Investigating Health Promotion Practice at an NHS Foundation Trust Hospital

1. Investigating Health Promotion Practice at an NHS Foundation Trust Hospital – Current Practice and Implications for the Future Charlotte Haynes, Stockport NHS Foundation Trust Gary Cook, Stockport NHS Foundation Trust Richard Edwards, University of Manchester

2. Plan • Brief Introduction • Hospitals’ responsibility • Research project • Aim • Method • Preliminary findings • Conclusions

3. Public Health Policies 1. Health inequalities 2. Smoking 3. Obesity 4. Drinking 5. Sexual health 6. Mental health SUPPORTING INFORMED CHOICE for all PERSONALISATION of support working in PARTNERSHIP “Every member of NHS staff has the potential to increase their role in raising people’s awareness of the benefits of healthy living”

4. Stockport NHS Foundation Trust’s commitment to health promotion • Healthy Hospitals Project: • Improving working lives • Health Information project • Healthy Wards Scheme (HWS) • Current health promotion practice • Health Education and Patient Information form: assess lifestyles and advise/offer interventions

6. Aims • Insight into health professionals’ beliefs, attitudes, and current practice of health promotion at a UK hospital. • What do patients expect? • Inform health promotion practice and policy within secondary care.

7. Method • Review patient case notes pre and post HWS • Validation – case notes and patient questionnaire data • Patient interviews  patient questionnaires • Staff interviews  staff questionnaires

8. Results 1 - Case Notes • n = 54, females, n = 25, males, n = 29 • Age range: 7 - 92yrs; mean: 60 ± 2.9yrs Females: 69 ± 3.8yrs Males: 58 ± 3.0yrs (1 tailed t-test p < 0.02) • LoS range 1 - 81 days; mean: 11 ± 3 days

9. Results 1 - Case Notes

10. Results 2 – Patient Interviews “Yes. Oh it does definitely. When you know you can’t [smoke] and you are not meant to, you don’t” smoker “Do you think the hospital’s no-smoking policy helped you/others stop smoking or reduce the amount smoked?” “I think it does but I still think it’s wrong that when you come in through the doors in reception that you see people stood there smoking all the time. It drives me a bit potty at times!” ex-smoker Do you think the no-smoking policy works? “It’s definitely working” smoker

11. “If drinking is bad for you I would want the advice” (>21 units/week) “Do you have any ideas for improving alcohol related HP?” “I’m not sure that anyone would take much notice” “I think most people don’t see the amount they drink as a problem”

12. “Not really. I manage ok” “Would you have liked to have been offered HP on a healthy diet?” “I’m more interested in getting better than what I am eating” “I don’t think they try and influence you at all ... sometimes perhaps it would be a good idea to have the advice on ... you could do with more fruit or whatever.” “Do you have any ideas for improving diet related HP?”

13. “Do you have any ideas for improving exercise related health promotion at the hospital or things you would like to see offered?” “Anybody that can walk should be offered a bit of exercise, a slow treadmill or something similar. Some sort of equipment in the ward or a room they can be taken to and supervised. You should be able to go into a room with equipment in it and sit down and do the exercise that way rather than in the ward”

14. Should all patients be asked about their risk behaviours? “Yes, they should be. Everybody should be” “It would be useful if the info is spread to someone who can help. Someone who is an expert in smoking or diet or whatever. Now is a good time to re-evaluate things” Which hospital staff would you prefer HP from? “I don’t think it would make any difference really. Providing it was somebody that you felt was talking to you, I don’t think it would matter” “I don’t care as long as they are experts in the area. Training is the most important not their position” General Issues

15. Patient responses “Yes, it is a good time but not at the beginning because I was just worried about what was wrong with me” “When you are admitted all you are interested in is getting help with what you have come in with. At the end all you are interested in is getting home” Staff responses “It’s about making a judgement about when to seize the opportunities with patients to give them health promotion” “When they are ill the most important thing is to get them better but also reinforce the health education messages” “I think it should start as soon as the admission” Should HP be provided in hospitals, and when?

16. Results 3 –Staff Interviews Who is responsible for providing HP? Obstacles Solutions? Screen & 1st level advice/info  Refer to “specialist” All staff Time Government Targets Hospital environment Consistency of message Resources Readily available info

17. Tentative Conclusions • Smoking and alcohol are well assessed but HP is more limited. • Diet and exercise are not well assessed. No HP provided. • Patients show less concern for alcohol and dietary advice than for smoking. • Patients want exercise facilities at the hospital. • Health professionals want clear, consistent, readily available information/pathways for HP.