Health Promoting Hospitals Research Articles

Guidance on health promoting and climate-friendly hospitals and health services

Abstract The negative impacts of climate change on health and the healthcare system are becoming increasingly evident. The healthcare sector, which accounts for nearly seven percent of Austria’s CO2 emissions, contributes to the exacerbation of climate change on one hand, but is also affected by its consequences on the other. To meet these challenges, it is necessary for healthcare facilities to both adopt climate-protective measures and adapt to the changed conditions. A project launched in 2023, supported by the Austrian Health Promotion Agenda and in cooperation with the Austrian Network of Health Promoting Hospitals and Health Services, has shown that there is a need for support in implementing climate protection measures in healthcare facilities. In response, the WHO Collaborating Centre for Health Promotion in Hospitals and Healthcare, located at the Competence Centre for Health Promotion and Healthcare at the Austrian National Public Health Institute, will work on the development of standards based on international models to support healthcare facilities in the introduction of climate-friendly practices until 2026. The methodology of the project includes the analysis of existing quality criteria and instruments, as well as a modified Delphi process with two rounds of online questionnaires directed at an international panel of experts. After each round, exchange meetings with a smaller group from the panel take place to achieve consensus. Based on the research findings and the Delphi consultations, a draft of standards and an implementation manual will be created. These drafts will be piloted in various healthcare facilities in Austria and other countries to assess their practicability and effectiveness. Following the pilot tests, the standards and the manual will be revised to integrate the practical insights gained. At the time of the conference, the initial results of the Delphi process will be presented, providing insights for the further development of the standards. Key messages • Integrating climate-friendly practices into all aspects of healthcare can reduce its environmental impact, improve health outcomes, and contribute to the broader sustainable development goals. • Climate-friendly approaches yield significant health, economic, and social co-benefits.

Effects of collaborative learning-based food literacy program on healthy eating behavior and hemoglobin A1c among older adults with uncontrolled type 2 diabetes: A randomized controlled trial study in Thailand.

Uncontrolled type 2 diabetes mellitus (T2DM) is a prevalent issue among older adults. Healthy eating behavior (HEB) is a significant factor contributing to blood sugar control. It is a complex behavior that requires knowledge, attitudes, and skills in food literacy, which can be achieved through collaborative learning by nurses. Although collaborative learning has successfully improved food literacy and HEB among adults and older adults in general, its effectiveness has not been investigated among older adults with uncontrolled T2DM. This randomized controlled trial aimed to examine the effects of the Collaborative Learning-Based Food Literacy Enhancement Program (CLFLEP) on HEB and hemoglobin A1c (HbA1c) levels among older adults with uncontrolled T2DM. Participants were 80 older adults with uncontrolled T2DM attending primary care units (PCUs) or sub-district health promotion hospitals in northern Thailand. They were randomly assigned to either the experimental group (n = 40) or the control group (n = 40). The experimental group received the CLFLEP to enhance four domains of food literacy through five major elements of collaborative learning, while the control group received standard care. Data were collected between January and June 2023 using the Demographic Data Form, the Eating Behavior Questionnaire, the HbA1c test, and the Short Food Literacy Questionnaire. Data analysis involved descriptive statistics for demographic characteristics and independent t-test and paired sample t-test for HEB and HbA1c based on intention-to-treat (ITT) and per-protocol (PP) analyses. The experimental group had a higher HEB score than the control group (p <0.001 for ITT and PP) and higher than their scores before program participation (p <0.001 for ITT and PP). The effect size (Cohen's d) was 1.46. The experimental group also had a lower HbA1c level than the control group (p = 0.002 for ITT and PP) and lower than their levels before program participation (p = 0.005 for ITT and 0.001 for PP). The effect size (Cohen's d) was 0.70. The CLFLEP was effective in promoting food literacy, HEB, and blood sugar control. Nurses can be trained to use this program to provide collaborative health education for older adults with uncontrolled T2DM. Nursing administrators can use these findings to develop organizational policies that enhance nurses' competencies as educators skilled in collaborative learning. TCTR20221222005 [Thai Clinical Trials Registry].

Nursing Informatics and Digital Technology Using in Aging Home Care Delivery Development

This participatory action research aimed to enhance nurses’ role in informatics and digital technology for aging home care delivery at 13 health-promoting hospitals, in Kantharawichai District, Mahasarakham Province, Northeastern Thailand from January - December 2021. There were 139 participants; 13 nurses, 52 community caregivers, 37 family caregivers, and 37 bed-bound elderly. The researchers facilitated the participants sharing of their own experiences and reflected on aging home care. This research included four phases; 1) Assessment; data was collected through in-depth interviews, small group dialogue, and observation of nurses and caregivers practicing, 2) Intervention planning; three times brainstorming was created for health problem identification and intervention planning, 3) Intervention; participants joined aging home care delivery, 4) Evaluation; brainstorming was created for each health promoting hospital evaluation. Content analysis was used for data analysis. Results showed that; Nurses as care managers of this PAR cooperative learning efforts increased knowledge, attitude, and practice in informatic and digital technology to develop aging home care. They formulated strategies to supervise caregivers caring for bed-bound elderly; 1) enhancing caregivers’ knowledge through the application, raising awareness and skill regarding informatics and digital technology applied for care plan and counseling, 2) promotion of online reports for aging caregiver activities, 3) creation line official for supervising caregiver caring, and 4) online network development of aging home care delivery linked to district hospital for medical consulting and local administrative organization for economic and social consulting. The empowering participatory process of this PAR could encourage nurses to create a way for effective supervision and cooperative primary care through line official effectiveness. This process can be applied to create and enhance informatics and digital technology for complex caring in rural areas.

Health Promotion Management in the Context of Breast Cancer Prevention Using the SADARI and CERDIK Methods at Al Ihsan Regional General Hospital, West Java Province

This study aims to determine the systematics of Health Promotion Management in Hospitals on the effectiveness of the performance of Hospital Health Promotion Services. By conducting studies, planning, implementation and evaluation as well as monitoring to measure the success of PKRS activities in accordance with the rules of the Regulation of the Minister of Health of the Republic of Indonesia Number 44 of 2018 concerning the Implementation of Hospital Health Promotion (PKRS). The research method used is Qualitative Descriptive with the data collection used is making questionnaires, and observations because they have close relevance to the problem. The results after collecting 20 respondents using the Pre Test revealed that the average score was 5.6 out of 100, which can be concluded that the knowledge of the hospital community is still minimal about the awareness of maintaining health with the Cerdik method and early examination of SADARI. After counseling and counseling activities with the same 20 respondents, it was seen that the increase in the number of community knowledge with an average score of 8.7 out of 100 was seen. The findings of this study show that the hospital health promotion management system has an impact on the effectiveness of educational services at Al Ihsan Hospital, West Java Province.

Factors Affecting Hospital Provision of Health-Promoting Services Transferred to Provincial Administration in Thailand.

Following the transfer of hospital services to provincial government oversight, it is essential to understand how such changes impact service quality and efficiency. This study, conducted from 1 March 2023 to 31 March 2024 at sub-district health-promoting hospitals in Thailand, aims to identify the factors affecting hospital service quality post-transfer and evaluate the role of professional nurses in maintaining service standards under new governance. Utilizing a mixed-methods design based on the Global Fund-HSS framework (2012), which categorizes factors into accessibility, processes, productivity, and outcomes, we collected data from 340 nurses and 400 patients through structured questionnaires. These questionnaires were divided into seven sections, capturing metrics such as the personal data of nurses, hospital service activities, and leadership qualities. We employed a Likert scale to gauge the perceptions and expectations of service quality and conducted paired t-tests to compare performance metrics before and after the administrative transfer. One-way ANOVA was used to assess variability among different service units, and binary logistic regression helped identify the key determinants of service quality. The analysis revealed a significant correlation between the attitudes and competencies of healthcare teams and the levels of service quality. Notably, service units transferred less than 50% exhibited minimal changes, indicating that the degree of transfer significantly impacts service outcomes. Despite these variations, the fundamental mission of promoting health remained consistent. The study emphasizes the critical role of nurses and recommends further research to identify additional factors that could improve service quality in transferred healthcare facilities, potentially contributing to enhanced healthcare delivery across restructured health systems.

Utilization Community-Based Rehabilitation Methods to Improve Independence and Quality of Life for Patients with Disabilities in Nara Phirom Health Promoting Hospital, Thailand

The disability community activity, Nara Phirom Health Promoting Hospital in Banglen District, Nakhon Pathom, Thailand, collaborated with the Faculty of Physiotherapy, Mahidol University to support the disability community. Using the Community-based rehabilitation (CBR) method, the aim to enhance independence and quality of life. Evaluation includes IADL for independence and WHOQoL Bref-100 for quality of life. Education on health, immobilization, and exercise was provided to patients, families, and caregivers. Therapists teached physical exercises, to be repeated 2-3 times daily by caregivers and family. The 1-month program, supervised by therapists, includes standing and walking for patients with lower extremity strength of 3/5 (measured by manual muscle testing). Rehabilitation involves crafting items like wallets and bags, stamps, and flowers from bottles. Results, patients with low function status (very dependent on other people) decreased by 64.3%, moderate function increased by 116.7% and independence increased by 111.1%. There was a significant improvement in quality of life (WHOQoL) and all domains after CBR program.

Lifestyle of primary healthcare professionals (nutrition, tobacco, sexual health): a cross-sectional survey

Introduction. Healthcare workers (HCWs) should theoretically have the necessary education and environment to adopt a healthy lifestyle, and they supposedly also should have a higher participation rate in WHP programmes. HCWs are, for several reasons, considered to be a key group in health promotion, especially due to the fact that the healthcare system reaches a substantial number of people in need of lifestyle changes such as increased physical activity (PA) [5]. Furthermore, healthcare professionals are considered to be the most credible source of health information [6]. HCWs' lifestyles can play an important role in increasing awareness among patients regarding lifestyle changes, because HCWs' own lifestyle habits and interests in lifestyle behaviour have been shown to positively influence their counselling practices and attitudes [6–7]. The international movement 'Health Promoting Hospitals and Health Services', which was initiated by the World Health Organization (WHO), highlights the importance of also focusing on the health and lifestyle of the employees. Methods. We conducted survey based on a standardized and adapted questionnaire that included socio-demographic data and points related to healthy lifestyle. We adhered to the latest recommendations on designing and reporting survey studies. Before conducting the study, the questionnaire was pretested among 5 experts and revised twice. The survey was conducted in Kazakh / Russian for respondents who speak two languages fluently at the choice of participants. The filling of the questionnaire took on average 45 minutes. We reported absolute numbers and percentages. Chi-square tests were used to compare responses between groups. Results were considered significant at a P value of &lt; 0.05. Statistical analyses were performed using the application SAS OnDemand for academia (version 3.81, Carry, North Carolina, USA). Results. Our data revealed that nurses were more likely to adhere to healthy eating principles and to have a regular diet at home. GPs were more likely to consume fast food and add salt when food is not salted enough. Nurses were more likely to eat greens regularly. GPs had a stronger belief in the impact of diet on health. More nurses rated their diet as healthy. Media promotion significantly influenced GPs for changing diet towards healthier options. Eating patterns vary according to the risk of stress. Research shows that chronic stress influences the amount and types of consumed food, contributing to both overeating and malnutrition, and that stress hormones can lead to the development of obesity. GPs are more likely to have used tobacco products compared to nurses. GPs are more likely to smoke more than 10 cigarettes per day. GPs have a slightly higher belief in the necessity of a healthy lifestyle compared to nurses. GPs and nurses have different testing frequencies for Hepatitis B and C, with nurses testing more frequently. GPs are more likely to have sexual activity after drinking alcohol. Conclusion. It is known that a healthy lifestyle of doctors affects the attitude of patients and their motivation to change their lifestyle. Thus, the lifestyle patterns of health workers, as well as the understanding of the motivation of these patterns, are more likely to affect public health.

Factors associated with oral health care behavior of people with type 2 diabetes mellitus: A hospital-based, cross-sectional study.

Oral healthcare behavior determines oral health status and the incidence of oral diseases. People with type 2 diabetes mellitus (T2DM) are at-risk of having low oral healthcare behavior and disease-related oral health. To investigate the oral health status and factors associated with oral healthcare behavior among people with T2DM in Thailand. In total, 401 people with T2DM participated in the study based on their attendance at a non-communicable disease clinic at sub-district health promotion hospitals in Bueng Kan, a north-eastern province in Thailand. A structured questionnaire was used to obtain variables of interest. Linear regression analysis at the 95% confidence interval (CI) was applied. The majority of participants were female (73.8%). More than three-quarters had more than 20 permanent teeth (77.6%), a decay missing filling tooth index was 10.6 teeth/person. Many participants had four permanent occlusal pairs (69.6%), had tooth decay (74.6%), and some participants had tooth filling (32.2%). Statistically significant factors associated with oral healthcare behavior were: having complications associated with diabetes mellitus (Beta = -0.097, 95%CI = -1.653, -0.046), oral health literacy (Beta = 0.119, 95%CI = 0.009, 0.150), educational level (Beta = 0.123, 95%CI = 0.103, 0.949), oral healthcare attitude (Beta = 0.258, 95%CI = 0.143, 0.333), and oral health services (Beta = 0.430, 95%CI = 0.298, 1.408). People with T2DM had good oral health status. People with T2DM with low oral health literacy, low attitude, and low level of oral health services were at a higher risk of poor oral healthcare behavior.

Strategies for Changing the Approach of Health Promoting Hospitals Based on the Importance-Performance Model: A Case Study in Yazd Hospitals in 2022

Background: Considering the key role of hospitals in improving the level of health, staff and community, implementing standards and promoting activities in hospitals is necessary to realize this important goal. Therefore, the study purpose to examine the strategies for changing the approach of health hospitals based on the importance-performance model. Methods: The present descriptive and cross-sectional study was conducted in 2022 in selected hospitals of Yazd province, Iran. 56 hospital managers and officials were selected by census method. Data was collected using the World Health Organization (WHO) questionnaire regarding HPH (health promoting hospital) standards which contains 69 questions. The data was analysed using SPSS26, and mean score and standard deviation of importance and performance of HPH standards were calculated. The status of HPH standards in the studied hospitals was investigated using the importance-performance analysis matrix. Results: The results showed that HPH standards had a moderate importance from the point of view of the studied people (3.89±0.76) and in the examination of the performance of the studied hospitals regarding HPH standards, the researchers implemented the standards in a moderate level (3.28±0.51). All the standards were identified as the points for keeping up the good work points based on importance-performance analysis matrix in the studied hospitals. Conclusion: In order to fully achieve the standards and improve the condition of hospitals, changing the views of hospital managers and health service policy-makers towards the HPH plan, creating specific and consistent policies and guidelines in the field of training and interventions provided to patients and employees is necessary and effective.

A BWM-TOPSIS Linear Programming Model for Evaluating the Performance of Health-Promoting Hospitals with McKinsey 7s Framework in Organizational Management

This research addresses the critical aspect of evaluating operational performance in health promotion hospitals, which play a vital role in providing medical services to local communities. The research proposes an integrated method for performance assessment, utilizing the Best-Worst Method (BWM) and the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) linear programming model. Taking the case of health promotion hospitals in Maha Sarakham province, Thailand, and considering the McKinsey 7s framework's seven criteria, BWM is employed to determine the criteria weights. Subsequently, the TOPSIS linear programming model selects the ideal health promotion hospital based on these weights. The BWM analysis reveals criteria weights in the following order: system, staff, skill, style, structure, strategy, and shared value. The TOPSIS linear programming model identifies SH12 as the top-performing health promotion hospital with a closeness coefficient value of 0.8821. Additionally, a Spearman's rank correlation test validates this proposed method against the original TOPSIS approach, yielding a correlation value of 1.0. These findings provide valuable guidance for organizations, particularly in shaping strategic policies and resource allocation within medical service units, medical equipment, and personnel management in organizational settings. This study offers that the proposed method is simpler and will aid in the ongoing analysis of strengths and weaknesses in the improvement of organizations and development, helping organizations adapt to changes.

Social Media Health Prevention Strategies for Hospitals to Captivate Young Adults' Interest

Social media has the potential to be used by hospitals to play their role as health-promoting hospitals. By utilizing social media, hospitals can perform health prevention services at a reasonable cost. Nowadays, youths are more likely to suffer non-communicable diseases (NCD) like Diabetic Mellitus due to lifestyle changes that are sedentary. However, most youths consider that health promotion messages that already exist are unappealing. The purpose of this study is to determine the relevant strategy to deliver a health promotion message through social media that can captivate the youth’s interest. This study is a qualitative study with a phenomenology design. Data collection was carried out from three focus group discussions (FGD) that were selected by purposive and selective sampling methods. The data was then analyzed with the inductive theme analysis method. Triangulation and transferability tests were conducted to assess the validity of this study. Health promotion delivery must ensure that the message is attractive and easy to understand To expand the target audience's understanding. Health promotion should be done by considering what the message is, who the target is, what kind of content is, and on what platform. Besides, the content should be relevant, entertaining, credible, and easy to be understood.

The views of general practitioners in Morocco about health promotion at the primary health care services: Qualitative study.

Health promotion (HP) is one of the key skills that every general practitioner (GP) should have, according to The World Organization of Family Doctors, but for several reasons, his practice remains insufficient. However, a gap would exist between the GPs' knowledge and their practices about HP. The aims of our study were to explore GPs' perceptions, knowledge, and practices in Morocco about HP and identify their barriers and needs to best practice HP actions. A qualitative case study was conducted among GPs, via semi-structured interviews following an interview guide. Purposive and snowball sampling were used to select our sample. It contained four themes, perceptions, practices, barriers and needs, and proposals for improvement. The interviews were recorded and then transcribed. Thematic content data analysis was done manually. Favorable ethical approval was obtained from the local ethics committee. Fourteen GPs participated in this study. The sex ratio was at one. GPs' practices were focused on the biomedical model with wide confusion of HP with prevention and therapeutic education. Their roles in HP were considered paramount. The number of patients during consultations, structures' care, and knowledge were the main barriers. The main cited needs were material resources and HP training. Our study has made it possible to make an inventory of the practice of HP in Morocco. Participants' practices were based on the curative aspect. There is a crucial need to implement continuing and contextualized training for general practitioners to strengthen their skills in HP. This training will help to succeed in the health-promoting hospital's strategy.

Patient Experience Pre-Implementation of an Enhanced Recovery After Surgery Protocol: A Qualitative Investigation.

This study explores the experience of adults undergoing major abdominal surgery pre-implementation of an Enhanced Recovery after Surgery program at a tertiary hospital in Melbourne, Australia, to enhance health promotion in Australian hospitals. Patients who were undergoing major abdominal surgery and who consented to participate were recruited in this study. Patients were chosen based on an inclusion-exclusion criterion. In-depth, semi-structured qualitative interviews were conducted by telephone and transcribed verbatim by the primary researcher. Thematic analysis was used and synthesised into five inductive themes. Eighteen participants aged between 51 and 82 years were interviewed. Codes were categorised into inductive themes: 1) preparedness for surgery; 2) communication; 3) aftercare; 4) expectations of surgery; and 5) overall experience utilising an iterative process. The following themes and subthemes emerged from the qualitative synthesis. Patients undergo a variety of experiences throughout the perioperative care period. Patient care and experience may be improved through increased access to patient engagement, information and communication, use of multimedia and teach-back method, optimization of the hospital environment and through providing adequate planning and support on discharge. Evidence of barriers to enhancing patient surgical experience can be used to guide the implementation of Enhanced Recovery after Surgery protocols in Australian hospitals and therefore may limit its generalizability. This will improve health promotion as these findings provide valuable insights into integrative methods that can be considered to be important for achieving person-centred care. This knowledge can be useful in clinical practice, implementation and education programs for ERAS.

Penerapan Strategi Promosi Kesehatan Rumah Sakit Melalui Pemberdayaan Pemberian Makanan Pendamping ASI Pada Baduta Stunting

The case of child stunting is one of the 6 goals in the global nutrition target which is to be completed by 2025 with the key indicator in the Sustainable Development Goal of Zero Hunger. Empowerment is the initial milestone in Hospital Health Promotion activities that can be implemented outside the building. Objectives to empower the provision of complementary breastfeeding to stunted mothers as a specific protection effort. The methods of outreach to the community around the hospital by providing pre-tests and post-tests to measure knowledge. The Results of the activity were carried out using two methods: presentation and evaluation. The first stage is the presentation and question and answer. The presentation goes through 4 activities: opening, introduction, implementation, and closing. The opening activity is carried out by explaining the purpose and objectives of the activity. The introduction stage is carried out by explaining the activities that will be carried out. Implementation activities are related to providing material to participants regarding the definition of Complementary Foods for Breast Milk, Types of Main Foods, Types of Snacks, Explanations about age categories, child development, texture of MP ASI, frequency of MP ASI, and quantity of MP ASI per portion, Things to pay attention to when cooking or the use of cooking utensils when making complementary food and then ending with a lid. The second stage is the evaluation stage, which shows an increase in the knowledge of stunting clown mothers, the participant quota is fulfilled and the material is delivered to the participants. Conclusions: There needs to be re-empowerment of stunting clown mothers.

Plant-Based Diet and Glycemic Control in Type 2 Diabetes: Evidence from a Thai Health-Promoting Hospital.

The prevalence of type 2 diabetes (T2DM) is associated with diet. While consumption of plant-based foods may reduce blood sugar levels, the impact of consuming plant-based foods on fasting blood sugar levels has not been well defined. This cross-sectional study was conducted at the Health-Promoting Hospital in Pak Phun Municipality, Thailand. It included 61 patients with T2DM and 74 controls matched for age and gender. Dietary intake levels among T2DM and controls were assessed by a validated food-frequency questionnaire from which plant-based-food scores were calculated. This study found significant differences between specific plant foods and fasting blood sugar levels in patients with T2DM. Adherence to a plant-based diet appeared to influence fasting blood sugar levels. Patients who consumed higher amounts of certain vegetables and fruits showed lower fasting blood sugar levels. Diabetic patients consumed more legumes than controls, but the consumption of cereals and nuts/seeds in the two groups were similar. Consumption of nuts and seeds was also associated with a 76.3% reduction in the risk of a T2DM diagnosis. These findings suggest the potential efficacy of glycemic control in T2DM patients. More work is required to explore strategies for preventing and treating metabolic disorders through dietary modification.

Facilitators and barriers for implementing screening brief intervention and referral for health promotion in a rural hospital in Alberta: using consolidated framework for implementation research

BackgroundScreening, brief intervention, and referral (SBIR) is an evidence-based, comprehensive health promotion approach commonly implemented to reduce alcohol and substance use. Implementation research on SBIR demonstrate that patients find it acceptable, reduces hospital costs, and it is effective. However, SBIR implementation in hospital settings for multiple risk factors (fruit and vegetable consumption, physical activity, alcohol and tobacco use) is still emergent. More evidence is needed to guide SBIR implementation for multiple risk factors in hospital settings.ObjectiveTo explore the facilitators and barriers of SBIR implementation in a rural hospital using the Consolidated Framework for Implementation Research (CFIR).MethodsWe conducted a descriptive qualitative investigation consisting of both inductive and deductive analyses. We conducted virtual, semi-structured interviews, guided by the CFIR framework. All interviews were audio-recorded, and transcribed verbatim. NVivo 12 Pro was used to organize and code the raw data.ResultsA total of six key informant semi-structured interviews, ranging from 45 to 60 min, were carried out with members of the implementation support team and clinical implementers. Implementation support members reported that collaborating with health departments facilitated SBIR implementation by helping (a) align health promotion risk factors with existing guidelines; (b) develop training and educational resources for clinicians and patients; and (c) foster leadership buy-in. Conversely, clinical implementers reported several barriers to SBIR implementation including, increased and disrupted workflow due to SBIR-related documentation, a lack of knowledge on patients’ readiness and motivation to change, as well as perceived patient stigma in relation to SBIR risk factors.ConclusionThe CFIR provided a comprehensive framework to gauge facilitators and barriers relating to SBIR implementation. Our pilot investigation revealed that future SBIR implementation must address organizational, clinical implementer, and patient readiness to implement SBIR at all phases of the implementation process in a hospital.

The Development of Screening Application of the Risk of Elderly with Dementia in Saraphi District, Chiang Mai Province

This research aimed to develop dementia screening tools through a mobile application for use by public health volunteers and medical personnel in an attempt to detect the risk of dementia at early stages in Saraphi district, Chiang Mai province and to explore the satisfaction of the application users towards the implementation of a dementia screening application. The sample group was 90 public health volunteers residing in Nongphueng sub-district, Yang Noeng sub-district, and Saraphi sub-district, and 15 medical personnel working in Ban Nongphueng Tambon health promotion hospital, Yang Noeng Tambon health promotion hospital, and Saraphi hospital, Saraphi District, Chiang Mai Province. The research methodology comprised eight steps as follows: 1) conducting documentary research on dementia symptoms, screening tools, and dementia data from medical personnel at the Chiang Mai Neurological Hospital. 2) carrying out a field study with community participation to investigate the circumstances of dementia in Tambon Nong Phueng, Tambon Yang Noeng, and Tambon Saraphi. 3) selecting 90 public health volunteers, and 15 medical personnel to participate in this research. 4) formulating a storyboard which described the application model 5) designing the system and create the application with the consultancy from a psychiatric doctor for the elderly and an occupational therapist. 6) testing the operation of the application and carry out the improvement. 7) preparing the manual 8) publicizing and making the application available. The data collection instrument consisted of a satisfaction questionnaire towards the implementation of an application for dementia screening. The statistics used in the research were mean and standard deviation. The dementia application, named "Brain Screening," was developed using the Flutter software development kit and the Dart programming language. It operates on the Android operating system. This application consists of four cognitive assessments: the 14-question item memory assessment, the Mini-Cog assessment, the 8-question item IQCODE-Modified assessment for relatives or caretakers to assess memories, and the AMT assessment for public health and medical personnel. Additionally, the satisfaction assessment of public health volunteers regarding the application's implementation yielded high levels of satisfaction, with an overall mean of 4.19 and a standard deviation of 0.53.

Street-level quasi-bureaucracy and professional discretion: how transformational leadership and public service motivation influence village health volunteers' professional discretion

PurposeVillage health volunteers are community health volunteers in Thailand that have helped the government deliver public health services for many years, particularly during the coronavirus disease 2019 (COVID-19) pandemic. Though labeled as “volunteers,” the village health volunteers are recruited, trained and supervised in a manner similar to how a government agency recruits, trains and supervises its street-level bureaucrats (SLBs). This study examines the two factors that affect how these street-level quasi-bureaucrats use their professional discretion: transformational leadership and public service motivation (PSM). Transformational leadership means a leadership style that develops, shares and sustains a vision to elevate SLBs to higher levels of performance, while PSM is defined as an SLB’s predisposition to make a difference by working in the public sector with a sense of calling. This study attempts to analyze the mediating role of psychological empowerment in the relationship between transformational leadership, PSM and professional discretion.Design/methodology/approachThe paper uses a three-wave survey-based quantitative method to avoid common method biases. This method provides evidence gathered from 105 subdistrict health promotion hospitals and 798 village health volunteers (VHVs) in five provinces in Thailand.FindingsPSM and transformational leadership influence the village health volunteers' use of professional discretion indirectly through the psychological empowerment mechanisms that make them feel positive toward their village health volunteer role and responsibility. The authors' findings suggest that the hospital directors' transformational leadership induces the village health volunteers' use of professional discretion by making them feel competent to do their work and feel fulfilled and valuable about their work. Similarly, the village health volunteers' PSM leads them to use professional discretion by making them feel fulfilled and valuable and by convincing them of the social and community impact of their work.Research limitations/implicationsWhile existing research focuses on VHVs' role in alleviating capacity constraints on the health care system, this study revealed an equally important role played by hospital directors. These directors' transformational leadership was instrumental in enhancing VHVs' psychological empowerment – particularly their perceptions of the meaning of their work and their competence – that ultimately enabled them to use professional discretion in their work. This study also highlighted the importance of VHVs' PSM, which leads to their use of professional discretion via the meaning and impact dimensions of psychological empowerment. Based on this study, PSM should also be incorporated into the community health volunteers' recruitment criteria. Also, public health agencies should consider including transformational leadership in the hospital directors' training programs and their promotion criteria.Practical implicationsAs VHVs' high-PSM level was found to enhance their professional discretion, the process of recruiting ordinary citizens to serve as community health volunteers should incorporate assessment of the candidates' PSM. Also, the Ministry of Public Health should design and assign tasks that citizen volunteers, particularly VHVs, consider meaningful and at which they feel competent.Social implicationsAside from technical training, directors of the subdistrict health promotion hospitals should regularly receive soft skill training (i.e. leadership training) and transformational leadership characteristics should be included in the government criteria for promotion.Originality/valueWhile past research has examined the impact of other leadership styles on psychological empowerment, this study took a further step by examining the mediating effects of psychological empowerment on the relationship between transformational leadership and professional discretion among VHVs. The authors analyzed the mechanism linking PSM to the VHVs' professional discretion. In addition, by examining the relative importance of different dimensions of psychological empowerment, this study offers a nuanced understanding of the psychological processes by which transformational leadership and PSM shape the SLBs' use of professional discretion in their work.

Pursuing the efficient operation of the primary healthcare hospitals in Thailand through efficiency assessment using the data envelopment analysis method.

This study aimed to assess the operational efficiency of Sub-District or Tambon Health Promoting Hospitals (THPHs) in Thailand's Eastern Economic Corridor (EEC) and to propose management guidelines for future improvements. The current state of Thailand's public health demonstrates that government policy has prioritized equal access to public health services in all areas. This increases the need for primary public health services, yet resources are limited and cannot be increased to meet the growing demand. The only effective way to address this issue is to develop the efficiency of public health operations. The sample consisted of 104 THPHs in Chachoengsao, a province in Thailand's EEC. Data for five input and seven output variables were collected between September 18 and November 15, 2023. An online survey was conducted to gather the required data for fiscal year 2022. Data envelopment analysis was used to measure the efficiency of THPHs. The average efficiency index of the 104 THPHs was 0.9066, with about 60% having an efficiency index of 1.00. When classified by size, it was found that the efficiency levels of the THPHs grew with size, considering that the average efficiency index of the small, medium, and large THPHs was 0.8642, 0.9140, and 0.9417, respectively. The proportion of efficient THPHs also increased with size, at 58.14%, 60.00%, and 66.67%, respectively. Regarding efficiency improvement targets, small THPHs had the highest output targets (28.40%), followed by medium THPHs (15.31%) and large THPHs (9.91%). For the inefficient THPHs, some management guidelines were made to improve their future performances.

Using the settings approach to health promotion in hospital and health services to support collaboration, engagement, and partnership in integrated care systems.

Introduction: Hospitals and health services within integrated care systems can implement the 2020 Standards for Health Promoting Hospitals and Health Services to promote the mutual values reflected in the nine pillars of integrated care, such as shared vision and multisectoral action, improving population health, people-centered care, community participation, staff health, leadership, and quality improvement. After the impact of the COVID-19 pandemic, a shift towards these shared values is needed to better address burnout and a decreasing workforce.&#x0D; Intervention: The International Network of Health Promoting Hospitals &amp; Health Services’ (HPH) 600 members from 33 countries work towards supporting the integration of health promotion into the organizational structure and culture of organizations to create health promoting settings. To operationalize this vision and guide decision makers in transforming their institutions into settings that support collaboration, engagement, and partnership, the 2020 Standards for Health Promoting Hospitals and Health Services and complimentary Self-Assessment tools were conceived. &#x0D; Five overarching standards, 18 substandards, and 86 standard statements resulted from a methodological consolidation of existing HPH standards (addressing equity, mental health, the environment, health literacy, patient-centered care, groups such as the elderly, children, and adolescents) and from two Delphi consultation rounds with HPH subject experts. The standards reflect over 30 years of knowledge and international experience in health promotion implementation across various areas of policy, practice, and evidence within the International HPH Network. Complementary self-assessment tools, developed with input from 14 countries, can be used to identify key members of multidisciplinary steering teams, to compare data and monitor progress, and develop targeted quality improvement plans based on data collected. Currently, the Standards are available in 11 languages on the HPH website.&#x0D; Outcomes: Hospitals and health services who adopt a comprehensive health promotion approach are agile, better able to respond to challenges and are receptive to change. During Delphi consultation rounds to define the standards, high ratings of relevance were given to population health needs, organizational commitment, and environmental health amongst countries contributing to the design of the Standards. The standards, therefore, strongly focus on organizational collaboration; engagement of patients, family, staff, and the community; and building alliances and partnerships between stakeholders along a patients’ care pathway. Organizations adopting this holistic approach are efficient, leading to better health outcomes, satisfaction for all involved, and lower costs, which are shared aims of integrated care. Health promoting settings are supportive of integrated care and can be implemented as a first step in a system-wide transformation. &#x0D;