javad moghri

Substance abuse is becoming a particularly alarming issue among women and has been a concerning surge in societies. Childcare is a principal part of pediatric preventive healthcare. A robust body of research has linked maternal substance use with less optimal motherhood and childcare. Given the challenges of parenting for mothers with substance use, as well as the existence of a gap in the literature regarding substance use mothers’ needs in childcare, this integrative literature review was performed. This review aimed to explore the parenting needs of drug-dependent women to optimize the long-term health and development of their children.

Electronic searching of Medline, PubMed, Scopus, Cochrane, Embase, Web of Science, SID, and Google Scholar was performed up to October 2024. Inclusion criteria consist of both English and Persian-published studies assessing childcare challenges and needs in drug-abused women. In the long run, 464 studies met the inclusion criteria. The quality of 20 final reports was evaluated by two researchers who extracted data based on the Whittemore and Knafl recommendations.

The childcare needs of these mothers were classified into two main categories: Health care & clinical services (primary health care, perinatal health care, home visits, reproductive health care, breastfeeding counseling, exclusive breastfeeding training, family-planning, self-care education, health education, mental health screening, and counseling, educated health providers, healthcare accessibility) and human & social services (parenting skills education, informative interventions, family counseling, psychological counseling, financial support, instrumental support, spiritual support, emotional support, risk behaviors control, social skills education, empower women, create peer communities, support networks, insurance plans).

The childcare needs of these mothers were classified into two main categories: health care & clinical services and human & social services. The findings of this research indicate that childcare for mothers affected by opioid use disorder necessitates a multi-disciplinary approach to identify, develop, and address their needs.

Drug abuse among mothers is an issue of utmost significance and lasting impact, as its connection to detrimental consequences for both mothers and children raises a heightened level of concern. Child protection services often refer to children with common psychosocial risk factors, making their care a significant challenge for families. Therefore, understanding and addressing the challenges mothers face in raising their children can help nurses and health science specialists develop effective programs for infant health improvement. The study aimed to identify the challenges faced by mothers with drug abuse in infant care.

The study, using conventional content analysis, was conducted from February 2022 to December 2023 and involved 20 substance-using mothers aged 17-41 with children under 12 months old. The study utilized semi-structured and in-depth interviews for data collection, and the Graneheim and Lundman method was applied through MAXQDA 2020 software for data analysis. The data collection continued until saturation was reached, and the main classes emerged.

The study identified four categories, including perceived threat from social judgments, fear of losing infant custody rights, lack of maternal care knowledge, and inefficiency of support networks, discussing the difficulties faced by mothers who are addicted to drugs concerning their infant care.

Recognizing the willingness of drug-using mothers to provide proper care for children, along with gaps in knowledge and support systems, necessitates a well-planned health promotion program for this cohort. Specialists play a crucial role in providing health and care services, particularly for infants.

The prevalence of breastfeeding is less common among adolescent mothers than adultmothers. These mothers experience various issues during breastfeeding. The present study aimed toexplore the normative needs of adolescent mothers during breastfeeding from health care providers’perspective. This qualitative content analysis study was conducted from October 2022 until June 2023.14 health care providers who had worked in the field of breast milk were purposefully selected withmaximum variation. Face-to-face semi-structured interviews were conducted and sampling continueduntil data saturation. Data analysis was performed using Graneheim and Lundman’s method withMAXQDA software version 10. The main concepts obtained from the data were classified into one theme entitled,“comprehensive support”, and seven categories including “need to correct wrong traditional beliefs”,“educational and counseling needs”, “providing quality services”, “need for psychological support”,“need for protective laws”, “financial needs”, and “the need for social network support”. Adolescent mothers in Iran have various needs during breastfeeding, and they requirethe assistance of their families, healthcare providers, and the government to fulfill them. Therefore, itis also recommended that policymakers in the health system should design policies to accommodatethe requirements of this group of mothers. In addition to policy development in the health system, theinfrastructure required for policy and law to be executed should be considered.

Access to services is one of the main intermediate outcomes of health system which directly affects people's health. Increasing demand for services, on the one hand, and insufficiency of existing beds according to the relevant standards in many hospitals in the country, on the other hand, necessitate the optimal use of existing beds. The present study aims to investigate the challenges of bed management in the referral educational hospitals of Mashhad.

This was a qualitative study using content analysis method. The study population consisted of managers working in Imam Reza and Ghaem hospitals, as referral hospitals in Mashhad, and staff managers. Authors continued data collection until saturation was reached. Researchers used in-depth and semi-structured interviews to collect data. For data analysis, the authors transcribed and coded interviews, and at the same time, collected data using MaxQDA 11 software.

Data were continuously compared in terms of similarities and differences to similar codes. They can be integrated together, leading to the creation of 7 main concepts. They included challenges regarding admission, bed allocation, sustainability, discharge, process, structure, and human resources.

Attention to the challenges of bed management in this study can greatly assist the correct emergency organization and patient flow in the hospital. Authorities need to recognize the problems arising from bed management and movie towards solving them. By doing so, the health system will enjoy higher productivity, and the patients ' access to health care will be enhanced without the need to increase the cost.

The health insurance extent of coverage was decided by the Health Insurance Organization in order to manage costs. In this plan, to determine the extent of payment by each medical center, the performance of the year 2017 was considered the base point. Furthermore, it should not cost more than the performance of the year 2017 or 10 % less. This issue had caused challenges in public hospitals; so, the purpose of this study is to explain the challenges of health insurance extent of coverage from the perspectives of the experts from Mashhad University of Medical Sciences and propose solutions.

This was a qualitative study conducted through content analysis method in 2022. In-depth and semi-structured interviews were used to collect data. The research population included experts such as staff and hospital managers, Medical group managers, and insurance managers and experts. It was done through purposeful sampling. Data collection continued until the codes were completed, and finally 17 people were interviewed. In each phase, data analysis and data collection were performed simultaneously, using content analysis method and MaxQDA10 software.

In this study, the 2 main concepts were management challenges (including sub-concepts of motivation, performance evaluation, patient admission, and hospital costs), and planning challenges (including sub-concepts of education, infrastructures, cross-sectional coordination, and foresight).

Based on the findings of this study and the challenges expressed, Health Insurance Organization can take steps toward upgrading the plan by considering the necessary prerequisites and providing solutions such as performance monitoring evaluation system, cost management, training the target groups, and appropriate clarification and announcements.

Leaving service by employees has many direct and indirect consequences and costs for the health system, and it is important to study and recognize it. The tendency to leave service is the best predictor of actual service left. In this study, we aimed to determine the organizational factors related to the tendency of non-governmental health workers to leave the service in the suburbs of Mashhad.

This descriptive-analytical study was performed on 323 health workers in 2018-2019. Data collection was performed by a researcher-made questionnaire included demographic characteristics, three dimensions of work environment, job demand, and social support. Research data were analyzed using descriptive and inferential statistics

The tendency to leave the service was about 64%. The mean score of work environment, job demand, and social support of organizational dimensions related to the tendency to leave were 45.95, 39.92, and 38.49, respectively. The results of multivariate regression analysis showed that with one unit increase in the scores of work environment, labor demand, and social support, provided that other variables are constant, the chances of leaving the service were reduced 0.923, ,0.899 and 0.876, respectively. (P <0.001).

In conclusion, clear job descriptions, appropriate salar,y and benefits considering to the type of work and workload, reducing ambiguity and role conflict, increasing job diversity, increasing authority, opportunities for advancement, supportive leadership can lead to increased job satisfaction and consequently, increase the tendency to stay and reduce the tendency to leave service.

The Covid-19 pandemic has had a significant impact on various aspects of people's lives. Different countries have adopted different policies to combat this disease. The purpose of this study is to review the policies adopted in the field of environmental health to combat Covid-19 in Iran.

This qualitative study was performed by document analysis method in February 2022. The research population was purposefully determined in consultation with six health policy and environmental health experts. For this purpose, the policies of the National Corona Headquarters as the highest policy reference in the field of Covid-19 were studied. Data analysis was performed using conventional content analysis method and MAXQDA software version 12.

In total, 255 codes, 25 sub-themes and 7 main themes in the field of environmental health to combat Covid-19 were identified. Public social activities, public environmental health, social distancing, borders control, infrastructure development, procurement and distribution of personal protective and disinfection equipment, and monitoring were the main themes identified in this research.

So far, a range of different policies in the field of environmental health have been adopted in Iran to deal with Covid-19. Local and international evidence, experiences of other countries, and socio-economic and political determinants play significant roles in policy development, policy reform, or abandoning previous policies.

Legislation on the physicians' dual practice and how to implement is limited. This study aimed to determine the prerequisites and executive challenges of the law prohibiting the physicians' dual practice in Iran.Materials &

In this qualitative study 41 stakeholders (consists of the members of parliament (MPs), former health ministers, heads of medical schools, hospital managers/heads, Ministry of Health officials, insurance and social security organization officials, general and specialist physicians, university professors and relevant experts) were selected by purposeful sampling. Data were collected using in-depth semi-structured interviews. The interviews were recorded and transcribed verbatim. The Framework analysis was used to analyze the data.

Important challenges to the implementation of the law prohibiting the physicians' dual practice of physicians in the public and non-governmental sectors, including the four main concepts of financial issues, issues related to implementation and supervision, issues related to the public sector capacity, and existing resistance.

Coordination and cooperation of various institutions and organizations in ministries, trade unions, and the three forces to solve problems and meet the needs seem necessary.

Patient engagement is a concept that has gained special importance in medical care today, and is considered as a valuable goal in patient care. With the evolution of modern health from a disease-centered model to a patient-centered model, patient interaction has played an important role in improving the health care processes. This study aims to identify the factors affecting the patient's interaction with the physician.

This is an applied study with a qualitative-descriptive method. First, the information of patients who underwent angioplasty in 2019 was extracted from the hospital information system. Then, in-depth interviews with patients were conducted using a semi-structured interview guide. In the next step, we analyzed the data using qualitative content analysis with MAXQDA.

After analyzing data, we were able to extract 1072 codes. Then, we categorized the codes into two sub-categories of supply side (physician) and demand side (patient). We identified 11 factors affecting supply-side interaction (information, physician behavior, education, access, cost, responsiveness, patient perception of physician expertise and skill, managerial weakness, facilities, trust, and satisfaction with physician), as well as seven factors on demand-side (personal problems, patient questioning spirit, response from other sources, financial problems, lack of knowledge and awareness, advice from others, and self-medication).

It is expected that the patient's interaction with his/her physician after angioplasty could accelerate the patient's recovery process, prevent possible complications, and reduce costs. Recognizing the effective factors and designing appropriate interventions on the supply and demand side that can lead to improving patient interactions with physicians, and pave the way for promoting community health.

Nurses’ turnover reduces quality of health care and increases costs. Neglecting the nurses’ quality of worklife can lead to their turnover. The aim of this study was to determine the relationship between nurses’ quality of worklife and their intention to leave work in public hospitals in Herat, Afghanistan.

This was a descriptive-analytical study, investigating nurses’ quality of worklife and their turnover intention in public hospitals. We used census method, and all 258 respondents completed the standardized questionnaire on quality of worklife. Nurseschr('39') turnover intention was also measured by using an item. Meanwhile, we used descriptive statistics to present demographic variables. Meanwhile, Mann-Whitney test, Chi-square, and Spearman correlation coefficient were used to determine relationships between the study analytic variables. In this study, SPSS version 26 was used.

The quality of worklife and the intention to leave was at an average level. No relationship was found between turnover intention and demographic variables (p>0.05). Results from the Spearman correlation coefficient demonstrate a significant inverse relationship between turnover intention and some aspects of the quality of worklife including participation and involvement, job security, wages and salaries, career honor, and job stress. In other words, an increase in any of the aforementioned aspects results in a decline in intention to leave (P<0.05). The relationship between intention to leave and quality of worklife was inverse and significant (r=0.279, P=0.001).

Participatory management in decision-making, paying attention to salaries and benefits, and assuring nurses that they will not lose their job in the event of any socio-economic change can increase job satisfaction, and reduce their intention to leave work.

Human resources play a highly important role in providing health services. The aim of this study was to determine the human resources required for the linear accelerator sector at Reza Radiotherapy-Oncology Center.

This applied analytical-descriptive study utilized human resources determination method based on workload indicator of staffing needs. Expert meetings were held to determine the components of workload and standard time. A survey was used to confirm the standard time of main activities, and interviews and personnel information system were used to determine the amount and factors related to available working time.  Furthermore, management system and registries were used to determine the annual workload. The data were analyzed using the Excel and SPSS software version 19.

Seven factors related to the annually available working time of employees were identified. Annually available working time for employees was set at 806 hours. Patient preparation, treatment, surgery, and case completion were identified as the main activities. The results of workload index calculations showed that the accelerator sector had a shortage of three people.

The results of this study showed that Reza Radiotherapy-Oncology Center is experiencing a shortage of professional staff in the linear accelerator sector. It seems that using the workload indicator of staffing needs method to determine and distribute the required human recourses is a necessary step for the optimal management of human recourses in specialized sectors.

Human Resources in the health sector not only is the most crucial source in health providing but account for nearly three-quarters of the health sectorchr('39')s costs. The purpose of this study was to estimate the required Human Resources of the CT scan department of the Reza Radiotherapy-Oncology Center based on the workload indicator of staffing needs in 2019.

This cross-sectional descriptive study used human resources determination based on staffing needschr('39') workload indicators. The method of conducting expert meetings was used to determine the components of workload and standard time. Also, Interviews and rules, and personnel systems were used to determine the amount and factors related to available working time, and to determine the annual workload, the hospital management system and observation of activity logs were used. Excel and SPSS19 software were used to analyze the data for determining the required human resources and timing data, respectively.

 7 factors related to staff annually available work time were identified. The available work time for CT scans staff was 1113 hours per year. In this study, imaging and simulation were determined as the main activities of the CT scans ward. The results of the workload indicator calculations showed that the CT scan section lacked 3 Personnel.

This study showed that Reza Radiotherapy Oncology Center is experiencing a shortage of professional CT scan staff, and the work pressure is (0.4). Therefore, CT scans are a top priority to provide the human resource.

Attracting and retaining physicians in rural and low-income areas are the most important challenges for health system policymakers, which affects the poor health status of the population living in these areas. The purpose of this study was to investigate the factors related to the willingness of the working physicians to stay in rural areas and evaluate them according to the recommendations of the World Health Organization.

This applied research was conducted using descriptive-analytical and cross-sectional method in 2019. The study population was 306 physicians working in rural health centers under the supervision of Mashhad University of Medical Sciences. They were chosen through the census method, and the data collection tool was a researcher-made questionnaire. Descriptive statistics, simple, and multiple ordinal regression models were used to analyze the data.

The results showed that the willingness of the working physicians to stay in rural areas of Mashhad was low (16 percent). Furthermore, there was a significant relationship among the importance of laws and regulations, the observance of educational dimension, laws and regulations, financial incentives and personal and professional supports with the willingness to stay in rural areas (p <0.05).

The use of adequate financial incentives commensurate with the expectations of employees and commensurate with the opportunity costs of living in rural areas, accompany with individual and job support for employees, can strengthen the effects of each dimension and ultimately the willingness to stay in rural areas.

Serodiscordant couples are faced with many social, sexual and relationship challenges in all aspects of their lives. The sources of conflicts could be disease acquisition, transfer of HIV to the uninfected partner, and fertility decisions. The current qualitative study was designed to explore the challenges faced by HIV negative women in serodiscordant relationships. This qualitative description was conducted in Mashhad, Northeast of Iran, between October 2018 and June 2019. 15 HIV-negative women who were living with their HIV-positive husbands were selected through purposive sampling method. The data were collected using semi-structured interviews. Data were analyzed using conventional content analysis adopted by Graneheim and Lundman. MAXQDA version 12, was used for data organization. Components of rigor including credibility, dependability, confirmability and transferability were considered. The main overarching theme which emerged from the qualitative study was “threats to family life”, consisting of five categories along with their subcategories. These categories included stigmatic reactions followed by disclosure of the status, social misconceptions and limitation of information sources, psychological disruptions, hard decision making for fertility, and role conflict in the family. This study provides an insight into different aspects of challenges faced by Iranian women in HIV-serodiscordant relationships. Also, our study supports the view of other investigators who believe that there is an urgent need for provision of counseling and empowerment interventions for HIV- serodiscordant couples.

Human resources, as the most important resources in health systems, account for nearly three-quarters of current expenditures. Therefore, it is necessary to determine the optimal level of human resources in healthcare facilities. This study aimed to use workload indicators of staffing need to estimate the required human resources in medical physics department at Reza Radiotherapy-Oncology Center.

This descriptive cross-sectional study was conducted in 2019. Data were collected through different means. Experts’ opinions on the components of workload and activity standard were collected during several meetings. Moreover, interviews with the managers of radiotherapy center manager and human resources, and exploration of rules and regulations and personnel systems were conducted to extract factors related to available working time. Finally, the annual workload was determined by searching the hospital management system and the activity logs. Data were analyzed by using Excel and SPSS version 19 software.

The results demonstrated seven factors related to staff annual available working time, that is, 1069 hours for medical physics. In this study, treatment planning, treatment recheck, mosaic and manual data entry were determined as the main activities of the medical physics department. Furthermore, the workload indicators of staffing need calculation showed that the medical physics department needs four more staff.

The results of the study showed a shortage of workforce in medical physics department at Reza Medical Center. The workload indicators of staffing need clearly identify the components of the workload and are recommended to be used for estimating human resources and professionals in specialized occupations associated with cancer treatment.

Considering the importance of knowing the implications of health care workers and specially physicians’ dual practice in health policy, the aim of this study is to identify and analyze the current evidence in this field for the first time, using systematic literature review methodology.
a thorough search were performed in credible databases, search engines, specialized databases, and reference list of identified studies. The selected inclusion criteria were studies which were done using one of the rigorous and reliable known scientific methods.
the overall search found 3242 records, and none of them were considered eligible for including in the study according to the selected criteria. After showing the lack of high quality evidence in this area, the current knowledge in this field was categorized and analyzed from two perspective.
Results showed that there is not any rigorous and scientifically reliable evidence about the real implications of health care workers’ dual practice, and most of the related studies have been relied on theoretic methods, which their core assumptions were undermined in the broader literature. Furthermore, findings suggested that dual practice implications are context specific and may vary or differ from system to another system.

Mixed health care systems to work simultaneously on both public and private facilities, is common today. This phenomenon referred to as dual practice (DP), has potential implications for access, quality, cost and equity of health services. This paper aimed to review systematically studies that assess the implications of DP among health workers.
MEDLINE, EMBASE, and The Cochrane library were searched for obtaining published literature between Feb 1990 and May 2014. Google and Google Scholars, organizational websites, and reference lists of relevant papers searched to get grey literature. Only studies concentrated on consequences and impacts of DP among health professionals and conducted using «randomized controlled trials», «non-randomized controlled trials», «controlled before and after studies», or «interrupted time series» were eligible for inclusion.
From 3242 records, we focused on 19 studies, which aimed to assess effects and impacts of dual practice. After that, the current understanding of DP positive and negative implications was categorized and discussed based on two perspectives.
There has been a propensity to over-reliance on theoretical methods in predicting the implications of this phenomenon. Almost all of the mentioned implications are based on theoretical predictions undermined in the broader literature. Furthermore, assessing the current literature showed positive and negative impacts of DP on different parts of the health system and various dimensions of service delivery. These implications are contexted specific and may vary from system to system.

Physician dual practice is a common phenomenon in almost all countries throughout the world, which could potential impacts on access, equity and quality of services. This paper aims to review studies in physician dual practice and categorize them in order to their main objectives and purposes.
Comprehensive literature searches were undertaken in order to obtain main papers and documents in the field of physician dual practice. Systematic searches in Medline and Embase from 1960 to 2013, and general searches in some popular search engines were carried out in this way. After that, descriptive mapping review methods were utilized to categorize eligible studies in this area.
The searches obtained 404 titles, of which 81 full texts were assessed. Finally, 24 studies were eligible for inclusion in our review. These studies were categorized into four groups - "motivation and forces behind dual practice", "consequences of dual practice", "dual practice Policies and their impacts", and "other studies" - based on their main objectives. Our findings showed a dearth of scientifically reliable literature in some areas of dual practice, like the prevalence of the phenomenon, the real consequences of it, and the impacts of the implemented policy measures.
Rigorous empirical and evaluative studies should be designed to detect the real consequences of DP and assess the effects of interventions and regulations, which governments have implemented in this field.

Inequality in households’ payments on food and health expenditures presents the accessibility and utili-zation patterns between them. This study investigated the Iranian rural and urban households’ inequality in payments on food and Out-of-Pocket health expenditures from 1998 to 2012. This descriptive study was conducted through the analysis of Iranian Statistics Centre data on Iranian households’ income and expenditures. The Gini Coefficients, Concentration and Kakwani indices have been calculat-ed for Iranian rural and urban households’ Out-of-Pocket health and food expenditures. The means of Iranian rural and urban total consumption expenditures inequality were 0.48 and 0.48, respec-tively. The means of concentration index of food expenditures for rural and urban regions were 0.35 and 0.34, respec-tively. The means of Out-of-Pocket payments for health services for rural and urban regions were 0.51 and 0.5, re-spectively. Finally the means of Kakwani index of Out-of-Pocket health payments in rural and urban households were -0.005 and -0.018, respectively. There are relative high levels of inequality in Iranian households’ payments on food and Out-of-Pocket health expenditures.

The burn injuries are one of the serious public health problems which impose a high economic burden on patients and their family, health sector and community in general. This study aimed to explore epidemiological data of burn patients and factors influencing costs of hospitalization due to burn injuries in Kermanshah Province situated in Western Iran. The study surveyed 625 burn patients who were admitted and died in the Imam Khomeini Hospital’s Burn Center in Kermanshah Province from 21 March 2009 to 20 March 2012. The data about demographics, cause of burn, burned body surface (BBS), length of stay (LOS), and cost of hospitalization were collected from hospital documentations. Descriptive analytical methods were used for data analysis. The mean and median age was 32.5 and 27 years respectively. The female/male ratio was 2.45 (181 male and 444 female). Flame was found as the most common cause of death due to burn (~93 % of all deaths). The mean cost of hospitalization per one day stay and per one percent of BBS was 2897062.5 and 234897 IRR, respectively. This study provides a holistic view for hospital managers and health policy-makers on demographic characteristics and cost of hospitalization due to burns in Kermanshah Province. Also the results showed that the cost of hospitalization in burn injury are related to the LOS, % BBS and the cause of burns.

Hospitals are highly resource-dependent settings, which spend a large proportion of healthcare financial resources. The analysis of hospital efficiency can provide insight into how scarce resources are used to create health values. This study examines the Technical Efficiency (TE) of 12 teaching hospitals affiliated with Tehran University of Medical Sciences (TUMS) between 1999 and 2011. The Stochastic Frontier Analysis (SFA) method was applied to estimate the efficiency of TUMS hospitals. A best function, referred to as output and input parameters, was calculated for the hospitals. Number of medical doctors, nurses, and other personnel, active beds, and outpatient admissions were considered as the input variables and number of inpatient admissions as an output variable. The mean level of TE was 59% (ranging from 22 to 81%). During the study period the efficiency increased from 61 to 71%. Outpatient admission, other personnel and medical doctors significantly and positively affected the production (P< 0.05). Concerning the Constant Return to Scale (CRS), an optimal production scale was found, implying that the productions of the hospitals were approximately constant. Findings of this study show a remarkable waste of resources in the TUMS hospital during the decade considered. This warrants policy-makers and top management in TUMS to consider steps to improve the financial management of the university hospitals.

Equitable distribution of health system resources has been a serious challenge for long ago among the health policy makers. Conducted studies have mostly ever had emphasis on equality rather than equity. In this paper we have attempted to examine both equality and equity in resources distribution. This is an applied and descriptive study in which we plotted Lorenz and concentration curves to describe graphically the distribution of hemodialysis beds and nephrologists as two complementary resources in health care in relation to hemodialysis patients. To end this, inequality and inequity were measured by calculating Gini- coefficient, concentration and Robin Hood indices. We used STATA and EXCEL software to calculate indicators. The results showed that inequality was not seen in hemodialysis beds in population level. However, distribution of nephrologists without considering population needs was accompanied with some sort of inequality. Gini- coefficient for beds and nephrologists distribution in population level was respectively 0.02 and 0.38. Hence, calculation of concentration index for distribution of hemodialysis beds and nephrologists with regard to population needs indicated that unlike beds distribution, equity gap between nephrologists distribution against patients distribution among the provinces was considerably significant again. Our results imply that although hemodialysis beds in Iran have been distributed in connection with the population need, nephrologists’ distribution is not the same as hemodialysis beds one and this imbalance in complementary resources, can affect both efficiency and equitable access to services for population.

Hospital Survey on Patient Safety Culture, known as HSOPS, is an internationally well known and widely used tool for measuring patient safety culture in hospitals. It includes 12 dimensions with positive and negative wording questions. The distribution of these questions in different dimensions is uneven and provides the risk of acquiescence bias. The aim of this study was to assess the questionnaire against this bias. Three hundred nurses were assigned into study and control groups randomly. Short form of HSOPS was distributed in the control group and totally reversed form of it was given to the study group. Percent positive scores and t-test were applied for data analysis. Statistical analyses were conducted using SPSS Version 16. Finally a total of 272 nurses completed the questionnaire. All dimensions with positive wording items in both groups had higher scores compared with their negative worded format. The first dimension «organizational learning and continued improvement» which had the only statistically significant difference, got 16. 2% less score in the study group comparing the other group. In addition six out of 18 differences in questions were statistically significant. The popular and widely used HSOPS is subject to acquiescence bias. The bias might lead to exaggerate the status of some patient safety culture composites. Balancing the number of positive and negative worded items in each composite could mitigate the mentioned bias and provide a more valid estimation of different elements of patient safety culture.