Knowledge production in Iranian social determinants of health research centers: Toward health equity.

Background: As the partner country of the WHO Commission on Social Determinants of Health (SDH), Iran has expanded the knowledge based on the social determinants of health- as one of commission recommendations- by establishing SDH research centers to collect evidence and design responses to the existing health equity gap. Considering the importance of the role assigned to these research centers, this study aimed to present the knowledge production of SDH research centers and determine their status in Iran's health research system (HRS). Methods: In this cross sectional study, research performance of SDH research centers was assessed based on international research indicators and compared with national medical research centers and HRS knowledge production. Then, SDH research centers were scored and ranked based on the research indicators. Results: Out of 37 approved SDH research centers, the knowledge performance of 33 research centers was reviewed. The total number of academic members was 334. The number of these centers' indexed published articles and the proportion of published articles per academic member have been doubled from 483 and 1.44 in 2015 to 984 and 2.94 in 2017. In this period, the number of citations of the past 5-year publications was 4355 according to Scopus database. The proportions of these centers' high-quality publication (Q1) and international collaborations per published articles were 14.8 and 8.25. In ranking, the first to third ranks were occupied by SDH research centers of Kermanshah, Kurdistan, and Qazvin Universities of Medical Sciences. Conclusion: Although knowledge production seems desirable in mentioned research centers, it is essential to create a virtual research network to increase intersectoral collaboration and develop strategies to solve the puzzle of gathering evidence on the social determinants affecting health inequities.

Local perceptions of mental health in Iran, Semnan Province.

INTRODUCTION: Understanding local perceptions of mental health in different cultures and contexts is crucial for designing and implementing appropriate mental healthcare services. METHODS: This qualitative study was conducted to investigate local perceptions of mental health in two highly populated provincial districts in Iran. Data were collected using the free list technique and interviews. A two-phase training workshop was held with the research team at a local health center, followed by a pilot study with the participation of six subjects. All the interviews were audio-recorded, transcribed, and then analyzed by the third and fourth authors in DEDOOSE. RESULTS: A total of 30 individuals (20 in the free list and 10 as key informants in the interviews) took part in the study. Based on the study findings and the key informants' ideas, mental health problems were categorized into three categories of depression, anxiety, and obsessive-compulsive disorder (OCD). CONCLUSIONS: Mental health problems appear to be expressed in different ways and with different symptoms in different cultures, and there is a distinct need for examining mental disorders in each culture and nationality separately using culturally appropriate tools for disease screening.

How Iranian lay people in three ethnic groups conceptualize a case of a depressed woman: an explanatory model.

OBJECTIVE(S): Although depression is a major public health problem, little is known about lay people's views of this subject in Iran. The aim of this study was to explore how depression in women is viewed among lay people in three major ethnic groups--Kurd, Turk, and Fars. DESIGN: Participants were selected from public urban healthcare centers. Four focus group discussions were conducted for each of the three ethnic groups and classified by level of education from three locations, in the capital city (Tehran), west (Ilam), and the northwest (Tabriz) of Iran. Twelve focus groups; 38 men and 38 women have been conducted by using a case vignette describing a woman with major depression. RESULTS: Depression symptoms were perceived as a temporary phenomenon. It was regarded as a colloquial term for feeling blue, mostly related to external stressors (social model). The common terms used in all ethnic groups were depression, and nerve/soul distress. Environmental cause and war were considered as external causes of the symptoms, and emotional factors, cognition distortion, and biological reasons, as internal factors. The participants believed it was necessary to seek help from religion, family and friends, positive thinking, and distraction from social problems, besides consultations with psychologists as counselors. Medication was often seen as the last resort. Stigma was mentioned as an important factor that makes people avoid visiting psychiatrists. CONCLUSION: These data may have implications for mental healthcare practice, especially for the approach to diagnosis of depression. Moreover, there is a need for developing and integrating gender-relevant and cultural indicators in the existing national mental health systems in Iran.

Knowledge production in Iranian cardiovascular research centers: A way to reduce the burden of disease.

BACKGROUND: According to the World Health Organization (WHO), non-communicable diseases (NCDs) including cardiovascular diseases (CVDs) will be responsible for almost 70% of all deaths in 2020. Therefore, knowledge production to find suitable ways to prevent, diagnosis, and effectively cover this disease in research centers is mandatory. Therefore, the present study is carried out with the aim to examine the results of studies performed in three years in Iranian cardiovascular centers. METHODS: Iranian cardiovascular research centers with more than three years of activity from 2015 to 2017 were evaluated. Research output, international collaboration, high quality publication, total citation, and average h-index (H) were evaluated and scored. RESULTS: 23 cardiovascular diseases research centers (CVDRCs) related to 15 universities of Medical Sciences (UMSs) were evaluated. The mean and standard deviation (SD) of age of the research activities in CVDRCs was 11.47 ± 8.60 years. Based on the research ranking, the first three centers were Isfahan Cardiovascular Research Center, Iran, Tehran Heart Center, and Shaheed Rajaei Cardiovascular Medical and Research Center, Iran, respectively, all of which have independent budget line. However, there is not any CVD research center in some provinces such as Zanjan, Kurdistan, Lorestan, and Arak, Iran. CONCLUSION: Mission oriented research activities in Iranian cardiovascular research centers may be effective in reducing the burden of CVDs. Moreover, establishment of CVD research centers in high risk areas may be useful.

Explanatory model of help-seeking and coping mechanisms among depressed women in three ethnic groups of Fars, Kurdish, and Turkish in Iran.

BACKGROUND: As one of the most prevalent diseases globally and as an important cause of disability, depressive disorders are responsible for as many as one in every five visits to primary care doctors. Cultural variations in clinical presentation, sometimes make it difficult to recognize the disorder resulting in patients not being diagnosed and not receiving appropriate treatment. To address this issue, we conducted a qualitative pilot study on three ethnic groups including Fars, Kurdish, and Turkish in Iran to test the use of qualitative methods in exploring the explanatory models of help-seeking and coping with depression (without psychotic feature) among Iranian women. METHODS: A qualitative study design was used based on an explanatory model of illness framework. Individual interviews were conducted with key informant (n=6), and depressed female patients (n=6). A hypothetical case vignette was also used in focus group discussions and individual interviews with lay people (three focus groups including 25 participants and six individual interviews; n=31). RESULTS: There were a few differences regarding help-seeking and coping mechanisms among the three ethnic groups studied. The most striking differences were in the area of treatment. Non-psychotic depressive disorder in all ethnicities was related to an external stressor, and symptoms of illness were viewed as a response to an event in the social world. Coping mechanisms involved two strategies: (1) solving problems by seeking social support from family and neighbors, religious practice, and engaging in pleasurable activities, and (2) seeking medical support from psychologists and family counselors. The Fars group was far more likely to recommend professional treatment and visiting psychiatrists whereas the other two ethnic groups (i.e., Turks and Kurds) preferred to consult family counselors, psychologists or other alternative care providers, and traditional healers. CONCLUSION: The study has educational and clinical implications. Cultural reframing of the patient's and family's perceptions about mental illness and depression may require community education. Family counseling, family therapy, and also religious practices can be used to empower the patient.

Assessment of Environmental Health Research Centers in Iran due to knowledge production and utilization.

BACKGROUND: Knowledge production in environmental health promotion is one of the most important goals at the national level and establishing environmental health research centers (EHRCs) is one of the main strategies that will lead to achieving this goal. In this study, we are going to present the results of knowledge production and research performance evaluation of EHRCs in Iran. METHODS: In this cross sectional study, a specific check list has been used to assess Knowledge production and utilization through annual evaluations undertaken by research centers in Iran. This article has the results of the 4-year evaluation (2011-2014). RESULTS: The total number of EHRCs under the supervision of universities of medical sciences (UMS) is 34. The number of faculty members at these centers is 291 and the total approved projects by research council of UMS during 2011-2014, were 538. The number of published article increased from 282 in 2011 to 709 in 2014. During this period, the number of citations to EHRCs' articles was 4488 in Scopus database. The number of EHRCs' articles which have been referred in text books were 39. The proportion of published articles per academic member in environmental health has been 1.8 per year. CONCLUSION: Based on research performance evaluation, knowledge production and research is desirable in EHRCs, but research utilization to health environmental promotion is still inadequate and should be assessed by qualitative evaluation.

Positive Mental Health from the perspective of Iranian society: A qualitative study.

Background: According to the World Health Organization, mental health relates, not only to the absence of mental disorder, but also to Positive Mental Health. Studies have shown that promoting positive mental health, not only reduces the prevalence and incidence of mental disorders, but also affects the process of treatment and reduces related burden. However, this concept has different interpretations in different cultures, and in many societies, mental health is still considered the absence of mental illness. Thus, the present study was conducted to provide an in-depth understanding of Iranian adults` perspective towards the concept of positive mental health. Materials and Methods: In the present qualitative study, eight focus group discussions (6 to 8 adults in each session) were held consisting of 30 to 60 year-old men and women from Tehran. Data were analyzed in "DeDoose" qualitative software using content analysis. Results: According to the data obtained, participants found no difference between positive mental health and mental health, mostly equating it to the absence of mental disorders and having positive energy, peace in and satisfaction with life. According to the results, positive mental health has four domains of emotional/psychological, spiritual, social, and life skills. Conclusion: Understanding an individual's positive mental health concepts culturally and providing appropriate community based programs can significantly promote the mental health of the community.

An explanatory model for the concept of mental health in Iranian youth.

Background: Mental health is considered as an integral and essential component of overall health. Its determinants and related factors are one of the most important research priorities, especially in adolescents and young people. Using a qualitative approach, the present study aimed to identify factors affecting the mental health of youth in Iran. Methods: In 2017, following content analysis principles, and using semi-structured in-depth interviews, we conducted a qualitative study exploring the opinions of young people about mental health. A targeted sampling method was used, and participants were young volunteers aged 18 to 30 who were selected from Tehran province, Iran. Inclusion criteria for participants was willingness to participate in the study, and ability to express their experiences. Data collection was done with individual in-depth interviews. According to the explanatory model, the interviews were directed toward the concept of mental health and path of causality and auxiliary behaviors. Results: 21 young adults participated, who met the study inclusion criteria, of whom 12 participants were male. Their mean age was 24.4 ± 0.41 years and their education varied from primary school to Master's degree. Mental health was considered as mental well-being and a sense of satisfaction and efficacy, not only the presence of a disease or mental disorder. Based on the opinions of the interviewees, three factors of personal characteristics, family and society are involved in mental health. Individual factors were associated with behavioral and physical problems. One of the most important issues was revealed as tensions in societal and family conflicts. Economic problems and unemployment of young people were also extracted from the social factor. Conclusion: In Iran, social factors such as jobs for the unemployed and job security are considered as important determinants in the mental health of young people.

Medical Science and Research in Iran.

BACKGROUND: During the last 3 decades, Iran has experienced a rapid population growth and at the same time the health of Iranian people has improved greatly. This achievement was mainly due to training and availability of health manpower, well organized public health network and medical science and research improvement. In this article, we aimed to report the relevant data about the medical science and research situation in Iran and compare them with other countries. METHODS: In this study, after reviewing science development and research indicators in medical sciences with participation of key stakeholders, we selected 3 main hybrid indexes consisting of "Research and Development (R&D) expenditures," "Personnel in Science and Technology sector" and "knowledge generation" for evaluation of medical science and research situation. Data was extracted from reliable databases. RESULTS: Over the past decade, Iran has achieved significant success in medical sciences and for the first time in 2015 based on Scopus index, Iran ranked first in the number of published scientific papers and number of citations in the region and among all Islamic countries. Also, 2% of the world's publications belong to Iran. Regarding innovation, the number of Iranian patents submitted to the United States Patent and Trademark Office (USPTO) was 3 and 43 in 2008 and 2013, respectively. In these years, the number of personnel in science and technology sectors including post graduate students, researchers and academic members in universities of medical sciences (UMSs) have increased. The female students in medical sciences field account for about twothirds of all students. Also, women comprise about one-third of faculty members. Since 5 years ago, Iran has had growth in science and technology parks. These achievements were attained in spite of the fact that research spending in Iran was still very low (0.5% of gross domestic product [GDP]) due to economic hardships and sanctions. CONCLUSION: Medical science and research development has been at least partially due to health technological development, training and availability of health manpower and improvement of overall health status in Iran compared to other Islamic countries.

The evaluation of a virtual education system based on the DeLone and McLean model: A path analysis.

Background: The Internet has dramatically influenced the introduction of virtual education. Virtual education is a term that involves online education and e-learning. This study was conducted to evaluate a virtual education system based on the DeLone and McLean model. Methods: This descriptive analytical study was conducted using the census method on all the students of the Nursing and Midwifery Department of Alborz University of Medical Sciences who had taken at least one online course in 2016-2017. Data were collected using a researcher-made questionnaire based on the DeLone and McLean model in six domains and then analyzed in SPSS-16 and LISREL-8.8 using the path analysis. Results: The goodness of fit indices (GFI) of the model represent the desirability and good fit of the model, and the rational nature of the adjusted relationships between the variables based on a conceptual model (GFI = 0.98; RMSEA = 0.014).The results showed that system quality has the greatest impact on the net benefits of the system through both direct and indirect paths (ß=0.52), service quality through the indirect path (ß=0.03) and user satisfaction through the direct path (ß=0.73). Conclusions: According to the results, system quality has the greatest overall impact on the net benefits of the system, both directly and indirectly by affecting user satisfaction and the intention to use. System quality should therefore be further emphasized, to use these systems more efficiently.

Research Ranking of Iranian Universities of Medical Sciences Based on International Indicators: An Experience From I.R. of Iran.

BACKGROUND: In recent years, international ranking systems have been used by diverse users for various purposes. In most of these rankings, different aspects of performance of universities and research institutes, especially scientific performance, have been evaluated and ranked. In this article, we aimed to report the results of research ranking of Iranian universities of medical sciences (UMSs) based on some international indicators in 2015. METHODS: In this study, after reviewing the research indicators of the majority of international ranking systems, with the participation of key stakeholders, we selected eight research indicators, namely research output, high-quality publications, leadership, total citations, citations per paper in 2015, papers per faculty member and h-index. The main sources for data gathering were Scopus, PubMed, and ISI, Web of Science. Data were extracted and normalized for Iranian governmental UMSs for 2015. RESULTS: A total of 18023 articles were indexed in 2015 in Scopus with affiliations of UMSs affiliation. Almost 17% of all articles were published in top journals and 15% were published with international collaborations. The maximum h-index (h-index = 110) belonged to Tehran University of Medical Sciences. The average paper per faculty member was 1.14 (Max = 2.5, Min = 0.13). The mean citation per published articles in Scopus was 0.33. CONCLUSION: Research ranking of Iranian UMSs can create favorable competition among them towards knowledge production.

How to Assess Quality of Research in Iran, From Input to Impact? Introduction of Peer-Based Research Evaluation Model in Iran.

BACKGROUND: Research evaluation is a systematic and objective process to measure relevance, efficiency and effectiveness of research activities, and peer review is one of the most important tools for assessing quality of research. The aim of this study was introducing research evaluation indicators based on peer reviewing. METHODS: This study was implemented in 4 stages. A list of objective-oriented evaluation indicators were designed in 4 axes, including; governance and leadership, structure, knowledge production and research impact. RESULTS: The top 10% medical sciences research centers (RCs) were evaluated based on peer review. Adequate equipment and laboratory instruments, high quality research publication and national or international cooperation were the main strengths in medical sciences RCs and the most important weaknesses included failure to adhere to strategic plans, parallel actions in similar fields, problems in manpower recruitment, knowledge translation & exchange (KTE) in service providers and policy makers' levels. CONCLUSION: Peer review evaluation can improve the quality of research.

The Role of Medical Research Centers in Health Research System Promotion in I.R. of Iran: 2001-2014.

BACKGROUND: Research centers, defined as organized research units having research as their primary mission, are positioned as an organizational solution to tighten the knowledge to do gap in health research system (HRS). Therefore, this study aims to explore the roles of medical research centers (MRCs) in promoting HRS. METHODS: In this cross-sectional study, we reviewed the evaluation results of research performance of MRCs from 2001 to 2014. Data of evaluation indicators (in knowledge production and capacity building domains) were gathered and finally compared for these years. RESULTS: In the mentioned period, the number of medical research centers has grown by more than 11 folds. In the domain of knowledge production, the total number of published articles and published articles in ISI, Web of Science per researcher rose from 0.5 and 0.05 to about 3.5 and 1.2, respectively. The number of indexed articles in scientific international databases has increased more than 66 times and the total number of citations of MRCs' articles has increased to more than 80000. In the domain of capacity building, the trend of workshops and held congresses is ascending. CONCLUSION: MRCs are well empowered in knowledge production in national HRS.

Health Research Governance: Introduction of a New Web-based Research Evaluation Model in Iran: One-decade Experience.

BACKGROUND: Governance is one of the main functions of Health Research System (HRS) that consist of four essential elements such as setting up evaluation system. The goal of this study was to introduce a new web based research evaluation model in Iran. METHODS: Based on main elements of governance, research indicators have been clarified and with cooperation of technical team, appropriate software was designed. Three main steps in this study consist of developing of mission-oriented program, creating enabling environment and set up Iran Research Medical Portal as a center for research evaluation. RESULTS: Fifty-two universities of medical sciences in three types have been participated. After training the evaluation focal points in all of medical universities, access to data entry and uploading all of documents were provided. Regarding to mission - based program, the contribution of medical universities in knowledge production was 60% for type one, 31% for type two and 9% for type three. The research priorities based on Essential National Health Research (ENHR) approach and mosaic model were gathered from universities of medical sciences and aggregated to nine main areas as national health research priorities. Ethical committees were established in all of medical universities. CONCLUSION: Web based research evaluation model is a comprehensive and integrated system for data collection in research. This system is appropriate tool to national health research ranking.

How Iranian women conceptualize mental health: an explanatory model.

BACKGROUND: In Iran, more than 25% of women suffer from mental disorders. Mental disorders and subclinical problems are associated with socioeconomic problem. At the community level, mental health promotion can reduce social damage. The aim of this study as a part of community based mental health promotion intervention was to explore how mental health in Iranian women is viewed. METHODS: According to a qualitative method in 2012, participants were selected by purposeful sampling from married women 18 to 65 years who are residents in Tehran. Fifteen in depth individual interviews were conducted with regard to the concept of mental health, causal pathway and help-seeking behavior according to explanatory model. RESULTS: Mental health was perceived as the same of emotional well-being. It conceptualized not only lack of mental disorder but also sense of satisfaction and healthy functioning. According to participant's view, the causal pathway of mental health problems were classified to individual, familial and social factors. Physical and behavioral problems were related to individual factor, Lack of marital adjustment was one of the most important issues in familial item and in social factor, cultural context and socio-economic problems were extracted. In help seeking process, all of the participants believed that the religion has important effect in mental health. CONCLUSION: Marital adjustment is an important stage in process of mental health in women.

Relationship between ways of coping and quality of life in married women: toward mental health promotion.

BACKGROUND: Adaptive ways of coping with stress are as a major component of mental health and also this is considered as a key element in quality of life. OBJECTIVES: The aim of this study was to investigate the relationship between quality of life and coping mechanisms in married women ages between 18-65 years in order to develop appropriate intervention programs to promote mental health. PATIENTS AND METHODS: THIS STUDY WAS A PART OF INTERVENTIONAL PROJECT TO MENTAL HEALTH PROMOTION IN MARRIED WOMEN THAT COMPLETED THROUGH A CROSS SECTIONAL STUDIES USING TWO STANDARD QUESTIONNAIRES: Ways of Coping (WOC) and Quality of Life questionnaire (WHO, QOL-BREF). RESULTS: The most and the least used ways in coping with stress were Planful Problem Solving and Confronting Coping. Considering the quality of life, the most and the least scores were related to social dimension and mental health. Also women who have higher quality of life used more Positive Reappraisal way and less Escape-Avoidance way to deal with stress (P < 0.05). CONCLUSIONS: It seems that implementation of an appropriate interventional program related to adaptive ways of coping in order to deal with stress is effective in mental health and quality of life promotion.

Service Users and Providers Expectations of Mental Health Care in Iran: A Qualitative Study.

BACKGROUND: Mental disorders are known to be an important cause of disabilities worldwide. Despite their importance, about two thirds of mentally ill people do not seek treatment, probably because of the mental health system's inability to decrease the negative side effects of the interaction with the mental health services. The World Health Organization has suggested the concept of responsiveness as a way to better understand the active interaction between the health system and the population. This study aimed to explore the expectations of mental health service users and providers. METHODS: Six focus group discussions were carried in Tehran, the capital of Iran. In total, seventy-four participants comprising twenty-one health providers and fifty-three users of mental health system were interviewed. Interviews were analyzed through content analysis. The coding was synchronized between the researchers through two discussion sessions to ensure the credibility of the findings. The results were then discussed with two senior researchers to strengthen plausibility. RESULTS: Five common domains among all groups were identified: accessibility, quality of interpersonal relationships, adequate infrastructure, participation in decisions, and continuity of care. The importance of cultural appropriateness of care was only raised by service users as an expectation of an ideal mental health service. CONCLUSIONS: Both users and providers identified the most relevant expectations from the mental health care system in Iran. More flexible community mental health services which are responsive to users' experiences may contribute to improving the process of care for mental health patients.

Health research system evaluation in I.R. of Iran.

BACKGROUND: Several systems have been proposed to rank academic institutions worldwide. We aimed to introduce a new method of Health Research System (HRS) evaluation in Iran. METHODS: In this cross-sectional study, a specific questionnaire has been used to assess stewardship, capacity building, and knowledge production through annual evaluations of HRS in Iran. This article has explored the results of the 5-year evaluation (2003 - 2008) and aims to introduce this method to other developing countries. RESULTS: According to our study, in the stewardship axes, all medical science universities designed strategic plans by 2008 and 70% of the approved projects were based on priorities. In the domain of capacity building, the trend in the number of arranged workshops and held congresses is ascending. In the domain of knowledge production, the number of Iranian biomedical research articles increased from 2996 in 2003 to 8816 in 2008.The proportion of ISI Web of Science/Pub Med indexed articles per academic members also increased from 0.09 to 0.33. CONCLUSION: We conclude that HRS evaluation in Iran has supported knowledge production and has strengthened evidence-based policy making. The adapted ranking system for evaluation of medical research activities is an effective strategy for HRS promotion.