BMC Public Health 2008, 8:284 http://www.biomedcentral.com/1471-2458/8/284 with one another. For example, for the health education strategy (PAT 5) to work optimally, patients who are empowered to self care and co-produce will be more able to take responsibility for developing and maintaining healthy lifestyles post-discharge (PAT 1 and 2). The hospi- tal also has to be an appropriate environment for provid- ing health education (e.g. suitable rooms; PAT 3); and empowerment to self manage diseases/impairments will often be associated with particular lifestyles (PAT 4). In addition to the WHO HPH network strategies, public health policy in the UK now highlights the importance of providing personalised support (understanding patients' cultural and social background, etc) to patients to enable them to lead a "healthy" life (not smoking, sensible alco- hol use, etc) [1]. While UK hospitals have always had ele- ments of health promotion within routine care, the explicit demand that hospitals provide health promotion services to patients for lifestyle development, in particular focusing on smoking, alcohol misuse, obesity, diet, and exercise, is relatively new [11]. An audit of health promotion activities within 9 English hospitals revealed that while the majority of hospitalised patients were screened for smoking (94.1%) and alcohol use (83.1%), few were screened for diet (23.0%), physical activity (2.6%) or obesity (11.7%). The provision of health education was poor: an average of 22.5% of patients received health education for smoking cessation, 36.0% for alcohol misuse and very few for diet, physical activity or weight management (numbers of patients iden- tified as requiring health education for the latter three risk factors was so low that reporting the average figures would be misleading) [12]. While the above findings present a bleak picture of health education services within hospitals, there is evidence that medical records show low levels of accuracy for the recording of such activities [13,14]. Direct observation is viewed as the "gold standard" for measuring practice; however it is not practical for exploring the provision of health education provision to hospitalised patients as these services may be delivered at any/many points during an admission. Previous research within primary care set- tings indicates that patients' recall of health education is more accurate than medical records [14]. It therefore appears that relying on patient recall may be the most pragmatic approach to measuring health education deliv- ered on potentially multiple occasions and by multiple healthcare professionals. There is evidence that approximately 50% of the English public support the NHS "taking a lead role in preventing illness and improving health" [15], and that the majority of adult hospitalised patients think hospitals should take a role in health education [16]. However, with the excep- tion of a study by McBride, 2004, views regarding the appropriateness of hospitals as a setting for the delivery of health promotion services, including health education, have received little investigation [16]. This study aimed to provide an insight into the provision of health education for smoking, alcohol misuse, obesity, diet, and exercise within a UK hospital following UK pub- lic health policy changes highlighted above and the WHO HPH strategy for health promoting lifestyle development for patients; and to address the paucity of research on patients' views of the appropriateness/acceptability of the hospital as a setting for the delivery of health promotion services for lifestyle development. Methods Rationale A search of the literature at the time of developing this study indicated that there was no one survey tool that ade- quately met the study research questions: What lifestyle development (health education) services do patients want from a hospital setting? Is the hospital a suitable setting for the delivery of health education services? And how are patients' views related to their lifestyles? A self-adminis- tered questionnaire was deemed the most appropriate tool for investigating the research questions as it could be distributed to a relatively large number of patients and allowed for anonymity, hence increasing the likelihood of honest opinions about views and experiences of health education within the hospital [17]. Questionnaire The following tools were adapted to assess the prevalence of smoking, alcohol misuse, obesity, physical inactivity and unhealthy diet (risk factors): Stockport Health and Lifestyle Survey [18], the "Five Shot Screening Tool": a val- idated test for detecting hazardous and harmful alcohol use [19], and a validated two-item dietary questionnaire [20]. As no questionnaires existed which addressed patients' attitudes to health education in hospitals a semi- structured interview was developed, based on face valid- ity, by the researcher and steering group (patient repre- sentatives, hospital management, nursing, clinician and academic representatives). This was undertaken to the point of data saturation: 10 hospital patients differing in age, gender and ethnicity. Following content analysis of the interviews and adaptation of the aforementioned existing tools, the questionnaire was designed. The steer- ing group and hospital patients provided comments on the coherence and legibility of the questionnaire to ensure that it adhered to the principles of good survey design [17]. The questionnaire was finalised following a pilot phase in which 19 recently discharged patients completed the questionnaire. Page 3 of 10 (page number not for citation purposes)