خدمات بهداشتی

Social capital is defined as a set of environmental characteristics and social relations that lead to the achievement of common goals and interests within the organization. To achieve its goals, the university of medical sciences must adopt an appropriate social capital model.

This research is developmental and applied in terms of purpose and qualitative in terms of data nature. Social capital shaping factors were classified using interpretive structural modeling (ISM), and the factors were stratified using cross-impact matrix multiplication applied to classification (MICMAC) analysis. The population of this research consisted of faculty members from  Iran University of  Medical Sciences, and semi-structured interviews were used to collect data. Sampling was conducted using a theoretical method, and a total of 15 professors were interviewed until data saturation.

The dimensions of social capital include identity at level 1, trust and commitments at level 2, common language, identifiers, and culture at level 3, network links at level 4, configuration of network relationships and proper organization at level 5, and norms at level 6.

The dimensions of configuration of network relations, proper organization, and norms were placed in the driver cluster, which includes variables with the lowest power of dependence and the highest power of influence. It is suggested that universities clearly define the norms; create a flexible structure; develop stronger bonds among employees; broden networking; emphasize the commonalities among employees; provide clarification; promote group learning, and foster trust and commitment among employees.

The most important way to control COVID-19, with high contagiousness and no specific treatment, is prevention. Due to the lack of a similar study, this research aimed to assess Covid-19 anxiety and the factors affecting the preventive behaviors of Covid-19 from the perspective of clients referring to the comprehensive health centers according to the social and cultural beliefs of the region. This cross-sectional study was conducted on 400 patients referring to comprehensive health centers of Birjand during the outbreak of COVID-19 in 2022. In this study, after obtaining informed consent from the clients, a researcher-made questionnaire regarding COVID-19 preventive behaviors, the COVID-19 anxiety scale, and the demographic information checklist were completed by participants. The most preventive behavior in the studied clients was wearing a mask when leaving home. The mean score of preventive behavior in women was significantly higher than that of men (P<0.001), and the mean score of preventive behavior according to the occupation of the clients was significantly different from each other (P=0.010). There was a positive and significant relationship between the anxiety score and preventive behavior of subjects, with a correlation coefficient of 0.321 (P<0.001). The correlation coefficient between risk perception and preventive behavior against Covid-19 was 0.325, while between vulnerability and preventive behavior, it was 0.333. Considering the relationship between anxiety and preventive behavior of individuals, it is possible to promote preventive behavior in individuals by increasing the awareness and appropriate information about the serious complications of the disease, as well as the ways of transmission through the national media and cyberspace.

The rate of exclusive breastfeeding in Iran at the ages of 3 and 6 months is estimated to be 44% and 27%, respectively, which is still far from the optimal index of the World Health Organization until 2030 (70% in the first six months). In order to monitor breastfeeding counseling centers, which have been set up with the aim of promoting breastfeeding and supporting mothers who have problems with breastfeeding.

This is a descriptive-retrospective study and all the mothers who were referred to the Health and Treatment Center No. 2 in Mashhad between April 2019 and March 2019 were examined. This health center has two active counseling clinics and the collection of information is based on documents registered in offices and computers. The inclusion criteria for study were not having breast diseases, having an infant child, being able to read and write and living in Mashhad city. The exclusion criteria were also the unwillingness to participate in the study and the newborn suffering from diseases that are incompatible with breastfeeding. Therefore, census sampling was done. The data were analyzed using SPSS 16 software and the significance level was less than 0.05.

In 42.8% of cases, mothers had started feeding combined formula with breast milk before visiting, and in 28.1% of cases, when referring to counseling milk clinics, it was reported that the baby was fed only with formula. After breastfeeding consultations and follow-ups at the end of six months, the rate of exclusive breastfeeding is 34.1% (12% increase compared to the initial reference) and combined formula feeding with breastmilk is 27.8% (a 22% decrease compared to the first visit). And feeding with powdered milk alone was calculated to be 36.5% (an increase of 8.4% compared to the first visit).

The positive role of breastfeeding counseling center in reducing the cases of artificial feeding is clear, and it is recommended to prepare written instructions based on the challenges in breastfeeding for breastfeeding counseling in the first month after delivery.

Organizational culture is a set of basic assumptions that the employees of an organization create when facing issues in order to adapt to the environment and achieve internal coherence. Responsibility and accountability of individuals is also one of the important indicators of mental health. This study was conducted to determine the relationship between organizational culture and employees’ responsibility.

The present cross-sectional study was conducted in 2021. In total, 191 employees of Golestan province health deputy, Gorgan city health center, comprehensive urban and rural health service centers participated in the study. Random stratified sampling method was used. Denison's organizational culture and Carroll's accountability questionnaires were used to collect data. Data were analyzed using SPSS-23 software. Ethical considerations were also observed at all stages of the study.

The overall score of organizational culture was below average. Only in the dimension of team orientation, the mean scores were higher than the average and in other dimensions it was below the average. The overall score of responsibility as well as altruism dimension was above average and in other dimensions less than average. In general, no statistically significant relationship was observed between the organizational culture and the employees' responsibility in the levels of providing health services in the health centers of Gorgan city.

The necessity of strengthening organizational culture in a scientific, practical and practical way is sensible. Managers of healthcare organizations should increase the responsibility of employees by providing incentives and welfare facilities.

A healthy society requires a healthy family. Studies have shown that men are more affected by the disease than women, and their mortality rate is higher than women. However, many men do not go to health centers to receive health services, so this study was conducted to investigate why men do not go to health centers.

This descriptive cross-sectional study was performed in 2020 on 380 men over 18. Data were collected using a two-part questionnaire including demographic questions and factors affecting men's lack of referral to health centers. The sampling method was multi-stage. Data analysis was performed by SPSS16 statistical software using an independent t-test, analysis of variance, and Scheffe post hoc tests.

According to the results of the study, non-referral to the centers had a significant relationship with ethnicity (p = 0.023) and level of education (p < 0.001). At the same time, there was no significant relationship between age, marriage, economic status, or occupation (p> 0.05). The inadequate physical condition of health centers (82.95 ±14.67) and lack of trust in health personnel (82.95 ±14.67) of the most important, as well as insufficient information and knowledge (61.22 ± 25.37). The least important factors were the lack of referral of men to health centers.

According to the findings, the need to improve the physical condition of the centers and confidentiality, the confidentiality of information, proper treatment of people, and enhancing personnel skills is important. These cases have been suggested to health managers so that with appropriate policies and planning, we can see an increase in the number of men going to the centers.

The Islamic Republic of Iran's health system is divided into three levels: the first level is the Primary Health Care (PHC) system, the second level includes specialized polyclinics/clinics, general and specialized hospitals, and the third level is the sub-specialized hospitals. Based on the available evidence, Iran's HS has evolved and progressed since 1984, becoming a comprehensive, public-centered, responsive, and cost-effective system, (Figure 1) (1,2).  
During the COVID-19 pandemic, countries reacted differently based on their HS infrastructure and structure, available primary resources (financial and human resources), and the severity of the disease spread. Evidence reveals that most countries relied on their hospitals and health systems to combat the COVID-19 epidemic. However, the health system’s response was slightly different in the Islamic Republic of Iran. Since the early days of identifying cases and preparing hospitals for admission and treatment of COVID-19 patients, the PHC system initiated a comprehensive reaction to combat the COVID-19 pandemic as the first line and the first point of the HS's contact with the community. In this regard, the PHC system determined the principal policies for combating COVID-19 as follows (3):- General vaccination based on the priorities in the national document Provision of active and essential healthcare and services (in-person/remotely)
- Early identification of COVID-19 cases and tracing their close contacts (family/workplace)
- Protection and isolation of vulnerable populations (reverse quarantine
- Ensuring compliance with isolation and quarantine rules (hotel quarantine and house quarantine)
- Development and improvement of outpatient COVID-19 treatment
Different solutions and strategies have been devised to implement and fulfill the determined policies, which can be divided into three general categories:a) Modifying the structure of service delivery
b) Modifying the programs and procedures
c) Improving the methods of service provision
Strategy 1: The first strategy is to make structural changes in the PHC system (Figure 2), which occurred in the first week of the outbreak in the Iran’s PHC system. Through alterations in structure, human resources, duties, and function, 1200 comprehensive urban (1099) and rural (111) health centers were designated as COVID -19 centers for suspected COVID-19 outpatients from rural health houses, urban health posts, rural/urban comprehensive health service centers, and other private centers.

One of the reasons that caused healths clients are feeling dissatisfaction with health organizations is expectations that they are creating and not able to meet according to their expectations. Therefore, the present study was conducted with the aim of production a branding model for health services with the of clients’ expectations approach.

This compound study was performed in 2021. The statistical population of this study in qualitative phase included 20 academic and institutional experts using snowball sampling and the Delphi technique. For the quantitative phase, 830 people referred to health centers were selected as service recipients. The validity of the questionnaire was confirmed by face, content, and structural validity, and its reliability was confirmed by Cronbach’s alpha of 0.96 Quantitative data were presented by EQS software version 6.1 with confirmatory factor analysis and using structural equations.

The results of factor structure in healthcare branding based on six main themes of competitive position, brand equity, brand accessibility, brand consolidation in the minds of clients and the market, branding strategies, and consumer-brand relationship with 19 sub-themes based on the perspective of health services clients (CFI=0/9, TLI=0/9, SRMR=0/049, RMSEA=0/09) had a good fit and the internal consistency of the items had significant levels (P<0/05).

The results of this study show that 19 sub-main themes confirm the six-factor structure of health services branding and were one of the effective themes in branding from the perspective of clients. Since the branding of health services improves the quantity and quality of services provided in the health system, therefore, it is suggested that by creating innovation in the quantity and quality of services provided, access to health services, creating a competitive advantage and empowering employees and improving communication skills, an effective step can be taken in health services branding planning.

Home quarantine to prevent the spread of Covid 19 has a number of psychological consequences, including feelings of loneliness that can have long-term negative consequences. The purpose of this study was to review studies on loneliness caused by Covid-19.

This study was a systematic review study. Articles published in 2020 (until August 10) using the keywords of Corona virus, loneliness, social isolation, mental health, Covid-19 and quarantine and by searching on reputable sites Pabmed, Science Direct, Google Scholar, Sage, Proquest Performed in the presentation of coronavirus, Covid-19 and alone. After screening, finally 33 original studies were obtained which were examined in terms of research quality and methodology. Finally, 14 articles were included in the research and analyzed.

At the time of the outbreak of Covid-19, 29.2% of the subjects showed signs of psychiatric disorders and 35.86% of the subjects experienced feelings of loneliness. Longitudinal findings as a safer way to explore feelings of loneliness over time showed that the elderly (over 65), the chronically ill, and those who lived alone before Covid-19 were at higher risk of loneliness. . Risk factors for feeling lonely include low economic status, female gender, younger people, having at least once Covid-19, weaker and older self-perception, low social support, and protective factors including employment, living with a spouse, Self-compassion, spiritual well-being, was a sense of social belonging.

Feeling lonely in quarantine is not a prevalent feeling, and health policymakers need to plan based on the individual characteristics of those at risk. These programs are better designed for the elderly (over 65), young people (under 30) and women to save them from the risk of health problems caused by loneliness.

Health services management is one of the important fields in health system. Assessing the abilities of graduates in this field will help to identify educational needs. Therefore, the purpose of this study was to evaluate the competency of bachelor graduateswho have employed in the health system units.

This cross-sectional study was conducted on 51 graduates, 41 junior employee and 28 senior employees of health-related organizations in East Azerbaijan Province and from the perspective of all three groups. The 360-degree method was employed using a researcher-made validity and reliability questionnaire with a 5-point Likert scale. Data analysis was performed using descriptive statistics and paired t-test.

Graduates in the field of ethics from a superior perspective (4.01 ±0.76), Customer orientation from the perspective of graduates (4.13 ± 0.76), Problem solving from the perspective of a colleague (3.94 ± 0.89), Service delivery management (3.93 ± 0.91) and change management from the perspective of a graduate (3.90 ± 0.85) And in the field of financial management (3.32 ± 1.14), human resource management (3.74 ± 0.81) and knowledge management from a superior perspective (3.46 ± 1.01) had less ability. The largest gap was identified in the field of financial management from the perspective of all three groups, but from the perspective of the graduates themselves, there was a greater gap in the field of information and communication management (3.89. 0.84).

This study showed that graduates in financial management and information and communication management need to be promoted. Therefore, reviewing the educational curriculum, using new teaching methods and holding supplementary training courses in these fields can help to improve graduates' abilities.

 Achieving a healthy society was one of the ideals of every human society. Achieving this important goal and achieving health in communities depends on the participation of health elites and trustees in health decision-making and policy-making. Because the elites of any society was the creators and drivers of great changes.

this qualitative research has been conducted with the ultimate goal of designing a model of participation of elites and trustees in the field of health (studied by Iran Health Insurance) with the data method of the foundation. For this purpose, while conducting open interviews with 8 university professors in the field of management and 15 elites and trustees in the field of health and paying attention to the concepts of participation and decision making, a set of basic themes (855 themes) were collected during the coding process. And categories (15 categories) were extracted from their hearts.

In the axial coding stage, the link between these categories is under the headings of causal conditions (weakness in policy-making, weakness in laws and supervision, financial problems, payment system), axial phenomenon (need for mechanisms for attracting and using elites and trustees), action strategies and Interaction (participation of elites and trustees in the field of health), context (preparation of infrastructure, design of financial and legal mechanisms, formation of policy room), intervening conditions (problems of inter-sectoral communication and culture-building-management-infrastructure-organizational conditions) And the consequences of elite participation (design and establishment of elite participation model- value creation and attention to the experience, skills and expertise of elites- organizational development and increase of efficiency and effectiveness-welcoming elite plans and solutions-creating identity and patriotism among elites - Preventing brain drain, realizing the vision and missions of the organization) was determined in the form of coding paradigm, then the components of the coding paradigm were described, the storyline was drawn and theory was created.

The findings showed that strategic purchasing has the greatest impact on the participation of elites and trustees and also increase the motivation of elites and trustees to participate in decisions; some characteristics and special conditions of this phenomenon are provided.

Clients are at the heart of the health system and their satisfaction indicates the correctness of the services. Therefore, the purpose of this study was to determine the factors relevant to the development of the status of responding to expectations in Alishahr Comprehensive Health Services Center in 2018.

The present study is qualitative in the form of directed content analysis.

According to the respondents, the four components of response time, the factor of manpower in response, the management factor in response, the factor of equipment and facilities in responding to the respondents are the most important factors in the satisfaction of the respondents. Accordingly, the factor of speed, accuracy in doing clientchr('39')s affairs (90.9%) is the most important factor of time component; The factor of behavior with concerning clients, the responsiveness and responsibility for the clientchr('39')s business and having tolerance and a positive desire to deal with the client (90.1%) are the most important factors of manpower; Transparency and proper information and quality of service (quality of service) (86.4) The most important factor of the management component; Finally, the factors of cleanliness of the workplace (creating a pleasant and elegant environment) and the physical appearance of the staff, the heating and cooling system, the proper sanitary, adornment and health and safety of the work environment (77.3%) are the most important factors of the equipment component and facilities.

Considering the results of this study that the provision of services in some cases is not optimal, it is suggested that by establishing a proper referral system and monitoring, it will increase the satisfaction of the clients.

Nowadays “change” in all aspects of humanchr('39')s life and organizations is rapidly increasing. By knowing the characteristics of change managers as the main pillars of change in healthcare organizations we can implement effective changes in healthcare systems. Therefore, the aim of this study was to determine the characteristics and competencies of change managers in healthcare system.

This descriptive cross-sectional study was conducted on nurses in educational hospitals of Kerman University of Medical Sciences in 2016. In this study 280 nurses entered the study based on stratified random sampling. To collect data, a valid and reliable questionnaire was used. Data were analyzed using cluster analysis by SPSS software version 16.  

The highest mean score regarding the characteristics of a change manager was related to "evaluation system and feedback" (9.22 ± 1.17), and "counselor and guider" in the process of change (9.31 ± 1.10). Conversely, "creating an amicable atmosphere in the workplace" (7.35 ± 2.45) and "thinking to reduce resistance" (8.04 ± 1.07) achieved the lowest scores. Totally, 4 roles as futurist and planner; coordinator and information provider; facilitator; and strategist were identified for a change manager in healthcare system.

Characteristics such as futurist, information provider, facilitator and strategist are the main traits of a change manager. Emphasizing these characteristics and making managers ready in this regard can enhance their performance in the process of change and makes the change easier.

Due to the importance of the individualschr('39') health literacy level in promoting community health, this research evaluates the studies conducted on health literacy in Iran and provides content analysis in this area.

Information sources or data:

 Iran Medical Articles Bank was launched in 2015 according to the needs of the Iranian Medical Research Society. This bank is a search engine for articles published in Iranian medical journals.

Selection methods for study:

 The keywords "health literacy", "health information literacy" and "sanitary literacy" were searched in the title or keywords of the articles. At the time of data collection (February 20, 2017), 72 articles were indexed in this database. The full text of the articles was studied and analyzed in terms of population, place of research, research method, tools and topic.

Test of Functional Health Literacy in Adults (TOFHLa) and Health Literacy of Iranian Adults (HELIA) questionnaires were the most important tools for measuring health literacy. The study population included diabetic patients, the elderly people, various patients, and students. The results indicate that the topics discussed in relation to health literacy were divided to five general thematic areas: "Health literacy assessment tool, measuring the levels of health literacy of patients and people, factors affecting the level of health literacy, patient education and communication".

In order to succeed in projects related to health literacy, looking at its different dimensions and planning in those areas will be very useful. The present study can provide a comprehensive view for a long-term planning to provide more practical and useful research.

Cutaneous leishmaniasis (CL) as a common disease in many tropical and subtropical countries has adverse economic consequences for patients and health care system. Some rural areas of Qom are considered as active foci of disease. This study was performed in order to evaluation of economic burden associated with CL in Qom, central Iran using Activity Based Costing.

In a cross-sectional study, data of 207 patients with CL based on laboratory diagnosis in the year 2018 were used to estimate the economic burden of the disease. Charts, frequency tables, and the financial softwares (Azarakhsh and Roozamad) in Excel were used to costs analysis.

The incidence of CL in Qom province was 16.02 per 100,000 people (207/1,292,000). Economic burden of the disease was estimated at 4,265,246,799 rials (85,387$). The average direct cost paid for each person with CL was 10,631,250 rials (212$) and indirect costs (overhead) for each person was about 9,653,807 rials (193$), the governmental cost per patient 20,285,057 rials (405$), direct out of pocket payments for each patient was around 320,000 rials (7$) and the total costs was estimated at 20,605,057 rials (412$) per patient.

Direct and indirect costs associated with diagnosis and treatment of CL disease may have a great impact on patients and health care system. So, it seems more cost effective to take preventive measures.

Assessment, identification, and presentation of management challenges of running programs can help policymakers and administrators to overcome these deficiencies and achieve the objectives of the plan. This study was conducted with the aim of explanation of the management challenges and solutions for its elimination in the health sector of health system reform plan Qom city.
 
In this qualitative study, participants were the experts and the executives of Qom health center, health services providers in the health centers affiliated to the deputy of health of Qom University of Medical Sciences and health services recipients referring to health centers in Qom city, selected by convenience sampling. The data were collected through individual interviews using a semi-structured questionnaire and analyzed by qualitative content analysis and an inductive approach. Challenges for health system reform in the field of health, were extracted by qualitative method.
 
The data of this study were categorized in 21 categories and 7 themes. From the perspective of the participants, the management challenges of health system reform in the health sector included waste of resource, the unexceptionable system, hasty implementation of the program, emphasis on quantity and directional reporting, ineffective monitoring, shortcomings in implementation of the program, and reduced quality of health services.
 
Based on the findings of this study, it is necessary to design effective strategies for management of resources, establishment of a system for collecting criticisms and suggestions and their application, judgment based on the quality of services, modification of the existing monitoring system, eliminating executive failures, and paying attention to the improvement of the quality of services.

Improving living conditions and increasing longevity and life expectancy has led to the phenomenon of aging in societies. This incremental rate causes a serious challenge for organizations that provide health and therapy services. In association to the mentioned challenge, the purpose of this study was to study Stauts and determiants of health services utilization among elderly elderly rural hubitant in Semnan City (Iran) in 2016. This was a cross-sectional study in which 395 elderly people in Semnan City were studied and the collected information was performed by using a structured questionnaire. Between the whole cases, 54% (224 people) used outpatient services. In outpatient services, 14.4% consult with specialists and 13.7% used services from educational hospital. 26% of the other cases used in patient services. That service from 56% among them used educational public hospitals. The related factors of the utilization rate of outpatient health service were: age (p=0.02), gender (p=0.02), marital status (p=0.01), income status (p=0.01), education (p=0.01). The related factors of the utilization rate of inpatient health service were: age (p=0.02), gender (p=0.03), marital status (p=0.05), income status (p=0.02). Obtaining benefit from health services has a meaningful relationship with various socio-economic factors such as sex and age, and income and education status, each of which can affect the level of health benefits of individuals. It also seems that multiplier is a multi-factor issue, and therefore proper planning for this growth demand is necessary.

In spite of the great importance of health and health services, the imbalance in distribution of such services has always been one of the main problems of planners. This research was carried out with the aim of ranking and comparing health and health services in cities in Lorestan province.
Data was collected from books and documents, and from experts in the field of health and health services. To do this, 18 indicators of health and related services were selected, and ranked utilizing the fuzzy TOPSIS method.
Results showed that there were significant differences among the cities under investigation, in terms of health services. Khorramabad ranked first for similarity index and Boroujerd ranked second (similarity index= 0.466). Also, Delfan and Dooreh came 9th and 10th , with a similarity index of 0.284 and 0. 283, respectively.
According to the analysis, the main weaknesses in the province were the pharmacist's per capita indices, per capita radiography centers, per capita urban health centers, per capita active beds, as well as the percentage of health centers in villages.

In the field of ​​health care, the quality has a special place and understanding the perceptions and expectations of the care recipients of the provided services is very important and the first step to improve the quality of care. Therefore, this study was conducted to examine the quality of mother-child care from perspectives of mothers in the primary health centers of Qom.
In this cross-sectional study, using multi-stage sampling method, 409 mothers referring to health care centers of Qom evaluated the quality of primary health care including family planning, immunization, growth monitoring of children. Demographic information as well as the standard SERVQUAL questionnaire with 22 questions (Quality assessment questionnaire with 5 dimensions of tangibles, assurance, reliability, responsiveness, and empathy) was used for collecting data. Data were analyzed by SPSS 21 with descriptive statistics and ANOVA, T-test and Pearson's correlation coefficient tests at the significant level of less than 0.05.
In all aspects, the quality gap was negative. The highest gap mean was observed in the tangible dimension (-1.59) then empathy (-1.53), accountability (-1.47) reliability (-1.28) and the lowest gap average was assurance (-1.10). In this study the gap between the services quality provided for working women and housewives indicate a significant difference (p>0.001). The education level had a significant relationship with provided services quality gap (p=0.024). Also age has a significant direct correlation with negative gap of quality in all dimensions (p The services quality and its dimensions’ analysis showed that there is a negative gap in service quality and its five dimensions between women's expectations and perceptions of the service recipient. In all cases, their expectations level was beyond perception.