Primary Health Care In Iran Research Articles

Exploring the Experts' Perspectives on the Most Important Risk Factors of Breast Cancer in Iranian Women: A Qualitative Delphi Consensus

Background: Several methods have been designed to assess the risk of breast cancer. But according to studies conducted in Iran, the risk of Iranian women could not be correctly calculated. Objective: This study aimed to explore the experts' perspectives on the most important risk factors of breast cancer in Iranian women. Method: In round one, the risk factors identified from an integrative review of literature and specialist interviews (Delphi round one) were used to design a questionnaire survey. In round two, specialists were asked to rate the importance of each risk factor. In round three, respondents were asked to reprioritize moderate important risk factors. The items considered very important in round three were included in the core risk factors set. Results: In the first round, a total of 119 items were obtained from the results of an integrative review of the literature and interview with experts. In round two, 30 specialists (response rate 50%) prioritized 119 risk factors of BC, and 43 low, 51 medium and 25 high-level risk factors were identified by the experts. From those, 43 low-level risk factors were removed, and 51 medium-level risk factors were carried forward to round three for consensus. No consensus was reached on any of the risk factors that went into round three (response rate 86.7%). Therefore, 25 high-level risk factors were recognized as the most important risk factors for BC in Iran. Conclusion: This study highlights the items that specialists feel would be most crucial to include in the clinical assessment of breast cancer risk. This study has the potential to provide an appropriate and usable tool for detecting high-risk women in primary health care in Iran.

Gap Analysis of Providing Primary Health Care in Comprehensive Rural Health Centers of Iran

Background: The lack of primary health care (PHC) assessment will lead to the lack of knowledge of the final client's needs and to deviation from the mission of the health system. This study was conducted to compare the understanding and experience of PHC providers and recipients regarding the principles of PHC in Iran.
 Methods: This cross-sectional descriptive-analytical study was conducted on Comprehensive Rural Health Centers (CRHCs) in 2022. The research population consisted of health service providers and recipients in rural areas. A Primary Care Assessment Tool (PCAT) was used. 410 child/ adolescent and 402 adult PCAT were completed by stratified cluster sampling method and 413 service providers were randomly selected. This questionnaire had 6 core domains and 3 ancillary domains. After collection and entering the Excel; data were analyzed by inferential statistics tests including Independent T-test and one-way ANOVA, by SPSS26 and STATA16 at the significant level of P>0.05.
 Results: Except for the Cultural Competence and Services Available domains, in the rest of the domains, there was not the same understanding between the service provider and recipient regarding PHC services. Also. child/adolescent PHC recipients had the same understanding as adult PHC recipients in the domains of Cultural Competence, Family Centeredness, Information System, Ongoing Care, and Access. But a significant difference was between the two groups in other domains, Primary Care Score, and Primary Care Expanded scores (P >0.05).
 Conclusions: For the common understanding between all three compared groups, cultural competence was the strongest component, and coordination-referral system, services provided, and community orientation were the weakest components. To fill this gap, increasing the health literacy of service recipients, real needs assessment, and providing services based on the needs of the community, reforming the processes of the referral system, and the commitment of the government to implement the processes seem necessary.

Mental Health Services Integration in Primary Health Care in Iran: A Policy Analysis.

Objective: The National Mental Health Services (N-MHSs) in Iran was integrated with Primary Health Care (PHC) in 1988. This study aimeds to analyze the policy of integrating N-MHSs in PHC, focusing on the analysis of the current situation, pathology, and the existing challenge. Method : This qualitative research was conducted in 2020 using a case study approach. This study used the policy triangle model to analyze the policy. The required data were collected via interviews, literature review, and document analysis. The interviews were conducted with 23 experts, stakeholders across the country who were selected through purposive sampling, and the data were analyzed using the content-analysis method. Results: The main goals of this policy were to raise mental health literacy among the people and eliminate its stigma in the society, while implementing the referral system for N-MHSs. Twenty weaknesses were extracted in eight areas, including negative views of mental health, weaknesses in human resource training, compensation for the service of psychologists, unfavorable working conditions of the workforce, inappropriate service delivery facilities, lack of meaningful communication between different levels of service delivery, poor inter-sectorial communication, and the challenging nature of mental health care. De-stigmatizing psychological disorders in the society and identifying hidden patients are some of the most significant achievements of this policy. Conclusion: Despite the successful implementation and significant achievements in integrating N-MHSs in PHC, the results of the present study indicate that there are many challenges in this field that require serious planning and attention from relevant authorities.

Designing an innovative primary health care model for the Iranian health system: A mixed methods study protocol

IntroductionToday, the main strategy of countries to improve the health status of people is primary health care (PHC). The present study has two main objectives: 1) scoping review and mapping of the characteristics of innovative PHC models in different countries, 2) developing and validating a model for innovative PHC considering the PHC conditions and challenges of the Islamic Republic of Iran. MethodsThe study will be performed in five phases. In this regard, first, a scoping review will be conducted to investigate the characteristics of innovative PHC. Second, a qualitative study will be performed on the PHC challenges in Iran. Third, another qualitative study will be conducted to identify the appropriate components for Iran's innovative PHC system, using the opinions of experts in this field. In the fourth phase, using the panel of experts, a suitable model will be designed for the Iranian PHC system. Eventually, in the fifth phase, the goals and components of the model developed by experts will be evaluated through a Delphi study, and the validity of the model will be measured using appropriate criteria. ResultsThe findings of this research provide considerable insight into how Iran's PHC system will be able to consider innovative models and changes in response to a new context and newly emerged problems. ConclusionGiven the importance of PHC in the present era and the need to pay more attention to and strengthen it for all communities, it seems necessary to conduct studies and provide appropriate conditions for the development of PHC.

History of primary health care in Iran.

The history of the primary healthcare system in Iran portrays a journey of strategic development and implementation that has resulted in significant advancements in healthcare access and overall population well-being. Starting in the early 1980s, Iran embarked on a comprehensive approach to health care delivery prioritizing universal access, equity, and community participation. The foundation of this system was established during the Alma-Ata Conference in 1978, which placed a strong emphasis on the role of primary health care in attaining health for all.Iran's unwavering commitment to this approach led to the creation of an extensive network of rural and urban health centers designed to offer essential health services and preventive care to all citizens. Over the years, the expansion of Iran's primary healthcare system has yielded noteworthy accomplishments. Maternal and child mortality rates have seen substantial declines, attributed to improved access to maternal care and immunization services. The effectiveness of the system in reaching diverse populations has been enhanced through community engagement and the integration of traditional medicine. Furthermore, Iran's focus on health education and disease prevention has resulted in heightened public awareness and the adoption of healthier lifestyles. Despite these achievements, challenges continue to persist. Disparities in the quality and accessibility of services between urban and rural areas remain a concern. Moreover, the ongoing necessity for infrastructure development, training of the health workforce, and efficient resource allocation underscore the continuous efforts required to strengthen the primary healthcare system. The history of Iran's primary health care system is marked by progress and achievements, underscored by an unwavering commitment to providing comprehensive, community-based care. Iran's journey serves as an exemplary model, highlighting the positive impact of prioritizing primary health care in achieving better health outcomes for its population. As Iran continues to evolve its health system, addressing challenges and building upon successes, the history of its primary health care system serves as a valuable lesson in the pursuit of accessible and equitable health care for all.

A framework for elderly participation in Primary Health Care in Tabriz Health complexes

BackgroundA framework for increasing elderly participation in Primary Health Care (PHC) is a vital issue considering the growing population. After examining the situation and elderly participation in the provision of PHC in the health complexes of Tabriz City, the present study presents the framework of elderly participation in PHC.MethodsThis is a mixed-method study. First, we reviewed the models of elderly participation in PHC worldwide using a comprehensive search of literature. Then, we extracted the service providers’ and the elderly's views regarding the obstacles and solutions for the elderly participation in PHC in Iran using the interviews and focus group discussions (FGD). We conducted three FGDs (8–10 people) and seven individual interviews. Data were analyzed using the content analysis method. We developed the proposed framework for the participation of the elderly in PHC using a panel of experts and checked and confirmed the framework's validity using the Delphi technique with 11 experts from the content validity index and modified kappa coefficient.ResultsBased on the result of included studies in the systematic review, the characteristics of the participation models were classified into five areas: the characteristics of the service user, the main facilitator of the intervention, the type of ownership of the center, the subject and the method of participation. The solutions and obstacles, and problems presented by the service providers and users in different areas include 12 themes (elderly participation, home care, and self-care, respect for the elderly, cooperation of different organizations, service package for the elderly, referral system, planning for the elderly, considering insurance for the elderly, the role of informing the elderly, mental health of the elderly, physical space of centers and training of elderly caregivers) and 46 sub-themes. The final framework also includes five themes (approaches and strategies to attract participation, indicators, and consequences of participation of the elderly, implementation strategies of elderly care, implementation infrastructure and goals and areas of participation of the elderly) and sub-themes.ConclusionThe results of the study indicate that the final framework obtained should be used based on a systematic model for elderly participation in PHC and should be implemented and followed up based on local strategies and specific indicators, considering all capacities.

Challenges of a Program for Public Mental Health Education with an Emphasis on Self-Care in Primary Health Care: A Qualitative Study

Introduction: Mental health education aims to increase mental health literacy plays a crucial role in community members mental health, but its implementation in primary health care faces obstacles and problems. Therefore, this study was conducted to explain the challenges of the public mental health education program with an emphasis on self-care in Iran primary health care.
 Methods: The present study was a qualitative study with a content analysis approach. Research sample consisted of 20 stakeholders through purposive sampling with maximum diversity. This study was conducted in Tehran and Alborz, Iran. Data were collected through in-depth and semi-structured interviews and analyzed by Graneheim and Lundman approach.
 Results: By analyzing the data, the challenges were categorized into six main themes and 15 categories. The six main themes included educational challenges, Inefficiency of the Educational Method, Unsuitable intersect oral collaboration, infrastructural challenges, inadequate resources and barriers to participation in education.
 Conclusions: Considering the key role of mental health education in promoting mental health literacy and prioritizing prevention in the field of mental health in primary health care, especially achieving universal health coverage; Given multidimensionality challenges and obstacles, reform and adoption of appropriate implementation methods using mental health experts seem necessary. Future research and policies could explore ways to optimize program implementation in primary health care.

Improving the primary health care in Iran: a policy brief

Background: Primary healthcare (PHC) is the best method to provide primary healthcare for the people, and is the most efficient and effective way to achieve and improve a high level of health in any society. Failure to pay attention to PHC and low-quality health services can lead to an increase in various diseases, and consequently a higher number of death toll in any society, which would cause economic damages. PHC in Iran received a lot of attention after the revolution in 1979. In PHC, a healthcare network was established throughout the country. With the development of PHC in the Islamic Republic of Iran, the causes of death have decreased, and the death due to infectious diseases, pregnancy, and childbirth problems have also decreased. Despite the vast achievements of PHC in Iran, in recent years, enough attention has not been paid to its reconstruction and consecration. Lack of sufficient financial resources, non-implementation of family doctors in cities and executive problems in family doctors, lack of human resources, lack of attention to the education of students in the health sector, their lack of students’ interest in learning the activities of this field, and structural and administrative problems are some of the existing challenges. Results of the present study suggest that policymakers in Iran need to invest more in PHC in order to improve health indicators, reduce patient admissions to hospitals, and make more appropriate use of limited financial resources. Using the infrastructure that already exists in this sector and strengthening the network of PHC play an important role in reducing household expenses; also, the position of the family doctor and its functions can be properly implemented in the society.

Retaining clinicians in suburban areas: An experience from Iran's primary health care system reform

AbstractIn June 2014, the first Health Complex was established in the suburban area of Tabriz, a northwest city of Iran. Health Complexes, as one of the decentralized models, have been formed based on universal health coverage principles. However, nearly two years after commencing work in the province, Health Complexes experience a high turnover of health care workers. This study aims to explore why primary health care workers set aside their roles in the health system and leave their jobs in opposition to the planned objectives. In this qualitative research, purposive and snowball sampling techniques were used for participants' selection. Data were collected through semistructured interviews and documentary review. Interviews were conducted with health officials, health care specialists, and other health workers who had left their jobs in Health Complexes in the suburban areas of Tabriz. Inductive and deductive content analysis was used to analyse data. The leading causes for health care workers leaving a job were divided into four main categories including organizational policies and regulations, financial and economic factors, sociocultural, and personal factors. Developing evidence‐informed interventions and strategies to improve payment systems, provide job security and opportunities for professional development, and adopt cooperative leadership are essential to decrease the turnover rate of health care workers at Health Complexes.

Influencing factors on the tendency of general practitioners to join in urban family physician program: a cross-sectional survey on Iranian physicians

BackgroundUrban family physician program (UFPP) is initiated as pilot by policy makers as a main reform in future of primary health care in Iran. Despite an ongoing pilot implementation of this program from 2012, it remains a main question about providing sufficient number of general practitioners (GPs). This study aimed to investigate the factors which affect GPs’ decision to join in the UFPP.MethodsIn this national cross-sectional study a sample of 666 GPs, using convenience sampling, filled a self-report questionnaire. The multivariate logistic regression was applied to explore the demographic, practice and views determinants of the tendency of GPs to join in the UFPP.ResultsMore than half of GPs (58.6%) participated in the study had a positive tendency to join in the UFPP. Older GPs (adjusted OR = 3.72; 95%CI 1.05–13.09), working in public sector (adjusted OR = 2.26; 95%CI 1.43–3.58), lower income level (adjusted OR = 6.69; 95%CI 2.95–15.16), higher economic expectations (adjusted OR = 2.08; 95%CI 1.19–3.63), and higher satisfaction from medicine profession (adjusted OR = 2.00; 95%CI 1.14–3.51) were the main factors which increased the GPs tendency to enter in UFPP.ConclusionsDecision for joining in the program is mainly affected by GPs’ economic status. This clarifies that if the program can make them closer to their target income, they would be more likely to decide for joining in the program.

Quality Assessment of Services in Primary Healthcare in Iran: A Systematic Review and Meta-analysis.

Primary healthcare (PHC) plays an important role in achieving universal health coverage (UHC). The SERVQUAL instrument is the tool for evaluating the quality of services in the health sector. The main purpose of this study is to evaluate the quality of services provided in PHC in Iran using the SERVQUAL instrument. We searched eight databases from January 2000 to September 2021. We analyzed the mean of various SERVQUAL instrument items using the DerSimonian-Laird approach via a random model with 95% confidence interval. Also, we used I2 to evaluate the heterogeneity of the studies. Finally, 17 studies were chosen for analysis in the present study. There were 8,767 study participants, out of which 8,237 were female and 530 were male. The mean dimensions of perception were as follows: Tangibles = 3.71, reliability = 4, responsiveness = 3.79, assurance = 3.83, and empathy = 3.86. For the expectation, the mean dimension were: Tangibles = 4.46, reliability = 4.46, responsiveness = 4.36, assurance = 4.36, and empathy = 4.36 respectively. The total gap quality between perception and expectation was -0.53. All dimensions of quality based on SERVQUAL were negative, and the quality of service in PHC is not satisfactory. Therefore, policymakers must adopt serious and effective programs to improve services in this area. We also recommend that quality management of services in PHC in Iran should move toward comprehensive optimization in all areas, and quality in this area should be a priority.

A qualitative study of challenges affecting the primary care system performance: Learning from Iran's experience.

Background and AimsPrimary care and the use of a referral system are essential components of any health system. The aim of this study was to investigate and identify the challenges affecting the performance of the primary health‐care system in Iran.MethodsThis qualitative study was carried out consisting of 14 interviews with experts and those familiar with the primary care system and its function. Purposive and snowball sampling was used to identify the samples. The recorded files were transcribed and entered into the MAXQDA‐11 software to be analyzed. The conventional content analysis approach was used for data analysis.ResultsThe findings of this study included 72 initial codes classified into 7 main themes and 18 subthemes. Seven main themes consist of governance, manpower, resources, financial management, services delivery, trans‐sectional, and social and cultural. The greatest challenges for Iran's primary health care (PHC) system are governance and human resources problems.ConclusionVarious dimensions of Iran's primary care system especially governance and human resources are facing several challenges that threaten its performance and efficiency. Policymakers and planners must address challenges fundamentally and do not get satisfied with superficial reforms that have short‐term and soothing effects. In this regard, enhancing governance functioning can profoundly solve numerous challenges of Iran's primary care system. We also suggest the strengthening of intersectoral collaboration.

Government Public Health Interventions: Crucial Steps in COVID-19 Pandemic in Iran

In the face of the global coronavirus disease 2019 (COVID-19) pandemic, governments worldwide have taken on the immense responsibility of implementing public health interventions to curb the spread of the virus. These interventions, ranging from social distancing to widespread diagnostic testing and vaccination, have played a pivotal role in safeguarding public health and mitigating the impact of this unprecedented crisis.Government intervention in controlling the spread of COVID-19 has been critical. In this respect, governments have showed their commitment to protecting citizens, promoting community well-being, and minimizing the strain on healthcare systems through implementing various measures. These interventions not only have saved many lives but also provided a sense of security and stability during the uncertain pandemic times, considering the unprecedented and invasive waves of infodemics and conspiracies. Various policies and approaches to fight the virus have been adopted in different countries based on cultural, social, economic, and health system conditions. (1,2) The most common and important government actions include public awareness campaigns, (3) prevention measures, (4) contact tracing, (5) diagnostic and treatment interventions, vaccination, and specialized care. In the context of Iran, despite the extensive and severe global sanctions imposed on the country, multifaceted interventions were carried out in the framework of Iran's primary healthcare system within a very short period after the onset of the global COVID-19 pandemic. The documentation and dissemination of these interventions can serve as valuable lessons for the present and future health systems. Some of these interventions included educating the community, promoting social distancing, establishing verbal screening structures, contact tracing, identifying and breaking the chain of disease transmission, engaging the public and community in disease control efforts, establishing specialized COVID-19 diagnostic laboratories, expanding nationwide diagnostic testing, setting up designated COVID-19 centers to accept referrals from public and private sectors at the primary level, developing and reviewing diagnostic and treatment protocols for COVID-19, establishing quarantine centers, and implementing general vaccination programs through prioritizing vulnerable and at-risk groups. Despite the remarkable success of the interventions undertaken to combat COVID-19, numerous challenges persist. Public concerns, fueled by the prevalence of infodemics and various rumors, act as a flood that threatens to dismantle the structures, dams of prevention, and public health interventions, eroding trust in healthcare authorities. Moreover, the emergence of different and novel virus strains further exacerbates people's anxieties, demanding increased efforts within the healthcare system. Therefore, it is necessary to enhance communication strategies to ensure public understanding and compliance with preventive measures. Considering the role of scientific research journals in promoting participatory decision-making and disseminating evidence-based information, these journals play a vital role in fostering trust between the public and the healthcare system.(6) Accordingly, the role of local scientific research journals in non-English language speaking countries is vital in the distribution of evidence-based data, clarification of national programs to battle the pandemic, as well as correcting misinformation and rumors among the general public. Considering the mentioned issues, the Depiction of Health journal, as a journal published in Persian language by the Health Services Management Research Center of Tabriz University of Medical Sciences, decided to release a special issue in collaboration with the Deputy Minister of Health, Ministry of Health and Medical Education (MOHE), and the Director of Iran's Primary Healthcare Management Network. This special issue covers policies, executive and preventive measures related to COVID-19 in the primary healthcare system based on evidence, government documents, field studies, and performance data conducted in primary healthcare systems during the time frame of 2019-2021. All articles in this special issue have undergone a rigorous peer review process in accordance with the standards set by the journal under the supervision of the journal's editor-in-chief.

Upoređivanje kognitivnog statusa starije populacije sa dijabetesom i bez dijabetesa u poslednjih deset godina u primarnoj zdravstvenoj zaštiti u Iranu

Introduction. Cognitive disorders and chronic diseases such as diabetes are common problems of aging. The aim of this study was to determine and compare the cognitive status of diabetic and non-diabetic elderly in the past ten years in primary health care in Iran. Method: This cross-sectional study was performed on people aged 60 years and older in Kerman, Iran in 2020. In total, this study was performed on 200 patients (100 diabetic and 100 non-diabetic) meeting inclusion criteria. The Short Mental Status Questionnaire (MMSE) and The Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) were used to assess cognitive function. The validity and reliability of the questionnaires were confirmed in this study. Data were analyzed using Chi-square, T-test, and ANOVA analysis in SPSS 21 software. Results. The results showed that there was a statistically significant difference between diabetic and non-diabetic groups in the current cognitive status and cognitive status in the last ten years. The mean scores of cognitive function from the short mental status questionnaire in the diabetic group were lower than in the non-diabetic group (p = 0.001). The mean scores of the cognitive deficit screening questionnaire in diabetic elderly were higher than in non-diabetic elderly (p < 0.001). Conclusion. Based on the results of this study, health care providers and family physicians should focus on controlling diabetes and identifying any cognitive impairment in the early stages of comprehensive care of diabetic patients.

Primary care physician payment mechanisms toward universal health coverage: A study of Iran and selected countries.

Primary care physician (PCP) payment mechanisms can be important tools for addressing issues of access, quality, and equity in health care. The purpose of the present study is to compare the PCP payment mechanisms of Iran, Canada, Australia, New Zealand, England, Sweden, Norway, Denmark, the Netherlands, Turkey, and Thailand. This is a descriptive-comparative study comparing the PCP payment mechanisms of Iran and selected countries in 2020. Data for each country are collected from reliable databases and are tabulated to compare their payment models. Framework analysis is used for data analysis. The results are provided in terms of PCP payment mechanisms, adjusting factor for capitation, reasons for fee-for-service payment, the role of pay-for-performance (PFP) programme, domain and indicators, and reasons for developing PFP in each country. The majority of the countries with high UHC service coverage index have applied a mix of PCP payment mechanisms, most of which include capitation and PFP. Moreover, adjusting capitation by factors such as age, sex, and health status will lead to provision of better services to high-risk populations. In recent years, PFP has been paid to Iranian PCPs in addition to salary. Given the various existing models for primary health care in Iran and the increasing burden of chronic diseases, a more appropriate combination of payment mechanisms that create more incentives to provide active and high-quality care should be developed. Also, when developing payment mechanisms, the required infrastructure such as electronic health record should be considered.

Prevalence of COVID-19 in Iran: results of the first survey of the Iranian COVID-19 Serological Surveillance programme

ObjectivesThis study aims to estimate the prevalence of coronavirus disease 2019 (COVID-19) in the general population of Iran. MethodsThe target population was all Iranian people aged 6 years and older in the country. A stratified random sampling design was used to select 28 314 people from among the individuals registered in the electronic health record systems used in primary health care in Iran. Venous blood was taken from each participant and tested for the IgG antibody against COVID-19. The prevalence of COVID-19 was estimated at provincial and national levels after adjusting for the measurement error of the laboratory test, non-response bias and sampling design. ResultsOf the 28 314 Iranians selected, 11 256 (39.75%) participated in the study. Of these, 5406 (48.0%) were male and 6851 (60.9%) lived in urban areas. The mean (standard deviation) participant age was 35.89 (18.61) years. The adjusted prevalence of COVID-19 until 20 August 2020 was estimated as 14.2% (95% uncertainty interval 13.3%–15.2%), which was equal to 11 958 346 (95% CI 11 211 011–12 746 776) individuals. The adjusted prevalences of infection were 14.6%, 13.8%, 16.6%, 11.7% and 19.4% among men, women, urban population, rural population and individuals aged 60 years or more, respectively. Ardabil, Golestan and Khuzestan provinces had the highest prevalence and Alborz, Hormozgan and Kerman provinces had the lowest. ConclusionsBased on the study results, a large proportion of the Iranian population had not yet been infected by COVID-19. The observance of hygienic principles and social restrictions should therefore continue until the majority of the population has been vaccinated.

Developing a Departmental Accreditation Model for Primary Healthcare in Iran

Background: Recently, the healthcare systems have turned towards cost-effective services such as primary healthcare (PHC) due to the increasing costs of health services. Objectives: This study aimed to develop a departmental accreditation model for primary healthcare in Iran. Methods: Initially, primary standards were obtained by making use of available scientific documents in service delivery units in the realm of primary healthcare in Iran as well as by obtaining feedback from their specialists. Then, all primary standards were entered into Delphi questionnaire and evaluated on a 9 point Likert scale by 15 - 20 experts based on two criteria of significance and feasibility. Finally, the final standards were specified based on the qualitative points obtained from the experts. Data were analyzed using SPSS version 18. Results: The final model obtained had 231 standards and 3065 measures in the twelve defined units. The total mean score was 8.38 and 7.65 for the sum of model measures in two criteria of significance and feasibility, respectively. The twelve standard domains were developed for accreditation of service provider units, including specialized realms of communicable diseases, non-communicable diseases, population and family health, mental-social health and addition, teenage, youth, and school health, disaster management, environmental health, occupational health, oral health, healthy nutrition, health education, and promotion, as well as medication and laboratory. Conclusions: Given that the developed model encompasses all PHC domains, its implementing will result in continuous enhancement in the quality and safety of PHC in Iran.

Strategic Analysis of Community Participation in Primary Health Care in Iran and Presentation of Promotion Strategies Using Internal and External Environment Assessment Techniques

Introduction: Community participation in health affairs and especially in the field of primary health care is one of the requirements for achieving the goals defined in this field. Accordingly, the present study was designed and implemented with the aim of strategic analysis of the internal and external environment in the field of primary health care in Iran and presentation of the promotion strategies to attract community participation. Methods: This is a qualitative study that was conducted using the internal and external environment assessment technique called SWOT. The data used were obtained through a semi-structured quality questionnaire and a survey on strengths and weaknesses, opportunities and threats, as well as proposed promotion strategies to improve community participation in the field of primary health care. Results: Analysis of external environment of the field of primary health care in Iran regarding community participation led to the identification of the opportunities such as increasing community literacy, the possibility of using public spaces and media as well as influential people to attract community participation; and threats such as financial and employment constraints of families, citizens' unfamiliarity with their effective role in health, and inadequate intersectoral participation. The evaluation of the internal environment led to the identification of strengths in such as native selection policy for health workers; and weaknesses such as lack of attention to evidence-based performance and poor time access to health activities. Conclusion: The findings of the present study indicate that there are internal weaknesses and external threats to community participation in the field of primary health care.

In This Issue

This issue of the journal commences with an editorial that provides some discussion about the current approaches to Covid and the tensions that exists in that context..... Editorial SettingsCovid-19: A strife of interests for us all and what problem are we attempting to solve? Research Articles Gender Equity in Australian Health Leadership Research Articles Assessing Quality of Healthcare Delivery When Making Choices: National Survey on Health Consumers’ Decision Making Practices Research Articles The Case for a Reciprocal Health Care Agreement between Australia and South Korea Commentary COVID-19 and Working Within Health Care Systems: the future is flexible Review Articles Review of Public Private Partnership in the Health Care in Hong Kong Viewpoint Article Hong Kong’s Growing Need for Palliative Care Services and the Role of the Nursing Profession Commentary Vietnam’s Healthcare System Decentralization: how well does it respond to global health crises such as covid-19 pandemic? Research Articles Publicly Financed Health Insurance Schemes and Horizontal Inequity in Inpatient Service Use in India Research Articles Distress and Quality of Life among Type II Diabetic Patients: Role of physical activity Viewpoint Article Achievements and Challenges of Iran Health System after Islamic Revolution: Structural reforms at the second step Research Articles Strategic Analysis of Community Participation in Primary Health Care in Iran and Presentation of Promotion Strategies Using Internal and External Environment Assessment Techniques Research Articles Utilization of Healthcare Services & Healthcare Expenditure Patterns in the Rural Households of Nepal

How do primary care providers work together in the Iranian PHC system?

Background: Providing coordinated services and forming appropriate cooperation among the members of the health team have a significant impact on other aspects of service provision, including accessibility and continuity of services. Methods: In this study information was obtained from a national study titled, "Evaluation of Primary Health Care in Iran", and framework analysis was conducted from the perspective of interprofessional cooperation status using the Amour model based on 5 underlying concepts of sharing, partnership, power, interdependency, and process. This is a mixed-method study of the transformative sequential type. In this study triangulation method was used, and data were collected by the Primary Care Evaluation Tool (PCET), interviewing experts and executive directors, and systematic review of the Primary Health Care (PHC) challenges in Iran. Results: The challenges of the PHC system in Iran are analyzed for providing coordinated care in the form of multidisciplinary teamwork based on the Amour model. The corresponding solutions for improving challenges of the concept are also presented. Conclusion: Based on the findings of this study the followings are suggested: sharing a collective specialized outlook; designing an integrated information system; improving the educational system through providing on-the-need academic education; strengthening the cooperation of community representatives and people's trustees in providing care; developing interdepartmental partnerships with related organizations with collective interests; moderating the workload of human resources; using electronic health records and automated referral of individuals in addition to appropriate training and promoting the culture from the existing philosophy of primary health care; highlighting the role of service providers as members of the care team; eliminating factors causing instability of suppliers, plans, and programs; and stability in the management approach despite changes in senior management.