A WHO-HPH operational program versus usual routines for implementing clinical health promotion: An RCT in health promoting hospitals (HPH)

Research output: Contribution to journalArticle


Background: Implementation of clinical health promotion (CHP) aiming at better health gain is slow despite its effect. CHP focuses on potentially modifiable lifestyle risks such as smoking, alcohol, diet, and physical inactivity. An operational program was created to improve implementation. It included patients, staff, and the organization, and it combined existing standards, indicators, documentation models, a performance recognition process, and a fast-track implementation model. The aim of this study was to evaluate if the operational program improved implementation of CHP in clinical hospital departments, as measured by health status of patients and staff, frequency of CHP service delivery, and standards compliance. Methods: Forty-eight hospital departments were recruited via open call and stratified by country. Departments were assigned to the operational program (intervention) or usual routine (control group). Data for analyses included 36 of these departments and their 5285 patients (median 147 per department; range 29-201), 2529 staff members (70; 10-393), 1750 medical records (50; 50-50), and standards compliance assessments. Follow-up was measured after 1 year. The outcomes were health status, service delivery, and standards compliance. Results: No health differences between groups were found, but the intervention group had higher identification of lifestyle risk (81% versus 60%, p < 0.01), related information/short intervention and intensive intervention (54% versus 39%, p < 0.01 and 43% versus 25%, p < 0.01, respectively), and standards compliance (95% versus 80%, p = 0.02). Conclusions: The operational program improved implementation by way of lifestyle risk identification, CHP service delivery, and standards compliance. The unknown health effects, the bias, and the limitations should be considered in implementation efforts and further studies.


  • Jeff Kirk Svane
  • Shu Ti Chiou
  • Oliver Groene
  • Milena Kalvachova
  • Mirna Zagrajski Brkić
  • Isao Fukuba
  • Tiiu Härm
  • Jerneja Farkas
  • Yen Ang
  • Mikkel Østerheden Andersen
  • Hanne Tønnesen
External organisations
  • National Yang-Ming University Taiwan
  • London School of Hygiene and Tropical Medicine
  • Institute of Public Health of the Republic of Slovenia
  • Lillebaelt Hospital
  • Copenhagen University Hospital
  • Bispebjerg Hospital
  • Cheng Hsin General Hospital
  • OptiMedis AG
  • Ministry of Health, Czech Republic
  • General Hospital “Dr. Tomislav Bardek"
  • Saitama Cooperative Hospital
  • National Institute for Health Development, Estonia
  • Penang Adventist Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Health Care Service and Management, Health Policy and Services and Health Economy


  • Clinical health promotion, Fast-track implementation, Health promoting hospitals, Hospital staff, Lifestyle risk, Patients, Quality improvement, Strategic implementation
Original languageEnglish
Article number153
JournalImplementation Science
Issue number1
Publication statusPublished - 2018 Dec 22
Publication categoryResearch