Assessing the e-health literacy level and its predictors in heart patients: A Case Study in a Heart Hospital Center in Iran.

BACKGROUND: eHealth literacy has many benefits for patients and community members, including the direct impact on improving the quality of patient education and reducing direct and indirect healthcare costs. Benefiting from eHealth literacy in patients with cardiovascular diseases can effectively provide healthcare services and manage these patients. This study aimed to evaluate eHealth literacy level and its factors affecting patients with cardiovascular diseases in a Heart Center Hospital. MATERIALS AND METHODS: This cross-sectional study was conducted in 2022. A valid and reliable questionnaire has been used for data gathering. From 147 distributed questionnaires among patients with cardiovascular diseases at Madani Heart Center Hospital in Khorramabad city, finally, 86 questionnaires have been collected completely. Data analyses were done using IBM Statistical Package for the Social Sciences (SPSS) software version 22 descriptive and analytical tests such as one-way ANOVA, independent sample t-test, and Spearman correlation coefficient based on the study objectives. RESULTS: The study showed that heart patients' eHealth literacy status is moderate (3.38 out of 5). The awareness of the availability of resources on the Internet had the highest score (3.79). The importance of using the Internet to obtain health information (r = 0.62, P < 0.001) and the ability to use the Internet (r = 0.62, P < 0.001) had the most significant relationship with eHealth literacy among patients with cardiovascular diseases. CONCLUSION: It is suggested that by increasing the level of Internet skills, expanding the use of the Internet for health-related services, using the Internet to make accurate health decisions among patients, extending the use of the Internet to access health resources, and reducing the patient's level of concern about their health status to improve the level of eHealth literacy of cardiovascular patients.

Socioeconomic status and self-rated health in Iran: findings from a general population study.

BACKGROUND: There are large gaps in health and well-being among different groups of the society. Socioeconomic factors play a significant role in determining the health status of the society. The present study was conducted to examine socioeconomic inequality in health status among the adult population of Khorramabad city, the capital of Lorestan province, wester part of Iran. METHODS: A cross-sectional study was conducted on 1348 participants selected through multistage sampling. A valid and reliable questionnaire was used for data collection. The wealth index as an indicator of the socioeconomic status (SES) was used to categorize the subjects in terms of the SES. The concentration index and concentration curve was used to measure socioeconomic inequity in poor self-rated health (SRH) of population. Finally, after determine the status of inequity in poor SRH, a decomposition analysis approach was used to identify the most important determinants of this inequity. RESULTS: The prevalence of poor SRH was 18.91% in all subjects, 38.52% in the lowest SES group, and 11.15% in the highest SES group. The value of the concentration index for poor SRH was - 0.3243 (95% CI - 0.3996 to - 0.2490), indicating that poor SRH was more concentrated among the poor. The results of decomposition analysis showed that SES (41.2%), higher body mass index (28.6%) and lack of physical activity (26.9%) were the most important factors associated with the concentration of poor SRH in the poor groups. CONCLUSION: Identification of socioeconomic factors affecting on health status is the first step for proper policymaking. Policymakers and health system managers at the national and subnational levels can use the results of this study as well as other similar domestic studies to design and implement proper interventions to promote equity and improve the health status of population.

A Systematic Review and Meta-Analysis of the Prevalence of Malnutrition Among 6-14-Year-Old Children in Iran.

Background: Malnutrition is a major public health issue worldwide. It has significant consequences, including weakened immune systems, which may lead to increased incidences of infectious disease and higher mortality, particularly in children. A systematic review and meta-analysis were conducted to estimate the overall prevalence of malnutrition (wasting, underweight, and stunting) among children of 6-14 years of age in Iran. Methods: Data were collected in 2018 based on searches of the PubMed, Science Direct, Scopus, Google Scholar, Science Information Database (SID), Magiran, Irandoc, and Iranmedex databases using the following keywords: childhood, childhood malnutrition, children, nutrition, malnutrition, wasting, underweight, stunting, child, student, boy, girl, cause, prevalence, and Iran, in order to identify studies eligible for inclusion in the review. Comprehensive Meta-Analysis, version 2 (CMA: 2) was used to estimate the overall prevalence of malnutrition. Results: Nine out of 328 articles were included in our analyses. The overall of wasting among children of 6-14 years of age in Iran based on the random-effects model (according to nine studies and 18,296 participants) was 12.5% (95% Confidence Interval, 7.1-21.2). The overall prevalence of underweight based on the random-effects model (according to 10 studies and 19,185 participants) was 19% (95% CI, 8.1-38.6). Also, the overall prevalence of stunting based on the random-effects model (according to 10 studies and 19,185 participants) was 20% (95% CI, 9.4-37.8). Conclusions: The results of this study show that the prevalence of malnutrition among 6-14-year-old children in Iran is similar to the global average. We need solutions that can be used for both prevention and reduction of malnutrition, especially in areas with middle or low socioeconomic status. It is necessary to identify factors associated with malnutrition in various geographic regions in order to implement appropriate programs based on factors with the highest impact in each region.

Factors Affecting the Acceptance of Mobile Health by Medical Sciences Students: A Cross-Sectional Study.

BACKGROUND: The use of mobile health has a pivotal role in the prevention and treatment of many diseases. This study aimed at determining the affecting factors in acceptance of mobile health by using a modified acceptance model, among medical sciences students in the south-west of Iran. MATERIALS AND METHODS: This cross-sectional, analytical study was conducted in 2017. The research population included all the students of Lorestan University of Medical Sciences (LUMS). The 352 of students selected as the samples of study through a stratified sampling method. Data gathering was done through a valid and reliable questionnaire. The data was analyzed using Linear Structural Relations (LISREL) and Statistical Package for the Social Sciences (SPSS) software. RESULTS: The findings showed that perceived usefulness (t7, 38= 2.16, p = 0.03), performance expectancy (t7, 70= 3.18, p = 0.01), facilitating conditions (t10, 61= 4.17, p < 0.001), and attitude to use (t7, 14= 5.49, p < 0.001) were effective in the behavior intention of mobile health. Moreover, the results showed that the behavior intention of mobile health applications (t10, 77= 8.10, p < 0.001) is effective on its user behavior. CONCLUSIONS: The results of our study showed that perceived usefulness, performance expectancy, facilitating conditions, and attitude to use of technology were the affecting factors in the acceptance of mobile health by the students. It is suggested that the policymakers and authorities comprehensively consider these important factors when introducing new technologies.

The Communicable Diseases Surveillance System in Iran: Challenges and Opportunities.

BACKGROUND: The aim of this study was to determine the challenges and opportunities of the Communicable Diseases Surveillance System (CDSS) in Iran. METHODS: This qualitative study was conducted using semi-structured interviews and focus group discussions (FGD) with 64 participants from October 2016 to April 2017. Purposeful sampling was used to recruit participants. The collected data were analyzed via the content analysis method. Data analysis was performed using MAXQDA10 software. RESULTS: The results of this qualitative study were categorized in two parts: Challenges and opportunities. The CDSS is facing challenges in the fields of stewardship, reporting, information analysis, information, interventions, and education. Good infrastructures and structure, the technical support provided by the Centre for Communicable Disease Control (CCDC), the achievements of the CDSS, and the suitable electronic systems are among the opportunities of CDSS. CONCLUSION: The results of this study showed that CDSS has several major challenges. Authorities and policymakers must not ignore communicable diseases and their management tools, including CDSS because of their focus on non-communicable diseases. Some important strategies to overcome the challenges of CDSS can be the following: motivating policy makers to put emphasis on communicable diseases as a national security issue, the ratification and modification of laws and regulations on reporting, the involvement of the CDSS in the accreditation of hospitals and the renewal of the license for healthcare professionals, and motivating organizations outside the health sector to participate in the programs through inter-institutional agreements.

A Decomposition Analysis of Inequality in Malnutrition among Under-Five Children in Iran: Findings from Multiple Indicator Demographic and Health Survey, 2010.

BACKGROUND: Nutritional status at the early stages of children's lives is essential for growth and development not only in infancy but also in adult life. This study aimed to measure the inequality in malnutrition among under-five children in Iran and explore the impact of socioeconomic factors on this inequality using a regression-based decomposition approach. METHODS: Data were extracted from Iran's Multiple-Indicator Demographic and Health Survey 2010. The concentration index of stunting, underweight, and wasting were applied in order to measure the magnitude of socioeconomic inequality in child malnutrition. Moreover, the concentration indices were decomposed to understand the contribution of socioeconomic variables in childhood malnutrition inequality. RESULTS: The obtained concentration indices of stunting, underweight, and wasting were respectively -0.177, -0.092, and -0.031. Socioeconomic inequality in stunting and underweight was statistically significant, however this socioeconomic gradient was not observed in wasting. More than 50% of the inequality in stunting and about 63% of the inequality in underweight were influenced by socioeconomic status. Furthermore, maternal education was associated with 19% and 22% of inequality in stunting and underweight respectively. CONCLUSION: The average reduction of malnutrition indices at the national level hides the burden of malnutrition among children in poor families. If government and policymakers seek to solve this problem, they have to take direct and targeted actions to eliminate the existing inequalities in the socioeconomic determinants associated with malnutrition.

Effective Factors in Adoption of Mobile Health Applications between Medical Sciences Students Using the UTAUT Model.

BACKGROUND: Students with complex health care services process face constant challenges with regard to health education. The mobile devices are an important tool that can install various applications for using information such as clinical guidelines, drug resources, clinical calculations, and the latest scientific evidence without any time and place limitations. And this happens only when students accept and use it. OBJECTIVE: The purpose of this article is to identify the factors influencing students in their intention to use mobile health (mHealth) by using Unified Theory of Acceptance and Use of Technology (UTAUT) model. METHODS: A standard questionnaire was used to collect the data from nearly 302 Lorestan University of medical science students including nutrition and public health, paramedicine, nursing and midwifery, pharmacy, dentistry, and medical schools. The data were processed using LISREL (Scientific Software International, Inc., Lincolnwood, Illinois) and SPSS (IBM Corp., Armonk, New York) softwares and the statistical analysis technique was based on structural equation modeling (SEM). RESULT: A total of 300 questionnaires including valid responses were used in this study. The results showed that mediator of age did not affect the predictors of intention to use mHealth, and the level of education and gender directly affected the intention to use. In addition, effort expectancy, facilitating condition, and behavioral intention directly and indirectly have effect on use, whereas the result revealed no significant relationship between two important processes of performance expectancy and social influence with students' behavioral intention to use the mHealth. CONCLUSIONS: The present study provides valuable information on mobile health acceptance factors for widespread use of this device among students of universities of medical sciences as a base infrastructure for a variety of information about health services and learning. Review and comparison of results with other studies showed that mHealth acceptance factors were different from other end users (elderly, patients, and health professionals).

Factors influencing the migration of Iranian healthcare professionals: A qualitative study.

BACKGROUND: The migration of healthcare specialists from developing countries has increased in recent years. This has caused a rapid reduction in the access to and quality of healthcare services in such countries. The aim of this study is to evaluate the factors affecting the migration of specialist human resources in Iran's healthcare system. METHODS: This is a qualitative study, which was carried out through semi-structured interviews between 2015 and 2016. For sampling, purposive sampling method with maximum variation sampling was used. Further, data saturation was observed by conducting 21 interviews, and data analysis was performed using the MAXQDA10 content analysis software. RESULTS: Factors affecting the migration of specialists were classified into five key themes, including structural, occupational, personal, socio-political and economic factors. These themes consisted of 12 categories and 50 subcategories. The most important factors affecting the migration of our study population were structural issues, occupational problems, and personal concerns. CONCLUSION: Identification of factors influencing migration is the first step to prevent the migration of specialist human resources. Implementing the recommendations proposed in this study would assist to prevent migration of medical professionals.

Factors affecting intent to immigration among Iranian health workers in 2016.

BACKGROUND: Loss of human resources in the health sector through migration has caused many problems in the delivery of healthcare services in developing countries. OBJECTIVE: The aim of this study was to determine factors influencing intention to migrate in skilled human resources in Iran's healthcare sector. METHODS: This cross-sectional study was carried out in 2016 in Iran. The study population included health sector human resources at the Tehran and Iran University of Medical Sciences. Using multi-stage cluster sampling, 827 people were selected for participation. Participants included four groups: hospital staff, health workers, medical students, and postgraduate students (Masters and PhD). Data were collected using a valid and reliable questionnaire and analyzed by descriptive parameters, chi-square and logistic regression test using SPSS version 18. RESULTS: Inclination to migrate, in the study population, was 54.77%. There was a significant relationship between inclination to migrate and age, work experience, employment status, marital status, familiarity with a foreign language, foreign language skills, foreign language courses, having relatives or family living abroad, and prior experience of being abroad (p<0.05). The most important factors influencing inclination to migrate were: reaching out for better life (81.92±21.95), interdisciplinary discrimination (80.83±20.75), and experience of living and studying abroad. (80.55±18.12). CONCLUSION: Considering the high rate of intention to emigrate in the studied population (54.77%), a lot of whom will emigrate if their situation is ready, it can be a serious problem for the health system in the near future in which it will face lack of skilled health workers, and so requires more attention of health sector authorities.

Designing a Medical Tourism Website: A Qualitative Study.

BACKGROUND: Informing plays a prominent role in attracting medical tourists. The enjoyment of proper medical information systems is one of the most important tools for the attraction of medical tourists. Iran's ability in designing and implementing information networks has remained largely unknown. The current study aimed to explore information needs for designing a medical tourism website. METHODS: This qualitative study was conducted in 2015 for designing Hospital Medical-Tourism Website (HMTW). A purposive sampling method was used and data were gathered using a semi-structured questionnaire. Totally, 12 faculty members and experts in the field of medical tourism were interviewed. Data were analyzed using the MAXQDA10 software. RESULTS: Totally 41 sub-themes and 10 themes were identified. The themes included the introduction of hospital, general guide for patients, tourism information, information related to physicians in hospital, costs, treatment follow-up, online hospital appointment scheduling in website, statistics and news of hospital medical tourism, photo gallery and contacts. Among the themes, the participants highly emphasized four themes including costs (100%), tourism information (91.6%), information related to physicians in hospital, (83.3%) and treatment follow-up (83.3%). CONCLUSION: This profitable industry can be developed through considering information requirements for hospital medical tourism website.

Factors influencing the adoption of health information technologies: a systematic review.

INTRODUCTION: The successful implementation of health information technologies requires investigating the factors affecting the acceptance and use of them. The aim of this study was to determine the most important factors affecting the adoption of health information technologies by doing a systematic review on the factors affecting the acceptance of health information technology. METHODS: This systematic review was conducted by searching the major databases, such as Google Scholar, Emerald, Science Direct, Web of Science, Pubmed, and Scopus. We used various keywords, such as adoption, use, acceptance of IT in medicine, hospitals, and IT theories in health services, and we also searched on the basis of several important technologies, such as Electronic Health Records (HER), Electronic Patient Records (EPR), Electronic Medical Records (EMR), Computerized Physician Order Entry (CPOE), Hospital Information System (HIS), Picture Archiving and Communication System (PACS), and others in the 2004-2014 period. RESULTS: The technology acceptance model (TAM) is the most important model used to identify the factors influencing the adoption of information technologies in the health system; also, the unified theory of acceptance and use of technology (UTAUT) model has had a lot of applications in recent years in the health system. Ease of use, usefulness, social impact, facilitating conditions, attitudes and behavior of users are effective in the adoption of health information technologies. CONCLUSION: By considering various factors, including ease of use, usefulness, and social impact, the rate of the adoption of health information technology can be increased.

Study of Functional Vulnerability Status of Tehran Hospitals in Dealing With Natural Disasters.

INTRODUCTION: At the time of disasters, hospitals are considered as one of the most important facilities which should provide emergency services continuously. The purpose of this study was to determine the functional vulnerability of Tehran hospitals in dealing with natural disasters. METHODS: This cross-sectional study was conducted in educational hospitals of Tehran University of Medical Science (TUMS), in 2013. Of all 26 hospitals, 12 hospitals were selected through single-stage cluster sampling, including six general (Shariati, Amiralam, Sina, Imam, Hazrat Rasoul, Baharlou) and six specialized (Bahrami, Hazrat-e Aliasghar, Shahid rajaie, Roozbeh, Moheb yas, Children Medical Center) hospitals. Data were collected using World Health Organization (WHO) checklist for functional indicators of safe hospitals, recommended for countries with similar climates. Data were collected through interviews with members of hospital crisis committees and direct observations. Data analysis was carried out using SPSS version 18 using descriptive statistics and Fisher's exact test. RESULTS: Fifty percent of hospitals in the study, in terms of functional vulnerability status, were in satisfactory condition with low level of vulnerability, 41.7% were in the moderate level and 8.3% were in a non-satisfactory condition with high levels of vulnerability. The results of Fisher's exact test showed that there wasn't a significant correlation between functional vulnerability and hospitals lifespan (p=0.99) and type of specialty (p=0.99). CONCLUSION: As this study, assesses hospitals' main weaknesses in terms of procedures, strategies, plans, human resources, monitoring and evaluation, it is essential that each of these areas be reviewed by hospital managers separately, in order to take significant actions to eliminate their weaknesses.