Quality of life in Iranian elderly population using the SF-36 questionnaire: systematic review and meta-analysis.

BACKGROUND: Ageing is a major known risk factor that is a threat to human health. To date, many studies have investigated quality of life (QOL) among the elderly population in the Islamic Republic of Iran. However, their results were inconsistent. AIMS: We designed this systematic review and meta-analysis to estimate the overall mean score of QOL based on the Short Form 36 Health Survey Questionnaire (SF-36) among the Iranian elderly population. METHODS: We searched international databases (Medline, Scopus and Science Direct) and national databases (Science In-formation Database, MagIran, IranMedex and Irandoc) up to February 2015. We included all cross-sectional studies that evaluated QOL among the Iranian elderly population using SF-36. RESULTS: Of 2150 studies identified, 15 were included in the meta-analysis. The mean scores for QOL in the 8 scales were: 47.58, 51.75, 55.42, 55.78, 59.55, 51.54, 47.85 and 51.31 for physical-role, physical function, mental health, bodily pain, social functioning, emotional-role, general health, and vitality, respectively. CONCLUSIONS: Our results indicated that health-related QOL decreased with increasing age. QOL was worse in women than in men, especially in physical-role and general health scales. Elderly people who lived in a nursing home had lower QOL than those who lived in their own home. So, health policy-makers should design comprehensive programmes to improve health-related QOL for the Iranian elderly population.

Life satisfaction as the main factor behind the elderly`s health knowledge utilization: A qualitative study in an Iranian context.

Background: The elderly population's health has become a priority as their numbers are on the rise and they are increasingly becoming vulnerable to physical and mental diseases. Studies show that an elderly person's health depends on his/her utilization of health knowledge in daily life. Hence, here we investigated the contributing factors of knowledge utilization in the elderly population. Methods: A qualitative study was conducted through conventional content analysis. Semi-structured in-depth interviews were held with 29 elderly individuals from Tehran. A focus group discussion was conducted (eight elderly individuals), and an expert panel was held with nine experts to complement the results. Results: Upon data analysis, four categories and seven subcategories were extracted. The main categories included provision of basic needs, maintaining dignity, life satisfaction, and negative feelings toward self and others. The concept of 'life satisfaction' held a pivotal role in relation to the other categories. Conclusion: Life satisfaction was the main category in the utilization of health knowledge among the elderly. Aging should be foreseen and forethought to increase life satisfaction. The followings can be effective in increasing life satisfaction in the elderly: Promoting positive-thinking, placing greater emphasis on spiritualism in life, employment of the elderly, and promoting the culture and tradition of respecting the elderly.

How to utilize tacit knowledge in health organizations: An Iranian perspective.

Background: Studies show that 90% of an organization's knowledge is embedded and synthesized in its employees' minds. Thus, when employees leave the organization or their positions change, their valuable knowledge, skills, and experiences are lost, however, if used properly, tacit knowledge can be a source of innovation and competitive advantage in an organization. This study aimed at exploring the methods for sharing and utilizing tacit knowledge in health organizations. Methods: In this study, qualitative approach was adopted to explore ways of utilizing tacit knowledge in health organizations. Tacit knowledge experts, who had published at least one relevant article, conducted 17 individual and 2 group interviews. Purposeful sampling was used to select the participants. Methods for sharing and utilizing tacit knowledge were explored by holding in-depth semi-structured interviews. Data were analyzed using thematic analysis. Results: The results were summarized into 5 categories and 18 themes. The categories included 'identification of different dimensions of organizational knowledge', 'prerequisites of tacit knowledge utilization', 'defining the process of tacit knowledge utilization', 'converting tacit to explicit knowledge', and 'converting tacit to tacit knowledge'. Participants believed that the process of converting tacit to explicit knowledge was a cyclical process that included the understanding the existing situation and detecting knowledge entry points, identifying knowledge items and harvesting them, assessment, codification, and standardization, entry into knowledge repository, and updating. Conclusion: Our results revealed that health organizations need the prerequisites of tacit knowledge sharing to acquire the capacity to utilize this kind of knowledge. Because the themes extracted in this study are rarely used in health organizations, the results will be helpful in guiding the development of knowledge utilization strategies and planning in these organizations.

Quality of Life in Elderly Iranian Population Using Leiden-Padua Questionnaire: A Systematic Review and Meta-Analysis.

The world population is getting old rapidly; the aging population is the new phenomenon in Iran too. The aim of this meta-analysis was to estimate the overall and subscales mean score of quality of life (QOL) based on the Leiden-Padua (LEIPAD) questionnaire among the elderly population of Iran. The major international and national databases including; Medlin, Scopus, Science Direct, SID, MagIran, IranMedex, and Irandoc was searched. All cross-sectional studies, which measured the QOL among the elderly population in Iran using the LEIPAD questionnaire, were included. Furthermore, we used the following key words, "Quality of life," "aging," "aged," "elderly," and "Iran." Of 2155 records, four articles reminded for the meta-analysis, which involved 628 participants with a mean age of 71.73 ± 4.28 years. The mean scores of QOL in each scale were as follows: 10.80 (9.30-12.31) for physical health, 13.51 (6.81-20.21) for self-care scale, 8.60 (5.07-12.14) for depression and anxiety, 12.48 (10.39-14.58) for cognitive functioning scale, 2.19 (0.67-3.72) for sexual functioning scale, 10.98 (5.87-16.09) for life satisfaction scale, and 5.90 (3.64-8.16) for social desirability scale. This study revealed that the total QOL for the elderly population is relatively low in Iranian society. It is appeared to provide social support, and upgrade their QOL seems to be essential for the elderly population.

Quality of Life in Elderly Iranian Population Using the QOL-brief Questionnaire: A Systematic Review.

BACKGROUND: Due to the increase in the elderly population in different societies, their primary needs, physical and mental health, and quality of life, is important. This study aimed to estimate the overall mean score of the QOL based on the Qol-Brief questionnaire in the elderly population of Iran. METHODS: The international and national databases, including; Medline, Scopus, Science Direct, MagIran, and SID were searched up to Feb 2015. All studies, addressed the quality of life among the healthy Iranian elderly population using WHO-QOL-BRIEF questionnaire, were included. The random effect model was used for data analysis and the results were reported with a 95% confidence. RESULTS: Out of 2150 studies, seven studies involved 1366 elderly participants were included in the meta-analysis. The pooled mean score of total QOL was 60.1±4.6. The pooled mean score of quality of life for physical health was 55.13 [51.03, 59.22], for environmental was 51.80 [45.50, 58.10], for psychological was 56.68 [53.29, 60.08] and for the social relationship was 57.82 [55.79, 59.86]. The men had a better status and in two health domains, including; physical and psychological health. CONCLUSION: The results of this study stress the necessity of attention to the quality of life in the domains of physical health (especially in women), and environmental health in the elderly population.

Health technology assessment in Iran: Barriers and solutions.

BACKGROUND: Health technology assessment (HTA) is a tool utilized for efficient dissemination of technology. For the purpose of encouraging decision-makers to utilize this tool, at first, we need to identify the obstacles in the processes of preparation, utilization, and implementation of HTAs. This study aims to define these barriers and offer solutions for effective utilization of HTA reports produced in Iran. METHODS: This qualitative content analysis determines the various beneficiaries of HTA, and utilizes a semi-structured interview with the participants who are all involved in the HTA. RESULTS: Nine out of ten people invited for the interviews accepted the researchers' invitation. An analysis of barriers and solutions for improving the utilization of HTA reports was conducted in three levels of policy makers (policy level), specialists in healthcare (professional level), and ordinary people (public level). The barriers in the policy level include unsuitability of reports for their audience, incompatible views toward the definition and necessity of health technology assessment, lack of financial resources for report preparation, and limitations in large-scale policymaking in Ministry of Health. Barriers in the professional level include lack of knowledge on HTA among serviceproviders. Barriers in the public level consist of information asymmetry. CONCLUSION: There are various barriers toward accurate utilization of HTAs in Iran. Thus, a systematic approach which involves people, brings about culture, improves infrastructures, and boosts supervision on the performance is recommended.

Worldwide inequality in production of systematic reviews.

BACKGROUND: Investment in science is vital for the development and well-being of societies. This study aims to assess the scientific productivity of countries by quantifying their publication of systematic reviews taking the gross national income per capita (GNIPC) into account. METHODS: Medline and ISI Web of Science were searched for systematic reviews published between 1st January 2006 and 31st December 2010. The productivity of each country was quantified by exploring the authors' affiliation. The GNIPC was used according to the World Bank Report. Concentration index (CI) was calculated as the index of inequality. RESULTS: CI of percentage of systematic reviews as a function of percentage of countries ranked by GNIPC was 0.82 which indicates inequality in production of systematic reviews in pro rich countries. Countries with high income produced 206.23 times more systematic reviews than low income countries, while this ratio for lower middle and upper middle countries was 9.67 and 12.97, respectively. The highest concentration index was observed in clinical sciences (0.76) and the lowest in public health (0.61). CONCLUSION: This study demonstrates a significant gap between industrialized and nonindustrialized countries in the production of systematic reviews. Addressing this gap needs tremendous national and international efforts.

People's trust in health news disseminated by mass media in Tehran.

BACKGROUND: People are increasingly interested in health news. As a mass media, the 'Islamic Republic of Iran Broadcasting' (IRIB) has the highest number of target audiences. In Iran, some people follow health news via health programs on satellites and other means of communication. However, all of these programs do not live up to the standards of scientific evidence. In this study, we examined Tehran people's trust in health news disseminated by the IRIB and other mass media outlets. METHODS: A cross-sectional study was conducted in Tehran. Through multistage sampling, 510 households proportional to size were randomly selected from five regions of Tehran including northern, eastern, western, southern and central regions. One person from each household completed the questionnaire through interviews. The questionnaire included questions on people's level of trust in health news delivered by the IRIB, satellite programs, the internet and magazines. It also included demographic questions. The validity and reliability of the questionnaire was evaluated. RESULTS: Among the interviewees, 50.6% was female. The highest level of trust by the participants was observed in the IRIB (65.2%), and the lowest trust was observed in satellite news (43.4%); p< 0.001. The interviewees believed that the IRIB news broadcasters had more mastery over the subject than the ones in satellite channels (p< 0.001). The IRIB's coverage of important and relevant health topics was also significantly perceived to be better than that of satellite news (p< 0.001). According to 83.5% of interviewees, the quality of health news had improved in the past 10 years. Fifty nine point eight percent of participants believed the quality and accuracy of the IRIB health news was monitored. CONCLUSION: People's higher level of trust in domestic news as compared to foreign sources and the better status of domestic sources in other areas such as precision in reporting, coverage of more important news, its delivery in lay language, the news broadcasters' proficiency, and other cases - from the participants' point of view - can highlight the significance of designing interventions for changing health behavior among domestic health news producers. Therefore, the results of this study can prove useful to health news policy makers in the IRIB.

Research's Practice and Barriers of Knowledge Translation in Iran.

BACKGROUND: Knowledge Translation is a process that includes synthesis, dissemination, exchange and application of knowledge to improve the health, services and products In this study we have attempted to examine the knowledge translation practice and its perceived barriers on the universalities and research institutes (research sector) in Iran. METHODS: Both qualitative and quantitative approaches were used. In the quantitative section, a questionnaire had prepared for this study was completed by 88 authors country wide from randomly selected papers. In the qualitative section 13 in-depth interviews and 6 focus group discussions were held with managers and policy makers, clinical and health service providers, and researchers. RESULTS: Twenty four percent of the authors had no interaction whatsoever with the target audience. Lack of expectation toward creating change in the target audience, researchers' incentives, low level of trust among researchers and decision makers, absence of a predefined mechanism for delivery of research results and inappropriate research priorities were among the most important barriers identified in the qualitative section. CONCLUSION: Translation of research findings into some concrete outputs which can affect health of people is not in mandate of researchers and subsequently they are not prepared for this as well. Based on the barriers identified, it seems that the following interventions are necessary: cooperation among policy makers at macro and meso (organizational) level and the research sector; establishing networks for researchers and decision makers in choosing the research topic, priority setting, and building trust among researchers and policy makers.

Barriers of clinical practice guidelines development and implementation in developing countries: a case study in iran.

BACKGROUND: Knowledge products such as clinical practice guidelines (CPG) are vitally required for evidence-based medicine (EBM). Although the EBM, to some extent, has been attended during recent years, no result has achieved thus far. The current qualitative study is to identify the barriers to establishing development system and implementation of CPGs in Iran. METHODS: Twelve semi-structured, in-depth interviews were conducted with a purposive sample of health policy and decision makers, the experts of development and or adaptation of CPGs, and the experts of EBM education and development. In addition, 11 policy-makers, decision-makers, and managers of the health system participated in a focus group discussion. The analysis of the study data was undertaken by thematic framework approach. RESULT: Six themes emerged in order of their frequency include practice environment, evidence-based health care system, individual professional, politician and political context, innovation (CPG) and patients. Most of the indications in the treatment environment focused on such sub-themes as regulations and rules, economical factors, organizational context, and social context. While the barriers related to the conditions of treatment environment, service provider and the features of innovation and patients had been identified before in other studies, very little attention has been paid to the evidence-based health care system and politician and political context. CONCLUSION: The lack of an evidence-based healthcare system and a political macro support are mentioned as the key barriers in Iran as a developing country. The establishment of a system of development and implementation of CPGs as the evidence-based practice tools will not be possible, unless the barriers are removed.

Quality of health news disseminated in the print media in developing countries: a case study in Iran.

BACKGROUND: Mass media play an important role in keeping people up-to-date with the latest health news. This study aims at investigating the quality of health news disseminated in the print media, its course of production and factors affecting its quality. METHODS: In the quantitative section of the study, 410 health-related news items, published during a six-month span in the Iranian public press, underwent content analysis. In the qualitative section, focus group discussions were held with journalists, editors-in-chief and news gatekeepers. RESULTS: The quantitative phase showed that 18% of the news articles were not fit for dissemination in public. The qualitative phase illustrated that multiple factors at various levels affect the quality of news, namely poor knowledge, inadequate motivations and context-related barriers. CONCLUSIONS: The quality of health news reporting is not desirable. Educational interventions need to be carried out to raise awareness among researchers and journalists. Also, certain steps should be taken to increase motivations and strengthen infrastructures, including designing guidelines and monitoring news.

Methodologies and messages in Iranian articles on maternal care, diabetes mellitus, and tuberculosis, published in 2001 - 2006.

INTRODUCTION: An article with a clear message can transfer research knowledge better. However, this is the case when the message suits the type of study methodology (research design) and its results. The objective of this study was to assess the presence of message articles and the type of study methodologies. METHODS: Articles published between 2001 and 2006, on maternal care, diabetes, and tuberculosis, which were based on studies performed on the Iranian population were investigated. A systematic search was performed in foreign databases 'Pubmed, Medline, and Embase', and national databases 'Iranmedex, SID (Scientific Information Database), and Iranpsych'. Seven hundred and ninety-five articles were examined for the type of study methodology and presence of an actionable message (one that specifies what and how an action should be carried out). RESULTS: Among the 795 articles accessed, cross-sectional studies were the most frequent (50.9%) and systematic reviews were the least frequent (0.4%). Cohort cases were observed in 6.9% of the cases. Actionable messages were observed in 22.1% of all the cases and 24.7% of the cross-sectional studies. CONCLUSIONS: Cohort studies increased from 5% in 2001 to 6.9% in 2006, but the shortage of systematic reviews represented a major weakness in the country's knowledge production process. Studies with a higher level of evidence such as systematic reviews, and cohort and interventional studies should be among the priorities of knowledge production in the country.

How should we assess knowledge translation in research organizations; designing a knowledge translation self-assessment tool for research institutes (SATORI).

BACKGROUND: The knowledge translation self-assessment tool for research institutes (SATORI) was designed to assess the status of knowledge translation in research institutes. The objective was, to identify the weaknesses and strengths of knowledge translation in research centres and faculties associated with Tehran University of Medical Sciences (TUMS). METHODS: The tool, consisting of 50 statements in four main domains, was used in 20 TUMS-affiliated research centres and departments after its reliability was established. It was completed in a group discussion by the members of the research council, researchers and research users' representatives from each centre and/or department. RESULTS: The mean score obtained in the four domains of 'The question of research', 'Knowledge production', 'Knowledge transfer' and 'Promoting the use of evidence' were 2.26, 2.92, 2 and 1.89 (out of 5) respectively.Nine out of 12 interventional priorities with the lowest quartile score were related to knowledge transfer resources and strategies, whereas eight of them were in the highest quartile and related to 'The question of research' and 'Knowledge production'. CONCLUSIONS: The self-assessment tool identifies the gaps in capacity and infrastructure of knowledge translation support within research organizations. Assessment of research institutes using SATORI pointed out that strengthening knowledge translation through provision of financial support for knowledge translation activities, creating supportive and facilitating infrastructures, and facilitating interactions between researchers and target audiences to exchange questions and research findings are among the priorities of research centres and/or departments.

How much importance do we give to target audiences in article writing?

OBJECTIVES: Writing papers can be used as a means to convey a message. Knowledge transfer is also about conveying the right message to the right target audience. The aim of this study was to determine the proportion of articles that had mentioned a clear message and the target audience in the abstract and the article as a whole, and also to examine their association with different determinant factors. METHODS: Articles published from 2001 to 2006 that were based on clinical and health system research conducted on Iranian populations and on maternal care, diabetes and tuberculosis were searched systematically in domestic and international databases. Eventually checklists (Additional file 1) were completed for 795 articles. RESULTS: Overall, 98.5% of articles had a clear message, whereas 12.5% had addressed the direct target audience. Presence of a clear message in formatted abstracts were seen 3.6 times more (CI95%: 1.5-8.7) than in articles without formatted abstracts (p = 0.005). Addressing of the direct target audience was seen twice as much in health system research articles as compared to clinical studies, odds ratio was 2.3 (CI95%: 1.47-3.48, p<0.001). CONCLUSIONS: Creating a format for journal abstracts seems to be an effective intervention for presenting the message in articles.

Research collaboration in Tehran University of Medical Sciences: two decades after integration.

BACKGROUND: In 1985 medical schools were integrated into the Ministry of Health, and the Ministry of Health and Medical Education was created in Iran. Under this infrastructure education, research and service provision are unified, and it is expected that collaboration between researchers and decision makers become easier in such an integrated context.The question here is how the researchers behavior in the biggest medical university of the country towards collaboration is, i.e. how much do decision makers participate in different stages of research? Which factors affect it? METHODOLOGY: The samples under study were all Tehran University of Medical Sciences (TUMS) completed research projects that had gotten grants in 2004 and were over by the time this study was done. Two questionnaires were designed for this study: i) the research checklist which was filled for 301 projects, ii) the researcher's questionnaire, which was sent to principle investigators, 208 of which were collected. Multiple linear regression analysis was used for evaluating the potential factors affecting individuals 'collaboration score'. RESULTS: Only 2.2 percent of TUMS' projects initiated in 2004 have had collaboration as a joint PI or co-investigator from non-academic organizations. The principle investigators mean collaboration score was 2.09, where 6 was the total score. So the collaboration score obtained was 35%. The 'type of research' had significant association with the collaboration score which is shown in the linear regression; collaboration was seen more in clinical (p = 0.007) and health system researches (p = 0.001) as compared to basic research. CONCLUSION: The present study shows that not many individuals collaborated as co-investigators from outside the university. This finding shows that research policy makers need to introduce interventions in this field. And assessment of barriers to collaboration and its facilitating factors should be considered in order to make it actually happen.

Knowledge transfer in Tehran University of Medical Sciences: an academic example of a developing country.

BACKGROUND: In the past two decades, scientific publications in Iran have considerably increased their medical science content, and the number of articles published in ISI journals has doubled between 1997 and 2001. The aim of the present study was to determine how frequently knowledge transfer strategies were applied in Tehran University of Medical Sciences (TUMS). We were also interested in studying the determining factors leading to the type of strategy selected. METHODOLOGY: All TUMS research projects that had received grants from inside and outside the university in 2004, and were completed by the end of 2006, were included in the study. In total, 301 projects were examined, and data on each of the projects were collected by the research team using a standardized questionnaire. The projects' principle investigators filled out a second questionnaire. In all, 208 questionnaires were collected. RESULTS: Researchers stated being more engaged in the passive strategies of knowledge transfer, especially those publishing in peer-reviewed journals. The mean score for the researchers' performance in passive and active strategies were 22% and 9% of the total score, respectively. Linear regression analysis showed that the passive strategy score decreased with the increase in the number of years working as a professional (p = 0.01) and personal interest as the only reason for choosing the research topic (p = 0.01). Regarding the active strategies of knowledge transfer, health system research studies significantly raised the score (p = 0.02) and 'executive responsibility' significantly lowered it (p = 0.03). CONCLUSION: As a study carried out in a Middle Eastern developing country, we see that, like many other universities in the world, many academicians still do not give priority to active strategies of knowledge transfer. Therefore, if 'linking knowledge to action' is necessary, it may also be necessary to introduce considerable changes in academic procedures and encouragement policies (e.g., employment and promotion criteria of academic members).