Zhou Fengqiong
Department of Health Management University of Montreal, Montreal, Quebec
The 18th International Conference on Health Promoting Hospital and Health Service, Manchester, UK, 14-16 April, 2010
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(WHOSATHPH); Explore a high effective health care service model through developing health promotion in hospital(HPH); Discuss the strategies for HPH development in undeveloped region.
Why the very different medical service conditions and resources perform the similar HP effect between China and the Unite States?
Total expenditure on health per capita (Intl $, WHO,2006)
Context
Different HPH developing conditions: China vs the U.S
ChinaUndeveloped country, Gross
national income per capita (PPP international
$): 4,6601.3billion populationPolluted environment
The USDeveloped CountryGross national income per
capita (PPP international $): 44,070
0.3billion populationHealthy environment
China health service resource is serious scarce, the condition of China HPH developing is very tough……
per 10000 population( data resource : WHO)
In Unite States, the cost of medical service is 5.9% of total family expenditure
In China, the cost of medical service is 12.5% of total family expenditure
One China Shanghai best HPH teaching Hospital ICU ward The US. hospital advanced ICU ward
China doctor’s office
Different HPH developing conditions: China vs the US.
China hospital register center
China hospital crowded and noisy waiting hall
The US hospital register center
U.S doctor’s office Patients’ waiting room
Probability of dying between 15 and 60 years (per 1 000 population) (resource: WHO statistic data,2006)
The National Public Health Promotion Effect
Cross-culture approach Translated the source instrument from English into Chinese; Back
translated it into English. 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.
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
from 5 June to 30 August 2008; 40 hospital leaders, 3 health management researchers, and 1 government officer were interviewed or investigated;
The Sampling cities were chosen from the different economic developed level in China: developed East region (Shanghai), middle developed region (Hefei), and undeveloped West-South region (Kunming);
Methods
9 hospitals, 15 hospital leaders were from Shanghai;
8 hospitals, 10 hospital leaders were from Hefei;
4 hospitals, 15 hospital leaders were from Kunming.
All the respondents voluntarily completed the questionnaire survey
independently; Repeated questionnaire survey was finished after 3-7
days based on voluntarily willingly.
The name of Shanghai Sample Hospitals GradeSick-beds
The First Affiliated Hospital of Kunming Medical University3
1500
The Second Affiliated Hospital of Kunming Medical University 1200
Wu Hua People Hospital 2 160
Wu Hua Fengning Community Hospital1
22
Wu Hua Community Health Service Center 0
Kunming Sample Hospitals Grade Sick-beds
The First Affiliated Hospital of Anhui Medical University
3
1890
Hefei Second Civic People Hospital 550
Hefei First Civic People Hospital 1600
Anhui Provincial Hospital 1400
Hefei Second Civic People Hospital 2 321
Shushan Administration Division San Li An Community Health Service Center
1
48
Shushan District community Health Service Center 50
Shushan Jingang Town Community Health Service Center 50
Anhui Sample Hospitals Grade Sick-beds
Result
Only one word was marked as different meaning between the back translation version and the original version by all of 40 items ( the word in Chinese version --- back-translation -- the original version is : 满足 – Satisfy -- Match). 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 the Chinese version WHOSATHPH has high internal consistency and good language equivalence. But it still needs to enlarge the sample size for the further strict reliability and validity test.
The Reliability of Chinese version WHOSATHPH
Multi Variance Analysis, SPSS16The full score = 200, N of items=40; N of Hospitals=22, N of Hospital leaders=40 The HPH general score: mean + SD = 154.1+ 36.87 (N= 22, 40)For five HPH standard domains(mean SD) from high to low: Continuity and cooperation 28.95 + 8.4 (72.4% of full score 40, N of items=8);Healthy workplace: 35.38 + 9.7(71.4% of full score 50,N of items=10);Patient information and prevention: 21.34 + 6.9 (71.1% of full score 30, N of items=6);Patients assessment: 23.85 + 7.1 (68.1% of full score 35, N of items =7);Management and policy 28.78+ 7.7 ( 62.6% of full score 45, N of items=9).Different Cities Hospitals HPH General ScoreShanghai HPH (N=15): 142.1 + 26.4Hefei HPH (N=10): 162.3 + 40.0Kunming HPH (N=15): 160.6 + 42.6Different Grades Hospitals HPH General ScoreGrade III (N=21) Mean + SD: 154.19 + 7.3Grade II (N=9) Mean + SD: 158.67 + 10.7 Grade I (N=11) Mean + SD: 144.82 + 14.54
The results indicated that Chinese hospital leaders self-assessed a high HPH developing level. China Hospitals HP level didn’t present general statistic significant difference in hospital size and in different economy developing regions.
The development level of China HPH (WHOSATHPH Investigation)
The general conclusion needs the further large size sampling investigation.
China HPH Developing Principles and strategiesEmphasize the patients-center, public benefits, disease prevention (ex. regularly free or cheap public disease screening) and health professional ethics. Primary healthcare service first. Focus on school health education and healthy lifestyle education. Depend on the regular evaluation and inspection of medial service quality and security; Emphasize the important role of Traditional Chinese Medicine in HP. Stress on the adaptive healthcare service development that matching the national/regional economic developing conditions.Focus on the HPH efficiency and close cooperation, stress on interactivity between the patients, public, and health professional workers. focus on the exchange of global successive experiences of advanced medical service theory, Technology, and management.
Discussion
China National Health Education Activities and Far-ranging National HP
Movement
Stress on the professional ethics and dedication spirit. Emphasize the public, universal, benevolent value of health service and National HP movement.
Over depend on the advanced medical professional service but ignore the national HP, ignore the entire society(public) participation of health promoting movement.
Focus on disease treatment but not disease prevention and health promotion. Health care system relies heavily on private and not-for-profit health insurance which is easy to drive the health care system toward the marketing business direction. Over stress the money value of health service but ignore the public benefit value of health service.
Lessons learnt from the US failing HPH practices
Stress on healthy lifestyle education since the childhood
National deversified health promotion campaign and government finance support
Synthesize Prevention and Treatment, Primary and Advanced Medical Service.
Utilize diversified medical service models,
encourage global acedemical exchange
An undeveloped country can develop an effective HPH through national health education and HP movement. HPH might be not related to the hospital sized and the advanced expensive service conditional. Foster a national HP value and culture is more effective and important than unique money investment for HPH developing. International culture-cross research of HPH is important for HPH developing.
Conclusions –issues expressing
Acknowledge University of Montreal Department of Administration of Health (Farand
Lambert, Régie Blais, et al) Direction of International Relation( Yves Guay) Fudan University (Fu Hua, Zhou Lei, et al) Anhui Medical University ( Ma Ying, et al) Kunming Medical University( Wan Chonghua, et al) Montreal University Women Club. Professor: Oliver Groëne and Jiqian Fang
China research cooperation partners for this research
Professor Fu Hua (First Line, middle) and his graduated students (Shanghai)
Prof. Wan Chonghua (Kunming)
Dr. Ma Ying`s students (Hefei)