The aim of this study was to assess the standards of HPHs at Shahid Madani Hospital in Tabriz, Iran, to identify the levels, barriers and facilitators of these standards. The finding showed a correlation between the HPH activities and the organizational post and working experience of the personnel. The possible cause of the correlation might be that by increasing the working experience of the personnel, they acquire more education and experience in HP standards and cooperation with other organizations. Also, working in different posts might lead to increased professional abilities.
The HPH activities in the studied hospital obtain an overall moderate score which is consistent with the findings of Afshari et al. in 9 hospitals of Isfahan, Iran. They reported that the HP activities in the studied hospitals were at the intermediate level and suggested that the policy makers and the managers be involved in the HP programs to integrate the policies and to implement the guidelines [24].
In the present study the lowest scores of HPH activities in this hospital belong to the management policy and the patient assessment standards which have effects on the other standards too. There were also barriers such as lack of specific programs and budgets for promoting health, and lack of guidelines for alcohol and smoking as well as reassessment of patients’ needs at discharge, in these two standards. Given that these problems are more relevant to the organization’s management and policy, for the organization’s managers to upgrade the standard of HPHs, budgets and specific plans need to be set for these standards.
Study of Johnson and Baum stated that the primary concept of the HPH in the mind of the participants was implementing the fifth strategy of the Ottawa Charter which is re-orienting the healthcare services towards prevention of illness and promotion of health. While using the hospitals as an environment for HP means that the other strategies of the Ottawa charter should be practiced including: building healthy public policy, creating supporting environments, strengthening community action, developing personal skills [19].
In this study, the average score of the patient assessment, building a healthy and safe environment and Continuity and cooperation were 1.45, 1.63 and 1.53 respectively. Also, the results showed that in these standards, there were some barriers such as lack of patient satisfaction assessment programs, plans to assess the health issues of employees, as well as training new staff and the lack of agreement on all patient information. Thus, the hospital should focus on all standards of the HPH, specially the two mentioned dimensions.
Tountas et al. stated that planning for HP should consider factors like support and acceptance of the hospital to institute HP principles regarding the viewpoints and benefits of various involved personnel, availability of reliable documents of the patients, and providing activities related to health problems of the patients and personnel [25]. The authorities of this hospital can use the barriers and facilitators of the standards of HPHs identified in this study. The hospital can improve health promotion standards by establishing specific programs on HPHs [26], special funding and training experienced people in the field of health promotion activities [27], encouraging cooperation between the other health service providers and NGOs, measuring the satisfaction of the patients, making the policies transparent, involving the personnel and the patients [27,28,29,30].
Also, considering these factors in planning and promoting health at the center, it can reduce costs, mortality and disabilities, as well as increase the level of satisfaction of visitors to the center [2, 30, 31]. Yaghoubi et al. when developing a conceptual model for hospitals committed to the HP, also stated that before developing the HP policies, they must have a good knowledge about the surrounding society, such as community’s epidemiological situatio, an appropriate assessment to differentiate the needs of the culture conflicts and the values of different groups of people in the community. They need to design a system for assessing and developing Health promotion. Also, they have to assess social and health Issues and the pattern of diseases in the community. So that, the programs and health promotion projects based on community needs would be implement [32].
However, there are also a number of limitations to the study including: the assessment of HPHs standards only in a public health center. Participants in this study were selected on a convenience basis and the lack of motivation among personnel such as low knowledge about HPH and HP interventions, the lack of key individuals’ participation as well.