Health promotion from the perspective of intersectionality: Derivation of a middle-range theory

Health promotion remains a central goal in nursing practice and policy. However, conventional approaches often overlook how overlapping social identities and structural inequities influence health outcomes. Intersectionality provides a critical framework for understanding these complex dynamics.

To derive a middle-range theory (MRT) that explains health promotion from an intersectional perspective, with the aim of informing nursing practice and advancing health equity.

This theoretical-reflective, qualitative study followed the derivation approach outlined by Walker and Avant (2019) to construct a MRT. Key concepts from intersectionality theory and health promotion literature were analyzed and synthesized to develop an explanatory model applicable to nursing.

The theory is structured around two central constructs: (1) Intersectionality and Health Promotion: conceptual relations, which explores the interplay between social markers, such as race, gender, class, and territory, and health; and (2) Flowing towards Equity and Maximum Potential in Health, a metaphorical model that illustrates how structural forces affect individuals' trajectories within the "river" of health promotion. This framework highlights sites for nursing intervention to disrupt inequities and enhance the flow toward optimal health.

Applying an intersectional lens to health promotion allows for the identification of hidden patterns, drivers, and opportunities for intervention. The proposed theory supports nursing practice by guiding the development of equity-focused strategies that address structural determinants and ensure that all individuals, particularly those historically marginalized, can achieve their maximum health potential. SO WHAT?: The application of this theory contributes to more equitable health promotion policies and practices by considering the interactions between different social markers, such as race, gender, class, and territory. In this way, it enables the formulation of strategies that address structural inequalities and promote a more comprehensive positive impact, ensuring that historically marginalized groups have full access to their maximum health potential.