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

Brief Introduction –Hospitals’ responsibility Research project –Aim –Method –Preliminary findings –Conclusions Plan

SUPPORTING INFORMED CHOICE for all PERSONALISATION of support working in PARTNERSHIP Public Health Policies “Every member of NHS staff has the potential to increase their role in raising people’s awareness of the benefits of healthy living” 1. Health inequalities2. Smoking 3. Obesity4. Drinking 5. Sexual health6. Mental health

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

Health Education and Patient Information (HP Form) Weight …… Height ….. BMI ……………… Advice required □ Leaflet given (list below) Diet: Normal Vegetarian Special requirements: Explain to patient that it is advisable to eat: □ Less fatty/fried foods, less sugary foods □ More starchy foods e.g. potatoes, pasta, bread, cereals □ 5 portions of fruit or vegetables a day □ “balance of good health” card given if appropriate □ BMI > 30 Patient advised to contact their practice nurse for comprehensive health check and advice, patient self-referral form given □ Confirm with surgeon if patient suitable for operation at this weight □ Alcohol Intake None □ Occasional □ Yes □ (units per week) ………….. Patient aware daily benchmarks are: 3-4 units for men, 2-3 units for women □ If intake > benchmark, give “Think about drink” flyer □ If intake > 50 units per week men or > 35 units per week women offer referral to hospital alcohol liaison worker □ Smoking: Never smoked □ Ex-smoker □ Current smoker □ Amount per day …………. Patient advised to stop before operation If not possible, advised not to smoke on day of operation □ Inform of smoke-free NHS policy □ Asked if would like to give up smoking □ If yes, give “stopping smoking made easier” leaflet □ Patient advised to contact GP/Link nurse for further advice □

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.

Method 1.Review patient case notes pre and post HWS 2.Validation – case notes and patient questionnaire data 3.Patient interviews  patient questionnaires 4.Staff interviews  staff questionnaires

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

Results 1 - Case Notes AlcoholSmokingDietExerciseBMI screened43/54 (80%)40/54 (74%) 1/54 HP needed4/43 (9%) 13/40 (33%) 3/54 treatment3/42/13 advice3/131/3

Results 2 – Patient Interviews “ Do you think the hospital’s no-smoking policy helped you/others stop smoking or reduce the amount smoked?” “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 no- smoking policy works? “It’s definitely working” smoker “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 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” “If drinking is bad for you I would want the advice” (>21 units/week)

“Would you have liked to have been offered HP on a healthy diet?” “Not really. I manage ok” “I’m more interested in getting better than what I am eating” “Do you have any ideas for improving diet related HP?” “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 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”

General Issues 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”

Should HP be provided in hospitals, and when? 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”

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

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.