Health Promoting Hospitals Research Articles

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.
 Intervention: The International Network of Health Promoting Hospitals & 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. 
 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.
 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. 

Assessing The Status Of Hospitals In Hamadan Iran With The Health Promoting Hospital Standards

Background — Changing public expectations for hospitals, as well as the increasing number of patients with chronic illnesses requiring ongoing support, along with high incidence of staff exposure to physical, mental and psychological risks, have led hospital councils to focus on health promotion as a vital component for both patients and the staff. The World Health Organization (WHO) introduces health promotion in healthcare to improve hospital efficacy. Due to the lack of sufficient information on the status of HPH standards in western Iran, the present study was designed to examine the status of HPH in Hamadan, a western province of Iran. Material and Methods — This study examined 20 hospitals in Hamadan, Iran, using the HPH self-assessment questionnaire developed by WHO. The questionnaire consists of five standards, including management policy (Standard 1), patient assessment (Standard 2), patient information and intervention (Standard 3), promoting a healthy workplace (Standard 4), and continuity and collaboration (Standard 5). Results — The overall hospital HPH score was 75.36±11.33 (out of 100). Among the five standards, patient information and intervention received the highest score (86.66±11.27), while promoting a healthy workplace received the lowest score (67.50±17.88). Public hospitals had a statistically significantly higher score on management policy (p=0.011). Similar trend was observed when comparing HPH with non-HPH network facilities (p=0.041). Other comparisons did not yield any significant differences (p>0.05). Conclusion — We established that hospitals in Hamadan, Iran, were only partially compliant with the Promoting Health Hospitals (HPH) program. The study highlighted the need to create a healthier workplace for hospital staff and indicated that this is a top priority for the examined hospitals. This scientific breakthrough provides important insight into how Iranian hospitals can take steps to create a healthier workplace for their employees, which will ultimately lead to better outcomes for patients.

Effectiveness of the Protection Motivation Theory-based Education Program among People at Risk of Stroke: A Randomized Controlled Trial

Stroke is a serious health issue that causes mortality and disability in the world’s population. People at risk of stroke need to manage the risk factors of stroke and adherence to stroke prevention, which are the key to success in improving clinical outcomes, particularly blood sugar and blood pressure levels. This randomized controlled trial, with a two-arm preand post-test, aimed to investigate the effectiveness of the Protection Motivation Theory-based Education Program on adherence to prevention and clinical outcomes among people at risk of stroke. The sample consisted of 58 adults visiting diabetes and hypertension clinics at a health-promoting hospital in a province in southern Thailand. They were recruited using multi-stage random sampling and randomly assigned into two arms. The experimental arm received the four-week Protection Motivation Theory-based Education Program (n = 29), and the control arm received only usual care (n = 29). Data were collected using a Demographic Data Form, the Morisky Medication Adherence Scale, the Adherence to Preventive Behavior Scale for Thai persons with prehypertension, a mercury sphygmomanometer, and a laboratory test recording form. Data were analyzed using descriptive statistics, Mixed Model ANOVA, and independent t-test. The results showed that after receiving the program, the experimental arm had higher adherence to stroke prevention, lower blood pressure, and lower HbA1C levels than before receiving the program and the control arm after the program completion. The findings indicate the program’s effectiveness in improving adherence to stroke prevention among people at risk of stroke, which results in better clinical outcomes. Thus, nurses can use this program in clinical practice with further testing in other settings with larger groups before it can be widely used.

Model of Health-Promoting Community Health Center in the Islands to Support Healthy Cities in South Sulawesi Province

Purpose: This study aims to find a model of Health-Promoting Puskesmas in the archipelago in supporting healthy cities in South Sulawesi Province.
 
 Theoretical Reference: Some healthy setting thinkers believe that the healthy cities approach as a tool in solving regional health problems is seen as a too broad concept. The Healthy Islands Concept (HIC) is one of the initiatives which has elemental settings to promote health in island people and communities. Healthy Island refers to island settings, one of which is the Community Health Center (Puskesmas). Realizing Health-Promoting Hospitals has become a global movement. Otherwise, realizing Health-Promoting Puskesmas which has a different position and roles and responsibilities in improving health has raised difficulties. Moreover, health problems in Puskesmas in urban areas can be different from Puskesmas on the island.
 
 Methods: This study uses quantitative analysis. There were 700 respondents selected as sample. They were the community that go to the Puskesmas or those in the working area of the Puskesmas. The research locations are in 3 archipelagic regencies/cities, namely islands in Makassar City, Pangkajene Islands Regency, and Selayar Islands Regency. The data were analyzed quantitatively using Confirmatory Factor Analysis (CFA) and then analyzed using Structural Equation Modeling/SEM.
 
 Results and Conclusion: Based on the data collection, it was found that there are 7 dimensions with 28 indicators that can form a model of a health-promoting Puskesmas in the islands. Further, the dimension that has the strongest contribution in establishing the model of a health center in islands is the work group dimension of healthy puskesmas with an average loading factor value for each indicator of > 9 so that it can be illustrated that these indicators are stronger than other indicators existing in other dimensions of the Puskesmas models in the islands. A Puskesmas model that is suitable for archipelagic areas has implications for efforts to prevent and improve health, as well as provide quality health services.
 
 Implication of Research: Thus, this Puskesmas model can improve the health status of the island community.
 
 Originality: The results of this research are expected to be input for the Ministry of Health, the Health Service, Provincial and district/city Governments, and also for society as a whole in realizing a Health-Promoting Puskesmas.

Faktor-Faktor yang Berhubungan dengan Implementasi Promosi Kesehatan Rumah Sakit

This study analyzes factors (superior support, commitment, resources, and communication) related to implementing Hospital Health Promotion (PKRS). The method used is quantitative with a cross-sectional analytical approach. The research results showed that there was a relationship between superior support (p=0.001), commitment (p=0.027), resources (p=0.000), and communication (p=0.022) on the implementation of Hospital Health Promotion (PKRS). In conclusion, the better the support from superiors, commitment of implementers, resources, and communication, the better the implementation of PKRS.
 
 Keywords: Supervisor Support, Commitment, Resources, Communication, Health Promotion

Evaluation of Affecting Factor in Health Promoting Hospital: Systematic Review and Meta-Analysis

Penting untuk mengembangkan konsep baru Health Promotion Hospital (HPH) karena perlunya penyesuaian dan revisi layanan promosi kesehatan rumah sakit (HP) di samping perawatan terapeutik. Ini adalah studi komprehensif dan meta-analitik untuk mengetahui korelasi faktor-faktor yang mempengaruhi dalam pelaksanaan promosi kesehatan rumah sakit selama 20 tahun sebelumnya. Investigasi komprehensif ini dilakukan sesuai dengan pedoman Tinjauan Sistematis dan Meta-Analisis (PRISMA) untuk item pelaporan. Hasil yang dievaluasi dalam penelitian ini termasuk perkiraan faktor dalam mempengaruhi promosi kesehatan di rumah sakit. Perbedaan rata-rata (MD) dari data kontinu digunakan untuk mengumpulkan data. 9 studi dipilih untuk meta-analisis. Karena variabilitas substansial dalam kedua kategori, model analisis efek acak digunakan. Kepemimpinan, Kebijakan dan Strategi, Orang, Kemitraan dan Sumber Daya, Proses, Hasil Pasien, Hasil Staf, Hasil Masyarakat, dan Komunikasi adalah faktor-faktor yang mempengaruhi di rumah sakit yang mempromosikan kesehatan. Kepemimpinan, Kebijakan dan Strategi, Kemitraan dan Sumber Daya Manusia, Proses, Hasil Pasien, Hasil Staf, dan Hasil Masyarakat semuanya memiliki dampak besar dalam mempengaruhi dan meningkatkan promosi kesehatan di rumah sakit.

Italian translation and cultural adaptation of health literate organisation self-assessment tool

Abstract Background The International Working Group Health Promoting Hospitals and Health Literate Healthcare Organizations has developed an English-language self-assessment tool for Organizational Health Literacy of Hospitals, designed to quality managers of healthcare organizations. It aims to diagnose strengths and weaknesses of the organization's health literacy, and our goal is to translate and culturally adapt it for Italy. Methods We have been following the Translation, Review, Adjudication, Pretesting, and Documentation team model for cross-cultural translation of questionnaires. Initially, two separate teams of translators worked independently to translate the tool from English to Italian. Next, the national coordinator organised six meetings to discuss, integrate, and unify the two versions, and any translation difficulties and suggested solutions were reported in the supporting tool that will be sent along with final agreed version of the tool to the International Coordination Centre. Finally, two experts will review the translation for the cultural adaptation. Results Difficulties related to comprehension in translation can arise from ambiguity in word choice, the need for contextual precision, and a lack of cultural appropriateness. The translation of English words that have become part of Italian language (e.g. ‘feedback', ‘stakeholder', ‘management', ‘standard') was also hugely discussed between the teams. Finally, to categorize the information entered into the supporting tool, 50% pertains to adaptation to context, 30% to simplification or clarification, and 20% to non-applicable items. Conclusions Cultural adaptation will improve the translation by reducing ambiguities, providing contextual clarifications, and rephrasing items to make them more appropriate for Italy. The Italian version of the tool will be piloted in local hospitals to support healthcare operators, patients, and the community in better managing the complexities of healthcare organizations. Key messages • Translation of health literacy self-assessment tool for Italian hospitals, aiming to reduce ambiguity and increase appropriateness for local context. • Culturally adapted tool to diagnose organizational health literacy in Italian hospitals will help healthcare organizations deal with complexity of healthcare and improve patient outcomes.

Essential Public Health Functions of Public Health Personnel in Subdistrict Health-promoting Hospitals, Thailand.

In Thailand, public health service roles have been defined by the Ministry of Public Health, while essential public health functions (EPHFs) were not assigned as necessity health-care service activities responding to the missions of primary care units. The aims were to determine the EPHFs and compare the necessity of performance and the actual performance according to the EPHFs of public health personnel in the subdistrict health-promoting hospitals (SHPHs). The exploratory sequential design of mixed methods was employed. The first phase consisted of three methods: a focus group discussion, a nominal group technique, and a cross-sectional survey used to determine the EPHFs. The second phase was to compare the necessity of performance and the actual performance according to the EPHFs of the personnel using a cross-sectional survey. The 285 SHPH directors in the second health region as samples were selected by random clusters. The findings revealed that 14 EPHFs and the necessity of performance average were higher than the actual performance average in the 14 EPHFs and 212 indicators with significance at a level of 0.05. The means of health assessment and primary medical care (EPHF3) presented the smallest difference, whereas Thai traditional and alternative medicines (EPHF11) indicated the largest average difference. EPHFs would be applied for setting a framework of working scope as policies and EPHFs could be recommended for use as individual guidelines or organizational assessment manuals to develop organizations efficiently.

Is mental health positively associated with workplace social capital among Danish hospital employees? A multilevel study

Being mentally healthy is associated with being more productive, creative, altruistic, and innovative, which are key values in Western society and highly relevant among hospital employees. However, studies investigating the promotion of mental health rather than the prevention of poor mental health and mental illnesses among hospital employees are limited. Thus, we examined the association between workplace social capital and mental health among hospital employees using electronic survey data collected from Danish hospital employees. The study sample consisted of 1452 employees, corresponding to 40% of the hospital staff. Mental health was assessed using the Mental Health Continuum Short Form, in which mental health is understood as a combination of emotional, psychological, and social well-being. Workplace social capital was assessed using Borg et al.’s (2014) Social Capital Questionnaire, which measures bonding, bridging, and linking social capital in relation to immediate management and the workplace as a whole in four separate subscales. Multiple imputations by chained equations were applied.Multilevel linear regression analyzes showed a positive association among bonding, bridging, and linking social capital in relation to immediate management and mental health. First, our results highlight that hospital employees’ mental health is associated with social capital in the workplace. Second, the strongest association was found between bridging social capital in work teams and mental health. Third, mental health was significantly poorer among employees aged between 25 and 35 years than among employees aged between 46 and 55 years. However, unlike our theoretical expectation, linking social capital in relation to the workplace as a whole was not associated with mental health. In conclusion, our results provide an impetus for further research on health promotion and interventions in hospitals and in similar sectors.

Validation of prediction algorithm for risk estimation of intracranial aneurysm development using real-world data

Intracranial aneurysm (IA) is difficult to detect, and most patients remain undiagnosed, as screening tests have potential risks and high costs. Thus, it is important to develop risk assessment system for efficient and safe screening strategy. Through previously published research, we have developed a prediction model for the incidence risk of IA using cohort observational data. This study was designed to verify whether such a prediction model also demonstrates sufficient clinical performance in predicting the prevalence risk at the point of health screening, using cross-sectional data. The study population comprised individuals who visited the Chonnam National University Hwasun Hospital Health Promotion Center in Korea for voluntary medical checkups between 2007 and 2019. All participants had no history of cerebrovascular disease and underwent brain CTA for screening purpose. Presence of IA was evaluated by two specialized radiologists. The risk score was calculated using the previously developed AI model, and 0 point represents the lowest risk and 100 point represents the highest risk. To compare the prevalence according to the risk, age-sex standardization using national database was performed. A study collected data from 5942 health examinations, including brain CTA data, with participants ranging from 20 to 87 years old and a mean age of 52 years. The age-sex standardized prevalence of IA was 3.20%. The prevalence in each risk group was 0.18% (lowest risk, 0–19), 2.12% (lower risk, 20–39), 2.37% (mid-risk, 40–59), 4.00% (higher risk, 60–79), and 6.44% (highest risk, 80–100). The odds ratio between the lowest and highest risk groups was 38.50. The adjusted proportions of IA patients in the higher and highest risk groups were 26.7% and 44.5%, respectively. The median risk scores among IA patients and normal participants were 74 and 54, respectively. The optimal cut-off risk score was 60.5 with an area under the curve of 0.70. We have confirmed that the incidence risk prediction model built through machine learning also shows viable clinical performance in predicting prevalence risk. By utilizing this prediction system, we can effectively predict not only the incidence risk but also the prevalence risk, which is the probability of already having the disease, using health screening data. This may enable us to consider strategies for the early detection of intracranial aneurysms.

Comparison of the results of developing standards for health promotion hospitals in public and private medical centers

Background: Developing standards for Health Promotion Hospitals (HPH) plays a crucial role in hospital accreditation. This study aimed to compare the development of HPH standards in public and private hospitals in Tabriz, Iran in 2021. Methods: This descriptive-analytical and cross-sectional study was conducted to evaluate all public and private hospitals in the city. Data were collected using observation and interviews through a valid and reliable HPH checklist. Data were analyzed using t test. Results: The study found that the standards for patients’ data and interventions (77.38%), continuity in treatment and cooperation (69.38%), management policy (61.92%), patient evaluation (60.76%), and providing a healthy workplace (42.7%) had the highest scores, respectively. Private hospitals scored higher than public hospitals in all dimensions. There was a significant difference between public and private hospitals regarding the total score (P=0.001), management policy(P=0.01), patient information and interventions(P=0.003), and continuity in treatment and cooperation (P=0.002). Conclusion: The competitive atmosphere among private hospitals appears to have improved their status in HPP, while public hospitals were less concerned with competition and improving their performance in this field. Additionally, ignoring human resource management policies has made the managers of all hospitals feel the need for further upgrading in terms of standards for promoting a healthy work setting.

Implementation of Hospital Health Promotion at PKU Muhammadiyah Wonosobo Hospital: A Qualitative Study

Management policy is the most significant hospital health promotion standard, and it also influences other standards. Health promotion in hospitals that is not implemented will cause problems for the community. Information that is not conveyed makes one's understanding and knowledge worse. Therefore, this study aims to evaluate of implementation of hospital health promotion in PKU Muhammadiyah Wonosobo Hospital. This qualitative research uses a case study design. As many as 7 respondents including officials, health workers, staff, patients, and families of patients have conducted in-depth interviews. According to the findings of this study, hospital health promotion at the institution in issue is poorly managed. Therefore, hospital policymakers must pay greater attention to preparing competent budgets and human resources to support maximum hospital health promotion.

Hospital Health Promotion Program Influence on Stroke Patients’ Motivation for Medical Rehabilitation

Stroke is the second leading cause of death and the third leading cause of disability. World Health Organization in 2021 found that around 70% of disability and 87% of deaths due to stroke occur in low- and middle-income countries. One of Indonesia’s efforts to minimize disability in post-stroke patients is medical rehabilitation. In an effort to maintain the patients’ motivation to adhere to medical rehabilitation, hospitals employ the hospital health promotion program. The purpose of this study is to analyze the effect of the hospital health promotion program on stroke patients' motivation for medical rehabilitation. This quantitative analytic study with a cross-sectional approach was conducted at Haji Adam Malik Central General Hospital and Medan Haji General Hospital. The research population was 124 post-stroke patients (48 patients from Haji Adam Malik Central General Hospital and 76 patients from Medan Haji General Hospital) and all of them were used as samples (total sampling). Data collection was conducted using a valid and reliable questionnaire (validity and reliability test carried out). Analysis was carried out using frequency distribution, chi-square, and double-log regression analysis. This study found that 90 out of 124 participants had high motivation for medical rehabilitation, while the rest had low motivation. The results showed that the hospital health promotion program had a significant effect on the motivation of stroke patients for medical rehabilitation, namely empowerment (OR=2.842), atmosphere building (OR=2.937), advocacy (OR=3.028), and partnerships (OR=2.738). Advocacy has the most impact on the patient’s motivation with OR=3.028. It can be concluded that hospital health promotion program has a positive influence on stroke patients’ motivation to undergo medical rehabilitation. Hence, implementation of similar health promotion program on other hospitals are highly encouraged to influence stroke patients’ motivation for medical rehabilitation.

Promosi Kesehatan Berbasis Media Digital Di Rumah Sakit PKU Muhammadiyah Kartasura

As information technology develops, the development of digital media has also shown its role in health promotion efforts. Health promotion is carried out through activities to provide information, influence and help the community to improve their health status. Currently, digital media is more dominantly used in health promotion activities. The use of various media to provide education, convey information and promote health really helps services to the community. So that people can more easily receive information quickly and accurately. This research aims to 1) the type of digital media used 2) the urgency of using digital media in health promotion efforts 3) the role of health promoters in carrying out health promotion based on digital media. In this case the solution offered to partners is to hold outreach regarding health promotion based on digital media in hospitals. The output target of this activity is that it is hoped that health workers will have knowledge in creating digital media-based health promotions in hospitals in more varied ways. In this service the author produced an article on digital media-based health promotion in hospitals

The correlation between NAFLD and serum uric acid to serum creatinine ratio.

With the prevalence of non-alcoholic fatty liver disease (NAFLD) increasing worldwide, many noninvasive techniques have been used to improve its diagnosis. Recently, the serum uric acid/creatinine (sUA/sCr) ratio was identified as an indicator of fatty liver disease. Therefore, we examined the relationship between sUA/sCr levels and ultrasound-diagnosed NAFLD in Korean adults. This study included 16,666 20-year-olds or older who received health checkups at a university hospital's health promotion center from January to December 2021. Among them, 11,791 non-patients with and without NAFLD were analyzed, excluding those without abdominal ultrasound, those without data on fatty liver, cancer, or chronic kidney disease severity, those with a history of alcohol abuse, and those with serum hs-CRP <5 mg/L. The odds ratio (OR) and 95% confidence interval (CI) of the sUA/sCr ratio according to the presence or absence of fatty liver disease and severity were calculated after correcting for confounding variables using logistic regression analysis. The receiver operating characteristic (ROC) curve and area under the curve (AUC) of the sUA/sCr ratio confirmed and compared the sensitivity and specificity of NAFLD and serum uric acid. sUA/sCr increased with fatty liver severity, and the post-correction OR in the NAFLD group was 1.183 (95% CI: 1.137-1.231) compared to the group without NAFLD. Concerning the fatty liver severity, the post-correction OR in the mild NAFLD group increased to 1.147 (95% CI: 1.099-1.196), and that in the moderate-to-severe NAFLD group increased to 1.275 (95% CI: 1.212-1.341) compared to the group without NAFLD. The sensitivity of sUA/sCr to fatty liver severity was 57.9% for the non-NAFLD group, 56.7% for the mild NAFLD group, and 59.0% for the moderate-to-severe NAFLD group; the specificity of sUA/sCr to fatty liver severity 61.4% for the non-NAFLD group, 57.3% for the mild NAFLD group, and 65.2% for the moderate-to-severe NAFLD group. NAFLD severity is associated with sUA/sCR.

Assessing the acceptability and feasibility of reactive drug administration for malaria elimination in a Plasmodium vivax predominant setting: a qualitative study in two provinces in Thailand

BackgroundReactive case detection (RACD) or testing and treatment of close contacts of recent malaria cases, is commonly practiced in settings approaching malaria elimination, but standard diagnostics have limited sensitivity to detect low level infections. Reactive drug administration (RDA), or presumptive treatment without testing, is an alternative approach, but better understanding regarding community acceptability and operational feasibility are needed.MethodsA qualitative study was conducted as part of a two-arm cluster randomized-controlled trial evaluating the effectiveness of RDA targeting high-risk villages and forest workers for reducing Plasmodium vivax and P. falciparum malaria in Thailand. Key informant interviews (KIIs) and focus group discussions (FGDs) were conducted virtually among key public health staff, village health volunteers (VHVs), and household members that implemented or received RDA activities. Transcriptions were reviewed, coded, and managed manually using Dedoose qualitative data analysis software, then underwent qualitative content analysis to identify key themes.ResultsRDA was well accepted by household members and public health staff that implemented it. RDA participation was driven by fear of contracting malaria, eagerness to receive protection provided by malaria medicines, and the increased access to health care. Concerns were raised about the safety of taking malaria medicines without having an illness, particularly if underlying health conditions existed. Health promotion hospital (HPH) staff implementing RDA noted its operational feasibility, but highlighted difficulty in traveling to remote areas, and requested additional travel resources and hiring more VHVs. Other challenges were highlighted including the need for additional training for VHVs on malaria activities and the inability of HPH staff to conduct RDA due to other health priorities (e.g., Covid-19). More training and practice for VHVs were noted as ways to improve implementation of RDA.ConclusionsTo maximize uptake of RDA, regular education and sensitization campaigns in collaboration with village leaders on the purpose and rationale of RDA will be critical. To alleviate safety concerns and increase participant safety, a rigorous pharmacovigilance program will be important. To accelerate uptake of RDA, trust between HPH staff and VHVs and the communities they serve must continue to be strengthened to ensure acceptance of the intervention.Trial registrationThis study was approved by the Committee on Human Research at the University of California San Francisco (19–28,060) and the local Ethics Committee for Research in Human Subjects at Tak Provincial Health office (009/63) and Kanchanaburi Provincial health office (Kor Chor 0032.002/2185). Local authorities and health officers in the provinces, districts, and villages agreed upon and coordinated the implementation of the study. All methods in this study were carried out in accordance with relevant guidelines and regulations.