Working invisibly: health workers talk about capacity-building in health promotion

A series of six focus groups was held with health promotion workers to explore the meaning and experience of 'capacity-building', a term which is used variously in the literature. The research is part of a participatory, practice-based project to develop outcome indicators in capacity-building. Capacity-building was defined as seeking to develop health promotion skills and resources, and also problem-solving capability, at five levels: the individual; within health care teams, within health organisations; across organisations; and within the community. While workers had little difficulty in identifying outcomes of capacity-building, indicators of quality or good process were more difficult to articulate. This was partly because capacity-building was described as an invisible, even secret process. Capacity-building is hidden from funders and administrators because it is not generally regarded as a legitimate project activity; that is, it is not directly linked to risk factor behaviours in priority areas such as cancer, heart disease and injury control. Capacity-building is also hidden from other workers in order to make it more effective. This is particularly the case with health promotion workers working within what they perceive to be hostile climates, such as health care settings experiencing funding cut backs. The invisibility of practitioners' capacity-building work has implications for quality control, guiding theory, practice ethics, peer support, worker morale and funding mechanisms in health promotion.