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In 2002, the Beijing Committee for Disease Prevention launched guidelines based on the Ottawa Charter for Health Promotion on health promoting hospitals (HPHs). HPH pilot projects were then initiated, on a voluntary basis, in 44 Beijing hospitals. Evaluations have been undertaken to assess the impacts of the pilot project. This article outlines thi...
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Citations
... One common barrier relates to limited understanding toward the concept of HP and HPHs. [8][9][10] Studies showed that managers and health-care professionals had limited understanding toward the concept of HP and some never heard about HPHs. [7,10,11] Other studies show that HP is a misunderstood concept in nursing, and many nurses still do not understand the extent to which they apply HP or health education in their practice. ...
... [8][9][10] Studies showed that managers and health-care professionals had limited understanding toward the concept of HP and some never heard about HPHs. [7,10,11] Other studies show that HP is a misunderstood concept in nursing, and many nurses still do not understand the extent to which they apply HP or health education in their practice. [12] One study showed that midwives had a limited knowledge about HP, and this concept often used interchangeably with health education. ...
... [5] This lack of understanding in health-care professionals hinders hospitals' ability to effectively reorient health services. [9,10] The implementation of the HP program is new in hospitals of Iran, and this concept has been taken into account just in line with the Accreditation and Quality Improvement Program. Hospitals move toward HP require the commitment of all health-care professional groups, [7,9,13] and the effective use of the potential of hospitals for implementing these programs is affected by the HP perceptions of these groups. ...
BACKGROUND: Although the World Health Organization has emphasized the need for reorientation of hospitals toward health promotion (HP), HP in hospitals of Iran is a new concept. This study investigated the concept of HP among health-care professionals working in educational hospitals of Isfahan, Iran, 2015.
METHODS: A descriptive exploratory qualitative approach was employed in this study, with semi-structured interviews to investigate HP concept. The study settings included four selected educational hospitals affiliated to the Isfahan University of Medical Sciences. A purposive sample consisted of 15 health-care professionals who were participated in the study.
RESULTS: Most of the participants perceived HP as a concept synonymous to health education and disease prevention. Other meaning attributes to HP were improved quality of life and well-being, clinical practice, individual and group approach to increase health, and holistic view to health. Some empowerment strategies were described by participants, but most of the participants rarely went beyond traditional health education strategy aimed at an individual target. A sizeable number of participants used interchangeably the terms “health promotion” with “prevention,” “health education,” and “hygiene”.
CONCLUSIONS: It seems that participants of this study had limited knowledge about HP. Health-care staff have a decisive role for reorienting hospitals toward HP; thus, there is a need for ongoing in-service training for health-care professionals of hospitals to focus on HP.
... All the 26 pinpointed studies were conducted in the developed countries where, adaptation of the HPH standards was initiated through formal approval of membership in the Health Promoting Hospital Network (HPHN). Only five studies were recognized to be published after 2014 and in 14 reports both barriers and facilitators of implementing the HPH standards Johnson 1998;Tountas et al. 2004;Guo et al. 2007;NHS Health Scotland 2010, Lin andLin 2011, Lee Table 3. Most frequently reported facilitators of and barriers to implement Health Promoting Hospital standards (n = # studies in which factor reported). ...
... Capacity building for implementing the HPH standards in the missions and policies of the hospitals as well as giving priority to health promotion and implementation of the HPH standards, promoting organizational culture, management practices, staff participation and basic structure of the hospitals were announced as major facilitators for their implementation (Lee et al. 2012, Lee, Chen, andTountas et al. 2004;Miseviciene and Zalnieraitiene 2012). Bi-multilateral collaboration and partnership between hospitals and other sections of the health systems (Tountas et al. 2004;Johnson and Nolan 2004;Guo et al. 2007;Lee et al. 2012;Lee, Chen, Powell, et al. 2014Miseviciene and Zalnieraitiene 2012;) was also reported to be a major facilitating factor for the HPH implementation. Resource-related factors such as having available funding, allocated time, human and material resources were other reported facilitating factors of implementing these standards Johnson and Nolan 2004;Guo et al. 2007;Lin and Lin 2010;Robert and Olivia 2015;Johansson, Weinehall, and Emmelin 2010;Miseviciene and Zalnieraitiene 2012; (Tables 1 and 2; Figure2). ...
... Bi-multilateral collaboration and partnership between hospitals and other sections of the health systems (Tountas et al. 2004;Johnson and Nolan 2004;Guo et al. 2007;Lee et al. 2012;Lee, Chen, Powell, et al. 2014Miseviciene and Zalnieraitiene 2012;) was also reported to be a major facilitating factor for the HPH implementation. Resource-related factors such as having available funding, allocated time, human and material resources were other reported facilitating factors of implementing these standards Johnson and Nolan 2004;Guo et al. 2007;Lin and Lin 2010;Robert and Olivia 2015;Johansson, Weinehall, and Emmelin 2010;Miseviciene and Zalnieraitiene 2012; (Tables 1 and 2; Figure2). ...
The Health Promoting Hospitals’ (HPH) initiative faces many challenges in practice to be implemented in diverse socio-economic and organizational settings. This systematic review was aimed to review empirical impeding factors and facilitators to pursuit the HPH standards. To provide a map of global research evidence on barriers and facilitators of adapting the HPH standards, several databases including PubMed, Embase and Scopus were searched using the relevant Medical Subject Headings (MeSH) for publications in June 1988 up to December 2018. The Socio Ecological Model (SEM) was employed to outline the pinpointed hurdles and supporting antecedents. Screening of the databases yielded 2,539 records of them 24 publications were eligible for inclusion and all were from developed countries. The most frequently reported facilitators were availability of resources, leadership and management support, intra health system collaboration/partnership and organizational capacity building for the HPH implementation. The most prevalent reported barriers were scarcity of resources, insufficiency of leadership and/or management support, paucity of skilled and informed/committed personnel, deficiency of evaluation programmes, not having health promoting approach amongst personnel, low priority of health promotion activities in hospitals and overall policy resistance to change. Based on the Socio Ecological Model’s (SEM) framework, the identified impeding and facilitating precedents could be scattered at all levels of the model i.e. individual to political strata. The identified challenges and compliances simply reflected the de facto situation in the developed countries to administer the HPH standards in traditional hospital settings.
... All the 26 pinpointed studies were conducted in the developed countries where, adaptation of the HPH standards was initiated through formal approval of membership in the Health Promoting Hospital Network (HPHN). Only five studies were recognized to be published after 2014 and in 14 reports both barriers and facilitators of implementing the HPH standards Johnson 1998;Tountas et al. 2004;Guo et al. 2007;NHS Health Scotland 2010, Lin andLin 2011, Lee Table 3. Most frequently reported facilitators of and barriers to implement Health Promoting Hospital standards (n = # studies in which factor reported). ...
... Capacity building for implementing the HPH standards in the missions and policies of the hospitals as well as giving priority to health promotion and implementation of the HPH standards, promoting organizational culture, management practices, staff participation and basic structure of the hospitals were announced as major facilitators for their implementation (Lee et al. 2012, Lee, Chen, andTountas et al. 2004;Miseviciene and Zalnieraitiene 2012). Bi-multilateral collaboration and partnership between hospitals and other sections of the health systems (Tountas et al. 2004;Johnson and Nolan 2004;Guo et al. 2007;Lee et al. 2012;Lee, Chen, Powell, et al. 2014Miseviciene and Zalnieraitiene 2012;) was also reported to be a major facilitating factor for the HPH implementation. Resource-related factors such as having available funding, allocated time, human and material resources were other reported facilitating factors of implementing these standards Johnson and Nolan 2004;Guo et al. 2007;Lin and Lin 2010;Robert and Olivia 2015;Johansson, Weinehall, and Emmelin 2010;Miseviciene and Zalnieraitiene 2012; (Tables 1 and 2; Figure2). ...
... Bi-multilateral collaboration and partnership between hospitals and other sections of the health systems (Tountas et al. 2004;Johnson and Nolan 2004;Guo et al. 2007;Lee et al. 2012;Lee, Chen, Powell, et al. 2014Miseviciene and Zalnieraitiene 2012;) was also reported to be a major facilitating factor for the HPH implementation. Resource-related factors such as having available funding, allocated time, human and material resources were other reported facilitating factors of implementing these standards Johnson and Nolan 2004;Guo et al. 2007;Lin and Lin 2010;Robert and Olivia 2015;Johansson, Weinehall, and Emmelin 2010;Miseviciene and Zalnieraitiene 2012; (Tables 1 and 2; Figure2). ...
Objective: This study aimed to investigate prospects of a sample of Iranian front line health care professionals about their perceived barriers to implement the HPH initiative. Methods: The six stages Q methodology was applied to systematically envisage divergent perspectives of the 33 health professionals (7 physicians, 2 managerial and 24 nurses) working in the 10 educational hospitals in Iran. Results: Analysis of the study participants’ viewpoints (the Q-sorts) resulted in a five factor solution (accounted for 48% of the total variance) to endorse main barriers of the HPH implementation in the typical Iranian hospitals. The health professionals’ dominant biomedical approach and their deficit commitment to health promotion programs, inappropriate decision-making mechanisms and insufficiency of the organizational infrastructure in the Iranian national health system (INHS) were among the important emanated factors to sustainably maintain the HPH program. Conclusion: The identified barriers reflect the spheres that need to be focused in interventions to facilitate the successful implementation of the HPH initiative in Iran and other developing countries. Practice implications: Despite the existent consensus about overall merits of the HPH to fulfill best interests of hospitalized patients, major challenges deems to exist for operability of this beneficial undertaking in Iran.
... Regarding first criterion that is lLeadership, one of the problems concerned managerial staff's attitudes toward HPH. In order to be able to initiate and implement HPH program for patients, their families, staff and the community as a hospital everyday activity, the participation and support of hospital leaders seems essential in the HPH implementation process (Guo et al., 2007;Yaghoubi et al., 2016). The importance of this role is also emphasized in other studies (Polluste et al., 2006).The hospital leaders have the best opportunity for the implementation of HPH; however, it is largely ignored by the HPH management team (Polluste et al., 2006, Guo et al., 2007. ...
... In order to be able to initiate and implement HPH program for patients, their families, staff and the community as a hospital everyday activity, the participation and support of hospital leaders seems essential in the HPH implementation process (Guo et al., 2007;Yaghoubi et al., 2016). The importance of this role is also emphasized in other studies (Polluste et al., 2006).The hospital leaders have the best opportunity for the implementation of HPH; however, it is largely ignored by the HPH management team (Polluste et al., 2006, Guo et al., 2007. In similar vein, we can refer to Rudolfstiftung Hospital that was successful in HPH programs implementation and enjoyed the support of managers and owners (Johnson and Baum, 2001). ...
... Regarding policy and strategy criteria, it can be said that in addition to leaders' support for the development of HPH, organizational support through developing HP strategies, and funding are also essential (Johnson and Baum, 2001;Johnson and Nolan, 2004;Guo et al., 2007;Pelikan, 2007). HPH manual and self-assessment form of WHO also emphasizes the key role of HPH strategy development (Groene, 2006). ...
One of the requirements for the implementation of Health Promoting Hospitals (HPHs) is comprehensive integration of health promotion (HP) activities and programs in hospital quality management system. Therefore, this systematic review was conducted utilizing a comprehensive European Foundation for Quality Managment (EFQM) model to determine appropriate criteria for the implementation and development of HPH. This systematic review considered the published literature on factors affecting the implementation and development of HPH during 1997-2016. Twenty-three articles were finalized for further investigation. EFQM was used as guidance for the investigation and analysis of studies conducted in relation to HPH. Regarding our results, real need analysis and accurate assessment of needs, attention to infrastructure factors, HPH standardization, promotion of self-care, knowledge enhancement and patient and staff skills training, improvement of quality indicators, continuous participation of HPH committee, designing HP interventions, paying attention to clinical outcome, equity in health, promoting a healthy work environment, continuity and cooperation etc. are among the factors contributing to HPH implementation and development. In case of having high capacity for successful HPH implementation, comprehensive HPH capacity building and resource development are not possible unless they are performed based on one of the framework emphasized by World Health Organization (WHO) such as EFQM.
... [3,9] In agreement with the present study, in a study by Aghakhani et al., participants did not consider health education activities their own responsibility, [15] and personnel's negative attitude, lack of HP knowledge, poor skill and self-efficacy, and low motivation were identified as barriers. [3,9,[16][17][18][19] There is no self-efficacy for implementation of HP activities, and the need for teaching the concept and skills such as interaction with patients, planning, and teaching skills is deeply felt, which highlights the importance of education and training of personnel. Participants also cited lack of education and proposed initiation of education for key hospital personnel as an effective strategy to facilitate hospital reorientation toward HP. ...
... Similar results were also found in other studies. [6,15,16,20,21] In Miseviciene and Zalnieraitiene and Aujoulat et al. study, nonparticipation of the multidisciplinary care team and imposing extra duties on nurses were identified as barriers. [20,22] HP relies on interdisciplinary activities, [3] and a coordinator in hospital and an external regulator can help eliminate this challenge. ...
Context:
The World Health Organization (WHO) has emphasized the need for reorientation of hospitals toward health promotion (HP).
Aims:
This study explores health-care professionals' perception of barriers and strategies to implementing HP in educational hospitals of Isfahan Province in Iran.
Settings and design:
The study settings included four selective educational hospitals and the Treatment Administration affiliation to the Isfahan University of Medical Sciences.
Subjects and methods:
A qualitative content analysis approach was employed in this study, with semi-structured in-depth interviews. Eighteen participants from hospital and accreditation managers, nurses, community medicine specialist, and directors of health-care quality improvement and accreditation participated in the study by purposeful sampling method. The data were analyzed using content analysis method.
Results:
The barriers can be categorized into the following areas: (1) barriers associated with patient and community, (2) barriers associated with health-care professionals, (3) barriers associated with the organization, and (4) external environment barriers. The results were summarized into four categories as strategies, including: (1) marketing the plan, (2) identifying key people and training, (3) phasing activities and development of feasible goals, and (4) development of strategic goals of health promoting hospitals and supportive policies.
Conclusions:
The interactions of individual, organizational, and external environmental factors were identified as barriers to implementation of HP in hospitals. To hospital reorientation toward HP, prioritizing the barriers, and using the proposed strategies may be helpful.
... The most common reported barriers for an organisation aiming to increase health promotion capacity were: lack of management support; 20,26,37,38 lack of dedicated health promotion staff; 25,26,30,41 Articles for full text evaluation staff who lacked skills or confidence in health promotion; 25,30,39,42 competing priorities; 25,28,29,[37][38][39]41,43 and a lack of time and resources allocated to health promotion activities. 29,30,37,41 A summary of these barriers is presented in Table 3. ...
... The most common reported barriers for an organisation aiming to increase health promotion capacity were: lack of management support; 20,26,37,38 lack of dedicated health promotion staff; 25,26,30,41 Articles for full text evaluation staff who lacked skills or confidence in health promotion; 25,30,39,42 competing priorities; 25,28,29,[37][38][39]41,43 and a lack of time and resources allocated to health promotion activities. 29,30,37,41 A summary of these barriers is presented in Table 3. ...
... The most common reported barriers for an organisation aiming to increase health promotion capacity were: lack of management support; 20,26,37,38 lack of dedicated health promotion staff; 25,26,30,41 Articles for full text evaluation staff who lacked skills or confidence in health promotion; 25,30,39,42 competing priorities; 25,28,29,[37][38][39]41,43 and a lack of time and resources allocated to health promotion activities. 29,30,37,41 A summary of these barriers is presented in Table 3. ...
Issue addressed
Primary healthcare settings are important providers of health promotion approaches. However, organisational challenges can affect their capacity to deliver these approaches. This review identified the common enablers and barriers health organisations faced and it aimed to explore the experiences health organisations, in particular Aboriginal organisations, had when increasing their health promotion capacity.
Methods
A systematic search of peer‐reviewed literature was conducted. Articles published between 1990–2014 that focused on a health care‐settings approach and discussed factors that facilitated or hindered an organisation's ability to increase health promotion capacity were included.
Results
Twenty‐five articles met the inclusion criteria. Qualitative (n = 18) and quantitative (n = 7) study designs were included. Only one article described the experiences of an Aboriginal health organisation. Enablers included: management support, skilled staff, provision of external support to the organisation, committed staffing and financial resources, leadership and the availability of external partners to work with. Barriers included: lack of management support, lack of dedicated health promotion staff, staff lacking skills or confidence, competing priorities and a lack of time and resources allocated to health promotion activities.
Conclusions
While the literature highlighted the importance of health promotion work, barriers can limit the delivery of health promotion approaches within primary healthcare organisations. A gap in the literature exists about how Aboriginal health organisations face these challenges.
So what?
Primary healthcare organisations wanting to increase their health promotion capacity can pre‐empt the common barriers and strengthen identified enablers through the shared learnings outlined in this review.
... This can also be seen in the current study as the dimension of Policy. For implementing HPH programs, access to adequate budget (28)(29)(30)(31)and the health promotion policy (28,31) are important. Using data obtained from the society and making the required policies, hospitals can develop and implement programs and interventions for health promotion (the dimension of Management). ...
... This can also be seen in the current study as the dimension of Policy. For implementing HPH programs, access to adequate budget (28)(29)(30)(31)and the health promotion policy (28,31) are important. Using data obtained from the society and making the required policies, hospitals can develop and implement programs and interventions for health promotion (the dimension of Management). ...
... Similarly, these phases have also been referred to in the present study. The administrators of BE Jing hospital (28) have considered the dimensions of Policy, Reorientation of health care services, Society, and Health Skills as the health promotion activities (28) which are similar to the dimensions of the current study conceptual model, as well as the design and implementation phases of health promotion in the proposed model of Kouranie hospital (14). In the present study, Dissemination (publishing health promotion programs and activities and their results at international conferences and NEWS media and arranging business meetings on HPH programs) with a good loading factor (0.64) had a high impact on the implementation of health promotion programs in the hospital. ...
Background:
Hospitals are the central entity of each health care system and Health Promoting Hospitals (HPH) was launched by WHO in 1988. However, there has not been any accurate and detailed model for establishing a HPH in Iran up to now. Therefore, this study aimed to determine factors affecting the establishment of a health promoting hospital in Iran using factor analysis method.
Methods:
This applied, cross-sectional and descriptive-analytical study was conducted in Iran in four steps. Confirmatory Factor Analysis (CFA) was used for determining factors affecting the establishment of a HPH.
Results:
Society (0.97) and Policy (0.74) had the highest regression weights (effects) and management had the lowest one.
Conclusion:
Community assessment was the most important dimension of proposed conceptual model for establishing a HPH.
... This can also be seen in the current study as the dimension of Policy. For implementing HPH programs, access to adequate budget (28)(29)(30)(31)and the health promotion policy (28,31) are important. Using data obtained from the society and making the required policies, hospitals can develop and implement programs and interventions for health promotion (the dimension of Management). ...
... This can also be seen in the current study as the dimension of Policy. For implementing HPH programs, access to adequate budget (28)(29)(30)(31)and the health promotion policy (28,31) are important. Using data obtained from the society and making the required policies, hospitals can develop and implement programs and interventions for health promotion (the dimension of Management). ...
... Similarly, these phases have also been referred to in the present study. The administrators of BE Jing hospital (28) have considered the dimensions of Policy, Reorientation of health care services, Society, and Health Skills as the health promotion activities (28) which are similar to the dimensions of the current study conceptual model, as well as the design and implementation phases of health promotion in the proposed model of Kouranie hospital (14). In the present study, Dissemination (publishing health promotion programs and activities and their results at international conferences and NEWS media and arranging business meetings on HPH programs) with a good loading factor (0.64) had a high impact on the implementation of health promotion programs in the hospital. ...
... In addition to facilitating the implementation process with teaching and training of staff to be able to handle the new activities, also staff and management attitudes 27,28 and individual lifestyle are surprisingly important for successful implementation of HP 29 . Interestingly, the patients are positive towards new interventions, and especially positive to being offered HP services as an integrated part of the patient pathways 30,31,32,33 . ...
... Based on the sparse literature on integration of effective health promotion into clinical routines, hospital staff, managers and patients generally have a positive approach to health promotion quality management (21)(22)(23). The patients usually express acceptance of and preference for effective health promotion programmes that can reduce their complications and period of recovery (24)(25)(26). ...
