Creative Strengths-Based Approaches to Health Promotion: Perspectives From Graduate Training Experiences

Introduction

In December 2018, the Institute of Indigenous Peoples’ Health, Canadian Institute for Health Research, a Canadian federal funding agency, hosted an intimate networking event in Victoria, British Columbia, Canada. The meeting spanned 2 days and showcased previous, current, and future health promotion priorities for Métis peoples (one of the three constitutionally recognized Indigenous populations in Canada). Métis citizens, Métis governance organizations, health promotion nonprofit organizations, early career researchers, and senior academics were invited to this two-day meeting. All participants selected were involved in health promotion research with Métis or other Indigenous communities.

When the meeting was over and people went their separate ways, Rosanne and I, ¹ two of the four early career researchers present at the meeting, took a walk at the edge of the Pacific Ocean. We debriefed about the lessons we learned and our emerging thoughts from this career development experience. As we meandered, our conversation turned to our experiences working with underserved populations (Indigenous and Canadian newcomers) within health promotion research. This led to a discussion about our PhD and postdoctoral training. We had never met, and our research was, and is, conducted in different geographic regions of Canada, at different institutions and with different mentors. We had no direct overlap of participants, communities we worked with, or research topics. Yet the commonalities of our experiences related to the successes and challenges we faced were striking. As we shared our training journeys, we discussed changes to health promotion pedagogy we hope to see in the future. These included understanding both the strengths and the challenges of creative strengths-based health promotion research conducted with vulnerable communities, ensuring that reflexivity and flexibility are components of the process, developing support networks, understanding personal limitations to effect change, and supporting self-care.

Framing Strengths-Based and Creative Approaches to Health Promotion

Strengths-based, or asset-based (as opposed to deficit-based) approaches, are essential to understand what is working and to identify possible solutions to challenges related to health and well-being (Bozic, Lawthom & Murray, 2018). Strengths-based approaches focus on aspects of resilience and on how success can be obtained, rather than documenting and expanding on problems and difficulties (Bozic et al., 2018). A key element needed to ensure that health promotion research and practice is strengths based is to establish relationships with participants and communities we work with. This helps ensure confidence in the information learned, provides opportunities to look for agencies of change, and provides nuanced understanding of context participating individuals are facing in order to avoid retraumatization (Kovach, 2009).

Many of the experiences we had, and the lessons we learned, would not have been possible with deficit-based research. Rosanne and I use creative approaches to help ensure that our work remains strengths based. Creative health promotion research and programming, such as the use of visual arts, music, and theatre, can help instill a sense of pride, a willingness to try new things, and a positive outlook for participants (Vettraino, Linds, & Jindal-Snape, 2017). The use of creative methods has been shown to lead to increased motivation and engagement and advance social skills, as well as to have a positive impact on health, self-esteem, emotional intelligence, and agency (Vettraino et al., 2017). We had the chance to witness these strengths within our own research projects. We both reflected on the satisfaction we received when participants enjoyed participating in research and the knowledge—as shared by participants—that participants were engaging in new ways with health promotion strategies.

When Strengths are Not Strengths

Engaging in creative strengths-based health promotion research with underserved communities is not without its challenges. Both Rosanne and I worked with underserved communities prior to entering graduate school. We had seen firsthand various gaps in health policies and service delivery that proved to be a key motivation for both of us to pursue further education and training. We were, and are still, committed to understanding health promotion through Indigenous and social determinants of health, health equity, and social justice lenses (Raphael, 2016). We both knew that the world is not a perfect place when we began our graduate training. We knew that within Canada children get hurt by the people who are supposed to love them (Cooper & Driedger, 2019), adults die of treatable infections because they cannot access health care, and many people live and work in unsafe conditions (Raphael, 2016). Yet the realities of some of the stories we heard and information we learned were profoundly shocking.

While we understand that identifying aspects that fall under the category of resiliency is an essential part of strength-based health promotion research, neither of us were fully prepared for what to do when we learned of situations that we were unable to change. An example of such an experience was participants housed in the motel rooms by the government for weeks, or months, on-end reporting gratitude in receiving food donations and their resulting frustrations with the need to eat unhealthy ready-to-eat donated food that they did not like because of the lack of cooking appliances in the motels (Blanchet, Nana, Sanou, Batal, & Giroux, 2018).

The Need for Reflexivity and Flexibility

When discussing unanticipated challenges, both Rosanne and I discussed the need for reflexivity and flexibility, aspects that were not highlighted sufficiently within methods classes that we completed during our graduate training. Reflexivity is an essential part of conducting successful health promotion research and programming. It requires time, patience, and space to think, elements that are not necessarily built into timelines (Pillow, 2003). Reflexivity is not an innate quality that everyone possesses, rather it requires a safe space to unpack complex concepts and opportunities to learn from people who have worked in similar environments (Kovach, 2009). Through the process of reflexivity, we may realize that priorities have to shift to meet health promotion needs—hence, the need for flexibility. For example, when we discovered that functional literacy levels of participants in a study about health messaging and decision-making practices were lower than expected, we had to modify data collection tools to accommodate their needs in order to continue to employ a strengths-based approach to data collection (Cooper & Driedger, 2017). While our mentors talked about the journey of creative strengths-based health promotion research and practice as nonlinear, the ability to fully comprehend flexibility required to meet the needs of participants was not discussed in detail. Even less discussed was how to explain to those who work within a biomedical research model why reflexivity and flexibility are necessary in strengths-based health promotion research and how our timelines may be vastly different from their experiences and expectations. It is our contention that health promotion education needs to encompass further training and mentorship for trainees (and biomedical researchers) about the importance of reflexivity and flexibility when using creative strengths-based approaches to health promotion research and practice as a way to avoid pitfalls.

It Takes a Village: Raising Health Promotion Researchers

Some of the best advice we received during our graduate and postgraduate training was to seek out likeminded people on similar career paths to talk with. As discussed above, an important challenge exists when people do not understand the complexities of working in an intimate way with people from underserved communities. Although creative strengths-based approaches to health promotion is growing in popularity, it remains an uncommon approach within most health departments and units. Finding opportunities to attend meetings, such as the one where Rosanne and I met, or attending short seminar trainings and preconference workshops are excellent places to find such people. Networking is often discussed in terms of career or advancement; however, its value in terms of personal benefits and learning opportunities are seldom mentioned to early career health promotion researchers. Opportunities for various stakeholders at all stages of their careers involved in health promotion to network outside of conference settings, when there is no need to worry about running to the next session or fine-tuning presentations, are relatively rare in the world of health promotion research. Meeting like-minded people to discuss the joys and the challenges within this field can be valuable at multiple levels (Thomas, 2019). It may also be necessary to seek colleagues in adjacent fields exploring socially constructed issues related to health and social justice, such as education, community economic development, or social development studies. With enhanced technologies and familiarity working across time zones, it has become increasingly possible to find, and to stay in contact with, people who share common philosophical approaches and experiences. These support networks create a community that can celebrate, commiserate, and provide sound advice (McDonald & Viehbeck, 2007). For us, these people proved to be essential sounding boards. They helped identify when we were experiencing vicarious trauma. They also helped contextualize our experiences and the experiences of participants. They were also there to celebrate unanticipated outcomes that came from using creative strengths-based approaches, such as participants returning to school in order to provide the example for their children that it is never too late to make a different choice.

Accepting Limitations and Engaging in Self-Care

It is essential that trainees know that they should not diminish their own strengths or challenges because these seem insignificant when compared with those of the people and the communities they are working with. In addition, people should not negatively internalize the privileges, resources, and opportunities they have. It is very easy to take on vicarious trauma, and it is just as easy to feel a sense of guilt when comparing what you have with that of your participants. We were lucky. We had strong mentors and peers to support us, and we had previous lived experience working within underserved communities and had spent considerable time developing tools and resources to use as an ally; however, we know many others who do not have this support experience and resilience.

The nature of education is that once the training is complete trainees will likely move onto work in another context. While they should be trained to change policies and programming where they can, mechanisms need to be in place to ensure that trainees feel okay leaving participants without solving identified challenges. Trainees need to be encouraged to seek out mental health supports when they need to. Trainees also need to understand that confidentiality does not mean that they cannot talk about issues they are facing with their support networks, and they need to be taught where personal and professional boundaries are. Without taking time for self-care, trainees may experience burnout. As such, many promising, compassionate health promotion practitioners and researchers may undertake other career paths that are perhaps less emotionally charged than creative strengths-based approaches to health promotion within vulnerable community contexts.

Conclusion

When we met at the early career researcher meeting, it was a year after our PhD graduations. We have had time to reflect on what worked and did not work during our graduate training. We had also put considerable thought into how we would mentor trainees who want to engage in creative strength-based approaches to health promotion research and practice. We believe in using strengths-based approaches in all areas of our lives, both personally and professionally, because we know it works. We know that people and communities will be more likely to engage in health promotion activities if they feel good about themselves, thus improving overall wellness. We also want training programs to learn from the successes and the challenges that we have faced. We want trainees to know that creative strengths-based does not mean ignoring challenges, and that it is expected that problems and difficulties will be identified by participants as a result of health promotion research. We want there to be a process of reflexivity built into training. We want trainees who engage in creative strengths-based health promotion research and practice to feel good about their experiences. We also want trainees to have realistic ideas about how to influence health promotion practice, to feel supported by their mentors and by their peers, and to engage in self-care. After all, education itself needs to promote wellness and success.