Svane Jeff Kirk, Egerod Ingrid, Tønnesen Hanne
WHO Collaborating Center (WHO-CC)/Clinical Health Promotion Center, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, Denmark.
Intensive Care Unit, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
SAGE Open Med. 2018 Aug 13;6:2050312118792394. doi: 10.1177/2050312118792394. eCollection 2018.
Health promotion is on the global agenda. The risks targeted include smoking, hazardous alcohol consumption, nutrition and insufficient physical activity. Implementation of clinical health promotion, however, remains a major challenge. While several processes, models and frameworks for strategic implementation exist, very few have been tested in randomized designs. Testing a strategic implementation process for clinical health promotion was only recently attempted via a randomized clinical trial on the World Health Organization Health Promotion Hospitals Recognition Process. The randomized clinical trial showed that the process improved central parts of implementation. To complement these findings, this nested qualitative study aimed to explore experiences and perceptions of staff and managers, who had completed the process, and generate hypotheses for improvements.
We interviewed a purposeful sample of 45 key informants from four countries, who worked at clinical departments and had undertaken the World Health Organization Health Promotion Hospitals implementation process. The informants included 14 managers, 14 medical doctors, 13 nurses and 4 other clinical staff. Interview transcripts were analyzed using qualitative content analysis and an inductive approach to coding and categorization supported by QSR NVivo.
The informants' experiences and perceptions centered around four global themes concerning (1) awareness, cultural re-orientation and integration; (2) learnings; (3) normalization and legitimacy and (4) a more evidence-based, structured and systematic approach to clinical health promotion. Informants were positive toward the implementation process, although it was sometimes challenging. The suggested improvements to increase acceptability related to the patient survey, time consumption, translation, tailoring to local circumstances and in-advance training.
Managers and staff were positive toward the World Health Organization Health Promotion Hospitals process, which was perceived to bring about positive changes and learnings. The findings also suggest that the implementation process may be improved by minor adjustments to process elements and design. It is our recommendation to use the process in clinical departments to further implementation of clinical health promotion.
健康促进已列入全球议程。其针对的风险包括吸烟、有害饮酒、营养问题以及身体活动不足。然而，临床健康促进的实施仍是一项重大挑战。尽管存在一些战略实施的流程、模式和框架，但很少有在随机设计中进行过测试的。直到最近，才通过一项关于世界卫生组织健康促进医院认可程序的随机临床试验，尝试对临床健康促进的战略实施过程进行测试。该随机临床试验表明，这一过程改善了实施的核心部分。为补充这些发现，这项嵌套式定性研究旨在探索已完成该过程的工作人员和管理人员的经验与看法，并提出改进的假设。
我们从四个国家有目的地抽取了45名关键信息提供者进行访谈，他们在临床科室工作并参与了世界卫生组织健康促进医院的实施过程。这些信息提供者包括14名管理人员、14名医生、13名护士和4名其他临床工作人员。访谈记录采用定性内容分析法进行分析，并采用归纳法进行编码和分类，借助QSR NVivo软件提供支持。
信息提供者的经验和看法围绕四个总体主题展开，即（1）意识、文化重新定位与融合；（2）学习；（3）常态化与合法性；（4）采用更具循证性、结构化和系统化的方法进行临床健康促进。尽管有时具有挑战性，但信息提供者对实施过程持积极态度。为提高可接受性而提出的改进建议涉及患者调查、时间消耗、翻译、因地制宜以及预先培训等方面。
管理人员和工作人员对世界卫生组织健康促进医院程序持积极态度，认为该程序带来了积极变化和学习成果。研究结果还表明，通过对流程要素和设计进行微小调整，实施过程可能会得到改进。我们建议在临床科室使用该程序，以进一步推动临床健康促进的实施。
