RESUMO
Objectives We aimed to investigate the progress of health promotion program implementation. This included an examination of the current status of and issues around planning, implementation, and evaluation of health and welfare services at the municipal level; further progress through focus on the population approach emphasized in Health Japan 21 (2nd) was also discussed.Methods A questionnaire survey on health promotion and welfare services was conducted among municipal offices in charge of health promotion. The status of health promotion program implementation was classified by types and fields. For focused health and welfare services, respondents were asked to answer a self-administered questionnaire about the process of planning, implementation, and evaluation. The details of services were confirmed by browsing reference materials or website information. We distributed the questionnaires to all 260 municipalities of 6 prefectures (Miyagi, Saitama, Shizuoka, Aichi, Osaka, and Wakayama); of which, 238 municipalities responded (response rate: 91.5%).Results Health promotion programs on nutrition and diet, physical activity, dental and oral health, prevention of lifestyle-related diseases, and promotion of regular health checkups were implemented with a high rate. Among the 238 municipalities, 85.2% responded that they focused on educational activities targeting the general population; of which 27.4% were considering using incentives to promote greater health awareness. Our survey indicated that 14.8% of municipalities focused on health education and classroom-style programs. While planning programs, 52.1% of municipalities used "materials from other municipalities where such programs were already implemented" and 89.1% of municipalities used them in incentive-related programs. Although 70% of municipalities were aware of health discrepancies among the local population, approximately 90% did not consider discrepancies between different economic, living environment, and occupation groups when planning programs. Although 87.3% of municipalities used number of participants as the main indicator in evaluating the programs, approximately 30% of municipalities used coverage rate and before-and-after assessments of health conditions as the main indicators.Conclusion Findings from this study suggest that improvements in the process of health promotion program planning and implementation, reference materials, and the perspective of health discrepancies are needed, along with an evaluation in programs focusing both on educational activities targeting the general population and incentive-related programs. It is also recommended that the central government and prefectures should not only introduce precedents, but also provide information. Using this, municipalities can demonstrate applied skills, such as the rationale and preparation status of the program, and propose evaluations based on the plan-do-check-act cycle.
