Cross-Culture Research for Developing (Chinese version) WHO Self-Assessment tool for Health Promotion in Hospital Objectives Through cross-culture research to develop a Chinese version WHO self-assessment tool for Health Promotion in Hospital; Explore a high effective health care service model through developing health promotion in hospital; Discuss the strategies for HPH development in undeveloped region. Context Why the different conditions and resources makes the similar health promotion result between China and U.S Total expenditure on health per 83 The Unite State capita (Intl $, WHO,2006) Canada 6714 80 China 78 75 75 3672 72 342 Female Male The Unite Canada China Life expectancy at State birth(years) What are the differences between China and Unite State for developing HPH China The Unite State 1. Poor HPH condition Excellent HPH condition and and resource resource 2. Poor medical service Advanced medical service management system management system 3. Serious shortage of Excellent health service health service resource support system and resource 4. Poor public health developing condition Advanced public health and resource developing condition and resource What are the different HPH developing conditions between China and the Unite State China The Unite State Developed Country 1. Undeveloped country, Gross national income Gross national income per per capita (PPP capita (PPP international international $): 4,660 $): 44,070 2. 1.3billion population 0.3billion population 3. Polluted environment Healthy environment The different level of health service resource and condition among Canada, China and U.S China has serious shortage of health service resource and poor condition for HPH. The Unite State(2000) Canada China(2005) 145 per 10000 population 101 94 34 26 19 14 10 9 Physicians density Nursing and Other health midwifery service providers personnel density density What the different HPH developing conditions between China and the Unite State China hospital ICU ward US hospital advanced technique ICU ward China doctor’s office U.S doctor’s office What are the different HPH developing conditions between China and the Unite State medical service Condition A China hospital patients’ room The U.S hospital patient’s room China hospital clinic environment U.S hospital clinic environment What are the different HPH developing conditions between China and the Unite State The hospital HP environment and conditions China hospital crowded register US hospital register center center China hospital crowded and noisy waiting hall US hospital waiting room Why the different conditions and resources makes the similar health promotion result? The Unite State Canada China 143 137 24 87 89 80 8 55 6 Male Female Probability of dying under five Probability of dying between 15 and (per 1 000 live births) 60 years (per 1 000 population) (resource: WHO statistic data) Methods Cross-culture approach Translated the source instrument from English into Chinese; Back translated it into English. Pilot test: Investigated 8 Chinese health specialists in Montréal. Spot field investigation (Non-probability sampling ) 22 Hospitals were sampled from three different Grades Chinese Hospitals which were investigated from 5 June to 30 August 2008; 40 hospital leaders, 3 health management researchers and 1 government officer were interviewed or were investigated; The Sampling cities were chosen from East, West and Middle regions, which stand for the different economic developed level in China: developed region (Shanghai), middle developed region (Hefei), and undeveloped region (Kunming); The sampling hospitals and the respondents 9 hospitals, 15 hospital leaders from Shanghai; 8 hospitals, 10 hospital leaders from Hefei; 4 hospitals, 15 hospital leaders from Kunming. All the respondents voluntarily completed the questionnaire survey independently ; Repeat questionnaire survey after 3-7 days based on voluntarily willingly. 2 health specialists and the author of WHO self- assessment tool for HPH (Prof. Oliver Groëne) commented the language equivalence of the back translation version. Shanghai Sick- The name of Sample Hospitals Grade beds Zhongshan Hospital 1700 The sixth Shanghai People Civic Hospital 3 1650 Jin Shan Hospital 605 Zhongshan Hospital The Eighth Shanghai People Civic Hospital 300 Fudan University 2 Xuhui Center Hospital 650 Xujiahui Community Hospital 150 Rihui Community Hospital 150 1 Tian Pinjia Community Hospital 150 Pudong Community Hospital 50 One Shanghai HPH Hospital Anhui Province Capital City: Hefei Grad sickb The name of Sample Hospitals e eds The First Affiliated Hospital of Anhui Medical 1890 University Hefei Second Civic People Hospital 550 3 The First Affiliated Hefei First Civic People Hospital 1600 Hospital of Anhui Medical University Anhui Provincial Hospital 1400 Hefei Second Civic People Hospital 2 321 Shushan Administration Division San Li An 48 Community Health Service Center Shushan District community Health Service Center 1 50 The inner environment of Shushan Jingang Town Community Health Service 50 the First Affiliated Hospital Center of Anhui Medical University Yunnan Province Capital City: Kunming Grad Sick- The name of Sample Hospitals e beds The First Affiliated Hospital of Kunming 1500 Medical University 3 The Second Affiliated Hospital of Kunming 1200 The First Affiliated Hospital of Medical University Kunming Medical University(KMU) Wu Hua People Hospital 2 160 Wu Hua Fengning Community Hospital 22 1 Wu Hua Community Health Service Center 0 HPH activities record of The First Affiliated Hospital of KMU China Grade III Hospital: Teaching Hospital The inner environment scene of China model HPH: the Sixth People Hospital of Shanghai. China Model HPH teaching hospital. One affiliated hospitals of Shanghai Jiao Tong University, 1650 sickbeds. One ward scene of Shanghai Zhongshan Hospital, China model HPH, One teaching hospitals of Shanghai of Fudan University, 1700 sickbeds. Scene pictures of sampling community hospitals 1. Health Education center in one Shanghai community hospital. 2.The environment of a second grade Shanghai communicated hospital. 3.One Hefei community 1 hospital. 2 3 Scene photos of investigation and interview Picture1: Interviewed a director of Health Ministry of Xuhui District, Shanghai. Picture2: Interviewed a Shanghai community hospital leader; Picture3: Kunming community hospital leaders were filling the questionnaire 1 2 3 Result 1: Reliability The general Cronbach's alpha of the Chinese version WHOSATHPH was 0.938. For each domains: management and policy was 0.793; patients assessment was 0.819; patient information and prevention was 0.807; healthy workplace was 0.785; continuity and cooperation was 0.755. The results showed that Chinese version WHOSATHPH has high internal consistency but it still needs to enlarge the sample size for the further reliability and validity test. Result 2: China HPH current level China hospital leaders self-assessment general score by WHO HPH Questionnaire: Five HPH standard domains: . Continuity and cooperation 28.95 (72.4% of full score 40); . Healthy workplace: 35.71(71.4% of 50),; . Patient information and prevention: 21.34 (71.1% of 30); . Patients assessment: 23.85 (68.1% 35); . Management and policy 28.17( 62.6% of 45). Different Grade hospitals HPH level ( full score 200) No statistic significant difference by Multi-Variance analysis . Grade III (N=21) Mean + SD: 154.19 + 7.34 . Grade II (N=9) Mean + SD: 158.67 + 10.7 . Grade I (n=11) Mean + SD: 144.82 + 14.54 The results showed that Chinese hospital leaders self-assessed a high level HPH, but the general conclusion needs the further large size sampling investigation. Discussion 1 China HPH developing principles, strategies, activities and Effects National Health Promotion Movement: All people are encouraged to join in different kinds of HP activities. Focus on the colourful, effective, and universal health education, stress on the role of all kinds of media: TV, radio, internet, and Newspaper in health education. Focus on interactivity between the patients, public, and health professional workers. The HPH Developing Principles of China Hospital Insist on patients-center and public benefits first. Take into account of the economic effect but not pursuing the marketing profit that can damage the social benefits from health service. Focus on the priority of primary health service, gradually meet people`s diverse or higher level demands of health service. Health service development must match the national or regional economic conditions. Focus on the quality and the efficiency. Stress the reasonable allocation of health resources. Prior to develop the rural health care service. Emphasize the important role of traditional Chinese medicine. China colourful Health Education Activities Lessons from the Unite State failing HPH Research/Const Home Health Other Personal ruction Care Care Focus on disease 3% 2% 9% treatment but not Public Health 3% Hospital Other Medical 33% disease prevention Products and HP. 4% Program Administration 6% Nursing Home 7% Physician & Over depended on the Clinical Drugs Services excellent professional 10% 23% service but ignore the entire social public participation of health promotion movement; The value of health service over emphasizes the individual right and freedom but ignore the entirety and cooperation. Over stress the money value of health service but ignore the public benefit value of health service. Lessons learnt from the Unite State failing HPH practice