Journal of Education and Health Promotion

Hospitals reorientation towards health promotion: A qualitative study of barriers to and strategies for implementation of health promotion in hospitals of Isfahan, Iran

Document Type : Original Article

Authors

. Atefeh Afshari
. Firoozeh Mostafavi
. Arman Latifi 1
. Leila Ahmadi Ghahnaviyeh 2
. Maryam Pirouzi 3
. Ahmad Ali Eslami

1 Department of Public Health, School of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran

2 Dehaghan Health Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Vice Chancellor for Resources and Management Development, Isfahan University of Medical Sciences, Isfahan, Iran,

Abstract
CONTEXT: The World Health Organization (WHO) has emphasized the need for reorientation of
hospitals toward health promotion (HP).
AIMS: This study explores health‑care professionals’ perception of barriers and strategies to
implementing HP in educational hospitals of Isfahan Province in Iran.
SETTINGS AND DESIGN: The study settings included four selective educational hospitals and the
Treatment Administration affiliation to the Isfahan University of Medical Sciences.
SUBJECTS AND METHODS: A qualitative content analysis approach was employed in this study,
with semi‑structured in‑depth interviews. Eighteen participants from hospital and accreditation
managers, nurses, community medicine specialist, and directors of health‑care quality improvement
and accreditation participated in the study by purposeful sampling method. The data were analyzed
using content analysis method.
RESULTS: The barriers can be categorized into the following areas: (1) barriers associated with
patient and community, (2) barriers associated with health‑care professionals, (3) barriers associated
with the organization, and (4) external environment barriers. The results were summarized into four
categories as strategies, including: (1) marketing the plan, (2) identifying key people and training, (3)
phasing activities and development of feasible goals, and (4) development of strategic goals of health
promoting hospitals and supportive policies.
CONCLUSIONS: The interactions of individual, organizational, and external environmental factors
were identified as barriers to implementation of HP in hospitals. To hospital reorientation toward HP,
prioritizing the barriers, and using the proposed strategies may be helpful.

Keywords

Health promoting hospital
health promotion
hospital
qualitative methods
1. WHO. Ottawa Charter for Health Promotion. First International
Conference on Health Promotion, Ottawa 21 November, 1986.
WHO/HPR/HEP/95.1; 1986. Available from: http://www.who.
int/healthpromotion/conferences/previous/ottawa/en/index4.
html. [Last accessed on 2014 May 10].
2. Pelikan JM, Krajic K, Lobnig H, Conrad G. Feasibility,
Effectiveness, Quality and Sustainability of Health Promoting
Hospital Projects: Conrad; 1998.
3. Lee CB, Chen MS, Powell MJ, Chu CM. Organisational change to
health promoting hospitals: A review of the literature. Springer
Sci Rev 2013;1:13‑23.
4. GroeneO, Jorgensen SJ. Health promotion in hospitals – A strategy
to improve quality in health care. Eur J Public Health 2005;15:6‑8.
5. World Health Organization. The International HPH Network;
2014. Available from: http://hphnet.org/index.php?option=com_
content&view=category&id=9&Itemid=5. [Last accessed on 2018
Mar 14].
6. Wieczorek CC, Marent B, Osrecki F, Dorner TE, Dür W. Hospitals
as professional organizations: Challenges for reorientation
towards health promotion. Health Soc Rev 2015;24:123‑36.
7. Whitehead D. Health promoting hospitals: The role and function
of nursing. J Clin Nurs 2005;14:20‑7.
8. Lee CB, Chen MS, Chien SH, Pelikan JM, Wang YW, Chu CM,
et al. Strengthening health promotion in hospitals with
capacity building: A Taiwanese case study. Health Promot Int
2015;30:625‑36.
9. Lee CB, Chen MS, Wang YW. Barriers to and facilitators of
the implementation of health promoting hospitals in Taiwan:
A top‑down movement in need of ground support. Int J Health
Plann Manage 2014;29:197‑213.
10. World Health Organization. The International Network of Health
Promoting Hospitals and Health Services: Integrating Health
Promotion into Hospitals and Health Services. World Health
Organization Regional Office for Europe; 2007. p. 1‑23. Available
from: www.euro.who.int/__data/assets/pdf_file/0009/99801/
E90777.pdf. [Last accessed on 2018 Mar 14].
11. Graneheim UH, Lundman B. Qualitative content analysis in
nursing research: Concepts, procedures and measures to achieve
trustworthiness. Nurse Educ Today 2004;24:105‑12.
12. Polit D, Beck C, Hungler B. Essentials of Nursing Research,
Methods, Appraisal & Utilization. Vol. 2. Philadelphia: Lippincott
Williams and Wilkins; 2006. p. 11‑23.
13. Whitehead D. The European Health Promoting Hospitals (HPH)
project: How far on? Health Promot Int 2004;19:259‑67.
14. Orlandi MA. Promoting health and preventing disease
in health care settings: An analysis of barriers. Prev Med
1987;16:119‑30.
15. Aghakhani N, Nia HS, Ranjbar H, Rahbar N, Beheshti Z. Nurses’
attitude to patient education barriers in educational hospitals of
Urmia university of medical sciences. Iran J Nurs Midwifery Res
2012;17:12‑5.
16. Guo XH, Tian XY, Pan YS, Yang XH, Wu SY, Wang W, et al.
Managerial attitudes on the development of health promoting
hospitals in Beijing. Health Promot Int 2007;22:182‑90.
17. Walthew P, Scott H. Conceptions of health promotion held by
pre‑registration student nurses in four schools of nursing in
New Zealand. Nurse Educ Today 2012;32:229‑34.
18. Farahani MA, Mohammadi E, Ahmadi F, Mohammadi N. Factors
influencing the patient education: A qualitative research. Iran J
Nurs Midwifery Res 2013;18:133‑9.
19. McHugh C, Robinson A, Chesters J. Health promoting
health services: A review of the evidence. Health Promot Int
2010;25:230‑7.
20. Miseviciene I, Zalnieraitiene K. Health promoting hospitals in Lithuania: Health professional support for standards. Health
Promot Int 2013;28:512‑21.
21. Lee CB, Chen MS, Powell M, Chu CM. Achieving organizational
change: Findings from a case study of health promoting hospitals
in Taiwan. Health Promot Int 2014;29:296‑305.
22. Aujoulat I, Le Faou AL, Sandrin‑Berthon B, Martin F, Deccache A.
Implementing health promotion in health care settings:
Conceptual coherence and policy support. Patient Educ Couns
2001;45:245‑54.
23. Johnson A, Nolan J. Health promoting hospitals: Gaining
an understanding about collaboration. Aust J Prim Health
2004;10:51‑60.
24. World Health Organization. Standards for Health Promotion in
Hospitals: WHO Regional Office for Europe; 2004. 
Journal of Education and Health Promotion
Volume 8, Issue 6
June 2018
Pages 1-8

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