ABSTRACT
Background: Iran, after China, emerged as one of the first COVID-19 epidemic countries. Despite all efforts to interrupt new transmission chains, the virus continued to quickly spread across the country. WHO has highlighted a crucial role for social factors and intersectoral collaboration to tackle COVID-19. This study aimed to identify challenges related to the upstream determinants and downstream risk factors of COVID-19 infection in Iran as perceived by health professionals at different levels of service administration. Methods: We conducted a qualitative study in October 2020. A directed qualitative content analysis was done to explore the views of health professionals and administrators toward determinants of COVID-19 infection in Iran. Using a deductive approach, we tested the implications of the WHO Commission on the Social Determinants of Health (CSDH) framework regarding COVID-19. Results: The determinants of COVID-19 infection in Iran are referred to as: 1) upstream social determinants, including political considerations in dealing with COVID-19, conflicting authority structures between and within organizations and sectors, poor intersectoral collaboration, unstable macroeconomic environment, pandemic crisis management, poor governance in the health system, cultural and societal values, trust and social capital, and individuals' socioeconomic status;and 2) downstream risk factors, including poor health literacy, poor compliance with COVID-19 prevention guidelines, secrecy related to the infection, individual's health status, lifestyle, and virus characteristics. Conclusion: It is essential to motivate people to practice preventive COVID-19 infection behaviors. To change the behavior at the population level, a complex fusion of policy and practice, and dealing with the complexity of structural determinants and downstream risk factors are needed. Please cite this article as: Jorjoran Shushtari Z, Shirazikhah M, Ahmadi S, Salimi Y, Biglarian A, Almasi A, Paykani T. Upstream Determinants and Downstream Risk Factors of COVID-19 Infection in Iran: A Qualitative Study of Health Professionals' Views. © Journal of Health Sciences and Surveillance System.All right reserved.
ABSTRACT
Background and Objectives: Vaccine acceptance could seriously affect global efforts to control the Covid-19 pandemic. The aim of this study was to estimate the Covid-19 vaccine acceptance and its related factors in Tehran and Kermanshah. Methods: A population-based cross-sectional study was conducted on 850 participants in Tehran and Kermanshah using the random digit dialing method. Multiple logistic regression was used to estimate the adjusted odds ratio of factors related to vaccine acceptance. Results: The frequency of the Covid-19 vaccine acceptance was 66.47% (95% confidence interval: 69.57%, 63.21%). Moreover, 86.02% of the participants stated that they would use any type of (Iranian / foreign) vaccine approved by the Iranian Ministry of Health. However, 13.98% of the participants stated that they only preferred foreign approved vaccines (if available). The variables of age, fatalism, and socioeconomic status had significant associations with the Covid-19 vaccine acceptance. Conclusion: Based on the results of this study, the Covid-19 vaccine acceptance was moderate. In order to achieve herd immunity by vaccination faster in our society, the strategy of prioritizing vaccination can be planned based on the related variables such as religious beliefs and fatalism, younger age groups, and people with higher socio-economic status that are willing to receive the vaccine. © 2021, Iranian Epidemiological Association. All rights reserved.
ABSTRACT
Aims Understanding the knowledge, attitude, and practices of persons with disabilities about COVID-19 are essential for taking targeted prevention and control measures. This study aimed to explore the level of knowledge, attitude, and practices related to COVID-19 in persons with disabilities and identify obstacles and facilitators of promoting their knowledge, attitude, and practices. Instrument & Methods A mixed qualitative-quantitative study was conducted on 1067 Persons with disabilities in Iran in 2020. The researchers collected descriptive data using an online researcher-made questionnaire that included demographic and knowledge, attitude, and practices sections which its participants were selected randomly from all Persons with disabilities in Iran. Data were analyzed by SPSS 20 and using the Kruskal–Wallis and one-way ANOVA tests. To identify facilitators and barriers to improving knowledge, attitude, and practices, semi-structured interviews were done with 31 participants who were selected using purposeful sampling. Data were analyzed by content analysis approach. Findings The mean±SD scores of knowledge, attitude, and practice of persons with disabilities were 17.7±0.5, 16.6±0.7, 16.9±0.9, respectively, which were good. One-hundred sixty-one codes were identified, which were categorized into three themes and nine sub-themes. The main facilitators of KAP improvement among study participants were educational content developed during the pandemic and their dissemination using social media, community participation, and the empowerment of PWDs. Weak governance was mentioned as an essential barrier for knowledge, attitude, and practices improvement. Conclusion Further interventions are needed to increase the knowledge and improving attitudes and practice of Persons with disabilities during the crisis. Among them, the following are in priority: strengthening the governance arrangement of rehabilitation;increasing community participation;providing support packages and their fair distribution;empowering Persons with disabilities;preparing infrastructures for telerehabilitation;public awareness and, if needed, informing health workers about the specific needs of persons with disabilities and how to treat them respectfully. Copyright © 2021, the Authors.