How can the Sendai framework be implemented for disaster risk reduction and sustainable development? A qualitative study in Iran.

BACKGROUND: The Sendai Framework is the United Nations' most significant approach to reducing the risk of disasters from 2015 to 2030. This framework designed for all communities. However, communities should create operational and remedial strategies based on their unique circumstances. Considering the gaps in the implementation of Sendai framework strategies in Iran, as a developing country, the present study was designed. METHOD: This study was conducted by using a qualitative direct content analysis method to find out the expert's opinions on the implementation of the Sendai framework in Iran from 2021 to 2023. 35 experts in the focus group discussion and 9 experts in the interview were the participants of the study. RESULTS: Study findings were merged and reported as one main theme entitled Executive actions for implementing the Sendai Framework, four categories, and 37 codes. Eleven codes for the strategy of understanding disaster risk, 11 codes for the strategy of strengthening disaster risk governance to manage disaster risk, eight codes for the strategy of Investing in disaster risk reduction for resilience, and finally, seven codes for the strategy of enhancing disaster preparedness for effective response and to "Build Back Better" in recovery, rehabilitation, and reconstruction were identified as implementation solutions. CONCLUSION: The Sendai Framework has not provided any detailed implementation solutions because the countries' economic, social, level of development, etc., are different. The study's findings can be used as a guide for other developing countries.

Determining the Factors Affecting the Retrofitting of Health-Care Facilities: A Qualitative Study.

OBJECTIVE: Health services are the first and most important demand for the affected people after disasters. Hospitals and staff of health centers are directly affected by disasters, and this issue is more critical due to the hospital conditions, such as the presence of patients, medical facilities, and equipment. Therefore, it is necessary to make hospitals retrofit against disasters. METHODS: This study was conducted qualitatively to extract experts' opinions about the factors affecting the retrofitting of health-care facilities in 2021. Semi-structured interviews were the basis of the data. In addition, to obtain data from different sources (triangulation), a focus group discussion (FGD) was held after the interviews. RESULTS: The findings of this study were extracted from interviewees and FGD in the form of 2 categories, 6 subcategories, and 23 codes. Main categories included external and internal factors. The subcategories of external factors were General government policies to reduce risk, The Programs of the Ministry of Health, and medical universities for retrofitting and Uncontrollable external factors. The subcategories of internal factors were Exposure of managers and staff of health-care organizations to various disasters, determining the types of vulnerabilities in health-care facilities, and Factors related to managerial actions. CONCLUSIONS: Retrofitting health-care facilities is one of the requirements for designing and constructing these facilities. The role of governments in this issue is more than other stakeholders because governments are the trustee of the health system and are responsible for the people's health. Therefore, governments must plan for the retrofitting of health facilities according to the disaster risk analysis and prioritization and their resources. Although, external factors play a very important role in influencing retrofitting policies, the role of internal factors should not be neglected. None of the internal and external factors alone can have a significant effect on retrofitting activities. For this purpose, a suitable combination of factors should be determined and the goal of the system should be to achieve resistant and resilient facilities against disasters.

Factors related to earthquake preparedness of households based on social-cognitive theory constructs: A systematic review.

Background: Earthquakes cause many casualties worldwide. Taking preventive measures and improving community preparedness is critical to reducing earthquake damage. The social cognitive theory explains how individual and environmental factors cause behavior. This review was conducted to identify the social cognitive theory structures, in research on the preparedness of households against earthquakes. Materials and methods: This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted from January 1, 2000, to October 30, 2021 in Web of Science, Scopus, PubMed, and Google Scholar. Studies were selected based on inclusion and exclusion criteria. The initial search yielded 9,225 articles, and finally, 18 articles were selected. Articles were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Results: Eighteen articles about disaster preparedness behaviors based on the socio-cognitive constructs were identified and reviewed. The essential constructs used in the reviewed studies included self-efficacy, collective efficacy, knowledge, outcome expectations, social support, and normative beliefs. Conclusion: By identifying the dominant structures that have been used in studies related to the preparedness of households against earthquakes, researchers can implement appropriate and more cost-effective interventions by focusing on improving suitable structures.

The viewpoints of residents of Kerman, Iran regarding the challenges and barriers of preparing households against earthquakes: A theory-guided qualitative content analysis.

Introduction: Earthquakes cause a lot of damage and casualties. For various reasons, most households are not prepared for earthquakes. This study aims to identify the challenges and barriers to households' preparedness against earthquakes from the viewpoint of Kerman residents. Methods: This qualitative-directed content analysis study was conducted from December 2021 to May 2022 in the city of Kerman in southeast Iran. Data was collected by purposive sampling through in-depth and semi-structured individual face-to-face interviews with 48 households. Results: After multiple rounds of analyzing and summarizing the data based on the social-cognitive theory and taking into consideration similarities and differences, five main categories and 19 subcategories created based on the results of data analysis and including (1) Challenges related to cognitive factors (2) Challenges related to behavioral factors (3) Challenges related to the physical environment (4) Challenges related to the social environment and (5) Challenges related to financial factors. Conclusion: Although the participants listed many challenges and barriers in different fields, in order to overcome the barriers and challenges of preparing households for an earthquake, the support of the authorities and the cooperation of the residents are necessary.

Investigating the Situation of Iranian Hospitals in Terms of Implementing Mandatory Patient Safety Standards: A Systematic Review.

Background: Evaluate the patient's safety status in Iranian hospitals using the Patient safety friendly hospital initiative (PSFHI) assessment tool provided by the World Health Organization. PSFHI assessment tool of 140 patient safety standards, they are classified as mandatory (20 standards), basic (90 standards) and advanced (30 standards). Mandatory standards are necessary criteria that hospitals must meet to register for PSFHI. The first stage of the patient safety program in Iran is to achieve the implementation of the mandatory standards to enter the patient safety friendly hospital program. We aimed to evaluate the patient's safety status in Iranian hospitals in terms of implementing mandatory patient safety standards. Methods: In this systematic review, articles were searched between 2001 and 2021 in Web of Science, PubMed, Scopus Google Scholar, and Iranian SID and Magiran databases. Keywords including patient safety, quality assessment, standards, patient safety friendly hospital, Iran were performed. These articles were evaluated independently by two researchers and the contradictions were discussed with the third author. Results: Finally, 7 eligible studies were included in the study. The highest score (75%) was related to the fourth domain of safe environment and the lowest score with (47%) was related to the second domain of engaging and interacting with the patient and the community. The overall average of compliance with standards in all four areas was 70%. Conclusion: Institutionalizing a patient safety culture, paying more attention to creating a culture to identify patients, educating staff and patients, and removing legal barriers, Increases the observance of mandatory patient safety standards in the Iran.

Design and validation of a preparedness evaluation tool of pre-hospital emergency medical services for terrorist attacks: a mixed method study.

INTRODUCTION: Terrorist attacks are one of the human problems that affect many countries, leaving behind a huge toll of disabilities and deaths. The aim of this study was to use a mixed-method analysis to design and validate an evaluation tool for pre-hospital emergency medical services for terrorist attacks. METHODS: The present study is a mixed-method (qualitative and quantitative) study that was conducted in two phases. In the qualitative phase (item generation), semi-structured interviews were conducted with 34 Iranian emergency medical technicians who were selected through a purposive sampling method and a scoping literature review was conducted to generate an item pool for the preparedness evaluation of Emergency Medical Services (EMS) in terrorist attacks. In the quantitative phase (item reduction), for validity of tool face, content and construct validity, were performed; for tool reliability, the test and retest and intra-class correlation coefficient were evaluated. RESULTS: At the first stage, 7 main categories and 16 subcategories were extracted from the data, the main categories including "Policy and Planning", "Education and Exercise "," Surge Capacity", "Safety and Security", "Command, Control and Coordination", "Information and Communication Management "and "Response Operations Management". The initial item pool included 160 items that were reduced to 110 after assessment of validity (face, content and construct). intra-class correlation coefficient (ICC = 0.71) examination and Pearson correlation test (r = 0.81) indicated that the tool was also reliable. CONCLUSION: The research findings provide a new perspective to understand the preparedness of pre-hospital emergency medical services for terrorist attacks. The existing 110-item tool can evaluate preparedness of pre-hospital emergency medical services for terrorist attacks through collecting data with appropriate validity and reliability.

Developing and psychometric testing of the evaluation tool for disaster exercises design stage: A mixed method study.

BACKGROUND: Exercise in different health sectors is an important step in preparing programs for disaster risk management. The present study aimed to develop and validate a tool for evaluating disaster exercises during the design stage in the health sector. METHODS: This methodological study was conducted in two phases using an explanatory sequential mixed method approach. Semi-structured interviews with 25 disaster-related health professionals were conducted during the qualitative phase (item generation), and a systematic review was done to evaluate items pool of disaster exercises design stage tool. The quantitative phase (item reduction) assessed both face and content validity, as well as reliability using Cronbach's alpha and intra-class correlation coefficient. RESULTS: At the first stage four main categories and eleven subcategories were extracted from the data, the main categories including "coordination, command and guidance of exercise", "hardware and software requirements of exercise ", "organizational exercise resources", and "communication and exercise public information". The initial items pool included 164 items that were reduced to 50 after the assessment of validity (face and content). Cronbach's alpha (0.89) and intra-class correlation coefficient (ICC = 0.72) tests indicated that the tool is also reliable. CONCLUSION: The research findings provide a new categorization perspective to understand the disaster exercises evaluation in the health sector. The existing 50-item tool can evaluate disaster exercises design stage in the health sector through collecting data with appropriate validity and reliability.

The reasons why patients abscond from public hospitals in southeastern Iran: a qualitative study.

BACKGROUND: Patient absconding from hospital is one of the permanent issues the hospitals face, which poses many risks and challenges to the patient, hospital, and society. The present study aimed to identify the reasons for patient absconding behavior for public hospitals in southeastern Iran. METHODS: The present study is a qualitative study which was conducted at three public hospitals in southeastern Iran using purposive sampling through semi-structured interviews with 63 informants involved in patient treatment process. Data were analyzed using Colaizzi content analysis (CCA) method. RESULTS: Three main themes of economic, social factors, and factors related to the hospital covering 15 subthemes were identified to explain the reasons for patients absconding behavior. CONCLUSION: There are many reasons for reducing patients absconding from hospitals, and one of the main reasons is the patients' economic and social problems. The absconding behavior can lead to harm and problems for patients, and some emotional and occupational consequences for the employees and nurses. Paying attention to this issue and considering some courses of action to prevent patient absconding might lead to a considerable promotion of public trust and eliminate many problems for hospitals.

Risk analysis and safety assessment of hospitals against disasters: A systematic review.

Both natural and man-made disasters are increasing in occurrence at the world. Hospitals and health-care centers are very complex and have a high potential for vulnerability depending on external and internal factors. Unfortunately, past experiences show that health-care centers and the health system are vulnerable to disasters. Therefore, risk analysis and safety assessment studies of hospitals and other health-care centers are absolutely necessary. This systematic review study was conducted on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English language international databases (Pub Med, Scopus, Embase, Web of Science, and Google Scholar) were searched through January 1, 2000 up to June 20, 2019. The quality of the studies was assessed using the International Narrative Systematic Assessment tool. From 3630 titles identified in this search, 24 studies were selected. The important findings of this study were grouped into five main categories: risk analysis method, type of disaster, hospital safety methods, hospital components and key outcomes of risk analysis, and hospital safety assessments. The nature of disasters is a threat to the lives and property of the people, and therefore hospitals must be available at the incidents and disasters and they must be able to respond to the needs of the disaster-affected community. The probability of an incident and its consequences can never be reduced to zero; because the severity of many natural and even man-made disasters is unpredictable and the probability of their occurrence is different; however, it is possible to identify weaknesses and strengths through risk analysis studies as well as hospital safety assessments and implement retrofitting programs based on the type of risks and safety status and reduce the level of risk to an acceptable level.

Telenursing: A step for care management in disaster and emergencies.

INTRODUCTION: Unusual impacts of disasters on normal living conditions pose challenges to the health system. Nurses who take care of disaster victims may face situations that make decision-making difficult; hereon, the use of new technologies can be a useful solution. The study aimed to identify the telenursing care during incidents and disasters. METHODS: The study was conducted at a medical science university in Iran from 2018 to 2019. This was a semi-structured interview-based qualitative study using content analysis. Eighteen nurses, nursing teachers, and emergency medical technicians were included in the study. Data analysis was performed using inductive content analysis and coding with MAXQDA (2010) software. The Lincoln and Guba (1985) trustworthiness criteria were used for the reliability and validity of the data. RESULTS: Telenursing in critical and supportive care was the main theme identified from data analysis. This theme included six main categories: (1) management of trauma, (2) technical skills, (3) care and decision-making in stressful situations, (4) management of patients with special needs, (5) life-saving intervention, and (6) psychological and emotional supports. CONCLUSIONS: Telenursing in disasters is the turning point of the care management of victims. In order to achieve this goal, nurses should acquire the relevant knowledge, skills, and abilities.

Telenursing in Incidents and Disasters: A Systematic Review of the Literature.

INTRODUCTION: Disasters of any kind can affect public health severely. A shortage of health care specialists, such as physicians and nurses, during a disaster is a challenge for health care systems. The use of technology is 1 emerging strategy for addressing the continually increasing demand for care. Moreover, nurses may use technology in their roles. Therefore, the purpose of this study was to identify the application of telehealth, and more specifically telenursing care, in incidents and disasters. METHODS: This systematic review study was conducted on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English language international databases (PubMed, Scopus, Embase, Web of Science, and Google Scholar) were searched through November 2018. The quality of the studies was assessed using the International Narrative Systematic Assessment tool. RESULTS: Of the 5,759 titles identified in this search, 17 studies met the inclusion criteria. The important findings of this study were grouped into 3 main categories: clinical teams, disaster and communication types, and key outcomes of the telehealth programs used in disasters and incidents. We did not find any articles in the field of telenursing care during incidents. DISCUSSION: Providing health care during a disaster is essential, and technology is of vital importance for such care. Because of the shortage of specialized nurses in disaster areas, the presence of such a group in the telehealth program will provide a new window for care. Thus, telenursing offers a means of improving health care response.

Patient safety culture in university hospital's emergency departments: A case study.

BACKGROUND: Improving patient safety culture in healthcare organization is the first step in reducing medical errors and improving patient safety. The aim of the study was to determine and to compare patient safety culture dimensions in emergency departments of selected educational hospitals of Kerman University of Medical Sciences. METHODS: This descriptive-analytical study was conducted in 2018 in the emergency departments Shahid Bahonar, Afzalipour, Shahid Beheshti, and Shafa hospitals. Data collection was carried using the Hospital Survey of Patient Safety Culture questionnaire which includes 42 questions and 12 dimensions. Data were analyzed using descriptive and analytical statistics. RESULTS: The highest and lowest mean related to the organizational learning (3.96 ± 0.34) and handoffs and transitions (2.27 ± 0.55). According to independent t test, there was a significant relationship between nurse's gender and patient safety culture. Also, according to analysis of variance test, there was a significant relationship between work experience and patient safety culture. CONCLUSIONS: The situation of patient safety culture was average at a moderate level. Development of reporting system and encouraging staff to report errors and adjusting nursing number and workload is suggested.

Prioritizing the health problems of slum residents using social determinants of health: A case study in a developing country.

INTRODUCTION: Today, countries are faced with the fact that despite unlimited human needs, resources are limited. The health sector has the same limitations as other sectors. Therefore, this study aimed to prioritize the health problems of the Kerman residents slums by using the social determinants of health. METHODS: The present study was carried out using a hierarchical analysis. The study population included experts of the deputy of social affairs, experts of the research center for SDH, experts of deputy of health, experts of social welfare in governing board of Kerman, and community health practitioners. Sixteen of these experts were selected using purposeful and snowball sampling methods. Expert Choice software was used to analyze the information. RESULTS: In this study, the health problems were prioritized. The highest priority among the main themes and subtheme was related to early childhood development and child labor, respectively. CONCLUSION: The early years of life are the most important years of life, and the experiences of these years will be the foundation of the future life of every human being. Therefore, if their needs and developmental areas are not answered properly during this period, their health will be compromised.

Identifying the health problems of slum residents using social determinants of health: Kerman, Iran.

INTRODUCTION: Although slum emerged in industrialized countries, today, all cities in the world are somehow facing this phenomenon. Slums create many problems in different areas, especially health for residents. Therefore, this research was conducted with the aim of identifying the health problems of the slum residents of Kerman city by using the social determinant of health approach. METHOD: The present study is an applied study that was carried out qualitatively using semistructured interviews. Samples were selected using purposeful and snowball sampling methods. Data were analyzed using the Colaizy method. RESULTS: In this study, the health problems of residents of slums in the city of Kerman were identified by interviews. In total, seven main themes and 32 sub-themes were extracted. The main concepts extracted include the economic and social class, the early childhood development, social exclusion and social support, employment and unemployment, addiction, food, transport, and traffic. CONCLUSION: The problems of slums people are very widespread, and almost all of the problems affect the health of slums people. The place of living, job, income, the early childhood development and nutritional status are determinants that affect people's health.

Hospital accreditation in Iran: A qualitative case study of Kerman hospitals.

BACKGROUND: According to published evidence, accreditation is one of the evaluating tools in health care organizations. But, there is disagreement among authorities and experts in this regard. This study aims to investigate the evaluation of hospital accreditation in an Iranian context. METHODS: In this qualitative study, a purposive sample of 170 informants was used. Semi-structured interviews were conducted to gather data, which were analyzed using a framework analysis method. RESULTS: Elicited themes were categorized into the domains of strengths of accreditation, weaknesses of accreditation, and accreditation model. The results showed that promoting a culture of quality management and patient safety can resolve many of the problems of an accreditation program. This cannot be achieved without a good working knowledge of accreditation and a strategy to diminish nervousness about the programme on the part of staff. CONCLUSION: The potential impacts of these findings highlight that a comprehensive consideration of the identified inconsistencies is required for a successful implementation of accreditation in Iran. Meetings with professionals and conferences can be considered effective ways of achieving this. ORIGINALITY/VALUE: It is hoped that our results will facilitate a reformulation of Iran's health policy.

A qualitative study on human resources for primary health care in Iran.

BACKGROUND: According to World Bank Group report, while Primary Health Care (PHC) services in Iran were appropriate to the needs of the population in the late 1970s and 1980s, the changing burden of diseases and shifting demand patterns have rendered the existing PHC system no longer suitable to meet current and emergent needs. Based on previous studies, one of the main PHC challenges in Iran relates to human resources issues. METHODS: This study was conducted in 2012 at 3 scales of local (Tabriz city), provincial (East Azerbaijan), and national levels. Two qualitative methods were used in the study: free-focus group discussions and in-depth interviews. Framework analysis was used to analyze collected data. Categories of analysis were developed using framework analysis approach, and main themes were emerged. RESULTS: Four themes were developed and finalized out of focus group discussions and interviews: availability of health workers in PHC, competency, PHC health workers' motivation, and PHC managerial issues. CONCLUSION: Based on findings and issues discovered in this study, several suggestions can be made, including development, implementation, and evaluation of needs assessment strategies for various vocational posts, promotion of educational courses and PHC-based training, strengthening of relationships and coordination between practical and scientific bodies, application of incentive programs in PHC, and strengthening of system management capacity through use of qualified managers.

Investigating the Appropriateness of Admission and Hospitalization at a Teaching Hospital: A Case of a Developing Country.

BACKGROUND: Reduction of inappropriate use of health services can decrease health care costs without harming the quality of services. This study aimed to investigate inappropriate admission and hospitalization at Afzalipour Hospital of Kerman, Iran. METHODS: Inappropriate admission and hospitalization were assessed via a cross-sectional study on 400 patients in Kerman Afzalipour Hospital, Kerman, Iran in 2015. The Iranian version of the Appropriateness Assessment Protocol was used for data collection. Chi-square tests and logistic regression were used to analyze the data. RESULTS: The rate of inappropriate admissions and hospitalization were 7.6% and 9% respectively. There was no significant relationship between inappropriate admissions and any of the studied variables; however, there was a significant relationship between inappropriate hospitalization and age, length of stay and hospital departments. CONCLUSION: If standard measures of admission and hospitalization execute correctly, unnecessary hospitalization rate can be reduced, so more patients can be treated and cost and workload of hospital personnel can be moderated.

Surge Capacity of Hospitals in Emergencies and Disasters With a Preparedness Approach: A Systematic Review.

OBJECTIVE: Surge capacity is one of the most important components of hospital preparedness for responding to emergencies and disasters. The ability to provide health and medical care during a sudden increase in the number of patients or victims of disasters is a main concern of hospitals. We aimed to perform a systematic review of hospital surge capacity in emergencies and disasters with a preparedness approach. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words "surge," "surge capacity," "preparedness," "hospital emergency department," "hospital," "surge capability," "emergency," "hazard," "disaster," "catastrophe," "crisis," and "tragedy" were used in combination with the Boolean operators OR and AND. The Google Scholar, ISI Web of Science, Science Direct, PubMed, Scopus, Ovid, Pro Quest, and Wiley databases were searched. RESULTS: A total of 1008 articles were extracted and 17 articles were selected for final review of surge capacity based on the objective of the study. Seventeen studies (1 randomized controlled trial, 2 qualitative studies, and 14 cross-sectional studies) investigated the surge capacity of hospitals in emergencies and disasters to evaluate the best evidence to date. The results of selected articles indicated that there are various ways to increase the capacity of hospitals in 4 domains: staff, stuff, structure, and system. CONCLUSION: Surge capacity is a basic element of disaster preparedness programs. Results of the current study could help health field managers in hospitals to prepare for capacity-building based on surge capacity components to improve and promote hospital preparedness programs. (Disaster Med Public Health Preparedness. 2017;11:612-620).

Determining patients' satisfaction level with hospital emergency rooms in Iran: a meta-analysis.

Emergency department is one of the important parts of hospitals, and patients' satisfaction with this department significantly affects their overall satisfaction with the hospital. Therefore, evaluating patients' satisfaction level with the emergency part has been taken into account in different studies. The purpose of this study was to systematically review all available primary studies and their results and to evaluate patients' satisfaction level with emergency rooms of hospitals. In this study, previous documents were reviewed; to do this, national and international databases were searched electronically and related articles were extracted. Reference list of the published studies were also reviewed to increase sensitivity and to select a greater number of articles. Reviewing and studying titles and texts of the articles, repeated and unrelated cases were excluded. The remaining articles were entered into stat aver., 11 for meta-analysis. After meta-analysis, 24 articles were selected. The lowest and highest satisfaction level was 24 and 98.4% respectively. Meta-analysis results of studies showed that general evaluation of patients' satisfaction level with emergency rooms of hospitals was 68.9% in Iran. This meta-analysis revealed that patients' satisfaction level with performance and with the way services were presented in emergency rooms of hospitals was desirable in Iran. Concerning multifactorial nature of patients' satisfaction, it is necessary to take this matter into regular and routine consideration.

The hospital incident command system: modified model for hospitals in iran.

INTRODUCTION: Effectiveness of hospital management of disasters requires a well-defined and rehearsed system. The Hospital Incident Command System (HICS), as a standardized method for command and control, was established in Iranian hospitals, but it has performed fairly during disaster exercises. This paper describes the process for, and modifications to HICS undertaken to optimize disaster management in hospitals in Iran. METHODS: In 2013, a group of 11 subject matter experts participated in an expert consensus modified Delphi to develop modifications to the 2006 version of HICS. RESULTS: The following changes were recommended by the expert panel and subsequently implemented: 1) A Quality Control Officer was added to the Command group; 2) Security was defined as a new section; 3) Infrastructure and Business Continuity Branches were moved from the Operations Section to the Logistics and the Administration Sections, respectively; and 4) the Planning Section was merged within the Finance/Administration Section. CONCLUSION: An expert consensus group developed a modified HICS that is more feasible to implement given the managerial organization of hospitals in Iran. This new model may enhance hospital performance in managing disasters. Additional studies are needed to test the feasibility and efficacy of the modified HICS in Iran, both during simulations and actual disasters. This process may be a useful model for other countries desiring to improve disaster incident management systems for their hospitals.