Willingness to pay for cataract surgery and its associated factors in selected medical centers in Urmia, Iran.

INTRODUCTION: Cataracts represent a significant public health issue and are the most prevalent vision disorder following refractive errors. They can restrict the economic, social, and psychological activities of those affected, thereby diminishing their quality of life. This study was undertaken to examine the willingness to pay for cataract surgery and the factors influencing this decision in selected medical centers in Urmia. The two-stage Heckman model was utilized to aid decision-making in financing this service. METHODS: This research was a descriptive-analytical study evaluating the economic aspects of health interventions, conducted from the patient's perspective. In this cross-sectional study, a sample size of 217 patients with cataract issues was selected using Michel Carson's table. These patients were from Imam Khomeini Hospital and Aftab Urmia Surgery Center in 2023. Data was collected using a conditional valuation approach to determine the maximum amount patients were willing to pay, as gathered through a questionnaire. The factors influencing the willingness to pay for cataract surgery were estimated using the two-stage Heckman regression model. The final effect value of each variable was calculated using Stata version 14 software. RESULTS: In this study, 81.11% of participants (176 individuals) expressed a willingness to pay for cataract surgery, with the average amount they were willing to pay being $206.3. However, out of the 217 respondents, 41 rejected the proposed amounts and were not willing to pay anything. The results of the Hemken model indicated that the income of patients and the size of their households significantly influenced their willingness to pay for cataract surgery. However, other variables investigated did not have a significant impact. CONCLUSION: The study results revealed a significant influence of both income and household size on the likelihood of willingness to pay, as well as the extent of willingness to pay for cataract surgery. Consequently, it is crucial to formulate policies and provisions that guarantee access to cataract services, particularly for individuals from large households with low income and high costs.

Development of a HIV Prevention Program to Promote Condom Use Among Iranian Female Sex Workers: Application of An Intervention Mapping Approach.

We used an Intervention Mapping Approach (IMA) to derive multi-level HIV prevention strategies aiming to develop an HIV prevention intervention program among female sex workers (FSWs). We also aimed at pilot testing the effects of the IMA-based "HIV Prevention and Awareness Program (HIV-PAP)" on safe sex behaviors and its determinants among FSWs in Tabriz, Iran. To develop HIV-PAP, we conducted the six-step process of IMA. At Step 1, in a cross-sectional study, 140 FSWs were face-to-face interviewed. At Step 2, the program matrix was provided based on the importance and variability for identifying priority factors. At Steps 3 and 4, the methods and strategies for behavioral change were selected, and the HIV-PAP program components and materials were developed. At Steps 5 and 6, evaluation (as a pilot testing with Static-Group Comparison design) was conducted applying a pre-experimental study, in which 30 FSWs were assigned to intervention (n = 15) and control (n = 15) groups. The intervention group participated in a two-month long program, and one month later, the initial questionnaires were completed by both groups. The respondents (M age: 33.4 years, SD: 9.7) acquired low score (less than 50%) in negotiating for condom use (49.8%) only, and moderate scores (50-65%) in perceived social support (61.6%) and knowledge (60.5%). Adjusted for other variables, the factors (R2 = 32.0%) associated with safe sex behaviors among FSWs were predisposing factors [self-efficacy (ß = 0.331), perceived norms (ß = 0.945), and perceived barriers (ß = 0.258)], condom use negotiation (ß = 1.386), and environmental factors (ß = 0.333). Our IM-based framework had an adequate fit index (χ2 = 130.8, CFI = 0.78). Looking for inter-group comparison after intervention, we found significant mean difference (MD) for knowledge (MD: 2.18; 95% Confidence Interval (CI) - .38 to 4.74, p < 0.05), self-efficacy to use condom (MD: 6.71; 95% CI - 1.85 to 9.29, p < 0.05), perceived risk (MD: 2.03; 95% CI 0.58, to 3.49, p < 0.05), perceived social support (MD: 4.64; 95% CI - 5.37 to 11.31, p < 0.01), and safe sexual behaviors (MD: 7.75; 95% CI - 4.19 to 9.71, p < 0.05). The HIV-PAP showed effectiveness in promoting safe sexual behaviors and their determinants among FSWs. Healthcare providers should better understand the determinants of safe sexual behaviors among FSWs in the settings with legal prohibitions for sex work. In such communities, they should try to either develop or adapt such stage-specific interventions, within which promoting the above-mentioned factors is the core priorities of the program.

The stochastic frontier analysis technique in measuring the technical and economic efficiency of hospital diagnostic laboratories: a case study in Iran.

An inefficient health system wastes scarce resources even if it makes considerable gains in accountability and equity. Such a system is expected to perform better. Therefore, it is vital to examine the current performance of health systems and their constituents and assess how to reach their maximum potential. This study aimed to evaluate the technical and economic efficiency of medical diagnostic laboratories in hospitals affiliated with Urmia University of Medical Sciences (UUMS) in 2016. In this descriptive-analytical study, data from diagnostic laboratories of the hospitals of UUMS have been inputted into Frontier4.1 software after taking the log of variables. Then, the technical and economic efficiency of the laboratories were obtained by estimating the production and cost function using the stochastic frontier analysis method, assuming input minimization for 2016. The mean technical and economic efficiency score of the diagnostic laboratories were determined to be 93.1% and 51.9%, respectively. These laboratories need to reduce their inputs and costs in order to achieve full efficiency without changing the amount of their output. Although the average economic efficiency of the diagnostic laboratories of the studied hospitals was high, there is still an increase in the efficiency of these units, given the cost of inputs at the time of allocating resources. In addition, it is possible to improve the technical efficiency of the clinical laboratories of hospitals affiliated with UUMS by 48.1% by applying the same level of inputs and without increasing the costs.

Predictors of Dengue Preventive Practices Based on Precaution Adoption Process Model among Health Care Professionals in Northwest of Iran.

Background: Dengue fever as a mosquito-borne disease, has rapidly spread due to climate change, globalization, and human behavior. Iran is prone to dengue fever, as its vector recently has been found in the country. This study aimed to assess predictors of dengue preventive practices based on Precaution Adoption Process Model (PAPM) factors in West Azerbaijan province, northwest of Iran. Methods: This cross-sectional study conducted on 405 health professionals of communicable disease sector who were interested in study participation. Data-gathering instrument was an online researcher-made questionnaire consisting of demographic characteristics (11 items), questions based on PAPM, and dengue preventive practices (85 items). Content validity and reliability of the instrument, content validity ratio, content validity index, and Cronbach α were utilized, respectively. Descriptive, analytical, and regression analysis using SPSS and STATA were examined. Results: Regression analysis revealed that awareness of appropriate actions for dengue prevention was a stronger predictor of preventive practice in borderline and appropriate categories (ß= 4.09, p< 0.001) and (ß= 4.42, p< 0.001), respectively. Among factors of PAPM, beliefs about precaution effectiveness and difficulty in borderline (ß= 1.04, p= 0.04) and appropriate (ß= 1.12, p= 0.03) groups had direct and significant relation with dengue preventive practice. Conclusion: The highest mean score of beliefs about hazard likelihood and severity factor was related to dengue prevention. Therefore, theory-based interventions that address beliefs about precaution effectiveness and difficulty can lead to assistance in acting. To improve dengue preventive practices, a well-designed promotive intervention that addresses associated factors in a context-specific manner is essential.

"I feel too lethargic to do physical activity": Perceptions of Iranian adults on the barriers to perform regular physical activity.

Background: Despite the intention to perform physical activity (PA), a number of individuals cannot manage to have PA program on a regular basis. In this study we explored the barriers of regular PA behavior among healthy adults in Tabriz, Iran. Methods: This qualitative study with a conventional content analysis approach, was carried out from June to September 2020. Nineteen 30-59 years old individuals, were purposefully (purposive sampling) selected to participate in the study. The participants were formerly registered as "physically inactive" in the health records of Tabriz Health System. Individual semi-structured interviews were conducted until data saturation. Data were managed using MAXQDA-10 software. Results: The barriers of regular PA that emerged from our data were being listless and lethargic, non-supportive environment, disintegration in PA education chain, and restrictive social norms. Conclusion: Our findings uncover several PA barriers that are less discussed in the literature. Poor level of regular PA among adults in Iran, as a developing context, is rooted in perceptions with social and economic origins, which should be taken into account by public health policy makers while planning PA promotion programs in such communities. To promote regular PA among healthy adults in developing countries, regular PA programs should be tailored to bridge the gap between their recognition of PA barriers and subsequent behavior change through creating group dynamics highlighting the measures to diminish the behavior.

Lessons learnt from pilot field test of a comprehensive advocacy program to support health promoting schools' project in Iran.

Background: Health promoting schools (HPS) project is currently being used in Iran but many challenges still lie ahead. The present study aimed, to test feasibility of implementing a comprehensive advocacy program (CAP) to overcome the obstacles and problems associated with the consummation of school health programs based on the HPS framework. Methods: This quasi-experimental study was performed through recruiting all schools that were enrolled in the national HPS program and located in Jolfa as the intervention group and all of the schools situated in the East Azerbaijan province as control. In order to collect data, Iranian Ministry of Health's checklists and external audit guidelines for HPS were utilized. In addition, to plan a CAP required data for coordinating fund raising activities including current rules and regulations regarding implementation of local health promotion interventions were collected. Results: Findings of the study revealed that the implemented CAP had improved all HPS dimensions' mean score in the intervention group. The observed change in the pre- and post-test score in the intervention group was significant (P < 0.05). The intervention was also successful in encouraging signing of an agreement among the participated organizations to be committed to pursue the adopted policies in facilitation of progress towards full implementation of the local HPS project. Conclusion: Commencing changes in the recruited schools' structure through coordinated multi-level activities is feasible and this must be considered as a priority where contextual determinants exist to motivate progress towards providing healthier educational settings for school aged children in Iran.

Risk Perception of HIV/AIDS and Low Self-Control Trait: Explaining Preventative Behaviors Among Iranian University Students.

BACKGROUND: In spite of developed countries there are progressive trend about HIV/AIDS and its' aspects of transmission in the low socio-economic societies. The aim of this was to explain the youth's behavior in adopting HIV/AIDS related preventive behaviors in a sample of Iranian university students by emphasizing on fear appeals approaches alongside examining the role of self-control trait for explaining adoption on danger or fear control processes based on Extended Parallel Process Model (EPPM). METHODS: A sample of 156 randomly selected university students in Jolfa, Iran was recruited in a predictive cross-sectional study by application of a researcher-designed questionnaire through self-report data collection manner. Sexual high risk behaviors, the EPPM variables, self-control trait, and general self-efficacy were measured as theoretical framework. RESULTS: Findings indicated that 31.3% of participants were in the fear control process versus 68.7% in danger control about HIV/AIDS and also the presence of multi-sex partners and amphetamine consumption amongst the participants. Low self-control trait and low perceived susceptibility significantly were related to having a history of multi-sex partners while high level of self-efficacy significantly increased the probability of condom use. CONCLUSION: Findings of the study were indicative of the protective role of high level of self-control, perceived susceptibility and self-efficacy factors on youth's high-risk behaviors and their preventative skills as well.

Challenges in developing health promoting schools' project: application of global traits in local realm.

BACKGROUND: Despite the importance of student health and school hygiene as an aspect of the infrastructure of community health, few feasibility studies have been conducted on school health programs in developing countries. This study examined possible barriers to and challenges of such programs from the executive perspective in East Azerbaijan Province in Iran. METHODS: This qualitative study used the content analysis approach to recognize barriers to and challenges of health promoting school program from the executive perspective. Fourteen experts were selected in the areas of children and adolescents and school health, physical education and school headmasters. Data were collected using semi-structured interviews and analyzed using the content analysis method. RESULTS: Five themes were extracted as major barriers and challenges: 1. Intraand inter-sectorial collaboration; 2. Policy and rule formulation; 3. Infrastructure and capacity; 4. Human resources; 5. Community involvement. CONCLUSION: The localized version of the current health promoting school program had major faults. If this program is considered to be a healthcare system priority, it should be revised to set effective policies for implementation and to sustain school health programs based on the capacities and objectives of each country.