Demographic characteristics
Of the 520 health care workers (HCWs) who were enrolled into the study, only 495 participants were considered for the final analysis (Figure 1). Of these, 39% (n=192) were medical doctors, 47% (n=234) were nurses and 14% (n=69) were allied health workers. The results further show that 26.26% (n=130) of the HCWs were from primary healthcare, 4% (n=17) were from secondary and 70.30% (n=348) were from tertiary healthcare facilities. Among these respondents, 75.42% (n=362) were females while 24.58% (n=118) were males.
Facility Related Indicator (FRI)
Fourteen dimensions were associated with health promotion practices among HCWs in the study area. These include - HP communication channel, HP coordinator, HP budget, data routinely captured on HP interventions, data available to staff for HP evaluation, HP quality assessment programme, provision to assess patient HP need, documentation of patient’s HP record, guidelines for reassessing patients HP need at discharge, guidelines for reassessing patients HP need post intervention, update on patients’ sociocultural background, HP policy, HP induction training for new staff, and HP performance appraisal system (See Additional file 1). When corrected for healthcare facility level, 14 dimensions were significant indicators of HP at tertiary facility level while only two dimensions were significant indicators of HP at primary healthcare level. On the other hand, none of the FRI dimension was a significant indicator of HP at secondary healthcare level (Table 1).
Table 1: Correlations of Facility Related Indicator Dimensions with level of health care Facility
|
FRI Dimensions
|
Profession
|
Primary Healthcare Level
|
Secondary Healthcare Level
|
Tertiary Healthcare Level
|
Yes
|
No
|
I don’t Know
|
P value
|
Yes
|
No
|
I don’t Know
|
P value
|
Yes
|
No
|
I don’t Know
|
P value
|
Any communication channel for HP in your facility
|
Doctors
|
2.48% (n=3)
|
3.31% (n=4)
|
0% (n=0
|
0.447
|
6.25% (n=1)
|
31.25% (n=5)
|
0% (n=0
|
0.117
|
7.29% (n=24)
|
44.68% (n=147)
|
0% (n=0
|
0.000
|
Nurses
|
52.90% (n=64)
|
34.71% (n=42)
|
0% (n=0
|
12.50% (n=2
|
6.25% (n=1
|
0% (n=0
|
15.81% (n=52)
|
16.72% (n=55)
|
0% (n=0
|
Allied HW
|
4.96% (n=6)
|
1.65% (n=2)
|
0% (n=0
|
31.25% (n=5)
|
12.50% (n=2)
|
0% (n=0
|
5.17% (n=17)
|
10.33% (n=34)
|
0% (n=0
|
HP coordinator
|
Doctors
|
0.78% (n=1)
|
1.55% (n=2)
|
3.10% (n=4)
|
0.197
|
0% (n=0)
|
31.25% (n=5)
|
6.25% (n=1)
|
0.321
|
3.89% (n=13)
|
19.46% (n=65
|
29.04% (n=97)
|
0.000
|
Nurses
|
51.94% (n=67)
|
16.28% (n=21)
|
20.16% (n=26)
|
6.25% (n=1)
|
6.25% (n=1)
|
6.25% (n=1)
|
10.48% (n=35)
|
9.28% (n=31)
|
12.28% (n=41)
|
Allied HW
|
3.88% (n=5)
|
0.08% (n=1)
|
1.55% (n=2)
|
12.50% (n=2)
|
12.50% (n=2)
|
43.75% (n=7)
|
4.49% (n=15)
|
2.40% (n=8)
|
8.68% (n=29)
|
HP budget
|
Doctors
|
0% (n=0)
|
12.50% (n=2
|
31.25% (n=5)
|
0.284
|
0% (n=0)
|
18.75% (n=3)
|
18.75% (n=3)
|
0.180
|
0.29% (n=1)
|
10.26% (n=35)
|
41.39% (n=141)
|
0.000
|
Nurses
|
11.72% (n=15)
|
18.75% (n=24)
|
57.81% (n=74)
|
0% (n=0)
|
0% (n=0)
|
18.75% (n=3)
|
5.87% (n=20)
|
4.99% (n=17)
|
21.70% (n=74)
|
Allied HW
|
0% (n=0)
|
3.13% (n=4)
|
3.13% (n=4)
|
0% (n=0)
|
6.25% (n=1)
|
37.50% (n=6)
|
1.47% (n=5)
|
4.11% (n=14)
|
9.97% (n=34)
|
Data routinely captured on HP interventions?
|
Doctors
|
1.56% (n=2)
|
0% (n=0)
|
3.91% (n=5)
|
0.384
|
0% (n=0)
|
18.75% (n=3)
|
18.75% (n=3)
|
0.111
|
1.18% (n=4)
|
15.09% (n=51)
|
33.14% (n=122)
|
0.000
|
Nurses
|
44.53% (n=57)
|
13.28% (n=17)
|
30.47% (n=39)
|
6.25% (n=1)
|
0% (n=0)
|
12.50% (n=2)
|
9.76% (n=33)
|
4.14% (n=14)
|
18.05% (n=61)
|
Allied HW
|
3.13% (n=4)
|
0.78% (n=1)
|
2.34% (n=3)
|
0% (n=0)
|
6.25% (n=1)
|
37.50% (n=6)
|
1.78% (n=6)
|
3.55% (n=12)
|
10.36% (n=35)
|
Data available to staff for HP evaluation?
|
Doctors
|
1.57% (n=2)
|
0.79% (n=1)
|
3.15% (n=4)
|
0.669
|
0% (n=0)
|
18.75% (n=3)
|
18.75% (n=3)
|
0.184
|
1.12% (n=4)
|
15.63% (n=53)
|
34.81% (n=118)
|
0.000
|
Nurses
|
38.58% (n=49)
|
21.26% (n=27)
|
28.35% (n=36)
|
6.25% (n=1)
|
0% (n=0)
|
12.50% (n=2)
|
9.44% (n=32)
|
6.79% (n=23)
|
16.52% (n=56)
|
Allied HW
|
3.15% (n=4)
|
0.79% (n=1)
|
2.36% (n=3)
|
0% (n=0)
|
12.50% (n=2)
|
31.25% (n=5)
|
1.77% (n=6)
|
2.95% (n=10)
|
10.91% (n=37%)
|
HP structures and facilities required
|
Doctors
|
3.97% (n=5)
|
1.59% (n=2)
|
0%
(n=0
|
0.865
|
31.25% (n=5)
|
6.25% (n=1)
|
0% (n=0
|
0.768
|
32.93% (n=109)
|
18.73% (n=62)
|
0% (n=0
|
0.356
|
Nurses
|
58.73% (n=74)
|
29.37% (n=37)
|
0% (n=0
|
12.50% (n=2
|
6.25% (n=1)
|
0% (n=0
|
21.45% (n=71)
|
11.48% (n=38)
|
0% (n=0
|
Allied HW
|
4.76% (n=6)
|
1.59% (n=2)
|
0% (n=0
|
37.50% (n=6)
|
6.25% (n=1)
|
0% (n=0
|
11.48% (n=38)
|
3.93% (n=13)
|
0% (n=0
|
HP quality assessment program
|
Doctors
|
1.65% (n=2)
|
1.65% (n=2)
|
2.48% (n=3)
|
0.052
|
0% (n=0)
|
6.25% (n=1)
|
31.25% (n=5)
|
0.432
|
4.23% (n=14)
|
10.57% (n=35)
|
37.16% (n=123)
|
0.000
|
Nurses
|
41.32% (n=50)
|
14.88% (n=18)
|
31.40% (n=38)
|
6.25% (n=1)
|
0% (n=0)
|
12.50% (n=2)
|
16.31% (n=54)
|
3.93% (n=13)
|
12.39% (n=41)
|
Allied HW
|
0.83% (n=1)
|
0% (n=0)
|
5.79% (n=7)
|
2.48% (n=3)
|
6.25% (n=1)
|
18.75% (n=3)
|
3.66% (n=12)
|
2.42% (n=8)
|
9.37% (n=31)
|
Provision to access patients HP need
|
Doctors
|
2.48% (n=3)
|
3.31% (n=4)
|
0% (n=0
|
0.137
|
12.50% (n=2)
|
25.00% (n=4)
|
0% (n=0
|
0.149
|
5.41% (n=49)
|
37.11% (n=118)
|
0.31% (n=1)
|
0.000
|
Nurses
|
49.59% (n=60)
|
21.49% (n=26)
|
0% (n=0
|
12.50% (n=2)
|
6.25% (n=1)
|
0% (n=0
|
23.27% (n=74)
|
10.06% (n=32)
|
0.31% (n=1)
|
Allied HW
|
4.13% (n=5)
|
2.48% (n=3)
|
0% (n=0
|
37.50% (n=6)
|
6.25% (n=1)
|
0% (n=0
|
5.66% (n=18)
|
7.86% (n=25)
|
0% (n=0)
|
HP need assessment done at first contact with hospital
|
Doctors
|
5.00% (n=4)
|
0% (n=0)
|
0% (n=0
|
0.562
|
11.11% (n=1)
|
11.11% (n=1)
|
0% (n=0
|
0.347
|
20.00% (n=33)
|
21.21% (n=35)
|
0% (n=0)
|
0.549
|
Nurses
|
70.00% (n=56)
|
20.00% (n=16)
|
0% (n=0
|
22.22% (n=2)
|
0% (n=0)
|
0% (n=0
|
24.24% (n=40)
|
20.60% (n=34)
|
1.12% (n=2)
|
Allied HW
|
3.75% (n=3)
|
1.25% (n=1)
|
0% (n=0
|
22.22% (n=2)
|
33.33% (n=3)
|
0% (n=0
|
7.27% (n=12)
|
5.45% (n=9)
|
0% (n=0)
|
Documentation of patient’s HP record
|
Doctors
|
0.83% (n=1)
|
2.48% (n=3)
|
2.48% (n=3)
|
0.061
|
0% (n=0)
|
18.75% (n=3)
|
18.75% (n=3)
|
0.193
|
10.61% (n=35)
|
20.30% (n=67)
|
20.61% (n=68)
|
0.000
|
Nurses.
|
54.55% (n=66)
|
10.74% (n=13)
|
22.31% (n=27)
|
12.50% (n=2)
|
0% (n=0)
|
6.25% (n=1)
|
18.49% (n=61)
|
6.67% (n=22)
|
7.58% (n=25)
|
Allied HW
|
19.01% (n=23)
|
1.65% (n=2)
|
2.48% (n=3)
|
18.75% (n=3)
|
6.25% (n=1)
|
18.75% (n=3)
|
4.55% (n=15)
|
4.85% (n=16)
|
6.36% (n=21)
|
Guidelines for reassessing patients HP needs at discharge
|
Doctors
|
0.84% (n=1)
|
2.52% (n=3)
|
2.52% (n=3)
|
0.228
|
0% (n=0)
|
18.75% (n=3)
|
18.75% (n=3)
|
0.059
|
6.27% (n=21)
|
19.10%(n=64)
|
25.97% (n=87)
|
0.000
|
Nurses
|
34.45% (n=41)
|
15.13% (n=18)
|
38.66% (n=46)
|
12.50% (n=2)
|
6.25% (n=1)
|
0% (n=0)
|
17.02%
(n=57)
|
7.46% (n=25)
|
8.66%
(n=29)
|
Allied HW
|
1.68% (n=2)
|
2.52% (n=3)
|
1.68% (n=2)
|
12.50% (n=2)
|
0% (n=0)
|
31.25% (n=5)
|
1.79%
(n=6%)
|
4.18%
(n=14)
|
9.55%
(n=32)
|
Guidelines for reassessing patients HP needs post intervention
|
Doctors
|
1.67% (n=2)
|
1.67% (n=2)
|
2.50% (n=3)
|
0.835
|
0% (n=0)
|
18.75% (n=3)
|
18.75% (n=3)
|
0.328
|
6.97%
(n=23)
|
19.09% (n=63)
|
26.36%
(n=87)
|
0.000
|
Nurses
|
37.50% (n=45)
|
13.33% (n=16)
|
36.67% (n=44)
|
6.25% (n=1)
|
0% (n=0)
|
12.50%
(n=2)
|
16.06%
(n=53)
|
8.18% (n=27)
|
7.88% (n=26)
|
Allied HW
|
2.50% (n=3)
|
1.67% (n=2)
|
2.50% (n=3)
|
6.25% (n=1)
|
6.25% (n=1)
|
31.25% (n=5)
|
1.81%
(n=6)
|
4.85% (n=16)
|
8.79% (n=29)
|
Update on patient’s socio- cultural background
|
Doctors
|
0.81% (n=1)
|
2.44% (n=3)
|
2.44% (n=3)
|
0.020
|
6.25% (n=1)
|
12.50%(n=2)
|
18.75% (n=3)
|
0.842
|
15.38%
(n=52)
|
15.98% (n=54)
|
19.82% (n=67)
|
0.000
|
Nurses
|
57.72% (n=71)
|
15.45% (n=19)
|
14.63% (n=18)
|
6.25% (n=1)
|
6.25% (n=1)
|
6.25%
(n=1)
|
24.56%
(n=83)
|
4.73% (n=16)
|
3.85% (n=13)
|
Allied HW
|
2.44% (n=3)
|
3.25% (n=4)
|
0.81% (n=1)
|
18.75% (n=3)
|
6.25% (n=1)
|
18.75% (n=3)
|
10.36%
(n=35)
|
0.89% (n=3)
|
4.44% (n=15)
|
Any health promotion policy
|
Doctors
|
0%
(n=0)
|
1.63% (n=2)
|
4.07% (n=5)
|
0.034
|
6.25% (n=1)
|
6.25% (n=1)
|
25%
(n=4)
|
0.683
|
4.49% (n=15)
|
8.08% (n=27)
|
39.82% (n=133)
|
0.000
|
Nurses
|
41.46% (n=51)
|
4.88% (n=6)
|
41.46% (n=51)
|
6.25% (n=1)
|
0% (n=0)
|
12.50% (n=2)
|
16.47% (n=55)
|
1.80% (n=6)
|
13.77% (n=46)
|
Allied HW
|
2.44% (n=3)
|
0% (n=0)
|
4.07% (n=5)
|
6.25% (n=1)
|
0% (n=0)
|
37.50% (n=6)
|
2.10% (n=7)
|
2.10% (n=7)
|
11.38% (n=38)
|
HP induction training for new staff
|
Doctors
|
1.61% (n=2)
|
1.61% (n=2)
|
2.42% (n=3)
|
0.468
|
0% (n=0)
|
18.75% (n=3)
|
18.75% (n=3)
|
0.251
|
2.70% (n=9)
|
21.62% (n=72)
|
28.23% (n=94)
|
0.000
|
Nurses
|
36.29% (n=45)
|
19.35% (n=24)
|
32.26% (n=40)
|
12.50% (n=2)
|
0% (n=0)
|
6.25%
(n=1)
|
21.62% (n=72)
|
3.00% (n=10)
|
7.51% (n=25)
|
Allied HW
|
1.61% (n=2)
|
3.23% (n=4)
|
1.61% (n=2)
|
12.50% (n=2)
|
12.50% (n=2)
|
18.75% (n=3)
|
3.90% (n=13)
|
4.50% (n=15)
|
6.91% (n=23)
|
HP performance appraisal system
|
Doctors
|
0.81% (n=1)
|
3.25% (n=4)
|
1.63% (n=2)
|
0.151
|
0% (n=0)
|
18.75% (n=3)
|
18.75% (n=3)
|
0.773
|
2.40% (n=8)
|
18.62% (n=62)
|
31.53% (n=105)
|
0.000
|
Nurses
|
34.96% (n=43)
|
21.95% (n=27)
|
30.89% (n=38)
|
0% (n=0)
|
6.25% (n=1)
|
12.50% (n=2)
|
17.11% (n=57)
|
5.71% (n=19)
|
9.31% (n=31)
|
Allied HW
|
0.81% (n=1)
|
1.61% (n=2)
|
4.07% (n=5)
|
6.25% (n=1)
|
12.50%
(n=2)
|
25.00%
(n=4)
|
2.10% (n=7)
|
3.00% (n=10)
|
10.21% (n=34)
|
Results obtained from a multinomial regression indicated that 6 dimensions were significantly associated with HP among health workers (Table 2). For medical doctors, four dimensions were observed to be significant in the final adjusted model. FRI dimensions observed to be predictors of HP among doctors were HP data available for evaluation (Coeff: 0.988, 95% CI: 0.369 – 1.607) and quality assessment program (Coeff: 0.787, 95% CI: 0.208 - 1.366,) which were observe to be 0.99 and 0.79 times respectively, higher compared to nurses. Other FRI dimensions - Provision to access patients HP need (Coeff: -2.695, 95% CI: -3.942 - -1.448) and HP need assessment done at first contact with the hospital (Coeff: -0.751, 95% CI: -1.444 - -0.057,) were observed to be negative predictors of HP among medical doctors (Table 2).
HP data available for evaluation (Coeff: 0.954, 95% CI: 0.149 - 1.759) and HP structures and facilities required (Coeff:1.787, 95% CI: 0.488 - 3.087) were positively associated with HP among AHW. These factors were 0.75 and 1.8 times higher compared to nurses, respectively. On the other hand, HP Budget (Coeff: -0.726, 95% CI: -1.361 - -0.091) and Provision to access patients HP need (Coeff: -1.798, 95% CI: -3.428 - -0.167) were negatively associated with HP practices among AHW (Table 2). The generalized Hosmer–Lemeshow test Chi-square was 16.13 with p-value 0.444, indicating a good fit of the final model.
Table 2: Facility Related Indicators’ dimension associated with Health Promotion in a multivariate analysis
FRI dimensions
|
Professions
|
Coeff (unadjusted)
|
95% conf. interval
|
Coeff (adjusted)
|
95% conf. interval
|
HP Budget
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.293
|
-0.364 - 0.950
|
0.163
|
-0.422 - 0.747
|
Allied workers
|
-0.805
|
-1.524 - -0.086
|
-0.726
|
-1.361 - - 0.091
|
HP data available for evaluation
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.886
|
0.235 - 1.537
|
0.988
|
0.369 - 1.608
|
Allied workers
|
1.113
|
0.205 - 2.022
|
0.954
|
0.149 - 1.759
|
HP Structures & Facilities required
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.944
|
0.122 - 1.765
|
0.563
|
-0.179 - 1.305
|
Allied workers
|
1.742
|
0.404 - 3.081
|
1.787
|
0.488 - 3.087
|
Quality assessment program
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.642
|
0.001 - 1.283
|
0.787
|
0.208 - 1.366
|
Allied workers
|
0.513
|
-0.248 - 1.274
|
0.573
|
-0.143 - 1.289
|
Prov to access HP need
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
-2.888
|
-4.244 - -1.532
|
-2.695
|
-3.942 - -1.448
|
Allied workers
|
-1.814
|
-3.566 - 0.063
|
-1.798
|
-3.428 - -0.167
|
HP need assessment done at first contact with the hospital
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
-0.675
|
-1.409 - 0.060
|
-0.751
|
-1.444 - -0.057
|
Allied workers
|
-0.814
|
-1.766 - 0.133
|
-0.789
|
-1.679 - 0.099
|
Health workers Related Indicator (HRI)
Ten dimensions comprising - education on disease condition, guidance on diet & lifestyle, need for routine check-up, adequate knowledge on patient condition, fitness and health screening, assist with welfare services, participation in HP training, coordinated HP training for staff, home visit, community-based placements, and follow up post discharge were associated with HP practice among HCWs (See Additional file 2). At health facility level, eight dimensions were statistically significant indicators of HP at tertiary level, three at the secondary level, and only one at the primary level (Table 3). The indicator dimensions that were statistically significant at the different healthcare levels are listed in Table 3.
Table 3: Correlations of Health workers Related Indicator Dimensions with level of health care Facility
HRI Dimensions
|
Responses
|
Primary Health Care Level
|
Secondary Health Care level
|
Tertiary Health care level
|
Doctors
|
Nurses
|
AHWs
|
P-value
|
Doctors
|
Nurses
|
AHWs
|
P-value
|
Doctors
|
Nurses
|
AHWs
|
P-value
|
Educate on disease condition
|
Strongly disagree
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
0.136
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
0.190
|
0.29% (n=1)
|
0.88% (n=3)
|
0.59% (n=2)
|
0.052
|
Disagree
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
5.88% (n=1)
|
0% (n=0)
|
1.76% (n=6)
|
0.29% (n=1)
|
0% (n=0)
|
Neutral
|
0% (n=0)
|
1.57% (n=2)
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
5.88% (n=1)
|
3.81% (n=13)
|
1.17% (n=4)
|
0.59% (n=2)
|
Agree
|
00% (n=0)
|
27.56% (n=35)
|
0% (n=0)
|
23.53% (n=4)
|
5.88% (n=1)
|
5.88% (n=1)
|
24.05% (n=82)
|
10.85% (n=37)
|
6.16% (n=21)
|
Strongly agree
|
5.51% (n=7)
|
59.06% (n=75)
|
6.30% (n=8)
|
17.65% (n=3)
|
5.88% (n=1)
|
29.41% (n=5)
|
21.99% (n=75)
|
19.06% (n=65)
|
8.50% (n=29)
|
Guidance on diet and lifestyle
|
Strongly disagree
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
|
0.59% (n=2)
|
0.88% (n=3)
|
0.29% (n=1)
|
0.000
|
Disagree
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
|
4.41% (n=15)
|
0.29% (n=1)
|
0.29% (n=1)
|
Neutral
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
|
5.88% (n=1)
|
0% (n=0)
|
11.76% (n=2)
|
0.356
|
10.00% (n=34)
|
2.05% (n=7)
|
1.76% (n=6)
|
Agree
|
1.57% (n=2)
|
31.50% (n=40)
|
0.79% (n=1)
|
|
29.41% (n=5)
|
5.88% (n=1)
|
11.76% (n=2)
|
24.71% (n=84)
|
9.12% (n=31)
|
6.77% (n=23)
|
Strongly agree
|
3.94% (n=5)
|
56.69% (n=72)
|
5.51% (n=7)
|
0.389
|
5.88% (n=1)
|
11.76% (n=2)
|
17.65% (n=3)
|
12.35% (n=42)
|
20.00% (n=68)
|
6.47% (n=22)
|
Need for routine checkup
|
Strongly disagree
|
0% (n=0)
|
0.79% (n=1)
|
0.79% (n=1)
|
0.426
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
0.505
|
0.89% (n=3)
|
0.89% (n=3)
|
1.48% (n=5)
|
0.000
|
Disagree
|
0% (n=0)
|
0.79% (n=1)
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
2.37% (n=8)
|
1.18% (n=)4
|
0% (n=0)
|
Neutral
|
0% (n=0)
|
0.79% (n=1)
|
0% (n=0)
|
11.76% (n=2)
|
0% (n=0)
|
0% (n=0)
|
5.33% (n=18)
|
1.78% (n=6)
|
3.55% (n=12)
|
Agree
|
0.79% (n=1)
|
29.37% (n=37)
|
1.59% (n=2)
|
11.76% (n=2)
|
5.88% (n=1)
|
17.65% (n=3)
|
28.40% (n=96)
|
8.88% (n=30)
|
5.62% (n=19)
|
Strongly agree
|
4.76% (n=6)
|
56.35% (n=71)
|
3.97% (n=5)
|
17.65% (n=3)
|
11.76% (n=2)
|
23.53% (n=4)
|
15.09% (n=51)
|
19.23% (n=65)
|
5.32% (n=18)
|
Adequate knowledge on patient condition
|
Strongly disagree
|
0% (n=0)
|
4.65% (n=6)
|
0% (n=0)
|
0.946
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
0.120
|
0.59% (n=2)
|
1.76% (n=6)
|
1.17% (n=4)
|
0.003
|
Disagree
|
0% (n=0)
|
3.88% (n=5)
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
11.76% (n=2)
|
2.05% (n=7)
|
2.05% (n=7)
|
1.47% (n=5)
|
Neutral
|
0% (n=0)
|
4.65% (n=6)
|
0.78% (n=1)
|
0% (n=0)
|
0% (n=0)
|
11.76% (n=2)
|
5.57% (n=19)
|
2.64% (n=9)
|
1.76% (n=6)
|
Agree
|
3.10% (n=4)
|
40.31% (n=52)
|
3.10% (n=4)
|
41.18% (n=7)
|
17.65% (n=3)
|
11.76% (n=2)
|
33.43% (n=114)
|
14.08% (n=48)
|
6.74% (n=23)
|
Strongly agree
|
2.33% (n=3)
|
34.88% (n=45)
|
2.33% (n=3)
|
0% (n=0)
|
0% (n=0)
|
5.88% (n=1)
|
10.26% (n=35)
|
11.73% (n=40)
|
4.69% (n=16)
|
Fitness and health screening
|
Strongly disagree
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
0.727
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
0.213
|
1.46% (n=5)
|
0% (n=0)
|
0.29% (n=1)
|
0.000
|
Disagree
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
11.76% (n=2)
|
5.88% (n=1)
|
0% (n=0)
|
7.60% (n=26)
|
0.88% (n=3)
|
0.88% (n=3)
|
Neutral
|
0% (n=0)
|
7.75% (n=10)
|
0% (n=0)
|
0% (n=0)
|
5.88% (n=1)
|
0% (n=0)
|
14.62% (n=50)
|
2.34% (n=8)
|
6.14% (n=21)
|
Agree
|
3.88% (n=5)
|
51.16% (n=66)
|
4.65% (n=6)
|
23.53% (n=4)
|
5.88% (n=1)
|
29.41% (n=5)
|
23.68% (n=81)
|
18.13% (n=62)
|
6.73% (n=23)
|
Strongly agree
|
1.55% (n=2)
|
29.46% (n=38)
|
1.55% (n=2)
|
5.88% (n=1)
|
0% (n=0)
|
11.76% (n=2)
|
4.39% (n=15)
|
11.11% (n=38)
|
1.75% (n=6)
|
Assist with welfare services
|
Strongly disagree
|
0% (n=0)
|
3.88% (n=5)
|
0% (n=0)
|
0.827
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
0.687
|
4.18% (n=14)
|
1.47% (n=5)
|
1.47% (n=5)
|
0.331
|
Disagree
|
0.78% (n=1)
|
10.85% (n=14)
|
0% (n=0)
|
5.88% (n=1)
|
5.88% (n=1)
|
0% (n=0)
|
7.94% (n=27)
|
5.88% (n=20)
|
2.06% (n=7)
|
Neutral
|
2.33% (n=3)
|
20.16% (n=26)
|
2.33% (n=3)
|
5.88% (n=1)
|
5.88% (n=1)
|
5.88% (n=1)
|
13.53% (n=46)
|
5.59% (n=19)
|
4.41% (n=15)
|
Agree
|
2.33% (n=3)
|
41.09% (n=53)
|
3.10% (n=4)
|
17.65% (n=3)
|
5.88% (n=1)
|
17.65% (n=3)
|
21.18% (n=72)
|
13.24% (n=45)
|
5.29% (n=18)
|
Strongly agree
|
0% (n=0)
|
12.40% (n=16)
|
0.78% (n=1)
|
11.76% (n=2)
|
0% (n=0)
|
17.65% (n=3)
|
5.29% (n=18)
|
5.88% (n=20)
|
2.65% (n=9)
|
Participated in HP training
|
No
|
3.20% (n=4)
|
44.80% (n=56)
|
4.80% (n=6)
|
0.408
|
29.41% (n=5)
|
12.50% (n=2)
|
29.41% (n=5)
|
0.827
|
34.34% (n=114)
|
20.78% (n=69)
|
6.02% (n=20)
|
0.001
|
Yes
|
2.40% (n=3)
|
43.20% (n=54)
|
1.60% (n=2)
|
5.88% (n=1)
|
6.25% (n=1)
|
12.50% (n=2)
|
18.37% (n=61)
|
10.84% (n=36)
|
9.64% (n=32)
|
Coordinated HP training for staff
|
No
|
3.20% (n=4)
|
52.00% (n=65)
|
4.00% (n=5)
|
0.976
|
37.50% (n=6)
|
6.25% (n=1)
|
31.25% (n=5)
|
0.090
|
48.50% (n=162)
|
20.06% (n=67)
|
13.17% (n=44)
|
0.000
|
Yes
|
2.40% (n=3)
|
36.00% (n=45)
|
2.40% (n=3)
|
0% (n=0)
|
12.50% (n=2)
|
12.50% (n=2)
|
4.19% (n=14)
|
11.08% (n=37)
|
2.99% (n=10)
|
Home visits
|
No
|
5.56% (n=7)
|
58.73% (n=74)
|
3.75% (n=4)
|
0.104
|
37.50% (n=6)
|
18.75% (n=3)
|
18.75% (n=3)
|
0.032
|
50.59% (n=171)
|
29.59% (n=100)
|
13.61% (n=46)
|
0.013
|
Yes
|
0% (n=0)
|
29.37% (n=37)
|
3.75% (n=4)
|
0% (n=0)
|
0% (n=0)
|
25.00% (n=4)
|
1.48% (n=5)
|
2.66% (n=9)
|
2.07% (n=7)
|
Community based placements
|
No
|
5.65% (n=7)
|
70.97% (n=88)
|
2.42% (n=3)
|
0.006
|
37.50% (n=6)
|
18.75% (n=3)
|
18.75% (n=3)
|
0.032
|
51.04% (n=172)
|
30.56% (n=103)
|
13.65% (n=46)
|
0.020
|
Yes
|
0% (n=0)
|
16.94% (n=21)
|
4.03% (n=5)
|
0% (n=0)
|
0% (n=0)
|
25.00% (n=4)
|
1.19% (n=4)
|
1.78% (n=6)
|
1.78% (n=6)
|
Follow up post discharge
|
No
|
1.65% (n=2)
|
30.58% (n=37)
|
0% (n=0)
|
0.162
|
0% (n=0)
|
18.75% (n=3)
|
0% (n=0)
|
0.000
|
20.35% (n=69)
|
23.60% (n=80)
|
4.42% (n=15)
|
0.000
|
Yes
|
4.13% (n=5)
|
57.85% (n=70)
|
5.79% (n=7)
|
37.50% (n=6)
|
0% (n=0)
|
43.75% (n=7)
|
31.27% (n=106)
|
8.85% (n=30)
|
11.50% (n=39)
|
Patient empowerment
|
No
|
5.60% (n=7)
|
76.00% (n=95)
|
4.80% (n=6)
|
0.370
|
37.50% (n=6)
|
18.75% (n=3)
|
31.25% (n=5)
|
0.230
|
48.51% (n=163)
|
30.06% (n=101)
|
14.58% (n=49)
|
0.687
|
Yes
|
0% (n=0)
|
12.00% (n=15)
|
1.60% (n=2)
|
0% (n=0)
|
0% (n=0)
|
12.50% (n=2)
|
3.57% (n=12)
|
1.79% (n=6)
|
1.49% (n=5)
|
Informs patient of risk factors
|
No
|
4.80% (n=6)
|
79.20% (n=99)
|
6.40% (n=8)
|
0.592
|
31.25% (n=5)
|
18.75% (n=3)
|
43.75% (n=7)
|
0.411
|
46.41% (n=155)
|
28.74% (n=96)
|
13.77% (n=46)
|
0.175
|
Yes
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
6.25% (n=1)
|
0% (n=0)
|
0% (n=0)
|
1.50% (n=5)
|
2.69% (n=9)
|
0.60% (n=2)
|
I don’t know
|
0.80% (n=1)
|
8.80% (n=11)
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
0% (n=0)
|
3.59% (n=12)
|
1.50% (n=4)
|
1.50% (n=5)
|
A total of ten HRI dimensions were significantly associated with HP among HCW (Table 4). Among the medical doctors, significant positive predictors of HP among the HRI dimensions were education on disease condition (Coeff: 2.273, 95% CI 1.393 - 3.710), guidance on diet and lifestyle (Coeff: 0.361, 95% CI 0.228 - 0.570), fitness and health screening (Coeff: 0.325, 95% CI 0.224 - 0.474), coordinated HP training for staff (Coeff: 0.216, 95% CI 0.106 - 0.441), home visits (Coeff: 0.141, 95% CI 0.039 - 0.501), and follow up post discharge (Coeff: 2.743, 95% CI 1.618 - 4.648) and patient empowerment (Coeff: 3.919, 95% CI 1.102 - 13.931). Furthermore, seven significant dimensions predictors of HRI emerged among AHW. These included - education on disease condition (Coeff: 2.117, 95% CI 1.107 - 4.048) and community-based placements (Coeff: 3.914, 95% CI 1.147 - 13.351) (Table 4). Other dimensions that were significant predictors of HP compared to nurses were need for routine check-up (Coeff: 0.564, 95% CI 0.389 - 0.818) Fitness and health screening (Coeff: 0.448, 95% CI 0.389 - 0.818) and (Coeff: 1.977, 95% CI 1.018 - 3.838). The adjusted multivariable model adequately fit the data (Generalized Hosmer-Lemeshow goodness-of-fit test statistic = 17.32, df. = 16, p = 0.365).
Table 4: Healthcare Workers Related Indicators’ dimensions associated with Health Promotion in a multivariate analysis
Dimensions
|
Professions
|
Coeff (unadjusted)
|
95% conf. interval
|
Coeff (adjusted)
|
95% conf. interval
|
Education on disease condition
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
2.270
|
1.358 - 3.796
|
2.273
|
1.393 - 3.710
|
Allied HW
|
2.291
|
1.176 - 4.462
|
2.117
|
1.107 - 4.048
|
Guidance on diet and lifestyle
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.347
|
0.216 - 0.559
|
0.361
|
0.228 - 0.570
|
Allied HW
|
0.581
|
0.318 - 1.062
|
0.640
|
0.356 - 1.153
|
Need for routine check-up
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.990
|
0.670 - 1.464
|
1.048
|
0.717 - 1.532
|
Allied HW
|
0.560
|
0.383 - 0.821
|
0.564
|
0.389 - 0.818
|
Fitness and health screening
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.304
|
0.204 - 0.453
|
0.325
|
0.224 - 0.474
|
Allied HW
|
0.463
|
0.291 - 0.732
|
0.448
|
0.291 - 0.689
|
Participated in HP training
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
1.109
|
0.634 - 1.942
|
1.130
|
0.653 - 1.955
|
Allied HW
|
2.099
|
1.073 - 4.108
|
1.977
|
1.018 - 3.838
|
Coordinated HP training for staff
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.193
|
0.092 - 0.406
|
0.216
|
0.106 - 0.441
|
Allied HW
|
0.273
|
0.116 - 0.640
|
0.318
|
0.140 - 0.721
|
Home visits
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.114
|
0.030 - 0.429
|
0.141
|
0.039 - 0.501
|
Allied HW
|
0.296
|
0.086 - 1.023
|
0.404
|
0.128 - 1.275
|
Community based placements
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.472
|
0.104 - 2.134
|
0.399
|
0.090 - 1.772
|
Allied HW
|
4.848
|
1.343 - 17.502
|
3.914
|
1.147 - 13.351
|
Follow up post discharge
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
2.513
|
1.458 - 4.331
|
2.743
|
1.618 - 4.648
|
Allied HW
|
5.154
|
2.354 - 11.287
|
5.005
|
2.350 - 10.660
|
Patient empowerment
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
4.811
|
1.294 - 17.886
|
3.919
|
1.102 - 13.931
|
Allied HW
|
1.007
|
0.295 -3.442
|
0.829
|
0.247 - 2.777
|
Outcome Related Indicator (ORI)
Eight indicator dimensions focussing on outcome related indicator were identified. The dimensions that were statistically significant in the study area were reduction of number of diseases, reduction of number of disabilities, and reduced health inequities. Others are improved needs assessments and improved community participation and mobilization (See Additional file 3). Further analysis at the facility levels showed that three indicator dimensions; reduction of number of diseases, reduction of number of disabilities and improved need assessment were statistically significant at the tertiary healthcare level. However, no indicator dimensions were statistically significant at both primary and secondary healthcare levels (Table 5).
Table 5: Correlations of Outcome Related Indicator Dimensions with level of health care Facility
|
|
Primary Health Care level
|
Secondary Health Care level
|
Tertiary Health care level
|
ORI Dimensions
|
Responses
|
Doctors
|
Nurses
|
AHWs
|
p-value
|
Doctors
|
Nurses
|
AHWs
|
P -value
|
Doctors
|
Nurses
|
AHWs
|
p-value
|
Coverage of target population
|
No
|
3.96% (n=4)
|
33.66% (n=34)
|
3.96% (n=4)
|
0.171
|
11.11% (n=1)
|
22.22% (n=2)
|
22.22% (n=2)
|
0.325
|
34.05% (n=63)
|
23.78% (n=44)
|
10.81% (n=20)
|
0.440
|
Yes
|
1.98% (n=2)
|
54.55% (n=55)
|
1.98% (n=2)
|
22.22% (n=2)
|
0.00% (n=0)
|
22.22% (n=2)
|
16.76% (n=31)
|
8.11% (n=15)
|
6.49% (n=12)
|
Reduction of number of deaths
|
No
|
4.95% (n=5)
|
48.51% (n=49)
|
29.70% (n=3)
|
0.380
|
0.00% (n=0)
|
11.11% (n=1)
|
22.22% (n=2)
|
0.325
|
20.00% (n=38)
|
13.16% (n=25)
|
10.53% (n=20)
|
0.096
|
Yes
|
0.99% (n=1)
|
39.60% (n=40)
|
29.70% (n=3)
|
33.33% (n=3)
|
11.11% (n=1)
|
22.22% (n=2)
|
30.53% (n=58)
|
18.95% (n=36)
|
6.84% (n=13)
|
Reduction of number of diseases
|
No
|
29.70% (n=3)
|
41.58% (n=42)
|
29.70% (n=3)
|
0.983
|
0.00% (n=0)
|
11.11% (n=1)
|
33.33% (n=3)
|
0.140
|
15.34% (n=29)
|
16.40% (n=31)
|
10.05% (n=19)
|
0.006
|
Yes
|
29.70% (n=3)
|
46.53% (n=47)
|
29.70% (n=3)
|
33.33% (n=3)
|
11.11% (n=1)
|
11.11% (n=1)
|
34.92% (n=66)
|
15.87% (n=30)
|
7.41% (n=14)
|
Reduction of number of injuries
|
No
|
4.95% (n=5)
|
59.41% (n=60)
|
3.96% (n=4)
|
0.717
|
11.11% (n=1)
|
11.11% (n=1)
|
33.33% (n=3)
|
0.539
|
31.74% (n=60)
|
16.93% (n=32)
|
12.70% (n=24)
|
0.138
|
Yes
|
0.99% (n=1)
|
28.71% (n=29)
|
1.98% (n=2)
|
22.22% (n=2)
|
11.11% (n=1)
|
11.11% (n=1)
|
18.52% (n=35)
|
15.34% (n=29)
|
4.76% (n=9)
|
Reduction of number of disabilities
|
No
|
3.96% (n=4)
|
62.38% (n=63)
|
1.98% (n=2)
|
0.161
|
11.11% (n=1)
|
22.22% (n=2)
|
44.44% (n=4)
|
0.076
|
28.57% (n=54)
|
25.40% (n=48)
|
12.70% (n=24)
|
0.013
|
Yes
|
1.98% (n=2)
|
25.74% (n=26)
|
3.96% (n=4)
|
22.22% (n=2)
|
0.00% (n=0)
|
0.00% (n=0)
|
21.69% (n=41)
|
6.88% (n=13)
|
4.76% (n=9)
|
Reduce health inequities
|
No
|
29.70% (n=3)
|
50.50% (n=51)
|
4.95% (n=5)
|
0.416
|
11.11% (n=1)
|
22.22% (n=2)
|
44.44% (n=4)
|
0.076
|
37.04% (n=70)
|
20.63% (n=39)
|
14.81% (n=28)
|
0.089
|
Yes
|
29.70% (n=3)
|
37.62% (n=38)
|
0.99% (n=1)
|
22.22% (n=2)
|
0.00% (n=0)
|
0.00% (n=0)
|
13.23% (n=25)
|
11.64% (n=22)
|
2.65% (n=5)
|
Improved needs assessments
|
No
|
4.00% (n=4)
|
51% (n=51)
|
5% (n=5)
|
0.444
|
22.22% (n=2)
|
0.00% (n=0)
|
33.33% (n=3)
|
0.196
|
41.27% (n=78)
|
20.11% (n=38)
|
11.11% (n=21)
|
0.012
|
Yes
|
2% (n=2)
|
37% (n=37)
|
1% (n=1)
|
11.11% (n=1)
|
22.22% (n=2)
|
11.11% (n=1)
|
8.99% (n=17)
|
12.17% (n=23)
|
6.35% (n=12)
|
Improved community participation and mobilization
|
No
|
4.95% (n=5)
|
42.57% (n=43)
|
1.98% (n=2)
|
0.180
|
11.11%
(n=1)
|
22.22%
(n=2)
|
44.44%
(n=4)
|
0.076
|
37.76
(n=71)
|
24.47%
(n=46)
|
9.57%
(n=18)
|
0.099
|
Yes
|
0.99% (n=1)
|
45.54%
(n=46)
|
3.96%
(n=4)
|
22.22%
(n=2)
|
0
|
0
|
12.76% (n=24)
|
7.98% (n=15)
|
7.44% (n=14)
|
Five dimensions were identified in the unadjusted and adjusted models for medical doctors (Table 6). The significant dimensions for medical doctors include reduction of number of diseases (Coeff 3.151, 95% CI 1.643 - 6.041), reduction of number of injuries (Coeff 0.412, 95% CI 0.191 - 0.886), Reduction of number of disabilities (Coeff 4.497, 95% CI 2.084 - 9.705), reduced health inequities (Coeff 0.424, 95% CI 0.215 - 0.835), and Improved needs assessments (Coeff 0.319, 95% CI 0.164 - 0.620). Among AHWs, 2 predictors each were significant for the unadjusted and adjusted models respectively and include - reduction of number of disabilities, (Coeff 3.522, 95% CI 1.333 - 9.304), and reduced health inequities (Coeff 0.181, 95% CI 0.063 - 0.524). The generalized Hosmer–Lemeshow test Chi-square was 8.47 with p-value 0.933, indicating a good fit of the final model.
Table 6: Outcome Related Indicators’ (ORI) dimension associated with Health Promotion in a multivariate analysis
ORI Dimensions
|
Professions
|
Coeff (unadjusted)
|
95% conf. interval
|
Coeff (adjusted)
|
95% conf. interval
|
Reduction of number of diseases
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
2.869
|
1.466 -5.615
|
3.151
|
1.643 - 6.041
|
Allied HW
|
1.135
|
0.469 - 2.745
|
1.014
|
0.439 - 2.344
|
Reduction of number of injuries
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.391
|
0.177 -0.866
|
0.412
|
0.191 - 0.886
|
Allied HW
|
0.520
|
0.185 - 1.461
|
0.535
|
0.199 - 1.434
|
Reduction of number of disabilities
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
4.829
|
2.198 - 10.612
|
4.497
|
2.084 - 9.705
|
Allied HW
|
3.554
|
1.297 - 9.739
|
3.522
|
1.333 - 9.304
|
Reduced health inequities
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.488
|
0.246 - 0.969
|
0.424
|
0.215 - 0.835
|
Allied HW
|
0.145
|
0.046 - 0.464
|
0.181
|
0.063 - 0.524
|
Improved needs assessments
|
Nurses (base outcome)
|
|
|
|
|
Doctors
|
0.378
|
0.189 - 0.756
|
0.319
|
0.164 - 0.620
|
Allied HW
|
1.019
|
0.451 - 2.305
|
0.986
|
0.454 - 2.140
|