health promotion and disease prevention including lifestyle ......health promotion, disease...

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


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



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



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



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



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



11

1 INTRODUCTION


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



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


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



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



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


2 What are good practices on knowledge training capacity and competency building

and advocacy of health professionals on health promotion and disease prevention


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




15

2 THEORETICAL BACKGROUND

21 Societal needs for health promotion and disease prevention


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



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



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 )



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



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



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



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



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



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)



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



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



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



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



28



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


used within the undergraduate and postgraduate programmes In CPD on the


bull Educational programmes on health promotion target knowledge skills and

attitudes of students






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



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



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



31


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



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




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


116

15

35

1417

7 8 5

29

0

10

20

30

40

50



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



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



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



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


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



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



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


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




40


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


httpwwwecdceuropaeu

ESCMID Workshop on

Migrants Health

15 2018 Muscat

Oman

httpsescmidpulselinksco

mevent14833

Control of multidrug-resistant micro-organisms in health care settings


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


httpsecdceuropaeuenepiet-euphemaboutintro

International Society for

Quality in Health Care 35th International Conference

22 2018 Kuala

Lumpur Malaysia

httpsisquaorgEventsmal

aysia-2018



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


24 2018 Ljubljana Slovenia

wwwephconferenceeu

Fellowship Multivariable

Analysis

25 2019 Madrid

Spain

Rapid Assessment and Survey methods (RAS)

module

35 2019 Zagreb Croatia


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



41


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



Project Management for Emergency Preparedness Budget and Finance Management


Autumn School on Medical

Education

19 2019 Chernivtsi

Ukraine

httpswwwfacebookcome

vents531981117209981

Project Management for Emergency Preparedness Practical Leadership Skills


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


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)



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





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


Yes No Unknown

2518

2225

12 11

75 7571

67

0

20

40

60

80

100


No Unknown Yes



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



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)



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



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



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



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



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



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) ()



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


prevention and lifestyle medicine in undergraduate post-graduate and

continuous professional education







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





54




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


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



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



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


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


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



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



58




Motor Sciences Physiotherapy

Universiteacute Libre de Bruxelles


Physical therapists

Nutrition amp Dietetics Thomas More University College


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


Master in Physical therapy and Rehabilitation



Physical therapists

Master in Physical therapy Universiteacute Libre de Bruxelles


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


Pharmacists

The European Certificate in

Lifestyle Medicine

The European Lifestyle

medicine organisation (ELMO) together with the Belgian Lifestyle

Medicine Organisation (BELMO)

Continuous


Medical doctors

Medical specialists (lifestyle

medicine) Physical therapists

Occupational therapists Nurses Psychologists General practitioners

Nutrition and Dietetics Erasmus Hogeschool Brussels


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


Dieticians

Nutrition and Dietetics University College Ghent


Dieticians

Bachelor in Applied Health Science

Howest University College


Lifestyle coaches

Physiotherapist Universiteacute Libre de Bruxelles


Osteopathy Physical therapists

Bachelor in Medicine Hasselt University Undergraduate

education

Medical doctors



59




Bachelor of Nutrition and Dietetics

University of Applied Sciences of Gent


Dieticians

Bulgaria




Bachelor programme in Social Work

Plovdiv University Department of Social work


Social workers

Rhinology Bulgarian Rhinologic

Society

Postgraduate

education

ENT doctors

Kinesitherapy Medical University Undergraduate education

Physical therapists

TRS rehabilitator Medical College Medical University


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




Physiotherapy Universities Undergraduate education

Physical therapists

Physiotherapy Charles University first

faculty of Medicine

Undergraduate

education

Physical

therapists

Physiotherapy Faculty of Medicine Masaryk University Brno


Physical therapists

Physiotherapy Palackyacute University Faculty of Physical Culture Department of Physiotherapy


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



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


Physical therapists

The Fairstart Foundation The Fairstart Foundation


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



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




Nursing (general nursing) Tartu Health Care College


Nurses

Psychology University of Tarty Institute of Psychology


Psychologists

Finland




NutritionNutrition therapy University of Eastern Finland


Clinical nutriontinists



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


Physical therapists Occupational

therapists Nurses

Public Health Nursing Metropolia University of Applied Sciences


Public Health nurse

Medical doctors training programme

University of Helsinki medical faculty


Medical doctors Nursing

Master degree in Health Management Psychologists

Dentists

Dental education University of Helsinki Faculty of Medicine Department of Oral and Maxillofacial Diseases


Dentists

France



Type of education


being trained

Occupational therapy school Croix Rouge Franccediloise Postgraduate education


Institut Reacutegional de Formation en Ergotheacuterapie

Association Saint Franccedilois dAssise



Occupational therapy Institut de formation en Ergotheacuterapie de Berck-sur-Mer site de Loos



Occupational therapy IFE Assas Undergraduate education


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 therapy UPEC Postgraduate

education

Occupational

therapists

Diplocircme de Dieacuteteacuteticien IUT biologie ou BTS dieacuteteacutetique


Dietitians

Programme deacuteducation et de promotion agrave la santeacute

CoDEPS 13 Continuous professional education

Nurses Psychologists Dentists Social workers

Public health Universiteacute de Bourgogne


Medical doctors

Public health Lyon University Undergraduate education

Medical specialists

Public health residency Faculty of medicine University of Nantes


Medical specialists



62



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


Medical doctors

Public health UFR sciences de santeacute - Universiteacute de Bourgogne


Medical doctors Medical specialists

Midwives Physical therapists

Nurses General practitioners

Germany



Type of education Type of health professionals

being trained

Visceral Surgery Augsburg University Continuous professional education

Medical specialist Physical therapists


Nurses Social workers

Human Medicine ndash The

cologne model study course (human medicine)

University of Cologne

Medical faculty

Undergraduate

education

Medical

specialists

Greece




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


Psychologists

Dentists

Sports Nutrition International Hellenic University


Dieticians

Preventive Dentistry National and

kapodistrian University of Athens school of dentistry

Undergraduate

education

Undergraduate

students

Nutrition amp Dietetics International Hellenic University


Medical specialists



63




Medicine ndash under and post graduate studies

School of health sciences University of Patras


Medical doctors

Pharmacy diploma Aristotle University of

Thessaloniki

Undergraduate

education

Pharmacists

Hungary




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


Medical doctors

Residency in Preventive Medicine and Public Health

Semmelweis University Postgraduate education

Medical specialists

Ireland




Master of Social Science in

Social Work

Maynooth University

(national University of Ireland Maynooth)

Postgraduate

education

Social workers



Physical therapists

Professional Master of Physiotherapy

University College Dublin


Physical therapists

Bachelor Physiotherapy University College Dublin


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


Medical specialists

Higher specialist training in Public Health Medicine

Royal College of Physicians in Ireland


Medical doctors Medical specialists General practitioners



64

Italy

Name of educational

programme

Name of educational

institution



Healthy Lifestyles CNAI ndash Italian Nurses association


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)



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


Medical doctors Medical

specialists

general practicioners

Igiene e Medicina Preventiva Universitagrave degli Studi dellrsquoAquila


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


Medical doctors

School of specialization in Hygiene and Preventive Medicine

University of Milan Postgraduate education

Medical doctors

Lithuania




Health Education and Promotion

Klaipeda State University of Applied sciences


Dietitians Physical therapists Nurses Dentists Social workers



65

Latvia

Name of educational

programme

Name of educational

institution



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




being trained

Bachelor in Nursing Studies University of Malta Faculty of Health Sciences department of Nursing


Nurses

FHs University of Malta Undergraduate education

General practitioners

Netherlands




being trained

Occupational Therapy Information not provided



Lifestyle and Healthcare Amsterdam University Medical Centre


Medical students

Portugal




being trained

PhD in Social Work ISCTE University Institute of Lisbon


Social workers

Bachelor degree in

Physiotherapy

Escola Superior de

Sauacutede de Santa Maria

Undergraduate

education

Physical

therapists

Physiotherapy IPC ESTeSC Coimbra Health school


Physical therapists

Licenciatura em Fisioterapia Escola Superior de Sauacutede - Instituto Politeacutecnico do Porto


Physical therapists

Degree in Physical therapy Instituto Piaget ndash Vila Nova de Gaia


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


Physical therapists



66




Clinical Education University Fernando Pessoa- Faculty of Health Sciences


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


Physical therapists Nurses

Psychologists Dentists

Public Health ARSLVT Postgraduate

education

Medical

specialists



Physical therapists



General practicioners

Romania




being trained

Nursing Education University Lucian Blaga Postgraduate education

Nurses

MedicinePharmacy - Health University of Oradea Faculty of medicine and

pharmacy Oradea

Postgraduation education


specialists Pharmacists Physical therapists Nurses


Slovakia




Social Work Constantine the philosopher University in Nitra


Social workers

Specialisation study in Clinical Psychology

Comenius University in Bratislava Faculty of

Arts


development

Medical specialists

psychologists

Slovenia

Name of educational

programme

Name of educational

institution

Type of

education

Type of health


Physiotherapy Alma Mater Europaea Undergraduate education

Physical therapists



67

Physiotherapy University of Novo mesto Faculty of Health sciences


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


Nutrional counselling Kinesiologists Physical therapists Nurses

Professional higher education study programme 1st cycle degree occupational

therapy

University of Ljubljana faculty of health sciences



Applied Kinesiology UP FVZ Undergraduate

education

Kinesiology

Physiotherapy Alma mater Europaea ndash Evropski center Maribor


Physical therapists

Bachelor in Physiotherapy University of Ljubliana Faculty of health sciences


Physical therapists

Health Promotion Angela Boskin Faculty of healthcare



therapists nurses

1st Bologna cycle study programme Physiotherapy

Angela Boskin Faculty of healthcare


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


Medical doctors

Psychology Faculty of arts University of Maribor


Psychologists

Spain




Human Nutrition and Dietetics

University of Zaragoza Undergraduate education

Dieticians


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


Dietitians

Bachelor in Pharmacy Universidad de Sevilla Undergraduate

education

Pharmacists


Spanish General Council of Social Work


Social workers



68

Bachelor in Pharmacy Universidad de Alcala Undergraduate education

Pharmacists

Bachelor in Medicine Faculty of medicine University of Cadiz Spain


Medical doctors General practitioners


Hospital Clinic de Barcelona


Nurses

Bachelor in Medicine Information not provided


Medical doctors

MasterBachelor in Pharmacy

University of Navarra Undergraduate education


Pharmacists


Univeristy of Navarra Undergraduate education

Nutritionists amp Dietitians

Pharmacy Universitad Ramon Lull


Pharmacists

Pharmacy IQS ndash FCSB Undergraduate education

Pharmacists

Master in Advanced Therapies and Innovation in Biotechnology

Universidad de Francisco de Vitoria


Pharmacists

Pharmacy Universidad of the Basque County


Pharmacists

Sweden




Master programme in Public Health

Karolinska institute Postgraduate education


Social workers

Dietetics programme Department of food and Nutrition


Dietician

Dietetics programme Department of food studies dietetics and nutrition


Dietician

Programme in Dietetics University of Gothenburg

Sahlgrenska Academy


Dietician

Master of Public Health Department of public health and caring sciences Uppsala University


Medical doctors Bachelor of science Physical

therapists Nurses Psychologists Dentists Social workers

United Kingdom




Bachelor (Hons) Occupational Therapy

Northumbria University Undergraduate education




69




Master (pre reg) Occupational Therapy

Master in Occupational Therapy

Leeds Beckett University




St Georgersquos University of London


Medical doctors Medical specialists Physical 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


Public Health speciality training

Health education England -north west


Medical doctors Medical specialists Researchers Nurses

Bachelor in (Hons) Occupational Therapy Master in (Pre-reg)

Occupational Therapy Occupational Therapy

Degree apprenticeship



Additional countries

Name of educational

programme

Name of educational

institution



Bachelor of Physiotherapy University of Prishtina Kosovo Albania


Physical therapists

Physiotherapy Faculty of health studies University of Sarajevo Bosnia-Herzegovina


Physical therapists

Fysioterapeututdanning NTNU Norway Undergraduate education

Physical therapists

Bachelor of science in Physiotherapy BFH

Berner Fachhochschule BFH Bern University of Applied Sciences Swiss


Physical therapists

Bachelor of science in Physiotherapy

ZHAW Zurich University of applied sciences Swiss


Physical therapists

Physical Therapy Sciences University of Iceland

School of Health Sciences

Undergraduate

education

Physical

therapists

Medicine International school of medicine Kazachstan


Medical doctors



70




Medicinesingle-cycle degree programme

University of Georgia Republic of Georgia

Medical doctors Psychologists General practicioners

Medicine Akaki tsereteli state University Republic of Georgia


Medical doctors Medical specialists Physical therapists Psychologists

Dentists General

practicioners

Public Health and Epidemiology

David tvildiani medical University Republic of

Georgia


Medical doctors

Biomedical and Healthcare Science doctoral programme

David tvildiani medical University Republic of Georgia


Medical doctors Biomedical Science master degree holders

Medicinesingle-cyle degree programme

University of Georgia Republic of Georgie


Medical doctors

Public Health Tbilisi State Medical University (TSMU)

Republic of Georgia


Medical doctors and public

health specialists

David tvildiani Medical

University


University Republic of Georgia

Undergraduate

education

Medical doctors



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



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



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



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


- 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



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



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



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


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



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



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


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


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



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


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



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-




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



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



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



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



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

pdf



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



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



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



90

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers

Other please specify

What type of medical specialist

Is the education




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



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


Nurses

Psychologists

Dentists

Social workers




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



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





Yes

No

Unknown



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


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers


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



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



Were there any partnerships in setting up the course on health promotion and

disease prevention For example other universities

Yes

No

Unknown



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



96


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers


Since when is the course on health promotion and disease prevention provided


What is the timescale of the course eg two weeks one month or one year



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


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



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


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



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



100

Concerning teaching methods of health promotion and disease prevention which

methods are used

1

Yes

2

No

3

Unknown

Lectures

Assignments


eLearning modules


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



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



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






Freephone number ()

00 800 6 7 8 9 10 11





4

Table of Contents

Preface 5

Executive summary 7

1 Introduction 11








3 Methodology 22











51 Results 45


6 Conclusions 53






5

PREFACE



























population



7

EXECUTIVE SUMMARY

Background
























research questions







Scope of the study






Methodology







8










partnerships







and social workers






Results



















following results





9

























70 respectively)

Conclusions















11

1 INTRODUCTION







































12












































13













































14










promotion in the EU














15
























Health 2010



16



















professionals too

























17
























education (CBME)50







inequities51












18





















Health Advocate



care system



Teach others



practice








19










































20











in Europe as well62













society








21

























22

3 METHODOLOGY







311 Online survey





country




medicine)




























23

























bull Accreditation

bull Partnerships




found in Annex 3



















24














































25








social workers

German professional







Ergotherapists


(EFAD)




Association (EFN)












Medical schools 298







Response obtained









26

312 Desk research



















- internists

- cardiologists

- psychiatrists


bull Dentists

bull Nurses



bull Pharmacists


bull Psychologists

bull Social workers















27





























practices








28



29



























Southern Europe







Respondents








30







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



31


NL Netherlands 2

PO Poland 0

PT Portugal 14

RO Romania 3

SE Sweden 4

SI Slovenia 14

SK Slovakia 2







Slovenia and Spain








Type of education







32








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


60

29

12




33













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


116

15

35

1417

7 8 5

29

0

10

20

30

40

50



34








n=148)


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


eLearning modules



35






Accreditation










Theories covered



99

0 1

94

4 2

89

6 4

0

20

40

60

80

100





36

















66

54

65

31

42

32

1

1

2

3

1

0 20 40 60 80 100

Population health


Health behaviour




37






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




Health economics

Ethics

Health care systems


Health inequalities


Health literacy





52

61

15

0 20 40 60 80 100






38















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



39

















as competencies


2019 (n=37)70




20 2017 Stockholm

Sweden

httpwwwecdceuropaeu



httpwwwecdceuropaeu



httpwwwecdceuropaeu







httpwwwdohad2017org


4035

150

20

40

60

80

100




40








httpwwwecdceuropaeu

ESCMID Workshop on

Migrants Health

15 2018 Muscat

Oman


mevent14833




care-settings










4 2018 Madrid Spain



facilitators





22 2018 Kuala

Lumpur Malaysia


aysia-2018



wwwecdceuropaeu





wwwelmocongresscom



wwwephconferenceeu


Analysis

25 2019 Madrid

Spain


module





29 2019 Rome Italy






41












Education

19 2019 Chernivtsi

Ukraine


vents531981117209981







introduction

11 2019 Stockholm

Sweden









Netherlands





wwwephconferenceeu















42



percentages)





24

4537

42

76

5563

58

0

20

40

60

80

100




4439

36

14

22

38

18

6256

6164

86

78

63

82

38

0

20

40

60

80

100






43













100 100

82

67

12

22

611

0

20

40

60

80

100


Yes No Unknown

2518

2225

12 11

75 7571

67

0

20

40

60

80

100


No Unknown Yes



44
























43

53

11

0 20 40 60 80 100






45









51 Results






health coaching




51)



46




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



47


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











77 23


6026

113






48





















30

4

4

11

17

15

15

22

10

Other

Social workers

Dentists


Medical doctors

Medical specialists

Psychologists

Nurses

Physical therapists



49





and public health








50























51













53

6 CONCLUSIONS







































54

















found in this study















action















55




















57








Austria



Type of education


being trained



Physical therapists


Applied Sciences

Undergraduate

education

Dieticians



Physical therapists



Physical therapists






Physical therapists





Undergraduate

education

Dietitians




Physiotherapy


education

Physical therapists



Nurses



Medical doctors

Belgium





Pharmacists


Physiotherapy


Physical therapists



58







Physical therapists



Dietitians


Physical therapists




education

Physical

therapists






Physical therapists







education


psychologists



Pharmacists


Lifestyle Medicine




Continuous


Medical doctors






Dieticians



Nurses


Physiotherapy


Physical therapists



Undergraduate

education

Nurses




Dieticians



Dieticians




Lifestyle coaches





education

Medical doctors



59







Dieticians

Bulgaria







Social workers


Society

Postgraduate

education

ENT doctors


Physical therapists



education

Medical specialists

Cyprus

Name of educational

programme

Name of

educational

institution

Type of

education

Type of

health

professionals

being trained

Physiotherapy

programme


education

Physical

therapists

Czech Republic





Physical therapists


faculty of Medicine

Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists


Nurses



Medical specialists



Medical specialists



60

Denmark

Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists





andor therapists






Nurses



Physical therapists



Estonia






Nurses



Psychologists

Finland









61




health promotion






therapists Nurses



Public Health nurse






Dentists



Dentists

France



Type of education


being trained
















Undergraduate

education

Occupational

therapists




education

Occupational

therapists



Dietitians






Medical doctors


Medical specialists



Medical specialists



62



Type of education





medicine



Continuous


Medical doctors






Germany




being trained








Medical faculty

Undergraduate

education

Medical

specialists

Greece





Physical therapists



Hellenic Dental


Continuous


Psychologists

Dentists



Dieticians



Undergraduate

education

Undergraduate

students



Medical specialists



63







Medical doctors


Thessaloniki

Undergraduate

education

Pharmacists

Hungary





Medicine


Budapest Faculty of


Undergraduate

education

Medical doctors




Medical doctors



Medical specialists

Ireland





Social Work

Maynooth University


Postgraduate

education

Social workers



Physical therapists




Physical therapists



Physical therapists


Physical therapists


development

Dentists



Medical specialists







64

Italy

Name of educational

programme

Name of educational

institution





Nurses









School of Medicine

Continuous

professional

education

Medical doctors

Medical


Dentists


Nurses




education

Dentists





specialists







Medical doctors



Medical doctors



Medical doctors

Lithuania










65

Latvia

Name of educational

programme

Name of educational

institution







Physical therapists


Physical therapists

Malta




being trained



Nurses



Netherlands




being trained






Medical students

Portugal




being trained



Social workers

Bachelor degree in

Physiotherapy

Escola Superior de


Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists



Physical therapists


Physical therapists




Physical therapists



66






Workers factory



Undergraduate

education

Physical

therapists







education

Medical

specialists



Physical therapists




Romania




being trained


Nurses


pharmacy Oradea





Slovakia






Social workers



Arts


development

Medical specialists

psychologists

Slovenia

Name of educational

programme

Name of educational

institution

Type of

education

Type of health



Physical therapists



67



Physical therapists








therapy





education

Kinesiology



Physical therapists



Physical therapists




therapists nurses




Physical therapists


Residency

Medical chamber of

Slovenia

Continuous


Medical doctors




Medical doctors



Psychologists

Spain






Dieticians


education

Nurses


Physical therapists




Dietitians


education

Pharmacists




Social workers



68


Pharmacists







Nurses



Medical doctors




Pharmacists






Pharmacists


Pharmacists




Pharmacists



Pharmacists

Sweden







Social workers



Dietician



Dietician


Sahlgrenska Academy


Dietician





United Kingdom









69














Bachelor (Hons)


Caterburry Christ

Church University

Undergraduate

education

Occupational

therapists














Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists


Physical therapists




Physical therapists




Physical therapists



Undergraduate

education

Physical

therapists



Medical doctors



70










Dentists General

practicioners



Georgia


Medical doctors








Medical doctors


Republic of Georgia



health specialists


University



Undergraduate

education

Medical doctors



71























behaviours






them











72











Medical specialist

























sports

76








73

- Public health

















ergometry








bull Competencies













audiovisual methods



74
























community levels)


assessments)




of health)










75



team

bull Competencies
























life related health


programming










health



76












methods




action




planning























77





and managingrdquo83

























bull

Knowledge


prevalence survival








78


risk scoring charts


disease



activity








Skills



level














etc)










86




79




271)




Knowledge





disease


strenuous exercise





Skills






sports













80

Knowledge






prevention



Skills





exercise limitation
















in rehabilitation











communityrdquo

Competencies




81









remedial measures



workplace



























and rehabilitation








82











preventive advice


and home situation



and rehabilitation








Dentist












oral diseases






trainingpractice


illness








83






physicians

Nurses
















Competencies 93










and (2)







84













compliance








Nurse specialist

















inequities


health





85






















bull Skills in








coachingtraining








being









86

Pharmacists






healthcare system





Physiotherapists



















Psychologist








pdf



87


EuroPsy programme













Social worker


































88









of social work




89



settings

























Medical doctors



90

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers



Is the education





Yes

No

Unknown


Yes

No


Yes

No

Unknown


Yes

No


curriculum





91






Yes

No

Unknown





Yes

No

Unknown




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers




92




year programme



homework


No

Unknown




93


Yes

No

Unknown


No

Unknown



Yes

No

Unknown


prevention


Yes

No

Unknown





Yes

No

Unknown



94




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers






and homework



95








Yes

No

Unknown





No

Yes please specify



Yes

No

Unknown



96


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers







97




No

Unknown



Yes

No

Unknown


No

Unknown



Yes

No

Unknown



98




heart failure






Unknown


1

Yes

2

No

3

Unknown

Population health

Human cognition

and behaviour

Health behaviour



99


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



100


methods are used

1

Yes

2

No

3

Unknown

Lectures

Assignments


eLearning modules





1

Yes

2

No

3

Unknown

Knowledge

Skills

Behaviour

attitudes




101



education

Yes please specify

No please specify






remarks





102


Free publications



Priced publications







Freephone number ()

00 800 6 7 8 9 10 11





4

Table of Contents

Preface 5

Executive summary 7

1 Introduction 11








3 Methodology 22











51 Results 45


6 Conclusions 53






5

PREFACE



























population



7

EXECUTIVE SUMMARY

Background
























research questions







Scope of the study






Methodology







8










partnerships







and social workers






Results



















following results





9

























70 respectively)

Conclusions















11

1 INTRODUCTION







































12












































13













































14










promotion in the EU














15
























Health 2010



16



















professionals too

























17
























education (CBME)50







inequities51












18





















Health Advocate



care system



Teach others



practice








19










































20











in Europe as well62













society








21

























22

3 METHODOLOGY







311 Online survey





country




medicine)




























23

























bull Accreditation

bull Partnerships




found in Annex 3



















24














































25








social workers

German professional







Ergotherapists


(EFAD)




Association (EFN)












Medical schools 298







Response obtained









26

312 Desk research



















- internists

- cardiologists

- psychiatrists


bull Dentists

bull Nurses



bull Pharmacists


bull Psychologists

bull Social workers















27





























practices








28



29



























Southern Europe







Respondents








30







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



31


NL Netherlands 2

PO Poland 0

PT Portugal 14

RO Romania 3

SE Sweden 4

SI Slovenia 14

SK Slovakia 2







Slovenia and Spain








Type of education







32








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


60

29

12




33













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


116

15

35

1417

7 8 5

29

0

10

20

30

40

50



34








n=148)


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


eLearning modules



35






Accreditation










Theories covered



99

0 1

94

4 2

89

6 4

0

20

40

60

80

100





36

















66

54

65

31

42

32

1

1

2

3

1

0 20 40 60 80 100

Population health


Health behaviour




37






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




Health economics

Ethics

Health care systems


Health inequalities


Health literacy





52

61

15

0 20 40 60 80 100






38















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



39

















as competencies


2019 (n=37)70




20 2017 Stockholm

Sweden

httpwwwecdceuropaeu



httpwwwecdceuropaeu



httpwwwecdceuropaeu







httpwwwdohad2017org


4035

150

20

40

60

80

100




40








httpwwwecdceuropaeu

ESCMID Workshop on

Migrants Health

15 2018 Muscat

Oman


mevent14833




care-settings










4 2018 Madrid Spain



facilitators





22 2018 Kuala

Lumpur Malaysia


aysia-2018



wwwecdceuropaeu





wwwelmocongresscom



wwwephconferenceeu


Analysis

25 2019 Madrid

Spain


module





29 2019 Rome Italy






41












Education

19 2019 Chernivtsi

Ukraine


vents531981117209981







introduction

11 2019 Stockholm

Sweden









Netherlands





wwwephconferenceeu















42



percentages)





24

4537

42

76

5563

58

0

20

40

60

80

100




4439

36

14

22

38

18

6256

6164

86

78

63

82

38

0

20

40

60

80

100






43













100 100

82

67

12

22

611

0

20

40

60

80

100


Yes No Unknown

2518

2225

12 11

75 7571

67

0

20

40

60

80

100


No Unknown Yes



44
























43

53

11

0 20 40 60 80 100






45









51 Results






health coaching




51)



46




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



47


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











77 23


6026

113






48





















30

4

4

11

17

15

15

22

10

Other

Social workers

Dentists


Medical doctors

Medical specialists

Psychologists

Nurses

Physical therapists



49





and public health








50























51













53

6 CONCLUSIONS







































54

















found in this study















action















55




















57








Austria



Type of education


being trained



Physical therapists


Applied Sciences

Undergraduate

education

Dieticians



Physical therapists



Physical therapists






Physical therapists





Undergraduate

education

Dietitians




Physiotherapy


education

Physical therapists



Nurses



Medical doctors

Belgium





Pharmacists


Physiotherapy


Physical therapists



58







Physical therapists



Dietitians


Physical therapists




education

Physical

therapists






Physical therapists







education


psychologists



Pharmacists


Lifestyle Medicine




Continuous


Medical doctors






Dieticians



Nurses


Physiotherapy


Physical therapists



Undergraduate

education

Nurses




Dieticians



Dieticians




Lifestyle coaches





education

Medical doctors



59







Dieticians

Bulgaria







Social workers


Society

Postgraduate

education

ENT doctors


Physical therapists



education

Medical specialists

Cyprus

Name of educational

programme

Name of

educational

institution

Type of

education

Type of

health

professionals

being trained

Physiotherapy

programme


education

Physical

therapists

Czech Republic





Physical therapists


faculty of Medicine

Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists


Nurses



Medical specialists



Medical specialists



60

Denmark

Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists





andor therapists






Nurses



Physical therapists



Estonia






Nurses



Psychologists

Finland









61




health promotion






therapists Nurses



Public Health nurse






Dentists



Dentists

France



Type of education


being trained
















Undergraduate

education

Occupational

therapists




education

Occupational

therapists



Dietitians






Medical doctors


Medical specialists



Medical specialists



62



Type of education





medicine



Continuous


Medical doctors






Germany




being trained








Medical faculty

Undergraduate

education

Medical

specialists

Greece





Physical therapists



Hellenic Dental


Continuous


Psychologists

Dentists



Dieticians



Undergraduate

education

Undergraduate

students



Medical specialists



63







Medical doctors


Thessaloniki

Undergraduate

education

Pharmacists

Hungary





Medicine


Budapest Faculty of


Undergraduate

education

Medical doctors




Medical doctors



Medical specialists

Ireland





Social Work

Maynooth University


Postgraduate

education

Social workers



Physical therapists




Physical therapists



Physical therapists


Physical therapists


development

Dentists



Medical specialists







64

Italy

Name of educational

programme

Name of educational

institution





Nurses









School of Medicine

Continuous

professional

education

Medical doctors

Medical


Dentists


Nurses




education

Dentists





specialists







Medical doctors



Medical doctors



Medical doctors

Lithuania










65

Latvia

Name of educational

programme

Name of educational

institution







Physical therapists


Physical therapists

Malta




being trained



Nurses



Netherlands




being trained






Medical students

Portugal




being trained



Social workers

Bachelor degree in

Physiotherapy

Escola Superior de


Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists



Physical therapists


Physical therapists




Physical therapists



66






Workers factory



Undergraduate

education

Physical

therapists







education

Medical

specialists



Physical therapists




Romania




being trained


Nurses


pharmacy Oradea





Slovakia






Social workers



Arts


development

Medical specialists

psychologists

Slovenia

Name of educational

programme

Name of educational

institution

Type of

education

Type of health



Physical therapists



67



Physical therapists








therapy





education

Kinesiology



Physical therapists



Physical therapists




therapists nurses




Physical therapists


Residency

Medical chamber of

Slovenia

Continuous


Medical doctors




Medical doctors



Psychologists

Spain






Dieticians


education

Nurses


Physical therapists




Dietitians


education

Pharmacists




Social workers



68


Pharmacists







Nurses



Medical doctors




Pharmacists






Pharmacists


Pharmacists




Pharmacists



Pharmacists

Sweden







Social workers



Dietician



Dietician


Sahlgrenska Academy


Dietician





United Kingdom









69














Bachelor (Hons)


Caterburry Christ

Church University

Undergraduate

education

Occupational

therapists














Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists


Physical therapists




Physical therapists




Physical therapists



Undergraduate

education

Physical

therapists



Medical doctors



70










Dentists General

practicioners



Georgia


Medical doctors








Medical doctors


Republic of Georgia



health specialists


University



Undergraduate

education

Medical doctors



71























behaviours






them











72











Medical specialist

























sports

76








73

- Public health

















ergometry








bull Competencies













audiovisual methods



74
























community levels)


assessments)




of health)










75



team

bull Competencies
























life related health


programming










health



76












methods




action




planning























77





and managingrdquo83

























bull

Knowledge


prevalence survival








78


risk scoring charts


disease



activity








Skills



level














etc)










86




79




271)




Knowledge





disease


strenuous exercise





Skills






sports













80

Knowledge






prevention



Skills





exercise limitation
















in rehabilitation











communityrdquo

Competencies




81









remedial measures



workplace



























and rehabilitation








82











preventive advice


and home situation



and rehabilitation








Dentist












oral diseases






trainingpractice


illness








83






physicians

Nurses
















Competencies 93










and (2)







84













compliance








Nurse specialist

















inequities


health





85






















bull Skills in








coachingtraining








being









86

Pharmacists






healthcare system





Physiotherapists



















Psychologist








pdf



87


EuroPsy programme













Social worker


































88









of social work




89



settings

























Medical doctors



90

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers



Is the education





Yes

No

Unknown


Yes

No


Yes

No

Unknown


Yes

No


curriculum





91






Yes

No

Unknown





Yes

No

Unknown




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers




92




year programme



homework


No

Unknown




93


Yes

No

Unknown


No

Unknown



Yes

No

Unknown


prevention


Yes

No

Unknown





Yes

No

Unknown



94




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers






and homework



95








Yes

No

Unknown





No

Yes please specify



Yes

No

Unknown



96


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers







97




No

Unknown



Yes

No

Unknown


No

Unknown



Yes

No

Unknown



98




heart failure






Unknown


1

Yes

2

No

3

Unknown

Population health

Human cognition

and behaviour

Health behaviour



99


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



100


methods are used

1

Yes

2

No

3

Unknown

Lectures

Assignments


eLearning modules





1

Yes

2

No

3

Unknown

Knowledge

Skills

Behaviour

attitudes




101



education

Yes please specify

No please specify






remarks





102


Free publications



Priced publications




4

Table of Contents

Preface 5

Executive summary 7

1 Introduction 11








3 Methodology 22











51 Results 45


6 Conclusions 53






5

PREFACE



























population



7

EXECUTIVE SUMMARY

Background
























research questions







Scope of the study






Methodology







8










partnerships







and social workers






Results



















following results





9

























70 respectively)

Conclusions















11

1 INTRODUCTION







































12












































13













































14










promotion in the EU














15
























Health 2010



16



















professionals too

























17
























education (CBME)50







inequities51












18





















Health Advocate



care system



Teach others



practice








19










































20











in Europe as well62













society








21

























22

3 METHODOLOGY







311 Online survey





country




medicine)




























23

























bull Accreditation

bull Partnerships




found in Annex 3



















24














































25








social workers

German professional







Ergotherapists


(EFAD)




Association (EFN)












Medical schools 298







Response obtained









26

312 Desk research



















- internists

- cardiologists

- psychiatrists


bull Dentists

bull Nurses



bull Pharmacists


bull Psychologists

bull Social workers















27





























practices








28



29



























Southern Europe







Respondents








30







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



31


NL Netherlands 2

PO Poland 0

PT Portugal 14

RO Romania 3

SE Sweden 4

SI Slovenia 14

SK Slovakia 2







Slovenia and Spain








Type of education







32








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


60

29

12




33













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


116

15

35

1417

7 8 5

29

0

10

20

30

40

50



34








n=148)


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


eLearning modules



35






Accreditation










Theories covered



99

0 1

94

4 2

89

6 4

0

20

40

60

80

100





36

















66

54

65

31

42

32

1

1

2

3

1

0 20 40 60 80 100

Population health


Health behaviour




37






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




Health economics

Ethics

Health care systems


Health inequalities


Health literacy





52

61

15

0 20 40 60 80 100






38















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



39

















as competencies


2019 (n=37)70




20 2017 Stockholm

Sweden

httpwwwecdceuropaeu



httpwwwecdceuropaeu



httpwwwecdceuropaeu







httpwwwdohad2017org


4035

150

20

40

60

80

100




40








httpwwwecdceuropaeu

ESCMID Workshop on

Migrants Health

15 2018 Muscat

Oman


mevent14833




care-settings










4 2018 Madrid Spain



facilitators





22 2018 Kuala

Lumpur Malaysia


aysia-2018



wwwecdceuropaeu





wwwelmocongresscom



wwwephconferenceeu


Analysis

25 2019 Madrid

Spain


module





29 2019 Rome Italy






41












Education

19 2019 Chernivtsi

Ukraine


vents531981117209981







introduction

11 2019 Stockholm

Sweden









Netherlands





wwwephconferenceeu















42



percentages)





24

4537

42

76

5563

58

0

20

40

60

80

100




4439

36

14

22

38

18

6256

6164

86

78

63

82

38

0

20

40

60

80

100






43













100 100

82

67

12

22

611

0

20

40

60

80

100


Yes No Unknown

2518

2225

12 11

75 7571

67

0

20

40

60

80

100


No Unknown Yes



44
























43

53

11

0 20 40 60 80 100






45









51 Results






health coaching




51)



46




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



47


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











77 23


6026

113






48





















30

4

4

11

17

15

15

22

10

Other

Social workers

Dentists


Medical doctors

Medical specialists

Psychologists

Nurses

Physical therapists



49





and public health








50























51













53

6 CONCLUSIONS







































54

















found in this study















action















55




















57








Austria



Type of education


being trained



Physical therapists


Applied Sciences

Undergraduate

education

Dieticians



Physical therapists



Physical therapists






Physical therapists





Undergraduate

education

Dietitians




Physiotherapy


education

Physical therapists



Nurses



Medical doctors

Belgium





Pharmacists


Physiotherapy


Physical therapists



58







Physical therapists



Dietitians


Physical therapists




education

Physical

therapists






Physical therapists







education


psychologists



Pharmacists


Lifestyle Medicine




Continuous


Medical doctors






Dieticians



Nurses


Physiotherapy


Physical therapists



Undergraduate

education

Nurses




Dieticians



Dieticians




Lifestyle coaches





education

Medical doctors



59







Dieticians

Bulgaria







Social workers


Society

Postgraduate

education

ENT doctors


Physical therapists



education

Medical specialists

Cyprus

Name of educational

programme

Name of

educational

institution

Type of

education

Type of

health

professionals

being trained

Physiotherapy

programme


education

Physical

therapists

Czech Republic





Physical therapists


faculty of Medicine

Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists


Nurses



Medical specialists



Medical specialists



60

Denmark

Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists





andor therapists






Nurses



Physical therapists



Estonia






Nurses



Psychologists

Finland









61




health promotion






therapists Nurses



Public Health nurse






Dentists



Dentists

France



Type of education


being trained
















Undergraduate

education

Occupational

therapists




education

Occupational

therapists



Dietitians






Medical doctors


Medical specialists



Medical specialists



62



Type of education





medicine



Continuous


Medical doctors






Germany




being trained








Medical faculty

Undergraduate

education

Medical

specialists

Greece





Physical therapists



Hellenic Dental


Continuous


Psychologists

Dentists



Dieticians



Undergraduate

education

Undergraduate

students



Medical specialists



63







Medical doctors


Thessaloniki

Undergraduate

education

Pharmacists

Hungary





Medicine


Budapest Faculty of


Undergraduate

education

Medical doctors




Medical doctors



Medical specialists

Ireland





Social Work

Maynooth University


Postgraduate

education

Social workers



Physical therapists




Physical therapists



Physical therapists


Physical therapists


development

Dentists



Medical specialists







64

Italy

Name of educational

programme

Name of educational

institution





Nurses









School of Medicine

Continuous

professional

education

Medical doctors

Medical


Dentists


Nurses




education

Dentists





specialists







Medical doctors



Medical doctors



Medical doctors

Lithuania










65

Latvia

Name of educational

programme

Name of educational

institution







Physical therapists


Physical therapists

Malta




being trained



Nurses



Netherlands




being trained






Medical students

Portugal




being trained



Social workers

Bachelor degree in

Physiotherapy

Escola Superior de


Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists



Physical therapists


Physical therapists




Physical therapists



66






Workers factory



Undergraduate

education

Physical

therapists







education

Medical

specialists



Physical therapists




Romania




being trained


Nurses


pharmacy Oradea





Slovakia






Social workers



Arts


development

Medical specialists

psychologists

Slovenia

Name of educational

programme

Name of educational

institution

Type of

education

Type of health



Physical therapists



67



Physical therapists








therapy





education

Kinesiology



Physical therapists



Physical therapists




therapists nurses




Physical therapists


Residency

Medical chamber of

Slovenia

Continuous


Medical doctors




Medical doctors



Psychologists

Spain






Dieticians


education

Nurses


Physical therapists




Dietitians


education

Pharmacists




Social workers



68


Pharmacists







Nurses



Medical doctors




Pharmacists






Pharmacists


Pharmacists




Pharmacists



Pharmacists

Sweden







Social workers



Dietician



Dietician


Sahlgrenska Academy


Dietician





United Kingdom









69














Bachelor (Hons)


Caterburry Christ

Church University

Undergraduate

education

Occupational

therapists














Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists


Physical therapists




Physical therapists




Physical therapists



Undergraduate

education

Physical

therapists



Medical doctors



70










Dentists General

practicioners



Georgia


Medical doctors








Medical doctors


Republic of Georgia



health specialists


University



Undergraduate

education

Medical doctors



71























behaviours






them











72











Medical specialist

























sports

76








73

- Public health

















ergometry








bull Competencies













audiovisual methods



74
























community levels)


assessments)




of health)










75



team

bull Competencies
























life related health


programming










health



76












methods




action




planning























77





and managingrdquo83

























bull

Knowledge


prevalence survival








78


risk scoring charts


disease



activity








Skills



level














etc)










86




79




271)




Knowledge





disease


strenuous exercise





Skills






sports













80

Knowledge






prevention



Skills





exercise limitation
















in rehabilitation











communityrdquo

Competencies




81









remedial measures



workplace



























and rehabilitation








82











preventive advice


and home situation



and rehabilitation








Dentist












oral diseases






trainingpractice


illness








83






physicians

Nurses
















Competencies 93










and (2)







84













compliance








Nurse specialist

















inequities


health





85






















bull Skills in








coachingtraining








being









86

Pharmacists






healthcare system





Physiotherapists



















Psychologist








pdf



87


EuroPsy programme













Social worker


































88









of social work




89



settings

























Medical doctors



90

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers



Is the education





Yes

No

Unknown


Yes

No


Yes

No

Unknown


Yes

No


curriculum





91






Yes

No

Unknown





Yes

No

Unknown




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers




92




year programme



homework


No

Unknown




93


Yes

No

Unknown


No

Unknown



Yes

No

Unknown


prevention


Yes

No

Unknown





Yes

No

Unknown



94




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers






and homework



95








Yes

No

Unknown





No

Yes please specify



Yes

No

Unknown



96


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers







97




No

Unknown



Yes

No

Unknown


No

Unknown



Yes

No

Unknown



98




heart failure






Unknown


1

Yes

2

No

3

Unknown

Population health

Human cognition

and behaviour

Health behaviour



99


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



100


methods are used

1

Yes

2

No

3

Unknown

Lectures

Assignments


eLearning modules





1

Yes

2

No

3

Unknown

Knowledge

Skills

Behaviour

attitudes




101



education

Yes please specify

No please specify






remarks





102


Free publications



Priced publications




5

PREFACE



























population



7

EXECUTIVE SUMMARY

Background
























research questions







Scope of the study






Methodology







8










partnerships







and social workers






Results



















following results





9

























70 respectively)

Conclusions















11

1 INTRODUCTION







































12












































13













































14










promotion in the EU














15
























Health 2010



16



















professionals too

























17
























education (CBME)50







inequities51












18





















Health Advocate



care system



Teach others



practice








19










































20











in Europe as well62













society








21

























22

3 METHODOLOGY







311 Online survey





country




medicine)




























23

























bull Accreditation

bull Partnerships




found in Annex 3



















24














































25








social workers

German professional







Ergotherapists


(EFAD)




Association (EFN)












Medical schools 298







Response obtained









26

312 Desk research



















- internists

- cardiologists

- psychiatrists


bull Dentists

bull Nurses



bull Pharmacists


bull Psychologists

bull Social workers















27





























practices








28



29



























Southern Europe







Respondents








30







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



31


NL Netherlands 2

PO Poland 0

PT Portugal 14

RO Romania 3

SE Sweden 4

SI Slovenia 14

SK Slovakia 2







Slovenia and Spain








Type of education







32








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


60

29

12




33













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


116

15

35

1417

7 8 5

29

0

10

20

30

40

50



34








n=148)


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


eLearning modules



35






Accreditation










Theories covered



99

0 1

94

4 2

89

6 4

0

20

40

60

80

100





36

















66

54

65

31

42

32

1

1

2

3

1

0 20 40 60 80 100

Population health


Health behaviour




37






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




Health economics

Ethics

Health care systems


Health inequalities


Health literacy





52

61

15

0 20 40 60 80 100






38















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



39

















as competencies


2019 (n=37)70




20 2017 Stockholm

Sweden

httpwwwecdceuropaeu



httpwwwecdceuropaeu



httpwwwecdceuropaeu







httpwwwdohad2017org


4035

150

20

40

60

80

100




40








httpwwwecdceuropaeu

ESCMID Workshop on

Migrants Health

15 2018 Muscat

Oman


mevent14833




care-settings










4 2018 Madrid Spain



facilitators





22 2018 Kuala

Lumpur Malaysia


aysia-2018



wwwecdceuropaeu





wwwelmocongresscom



wwwephconferenceeu


Analysis

25 2019 Madrid

Spain


module





29 2019 Rome Italy






41












Education

19 2019 Chernivtsi

Ukraine


vents531981117209981







introduction

11 2019 Stockholm

Sweden









Netherlands





wwwephconferenceeu















42



percentages)





24

4537

42

76

5563

58

0

20

40

60

80

100




4439

36

14

22

38

18

6256

6164

86

78

63

82

38

0

20

40

60

80

100






43













100 100

82

67

12

22

611

0

20

40

60

80

100


Yes No Unknown

2518

2225

12 11

75 7571

67

0

20

40

60

80

100


No Unknown Yes



44
























43

53

11

0 20 40 60 80 100






45









51 Results






health coaching




51)



46




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



47


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











77 23


6026

113






48





















30

4

4

11

17

15

15

22

10

Other

Social workers

Dentists


Medical doctors

Medical specialists

Psychologists

Nurses

Physical therapists



49





and public health








50























51













53

6 CONCLUSIONS







































54

















found in this study















action















55




















57








Austria



Type of education


being trained



Physical therapists


Applied Sciences

Undergraduate

education

Dieticians



Physical therapists



Physical therapists






Physical therapists





Undergraduate

education

Dietitians




Physiotherapy


education

Physical therapists



Nurses



Medical doctors

Belgium





Pharmacists


Physiotherapy


Physical therapists



58







Physical therapists



Dietitians


Physical therapists




education

Physical

therapists






Physical therapists







education


psychologists



Pharmacists


Lifestyle Medicine




Continuous


Medical doctors






Dieticians



Nurses


Physiotherapy


Physical therapists



Undergraduate

education

Nurses




Dieticians



Dieticians




Lifestyle coaches





education

Medical doctors



59







Dieticians

Bulgaria







Social workers


Society

Postgraduate

education

ENT doctors


Physical therapists



education

Medical specialists

Cyprus

Name of educational

programme

Name of

educational

institution

Type of

education

Type of

health

professionals

being trained

Physiotherapy

programme


education

Physical

therapists

Czech Republic





Physical therapists


faculty of Medicine

Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists


Nurses



Medical specialists



Medical specialists



60

Denmark

Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists





andor therapists






Nurses



Physical therapists



Estonia






Nurses



Psychologists

Finland









61




health promotion






therapists Nurses



Public Health nurse






Dentists



Dentists

France



Type of education


being trained
















Undergraduate

education

Occupational

therapists




education

Occupational

therapists



Dietitians






Medical doctors


Medical specialists



Medical specialists



62



Type of education





medicine



Continuous


Medical doctors






Germany




being trained








Medical faculty

Undergraduate

education

Medical

specialists

Greece





Physical therapists



Hellenic Dental


Continuous


Psychologists

Dentists



Dieticians



Undergraduate

education

Undergraduate

students



Medical specialists



63







Medical doctors


Thessaloniki

Undergraduate

education

Pharmacists

Hungary





Medicine


Budapest Faculty of


Undergraduate

education

Medical doctors




Medical doctors



Medical specialists

Ireland





Social Work

Maynooth University


Postgraduate

education

Social workers



Physical therapists




Physical therapists



Physical therapists


Physical therapists


development

Dentists



Medical specialists







64

Italy

Name of educational

programme

Name of educational

institution





Nurses









School of Medicine

Continuous

professional

education

Medical doctors

Medical


Dentists


Nurses




education

Dentists





specialists







Medical doctors



Medical doctors



Medical doctors

Lithuania










65

Latvia

Name of educational

programme

Name of educational

institution







Physical therapists


Physical therapists

Malta




being trained



Nurses



Netherlands




being trained






Medical students

Portugal




being trained



Social workers

Bachelor degree in

Physiotherapy

Escola Superior de


Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists



Physical therapists


Physical therapists




Physical therapists



66






Workers factory



Undergraduate

education

Physical

therapists







education

Medical

specialists



Physical therapists




Romania




being trained


Nurses


pharmacy Oradea





Slovakia






Social workers



Arts


development

Medical specialists

psychologists

Slovenia

Name of educational

programme

Name of educational

institution

Type of

education

Type of health



Physical therapists



67



Physical therapists








therapy





education

Kinesiology



Physical therapists



Physical therapists




therapists nurses




Physical therapists


Residency

Medical chamber of

Slovenia

Continuous


Medical doctors




Medical doctors



Psychologists

Spain






Dieticians


education

Nurses


Physical therapists




Dietitians


education

Pharmacists




Social workers



68


Pharmacists







Nurses



Medical doctors




Pharmacists






Pharmacists


Pharmacists




Pharmacists



Pharmacists

Sweden







Social workers



Dietician



Dietician


Sahlgrenska Academy


Dietician





United Kingdom









69














Bachelor (Hons)


Caterburry Christ

Church University

Undergraduate

education

Occupational

therapists














Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists


Physical therapists




Physical therapists




Physical therapists



Undergraduate

education

Physical

therapists



Medical doctors



70










Dentists General

practicioners



Georgia


Medical doctors








Medical doctors


Republic of Georgia



health specialists


University



Undergraduate

education

Medical doctors



71























behaviours






them











72











Medical specialist

























sports

76








73

- Public health

















ergometry








bull Competencies













audiovisual methods



74
























community levels)


assessments)




of health)










75



team

bull Competencies
























life related health


programming










health



76












methods




action




planning























77





and managingrdquo83

























bull

Knowledge


prevalence survival








78


risk scoring charts


disease



activity








Skills



level














etc)










86




79




271)




Knowledge





disease


strenuous exercise





Skills






sports













80

Knowledge






prevention



Skills





exercise limitation
















in rehabilitation











communityrdquo

Competencies




81









remedial measures



workplace



























and rehabilitation








82











preventive advice


and home situation



and rehabilitation








Dentist












oral diseases






trainingpractice


illness








83






physicians

Nurses
















Competencies 93










and (2)







84













compliance








Nurse specialist

















inequities


health





85






















bull Skills in








coachingtraining








being









86

Pharmacists






healthcare system





Physiotherapists



















Psychologist








pdf



87


EuroPsy programme













Social worker


































88









of social work




89



settings

























Medical doctors



90

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers



Is the education





Yes

No

Unknown


Yes

No


Yes

No

Unknown


Yes

No


curriculum





91






Yes

No

Unknown





Yes

No

Unknown




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers




92




year programme



homework


No

Unknown




93


Yes

No

Unknown


No

Unknown



Yes

No

Unknown


prevention


Yes

No

Unknown





Yes

No

Unknown



94




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers






and homework



95








Yes

No

Unknown





No

Yes please specify



Yes

No

Unknown



96


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers







97




No

Unknown



Yes

No

Unknown


No

Unknown



Yes

No

Unknown



98




heart failure






Unknown


1

Yes

2

No

3

Unknown

Population health

Human cognition

and behaviour

Health behaviour



99


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



100


methods are used

1

Yes

2

No

3

Unknown

Lectures

Assignments


eLearning modules





1

Yes

2

No

3

Unknown

Knowledge

Skills

Behaviour

attitudes




101



education

Yes please specify

No please specify






remarks





102


Free publications



Priced publications




7

EXECUTIVE SUMMARY

Background
























research questions







Scope of the study






Methodology







8










partnerships







and social workers






Results



















following results





9

























70 respectively)

Conclusions















11

1 INTRODUCTION







































12












































13













































14










promotion in the EU














15
























Health 2010



16



















professionals too

























17
























education (CBME)50







inequities51












18





















Health Advocate



care system



Teach others



practice








19










































20











in Europe as well62













society








21

























22

3 METHODOLOGY







311 Online survey





country




medicine)




























23

























bull Accreditation

bull Partnerships




found in Annex 3



















24














































25








social workers

German professional







Ergotherapists


(EFAD)




Association (EFN)












Medical schools 298







Response obtained









26

312 Desk research



















- internists

- cardiologists

- psychiatrists


bull Dentists

bull Nurses



bull Pharmacists


bull Psychologists

bull Social workers















27





























practices








28



29



























Southern Europe







Respondents








30







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



31


NL Netherlands 2

PO Poland 0

PT Portugal 14

RO Romania 3

SE Sweden 4

SI Slovenia 14

SK Slovakia 2







Slovenia and Spain








Type of education







32








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


60

29

12




33













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


116

15

35

1417

7 8 5

29

0

10

20

30

40

50



34








n=148)


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


eLearning modules



35






Accreditation










Theories covered



99

0 1

94

4 2

89

6 4

0

20

40

60

80

100





36

















66

54

65

31

42

32

1

1

2

3

1

0 20 40 60 80 100

Population health


Health behaviour




37






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




Health economics

Ethics

Health care systems


Health inequalities


Health literacy





52

61

15

0 20 40 60 80 100






38















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



39

















as competencies


2019 (n=37)70




20 2017 Stockholm

Sweden

httpwwwecdceuropaeu



httpwwwecdceuropaeu



httpwwwecdceuropaeu







httpwwwdohad2017org


4035

150

20

40

60

80

100




40








httpwwwecdceuropaeu

ESCMID Workshop on

Migrants Health

15 2018 Muscat

Oman


mevent14833




care-settings










4 2018 Madrid Spain



facilitators





22 2018 Kuala

Lumpur Malaysia


aysia-2018



wwwecdceuropaeu





wwwelmocongresscom



wwwephconferenceeu


Analysis

25 2019 Madrid

Spain


module





29 2019 Rome Italy






41












Education

19 2019 Chernivtsi

Ukraine


vents531981117209981







introduction

11 2019 Stockholm

Sweden









Netherlands





wwwephconferenceeu















42



percentages)





24

4537

42

76

5563

58

0

20

40

60

80

100




4439

36

14

22

38

18

6256

6164

86

78

63

82

38

0

20

40

60

80

100






43













100 100

82

67

12

22

611

0

20

40

60

80

100


Yes No Unknown

2518

2225

12 11

75 7571

67

0

20

40

60

80

100


No Unknown Yes



44
























43

53

11

0 20 40 60 80 100






45









51 Results






health coaching




51)



46




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



47


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











77 23


6026

113






48





















30

4

4

11

17

15

15

22

10

Other

Social workers

Dentists


Medical doctors

Medical specialists

Psychologists

Nurses

Physical therapists



49





and public health








50























51













53

6 CONCLUSIONS







































54

















found in this study















action















55




















57








Austria



Type of education


being trained



Physical therapists


Applied Sciences

Undergraduate

education

Dieticians



Physical therapists



Physical therapists






Physical therapists





Undergraduate

education

Dietitians




Physiotherapy


education

Physical therapists



Nurses



Medical doctors

Belgium





Pharmacists


Physiotherapy


Physical therapists



58







Physical therapists



Dietitians


Physical therapists




education

Physical

therapists






Physical therapists







education


psychologists



Pharmacists


Lifestyle Medicine




Continuous


Medical doctors






Dieticians



Nurses


Physiotherapy


Physical therapists



Undergraduate

education

Nurses




Dieticians



Dieticians




Lifestyle coaches





education

Medical doctors



59







Dieticians

Bulgaria







Social workers


Society

Postgraduate

education

ENT doctors


Physical therapists



education

Medical specialists

Cyprus

Name of educational

programme

Name of

educational

institution

Type of

education

Type of

health

professionals

being trained

Physiotherapy

programme


education

Physical

therapists

Czech Republic





Physical therapists


faculty of Medicine

Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists


Nurses



Medical specialists



Medical specialists



60

Denmark

Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists





andor therapists






Nurses



Physical therapists



Estonia






Nurses



Psychologists

Finland









61




health promotion






therapists Nurses



Public Health nurse






Dentists



Dentists

France



Type of education


being trained
















Undergraduate

education

Occupational

therapists




education

Occupational

therapists



Dietitians






Medical doctors


Medical specialists



Medical specialists



62



Type of education





medicine



Continuous


Medical doctors






Germany




being trained








Medical faculty

Undergraduate

education

Medical

specialists

Greece





Physical therapists



Hellenic Dental


Continuous


Psychologists

Dentists



Dieticians



Undergraduate

education

Undergraduate

students



Medical specialists



63







Medical doctors


Thessaloniki

Undergraduate

education

Pharmacists

Hungary





Medicine


Budapest Faculty of


Undergraduate

education

Medical doctors




Medical doctors



Medical specialists

Ireland





Social Work

Maynooth University


Postgraduate

education

Social workers



Physical therapists




Physical therapists



Physical therapists


Physical therapists


development

Dentists



Medical specialists







64

Italy

Name of educational

programme

Name of educational

institution





Nurses









School of Medicine

Continuous

professional

education

Medical doctors

Medical


Dentists


Nurses




education

Dentists





specialists







Medical doctors



Medical doctors



Medical doctors

Lithuania










65

Latvia

Name of educational

programme

Name of educational

institution







Physical therapists


Physical therapists

Malta




being trained



Nurses



Netherlands




being trained






Medical students

Portugal




being trained



Social workers

Bachelor degree in

Physiotherapy

Escola Superior de


Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists



Physical therapists


Physical therapists




Physical therapists



66






Workers factory



Undergraduate

education

Physical

therapists







education

Medical

specialists



Physical therapists




Romania




being trained


Nurses


pharmacy Oradea





Slovakia






Social workers



Arts


development

Medical specialists

psychologists

Slovenia

Name of educational

programme

Name of educational

institution

Type of

education

Type of health



Physical therapists



67



Physical therapists








therapy





education

Kinesiology



Physical therapists



Physical therapists




therapists nurses




Physical therapists


Residency

Medical chamber of

Slovenia

Continuous


Medical doctors




Medical doctors



Psychologists

Spain






Dieticians


education

Nurses


Physical therapists




Dietitians


education

Pharmacists




Social workers



68


Pharmacists







Nurses



Medical doctors




Pharmacists






Pharmacists


Pharmacists




Pharmacists



Pharmacists

Sweden







Social workers



Dietician



Dietician


Sahlgrenska Academy


Dietician





United Kingdom









69














Bachelor (Hons)


Caterburry Christ

Church University

Undergraduate

education

Occupational

therapists














Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists


Physical therapists




Physical therapists




Physical therapists



Undergraduate

education

Physical

therapists



Medical doctors



70










Dentists General

practicioners



Georgia


Medical doctors








Medical doctors


Republic of Georgia



health specialists


University



Undergraduate

education

Medical doctors



71























behaviours






them











72











Medical specialist

























sports

76








73

- Public health

















ergometry








bull Competencies













audiovisual methods



74
























community levels)


assessments)




of health)










75



team

bull Competencies
























life related health


programming










health



76












methods




action




planning























77





and managingrdquo83

























bull

Knowledge


prevalence survival








78


risk scoring charts


disease



activity








Skills



level














etc)










86




79




271)




Knowledge





disease


strenuous exercise





Skills






sports













80

Knowledge






prevention



Skills





exercise limitation
















in rehabilitation











communityrdquo

Competencies




81









remedial measures



workplace



























and rehabilitation








82











preventive advice


and home situation



and rehabilitation








Dentist












oral diseases






trainingpractice


illness








83






physicians

Nurses
















Competencies 93










and (2)







84













compliance








Nurse specialist

















inequities


health





85






















bull Skills in








coachingtraining








being









86

Pharmacists






healthcare system





Physiotherapists



















Psychologist








pdf



87


EuroPsy programme













Social worker


































88









of social work




89



settings

























Medical doctors



90

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers



Is the education





Yes

No

Unknown


Yes

No


Yes

No

Unknown


Yes

No


curriculum





91






Yes

No

Unknown





Yes

No

Unknown




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers




92




year programme



homework


No

Unknown




93


Yes

No

Unknown


No

Unknown



Yes

No

Unknown


prevention


Yes

No

Unknown





Yes

No

Unknown



94




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers






and homework



95








Yes

No

Unknown





No

Yes please specify



Yes

No

Unknown



96


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers







97




No

Unknown



Yes

No

Unknown


No

Unknown



Yes

No

Unknown



98




heart failure






Unknown


1

Yes

2

No

3

Unknown

Population health

Human cognition

and behaviour

Health behaviour



99


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



100


methods are used

1

Yes

2

No

3

Unknown

Lectures

Assignments


eLearning modules





1

Yes

2

No

3

Unknown

Knowledge

Skills

Behaviour

attitudes




101



education

Yes please specify

No please specify






remarks





102


Free publications



Priced publications




8










partnerships







and social workers






Results



















following results





9

























70 respectively)

Conclusions















11

1 INTRODUCTION







































12












































13













































14










promotion in the EU














15
























Health 2010



16



















professionals too

























17
























education (CBME)50







inequities51












18





















Health Advocate



care system



Teach others



practice








19










































20











in Europe as well62













society








21

























22

3 METHODOLOGY







311 Online survey





country




medicine)




























23

























bull Accreditation

bull Partnerships




found in Annex 3



















24














































25








social workers

German professional







Ergotherapists


(EFAD)




Association (EFN)












Medical schools 298







Response obtained









26

312 Desk research



















- internists

- cardiologists

- psychiatrists


bull Dentists

bull Nurses



bull Pharmacists


bull Psychologists

bull Social workers















27





























practices








28



29



























Southern Europe







Respondents








30







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



31


NL Netherlands 2

PO Poland 0

PT Portugal 14

RO Romania 3

SE Sweden 4

SI Slovenia 14

SK Slovakia 2







Slovenia and Spain








Type of education







32








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


60

29

12




33













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


116

15

35

1417

7 8 5

29

0

10

20

30

40

50



34








n=148)


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


eLearning modules



35






Accreditation










Theories covered



99

0 1

94

4 2

89

6 4

0

20

40

60

80

100





36

















66

54

65

31

42

32

1

1

2

3

1

0 20 40 60 80 100

Population health


Health behaviour




37






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




Health economics

Ethics

Health care systems


Health inequalities


Health literacy





52

61

15

0 20 40 60 80 100






38















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



39

















as competencies


2019 (n=37)70




20 2017 Stockholm

Sweden

httpwwwecdceuropaeu



httpwwwecdceuropaeu



httpwwwecdceuropaeu







httpwwwdohad2017org


4035

150

20

40

60

80

100




40








httpwwwecdceuropaeu

ESCMID Workshop on

Migrants Health

15 2018 Muscat

Oman


mevent14833




care-settings










4 2018 Madrid Spain



facilitators





22 2018 Kuala

Lumpur Malaysia


aysia-2018



wwwecdceuropaeu





wwwelmocongresscom



wwwephconferenceeu


Analysis

25 2019 Madrid

Spain


module





29 2019 Rome Italy






41












Education

19 2019 Chernivtsi

Ukraine


vents531981117209981







introduction

11 2019 Stockholm

Sweden









Netherlands





wwwephconferenceeu















42



percentages)





24

4537

42

76

5563

58

0

20

40

60

80

100




4439

36

14

22

38

18

6256

6164

86

78

63

82

38

0

20

40

60

80

100






43













100 100

82

67

12

22

611

0

20

40

60

80

100


Yes No Unknown

2518

2225

12 11

75 7571

67

0

20

40

60

80

100


No Unknown Yes



44
























43

53

11

0 20 40 60 80 100






45









51 Results






health coaching




51)



46




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



47


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











77 23


6026

113






48





















30

4

4

11

17

15

15

22

10

Other

Social workers

Dentists


Medical doctors

Medical specialists

Psychologists

Nurses

Physical therapists



49





and public health








50























51













53

6 CONCLUSIONS







































54

















found in this study















action















55




















57








Austria



Type of education


being trained



Physical therapists


Applied Sciences

Undergraduate

education

Dieticians



Physical therapists



Physical therapists






Physical therapists





Undergraduate

education

Dietitians




Physiotherapy


education

Physical therapists



Nurses



Medical doctors

Belgium





Pharmacists


Physiotherapy


Physical therapists



58







Physical therapists



Dietitians


Physical therapists




education

Physical

therapists






Physical therapists







education


psychologists



Pharmacists


Lifestyle Medicine




Continuous


Medical doctors






Dieticians



Nurses


Physiotherapy


Physical therapists



Undergraduate

education

Nurses




Dieticians



Dieticians




Lifestyle coaches





education

Medical doctors



59







Dieticians

Bulgaria







Social workers


Society

Postgraduate

education

ENT doctors


Physical therapists



education

Medical specialists

Cyprus

Name of educational

programme

Name of

educational

institution

Type of

education

Type of

health

professionals

being trained

Physiotherapy

programme


education

Physical

therapists

Czech Republic





Physical therapists


faculty of Medicine

Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists


Nurses



Medical specialists



Medical specialists



60

Denmark

Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists





andor therapists






Nurses



Physical therapists



Estonia






Nurses



Psychologists

Finland









61




health promotion






therapists Nurses



Public Health nurse






Dentists



Dentists

France



Type of education


being trained
















Undergraduate

education

Occupational

therapists




education

Occupational

therapists



Dietitians






Medical doctors


Medical specialists



Medical specialists



62



Type of education





medicine



Continuous


Medical doctors






Germany




being trained








Medical faculty

Undergraduate

education

Medical

specialists

Greece





Physical therapists



Hellenic Dental


Continuous


Psychologists

Dentists



Dieticians



Undergraduate

education

Undergraduate

students



Medical specialists



63







Medical doctors


Thessaloniki

Undergraduate

education

Pharmacists

Hungary





Medicine


Budapest Faculty of


Undergraduate

education

Medical doctors




Medical doctors



Medical specialists

Ireland





Social Work

Maynooth University


Postgraduate

education

Social workers



Physical therapists




Physical therapists



Physical therapists


Physical therapists


development

Dentists



Medical specialists







64

Italy

Name of educational

programme

Name of educational

institution





Nurses









School of Medicine

Continuous

professional

education

Medical doctors

Medical


Dentists


Nurses




education

Dentists





specialists







Medical doctors



Medical doctors



Medical doctors

Lithuania










65

Latvia

Name of educational

programme

Name of educational

institution







Physical therapists


Physical therapists

Malta




being trained



Nurses



Netherlands




being trained






Medical students

Portugal




being trained



Social workers

Bachelor degree in

Physiotherapy

Escola Superior de


Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists



Physical therapists


Physical therapists




Physical therapists



66






Workers factory



Undergraduate

education

Physical

therapists







education

Medical

specialists



Physical therapists




Romania




being trained


Nurses


pharmacy Oradea





Slovakia






Social workers



Arts


development

Medical specialists

psychologists

Slovenia

Name of educational

programme

Name of educational

institution

Type of

education

Type of health



Physical therapists



67



Physical therapists








therapy





education

Kinesiology



Physical therapists



Physical therapists




therapists nurses




Physical therapists


Residency

Medical chamber of

Slovenia

Continuous


Medical doctors




Medical doctors



Psychologists

Spain






Dieticians


education

Nurses


Physical therapists




Dietitians


education

Pharmacists




Social workers



68


Pharmacists







Nurses



Medical doctors




Pharmacists






Pharmacists


Pharmacists




Pharmacists



Pharmacists

Sweden







Social workers



Dietician



Dietician


Sahlgrenska Academy


Dietician





United Kingdom









69














Bachelor (Hons)


Caterburry Christ

Church University

Undergraduate

education

Occupational

therapists














Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists


Physical therapists




Physical therapists




Physical therapists



Undergraduate

education

Physical

therapists



Medical doctors



70










Dentists General

practicioners



Georgia


Medical doctors








Medical doctors


Republic of Georgia



health specialists


University



Undergraduate

education

Medical doctors



71























behaviours






them











72











Medical specialist

























sports

76








73

- Public health

















ergometry








bull Competencies













audiovisual methods



74
























community levels)


assessments)




of health)










75



team

bull Competencies
























life related health


programming










health



76












methods




action




planning























77





and managingrdquo83

























bull

Knowledge


prevalence survival








78


risk scoring charts


disease



activity








Skills



level














etc)










86




79




271)




Knowledge





disease


strenuous exercise





Skills






sports













80

Knowledge






prevention



Skills





exercise limitation
















in rehabilitation











communityrdquo

Competencies




81









remedial measures



workplace



























and rehabilitation








82











preventive advice


and home situation



and rehabilitation








Dentist












oral diseases






trainingpractice


illness








83






physicians

Nurses
















Competencies 93










and (2)







84













compliance








Nurse specialist

















inequities


health





85






















bull Skills in








coachingtraining








being









86

Pharmacists






healthcare system





Physiotherapists



















Psychologist








pdf



87


EuroPsy programme













Social worker


































88









of social work




89



settings

























Medical doctors



90

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers



Is the education





Yes

No

Unknown


Yes

No


Yes

No

Unknown


Yes

No


curriculum





91






Yes

No

Unknown





Yes

No

Unknown




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers




92




year programme



homework


No

Unknown




93


Yes

No

Unknown


No

Unknown



Yes

No

Unknown


prevention


Yes

No

Unknown





Yes

No

Unknown



94




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers






and homework



95








Yes

No

Unknown





No

Yes please specify



Yes

No

Unknown



96


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers







97




No

Unknown



Yes

No

Unknown


No

Unknown



Yes

No

Unknown



98




heart failure






Unknown


1

Yes

2

No

3

Unknown

Population health

Human cognition

and behaviour

Health behaviour



99


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



100


methods are used

1

Yes

2

No

3

Unknown

Lectures

Assignments


eLearning modules





1

Yes

2

No

3

Unknown

Knowledge

Skills

Behaviour

attitudes




101



education

Yes please specify

No please specify






remarks





102


Free publications



Priced publications




9

























70 respectively)

Conclusions















11

1 INTRODUCTION







































12












































13













































14










promotion in the EU














15
























Health 2010



16



















professionals too

























17
























education (CBME)50







inequities51












18





















Health Advocate



care system



Teach others



practice








19










































20











in Europe as well62













society








21

























22

3 METHODOLOGY







311 Online survey





country




medicine)




























23

























bull Accreditation

bull Partnerships




found in Annex 3



















24














































25








social workers

German professional







Ergotherapists


(EFAD)




Association (EFN)












Medical schools 298







Response obtained









26

312 Desk research



















- internists

- cardiologists

- psychiatrists


bull Dentists

bull Nurses



bull Pharmacists


bull Psychologists

bull Social workers















27





























practices








28



29



























Southern Europe







Respondents








30







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



31


NL Netherlands 2

PO Poland 0

PT Portugal 14

RO Romania 3

SE Sweden 4

SI Slovenia 14

SK Slovakia 2







Slovenia and Spain








Type of education







32








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


60

29

12




33













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


116

15

35

1417

7 8 5

29

0

10

20

30

40

50



34








n=148)


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


eLearning modules



35






Accreditation










Theories covered



99

0 1

94

4 2

89

6 4

0

20

40

60

80

100





36

















66

54

65

31

42

32

1

1

2

3

1

0 20 40 60 80 100

Population health


Health behaviour




37






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




Health economics

Ethics

Health care systems


Health inequalities


Health literacy





52

61

15

0 20 40 60 80 100






38















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



39

















as competencies


2019 (n=37)70




20 2017 Stockholm

Sweden

httpwwwecdceuropaeu



httpwwwecdceuropaeu



httpwwwecdceuropaeu







httpwwwdohad2017org


4035

150

20

40

60

80

100




40








httpwwwecdceuropaeu

ESCMID Workshop on

Migrants Health

15 2018 Muscat

Oman


mevent14833




care-settings










4 2018 Madrid Spain



facilitators





22 2018 Kuala

Lumpur Malaysia


aysia-2018



wwwecdceuropaeu





wwwelmocongresscom



wwwephconferenceeu


Analysis

25 2019 Madrid

Spain


module





29 2019 Rome Italy






41












Education

19 2019 Chernivtsi

Ukraine


vents531981117209981







introduction

11 2019 Stockholm

Sweden









Netherlands





wwwephconferenceeu















42



percentages)





24

4537

42

76

5563

58

0

20

40

60

80

100




4439

36

14

22

38

18

6256

6164

86

78

63

82

38

0

20

40

60

80

100






43













100 100

82

67

12

22

611

0

20

40

60

80

100


Yes No Unknown

2518

2225

12 11

75 7571

67

0

20

40

60

80

100


No Unknown Yes



44
























43

53

11

0 20 40 60 80 100






45









51 Results






health coaching




51)



46




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



47


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











77 23


6026

113






48





















30

4

4

11

17

15

15

22

10

Other

Social workers

Dentists


Medical doctors

Medical specialists

Psychologists

Nurses

Physical therapists



49





and public health








50























51













53

6 CONCLUSIONS







































54

















found in this study















action















55




















57








Austria



Type of education


being trained



Physical therapists


Applied Sciences

Undergraduate

education

Dieticians



Physical therapists



Physical therapists






Physical therapists





Undergraduate

education

Dietitians




Physiotherapy


education

Physical therapists



Nurses



Medical doctors

Belgium





Pharmacists


Physiotherapy


Physical therapists



58







Physical therapists



Dietitians


Physical therapists




education

Physical

therapists






Physical therapists







education


psychologists



Pharmacists


Lifestyle Medicine




Continuous


Medical doctors






Dieticians



Nurses


Physiotherapy


Physical therapists



Undergraduate

education

Nurses




Dieticians



Dieticians




Lifestyle coaches





education

Medical doctors



59







Dieticians

Bulgaria







Social workers


Society

Postgraduate

education

ENT doctors


Physical therapists



education

Medical specialists

Cyprus

Name of educational

programme

Name of

educational

institution

Type of

education

Type of

health

professionals

being trained

Physiotherapy

programme


education

Physical

therapists

Czech Republic





Physical therapists


faculty of Medicine

Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists


Nurses



Medical specialists



Medical specialists



60

Denmark

Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists





andor therapists






Nurses



Physical therapists



Estonia






Nurses



Psychologists

Finland









61




health promotion






therapists Nurses



Public Health nurse






Dentists



Dentists

France



Type of education


being trained
















Undergraduate

education

Occupational

therapists




education

Occupational

therapists



Dietitians






Medical doctors


Medical specialists



Medical specialists



62



Type of education





medicine



Continuous


Medical doctors






Germany




being trained








Medical faculty

Undergraduate

education

Medical

specialists

Greece





Physical therapists



Hellenic Dental


Continuous


Psychologists

Dentists



Dieticians



Undergraduate

education

Undergraduate

students



Medical specialists



63







Medical doctors


Thessaloniki

Undergraduate

education

Pharmacists

Hungary





Medicine


Budapest Faculty of


Undergraduate

education

Medical doctors




Medical doctors



Medical specialists

Ireland





Social Work

Maynooth University


Postgraduate

education

Social workers



Physical therapists




Physical therapists



Physical therapists


Physical therapists


development

Dentists



Medical specialists







64

Italy

Name of educational

programme

Name of educational

institution





Nurses









School of Medicine

Continuous

professional

education

Medical doctors

Medical


Dentists


Nurses




education

Dentists





specialists







Medical doctors



Medical doctors



Medical doctors

Lithuania










65

Latvia

Name of educational

programme

Name of educational

institution







Physical therapists


Physical therapists

Malta




being trained



Nurses



Netherlands




being trained






Medical students

Portugal




being trained



Social workers

Bachelor degree in

Physiotherapy

Escola Superior de


Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists



Physical therapists


Physical therapists




Physical therapists



66






Workers factory



Undergraduate

education

Physical

therapists







education

Medical

specialists



Physical therapists




Romania




being trained


Nurses


pharmacy Oradea





Slovakia






Social workers



Arts


development

Medical specialists

psychologists

Slovenia

Name of educational

programme

Name of educational

institution

Type of

education

Type of health



Physical therapists



67



Physical therapists








therapy





education

Kinesiology



Physical therapists



Physical therapists




therapists nurses




Physical therapists


Residency

Medical chamber of

Slovenia

Continuous


Medical doctors




Medical doctors



Psychologists

Spain






Dieticians


education

Nurses


Physical therapists




Dietitians


education

Pharmacists




Social workers



68


Pharmacists







Nurses



Medical doctors




Pharmacists






Pharmacists


Pharmacists




Pharmacists



Pharmacists

Sweden







Social workers



Dietician



Dietician


Sahlgrenska Academy


Dietician





United Kingdom









69














Bachelor (Hons)


Caterburry Christ

Church University

Undergraduate

education

Occupational

therapists














Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists


Physical therapists




Physical therapists




Physical therapists



Undergraduate

education

Physical

therapists



Medical doctors



70










Dentists General

practicioners



Georgia


Medical doctors








Medical doctors


Republic of Georgia



health specialists


University



Undergraduate

education

Medical doctors



71























behaviours






them











72











Medical specialist

























sports

76








73

- Public health

















ergometry








bull Competencies













audiovisual methods



74
























community levels)


assessments)




of health)










75



team

bull Competencies
























life related health


programming










health



76












methods




action




planning























77





and managingrdquo83

























bull

Knowledge


prevalence survival








78


risk scoring charts


disease



activity








Skills



level














etc)










86




79




271)




Knowledge





disease


strenuous exercise





Skills






sports













80

Knowledge






prevention



Skills





exercise limitation
















in rehabilitation











communityrdquo

Competencies




81









remedial measures



workplace



























and rehabilitation








82











preventive advice


and home situation



and rehabilitation








Dentist












oral diseases






trainingpractice


illness








83






physicians

Nurses
















Competencies 93










and (2)







84













compliance








Nurse specialist

















inequities


health





85






















bull Skills in








coachingtraining








being









86

Pharmacists






healthcare system





Physiotherapists



















Psychologist








pdf



87


EuroPsy programme













Social worker


































88









of social work




89



settings

























Medical doctors



90

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers



Is the education





Yes

No

Unknown


Yes

No


Yes

No

Unknown


Yes

No


curriculum





91






Yes

No

Unknown





Yes

No

Unknown




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers




92




year programme



homework


No

Unknown




93


Yes

No

Unknown


No

Unknown



Yes

No

Unknown


prevention


Yes

No

Unknown





Yes

No

Unknown



94




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers






and homework



95








Yes

No

Unknown





No

Yes please specify



Yes

No

Unknown



96


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers







97




No

Unknown



Yes

No

Unknown


No

Unknown



Yes

No

Unknown



98




heart failure






Unknown


1

Yes

2

No

3

Unknown

Population health

Human cognition

and behaviour

Health behaviour



99


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



100


methods are used

1

Yes

2

No

3

Unknown

Lectures

Assignments


eLearning modules





1

Yes

2

No

3

Unknown

Knowledge

Skills

Behaviour

attitudes




101



education

Yes please specify

No please specify






remarks





102


Free publications



Priced publications




11

1 INTRODUCTION







































12












































13













































14










promotion in the EU














15
























Health 2010



16



















professionals too

























17
























education (CBME)50







inequities51












18





















Health Advocate



care system



Teach others



practice








19










































20











in Europe as well62













society








21

























22

3 METHODOLOGY







311 Online survey





country




medicine)




























23

























bull Accreditation

bull Partnerships




found in Annex 3



















24














































25








social workers

German professional







Ergotherapists


(EFAD)




Association (EFN)












Medical schools 298







Response obtained









26

312 Desk research



















- internists

- cardiologists

- psychiatrists


bull Dentists

bull Nurses



bull Pharmacists


bull Psychologists

bull Social workers















27





























practices








28



29



























Southern Europe







Respondents








30







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



31


NL Netherlands 2

PO Poland 0

PT Portugal 14

RO Romania 3

SE Sweden 4

SI Slovenia 14

SK Slovakia 2







Slovenia and Spain








Type of education







32








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


60

29

12




33













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


116

15

35

1417

7 8 5

29

0

10

20

30

40

50



34








n=148)


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


eLearning modules



35






Accreditation










Theories covered



99

0 1

94

4 2

89

6 4

0

20

40

60

80

100





36

















66

54

65

31

42

32

1

1

2

3

1

0 20 40 60 80 100

Population health


Health behaviour




37






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




Health economics

Ethics

Health care systems


Health inequalities


Health literacy





52

61

15

0 20 40 60 80 100






38















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



39

















as competencies


2019 (n=37)70




20 2017 Stockholm

Sweden

httpwwwecdceuropaeu



httpwwwecdceuropaeu



httpwwwecdceuropaeu







httpwwwdohad2017org


4035

150

20

40

60

80

100




40








httpwwwecdceuropaeu

ESCMID Workshop on

Migrants Health

15 2018 Muscat

Oman


mevent14833




care-settings










4 2018 Madrid Spain



facilitators





22 2018 Kuala

Lumpur Malaysia


aysia-2018



wwwecdceuropaeu





wwwelmocongresscom



wwwephconferenceeu


Analysis

25 2019 Madrid

Spain


module





29 2019 Rome Italy






41












Education

19 2019 Chernivtsi

Ukraine


vents531981117209981







introduction

11 2019 Stockholm

Sweden









Netherlands





wwwephconferenceeu















42



percentages)





24

4537

42

76

5563

58

0

20

40

60

80

100




4439

36

14

22

38

18

6256

6164

86

78

63

82

38

0

20

40

60

80

100






43













100 100

82

67

12

22

611

0

20

40

60

80

100


Yes No Unknown

2518

2225

12 11

75 7571

67

0

20

40

60

80

100


No Unknown Yes



44
























43

53

11

0 20 40 60 80 100






45









51 Results






health coaching




51)



46




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



47


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











77 23


6026

113






48





















30

4

4

11

17

15

15

22

10

Other

Social workers

Dentists


Medical doctors

Medical specialists

Psychologists

Nurses

Physical therapists



49





and public health








50























51













53

6 CONCLUSIONS







































54

















found in this study















action















55




















57








Austria



Type of education


being trained



Physical therapists


Applied Sciences

Undergraduate

education

Dieticians



Physical therapists



Physical therapists






Physical therapists





Undergraduate

education

Dietitians




Physiotherapy


education

Physical therapists



Nurses



Medical doctors

Belgium





Pharmacists


Physiotherapy


Physical therapists



58







Physical therapists



Dietitians


Physical therapists




education

Physical

therapists






Physical therapists







education


psychologists



Pharmacists


Lifestyle Medicine




Continuous


Medical doctors






Dieticians



Nurses


Physiotherapy


Physical therapists



Undergraduate

education

Nurses




Dieticians



Dieticians




Lifestyle coaches





education

Medical doctors



59







Dieticians

Bulgaria







Social workers


Society

Postgraduate

education

ENT doctors


Physical therapists



education

Medical specialists

Cyprus

Name of educational

programme

Name of

educational

institution

Type of

education

Type of

health

professionals

being trained

Physiotherapy

programme


education

Physical

therapists

Czech Republic





Physical therapists


faculty of Medicine

Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists


Nurses



Medical specialists



Medical specialists



60

Denmark

Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists





andor therapists






Nurses



Physical therapists



Estonia






Nurses



Psychologists

Finland









61




health promotion






therapists Nurses



Public Health nurse






Dentists



Dentists

France



Type of education


being trained
















Undergraduate

education

Occupational

therapists




education

Occupational

therapists



Dietitians






Medical doctors


Medical specialists



Medical specialists



62



Type of education





medicine



Continuous


Medical doctors






Germany




being trained








Medical faculty

Undergraduate

education

Medical

specialists

Greece





Physical therapists



Hellenic Dental


Continuous


Psychologists

Dentists



Dieticians



Undergraduate

education

Undergraduate

students



Medical specialists



63







Medical doctors


Thessaloniki

Undergraduate

education

Pharmacists

Hungary





Medicine


Budapest Faculty of


Undergraduate

education

Medical doctors




Medical doctors



Medical specialists

Ireland





Social Work

Maynooth University


Postgraduate

education

Social workers



Physical therapists




Physical therapists



Physical therapists


Physical therapists


development

Dentists



Medical specialists







64

Italy

Name of educational

programme

Name of educational

institution





Nurses









School of Medicine

Continuous

professional

education

Medical doctors

Medical


Dentists


Nurses




education

Dentists





specialists







Medical doctors



Medical doctors



Medical doctors

Lithuania










65

Latvia

Name of educational

programme

Name of educational

institution







Physical therapists


Physical therapists

Malta




being trained



Nurses



Netherlands




being trained






Medical students

Portugal




being trained



Social workers

Bachelor degree in

Physiotherapy

Escola Superior de


Undergraduate

education

Physical

therapists



Physical therapists



Physical therapists



Physical therapists


Physical therapists




Physical therapists



66






Workers factory



Undergraduate

education

Physical

therapists







education

Medical

specialists



Physical therapists




Romania




being trained


Nurses


pharmacy Oradea





Slovakia






Social workers



Arts


development

Medical specialists

psychologists

Slovenia

Name of educational

programme

Name of educational

institution

Type of

education

Type of health



Physical therapists



67



Physical therapists








therapy





education

Kinesiology



Physical therapists



Physical therapists




therapists nurses




Physical therapists


Residency

Medical chamber of

Slovenia

Continuous


Medical doctors




Medical doctors



Psychologists

Spain






Dieticians


education

Nurses


Physical therapists




Dietitians


education

Pharmacists




Social workers



68


Pharmacists







Nurses



Medical doctors




Pharmacists






Pharmacists


Pharmacists




Pharmacists



Pharmacists

Sweden







Social workers



Dietician



Dietician


Sahlgrenska Academy


Dietician





United Kingdom









69














Bachelor (Hons)


Caterburry Christ

Church University

Undergraduate

education

Occupational

therapists














Name of educational

programme

Name of educational

institution





Physical therapists



Physical therapists


Physical therapists




Physical therapists




Physical therapists



Undergraduate

education

Physical

therapists



Medical doctors



70










Dentists General

practicioners



Georgia


Medical doctors








Medical doctors


Republic of Georgia



health specialists


University



Undergraduate

education

Medical doctors



71























behaviours






them











72











Medical specialist

























sports

76








73

- Public health

















ergometry








bull Competencies













audiovisual methods



74
























community levels)


assessments)




of health)










75



team

bull Competencies
























life related health


programming










health



76












methods




action




planning























77





and managingrdquo83

























bull

Knowledge


prevalence survival








78


risk scoring charts


disease



activity








Skills



level














etc)










86




79




271)




Knowledge





disease


strenuous exercise





Skills






sports













80

Knowledge






prevention



Skills





exercise limitation
















in rehabilitation











communityrdquo

Competencies




81









remedial measures



workplace



























and rehabilitation








82











preventive advice


and home situation



and rehabilitation








Dentist












oral diseases






trainingpractice


illness








83






physicians

Nurses
















Competencies 93










and (2)







84













compliance








Nurse specialist

















inequities


health





85






















bull Skills in








coachingtraining








being









86

Pharmacists






healthcare system





Physiotherapists



















Psychologist








pdf



87


EuroPsy programme













Social worker


































88









of social work




89



settings

























Medical doctors



90

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers



Is the education





Yes

No

Unknown


Yes

No


Yes

No

Unknown


Yes

No


curriculum





91






Yes

No

Unknown





Yes

No

Unknown




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers




92




year programme



homework


No

Unknown




93


Yes

No

Unknown


No

Unknown



Yes

No

Unknown


prevention


Yes

No

Unknown





Yes

No

Unknown



94




Yes

No

Unknown


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers






and homework



95








Yes

No

Unknown





No

Yes please specify



Yes

No

Unknown



96


Medical doctors

Medical specialists

Physical therapists


Nurses

Psychologists

Dentists

Social workers







97




No

Unknown



Yes

No

Unknown


No

Unknown



Yes

No

Unknown



98




heart failure






Unknown


1

Yes

2

No

3

Unknown

Population health

Human cognition

and behaviour

Health behaviour



99


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



100


methods are used

1

Yes

2

No

3

Unknown

Lectures

Assignments


eLearning modules





1

Yes

2

No

3

Unknown

Knowledge

Skills

Behaviour

attitudes




101



education

Yes please specify

No please specify






remarks





102


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