Adaptability, challenges and capacities to implement Health Promoting Hospitals (HPH) program in the educational hospitals’ of the Tabriz University of Medical Sciences: a mixed method study

Abstract

Introduction: Despite the expansion of Health Promoting Hospitals (HPH) approach in term of applicability, identify barriers and facilitators to the implementation of it in several countries of the world, the conception is still not ascertained in Iran. Purpose: Adaptability, challenges and capacities to implement Health Promoting Hospitals (HPH) program in the educational hospitals’ of the Tabriz University of Medical Sciences: a mixed method study Material and Method: this study was performed in three-stage, systematic review towards identifies challenges and capacities to implement HPH program in the world, adaptability and applicability of HPH standards among 10 educational hospitals’ and 354 health professionals by using validated self-assessment tool, and in the final stage we use Q Methodology in order to identify challenges and capacities to implement HPH program among health professionals who had prior knowledge about HPH program, respectively. Results: systematic results in this study show that Lack of resources, lack of knowledge and skills or commitment of health professionals, lack of leadership or support to the program of HPH by the organization, policy makers and managers, lack of evaluation program, lack of background and experience of health promotion in hospitals, lack of cooperation and employee participation, lack of prioritization of health promotion in hospitals, resistance to change and ineffective managers were iportent challenges to implement HPH program. In the section of adaptability and applicability of HPH program, results shown that the mean adaptability score of the HPH standards was 60.0 ± SD: 13.0 (range: 0-136), only 32% of the study respondents endorsed the HPH standards’ overall appositeness in the studied hospitals and finally Q Method results shown that five factors: (i) dominant biomedical approach of the Health Care Professionals (HCPs) in the Iranian National Health System (INHS) and their lack of full commitment to health promotion programs, (ii) inappropriate decision-making mechanisms in the INHS for policy formulation, (iii) low priority of health promoting initiatives in the INHS (iv) insufficiency of the INHS’s organizational infrastructure to sustainably maintain the HPH program (v) knowledge gap amongst top and mid-level managers of the INHS to assign the HPH program and four factors: organizational commitment, available funding, Infrastructure availability, and giving priority to health promotion and health professional training were barriers and facilitators to adopt the Health Promoting Hospitals (HPH) initiative from the perspectives of health professionals, respectively. Conclusion: The identified barriers reflect the spheres that need to be focused in interventions to facilitate the successful implementation of the HPH initiative in Iran and other developing countries. Results of this study shown that adaptability and applicability of HPH program is low among educational hospitals affiliated the Tabriz University of Medical Science. Therefore, identify barriers and facilitators of implementation of HPH program can be help to planning, implementation and evaluation health promotion program among educational hospitals. Fulsome investigations are recommended to add further insight to barriers of the HPH accomplishment and find resolution for overcoming the pinpointed challenges.