Health Services In Iran Research Articles

Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed-methods study.

Previous research has indicated that community-based mental health services in Iran are restricted, leading to overcrowding in psychiatric wards. This overcrowding has been linked to a range of problems, such as violence, suicide and medical errors. Despite the abundance of research on patient safety, there is still a lack of understanding regarding how mental health nurses (MHNs) create a secure environment within these wards. This study focused on exploring a safe environment provided by MHNs in inpatient psychiatric wards at Farshchian (Sina) Hospital, Hamadan, Iran. An explanatory mixed-methods study was conducted. Initially, the Safe Environment Scale was distributed to all MHNs (n = 48) working in three wards at Farshchian (Sina) Hospital to evaluate the current status. The scale measured two dimensions, and descriptive statistics were used to analyse the collected data. Subsequently, 20 MHNs were selected for semi-structured interviews using purposeful sampling at the same hospital to interpret and fill gaps in the quantitative findings. The data collected from the interviews were analysed using conventional content analysis. The perception and engagement of MHNs in creating a safe environment in the inpatient psychiatric wards were found to be at a medium level, according to the Safe Environment Scale (mean ± SD, 14.67 ± 4.18 and 85.27 ± 17.57, respectively). The qualitative study identified several categories in the results, including 'Hyper-vigilance to safety and security environment', 'Therapeutic communication gap', 'Nurse burnout', 'Staff safety and security need' and 'Environmental safety hazards'. MHNs employ a hyper-vigilant strategy to guarantee a secure atmosphere within psychiatric wards. However, this approach may inadvertently impede the establishment of a safe environment and even diminish MHNs' perception and involvement in its maintenance. According to our research, it appears that MHNs need to improve their education and training in order to successfully implement the vigilance strategy for establishing a secure environment. Additionally, it is essential for them to prioritize therapeutic communication with patients, as this plays a vital role in promoting a safe environment within inpatient psychiatric wards.

A model of financial support for the poor to access health services in Iran: Delphi technique

PurposeReducing inequity in health between the poor and the rich is one of the challenges of the Iranian health sector. Access to health services in Iran is lower in the lowest-income quarter, and the rich use health services more. The purpose of this study is to provide a comprehensive framework for enabling financial access by the poor to health services in Iran.Design/methodology/approachPolicy options were validated and approved by experts and specialists in two stages using the Delphi technique. The sample was consisted of 22 well-known experts on the subject who were selected based on purposive sampling. To evaluate the reliability of the questionnaire, a pilot study was conducted with five participants. Dimensional validity of the policy model, which was agreed upon by more than 75% of the participants was acceptable.FindingsThe main aspects of the model were divided into five categories: identifying the poor, policymaking to prevent the aggravation of health poverty, providing targeted funding, highlighting the importance of coherent regulation and ensuring financial accessibility to health services for the poor. This model could align the activities of all stakeholders in the form of a network and considers its prerequisites.Originality/valuePrevention of dire financial consequences in the case of referral to follow up the treatment alongside exemption and financial protection policies through the networking activities of organizations involved in this field is a crucial step in securing financial support for the poor. Although the researchers included a wide range of policymakers in the Delphi study to gather all perspectives about options for financially support the poor, there may be some potential neglected policy advices.

Explanation of Socio-economic Inequality in Medicine Use: A Cross-sectional Analysis from Iran.

Despite the favorable progress in the production of medicines, there is no significant access to these important health inputs among different socio-economic groups. This study aimed to measure and explain socio-economic inequality in prescribed and non-prescribed medicine use in Iran. Data were obtained from a recent household survey on health services in Iran conducted in 2016. The Erreygers concentration index (ECI) was used to measure socio-economic inequality in the use of prescribed and non-prescribed medicines. In addition, Decomposition analysis was conducted to explain socio-economic inequality. The ECI revealed pro-rich socio-economic inequality in prescribed medicine use (ECI = 0.067, SE = 0.010), indicating that prescribed medicine use was concentrated on the better-offs. On the other hand, this index showed pro-poor inequality in non-prescribed medicine use (ECI = -0.064, SE = 0.009). Decomposition analysis showed that economic status and place of residence were the main determinants of socio-economic inequality in prescribing medicines. These factors and the number of health care needs explained the majority of socio-economic inequality in non-prescribed medicine use. Despite previous positive beliefs, we found remarkable socio-economic inequality in the use of medicines in Iran. Facilitating access to pharmaceutical services for disadvantaged households and rural residents and promoting of national essential medicines list could be recommended against socio-economic inequality in the pharmaceutical market of Iran.

Policy Factors Affecting the Technological Catch-up of Electronic Health Services in Iran through Blockchain Technology

Policy Factors Affecting the Technological Catch-up of Electronic Health Services in Iran through Blockchain Technology

Retention of dental practitioners in rural health services in Iran: Experiences from Kerman province

In Iran, the inequitable distribution of health-care staff, especially dental practitioners between rural and urban areas has a major impact on the delivery of care for those living in rural communities. This study investigated the factors affecting the retention of dental practitioners to stay in the rural areas. This is a cross-sectional study conducted in 2019. All dental practitioners working in health services centers covering a population lower than 20,000 people in Kerman province participated in this study (n = 81). A researcher-designed questionnaire was used for the data collection. The data were analyzed using the descriptive statistics and logistic regression through the SPSS software. The mean age of the participants was 29.2 ± 6.5 and 39.5% were female. The results showed that about two-thirds of native dentists (with local origin), 73.3% of married dentists, and all dental practitioners who had no children or had a child under the age of six were willing to continue working with their current Comprehensive centers of health services compared to other dentists. Univariate and multivariate logistic regression showed that there was a significant relationship among dentists' age, monthly salary, and facilities available in the area (place of residence, availability of vehicles, etc.), view of dental practitioners on living in a rural area, and view of dentists' families on living and working in the area (p < 0.05). More than half of the dental practitioners declared their willingness to stay in rural areas, although, in practice, this amount of presence in rural areas does not meet the needs of residents. Financial issues, amenities, and facilities in the rural areas can have a positive impact on the retention of dental practitioners.

Health-Care Professionals' Assessments of, and Recommendations for, Sexual-Health Education and Service Provision for Young People in Tehran

Background: Only limited Sexual Health and Relationships Education (SHRE) is provided in Iranian schools and universities while research has highlighted demand and need for improved SHRE among young adults. We explored health-care professionals' (HCPs) assessments of, and recommendations for, SHRE and service provision for young people in Tehran.Design and Methods: Semi-structured interviews were conducted with a sample of 17 HCPs based in Tehran and verbatim transcripts were analyzed using thematic analysis.Results: Participants confirmed the need for improved SHRE and service provision for young adults. HCPs described how a lack of reliable educational resources for young adults, taboo and cultural barriers, and a lack of trust and confidentiality prevented young people from accessing information and services. They unanimously supported education and services to be augmented, and provided recommendations on how this could be achieved.Conclusions: A number of positive suggestions for the improvement of SHRE and Iranian sexual health services in Iran were identified.

Integrating Mental Health Services into the Primary Health Care System: The Need for Reform in Iran.

Objective: The main objective of this study was to review aspects of the current situation and structure of the integrated mental health care services for planning a reform. Aspects of the newly designed infrastructure, along with specification of duties of the various human resources, and its relation with Iran’s Comprehensive Mental and Social Health Services (the SERAJ Program), will also be presentedMethod: This is a study on service design and three methods of literature review, deep interview with stakeholders, and focused group discussions. In the literature review, national and international official documents, including official reports of the World Health Organization (WHO) and consultant field visits, were reviewed. Deep semi-structured interviews with 9 stakeholders were performed and results were gathered and categorized into 3 main questions were analyzed using the responsibility and effectiveness matrix method. The Final results were discussed with experts, during which the main five-domain questions were asked and the experts’ opinions were observed.Results: In this study, the main gaps of the public mental health care (PHC) services in Iran were identified, which included reduction of risk factors for mental disorders, training the general population, early recognition and treatment of patients with mental disorders, educating patients and their families, and rehabilitation services. The new model was then proposed to fill these gaps focusing on increasing access, continuity of care, coordination in service delivery, and comprehensiveness of care. A mental health worker was placed besides general healthcare workers and general practitioners (GPs). Services were prioritized and the master flowchart for mental health service delivery was designed.Conclusion: A reform was indeed necessary in the integrated mental health services in Iran, but regarding the infrastructure needed for this reform, including human and financial resources, support of the senior authorities of the Ministry of Health (MOH) is necessary for the continuity and enhancement of services. In this model, attention has been given to the principles of integrating mental health services into primary health care. Current experience shows that the primary health care system has been facing many executive challenges, and mental health services are not exclusion to this issue. Monitoring and evaluation of this model of service and efforts for maintaining sustainable financial resources is recommended to make a reform in this system and to stabilize it.

The Burden of Stroke in Kurdistan Province, Iran From 2011 to 2017.

ObjectivesThe aim of this study was to calculate the burden of stroke in Kurdistan Province, Iran between 2011 and 2017.MethodsIncidence data extracted from the hospital information system of Kurdistan Province and death data extracted from the system of registration and classification of causes of death were used in a cross-sectional study. The World Health Organization method was used to calculate disability-adjusted life years (DALYs).ResultsThe burden of stroke increased from 2453.44 DALYs in 2011 to 5269.68 in 2017, the years of life lost increased from 2381.57 in 2011 to 5109.68 in 2017, and the years of healthy life lost due to disability increased from 71.87 in 2011 to 159.99 in 2017. The DALYs of ischaemic stroke exceeded those of haemorrhagic stroke. The burden of disease, new cases, and deaths doubled during the study period. The age-standardised incidence rate of ischaemic stroke and haemorrhagic stroke in 2017 was 21.72 and 20.72 per 100 000 population, respectively.ConclusionsThe burden of stroke is increasing in Kurdistan Province. Since health services in Iran are based on treatment, steps are needed to revise the current treatment services for stroke and to improve the quality of services. Policy-makers and managers of the health system need to plan to reduce the known risk factors for stroke in the community. In addition to preventive interventions, efficient and up-to-date interventions are recommended for the rapid diagnosis and treatment of stroke patients in hospitals. Along with therapeutic interventions, preventive interventions can help reduce the stroke burden.

In Honor of Dr. Abdul Hussein Taba: Iranian Physician and Former Director of the Eastern Mediterranean Region of the World Health Organization.

The honorable Abdul Hussein Tabatabaei was born in 1911 in Iran and received his medical education in the United Kingdom. Famously known as Dr. A.H. Taba, he was a well-respected man for his significant impact on the improvement of the national and global healthcare services and support for social justice. Before joining the World Health Organization (WHO), he was twice elected to the Iranian national assembly and served as the under-secretary of health services in Iran. Later, he joined the WHO and was elected as the Director of the Eastern Mediterranean Region (EMRO) in Alexandria in 1957 - a position he maintained for 25 years. During his tenure as the Regional Director, he rendered valuable assistance to the development and expansion of major health issues such as development and expansion of the health workforce, improvement of the national health services and controlling of various communicable diseases in the member countries and across the WHO regional offices.

Facilitators of Adolescent Girls’ Access to Sexual and Reproductive Health Services in Iran: A Qualitative Study

Facilitators of Adolescent Girls’ Access to Sexual and Reproductive Health Services in Iran: A Qualitative Study

Designing a Quality Management Model for Health Services in Iran

Introduction: Nowadays, the quality of services, especially in high volume clients, such as financial and care services, has become increasingly important. Therefore, quality of service in accordance with professional standards and customer expectations is important and a first step for it is a quality improvement. Objective: The purpose of this study was to design a quality management model for providing health care in Iran. Method: In this study, the comparative method was used to evaluate the health care quality indicators in selected countries (America-England-Japan-Malaysia-Egypt) and to compare their health care strategies. Hospital managers and people responsible for improving hospital quality in Iran have been involved in this research (377 questionnaire were analyzed). The study lasted from September 2018 to September 2019. Maxqda software was used to classify the adaptive variables. Maxqda software was used to classify the adaptive variables. LISREL software were used- Exploratory and confirmatory factor analysis- to identify the dimensions and validation of the mode . Results: Twenty-four types of health care variables were identified from 6 countries. Exploratory factor analysis and questionnaire resulted in four general criteri: Quality Assurance, Quality Planning, Quality Control and Quality Improvement. Confirmatory factor analysis also showed that the identified dimensions are valid . Conclusion: Considering that guarantee,control, planning and quality improvement have the highest impact respectively, continuous planning at the level of hospitals can lead to a significant increase in the quality of health care delivery.

Designing the Model of the Management of Mental Health Services

Introduction: Having mental health is necessary for the growth and prosperity of humans and as a result of the growth of societies.Objectives: The purpose of this study was to design a mental health management model in Iran.Methods: In this exploratory study, a review study was first performed to analyze the current state of mental health services in Iran and the world. Countries were selected to compare mental health management with Iran in 6 domains. 311 faculty members with mental health were completed by completing a questionnaire with 50 items in the study. Using the factor analysis, the final model was explained. Results: The effective domains in Iranian mental health services management were named in 8 areas: Mental Health in Particular, Key Centers and Task-Shifting, Human Resources and Specialists Training, Psychological Services for Children and Adolescents, Financial Resources and Hospital Services, Mental Health in PHC and Primary medical services, Policy-Making and Human Rights, Monitoring and Control, Community-Based Services. Conclusions: The proposed model of mental health services management in Iran consists of 8 domains, which is a comprehensive and multidimensional concept. Paying attention to its factors can lead to the successful management of mental health services in Iran.

Barriers of Adolescents' Access to Reproductive and Sexual Health Services in Iran: A Systematic Review

Background: Adolescence is an important period in human life and the low-level access of adolescents to reproductive and sexual health services is a concern because preventive, diagnostic and therapeutic services are needed for healthy sexual and reproductive behaviors. This study was conducted with the aim of considering the barriers against adolescent access to reproductive and sexual health services in Iran. Materials and Methods: All Iranian qualitative and quantitative studies which were published without time limit were entered in this systematic review article. The investigation was performed in the international databases such as Scopus, Medline, ProQuest, and Cochrane Library and national databases such as Magiran, SID, IranDoc, and Barakat Knowledge Network System. Keywords were selected based on the Mesh and include: Youth, Teenager, Adolescent health service, and Iran, combined with the Boolean OR and AND operators. Ultimately, two researchers reviewed articles for the quality appraisal (Newcastle-Ottawa tool for observational studies and JBI-QARI tool for qualitative studies), and extracted their main findings, independently. Results: Finally, 10 articles (with 1,933 population) that comprised including criteria were selected. Articles were quantitative (n=8), and qualitative (n=2) types and their year of publication varied from 2009 to 2018. Barriers against adolescent access to reproductive and sexual health services were classified into four main categories (individual barriers, structural barriers, social barriers, and policy barriers). Conclusion: Based on the results, the barriers of adolescent access to reproductive and sexual health services include individual, structural, social, and policy barriers. Because the development of adolescents’ demands is crucial for all societies, through identification and removal of these barriers, we can promote the access of the youth to adolescent health services.

Women's right to health in Iran: Domestic implementation of international human rights law.

In Iran, discrimination based on gender in enjoyment of the right to health is prohibited. Making health services physically and financially accessible to the entire population and removing social and cultural barriers of women's access to health services are main considerations of the health laws and policies of Iran. The health of Iranian women has improved considerably in recent years. But there are disparities in health status and access of women to health services around the country. Some groups of women, including the poor, the elderly, the disabled, the illegal immigrant, and those without an appropriate male guardian, and rural women have limited access to health services in Iran. To realize women's right to health, this country should immediately remove the disparities and use all the necessary means including legislative, administrative, budgetary, promotional, and judicial measures. National plans on women's empowerment and support should be interpreted in provincial programs and action plans. Moreover, a monitoring system and certain benchmarks for tracing the progress of the plans should be established. Realizing other economic, social, and cultural rights including the rights to food, shelter, education, work, social security, and participation in society will improve the Iranian women's enjoyment of their right.

Spirituality and Health Services in Iran

Spirituality and Health Services in Iran

The Role of the Male Guardian in Women’s Access to Health Services in Iran

The law in Iran regards men as the heads of families and guardians of women, responsible for funding women's necessities of life. Having a male guardian might be an advantage for poor women, provided the male guardian fulfils his obligations. The law has several provisions to support women who are without a male guardian. However, some eligible women still face difficulties in enjoying their rights such as the right to social security. A married woman whose husband has enough financial resources, but does not provide access to necessities of life such as health care for her, is not eligible to receive governmental financial aid. The law recognizes her right to get divorced; however, this is not an appropriate solution for a woman with a low socio-economic status. In addition, the role of guardianship gives men the right to interfere in some rights of women, including the right to access health services. This policy is a discriminatory treatment of women and a violation of their right to control their body and health. Women are fully capable adults able to make autonomous decisions about their lives. The government of Iran should reconsider the laws and policies which negatively impact the ability of women to enjoy their right to health. Also, the government should identify and remove all barriers in the law and cultural attitudes of the population that hinder women's access to health services and social security. Women's rights should be guaranteed regardless of their marital status.

Assessing quality of health services with the SERVQUAL model in Iran. A systematic review and meta-analysis.

The five-dimension service quality (SERVQUAL) scale is one of the most common tools for evaluating gaps between clients' perceptions and expectations. This study aimed to assess the quality of health services in Iran through a meta-analysis of all Iranian studies which used the SERVQUAL tool. A systematic literature review has been performed in Web of Science, PubMed, Scopus, Google Scholar, Iran Medex, Magiran and Scientific Information Database. All relevant English or Persian studies published between January 2009 and April 2016 were have been selected. Papers were considered if they regarded all five dimensions of the SERVQUAL tool for assessing the quality of health care services. Two reviewer independently extracted mean and standard deviation of five dimensions and characteristics of studies. The quality of studies included in meta-analysis using STROBE checklist. Of 315 studies initially identified, 12 were included in our meta-analysis. All analyses were performed in Stata MP v. 14. Patients' perceptions were lower than their expectations (gap = -1.64). Responsibility (-1.22) and reliability (-1.15) had the lowest gaps, and tangibility and empathy (-1.03) had the largest gaps. Except gender, other variables had no significant associations with gaps. Patients in the cities of Arak (-3.47) and Shiraz (-3.02) had the largest gaps. All dimensions of service quality were negative, which implies that the quality of health services in Iran has not been satisfying to patients and needs to be improved.

Identification determinant factors on willingness to pay for health services in Iran

BackgroundA common method used to examine the relationship between internal preferences and caring externalities is willingness to pay (WTP) approach. We aimed to estimate WTP for health status with different severity level and identify determinant factors on WTP.MethodsFor determining main factors in WTP, a cross-sectional study was conducted in Shiraz in the southeast of Iran, in March to April 2015. The open-ended method was used to estimate monthly WTP in private and altruistic section. Multivariate regression analyses using ordinary least squares were applied to examine the effect of Scio–demographic factors on WTP using SPSS software 21.ResultsParticipants were willing to pay an average amount of $ 295 in health status 1 and an average amount of $ 596 in health status 6 (worst status) for internal preferences. Altruistic WTP for health status 1 was $ 294 and participants were willing to pay an average amount of $ 416 in health status 6. Multiple regression analysis identified monthly income as the key determinant of WTP for internal preferences and caring externalities (P < 0.01). With an increase of 1% in income, private WTP increase 1.38% in health status 1.ConclusionsThe finding indicates that the mean of WTP increases at severe health status; therefore, health policy maker should allocate resources toward severe health status.

Right to sexual and reproductive health in new population policies of Iran

Sexual and reproductive health services in Iran are influenced by population policies. Willingness of Iranian policy makers to control the population's growth rate resulted in the provision of countrywide family planning services and contraceptives from 1990 to 2013. Now policy makers favour population growth because of a statistically significant decline in the fertility rate and ageing of the population. New population policies contain incentives for higher fertility and limitations on family planning services. Some elements of these policies contradict standards of international human rights treaties including prohibition against retrogressive measures and limitations on sexual and reproductive health services. These policies may jeopardize individual and public health. Iran should immediately revoke these laws and policies and progressively improve people's enjoyment of their right to sexual and reproductive health. The country's population policies should focus on encouraging people to have higher fertility by providing financial and social support to parents and future children.

Child and Adolescent Mental Health Care in Iran: Current Status and Future Directions.

The need for mental health care among children and adolescents in Iran, as in other low and middle income countries (LAMIC) remains mostly unmet. In this paper, we sought to provide an overview of the extent of unmet need and mental health services in Iran. We also aimed to propose approaches to address this gap. We reviewed the published epidemiologic studies of child and adolescent mental and behavioral health problems in Iran. We also examined the current status of child mental health services and the gaps between current needs and available services based on published literature that included papers published in scientific journals, as well as governmental and other administrative reports. The contextual issues relevant to child mental health care were also explored, as well as the possibilities to introduce new or scale up promising services. Child and adolescent mental and behavioral health problems are highly prevalent in Iran. Different studies have estimated that 16.7% to 36.4% of children and adolescents suffer from one or more mental health problems. However, there is a serious scarcity of resources to meet this need. Available services are delivered by independent public organizations (e.g., Ministry of Health, Welfare Organization, and Ministry of Education) or private sector with inefficient communication and collaboration among them and no mandatory national mental health policy. Available specialized child and adolescent services are mostly confined to small inpatient units and university outpatient facilities in larger cities, and there is a scarce evidence for the effectiveness of the available services. Expansion of primary care's role in timely detection and management of child and adolescent mental health problems, implementation of task-shifting and -sharing initiatives, as well as improved collaboration among responsible governmental and non-governmental sectors are some of the most promising future venues to improve mental health care for the Iranian youth.