The relationship between demographic factors and known risk factors with breast cancer in women aged 30-69.

Background: Breast cancer is one of the most important causes of cancer deaths in women. The present study was conducted to determine the relationship between demographic factors and known risk factors with breast cancer in women aged 30-69. Method: This case-control study was conducted with two matched and unmatched control groups. Three hundred fifty women aged 30-69 with breast cancer, 350 age-matched women without cancer, and 350 not age-matched women were included in the study. Controls were selected from the records of women whose breast cancer screening results were normal. Study subjects were evaluated regarding the risk factors for breast cancer. The data collection tool was a checklist including the risk factors investigated in the integrated health system. The collected data were analyzed utilizing SPSS22 software at a significance level of less than 0.05. Results: The average age in the case group was 46.63±11.77 years and 49.61±8.39 in the unmatched control group. The average age of marriage in the case group was 21.54±4.31, and the average age of women at first pregnancy in the case group was 24.06±3.39 years. In the case group, 163 people (46.57%) lived in the city, 221 people (63.14%) were over 40 years old, and 337 people (96.28%) were married. In multivariate analysis, the variable 'age of marriage' 0.821 (0.691-0.976) and 'age of first pregnancy' 1.213 (1.020-1.443) showed a significant relationship with breast cancer which were observed as predictors of breast cancer in comparison to the unmatched control group (P-value <0.05). Conclusion: The age of the first pregnancy and the type of delivery were observed as predictors of breast cancer. Therefore, by performing breast cancer screening in women who are exposed to these risk factors, early diagnosis of the disease and increasing the speed of their treatment can be significantly helped.

Determining the challenges and opportunities of virtual teaching during the COVID-19 pandemic: a mixed method study in the north of Iran.

The aim of this study was to determine the challenges and opportunities of virtual education during the COVID-19 pandemic. This study was conducted in 2022-2023 with a mixed method. During the quantitative phase, we chose 507 students from Mazandaran Province medical universities (both governmental and non-governmental) by stratified random sampling and during the qualitative phase 16 experts were collected by purposive sampling until we reached data saturation. Data collecting tools consisted of questionnaires during the quantitative phase and semi-structured interview during the qualitative phase. Data was analyzed using SPSS21 and MAXQDA10. Mean scores of the total score was 122.28±23.96. We found a significant association between interaction dimension and background variables (P < 0.001). The most important privilege of virtual education is uploading the teaching material in the system so that students can access the material constantly and the most important challenge regarding virtual education is lack of proper network connection and limited bandwidth. Virtual education proved to be a suitable alternate to traditional methods of medical education during the COVID-19 pandemic in theoretical topics, we recommend that educational policymakers would take the necessary actions to provide the requirements and facilities needed to improve the quality of virtual education.

Burden of upper gastrointestinal cancers in the east of Golestan province (Golestan cohort study).

BACKGROUND: Cancers, especially Upper Gastrointestinal Cancers (UGCs), pose a substantial burden on society, particularly in developing nations. Golestan province, Iran, is known for its high UGC rates globally. AIMS: This study delves into the disease burden of UGCs in the eastern part of Golestan province. METHODS AND RESULTS: This study was conducted using the results of the Golestan cohort study. 2711 patients participating in this cohort, who visited Atrak Clinic during 2001-2020, participated in this study. After excluding patients with incomplete records, 2481 patients were included in the study. To compute the metrics of years of life lost (YLL), years of life lived with disability (YLD), and disability-adjusted life years (DALY), we utilized the World Health Organization's standard life table, stratified by age and gender. The majority of UGC patients in our study were married (81.8%), had limited formal education (82.6%), and were predominantly male (61.1%). A substantial proportion resided in suburban areas (85.8%), and over half of the patients (52%) reported a history of drug addiction. The mean age at diagnosis for men was 65.76 years with a standard deviation of 11.34, while for women, it was 64.38 years with a standard deviation of 11.66. Regarding disease impact, YLL, YLD, and DALY for men were 21 240, 1956, and 23 196 (307.8 per 100 000), respectively. For women, these figures were 15 609 for YLL, 1367 for YLD, and 16 976 (223.1 per 100 000) for DALY. CONCLUSION: After the increasing trend of the burden of UGCs in Golestan province in the early years of the study, this rate has been decreasing in recent years. Effective strategies necessitate collaborative efforts across various sectors to alleviate this burden, focusing on preventive measures, timely diagnosis, and well-coordinated therapeutic interventions.

Strengthening E-learning strategies for active learning in crisis situations: a mixed-method study in the COVID-19 pandemic.

BACKGROUND: Medical universities are responsible for educating and training healthcare workers. One of the fields significantly impacted by the pandemic is medical education. The aim of this study is to identify strategies for enhancing e-learning for active learning and finding solutions for improving its quality. METHODS: This mixed-method (quantitative-qualitative) research was conducted in 2023 at three selected universities in Mazandaran Province. In the quantitative phase, 507 students participated via stratified random sampling using a standard questionnaire. In the qualitative phase, data were collected through semi-structured interviews with 16 experts until data saturation was achieved. SPSS 21 and MAXQDA 10 software were used for data analysis. RESULTS: In the multivariate regression analysis, an increase of one point in the dimensions of student-teacher interaction, active time, immediate feedback, and active learning corresponded to an average increase in learning scores of 0.11, 0.17, 0.16, and 1.42 respectively (p≤0.001). After the final analysis in the qualitative phase, four main domains (infrastructure, resources, quantity of education, and quality of education) and 16 sub-domains with 84 items were identified. CONCLUSIONS: The greatest challenge in e-learning is the interaction and cooperation between students and teachers. The implementation of the identified strategies in this research could provide useful evidence for policymakers and educational administrators to implement interventions aimed at addressing deficiencies and enhancing e-learning.

Qualitative analysis of the coding of pathological data of cancer registry centers: A study in North of Iran.

BACKGROUND: The cancer registry system is an important part of the cancer control program. Improper coding of cancers leads to misclassification and incorrect statistical information about cancer. Therefore, in this study, the main objective of the qualitative analysis was the accuracy in assigning the codes to the pathological reports in the centers responsible for cancer registry. METHODS: This study was descriptive, retrospective and applied. The data source in this study included 15,659 pathology reports received during the years 2017-2019 in the population-based cancer registry centers of Mazandaran province. Out of 1800 reports, 1765 samples of reports were selected and analysis was done on them by stratified random sampling method. A researcher-made checklist was used to collect data, and the Kappa agreement coefficient and Cohen's agreement percentage were presented to check the accuracy of the reports. STATA13 was used for data analysis. RESULTS: 1150 of 1765 pathology reports (65.0%), did not have a topographic, morphological and behavioral codes and 410 (23.2%) had grade codes. The Kappa coefficient in reports with a topography code was 0.916 and with a morphology code it was 0.929, respectively. In behavior coding, the highest agreement is in the category of benign cancers at 65.2% and in grade coding in the category without grade is 100%. CONCLUSION: The most reports were on carcinoma morphology, and the Kappa coefficient in morphology codes has almost complete reliability. In terms of behavior coding, there was the most agreement in the category of benign cancers. The Kappa coefficient in given behavior codes has low reliability.

Health care quality model of family physician program in Iran (mixed method).

Background: There has been a growing international evolution of the role and purpose of quality improvement in primary health care. The present study aimed to develop a quality model of the Family Physician program in Iran. Methods: In the qualitative part of these mixed-method studies, grounded theory was used according to the systematic method of Strauss and Corbin. Semi-structured interviews were conducted with recipients and providers of Family Physician cares in the pilot provinces of Iran in 2020 to 2021 and continued until the theoretical saturation based on the purposive technique. The qualitative evaluation of the model was performed and approved. Structural equation modeling and Amos software were used to quantify the model. Results: The results of the structural equation analysis showed that the conceptual model of the research with chi-square test was 2.96 and RMSEA= 0.066, GFI=0.860 are well fitted. Structure, context, process, accountability, attitude, and empowerment factors directly and indirectly provide good predictors for the quality of care in the family physician program. The most important research findings in the field of quality improvement in the family physician's cares included factors such as developing the attitude and vision of society, providers and policymakers in health subject and health needs, simultaneously corrections in all levels of the referral system, attention and adaptation to the context of society, developing the infrastructures and improving the related processes, systematic appraisal, and accountability and pay attention to the empowerment. Conclusion: To achieve the quality of care in the family physician program, we need change and development in our attitudes, context, infrastructures and processes, accountability and empowerment systems, and overall modification .

Quality assessment of pathologic data in cancer registry centers based on ICD-O-3.

Background: Prerequisite for achieving the goals of the registration program is the existence of valid and accurate data, and the usability of this data is possible if they are coded correctly. This study assets the quality of pathological data of the population-based cancer registration centers based on ICD-O-3. Methods: This applied study was performed descriptively and retrospectively. The study population included 20129 pathology reports sent to the population-based cancer registration center of Mazandaran Province during 2018-2020. A total of 2015 out of, 2050 samples of the received reports were examined according to stratified random sampling method. A researcher checklist was made to collect the data, and STATA 13 and Cohen's Kappa agreement coefficient were used to analyze the data. Results: Among the 2015 reports of pathology, 1114 (55.3%) pathology reports were related to government centers, (42.9%) 865 cases were registered with their topographic code, morphology and behavior. Based on the registration of the exact topographic code, the kappa coefficient and the total agreement were 0.266 and 27.70%, respectively. Kappa coefficient in all received reports and reports with topographic code was 0.346 and 0.906, respectively. In the reports with topographic code, the most reports of cancers were related to cancers of the gastrointestinal organs (97.6%) 246. Conclusion: The accuracy of the codes given in the pathology centers in terms of topographic, morphological, behavioral and grade codes based on the percentage of agreement with the coding was above average, which were higher in governmental centers and also in some cancers.

A knowledge implementation model in health system management based on the PARIHS model.

BACKGROUND: The gap between knowledge and practice, along with postponing or not implementing research findings in practice and policy-making, is one of the reasons for low-quality services. Hence, this study aimed at presenting a model of knowledge implementation in health system management in Iran. METHODS: The present two-phase study was first performed qualitatively using a directive content analysis approach based on the Promoting Action on Research Implementation in Health Services (PARIHS) model. The researchers extracted the barriers and facilitators by conducting semi-structured individual interviews. Then, in a three-stage Delphi study, 25 health experts determined the barrier removal strategies. Data were analysed using MAXQDA10 software. RESULTS:  The content analysis of the interviews led to the emergence of 1212 codes under three categories of evidence, context and facilitation. The findings indicate that health managers make fewer decisions based on research findings. Instead, they make decisions regarding the experiences of service providers and organization data. In addition to the subcategories in the PARIHS model, the researchers extracted political, social and administrative factors under the context category. The relationships between the features of evidence, context, facilitation, barriers and strategies were presented in the final model. CONCLUSION:  The presented model comprehensively emphasizes the evidence resources, context preparation, and facilitation of the knowledge implementation process.

Factors affecting health services strategic purchasing for breast cancer patients: a mixed study in Iran.

BACKGROUND: Inappropriate ways of health services purchasing for cancer patients can be challengeable and costly and seriously affect the access to health services and outcomes. This study aimed at Factors affecting health services strategic purchasing for breast cancer patients. METHODS: As a mixed study, this research was conducted in Iran in 2020. In the qualitative phase, 21 specialists and professionals in the field of health services purchasing were purposefully selected and interviewed. After data saturation, interviews were analyzed with the framework analysis and a structured questionnaire was made based on these analyses. 400 breast cancer patients were selected by randomized sampling and completed the questionnaire. Data were analyzed with SPSS23 in p < .05. RESULTS: The highest mean rate of the three main categories belonged to "insurance trusteeship" (4.71 ± .35), followed by "supply management" (4.48 ± .27) and "financial performance" (4.48 ± .37). There were significantly differences between the mean rates of the main categories and the cut-off point (p < .001). In addition, "insurance trusteeship" ranked first (2.58), followed by financial performance (1.77) and supply management (1.65). CONCLUSION: Of main components in health services strategic purchasing for breast cancer patients, insurance trusteeship, supply management, and financial performance ranked first to third, respectively. Therefore, healthcare policy-makers should consider the placement of insurance trusteeship and coordinate between purchasers and providers for making reform in the health system.

Designing an Informal Payment Model for Patients Admitted in the Iran Health System: A qualitative Study.

BACKGROUND: Countries rely on out-of-pocket spending to different degrees and employ varying techniques. This study aimed at designing an out-of-pocket payment model of patients admitted to the Iran health system. METHODS: This study was a combined qualitative and quantitative study. The statistical population of the qualitative section was 30 experts who were purposefully selected and continued by snowball method until data saturation, and in the quantitative section were 212 managers of the Ministry of Health. The questionnaire was designed based on qualitative analysis. Content validity was confirmed based on expert opinion and structural validity using exploratory factor analysis and confirmatory factor analysis. Reliability was confirmed using CRONBACH's alpha coefficient and composite reliability. For model adequacy, KMO index and Bartlett test were used, and for model fit, CFI and IFI fitness index were used. RESULTS: Based on the results of 6 main themes, 20 Concept and 120 sub-themes of out of pocket payment of hospitalized patients were extracted. The value of chi-square was 4599.861, the degree of freedom was 2421 and the result of their ratio was 1.899 in the model, which was an acceptable value. CFI and IFI fitness indicators are acceptable. The SRMR index was 0.1153, which indicates the adequacy of the model. CONCLUSION: The findings showed that the main dimensions of out of pocket payment of hospitalized patients include causal factors, underlying factors, intervening factors, pivotal categories, strategies and consequences. Therefore, the use of a paradigm model to pay attention to all the effective dimensions in reducing the payment of hospitalized patients is recommended.

Pattern of infectious diseases in northern Iran: An approach to internal medicine management.

BACKGROUND: Despite the development of their prevention and treatment, infectious diseases cause high mortality, many disabilities and inadequate living conditions worldwide. The aim of this study was to evaluate the pattern of infectious diseases in northern Iran with an approach to internal medicine management. METHODS: This cross-sectional research was conducted in 2019 on all 7095 infectious diseases patient records that referred to Ghaemshahr Razi Hospital, Mazandaran Province, Iran during 2012-2018. A checklist prepared by investigator was used to collect the data. The extracted data were coded and entered into SPSS 22 and analyzed using K2 and independent t-test at p<.05. RESULTS: The mean age of the study patients was 29.7±26.4. 4372 (61%) of the cases were males and the mean duration of hospitalization was 41.6±33.5. Age was significantly correlated to infectious diseases (P=.001). Gastroenteritis was the most common infectious disease among the men and women with 2442 (60.5%) and 1594 (39.47%), respectively. Based on the Pearson's correlation test, the relationship between leptospirosis, brucellosis, pulmonary tuberculosis, shigellosis, sepsis and infectious mononucleosis with gender, habitation, admission mode, discharged mode and age was significant (p<.05). CONCLUSION: As the high frequent diseases were gastroenteritis, leptospirosis, brucellosis and sepsis and an increasing trend was in the prevalence of gastroenteritis, leptospirosis and lung tuberculosis, health system managers should consider training courses, preventive strategies, real-time interventions, increased hospital bed rate for patients with infectious diseases and so on.

A Model for Organizational Entrepreneurship with Organizational Culture Approach in Iran's Teaching Hospitals.

BACKGROUND: One of the most basic tools and strategies for developing new ideas and entrepreneurship is establishing the entrepreneurial culture in the organization. Thus, the purpose of this study was to examine the effect of organizational culture on entrepreneurship of district 1 teaching hospitals in Iran. METHOD: The study was applied in terms of purpose and descriptive-analytical of survey type in terms of nature that was conducted in 2019 on 946 staff members of district 1 teaching hospitals in Iran using census sampling method. The measurement tools used were standard questionnaires of Margaret Hill Entrepreneurship and Edgar Schein Organizational Culture. Pearson correlation coefficient was used to determine the relationship between organizational culture and organizational entrepreneurship. Partial least squares (PLS) was used for structural equation modeling (SEM) and analyzed in Smart pls2 software. RESULTS: The results showed that there is a significant direct relationship between the organizational culture and organizational entrepreneurship (r=0.94). Also, there was a relationship between the internal consistency component with organizational entrepreneurship (r=0.93), between the external compatibility component with organizational entrepreneurship (r=0.90). (p≤0.05). CONCLUSION: The results indicated a positive and significant relationship between organizational culture and its dimensions (internal consistency and external compatibility) with organizational entrepreneurship. Thus, making the decisions that concentrate on the organizational culture of the hospitals and taking steps to coordinate people's values and norms that promote organizational culture and enhance organizational entrepreneurship are recommended.

Relationship between international tourism and concentrations of PM 2.5: an ecological study based on WHO data.

Tourism is regarded as a major global industry. Given the importance of identifying factors affecting the tourism industry and attracting international tourists, the present ecological study explored the impact of environmental pollution on the number of international tourists arrival using concentrations of PM2.5 (particulate matter 2.5 µm or less in size) in a multivariate framework under the context of 190 countries. Using panel data from 190 countries, the author explored the data on the number of international tourists arriving in countries in 2017 extracted from the World Bank (WB) website, and obtained the information about the concentrations of PM2.5 from the World Health Organization (WHO) website. Pearson's correlation coefficient and linear regression analysis were used to examine the correlation of the number of tourists with the variables of daily concentrations of PM2.5, societal safety, international conflict, and the relationship of tourist arrival with the studied variables, respectively. The number of countries with low, moderate, and high concentrations of PM2.5 in urban areas was 33, 116, and 41, respectively. This numbers for rural areas was 47, 102, and 42 countries, respectively. The mean concentrations of PM2.5 in the surveyed countries was 23.90 ± 15.81 and 25.69 ± 16.76 for rural and urban areas, respectively. The estimation results revealed that there was a significant correlation between the number of tourists with the concentrations of PM2.5 in the rural areas (p = 0.01). There was also a significant relationship between the human development index (HDI) and the concentration of PM2.5. A significant relationship was observed in the results of univariate linear regression analysis between tourist arrival with rural concentrations of PM2.5 (p = 0.02) and societal safety (p = 0.003). After adjusting the effect of societal safety variables, domestic and international conflict, the relationship between tourist arrivals and concentrations of PM2.5 in rural area remained significant (p = 0.02). The results imply that by reducing the concentration of PM2.5 the positive attitude of tourists for traveling to countries with healthy air can be earned.

Investigating prevalence job stress and illness among hospital staff providing health tourism services (HSPHTS) in Iran.

BACKGROUND: Health tourism or treatment tourism is one of threatening fields that causes (added s) increase in prevalence of job stress and illnesses among hospital staff of providing health tourism services (HSPHT). The aim of this study is to determine the prevalence of job stress and illnesses among hospitals staff of providing health tourism services in touristic cities as Tehran and Shiraz in Iran. METHODS: This cross-sectional, descriptive-analytical study was carried out among the staff of 10 hospitals providing health tourism services in cities of Tehran and Shiraz, Iran, in 2019. In these hospitals, 1250 staff were chosen by cluster sampling method from each job task as doctor, nurse, office worker, and paramedical and cleaner worker. Also, 1100 staff working in other general hospitals (non-HSPHTS) were selected as the control sample. Then, the demographic information and prevalence of job stress were gathered by Osipow job stress questionnaire and the illnesses were accumulated by self-reporting questionnaire. Finally, data were analyzed in SPSS 20 software. Chi-square and Pearson's parametric tests were used in the study. RESULTS: Prevalence of illnesses among HSPHTS was more than that in general hospitals (Pvalue < 0.05). The most prevalent illnesses were respiratory (11.08%), digestive (9.2%), and cutaneous (9.04%), respectively. Also, the prevalence of job stress among HSPHTS was more than that in general hospitals (Pvalue < 0.05). There was a significant relationship between prevalence of illnesses and job stress among the staff of hospitals and the increase in the number of visited tourists in the hospitals providing health tourism services. CONCLUSION: Results of the study showed that the prevalence of job stress (%33.76) and illnesses (%43.66) among the HSPHTS was respectively 2 and 2.6 times more than that among the staff of general hospitals. Thus, it is necessary to observe sanitary actions and considerations more seriously in these hospitals.

The Requirements of Strategic Purchasing of Health Services for Cancer Patients: A Qualitative Study in Iran.

The strategic purchasing creates dynamics and providers' competitiveness among the internal market of governmental sector with ensuring appropriate payments and promoting quantity-quality of service delivery that lead to improve the health system efficiency. This study aimed to determine the requirements for the strategic purchasing of health services for cancer patients in Iran. As a qualitative research with a framework analysis, this study was conducted in Iran from July 2018 to February 2019. The participants were included some administrating managers, experts, and specialists of insurance selected purposefully by snowball sampling method. The framework analysis of the study included 5 steps. Data were saturated after 21 semistructured interviews. The main findings included 3 main themes (supply management, insurance trusteeship, and financial performance) and 14 subthemes (strategic purchasing infrastructures, practical guidelines, trusteeship structure, service package, service quality, service quantity, role of other organizations and groups, training, establishment of an insurance thought, strategic management, communication, price, efficiency and effectiveness, and resource provision). The strategic purchasing model of health services increases the power of service purchasers and payment based on defined priorities, resulting in providers' coordinating for care provision, enhancement of financial performance and cancer patients' better access to health services, improvement of life quality, and financial protection.

A 25-year trend in gastrointestinal cancers in northern Iran (1991-2016).

BACKGROUND: Identifying the incidence of cancer helps in planning and prioritizing resources for its screening, prevention, treatment and diagnosis. This study aimed at investigating a 25-year trend in gastrointestinal cancer in northern Iran during 1991-2016. METHODS: This research was a trend analysis. The study population was one thousand five hundred and thirty-five cancer patients referring to Shahid Rajai Hospital in Babolsar, northern Iran, as the only center for radiotherapy in the North of Iran, during 1991-2016. SPSS version 22 was used for entering data and t-test, ᵡ2 and ANOVA were used for analyzing data in the significant level of ≤0.05. RESULTS: The highest incidence of stomach cancer was 111 (35%) in 2011 and the lowest incidence was 44 (16.3%) in 1996, The highest frequency of esophageal cancer was reported 137(56.1%) cases in 1991 and the lowest frequency was 78 (26.3%) cases in 2016, while the highest incidence of colorectal cancer was 109 (36.7%) cases in 2016 and its lowest frequency was 32 (16.3%) in 1996. There was also a significant difference in the frequency of gastrointestinal cancers in different studied years (p <0.001). CONCLUSION: The trends in the incidence of stomach and colorectal cancers in northern Iran were increasing while esophageal cancer was decreasing.

Ranking Factors Affecting the Attraction of Foreign Medical Tourists in Hospitals Affiliated to Mashhad University of Medical Sciences Based on Marketing Mix Model.

BACKGROUND: This study was designed to rank factors affecting attraction of foreign medical tourists based on marketing mix model. METHODS: In this descriptive study, data were collected through a questionnaire. Foreign patients, hospitalized from Jan 2015 to Sep 2016 in all hospitals of Mashhad were chosen as the study population (13 hospitals). Data analysis was conducted using Friedman test and Wilcoxon test in SPSS 21 at a significance level of 0. 05. RESULTS: Factors of staff, service and process gained the highest score from the perspective of patients; while price, facilities and promotion scored the lowest among parameters affecting the attraction of medical tourists to hospitals of Mashhad. In this context, factors of staff (96%) and price (66%) had the highest and lowest effect on absorption of tourists, respectively. CONCLUSION: To promote medical tourism, important factors such as staff, service, and process should be further stressed and variables of price, facilities and promotion demand for a revision by the authorities in this industry.

Datasets on organizational citizenship behavior in the selected hospitals with different ownership.

Studying the role of employees as the base of an organization on achieving organizational goals has increased in recent years [1]. To have better organizational citizens, organizations should encourage their staff [2]. As the most powerful form of organizational behavior, organizational citizenship is more influential than organizational cooperation [3]. Studies have shown that cooperative behavior, such as the citizenship behavior results in easier organizational communication, promoting organizational planning, improving inter-personal cooperation and developing better organizational climate, directly influence staff satisfaction, work life quality, service-provision, job commitment and financial output [4]. As the most fundamental organizational behavior, the organizational citizenship behavior (OCB) causes so-called organizational effectiveness. This study Focused on the comparing organizational citizenship behavior components including conscientiousness, courtesy, altruism, sportsmanship and civic virtue among hospitals based on ownership. Research population included all therapeutic and non-therapeutic employees working in the five selected hospital located in Golestan province, Iran in 2016. This study is approved by Ethical committee of Islamic Azad Sari Branch. Based on Cochran׳s sampling formula, 312 employees working in different hospital sections and units (nurses and administrative personnel) were proportionally selected as the research sample. They completed the Persian version of Podsakoff׳s standard scale measuring organizational citizenship behavior. The data were analyzed using SPSS 22 and applying inferential statistics approaches such as t-test, Tukey, and ANOVA in the confidence interval of 95%.

Relationship of Employees' Achievement Motivation and Quality of Working Life with Their Self-efficacy at Selected Hospitals with a Multi-group Analysis: Moderating Role of Organizational Ownership.

INTRODUCTION: Motivational deficiencies and the low quality of working life significantly reduce employees' work performance and consequently their efficacy (effectiveness and proper performance in doing a task or specific tasks). AIM: The aim of this study was to determine the relationship between achievement motivation and quality of working life with self-efficacy among staff working in Mazandaran hospitals, by taking organizational ownership as a mediator variable. MATERIALS AND METHODS: This study was an applied descriptive-correlation. Research population consisted of all staff working in selected hospitals of Mazandaran Province, Iran. 341 employees were selected with randomly-stratified sampling as the statistical sample. Three valid questionnaires were used for data collection. Data were analysis based on structured equations and path analysis with SPSS19 and AMOS. RESULTS: In private hospitals, there was a significant relationship between the quality of working life and self-efficacy (p<0.001). In relationship between achievement motivation and self-efficacy, there was no significant differences between university hospitals and social security hospitals, but relationship between the quality of working life and self-efficacy was significant (p <0. 05). Considering achievement motivation and self-efficacy in private hospitals and university hospitals, a significant differences was observed (p<0. 05). CONCLUSION: The hospital ownership has a moderating in relationship of achievement motivation and quality of working life with self-efficacy. Staff's empowerment courses for university hospitals and improvement in the overall space of job, increase in job security, reducing salary differences is suggested for private hospitals.