Staff experiences with strategic implementation of clinical health promotion: A nested qualitative study in the WHO-HPH Recognition Process RCT

Objectives: 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. Methods: 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. Results: 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. Conclusions: 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

Fast and well-reported implementation: Fast-IM and RE-AIM.

Background Implementation in healthcare is often slow and poorly reported. Results include suboptimal outcomes and ad-verse consequences for patients. However, promising tools to remedy implementation speed and reporting already exist – such as the evidence-based, fast-track implementation model (Fast-IM) and the comprehensive RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) reporting format.Metods In combination, Fast-IM and RE-AIM may constitute a new best practice for fast and well-reported implementation. The aim of this article was to visualize the feasibility of the combination in practice via 3 examples concerning smoking cessa-tion among patients, simulation-based training of healthcare professionals, and mandatory regulation.Results Combining Fast-IM and RE-AIM is feasible and provides a useful overview of both implementation process and results.Conclusion This article describes a new best practice for fast and well-reported implementation by combining Fast-IM and RE-AIM

A WHO-HPH operational program versus usual routines for implementing clinical health promotion : An RCT in health promoting hospitals (HPH)

Background: Implementation of clinical health promotion (CHP) aiming at better health gain is slow despite its effect. CHP focuses on potentially modifiable lifestyle risks such as smoking, alcohol, diet, and physical inactivity. An operational program was created to improve implementation. It included patients, staff, and the organization, and it combined existing standards, indicators, documentation models, a performance recognition process, and a fast-track implementation model. The aim of this study was to evaluate if the operational program improved implementation of CHP in clinical hospital departments, as measured by health status of patients and staff, frequency of CHP service delivery, and standards compliance. Methods: Forty-eight hospital departments were recruited via open call and stratified by country. Departments were assigned to the operational program (intervention) or usual routine (control group). Data for analyses included 36 of these departments and their 5285 patients (median 147 per department; range 29-201), 2529 staff members (70; 10-393), 1750 medical records (50; 50-50), and standards compliance assessments. Follow-up was measured after 1 year. The outcomes were health status, service delivery, and standards compliance. Results: No health differences between groups were found, but the intervention group had higher identification of lifestyle risk (81% versus 60%, p < 0.01), related information/short intervention and intensive intervention (54% versus 39%, p < 0.01 and 43% versus 25%, p < 0.01, respectively), and standards compliance (95% versus 80%, p = 0.02). Conclusions: The operational program improved implementation by way of lifestyle risk identification, CHP service delivery, and standards compliance. The unknown health effects, the bias, and the limitations should be considered in implementation efforts and further studies

Handling Clinical Health Promotion in the HPH DATA MODEL: Basic Documentation of Health Determinants in Medical Records of tobacco, malnutrition, overweight, physical inactivity &amp; alcohol

BackgroundClinical Health Promotion activities contribute to the reduction of disease and treatment, and improve outcomes and prognosis. Accordingly, major health determinants such as smoking, physical inactivity, risk of malnutrition, overweight and hazardous drinking should be easily identified in the medical records. To that end, this study evaluates a simple 9 question health documentation model (HPH DATA Model) to be used in the medical records of patients in need of health promotion. MethodsThe multi-national study took place in 78 pilot centres from 12 nations / regions. First, the HPH DATA Model was pilot tested by clinical specialists in a standardised manner for control under international conditions (A). Then it was tested under local conditions (B). After gaining familiarity with the model, the clinical specialists evaluated whether the model was understandable, applicable and sufficient (C). They were also invited to give comments. ResultsThe response rate was 87-100%; the missing data among responders were 0 - 2.6%. The inter-rater agreement in documenting the 5 risk factors using the HPH DATA Model was substantial to nearly perfect across the pilot centres at International Conditions (A); Kappa value 0.85 (0.65 - 0.99). The clinical specialists categorized 66% (29 - 94%) of the patients from their own clinical practice regarding the need for health promotion (B). Except for waist measure-ments, the clinical specialists found the model understandable, applicable and sufficient. It was also determined that the clinical specialists were in need of a more comprehensive definition of the term “severe illness” (C).ConclusionsThe simple HPH DATA Model for systematic registration of 5 significant health determinants was found to be understandable, applicable and sufficient in different clinical settings