Syntax Literate: Jurnal Ilmiah Indonesia
p�ISSN: 2541-0849 e-ISSN: 2548-1398
Vol. 7, No. 09, September 2022
EVALUATION OF AFFECTING FACTOR IN HEALTH PROMOTING
HOSPITAL: SYSTEMATIC REVIEW AND META-ANALYSIS
Dimas Maulana Syafeli1*, Ede Surya Darmawan2
1*,2 Faculty of Public Health Sciences, University of Indonesia, Jakarta,
Indonesia
Email: [email protected]
Abstrak
Penting untuk mengembangkan konsep baru Health
Promotion Hospital (HPH) karena perlunya
penyesuaian dan revisi layanan
promosi kesehatan rumah
sakit (HP) di samping perawatan
terapeutik. Ini adalah studi komprehensif dan
meta-analitik untuk mengetahui
korelasi faktor-faktor yang
mempengaruhi dalam pelaksanaan
promosi kesehatan rumah
sakit selama 20 tahun sebelumnya. Investigasi
komprehensif ini dilakukan
sesuai dengan pedoman Tinjauan
Sistematis dan Meta-Analisis (PRISMA) untuk item pelaporan.
Hasil yang dievaluasi dalam penelitian ini termasuk perkiraan
faktor dalam mempengaruhi promosi kesehatan di rumah sakit.
Perbedaan rata-rata (MD) dari
data kontinu digunakan untuk mengumpulkan data. 9
studi dipilih untuk meta-analisis.
Karena variabilitas substansial dalam kedua kategori, model analisis efek acak
digunakan. Kepemimpinan, Kebijakan dan Strategi, Orang, Kemitraan dan Sumber Daya, Proses, Hasil Pasien, Hasil Staf, Hasil Masyarakat, dan Komunikasi adalah faktor-faktor yang mempengaruhi di rumah sakit yang mempromosikan kesehatan. Kepemimpinan, Kebijakan
dan Strategi, Kemitraan dan Sumber Daya Manusia, Proses, Hasil Pasien,
Hasil Staf, dan Hasil Masyarakat semuanya memiliki dampak besar dalam mempengaruhi dan meningkatkan promosi kesehatan di
rumah sakit.
Kata kunci: Health promoting
hospital, affecting factor, Meta-Analysis
Abstract
It is important to
develop a new concept of Health Promotion Hospital (HPH) because of the
necessity for adjustments and revisions to hospital health promotion (HP)
services alongside therapeutic treatments. This is a comprehensive and
meta-analytic study to determine the correlation of influencing factors in hospital
health promotion implementation during the previous 20 years. This
comprehensive investigation was carried out in accordance with the Systematic
Review and Meta-Analysis (PRISMA) guidelines for reporting items. Outcomes
evaluated in this study included estimated factor in affecting health promotion
in hospital. The mean difference (MD) of continuous data was used to pool the
data. 9 studies were chosen for meta-analysis. Because of the substantial
variability in both categories, a random-effect model of analysis was used.
Leadership, Policy and Strategy, People, Partnership and Resource, Processes,
Patient Results, Staff Results, Society Results, and Communication were the
factors affecting in health promoting hospital. Leadership, Policy and Strategy,
People Partnership and Resource, Processes, Patient Results, Staff Results, and
Society Results all had a substantial impact in affecting and improving health
promotion in hospitals.
Keywords: Health promoting hospital, affecting factor,
Meta-Analysis
Introduction
Because of the
necessity for adjustments and revisions to hospital organizational processes,
as well as the inclusion of health promotion (HP) services alongside
therapeutic treatments. It is important to develop a new concept of Health Promotion
Hospital (HPH) due to the continuously changing internal and external
environment of the hospital.(Yaghoubi et
al., 2018) Hospitals
according to WHO (World Health Organization) are an integral part of health
service facilities which have the obligation to provide complete health
services ranging from curative, rehabilitative, preventive to promotive (World Health Organization, 2018) The benefits of implementing Health Promoting Hospital include being
able to provide a good impact on increasing literacy, satisfaction and health
status of patients, the surrounding community and hospital staff as well as
providing high quality and safe services.(Paterick et
al., 2017) In
addition, it can reduce the incidence of readmission rate in the hospital.
Conversely, if it has not been implemented, the community will lose their right
to receive balanced health information and education.(Janssen et al., 2014)
Health promotion
at the hospital also aims to increase patient, family, and visitor awareness
and interest in playing a constructive part in illness cure and prevention
activities. The goal of a Health Promoting Hospital (HPH) is to improve the
knowledge, attitudes, and behavior of Hospital patients while also maintaining
the Hospital environment and making the best use of the services given by the
Hospital.(Wartiningsih
et al., 2020) Thus the
implementation of HPH is very important because it is not only beneficial for
patients to encourage healthy behavior, prevent patients from re-treatment and
also maintain the patient's quality of life, but this program can also improve
the health status of the Hospital staff so that it has an impact on increasing
productivity and quality of work of staff due to reduced absenteeism.(Young, 2014)
HPH program
implementation is expected to reduce treatment costs and increase patient
satisfaction. HPH implementation has not been optimal due to the low knowledge
of hospital staff about the HPH concept. In addition, communication between
officers has not been well established, causing various obstacles in HPH
implementation.(Sadeghi et
al., 2021) One of the
obstacles often faced by most hospitals is the absence of special staff to run
various HPH programs. On the other hand, most hospitals give double duty to the
HPH division in the form of marketing the hospital.(Barmo et al.,
2020) This is a
comprehensive and meta-analytic study to determine the correlation of
influencing factors in hospital health promotion implementation during the
previous 20 years.
Methods
In June 2023, a
systematic review and meta-analysis were conducted following PRISMA guidelines
to explore factors influencing the implementation of health promotion in
hospitals. Various internet resources, including Science Direct, PubMed,
Cochrane Library, ProQuest, and Google Scholar, were utilized for the study.
The eligibility criteria focused on real-world studies within the last twenty
years, with preference given to high-quality research based on risk of bias
evaluation. The search strategy incorporated keywords like "health
promotion in hospital," "HPH," "health promotion," or
"hospital�s health promotion," combined with terms like
"Implementation Factor" or "factors" or "affecting
factors" or "contribution factors." The statistical analysis
involved the use of the Newcastle-Ottawa Scale for Retrospective Studies, and
outcomes were assessed through mean differences (MD) in continuous data.
Heterogeneity was evaluated using the I2 statistic, and a random-effects model
was employed for significant heterogeneity. The entire meta-analysis utilized
Review Manager version 5.4 and Comprehensive
Meta-Analysis version 3.0, declaring statistical significance at a p-value of
0.05. The outcomes focused on estimating factors affecting health promotion in
hospitals.
Results and Discussion
Figure 1 depicts a search flow diagram. Following the screening of 163
titles and abstracts, 84 studies were accessed for full-text eligibility. In
total, 9 studies were chosen for meta-analysis.
Figure 1. Flowchart
of the PRISMA Screening Criteria and Included Studies
Table 1 presents a
summary of the included studies, including country, study design, demographic
target, implementation, and study outcome. Four studies (Figure 2) including
723 individuals were divided into case groups (n = 453) and control groups (n =
270) to determine the impact of leadership on hospital health promotion.
Because of the substantial variability in both categories, a random-effect
model of analysis was used. Pooled analysis in Fig. 2 showed that the studies
included had a high heterogeneity (I2 = 78%) and there was a significant
association between leadership in affecting the health promotion of hospital (MD
0.31, 95% confidence interval [CI] 0.14 to 0.70, p 0.004). These included
studies carried out in Greece (n=1), Taiwan (n=2), and Iran (n=1).
Figure 2. Forest Plot and Funnel Plot of
Leadership
Seven studies (Figure
3) including 2100 individuals were divided into case groups (n = 1324) and
control groups (n = 776) to determine the impact of policy and strategy on
hospital health promotion. Because of the substantial variability in both
categories, a random-effect model of analysis was used. Figure 3 revealed that
the included studies were highly heterogeneous (I2 = 97%) and there was a
significant association between policy and strategy in affecting the health
promotion of hospital (MD 0.16, 95% confidence interval [CI] 0.05 to 0.54, p
0.003). These included studies carried out in Taiwan (n=2), and Iran (n=3),
England (n=1), Austria (n=1).
Figure 3. Forest Plot and Funnel Plot of Policy
and Strategy
Seven studies (Figure
4) including 1767 participants were divided into case groups (n = 1203) and
control groups (n = 564) to determine the impact of people on hospital health
promotions. Because of the substantial variability in both categories, a
random-effect model of analysis was used. Figure 4 revealed that the included
studies were highly heterogeneous (I2 = 91%) and there was a significant
association between people in affecting the health promotion of hospital (MD
0.16, 95% confidence interval [CI] 0.06 to 0.44, p 0.003). These included
studies carried out in Taiwan (n=1), and Iran (n=2), England (n=1), Austria
(n=1), Indonesia (n=1), Greece (n=1).
Figure 4. Forest Plot and Funnel Plot of
People
Five studies (Figure
5) including 1643 people were divided into case groups (n = 1103) and control
groups (n = 540) to determine the influence of partnership and resources on
hospital health promotion. Because of the substantial variability in both
categories, a random-effect model of analysis was used. Figure 5 revealed that
the included studies were highly heterogeneous (I2 = 97%) and there was a
significant association between partnership and resources in affecting the
health promotion of hospital (MD 0.15, 95% confidence interval [CI] 0.02 to
1.03, p 0.05). These included studies carried out in Taiwan (n=2), and Iran
(n=1), Indonesia (n=1), Greece (n=1).
Figure 5. Forest Plot and Funnel Plot of
Partnership and Resources
Five studies (Figure
6) including 1178 people were divided into case groups (n = 740) and control
groups (n = 438) to determine the impact of processes on hospital health
promotion. Because of the substantial variability in both categories, a
random-effect model of analysis was used. Figure 6 revealed that the included
studies were highly heterogeneous (I2 = 93%) and there was a significant
association between processes in affecting the health promotion of hospital (MD
0.28, 95% confidence interval [CI] 0.10 to 0.74, p 0.01). These included
studies carried out in Iran (n=1), Indonesia (n=1), Greece (n=1), England
(n=1), Taiwan (n=1).
Figure 6. Forest Plot and Funnel Plot of
Processes
Seven studies (Figure
7) involving 1399 individuals were divided into case groups (n = 879) and control
groups (n = 520) to determine the impact of patient outcomes on hospital health
promotions. Because of the substantial variability in both categories, a
random-effect model of analysis was used. Figure 7 revealed that the included
studies were highly heterogeneous (I2 = 92%) and there was a significant
association between patient results in affecting the health promotion of
hospital (MD 0.24, 95% confidence interval [CI] 0.11 to 0.52, p 0.0003). These
included studies carried out in Iran (n=2), Greece (n=1), England (n=1), Taiwan
(n=2), Austria (n=1).
Figure 7. Forest Plot and Funnel Plot of
Patient Results
Three studies (Figure
8) including 1066 participants were divided into case groups (n = 652) and
control groups (n = 414) to determine the impact of hospital staff results on
health promotion. Because of the substantial variability in both categories, a
random-effect model of analysis was used. Figure 8 revealed that the included
studies were highly heterogeneous (I2 = 96%) and there was a significant
association between staff results in affecting the health promotion of hospital
(MD 0.24, 95% confidence interval [CI] 0.06 to 0.89, p 0.03). These included
studies carried out in England (n=1), Taiwan (n=1), Austria (n=1).
Figure 8. Forest Plot and Funnel Plot of
Staff Results
Six studies (Figure 9) including 1625 people were divided into case
groups (n = 1075) and control groups (n = 550) to calculate the impact of
societal outcomes on hospital health promotion. Because of the substantial
variability in both categories, a random-effect model of analysis was used. Figure
9 revealed that the included studies were highly heterogeneous (I2 = 92%) and
there was a significant association between society results in affecting the
health promotion of hospital (MD 0.14, 95% confidence interval [CI] 0.04 to
0.44, p 0.0008). These included studies carried out in Iran (n=2), Greece
(n=1), England (n=1), Taiwan (n=1), Austria (n=1), Greece (n=1).
Figure 9. Forest Plot and Funnel Plot of Society Results
Three studies (Figure
10) including 1046 individuals were divided into case groups (n = 727) and
control groups (n = 319) to determine the impact of communication on hospital
health promotion. Because of the substantial variability in both categories, a
random-effect model of analysis was used. Figure 10 revealed that the included
studies were highly heterogeneous (I2 = 96%) and there was a insignificant association between communication in
affecting the health promotion of hospital (MD 0.10, 95% confidence interval
[CI] 0.01 to 1.13, p 0.06). These included studies carried out in Iran (n=2),
Indonesia (n=1).
Figure 10. Forest Plot and Funnel Plot of
Communication
Discussion
This study investigated factors affecting HPH implementation and
development in 9 scientifically published papers. Most of the studies were
cross sectional study, before after study, and randomized control trials study.
According to the findings, there were certain issues with HPH implementation,
such as a lack of knowledge of the HPH, as well as a lack of financial
resources, leadership, policy and strategy, human resources or people,
partnership, processes such as program evaluating and monitoring, collaborating
in patient, staff, and community, also communication.
The issues involving managerial staff attitudes toward health-promoting
hospitals is leadership.(Worringer et
al., 2020) The
hospital's chief executive officer should propose and implement
health-promoting initiatives for patients, patient�s families, staff, and the
communities.(Ghiasipour et
al., 2017) The
participation and assistance of hospital leaders appear to be necessary in the
health-promoting hospital implementation process.(Bokhour et
al., 2018) Establishing
a holistic health-promoting hospital approach that includes project management
and organizational growth necessitates the presence and support of leadership.(Akerjordet et
al., 2018) One reason
for managers' reluctance to implement HP projects is that they are not
immediately profitable. As a result, the hospital's CEO does not emphasize
these tasks in the hospital's operational programs.(Yaghoubi et
al., 2018)
It may be stated that, in addition to the support of leaders for the
creation of a health-promoting hospital, organizational support through the
development of health-promotion strategies and money are also required.(Kruk et al., 2018) To develop a complete health-promoting hospital approach, hospitals
should incorporate health-promoting aims, values, and principles into their
vision and mission statements.(MULIANINGSIH, 2023) These elements are significant in policy and strategy criteria. For
health promotion implementation, two primary strategies are advocated. There is
the creation of financial management and budgeting strategies, as well as the
distribution of resources from local communities or non-governmental
organizations (NGOs) to meet a financial shortfall.(Yaghoubi et
al., 2018) Certainly,
the Integration Model will help to develop the strategies in implementing health
promotion of hospital. A previous study investigated 52 health promotions and
focused on policy formulation for the establishment of health promotion in
Taiwan hospital including embodying health promotion in its goals and mission, government
financial support, development of committees health promotion task force,
health promotion resources and policies, lack of health promotion insurance
coverage, inconsistency of government health promotion policies, and opposition
to change in hospitals.(Wang et al., 2019)
The other factor is human resources (people). Employee commitment and
participation in health promotion programs is the key to a comprehensive health
promotion program in the hospital.(Ghiasipour et
al., 2017) Hospitals
should assign qualified and specialized staff to health promotion programs,
train dedicated staff to implement health promotion programs, and review health
promotion programs to ensure that they are perform well. Professional
health workers need regular training, especially in communication and teaching
skills.(Rosen et al., 2018) In terms of patient needs assessment and diagnostic teams, providing
clear and relevant information to patients, and providing follow-up healthcare
and post-discharge rehabilitation, this fundamental element of empowering
patients, staff, and communities to establish and develop health promotion is
emphasized in all articles reviewed.(DeSai et al.,
2021) Furthermore,
staff members are the ones who deliver health-promoting hospital to patients,
and both the health and competences of staff and management have been linked to
the implementation of health-promoting hospital. Staff shortages in
health-promoting hospital competencies are another major impediment to actually
delivering services.(Quirk et al., 2018) Improving both competences and lifestyle risks among employees and
managers appears likely to lessen barriers to health-promoting hospital
implementation.(Wang et al., 2019)
Collaboration and resources, another influencing aspect is criteria,
which often relates to long-term relationships with suppliers, product support
from suppliers, and lowered consumption of financial and physical resources.(Alderwick et
al., 2021) A lack of
proper knowledge of the concept of a health-promoting hospital, insufficient
funds, and a lack of people, time, and skills in the field of health promotion
programs are all extremely effective and can be barriers to establishing a
health-promoting hospital.(Afshari et
al., 2016) Attracting
community involvement and groups outside of the hospital is critical to the
success of health promotion. As a result, a study in Taiwan discovered that
insufficient support from the hospital's external environment can be a barrier
to health promotion in hospital.(Svane et al.,
2018)
Although in this study it was found that there was no significant effect
on communication in creating a good health promoting hospital, previous
research stated that the impact of communication on health promotion
implementation because communication is a crucial aspect in hospital health
promotion implementation.(Barmo et al.,
2020) The goal
of communication is to ensure that the health promotion is well received by
patients, their families, and hospital staff.(Kusumaningrum
et al., 2021) Despite
the support and commitment of good implementers, other factors such as
insufficient resources, a lack of communication among stakeholders involved in
health promotion hospital activities, and attitudes toward this concept and its
influence can all have an impact on its implementation.(Crable et al.,
2020) Communication,
such as meetings or stakeholder gatherings, is required to maximize health
promotion hospital planning and assessment by incorporating many disciplines so
that strategies can be optimized. For implementation, several health promotion hospital
methods are developed and it is important to build a practice guidelines of HPH
activities.(Pereira et al., 2022)
Conclusion
There was a substantial association between Leadership, Policy and
Strategy, People Partnership and Resource, Processes, Patient Results, Staff
Results, and Society Results in effecting and increasing health promotion in
hospitals, according to this meta-analysis. In this study, communication shows
a negligible correlation.
BIBLIOGRAFI
Afshari, A., Mostafavi, F., Keshvari, M., Ahmadi Ghahnaviye, L., Piruzi,
M., Moazam, E., Hejab, K., & Eslami, A.-A. (2016). Health promoting
hospitals: a study on educational hospitals of Isfahan, Iran. Health
Promotion Perspectives, 6(1), 23�30.
https://doi.org/10.15171/hpp.2016.04
Akerjordet, K., Furunes, T., & Haver, A. (2018).
Health-promoting leadership: An integrative review and future research agenda. Journal
of Advanced Nursing, 74(7), 1505�1516. https://doi.org/https://doi.org/10.1111/jan.13567
Alderwick, H., Hutchings, A., Briggs, A., & Mays, N.
(2021). The impacts of collaboration between local health care and non-health
care organizations and factors shaping how they work: a systematic review of
reviews. BMC Public Health, 21(1), 753.
https://doi.org/10.1186/s12889-021-10630-1
Askari, R., Mir Hosseini, R., Montazeral Faraj, R., &
Jambarsang, S. (2022). Evaluation of the Effect of Implementing Health
Promoting Hospitals Program on the Level of Attitude of Cardiac Patients
TT� -. Mdrsjrns, 10(2),
341�346.
Barmo, S., Mochtar Thaha, R., Nasir, S., Bahry Noor, N.,
& Furqaan Naiem, M. (2020). The Influence of Communication, Resources, and
Disposition on the Implementation of Health Promotion Hospital at Bhayangkara
Hospital. International Journal of Multicultural and Multireligious
Understanding (IJMMU), 7(9), 315.
Bokhour, B. G., Fix, G. M., Mueller, N. M., Barker, A. M.,
Lavela, S. L., Hill, J. N., Solomon, J. L., & Lukas, C. V. (2018). How can
healthcare organizations implement patient-centered care? Examining a� large-scale cultural transformation. BMC
Health Services Research, 18(1), 168.
https://doi.org/10.1186/s12913-018-2949-5
Crable, E. L., Biancarelli, D., Walkey, A. J., &
Drainoni, M.-L. (2020). Barriers and facilitators to implementing priority
inpatient initiatives in the� safety net
setting. Implementation Science Communications, 1, 35.
https://doi.org/10.1186/s43058-020-00024-6
DeSai, C., Janowiak, K., Secheli, B., Phelps, E., McDonald,
S., Reed, G., & Blomkalns, A. (2021). Empowering patients: simplifying
discharge instructions. BMJ Open Quality, 10(3).
https://doi.org/10.1136/bmjoq-2021-001419
Ghiasipour, M., Mosadeghrad, A. M., Arab, M., &
Jaafaripooyan, E. (2017). Leadership challenges in health care organizations:
The case of Iranian� hospitals. Medical
Journal of the Islamic Republic of Iran, 31, 96.
https://doi.org/10.14196/mjiri.31.96
Groene, O., Alonso, J., & Klazinga, N. (2010).
Development and validation of the WHO self-assessment tool for health promotion� in hospitals: results of a study in 38
hospitals in eight countries. Health Promotion International, 25(2),
221�229. https://doi.org/10.1093/heapro/daq013
Janssen, B. M., Van Regenmortel, T., & Abma, T. A.
(2014). Balancing risk prevention and health promotion: towards a harmonizing
approach in� care for older people in the
community. Health Care Analysis : HCA : Journal of Health
Philosophy and Policy, 22(1), 82�102.
https://doi.org/10.1007/s10728-011-0200-1
Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie,
H. H., Roder-DeWan, S., Adeyi, O., Barker, P., Daelmans, B., Doubova, S. V,
English, M., Garc�a-Elorrio, E., Guanais, F., Gureje, O., Hirschhorn, L. R.,
Jiang, L., Kelley, E., Lemango, E. T., Liljestrand, J., � Pate, M. (2018).
High-quality health systems in the Sustainable Development Goals era: time for
a� revolution. The Lancet. Global
Health, 6(11), e1196�e1252.
https://doi.org/10.1016/S2214-109X(18)30386-3
Kusumaningrum, A. E., Rusmita, E., Susanti, S., Sari, A. R.,
& Makmuriana, L. (2021). Efficiency of the ethnopsychotherapeutic
communication culture of medical personnel for patients needs in Indonesia. Linguistics
and Culture Review, 6, 24�34.
https://doi.org/10.21744/lingcure.v6ns4.2006
MULIANINGSIH, N. I. P. B. (2023). Integration Health
Promotion Into Hospital Care: Development of Health Promoting Hospital (HPH) : The Benefits, Challenges and The Implementation For
Future Hospital in
Indonesia. HealthY : Jurnal Inovasi Riset Ilmu Kesehatan, 2(1
SE-), 51�64. https://doi.org/10.51878/healthy.v2i1.2051
Paterick, T. E., Patel, N., Tajik, A. J., &
Chandrasekaran, K. (2017). Improving health outcomes through patient education
and partnerships with� patients. In Proceedings
(Baylor University. Medical Center) (Vol. 30, Issue 1, pp. 112�113).
https://doi.org/10.1080/08998280.2017.11929552
Pereira, V. C., Silva, S. N., Carvalho, V. K. S., Zanghelini,
F., & Barreto, J. O. M. (2022). Strategies for the implementation of
clinical practice guidelines in public health: an overview of systematic
reviews. Health Research Policy and Systems, 20(1), 13.
https://doi.org/10.1186/s12961-022-00815-4
Quirk, H., Crank, H., Carter, A., Leahy, H., & Copeland,
R. J. (2018). Barriers and facilitators to implementing workplace health and
wellbeing services in the NHS from the perspective of senior leaders and
wellbeing practitioners: a qualitative study. BMC Public Health, 18(1),
1362. https://doi.org/10.1186/s12889-018-6283-y
Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L.
E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in
healthcare: Key discoveries enabling safer, high-quality care. The American
Psychologist, 73(4), 433�450. https://doi.org/10.1037/amp0000298
R�thlin, F., Schmied, H., & Dietscher, C. (2015).
Organizational capacities for health promotion implementation: Results from an
international hospital study. Health Promotion International, 30(2),
369�379. https://doi.org/10.1093/heapro/dat048
Sadeghi, M., Rahimi, M., Poornoroz, N., & Jahromi, F. F.
(2021). Patient satisfaction with hospital services after the implementation
of the health system. 12(1), 31�36.
Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati,
A., Petticrew, M., Shekelle, P., Stewart, L. A., & Group, P. (2015). meta-analysis
protocols ( PRISMA-P ) 2015 : elaboration and explanation. 7647(February
2011), 1�25. https://doi.org/10.1136/bmj.g7647
Svane, J. K., Chiou, S.-T., Groene, O., Kalvachova, M.,
Brkić, M. Z., Fukuba, I., H�rm, T., Farkas, J., Ang, Y., Andersen, M. �.,
& T�nnesen, H. (2018). A WHO-HPH operational program versus usual routines
for implementing clinical health promotion: an RCT in health promoting
hospitals (HPH). Implementation Science, 13(1), 153.
https://doi.org/10.1186/s13012-018-0848-0
Tountas, Y., Pavi, E., Tsamandouraki, K., Arkadopoulos, N.,
& Triantafyllou, D. (2004). Evaluation of the participation of Aretaieion
Hospital, Greece in the WHO Pilot Project of Health Promoting Hospitals. Health
Promotion International, 19(4), 453�462. https://doi.org/10.1093/heapro/dah407
Wang, Y. W., Chia, S. L., Chou, C. M., Chen, M. S., Pelikan,
J. M., Chu, C., Wang, M. H., & Lee, C. B. (2019). Development and
validation of a self-assessment tool for an integrative model of health
promotion in hospitals: Taiwan�s experience. International Journal of
Environmental Research and Public Health, 16(11).
https://doi.org/10.3390/ijerph16111953
Wartiningsih, M., Supriyanto, S., Widati, S., Ernawaty, E.,
& Lestari, R. (2020). Health promoting hospital: A practical strategy to
improve patient loyalty in� public
sector. Journal of Public Health Research, 9(2), 1832.
https://doi.org/10.4081/jphr.2020.1832
World Health Organization. (2018). Integrating health
services. Technical Series on Primary Health Care, 1�14.
Worringer, B., Genrich, M., M�ller, A., Junne, F.,
Consortium, C. O. T. S., & Angerer, P. (2020). How Do Hospital Medical and
Nursing Managers Perceive Work-Related Strain on� Their Employees? International Journal of
Environmental Research and Public Health, 17(13).
https://doi.org/10.3390/ijerph17134660
Yaghoubi, M., Javadi, M., Bahadori, M., & Ravangard, R.
(2016). Health promoting hospitals model in Iran. Iranian Journal of Public
Health, 45(3), 362�369.
Yaghoubi, M., Karamali, M., & Bahadori, M. (2018). Effective
factors in implementation and development of health promoting hospitals: A
systematic review. Health Promotion International, 33(3), 1�13.
https://doi.org/10.1093/heapro/day024
Young, S. (2014). Healthy behavior change in practical
settings. In The Permanente journal (Vol. 18, Issue 4, pp. 89�92).
https://doi.org/10.7812/TPP/14-018
|
Copyright
holder:
Dimas
Maulana Syafeli, Ede Surya Darmawan (2023)
|
|
First
publication right:
Syntax Literate:
Jurnal Ilmiah Indonesia
|
|
This
article is licensed under:
|