Background: Health promotion interventions targeting ethnic minorities have been limited in Nordic countries. A new arena in this regard in a Danish context is found in municipalities, which recently assumed responsibility for health promotion and disease prevention. Knowledge about the implementation of these efforts, including health education approaches applied, is scarce.

Purpose: The purpose of this qualitative and exploratory study was to examine aspects of the health education approach(es) in diabetes courses for Arabic speaking citizens in municipal health care centres in Denmark.

Methods:  The study was designed as a collective case study. Data was generated through observations of diabetes courses (19) and introductory interviews (4) with Arabic speaking citizens in three municipal health care centres. Semi-structured interviews were conducted with heads (5) and health care professionals (9).  Field and interview notes were analyzed using a content-driven approach to identify relevant themes and findings.

Results: Heads of the health care centres described the health pedagogical ideals as action-oriented, participatory and upstream. In practice, health care professionals navigated between two different approaches:  an action oriented approach aligned with the health pedagogical ideals and a traditional downstream compliance oriented approach. The different approaches were observed in relation to 1) using a holistic versus a biomedical health concept, 2) the health care professional as an equal versus an expert and 3) using a ‘health educator’ versus an interpreter to translate.

Conclusions: Health pedagogical ideals were aligned with recent literature and theory in the field - while practice was more complex. The co-existence of two the approaches in practice may be related to several factors:  the organizational setting is new, undefined and flexible allowing for variations; the practice field is new, characterized by learning by doing and trying out different methods; the health care professionals’ biomedical background as well as their perception that the compliance oriented approach was useful with this target group influenced practice. At a more general level, the results indicated that translating theoretical ideals into practice is a multifaceted and dynamic process.