Bakgrund Ohälsosam stress och utmattningssyndrom ökar i samhället idag och kan leda till allvarliga psykiska och fysiska besvär hos människor. Det höga antalet sjukskrivningsdagar som ohälsosam stress leder till ger stora ekonomiska konsekvenser för samhället. Det är vetenskapligt bevisat att avslappningsövningar såsom meditation, mindfulness och yoga kan få kroppen att slappna av. Det identifieras däremot en kunskapslucka inom delar av hälso- och sjukvården om hur avslappningsövningar kan användas som egenvårdsåtgärd i omvårdnaden av patienter med symptom på ohälsosam stress. Syfte Syftet var att beskriva upplevelser av avslappningsövningar som egenvårdsåtgärd hos personer med symptom på ohälsosam stress. Metod Icke systematisk litteraturöversikt har använts som metod för att sammanfatta tidigare gjord forskning. Sökningar i databaserna PubMed och CINAHL har gjorts och det har gett 16 vetenskapliga artiklar som har svarar mot syftet. Integrerad dataanalys användes för att få en bra bild över resultaten. Resultat I resultatet av litteratursökningen identifierades två huvudkategorier med sammanlagt sex underkategorier. Den första huvudkategorin var “Avslappningsövningars påverkan på ohälsosam stress och utbrändhetsvariabler” med underkategorierna: “Påverkan på ohälsosam stress”, “Mätbar minskning av stressnivåer”, “Påverkan på utbrändhetsvariabler” och “Långvarig påverkan på stress och utbrändhetsvariabler”. Huvudkategori två var “Hindrande och möjliggörande faktorer för att utföra avslappningsövningar” med underkategorierna: “Hindrande faktorer” och “Möjliggörande faktorer”. Slutsats Avslappningsövningar som egenvårdsåtgärd visade sig minska människors stressymptom och främja den psykiska hälsan. Stressreduceringen orsakade även positiva fysiologiska effekter i kroppen. Att utföra avslappningsövningar som egenvård var dock komplicerat för en del stressade deltagare i de undersökta studierna. Denna litteraturöversikts resultat kan vara till hjälp för vårdpersonal som vårdar människor som upplever stressrelaterade besvär. Avslappningsövningar som egenvårdsåtgärd kan ha en betydande roll i omvårdnaden av dessa patienter och de är även till hjälp för stressade yrkesgrupper i samhället såsom till exempel vårdpersonal. / Background Unhealthy stress problems and burnout are increasing in society today and the high number of sick leave days that unhealthy stress entails leads to high costs for society. It is scientifically proven that relaxation methods such as mindfulness, meditation and yoga help people relax and calm down. In healthcare, stressed patients can be helped to perform relaxation exercises, but there is a knowledge gap in how the exercises should be taught as a self-care method to the patients. Aim The purpose was to describe experiences of relaxation therapy as a self-care method for people who experience unhealthy stress problems. Method A non-systematic literature review has been used as a method to summarize previously done research. Searches in the databases PubMed and CINAHL have been done and it has yielded 16 scientific articles that have answered the purpose of the study. Integrated data analysis was used to get a good picture of the results. ResultsIn the result of the literature search, two main categories were identified with a total of six subcategories. The first main category was "Impact of relaxation exercises on unhealthy stress and burnout variables" with the subcategories: "Impact on stress", "Measurable reduction of stress levels", "Impact on burnout variables" and "Long-term impact on stress and burnout variables". The main category two was "Obstructive and enabling factors for performing relaxation exercises" with the subcategories: "Obstructive factors" and "Enabling factors". Conclusions Relaxation exercises were shown to reduce people's stress symptoms and promote mental health. The stress reduction also showed positive physiological effects on the body. But performing relaxation exercises as a self-care method was complicated for some stressed participants in the studies. The results of this study can be helpful for healthcare professionals who take care of people who experience stress-related problems. Relaxation exercises as a self-care measure can play a significant role in the care of these patients and it is also helpful for stressed professional groups in the society, such as caregivers.

Purpose: Coordinated school health programs (CSHPs), a type of health promoting school (HPS) program adopted by Canada and the USA, were developed to provide a comprehensive approach to school health in the USA. Community partnerships are central to CSHP and HPS efforts, yet the quality of collaboration efforts is rarely assessed. The purpose of this paper is to use Himmelman’s strategies for working together to assess the types of partnerships that are being formed by CSHPs and to explore the methodological usefulness of this framework. The Himmelman methodology describes four degrees of partnering interaction: networking, coordinating, cooperating, and collaborating, with each degree of interaction signifying a different level of partnership between organizations. Design/methodology/approach: Data were collected as part of the 2008-2009 and 2009-2010 CSHP annual Requests for Proposal from all 131 public school systems in Tennessee. Thematic analysis methods were used to assess partnerships in school systems. Descriptive analyses were completed to calculate individual collaboration scores for each of the eight CSHP components (comprehensive health education, physical education/activity, nutrition services, health services, mental health services, student, family, and community involvement, healthy school environment, and health promotion of staff) during the two data collection periods. The level of collaboration was assessed based on Himmelman’s methodology, with higher scores indicating a greater degree of collaboration. Scores were averaged to obtain a mean score and individual component scores were then averaged to obtain statewide collaboration index scores (CISs) for each CSHP component. Findings: The majority of CSHPs partnering activities can be described as coordination, level two in partnering interaction. The physical activity component had the highest CISs and scored in between coordinating and cooperating (2.42), while healthy school environment had the lowest score, scoring between networking and coordinating (1.93), CISs increased from Year 1 to Year 2 for all of the CSHP components. Applying the theoretical framework of Himmelman’s methodology provided a novel way to quantify levels of collaboration among school partners. This approach offered an opportunity to use qualitative and quantitative methods to explore levels of collaboration, determine current levels of collaboration, and assess changes in levels of collaboration over the study period. Research limitations/implications: This study provides a framework for using the Himmelman methodology to quantify partnerships in a HPS program in the USA. However, the case study nature of the enquiry means that changes may have been influenced by a range of contextual factors, and quantitative analyses are solely descriptive and therefore do not provide an opportunity for statistical comparisons. Practical implications: Quantifying collaboration efforts is useful for HPS programs. Community activities that link back to the classroom are important to the success of any HPS program. Himmelman’s methodology may be useful when applied to HPSs to assess the quality of existing partnerships and guide program implementation efforts. Originality/value: This research is the first of its kind and uses a theoretical framework to quantify partnership levels in school health programs. In the future, using this methodology could provide an opportunity to develop more effective partnerships in school health programs, health education, and public health.

Individer som ska tillbaka i arbete efter långtidssjukskrivning upplever att en hälsofrämjande kommunikation är en viktig och framgångsrik faktor i processen. Studien som har genomförts är en fallstudie där syftet var att undersöka hur arbetsmarknadskonsulenter och arbetshandledare arbetar med hälsofrämjande kommunikation för att få långtidssjukskrivna att återgå i arbete. För att besvara studiens frågeställning som framkom utifrån syftet har den salutogena teorin tillsammans med tidigare forskning tillämpats. En kvalitativ metod har tillämpats genom att tolv anställda intervjuats inom den mellansvenska kommunen och materialet som samlades in analyserades genom en tematisk analys. Av analysen framgick tre teman utifrån datainsamlingen, olika kommunikationsstilar, individanpassad kommunikation samt samtalsmetoder. Resultatet påvisar att arbetsmarknadskonsulenterna samt arbetshandledarna tillämpar flertalet tillvägagångssätt i kommunikationen för att öka deltagandet för långtidssjukskrivna. För att öka deltagandet tillämpar de en hälsofrämjande kommunikationen främst genom att engagera, stötta och vägleda deltagarna genom att bemöta varje individ utifrån deras specifika situation. Ämnet är tidigare relativt outforskat och därmed är det av intresse att undersöka detta vidare vid framtida studier. / Individuals who are going back to work after long-term sick leave experience that health promoting communication is an important and vital factor in the process. The study that has been conducted is a case study where the purpose was to investigate how labor market consultants and work supervisors work with health-promoting communication to get those on long-term sick leave to return to work. In order to answer the question of the study that emerged from the purpose, the salutogenic theory together with previous research has been applied. A qualitative method has been applied by interviewing 12 employees within the central Swedish municipality and the collected material was analyzed through a thematic analysis. The analysis revealed three themes based on the data collection, different communication styles, individualized communication and conversation methods. The results show that the labor market consultants and the supervisors apply the majority of approaches in communication to increase participation for those on long-term sick leave. To increase participation, they apply a health-promoting communication primarily by engaging, supporting and guiding the participants by responding to each individual based on their specific situation. The subject is previously relatively unexplored and thus it is of interest to investigate this further in future studies.

In the recent years, the consumer choices have been focused on health-promoting plant-based food and their preferences are oriented towards regional foodstuff from local productions. Therefore, an important factor for vegetables grown Trentino-Alto Adige (Italy) is to point out the added value of alpine farming to evaluate the nutritional values of farming products. Omics technologies (e.g. genomics, transcriptomics, proteomics and metabolomics) are aimed at investigating the assessment of different pools of molecules and how they are translated into the structure, function, and dynamics of a biological system or systems in order to provide a comprehensive characterization of a specific organism. Research use the omics techniques to exhaustively understand the functionality of food components. Several sophisticated chromatographic methods, spectroscopic techniques and chemometric tools are applied to give an insight into a comprehensive overview of the intrinsic quality, typicality and regionality of specific plant-based foods in the present PhD thesis: apples and potatoes. The quality of these foods is evaluated by quantifying the secondary metabolites to investigate their nutraceutical values. The aim of this PhD project is to use several analytical techniques (LC-MS, UV-VIS) that are capable of comprehensively characterizing the food metabolome with particular emphasis on those components with high nutritional values. The data analysis and data handling of omics data requires advanced bioinformatic, statistical, and chemometric tools. Potatoes and apples are chosen as target matrices for these studies for their relevance in the local economy and for the peculiar chemical composition of particular interest for their health-promoting proprieties. The information is acquired using several sophisticated chromatographic and spectroscopic techniques, such as ultra-high performance liquid chromatography coupled with triple quadrupole mass spectrometry (UHPLC– MS/MS) and UV/VIS. It is integrated to chemometric approaches (principal component analysis (PCA), partial least square regression (PLS), and data fusion) to achieve a comprehensive targeted chemical characterization. The sampling procedures gathers, in the case of the potatoes study, reference cultivars that may be found in the common retailers of Trentino/Alto-Adige and different production areas, the apples of 22 cultivars were harvest from the fields of the Laimburg Research Centre (Vadena, Italy) to guaranty comparability of the obtained data. Our results may be used as solid foundation for a reliable evaluation of apples and potatoes healthy "potential" value based on cutting-edge techniques, which are capable of providing comprehensive data regarding the alpine food quality parameters with high efficiency and reliability

The objective of this project is to challenge the traditional interior design of gynaecologist clinics and develop a fresh and innovative concept that enhances the overall experience for patients. By utilising colour, material, and form, this interior concept aims to transform the perception of healthcare facilities, ultimately improving the well-being and comfort of patients during gynaecological visits. To exemplify a different, more welcoming and safe environment, my experiments have involved using colour, material and form, as well as purpose designed chairs for the waiting room as well as the examination rooms, respectively. Besides this I have explored distractive elements during the patients’ examination. The design process for this project involved conducting qualitative research and studying existing gynaecologist clinic designs, patient experiences, and current trends in healthcare environments. Valuable insights has been gathered through interviews with healthcare professionals and patients, which helped identify areas for potential improvement. Additionally, the project explored the use of innovative design techniques, materials, and spatial configurations that foster a sense of privacy, and well- being. The design process also involves the development of design sketches and digital visualisations to aid in the visualisation and refinement of the interior concept. By utilising all design elements, the concept aims to create a health-promoting experience that ensures a safe, pleasant, and welcoming environment for both patients and staff.

Previous empirical research of co-workership focuses on experiences of implementation or development programs. This study particularly intends to examine co-workership itself as there are no studies with the same focus. The purpose of this study was to shed light on employees’ perceptions of co-workership after an implementation of the topic and describe employees’ perceptions of sustainable and health-promoting working life factors in relation to co-workership. This is a qualitative study with semi-structured interviews based on ten employees from the same organization. The data collection is analyzed according to a phenomenographic approach to highlight significantly different perceptions. The outcome space describes employees’ perceptions of co-workership. Categories which highlight interactions & relationships and organizational insight & awareness as central perceptions of co-workership in this study. The category harmony emerged from perceptions of sustainable and health-promoting working life factors. Finally, the category symbiotic relationship, refers to perceptions of the relationship between sustainable and health-promoting working life factors and co-workership. This research contributes to increasing knowledge about how employees and work groups perceive co-workership where the implementation has taken place. Which also highlight the topics importance in promoting a sustainable and healthy working life.

Bakgrund: Diabetes typ 2 har blivit en av vår tids största folkhälsosjukdomar. Det som är hoppfullt är att sjukdomen går att fördröja och till och med förhindra med sunda levnadsvanor. För de redan drabbade går det att göra mycket för att förbättra hälsan och förhindra följdsjukdomar. Distriktssköterskor har en central roll i diabetesvård inom primärvård, för att genom det hälsofrämjande samtalet motivera patienter till egenvård. Syfte: Syftet med studien var att belysa förutsättningar som distriktssköterskor inom primärvård har för hälsofrämjande samtal med patienter som har diabetes typ 2. Metod: Studien genomfördes med kvalitativ metod där 14 distriktssköterskor svarade på en enkät med öppna frågor. Resultatet bearbetades med hjälp av kvalitativ innehållsanalys. Resultat: Förutsättningar för goda hälsofrämjande samtal påverkas av distriktssköterskans utbildning, avsatt tid för samtalet och möjligheten att inhämta och lämna ut adekvat information. Teamarbetet är av betydelse och den viktigaste teammedlemmen är patienten. Det är viktigt att patienten känner delaktighet i samtalet för att bli motiverad att ta ansvar för sin hälsa. Konklusion: Utbildning, tid och information är viktiga premisser för ett bra patientmöte. Det visade sig också att samarbete med andra professioner och samarbete med patienten är viktigt för ett bra teamarbete. / Background: Type 2 diabetes has become one of the biggest public health diseases of our time. What is hopeful is that the disease can be delayed and even prevented with healthy lifestyle habits. For those already affected, there is much you can do yourself to improve your health and prevent sequelae. The district nurse has a central role in diabetes care in primary care, in order to motivate the patient to self-care through the health-promoting conversation. Aim: The purpose of the study was to highlight the presuppositions that district nurses in primary care have for health-promoting conversations with patients who have type 2 diabetes. Method: The study was conducted using a qualitative method where 14 district nurses answered a questionnaire with open questions. The results were processed using qualitative content analysis. Findings: Presuppositions for good health-promoting conversations are affected by the district nurse's education, the time allocated for the conversation and the ability to obtain and provide adequate information. Teamwork is important and the most important team member is the patient. It is important that the patient feels participation in the conversation in order to be motivated to take responsibility for their health. Conclusion: Education, time and information are important premises for a good patient meeting. It also showed that collaboration with other professions and collaboration with the patient is important for good teamwork.

Hälsa i arbetslivet är ett prioriterat område i politiken och återfinns i målområde fyra som är kopplat till det svenska folkhälsomålet. På senare år har hälsa i arbetslivet uppmärksammats eftersom den arbetsrelaterade ohälsan har ökat, vilket har resulterat i sjuktal som skjuter i höjden med ökande kostnader som följd. Människor spenderar stor del av sin livstid i arbetslivet och för att bibehålla en god hälsa genom livets alla skeden är goda arbetsförhållandena en förutsättning för att människor ska må bra. En viktig del i det hälsofrämjande arbetet i arbetslivet handlar om ledarskap, vilket påverkar människors hälsa i stor utsträckning. Tidigare studier visar att ledarskap har stor betydelse för människors hälsa och därför har denna studie genomförts. Syftet med studien är att undersöka chefers upplevelse av ledarskapets betydelse för medarbetarnas hälsa. En kvalitativ metodansats har används för att besvara studiens syfte. Fem chefer inom den privata sektorn har deltagit vid individuella semistrukturerade intervjuer. Det empiriska materialet har analyserats genom en manifest innehållsanalys. Resultatet visar att cheferna anser att ledarskap har stor betydelse för medarbetarnas hälsa. En utmaning som framkommit i studien är att cheferna uttrycker en frustration över bristande resurser och prioritering från företagsledning, vilket försvårar för cheferna att bedriva ett hälsofrämjande ledarskap. / Work related health is a priority area in national policy, being the fourth public national health target area which is connected to the Swedish public health goal. In recent years work related health has been highlighted due to that work related illness has increased, with the result of increased morbidity and with increasing costs as a result. People spend a whole lot of their lifetime at work, to keep a good health through all stages in life it is important that working conditions are good. Health promoting leadership is important at work, and affects people greatly. Previous research show that leadership affects people’s health and this is the reason why the study was conducted. The aim of this study was to examine the managers’ perception of the importance of leadership for employee health. A qualitative method was used to answer the purpose of the study. In this study five mangers in the private sector has participated in individual semi-structured interviews. The empirical material was analyzed by a manifest content analysis. The result show that leadership is important for the employees’ health. A challenge for managers in this study is a frustration over the lack of resources and priority from upper management.

Le concept d’Hôpital Promoteur de Santé (HPS) a pris beaucoup d’importance depuis son élaboration vers la fin des années quatre-vingt. Dans le contexte de la dernière réforme, le réseau montréalais des HPS et CSSS a été créé. Le Centre Universitaire de Santé McGill (CUSM) fait partie de ce réseau depuis 2007. Cette étude vise la création d’un milieu hospitalier promoteur de la santé pour les patients et s’adresse à l’expérience d’un repas pour les personnes âgées nécessitant une diète purée. Une étude de cas qualitative a été utilisée pour explorer la perception de patients vis-à-vis les aspects relatifs à leur cabaret, l’assistance qu’ils recevaient et le contexte social de leur repas. Les impressions des professionnels de la santé quant à l’expérience des patients ont aussi été obtenues. Les résultats indiquent que l’identification difficile des aliments en purée, la saveur, l’apparence et la variété sont tous des éléments qui affectent négativement leur expérience repas. Des sentiments d’impuissance ont aussi été rapportés par les patients et les professionnels de la santé. Le contexte social du repas a été souligné comme étant un aspect à cibler pour améliorer l’expérience des patients. Un programme utilisant des purées formées pourrait contrecarrer les effets négatifs de la prescription d’une diète purée. Des changements dans les pratiques infirmières, à savoir la création d’une ambiance sociale agréable au moment des repas, semble être une option peu couteuse qui pourrait améliorer l’expérience repas des patients et diminuer les sentiments d’impuissance relevés par les professionnels de la santé à l’égard de cet aspect de soin. / The Health Promoting Hospital (HPH) concept has gained much momentum since its development in Europe in the late nineteen eighties. The Montreal network of HPH was created in 2005, within the context of the last reform. The McGill University Health Center (MUHC) is a part of this network since 2007. This study focuses on the creation of a health promoting hospital setting for patients and addresses the mealtime experience of older hospitalized patients requiring a puree diet. A qualitative case study design was used to explore patients’ perceptions of aspects of their puree meal tray, assistance provided by staff and the social context in which the meal was taken. Health professionals’ view of the patients’ experience were also obtained. Results indicate that the difficult identification of food items, flavour, appearance and variety were all important factors negatively affecting the mealtime experience. Feelings of loss of control were also reported by patients and staff. The social context in which the meal was taken was highlighted as an area which could be targeted to improve mealtimes. A program using formed puree food items could help lessen the negative impact of the prescription of a puree diet. Changes in nursing practices regarding the creation of a pleasant social atmosphere were identified as an inexpensive option to improve the mealtime experience for patients and decrease feelings of lack of control for staff in this aspect of care.

En 2006, un hôpital universitaire de la région de Montréal a décidé d’implanter le projet « Hôpital Promoteur de Santé » dans un contexte où les conditions de travail des infirmières étaient particulièrement difficiles. Une étude de cas a été menée dans le CHU, afin de mieux comprendre le contexte interne d’implantation du sous-projet ‘milieu de travail promoteur de santé’. Des entrevues ont été menées auprès de 7 acteurs-clés du niveau stratégique et 18 infirmières-chefs pour examiner leurs perceptions relativement à l’implantation du projet HPS, et plus particulièrement d’un ‘milieu de travail promoteur de santé’ pour les infirmières. Un questionnaire a aussi été administré par entrevue à quatre acteurs-clés stratégiques du CHU afin d’évaluer la compatibilité des pratiques organisationnelles avec les critères d’une des dimensions du projet HPS, le milieu de travail promoteur de santé. Les résultats montrent des similitudes et des différences parmi les perceptions des acteurs stratégiques au sujet du contexte interne d’implantation. Les similitudes portent sur l’utilité, la compatibilité du sous-projet ‘milieu de travail promoteur de santé’ avec les valeurs de l’organisation, la nécessité d’une implantation graduelle ainsi que sur l’existence d’obstacles à l’implantation. Les différences ont mené à cinq discours d'acteurs stratégiques aux niveaux d’engagement différents, en fonction de facteurs d'intelligibilité (i.e. compréhension du concept HPS, rôle perçu dans l'implantation, stratégie d'implantation, vision des implications du concept HPS). Les résultats révèlent aussi que toutes les infirmières-chefs perçoivent l’utilité et la compatibilité du sous-projet ‘milieu de travail promoteur de santé’ avec les valeurs, normes, stratégies et buts organisationnels, ainsi que les mêmes obstacles à son implantation perçus par les acteurs stratégiques. Ils montrent aussi l’existence de deux groupes différents chez les infirmières-chefs quant aux stratégies proposées et utilisées pour implanter un ‘milieu de travail promoteur de santé’. Ainsi, les stratégies des infirmières-chefs du groupe 1 peuvent être assimilées à celles de leaders transactionnels, tandis que les infirmières-chefs du groupe 2 peuvent être assimilées à celles de leaders transformationnels. Finalement, les résultats de l’analyse des données du questionnaire indiquent divers niveaux de compatibilité des pratiques de l’hôpital par rapport aux critères d’un ‘milieu de travail promoteur de santé’. Ainsi, la compatibilité est élevée pour les critères portant sur l'organisation apprenante et performante, les stratégies pour un milieu de travail sain et sécuritaire, les activités liées à la promotion de saines habitudes de vie ainsi que les modifications de l'environnement physique et social. Cependant, elle est faible pour les critères portant sur la politique de promotion de la santé et la participation des infirmières. Notre étude a souligné l’importance de l’état de préparation d’une organisation de santé à l’implantation d’une innovation, un concept peu étudié dans les études sur l’implantation efficace d’innovations dans les services de santé, plus particulièrement du projet HPS. Nos résultats ont également mis en évidence l’importance, pour un hôpital souhaitant implanter un milieu de travail promoteur de santé, de former son personnel et ses gestionnaires au sujet du projet HPS, de disposer d’un plan de communication efficace, et de réaliser un état des lieux préalablement à l’implantation. / In 2006, a University Hospital in Montreal decided to implement the "Health Promoting Hospital" project in a context where nurses’ working conditions were particularly difficult. A case study was conducted at the University Hospital in order to better understand the internal context of implementation of the subproject ‘health promoting workplace'. Interviews were conducted with 7 strategic stakeholders and 18 head nurses to examine their perceptions about the implementation of the HPH project, and particularly of a ‘health promoting workplace’ for nurses. A questionnaire was administered by interview to four key strategic stakeholders of the hospital to assess the compatibility of organizational practices with the standards and criteria of one dimension of the HPH project i.e. the health promoting workplace. The results show similarities and differences among strategic stakeholders’ perceptions about the internal context of implementation. The similarities are on utility, compatibility of the subproject ‘health promoting workplace’ with the organizational values, the need for a gradual implementation, as well as obstacles to its implementation. Differences have lead to five discourses from strategic actors with different levels of commitment. These levels depend on factors of intelligibility (i.e. understanding of the HPH concept, perceived role in the implementation, implementation strategies, vision of implications of the HPH concept). The results also reveal that all head nurses perceive the usefulness and compatibility of the subproject ‘health promoting workplace' with the organizational values, norms, strategies and goals, as well as the same obstacles to its implementation perceived by the strategic stakeholders. They also show two groups of head nurses differing on proposed and used strategies to implement a ‘health promoting workplace’. The strategies of group 1 can be compared to those of transactional leaders, while those of group 2 can be compared to transformational leaders. Finally, results from the questionnaire show various levels of compatibility between hospital practices and the criteria of a health promoting workplace. Compatibility is high on the criteria for organizational learning and efficiency, health and safety strategies, activities related to health promoting lifestyles, and changes in the physical and social environment. However, it is low for the criteria on health promotion policy and nurses’ participation. Our study has shown the importance of organizational readiness to implement an innovation, a concept hardly considered in the studies about the implementation efficacy of innovations in health services, and particularly the HPH project. Our results also highlighted the importance for a hospital wishing to implement a ‘health promoting workplace’, to train its staff and managers about the HPH project, to have an effective communication plan, and to achieve an organizational diagnostic prior to implementation.