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Abstract
There is a growing international awareness and development of health promotion in hospitals. For patients, this involves encouraging
them to take an active participatory role according to their specific health potentials. The aim of this study was to investigate their receptivity
to health promotion in an acute hospital setting. Data are drawn from a questionnaire survey of 320 adult in-patients (100% response rate),
excluding terminally ill patients for ethical reasons. In general, respondents supported the development of health promotion in the hospital
setting. Concerns were expressed over the knowledge base and the ability of professionals to deliver health education interventions that
met their specific needs. Non-smokers were more supportive than those who smoked. For effectiveness, the hospital needs to be considered
as a whole system where policies and practices are mutually supportive and integrated into the culture of the organisation. The survey
identified that this is not always in evidence.
2003 Elsevier Ireland Ltd. All rights reserved.
Keywords: Health Promoting Hospital; Health promotion; Hospital; Patients; Receptivity
1. Introduction
There has been a growing international awareness and
development of health promotion in the hospital setting
[13]. There has been structured development through the
World Health Organisation (Europe) Health Promoting
Hospital (HPH) movement. The Health Promoting Hospital
concept has been described as an umbrella concept consisting of a number of methods that share the common focus
of better health and the empowerment of patients, staff and
the local community [4]. This approach has provided concrete strategies for project implementation that are based
on the WHO Ottawa Charter for health promotion which
defines health promotion as the process of enabling people
to increase control over and to improve their health [5].
Indeed, the concept of empowerment is a common feature
of discussions on health education and health promotion
[6]. For hospital patients, this involves encouraging them
to take an active participatory role [7]. Thus, a major issue
is the evaluation of the individual empowerment process in
terms of the extent to which the capacity to exert control
over personal determinants of health are reinforced [6].
2. Method
The hospital can act as a change agent and is also a
physical and social setting [4]. Attitudes concerning these
factors are indicators of receptivity to health promotion in
the hospital setting. Thus, patients attitudes towards the
broad concept of health promotion in the hospital setting
and towards specific interventions were investigated. This
included attitudes towards both the principle of health promotion in the hospital and a smoking policy as an example
0738-3991/$ see front matter 2003 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/S0738-3991(03)00198-8
74
It was not assumed that patients accorded distinction between the meanings of the terms health promotion and
health education. In attitudinal questions, indirect questions were used as this tends to counter respondents giving
answers perceived as being those desired by the researcher
[12]. Expert health care professionals and a convenience
sample of patients reviewed individual items and the entire questionnaire for clarity and relevance. Multiple choice
questions included a Dont know category so that respondents were not forced to select an option that did not represent their views.
2.2. Questionnaire
Questions were developed from previously validated surveys [11]. These surveys had been designed for use with
a health care professional population. Minor changes were
made to questions so that they were appropriate for a lay
sample. The questionnaire was subsequently piloted with a
convenience sample of 10 medical and 10 surgical patients.
Patients were invited to agree or disagree with statements relating to health promotion and lifestyle issues using
four-point Likert-type scales. Attitude statements were designed to be relevant to the patients in order to encourage
3. Results
3.1. Receptivity to health promoting policies
To ascertain broad attitudes towards the principle of health
promotion in the hospital setting, respondents were asked
whether hospitals should be taking a role in promoting health
as well as being centres for the treatment of disease. Compatible with the Health Promoting Hospital concept whereby
hospitals should develop health-orientated perspectives and
objectives, 300 patients (95.2%) agreed with the principle.
To investigate whether this attitude is consistent when
applied to a specific policy, patients were asked whether
100
87.2
86
90
80
70
60
smokers
50
non-smokers
40
29.1
32.8
30
20
10
0
for staff
75
for patients
Fig. 1. Percentages of patients agreeing that smoking should be banned on hospital premises for staff and for patients, n = 315.
76
alcohol consumption
7.3
92.7
69.3
smoking*
31.7
exercise level
50.5
49.5
weight
49.1
50.9
0%
change
not change
50%
100%
Fig. 2. Patients expressing a wish to modify their lifestyle by percentage of population, n = 318; () percentage of smokers, n = 56.
interfere with peoples lives by telling them to stop smoking, lose weight or take more exercise. Although there is no
significant difference in response by age or gender of patient, there is a significant difference according to the age
of leaving school (P < 0.05, d.f. = 9, n = 287). Those
patients who left school at the minimum statutory school
leaving age were more than twice as likely to agree with
the statement (35.6%) than those who remained at school
(15.1%) beyond this age. Patients were asked if they would
have liked information or advice from their nurse about exercise, smoking, diet or alcohol. One hundred forty-one patients (44.1%) did not want advice. Those in the younger
age group, 1624 years, were significantly less likely to have
information or advice (P < 0.01, 2 = 16.17, d.f. = 2,
n = 310). However, those who left school at the statutory
minimum school leaving age were significantly more likely
to have information or advice (P < 0.01, 2 = 18.9, d.f. =
3, n = 310). Although the majority of this group expressed
the view that nurses should challenge lifestyle issues and
that they would have liked information or advice there is
alcohol (n=23)
diet (n=57)
smoking (n=32)
exercise (n=46)
0%
50%
read all
mostly read
100%
not read
Fig. 3. Patients reported reading of leaflets on lifestyle issues given to them in the ward.
alcohol (n=23)
43.5
47.8
diet (n=54)
53.7
smoking (n=29)
55.2
exercise (n=46)
0%
8.7
35.2
37.9
50
43.5
very useful
quite useful
77
11.1
6.9
6.5
100%
78
in increasing receptivity to the HPH approach. For example, policies could be developed that allowed smoking in
some areas which, over time, moved the hospital towards
becoming smoke-free. This could be combined with health
education and the offering of alternative methods to support
individual smoking and stress reduction.
Most patients expressed the views that they would like
information and advice regarding lifestyle issues and that
they are reassured by explanations. This suggests that they
wished to make informed choices about their lifestyle, an
attitude supporting the empowerment of patients and compatible with the HPH approach to promoting health.
Although individual items have identified differences in
response according to demographic characteristics, no clear
pattern emerges. It is not possible from the data to identify
patients from demographic features who might be more receptive and thus assist the hospital culture to change. It appears that those patients who do not smoke are the group
most likely to be favourable towards the HPH approach in
that their views are most in accordance with its principles.
This is independent of age group, gender and educational
attainment.
4.1. Conclusion
The survey has demonstrated that patients are generally
receptive to health promotion in the hospital setting. Most
patients expressed a desire to modify some aspect of their
lifestyle behaviour and wanted to be able to make informed
choices about their lifestyle.
A key feature of the HPH and effective health promotion
is that a hospital needs to be considered as a whole system.
This means that policies and practice are mutually supportive
and that health promotion is integrated into the culture of
the hospital.
4.2. Practice implications
The findings of this study suggest that hospital-based practitioners should be encouraged to develop their role in health
promotion. A strategy should be developed across the hospital setting so that initiatives do not contradict each other.