Factors facilitating and inhibiting the social participation of the elderly in health-oriented activities in Shiraz, Southern Iran.

BACKGROUND: The social participation (SP) of the elderly is one of the factors that contribute to the improvement of their well-being. SP, one of the most important factors of active ageing, is mainly influenced by a number of facilitating or inhibiting factors. AIMS: This study aimed to identify the factors that prevent and facilitate the SP of the elderly population in Iran. METHODS: A cross-sectional study carried out in Shiraz, southern Iran in 2021. Participants were selected using a convenience sampling method. Shiraz is divided into 11 districts and the largest park in each district is selected for data gathering. The questionnaires were completed by 612 people aged over 60. Data were collected using the Canadian Elderly Survey Project scale and a health-related lifestyle questionnaire and were analyzed using t-test, ANOVA, Pearson's correlation, and ANCOVA. RESULTS: The mean SP score of the elderly in Shiraz was 24.2 out of 60, which is below the midpoint. The results of the covariance analysis revealed that the SP had a significant relationship with the experience of physician consultation, cost barriers, age, marital status, income level, and education level (P < 0.001). Moreover, the results of Pearson correlation revealed a significant correlation between SP and different dimensions of health-oriented activities (< 0.001). CONCLUSIONS: This study revealed that the main barriers to older people's participation in health-related activities are cost and access barriers, such as transportation issues. Moreover, higher income level and higher educational attainment have been recognized as the main facilitators of SP in the elderly. In this regard, it can be suggested to apply a combination of health promotion strategies, financial support programs, and development of optimal transportation infrastructure to increase the SP of the elderly.

Analyzing the interaction of main components of hidden curriculum in medical education using interpretive structural modeling method.

BACKGROUND: Hidden curriculum (HC) is considered as unintended learning experiences in medical education (ME). This may include values, norms, beliefs, skills, and knowledge which could potentially influence learning outcomes. HC has key components that must be identified and considered properly by individuals and organizations involved in ME. OBJECTIVES: This study aimed to determine the main components of hidden curriculum in medical education (HCME) and the interrelationships among them. METHODS: In this mixed-method study initially we performed a scoping review and determined the main components of HCME using qualitative content analysis approach. Then, the interrelationships among these components were investigated using Interpretive Structural Modeling (ISM). RESULTS: Ten key components for HCME were identified in scoping review. We classified them into four main categories including structural, educational, cultural, and social factors. The ISM analysis revealed that organizational rules and structure, dominant culture of educational environments, teaching and assessment approaches, as well as clinical and educational physical setting were the independent or driving factors. While, social components were dependent and influenced by basic components. CONCLUSION: The ISM model indicated that role modeling behaviors and interpersonal relationships (social factors) are under influence of underlying organizational and educational factors. These results should be considered at all stages of educational management including planning process, implementation of the programs, and development of formal curricula. According to the importance of contextual factors, components of HC must be analyzed and interpreted based on the specific conditions of each educational institution.

Income inequality among general practitioners in Iran: a decomposition approach.

BACKGROUND: General practitioners (GPs) are among the most important resources of healthcare system and public health is considerably influenced by the function of this group. Income inequality among GPs considerably affects the motivation and performance of this group. The present study aims to examine the income inequality among Iranian GPs in order to provide the necessary evidence for health human resource policy. METHODS: In this cross-sectional study, the distribution of income and wage inequality among GPs was investigated using income quintiles. We also used the Dagum's model to analyze the inequality between different groups of GPs through the decomposition of the Gini coefficient. Moreover, a regression model was used to determine the effective factors on GPs' income. RESULTS: The results of this study indicated that income and wages of GPs in the highest quintile were eight times more than those of doctors at the lowest quintile. Regression estimates showed that factors such as gender, practice setting, and activity as the family physician (P < 0.001) were effective on income of GPs; and also male and self-employed GPs had significantly more wage (P < 0.001). Total Gini coefficient of GPs' income and wage were estimated at 0.403 and 0.412, respectively. Highest monthly income was found in GPs with 16-20 years practice experience ($8358) based on Purchasing Power Parity (PPP), male ($8339 PPP), and self-employed GPs ($8134 PPP) subgroup. However, the female ($5389 PPP) and single ($5438 PPP) GPs had the lowest income. Population share; income/wage share; income/wage mean; Gini coefficient; and within, between and overlap decomposed components of Gini coefficient are also reported for each GPs subgroups. CONCLUSIONS: We found significant inequalities in income and wages among Iranian GPs. Adjustment of income based on working hours indicated that one of the most common causes of income inequality among GPs in Iran was different workloads among different groups. Since the motivation and function of physicians can be influenced by income inequality, policymakers in the health system should consider factors increasing such inequalities.