowledge and skills acquired in accordance with points (1)
and (2)
9 Competency to independently initiate immediate measures to pre- serve life and to carry
out measures in crisis and disaster situations
9191 Field JC Cowpe JG Walmsley AD The Graduating European Dentist A New Undergraduate Curriculum
Framework Eur J Dent Educ 201721(Suppl 1)2-10 httpsdoiorg101111eje12307 92 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf 93 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
84
10 Competency to independently advise instruct and support individuals needing care
and their attachment figures
11 Competency to independently ensure the quality of nursing care and assess it
12 Competency to communicate comprehensively and professionally and to cooperate
with members of other professions in the health sector
13 Competency to analyse the quality of care in order to improve their own professional
practice as general care nurses
The competences included in Directive 201355EU are different from the competences
contained in the EFN Competency Framework These competences contain the following
competences on health promotion and disease prevention guidance and teaching
bull To promote healthy lifestyles preventive measures and self-care by strengthening
empowerment promoting health and enhancing behaviours and therapeutic
compliance
bull To independently protect the health and well-being of individuals families or
groups being cared for ensuring their safety and promoting their autonomy
bull To integrate promote and apply theoretical methodological and practical
knowledge This enables the promotion and the development of nursing care in
long term care co-morbidity and in situations of dependency in order to maintain
an individualrsquos personal autonomy and hisher relationships with the environment
in every moment of the healthillness process
Nurse specialist
The European Specialist Nurses Organisation (ESNO) defines the nurse specialist as follows
ldquoThe Nurse Specialist (NS) is an advanced practice Nurse prepared as a specialist within a
clinical specialty at the masterrsquos post masterrsquos or doctoral levelrdquo94 Following the ESNO the
competencies should be considered as a reference template and guidelines for the different
specialities in which each speciality can define its own knowledge skills and attitudes
Generic competencies are the clinical role patient relationship patient teachingcoaching
mentoring research organisation and management communication and teamwork ethic
and decision making leadership and policy making and prevention The competency of
prevention is based on the case for investing in public health from the World Health
Organization95 The competency of prevention is based on the ability of promoting health
and prevent disease by the capacity to develop and put in place intervention in
bull Surveillance of population health and wellbeing
bull Disease prevention at the 3 levels of prevention (primary secondary)
bull Ability to promote health and prevent disease
bull Monitoring and response to health hazards and emergencies
bull Health promotion including actions to address social determinants and healthy
inequities
bull Advocacy communication and social mobilization for health advancing public
health
bull Research to inform policy and practice96
94 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf 95 httpwwweurowhoint__dataassetspdf_file0009278073Case-Investing-Public-Healthpdfua=1 96 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
85
Occupational therapist
The World Federation of Occupational Therapists (WFOT) provided minimum standards for
the education of occupational therapists97 One of the settings in which occupational
therapists work is defined as following ldquoCommunity or group approaches such as health
promotion community development community based rehabilitation injury prevention
environmental design disaster preparation and recoveryrdquo Furthermore under essential
knowledge skills amp attitudes for competent practice the following (could) relate to health
promotion and disease prevention
bull Knowledge about
- The relationship between occupation and human development over the life
course including healthy ageing
- The relationship between psychological social and economic factors and
occupation (eg stress adjustment to life changes including disability
societal disruption natural or man-made disaster displacement)
- Early identification and functional interventions focusing on somatosensory
stimulation and performance mechanisms mitigating early developmental and
environmental factors impacting negatively on behaviour and learning
- How activity limitations and participation in occupation affect health This
includes the ability to maintain a healthy environment and personal factors
such as adjustment interpersonal relationships and social networks
- How health conditions and threats to health affect participation in work
bull Skills in
- Inter-sectoral collaboration in public health initiatives
- Assessing health in relation to occupation
In addition the Tuning programme described the reference points for the design and
delivery degree programmes in occupational therapy98 in which they first ranked subject
specific competency One of the highest ranked included
bull Enable individualsgroupsorganisationscommunities to be engaged in occupation
through health promotion prevention rehabilitation treatment and
coachingtraining
In the final set of subject specific competences however this is mentioned less explicitly
and only the following are related to health promotion and disease prevention
bull Knowledge the occupational therapist is able to
- Work in partnership with individuals and groups using occupation in
prevention rehabilitation and treatment in order to promote participation
health and well-being
- Explain the relationship between occupational performance health and well-
being
- Collaborate with communities to promote and develop the health and well-
being of their members through their participation in occupation
- Develop new knowledge of occupation and occupational therapy practice
particularly in relation to local andor emerging health and social challenges
97 httpswwwwfotorgassetsresourcesCOPYRIGHTED-World-Federation-of-Occupational-Therapists-
Minimum-Standards-for-the-Education-of-Occupational-Therapists-2016apdf 98 httptuningacademyorgwp-contentuploads201402RefOccupationalTherapy_EU_ENpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
86
Pharmacists
In a two-stage large-scale Delphi process fifty competences of pharmacy practice were
ranked and the Quality Assurance in European Pharmacy Education and Training (PHAR-
QA) framework was harmonized and validated99 Of these fifty competences the following
relate to health promotion and disease prevention
bull Ability to promote public health in collaboration with other professionals within the
healthcare system
bull Ability to provide appropriate lifestyle advice to improve patient outcomes
bull (eg advice on smoking obesity etc)
bull Ability to use pharmaceutical knowledge and provide evidence-based advice on
public health issues involving medicines
Physiotherapists
According to the World Confederation for Physical Therapy (WCPT) the scope of physical
therapists practices includes (among others) public health strategies and advocating for
patientsclients and for health100 Furthermore it is described that physical therapists may
have the following purposes
bull promoting the health and wellbeing of individuals and the general publicsociety
emphasising the importance of physical activity and exercise
bull preventing impairments activity limitations participatory restrictions and
disabilities in individuals at risk of altered movement behaviours due to health
factors socio-economic stressors environmental factors and lifestyle factors
The European Network of Physiotherapy in Higher Education (ENPHE) also described
professional competencies of physiotherapists101 According to the ENPHE one of the roles
of a physiotherapist is to be a
bull Health care promotor
- Advocate on health and wellbeing promotion and disease or injury prevention
on behalf of patientclients and the profession to enhance individual
community and public health
- Promote adherence to local regional national and EU health and safety
policies guidelines and protocols
Psychologist
The European Federation of Psychologistsrsquo Associations developed the European Certificate
in Psychology ndash the EuroPsy102 The Tuning programme also published lsquoReference points for
the design and delivery of degree programmes in Psychologyrsquo103 in which they state that
the Tuning programme and the EuroPsy programme have experienced a parallel
development over the last ten years In fact the Tuning document presents a reference
99 httpswwwncbinlmnihgovpmcarticlesPMC5419365 100 httpswwwwcptorgpolicyps-descriptionPT 101 httpwwwenpheorgwp-
contentuploads201910ESCO_report_ENPHE_recommendations_April_2017pdf 102 httpwwwinpa-europsyitmoduliEuroPsy20Regulations20July202011pdf 103httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNPsychology_reference_points
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
87
point for the design and delivery of degree programmes in psychology on the basis of the
EuroPsy programme
Based on the definition of the key role of the professional psychologist health promotion
and disease prevention could be part of the profession as this has been described as
follows to develop and apply psychological principles knowledge models and methods in
an ethical and scientific way in order to promote the development well-being and
effectiveness of individuals groups organisations and society However no specific
competences related to health promotion and disease prevention are now described in the
documents It is plausible though that psychologist do act to promote health as the core
of their profession is to help others to understand behaviour to improve performance and
well-being or to alleviate problems and distress As these emergent specialisms develop in
response to new demands there is a tendency to develop education and training
programmes thus increasing the specialisation and the requirement for specialist skills of
professional psychology
Social worker
Global standards for the education and training of the social work profession are developed
by the International Association of Schools of Social Work (IASSW)104 The IASSW
worldwide association of schools of social work other tertiary level social work educational
programmes and social work educators These global standards include for example
standards regarding the schoolrsquos core purpose or mission statement standards regarding
programme objectives and outcomes standards with regard to programme curricula
including field education The standards with regard to the core curricula are organised into
four conceptual components domain of the social work profession domain of the social
work professional methods of social work practice and paradigm of the social work
profession under which several sub-domains are described which mainly relate to aspects
such as inadequacies discrimination tradition and culture social stability and ethical
principles The following touch upon the field of health promotion and disease prevention
bull Knowledge of human behaviour and development and of the social environment
with particular emphasis on the person-in-environment transaction life-span
development and the interaction among biological psychological socio-structural
economic political cultural and spiritual factors in shaping human development
and behaviour (domain of the social work profession)
bull Sufficient practice skills in and knowledge of assessment relationship building
and helping processes to achieve the identified goals of the programme for the
purposes of social support and developmental protective preventive andor
therapeutic intervention ndash depending on the particular focus of the programme or
professional practice orientation (methods of social work practice)
bull The application of social work values ethical principles knowledge and skills to
promote care mutual respect and mutual responsibility amongst members of a
society (methods of social work practice)
bull Problem-solving and anticipatory socialisation through an understanding of the
normative developmental life cycle and expected life tasks and crises in relation
to age-related influences with due consideration to socio-cultural expectations
(paradigm of the social work profession)
104 httpswwwiassw-aietsorgwp-contentuploads201808Global-standards-for-the-education-and-training-
of-the-social-work-professionpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
88
The European Social Network (ESN) investigated the social services workforce throughout
Europe and provided an overview of qualifications and skills in different Member States in
their research report showing that qualification and skills for social care workers differ per
country105 In fact in some countries there are specific training routes for social care
workers including specialised training courses or apprenticeships and the content of these
trainings depends on the service user group and is generally defined at a local or authority
level A questionnaire was set out in which essential components of social care workers
were identified which showed that health and safety is seen as an important component
of social work
105 httpswwwesn-euorgsitesdefaultfilespublicationsInvesting_in_the_social_service_workforce_WEBpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
89
ANNEX 3 ONLINE SURVEY
Survey Health promotion and disease prevention in health and educational
settings
Health promotion and disease prevention in health and educational settings -
medical schools The European Union has commissioned Ecorys an international
research and consultancy agency to conduct a project on health promotion and
disease prevention in health and educational settings In order to provide an EU
wide overview and to better support national governments we would like to ask
for your cooperation The project will develop an EU wide overview of the
educationtraining programmes for basic education postgraduate education as
well as continuous professional development with regard to education on health
promotion Your help will therefore be key in the collection of information and
data on public health initiatives in medical and non-medical education The survey
will take approximately 20 minutes of your time You do not need to complete this
survey at once You may leave the survey and continue at a later moment in
time Questions can be saved by clicking on the pauze button (below the
questionnaire) When doing so a new URL link will be provided We would be
pleased if you could provide this information by means of an online questionnaire
to Ecorys who is also available in case you have questions or you would like
additional information bull Ms Emalie Hurkmans (Project Coordinator) tel +31
(0)6 280 579 21 email emaliehurkmansecoryscom bull Ms Tessa Huis in lsquot
Veld tel +31 6 29 22 10 58 email tessahuisintveldecoryscom
What is the name of your education
What are the website details of the educationPlease enter the link of the website
with information of the education
Can you give a brief description of the education
What type of health professionals are trained in the education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
90
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
What type of medical specialist
Is the education
Undergraduate education
Postgraduate education
Continuous professional development
Is the course accreditated
Yes
No
Unknown
Does the course cover the topic health promotion and disease prevention
Yes
No
Is the education accreditated
Yes
No
Unknown
Does the education cover the topic health promotion and disease prevention
Yes
No
How is the topic health promotion and disease prevention incorporated in the
curriculum
In a seperate module
Topic incorporated into curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
91
Who is (are) the contact person(s) of the module health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Was there any partnerships in setting up the module health promotion and disease
prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Has the education obtained any funding to set up the module on health promotion
and disease prevention EU funding national public funding local public funding
or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
92
Since when is the module on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the module Eg is it a two weeks one month or one
year programme
What is the typical quantity in hours spend at health promotion and disease
prevention by participants The amount of hours spent on attendence and
homework
Is the module health promotion and disease prevention accreditated separately
No
Unknown
Yes please specify how many points are given
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
93
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the module
No
Unknown
Yes please specify what type of exam
Is the module also provided at other locations For example at other universities
Yes
No
Unknown
Is there a contact person(s)expert for the topic health promotion and disease
prevention
Was there any partnerships in incorporating it in the curriculum
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
94
Has the education obtained funding to incorporate health promotion and disease
prevention into the curriculum EU funding national public funding local public
funding or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is health promotion and disease prevention incorporated into the whole
curriculum eg since September 2017
What is the typical quantity in hours (approximately) spend at health promotion
and disease prevention by participants The amount of hours spent on attendence
and homework
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
95
In what way are knowledge and skills with regard to health promotion and disease
prevention tested in the curriculum For example incorporated into a written exam
Who is (are) the contact person(s) of the course on health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Were there any partnerships in setting up the course on health promotion and
disease prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
business NGOs individual citizens governmental agencies who have a role fill in
yes and add by the partnership in place
No
Yes please specify
Has the education obtained any funding to set up the course on health promotion
and disease prevention
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
96
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is the course on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the course eg two weeks one month or one year
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
97
What is typical quantity in hours spend at health promotion and disease prevention
by participants The amount of hours spent on attendence and homework
Is the course on health promotion and disease prevention accreditated separately
No
Unknown
Yes how many points are given
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the course
No
Unknown
Yes what type of exam
Is the course provided at multiple locations For example at other universities
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
98
What are the general objectives of the teaching activities on health promotion and
disease prevention eg arise awareness among Medical Doctors on the
importance of physical activity within the elderly population with a high risk of
heart failure
Which stakeholders were involved in developing the teaching activities on health
promotion and disease prevention
Is there made use of a mono- or multidisciplinary approach
Monodisciplinairy approach
Multidisciplinary approach
Unknown
Does the education include theories of
1
Yes
2
No
3
Unknown
Population health
Human cognition
and behaviour
Health behaviour
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
99
Does the education include
1
Yes
2
No
3
Unknown
Epidemiology and
bio-statistics
(research
capacity)
Methods of
evidence-based
medicine
Health policies
and regulation
Health economics
Ethics
Health care
systems
Digitalisation in
health promotion
Health inequalities
Disease
prevention in
teams
Health literacy
Health behaviour
change
techniques
Communication
skills
Digital health
coaching
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
100
Concerning teaching methods of health promotion and disease prevention which
methods are used
1
Yes
2
No
3
Unknown
Lectures
Assignments
Field training in real environments
eLearning modules
Other please specify
Concerning covered competencys or capacities of health promotion and disease
prevention the main focus is on
What are the expected outcomes
1
Yes
2
No
3
Unknown
Knowledge
Skills
Behaviour
attitudes
Relevant output (if available) eg number of students following the module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
101
Do you think it is likely you will apply the learned knowledge and skills (on health
promotion and disease prevention) in daily practice after completion of this
education
Yes please specify
No please specify
Not sure please specify
Is there a reason why this education might be a good example for other
educational settings with regard to the way that health promotion and disease
prevention is covered in the education
Are there any remarks Please feel free to give overall remarks or initiative-specific
remarks
Your responses have been registered Thank you for taking the time to complete
the survey your input is valuable to us
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
102
HOW TO OBTAIN EU PUBLICATIONS
Free publications
bull one copy via EU Bookshop (httpbookshopeuropaeu)
bull more than one copy or postersmaps from the European Unionrsquos representations (httpeceuropaeurepresent_enhtm) from the delegations in non-EU countries (httpeeaseuropaeudelegationsindex_enhtm) by contacting the Europe Direct service (httpeuropaeueuropedirectindex_enhtm) or calling 00 800 6 7 8 9 10 11 (freephone number from anywhere in the EU) () () The information given is free as are most calls (though some operators phone boxes or hotels may charge you)
Priced publications
bull via EU Bookshop (httpbookshopeuropaeu)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
11
1 INTRODUCTION
By 2020 the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices2 In Europe such chronic diseases as
cancer cardiovascular diseases diabetes and chronic respiratory diseases are giving the
greatest disease burden3 The Global Burden of Disease (GBD) 2016 study estimates that
over 91 of deaths and over 87 of DALYs in the European Union (EU) are the result of
non-communicable diseases (NCDs) of which 61 and 43 respectively can be attributed
to modifiable risk factors4 To a large extent lifestyle factors unhealthy diets tobacco use
harmful use of alcohol and physical inactivity have been identified as the top risk factors
for NCDs in the EU5 The last non-communicable diseases progress monitor 2017 of the
WHO underlines that ldquoNCDs share key modifiable behavioural risk factors like tobacco
use unhealthy diet lack of physical activity and the harmful use of alcohol which in turn
lead to overweight and obesity raised blood pressure raised cholesterol and ultimately
diseaserdquo6 Since NCDs share many related modifiable risk factors and often do not occur in
isolation7 prevention must be integrated into population approaches to combat NCDs as a
group8 In recognition of this important public health challenge investing in effective health
promotion and disease prevention is critical to improve the quality of life and well- being of
European citizens910 as well as their productivity and NCDrsquos burden on health systems and
economy of European societies11
Strengthening the investments in health promotion and disease prevention is key to delay
the onset and reduce the burden of NCDs in Europe12 As there is a great need for chronic
disease management the healthcare setting is crucial for health promotion in both primary
and secondary prevention of NCDs13 For example obesity is a major modifiable risk factor
2 Chopra M et al (2002) A global response to a global problem the epidemic of overnutrition
httpswwwncbinlmnihgovpmcarticlesPMC2567699pdf12571723pdf 3 WHO (2006) Gaining Health The European strategy for the prevention and control of noncommunicable
diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf 4 EU burden from non-communicable diseases and key risk factors httpseceuropaeujrcenhealth-
knowledge-gatewaysocietal-impactsburden 5 WHO (2014) Prevention and control of noncommunicable diseases in the European Region a progress report
httpwwweurowhoint__dataassetspdf_file0004235975Prevention-and-control-of-noncommunicable-diseases-in-the-European-Region-A-progress-report-Engpdf
6 WHO (2017) Noncommunicable diseases progress monitor 2017 httpappswhointirisbitstream handle106652589409789241513029-engpdfjsessionid=0613BF26D66A7DA9D1C91AD325E0A75Dsequence=1
7 httpsacels-cdncomS00917435150028321-s20-S0091743515002832-mainpdf_tid=88fea2bf-946a-44c2-be59-0edbabc2c2e8ampacdnat=1541511066_feedfb33968e2ac2f5b47a3452254a9f
8 Integrated approach to prevent noncommunicable diseases httpwwweurowhointenhealth-topicsnoncommunicable-diseasescanceractivitiesintegrated-approach-to-prevent-noncommunicable-diseases
9 WHO (2006) Gaining Health The European Strategy for the prevention and control of noncommunicable diseases httpwwweurowhoint__dataassetspdf_file000876526E89306pdf
10 Scriven A (2017) Promoting Health a Practical Guide Seventh Edition httpsbooksgooglenl
bookshl=nlamplr=ampid=fJwqDwAAQBAJampoi=fndamppg=PP1ampdq=importance+health+ promotion+and+disease+prevention+European+Commissionampots=jcXZvCYJIQampsig=8D8Yqa9wKa_DlaaYUky_EtUxd_gv=onepageampq=importance20health20promotion20and20disease20prevention20European20Commissionampf=false
11 Tender 12 Chrodis (2015) Health promotion and primary prevention in 14 European countries a comparative overview
of key policies approaches gaps and needs httpchrodiseuwp-contentuploads 201507 FinalFinalSummaryofWP5CountryReportspdf
13 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
12
for type II diabetes (DM II) and thus efficacy of the intervention matters In economic
modelling for eight European countries a body-mass index reduction in the adult population
of 5 compared to 1 resulted a three-fold reduction in the incidence of DM II14 Apart
from the health losses caused directly by NCDs underlying conditions may also increase
susceptibility for other diseases Patients with diabetes and serious heart conditions eg
were identified as risk populations for COVID-1915 New health threats like climate crisis
will have an impact on healthcare systems and need for adaptation options including
training of health care workers integrated heatwave early warning systems especially for
the most vulnerable populations and supporting lifestyle changes toward healthy choices
that are at the same time climate and health friendly16
Healthcare providers such as doctors especially general practitioners (GPs) nurses social
workers physiotherapists dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs17 Health
promotion is collaborative work where professionals strengthen the message and help
patients to choose and implement healthier behaviours Counselling on and prescription of
a healthy lifestyle is particularly important to socioeconomically vulnerable and
disadvantaged population groups which are disproportionally affected by unhealthy
lifestyles and are more difficult to reach18 Secondary and tertiary prevention in chronic
diseases is embedded into good quality care since good nutrition status decreases the risk
of reinfarction as does smoking cessation For these reasons health promotion was
explicitly recognized as an integral part of the professional role of the GP in several policy
statements at both the European and the national level19 While many policy statements
and NCDs practice guidelines include a call for behavioural change as the first line of
prevention and management providers often do not provide behavioural change
counselling in their care20
A recently published report by the European Commission and WHO Europe (2018) identified
barriers for prescribing and counselling on exercise schemes and on promoting physical
activity in the health sector These were the lack of confidence and knowledge and skills by
health professionals on providing effective counselling21 For example Koutoukidis et al
(2017) performed a qualitative study on the perspective of healthcare professionals on
lifestyle advice to cancer survivors Health professional-centred barriers to provision of
lifestyle advice were a lack of knowledge on healthy lifestyle guidelines the feeling that
14 Webber L Divajeva D Marsh T McPherson K Brown M Galea G et al The future burden of obesity-related
diseases in the 53 WHO European-Region countries and the impact of effective interventions A modelling study BMJ Open 2014
15 Centre for Disease Control and Prevention (2020) Coronavirus disease 2019 Groups at higher risk for severe illness httpswwwcdcgovcoronavirus2019-ncovneed-extra-precautionsgroups-at-higher-riskhtml
16 Drummond P Ekins P Grubb M Lott MSEng M Byass P Nilsson M et al The Lancet Commissions Institute for Sustainable Resources (P Health and climate change policy responses to protect public health thelancetcom 2015
17 Catapano AL et al (2007) Averting a pandemic health crisis in Europeby 2020 what physicians need to know regarding cholesterol management httpswwwncbinlmnihgovpubmed17446817
18 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the European Union Member States of the WHO European Region httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
19 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20 European20General20Practicepdf
20 httpswwwncbinlmnihgovpmcarticlesPMC4561845pdf101177_1559827615580307pdf 21 WHO (2018) Promoting physical activity in the health sector Current status and success stories from the
European Union Member States of the WHO European Region httpwwweurowhoint dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
13
they were not the right person to provide advice and lack of time and resources22
Additional barriers mentioned in the World Book of Family Medicine ndash European Edition
2015 are perceived as lack of time or competing work load insufficient reimbursement
doubts about patientsrsquo acceptance and willingness to receive lifestyle counselling low self-
efficacy insufficient skills and training doubts about effectiveness of interventions and
health promotion perceived as outside professional role2324 Therefore while most health
professionals seem to acknowledge the need for lifestyle advice there seems to be a
mismatch between roles competencies training and possibilities among health
professionals and action25 Factors causing this mismatch differ from individual and
organizational context wherefore strategies to address these barriers will also vary26
These findings underline the need for developing and strengthening lifestyle medicine in
health professionalsrsquo education27 defined as lsquothe integration of lifestyle practices into the
modern practice of medicine both to lower the risk factors for chronic disease andor if
disease already present serve as an adjunct in its therapy Lifestyle medicine brings
together sound scientific evidence in diverse health-related fields to assist the clinician in
the process of not only treating disease but also promoting good healthrsquo28 Hence lifestyle
medicine covers the systematised approach for prevention and management of chronic
disease addressing eg diet physical activity behaviour change stress and coping and
tobaccosubstance abuse29 Health professionals need to learn how to overcome the
identified barriers mentioned above30 and how to effectively and efficiently counsel their
patients towards adopting and sustaining healthier behaviours31
Moreover digitalization is changing the scenery for lifestyle medicine and chronic disease
management Patient engagement can be enhanced with applications self-monitoring or
self-management tools To successfully embed these new forms of care professionals must
develop new skills32 However studies have shown that medical students are not formally
trained in major concepts known to influence health33 Philips et al (2014) states that
including lifestyle medicine in undergraduate medical curricula would have important public
health implications by efficiently promoting the prevention and treatment of NCDs34 A
study by Dacey et al (2012) states that face-to-face continuing medical education formats
22 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 23 httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20
European20General20Practicepdf 24 Geense WW van de Glind IM Visscher TL van Achterberg T Barriers facilitators and attitudes influencing
health promotion activities in general practice an explorative pilot study BMC-family practice 2013 1420 25 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 26
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
27 Polak R et al (2015) Lifestyle Medicine Education httpswwwncbinlmnihgov pmcarticles PMC4561845
28 Rippe JM (2019) Lifestyle Medicine Third Edition CRC Press 29 Kushner RF and Webb Sorensen K (2013) Lifestyle medicine the future of chronic disease management
Obesity and nutrition 201320 30 Koutoukidis DA Lopes S Fisher A Williams K Croker H amp Beeken RJ (2017) Lifestyle advice to cancer
survivors a qualitative study on the perspective of health professionals BMJ open 20188 31 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) The impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 32 Eg Richard A A amp Shea K (2011) Delineation of Self-Care and Associated Concepts Journal of Nursing
Scholarship 43(3) no-no httpdoiorg101111j1547-5069201101404x 33 httpscdnymawscomwwwacpmorgresourceresmgrlifestylemedicine-filesajpm-lmcommentarypdf 34 Philips E Pojednic R Polak R Bush J amp Trilk J (2014) including lifestyle medicine in undergraduate
medical curricula Medical education online
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
14
have a positive impact on physician behaviour toward health promotion and disease
prevention by increasing their knowledge confidence and practices that help patients to
adopt healthy behaviours35 Similar results can be expected among other health
professionals as well
The World Book of Family Medicine ndash European Edition 2015 states that the shared aim to
integrate health promotion disease prevention and lifestyle medicine has not been fully
achieved Future activities as to how lifestyle interventions can be better integrated need
collaborative approaches36 As a starting point for more collaborative action this study
seeks to provide a mapping of the current situation on health professionals training in health
promotion in the EU
11 Research questions
To that end this study seeks to answers to the following research questions
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and continuous
professional education
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
35 Dacey M Arnstein F Kennedy MA Wolfe J amp Philips EM (2012) the impact of lifestyle medicine
continuing education on provider knowledge attitudes and counselling behaviours Medical teacher 36
httpwwwwoncaeuropeorgsitesdefaultfiles03320E2809320Health20Promotion20In20European20General20Practicepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
15
2 THEORETICAL BACKGROUND
21 Societal needs for health promotion and disease prevention
Classically public health targets at activity levels can be described in operational models
like Friedenacutes pyramid model37 It is operationalized into the fundamental composition
organization and operation of society from the underpinnings of the determinants of
health like socioeconomic status6 We use this model as a substructure in looking into
health professionalsrsquo education as they contribute to public health in these levels (Figure
21) Society needs to evaluate cost-effectiveness of public health efforts and find a balance
between the levels of actions at each level We use this framework to enable us to present
the needs of societies in general for different health professionals and their roles and
competencies in public health
Figure 21 Frieden Pyramid of health impact of health professional activities at the different levels of society (T Frieden 2010 CDC)
Healthcare services can contribute in mitigating the burden of disease by socioeconomic
disadvantages Health professionals have a key role in developing health services so their
competency to take account of differences in abilities of people to benefit from health
services is vital But more is needed Traditionally health professionals have been managing
the individual risk factors and provision of services That is not enough For example in
cardiovascular diseases the ldquoperfect treatment approachrdquo fails to prevent almost half of the
disease burden37 In cancer diseases individual health behaviours like smoking contribute
in more direct manner Therefore we need to develop educational systems that support
health professionals to take part in new public health approaches by planning interventions
that change the environmental context to make healthy options the default choice
37 Frieden TR A framework for public health action The health impact pyramid American Journal of Public
Health 2010
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
16
regardless of education income service provision or other societal factors37 These are
equally needed in out-of-health contexts like climate change where socio-economic
inequalities and (health) behavioural choices are among major drivers of climate changes38
Policies can influence environments to support healthier choices and we need health
professionals in policy development and execution Still health behaviour changes happen
at the individual level We need more efficient skills in personalized health coaching of
individuals to increase the cost-effectiveness of treatment of NCDs39 An ageing population
and increasing rates of chronic disease as well as advances in medical science and health
information technology to make care safer and more efficient require a rethinking of how
care is delivered Digitalization of services will challenge healthcare professionals and
collaborative care models have become more common40 Instead of requiring compliance
from patients patient-centred approaches are required from professionals This means that
clinical interventions need to be complemented by counselling and education to achieve
long-lasting protective measures Health coaching is aiming to empower patients in co-
management of their disease41 and emphasize and support patientsrsquo autonomy instead of
merely compliance It is based on shared decision-making and collaborative goal setting
facilitated by motivational interviewing42 Health coaching is already happening in digital
environments This paradigm shift requires new skills and attitudes from health
professionals too
New approaches to public health on societal level the paradigm shift to health coaching on
patient level and new forms of healthcare delivery pose a big challenge to the educational
system of health professionals It needs to prepare new professionals and train health
professionals already working in the healthcare system to master a wider scope of
knowledge and develop new skills and attitudes to implement these new approaches in a
safe effective and efficient way
22 Health profession competencies
Healthcare service is a complex and interconnected network of professionals There are
common professional competencies needed in health care and health promotion
(communication collaboration) but they are applied to meet the learning aims of each
profession or level of education If we want to increase the implementation of lifestyle
counselling or systemwide changes we need to evaluate knowledge skills and attitudes
required for the changes and to define the competencies needed to support this change
Professional competencies sum the elements of abilities (knowledge skills attitudes and
behaviours) that enable a professional to accomplish the activities described in a task
statement that outlines what the professional is expected to do43
38 Watts Nick Amann Markus Arnell Nigel et al (66 more authors) (2019) Report of The Lancet Countdown
on Health and Climate Change The Lancet ISSN 0140-6736 httpsdoiorg101016S0140-6736(19)32596-6)
39 Hale R Giese J Cost-Effectiveness of Health Coaching Prof Case Manag 2017 40 Falconer E Kho D Docherty JP Use of technology for care coordination initiatives for patients with mental
health issues A systematic literature review Neuropsychiatric Disease and Treatment 2018 41 Hayes E McCahon C Panahi MR Hamre T Pohlman K Alliance not compliance Coaching strategies to
improve type 2 diabetes outcomes J Am Acad Nurse Pract 2008 42 Olsen JM Health Coaching A Concept Analysis Nurs Forum 2014 43 Kraiger etal 1993 Application of cognitive skill-based and affective theories of learning outcomes to new
methods of training evaluation
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
17
Learning Outcome Typology by Kraiger is a widely used descriptive model for setting targets
and learning outcomes in education43 It comprises cognitive (knowledge) psychomotor
(skill-based) affective and behavioural (attitudes) components This classification scheme
for learning outcomes is based on Bloomrsquos work (1956) of three learning domains including
cognitive domain the affective domain and psychomotor44 45Knowledge can be factual and
declarative knowledge information and concepts or processes and organizations or
metacognitive strategies like allocation and regulation of professional performance Skills
include simple routine development and procedures needed at work and more complex
skills needed for the ability to monitor the performance along other tasks Attitudes are
linked with professionalsrsquo perceptions on learning self-efficacy at work perception about
ability to perform and ability to goal setting It has domains on professionalism Knowledge
can be obtained in reading or e-Learning modules skills require active teaching methods
and attitudes develop over time Behaviours then are complex situations where knowledge
skills and attitudes are utilised in professional manners In education planning outcomes
are defined by these elements
Competency frameworks are an effective method for achieving outcome-based education46
They provide a tool for capturing the elements and abilities (knowledge skills attitudes
and behaviours) needed in effective and safe patient work47They can serve in evaluating
the components of different specialities or societal needs like in this report public health
needs Competencies define an acceptable and feasible description of professional
behaviours used in relation to health promotion Competency building is at the basis in
developing similar programmes in the US4849 Meaningful assessment of competencies
developed is critical for the implementation of effective competency-based medical
education (CBME)50
The International Union for Health Promotion and Education (IUHPE) published an
extensive list of core competencies and professional standards for health promotion in
201651 It defines acuteHealth Promotion actionrsquo in the context of these competencies and
standards to describe programmes policies and other organised Health Promotion
interventions that are empowering participatory holistic inter-sectoral equitable
sustainable and multi-strategy in nature and aim to improve health and reduce health
inequities51
44 Bloom BS (1956) Taxonomy of educational objectives The classification of educational goals New York NY
Longmans Green 45 Cruz-Cunha MM (2012) Handbook of Research on Serious Games as Educational Business and Research Tools 46 Frank JR Danoff D The CanMEDS initiative Implementing an outcomes-based framework of physician
competencies Med Teach 200729(7)642ndash7 47 Cooke M Irby DM Sullivan W Ludmerer KM Medical education American medical education 100 years after
the flexner report N Engl J Med [Internet] 2006355(13)1339-1344+1306 Available from httpwww
scopuscominwardrecordurleid=2-s20-33749062559amppartnerID=40ampmd5=d949feb 758c984c732a419 cada174c85
48 Alaranta A Alaranta H Patja K Palmu P Praumlttaumllauml R Martelin T et alSnuff use and smoking in Finnish Olympic athletes Int J Sports Med 200627(7)
49 Van Horn L Lenders CM Pratt CA Beech B Carney PA Dietz W et al Advancing Nutrition Education Training and Research for Medical Students Residents Fellows Attending Physicians and Other Clinicians Building Competencies and Interdisciplinary Coordination Adv Nutr 2019
50 Lockyer J Carraccio C Chan MK Hart D Smee S Touchie C et al Core principles of assessment in competency-based medical education Med Teach 201739(6)609ndash16
51 IUHPE (2016) Core competencies and professional standards for health promotion full version httpwwwukphrorgwp-contentuploads201702Core_Competencies_Standards_linkEpdf )
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
18
We present CanMEDS as an example of a framework that includes content-specific
competencies (Table 21) CanMEDS was developed for medical experts but most
competencies are applicable to all health professionals
Table 21 CanMEDS in short form52 original version53
Competency Short description
Medical Expert Apply clinical skills and knowledge of the biomedical sciences to fulfil your scope of practice
Collaborate with patients and families for patient-centred care and management
Contribute to health care quality and patient safety
Communicator Build rapport and empathy in all interactions with patients and include families (with the patientrsquos consent)
Understand the patientrsquos perspectives expectations and socio-economic issues
Use active listening patient-centred interviewing skills and culturally safe communication
Share information in plain language to promote patientsrsquo understanding
Clearly document and share information with patients and others on the care team
Collaborator Collaborate by sharing knowledge and perspectives sharing responsibilities learning together
Collaborate in care education advocacy administration and scholarship
Leader Take responsibility for the ongoing operation evolution and continuous
improvement of the healthcare system
Expand beyond a clinical or technical role to take on administrative teaching and scholarly roles and responsibilities
Exercise efficient use of resources to achieve cost-effective care
Contribute to improvements in personal practice team organization and system
Health Advocate
Understand and address the determinants of health that affect patients and support patients to navigate through the health care system
Collaborate with communities and populations to influence change in the health
care system
Contribute to health promotion and disease prevention Understand determinants and needs speak on behalf of others increase awareness
Scholar Plan for and engage in life-long learning
Teach others
Evaluate and apply evidence to day-to-day practice
Contribute to research including creation dissemination and translation into
practice
Professional Commit to patients society profession and ldquoselfrdquo Patients ndash maintain clinical competency and adhere to ethical standard Society ndash demonstrate social accountability by responding to societal needs and
expectations Profession ndash peer assessment mentorship supporting others setting standards Self ndash participate in self-assessment and reflection build self-awareness and manage own well-being
52 Michener Institute No Title CanMEDS framework in short [Internet] Available from httpsmichenercawp-
contentuploads201805CanMEDS-Framework-Summarypdf 53 Frank JR Snell L Sherbino J E CanMEDs 2015 Physician Competency Framework [Internet] CanMEDS 2015
Physician Competency Framework Ottawa Royal College of Physicians and Surgeons of Canada 2015 p 1ndash30 Available from httpwwwroyalcollegecaportalpageportalrccanmedsresourcespublications
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
19
23 Educational systems for health professions in Europe
According to the EU Treaty European citizens have a virtue of rights of free movement as
workers freedom of establishment and freedom of service providers54 Directives on the
requirements of professional qualifications in EU their recognition and Regulation55
facilitate the mobility of health personnel Each member state will apply this directive in
the national legislation on health professional qualifications There is a system of automatic
recognition based on harmonised minimum training requirements This system depends on
the timely notification of new or changed evidence of formal qualifications by MS and their
publication by the Commission Otherwise holders of such qualifications have no
guarantees that they can benefit from automatic recognition
The undergraduate education in Europe is coordinated through the Bologna Process which
is an intergovernmental cooperation of 48 European countries in the field of higher
education It guides the collective effort of public authorities universities teachers and
students together with stakeholder associations employers quality assurance agencies
international organizations and institutions including the EC to bring more coherence to
higher education systems across Europe56 Under the Bologna Process all 48 participating
European countries agreed to ensure mutual recognition of qualifications and learning
periods abroad completed at other universities Nonetheless it should be noted that across
Europe healthcare systems and educations may still significantly differ
While professional activity is regulated by national law in individual member states57
faculties and other academic institutions have collaborated in the establishment of a
framework of competencies based on the scientific advances and new methodologies in
education In fact EU Directives of the European Parliament and Council on the recognition
of professional qualifications have consolidated a system of mutual recognition between
MS58 Examples include the PHARMINE for pharmacists and MEDINE for medical doctors59
This collaboration is in line with the Bologna Process
24 Relevant educational settings for health promotion
Inclusion of health promotion and lifestyle medicine in undergraduate medical curricula is
expected to have important public health implications However in current medical
education this subject is minimal to nonexistent60 This is a global problem In 2016 the
American associations around NCDs launched a joint programme called lsquoThe Lifestyle
54 Treaty on the Functioning of the European Union (TFEU) Articles 45 49-62 55 European Parliament C of the EU Directive 200536EC on the recognition of professional qualifications and
Regulation [Internet] 2013 Available from httpseur-lexeuropaeulegal-
contentENALLuri=celex3A32013L0055 56 The Bologna process and the European Higher Education Area httpseceuropaeu education policies
higher-educationbologna-process-and-european-higher-education-area_en 57 UEMS (2017) Charter on training of medical specialists in the EU httpswwwuemseu
dataassetspdf_file001943561ETR-Psychiatry-201703pdf 58 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 59 Sanchez-Pozo A (2016) A comparison of competences for Healthcare professions in Europe
httpswwwncbinlmnihgovpmcarticlesPMC5419388pdfpharmacy-05-00008pdf 60 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
20
Medicine Education Collaborativerdquo for improvement of health promotion education among
health professionals and in medical schools61 This initiative will a) work for high-quality
curricular material on an easily navigable website b) provide support for medical schools
to advocate for and implement lifestyle medicine curricula into their own institutions c)
aim to increase awareness and legislative initiatives that encourage adoption of lifestyle
medicine into medical school education d) develop and conduct assessment in the
following areas Student Health Student Knowledge and Programme Effectiveness and
e) train and support medical students as effective champions of lifestyle medicine whose
engagement with the curriculum lead to increased adoption within medical schools and
enhanced collaboration nationallyError Bookmark not defined This need has been acknowledged
in Europe as well62
Besides education in medical schools continuous professional development (CPD) is an
essential component in health education to ensure that professionals graduated in past
decades keep their competencies up to date and acquire new competencies needed for
health promotion disease prevention and lifestyle medicine It is important to encourage
further strengthening of CPD for those professions that benefit from automatic recognition
of their professional qualifications Member states should in particular encourage CPD for
physicians medical specialists general practitioners nurses responsible for general are
dental practitioners specialized dental practitioners veterinary surgeons midwives
pharmacists and architects63 Given the rapid developments in societal needs and
approaches towards health promotion and disease prevention and spectacular increase in
technological support facilities lifelong learning is imperative for health professionals and
should be oriented towards the competencies required to best serve their population and
society
Figure 22 Lifelong learning is an iterative process where learners build knowledge skills
attitudes and behaviours on top of their current professional competency
61 Trilk J Nelson L Briggs A Muscato D Including Lifestyle Medicine in Medical Education Rationale for
American College of Preventive MedicineAmerican Medical Association Resolution 959 Am J Prev Med 2019 62 European Lifestyle Medicine organisation httpswwweulmorg 63 Lim SS Vos T Flaxman AD Danaei G Shibuya K Adair-Rohani H et al A comparative risk assessment of
burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions 1990-2010 A systematic analysis for the Global Burden of Disease Study 2010 Lancet 2012
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
21
25 Theoretical framework for this study
In this study we touch upon the existing levels of health promotion disease prevention
and lifestyle medicine in health and educational settings in the EU and make a preliminary
assessment of its relevance
As right now health professional competencies seem more practical we approached the
mapping of competencies in health education through professions rather than with an
overall theoretical framework Thus we aim to create a general picture for different health
professions at different levels of education
For the assessment of relevance of the existing levels of health promotion in education we
aligned the competency framework of Kraiger with Friedenrsquos public health framework We
used three components64 of Kraigerrsquos Learning Typology
bull Knowledge cognitive and mental abilities
bull Skills psychomotor manual and physical abilities to perform tasks
bull Attitude (or self) perceptions growth in feelings or emotional areas
We used the integrated framework as an analytical tool to classify content areas covered
and their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future
This study is an important first step as we know little about present practices However
more detailed research will obviously be needed
64 Given the limitations of the study behaviour ndash the fourth component ndash is not included Behaviour refers to
practices to utilise knowledge skills and attitude in work environment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
22
3 METHODOLOGY
31 Mapping of health educational programmes in the EU
The first aim was to provide a general overview on how health professionals are trained in
health promotion and disease prevention and lifestyle medicine in the EU To that end we
conducted an online survey to map the educational programmes of health professionals in
the EU In addition to the proposed methodology we also conducted desk research to
create an overview of competency profiles of health professionals in the EU
311 Online survey
This study looks at undergraduate education postgraduate education and CPD courses in
all healthcare professions across the EU Within the EU different organisations are
responsible for the education of healthcare professionals
bull The undergraduate education programmes are organised by universities in each
country
bull The post-graduate education programmes are organised differently in each
country This includes a set of European organisations that run the guidelines
and portfolioacutes for each profession or specialty within this profession (like in
medicine)
bull CPD programmes are even more diverse between countries and can be accredited
both by European organisations and universities
Due to the wide scope of the study and the different levels of healthcare educational
programmes no country correspondents could be found with a full overview of educational
programmes addressing health promotion and disease prevention in their country
Therefore we chose for a snowball methodology to obtain information on all levels of health
professional education The snowball methodology consists of two steps First we identified
potential organisations in the EU to take part in the survey Second we asked those
organisations to recruit other organisations or stakeholders in their national andor
international network of colleagues and spread the survey among those This method
required more effort and time in the beginning but once the lsquoballrsquo was rolling it provided
us with a growing dataset including the perspectives from healthcare educators healthcare
professional associations and healthcare students and residents The snowball method
implies a risk of selection bias as educational institutions that have implemented health
promotion within their programmes ie the front-runners may have been more inclined
to respond than those who have not
In addition this recruitment process served as a communication and dissemination vehicle
and increased the engagement to the mapping Many organisations expressed their interest
to join the workshop as well as willingness to disseminate the results to their members and
collaborators Because of the growing interest we decided to extend the deadline after the
workshop organised on 13 February so attendees could spread the survey among their
national andor international networks
Our original workplan included an Excel worksheet to be sent to the national health
coordinators in each EU country but as we chose a different strategy it was necessary to
develop a more user-friendly and flexible method Therefore an online survey was
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
23
developed This enabled refinement of questions to each level of education with core sets
of questions Survey links proved to be easy to use and shared within educational facilities
or associations which led to higher response
In this section we discuss in more detail how the survey was developed and how relevant
international organisations were recruited
Development of an online survey
First we developed a mapping tool (stand-alone Excel document) to map the current
situation of professionals trained in health promotion This mapping tool was validated by
both Chafea and DG SANTE and by the external experts in the core research team After a
pilot phase an online survey was developed for all healthcare professions based on the
content of the mapping tool This was a necessary step to boost response as the online
survey proved to be more user-friendly and easier to share among educational facilities or
associations than the mapping tool in Excel
Among other topics the survey contained questions on the
bull Training programme for which the respondent is filling in the survey (which
(educational) institute and health profession portfolio etc)
bull Type of training programme (undergraduate education postgraduate education or
continues professionalrsquos development
bull Type of health professional targeted (eg GPrsquos physiotherapists etc)
bull Implementation in the curriculum
bull Description of the health promotion component in the programme (eg teaching
methods monodisciplinary approach or multidisciplinary approach expected
outcomes in knowledge skills and attitude)
bull Targeted funding
bull Accreditation
bull Partnerships
The questions in the survey correspond with the information requested in the Tender
Specifications Note that the survey maps the educational offer effectiveness of education
is outside the scope of this study The complete questionnaire used in the survey can be
found in Annex 3
Recruitment of relevant international organisations EU and national medical and
non-medical associations medical faculties national and international institutes
networks and organisations
As we used a snowball method it is not possible to provide the exact number of persons
who received the survey and response rates Instead we present each of the steps taken
to approach respondents and final response obtained
Recruitment of European associations
First we connected with major networks in the fields of graduate post-graduate and
continuous professional development for their support as these organisations have an
overview of the three levels of health professional education These associations represent
entire professions or part of the professions (like post-graduates) in all European countries
National professional organisations are members of these umbrella organisations For
example the Union of Medical Specialists (UEMS) represents 16 million medical specialists
It has 40 full member associations (Member States of the EU amp Member States of the
European Economic Area) associate member associations (Member States of the Council
of Europe) and observer member associations (other countries eg the United States)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
24
The UEMS represents more than 50 medical disciplines through various bodies
and structures The most important ones are the 43 Specialist Sections which represent
independently recognised specialties All health professionals health professional students
and post-graduates are organised in a similar manner These organisations are in a good
position to provide information and disseminate it across EU countries
Overall 24 EU associations were approached by email to spread the survey among their
networks (see Table 31 for a complete overview) We aimed to cover all professions within
the scope of this study ie physicians physiotherapists occupational therapists
psychologists nurses social workers dentists pharmacies dietitians throughout Europe
Therefore European associations with focus on educational programmes for these specific
professions were approached
Table 31 Approached European Associations
No European Associations
1 European Medical Association (EMANET)
2 The European Union of General Practitioners (UEMO)
3 European Union of medical specialists (UEMS)
4 European Medical Students Association EMSA)
5 European Forum of Medical associations (EFMA)
6 European Federation of Nurses Associations (EFN)
7 European Association of schools of social work
8 European Network of Physiotherapy in Higher Education
9 European Region ndash World Confederation of Physical Therapy (ER-WCPT)
10 European Network of Occupational Therapy in Higher Education (ENOTHE)
11 Council of Occupational therapists of European Countries (COTEC) part of the World
12 Federation of Occupational Therapists (WFOT)
13 Federation of National Psychologists Associations
14 European federation of nurse educators (FINE) association
15 Association for Dental Education in Europe
16 Council of European Dentists
17 Association for Medical Education in Europe (AMEE)
18 Pharmaceutical group of the European Union (PGEU)
19 European Pharmacists Forum (EPF)
20 European Association of faculties of pharmacy (EAFP)
21 European network of medical residents in Public health
22 The Association of Medical Schools Europe (AMSE)
23 The European Society of Preventive Medicine (ESPREV)
24 The European Lifestyle Medicine Organisation (ELMO)
Recruitment of national associations
Second national health associations for all Member States and all professions were
approached to fill in the survey This step was crucial to increase the response National
health associations were selected using the member list of European organisations Table
32 shows the European organisations used to identify national health associations that
were invited to participate in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
25
Table 32 Examples of the approached national associations
Profession European Association Examples of approached national associations (1 out of 28)
Medical doctors Standing committee of European Doctors (CPME)
Czech Medical Chamber
Physiotherapists World confederation for physical therapy (WCPT)
Swedish Association of Physiotherapists
Social workers International federation of
social workers
German professional
association for social work
Psychologists European Federation of psychologistsrsquo association (EFPA)
Croatian psychological association
Occupational therapists Council of occupational
therapists for the European Countries (COTEC)
Association of Bulgarian
Ergotherapists
Dietitians The European Federation of the associations of dieticians
(EFAD)
French Association of Nutritionist Dietitians
Dentists Council of European Dentists Irish dental association
Nurses European Federation of Nurses
Association (EFN)
Polish Nurse Association
Pharmacists Pharmaceutical group of European Union (PGEU)
Malta Chamber of Pharmacists
Recruitment of national educational organisations
Last the list of the selected associations was used to identify relevant national educational
organisations These national educational organisations (eg University of Maastricht
Faculty of Health Medicine and Life Sciences Kaunas University Medical School Lifestyle
Medicine University of Helsinki Faculty of Medicine) were approached individually and
asked to fill in the survey and spread it throughout their network
Table 33 Number of national educational organisations approached
Profession Number of approached national education organisations
Medical schools 298
Schools of physiotherapy 29
School of social work 31
School of dietitians 40
School of Occupational therapists 45
School of dentists 85
School of pharmacists 56
Response obtained
In total we received information on 176 educational practices till mid-February The
workshop organized in Luxembourg65 gave an additional boost and resulted in 32 more
practices reported in the survey In total this mapping exercise is based on information on
208 practices of health promotion in educational settings
65 Workshop ldquoPromoting lifestyle medicine competencies and education of health professionals in the EU todayrdquo
13th February 2020 Luxembourg Organized by Chafea and DG SANTE
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
26
312 Desk research
Desk research was conducted on both scientific and grey literature with the main purpose
to establish an overview of the competency profiles of health professionals in the field of
health promotion and disease prevention This overview was created to gain insight to what
extent competency profiles related to health promotion and disease prevention are covered
in the educational standards of different health professions in the EU We have made use
of reports published online and scientific articles on competency profiles or educational
standards set at EU level (eg European standards in medical training (UEMS) as the EU
Directives of the European Parliament and Council on the recognition of professional
qualifications have consolidated a system of mutual recognition between Member States3
When reports on EU level could not be identified we selected articles on global standards
such as for the profession of social work (ie global standards for the education and training
of the social work profession)
Based on the identified literature we have described the competency profiles for each of
the following healthcare professions
bull (undergraduate) Medicine
bull Medical specialists
- sports medicine specialists
- public health specialists
- internists
- cardiologists
- psychiatrists
- general practitioners
bull Dentists
bull Nurses
bull Nurse specialists
bull Occupational therapists
bull Pharmacists
bull Physiotherapists
bull Psychologists
bull Social workers
The selection of healthcare professions included in the desk research was made in
consultation with Chafea DG SANTE and the experts
The assessment of the competency profiles was based on the three Domains of Learning
KSAs as described in Chapter 2
bull Cognitive mental skills (knowledge)
bull Psychomotor manual or physical skills (skills)
bull Affective growth in feelings or emotional areas (attitude or self)
This method was chosen as especially ldquolack of confidence and knowledge and skills by
health professionals on providing effective counsellingrdquo was identified as a barrier for
prescribing and counselling on promoting physical activity in the healthcare sector66 In
Chapter 4 the results are described in detail
66 httpwwweurowhoint__dataassetspdf_file0008382337fs-health-engpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
27
32 Long list of good practices
From the survey results we have drawn a long list of good practices As agreed with Chafea
and DG SANTE these good practices were selected using the following four selection criteria
bull The programme contains a multidisciplinary approach
bull The education is mandatory (including an exam)
bull The education covers the following topics digitalisation in health eHealth and
digital health coaching
bull The expected outcome includes change in skills and or behaviour
Several variables were included in the longlist country name of the programme name of
the institute whether there is a focus on knowledge skills and behaviour the type of
professionals who are being trained the theories that are covered by the education (eg
human cognition and behaviour health behaviour change techniques communication skills
etc) education methods used year since the education is provided the time spend in the
modules in hours and lastly in case of one full module the duration of this module To
enable comparison between good practices based on different variables the preliminary
longlist can be found in a separate Excel document Chapter 5 includes an overview of the
coverage and content of the long list of good practices
After closing of the online survey we analysed the longlist of good practices along the
following research questions
bull What content items of health promotion disease prevention and lifestyle
counseling do programmes consist of
bull What kinds of learning aims do they have
bull How do they distribute in Friedens model of levels of health promotion
bull Are there differences between professional groups
First we analysed the distribution of the learning skills separately by the levels of education
(undergraduate postgraduate and CPD) We expected that adult learning will be more
directed towards skills (learning by doing) than the undergraduate and postgraduate
programmes Secondly we analysed the educational methods and tools used in the good
practices
Good practices can be submitted to the European Commissionrsquos Best Practice Portal to be
assessed by external evaluators against criteria adopted by the Steering Group on Health
Promotion Disease Prevention and Management of NCDs Practices rated as best against
these criteria will be published on the European Commissionrsquos Best Practice Portal67
67 httpswebgateeceuropaeudynabp-portal
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
28
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
29
4 MAPPING OF THE CURRENT SITUATION IN HEALTH PROMOTION TRAINING IN THE EU
41 Overview of educational programmes in the EU
411 Summary of the main findings in the survey
A high percentage (93) of respondents (n=197) indicated that health promotion and
disease prevention are implemented in their educational programmes or modules For
undergraduate education postgraduate education and CPD these percentages were 95
93 and 83 respectively Other results include
bull More than half of the respondents indicated that they filled in the questionnaire
based on undergraduate educational settings Throughout Europe these numbers
were relatively similar
bull Physiotherapists seem to be the professional group most actively involved in
health promotion training activities The vast majority applies multidisciplinary
approaches and thus bring other professions on board too
bull Overall traditional teaching methods (lectures and assignments) are most often
used within the undergraduate and postgraduate programmes In CPD on the
other hand e-Learning is most frequently used (67)
bull Educational programmes on health promotion target knowledge skills and
attitudes of students
bull Health behaviour human cognition and behaviour and population health are the
theories covered in most education programmes On a more detailed level
communications skills ethics and methods of evidence-based medicine are
covered most within the education Digital health coaching digitalisation health
economics receive less attention
bull Targeted funding was most often obtained for CPD (33) compared to
undergraduate and postgraduate education (15 and 6) when the topic is
covered in most modules Funding was more often obtained in Northern and
Southern Europe
bull The ratio health promotion covered in all modules of the educational programme
vs one full module primarily dedicated to health promotion was 63 (all
modules)37 (full module) With regard to full modules high percentages
indicated that these are mandatory and that there is an exam at the end of the
module (81 70 respectively)
412 Detailed results of the survey
Respondents
In the following section we provide a detailed description of the survey results The survey
targeted undergraduate education postgraduate education and CPD programmes in all
Member States Overall 208 respondents filled in the questionnaire about their educational
practice Note the results presented in the remainder of this report are exclusively based
on the answers respondents provided in the survey
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
30
Table 41 and Figure 41 provide an overview of the number of practices reported per
European countries A detailed overview of the educational programmes collected
throughout Europe can be found in Annex 1
Figure 41 Practices collected in the survey by European countries (n=208)
Table 41 Number of respondents per European Member State 2019-2020 (n=208)
Abbreviations EU Member State Number of respondents
AT Austria 12
BE Belgium 23
BG Bulgaria 4
CY Cyprus 1
CZ Czech Republic 7
DE Germany 1
DK Denmark 8
EE Estonia 2
ES Spain 22
FI Finland 6
FR France 15
GB United Kingdom 6
GR Greece 10
HR Croatia 0
HU Hungary 3
IE Ireland 8
IT Italy 10
LT Lithuania 1
LU Luxembourg 0
LV Latvia 5
MT Malta 6
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
31
Abbreviations EU Member State Number of respondents
NL Netherlands 2
PO Poland 0
PT Portugal 14
RO Romania 3
SE Sweden 4
SI Slovenia 14
SK Slovakia 2
Additional countries 19
TOT 208 the UK is included as a Member State in this study as the results were obtained before Brexit
For mapping purposes we made a breakdown of results by region ie Northern Europe
Eastern Southern and Western Europe (based on United Nations Regional Groups)
Furthermore we compare results of individual countries for which at least 10 practices have
been reported in the survey These are Austria Belgium France Greece Italy Portugal
Slovenia and Spain
Table 42 European countries per region
Region European countries
West Austria Belgium France Ireland Germany
Luxembourg Netherlands United Kingdom Switzerland
North Denmark Sweden Estonia Finland Lithuania Latvia Norway
East Bulgaria Czech Republic Hungary Romania Slovakia Poland Georgia Kazakhstan
South Italy Spain Cyprus Portugal Greece Malta Slovenia Croatia Bosnia Kosovo Serbia
Type of education
We asked the respondents to indicate the type of educational setting As shown in Figure
42 more than half of the practices (60) refer to undergraduate educational settings and
approximately one third to postgraduate educational settings Only twelve percent of the
reported educational settings is related to CPD
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
32
Figure 42 Practices by educational level (n=199 in percentages)
Figure 43 and Figure 44 show the distribution in type of education per region and on
country level respectively For Western Southern and Northern Europe distribution is in
line with the overall results In Eastern Europe practices reported are more evenly
distributed over undergraduate and postgraduate education Also the share of CPD
practices is high in comparison with other regions and overall results
Figure 43 Practices by type of education per region (n=204 in percentages)
64
42
62
60
29
37
27
30
7
21
12
10
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Undergraduate education Postgraduate education Continuous professional development
60
29
12
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
33
Figure 44 Practices by type of education per country (in percentages)
Type of health professions
An overview of the type of health professional trained in the educational practices is
provided in figure 45 Remarkably over one third (35) of the educational practices
reported are oriented to physical therapists Note that multiple answers could be provided
Figure 45 Type of health professional being trained (n=208 in percentages)
Medical specialists refer to doctors with an extra expertise in one type of medicine eg including sports
medicine public health internal medicine cardiology psychiatry and the general practitioner68 General
practitioners refers to doctors working within General Practice or Family Medicine (GPFM)69 Medical doctors refers
to doctors without any specialization
68 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 69 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
83
70
27
50
30
62
71
71
8
22
60
30
60
23
14
19
8
9
13
20
10
15
14
10
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Undergraduate education Postgraduate education Continuous professional development
116
15
35
1417
7 8 5
29
0
10
20
30
40
50
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
34
Health professionals involved as educators in health promotion and disease prevention are
shown in Figure 46 Physical therapists are most often active as teachers of health
promotion (36) which coincides with the high share of practices oriented to this
profession Some professions like medical specialists nurses and psychologists are
represented more often as teacher then as trainee of the educational practices This implies
they are involved in programmes oriented towards other health professions and is in line
with a multidisciplinary approach that is applied by the vast majority of practices ( 81
n=148)
Figure 46 Health professionals teaching contents of health promotion (n=90 in
percentages)
Methods of education
Survey results show that traditional methods ie lectures and assignments are most often
used (Figure 47) Assignment refers to home school projects such as writing papers In
CPD eLearning methods are more often used (67) compared to undergraduate (45)
and post graduate education (39) The use of field training is relatively similar for the
different levels of education
Figure 47 Teaching methods applied (n=145 in percentages)
8
27 26
36
14
24 23
6 7
37
0
10
20
30
40
50
97
81
74
46
0 10 20 30 40 50 60 70 80 90 100
Lectures
Assignments
Field training in real environments
eLearning modules
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
35
Knowledge skills and behaviour
As for the outcome of the education respectively 99 94 and 89 of all practices
indicate knowledge skills and behaviour as expected outcomes (Figure 48) There are no
significant differences between types of education
Figure 48 Knowledge skills and behaviour (n=142 in percentages)
Accreditation
Overall 39 of the educational practices is accredited on European or international level
53 is accredited at a national level and only 5 lacks accreditation (n=179) Comparing
the different levels of education the rate of accreditation at a European or nation level
varies At a European level these are 46 33 22 at the national level 47 58
67 for undergraduate education postgraduate education and CPD respectively
Throughout Europe the level of accreditation of education is high in Northern Eastern
Southern and Western countries the share of practices without accreditation is 11 0
5 and 3 respectively (n=197) Eastern European countries have regulated their
accreditation more often on a national level compared to the other countries
Theories covered
Figure 49 shows that health behaviour human cognition and behaviour and population
health are covered in most educational practices to a high or at least limited extent
99
0 1
94
4 2
89
6 4
0
20
40
60
80
100
Yes No Unknown Yes No Unknown Yes No Unknown
Knowledge Skills Behavior
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
36
Figure 49 Theories covered by the education (n=137 (in percentages)
Figure 410 provides a more detailed overview of contents covered in the educational
programmes and shows that communications skills ethics and methods of evidence-based
medicine are mostly covered within the education Contents least covered are digital health
coaching digitalisation health economics
Funding and partnerships
Figure 411 provides an overview of the practices that a) obtained targeted funding to
incorporate health promotion and disease prevention in the curriculum b) for which a
partnership is set up for execution of teaching activities on health promotion or c) built on
existing partnerships to incorporate health promotion in the curriculum of the whole
educational programme This overview only includes educational practices where health
promotion and disease is incorporated in most modules
Funding differed between level of education 15 6 and 33 of the undergraduate
education postgraduate education and CPD received targeted funding to incorporate health
promotion in the curriculum Hence funding seems to play a more important role for CPD
than for undergraduate and postgraduate education
66
54
65
31
42
32
1
1
2
3
1
0 20 40 60 80 100
Population health
Human cognition and behavior
Health behaviour
Yes very much Yes but limited No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
37
Figure 410 Theories that are included within education on health promotion (n=137 in percentages)
Figure 411 Funding and partnerships when health promotion is covered in most modules of the educational programme (n=123 in percentages)
Figure 412 provides a comparison of funding obtained by European region Remarkably
in Western Europe the share of practices with targeted funding to incorporate health
promotion is much lower than in the other EU regions
48
69
40
16
54
48
20
34
37
41
49
64
9
44
24
55
51
42
47
50
50
48
44
42
31
43
7
6
4
4
3
4
25
25
9
9
5
2
42
1
1
1
1
1
1
5
5
5
6
4
3
6
0 20 40 60 80 100
Epidemiology and bio-statistics (research capacity)
Methods of evidence-based medicine
Health policies and regulation
Health economics
Ethics
Health care systems
Digitalisation in health promotion
Health inequalities
Disease prevention in teams
Health literacy
Health behavior change techniques
Communication skills
Digital health coaching
Yes very much Yes but limited No Unknown
52
61
15
0 20 40 60 80 100
Partnerships in incorporating it in the curriculum of thewhole educational programme
Partnerships for execution of teaching activities
Funding to incorporate health promotion in curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
38
Figure 412 Funding to incorporate health promotion for programmes covering health promotion in most modules by region (n=119 in percentages)
Comparing individual countries figure 413 shows that funding is obtained for the
educational programmes reported in Slovenia Italy and France while this is not the case
or unknown in Portugal Belgium and Austria
Figure 413 Funding to incorporate health promotion when health promotion is covered in
most modules of the educational programme by country (n=71 in percentages)
Dedicated modules to health promotion
In a majority of practices (63) health promotion disease prevention and lifestyle
medicine are covered in all modules of the educational programme as opposed to coverage
in one module primarily dedicated to health promotion (37) Undergraduate and
postgraduate education show a similar pattern while in CPD programmes full modules
primarily dedicated to health promotion are relatively restricted namely 15 (Figure 414)
Both options have the potential to be effective depending on context implementation and
other factors The data gathered in this study do not allow any statement on effectiveness
of each option
20
12
21
3
80
82
70
85
6
9
13
0 20 40 60 80 100
Northern Europe
Eastern Europe
Southern Europe
Western Europe
Yes No Unknown
13
29
0
9
30
89
100
38
71
40
100
73
70
11
50
18
0 20 40 60 80 100
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
Yes No Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
39
Figure 414 Share of practices with one full module primarily dedicated to health promotion
(n=140 in percentages)
Visibility of health promotion in CPD
In CPD health promotion is often integrated into disease-oriented or risk behaviour-
based contents making it harder to identify the subject in events available The
Union of European Medical Specialists (UEMS) has an electronic database for
accrediting continuous medical education This data set contains keywords Using
health promotion public health or lifestyle as keywords 37 educational events were
found in the years 2017-19 (Table 415) There were 6 events in year 2017 3 in
year 2018 and 8 in year 2019 Average number of credits (1 ECMEC equals 1 hour
maximum 6 per day) was 296 average length of events 45 days This illustrates
availability of international training on health promotion and public health for
medical professions In other events these themes may have been touched upon
as well but are not the main subject So there might be a need to make health
promotion more visible in CPD events Competency-based education could provide
a solution if health promotion disease prevention and lifestyle medicine are defined
as competencies
Table 415 CPD events with health promotion public health or lifestyle as keyword 2017-
2019 (n=37)70
Title ECMEC Year Location Website
Control of multidrug-
resistant micro-organisms in health care settings
20 2017 Stockholm
Sweden
httpwwwecdceuropaeu
Epidemiology and public health microbiology for facilitators
30 2017 Spetses Greece
httpwwwecdceuropaeu
Fellowship (EPIET amp EUPHEM) introductory course
86 2017 Spetses Greece
httpwwwecdceuropaeu
International Society for Quality in Health Care 34th International Conference
23 2017 London United Kingdom
httpisquaorgEventslondon-2017
DOHaD 2017 10th World Congress DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE
25 2017 Rotterdam Netherlands
httpwwwdohad2017org
70 Source UEMS database of accredited events 2017-2019
4035
150
20
40
60
80
100
Undergraduate education Postgraduate education Continuous professional development
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
40
Title ECMEC Year Location Website
10th European Public Health Conference
23 2017 Stockholm Sweden
httpsephconferenceeu
Methods and tools for evidence-based practice
and decision-making in Public Health with special emphasis on communicable disease
22 2018 Stockholm Sweden
httpwwwecdceuropaeu
ESCMID Workshop on
Migrants Health
15 2018 Muscat
Oman
httpsescmidpulselinksco
mevent14833
Control of multidrug-resistant micro-organisms in health care settings
17 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventscourse-control-multidrug-resistant-micro-organisms-mdros-health-
care-settings
ECDC Summer School 2018 23 2018 Stockholm Sweden
httpsecdceuropaeuennews-eventsecdc-summer-school-2018
3rd International Conference of the European Network for Smoking and Tobacco Prevention
15 2018 Madrid Spain
httpsenspconferenceorg
European Observatory Venice Summer School 2018
25 2018 San Servolo Italy
wwwtheobservatorysummerschoolorg
Letrsquos talk about nutrition (NESG)
4 2018 Madrid Spain
httpespencongresscomprogrammelll-courses
Epidemiology and public health microbiology for
facilitators
28 2018 Spetses Greece
httpsecdceuropaeuenepiet-euphemaboutintro
International Society for
Quality in Health Care 35th International Conference
22 2018 Kuala
Lumpur Malaysia
httpsisquaorgEventsmal
aysia-2018
Fellowship (EPIET amp EUPHEM) introductory course
93 2018 Spetses Greece
wwwecdceuropaeu
EGEA 2018 ndash ldquoNutrition and health from science to practicerdquo
16 2018 Lyon France httpswwwegeaconferencecom
1st EUROPEAN LIFESTYLE MEDICINE CONGRESS
13 2018 Geneva Switzerland
wwwelmocongresscom
11th European Public Health Conference
24 2018 Ljubljana Slovenia
wwwephconferenceeu
Fellowship Multivariable
Analysis
25 2019 Madrid
Spain
Rapid Assessment and Survey methods (RAS)
module
35 2019 Zagreb Croatia
ECDC Summer School 2019 28 2019 Stockholm Sweden
httpswwwecdceuropaeuennews-eventsecdc-summer-school-2019
Fellowship Vaccinology Module
29 2019 Rome Italy
Programme Planning and Implementationrdquo Training Program for Resolve to
Prevent Epidemics Initiative
39 2019 Butaro Rwanda
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
41
Title ECMEC Year Location Website
Skill-mix innovation in primary and chronic care mobilizing the health workforce
28 2019 Venice Italy wwwtheobservatorysummerschoolorg
Evolutionary Medicine Conference 2019 5th international meeting of the International Society for Evolution Medicine and Public Health
15 2019 Zurich Switzerland
httpsisemphorg2019-Meeting
Fellowship (EPIET amp EUPHEM) introductory course
85 2019 Spetses Greece
Project Management for Emergency Preparedness Budget and Finance Management
20 2019 Butaro Rwanda
Autumn School on Medical
Education
19 2019 Chernivtsi
Ukraine
httpswwwfacebookcome
vents531981117209981
Project Management for Emergency Preparedness Practical Leadership Skills
24 2019 Butaro Rwanda
International Society for Quality in Health Care 36th International Conference Cape Town 20102019 - 23102019
18 2019 Cape Town South Africa
httpswwwisquaorgeventscp2019html
Public Health Genomics an
introduction
11 2019 Stockholm
Sweden
httpsecdceuropaeuenne
ws-eventspublic-health-genomics-introduction
ENSP Tobacco treatment
specialistsrsquo training
5 2019 Paris France httpenspnetwork
World Health Summit 2019 16 2019 Berlin Germany
wwwworldhealthsummitorg
Time Series Analysis 28 2019 Bilthoven
Netherlands
httpsecdceuropaeuenep
iet-euphemaboutexperience
12th European Public Health Conference
16 2019 Marseille France
wwwephconferenceeu
Outbreak Investigation Module
30 2019 Nicosia Cyprus
httpswwwecdceuropaeuenepiet-euphemaboutexperience
Source UEMS database of accredited events 2017-2019
Looking at the regional level we found that in most regions a majority of practices cover
the topic in all (or most) modules of the educational programme (Figure 416) In Northern
Europe this is most pronounced with as much as 76 of the practices reported covering
health promotion in all modules whereas in Eastern Europe this applies for 55 of
practices A similar analysis for individual countries shows that only in Spain health
promotion is covered in a dedicated module in the majority (62) of educational practices
reported while in all other countries the topic is mostly covered in all (or most) modules of
the programme Percentages vary from 56 (Austria) to 86 (Greece Figure 417)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
42
Figure 416 How is health promotion implemented in education by region (n=148 in percentages)
Figure 417 How is health promotion implemented in education by country (n=120 in
percentages)
55 participants answered specific questions on the full module dedicated to health
promotion 81 of them indicated that the education is mandatory As figure 418 shows
in Northern and Eastern Europe all dedicated module on health promotion form part of
mandatory education In Western Europe one out of three modules is optional for students
24
4537
42
76
5563
58
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
4439
36
14
22
38
18
6256
6164
86
78
63
82
38
0
20
40
60
80
100
Austria Belgium France Greece Italy Portugal Slovenia Spain
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
43
Figure 418 Full modules on health promotion that are part of mandatory education by region (n=47 in percentages)
An exam is taken at the end of the module in 70 of the cases Between regions
percentages do not differ much (Figure 419) Please note that results are based on a
limited number of practices as response for this question was low
Figure 419 Exam at the end of dedicated module by region (n=47 in percentages)
When asked whether the module on health promotion and disease prevention was
accredited separately 15 indicate that this is the case 30 report that the module is
provided at multiple locations
Figure 420 provides an overview of respondents who indicate that funding was obtained
to set up the module as well as the use of partnerships for implementation of teaching
activities on health promotion or in setting up the module Lastly it was indicated that
mostly lsquootherrsquo professionals are teaching these modules
100 100
82
67
12
22
611
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
Yes No Unknown
2518
2225
12 11
75 7571
67
0
20
40
60
80
100
Northern Europe Eastern Europe Southern Europe Western Europe
No Unknown Yes
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
44
Figure 420 Funding and partnerships for dedicated modules (n=47 in percentages)
42 Overview of competency profiles of health professionals in the EU
A detailed description of the competency profiles per healthcare profession as obtained
from the desk research can be found in Annex 2 Competency profiles per professions
These profiles provide a solid basis for health promotion and disease prevention
Most competency profiles mention health promotion andor disease prevention Overall
the competencies of medical specialists are most comprehensively described including the
competencies for health promotion Although there are many similarities between the
different competency profiles we have identified differences in the coverage of domains of
learning ie knowledge skills and attitudes (see chapter 23) Knowledge refers to
cognitive or mental competencies skills to competencies to perform tasks or activities and
attitudes to competencies related to beliefs or values An example of an attitude
competency is ldquoexemplify appropriate lifestyle in personal behaviourrdquo In professions that
are less physically oriented emphasis is on knowledge and attitude rather than on skills
related to health promotiondisease prevention This mainly holds for psychiatry and social
workers For professions in which lifestyle is an essential component ie sports medicine
and public health emphasis is on skills rather than attitudesOnly for cardiology nurses
nurse specialists and pharmacists competency profiles describe competences in all
domains of learning ieknowledge skills and attitudes
Many competency profiles leave room for interpretation and competencies described are
not ranked in order of importance In addition profiles do not state whether competencies
should be practised in a pro-active (within every treatment) or reactive way (only when
treating diseases with a clear lifestyle component
43
53
11
0 20 40 60 80 100
Partnerships in setting up module
Partnerships for execution of teachingactivities
Funding to set up module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
45
5 LONG LIST OF GOOD PRACTICES
In this chapter we present the coverage and content of the long list of good practices The
list is also available in an Excel-file that provides the opportunity to easily make selections
by different variables such as country type of programme (undergraduate postgraduate
CPD) or the characteristics of the education programme
We also provide an analysis of content areas covered and their weight in educational
programmes learning objectives learning typology and educational methodology using
Kraigerrsquos typology and Friedenrsquos pyramid as analytical tools
51 Results
From the survey results we have drawn a long list of good practices In agreement with
Chafea and DG SANTE good practices were selected based on four criteria
1 The programme contains a multidisciplinary approach
2 The education is mandatory (including an exam)
3 The education covers the following topics digitalisation in health eHealth and digital
health coaching
4 The expected outcome includes change in skills andor behaviour
This resulted in a long list of 70 good practices that meet all criteria Educational practices
cover all regions of Europe and originate from 20 Member States (Figure 51 and Table
51)
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
46
Figure 51 Number of good practices selected for long list by country 2019-2020
Table 51 Number of good practices selected based on the four selection criteria per European Member State 2019-2020
Abbreviations EU Member State Number of good
practices
AT Austria 6
BE Belgium 11
BG Bulgaria 2
CY Cyprus 1
CZ Czech Republic 2
DE Germany 0
DK Denmark 5
EE Estonia 1
ES Spain 7
FI Finland 2
FR France 6
GR Greece 7
HR Croatia 0
HU Hungary 1
IE Ireland 3
IT Italy 2
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
47
Abbreviations EU Member State Number of good practices
LT Lithuania 1
LU Luxembourg 0
LV Latvia 1
MT Malta 0
NL Netherlands 0
PO Poland 0
PT Portugal 2
RO Romania 1
SE Sweden 2
SI Slovenia 7
SK Slovakia 0
TOT 70
Of all selected good practices of healthcare educational programmes 16 practices (23)
cover health promotion and disease prevention in one full module primarily dedicated to
the subject In 54 good practices (77) the educational programmes incorporate the topic
of health promotion and disease prevention in all or most modules (Figure 52)
Figure 52 How is health promotion covered in selected good practices (n=70 in percentages)
When dividing good practices by type of education programme we see that all types
educational programmes are represented (Figure 53) The highest share of good practices
is focused on undergraduate education (60 n=42) Two practices are focused on both
undergraduate and postgraduate education
Figure 53 Type of education () represented by selected good practices (n=70)
77 23
All modules One module
6026
113
Undergraduate education
Post graduate education
Continuous professionaldevelopment
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
48
Figure 54 presents the absolute number of selected good practices by type of profession
trained The absolute number sums up till 128 as multiple professions can be trained within
one programme This shows a good variation of health professionals Most good practices
focus on nurses (17 n=22) and medical doctors (13 n=17)
Figure 54 Good practices by profession being trained (n=70 in absolute numbers)
In addition to those described above other variables are included in the separate Excel file
mentioned above These include the name of the programme and the institute focus on
knowledge skills and behaviour type of professionals being trained theories covered in
the education (eg human cognition and behaviour health behaviour change techniques
communication skills etc) education methods used when the education started time
spent on the modules in study hours (ECDEC) and in case of one full module the duration
of this module This Excel file allows to make cross comparisons between different variables
52 Analysis of good practices
In this section good practices are analysed more in detail Figure 55 presents the
distribution of content areas in health promotion and their weight in educational
programmes Methodological training like evidence-based methods (EBM) varies in
programmes but has a strong position Lifestyle intervention skills are widely taught
however new technologies are still on their way in becoming part of health promotion
education Interestingly health economics rate less in these practices in spite of its close
link with health promotion as part of public health policies
30
4
4
11
17
15
15
22
10
Other
Social workers
Dentists
Occupational therapists
Medical doctors
Medical specialists
Psychologists
Nurses
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
49
Figure 55 Results for good practices(n=70) ldquoDoes the education of the initiative includerdquo
Numbers refer to Frieden model in levels of health promotion with exception of methodological contents marked
as tools (1) counselling and education (2) clinical interventions (4) changing the context to make individualrsquos
default decisions healthy (5) socioeconomic factors (6) methods in studying and evaluating health promotion
and public health
We used Friedenrsquos pyramid of levels of health promotion (Frieden 2010) and Kraigerrsquos
typology of learning (Kraiger et al 1993) to describe the abilities that professionals are
expected to acquire Based on their description learning objectives move in a knowledge
level skill building or into attitudinal objectives Figure 56 gives a graphical visualization
of the results of our analysis The dark blue green and light blue rectangles represent the
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
50
Figure 56 Learning objectives categorised into Friedenrsquos levels and learning typology
(knowledge skills attitudes) of good practices (n=70)
different domains of learning knowledge skills and attitudes The size of the rectangles is
proportional to their share in all domains in the educational practice
Within each domain of learning contents are categorized Their vertical order reflects the
order of impact levels of Frieden (from individual patient to society level) and again size
corresponds to share in the curriculums content
This analysis provides a general picture of educational practices in health promotion
disease prevention and lifestyle medicine The graph shows that practices are
predominantly oriented towards knowledge-based competencies (around 60 of the
curriculum) Roughly one third of the programme has skills-oriented learning objectives
while competencies regarding attitudes are addressed in around 10 percent of the
programmersquos content
Looking into knowledge-based competencies the broad spectrum of individual to societal
levels of impact is addressed On a societal level social and medical aspects are widely
represented while the economic angle is scarcely present Technological developments like
digitalisation are present to a modest extent
Skill-oriented learning objectives focus in communicative competences like communication
skills behaviour change techniques and teamwork Health coaching is covered in a small
number of practices Interestingly in methodological contents the aim of skills-oriented
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
51
education is to provide mainly knowledge like in EBM Few practices include practical skills
for communication and coaching in their objectives
Competence-building in the domain of attitudes form a minimal part of educational
practices They are reflected in eg health literacy and ethics However these are also
taught in a hidden curriculum as well
Educational methodologies in the survey include lectures assignments e-Learning and
real-world field assignments As these are the selected good practices it was to be expected
that multiple methods are used in most of these programmes (given selection criterium 3)
In 37 programmes all methods are in use E-Learning is used in 41 programmes
Figure 57 Educational methods used in good practices (n=70 in percentages) ()
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
53
6 CONCLUSIONS
The competency profiles as well as information on a large number of educational practices
in health promotion disease prevention and lifestyle medicine for health professionals in
the EU allow us to formulate answers to the research questions that guided this study
1 How are health professionals in the EU being trained in health promotion
prevention and lifestyle medicine in undergraduate post-graduate and
continuous professional education
Health promotion disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study medical
doctors medical specialists physiotherapists occupational therapists psychologists
nurses social workers dentists pharmacies and dietitians This finding means that
important progress has been made in past decades71there is a growing and diverse health
promotion workforce in Europe public health has made its entrance in the education of
every health professional The educational practices collected show that this is true for all
regions of the EU However there is no overall body that has responsibility for quality
assuring standards of training and professional practice at the European level
The information on around 200 practices from 25 EU Member States (including UK) shows
that the majority of educational practices take place in undergraduate settings while
training events on health promotion for health professionals active in the field are relatively
scarce in continuous professional development (CPD) a limited number of practices on
health promotion are reported and indeed few courses or training events on health
promotion are available in the CPD calendar of the UEMS database of accredited events
Education on health promotion aims at developing competencies in knowledge skills and
attitude and most often has a multidisciplinary character Especially medical doctors nurses
and psychologists are often involved in educating other disciplines on health promotion
Health behaviour human cognition and behaviour as well as population health are part of
educational practices for all professions A majority also include communication skills
methods of EBM and ethics
The most common way to teach health professionals on health promotion disease
prevention and lifestyle medicine is the integration of the subject in most of all modules of
the curriculum Dedicated modules on health promotion are developed in undergraduate
and postgraduate education but are scarce in CPD This may contribute to the invisibility of
the subject in training for professionals active in the field
Four out of ten educational practices on health promotion are accredited on the European
(or international) level half of them have national accreditation
71 Morales Arantxa Santa-Mariacutea Barbara Battel-Kirk Margaret M Barry Louisa Bosker Anu Kasmel Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe Glob Health Promot 2009 Jun16(2)21-31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
54
2 What are good practices on knowledge training capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine
Based on in-depth analysis of a selection of 70 good practices knowledge proves to be the
predominant domain of learning Theories covered relate to different levels of impact of
Friedenrsquos pyramid but emphasis is on the individual patient level with a predominant
position for evidence-based medicine Health economics receive remarkably little attention
This may be disadvantageous for advocacy of health promotion which requires influencing
decision-making on public funding
Around one third of educational contents are dedicated to competencies in the domain of
skills and mainly target communicative skills Interestingly they provide mainly knowledge
rather than practical training Competencies in the domain of attitude are addressed least
Ethics and health literacy are theories are the most common examples of attitude-oriented
contents When looking at the competencies defined by health professionals advocacy has
a solid role in all of them with defined skills It was represented in only few domains like
health economics so it may well be that educating advocacy skills are more common than
found in this study
Good practices use a mix of educational methods including lectures assignments real-
world practices and digital study methods
In conclusion this study is a first step in gaining knowledge and insights in the state of
affairs of health professionalsrsquo education in health promotion disease prevention and
lifestyle medicine in the EU It is an important step as we know little about present
practices However more detailed research will obviously be needed
The results of our in-depth analysis of good practices provide qualitative information We
used the integrated framework as an analytical tool to classify content areas covered and
their weight in educational programmes learning objectives learning typology and
educational methodologies applied Thus health promotion education in its present form is
pictured against health needs for the near future The information supplied by the
respondents show the culture of describing health promotion and education objectives
Therefore no lsquohardrsquo conclusions can be drawn However some cautious notions are
worthwhile to mention as they flag opportunities for learning and improving by collaborative
action
First it is worthwhile to stress the progress made While 20 years ago health professionals
were hardly trained in health promotion and lifestyle medicine and at best received some
instruction on specific disease-related unhealthy habits (like smoking for lung diseases) it
is now part of standard education for most health professionals That is an important
development and essential for collaboration across professions
However more can be done Health promotion education should respond to societyrsquos needs
and therefore educational needs are constantly changing and providers of education need
to follow needs in the field Increasing recognition of societal impact on health inequalities
the paradigm shift from treating to coaching patients changes in the way care is delivered
the digital revolution and the need to contain the cost of our healthcare systems represent
a multitude of challenges and relentless educational efforts in health promotion disease
prevention and lifestyle medicine
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
55
To name a few the balance between domains of learning in curricula will have to redefined
as in health coaching skills attitudes and knowledge are equally important Health
professionals will have to manage health economics to speak the language of policy makers
Teaching methodologies have gained from the technological revolution and there is
potential in utilising them even more Also there is a necessity to do so in order to provide
for effective health promotion Health literacy has got alongside data literacy Therefore
education needs to respond to in using more technologies as well as teaching adaptation of
technologies into care This is not common practice yet The constant development in needs
also stresses the need for continuous professional development in health promotion
disease prevention and lifestyle medicine To date CPD seems to be underrepresented in
educational practices on health promotion and more heavily dependent on external funding
than in undergraduate and postgraduate courses
The experience developed in the good practices collected in the survey represents a
valuable body of knowledge skills and attitudes among health educators With collaborative
efforts this can serve as an important capital to promote continuous development and
improvement of educational practices in health promotion disease prevention and lifestyle
medicine in all European countries
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
57
ANNEX 1 SURVEY RESULTS BY COUNTRY
In this annex we provide the names of all educational programmes by country filled in in
the survey In addition the following variables of the educational programmes are
provided the name of the educational institution type of education and type of health
professionals being trained This information is based on the information provided by the
respondents from each country If certain boxes are not filled in this means that only
partial information of this educational programme is provided
Austria
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Bachelorstudiengang Physiotherapie
FH JOANEUM GmbH Undergraduate education
Physical therapists
Dietetics Health University of
Applied Sciences
Undergraduate
education
Dieticians
Physiotherapy University of Applied Sciences St Polten
Undergraduate education
Physical therapists
Bachelorrsquos Degree Programme Physiotherapy
FH Campus Wien Undergraduate education
Physical therapists
Dietetics and Nutrition FH Joanneum Undergraduate education
Medical Doctors Non-specialized dietitians
Bachelor Programme Physiotherapy
University of Applied Sciences Upper Austria
Undergraduate education
Physical therapists
Degree Programme Dietetics
(Bachelor of Science)
University of Applied
Sciences Upper Austria
Undergraduate
education
Dietitians
Midwifes Speak and language therapists Biomedical scientists Radiological
technologists Physical therapists Occupational therapists Nurses
Bachelor in Health Studies
Physiotherapy
FH Kaernten Undergraduate
education
Physical therapists
Nursing Science Medical University of Graz
Postgraduate education
Nurses
Public Health Medical University of Vienna
Continuous professional development
Medical doctors
Belgium
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Drug Development KU Leuven Undergraduate education
Pharmacists
Bachelor and master Rehabilitation Sciences and
Physiotherapy
University of Antwerp Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
58
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Motor Sciences Physiotherapy
Universiteacute Libre de Bruxelles
Undergraduate education
Physical therapists
Nutrition amp Dietetics Thomas More University College
Undergraduate education
Dietitians
Adad Adad Undergraduate education
Physical therapists
Master Physiotherapy and
Rehabilitation Science
KU Leuven Postgraduate
education
Physical
therapists
Occupational therapist HE Vinci Parnasse ISEI Undergraduate education
Occupational therapists
Master in Physical therapy and Rehabilitation
Universiteacute Libre de Bruxelles
Postgraduate education
Physical therapists
Master in Physical therapy Universiteacute Libre de Bruxelles
Postgraduate education
Medical specialists Physical
therapists (Sport medicine)
Nutrition and dietetics Thomas More University College
Continuous professional
education
Medical doctors Dieticians
psychologists
Information not provided Information not provided
Undergraduate education
Pharmacists
The European Certificate in
Lifestyle Medicine
The European Lifestyle
medicine organisation (ELMO) together with the Belgian Lifestyle
Medicine Organisation (BELMO)
Continuous
professional education
Medical doctors
Medical specialists (lifestyle
medicine) Physical therapists
Occupational therapists Nurses Psychologists General practitioners
Nutrition and Dietetics Erasmus Hogeschool Brussels
Undergraduate education
Dieticians
Master in Nursing and Midwifery
University of Antwerp Postgraduate education
Nurses
Bachelor amp Master Rehabilitation Sciences amp
Physiotherapy
KU Leuven Undergraduate education
Physical therapists
Bachelor Nursing University of Applied
Sciences Gent HOGENT
Undergraduate
education
Nurses
Professional Bachelor in Nutrition and Dietetics
University colleges Leuven Limburg
Undergraduate education
Dieticians
Nutrition and Dietetics University College Ghent
Undergraduate education
Dieticians
Bachelor in Applied Health Science
Howest University College
Undergraduate education
Lifestyle coaches
Physiotherapist Universiteacute Libre de Bruxelles
Postgraduate education
Osteopathy Physical therapists
Bachelor in Medicine Hasselt University Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
59
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor of Nutrition and Dietetics
University of Applied Sciences of Gent
Undergraduate education
Dieticians
Bulgaria
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor programme in Social Work
Plovdiv University Department of Social work
Undergraduate education
Social workers
Rhinology Bulgarian Rhinologic
Society
Postgraduate
education
ENT doctors
Kinesitherapy Medical University Undergraduate education
Physical therapists
TRS rehabilitator Medical College Medical University
Continuous professional
education
Medical specialists
Cyprus
Name of educational
programme
Name of
educational
institution
Type of
education
Type of
health
professionals
being trained
Physiotherapy
programme
Nicosia University Undergraduate
education
Physical
therapists
Czech Republic
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy Universities Undergraduate education
Physical therapists
Physiotherapy Charles University first
faculty of Medicine
Undergraduate
education
Physical
therapists
Physiotherapy Faculty of Medicine Masaryk University Brno
Undergraduate education
Physical therapists
Physiotherapy Palackyacute University Faculty of Physical Culture Department of Physiotherapy
Postgraduate education
Physical therapists
General Nursing Masaryk University Undergraduate education
Nurses
Prakticky zubni lekar (Practical Dentist)
Czech Dental Chamber Continuous professional education
Medical specialists
Health Promotion Ministry of Health Czech Republic
Continuous professional education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
60
Denmark
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Musculoskeletal physiotherapy
Aalborg University Postgraduate education
Physical therapists
Master in Physiotherapy University of Southern Denmark
Postgraduate education
Physical therapists
The Fairstart Foundation The Fairstart Foundation
Continuous professional education
Orphanage staff (each orphanage has
professional staff such as psychologists social workers
andor therapists
These staff members are responsible to work with each child on an individual basis) School
teachers Psychologists Social workers
Bachelor in Physiotherapy University College North Denmark
Undergraduate education
Occupational therapists
Nurses
Bachelorrsquos degree Programme of Physiotherapy
VIA University college Postgraduate education
Physical therapists
Master of Public Health Aalborg University Undergraduate education
Midwives Nurses Therapists Psychologists Medical Specialists
Estonia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Nursing (general nursing) Tartu Health Care College
Undergraduate education
Nurses
Psychology University of Tarty Institute of Psychology
Undergraduate education
Psychologists
Finland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
NutritionNutrition therapy University of Eastern Finland
Postgraduate education
Clinical nutriontinists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
61
Masterrsquos programme of Human Nutrition and food-related behaviour
University of Helsinki Undergraduate education
Nutrition experts who work in eg community
health promotion
Master of Healthcare advanced practice ndash supporting self-care and
care of non-communicable diseases
Savonia University of Applied Sciences
Postgraduate education
Physical therapists Occupational
therapists Nurses
Public Health Nursing Metropolia University of Applied Sciences
Postgraduate education
Public Health nurse
Medical doctors training programme
University of Helsinki medical faculty
Undergraduate education
Medical doctors Nursing
Master degree in Health Management Psychologists
Dentists
Dental education University of Helsinki Faculty of Medicine Department of Oral and Maxillofacial Diseases
Undergraduate education
Dentists
France
Name of educational programme
Name of educational institution
Type of education
Type of health professionals
being trained
Occupational therapy school Croix Rouge Franccediloise Postgraduate education
Occupational therapists
Institut Reacutegional de Formation en Ergotheacuterapie
Association Saint Franccedilois dAssise
Postgraduate education
Occupational therapists
Occupational therapy Institut de formation en Ergotheacuterapie de Berck-sur-Mer site de Loos
Postgraduate education
Occupational therapists
Occupational therapy IFE Assas Undergraduate education
Occupational therapists
Arrecircteacute du 5 juillet 2010
relatif au diplocircme drsquoEacutetat drsquoergotheacuterapeute
Institut de Formation
en Ergotheacuterapie du CHU Rouen Normandie
Undergraduate
education
Occupational
therapists
Occupational therapy school Croix Rouge Francaise Postgraduate education
Occupational therapists
Occupational therapy UPEC Postgraduate
education
Occupational
therapists
Diplocircme de Dieacuteteacuteticien IUT biologie ou BTS dieacuteteacutetique
Postgraduate education
Dietitians
Programme deacuteducation et de promotion agrave la santeacute
CoDEPS 13 Continuous professional education
Nurses Psychologists Dentists Social workers
Public health Universiteacute de Bourgogne
Postgraduate education
Medical doctors
Public health Lyon University Undergraduate education
Medical specialists
Public health residency Faculty of medicine University of Nantes
Undergraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
62
Name of educational programme
Name of educational institution
Type of education
Type of health professionals being trained
Master in Public Health Karolinska Institute Postgraduate education
Occupational therapists Social Workers
Public health and social
medicine
Universiteacute Versailles
Saint Quentin en Yveline
Continuous
professional education
Medical doctors
Public health UFR sciences de santeacute - Universiteacute de Bourgogne
Postgraduate education
Medical doctors Medical specialists
Midwives Physical therapists
Nurses General practitioners
Germany
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Visceral Surgery Augsburg University Continuous professional education
Medical specialist Physical therapists
Occupational therapists
Nurses Social workers
Human Medicine ndash The
cologne model study course (human medicine)
University of Cologne
Medical faculty
Undergraduate
education
Medical
specialists
Greece
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Physiotherapy University of Thessaly Undergraduate education
Physical therapists
Oral education programme
for children via experiential learning
Hellenic Dental
Association-Dental School of Athens-Hellenic Society of Paediatric Dentistry
Continuous
professional education
Psychologists
Dentists
Sports Nutrition International Hellenic University
Postgraduate education
Dieticians
Preventive Dentistry National and
kapodistrian University of Athens school of dentistry
Undergraduate
education
Undergraduate
students
Nutrition amp Dietetics International Hellenic University
Postgraduate education
Medical specialists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
63
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicine ndash under and post graduate studies
School of health sciences University of Patras
Undergraduate education
Medical doctors
Pharmacy diploma Aristotle University of
Thessaloniki
Undergraduate
education
Pharmacists
Hungary
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Public Health and Preventive
Medicine
Semmelweis University
Budapest Faculty of
Medicine Department of Public Health
Undergraduate
education
Medical doctors
Academic programme of Medicine
Semmelweis University Faculty of Medicine
Undergraduate education
Medical doctors
Residency in Preventive Medicine and Public Health
Semmelweis University Postgraduate education
Medical specialists
Ireland
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master of Social Science in
Social Work
Maynooth University
(national University of Ireland Maynooth)
Postgraduate
education
Social workers
Information not provided Information not provided
Undergraduate education
Physical therapists
Professional Master of Physiotherapy
University College Dublin
Postgraduate education
Physical therapists
Bachelor Physiotherapy University College Dublin
Undergraduate education
Physical therapists
Bachelor Physiotherapy RCSI Undergraduate education
Physical therapists
Irish Dental Association Irish dental association Continuous professional
development
Dentists
Public Health Medicine Royal College of Physicians in Ireland
Postgraduate education
Medical specialists
Higher specialist training in Public Health Medicine
Royal College of Physicians in Ireland
Postgraduate education
Medical doctors Medical specialists General practitioners
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
64
Italy
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Healthy Lifestyles CNAI ndash Italian Nurses association
Continuous professional education
Nurses
Management for Health Professionals
University of Rome Postgraduate education
Midwifes Physical therapists Nurses
Corso di laurea in Terapia occupazionale (Bachelor in Occupational therapy)
Universitagrave degli Studi di Milano (State University of Milan)
Undergraduate education
Occupational therapists
Life Sciences University of Catania
School of Medicine
Continuous
professional
education
Medical doctors
Medical
specialists Physical therapists Occupational therapists Nurses
Dentists
Health promotion University of pavia Undergraduate education
Nurses
Corso di Laurea Magistrale
in Odontoiatria e Protesi Dentaria
Universitagrave di Parma Undergraduate
education
Dentists
Hygiene preventive medicine and public health
Universitagrave Cattolica del Sacro Cuore
Postgraduate education
Medical doctors Medical
specialists
general practicioners
Igiene e Medicina Preventiva Universitagrave degli Studi dellrsquoAquila
Postgraduate education
Medical doctors non-specialized
Post graduate school of Public Health
University of Sienna Postgraduate education
Medical doctors
Hygiene and Public Health University of Bari Aldo Moro
Postgraduate education
Medical doctors
School of specialization in Hygiene and Preventive Medicine
University of Milan Postgraduate education
Medical doctors
Lithuania
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Health Education and Promotion
Klaipeda State University of Applied sciences
Undergraduate education
Dietitians Physical therapists Nurses Dentists Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
65
Latvia
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Dentistry Riga Stradins University Undergraduate education
Dentists General practicioners
Professional Bachelor programme Physiotherapy
LASE Postgraduate education
Physical therapists
Physiotherapy Riga Stradins University Undergraduate education
Physical therapists
Malta
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Bachelor in Nursing Studies University of Malta Faculty of Health Sciences department of Nursing
Undergraduate education
Nurses
FHs University of Malta Undergraduate education
General practitioners
Netherlands
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Occupational Therapy Information not provided
Undergraduate education
Occupational therapists
Lifestyle and Healthcare Amsterdam University Medical Centre
Undergraduate education
Medical students
Portugal
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
PhD in Social Work ISCTE University Institute of Lisbon
Postgraduate education
Social workers
Bachelor degree in
Physiotherapy
Escola Superior de
Sauacutede de Santa Maria
Undergraduate
education
Physical
therapists
Physiotherapy IPC ESTeSC Coimbra Health school
Undergraduate education
Physical therapists
Licenciatura em Fisioterapia Escola Superior de Sauacutede - Instituto Politeacutecnico do Porto
Undergraduate education
Physical therapists
Degree in Physical therapy Instituto Piaget ndash Vila Nova de Gaia
Undergraduate education
Physical therapists
Degree in Physical therapy ESSATLA Continuous professional development
Physical therapists
Curso Licenciatura em Fisioterapia
Instituto Politeacutecnico de Sauacutede do Norte Escola Superior de Sauacutede do Vale do Ave CESPU
Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
66
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Clinical Education University Fernando Pessoa- Faculty of Health Sciences
Continuous professional development
Workers factory
Physiotherapy (Bachelor) School of healthy-
polytechnic institute of Setubal
Undergraduate
education
Physical
therapists
Physiotherapy Escola Superior De Sauacutede Do Vale Do Sousa do Instituto
Politeacutecnico De Sauacutede Do Norte
Undergraduate education
Physical therapists Nurses
Psychologists Dentists
Public Health ARSLVT Postgraduate
education
Medical
specialists
Information not provided Information not provided
Postgraduate education
Physical therapists
Information not provided Information not provided
Undergraduate education
General practicioners
Romania
Name of educational programme
Name of educational institution
Type of education Type of health professionals
being trained
Nursing Education University Lucian Blaga Postgraduate education
Nurses
MedicinePharmacy - Health University of Oradea Faculty of medicine and
pharmacy Oradea
Postgraduation education
Medical doctors Medical
specialists Pharmacists Physical therapists Nurses
Dentists General practicioners
Slovakia
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Social Work Constantine the philosopher University in Nitra
Postgraduate education
Social workers
Specialisation study in Clinical Psychology
Comenius University in Bratislava Faculty of
Arts
Continuous professional
development
Medical specialists
psychologists
Slovenia
Name of educational
programme
Name of educational
institution
Type of
education
Type of health
professionals being trained
Physiotherapy Alma Mater Europaea Undergraduate education
Physical therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
67
Physiotherapy University of Novo mesto Faculty of Health sciences
Undergraduate education
Physical therapists
Faculty of health sciences University of Primorska Continuous professional education
Dietetics Physical therapists Occupational therapists Nurses
Nursing Applied Kinesiology Physiotherapy and Nutritional counselling ndash dietetics
University of Primorska Faculty of Health Sciences Slovenia
Undergraduate education
Nutrional counselling Kinesiologists Physical therapists Nurses
Professional higher education study programme 1st cycle degree occupational
therapy
University of Ljubljana faculty of health sciences
Undergraduate education
Occupational therapists
Applied Kinesiology UP FVZ Undergraduate
education
Kinesiology
Physiotherapy Alma mater Europaea ndash Evropski center Maribor
Undergraduate education
Physical therapists
Bachelor in Physiotherapy University of Ljubliana Faculty of health sciences
Undergraduate education
Physical therapists
Health Promotion Angela Boskin Faculty of healthcare
Postgraduate education
Physical therapists Occupational
therapists nurses
1st Bologna cycle study programme Physiotherapy
Angela Boskin Faculty of healthcare
Undergraduate education
Physical therapists
Public Health Medical
Residency
Medical chamber of
Slovenia
Continuous
professional development
Medical doctors
Public Health National institute of public health of the
Republic of Slovenia
Postgraduate education
Medical doctors
Psychology Faculty of arts University of Maribor
Postgraduate education
Psychologists
Spain
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Human Nutrition and Dietetics
University of Zaragoza Undergraduate education
Dieticians
Continuous professional
education
Nurses
Physiotherapy University of Coruna Undergraduate education
Physical therapists
EHEA Degree in Human Nutrition and Dietetics
Blanquerna School of Health Sciences ndash Universitad Ramon Lull
Undergraduate education
Dietitians
Bachelor in Pharmacy Universidad de Sevilla Undergraduate
education
Pharmacists
Continuous professional development
Spanish General Council of Social Work
Continuous professional education
Social workers
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
68
Bachelor in Pharmacy Universidad de Alcala Undergraduate education
Pharmacists
Bachelor in Medicine Faculty of medicine University of Cadiz Spain
Undergraduate education
Medical doctors General practitioners
Residency in Preventive Medicine and Public Health
Hospital Clinic de Barcelona
Postgraduate education
Nurses
Bachelor in Medicine Information not provided
Undergraduate education
Medical doctors
MasterBachelor in Pharmacy
University of Navarra Undergraduate education
Postgraduate education
Pharmacists
Human Nutrition and Dietetics
Univeristy of Navarra Undergraduate education
Nutritionists amp Dietitians
Pharmacy Universitad Ramon Lull
Undergraduate education
Pharmacists
Pharmacy IQS ndash FCSB Undergraduate education
Pharmacists
Master in Advanced Therapies and Innovation in Biotechnology
Universidad de Francisco de Vitoria
Postgraduate education
Pharmacists
Pharmacy Universidad of the Basque County
Undergraduate education
Pharmacists
Sweden
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master programme in Public Health
Karolinska institute Postgraduate education
Occupational therapists
Social workers
Dietetics programme Department of food and Nutrition
Undergraduate education
Dietician
Dietetics programme Department of food studies dietetics and nutrition
Undergraduate education
Dietician
Programme in Dietetics University of Gothenburg
Sahlgrenska Academy
Undergraduate education
Dietician
Master of Public Health Department of public health and caring sciences Uppsala University
Postgraduate education
Medical doctors Bachelor of science Physical
therapists Nurses Psychologists Dentists Social workers
United Kingdom
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Bachelor (Hons) Occupational Therapy
Northumbria University Undergraduate education
Occupational therapists
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
69
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Master (pre reg) Occupational Therapy
Master in Occupational Therapy
Leeds Beckett University
Postgraduate education
Occupational therapists
Bachelor (Hons) Occupational Therapy
St Georgersquos University of London
Undergraduate education
Medical doctors Medical specialists Physical therapists
Occupational therapists
Bachelor (Hons)
Occupational Therapy
Caterburry Christ
Church University
Undergraduate
education
Occupational
therapists
Bachelor (Hons) Occupational Therapy Master in (pre-reg) Occupation Therapy Occupational Therapy degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Public Health speciality training
Health education England -north west
Postgraduate education
Medical doctors Medical specialists Researchers Nurses
Bachelor in (Hons) Occupational Therapy Master in (Pre-reg)
Occupational Therapy Occupational Therapy
Degree apprenticeship
University of Brighton Undergraduate education
Occupational therapists
Additional countries
Name of educational
programme
Name of educational
institution
Type of education Type of health
professionals being trained
Bachelor of Physiotherapy University of Prishtina Kosovo Albania
Postgraduate education
Physical therapists
Physiotherapy Faculty of health studies University of Sarajevo Bosnia-Herzegovina
Undergraduate education
Physical therapists
Fysioterapeututdanning NTNU Norway Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy BFH
Berner Fachhochschule BFH Bern University of Applied Sciences Swiss
Undergraduate education
Physical therapists
Bachelor of science in Physiotherapy
ZHAW Zurich University of applied sciences Swiss
Undergraduate education
Physical therapists
Physical Therapy Sciences University of Iceland
School of Health Sciences
Undergraduate
education
Physical
therapists
Medicine International school of medicine Kazachstan
Undergraduate education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
70
Name of educational programme
Name of educational institution
Type of education Type of health professionals being trained
Medicinesingle-cycle degree programme
University of Georgia Republic of Georgia
Medical doctors Psychologists General practicioners
Medicine Akaki tsereteli state University Republic of Georgia
Postgraduate education
Medical doctors Medical specialists Physical therapists Psychologists
Dentists General
practicioners
Public Health and Epidemiology
David tvildiani medical University Republic of
Georgia
Postgraduate education
Medical doctors
Biomedical and Healthcare Science doctoral programme
David tvildiani medical University Republic of Georgia
Postgraduate education
Medical doctors Biomedical Science master degree holders
Medicinesingle-cyle degree programme
University of Georgia Republic of Georgie
Undergraduate education
Medical doctors
Public Health Tbilisi State Medical University (TSMU)
Republic of Georgia
Undergraduate education
Medical doctors and public
health specialists
David tvildiani Medical
University
David tvildiani Medical
University Republic of Georgia
Undergraduate
education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
71
ANNEX 2 COMPETENCY PROFILES PER PROFESSIONS
Undergraduate medicine
The CanMEDS framework is worldwide the most commonly used and adapted model that
identifies and describes the abilities physicians require in order to effectively meet the
health care needs of the people they serve72 Within European Member States modifications
of this model are used within health and educational settings (for example in the
Netherlands and Finland) for undergraduate medicine and medical specialisations The
CanMEDS model defines seven roles of the physician namely (1) medical expert (the
integrating role) (2) communicator (3) collaborator (4) leader (5) health advocate (6)
scholar and (7) professional73 The role of health advocate is defined as physicians
contributing their expertise and influence as they work with communities or patient
populations to improve health ldquoimproving health is not limited to mitigating illness or
trauma but also involves disease prevention health promotion and health protection
Improving health also includes promoting health equity whereby individuals and
populations reach their full health potential without being disadvantaged by for example
race ethnicity religion gender sexual orientation age social class economic status or
level of educationrdquo Within this role two key competencies are defined74
1 Respond to an individual patientrsquos health needs by advocating with the patient within
and beyond the clinical environment
a Work with patients to address determinants of health that affect them and their access
to needed health services or resources
b Work with patients and their families to increase opportunities to adopt healthy
behaviours
c Incorporate disease prevention health promotion and health surveillance into
interactions with individual patients
2 Respond to the needs of the communities or populations they serve by advocating with
them for system-level change in a socially accountable manner
d Work with a community or population to identify the determinants of health that affect
them
e Improve clinical practice by applying a process of continuous quality improvement to
disease prevention health promotion and health surveillance activities
f Contribute to a process to improve health in the community or population they serve
In addition the European Thematic Network project MEDINE (2004-2007) and Tuning
Project (Medicine) under its auspice (MEDINE) have generated and gained widespread
consensus on a set of competences for primary medical degree qualifications in Europe
(ie undergraduate medicine)75 Within this project it is stated that graduates in medicine
72 httpwwwroyalcollegecarcsitecanmedscanmeds-framework-e 73 httpwwwroyalcollegecarcsitecanmedsabout-canmeds-e 74 httpwwwroyalcollegecarcsitecanmedsframeworkcanmeds-role-scholar-e 75 httptuningacademyorgmedine-medicinelang=en
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
72
would need the ability to ldquopromote health engage with population health issues and work
effectively in a health care systemrdquo76 The following points define health promotion
bull provide patient care which minimises the risk of harm to patients
bull apply measures to prevent the spread of infection
bull recognise own health needs and ensure own health does not interfere with
professional responsibilities
bull conform with professional regulation and certification to practise
bull receive and provide professional appraisal
bull make informed career choices
bull engage in health promotion at individual and population levels
Medical specialist
The European Union of Medical Specialists (UEMS) contributed significantly to the
improvement of post-graduate training through the development of a European Curriculum
in each medical speciality as well as the elaboration of training standards77 Within this
section we provide a detailed description of the European training requirements for a
selection of medical specialists including sports medicine public health internal medicine
cardiology psychiatry and the general practitioner78 This selection was based on the fact
that within these specialities lifestyle might be an essential component or important part of
the treatment of chronically ill patients
1) Medical specialist sports medicine
Sports medicine is defined by the European Commission as a ldquomultidisciplinary clinical and
academic speciality of medicine dealing with health promotion for the general population
by stimulating a physically active lifestyle and diagnosis treatment prevention and
rehabilitation following injuries or illnesses from participation to physical activities
exercises and sport at all levelsrdquo79 As health promotion and prevention are both
incorporated in the definition of sports medicine these topics are included throughout the
whole curriculum of sports medicine The curriculum of sports medicine aimed to provide
theoretical understanding and practical skills to provide first line clinical services80 Within
the training requirements for the speciality of sports medicine it is stated that sports
medicine does not solely take care for sporting elite athletes but as well for its important
role to promote exercise as a medical tool meant for patients with chronic diseases81
bull Theoretical knowledge aims to provide theoretical understanding and practical skills to
provide first line clinical services
- Clinical To provide pre-participation clinical screening and examination before
exercise and competition as well as medical assistance to the athletes engaged in all
sports
76
httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNLearning_Outcomes_Competences_for_Undergraduate_Medical_Education_in_Europepdf
77 httpswwwuemseu__dataassetspdf_file00111415906pdf 78 httpswwwuemseuareas-of-expertisepostgraduate-trainingeuropean-standards-in-medical-training 79 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 80 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf 81 httpswwwuemseu__dataassetspdf_file0009111798UEMS-201947-European-Training-
Requirements-in-Sports-Medicinepdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
73
- Public health
bull As part of a multi-disciplinary team to encourage and promote physical activity as
a lever for healthy living
bull To identify impediments to an active lifestyle and work within a multi-disciplinary
framework to remove those impediments or minimize their impact
bull To work alongside local health authoritiespublic health clinicians developing
exercise opportunities for the general public for health gain
bull To liaise with public (local authoritieseducationvoluntary) and private sector to
advise on the health aspects of exercise programmes for physical activity of special
groups like women children adolescents and aging population
bull Practical and clinical skills
bull To foster the integration of knowledge and practical skills acquired during the
cardiology orthopaedics physical amp rehabilitation medicine general practice
medicine and physiology internships
bull To learn to put into practice information gained in the relevant course work
bull To extend and deepen their knowledge in the assessment of fitness such as
isokinetic and functional muscle performance cycle ergometry and treadmill
ergometry
bull To gain experience in the use of such test results in the decision making with regard
to diagnosis recommendations and therapy for people of both gender and in
different age groups and performance levels
bull With regard to elite sport trainees will learn how to diagnose treat and prevent
overtraining and overexertion
bull To become proficient in activities related to for example hygiene and nutrition
and will work closely with trainers athletes physiotherapists officials etc
bull Competencies
bull Clinical and instrumental assessment to determine the pathophysiology
mechanisms and the underlying diagnosis of the patientrsquos condition
bull Trainees are expected to complete evidence of reflective practice through case
reports and other experiences in their training record
bull Other self-directed work will be planning data collection analysis and presentation
of audit and research work
bull The mandatory training record (hand written diary or preferably electronic
logbook) will contain evidence of academic pursuits and should be checked and
documented regularly by the Supervisor
bull Trainees will take part and be able to lead in teaching and will be expected to
develop skills to teach undergraduates postgraduates and non-medical staff in
small groups and formal lectures making personal presentations using a variety of
audiovisual methods
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
74
bull They will be expected to present at journal clubs and make case presentations at
grand rounds or similar settings
bull They will be expected to undertake personal audit and research and make
presentations of their findings at clinical meetings
bull Prescription as much evidence-based as possible of medical and physical
treatments (including drug treatment physical modalities innovative
technologies natural factors and others) as well as of technical aids
bull Prevention and management of complications
bull Skill to perform and participate in research
2) Medical specialist public health
The European Commission defines public health ldquoas the science and art of preventing
disease prolonging life and promoting mental and physical health and efficiency through
organized community effort Public health may be considered as structures and processes
by which the Health of the population is understood safeguarded and promoted through
the organized efforts of societyrdquo82 Public health specialists aim to improve populationrsquos
health by using the following skills and competencies
bull Theoretical knowledge on a range of fields including epidemiology prevention health
promotion public health research behavioural sciences health programme evaluations
health need assessments and quality and safety in healthcare
bull Practical and clinical skills
- Surveillance and evaluation of the health of the population (trained in epidemiology)
- Planning and evaluation of health services and public health control
- Analysing the health of the population (analysing determinants on individual and
community levels)
- Plan participate in or evaluate preventive and control programmes (public health
assessments)
- Participate in multidisciplinary health impact assessment
- Inform decision-makers about potential impacts and to identify appropriate and
sustainable actions to manage those effects (including environmental determinants
of health)
- Organisational issues in healthcare (participating in policy and strategic development
quality and safety management)
- Generate and share new evidence on the ways in which social determinants influence
population health and health equity
- Sufficient linguistic ability to communicate with hisher public health colleagues
82 httpswwwuemseu__dataassetspdf_file001198435UEMS-201924-European-Training-
Requirements-for-Public-Healthpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
75
- Develop high professional ethical standard including respect towards human rights
participants in public health programmes colleges and other professionals in the
team
bull Competencies
- Establish the expertise role as a Public Health Physician
bull Function as public health leaders and consultants to health services and other
organizations and institutions in order to provide safe appropriate cost effective
and equal health care to groups communities and populations
bull Establish and maintain medical knowledge skills and attitudes appropriate to their
practice including the organization and financing of health care public health
control and public health law
- Perform expertise analyses of the health of the population
bull Apply and combine medical and epidemiological competencies for the surveillance
and evaluation of the health of the population
bull Identify the determinants of health of populations and risks for public health and
implications for interventions and policy
bull Evaluate health problems biopsychosocial mechanisms andor health care issues
for different population groups and their implications for the community
bull Critically evaluate epidemiological demographic health statistical and
environmental pollution data and their sources and apply them appropriately to
public health issues
bull Identify community health needs and advise about their implications for public
health and medical care services
- Lead and supervise public health interventions
bull Select develop implement and monitor public health surveillance and
interventions namely in the areas of human behaviour social and physical
environment food safety and nutrition health care associated risks and working
life related health
bull Promote the health of individuals communities and populations through health
programming
bull Contribute to the organization and evaluation of societal and health care
programmes aiming to promote health and social functioning among individuals
with long-term diseases and disabilities
bull Contribute to the planning organization supervision of and evaluation of societal
and health care programmes promoting the health of specific target groups such
as children elderly and vulnerable and underserved groups in society
bull Contribute to the organization of and evaluate primary and secondary medical
prevention programmes
bull Contribute to strengthening regulatory frameworks for protecting and improving
health
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
76
- Function as expertise in planning and evaluation of Public Health and Medical Care
bull Evaluate Public Health and other service programmes concerning processes and
outputs from the different perspectives of care seekers professional health care
workers and health managers
bull Analyse and differentiate between need demand and supply and assess the health
of a defined population and identify areas for improvement including the allocation
of health care resources delivery
bull Evaluate the outcome quality and safety of care and promote quality development
systems based on evidence and public health principles
bull Apply health economic principles and methods such as cost-effectiveness cost-
utility and cost-benefits considering the strengths and weaknesses of different
methods
bull Use methods to determine priorities and their strengths and weaknesses and
promote awareness of the competing and conflicting influences on public and
political perceptions of the need for health care and the resulting constraints on
action
bull Promote and evaluate collaboration between health services and other welfare
organizations in society
bull Evaluate and contribute to the policy and strategic development in health care
planning
bull Contribute to the planning and evaluation of different sectors of society by health
impact assessments and public health medical reports and consultations
- Communicate and develop public health medical expertise
bull Lead supervise and participate in an interprofessional health care team
bull Consult other (health) professionals and policymakers and recognise the
advantages and limits of their expertise
bull Effectively convey oral and written information about public health issues including
adequate public health reporting and effective interaction with media
bull Stimulate and motivate others so that they recognise the importance of the public
health population perspective
bull Maintain and enhance professional activities through ongoing learning and
research and contribute appropriately to the generation dissemination application
and translation of new public health knowledge and practices
3) Medical specialist internal medicine
The UEMS defines an internist as ldquoa physician trained in the scientific basis of medicine
who specialises in the assessment diagnosis and management of general medical
problems atypical presentations multiple problems and consequential complex health
issues and system disorders (Professional) The physician is skilled in the management of
acute unselected medical emergencies and the management of patients in a holistic and
ethical way considering all psychosocial as well as medical factors for enhancing quality of
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
77
life The physician values the continuing care of all patients irrespective of the nature of the
patients complaint and is committed to lifelong continued professional development
(Scholar) The physician practices clinical audit and evidence-based medicine The
physician functions in a number of roles including clinical counselling educating leading
and managingrdquo83
Internists have a fundamental role in modern healthcare systems Within the definition of
the internist the shift towards a preventive strategy focusing on health promotion is
highlighted by the acknowledgement of the high prevalence of chronic and complex
diseases that are associated with the lifestyle of ageing western societies The role of
healthcare advocate (a role defined in the CanMED framework) is an important part of the
internistrsquos function and forms the generic competencies of an internist (see section 11)
However lifestyle promotion and disease prevention is not a specific area of expertise
Specific areas of the internist include multi-morbidity and ageing acute care medical
consultation shared-decision-making collaborative care transition in care vulnerable
adult patient safety and quality of care and medical leadership
4) Medical specialist cardiology
According to the training requirements for the speciality of cardiology84 training in
cardiology should be based on the syllabus of the ESC core Curriculum for the general
cardiologist part 2 ldquothe core curriculum per topicrdquo85 The necessary core cardiology
competencies are set out as cardiology learning objectives with the knowledge skills
attitudes and competencies needed to fulfil the objectives One of the core cardiology
competences is cardiovascular prevention aiming to
bull Assess and manage patients with risk factors for cardiovascular disease
bull Understand the mode of action of different prevention methods
bull Describe cardiovascular disease and risk factors in the local community
bull Contribute to the global efforts in reducing cardiovascular morbidity and mortality
by communicating the prevention message to the public
bull To approach prevention in a holistic way understanding the potentiation of
cardiovascular risk by clustering of risk factors
bull
Knowledge
bull Epidemiology of cardiovascular disease in the local community incidence
prevalence survival
bull Risk factors in the local community
83 httpswwwuemseu__dataassetspdf_file001744450UEMS-201613-European-Training-
Requirements-Internal-Medicinepdf 84 httpswwwuemseu__dataassetspdf_file001119577UEMS-201324-SECTIONS-AND-BOARDS-
Cardiology-European-Training-Requirements-20131019pdf 85 httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_
9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
78
bull Risk assessment in primary prevention multifactorial risk interaction and use of
risk scoring charts
bull The impact of lifestyle on people at risk of and patients with cardiovascular
disease
bull The potential of lifestyle changes to prevent and ameliorate cardiovascular
disease diet and nutrition toxic habits (smoking alcohol and others) physical
activity
bull Emerging risk factors (social economic stress depression and personality type)
bull Treatmentprevention strategies for major risk factors and changes in lifestyle
including corresponding pharmacologic therapies
bull The comprehensive approach required for multiple risk factors
bull Patient compliance
In addition the main objectives and knowledge competence are further specified by
hypertension dyslipidaemia diabetes and lifestyle
Skills
bull obtain a relevant history and perform an appropriate clinical examination
bull evaluate cardiovascular risk and assess global cardiovascular risk at the individual
level
bull evaluate cardiovascular risk at population level (mortality morbidity disability)
bull evaluate the benefit of prevention at individual and population levels
bull manage risk factors appropriately including pharmacological and non-
pharmacological therapies
bull communicate their importance to patients their families and the wider
community including smoking cessation diet and exercise
bull communicate the importance of patient compliance and behaviour
bull motivate patients and families to change lifestyles and be compliant with
prescriptionsrecommendations
bull monitor patient compliance and behaviour
bull evaluate the benefit of risk factor intervention for the individual patient
Behaviours and attitudes
bull Non-judgemental attitude to patients regarding their lifestyle (eg smoking diet
etc)
bull Exemplify appropriate lifestyle in personal behaviour
bull Team working with other physicians including general practitioners
diabetologists nephrologists and elderly care physicians for the management of
specific risk factors
bull Team working with all professionals with a role in primary and secondary
prevention (nurses dieticians teachers and politicians)
Another core competency is the physical activity and sport in primary and secondary
prevention Further defined in sports cardiology and cardiac rehabilitation
Sports cardiology aiming86
86
httpswatermarksilverchaircomeht234pdftoken=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U-53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
79
bull To conduct strategies to implement healthy lifestyle in particular physical and
sports activities in the general population (primary prevention)
bull To evaluate cardiovascular risk and exercise capacity (see Chapters 22 and
271)
bull To recognize the characteristics of the athletersquos heart
bull To appropriately detect contraindications to exercisecompetition and
appropriately provide non-contraindication certificates
Knowledge
bull Exercise and sports physiology
bull Benefits of exercise training
bull Safety issues in exercise and sport
bull Diagnostic criteria and appropriate investigations in athletes with cardiovascular
disease
bull Risk factors for and mechanisms of sudden cardiac death (SCD) during and after
strenuous exercise
bull Specific population challenges and exercise programmes in appropriate settings
bull Recommendations for professional and recreational sports participation
bull SCD in patients athletes and in the population at large and
bull Mechanisms of action of illicit drugs
Skills
bull perform an individual CVD risk assessment using appropriate information from
history laboratory assessment including full lipid profile and clinical data
bull recognize pathological cardiovascular changes and differentiate them from the
characteristic features of lsquoathletersquos heartrsquo and
bull use prevailing recommendations for eligibility for participation in competitive
sports
Behaviours and attitudes
bull Recognition of the role of active lifestyle exercise and sport in the promotion of
health and in the prevention of the most threatening diseases including
cardiovascular diseases
Cardiac rehabilitation aiming
bull To evaluate and manage cardiovascular risk
bull To evaluate exercise capacity and causes of exercise intolerance
bull To provide appropriate rehabilitation and secondary prevention to patients with
cardiovascular diseases
7KU5nHwnMt5NZ0-izF_LC-uXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX6-7QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4S-FbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEULdcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5-Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCc-Ezp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPkt-MU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8-Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7-LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
80
Knowledge
bull Multi-disciplinary risk factor intervention
bull Definition of comprehensive cardiovascular prevention and rehabilitation
bull Effects of behavioural change including physical activity nutrition education and
psychosocial risk factors on quality of life cardiovascular risk and outcome
bull Rehabilitation as a component of cardiac care and a promoter of secondary
prevention
bull Target populations and risk stratification of patients
bull Psychological aspects of rehabilitation and exercise practice
Skills
bull take a relevant history and perform an appropriate clinical examination including
the specific evaluation of the elderly patient
bull perform and interpret risk stratification using indicated tests
bull interpret a cardiopulmonary exercise test and distinguish different causes of
exercise limitation
bull prescribe exercise-based rehabilitation programmes and other lifestyle
interventions according to the patientrsquos condition in collaboration with other
specialists when necessary and
bull motivate the patient to ensure long-term adherence to lifestyle changes and
continuing exercise programmes
Behaviours and attitudes
bull rehabilitation as a component of cardiac care
bull the importance of rehabilitation and secondary prevention for professional
personal and social life among patients with heart disease
bull the interplay of physical and psychological aspects of heart disease and the
positive influence of exercise on cardiovascular risk factors
bull the role of other professionals including nurse specialists physiotherapists ergo
physiologists psychologists dieticians and general practitioners in rehabilitation
and secondary prevention and
bull the importance of patient and family education and the role of other professionals
in rehabilitation
5) Medical specialist psychiatry
The UEMS has issued a charter of requirements for the training in psychiatry in 2000 with
an additional European Framework for Competencies in Psychiatry in 2009 The learning
outcomes in the European Framework for Competencies in Psychiatry (EFCP) are arranged
under the seven physician roles derived from the CanMEDS framework87 Within the EFCP
it is stated that ldquopsychiatrists recognise the importance of advocacy and health promotion
in responding to the challenges represented by those social environmental and biological
factors that determine the mental health and well-being of patients and society They
recognise advocacy as an essential and fundamental component of mental health promotion
that occurs at the level of the individual patient the practice population and the broader
communityrdquo
Competencies
87 httpuemspsychiatryorgwp-contentuploads2013092009-Oct-EFCPpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
81
bull identify the determinants of mental disorder as well as the factors that may
contribute to positive mental health so as to be able to prevent disorder and
promote mental health
- recognise the determinants of mental health of populations and how public
policy including legislation impacts on mental health
- promote positive mental and physical health in patients particularly in those
with severe mental disorder based on best evidence
- recognise the impact of mental disorder on families and carers and take
remedial measures
- collaborate with other community sectors to promote mental health and
prevent mental disorder at all levels focusing particularly on family school and
workplace
- identify and address barriers and inequity in access to care particularly for
vulnerable or marginalised populations
bull Identify and address issues and circumstances when advocacy on behalf of
patients professions or society is necessary
- respect and promote the human rights of people with mental disorders and
collaborate with user and carer associations and advocacy groups
- empower people with mental disorders and their carers
- recognise and address prejudice stigma and discrimination associated with
mental disorder and its treatment
- use strategies to enhance patientrsquos self-management and autonomy
- actively oppose the use of psychiatry for political repression
- recognise the possibility of conflict inherent in their role as a health advocate
for a patient or community with that of manager or gatekeeper
6) General practitioner
The European training requirements for General PracticeFamily Medicine (GPFM) specialist
training88 defined twelve central characteristics of the practice before determining the core
competences Related to health promotion and disease prevention two of these
characteristics are as following ldquopromotes health and well-being both by appropriate and
effective interventionrdquo and ldquohas a specific responsibility for the health of the communityrdquo
The twelve characteristics are clustered into six core competences primary care
management person-centred care specific problem solving skills comprehensive
approach community orientation holistic modelling Under comprehensive approach the
following abilities relate to health promotion and disease prevention
bull to promote health and wellbeing by applying health promotion and disease
prevention strategies appropriately
bull to manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
Furthermore community orientation includes the ability
bull to reconcile the health needs of individual patients and the health needs of the
community in which they live in balance with available resources
88 httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-documentseuropean-
training-requirements-gp-fm-specialist-training-euract-2018pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
82
In the more comprehensive assessment of GPrsquos performance in daily practice by the
European Academy of Teachers in General PracticeFamily Medicine (EURACT)89 these
abilities are further defined as following
bull To promote health and wellbeing by applying health promotion and disease
prevention strategies appropriate
- Identifies opportunity for health promotion intervention
- Makes use of structured medical record as reminder of preventive activities
- Makes use of teamwork
- Uses communication skills
- Is aware of any personal prejudices which might influence negatively
preventive advice
- Makes recommendations which are feasible in the context of patientrsquos lifestyle
and home situation
- Acts as suitable role model
bull To manage and co-ordinate health promotion prevention cure care and palliation
and rehabilitation
- Provides appropriate medical management
- Involves members of practice team eg through case conference
- Performsarranges home visit (consider relevant team members) ndash needs
assessment eg cause of falls
- Involves relatives
- Facilitates communication (two-way) with hospital
- Involves external community resources (eg home help etc)
Dentist
According to the profile and competences for the graduating European dentist one of the
major competences for dentists is to improve oral health of individuals families and groups
in the community On graduation a dentist must be competent at promoting and improving
the oral health of individuals families and groups in the community90 Furthermore with
regard to health promotion and disease prevention a dentist
bull Must be competent at
- Applying the principles of health promotion and disease prevention via
comprehensive preventive measures to individuals and the community
according to their risk assessment status
- Understanding the complex interactions between oral health nutrition general
health drugs and diseases that can have an impact on oral health care and
oral diseases
- Providing appropriate dietary advice
bull Have knowledge of
- The organisation and provision of health care in the community and in the
specialist hospital service in the country of training
- The prevalence of the common dental conditions in the country of
trainingpractice
- The social cultural and environmental factors which contribute to health or
illness
- The strategies to overcome barriers to dental care for disabled elderly
socially deprived and ethnic minority groups
- Training auxiliaries in basic skills of oral health promotion
89httpseuractwoncaeuropeorgsiteseuractdevfilesdocumentspublicationsofficial-
documentseuractperformanceagendadC3BCsseldorf2014-openaccessebookversionpdf 90 httpwwwdentuoagrfileadmindentuoagruploadsusefull_filesADEE-competences-2009_enpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
83
In 2017 a new updated framework was published for undergraduate education for dentists
including a revised structure of the educational domains and their areas of competence In
the revised framework health promotion and disease prevention compromises one of the
areas of competence in the domain ldquodentistry in societyrdquo in the educational strategy of a
dentist91 Note Dentists can also specialise in public health in a similar programme as
physicians
Nurses
The training for nurses responsible for general care shall following the Directive
201355EU include a set of eight competences 92 The training for nurses should provide
assurance that the ability of the following knowledge and skills
1 comprehensive knowledge of the sciences on which general nursing is based including
sufficient understanding of the structure physiological functions and behaviour of
healthy and sick persons and of the relationship between the state of health and the
physical and social environment of the human being
2 sufficient knowledge of the nature and ethics of the profession and of the general
principles of health and nursing
3 adequate clinical experience such experience should be gained under the supervision
of qualified nursing staff and in places where the number of qualified staff and equipment
are appropriate for the nursing care of the patient
4 the ability to participate in the practical training of health personnel and experience of
working with such personnel
5 experience of working with members of other professions in the health sector
Competencies 93
6 Competency to independently diagnose the nursing care required using current
theoretical and clinical knowledge as well as to plan organise and implement nursing
care when treating patients on the basis of page the knowledge and skills acquired in
accordance with points (1) (2) and (3) in order to improve professional practice
7 Competency to work together effectively with other players in the health sector including
participation in the practical training of health personnel on the basis of the knowledge
and skills acquired in accordance with points (4) and (5)
8 Competency to empower individuals families and groups towards healthy lifestyles and
self-care on the basis of the knowledge and skills acquired in accordance with points (1)
and (2)
9 Competency to independently initiate immediate measures to pre- serve life and to carry
out measures in crisis and disaster situations
9191 Field JC Cowpe JG Walmsley AD The Graduating European Dentist A New Undergraduate Curriculum
Framework Eur J Dent Educ 201721(Suppl 1)2-10 httpsdoiorg101111eje12307 92 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf 93 httpwwwefnwebbewp-contentuploadsEFN-Competency-Framework-19-05-2015pdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
84
10 Competency to independently advise instruct and support individuals needing care
and their attachment figures
11 Competency to independently ensure the quality of nursing care and assess it
12 Competency to communicate comprehensively and professionally and to cooperate
with members of other professions in the health sector
13 Competency to analyse the quality of care in order to improve their own professional
practice as general care nurses
The competences included in Directive 201355EU are different from the competences
contained in the EFN Competency Framework These competences contain the following
competences on health promotion and disease prevention guidance and teaching
bull To promote healthy lifestyles preventive measures and self-care by strengthening
empowerment promoting health and enhancing behaviours and therapeutic
compliance
bull To independently protect the health and well-being of individuals families or
groups being cared for ensuring their safety and promoting their autonomy
bull To integrate promote and apply theoretical methodological and practical
knowledge This enables the promotion and the development of nursing care in
long term care co-morbidity and in situations of dependency in order to maintain
an individualrsquos personal autonomy and hisher relationships with the environment
in every moment of the healthillness process
Nurse specialist
The European Specialist Nurses Organisation (ESNO) defines the nurse specialist as follows
ldquoThe Nurse Specialist (NS) is an advanced practice Nurse prepared as a specialist within a
clinical specialty at the masterrsquos post masterrsquos or doctoral levelrdquo94 Following the ESNO the
competencies should be considered as a reference template and guidelines for the different
specialities in which each speciality can define its own knowledge skills and attitudes
Generic competencies are the clinical role patient relationship patient teachingcoaching
mentoring research organisation and management communication and teamwork ethic
and decision making leadership and policy making and prevention The competency of
prevention is based on the case for investing in public health from the World Health
Organization95 The competency of prevention is based on the ability of promoting health
and prevent disease by the capacity to develop and put in place intervention in
bull Surveillance of population health and wellbeing
bull Disease prevention at the 3 levels of prevention (primary secondary)
bull Ability to promote health and prevent disease
bull Monitoring and response to health hazards and emergencies
bull Health promotion including actions to address social determinants and healthy
inequities
bull Advocacy communication and social mobilization for health advancing public
health
bull Research to inform policy and practice96
94 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf 95 httpwwweurowhoint__dataassetspdf_file0009278073Case-Investing-Public-Healthpdfua=1 96 httpswwwesnoorgassetsharmonise-common_training_frameworkpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
85
Occupational therapist
The World Federation of Occupational Therapists (WFOT) provided minimum standards for
the education of occupational therapists97 One of the settings in which occupational
therapists work is defined as following ldquoCommunity or group approaches such as health
promotion community development community based rehabilitation injury prevention
environmental design disaster preparation and recoveryrdquo Furthermore under essential
knowledge skills amp attitudes for competent practice the following (could) relate to health
promotion and disease prevention
bull Knowledge about
- The relationship between occupation and human development over the life
course including healthy ageing
- The relationship between psychological social and economic factors and
occupation (eg stress adjustment to life changes including disability
societal disruption natural or man-made disaster displacement)
- Early identification and functional interventions focusing on somatosensory
stimulation and performance mechanisms mitigating early developmental and
environmental factors impacting negatively on behaviour and learning
- How activity limitations and participation in occupation affect health This
includes the ability to maintain a healthy environment and personal factors
such as adjustment interpersonal relationships and social networks
- How health conditions and threats to health affect participation in work
bull Skills in
- Inter-sectoral collaboration in public health initiatives
- Assessing health in relation to occupation
In addition the Tuning programme described the reference points for the design and
delivery degree programmes in occupational therapy98 in which they first ranked subject
specific competency One of the highest ranked included
bull Enable individualsgroupsorganisationscommunities to be engaged in occupation
through health promotion prevention rehabilitation treatment and
coachingtraining
In the final set of subject specific competences however this is mentioned less explicitly
and only the following are related to health promotion and disease prevention
bull Knowledge the occupational therapist is able to
- Work in partnership with individuals and groups using occupation in
prevention rehabilitation and treatment in order to promote participation
health and well-being
- Explain the relationship between occupational performance health and well-
being
- Collaborate with communities to promote and develop the health and well-
being of their members through their participation in occupation
- Develop new knowledge of occupation and occupational therapy practice
particularly in relation to local andor emerging health and social challenges
97 httpswwwwfotorgassetsresourcesCOPYRIGHTED-World-Federation-of-Occupational-Therapists-
Minimum-Standards-for-the-Education-of-Occupational-Therapists-2016apdf 98 httptuningacademyorgwp-contentuploads201402RefOccupationalTherapy_EU_ENpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
86
Pharmacists
In a two-stage large-scale Delphi process fifty competences of pharmacy practice were
ranked and the Quality Assurance in European Pharmacy Education and Training (PHAR-
QA) framework was harmonized and validated99 Of these fifty competences the following
relate to health promotion and disease prevention
bull Ability to promote public health in collaboration with other professionals within the
healthcare system
bull Ability to provide appropriate lifestyle advice to improve patient outcomes
bull (eg advice on smoking obesity etc)
bull Ability to use pharmaceutical knowledge and provide evidence-based advice on
public health issues involving medicines
Physiotherapists
According to the World Confederation for Physical Therapy (WCPT) the scope of physical
therapists practices includes (among others) public health strategies and advocating for
patientsclients and for health100 Furthermore it is described that physical therapists may
have the following purposes
bull promoting the health and wellbeing of individuals and the general publicsociety
emphasising the importance of physical activity and exercise
bull preventing impairments activity limitations participatory restrictions and
disabilities in individuals at risk of altered movement behaviours due to health
factors socio-economic stressors environmental factors and lifestyle factors
The European Network of Physiotherapy in Higher Education (ENPHE) also described
professional competencies of physiotherapists101 According to the ENPHE one of the roles
of a physiotherapist is to be a
bull Health care promotor
- Advocate on health and wellbeing promotion and disease or injury prevention
on behalf of patientclients and the profession to enhance individual
community and public health
- Promote adherence to local regional national and EU health and safety
policies guidelines and protocols
Psychologist
The European Federation of Psychologistsrsquo Associations developed the European Certificate
in Psychology ndash the EuroPsy102 The Tuning programme also published lsquoReference points for
the design and delivery of degree programmes in Psychologyrsquo103 in which they state that
the Tuning programme and the EuroPsy programme have experienced a parallel
development over the last ten years In fact the Tuning document presents a reference
99 httpswwwncbinlmnihgovpmcarticlesPMC5419365 100 httpswwwwcptorgpolicyps-descriptionPT 101 httpwwwenpheorgwp-
contentuploads201910ESCO_report_ENPHE_recommendations_April_2017pdf 102 httpwwwinpa-europsyitmoduliEuroPsy20Regulations20July202011pdf 103httpwwwunideustoorgtuningeuimagesstoriesSummary_of_outcomes_TNPsychology_reference_points
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
87
point for the design and delivery of degree programmes in psychology on the basis of the
EuroPsy programme
Based on the definition of the key role of the professional psychologist health promotion
and disease prevention could be part of the profession as this has been described as
follows to develop and apply psychological principles knowledge models and methods in
an ethical and scientific way in order to promote the development well-being and
effectiveness of individuals groups organisations and society However no specific
competences related to health promotion and disease prevention are now described in the
documents It is plausible though that psychologist do act to promote health as the core
of their profession is to help others to understand behaviour to improve performance and
well-being or to alleviate problems and distress As these emergent specialisms develop in
response to new demands there is a tendency to develop education and training
programmes thus increasing the specialisation and the requirement for specialist skills of
professional psychology
Social worker
Global standards for the education and training of the social work profession are developed
by the International Association of Schools of Social Work (IASSW)104 The IASSW
worldwide association of schools of social work other tertiary level social work educational
programmes and social work educators These global standards include for example
standards regarding the schoolrsquos core purpose or mission statement standards regarding
programme objectives and outcomes standards with regard to programme curricula
including field education The standards with regard to the core curricula are organised into
four conceptual components domain of the social work profession domain of the social
work professional methods of social work practice and paradigm of the social work
profession under which several sub-domains are described which mainly relate to aspects
such as inadequacies discrimination tradition and culture social stability and ethical
principles The following touch upon the field of health promotion and disease prevention
bull Knowledge of human behaviour and development and of the social environment
with particular emphasis on the person-in-environment transaction life-span
development and the interaction among biological psychological socio-structural
economic political cultural and spiritual factors in shaping human development
and behaviour (domain of the social work profession)
bull Sufficient practice skills in and knowledge of assessment relationship building
and helping processes to achieve the identified goals of the programme for the
purposes of social support and developmental protective preventive andor
therapeutic intervention ndash depending on the particular focus of the programme or
professional practice orientation (methods of social work practice)
bull The application of social work values ethical principles knowledge and skills to
promote care mutual respect and mutual responsibility amongst members of a
society (methods of social work practice)
bull Problem-solving and anticipatory socialisation through an understanding of the
normative developmental life cycle and expected life tasks and crises in relation
to age-related influences with due consideration to socio-cultural expectations
(paradigm of the social work profession)
104 httpswwwiassw-aietsorgwp-contentuploads201808Global-standards-for-the-education-and-training-
of-the-social-work-professionpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
88
The European Social Network (ESN) investigated the social services workforce throughout
Europe and provided an overview of qualifications and skills in different Member States in
their research report showing that qualification and skills for social care workers differ per
country105 In fact in some countries there are specific training routes for social care
workers including specialised training courses or apprenticeships and the content of these
trainings depends on the service user group and is generally defined at a local or authority
level A questionnaire was set out in which essential components of social care workers
were identified which showed that health and safety is seen as an important component
of social work
105 httpswwwesn-euorgsitesdefaultfilespublicationsInvesting_in_the_social_service_workforce_WEBpdf
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
89
ANNEX 3 ONLINE SURVEY
Survey Health promotion and disease prevention in health and educational
settings
Health promotion and disease prevention in health and educational settings -
medical schools The European Union has commissioned Ecorys an international
research and consultancy agency to conduct a project on health promotion and
disease prevention in health and educational settings In order to provide an EU
wide overview and to better support national governments we would like to ask
for your cooperation The project will develop an EU wide overview of the
educationtraining programmes for basic education postgraduate education as
well as continuous professional development with regard to education on health
promotion Your help will therefore be key in the collection of information and
data on public health initiatives in medical and non-medical education The survey
will take approximately 20 minutes of your time You do not need to complete this
survey at once You may leave the survey and continue at a later moment in
time Questions can be saved by clicking on the pauze button (below the
questionnaire) When doing so a new URL link will be provided We would be
pleased if you could provide this information by means of an online questionnaire
to Ecorys who is also available in case you have questions or you would like
additional information bull Ms Emalie Hurkmans (Project Coordinator) tel +31
(0)6 280 579 21 email emaliehurkmansecoryscom bull Ms Tessa Huis in lsquot
Veld tel +31 6 29 22 10 58 email tessahuisintveldecoryscom
What is the name of your education
What are the website details of the educationPlease enter the link of the website
with information of the education
Can you give a brief description of the education
What type of health professionals are trained in the education
Medical doctors
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
90
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
What type of medical specialist
Is the education
Undergraduate education
Postgraduate education
Continuous professional development
Is the course accreditated
Yes
No
Unknown
Does the course cover the topic health promotion and disease prevention
Yes
No
Is the education accreditated
Yes
No
Unknown
Does the education cover the topic health promotion and disease prevention
Yes
No
How is the topic health promotion and disease prevention incorporated in the
curriculum
In a seperate module
Topic incorporated into curriculum
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
91
Who is (are) the contact person(s) of the module health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Was there any partnerships in setting up the module health promotion and disease
prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Has the education obtained any funding to set up the module on health promotion
and disease prevention EU funding national public funding local public funding
or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
92
Since when is the module on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the module Eg is it a two weeks one month or one
year programme
What is the typical quantity in hours spend at health promotion and disease
prevention by participants The amount of hours spent on attendence and
homework
Is the module health promotion and disease prevention accreditated separately
No
Unknown
Yes please specify how many points are given
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
93
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the module
No
Unknown
Yes please specify what type of exam
Is the module also provided at other locations For example at other universities
Yes
No
Unknown
Is there a contact person(s)expert for the topic health promotion and disease
prevention
Was there any partnerships in incorporating it in the curriculum
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
businesses NGOs individual citizens governmental agencies who have a role) fill
in yes and replace namely () by the partnership in place
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
94
Has the education obtained funding to incorporate health promotion and disease
prevention into the curriculum EU funding national public funding local public
funding or commercial private funding (eg pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is health promotion and disease prevention incorporated into the whole
curriculum eg since September 2017
What is the typical quantity in hours (approximately) spend at health promotion
and disease prevention by participants The amount of hours spent on attendence
and homework
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
95
In what way are knowledge and skills with regard to health promotion and disease
prevention tested in the curriculum For example incorporated into a written exam
Who is (are) the contact person(s) of the course on health promotion and disease
prevention Enter the name(s) and mailaddres(ses) of the contact person(s) who
hashave the authority to require consultation
Were there any partnerships in setting up the course on health promotion and
disease prevention For example other universities
Yes
No
Unknown
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention If there are any partnerships (eg
business NGOs individual citizens governmental agencies who have a role fill in
yes and add by the partnership in place
No
Yes please specify
Has the education obtained any funding to set up the course on health promotion
and disease prevention
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
96
Which health professionals are teaching health promotion and disease prevention
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other please specify
Since when is the course on health promotion and disease prevention provided
eg since September 2017
What is the timescale of the course eg two weeks one month or one year
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
97
What is typical quantity in hours spend at health promotion and disease prevention
by participants The amount of hours spent on attendence and homework
Is the course on health promotion and disease prevention accreditated separately
No
Unknown
Yes how many points are given
Is it mandatory education
Yes
No
Unknown
Is there an exam at the end of the course
No
Unknown
Yes what type of exam
Is the course provided at multiple locations For example at other universities
Yes
No
Unknown
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
98
What are the general objectives of the teaching activities on health promotion and
disease prevention eg arise awareness among Medical Doctors on the
importance of physical activity within the elderly population with a high risk of
heart failure
Which stakeholders were involved in developing the teaching activities on health
promotion and disease prevention
Is there made use of a mono- or multidisciplinary approach
Monodisciplinairy approach
Multidisciplinary approach
Unknown
Does the education include theories of
1
Yes
2
No
3
Unknown
Population health
Human cognition
and behaviour
Health behaviour
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
99
Does the education include
1
Yes
2
No
3
Unknown
Epidemiology and
bio-statistics
(research
capacity)
Methods of
evidence-based
medicine
Health policies
and regulation
Health economics
Ethics
Health care
systems
Digitalisation in
health promotion
Health inequalities
Disease
prevention in
teams
Health literacy
Health behaviour
change
techniques
Communication
skills
Digital health
coaching
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
100
Concerning teaching methods of health promotion and disease prevention which
methods are used
1
Yes
2
No
3
Unknown
Lectures
Assignments
Field training in real environments
eLearning modules
Other please specify
Concerning covered competencys or capacities of health promotion and disease
prevention the main focus is on
What are the expected outcomes
1
Yes
2
No
3
Unknown
Knowledge
Skills
Behaviour
attitudes
Relevant output (if available) eg number of students following the module
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
101
Do you think it is likely you will apply the learned knowledge and skills (on health
promotion and disease prevention) in daily practice after completion of this
education
Yes please specify
No please specify
Not sure please specify
Is there a reason why this education might be a good example for other
educational settings with regard to the way that health promotion and disease
prevention is covered in the education
Are there any remarks Please feel free to give overall remarks or initiative-specific
remarks
Your responses have been registered Thank you for taking the time to complete
the survey your input is valuable to us
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
102
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