Barriers to financial access of disabled people to health services in rural areas: A case study of Iran.

BACKGROUND: People with disabilities (PWDs) account for a significant percentage of the world's population, with a higher prevalence in less developed countries. Access to healthcare services is the main component of health systems performance, with lower access for PWDs living in rural areas. The current study aimed to investigate PWD's access to healthcare services in rural areas of Iran and, secondly, factors that contribute to this issue. MATERIALS AND METHODS: Following a cross-sectional design, the current descriptive-analytical study is performed in the north of Iran. Using the quota sampling technique, 471 PWDs were recruited. Data were collected using a valid and reliable questionnaire, covering three dimensions of access, by face-to-face interview. Data analysis was administered using central tendency indicators and multiple regression by SPSS version 17. Statistical significance was considered when the P value <0.05. RESULTS: The mean score of PWD's access to healthcare services for dimensions of utilization, availability, and affordability was 8.91 (±6.86), 14.54 (±2.3), and 51.91 (±8.78), indicating very low, low, and moderate levels of access. All three regression models were significant (P < 0.05), and variables of gender, age, marital status, education level, residence status, the income of the household head, receiving financial aid, and house area showed a significant effect (P < 0.05). CONCLUSION: This study demonstrated the seriousness of paying attention to PWD's financial access to healthcare services, particularly in rural areas of Iran. Hence, policymakers should better focus on this problem, mainly regarding accessibility and utilization and factors that result in inequalities.

Community-based education: An effective policy for earthquake preparedness in Iran: Empirical study.

BACKGROUND: As natural or man-made shocks, disasters are sudden events that require emergency and fundamental measures. The need to be prepared for disasters has become clearer than ever worldwide. This study aimed to investigate the effect of earthquake preparedness training using the face-to-face or cascade method in rural households living in Juybar County (Iran) in 2018. METHODS AND MATERIAL: Following an experimental design with a pretest and posttest, the study was performed on married women aged 10-49 living in Kurdkolay village of Juybar county (n = 372). Participants were randomly categorized into two groups of training (n = 95) and face-to-face cascade method (n = 95). Data were collected using the Disaster Preparedness Assessment Index, comprising demographic and education sections. Data were collected using the disaster preparedness assessment index and analyzed using SPSS version 24. RESULTS: The findings indicated improved preparedness in all five dimensions in both groups. There was a significant difference between the study groups immediately and one week after the intervention (P < 0.05); i.e. a higher impact for the face-to-face cascade method. Meanwhile, both groups presented a similar level of preparedness 90 days after receiving the intervention (P > 0.05). CONCLUSIONS: The face-to-face cascade method was more effective in the short term, while no difference was found in the long term. Crisis managers and policymakers should choose their preferred method based on available facilities, human resources, and context to increase preparedness against earthquakes. Mothers play a vital role in educating and nurturing their children. It is suggested to conduct educational programs at the community level using the most appropriate methods that are chosen based on the best evidence.

Non-financial access to healthcare services in rural areas: A case study of people with disabilities living in Northern Iran.

INTRODUCTION: Access to healthcare for persons with disabilities (PWDs) is an important but often ignored issue for achieving universal health coverage. The current study aimed to investigate PWDs' access to healthcare in the rural areas in north of Iran. METHODS: Following a descriptive-analytical design, 471 persons with disabilities (PWDs) living in the Nor city, Mazandaran province, were selected using quota sampling. Data were collected by a valid and reliable questionnaire that contained dimensions of time, geography, physical, and acceptability using face-to-face interviews. The findings are provided by central and dispersion indicators and analyses are performed with linear Regression using SPSS version 17. RESULTS: PWDs had moderate access to healthcare services in all dimensions. The regression models for access to health services in all four dimensions were significant (p<0.05). The results showed that in the geographical dimension, the variables of marital status, income, receipt of financial aid, supplementary insurance, and type of disability; in the physical dimension, the variables of income, responsibility for taking care of the family, supplementary insurance, and type of disability; in the time dimension, supplementary insurance, home area, and type of disability; and in the aspect of service acceptability, only the variables of type of disability and internet access had a significant effect (p<0.05). CONCLUSION: A small percentage of PWDs had high access to health services. Hence, improving their access to healthcare services, particularly in rural and less developed areas, and developing appropriate policies should be the focus of Iranian policy-makers.

Challenges of Rural Family Physician Policy in Iran.

As per the goals of the family physician program, it is essential to pay attention to the effectiveness and performance of FPP. Although the implementation of the FPP program is an important development in the discussion of rural health insurance and the provision of health services and referral systems in the country, the evidence suggests that by identifying challenges and taking appropriate action, this plan can be improved. This study aimed to investigate the challenges of rural Family Physician Policy (FPP) in northern Iran. This study comprised a mixed method. The former intended to identify the challenges of rural FFP using the narrative review method. To achieve a comprehensive list of challenges, a narrative review and content analysis were performed and semi-structured interviews were held with key stakeholders of FPP in the north of Iran, including physicians, managers, and policymakers. Identified challenges were categorized into eight categories including the weakness of the health insurance system, low comprehensiveness of executive guidelines, inappropriate recruitment and maintenance of human resources, weakness of cultural context, low efficacy of health information management system, poor educational effectiveness, inappropriate motivational mechanisms, and weakness of the referral system. As per the quantitative findings, "weakness of the referral system" and "inappropriate recruitment and maintenance of human resources" had the lowest and highest weaknesses, respectively. To address existing challenges in the rural FPP, a comprehensive plan of action should be developed with an emphasis on human resource management, health information management system, comprehensive rural health insurance, and legislation.

Community health workers (Behvarz) in primary health care: a qualitative inductive content analysis of challenges.

BACKGROUND: Behvarzs are the backbone of primary healthcare services in the Iranian health system and play a key role in providing efficient, responsive, and equitable services at the first level of service provision. This study aimed to identify the challenges of Behvarzs to provide a perspective for policymakers and managers to help them formulate future programs to enhance the efficiency of the health system. METHODS: Following a qualitative design, an inductive content analysis approach was used to analyse the data. The healthcare network of the Alborz province (Iran) was considered as the study context. A total of 27 interviews were conducted with policymakers, development managers, managers of Behavrz training centres, and Behvarz workers in 2020. All interviews were audio-taped and transcribed, followed by data analysis using MAXQDA ver. 10. RESULTS: Five themes were identified: service provision (scope of services, ambiguity of roles, non-compliance with the referral system, the quality of data entry, quality of services), access to equipment (quantity, quality), administrative issues (macro planning, micro planning), training (appropriateness of information, quality of training, recruiting related staff), perceived equity and fairness (balance between workload, income, and benefits, job satisfaction, job promotion). CONCLUSION: Occupational challenges affect the performance of Behvarzs in responding to society's needs because they not only play a major role in the health system, but also contribute to addressing the communication gap between local communities and high-level institutions, leading to the alignment of policy implementation. Therefore, strategies that emphasise the role of Behvarzs should be followed to promote community engagement.

Stakeholders analysis of COVID-19 management and control: a case of Iran.

BACKGROUND: The COVID-19 pandemic is a multi-faceted phenomenon with many political, economic and social consequences. Success in managing and controlling this pandemic depends on the coordinated efforts of many organizations and institutions. Therefore, this study aimed to identify and analyze the actors and stakeholders related to managing and controlling this pandemic in Iran. METHODS: This mix-method stakeholder analysis was conducted in 2021 nationwide as retrospectively. The purposive sampling method was applied when inviting eligible participants to participate in the study. Our study was conducted in two phases. In the qualitative phase, data were collected using a semi-structured interview. An interview guide was developed based on the WHO stakeholder analysis framework. In the quantitative phase, we used a questionnaire developed based on the study framework. Each question was scored on a 5-point Likert scale, with a score greater than 4 was considered as high, 3-4 was considered as moderate, and 1-3 was considered as low. Data were analyzed using framework analysis, WHO stakeholders' analysis framework and MENDELOW matrix. MAXQDA qualitative data analysis software Version 11 and Policy Maker software (Version. 4) were used for data analysis. RESULTS: A total of 48 stakeholders were identified. Ministry of Health (MoH), National Headquarters for Coronavirus Control (NHCC) had the highest participation level, high supportive position, and knowledge of the subject. The Parliament of Iran (PoI), Islamic Revolutionary Guard Corps (IRGC), and Islamic Republic of Iran Broadcasting (IRIB) had the highest power/influence during the Covid-19 epidemic. Only two stakeholders (6.06%) had high participation, and 18.18% had moderate participation. All stakeholders except for the NHCC and the MoH lacked appropriate knowledge of the subject. Furthermore, only three stakeholders (9.09%) had high power/influence. CONCLUSION: Given the multidimensional nature of Covid-19, most institutions and organizations were involved in managing this pandemic. Stakeholders with high power/authority and resources had a low/moderate participation level and a moderate supportive position. Moreover, organizations with a high supportive position and participation had low power/authority and resources to cope with COVID-19.

The Value Framework Governing Iran's Health System Policy: A Practical Gap.

Background: The value framework governing the health system can guide the policymaking. This study presents a set of values governing the health policies for adopting policies that are in harmony with the ideology of Iran. Methods: This study was conducted in two phases. In the first phase, using the qualitative approach, Shams et al. framework was adopted to identify values. Identification of health-related national documents (nine documents) was performed purposefully. In the next phase, semi-structured interviews on individual experts in the health system were carried out. The key question was "What values and principles govern the health policy system?" Participants included 15 individuals. Both phases were analyzed based on qualitative content analysis. Results: In this study, a taxonomy of values governing policymaking is presented. Results show that equity in different dimensions, comprehensive health and a healthy human being, pioneering in health in the region, and accountability are the most important terminal vaqlues. Individual responsibility, government responsibility for health, endogenous and extrinsic economics, fair access, transparency, efficiency, quality and integrity in the supply, development and fair allocation of public health resources, and professional commitment are the most important instrumental values in Iran. Participants believed that, despite the many higher-order documents available, the health system policymaking was not based on a predetermined value. Conclusions: It is not enough to provide a set of values in upstream documents for implementation. It is necessary to specify the relative weight of the reference values in policymaking and their relation to each other in order to apply them in policymaking.

Efficacy of active and passive evidence-based practice training for postgraduate medical residents: a non-randomized controlled trial.

OBJECTIVE: This study examined the effects of two evidence-based practice (EBP) educational programs for postgraduate medical residents on their attitude, behavior, knowledge, outcome, and competencies in EBP. RESULTS: Forty-five and thirty-five medical residents were recruited in the active and passive educational intervention groups, respectively. Among those, 39 and 30 participants were included in the final analysis. The participants of the active group received 12 h of EBP-structured presentation. The passive educational group received EBP education through their daily rounds, evidence-based journal clubs, and morning reports. Participants were evaluated with EBP-KABQ and ACE tools questionnaires. The active and passive intervention groups were not significantly different from each other at the baseline in the EBP-KABQ questionnaire and ACE tools score (p > 0.05). However, most questions in the EBP-KABQ questionnaire were significantly different from the pre-intervention measurement and the passive intervention group after the educational intervention. Educational intervention in both groups led to a significant difference in ACE tools score between groups (8.86 ± 2.62 vs. 7.31 ± 2.92, p = 0.029, in the active and passive groups, respectively). Paired t-test analysis revealed that our intervention led to a significant increase in ACE tool scores in both groups (p < 0.000, in both groups).

Model for Value-based Policy-making in Health Systems.

BACKGROUND: Values are at the heart of discussions related to policy-making and any kind of reforms in health systems. Despite wide recognition of its importance, the concept of value is still vague and the policy-making processes remain astray with respect to values. This study aims to provide a model of value-based policy-making and to explain the concept value and how it affects policy-making. METHODS: The main question of the current study is to explain the concept of value-based policy-making and developing a model, based on the explained concept. In this line, critical review method and Carnwell and Daly approach and using particular keywords related to stewardship, and searching databases were used. In the initial search, 739 studies were obtained, of which using targeted sampling method, 11 studies were finally selected. Then, in order to design and explain different aspects of the value concept in the health system and to develop a model, selected studies were criticized, and finally, the conceptual model of value is designed and explained. RESULTS: The concept of value and its effects, dimensions and its relation to principles, evidence and criteria were determined at different stages of the policy-making process. It was also revealed that value-based policy-making in a health system is contingent upon the realization of terminal values. CONCLUSIONS: In the process of selecting the best policy option, it is necessary to identify the relationship between terminal, instrumental, criterion, and evidence to avoid deviating from the reference value framework in any country and to avoid blindly imitating other experiences in other countries.

Factors Affecting the Failure to Report Medical Errors by Nurses Using the Analytical Hierarchy Process (AHP).

This cross-sectional study aimed to determine factors affecting the failure to report medical errors in teaching hospitals affiliated to Iran. The required data were collected during stages of systematic review and develop of researcher-made questionnaire. A total of 131 nurses were selected using Cochran's sample size formula. The collected data were analyzed by Analytic Hierarchy Process (AHP) using Expert Choice software. Results showed that the most important factors affecting the failure to report medical errors by nurses were, respectively, management-related factors (W = 0.595), nurse-related factors (W = 0.276), and factors related to the error reporting process (W = 0.128).

Stewardship in Health, Designing a Multi-Layer Meta Model: A Review Article.

BACKGROUND: In the current study, we aimed to explain the concept of stewardship by employing a critical review perspective and, finally, to develop a model. METHODS: Critical review method and Carnwell and Daly approach and using particular keywords related to stewardship, and searching databases were used. In the initial search, until 2018, 1050 studies were obtained, which using targeted sampling method, 32 studies were finally selected. Then, selected studies were criticized and finally, and the conceptual model of stewardship was designed and explained. RESULTS: After reviewing and criticizing; the concept and aspects of the model were categorized in the sub-tasks of knowledge-generation, strategic framework, evidence-based policy-making, system design, resource allocation, capacity building, enforcement/alignment, that through operation leads to achieving goals. Final model was categorized into three effective levels. CONCLUSION: Some studies mentioned the governance and stewardship as same concepts, while our results showed that policy-making, governance and leadership, and many other concepts, can be categorized as a part of stewardship.

Measuring Efficiency of Knowledge Production in Health Research Centers Using Data Envelopment Analysis (DEA): A Case Study in Iran.

INTRODUCTION: Efficiency analysis is necessary in order to avoid waste of materials, energy, effort, money, and time during scientific research. Therefore, analyzing efficiency of knowledge production in health areas is necessary, especially for developing and in-transition countries. As the first step in this field, the aim of this study was the analysis of selected health research center efficiency using data envelopment analysis (DEA). METHODS: This retrospective and applied study was conducted in 2015 using input and output data of 16 health research centers affiliated with a health sciences university in Iran during 2010-2014. The technical efficiency of health research centers was evaluated based on three basic data envelopment analysis (DEA) models: input-oriented, output-oriented, and hyperbolic-oriented. The input and output data of each health research center for years 2010-2014 were collected from the Iran Ministry of Health and Medical Education (MOHE) profile and analyzed by R software. RESULTS: The mean efficiency score in input-oriented, output-oriented, and hyperbolic-oriented models was 0.781, 0.671, and 0.798, respectively. Based on results of the study, half of the health research centers are operating below full efficiency, and about one-third of them are operating under the average efficiency level. There is also a large gap between health research center efficiency relative to each other. CONCLUSION: It is necessary for health research centers to improve their efficiency in knowledge production through better management of available resources. The higher level of efficiency in a significant number of health research centers is achievable through more efficient management of human resources and capital. Further research is needed to measure and follow the efficiency of knowledge production by health research centers around the world and over a period of time.

Model for implementing evidence based health care system in iran.

BACKGROUND: Regarding the role and importance of paradigm of evidence based practice and its remarkable impact on the effectiveness and efficiency of clinical services and healthcare, development of an integrated system seems necessary in order to manage dispersed data and ensure using evidence in clinical decision making, thus the aim of this study was designing a model for implementing national system of evidence based health care in Iran. METHODOS: THIS PAPER IS A STUDY OF COMPARATIVE TYPE WHICH HAS BEEN WRITTEN IN THREE STAGES: investigation of structure and process of evidence based practice in selected countries, investigation and analysis of current status in Iran in this regard and recommendation of strategies which make model implementation feasible in the country. Such methods as review of literature, focus group discussion and Delphi technique were used for investigation. RESULTS: According to studies, insuring an evidence based practice culture in the country requires a system called National Evidence Based Health Care System which consists of three subsystems including national system of clinical knowledge management, national evidence-based practice system and integrated national network of clinical effectiveness. CONCLUSION: The ultimate goal of health care system in every country is maintaining and improving community health. Achievement of this goal depends on effectiveness of delivered services and consistency of the services with national and local priorities. In order to achieve clinical effectiveness, the best practice should be realized in the country, implementation of which requires a set of macro and micro strategies enabling facilitation, promotion or guaranteeing clinical knowledge application in the country.