Transcending technology boundaries and maintaining sense of community in virtual mental health peer support: a qualitative study with service providers and users.

BACKGROUND: This qualitative study explores the experiences of peer support workers (PSWs) and service users (or peers) during transition from in-person to virtual mental health services. During and following the COVID-19 pandemic, the need for accessible and community-based mental health support has become increasingly important. This research aims to understand how technological factors act as bridges and boundaries to mental health peer support services. In addition, the study explores whether and how a sense of community can be built or maintained among PSWs and peers in a virtual space when connections are mediated by technology. This research fills a gap in the literature by incorporating the perspectives of service users and underscores the potential of virtual peer support beyond pandemic conditions. METHODS: Data collection was conducted from a community organization that offers mental health peer support services. Semi-structured interviews were conducted with 13 employees and 27 service users. Thematic analysis was employed to identify key themes and synthesize a comprehensive understanding. RESULTS: The findings highlight the mental health peer support needs that were met through virtual services, the manifestation of technology-based boundaries and the steps taken to remove some of these boundaries, and the strategies employed by the organization and its members to establish and maintain a sense of community in a virtual environment marked by physical distancing and technology-mediated interrelations. The findings also reveal the importance of providing hybrid services consisting of a mixture of in person and virtual mental health support to reach a broad spectrum of service users. CONCLUSIONS: The study contributes to the ongoing efforts to enhance community mental health services and support in the virtual realm. It shows the importance of virtual peer support in situations where in-person support is not accessible. A hybrid model combining virtual and in-person mental health support services is recommended for better accessibility to mental health support services. Moreover, the importance of organizational support and of equitable resource allocation to overcome service boundaries are discussed.

Work-life boundary management of peer support workers when engaging in virtual mental health support during the COVID-19 pandemic: a qualitative case study.

BACKGROUND: Mental health care needs have increased since the COVID-19 pandemic was declared. Peer support workers (PSWs) and the organizations that employ them have strived to provide services to meet increasing needs. During pandemic lockdowns in Ontario, Canada, these services moved online and were provided by PSWs from their homes. There is paucity of research that examines how providing mental health support by employees working from home influences their work-life boundaries. This research closes the gap by examining experiences of work-life boundary challenges and boundary management strategies of PSWs. METHODS: A qualitative case study approach was adopted. Interviews with PSWs who held formal, paid positions in a peer support organization were conducted. Data was analyzed thematically using both inductive and deductive approaches. Descriptive coding that closely utilized participants' words was followed by inferential coding that grouped related themes into conceptual categories informed by boundary theory. Member checking was conducted. RESULTS: PSWs provided accounts of work-life boundary challenges that we grouped into three categories: temporal (work schedule encroachments, continuous online presence), physical (minimal workspace segregation, co-presence of household members and pets) and task-related (intersecting work-home activities). Strategies used by PSWs to manage the boundaries consisted of segmenting the work-life domains by creating separate timescapes, spaces and tasks; and integrating domains by allowing some permeability between the areas of work and life. CONCLUSION: The findings from this study can help inform management, practices, future research and policy on health care workforce. The study highlights the need to attend to the consequences of greater work-life integration for mental health workers since their successful practice is largely dependent on maintaining self-care. Training regarding work-life boundary management is highlighted as one of the ways to approach situations where work from home is required.

A Narrative Review of Factors Influencing Peer Support Role Implementation in Mental Health Systems: Implications for Research, Policy and Practice.

With increasing calls to incorporate recovery principles into conventional mental health care, the importance of peer support worker (PSW) services has gained attention. However, studies consistently show that PSWs remain underutilized. Although research addresses several factors that influence formal implementation of their role, there is lack of a comprehensive framework that synthesizes the factors and addresses their interlevel interactions. This paper provides a narrative review and synthesis of literature on multilevel factors that influence formal PSW role implementation in mental health systems. We conducted a search of literature and reviewed 38 articles that met inclusion criteria. Our thematic analysis involved identifying first and second order categories that applied across studies, and developing third order interpretations through iterations. We synthesized the findings in a multilevel framework consisting of macro, meso and micro level influences. Influencing factors at the macro level include broader socio-cultural factors (medical model, recovery values, professional power dynamics, training and certification), regulatory and political factors (policy mandates, political commitment), and economic and financial factors (funding, affordability of services). Factors at the meso level include organizational culture, organizational leadership, change management, and human resource management policies. Micro level influences pertain to relationships between PSWs and team members, and PSW wellbeing. Interlevel interactions are also outlined. Limitations and implications for research, policy and practice are addressed.

Projection of Health Sector Workforce Requirement: Vision 2025.

BACKGROUND: This study was conducted with a long-term vision (2014-2025) targeted workforce requirement projection by occupational groups in Iran's health sector. METHODS: The "modified & combined model" used including Hall Model and Australian health workforce estimation model. It was a need-based approach with three components of estimation; requirements, supply with current growth and net required workforce. Requirement estimated by three assumptions: active workforce calculation; the growth of health service delivery resources and facilities; and daily individual working hours, created eight different scenarios. Economic feasibility of each scenario determined. To forecast the supply, used accurate numbers of the existing pool of practicing workforce in addition to inflows, minus losses from the profession. To calculate total recruits required, base year stock deducted from projected requirement and by adding Net flow, recruits required calculated. RESULTS: The health sector will need 781,887 workforces to realize service's needs. Workforce supply with the existing trend in the target year was 799,347. Therefore, workforce balance would be 17,460 surpluses. Moreover, to estimate required workforce and substitution number for the exited ones during the study periods till the target year, 547,136 individuals should be recruited mostly nurses and physicians. CONCLUSION: Limiting the workforce required to economic feasibility challenge workforce accessibility in the future as it is sensed in present tense as well. Therefore, in addition augmenting GDP and health funds, it is necessary alternative policies such as increasing share of health sector from GDP, prioritization of workforce needs or moving towards other proper policies.

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

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

Estimate General Practitioners Active Supply in Iran: Capture-Recapture Method for Three Data Sources.

BACKGROUND: Accurate estimation of active general practitioners (GPs) is a concern for health authorities to estimate requirements. This study aimed to accurately estimate GPs active supply in Iran using three sources capture-recapture (CRC) method. METHODS: This cross-sectional study collected data during 2015-2016, targeting all GPs registered in three independent data sources; a national survey from all hospitals, database of human resource management office at health ministry and physicians' offices databank. Variables including medical council codes, GP names, surnames and national ID codes were used for data linkage among the three sources. Three sources CRC method was applied using log-linear models to estimate the total number of active GPs in STATA software. RESULTS: Overall, 27,048 GPs were identified after removing the duplicate records. Based on CRC three sources data, the total number of GPs were 53,630 in 2015-2016. Distribution of GPs per 1,000 population among the provinces indicates that provinces of Kohgiluyeh & Boyer Ahmad, Mazandaran, Golestan and Yazd with ratios of 1.28, 1.28, 1.21 and 1.17 physicians rank the highest proportion of GPs and the provinces of Sistan & Baluchestan, Ilam, Zanjan, Alborz, North Khorasan with corresponding ratios of 0.24, 0.40, 0.40, 0.43 and 0.45 GPs ranked the lowest. CONCLUSION: CRC method is known to be the best and rapidest method to estimate active GP due to its compatibility for the current situation of databanks in Iran. Therefore, this method is a good application in human resource distribution and planning.

Human resources for health strategies: the way to achieve universal health coverage in the Islamic Republic of Iran.

BACKGROUND: It is impossible to achieve universal health coverage (UHC) without an adequate, competent and motivated workforce. AIMS: The study aimed to describe how the Iranian health sector has formulated its human resources strategies to achieve UHC. METHODS: This was a qualitative study using a conceptual framework approach to content analysis. Primary data were gathered through expert focused group discussions and document analyses. Both transcribed discussions and the selected documents were analysed using in-depth thematic analysis. A conceptual framework from the Global Health Workforce Alliance was used for content analysis and to draft and develop the strategies. The framework suggested five human resources for health (HRH) pathways to achieve UHC aspects structured according to availability, accessibility, acceptability and quality. RESULTS: Thirty strategies were formulated for Iranian HRH. Eleven of the developed strategies were related to the field of education and training, such as development of new required academic disciplines; balancing university admissions based on workforce requirements; and enrolling local students from deprived and underserved areas. Ten of the developed strategies were structured under the workforce accessibility dimension. CONCLUSIONS: Strategies for HRH were formulated by adopting a comprehensive, scientific and collaborative approach to ensure alignment with the country's health system priorities and Global Strategy on Human Resources for Health to overcome health workforce challenges.

Effect of dual practice on service delivery time by surgeons in the Islamic Republic of Iran: multi-level analysis of a national survey, 2016.

BACKGROUND: One of the work patterns which affects the supply of specialists is the phenomenon of dual practice (DP), i.e., working simultaneously in the public and private sectors. Uncontrolled DP in the surgery health workforce can have adverse effects on access to surgeons, efficiency, effectiveness and quality of surgery services. AIMS: The aim of this article is to examine the impact of DP on service delivery time by surgeons. METHODS: We used a prestructured form to collect data on surgery specialists in all 925 Iranian hospitals. National medical ID codes, council ID codes, first name, surname and father's name were used for data matching. Multilevel linear regression was used to assess the association between DP and study variables, which were recruitment type, faculty status, experience, sex and age. RESULTS: The 4642 surgery specialists in this study, representing 31.08% of the total number of surgeons identified, spent mean 1.09 (standard deviation 0.33) hours full-time equivalent (FTE) on health care service delivery. Specialists with DP had long service delivery time (ß = 0.427). Female specialists (ß = -0.049) and full-time specialists (ß = -0.082) spent less time on health care service delivery. Permanent specialists had higher FTE (P < 0.001) and as the population increases, FTE increases (P < 0.05). CONCLUSIONS: Although DP had a direct impact on surgeons' working hours, it seems that a greater share of the difference in working time was used in the private sector services, leading to poor access to surgery services in the public sector. Therefore, it is necessary to develop a systems approach to regulate DP.

Factors influencing medical specialists' dual practice in the Islamic Republic of Iran.

BACKGROUND: Dual practice (DP) is performing several different jobs at the same time and has effects on healthcare services delivery. AIMS: To identify the causes of medical specialists' tendency towards DP in the Islamic Republic of Iran. METHODS: We used a qualitative approach to identify the factors affecting DP in medical specialists in 2016. We used a purposive and outlier sampling method to conduct semistructured deep interviews with 14 key informants. The data analysis was performed simultaneously with data collection using thematic content analysis by MAXQDA (version 10.0). Interviews continued up to data saturation. The quality of the study was ensured by addressing the criteria of Guba and Lincoln. RESULTS: The results of the interviews showed six themes and 16 subthemes for specialists' propensity to DP. Major themes included financial incentives, cultural attitudes about professional identity of physicians, experience and academic level of specialists, controlling approaches in the public sector, available infrastructure for responding to the population needs in the public sector, and regional characteristics of health service locations. CONCLUSIONS: Medical specialists' DP is a multidimensional issue, influenced by different factors such as financial incentives, cultural attitudes and available infrastructure. Considering the capacities and conditions of each country, control and management of this phenomenon require regulatory and incentive mechanisms, which in the long term can modify private and public sector differences and increase the willingness of doctors to work in the public sector.

Extent and nature of dual practice engagement among Iran medical specialists.

BACKGROUND: Dual practice (DP) by medical specialists is a widespread issue across health systems. This study aims to determine the level of DP engagement among Iran's specialists. METHODS: A pre-structured form was developed to collect the data about medical specialists worked in all 925 Iran hospitals in 2016. The forms were sent to the hospitals via medical universities in each province. The data were merged at the national level and matched using medical council ID codes, national ID codes, and eventually a combination of the first name, surname, and father's name. RESULTS: A total of 48 345 records were collected for 30 273 specialists from 858 (93%) hospitals out of total 925 hospitals. Sixteen thousand eight hundred forty-nine (69% of) specialists were non-faculty members and 6317 (26% of) specialists were employed on a contract basis. Eleven thousand six hundred and thirty-eight (47.7% of) specialists were engaged in DP on total. Female specialists had 0.78 times less DP chance; faculties compared to non-faculties had 0.65 times more DP chance and full-time geographic specialists compared to non-full-time specialists had 0.15 times more DP chance. DP was more frequent in specialists with higher age and more job experience and in provinces with more population, deprivation, and higher number of specialists per facility (P < 0.05). CONCLUSIONS: The level of DP is relatively high among Iran medical specialists, especially in geographic full-time specialists. However, they are totally banned and they receive extra payment for being full-time; restrictive regulations and financial incentives without considering other factors might not eliminate DP in specialists and it should be addressed based on conditions of each country and regions inside the country.