Patients' views on health promotion and disease prevention services provided by healthcare workers in a South African tertiary hospital

BACKGROUND

Patients' views and experiences in healthcare institutions provide a means of assessing the quality of services patients receive from healthcare workers (HCWs). However, the views of patients on the health promotion (HP) and disease prevention (DP) services offered by HCWs and the delivery mode have not been adequately studied.

AIM

This study assessed the views of patients on HP and DP services provided by various categories of HCWs.

SETTING

The study was conducted at a tertiary hospital in the Nelson Mandela Bay Municipality, South Africa.

METHOD

An exploratory cross-sectional study was conducted among 500 patients. The questionnaire elicited responses from patients regarding the HP and DP services received from the different cadres of HCWs at three different admission phases: pre-admission phase (PAP), admission phase (ADP), and post-admission phase (POP). Descriptive, bivariate, and multivariate analysis was conducted.

RESULTS

In the PAP, most patients (83.33%, n = 5; 87.85%, n = 217; and 76.14%, n = 150) seen by the rehabilitation health workers, medical doctors, and nurses respectively were empowered to manage their health. Patients attended to by nurses were 0.45 (95% CI 0.27-0.74) times less likely than those attended to by medical doctors to receive information that that will help them address the physical and environmental needs. In the ADP, patients attended to by nurses were less likely, compared to those attended to by medical doctors to be empowered to have good control over their health. In the POP, patients attended to by nurses are more likely to have their health behaviours change for better compared to those not seen by any HCW.

CONCLUSION

Patients attending tertiary hospital received greater HP and DP services during the PAP and ADP of patient care. Greatest influence for behavioural change of patients on HP and DP were achieved from the medical doctors, nurses and rehabilitation service staff. Improving structural factors may prove beneficial in enhancing patients' experience from all HCW groups and phases of patient care.

Implementing Screening, Brief Intervention and Referral Intervention for Health Promotion and Disease Prevention in Hospital Settings in Alberta: A Pilot Study

Objective: This study assessed the feasibility of implementing screening, brief intervention and referral (SBIR) intervention in hospital settings. Methods: This cross-sectional study evaluated the implementation of the SBIR intervention in a hospital in Alberta for tobacco use, alcohol intake, physical inactivity, and insufficient vegetable and fruit consumption. Patients were interviewed approximately 4-month later to collect data on the acceptability and effectiveness of the intervention received (n = 108). The data were primarily analyzed using descriptive statistics. Results: Of 108 patients, >80% agreed that "they were ok with being screened" for the risk factors during their hospital visit. Up to 68% of patients recalled the provider's brief education. At the follow-up, 20% of patients quit tobacco, 50% reduced alcohol use, 30% increased physical activity, and 25% increased vegetable and fruit intake. Conclusion: Risk factor screening was acceptable for patients. Patients recalled the brief education they received from healthcare providers. Patients reported risk-reducing changes in their risk factors. Our future work will integrate the SBIR approach within the Electronic Clinical Information System and use robust research methods to investigate the impact of SBIR on patients' behavior change.

Effectiveness of brief counselling in a hospital setting for smoking cessation and risky alcohol drinking reduction: randomised clinical trial protocol

INTRODUCTION

Chronic diseases are a public health problem, and 80% of them are related to modifiable risk factors such as unhealthy diet, physical inactivity, smoking, and risky alcohol consumption. Although the intervention in smoking and hazardous alcohol drinking has proven to be effective in Primary Care, it is unknown whether it works in the same way in the hospital setting.

OBJECTIVE

To evaluate the effectiveness of brief counselling in order to modify the stage of change in smokers and at-risk drinkers treated in a high complexity hospital.

METHODS

A Randomised controlled trial to be conducted, in which an evaluation is made of four brief counselling strategies for smoking cessation and risky alcohol consumption compared to usual care, selected according to the patient's stage of change. The primary result will be the proportion of patients in each of the groups (intervention and control) with identified progress in the stage of change. The reduction of consumption will be also be analysed. Protocol registered at ClinicalTrials.gov (NCT03521622).

RESULTS

The results will be published in scientific journals, and its application aims to generate behavioural intervention protocols for modifiable risk factors in high complexity hospitals. The trial was presented and approved by the Ethics and Research Committee of the Pontificia Universidad Javeriana and Hospital Universitario de San Ignacio, Bogota, Colombia (Approval 01/2018).

Effectiveness of Brief Counseling in a Hospital Setting for Smoking Cessation and Risky Alcohol Drinking Reduction: Randomized Clinical Trial Protocol

INTRODUCTION

Chronic diseases are a public health problem, and 80% of them are related to modifiable risk factors such as unhealthy diet, physical inactivity, smoking, and risky alcohol consumption. Although the intervention in smoking and hazardous alcohol drinking has proven to be effective in Primary Care, it is unknown whether it works in the same way in the hospital setting.

OBJECTIVE

To evaluate the effectiveness of brief counselling in order to modify the stage of change in smokers and at-risk drinkers treated in a high complexity hospital.

METHODS

A Randomised controlled trial to be conducted, in which an evaluation is made of four brief counselling strategies for smoking cessation and risky alcohol consumption compared to usual care, selected according to the patient's stage of change. The primary result will be the proportion of patients in each of the groups (intervention and control) with identified progress in the stage of change. The reduction of consumption will be also be analysed. Protocol registered at ClinicalTrials.gov (NCT03521622).

RESULTS

The results will be published in scientific journals, and its application aims to generate behavioural intervention protocols for modifiable risk factors in high complexity hospitals. The trial was presented and approved by the Ethics and Research Committee of the Pontificia Universidad Javeriana and Hospital Universitario de San Ignacio, Bogota, Colombia (Approval 01/2018).

Post-traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge

BACKGROUND

Post-traumatic stress (PTS) symptoms following intensive care unit (ICU) treatment can lead to post-traumatic stress disorder and represent a severe health burden. In trauma patients, a strong sense of coherence (SOC) is associated with fewer PTS symptoms. However, this association has not been investigated in a general ICU sample.

AIMS AND OBJECTIVES

To examine the occurrence of PTS symptoms in general ICU patients early after ICU discharge and to assess possible associations between PTS symptoms and SOC, ICU memory, pain, and demographic and clinical characteristics.

DESIGN

This was a cross-sectional study.

METHODS

Adult patients aged ≥18 years admitted for ≥24 hours to five ICUs between 2014 and 2016 were recruited. PTS symptoms and SOC were measured at the ward within the first week after discharge from the ICU using the Posttraumatic Stress Scale-10 and Sense of Coherence Scale-13. Multiple linear regression analysis was used to identify associations between PTS symptoms and SOC and the selected independent variables.

RESULTS

A total of 523 patients were included (17.8% trauma patients; median age 57 years [range 18-94]; 53.3% male). The prevalence of clinically significant PTS symptoms was 32%. After adjustments for gender and age, lower SOC (P < 0.001), more ICU delusional memories (P < 0.001), greater pain interference (P < 0.001), not being a trauma patient (P = 0.02), and younger age (P = 0.03) were significantly associated with more PTS symptoms.

CONCLUSIONS

One third of patients experienced clinically relevant PTS symptoms early after discharge from the ICU. In the present study, SOC, delusional memory, pain interference, younger age, and not being a trauma patient were factors associated with more PTS symptoms.

RELEVANCE TO CLINICAL PRACTICE

Early individual follow up after ICU discharge focusing on pain relief and delusional memory may reduce PTS symptoms, with a potential of improving rehabilitation.

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.

The Impact of Setting the Standards of Health Promoting Hospitals on Hospital Indicators in Iran

Hospitals play a critical role in the health promotion of the society. This study aimed to determine the impact of establishing standards of health promoting hospitals on hospital indicators in Shahroud. This applied study was a quasi-experimental one which was conducted in 2013. Standards of health promoting hospitals were established as an intervention procedure in the Fatemiyeh hospital. Parameters of health promoting hospitals were compared in intervention and control hospitals before and after of intervention (6 months). The data were analyzed using chi-square and t-test. With the establishment of standards for health promotion hospitals, standard scores in intervention and control hospitals were found to be 72.26 ± 4.1 and 16.26 ± 7.5, respectively. T-test showed a significant difference between the mean scores of the hospitals under study (P = 0.001).The chi-square test also showed a significant relationship between patient satisfaction before and after the intervention so that patients' satisfaction was higher after the intervention (P = 0.001). Commenting on the short-term or long-term positive impacts of establishing standards of health promoting hospitals on all hospital indicators is a bit difficult but preliminary results show the positive impact of the implementation of standards in case hospitals which has led to the improvement of many indicators in the hospital.

Patient education for alcohol cessation intervention at the time of acute fracture surgery: study protocol for a randomised clinical multi-centre trial on a gold standard programme (Scand-Ankle)

BACKGROUND

Patients with hazardous alcohol intake are overrepresented in emergency departments and surgical wards. These patients have an increased risk of postoperative complications with prolonged hospital stays and admissions to intensive care unit after surgery. In elective surgery, preoperative alcohol cessation interventions can reduce postoperative complications, but no studies have investigated the effect of alcohol cessation intervention at the time of acute fracture surgery. This protocol describes a randomised clinical trial that aims to evaluate the effect of a new gold standard programme for alcohol cessation intervention in the perioperative period regarding postoperative complications, alcohol intake and cost-effectiveness.

METHODS/DESIGN

Patients with hazardous alcohol intake undergoing ankle fracture surgery will be recruited into the trial from multiple orthopaedic wards at university hospitals in Denmark, Sweden and Norway. Included patients will be randomly allocated to either standard care or the gold standard programme aimed at complete alcohol abstinence before, during and 6 weeks after surgery. It includes a structured patient education programme and weekly interventions meetings at the orthopaedic outpatient clinic. Furthermore, patients are provided with thiamine and B-vitamins, alcohol withdrawal prophylaxis and treatment, and disulfiram to support abstinence. Alcohol intake is biochemically validated (blood, urine and breath tests) at the weekly intervention meetings and follow-up visits. Follow-up assessments will be conducted 6 weeks and 3, 6, 9 and 12 months after surgery for all patients. The effect of the gold standard programme will be assessed comparing the outcome measures between the intervention and control group at each follow-up point.

DISCUSSION

The study will provide new knowledge about how to prevent alcohol-related postoperative complications at the time of acute fracture surgery. If effective, the results will be a benefit for the clinical course, patients and society alike.

TRIAL REGISTRATION

The protocol is registered in ClinicalTrials.gov (Id: NCT00986791 ).