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

A series of six focus groups was held with health promotion workers to expl ore the meaning and experience of 'capacity-building', a term which is used variously in the literature. The research is part of a participatory, prac tice-based project to develop outcome indicators in capacity-building. Capa city-building was defined as seeking to develop health promotion skills and resources, and also problem-solving capability, at five levels: the indivi dual; within health care teams, within health organisations; across organis ations; and within the community. While workers had little difficulty in id entifying outcomes of capacity-building, indicators of quality or good proc ess were more difficult to articulate. This was partly because capacity-bui lding was described as an invisible, even secret process. Capacity-building is hidden from funders and administrators because it is not generally rega rded as a legitimate project activity; that is, it is not directly linked t o risk factor behaviours in priority areas such as cancer, heart disease an d injury control. Capacity-building is also hidden from other workers in or der to make it more effective. This is particularly the case with health pr omotion workers working within what they perceive to be hostile climates, s uch as health care settings experiencing funding cut backs. The invisibilit y of practitioners' capacity-building work has implications for quality con trol, guiding theory, practice ethics, peer support, worker morale and fund ing mechanisms in health promotion.