Conductas sexuales de riesgo

This question is assessed from two perspectives: with regard to the international networks’

historic role in network formation (sub-chapter 8.7.1) and with regard to the national / re-gional networks’ current use of the international HPH network (sub-chapter 8.7.2).

8.7.1 Network viability and the role of the international HPH network in network formation

The national and regional HPH networks can be distinguished with regard to the condi-tions of their establishment. As outlined in chapter 2, there is a big group of networks that were founded subsequently to the European Pilot Project of Health Promoting Hospitals and Health Services, and a few more were founded in relation to a workshop on network estab-lishment supported by the European Commission in 1996. Specifically the founders of the networks with an EPHP background experienced a common history. Is there any empirical evidence for this background having an impact on network viability?

Of the 46 HPH networks founded until to-date (compare chapter 8.1), 24 (50%) can be – directly or indirectly (in the case of numerous regional networks in Italy⁵⁵) – related to the EPHP (compare Table 40 below). These figures make the EPHP the biggest single impact factor on network foundation in the history of HPH.

Table 40: Foundations of national / regional HPH networks in countries / regions with former EPHP member hospitals (n=14 countries)

Country / region Network founded during or

immedi-ately after EPHP project Network foundation later

Austria  ---

France  ---

Germany (5 hospitals)  ---

Greece  ---

Hungary  ---

Ireland  ---

Italy (2 hospitals in regions Lombardia und Veneto)

 (11 regional networks)

Poland (2 hospitals)  ---

Sweden  ---

Czech Republic --- 

UK England  ---

55 The national Italian HPH network that was founded after the participation of two Italian hospitals in the EPHP has the strategy to establish regional networks in the Italian provinces.

Country / region Network founded during or

immedi-ately after EPHP project Network foundation later Northern

Ireland  ---

Scotland --- 

Wales  ---

TOTAL 11 networks 13 networks

The foundation of three more networks – Belgium, Denmark, and Finland – goes back to the EU workshop in 1996, referred to above. As outlined in chapter 2.5 (which describes phase 4 of the development of the international HPH network), the initiation of new national / regional HPH networks slowed down considerably between 2001 and 2005, and increased again together with the re-establishment of the International HPH Network as an internation-al association, the increasing use of the five standards for heinternation-alth promotion (Gröne 2006) as a specific tool provided by the international network, and the initiation of new international projects relating HPH very much to the hospital core business (e.g. a project on developing DRGs for health promotion; a project on assessing patient records for health promotion con-tents) from 2005 onwards. This further confirms the importance of joint (international) pro-jects as key factors in the initiation and establishment of deliberately installed networks with a common purpose, such as HPH.

But what about the impact of joint projects like the EPHP on sustained network viability?

As shown in Table 32 in the introduction to chapter 8, 17 of the 46 HPH networks founded between 1993 and 2011 were, in 2011, either formally closed down, went through at-risk peri-ods or had experienced temporary closure. These included 7 directly EPHP-inspired networks, 4 Italian regional networks (which are indirectly linked to the EPHP since the establishment of regional networks is part of the national, EPHP-inspired Italian HPH network) and 6 not-EPHP-related networks. Thus, all in all, 65% of the at-risk networks were EPHP-founded or inspired, as opposed to 35% without an EPHP background. Most likely, the explanatory fac-tor behind the rather high proportion of EPHP-inspired networks amongst the vulnerable networks is network age: The median age of all 17 vulnerable and closed-down networks, in 2011, was 14 years, while the median age of the 29 sustainable networks was 10 years. Since the EPHP-inspired networks were founded as the earliest ones in HPH, they are naturally over-represented amongst the older networks (compare Figure 75 below).

Figure 75: Median age of all, of vulnerable an of sustainable HPH networks, founded with and with-out a historic relation to the EPHP (N=46 networks)

These findings confirm the interpretation of age as an important risk factor for network vi-ability. For Healthy Cities, Göpel (2007) came to a similar interpretation, stating that motiva-tion for networking was declining over time. However, as already stated earlier, another reason might be that networks – so as human beings – are, throughout their life course, exposed to a multitude of risk factors which makes it more likely for older ones to become vulnerable if they did not manage to take adequate counter-measures in time.

8.7.2 Network viability and the networks’ current usage of the international HPH network

The networks’ current usage of offers from the international HPH network was presented in chapter 6. Each national / regional network in the PRICES-HPH network sample utilized at least 2 of the 8 pre-defined international offers, the median being 6 and thus comparably high. Vulnerable networks, however, had a median of only 4.5. Rank differences between the two groups were significant according to a Mann-Whitney-test (sig. = .042, p < 5%). It might therefore make sense for the international network to specifically contact and, if need be, sup-port national / regional HPH networks that obviously don’t use the international offers over a certain period of time.

12

14

10

14

14

12 8

9,5

7

0 5 10 15

Median age all

Median age vulnerable networks

Median age sustainable networks

All networks EPHP-inspired Other