[Health-promoting activities and facilitating/inhibiting factors in hospitals, clinics, and nursing care facilities: Public interest corporation survey results]

Objective Medical and nursing care services within community-based integrated care systems are vital in community health. This study aimed to assess the current status of health-promoting activities across hospitals, clinics, and nursing homes operated by the Japan Association for Development of Community Medicine and explore differences depending on the type of facility and strategies for expanding these activities.Methods Between April 2022 and September 2023, we conducted web-based surveys, followed by telephone and email interviews. The survey covered three main areas; health-promoting activities for patients/users, the community, and staff (options), willingness to expand activities (10-point scale), and facilitating and inhibiting factors (open-ended responses). Responses were analyzed according to facility type, and activities were categorized according to the 2020 Standards for Health-Promoting Hospitals and Health Services (The 2020 HPH Standards).Results The response rate was 100%. Activities were implemented across all facilities. The percentages of facilities that implemented activities in hospitals, clinics, and nursing homes were as follows; patients/users (96.0, 84.5, 94.4, P = 0.011), community (96.0, 83.3, 100.0, P < 0.001), and staff (100.0, 72.9, 94.4, P < 0.001). The implementation rates were significantly lower in clinics than in hospitals and nursing homes. The mean number of activities in small clinics with < 50 staff (S) was significantly lower than that in large clinics with > 50 staff (L) for patients/users (S, L, difference) (4.1, 6.2, P = 0.034), community (4.9, 9.1, P < 0.001), and staff (1.6, 3.8, P < 0.001). Willingness did not vary by facility type (median of 7.0); however, conviction, as a determinant of willingness, was slightly higher in clinics and nursing homes than in hospitals (hospital = 7.0, clinics and nursing homes = 8.0). The most common facilitating factor for hospitals was "development of organizational structure," such as the establishment of a promotion committee, whereas for clinics and nursing homes, it was the "provision of educational materials and know-how." The most common inhibiting factor was "increasing workload." These activities aligned with almost all 2020 HPH standards; however, the evaluation system needed improvement.Conclusion All facilities are implementing health-promoting activities according to the 2020 HPH standards and have expressed eagerness to expand their activities. Developing organizational structures, ensuring the profitability of activities, developing evaluation indicators for measuring results, and establishing an evaluation system are crucial for expansion.