From Information to Interaction: A Collaborative Approach to Health Improvement Programmes

Background: The information driven behavioural approach adopted by health promotion programmes has been criticised for focusing on individual agency while neglecting the impact of structural factors on health. Recent scholarship argues for a relational paradigm in public health which emphasises collaboration with citizens and other network actors as a key to reduce health inequalities. There is little evidence how this collaborative interactional process is supported and experienced in a health promotion context. Objectives: The study examines a collaborative interactional model of promoting lifestyle changes to improve health with a focus on how networks, relationships between various actors, including members of the public, public service users, service staff and health professionals, and the roles they assume in this context shape the process. Methods: The paper draws on network and social practices theories, interviews with different actors engaged in a public health programme in England and field observation. Findings: A collaborative interaction approach may balance the focus on structure (institutional actors) and agency (individuals). Collaborating with existing support services to develop health programmes provides access to the special insight these actors have about their users facilitating a better understanding of the world of each individual. Interaction and dialogue were identified as ways to empower and support people to take action to change. However, the encounters between different actors were shaped by power relationships which enabled or constrained individual participation. In the light of the limitations of behavioural theories, network and social practice theories are proposed as offering a comprehensive conceptualization to better understand and address the interplay between structures and agency. Conclusions: Interaction does not substitute information in health improvement programmes. However, an interaction based approach encourages actor participation while creating the space for open dialogue, shared learning and collaboration in health improvement programmes.