Fast-track implementation of clinical health promotion

Introduction Clinical health promotion (CHP) addressing the risks of daily smoking, malnutrition and overweight/obesity, hazardous alcohol consumption and insufficient physical activity (SNAP) is relevant in hospitals. CHP improves clinical quality, outcomes, and patient safety and also contributes to population health. A prerequisite to obtaining clinical benefits, however, is remedying the slow and lacking CHP implementation. Aim The aim of this thesis was 1) to develop a new operational program for CHP (paper I), 2) to describe the fast-track implementation model (Fast-IM) used and a comprehensive reporting format (paper II), 3) to evaluate the effect of the operational program (paper III), and 4) to explore how staff and managers experienced the program (paper IV). Materials and methods An operational program for CHP was developed in the Fast-IM format using available resources (paper I). The Fast-IM was further described along with a comprehensive reporting format (paper II). The effect of the program was evaluated in a randomized clinical trial (RCT) at the level of clinical hospital departments (paper III). Staff and managers from the RCT’s intervention group were interviewed about their experiences with and perceptions of the program (paper IV). Results The operational program was developed, although the evidence to build on was sparse (paper I). The Fast-IM and the reporting format were described and might prove useful for speeding up implementation and monitoring of CHP, especially regarding the low frequency of intensive intervention to only 0-35% of patients with SNAP risk and the low rate of follow up for effect for only 0-25% (paper II). Potential health effects remained unknown, but the program improved implementation; SNAP risk identification (81% vs. 60%, p<0·01), information and intervention (54% vs. 39%, p<0·01 for information/shorter intervention and 43% vs. 25%, p<0·01 for intensive intervention), as well as standards compliance (95% vs. 80%, p=0·02) (paper III). Staff and managers were positive towards the program (paper IV). Conclusion The operational program for CHP in the Fast-IM format can be useful for fasttracking implementation in hospitals in a way that is generally considered meaningful and acceptable among staff and managers. The immediate health effects of individual CHP programs are known from the literature, but health gain resulting from the operational program, as well as the Fast-IM’s potential effect in other areas, remains to be demonstrated in future randomized studies.