Institutional Accreditation in Medical Education: The Experience of The Survey Visit Teams.

OBJECTIVES: This study discussed about challenges and opportunities of institutional accreditation in Iranian medical universities. The lesson learned of the first round of the accreditation would direct initiatives and solutions for future accreditation. METHODOLOGY: This research is a qualitative content analysis research that studied the experience of the survey visit teams. Semistructured interviews with a purposive sampling approach were done to reach data saturation. Constant comparative method was used to analyze the data. RESULTS: The emergent themes were incompatible scheduling with accreditation workload, accreditation sustainability, the weakness of the survey instrument, advantage of the survey instrument, the quality of evaluators' survey, the opportunity of progress for universities, accreditation perspective, defendable cost opportunity, perceived injustice, and the leading strategies. In this study, the relationship between categories and themes was shown with a systematic approach. CONCLUSION: In medical education systems, it is necessary to continue the research and development studies using the findings in each accreditation period to achieve the prospect of international accreditation.

Comparison of physical growth of teenage girls with low birth weight and normal weight of Isfahan in 2016 - 2017.

INTRODUCTION: One of the probable risks of low birth weight (LBW) is low body growth at teenage, and most of the parents are concerned about it. This study was conducted to compare the body growth of girls at teenage in two groups. METHODOLOGY: In this descriptive-comparative research, the body growth of 350 girls (250 students having normal birth weight (NBW) and 125 students having LBW) at the ninth grade in Isfahan, Iran, was studied. These students were chosen randomly out of 13 select schools from six districts of education in Isfahan, Iran. The data were analyzed by Independent t-test, Chi-square test, and Mann-Whitney U-test. RESULTS: This study showed that there is a meaningful difference in weight, height, BMI, and the age of menarche. The highest weight, height, and BMI frequency (52.8 kg, 162.8 cm, and 3.31, respectively) belongs to girls having NBW compared with girls having LBW (50.6 kg, 159.3 cm and 3.36, respectively) and Independent t-test showed that weight and height average and body mass index (BMI) of girls having NBW are higher meaningfully (P < 0.001). In addition, the girls having NBW had reached the age of menarche at 12.36 ± 1.12 and 12.09 ± 1.01 at girls having LBW. Furthermore, there was a meaningful difference (P < 0.001) between the ages of menarche. CONCLUSION: Regarding the existence, it is recommended that the children having LBW should be kept under special care. Of course, the resulted difference is not very important and concerning for the parents, but further study is needed to reach the final conclusion.

Survey of lifestyle and its relationship with health value of mid-aged women referring to comprehensive health centers of Isfahan in 2016.

INTRODUCTION: Health needs a lifestyle upgrade. Lifestyle is important because it affects the quality of life and the diseases' prevention. This study aimed to investigate the lifestyle and its relationship with health-care value of mid-aged women. METHODS: This descriptive-analytic study was conducted on 287 middle-aged women in Isfahan in 2016. Samples were randomly selected among the centers as well as from those referring to comprehensive urban health centers. Walker's Health-Promoting Lifestyle Profile II and a researcher-made health-care value questionnaire were provided to mid-aged women. Data were analyzed using descriptive statistics, Pearson's correlation coefficient tests, and multiple linear regression (MLR) analysis. RESULTS: The average health value score in women was 59.6 and the total lifestyle score was 57.9 out of 100, which is in the semi-desirable range. The highest score among the lifestyle domains was related to the interpersonal relationship (67.6) and the lowest score was related to physical activity (39.4). Pearson's correlation coefficient showed that there is a direct relation between the health value score and the total score of lifestyle and all its domains (P < 0.001). MLR model showed that the areas of responsibility (P < 0.001), interpersonal relationships (P < 0.001), and physical activity (P = 0.01) have the highest predictive value for the health value score among the different domains of lifestyle score. CONCLUSION: Lifestyle and health value of mid-aged women in Isfahan are in the semi-desirable range and lifestyle has a direct relationship with health value. Therefore, lifestyle enhancement can enhance the health value and take steps to improve health in the community.

The Effects of Mental Health Training Program on Stress, Anxiety, and Depression during Pregnancy.

BACKGROUND: The process of becoming a mother is considered as an enjoyable and evolutionary event of women's life. However, due to physical and mental changes, it can be associated with some degree of stress and anxiety that may lead to mental health problems. This study aimed to compare the effects of mental health training during pregnancy on stress, anxiety, and depression between two groups of couples and pregnant women. MATERIALS AND METHODS: This randomized clinical trial was conducted on 120 pregnant women referring to health centers in Isfahan, Iran, from September to February 2016. The participants were randomly divided into three groups: couples (with the partner present), pregnant women (without the partner present), and control group (routine care). After completing the pretest, the intervention groups received four sessions of pregnancy mental health training. Data were collected using the Depression, Anxiety, and Stress Scales (DASS-42) and a demographic characteristics form. The collected data were analyzed using Statistical Package for the Social Sciences software. RESULTS: Before the intervention, no statistical difference was observed among the three groups in the mean scores of stress, anxiety, and depression. The mean score of depression, anxiety, and stress decreased significantly in the intervention groups 2 weeks after the intervention respectively (F=5.84, p=0.004), (F=14.76, p < 0.001) and (F=11.98, p < 0.001). No significant difference was observed between the couples and pregnant women groups in terms of depression (p = 0.140). CONCLUSIONS: The results of this study showed that mental health training for pregnant women, especially with the presence of the partner, is a useful intervention in preventing stress, anxiety, and depression.

Comparison of the Relationship between Women' Empowerment and Fertility between Single-child and Multi-child Families.

BACKGROUND: The reduction in fertility and increase in the number of single-child families in Iran will result in an increased risk of population aging. One of the factors affecting fertility is women's empowerment. This study aimed to evaluate the relationship between women's empowerment and fertility in single-child and multi-child families. MATERIALS AND METHODS: This case-control study was conducted among 350 women (120 who had only 1 child as case group and 230 who had 2 or more children as control group) of 15-49 years of age in Isfahan, Iran, in 2016. For data collection, a 2-part questionnaire was designed. Data were analyzed using independent t-test, Chi-square test, and logistic regression analysis. RESULTS: The difference between average scores of women's empowerment in the case group 54.08 (9.88) and control group 51.47 (8.57) was significant (p = 0.002). Simple logistic regression analysis showed that under diploma education, compared to postgraduate education, (OR = 0.21, p = 0.001) and being a housewife, compared to being employed, (OR = 0.45, p = 0.004) decreased the odds of having only 1 child. Multiple logistic regression results showed that the relationship between women's empowerment and fertility was not significant (p = 0.265). CONCLUSIONS: Although women in single-child families were more empowered, this was not the main reason for their preference to have only 1 child. In fact, educated and employed women postpone marriage and childbearing and limit fertility to only 1 child despite their desire.

Comparative Investigation of Indicators of Growth and Behavioral Disorders in Children with Normal, Low, and Very Low Birth Weight at Pre-school Age in Isfahan during 2015.

INTRODUCTION: Birth weight is one of the most important indicators of infant's health and could predict their health condition in future. This study was conducted to determine and compare indicators of growth [weight, height, and body mass index (BMI)] and behavioral disorders in children with normal, low, and very low birth weight at pre-school age. MATERIALS AND METHODS: In this descriptive analytical study, 236 children (126 with normal weight, 100 with low birth weight, and 10 with very low birth weight) at pre-school age were investigated in three groups. Data collection tools were a two-part questionnaire including the Rutter Children Behavior Questionnaire for parents, and parents' and children's demographic characteristics questionnaire, scale, and stadiometer. Data were analyzed using descriptive statistics, variance analysis, Chi square, and Kruskal-Wallis tests. RESULTS: The mean of weight, height, and BMI at pre-school age in three groups had a significant difference (P = 0.009) and it was lower in the group with very low birth weight than the other two groups; however, the difference between the group with normal birth weight and the group with low birth weight was not significant (P = 0.10). The mean score of behavioral disorder had no significant difference between groups (P = 0.49). CONCLUSIONS: Results showed that children with very low birth weight grew less than the other two groups. Therefore, this group needs special attention and long-term follow-up for taking care of them to ensure better growth. It is recommended to conduct more extended studies to evaluate behavioral disorders in these children.

The Relationship between the Amount of Saturated Fat Intake and Semen Quality in Men.

INTRODUCTION: Infertility in men is one of the current problems of human society. Some studies suggest that the metabolic status of a man, including cholesterol intake, closely correlates with sperm function. The aim of this study was to evaluate the correlation between saturated fat intake and semen quality among men referring to the Isfahan Fertility and Infertility Center, Iran. MATERIALS AND METHODS: This cross-sectional study was conducted on all men who referred to the Isfahan Fertility and Infertility Center. The study population consisted of 120 men selected through simple random sampling. The data collection tool consisted of a two-part questionnaire including a demographic and anthropometric characteristics form and the Food Frequency Questionnaire (FFQ). The FFQ consists of 168 items that assess food and nutrient intake for 3 months. The reliability and validity of the instruments were confirmed in previous studies. Semen analysis was performed using computer-aided semen analysis (CASA) method. Descriptive statistics and logistic regression test were used to analyze the data. RESULTS: Results showed that the chances of having semen volume of higher than 1.5 ml (normal volume) increased by 27.5% for every 1 g increase in total fat (CI: 1.11-1.46) (P = 0.001) and reduced 38% for every 1 g increase in saturated fat (CI: 0.42-0.90, P = 0.010). No association was found between semen quality and intake of dietary fats. CONCLUSIONS: Based on the findings of this study and the prevalence of infertility in recent decades, changes in diet and saturated fatty acids intake may improve semen quality.

Effect of educational intervention program for parents on adolescents'nutritional behaviors in Isfahan in 2016.

BACKGROUND: Family participation is an important element on nutritional education especially for students. Parents have a key role in instilling and understanding healthy eating habits, but yet the use of family participation strategies in the nutrition education was low. The aim of this study is determining the effect of parental educational intervention program for parents on adolescents' nutritional behaviors in Isfahan, Iran in 2016. MATERIALS AND METHODS: This study was a kind of field trial that conducted on 63 girl teenagers from junior high schools of Isfahan in 2016 that were randomly divided into two groups of intervention and control. The data collection tool which was a researcher made questionnaire was completed in both groups before and 1 month after the intervention. The intervention included three training sessions for parents and giving educational compact disc and forwarding SMS. To analysis of data independent t-test and paired t-test were used. RESULTS: Paired t-test showed that in intervention group the average score of fruit (P = 0.03) and in control group the average score of vegetables (P < 0.05) were significant statistical difference, but in other aspects of nutritional behaviors was not a significant difference. Independent t-test showed that after intervention, mean scores nutritional behavior of adolescent girls in both groups had no significant differences. CONCLUSIONS: No significant difference was in the nutritional behaviors before and after the intervention. Hence, just educating the parents is not enough for achieving appropriate nutritional behaviors in the adolescents.

An investigation on the quality of midwifery services from the viewpoint of the clients in Isfahan through SERVQUAL model.

BACKGROUND: Quality of care is of great importance in health services as these services have the important mission to preserve health, and to give care to the society. The present study aimed to investigate the quality of midwifery services from the viewpoint of the clients, under coverage of health care centers in Isfahan, through SERVQUAL model. MATERIALS AND METHODS: This descriptive and analytical study was conducted on 218 subjects in 2014. Study population comprised the women referring to midwifery services clinics in health care centers in Isfahan. Data of the subjects (n = 218) were collected by SERVQUAL model containing the dimensions of tangibles, reliability, responsiveness, assurance, and empathy. Data were analyzed by paired t-test, Spearman and Pearson correlation coefficients, and independent t-test through SPSS 20. RESULTS: There was a negative gap in all five relevant dimensions of giving services. The widest gap was in the mean of dimension of tangibles (-1.5), and the narrowest gap was in the dimension of assurance (-0.9). There was no significant association between the scores of expectations and perceptions, and age, education level, occupation, and marital status. CONCLUSIONS: The obtained negative gap showed that the level of service receivers' perception from existing condition was far from their expectation, and there was a wide gap between attaining their satisfaction with midwifery services and their expectation and reaching their appropriate level of services.

Evaluating performance of the operational managers of obstetrics and gynecology service providing wards.

BACKGROUND: The goal of hospitals, as the most important health care providing centers, is to improve the health level of the society. Achieving this goal is directly related with performance of the managers. This study was conducted to evaluate the performance of operational managers of obstetrics and gynecology service providing wards from the point of view of the staff at educational hospitals of Isfahan University of Medical Sciences in 2015. MATERIALS AND METHODS: In this descriptive study, target population comprised all supervisors and the staff working at obstetrics and gynecology and maternity wards. Data were collected through a researcher-made questionnaire after evaluation of its reliability and validity using questions on managerial performance (planning, organizing, leadership, and control dimensions) and demographic characteristics of the managers and staff. Data were analyzed using independent t-test, one sample t-test, Spearman and Pearson coefficient tests, and one-way analysis of variance. RESULTS: The total mean score of staff's point of view toward performance of managers' performance was significantly higher than the average level (P < 0.001, t = 13.2). In addition, mean scores of managerial performance in planning (P < 0.001, t = 14.93), organizing (P < 0.001, t = 11.64), leadership (P < 0.001, t = 11.16), and control (P < 0.001, t = 13.75) dimensions were significantly higher than the moderate level. CONCLUSIONS: With respect to the fact that maintaining and improving the health of mothers and neonates depends on the management and managers' performance in obstetrics and gynecology service providing wards, more than moderate managers' performance need to be improved. It is recommended that higher-level managers pay special attention to the empowerment of managerial skills among operational managers.

Identification and assessment of common errors in the admission process of patients in Isfahan Fertility and Infertility Center based on "failure modes and effects analysis".

BACKGROUND: Infertility and errors in the process of its treatment have a negative impact on infertile couples. The present study was aimed to identify and assess the common errors in the reception process by applying the approach of "failure modes and effects analysis" (FMEA). MATERIALS AND METHODS: In this descriptive cross-sectional study, the admission process of fertility and infertility center of Isfahan was selected for evaluation of its errors based on the team members' decision. At first, the admission process was charted through observations and interviewing employees, holding multiple panels, and using FMEA worksheet, which has been used in many researches all over the world and also in Iran. Its validity was evaluated through content and face validity, and its reliability was evaluated through reviewing and confirmation of the obtained information by the FMEA team, and eventually possible errors, causes, and three indicators of severity of effect, probability of occurrence, and probability of detection were determined and corrective actions were proposed. Data analysis was determined by the number of risk priority (RPN) which is calculated by multiplying the severity of effect, probability of occurrence, and probability of detection. RESULTS: Twenty-five errors with RPN ≥ 125 was detected through the admission process, in which six cases of error had high priority in terms of severity and occurrence probability and were identified as high-risk errors. CONCLUSIONS: The team-oriented method of FMEA could be useful for assessment of errors and also to reduce the occurrence probability of errors.

Health providers' compliance with pregnant women's Bill of Rights in labor and delivery in Iran.

BACKGROUND: Delivery is one of the most important crises with mental, social, and deep emotional dimensions in women's life. Health providers' respect to pregnant women's Bill of Rights, as an important component of providing humanistic and ethical care, is of utmost importance. This study aimed to determine health providers' compliance with the pregnant women's Bill of Rights in labor and delivery and some of its related factors in 2013. MATERIALS AND METHODS: This descriptive, cross-sectional study was carried out on the subjects selected through census sampling (N = 257) from among the healthcare providers working in the labor rooms of four educational hospitals. The data were collected by a self-reported questionnaire whose validity and reliability were established. Data were analyzed through descriptive and inferential statistics. RESULTS: The compliance with pregnant women's Bill of Rights was found to be at a very high level in 22.8% of the midwifery students, 28.6% of the residents of obstetrics and gynecology, 21.9% of the interns, 50% of the obstetrics and gynecology faculty members (professors), and 31.9% of the midwives. There was a significant difference between the five groups of service providers in terms of overall compliance with mothers' rights (P = 0.002). The results showed that the residents in higher years of education (P = 0.001), midwifery students in higher semesters (P = 0.001), midwives with more work experience (P < 0.001), and personal experience of being hospitalized in labor room (P < 0.001) had a higher compliance with Bill of Rights. Meanwhile, there was no significant difference in compliance with Bill of Rights between labor and age (P = 0.82). CONCLUSIONS: The results showed that the health providers' compliance with the pregnant women's Bill of Rights was not acceptable in the labor room. Therefore, necessary actions are needed to remove the barriers against pregnant women's compliance of Bill of Rights and to facilitate the compliance with it in hospitals.

The effect of four-phase teaching method on midwifery students' emotional intelligence in managing the childbirth.

BACKGROUND: An active teaching method has been used widely in medical education. The aim of this study was to determine the effectiveness of the four-phase teaching method on midwifery students' emotional intelligence (EQ) in managing the childbirth. MATERIALS AND METHODS: This was an experimental study that performed in 2013 in Isfahan University of Medical Sciences. Thirty midwifery students were involved in this study and selected through a random sampling method. The EQ questionnaire (43Q) was completed by both the groups, before and after the education. The collected data were analyzed using SPSS 14, the independent t-test, and the paired t-test. The statistically significant level was considered to be <0.05. RESULTS: The findings of the independent t-test did not show any significant difference between EQ scores of the experimental and the control group before the intervention, whereas a statistically significant difference was observed after the intervention between the scores of two groups (P = 0.009). The paired t-test showed a statistically significant difference in EQ scores in the two groups after the intervention in the four-phase and the control group, respectively, as P = 0.005 and P = 0.018. Furthermore, the rate of self-efficiency has increased in the experimental group and control group as 66% and 13% (P = 0.024), respectively. CONCLUSION: The four-phase teaching method can increase the EQ levels of midwifery students. Therefore, the conduction of this educational model is recommended as an effective learning method.

Effect of acupressure on milk volume of breastfeeding mothers referring to selected health care centers in Tehran.

BACKGROUND: Breast milk is the main food source for infants' growth and development. Insufficient milk is one of the obstacles to the adequate use of this substance. One of the treatments to help this issue is acupressure. Therefore, the present study was designed to determine the effect of acupressure on maternal milk volume. MATERIALS AND METHODS: This study is a randomized clinical trial in which 60 breastfeeding mothers complaining of hypogalactia and meeting the inclusion criteria were studied. In addition to providing routine education, bilateral acupressure was performed for 12 consequentia l days on the acupoints of SI1, LI4, and GB21 in the intervention group, as three sessions per week with each session conducted 2-5 times. The control group received only routine education. In both groups, breast milk volume before intervention and 2 and 4 weeks after intervention was evaluated by an electric pump. Data were analyzed by descriptive and inferential statistical analysis through SPSS. RESULTS: The t-test showed no significant difference in the mean volume of milk in the two groups (P = 0.543). Mean volumes of milk before and 2 and 4 weeks after the intervention were 10.5 (8.3), 33 (13.44), and 36.2 (12.8), respectively, in the acupressure group and 9.5 (7.7), 17.7 (9.4), 18 (9.5), respectively, in the control group. Analysis of variance (ANOVA) test showed a significant difference in the mean volume of milk at 2 and 4 weeks after the intervention (P < 0.001). CONCLUSIONS: Both acupressure and general education methods were effective on the milk volume of breastfeeding mothers. Acupressure method was more effective than the other method. Therefore, application of acupressure as a method of alternative medicine to increase breastfeeding is suggested.

Association between women's autonomy and family planning outcome in couples residing in Isfahan.

BACKGROUND: One of the important factors in the prediction of family planning outcome is paying attention to women's role in decision making concerning fertility and household affairs. With the improvement of women's status and autonomy, their control over fertility is expected to increase. The present study aimed to investigate the association between women's autonomy and family planning outcome of the couples residing in Isfahan. MATERIALS AND METHODS: This is cross-sectional study. Two hundred and seventy women of childbearing age, eligible for family planning and residing in Isfahan, were selected through random cluster sampling and they filled a researcher-made questionnaire. Women's autonomy was measured with the questions on their decision-making autonomy concerning household affairs and physical mobility autonomy. The association between women's autonomy and family planning outcome was analyzed through statistical methods. RESULTS: The results showed that the mean of women's decision-making, physical mobility, and general autonomy was 50. Women's autonomy had a direct significant association with the type of contraception method (P = 0.01) and the length of usage of their present contraception method (P = 0.04) as well as where they received family planning services (P = 0.02). CONCLUSIONS: Analysis of data revealed women with higher autonomy used a more efficient contraception method and continued their contraception method for a longer time, which leads to improvement of couples' family planning outcome. Therefore, family planning services should be planned and provided with women's autonomy under consideration.

Evaluation of growth and development pattern in normal, low and very low birth weight neonates at 18 months of age.

INTRODUCTION: Growth and development monitoring could lead to general judgment about children's health. With advances in NICUs establishment, the survival rate of very low birth weight (VLBW) neonates has increased in many countries including Iran. Because of the lack of studies about growth and development pattern of low birth weight (LBW) and VLBW neonates in Iran, the present study aimed to compare growth and development of normal, low and very low birth weight neonates at 18 months of age. MATERIALS AND METHODS: In a cross- sectional descriptive study, 214 children with age 18 months were enrolled (90 LBW, 90 LBW and 34 VLBW) and their growth and development were assessed. Data gathering tool was a researcher made questionnaire including anthropometrics measures and developmental key points. Data analyzed by descriptive (mean and SD) and inferential (ANOVA) tests using SPSS version 15. RESULTS: There were significant differences in the mean of anthropometric indexes between three groups. Majority of subjects in three groups had normal weight growth trend. Mean scores of gross motor and fine motor development indexes had significant association with birth weight. Meanwhile, there was no significant association between mean scores of social/cognitive and also language developmental aspects and birth weight. CONCLUSION: Findings revealed that in LBW and VLBW children, growth indexes at the age of 18 months are so far from those of NBW neonates. Further nationwide prospective studies, with a longer period of time is needed to estimate when Iranian LBW children reach at the levels of NBW ones.

A comparative study of the attitudes of managers, employees and clients in the field of social barriers of family planning counseling in health care centers of Isfahan in 2012.

BACKGROUND: Appropriate family planning counseling for informed choice, the right and responsible use of contraceptive methods is very important. Various barriers such as social barriers can have the effect on family planning counseling. In addition, investigation of those barriers from the perspective of managers, staff and clients, who are major members in health care system, has great importance. The present study was conducted with the goal of comparing managers', employees', and clients' viewpoints about social barriers in family planning counseling in health care centers in Isfahan in 2012. MATERIALS AND METHODS: This is a cross-sectional one-step three-group comparative descriptive study conducted on 295 subjects including 59 managers, 110 employees, and 126 clients in medical health care centers in Isfahan in 2012. Managers and employees were selected by census sampling and the clients were recruited through convenient random sampling. The data collection tool was a researcher made questionnaire, which was designed in two sections of fertility and personal characteristics and viewpoint measurement. Descriptive and inferential statistical test were used to analyze the data. RESULTS: The obtained results showed significant difference between mean scores of viewpoints in three groups of managers, employees, and clients concerning social barriers in family planning counseling (P = 0.001). In addition, most of the managers and employees reported social barriers as the barriers in process of family planning in a large level and clients reported it in moderate level. CONCLUSION: The results express the necessity of health services managers' planning to modify or delete social barriers, especially the agreed barriers from the viewpoint of managers and employees that effect on family planning counseling and quality of service provided by them.

Comparison of the perspectives of managers, employees and clients regarding the individual barriers of family planning counseling in healthcare centers of isfahan in 2012.

BACKGROUND: Family planning is a lifestyle that is selected voluntarily and is based on the knowledge, attitude and responsible decision making by couples in order to promote the health and welfare of the family and the advancement of the society. In this regard, family planning counseling plays an important role in making informed decisions if used properly and in a responsible way. Detection of individual barriers in family planning counseling based on the viewpoints of managers, employees and clients who are key participants in the healthcare service provision is a major step towards appropriate planning to modify or eliminate such barriers. OBJECTIVES: The present study was conducted with the goal of comparing managers', employees' and clients' viewpoints about individual barriers in family planning counseling in health care centers in Isfahan in 2012. PATIENTS AND METHODS: This was a cross-sectional one-step three-group comparative descriptive study conducted on 295 subjects including 59 managers, 110 employees and 126 clients in medical health care centers in Isfahan in 2012. The managers and employees were selected by census sampling, and the clients were recruited through convenient random sampling. The data collection tool was a researcher-designed questionnaire, which was designed in two sections of fertility and personal characteristics, and viewpoint measurement. Descriptive and inferential statistical tests were used to analyze the data. RESULTS: The obtained results showed significant differences between mean scores of viewpoints in three groups of managers, employees and clients concerning individual barriers in family planning counseling. In addition, most of the managers, employees and clients reported individual barriers as an intermediate level barrier in the process of family planning counseling. CONCLUSIONS: Results indicate that subjects in three studied groups hold different views regarding the individual barriers in family planning counseling. This difference in the perspectives may be a factor that affects the quality of the provided services. Therefore, it is necessary for the healthcare providers to consider the main concerns of their clients regarding family planning.

A comparative study on managers', staffs' and clients' viewpoints about organizational and structural obstacles in family planning counseling in health-care centers in Isfahan in 2012.

BACKGROUND: Organizational and structural obstacles are a group of major obstacles in achievement of appropriate family planning counseling. Detection of these obstacles from the viewpoint of managers, staffs and clients who are key members in health services providing system is a major step toward appropriate planning to modify or delete this group of obstacles. The present study was conducted with the goal of comparing managers', staffs' and clients' viewpoints about organizational and structural obstacles in family planning counseling in health-care centers in Isfahan in 2012. MATERIALS AND METHODS: This is a cross-sectional one-step three-group comparative descriptive study conducted on 295 subjects including 59 managers, 110 staffs and 126 clients in medical health-care centers in Isfahan in 2012. Managers and the staffs were selected by census sampling and the clients were recruited through convenient random sampling. The date collection tool was a researcher made questionnaire, which was designed in two sections of fertility and personal characteristics and viewpoint measurement. Descriptive and inferential statistical test were used to analyze the data. RESULTS: The obtained results showed no significant difference between mean scores of viewpoints in three groups of managers, staffs and clients concerning organizational and structural obstacles in family planning counseling (P = 0.677). In addition, most of the managers, staffs and clients reported organizational and structural obstacles as the obstacles in the process of family planning in moderate level. CONCLUSION: The results showed the necessity of health services managers' planning to modify or delete organizational and structural obstacles especially the agreed obstacles from the viewpoint of managers, staffs and clients.

The evaluation of reproductive health PhD program in Iran: The input indicators analysis.

BACKGROUND: Appropriate quality achievement of a PhD program requires frequent assessment and discovering the shortcomings in the program. Inputs, which are important elements of the curriculum, are frequently missed in evaluations. The purpose of this study was to evaluate the input indicators of reproductive health PhD program in Iran based on the Context, Input, Process, and Product (CIPP) evaluation model. MATERIALS AND METHODS: This is a descriptive and evaluative study based on the CIPP evaluation model. It was conducted in 2013 in four Iranian schools of nursing and midwifery of medical sciences universities. Statistical population consisted of four groups: heads of departments (n = 5), faculty members (n = 18), graduates (n = 12), and PhD students of reproductive health (n = 54). Data collection tools were five separate questionnaires including 37 indicators that were developed by the researcher. Content and face validity were evaluated based on the experts' indications. The Cronbach's alpha coefficient was calculated in order to obtain the reliability of the questionnaires. Collected data were analyzed by SPSS software. Data were analyzed by descriptive statistics (mean, frequency, percentage, and standard deviation), and one-way analysis of variance (ANOVA) and least significant difference (LSD) post hoc tests to compare means between groups. RESULTS: The results of the study indicated that the highest percentage of the heads of departments (80%), graduates (66.7%), and students (68.5%) evaluated the status of input indicators of reproductive health PhD program as relatively appropriate, while most of the faculties (66.7%) evaluated that as appropriate. CONCLUSIONS: It is suggested to explore the reasons for relatively appropriate evaluation of input indicators by further academic researches and improve the reproductive health PhD program accordingly.