Abstract
BackgroundThe increasingly recognized need for reorganizing the primary health care services in Iraq calls for a comprehensive assessment of the system to better understand its problems and needs for development. As part of such comprehensive assessment and due to the important role of primary health care providers in adopting any change, we ought to explore the range and diversity of viewpoints of primary health care providers towards the Iraqi primary health care system.MethodsThis explorative study was carried out in Erbil governorate, Iraq from May to July 2011. Data were collected from primary health care providers using Q-methodology to elicit subjective viewpoints and identify shared patterns among individuals. Forty primary health care providers representing eight primary health care centers sorted 41 statements reflecting different aspects of the Iraqi primary health care system into a distribution on a scale of nine from “disagree most” to “agree most”. By-person factor analysis was used to derive latent viewpoints through centroid factor extraction and varimax rotation of factors.ResultsAnalysis of the participants’ Q-sorts resulted in four distinct viewpoints among primary health care providers toward the current primary health care system. One factor emphasized positive aspects of the current primary health care system that is content with the current primary health care system. The other three factors highlighted the negative aspects and they included (i) professionally-centered viewpoint, (ii) comprehensive perception and problem-based solutions and (iii) critical to leadership/governance aspects of the system.ConclusionsThis study revealed diverse viewpoints of primary health care providers toward the current Iraqi primary health care system and recognized the particular issues related to each viewpoint. The findings can contribute to a better understanding of health policy makers and primary health care managers concerning the problems facing the primary health care system that might contribute to change in the management of this system.
Highlights
The increasingly recognized need for reorganizing the primary health care services in Iraq calls for a comprehensive assessment of the system to better understand its problems and needs for development
Forty primary health care (PHC) providers participated in the study
One factor emphasized the positive aspects of the current PHC system and three factors highlighted the negative aspects
Summary
Setting This study was carried out on a sample of PHC providers selected from eight main PHC centers located in urban and semi-urban areas of Erbil governorate of Iraq from May to July 2011. After the Q-sample was created, a Q-sort grid was developed, which involved creating a quasi-normal distribution with 41 cells equal to the number of the Q-sample statements (Figure 1) This Q-sort constituted the data collection instrument for the study. Both language versions of the Q-sort were pilot-tested with a convenience sample of seven PHC providers. A statement’s factor score is the normalized weighted average statement score (Z-score) of respondents that define that factor Based on their Z-scores, statements were attributed to the original quasi-normal distribution, resulting in a composite (or idealized) Q sort for each factor. System building blocks [26] was used wherever applicable to assist in factor interpretation
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