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Presentation For Chinese Version Whosathph (Zfq Complete Version)

  1. 1. Cross-Culture Research for Developing Chinese version of the WHO Self-Assessment Tool for Health Promotion in Hospital Fengqiong Zhou Department of Health Management Canadian Conference on Global Health 2010 (formerly Canadian Conference on International Health) GLOBAL HEALTH: A HUMANITARIAN CRISIS? Sunday, October 31st to Wednesday November 3rd, 2010,Oattwa
  2. 2. OUTLINE  1. Object  2. Context  3. Methodology  4. Result  5. Result explanation and discuss  6. Conclusion
  3. 3. Objective -1 Develop a Chinese version of WHO Self- Assessment Tool for Health Promotion in Hospital (WHOSATHPH) through cross-culture research method. 
  4. 4. Objective -2  Discuss the strategies of developing health promotion in hospital(HPH) in undeveloped regions;  Explore the role of value and culture of HPH on performance effect of health care system.
  5. 5. Context  Why develop HPH?  Hospitals play a central role in the health care system; Hospital cost $ >= 60% of total health expenditure Hospital expenditures are the main part of total health investment in most countries;
  6. 6.  Hospitals produce a great deal of waste materials;  Hospitals can become Potentially hazardous workplaces.
  7. 7. Hospitals are high “people volume” institutions and are the distribution centers of health and disease knowledge.
  8. 8. Why develop WHOSATHPH ?  WHOHPH theory and principles offset the defects of the current hospital service evaluation standard system.
  9. 9. Traditional Hospital Service Evaluation System  International Organization for Standardization (ISO),  Total Quality Management (TQM),  Principles of European Foundation for Quality Management (EFQM) .  The Joint Commission on Accreditation of Health Care Organizations (JCAHO),  Joint Commission International (JCI)
  10. 10. Traditional Values and Strategies for Hospital Management Quality Control In hospital Disease Treatment Health Expert Pharmacy Medical Science Technology
  11. 11. The defects of Traditional Hospital Service Model Health Expert
  12. 12. American people assess their health care system U.S. is... Better Worse Same DK/Ref Canada 40% 30% 4% 26% France 31% 14% 3% 53% Great Britain 37% 17% 6% 40% Source: Debating Health: Election 2008, Harvard School of Public Health/Harris Interactive. March 5-8, 2008 http://www.hsph.harvard.edu/news/press-releases/2008-releases/republicans- democrats-disagree-us-health-care-system.html.
  13. 13. WHO HPH Conception and Principle
  14. 14. Theory and Principles of HPH Source from: Groene Oliver, 2006
  15. 15. New functions and roles for HPH Lifestyle intervention Nutrition, In and outside water, air, Hospital exercise Patient & Health People’s Pharmacy Education HEALTH Medias and propaganda Social Science Medical science Foster Health and technology Values and Culture
  16. 16. Main values and principles of WHO HPH development HEALTH
  17. 17. Health Investment and Health Promotion Total expenditure on health Life Expectancy at Birth per capita (Intl $, 2006) 80 6714 The United States China 75 75 72 342 The United States China Female Male
  18. 18. The resources for HPH development between China and USA 145 The United States(2000) China(2005) 94 In Unite States, the cost of medical service is 5.9% of total family expenditure 26 14 10 9 Physicians Nursing and Other health density midwifery service personnel providers In China, the cost of medical service is density density 12.5% of total family expenditure per 10000 population ( data resource : WHO)
  19. 19. The challenges and questions for HPH development  The effectiveness and strategies for HPH development;  The management and performance of HPH in health care system;  The Relationship between Health Promotion and economic development, burden or motivation?
  20. 20. The Challenges for China HPH Development The changes for Chinese health professionals to develop HPH are very big. Serve 1.3billion population who live in the polluted environment. China’s health service resources are scarce. Even so, the limited Health resource distribution is extremely unbalance and unfair. •
  21. 21. Because of the serious defect of health policy and political policy and institution, serious insufficient financial investment on health care system, China health professionals have to gain money from patients’ pocket directly. Patient can not get equal access health service.
  22. 22. China’s health service resources are scarce. Even so, the limited Health resource distribution is extremely unbalance and unfair. Patient can not get equal access health service. China Hospital VIP Ward
  23. 23. Sanitarium for General hospital Senior Officers for Public
  24. 24. Nursing Hospitals and wards for Officers 
  25. 25. China General Hospital and ward 
  26. 26. China Doctors’ Work Environment Health workers generally have to face various huge work stress and work in unsafe work environment.
  27. 27. China Doctor Moral Models: China government requirements to health workers, only contribute their life and talent without asking for any remuneration = be a happy slavery
  28. 28. One Chinese Hospital’s doctors and Nurse have to take on Helmet when they work.
  29. 29.  Developing a Chinese version WHOASHPH and test its reliability for further international comparison research and help China hospital leaders practice and follow complete HPH principle;  Give a primary description of China HPH developing level;  Found the further research for HPH theory developing and practices.
  30. 30. A falling leaf can indicate that autumn’s coming……
  31. 31. Methodology
  32. 32. Cross-culture research Reliability process Test Translated the Spot field source Back investigation Pilot instrument from translated English into test it into (Non-probability Chinese English sampling )
  33. 33. Cross-culture research process:  Translated the source instrument from English into Chinese;  Pilot test: Investigated 8 Chinese health specialists in Montré al;  Back translated it into English;  Two health specialists and the author of WHO self- assessment tool for HPH (Prof. Oliver Groë ne) commented the language equivalence of the back translation version. 
  34. 34. WHOSATHPH (Groene Oliver, 2006)
  35. 35. WHOSATHPH (Groene Oliver,2006)
  36. 36. Standard1 Management policy
  37. 37. Semantic Equivalence Research Chinese version and English version 针对问题 to item 针对词语 to word and phrase 用自己的 对条目作用意义的评 你认为这个问题问 话复述 对选择答案 对某个特定术语和词组的认识 价comment the value 的是什么what do 标准 repeat 的解释 understanding to a term and 每个词语的理解 understanding to words to this item you think about stand 维度 条目 by own`s explanation phrase this question ard doma item words in code 符合 准确 不清楚n 不符合 准确 不理解的词 有价值 不清楚do 错误w 能 不能n 逻辑 不清楚no 不合适的词 建议用词sugge 没有n corre o illogi corre 错误wrong can`t valuab n`t rong yes o logic clear not proper sted word o ct clear cal ct understand le know al 1.1 1.2 1 1.3 1.4 一 2.1 2 2.2 2.3 3.1 3 3.2
  38. 38. Spot field investigation (Non-probability sampling )  22 Hospitals were sampled from three different “GRADS” 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 chosen were from the different economic development levels in China developed East region (Shanghai), middle developed region (Hefei), and undeveloped West-South region (Kunming);
  39. 39. The Geography of the Sample Hospitals
  40. 40. Sick- The name of Shanghai Sample Hospitals Grade beds
  41. 41. Kunming Sample Hospitals Grade Sick-beds The First Affiliated Hospital of Kunming Medical University 1500 3 The Second Affiliated Hospital of Kunming Medical University 1200 Wu Hua People Hospital 2 160 Wu Hua Fengning Community Hospital 22 1 Wu Hua Community Health Service Center 0 Anhui Sample Hospitals Grade Sick-beds The First Affiliated Hospital of Anhui Medical University 1890 Hefei Second Civic People Hospital 550 3 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 48 1 Shushan District community Health Service Center 50 Shushan Jingang Town Community Health Service Center 50
  42. 42. China Best Teaching Hospitals
  43. 43. Shanghai Community Hospital
  44. 44. 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 also completed voluntarily after 3-7 days .
  45. 45. The HPH activities Record in Kunming First Affiliated Hospital
  46. 46. Results
  47. 47. The Reliability of Chinese version WHOSATHPH Language equivalence test Backward translation English version compared with the original English version; completely the same WHO Self assessment tool for HPH WHO Self assessment tool for HPH 1.2 The hospital arranges the resources for the implementation of health promotion Objective: Objective • 1.2.1 • The hospital makes a special budget 1. to describe the framework • To describe the framework for the and materials to ensure the of health promotion, to organization’s activities implementation of health promotion concerning health promotion as services.(evidence: check the budget integrate health promotion and personnel resources) an integral part of the • 1.2.2 as a part into the quality organization’s quality • All clinical departments can provide the management system in management system. operational guidelines or pathways with regard to health promotion.(evidence: hospital. check guidelines) • 1.2.3 1. completely the same • The easy recognized structures and thing facilities (including resources, spaces, 2.almost the same equipments) for health promotion have been built up by the hospital. 3. Some • (evidence: special elevator for patients.) 4. almost not 5. completely different 9 6 48
  48. 48. Only one word was marked as having a 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).
  49. 49. The reliability of Chinese version WHOSAHPH 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 further large sample size research for the further validity test.
  50. 50. Self assessment of HPH development score mean by China hospital leaders (ANOVA, SPSS.16) Grade I Grade II Grade III Officer TOTAL and Mean SD Mean SD Mean SD Mean SD other Number 11 9 21 2 41 Total means 144.82 48.2 158.67 32.1 154.19 33.6 148 152.7 37.1 management 28.45 8.1 29.44 8.6 27.67 7.9 28 27.6 7.97 policy patient 22.6 8.8 23.8 6.2 24.1 6.6 38 23.6 7.0 assessment patient information and 19.45 9.7 21.33 5.8 21.57 5.7 16 20.35 6.9 intervention Develop healthy 32 13.6 36.89 7.7 35.43 8.7 36 34.8 10.0 workplace continuity and 26.18 11.8 30.22 6.1 28.43 7.4 30 28.22 8.4 cooperation
  51. 51. China HPH development level Total Grade1 Grade2 Grade3 sha Ku Kun shangha Kunmi ngh Hefe Kunmi shang Hef nmi shan Hef min i Hefei ng ai i ng hai ei ng ghai ei g N 12 10 13 3 3 2 3 2 3 6 5 8 Total HPH mean 145 132. 156. 165 148. 170. score 136.83 148.2 168.8 .3 3 168.5 143.33 5 .3 129.3 2 1 management policy 22.67 29.4 33.92 25 29.7 34.5 23.33 29 36 21.17 29.4 33 38. patient assessment 34.33 26.2 45.23 33 21.7 47 38 28 40 30.5 26.2 46.8 patient information 20. and intervention 18.83 23.8 23.31 67 18.7 24.5 18.33 26 22 18.17 23.8 23.5 developa healthy 32. 39. workplace 33.42 37.2 38 33 33.7 38 33.33 37.5 33 34 37.2 37.5 continuity and cooperation 27.58 31.6 28.31 29 28.7 24.5 30.33 36 28 25.58 31.6 29.4
  52. 52. Self assessment of HPH development score mean by China hospital leaders
  53. 53. The mean Score of Self-assessment HPH by China Hospital leaders Cities : Shanghai HPH (N=15): 142.1 + 26.4 Hefei HPH (N=10): 162.3 + 40.0 Kunming HPH (N=15): 160.6 + 42.6
  54. 54. Different Grades Hospitals: Grade III (N=21) Mean + SD: 154.19 + 7.3 Grade 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 development level. China Hospitals HP level didn’t present general statistic significant difference in hospital size and in regions with different levels of economic development.
  55. 55. Discussion
  56. 56. China HPH development feature Groene Oliver found that Europe bigger hospitals may have better possibilities to implement health promotion standards than smaller ones in European HPH development research. But in this study, China’s HPH development level didn’t show that HP level is related to hospital size or economic development levels. However, further large sample size research is needed for more general results and conclusion about China HPH development situation.
  57. 57. TCM and HPH  HP has always been China’s basic rule and policy with respect to health development because of HP value in TCM.  To handle the pressures resulting from the shortage of the health investment, China Health Ministry has to depend on TCM to provide accessible, affordable, safe and effective health services.
  58. 58. China Health Promotion Philosophy A great doctor must concentrate and aspirate his profession without any selfish desire and lust when he treats disease. He ought to have great philanthropy and compassion to people, and swears to rescue Patient’s sufferings. — Dr. Simiao Sun (541-682)
  59. 59. Golden Rules for Health Promotion Dr. Simiao Sun ( 581-682)  To promote health, people should keep good life style and life habits.  People should self perfect his personal quality, don't touch the deleterious things. As long as people self health promotion of his body and spirit, he will not attach any disease neither his body nor his mind. There is not any source to produce disaster. It is the Golden Rule for health promotion.
  60. 60. Golden Rules for Health Promotion  People, who well know the strategy of health promotion, focus on the prevention of disease. This is the Golden Rule of health promotion.  Therefore, when people practice the activities of health promotion, he not only focuses on medicine and nutrition, but also stressed on his behaviours.  Only when people have perfected his behaviours, he could have long well healthy life even without medicine.  Without quality healthy behaviours, people could not have long quality life; even he has the best medicine.
  61. 61. Long Health Life/ China HP culture and practice China Famous TCM doctors all have a health long life. In the history, sixty TCM famous doctors lived over 70 years old, most of them lived over 80 years old, a few of them even lived over 100 years old. A famous TCM doctor who is 94 A 90 years old Chinese lady who has excellent health body with natural black years old, he daily works time hair. She started to practise healthy daily is 10 hours. food style 60 years ago when she was sick. Since she ate healthy food daily, she never gets sick and always keeps health.
  62. 62. TCM integrates health philosophy, health value and culture concerns into the social sciences that advocates the disease prevention rather than treatment, treats ailments in a timely way before it becomes serious, stresses that disease treatment should combine mental and physical elements, emphasizes the harmony between mind and body, man and society, as well as man and nature. all of which match the core principles of WHO HPH.
  63. 63. China HPH Developing Principles and Strategies Emphasize the patients-center; public benefits, disease prevention, (ex. Regular and free or cheap public disease screening) Primary healthcare service first. Focus on school health education and healthy lifestyle education. 
  64. 64.  Depend on the regular evaluation and inspection of medial service quality and security;  Emphasize health professional ethics;  Stress on the adaptive healthcare service development that matching the national/regional economic developing conditions.
  65. 65. Various evaluation and Competition
  66. 66. Shanghai HPH Practices Effect In 2007, Shanghai health expenditure per capital ranged from $90 to $540, life expectancy was 78.37/83.29( M/F) years, infant mortality was 3/1000, Maternal Mortality was 6.68/100000 given birth. (Data source: Shanghai Health Ministry, 2008 Statistic Report).
  67. 67.  Focus on HPH efficiency and close cooperation.  Stress on interactivity between patients, the public, and health professional workers.  Focus on the exchange of successful world experiences regarding New theory, technology, and management.
  68. 68. China The USA Undeveloped country, Gross Developed Country national income per capita Gross national income per (PPP international $): 4,660 capita (PPP international 1.3billion population, $): 44,070 Polluted environment, 0.3billion population Healthy environment
  69. 69. China HPH Developing Conditions Chinese doctor’s office U.S doctor’s office Chinese hospital crowded and noisy The US hospital register center waiting hall
  70. 70. One China best HPH teaching Hospital ICU ward The US. hospital ICU ward
  71. 71. China National Health Education Activities and Far-ranging National HP Movement Stress is put on the professional ethics and a spirit of dedication. Emphasize the public, universal, and benevolent value of health service and National HP movement.
  72. 72. USA Hospital Service Model is disease treatment model but not health promotion model
  73. 73. Lessons learnt from the US failing in HPH practices The health care system relies heavily on private and not-for-profit health insurance which drives the health care system in a marketing business direction. Over stress the money value and business marketing role of the health service system; It ignores the public benefit value and public participation of health service.
  74. 74. Lessons learnt from the US failing in HPH practices Over depend on advanced medical professional services; Ignores the national Pubic HP; Ignores the important role of the entire society’s (public) participation in the health promotion movement; Ignores fostering a healthy lifestyle and culture development.
  75. 75. Conclusions
  76. 76. •The Chinese version WHOSATHPH has a high internal consistency and good language equivalence. Reliability •HPH development level may not be related directly to advanced and expensive medical equipment, the environment conditions and health expenditure's. •The hospital size might be not related to the HPH developing level. Value of HPH Development • Developing country ( or an economically undeveloped region) can develop high effective performance of HPH through national public Strategy of participation movement. HPH • Fostering a national HP value and culture is more effective and important than unique money investment for HPH developing.
  77. 77. Issues and suggestions for HPH Development
  78. 78. Synthesize Prevention and Treatment, National deversified health Primary and Advanced Medical Service. promotion campaign and government financial support Stress on healthy lifestyle education since childhood
  79. 79. Acknowledgement  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
  80. 80. China research cooperation partners for this research Professor Fu Hua (First Line, middle) and his graduated students (Shanghai) Dr. Ma Ying`s students Prof. Wan Chonghua (Hefei) (Kunming)
  81. 81. The First Affiliated Hospital of Sun Yat-sen University (Guangzhou) The hospital where I had worked for seven years. Today, it has 2228 hospital beds, has the most advanced medical equipment, is one largest hospital in