Establishing research impact assessment in Iran: The first report from a non-high-income country.

Background: This study presents the first report on research impact assessment (RIA) in non-high-income countries, undertaken as a pilot initiative in 2021. Within it, we aimed to explore the feasibility of employing the 'payback' model for evaluating the impact of health research and enhancing the accountability of universities. We focussed on three key impact domains: 'production of decision support documents and knowledge-based products,' 'implementation of research results,' and 'health and economic impact.' Methods: We adopted a case study approach to assess the impact of 5334 health research projects conducted by researchers from 18 universities from 2018 to 2020. Researchers were required to submit evidence related to at least one of the specified impact domains; six scientific committees verified and scored claimed impacts at the national level. Results: Only 25% of the assessed projects achieved impact in at least one domain, with the production of decision support documents and knowledge products being the most reported impact. Notably, economic impact was verified in only three projects, indicating room for improvement in this area. Technology research exhibited the highest acceptance rate of claimed impact, suggesting a positive correlation between technology-focused projects and impactful outcomes. Conclusions: This study demonstrates the feasibility of employing a case study approach and the 'payback' model to evaluate the impact of health research, even within the constraints of a moderately equipped research infrastructure. These findings underscore the potential of integrating RIA into the governance of health research in Iran and other non-high-income countries, as well as the importance of using RIA to assess the accountability of health research systems, guide the allocation of research funding, and advocate for the advancement of health research. The study sets a precedent for future assessments in similar contexts and contributes to the ongoing global dialogue on the societal impact of health research.

Healthcare System Responsiveness in Covid-19: An Experience from Capital City of I.R of Iran.

Background: As a public health emergency, coronavirus disease 2019 (Covid-19) is a threat to our future; therefore, appropriate health system responsiveness (HSR), as an important criterion, is of crucial importance. This study aimed to evaluate the different dimensions of responsiveness of healthcare centers, both public and private, providing COVID-19 services in Tehran. Methods: Following a cross-sectional design, this study was conducted in Tehran (the capital city of I.R. Iran) from May to November 2020. Data were collected using the World Health Organization (WHO) questionnaire on responsiveness. Two hundred questionnaires were filled out through face-to-face or phone call interviews in two public and private hospitals (100 in each) providing Covid-19 services. Participants were selected using the convenience sampling technique among all those who received Covid-19 services during the past six months in the city of Tehran. Results: The mean age of participants was 45.9 ± 15.9 and 51.5% were female. On an average, 52.6% of the respondents evaluated at least one dimension of responsiveness as appropriate and/or strongly appropriate. Communication obtained the highest score (58.2%), followed by confidentiality (56.5%), dignity (56%), and prompt attention (52%). Meanwhile, autonomy and choice were evaluated as poor (moderate, weak, and strongly weak) by 63.5 and 52.5% of respondents. There was no significant association between the type of healthcare center (i.e., public or private) and responsiveness (p-value = 0.896). However, there was a significant difference between gender (p-value = 0.036) and education level (p-value = 0.014) with responsiveness. According to the respondents, prompt attention and choice were the most and least important dimensions, respectively. Conclusions: Evaluation of HSR in the era of COVID-19 not only provides a tool for qualitative assessment of services but also plays an important role in providing feedback to policymakers to adopt effective policies.

Iranian nongovernmental organizations' initiatives in COVID-19 pandemic.

BACKGROUND: With the outbreak of the COVID-19 virus crisis worldwide, including Iran, the need for corona prevention and treatment has become a national priority. With many businesses closed in the wake of COVID-19 and job losses and declining incomes, vulnerable individuals' and families' access to the minimum wage and healthcare facilities is falling, and their health is exposed to a great risk. In Iran, a significant number of vulnerable groups are supported by nongovernmental organizations (NGOs). This study is designed to understand the performance of NGOs after the onset of the COVID-19 crisis. MATERIALS AND METHODS: This study was carried out based on qualitative research between June and September 2020 in Tehran. This study was conducted using individual interviews with 33 managers and experts of 24 active NGOs providing services to vulnerable groups and a member of an NGO network. Data were analyzed using content analysis. RESULTS: Two main themes of service initiatives were extracted: (a) service initiatives to protect the target population against COVID-19 infection and its aftermath and (b) management initiatives to retain staff, finance, and adapt the organization to crisis situations. Service initiatives included five categories of health service initiatives, livelihood, employment, education, and leisure initiatives, while organizational management initiatives include human resource management, financial management, and communication with organizations. CONCLUSION: The COVID-19 breadth and its special features have set it apart from other crises and have led NGOs to work hard on several fronts to care for the most vulnerable people against the epidemic and its consequences and maintain the performance of their organizations. The unique role of cyberspace has made it one of the definitive pillars of the activities of NGOs, not only during the epidemic but also after its end.

Determining the effectiveness of cognitive behavioral therapy interventions based on the transdiagnostic approach in the treatment of common mental health problems: Presenting an experience from the Islamic Republic of Iran.

INTRODUCTION: There is growing support to develop transdiagnostic approaches that provide new insights into mental health problems and cut across the existing traditional diagnostic boundaries all over the world. The present study was conducted to test the transdiagnostic cognitive behavioral therapy (TCBT) approach in treating patients with common mental health problems and evaluate its effectiveness compared to the current treatment settings of the healthcare system. METHODS: A randomized controlled trial was conducted in Semnan Province, north of Iran. The study took pace in urban health centers. A sample of 520 Iranian adults, tested as positive on the Kessler Psychological Distress Scale, were enrolled. Participants who received a score above the cut-off point in any of the three mental health disorders (depression, anxiety, or obsessive compulsive disorder [OCD]) based on the locally validated study instrument were randomly allocated to the study. The intervention group received TCBT during eight sessions provided by trained general health service providers without previous mental health training; the standby control group received Mental Health Services as Usual (MHSU). The post-test interviews were conducted using the study instrument after the completion of both group treatments. RESULTS: A total of 459 individuals (87.8% female) ultimately entered the study. The withdrawal rate was 24% (53 participants in the TCBT and 56 in the MHSU). Reduction in depression, anxiety, and OCD symptoms was significant within each group and when comparing TCBT and MHSU (mean difference). CONCLUSION: This trial recommends that the transdiagnostic CBT approach can be effective in improving common mental health problems and functions among individuals by trained general healthcare providers in the primary healthcare system. The results can be more useful in decision making when defining the process of providing mental healthcare in the National Primary Healthcare System.

Peer Review Research Evaluation in Iran: Strengths, Weaknesses and Suggestions.

BACKGROUND: Peer based evaluation is a qualitative assessment done in different fields and levels. The aim of this study was to express the results of peer review evaluation in selected Iranian clinical research centers. METHODS: Four main domains consist of Leadership and governance, Structure, Knowledge products and Impact in thirty Iranian clinical research centers were evaluated based on peer review in 2019. Strengths and weak points with peer's suggestions were extracted based on qualitative analysis. RESULTS: Governance and impact domains have been more weak points than others. Equipment, facilities, physical space and human resource have been desirable in many research centers, and also there were some good developments in research publication. The most important suggestion was pay more attention to technology in planning, infra-structure and impact levels. CONCLUSION: Review missions of clinical research centers with more emphasis on health impact is necessary to clinical improvement.

Local perceptions of mental health in Iran, Semnan Province.

INTRODUCTION: Understanding local perceptions of mental health in different cultures and contexts is crucial for designing and implementing appropriate mental healthcare services. METHODS: This qualitative study was conducted to investigate local perceptions of mental health in two highly populated provincial districts in Iran. Data were collected using the free list technique and interviews. A two-phase training workshop was held with the research team at a local health center, followed by a pilot study with the participation of six subjects. All the interviews were audio-recorded, transcribed, and then analyzed by the third and fourth authors in DEDOOSE. RESULTS: A total of 30 individuals (20 in the free list and 10 as key informants in the interviews) took part in the study. Based on the study findings and the key informants' ideas, mental health problems were categorized into three categories of depression, anxiety, and obsessive-compulsive disorder (OCD). CONCLUSIONS: Mental health problems appear to be expressed in different ways and with different symptoms in different cultures, and there is a distinct need for examining mental disorders in each culture and nationality separately using culturally appropriate tools for disease screening.

Knowledge production in Iranian cardiovascular research centers: A way to reduce the burden of disease.

BACKGROUND: According to the World Health Organization (WHO), non-communicable diseases (NCDs) including cardiovascular diseases (CVDs) will be responsible for almost 70% of all deaths in 2020. Therefore, knowledge production to find suitable ways to prevent, diagnosis, and effectively cover this disease in research centers is mandatory. Therefore, the present study is carried out with the aim to examine the results of studies performed in three years in Iranian cardiovascular centers. METHODS: Iranian cardiovascular research centers with more than three years of activity from 2015 to 2017 were evaluated. Research output, international collaboration, high quality publication, total citation, and average h-index (H) were evaluated and scored. RESULTS: 23 cardiovascular diseases research centers (CVDRCs) related to 15 universities of Medical Sciences (UMSs) were evaluated. The mean and standard deviation (SD) of age of the research activities in CVDRCs was 11.47 ± 8.60 years. Based on the research ranking, the first three centers were Isfahan Cardiovascular Research Center, Iran, Tehran Heart Center, and Shaheed Rajaei Cardiovascular Medical and Research Center, Iran, respectively, all of which have independent budget line. However, there is not any CVD research center in some provinces such as Zanjan, Kurdistan, Lorestan, and Arak, Iran. CONCLUSION: Mission oriented research activities in Iranian cardiovascular research centers may be effective in reducing the burden of CVDs. Moreover, establishment of CVD research centers in high risk areas may be useful.

Knowledge production in Iranian social determinants of health research centers: Toward health equity.

Background: As the partner country of the WHO Commission on Social Determinants of Health (SDH), Iran has expanded the knowledge based on the social determinants of health- as one of commission recommendations- by establishing SDH research centers to collect evidence and design responses to the existing health equity gap. Considering the importance of the role assigned to these research centers, this study aimed to present the knowledge production of SDH research centers and determine their status in Iran's health research system (HRS). Methods: In this cross sectional study, research performance of SDH research centers was assessed based on international research indicators and compared with national medical research centers and HRS knowledge production. Then, SDH research centers were scored and ranked based on the research indicators. Results: Out of 37 approved SDH research centers, the knowledge performance of 33 research centers was reviewed. The total number of academic members was 334. The number of these centers' indexed published articles and the proportion of published articles per academic member have been doubled from 483 and 1.44 in 2015 to 984 and 2.94 in 2017. In this period, the number of citations of the past 5-year publications was 4355 according to Scopus database. The proportions of these centers' high-quality publication (Q1) and international collaborations per published articles were 14.8 and 8.25. In ranking, the first to third ranks were occupied by SDH research centers of Kermanshah, Kurdistan, and Qazvin Universities of Medical Sciences. Conclusion: Although knowledge production seems desirable in mentioned research centers, it is essential to create a virtual research network to increase intersectoral collaboration and develop strategies to solve the puzzle of gathering evidence on the social determinants affecting health inequities.

Situation Analysis for Promotion of Hot-Lines: An Experience from Iran.

BACKGROUND: The hot line services were developed in response to the perceived need for 24-hour help services in crises ranging from suicide to unwanted pregnancy. This study is aimed at analyzing the strengths, weaknesses, challenges, and suggestions of improving the performance of the help centers from the perspective of key stakeholders. METHODS: We conducted a qualitative study to elicit the key informants' opinion regarding the performance of Iranian hot-lines. All the conversations were audio-recorded with the permission of the participants. To reach the saturation limit, the number of interviews was completed in the saturation of data. Data was gathered from 15 individual in-depth interviews. Collecting and analyses of data was based on content analysis through which simultaneously during texts open coding, main concepts were extracted and then in axial coding similar concepts were categorized. RESULTS: According to the study results, there is no specific and independent system for assessing the hot- lines. One of the major weaknesses was the lack of standard protocols. Most participants believed that most of these guidelines came from the general principles of counseling and are not standard. As another point, the existence of referral services is one of the main problems of counseling lines. The most important suggestion from the majority of experts were the development of services and modification of their investments. CONCLUSIONS: The findings, in addition to providing the applied data for policy-making in the health system, will significantly contribute to the creation of scientific, technical, and skillful personnel in the community of researchers.

Factors Affecting Social Health from Young Adults' Perspective: A Qualitative Study.

BACKGROUND: Factors affecting social health, especially in young adults, are among the most important research priorities. Knowledge of social factors affecting young adults' health will lead to understand them in the social context. The present study is aimed to explain the perspective of young adults on social factors affecting health. METHODS: In the present qualitative content analysis study, semi-structured open interviews were conducted through targeted sampling of young volunteers aged 18-30 who were selected from Tehran Province. Interviews were recorded, transcribed, and analyzed. The inclusion criteria for participants were willingness to participate in the study and ability to express their personal experiences. Twenty-one data were collected through collection was done with individual in-depth interviews. RESULTS: Using this qualitative approach, the present study was conducted to identify factors affecting social health from the perspective of young adults. The analysis led to the extraction of three main categories, each with two or three subcategories: expectations regarding the community, expectations regarding the family, and expectations regarding infrastructures. CONCLUSIONS: Our findings shown that social support considered as effective elements in providing social health of young adults. The evidence on controlling factors should be considered in promoting the social health of specific target groups. The results of the present study could be used for better planning of interventions in youth social health domains.

Introduction of a Community-Based Participatory Model for Women's Mental Health Promotion in Iran: A-Z.

BACKGROUND: To address the disproportionate burden of poor mental health among women, we present a community based participatory research (CBPR) model used to develop a women's mental health promotion program for Iranian women. METHODS: This is a multi-phase interventional study using a CBPR approach among married women age 18-65 living in Tehran. First, participants described the process of women's mental health. Subsequent steps involved participatory needs assessment, priority setting, intervention design, and evaluation. Finally, a conceptual model of women's mental health promotion was developed. RESULTS: "Seeking comfort" emerged as the core process in women's mental health. To promote mental health, women prioritized training on coping mechanisms to deal with stress. Women receiving this training used more problem-based coping methods and reported a higher quality of life than the comparison group. CONCLUSIONS: The resulting conceptual model illustrates the utility of using a CBPR approach to develop women's mental health promotion programs.

Social Determinants of Positive Mental Health in Iranian Society: A Qualitative Approach.

BACKGROUND: Based on the World Health Organization definition, mental health is the absence of mental disorders and presence of positive mental health (PMH). As the social determinants of mental disorders and PMH are not the same in different cultures and in order to promote community mental health, social determinants of PMH should be identified, which is the aim of this study. METHODS: This was a qualitative study conducted in Tehran. Data were collected through eight focus group discussions with the general population aged between 30 and 60 years and ten semi-structured interviews with mental health professionals from Tehran. Data were analyzed through directional content analysis using Dedoose software. RESULTS: Fifty-one lay people and ten mental health professionals participated in this study. The process of content analysis resulted in two main themes: (a) structural determinants of PMH which consist of socioeconomic and political context and socioeconomic position and (b) intermediary determinants of PMH which consist of working condition, living condition, family factors, lifestyle, psychosocial factors, and health system. CONCLUSIONS: Improvement of living conditions, with emphasis on working conditions as one of the intermediary social determinants, will play an important role in promoting PMH.

Assessment of Environmental Health Research Centers in Iran due to knowledge production and utilization.

BACKGROUND: Knowledge production in environmental health promotion is one of the most important goals at the national level and establishing environmental health research centers (EHRCs) is one of the main strategies that will lead to achieving this goal. In this study, we are going to present the results of knowledge production and research performance evaluation of EHRCs in Iran. METHODS: In this cross sectional study, a specific check list has been used to assess Knowledge production and utilization through annual evaluations undertaken by research centers in Iran. This article has the results of the 4-year evaluation (2011-2014). RESULTS: The total number of EHRCs under the supervision of universities of medical sciences (UMS) is 34. The number of faculty members at these centers is 291 and the total approved projects by research council of UMS during 2011-2014, were 538. The number of published article increased from 282 in 2011 to 709 in 2014. During this period, the number of citations to EHRCs' articles was 4488 in Scopus database. The number of EHRCs' articles which have been referred in text books were 39. The proportion of published articles per academic member in environmental health has been 1.8 per year. CONCLUSION: Based on research performance evaluation, knowledge production and research is desirable in EHRCs, but research utilization to health environmental promotion is still inadequate and should be assessed by qualitative evaluation.

Priorities of positive mental health promotion in the Iranian community: a qualitative study.

BACKGROUND: Positive Mental Health (PMH) enables people to cope with the common stresses of life and adversity to achieve their full potential and humanity. In many communities, promoting PMH via prioritized interventions has been considered as a key component of public health policies to optimize mental well-being. OBJECTIVE: To set the priorities of interventional programs of Iranian PMH promotion according to the World Health Organization (WHO) Priority Public Health Condition (PPHC) analytical framework. METHODS: This qualitative study was implemented in 2017 in Tehran, Iran and had two main phases. In a qualitative needs-assessment phase, needs of the community's PMH were collected through eight focus group discussions with a general population aged 30 to 60 years-old. In a priority-setting phase, the priorities of PMH were extracted through an expert panel consisting of mental health professionals and policy makers. Data gathering was implemented based on purposeful sampling according to inclusion criteria. Data were analyzed based on directional content analysis using Dedoose software version 7.6.6. RESULTS: Fifty-one people and ten mental health professionals and policymakers participated in this study. The process of data analyzing, categorized PMH needs in 4 main categories, 15 subcategories and 46 codes. The four categories were financial security, social security, healthy lifestyle and promoting psychological factors. In the expert panel, first, the indicators of PMH priority setting were determined and then based on the priority public health condition analytical framework of the World Health Organization, the most important of PMH priority in each level was indicated as "creating job positions" in socioeconomic level, "providing proper working conditions" in differential exposure, "promoting practical life skills training" in the differential vulnerability, "easy and affordable access to mental health services" in differential healthcare outcome. CONCLUSION: Appropriate policymaking and regulation at national level regarding employment, promoting working conditions, and reducing unemployment, promote community PMH as well as expanding accessible and affordable mental health services in the national healthcare system and empowering the community through providing practical life skill courses.

Positive Mental Health from the perspective of Iranian society: A qualitative study.

Background: According to the World Health Organization, mental health relates, not only to the absence of mental disorder, but also to Positive Mental Health. Studies have shown that promoting positive mental health, not only reduces the prevalence and incidence of mental disorders, but also affects the process of treatment and reduces related burden. However, this concept has different interpretations in different cultures, and in many societies, mental health is still considered the absence of mental illness. Thus, the present study was conducted to provide an in-depth understanding of Iranian adults` perspective towards the concept of positive mental health. Materials and Methods: In the present qualitative study, eight focus group discussions (6 to 8 adults in each session) were held consisting of 30 to 60 year-old men and women from Tehran. Data were analyzed in "DeDoose" qualitative software using content analysis. Results: According to the data obtained, participants found no difference between positive mental health and mental health, mostly equating it to the absence of mental disorders and having positive energy, peace in and satisfaction with life. According to the results, positive mental health has four domains of emotional/psychological, spiritual, social, and life skills. Conclusion: Understanding an individual's positive mental health concepts culturally and providing appropriate community based programs can significantly promote the mental health of the community.

An explanatory model for the concept of mental health in Iranian youth.

Background: Mental health is considered as an integral and essential component of overall health. Its determinants and related factors are one of the most important research priorities, especially in adolescents and young people. Using a qualitative approach, the present study aimed to identify factors affecting the mental health of youth in Iran. Methods: In 2017, following content analysis principles, and using semi-structured in-depth interviews, we conducted a qualitative study exploring the opinions of young people about mental health. A targeted sampling method was used, and participants were young volunteers aged 18 to 30 who were selected from Tehran province, Iran. Inclusion criteria for participants was willingness to participate in the study, and ability to express their experiences. Data collection was done with individual in-depth interviews. According to the explanatory model, the interviews were directed toward the concept of mental health and path of causality and auxiliary behaviors. Results: 21 young adults participated, who met the study inclusion criteria, of whom 12 participants were male. Their mean age was 24.4 ± 0.41 years and their education varied from primary school to Master's degree. Mental health was considered as mental well-being and a sense of satisfaction and efficacy, not only the presence of a disease or mental disorder. Based on the opinions of the interviewees, three factors of personal characteristics, family and society are involved in mental health. Individual factors were associated with behavioral and physical problems. One of the most important issues was revealed as tensions in societal and family conflicts. Economic problems and unemployment of young people were also extracted from the social factor. Conclusion: In Iran, social factors such as jobs for the unemployed and job security are considered as important determinants in the mental health of young people.

A Comprehensive Health Plan: The Lifestyle Affecting Factors in Iranian Youth.

BACKGROUND: Factors affecting lifestyle become one of the most priorities of the research field, especially in adolescents and youth. Using a qualitative approach, this study aimed to understand what factors are affecting young people's healthy lifestyle. METHODS: Using the conventional content analysis, and used the semi-structured in-depth interviews, we conducted a qualitative study to elicit the youth opinion considering their lifestyle affecting factors. Initially, purposeful sampling method was considered for data collection. Participants were selected from volunteered youths 18-30 years whom were selected from the Tehran city. Inclusion criteria for the participants were; (a) willingness to participate in the study, and (b) ability to express experiences. RESULTS: According to findings, although the majority of participants agreed on the important role of lifestyle related behaviors in their healthy life, the lack of essential motivation and the pressure of educational assignments remove it from their daily program priorities. The most important barrier to observing the healthy lifestyle was expressed as; the acceptance of the concept by the individual and the social and economic potential of the individual. It was also suggested that practical interventions should focus on improving more participator engagement of all of the related stakeholders. CONCLUSIONS: We proposed the participatory strategies for youth healthy lifestyle promotion. Through which based on a specific needs the assessment of different target groups, designing, development, and implementation of health programs led to more effective interventions.

The evaluation of a virtual education system based on the DeLone and McLean model: A path analysis.

Background: The Internet has dramatically influenced the introduction of virtual education. Virtual education is a term that involves online education and e-learning. This study was conducted to evaluate a virtual education system based on the DeLone and McLean model. Methods: This descriptive analytical study was conducted using the census method on all the students of the Nursing and Midwifery Department of Alborz University of Medical Sciences who had taken at least one online course in 2016-2017. Data were collected using a researcher-made questionnaire based on the DeLone and McLean model in six domains and then analyzed in SPSS-16 and LISREL-8.8 using the path analysis. Results: The goodness of fit indices (GFI) of the model represent the desirability and good fit of the model, and the rational nature of the adjusted relationships between the variables based on a conceptual model (GFI = 0.98; RMSEA = 0.014).The results showed that system quality has the greatest impact on the net benefits of the system through both direct and indirect paths (ß=0.52), service quality through the indirect path (ß=0.03) and user satisfaction through the direct path (ß=0.73). Conclusions: According to the results, system quality has the greatest overall impact on the net benefits of the system, both directly and indirectly by affecting user satisfaction and the intention to use. System quality should therefore be further emphasized, to use these systems more efficiently.

Contribution of Health Researches in National Knowledge Production: A Scientometrics Study on 15-Year Research Products of Iran.

BACKGROUND: Researchers, practitioners, and policymakers call for updated valid evidence to monitor, prevent, and control of alarming trends of health problems. To respond to these needs, health researches provide the vast multidisciplinary scientific fields. We quantify the national trends of health research outputs and its contribution in total science products. METHODS: We systematically searched Scopus database with the most coverage in health and biomedicine discipline as the only sources for multidisciplinary citation reports, for all total and health-related publications, from 2000 to 2014. These scientometrics analyses covered the trends of main index of scientific products, citations, and collaborative papers. We also provided information on top institutions, journals, and collaborative research centers in the fields of health researches. RESULTS: In Iran, over a 15-year period, 237,056 scientific papers have been published, of which 81,867 (34.53%) were assigned to health-related fields. Pearson's Chi-square test showed significant time trends between published papers and their citations. Tehran University of Medical Sciences was responsible for 21.87% of knowledge productions share. The second and the third ranks with 11.15% and 7.28% belonged to Azad University and Shahid Beheshti University of Medical Sciences, respectively. In total fields, Iran had the most collaborative papers with the USA (4.17%), the UK (2.41%), and Canada (0.02%). In health-related papers, similar patterns of collaboration followed by 4.75%, 2.77%, and 1.93% of papers. CONCLUSIONS: Despite the ascending trends in health research outputs, more efforts required for the promotion of collaborative outputs that cause synergy of resources and the use of practical results. These analyses also could be useful for better planning and management of planning and conducting studies in these fields.