Challenges in Providing Care for Patients with Chronic Diseases during Disasters: A Qualitative Study with Focus on Diabetes and Chronic Respiratory Diseases in Iran.

Background: Non-communicable diseases are of the major health challenges and the leading cause of death in Iran and at the global level. Moreover, Iran is a disaster-prone country and considering the exacerbation of diabetes and chronic respiratory diseases in natural disasters, its healthcare system is facing challenges. This study was designed to explore challenges in providing healthcare services to patients with diabetes and chronic respiratory diseases during disasters in Iran. Materials and Methods: The conventional content analysis is used in this qualitative study. Participants included 46 patients with diabetes and chronic respiratory diseases, and 36 of stakeholders were experienced and had theoretical knowledge. Participants' selection started by means of purposive sampling and continued to the point of data saturation. Data collection was carried out employing semi-structured interviews. Data analysis was performed using Graneheim and Lundman method. Results: Based on participants' experiences, four major challenges in providing care to patients with diabetes and chronic respiratory diseases during natural disasters include integrated management (with three subcategories: control and supervision, patient data management, volunteer management), physical, psychosocial health (with three subcategories: psychological impacts, exacerbation of signs and symptoms, special patient characteristics), health literacy and the behavior (with three subcategories: risk perception, values and beliefs, education and awareness) and barriers to healthcare delivery (with three subcategories: facilities and human resources, financial and living problems and insurances, accessibilities and geographic access). Conclusion: Developing countermeasures against medical monitoring system shutdown in order to detect medical needs and problems faced by chronic disease patients including those with diabetes and chronic obstructive pulmonary disease (COPD), is essential in preparedness for future disasters. Developing effective solutions may result in improved preparedness and better planning of diabetic and COPD patients for disasters, and potentially promote health outcomes during and after disasters.

A qualitative evaluation of the challenges in management for patients with chronic diseases during disasters in Iran.

BACKGROUND: Iran's health care system faces significant challenges in managing the growing burden of non-communicable diseases, and these are exacerbated during the frequent natural disasters. The current study was designed to understand challenges in providing healthcare services to patients with diabetes and chronic respiratory diseases during such crisis periods. METHODS: The conventional content analysis was used in this qualitative study. Participants included 46 patients with diabetes and chronic respiratory diseases, and 36 stakeholders with knowledge and experience in disasters. Data collection was carried out employing semi-structured interviews. Data analysis was performed using Graneheim and Lundman method. RESULTS: Four major challenges in providing care to patients with diabetes and chronic respiratory diseases during natural disasters include integrated management, physical, psychosocial health, health literacy and the behavior and barriers to healthcare delivery. CONCLUSIONS: Developing countermeasures against medical monitoring system shutdown in order to detect medical needs and problems faced by chronic disease patients including those with diabetes and chronic obstructive pulmonary disease (COPD), is essential in preparedness for future disasters. Developing effective solutions may result in improved preparedness and better planning of diabetic and COPD patients for disasters.

The Policy Gap and Inefficiency in Public Volunteers' Response to Assist the Hospitals After Natural Disasters in Iran: A Grounded Theory Methodology.

OBJECTIVE: This study aims to explore a public volunteer's hospital response model in natural disasters in Iran. METHODS: This study employed grounded theory using the Strauss and Corbin 2008 method and data analysis was carried out in three steps, namely open, axial, and selective coding. The present qualitative study was done using semi-structured interviews with 36 participants who were on two levels and with different experiences in responding to emergencies and disasters as "public volunteers" and "experts". National and local experts were comprised of professors in the field of disaster management, hospital managers, Red Crescent experts, staff and managers of Iran Ministry of Health and Medical Education. RESULTS: The main concept of the paradigm model was "policy gap and inefficiency" in the management of public volunteers, which was rooted in political factions, ethnicity, regulations, and elites. The policy gap and inefficiency led to chaos and "crises over crises." Overcoming the policy gap will result in hospital disaster resilience. Meanwhile, the model covered the causal, contextual, and intervening conditions, strategies, and consequences in relation to the public volunteers' hospital response phase. CONCLUSIONS: The current public volunteers' hospital in Iran suffered from the lack of a coherent, comprehensive, and forward-looking plan for their response. The most important beneficiaries of this paradigm model will be for health policy-makers, to clarify the main culprits of creating policy gap and inefficiency in Iran and other countries with a similar context. It can guide the decision-makings in upstream documents on the public volunteers. Further research should carried out to improve the understanding of the supportive legal framework, building the culture of volunteering, and enhancing volunteers' retention rate.

Determining factors on volunteers' presence in hospital response to disasters and emergencies: a qualitative study.

BACKGROUND: Volunteers' presence, as a critical issue in hospital response to disasters and emergencies, helps to readiness and quick response to the phenomena, preventing deaths caused by such incidences. This study aimed to determine the main factors affecting popular volunteers' presence in hospital response to disasters and emergencies in Iran. METHODS: This qualitative study, conducted on 31 semi-structured interviews during the years 2019 and 2020, concerning emergency specialist working in various health organization nationwide between June 2019 and April 2020. The non-structured and semi-structured interviews were adopted to gather concept code and analyzed using Graneheim recommendation method. RESULTS: Four main categories, identified as effective factors on volunteers' presence in hospital response to disasters and emergencies, including nine subcategories: (1) organizing and managing volunteers (with two sub-categories: (a) calling and registering volunteers, and (b) identifying volunteers' ability); (2) organizational structure (with two sub-categories: (a) operational planning and (b) coordination and communication); (3) training (with two sub-categories: (a) training in disasters and (b) volunteer training); and (4) volunteer challenges (with three sub-categories: (a) volunteer interaction with organizations, (b) volunteer logistics, and (c) volunteering culture). CONCLUSIONS: Exploring effective factors as regards volunteers' presence in hospital response phase in disasters to adopt a policy based on the experiences of managers and heads of health can help planners to provide effective design and implementation. It can scientifically contribute to disaster risk management and hospital emergency response in Iran.

Comment on Choi, Y.-J.; Choi, H.-B.; O'Donnell, M. Disaster Reintegration Model: A Qualitative Analysis on Developing Korean Disaster Mental Health Support Model. Int. J. Environ. Res. Public Health 2018, 15, 362.

Recently, Choi et al. published an article in the International Journal of Environmental Research and Public Health, indicating that mental health disorders were experienced by disaster survivors in Korea. [...].

Preparedness challenges of the Iranian health system for dust and sand storms: A qualitative study.

BACKGROUND: The dust and sand storms (DSS) in Iran increased in recent years, which have caused adverse health effects. Regarding the effects of DSS on the health indicators, the health system plays a key role based on the mission and the services which it provides. The present study was conducted, in Iran, to fill the existing knowledge gap and to understand the preparedness challenges of the health system in response to the DSS. MATERIALS AND METHODS: Twenty-one semi-structured interviews, in 2016-2017, were undertaken. This study carried out using purposeful sampling with key informants in the Khuzestan Province, national policymakers in Tehran, as well as people affected by this phenomenon. A qualitative approach, using the conventional content analysis, was employed to analyze the collected data. RESULTS: Four main categories that appear to explain the preparedness challenges of the health system for DSS include the risk assessment, knowledge management, organizational elements, as well as monitoring and evaluation. CONCLUSIONS: It is imperative that policymakers of the country pay special attention to the hazard risk understanding and managing the various aspects of the beliefs and attitudes associated with DSS. The development of early warning system, regular drills and exercises, as well as public and specialized health promotion training related to this phenomenon are suggested.

Preparedness components of health systems in the Eastern Mediterranean Region for effective responses to dust and sand storms: a systematic review.

Background: Dust and Sand Storm (DSS), according to estimates by global reports, will increase dramatically in the Eastern Mediterranean Region (EMR). Numerous health problems caused by DSS will be severely affected regions and vulnerable groups. This study aimed to identify the components of the preparedness of health systems for the DSS phenomenon in EMR. Methods: In this systematic review, the peer-reviewed papers in four electronic databases, including Medline through PubMed, Scopus, ISI Web of Science and the Cochrane library, as well as available grey literature, were searched and selected. The research process was carried out by including papers whose results were related to the potential health effects caused by desert dusts in EMR. Was used the combination of three groups of keywords: the exposure factor, health effects as outcomes, and the countries located in EMR. The focus was on the PRISMA checklist, with no time limitations until December 2017. Finally, through 520 related citations, 30 articles were included. Descriptive and thematic content analyses were evaluated. Results: The preparedness components were divided into three and ten main categories and subcategories, respectively. The three categories covered the areas of DSS hazard identification, planning and policy-making, and risk assessment. Conclusions: Recognition of the health system preparedness factors for DSS in EMR will help policy-makers and managers perform appropriate measures when dealing with this hazard. More studies should be conducted to understand these factors in other parts of the world. Registration: PROSPERO registration number CRD42018093325.