Factors Associated With Failure of Health System Reform: A Systematic Review and Meta-synthesis.

OBJECTIVES: The health system reform process is highly political and controversial, and in most cases, it fails to realize its intended goals. This study was conducted to synthesize factors underlying the failure of health system reforms. METHODS: In this systematic review and meta-synthesis, we searched 9 international and regional databases to identify qualitative and mixed-methods studies published up to December 2019. Using thematic synthesis, we analyzed the data. We utilized the Standards for Reporting Qualitative Research checklist for quality assessment. RESULTS: After application of the inclusion and exclusion criteria, 40 of 1837 articles were included in the content analysis. The identified factors were organized into 7 main themes and 32 sub-themes. The main themes included: (1) reforms initiators' attitudes and knowledge; (2) weakness of political support; (3) lack of interest group support; (4) insufficient comprehensiveness of the reform; (5) problems related to the implementation of the reform; (6) harmful consequences of reform implementation; and (7) the political, economic, cultural, and social conditions of the society in which the reform takes place. CONCLUSIONS: Health system reform is a deep and extensive process, and shortcomings and weaknesses in each step have overcome health reform attempts in many countries. Awareness of these failure factors and appropriate responses to these issues can help policymakers properly plan and implement future reform programs and achieve the ultimate goals of reform: to improve the quantity and quality of health services and the health of society.

Risk-Taking Behaviors Considering Internet Gaming Disorder among Iranian University Students: A Latent Class Analysis.

BACKGROUND: Dangerous behaviors adversely affect the health of adolescents and young adults. This study aimed to identify the subgroups of college students based on the parameters of risky behavior and analyze the impact of demographic factors and internet gaming disorder (IGD) belonging to each class. STUDY DESIGN: A cross-sectional study. METHODS: The study was conducted on 1355 students through a multi-stage random sampling method in 2020. A survey questionnaire was used to collect data, and all students completed 1294 sets of questionnaires. The data were analyzed using t test and latent class analysis (LCA) through SPSS and PROC LCA in SAS 9.2 software. RESULTS: Three latent classes have been identified as low-risk (75%), tobacco smoker (8%), and high-risk (17%). There was a high possibility of risky behavior in the third class. Marital status (being single) (OR = 2.28, 95% CI: 1.19-4.37), unemployment (having no job) along with education (OR = 1.56, 95% CI: 1.04-2.33), and IGD (OR = 1.06, 95% CI: 1.04-1.09) increased the risk of inclusion in the tobacco smoker class. Moreover, unemployment (having no job) along with education (OR = 1.43, 95% CI: 1.11-1.84) increased the chance of being in the high-risk class. CONCLUSION: According to the findings of this study, 25% of the students were tobacco smokers or were in the high-risk class. The results of this study may help develop and evaluate preventive strategies that simultaneously take into account different behaviors.

Geographic Distribution of Active Medical Specialists in Iran: A Three-Source Capture-Recapture Analysis.

BACKGROUND: Estimation of health workforce supply becomes problematic when there is no knowledge about the number of active specialists. The aim of this study is to estimate active specialists and their geographic accessibility in Iran. METHODS: We enrolled all medical specialists from the Iranian Ministry of Health database (14151), national hospitals survey (28898) and Continuing Medical Education registries (13159) in 2015. Duplicate records across the three registries were identified based on the similarity of national ID codes and medical council codes. The number of active medical specialists was estimated by three-source capture-recapture method using Stata 12 software. RESULTS: A total of 33,416 specialists were identified from three sources. We estimated the number of specialists at 39127 (95% CI: 38823.6-39448.4) in 2015. Of these, 45.4% pertained to the province of Tehran while only less than 1.8% of specialists were in the provinces of Ilam (0.50%), South Khorasan (0.56%) and Kohgiloye and Boyerahmad (0.59%). The estimated ratio for specialists was 4.9 per 10000 population and ranged from 9.2 per 10000 in Tehran to 1.5 per 10000 population in Sistan and Balochestan. The overall completeness of data registries by three sources was 85.4%. CONCLUSION: The current distribution of specialists appears to be imbalanced. It is suggested to adopt appropriate policies to improve the distribution and maintenance of medical specialists in different parts of Iran.