BMC Public Health 2008, 8:284 http://www.biomedcentral.com/1471-2458/8/284 For the purposes of the study, the term health promotion rather than "health education" was used throughout the questionnaire as the former term was deemed more famil- iar to the public and there were concerns that "education" would be interpreted as reflecting a "teacher-pupil" rela- tionship rather than a collaborative relationship where the patient plays an active role in their lifestyle develop- ment. "Health promotion" was defined as any action taken by a member of staff at the hospital to enable the patient to take control over aspects of their lifestyle that may have a negative effect on their health. Actions included verbal and written advice, medications and refer- ral to specialists/services that aim to change unhealthy behaviours into healthy behaviours (e.g. quitting smok- ing). While patients were being asked their views on "health promotion", given that the definition provided more accurately reflects "health education", the latter term will be used throughout the paper. The questionnaire followed the same format for each risk factor (smoking, alcohol, diet, exercise, and weight). Patients were asked whether they agreed that "all adult patients should be asked about their risk factor" (screen- ing agreement). Responses were on a five point likert scale ranging from "strongly agree" to "strongly disagree". Patients were then asked whether anyone at the hospital asked them about the risk factor (screening). For example "During your hospital admission were you asked about the amount of alcohol you drink?" Participants could answer "yes" or "no". Measurements of height and weight were not asked about as this does not necessarily indicate that body mass index (BMI) was calculated. Information was then gathered on whether the patient has a risk factor (risk factor prevalence). They were then asked whether they wanted to change their "risky" behaviour (change). The options were "yes" or "no". Information on the type of health education delivered within the hospital was gathered. This could range from leaflets, verbal advice, referral to a specialist/service. Participants were asked to circle the correct option(s) and there was a free text option for describing any additional health education delivered. Patients were asked who delivered the health education and to rate the "helpfulness" of the health education on a likert scale from 1 ("not at all helpful") to 5 ("very help- ful"). Patients were also asked a set of general questions relating to the appropriateness of health education within hospitals. Participants Participants for this study were selected on the basis that they were from the adult (≥ 17 years old) hospitalised and day-case patient populations of one Acute Trust. A routine was established in which all patients discharged alive between January and March 2006 were identified within one week of their discharge from twelve wards represent- ing surgery and medicine. Patients who were terminally ill were excluded from this study as it was deemed inappro- priate to deliver health education to these patients. A total of 322 people were identified and sent a question- naire within a maximum of one month of their discharge. To optimise return-rate patients were sent a pre-letter, pre- paid return addressed envelopes along with the question- naire, and two reminders sent 1 week and 2 weeks follow- ing the questionnaire. Analyses An Excel workbook was developed for recording all data. Analyses were performed using StatsDirect Version 2.4.5 and SPSS 15.0. Patients who returned the questionnaire are described as "responders" and those who did not return the questionnaire "non-responders". Differences in age between responders and non-responders were assessed by one-way ANOVA with gender as a factor. Mann-Whitney U tests were employed to assess differ- ences in length of stay (LoS) and Index of Multiple Depri- vation (IMD) scores [21] as data were distributed non- parametrically. IMD scores provide an indicator of depri- vation based on income, employment status, self- reported health and disability, educational level, housing, living environment and crime based on geographical area (the small area level). The higher the score, the greater the level of deprivation. Proportion differences for screening of smoking and alcohol use, smoking behaviour and alco- hol misuse were calculated for responders versus non- responders based on findings in patients' case notes. All reported significance values are two-tailed. In order to describe the responses to all questions, these were subject to descriptive statistics: proportions, proportions ± 95% confidence interval (CI) and tests for proportion differ- ences where appropriate. SCREENING AGREEMENT questions were also subject to the Friedman test to exam- ine whether responses were similar across the four risk fac- tors (smoking, diet, alcohol and exercise). This study received Local Research Ethics approval. Results Demographics One hundred and three females and eighty-seven males returned the questionnaire (59% response rate). The mean age and median length of stay for responders and non-responders are reported in table 2. There was a trend towards male non-responders being younger than female non-responders and all responders. There were no signifi- cant differences in the median length of stay or socio-eco- nomic status (IMD score) between the groups, nor in the proportion of responders and non-responders who were (according to their medical case notes) screened for smok- ing and alcohol, or identified as misusing alcohol (see Page 4 of 10 (page number not for citation purposes)