Barriers to financial access of disabled people to health services in rural areas: A case study of Iran.

BACKGROUND: People with disabilities (PWDs) account for a significant percentage of the world's population, with a higher prevalence in less developed countries. Access to healthcare services is the main component of health systems performance, with lower access for PWDs living in rural areas. The current study aimed to investigate PWD's access to healthcare services in rural areas of Iran and, secondly, factors that contribute to this issue. MATERIALS AND METHODS: Following a cross-sectional design, the current descriptive-analytical study is performed in the north of Iran. Using the quota sampling technique, 471 PWDs were recruited. Data were collected using a valid and reliable questionnaire, covering three dimensions of access, by face-to-face interview. Data analysis was administered using central tendency indicators and multiple regression by SPSS version 17. Statistical significance was considered when the P value <0.05. RESULTS: The mean score of PWD's access to healthcare services for dimensions of utilization, availability, and affordability was 8.91 (±6.86), 14.54 (±2.3), and 51.91 (±8.78), indicating very low, low, and moderate levels of access. All three regression models were significant (P < 0.05), and variables of gender, age, marital status, education level, residence status, the income of the household head, receiving financial aid, and house area showed a significant effect (P < 0.05). CONCLUSION: This study demonstrated the seriousness of paying attention to PWD's financial access to healthcare services, particularly in rural areas of Iran. Hence, policymakers should better focus on this problem, mainly regarding accessibility and utilization and factors that result in inequalities.

Evolving Adult ADHD Care: Preparatory Evaluation of a Prototype Digital Service Model Innovation for ADHD Care.

BACKGROUND: Given the prevalence of ADHD and the gaps in ADHD care in Australia, this study investigates the critical barriers and driving forces for innovation. It does so by conducting a preparatory evaluation of an ADHD prototype digital service innovation designed to help streamline ADHD care and empower individual self-management. METHODS: Semi-structured interviews with ADHD care consumers/participants and practitioners explored their experiences and provided feedback on a mobile self-monitoring app and related service innovations. Interview transcripts were double coded to explore thematic barriers and the enablers for better ADHD care. RESULTS: Fifteen interviews (9 consumers, 6 practitioners) revealed barriers to better ADHD care for consumers (ignorance and prejudice, trust, impatience) and for practitioners (complexity, sustainability). Enablers for consumers included validation/empowerment, privacy, and security frameworks, tailoring, and access. Practitioners highlighted the value of transparency, privacy and security frameworks, streamlined content, connected care between services, and the tailoring of broader metrics. CONCLUSIONS: A consumer-centred approach to digital health service innovation, featuring streamlined, private, and secure solutions with enhanced mobile tools proves instrumental in bridging gaps in ADHD care in Australia. These innovations should help to address the gaps in ADHD care in Australia. These innovations should encompass integrated care, targeted treatment outcome data, and additional lifestyle support, whilst recognising the tensions between customised functionalities and streamlined displays.

Community-based education: An effective policy for earthquake preparedness in Iran: Empirical study.

BACKGROUND: As natural or man-made shocks, disasters are sudden events that require emergency and fundamental measures. The need to be prepared for disasters has become clearer than ever worldwide. This study aimed to investigate the effect of earthquake preparedness training using the face-to-face or cascade method in rural households living in Juybar County (Iran) in 2018. METHODS AND MATERIAL: Following an experimental design with a pretest and posttest, the study was performed on married women aged 10-49 living in Kurdkolay village of Juybar county (n = 372). Participants were randomly categorized into two groups of training (n = 95) and face-to-face cascade method (n = 95). Data were collected using the Disaster Preparedness Assessment Index, comprising demographic and education sections. Data were collected using the disaster preparedness assessment index and analyzed using SPSS version 24. RESULTS: The findings indicated improved preparedness in all five dimensions in both groups. There was a significant difference between the study groups immediately and one week after the intervention (P < 0.05); i.e. a higher impact for the face-to-face cascade method. Meanwhile, both groups presented a similar level of preparedness 90 days after receiving the intervention (P > 0.05). CONCLUSIONS: The face-to-face cascade method was more effective in the short term, while no difference was found in the long term. Crisis managers and policymakers should choose their preferred method based on available facilities, human resources, and context to increase preparedness against earthquakes. Mothers play a vital role in educating and nurturing their children. It is suggested to conduct educational programs at the community level using the most appropriate methods that are chosen based on the best evidence.

The social and environmental factors impacting the motivation of adolescents for weight control, why and how? A qualitative study.

INTRODUCTION: Overweight and obesity are common problems among teenagers regardless of ethnicity, race, and socio-economic status. Therefore, this study aims to explore the social and environmental factors impacting adolescents motivation for weight control in Gilan province, Iran. METHODOLOGY: Following a qualitative design, a content analysis approach was used to analyze the data. A total of 79 interviews were conducted with Adolescents (n = 23), Friends and Peers (n = 15), Parents (n = 12), Managers (n = 16), and Health care providers (n = 13), regarding adolescents obesity during 2019. MAXQDA V.10 software was used for our analysis. FINDINGS: The main categories of environmental and social factors affecting adolescents motivation for weight control were external factors (the relative success of weight control intervention programs, the lack of environmental and social support, and the lack of family support for teenagers) that each one had some subcategories, and internal factors (competence, relatedness, and autonomy). CONCLUSION: This study demonstrated the necessity of identifying environmental and social factors that are effective in reducing adolescents' motivation for weight loss. These factors are so influential that teenagers can't overcome them without receiving support from their environment and the government health-related policies. So, it seems that we need integrated multisectoral approaches and we suggest that health policymakers develop practical policies to control adolescents obesity by focusing on factors that have been mentioned in this study.

Non-financial access to healthcare services in rural areas: A case study of people with disabilities living in Northern Iran.

INTRODUCTION: Access to healthcare for persons with disabilities (PWDs) is an important but often ignored issue for achieving universal health coverage. The current study aimed to investigate PWDs' access to healthcare in the rural areas in north of Iran. METHODS: Following a descriptive-analytical design, 471 persons with disabilities (PWDs) living in the Nor city, Mazandaran province, were selected using quota sampling. Data were collected by a valid and reliable questionnaire that contained dimensions of time, geography, physical, and acceptability using face-to-face interviews. The findings are provided by central and dispersion indicators and analyses are performed with linear Regression using SPSS version 17. RESULTS: PWDs had moderate access to healthcare services in all dimensions. The regression models for access to health services in all four dimensions were significant (p<0.05). The results showed that in the geographical dimension, the variables of marital status, income, receipt of financial aid, supplementary insurance, and type of disability; in the physical dimension, the variables of income, responsibility for taking care of the family, supplementary insurance, and type of disability; in the time dimension, supplementary insurance, home area, and type of disability; and in the aspect of service acceptability, only the variables of type of disability and internet access had a significant effect (p<0.05). CONCLUSION: A small percentage of PWDs had high access to health services. Hence, improving their access to healthcare services, particularly in rural and less developed areas, and developing appropriate policies should be the focus of Iranian policy-makers.

Challenges of Rural Family Physician Policy in Iran.

As per the goals of the family physician program, it is essential to pay attention to the effectiveness and performance of FPP. Although the implementation of the FPP program is an important development in the discussion of rural health insurance and the provision of health services and referral systems in the country, the evidence suggests that by identifying challenges and taking appropriate action, this plan can be improved. This study aimed to investigate the challenges of rural Family Physician Policy (FPP) in northern Iran. This study comprised a mixed method. The former intended to identify the challenges of rural FFP using the narrative review method. To achieve a comprehensive list of challenges, a narrative review and content analysis were performed and semi-structured interviews were held with key stakeholders of FPP in the north of Iran, including physicians, managers, and policymakers. Identified challenges were categorized into eight categories including the weakness of the health insurance system, low comprehensiveness of executive guidelines, inappropriate recruitment and maintenance of human resources, weakness of cultural context, low efficacy of health information management system, poor educational effectiveness, inappropriate motivational mechanisms, and weakness of the referral system. As per the quantitative findings, "weakness of the referral system" and "inappropriate recruitment and maintenance of human resources" had the lowest and highest weaknesses, respectively. To address existing challenges in the rural FPP, a comprehensive plan of action should be developed with an emphasis on human resource management, health information management system, comprehensive rural health insurance, and legislation.

Community health workers (Behvarz) in primary health care: a qualitative inductive content analysis of challenges.

BACKGROUND: Behvarzs are the backbone of primary healthcare services in the Iranian health system and play a key role in providing efficient, responsive, and equitable services at the first level of service provision. This study aimed to identify the challenges of Behvarzs to provide a perspective for policymakers and managers to help them formulate future programs to enhance the efficiency of the health system. METHODS: Following a qualitative design, an inductive content analysis approach was used to analyse the data. The healthcare network of the Alborz province (Iran) was considered as the study context. A total of 27 interviews were conducted with policymakers, development managers, managers of Behavrz training centres, and Behvarz workers in 2020. All interviews were audio-taped and transcribed, followed by data analysis using MAXQDA ver. 10. RESULTS: Five themes were identified: service provision (scope of services, ambiguity of roles, non-compliance with the referral system, the quality of data entry, quality of services), access to equipment (quantity, quality), administrative issues (macro planning, micro planning), training (appropriateness of information, quality of training, recruiting related staff), perceived equity and fairness (balance between workload, income, and benefits, job satisfaction, job promotion). CONCLUSION: Occupational challenges affect the performance of Behvarzs in responding to society's needs because they not only play a major role in the health system, but also contribute to addressing the communication gap between local communities and high-level institutions, leading to the alignment of policy implementation. Therefore, strategies that emphasise the role of Behvarzs should be followed to promote community engagement.

The Value Framework Governing Iran's Health System Policy: A Practical Gap.

Background: The value framework governing the health system can guide the policymaking. This study presents a set of values governing the health policies for adopting policies that are in harmony with the ideology of Iran. Methods: This study was conducted in two phases. In the first phase, using the qualitative approach, Shams et al. framework was adopted to identify values. Identification of health-related national documents (nine documents) was performed purposefully. In the next phase, semi-structured interviews on individual experts in the health system were carried out. The key question was "What values and principles govern the health policy system?" Participants included 15 individuals. Both phases were analyzed based on qualitative content analysis. Results: In this study, a taxonomy of values governing policymaking is presented. Results show that equity in different dimensions, comprehensive health and a healthy human being, pioneering in health in the region, and accountability are the most important terminal vaqlues. Individual responsibility, government responsibility for health, endogenous and extrinsic economics, fair access, transparency, efficiency, quality and integrity in the supply, development and fair allocation of public health resources, and professional commitment are the most important instrumental values in Iran. Participants believed that, despite the many higher-order documents available, the health system policymaking was not based on a predetermined value. Conclusions: It is not enough to provide a set of values in upstream documents for implementation. It is necessary to specify the relative weight of the reference values in policymaking and their relation to each other in order to apply them in policymaking.

The Aging Experiences of LGBTQ Ethnic Minority Older Adults: A Systematic Review.

BACKGROUND AND OBJECTIVES: In gerontological research and practice, an increasing amount of attention is being paid to lesbian, gay, bisexual, transgender, and queer (LGBTQ) older people and how their experiences differ from their heterosexual and cisgender counterparts. However, LGBTQ older adults themselves are not a homogenous group. Moreover, as the immigrant populations in industrialized nations age, the number of LGBTQ older adults from ethnic minority backgrounds will only grow. This systematic review hence investigates the experiences of LGBTQ ethnic minority older adults. RESEARCH DESIGN AND METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a systematic search in 5 databases for English peer-reviewed studies. The retrieved articles were coded and analyzed inductively using an intersectional framework to tease out the varying influences of ethnicity, age, gender, and sexual identity on the LGBTQ ethnic minority older adults' experiences. RESULTS: A total of 30 articles across 21 studies (13 qualitative, 7 quantitative, and 1 mixed-methods) were identified. Six key themes emerged from the studies: stigma and discrimination; isolation, support and belonging; interactions with services and institutions; self-acceptance, resilience, and agency; mental health and well-being; and uncertain futures. DISCUSSION AND IMPLICATIONS: The experiences of LGBTQ ethnic minority older adults echo those of LGBTQ ethnic majority older adults when they are shaped by gender and sexual identity factors. Nevertheless, significant differences in experiences-both positive and negative-emerge when cultural and ethnicity-related factors come to the fore. These findings emphasize the need for intersectional aging policies and services that go beyond catering for LGBTQ older adults to include the diversity within this subpopulation.

Thematic analysis of the policies of Iran's health higher education.

BACKGROUND: In 1985, the Iranian parliament approved the integration of Medical Education and Health Services and the establishment of the Ministry of Health and Medical Education, which has since been the policymaker of Health Higher Education in Iran. The policies are not based on a codified framework and many were abolished at some point. Some critical issues are not addressed and some activities overlap. The purpose of the present study was to identify the content themes of core policies in the Iranian Health Higher Education system and provide a detailed policy orientation taxonomy. MATERIALS AND METHODS: This qualitative study was conducted in 2019 using the thematic content analysis of documents relevant to Higher Education and Health Higher Education, including upstream documents, and documents and enactments of the Deputy Minister of Education and its policy centers. RESULTS: From 586 policy documents, six main themes or six core policy orientations in the Health Higher Education System were identified, including Development of Medical Education System Policies; Ensuring the Alignment of Operations with Policies; Policies Related to Medical Education Development; Value-orientation; Networking and Development of Medical Education System Interactions; and the Development of Research, Management, and Translation of Medical Education knowledge. CONCLUSION: Developing a taxonomy of Health Higher Education policy orientations helps policymakers identify the neglected and overstressed areas. It can provide education policymakers with categorized and comprehensive information to quickly access accurate information, make informed decisions, avoid mistakes, and increase productivity.

Model for Value-based Policy-making in Health Systems.

BACKGROUND: Values are at the heart of discussions related to policy-making and any kind of reforms in health systems. Despite wide recognition of its importance, the concept of value is still vague and the policy-making processes remain astray with respect to values. This study aims to provide a model of value-based policy-making and to explain the concept value and how it affects policy-making. METHODS: The main question of the current study is to explain the concept of value-based policy-making and developing a model, based on the explained concept. In this line, critical review method and Carnwell and Daly approach and using particular keywords related to stewardship, and searching databases were used. In the initial search, 739 studies were obtained, of which using targeted sampling method, 11 studies were finally selected. Then, in order to design and explain different aspects of the value concept in the health system and to develop a model, selected studies were criticized, and finally, the conceptual model of value is designed and explained. RESULTS: The concept of value and its effects, dimensions and its relation to principles, evidence and criteria were determined at different stages of the policy-making process. It was also revealed that value-based policy-making in a health system is contingent upon the realization of terminal values. CONCLUSIONS: In the process of selecting the best policy option, it is necessary to identify the relationship between terminal, instrumental, criterion, and evidence to avoid deviating from the reference value framework in any country and to avoid blindly imitating other experiences in other countries.

Relationship between Organizational Citizenship Behavior and Social Capital: Survey from Hospital Setting.

Background: The importance of organizational citizenship behavior in the hospital is increasing positive relationships between employees and engages them in organizational activities.Methods: This study is a descriptive-correlation survey, the research population consisted of all the staff of selected hospital of IUMS, and 312 of them were chosen based on the formulas and were selected by two-stage sampling. The tools used in the study were two questionnaires.Results: The mean and standard deviation of the two components of social capital and citizenship behavior were moderate.Conclusion: Strengthening the components of employee's citizenship behavior can increase the staff's satisfaction and productivity while increasing social capital in hospitals.

Values in Health Policy - A Concept Analysis.

BACKGROUND: Despite the significant role "values" play in decision-making no definition or attributes regarding the concept have been provided in health policy-making. This study aimed to clarify the defining attributes of a concept of value and its irrelevant structures in health policy-making. We anticipate our findings will help reduce the semantic ambiguities associated with the use of "values" and other concepts such as principles, criteria, attitudes, and beliefs. METHODS: An extensive search of literature was carried out using electronic data base and library. The overall search strategy yielded about 1540 articles and 450 additional records. Based on traditional qualitative research, studies were purposefully selected and the coding of articles continued until data saturation was reached. Accordingly, 31 articles, 2 books, and 5 other documents were selected for the review. We applied Walker and Avant's method of concept analysis in studying the phenomenon. Definitions, applications, attributes, antecedents, and consequences of the concept of "value in health policy-making" were extracted. We also identified similarities and differences that exist between and within them. RESULTS: We identified eight major attributes of "value in health policy-making": ideological origin, affect one's choices, more resistant to change over time, source of motivation, ability to sacrifice one's interest, goal-oriented nature for community, trans-situational and subjectivity. Other features pinpointed include alternatives, antecedents, and consequences. Alternative, antecedents and consequences case may have more or fewer attributes or may lack one of these attributes and at the same time have other distinctive ones. CONCLUSION: Despite the use of the value framework, ambiguities still persist in providing definition of the concept value in health policy-making. Understanding the concept of value in health policy-making may provide extra theoretical support to decision-makers in their policy-making process, to help avoid poor policy formulation and wastage of limited resources.

The relationship between learning style preferences and gender, educational major and status in first year medical students: a survey study from iran.

BACKGROUND: Identifying and employing appropriate learning styles could play an important role in selecting teaching styles in order to improve education. OBJECTIVES: This study aimed to determine the relationship between learning styles preferences and gender, educational major and status in first year students at Isfahan University of Medical Sciences. PATIENTS AND METHODS: A cross-sectional study employing the visual-aural-read/write-kinesthetic (VARK) learning style's questionnaire was done on 184 first year students of medicine, pharmacy, dentistry, nursing and health services management at Isfahan University of Medical Sciences in 2012. The validity of the questionnaire was assessed through experts' views and reliability was calculated using Cronbach's alpha coefficients (α = 0.86). Data were analyzed using the SPSS ver.18 software and x(2) test. RESULTS: Out of 184 participants who responded to and returned the questionnaire, 122 (66.3%) were female; more than two-thirds (68.5%) of the enrolled students were at the professional doctorate level (medicine, pharmacy, dentistry) and 31.5% at the undergraduate level (nursing and health services management). Eighty-nine (48.4%) students preferred a single-modal learning style. In contrast, the remaining 95 students (51.6%) preferred multi-modal learning styles. A significant relationship between gender and single modal learning styles (P = 0.009) and between status and learning styles (P = 0.04) was observed. CONCLUSIONS: According to the results, male students preferred to use the kinesthetic learning style more than females, while, female students preferred the aural learning style. Knowledge about the learning styles of students at educational institutes is valuable and helps solve learning problems among students, and allows students to become better learners.

Model for implementing evidence based health care system in iran.

BACKGROUND: Regarding the role and importance of paradigm of evidence based practice and its remarkable impact on the effectiveness and efficiency of clinical services and healthcare, development of an integrated system seems necessary in order to manage dispersed data and ensure using evidence in clinical decision making, thus the aim of this study was designing a model for implementing national system of evidence based health care in Iran. METHODOS: THIS PAPER IS A STUDY OF COMPARATIVE TYPE WHICH HAS BEEN WRITTEN IN THREE STAGES: investigation of structure and process of evidence based practice in selected countries, investigation and analysis of current status in Iran in this regard and recommendation of strategies which make model implementation feasible in the country. Such methods as review of literature, focus group discussion and Delphi technique were used for investigation. RESULTS: According to studies, insuring an evidence based practice culture in the country requires a system called National Evidence Based Health Care System which consists of three subsystems including national system of clinical knowledge management, national evidence-based practice system and integrated national network of clinical effectiveness. CONCLUSION: The ultimate goal of health care system in every country is maintaining and improving community health. Achievement of this goal depends on effectiveness of delivered services and consistency of the services with national and local priorities. In order to achieve clinical effectiveness, the best practice should be realized in the country, implementation of which requires a set of macro and micro strategies enabling facilitation, promotion or guaranteeing clinical knowledge application in the country.

Are hospitals ready to response to disasters? Challenges, opportunities and strategies of Hospital Emergency Incident Command System (HEICS).

BACKGROUND: Applying an effective management system in emergency incidents provides maximum efficiency with using minimum facilities and human resources. Hospital Emergency Incident Command System (HEICS) is one of the most reliable emergency incident command systems to make hospitals more efficient and to increase patient safety. This research was to study requirements, barriers, and strategies of HEICS in hospitals affiliated to Isfahan University of Medical Sciences (IUMS). METHODS: This was a qualitative research carried out in Isfahan Province, Iran during 2008-09. The study population included senior hospital managers of IUMS and key informants in emergency incident management across Isfahan Province. Sampling method was in non-random purposeful form and snowball technique was used. The research instrument for data collection was semi-structured interview; collected data was analyzed by Colaizzi Technique. RESULTS: Findings of study were categorized into three general categories including requirements (organizational and sub-organizational), barriers (internal and external) of HEICS establishment, and providing short, mid and long term strategies. These categories are explained in details in the main text. CONCLUSIONS: Regarding the existing barriers in establishment of HEICS, it is recommended that responsible authorities in different levels of health care system prepare necessary conditions for implementing such system as soon as possible via encouraging and supporting systems. This paper may help health policy makers to get reasonable framework and have comprehensive view for establishing HEICS in hospitals. It is necessary to consider requirements and viewpoints of stakeholders before any health policy making or planning.