CHALLENGES AND PERSPECTIVES OF HEALTH EDUCATION IN THE TRANSITION FROM A HOSPITAL-CENTRIC MODEL TO HEALTH PROMOTION
DOI:
https://doi.org/10.56238/revgeov17n5-073Keywords:
Health Education, Health Promotion, Hospital-Centered Model, Paradigm Shift, Digital Health TechnologiesAbstract
This bibliographic review analyzes the transition from the hospital-centered (biomedical) model to the Health Promotion paradigm, focusing on the strategic role of Health Education in this process. The traditional biomedical model is criticized for its reductionist, fragmented, and financially unsustainable nature, especially in the face of the rise of chronic diseases. Health Education is presented as a central tool for this change, encompassing both traditional behavior-change approaches and emancipatory perspectives grounded in Paulo Freire. Multiple barriers to effective implementation are identified: professionals' intrapersonal beliefs, gaps in academic training, institutional resistance, systemic focus on curative care, and low community health literacy. Regarding future perspectives, the Astana Declaration (WHO), the "Health in All Policies" concept, innovative comprehensive care models such as the Two-Circle Model, and the integration of digital technologies (artificial intelligence, wearables, genomics, telehealth) stand out. The conclusion is that the effective transition requires coordinated efforts in curriculum reform, resource allocation, professional training, health literacy promotion, and ethical integration of digital technologies.
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References
1. A Revitalized Biopsychosocial Model: Core Theory, Research Paradigms, and Clinical Implications. Bolton D. Psychological Medicine. 2023;53(16):7504-7511. doi:10.1017/S0033291723002660.
2. Competencies for psychology practice in primary care. Sara Honn Qualls, Michele J. Karel, Annette Stanton, et al. American Psychological Association (2015).
3. Improving the Effectiveness of Healthcare: Diagnosis-Centered Care vs. Person-Centered Health Promotion, a Long Forgotten New Model. Martyushev-Poklad A, Yankevich D, Petrova M. Frontiers in Public Health. 2022;10:819096. doi:10.3389/fpubh.2022.819096.
4. The Biopsychosocial Model of Illness: A Model Whose Time Has Come. Wade DT, Halligan PW. Clinical Rehabilitation. 2017;31(8):995-1004. doi:10.1177/0269215517709890.
5. Learning Lessons From Past Mistakes: How Can Health in All Policies Fulfil Its Promises?. Bacigalupe A, Esnaola S, Martín U, Zuazagoitia J. Journal of Epidemiology and Community Health. 2010;64(6):504-5. doi:10.1136/jech.2010.110437.
6. Twenty-Five Years After the Ottawa Charter: The Critical Role of Health Promotion for Public Health. Potvin L, Jones CM. Canadian Journal of Public Health = Revue Canadienne De Sante Publique. 2011 Jul-Aug;102(4):244-8.
7. Health Status Measurement in the Evaluation of Health Promotion. Breslow L. Medical Care. 1989;27(3 Suppl):S205-16. doi:10.1097/00005650-198903001-00017.
8. Revisiting Alma-Ata: What Is the Role of Primary Health Care in Achieving the Sustainable Development Goals?. Hone T, Macinko J, Millett C. Lancet (London, England). 2018;392(10156):1461-1472. doi:10.1016/S0140-6736(18)31829-4.
9. Health Education: A Rogerian Concept Analysis. Pueyo-Garrigues M, Whitehead D, Pardavila-Belio MI, et al. International Journal of Nursing Studies. 2019;94:131-138. doi:10.1016/j.ijnurstu.2019.03.005.
10. Drivers of Poor Medical Care. Saini V, Garcia-Armesto S, Klemperer D, et al. Lancet (London, England). 2017;390(10090):178-190. doi:10.1016/S0140-6736(16)30947-3.
11. A New Doctor in the House: Ethical Issues in Hospitalist Systems. Pantilat SZ, Alpers A, Wachter RM. JAMA. 1999;282(2):171-4. doi:10.1001/jama.282.2.171.
12. Outcomes of Care by Hospitalists, General Internists, and Family Physicians. Lindenauer PK, Rothberg MB, Pekow PS, et al. The New England Journal of Medicine. 2007;357(25):2589-600. doi:10.1056/NEJMsa067735.
13. The Role of the Hospital in a Changing Environment. McKee M, Healy J. Bulletin of the World Health Organization. 2000;78(6):803-10.
14. Educational Interventions for Improving Primary Caregiver Complementary Feeding Practices for Children Aged 24 Months and Under. Arikpo D, Edet ES, Chibuzor MT, Odey F, Caldwell DM. The Cochrane Database of Systematic Reviews. 2018;5:CD011768. doi:10.1002/14651858.CD011768.pub2.
15. Interventions for Improving Health Literacy in Migrants. Baumeister A, Aldin A, Chakraverty D, et al. The Cochrane Database of Systematic Reviews. 2023;11:CD013303. doi:10.1002/14651858.CD013303.pub2.
16. Theory-Based Interventions for Contraception. Lopez LM, Grey TW, Chen M, Tolley EE, Stockton LL. The Cochrane Database of Systematic Reviews. 2016;11:CD007249. doi:10.1002/14651858.CD007249.pub5.
17. Clinical Preventive Medicine in Primary Care: Background and Practice: 2. Delivering Primary Preventive Services. Hensrud DD. Mayo Clinic Proceedings. 2000;75(3):255-64. doi:10.4065/75.3.255.
18. Creating Critical Consciousness in Health: Applications of Freire's Philosophy and Methods to the Health Care Setting. Minkler M, Cox K. International Journal of Health Services : Planning, Administration, Evaluation. 1980;10(2):311-22. doi:10.2190/023K-58E7-6TM8-3RRM.
19. Popular Education for Health Promotion and Community Empowerment: A Review of the Literature. Wiggins N. Health Promotion International. 2012;27(3):356-71. doi:10.1093/heapro/dar046.
20. Reducing Inequities Through Participatory Research and Community Empowerment. Travers KD. Health Education & Behavior : The Official Publication of the Society for Public Health Education. 1997;24(3):344-56. doi:10.1177/109019819702400307.
21. What Should We Talk About? Contributions From Freirean Thematic Investigation in Health Education With Adolescents. Gontijo DT, Calheiros MNS, Jucá AL, Monteiro RJS. Health Promotion International. 2023;38(6):daad160. doi:10.1093/heapro/daad160.
22. The Emancipatory Perspective of Health Literacy in Brazil: Contributions From the Freirean Thought to Knowledge Translation Regarding a Global Concept. Peres F. Cadernos De Saude Publica. 2025;40(11):e00089824. doi:10.1590/0102-311XPT089824.
23. Emancipatory Promotion of Health: Contributions From Brazil in the Context of the Global South. Porto MF. Health Promotion International. 2019;34(Supplement_1):i56-i64. doi:10.1093/heapro/day086.
24. Freirian Praxis in Health Education: Research Results From an Adolescent Prevention Program. Wallerstein N, Sanchez-Merki V. Health Education Research. 1994;9(1):105-18. doi:10.1093/her/9.1.105.
25. Primary Health Care and Sustainable Development Goals. Chotchoungchatchai S, Marshall AI, Witthayapipopsakul W, et al. Bulletin of the World Health Organization. 2020;98(11):792-800. doi:10.2471/BLT.19.245613.
26. Barriers and Facilitators for the Implementation of Primary Prevention and Health Promotion Activities in Primary Care: A Synthesis Through Meta-Ethnography. Rubio-Valera M, Pons-Vigués M, Martínez-Andrés M, et al. PloS One. 2014;9(2):e89554. doi:10.1371/journal.pone.0089554.
27. Organizational Structure and Human Agency Within the South African Health System: A Qualitative Case Study of Health Promotion. Rwafa-Ponela T, Goudge J, Christofides N. Health Policy and Planning. 2021;36(Supplement_1):i46-i58. doi:10.1093/heapol/czab086.
28. Health Promotion Capacity and Institutional Systems: An Assessment of the South African Department of Health. Rwafa-Ponela T, Christofides N, Eyles J, Goudge J. Health Promotion International. 2021;36(3):784-795. doi:10.1093/heapro/daaa098.
29. Mobile Phone Messaging for Preventive Health Care. Vodopivec-Jamsek V, de Jongh T, Gurol-Urganci I, Atun R, Car J. The Cochrane Database of Systematic Reviews. 2012;12:CD007457. doi:10.1002/14651858.CD007457.pub2.
30. New Political Science Analysis of the Renewed Push for Preventive Health: 'Can It Be Any Different This Time Around?'. Cairney P, Boswell J, Mahmood H, Bliss A. Social Science & Medicine (1982). 2025;384:118568. doi:10.1016/j.socscimed.2025.118568.
31. Collaboration Between Local Health and Local Government Agencies for Health Improvement. Hayes SL, Mann MK, Morgan FM, Kelly MJ, Weightman AL. The Cochrane Database of Systematic Reviews. 2012;10:CD007825. doi:10.1002/14651858.CD007825.pub6.
32. An Integrated Framework for Achieving National Health Goals. Jonas WB, Adibe B. JAMA Health Forum. 2022;3(5):e221109. doi:10.1001/jamahealthforum.2022.1109.
33. The Application of Preventive Medicine in the Future Digital Health Era. De la Torre K, Min S, Lee H, Kang D. Journal of Medical Internet Research. 2025;27:e59165. doi:10.2196/59165.
34. Artificial Intelligence in Health Promotion and Disease Reduction: Rapid Review. Yousefi F, Naye F, Ouellet S, et al. Journal of Medical Internet Research. 2025;27:e70381. doi:10.2196/70381.
35. Application of Emerging Information Technologies in the Prevention and Control of Chronic Diseases. Feng T, Li Y, Feng Y, Zeng C. Frontiers in Public Health. 2026;14:1755672. doi:10.3389/fpubh.2026.1755672.
36. Mobile Health and Preventive Medicine. Waalen J. The Medical Clinics of North America. 2023;107(6):1097-1108. doi:10.1016/j.mcna.2023.06.003.
37. Digital Health Promotion: Promise and Peril. Koh A, Swanepoel W, Ling A, et al. Health Promotion International. 2021;36(Supplement_1):i70-i80. doi:10.1093/heapro/daab134.
38. Future Trends and Possible Applications of Digital Technologies in Setting-Based Prevention and Health Promotion-A Delphi Survey. Stark AL, Albrecht J, Dongas E, Choroschun K, Dockweiler C. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2023;66(3):320-329. doi:10.1007/s00103-023-03669-5.
39. Transforming Global Approaches to Chronic Disease Prevention and Management Across the Lifespan: Integrating Genomics, Behavior Change, and Digital Health Solutions. Thomas SA, Browning CJ, Charchar FJ, et al. Frontiers in Public Health. 2023;11:1248254. doi:10.3389/fpubh.2023.1248254.
40. Components, Prospects and Challenges of Personalized Prevention. Jaskulski S, Nuszbaum C, Michels KB. Frontiers in Public Health. 2023;11:1075076. doi:10.3389/fpubh.2023.1075076.
