BMC Public Health 2008, 8:284 http://www.biomedcentral.com/1471-2458/8/284 pictorial presentation or a combination of written and verbal presentation, yet the most frequent form health education took was verbal advice. The questionnaire showed good criterion validity as risk factor prevalence in this sample was similar to national and local profiles for the age group: 22% of the local pop- ulation are smokers and 22% are estimated to be obese [24]. In England, 87% of the population does not con- sume five portions of fruit and vegetables a day, 63% of men and 76% of women are physically inactive [25]; and approximately 20% of adult in-patients are expected to be hazardous or harmful drinkers [26]. The percentage of smokers wanting to quit is also similar to previous reports that more than 70% of smokers wish to quit [27]. There is however little data on the proportion of people with other risk factors who want to change their behaviour. The information on the percentage of patients wishing to reduce the amount of alcohol they drink, reduce their weight, and improve their diet and level of physical activ- ity can be used by hospitals as the basis for developing realistic standards for the number of patients delivered health education once a risk factor has been identified. The findings indicate that hospitals should initially aim to deliver health education to a minimum of 70% of smok- ers and obese individuals and 50% of people misusing alcohol, consuming an unhealthy diet and physically inactive. The timing of health education is also important to patients. While the majority felt that the time around dis- charge was the most appropriate period for health educa- tion, those receiving health education reported that it was usually delivered on admission. This may be because admission is the usual time for screening of risk factors. However, it is likely that this is not necessarily the opti- mum time for health education as patients may be in an unreceptive state due to their condition and their primary concern may be the immediate improvement in health (Haynes, 2004 unpublished). As the purpose of health promotion is to enable people to change a behaviour, it is important to assess whether the different potential forms of health education have achieved this. This was evaluated by asking patients how "helpful" the health education services they received were. While more patients viewed the services as "helpful" than "unhelpful", given that so few patients received any form of health education, it is not possible to draw definitive conclusions concerning the "helpfulness" of the different services. It is recommended that this question remains as it could provide valuable information about health educa- tion services when they are delivered to a larger number of patients. Given that primary care is the traditional setting for the delivery of health education it was surprising that approx- imately a quarter of respondents expressed disagreement with the statement "I would prefer health promotion [education] from my GP rather than hospital staff". While this infers that they would prefer health education from a hospital, further research is required to verify this finding (e.g. changing the statement to "I would prefer to get health education from hospital staff instead of my GP"); and to explore the reasons for this preference. For exam- ple, are hospital staff viewed as more approachable than GPs? Is there a perception of greater anonymity within a hospital, circumventing embarrassment? Although 1 in 10 respondents expressed that they never wanted health education while hospitalised, it is encouraging that only 3% disagreed with the statement that "hospital is a good place for patients to receive health promotion [educa- tion]". Disagreement with the statements "I would like the hospi- tal to let my GP know about my smoking, diet, exercise, and alcohol intake/the health promotion [education] I received from hospital staff" indicates that there is an objection to the sharing of information between hospitals and GPs. However, the use of the word "like" may be the reason, and further research is required to clarify whether there is an actual objection. If there is a true objection to communication between hospitals and GPs, it may be dif- ficult to justify automatically informing a patient's GP of their patient's risk factors and health education delivered, and hospitals may need to ensure that they have patient consent for sharing this type of information. However an argument can be made for the transfer of information as being in the public interest and part of continuing care, and therefore not subject to the need for informed patient consent [28]. With the drive towards greater collabora- tion/communication between services, and the creation of electronic patient records available to all health care providers, these findings are of concern. Reasons for such an objection also require clarification. There was no evi- dence that disagreement with the sharing of information was related to the presence of risk factors. Study Limitations There were some limitations to this study. The sample included patients from only one hospital and results may therefore not be generalisable to other hospital popula- tions. The trend towards fewer young men responding to the questionnaire indicates that the views of this group were not expressed. Young men are less likely than other populations to respond to questionnaires [29]; and it may be that other methods such as focus groups are more appropriate for investigating this group's preferences for health promotion services for lifestyle development. The views of this population need to be explored as young Page 8 of 10 (page number not for citation purposes)