Quality-of-life index and its related factors during COVID-19 pandemic: A community-based study in Rashtian women/Iran.

BACKGROUND: The changes in everyday life, caused by the COVID-19 pandemic, were rapid and unprecedented. This pandemic affected not only physical health but also well-being and life satisfaction. This study was designed to assess the status of a quality-of-life index and some related factors during the coronavirus pandemic in the public population of Rashtian women. MATERIALS AND METHODS: This cross-sectional study was performed on 784 Rashtian women who were selected by cluster random sampling between 2020 and 2021. The data collection tool was the Ferrans and Powers Quality of Life questionnaire, which has two parts: satisfaction and importance of life. Each section consists of four subscales: health and performance, social and economic, psychological/spiritual, and family. Data analysis was done using descriptive and analytic statistics. RESULTS: The mean score of the quality-of-life index in this study was 21.39 (of 30), which is higher than the mean level. The scores obtained from the satisfaction section were inferior to the similar questions in the important section. The findings showed that there was no statistically significant difference between the quality-of-life scores of women living in different urban areas (P > 0.05). CONCLUSION: The feeling of satisfaction increases the ability to cope with problems and mental pressures and improves the level of mental and physical health of couples and ultimately of all members of society. So although the overall quality of life was above average, appropriate interventions should be designed to maintain and improve their satisfaction.

Governance in community based health programmes in I.R of Iran.

OBJECTIVE: To assess the nature of community-based health programme experience in Iran, and use the results in order to advocate more friendly policies in community, academy and funding organisations. METHODS: The qualitative study was done in 2010-11 at various locations in Iran using semi structural in-depth interviews with the principals and managers of programmes, and focus group discussions with volunteers and service users of 13 Community Based Health Programmes which were active for at least five years. A total of 21 in-depth interviews and 20 focus group discussions were conducted. Data analysis was based on deductive-inductive content analysis approach considering the pre-determined structure in accordance with the study questions. The participants' views were analysed within the main category of governance, including the three sub-categories of leadership, monitoring and evaluation, and resource mobilisation. RESULTS: According to the participants, governmental programmes have centralised decision-making and management processes and local volunteers have no role in selecting managers at different levels of a programme. Such programmes are funded by the governmental core resources. In non-government organisations, resources available for such purposes mainly come through charitable individuals, service delivery fees and profitable economical activities, financial participation of volunteers and by using other organisations' facilities. In most programmes, there were no systematic process for monitoring and evaluation. CONCLUSION: Community-based Health programmes in Iran need to be revised in line with the positive input.There is a need to have community-based units within the Ministry of Health and Medical Education and other relevant organisations.

Healthcare System Responsiveness in Covid-19: An Experience from Capital City of I.R of Iran.

Background: As a public health emergency, coronavirus disease 2019 (Covid-19) is a threat to our future; therefore, appropriate health system responsiveness (HSR), as an important criterion, is of crucial importance. This study aimed to evaluate the different dimensions of responsiveness of healthcare centers, both public and private, providing COVID-19 services in Tehran. Methods: Following a cross-sectional design, this study was conducted in Tehran (the capital city of I.R. Iran) from May to November 2020. Data were collected using the World Health Organization (WHO) questionnaire on responsiveness. Two hundred questionnaires were filled out through face-to-face or phone call interviews in two public and private hospitals (100 in each) providing Covid-19 services. Participants were selected using the convenience sampling technique among all those who received Covid-19 services during the past six months in the city of Tehran. Results: The mean age of participants was 45.9 ± 15.9 and 51.5% were female. On an average, 52.6% of the respondents evaluated at least one dimension of responsiveness as appropriate and/or strongly appropriate. Communication obtained the highest score (58.2%), followed by confidentiality (56.5%), dignity (56%), and prompt attention (52%). Meanwhile, autonomy and choice were evaluated as poor (moderate, weak, and strongly weak) by 63.5 and 52.5% of respondents. There was no significant association between the type of healthcare center (i.e., public or private) and responsiveness (p-value = 0.896). However, there was a significant difference between gender (p-value = 0.036) and education level (p-value = 0.014) with responsiveness. According to the respondents, prompt attention and choice were the most and least important dimensions, respectively. Conclusions: Evaluation of HSR in the era of COVID-19 not only provides a tool for qualitative assessment of services but also plays an important role in providing feedback to policymakers to adopt effective policies.

Understanding determinants of socioeconomic inequality in mental health in Iran's capital, Tehran: a concentration index decomposition approach.

BACKGROUND: Mental health is of special importance regarding socioeconomic inequalities in health. On the one hand, mental health status mediates the relationship between economic inequality and health; on the other hand, mental health as an "end state" is affected by social factors and socioeconomic inequality. In spite of this, in examining socioeconomic inequalities in health, mental health has attracted less attention than physical health. As a first attempt in Iran, the objectives of this paper were to measure socioeconomic inequality in mental health, and then to untangle and quantify the contributions of potential determinants of mental health to the measured socioeconomic inequality. METHODS: In a cross-sectional observational study, mental health data were taken from an Urban Health Equity Assessment and Response Tool (Urban HEART) survey, conducted on 22 300 Tehran households in 2007 and covering people aged 15 and above. Principal component analysis was used to measure the economic status of households. As a measure of socioeconomic inequality, a concentration index of mental health was applied and decomposed into its determinants. RESULTS: The overall concentration index of mental health in Tehran was -0.0673 (95% CI = -0.070 - -0.057). Decomposition of the concentration index revealed that economic status made the largest contribution (44.7%) to socioeconomic inequality in mental health. Educational status (13.4%), age group (13.1%), district of residence (12.5%) and employment status (6.5%) also proved further important contributors to the inequality. CONCLUSIONS: Socioeconomic inequalities exist in mental health status in Iran's capital, Tehran. Since the root of this avoidable inequality is in sectors outside the health system, a holistic mental health policy approach which includes social and economic determinants should be adopted to redress the inequitable distribution of mental health.

Iranian nongovernmental organizations' initiatives in COVID-19 pandemic.

BACKGROUND: With the outbreak of the COVID-19 virus crisis worldwide, including Iran, the need for corona prevention and treatment has become a national priority. With many businesses closed in the wake of COVID-19 and job losses and declining incomes, vulnerable individuals' and families' access to the minimum wage and healthcare facilities is falling, and their health is exposed to a great risk. In Iran, a significant number of vulnerable groups are supported by nongovernmental organizations (NGOs). This study is designed to understand the performance of NGOs after the onset of the COVID-19 crisis. MATERIALS AND METHODS: This study was carried out based on qualitative research between June and September 2020 in Tehran. This study was conducted using individual interviews with 33 managers and experts of 24 active NGOs providing services to vulnerable groups and a member of an NGO network. Data were analyzed using content analysis. RESULTS: Two main themes of service initiatives were extracted: (a) service initiatives to protect the target population against COVID-19 infection and its aftermath and (b) management initiatives to retain staff, finance, and adapt the organization to crisis situations. Service initiatives included five categories of health service initiatives, livelihood, employment, education, and leisure initiatives, while organizational management initiatives include human resource management, financial management, and communication with organizations. CONCLUSION: The COVID-19 breadth and its special features have set it apart from other crises and have led NGOs to work hard on several fronts to care for the most vulnerable people against the epidemic and its consequences and maintain the performance of their organizations. The unique role of cyberspace has made it one of the definitive pillars of the activities of NGOs, not only during the epidemic but also after its end.

Social participation among Iranian community-dwelling older adults: A grounded theory study.

Background: Iran is among the countries whose older adult population is increasing rapidly. The social dimension of health in older adults affects their other existential dimensions. Social participation is a key determinant of health for older adults. This study aimed to explore the process of social participation among community-dwelling older adults. Methods: This is a qualitative study with the grounded theory approach. The study population consisted of eligible community-dwelling older adults. The participants were initially selected by purposeful sampling. Data were collected through semi-structured interviews. The time and place of the interviews were arranged in discussion with the participants in advance. Lincoln and Guba's criteria were used to assess the scientific accuracy and validity of the study. The university ethics committee issued the ethics code for the study. Data were analyzed using Corbin and Strauss approach. Result: The results of interviews with 15 participants, in this study, led to the emergence of 12 main categories and 32 subcategories with the core concept of "older adults' desire to stay active". Social participation of older adults was a concept clarified with the efforts of older adults to stay active in the community. Categories are fully described in the manuscript. Conclusion: Staying active is one of the main concerns regarding the concept of older adults' social participation. The existence of conducive underlying factors, such as a participation-seeking older adult, family, and society, assists in the development of social participation at various levels and multiple forms among older adults.

Determining the effectiveness of cognitive behavioral therapy interventions based on the transdiagnostic approach in the treatment of common mental health problems: Presenting an experience from the Islamic Republic of Iran.

INTRODUCTION: There is growing support to develop transdiagnostic approaches that provide new insights into mental health problems and cut across the existing traditional diagnostic boundaries all over the world. The present study was conducted to test the transdiagnostic cognitive behavioral therapy (TCBT) approach in treating patients with common mental health problems and evaluate its effectiveness compared to the current treatment settings of the healthcare system. METHODS: A randomized controlled trial was conducted in Semnan Province, north of Iran. The study took pace in urban health centers. A sample of 520 Iranian adults, tested as positive on the Kessler Psychological Distress Scale, were enrolled. Participants who received a score above the cut-off point in any of the three mental health disorders (depression, anxiety, or obsessive compulsive disorder [OCD]) based on the locally validated study instrument were randomly allocated to the study. The intervention group received TCBT during eight sessions provided by trained general health service providers without previous mental health training; the standby control group received Mental Health Services as Usual (MHSU). The post-test interviews were conducted using the study instrument after the completion of both group treatments. RESULTS: A total of 459 individuals (87.8% female) ultimately entered the study. The withdrawal rate was 24% (53 participants in the TCBT and 56 in the MHSU). Reduction in depression, anxiety, and OCD symptoms was significant within each group and when comparing TCBT and MHSU (mean difference). CONCLUSION: This trial recommends that the transdiagnostic CBT approach can be effective in improving common mental health problems and functions among individuals by trained general healthcare providers in the primary healthcare system. The results can be more useful in decision making when defining the process of providing mental healthcare in the National Primary Healthcare System.

Validation of the Persian version of the mental health literacy scale in Iran.

The present study was designed to validate an English version of the mental health literacy scale into Persian, in Iran. Statistical population consisted of all residents of 22 municipal districts of Tehran, Iran, in 2018. Multistage sampling methods were used (sample size = 1026). All participants filled the Mental Health Literacy scale; 12-item General Health Questionnaire; Multidimensional Health Locus of Control scale and a demographic checklist. Exploratory and confirmatory factor analysis, the intra-class correlation coefficient was used for analysing data. All analyses were run with SPSS and AMOS Graphics version 18. Exploratory factor analysis revealed five components (24 items) explaining 21.68%, 20.24%, 8.97%, 6.48% and 5.36% of the variance respectively (totally explained variance = 62.74%). Confirmatory factor analysis showed an acceptable goodness-of-fit (CMIN/DF = 3.19, GFI = 0.887, CFI = 0.893, IFI = 0.894, TLI = 0.877, RMSEA = 0.065). The values of Cronbach's alpha showed satisfactory internal consistency. Two clinical correlates of mental health literacy were investigated. The structure of the mental health literacy scale was to some extent different from the one in O'Connor et al. study, but it was consistent with the definition of MHL presented by Jorm et al. This is the first Persian version of the MHL in the general population in Iran and undoubtedly needs to be checked on more studies.

Testing the WHO responsiveness concept in the Iranian mental healthcare system: a qualitative study of service users.

BACKGROUND: Individuals' experience of interacting with the healthcare system has significant impact on their overall health and well-being. To relate patients' experiences to a common set of standards, the World Health Organization (WHO) developed the concept of health system responsiveness. This study aimed to assess if the WHO responsiveness concept reflected the non-medical expectations of mental healthcare users in Teheran. METHODS: In this qualitative study, four mixed focus group discussions were formed, comprising 53 mental health service users in Tehran, Iran, in 2010. Content analysis was performed for data analysis. Responses were examined in relation to the eight domains of the WHO's responsiveness model. RESULTS: There were many commonalities between the findings of this study and the eight domains of the WHO responsiveness model, although some variations were found. Effective care was a new domain generated from our findings. In addition, the domain of prompt attention was included in two new labelled domains: attention and access to care. Participants could not differentiate autonomy from choice of healthcare provider, believing that free choice is part of autonomy. Therefore these domains were unified under the name of autonomy. The domains of quality of basic amenities, access to social support, dignity and confidentiality were considered to be important for the responsiveness concept. Some differences regarding how these domains should be defined were observed, however. CONCLUSIONS: The results showed that the concept of responsiveness developed by the WHO is applicable to mental health services in Iran. These findings might help policy-makers' better understanding of what is useful for the improvement of mental health services.

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.

The Barriers, Challenges, and Strategies of COVID-19 (SARS-CoV-2) Vaccine Acceptance: A Concurrent Mixed-Method Study in Tehran City, Iran.

Acceptance and willingness to receive the vaccine are among the main factors in the success or failure of a health system in implementing the vaccination program. The present study was conducted in Tehran, the political and economic capital of Iran, to determine the acceptance of the COVID-19 vaccine and identify its associated factors, and explain the most important barriers and acceptance strategies for vaccination. This research was a concurrent quantitative and qualitative mixed-method study. In the quantitative part, 1200 individuals aged more than 18 years were selected from the households in 22 districts of Tehran City, with a multistage stratified cluster sampling method. Two questionnaires were used to evaluate the acceptance of the COVID-19 vaccine and vaccine acceptance determinants. The qualitative content analysis method addressed the influencing factors, as well as challenges and strategies related to the acceptance of the COVID-19 vaccine in four groups of Tehran inhabitants: the elderly, people with underlying diseases, healthcare workers, and the general population. The related data were simultaneously collected by applying in-depth semi-structural interviews and a data analysis process. Furthermore, we used the Graneheim and Lundman method for data analysis. We analyzed the data of 1200 people with a mean (SD) age of 46.4 (11.1) years, and approximately 58% of them were men. The vaccine acceptance was 83.6% (95% CI: 81.3-85.9). Among those who welcomed vaccination, 58% preferred the imported vaccines, 25% the Iranian ones, and 17% both. There was a significant association between the variables of age (adjusted odds ratio [AOR] = 1.72, 95% CI: 1.01-2.93), being single (AOR = 0.54, 95% CI: 0.41-0.91), moderate pharmacotherapy adherence (AOR = 0.58, 95% CI: 0.4-0.85), and the willingness to receive COVID-19 vaccine. Qualitative study after interviewing 45 people from four study groups showed an insufficient social trust in healthcare system officials, pharmaceutical and vaccine production companies; distrust in the effectiveness of the vaccines, concerns about the vaccine adverse effects, being tracked by microchips after vaccination, traditional anti-vaccination movements, the feeling the inessentiality of vaccination, and uncertainty about the fair distribution of the vaccine. These concerns were the main challenges addressed by the study groups. A good proportion of Tehran residents reported their willingness to receive the COVID-19 vaccine. Additionally, they expressed their critical concerns, such as insufficient trust in the healthcare system, vaccine safeties, and adverse effects that were the significant barriers to vaccine acceptance. It seems that conflicts raised by the shortage of vaccines and their import due to the sanctions have led to intense desire and demand in the general population, and especially the elderly, for vaccination. Besides, vaccination phobia in some individuals requires further investigations.

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.

Are the predictors of sexual violence the same as those of nonsexual violence? A gender analysis.

INTRODUCTION: Violence manifests itself in such multifarious ways as sexual, physical, and psychological abuse. What has hitherto eluded the medical community, however, is whether sexual and nonsexual abuse share the same predictors. AIM: Drawing upon a representative sample of married men and women in the Iranian capital, Tehran, we aimed to determine: (i) the overlap between sexual abuse and physical and psychological violence, and (ii) the predictors that sexual violence victimization share with physical and psychological violence victimization. MAIN OUTCOME MEASURES: Victimization through any type of sexual coercion by the husband in the context of the current marital relationship, as determined via the conflict tactic scales-revised (CTS-2). METHODS: In a cross-sectional survey in Tehran in 2007, 460 married Iranian men and women were selected via a multicluster sampling method from four different randomized regions. Independent variables comprised sociodemographic characteristics, subscores of psychological, and personality characteristics known to be allied with intimate abuse (personal and relationship profile), and dichotomus data on victimization history through all types of violence by the spouse including psychological aggression, physical assault, and sexual coercion (CTS-2). RESULTS: In both genders, the experience of physical or psychological violence increased the likelihood of sexual violence victimization. In both genders, higher conflict was a predictor of sexual and psychological violence victimization. In addition, the common predictors of sexual and physical violence victimization were low self-control and high violent socialization in the men and women, respectively. CONCLUSIONS: Sexual violence victimization shares some factors with the victimization of nonsexual types of marital abuse, but this seems to be partially gender dependent.

Associations between coerced anal sex and psychopathology, marital distress and non-sexual violence.

BACKGROUND: There is a dearth of scientific data on anal intercourse in heterosexual relationships. Likewise, anal sex within marital relationships has yet to be fully explored. OBJECTIVES: Among a representative sample of married women in the Iranian capital, Tehran, we aimed to determine the association of self-reported coerced anal sex with: (i) self-reported coerced vaginal sex; (ii) self-reported non-sexual violence; (iii) psychopathology; and (iv) marital attitude. METHOD: The data presented here were obtained from the Family Violence Survey conducted in Tehran in 2007. A total of 230 married Iranian women were selected via a multi-cluster sampling method from four different randomized regions. The subjects' sociodemographic data, psychological distress (Symptom Check List; SCL-90-R), personality, and relationship characteristics (Personal and Relationships Profile), and marital attitude (Marital Attitude Survey) were gathered. In addition, the participants' self-reported histories of lifetime victimization through all types of violence by the husband, including coerced anal and vaginal sex as well as psychological and physical assault (Conflict Tactic Scales-Revised; CTS-2), were collected. RESULTS: There were associations between self-reported victimization through coerced anal and vaginal sex (P < 0.001), psychological (P < 0.001), and physical aggression (P < 0.001). Those reporting to have been forced into anal intercourse cited higher rates of paranoid and psychotic features, jealousy, attribution of problems to one's own behavior, conflict, and male dominance, as well as lower expectations of improvement in one's marital relationship. CONCLUSION: In marital relationships, women are at a higher risk of coerced anal sex if subjected to other types of sexual or non-sexual violence. Higher rates of psychopathology and poorer marital relationships are also allied to self-reported anal sexual coercion.

Introduction of a Community-Based Participatory Model for Women's Mental Health Promotion in Iran: A-Z.

BACKGROUND: To address the disproportionate burden of poor mental health among women, we present a community based participatory research (CBPR) model used to develop a women's mental health promotion program for Iranian women. METHODS: This is a multi-phase interventional study using a CBPR approach among married women age 18-65 living in Tehran. First, participants described the process of women's mental health. Subsequent steps involved participatory needs assessment, priority setting, intervention design, and evaluation. Finally, a conceptual model of women's mental health promotion was developed. RESULTS: "Seeking comfort" emerged as the core process in women's mental health. To promote mental health, women prioritized training on coping mechanisms to deal with stress. Women receiving this training used more problem-based coping methods and reported a higher quality of life than the comparison group. CONCLUSIONS: The resulting conceptual model illustrates the utility of using a CBPR approach to develop women's mental health promotion programs.

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.

Inequality in Responsiveness: A Study of Comprehensive Physical Rehabilitation Centers in Capital of Iran.

OBJECTIVE: Responsiveness refers to meeting the legitimate expectations of people who interact with the health system. This study aimed to assess the presence of any inequality in responsiveness based on the different sociodemographic groups. METHODS: This cross-sectional study was carried out in Tehran. A total of 610 people with a physical disability from 10 comprehensive physical rehabilitation centers (5 public and 5 private) were included in the study through quota sampling. Data were gathered using the World Health Organization Standard Responsiveness Questionnaire and a sociodemographic checklist. Relative inequality indices were used for the analytical statistics. RESULTS: Study respondents between 18 and 59 years and those equal to or older than 60 years formed 78.1% (475/610) and 21.9% (133/610) of the total study sample, respectively. The study sample consisted of 298 (48.7%) women and 312 (51.3%) men, and their mean age was 46.4 and 45.6 years, respectively. No significant inequality was found in responsiveness of total centers based on the socioeconomic status of the study participants. However, in the private comprehensive physical rehabilitation centers, significant inequality was found in responsiveness based on residential area per capita, with more reporting of poor responsiveness by people with physical disability in the lower residential area per capita quintiles (Wagstaff index [WI] = -0.262; P = .01). Inequality in responsiveness was also found in the public centers based on education level, with poorer experience in people with higher level of education quintiles (WI = 0.163; P = .02). CONCLUSION: In the private sector, economic issues are the main reason for the poorer experiences. Furthermore, residential area per capita showed to be a more sensitive index among economic indices to measure inequality. In public sector, education level was the key social factor. More attention and interventions need to be implemented by mid-level policymakers and rehabilitation service providers to meet the needs of people with physical disability.

Responsiveness of Physical Rehabilitation Centers in Capital of Iran: Disparities and Related Determinants in Public and Private Sectors.

Background: Responsiveness as a non-medical, non-financial goal of the health system is of special importance to people with physical disability. The current study assessed the experiences of people with physical disabilities when they encounter rehabilitation centers in Tehran. Methods: This cross-sectional study was conducted in Tehran, the capital of Iran. The sample consisted of 610 people with physical disabilities referred to 10 comprehensive rehabilitation centers (CRCs) selected by Quota sampling. Data were collected by a standard responsiveness questionnaire proposed by the World Health Organization (WHO) and were analyzed by a standard protocol. Blinder-Oaxaca analysis was done to explain the inequality in performance of public and private sectors. Results: Study participants included 298 (48.7%) women and 312 (51.3%) men. The mean age of the respondents was 46.3 (SD = 14.3) for women and 45.6 (SD = 15.4) for men. Prompt attention (33.3%) and confidentiality (1.3%) were the most and least important reported domains, respectively. Overall poor responsiveness was reported by 20.9% of respondents. Private rehabilitation centers showed significantly better performance in communication, basic amenities and autonomy compared to public centers (P ≤ 0.05). Perceived social class explained 76% of the inequality in autonomy in the private and public sector (P ≤ 0.05). Conclusion: Improving overall responsiveness in domains that are of high importance from the respondents' viewpoint but are performing poorly-areas such as prompt attention and basic amenities-is essential. Additionally, interventions are needed to improve the performance of the public centers and providers in the areas of participation of service users in all social classes in their rehabilitation decisions and procedures, clear communication, and basic amenities.

Drug Use among Street Children in Tehran, Iran: A Qualitative Study.

INTRODUCTION AND OBJECTIVE: Globally, children who work and live on the streets are at higher risk of undesired behavioral health outcomes, including increased drug use and abuse. Considering the rapid growth of this population in Iran and the lack of program planning that is partly due to a scarcity of research-based information, this study was conducted in 2013 to investigate drug use among street children in Tehran. 1METHOD: With a qualitative design, we conducted a Rapid Assessment and Response Survey of street children in Tehran, 2012-2013. Data were also obtained from 10 focus group discussions with street children using semi-structured questionnaires and 27 in-depth interviews with key informants in governmental, non-governmental, and international organizations. RESULTS: The variation in age at first use, type of drugs, and pattern of drug use were found based on ethnicity. Consuming of Alcohol was reported to be more among an ethnic group. Drug use problems were commonly described among families of street children. Children whose parents had drug-use problems described using drugs earlier than other children. Informants reported that families with drug-related problems used children for procurement of drugs. Children themselves described using drugs to cope with stress, and to reduce physical and psychological stressors and problems, such as fatigue, sadness, and pressure, resulting from frequent failures in life. CONCLUSION: These results suggest that intervention and prevention programs dealing with drug use of street children in Iran should include family and peers when addressing drug use by street children.

Disclosure of HIV Status and Social Support Among People Living With HIV.

BACKGROUND: Disclosure of HIV is important for improving self-care behaviors, psychological well-being, commitment to the treatment, and reducing risk of transmission. One of the major benefits of disclosure is social support, which is an essential resource for effective coping with HIV infection. However, receiving any social support requires disclosing of HIV status. OBJECTIVES: This study aimed to determine the disclosure of HIV status and its related factors such as social support in addition to demographic and disease characteristics among people living with HIV in Iran. PATIENTS AND METHODS: This cross-sectional study, using simple random sampling, was carried out on 175 people with HIV/AIDS who referred to Behavioral Counseling Centers. The self-administrated, Norbeck Social Support Questionnaire was used to measure social support. Disclosure of HIV status was assessed with an investigator-designed questions. Multiple logistic regression analysis with backward Likelihood Ratio method was applied to identify the adjusted odds ratio between disclosure as dependent variable and demographic variables, social support as independent variables. RESULTS: Participants were often disclosed their HIV status to family members. But there were differences about disclosure of HIV status within the context of the family. Family members were perceived as more supportive. Multiple logistic regression analysis demonstrates that the gender (adjusted OR = 0.181; 95% CI .068-0.479), CD4 cell count (adjusted OR = 0.997; 95% CI 0.994-0.999), route of transmission (injection-drug user [adjusted OR = 9.366; 95% CI 3.358-26.123] and other routes [tattooing, mother to child, dental services, etc.], [adjusted OR = 3.752; 95% CI 1.157-12.167]), and functional support variable (adjusted OR = 1.007; 95% CI 1.001-1.013) remained in the model as significant predictors for disclosure. CONCLUSIONS: The results of this study regarding disclosure of HIV status and its relations to social support and some demographic variables can provide an understanding based on the evidence for promotion of knowledge and coping interventions about people living with HIV/AIDS and their perceived social support status.