The WHO Health Promoting Hospitals & Health Care Network (HPH) guidance¹ and UK public health policy² require hospitals to have in place services which enable patients to improve their health through adopting healthy behaviours, i.e. health education. I report here on the findings from a study which investigated hospitalised patients’ experiences and views of health education for, amongst other lifestyle issues, diet³.

Methods

Recently discharged adult hospital patients (n=322) were sent a survey which included questions on whether the patient agreed that “all adult [hospital] patients should be asked about their diet” (Responses were on a five point likert scale ranging from “strongly agree” to “strongly disagree”). Responders were asked about their fruit and vegetable consumption⁴, whether they received health education for diet, whether it was “helpful” (likert scale from 1 “not at all helpful” to 5 “very helpful”), and if they wanted to consume a healthier diet (responses: “yes” or “no”). Participants were also asked a set of general questions concerning health education within hospitals.

Health education was defined as any action taken by a member of staff at the hospital to enable the patient to take control over aspects of their lifestyle that may have a negative effect on their health. Actions included verbal advice, written advice, and referral to specialists/services that aim to improve diet. Responses to questions were subject to descriptive statistics: proportions, 95% confidence intervals (CI) and tests for proportion differences where appropriate. All reported significance values are two-tailed.

Patient’s experiences and views

There was a 59% response rate. Responders were between the ages of 17 and 76 years, mean age was 57.0 ± 1.3 years (SE) and length of hospital stay ranged from 1 to 50 days, with a median of 4 days. Key findings were as follows:

• The majority of responders (84%) agreed that all adult patients should be asked about their diet, 11% were undecided and only 5% disagreed.
  
• There were 83% of respondents that consumed less than five portions of fruit and vegetables a day (95% CI = 76% to 88%).
  
• Significantly more people who consumed less than five portions of fruit and vegetables a day wanted dietary advice during their hospital admission compared to those who consumed five or more portions a day (67% and 36% respectively, P < 0.002).
  
• A quarter of responders were asked about their usual diet during their hospital admission (95% CI =19% to 32%);
  
• Only 12% of patients consuming less than five portions of fruit and vegetables a day received health education for diet (95% CI = 7% to 18%).
  
• Dietary health education was delivered in the form of leaflets (n = 6) or verbal advice (n = 11). None were referred to a specialist or service.
  
• Numbers were too small to conclude how helpful the health education was: 4 reported that it was not helpful, 6 that it was neither helpful nor unhelpful and 6 found the health education helpful.

Over 60% of patients wanted health education around discharge, but the majority receiving health education did so at admission. The majority agreed that “the hospital is a good place for patients to receive” health education (87%) and that “the hospital should provide patients with details of community organisations that provide” health education (83%).

Hospitals, a good place for health promotion

The study findings indicate that hospitals are viewed as an appropriate and acceptable setting for the delivery of health education for diet. There was clear support for assessing adult hospital patients for diet and considerable demand for health education, but very low levels of dietary assessment and health education. The challenge facing hospitals is how to meet their patients’ demand for health education on diet. Guidance on delivering health education within hospitals has been provided by the WHO HPH15, and there is some evidence of effective actions that can be taken to increase patients’ fruit and vegetable consumption6: All food provision within the hospital should include a variety of fruit and vegetables alongside active promotion of healthy food choices⁵. Patients with low consumption of fruit and vegetable need to be identified and provided with a combination of written and verbal health education materials⁷ and offered brief interventions which have been shown to improve diet and nutrition^{6, 8}.