Challenges on the road to recovery: Exploring attitudes and experiences of clients in a community-based buprenorphine program in Baltimore City.

OBJECTIVE: This qualitative study identifies and describes experiences and challenges to retention of individuals with opioid use disorder (OUD) who participated in a low-threshold combined buprenorphine-peer support treatment program in Baltimore. METHODS: In-depth semi-structured interviews with staff and former clients of the Project Connections Buprenorphine Program (PCBP) (9 people) and focus group discussions with current and previous clients of PCBP (7 people) were conducted. Content analysis was used to extract themes regarding barriers to enrolling and remaining in, and transitioning from the program. RESULTS: Primary challenges identified by the participants included struggles with cravings and symptoms of withdrawal, comorbid mental health issues, criminal justice system involvement, medication stigma, and conflicts over level of flexibility regarding program requirements and the role of employment. CONCLUSIONS: This study identified several obstacles clients face when seeking care through a combined buprenorphine-peer support model. Findings highlight potential programmatic factors that can be improved and additional resources that may support treatment retention rates and better outcomes. Despite challenges, low-threshold and community-based programs can increase access to effective maintenance treatment for OUD, especially among vulnerable populations who may not have access to formal health services.

Problems of providing services to people affected by HIV/AIDS: service providers and recipients perspectives.

This qualitative study aimed to identify the health-care problems of people living with HIV (PLHIV) in 2 large cities: Tehran and Kermanshah. Two main groups of stakeholders - service providers (policy-makers, managers, physicians and counsellors) and service recipients (PLHIV and their relatives) - participated in focus group discussions and in-depth interviews. We identified 24 themes covering the major health problems of PLHIV, including: incomplete and inadequate coverage of health-care services; patients' substance abuse; patients' fear of stigma; occupational burnout of certain service providers; patients' dissatisfaction with some of the services provided by counselling centres/clinics; medical staff's failure to observe confidentiality; and patients' lack of access to required specialized services. The problems and needs identified can inform the design and implementation of health programmes in our country and elsewhere in the Eastern Mediterranean Region.

Association of Maternal Working Condition with Low Birth Weight: The Social Determinants of Health Approach.

BACKGROUND: The socioeconomic conditions have made more job opportunities available to women. This has created interest to conduct studies on the effect of working lifestyle on pregnancy outcomes. AIM: This study was conducted with the aim to assess the relationship between mothers' working status as a social determinant and the incidence of low birth weight (LBW) of the newborn. SUBJECTS AND METHODS: This case-control study was conducted on 500 women with normal weight infants (control group) and 250 women with LBW infants (case group) in selected hospitals in Tehran. Data were collected using a researcher-made questionnaire, designed to assess the effect of mothers' prenatal lifestyle, as a social determinant, on LBW of the newborn. A section of the questionnaire involved assessment of mother's working condition in terms of the work environment, activities, and job satisfaction. Data were analyzed using Chi-square and logistic regression tests. RESULTS: LBW among employed mothers was 5 times more likely than unemployed ones (odds ratio = 5.35, P < 0.001). Unfavorable work conditions such as humid environment, contact with detergents, and being in one standing or sitting position for long hours were significantly associated with LBW (P < 0.001). CONCLUSION: The present study showed that unfavorable work conditions were associated with LBW; therefore, they need special attention.

Health research evaluation and its role on knowledge production.

BACKGROUND: Knowledge production and evaluation are two important functions of health research system (HRS). In this article, we aimed to reveal the correlation between evaluation of health research organizations and health knowledge production promotion. METHODS: A comprehensive evaluation system was developed to evaluate the academic performance of national medical science universities on an annual basis. It assess following domains; stewardship, capacity building and knowledge production. Measurable indicators for each domain were assigned, a 'research profile' for each department was provided. In this study, we compared the results of annually national Health Research System evaluation findings during 2005-2008. RESULTS: The number of scientific articles has been increased from 4672 to 8816 during 2005 to 2008. It is mentionable that, the number of articles which has been published in indexed data bases has risen too. This fact could be related to directed policy for more international publication of scientific articles from Iran. The proportion of total articles to the number of academic members was 1.14 in 2008, comparing to 0.84 in 2005. It means that this proportion have increased about twice (0.7 Vs 0.45) during mentioned time. Moreover, other scientific products such as authored books based on domestic researches and cited articles in textbooks have increased according to special attention to knowledge production by policy makers. CONCLUSION: We conclude that Health System Research evaluation could be used as a mean for implementing policies and promoting knowledge production.

Adapting research to local contexts based on the model of Campinha-Bacote for cultural competence: a case scenario of 3 ethnic groups in the Islamic Republic of Iran.

This article examines the issue of cultural competence in qualitative cross-cultural mental health research. Conducting qualitative research on mental health and illness requires the researchers to acquire sensitivity to different cultures and develop the skills of cultural competence. We outline the main aims and steps of implementation when incorporating concepts of cultural competence into a qualitative research study. We present a case scenario from studies on women's depression in 3 ethnic groups (Fars, Kurd and Turk) in the Islamic Republic of Iran. The article presents a brief overview of the Campinha-Bacote model and addresses the 5 major constructs of cultural competence as they were applied in the 3 phases of the research process.

Adapting research to local contexts based on the model of Campinha-Bacote for cultural competence: a case scenario of 3 ethnic groups in the Islamic Republic of Iran

This article examines the issue of cultural competence in qualitative cross-cultural mental health research. Conducting qualitative research on mental health and illness requires the researchers to acquire sensitivity to different cultures and develop the skills of cultural competence. We outline the main aims and steps of implementation when incorporating concepts of cultural competence into a qualitative research study. We present a case scenario from studies on women's depression in 3 ethnic groups [Fars, Kurd and Turk] in the Islamic Republic of Iran. The article presents a brief overview of the Campinha-Bacote model and addresses the 5 major constructs of cultural competence as they were applied in the 3 phases of the research process

An Explanatory Model of Depression among Female Patients in Fars, Kurds, Turks Ethnic Groups of Iran.

BACKGROUND: Depressive disorder is globally estimated to be as many as one in five visits to primary health care. Approximately more than 50% of depressed women in primary care are not diagnosed. As a part of a major investigation into perceptions of women's depression, this study explored how female patients and their relatives conceptualize patients' conditions in three ethnic groups in Iran (Fars, Kurds and Turks). METHODS: Qualitative methods were used for data collection. Depressed women and their relatives were purposively selected from the public psychiatric clinics affiliated to university of medical sciences in the three study cities. Twenty-five depressed women and 14 relatives were interviewed in three ethnic groups. RESULTS: One theme "illness meaning", including three categories: perceived symptoms, label of the illness, and effects of the illness was found through the content analysis. The participants perceived symptoms of illness as somatic and psychological depending on the participant's assumed reason for the onset of the illness. There were most similarities in term used for of the illness in the three ethnic groups. Most of the study participants described the illness in terms of nerve problems/illness, and depression "afsordehgi". The most important effects that depressed women had experienced because of their illness were marital conflict or a guilt feeling originating from their inability to support family. CONCLUSION: These findings suggest the need to recognize and choose appropriate diagnostic approach for depressed women in the context of Iran.