The impact of legal and organizational regulations on the nutritional behavior of patients-consumers of spa treatment services in Poland.

Health resort treatment facilities, regardless of the ownership status (public, private), most often carry out their activities based on contracts with the Polish public payer of the health care system, therefore the operation of sanatoriums is a fully-fledged element of the health care system, such as inpatient treatment, outpatient treatment and basic health care. The system designed in this way is designed to improve the organization of benefits, including by incorporating new useful organizational and legal tools. Thus, health education, along with its nutritional aspect, which is its inseparable part, is a perfect example of how to positively influence the behavior of consumers of spa treatment services. The structure of the study included the desk research method related to the consolidation and processing of information on applicable legal regulations and an individual in-depth, structured interview, using an original interview scenario. Based on the deliberate selection of the sample, 14 interviews were conducted. The interlocutors were representatives of the management of spa treatment facilities, academics and representatives of non-governmental organizations. The interview included functional and organizational, financial, competence and substantive aspects related to the implementation of nutritional education in spa treatment facilities in Poland. The use of a structured interview with experts made it possible to present the area of health education, including nutrition, in a broad light of the knowledge and experience of health care practitioners and theorists. Opinions were obtained on the optimal methods of assessing the effectiveness of education in the conditions of spa treatment and a set of system and organizational recommendations. Reporting of the results was presented using the COREQ checklist. It is justified to consider broadly understood health education in spa treatment facilities as a kind of wholesome health service, which may constitute effective systemic support for health policy and, consequently, increase the importance of prophylaxis and improve the health condition of the population. Such a legislative change will force organizational changes that may ultimately lead to a change in eating habits. Moreover, it is highly useful to use the potential of paramedical professionals, including dieticians, health educators and health promotion specialists.

Selected Organizational and Managerial Aspects of Health and Nutrition Education of Various Types of Consumers of Spa Treatment Services in Poland.

Consumer education, including nutrition education, understood as a process based on scientific principles, is becoming a very effective element in influencing the health of the population in the modern world. This work is based on direct research carried out in 2016-2018 in the form of a questionnaire interview among patients-consumers of educational services in spa treatment facilities. The research sample was N = 1000 (600 people were tested with the use of PAPI (Paper and Pencil Interview), and 400 people with the use of CAWI (Computer-Assisted Web Interview)) and concerned a representative group of spa patients in Poland. In addition, as a supplement, a direct survey was conducted in the form of a Computer-Assisted Telephone Interview with managers of spa treatment facilities (N = 50). Consumers of spa treatment services differ from each other, and types can be distinguished based on their professional activity status and the type of entity that pays for their stay in the spa, and, using cluster analysis, the status of professional activity in relation to their education level. The nutritional education system is based on highly specialized medical personnel. At the same time, it does not use the available assessment tools based on proven monitoring and evaluation indicators. Health education, which also includes nutritional education, apart from disease prevention, is the basic tool for health promotion in spa treatment conditions, enabling the introduction of a permanent change in the patients' lifestyles, the additional advantages of which are low costs and relatively high efficiency. In the course of the study, several useful patient profiles were also distinguished, thanks to which it is possible to select dedicated educational methods for selected groups of recipients.