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 (), 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 2 Xuhui Center Hospital 650 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: 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 , 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

Without integrated and universal health insurance system. Health care system relies heavily on private and not-for-profit health insurance which is easy to drive the health service toward the marketing business direction. Over depended on the advanced medical science technique, pharmacy, and medical equipment developing, but ignore to foster the healthy value and culture of HP for the entire society and ignore the public benefit nature of health service. Lessons learnt from China HPH Practices  Emphasis on disease prevention while treating disease, for example, regularly free disease screening(see picture)

 Emphasize the effective, interactive health educations;

 Stress the role of evaluation on improving the HP effect and result , and emphasize the application of the information feedback system for health service quality control.

 Insist on the public, universal, benevolent value in health service. Stress on the professional ethics. Lessons learnt from China HPH Practices Stress the role of Traditional Chinese Medicine to develop HPH. Emphasize to utilize the advantages of the private hospitals that to provide the substitution health service for Public Hospitals. Stress the close cooperation between the different disciplines and organizations. Stress on learning the global successive experiences and advanced theory and technology and management in health field. Lessons learnt from China and U.S for success HPH practices

Synthesize the prevention and treatment, primary and secondary medical service.

National health promotion campaign

Focus on healthy lifestyle education since kindergarden

Utilize diversified medical service models Conclusions

标准二 患者评估 (Patient Assessment)  Chinese version WHOSATHPH 医院确保医务人员在临床实践中建立与患者的合作伙伴关系，医务人员能系统地评估患者健康促 进活动的需要。 目标 has reliability in internal 支持对患者的临床治疗，改善病人预后并促进患者的健康和幸福感。 标准 consistency and time 编号 标 准 2．1 医院采取措施确保所提供的服务满足所有患者健康促进的需要。 consistency and general content 全 做 做 做 一 不 部 了 到 了 点 知 医院向患者提供以下指南：吸烟、饮酒、营养, 以及 做 大 一 一 没 道 conception validity. 2.1.1 有关心理--社会--经济状态的健康教育。 到 部 半 点 做 (证据：例如检查资料的易获取程度) 分  China hospital leaders self- 5 4 3 2 1 0 评

assessed their hospitals’ in high 议： 全 做 做 做 一 不 部 了 到 了 点 知 health promoting level. 医院的各项操作指南/操作规程在过去一年内经过修 做 大 一 一 没 道 2.1.2 订。 到 部 半 点 做 (证据：例如审查修订日期、负责修订指南的人员) 分  Chinese health promoting level 5 4 3 2 1 0

评 in hospital is not related with 议： hospital size. 全 做 做 做 一 不 部 了 到 了 点 知 医院向某些特定的患者群 (如哮喘患者、糖尿病患 做 大 一 一 没 道 者、慢性阻塞性肺病患者、手术患者，康复患者等) 2.1.3 到 部 半 点 做  China HPH developing level is 提供 认识自己健康促进需要的指导手册。 (证据: 例 分 如检查在临床科室里接受专科治疗的患者) not related with different 5 4 3 2 1 0 评

议： economy developing level. The general conclusion needs the further large size sampling investigation and research. China research cooperation team for this research

Prof. Fu Hua (First Line, middle) and his graduated students in HP programme (Shanghai) Prof. Ma Ying`s students (He Fei) Prof. Wan Chonghua (Kun Ming) Acknowledge

 University of Montreal

 Direction of International Relation(Mr. Guay Yves)

 Department of Administration of Health (Mr. Farand Lambert , Mr. Blais Régis)

 Fudan University ;

 Anhui Medical University ;

 Kunming Medical University;

 The University Women Club. Particularly appreciate : Mr. Oliver Groëne