مجله تحقیقات نظام سلامت حکیم
سال هجدهم شماره 2 (پیاپی 69، تابستان 1394)

Stewardship besides generation of resources, financing and service provision is a main function of health systems that can directly affects the other four functions. Stewardship includes decision making about priorities and ensuring to address them. Achieving better indices in the population health is related to effective stewardship. This study reviewed the roots of the health system problems by stewardship analysis and proposed betterment solutions in order to protect the public benefits.
This was a qualitative study. Stewardship conceptual framework and guide questions were developed using the scientific resources. Data were analyzed using the content analysis; and the situation was described. Root causes and proposed solutions were extracted from data of the focus group discussions with experts and pioneers of the health system.
All domains of stewardship including intelligence generation, policy formulation, setting vision and strategies and regulation and control had major problems. Some effective roots of the governance issues are: the absence of improving plan, week knowledge, attitude and skill of researchers, policy makers and managers. The proposed solutions to improve the stewardship’s function in the Ministry of Health and Medical Education include: - developing decision making dashboard for top managers; - composing policy making stakeholders network; - developing knowledge management system to utilize tacit knowledge and international experiences; - preparing a plan for achieving 2025 vision; - organizing the planning, implementation and evaluation system to the districts level and administrative units; - developing inter-sectoral coordination; - reviewing policies for supervising private sector and consumer protection.
Since the stewardship affects other three functions of the health system, lack of attention to this function will result in difficulties in achieving health goals and will waste resources in health sector. Traditionally, the Ministers of Health and Medical Education have missions in the areas of finance, resources generation and service provision; however, reviewing the past priorities have shown that less time and energy has been spent to improve the ministry of health governance. The main audiences of this study are Deputies of Health Minster Council and members of the Health Committee of Parliament. This evidence on the stewardship system can help them to manage the ministry of health rationally and responsively.

Primiparous women who start breastfeeding face with many challenges. Breastfeeding self-efficacy is an important psychological and motivational influencing factor in breastfeeding success. The aim of the present study was to examine the impact of peer education on breastfeeding self-efficacy in primiparous women.
This cluster randomized controlled trial was conducted among 107 primiparous women. Six health centers were selected and randomly divided into two control and intervention groups. Women were recruited through consecutive sampling. The control group received two routine educational sessions in the health centers (one session before and one session after childbirth). Intervention group received two more sessions of breastfeeding education before and after delivery from peers that were qualified and experienced two years of successful breastfeeding. Data were collected using the Breastfeeding Self-efficacy questionnaire at eight weeks postpartum. Data were analyzed in the SPSS-20 using the t-test and chi-squared test.
The mean score of breastfeeding self-efficacy in the control and intervention groups were 46.55± 6.23 and 51.87± 6.08, respectively after the intervention (p>0.001).
The findings of this study revealed that breastfeeding through peer education increased self-efficacy in primiparous women eight weeks after the education.

The aim of the present study was to assess the effect of group counseling based on cognitive-behavior therapy on depression and self-efficacy in male addicts with successful withdraw.
This was an experimental study. The study population consisted of male addicts with successful withdraw who were referred to the residential Kowsar institute for psychological rehabilitation. Forty participants were selected using the random sampling method. The participants were divided and assigned randomly into two equal groups. The participants completed the Sherer self-efficacy scale and Zung self assessment Depression Scale. The experiment group received 12 sessions of cognitive– behavioral therapy. The control group received usual care. Data were analyzed in the SPSS-16 using the multivariate variance analysis method and the independent t-test.
After the intervention, the means (standard deviations) of the depression scale were 60.70 (6.44) and 63.35 (35.5) in the experiment and control groups, respectively. After the intervention, the means (standard deviations) of the self-efficacy were 57.60 (4.13) and 42.40 (4.88) in the experiment and control groups, respectively. The results of this study showed that cognitive - behavioral therapy significantly affected the depression and self-efficacy of male addicts (p The cognitive - behavioral therapy was effective in depression and self-efficacy among male addicts with successful withdraw.

Undetected Neonatal Congenital Hypothyroidism (NCH) can cause severe retardation and impaired child development; and results in heavy burden on family and the society. Knowing geographical distribution and high risk areas are essential prerequisites for decision-making and planning in health system. The aim of this study was to determine the spatial distribution of the NCH using Geographic Information System (GIS) in Fars province.
In this cross-sectional study, pattern of the disease from 2005 to 2013 was determined using the data extracted from screening programs of the Department of Health. Data were entered into the MS-excel sheets. Using the spatial statistical functions and Global and Local Spatial Autoregressive, focal points of the disease were identified. Zoning maps and spatial patterns were generated and analyzed using the spatial interpolation functions.
The results of this study showed that the incidence of the disease was 2 to 10 cases per 1000 neonates (1.6 to 8 per 1,000 female newborns and 1.8 to 9 per 1000 male neonates) during the study period. The statistical significance level (p-value) and the index of spatial autocorrelation (Moran's I) showed that the spatial distribution pattern of the congenital hypothyroidism in newborns had a random pattern during the study period.
The analysis of spatial distribution of the congenital hypothyroidism in newborns showed differences in different geographical areas of the province. The pattern showed steady decrease and tended to be focused on specific areas of the space.

Out of pocket expenditure for health services is a major issue of health system in developing countries. Health insurance is a way to confront this problem. Regarding advancements in medical diagnosis and treatment, providing an appropriate healthcare package is difficult. This study aimed to create a hypothetical market to elicit willingness to pay and demand for complementary health insurance.
We used a multi-stage sampling method to select 1023 head householders in Kerman. The Bidding Game approach was used to estimate willingness to pay; and the multiple linear regression and ordinary least square were used to elicit the demand for health insurance and its influencing factors. The variance inflation factor was used to assess collinearity; and the Breusch-Pagan test was used to review heteroscedasticity.
The average willingness to pay for complementary health insurance was 220156 Rials per se in one month. Risk aversion, household income, health insurance status, employment states and marital status affected the willingness to pay. The price elasticity was estimated about -1/54 percent. Risk aversion was the most influencial factor in the individuals’ insurance demand. Risk level had no effect in the individuals’ insurance demand.
From a policymaker’s point of view, willingness to pay can be assumed as a criterion to determine premium in health insurance. Identifying willingness to pay in risk aversion people and risk pooling can reduce exposure to large financial losses.

Men who have sex with men (MSM) are at risk of acquiring sexually transmitted infections (STIs) including the HIV. Few studies have been conducted regarding the epidemiologic status of HIV and STIs among the MSM. The aim of this study was to assess the prevalence and risk factors of the STIs among the MSM.
In this cross-sectional study, 43 men with history of sexual contact with other men in the last year were invited to the study. After ensuring the confidentiality, the participants completed the study questionnaire and underwent testing for the HCV-Ab, HBS-Ag, VDRL and HIV-Ab. Positive HIV test results was confirmed with the Western Blot.
More than half of the participants had a history of child sexual abuse. About half of the participants (44.2%) had symptoms of the STIs. Prevalence of the HIV was 7% and prevalence of the Hepatitis C and Hepatitis B were 18.6% and 2.3%, respectively. There were no positive cases of Syphilis. Only 7% of the MSM always used condoms in their sexual contacts. Decreasing sexual satisfaction was the most important reason mentioned by the MSM who did not use condoms.
In order to control the HIV epidemic in people with high risk behaviors, focusing on the intervention (prevention and treatment) services including condoms promotion, educational programs, and HIV counseling and testing seems to be necessary

All measurements, including medical students’ assessment, are potentially prone to error from various sources. Considering the importance of maintaining the quality of assessment methods in medical education, finding methods to estimate the error and to decrease it, is essential. Many developments have been achieved in measurement theories during recent years, which can be used in this way.
In this study, following reviewing the classical test theory (CTT) and its limitations, we discuss the generalizability theory (GT) using some examples of the Objective Structured Clinical Examination.
According to the CTT, students’ scores in exams are not their true scores and are accompanied with some levels of error. Determining reliability of tests helps us to assess how much the random error has been affected the score. In the CTT, it is impossible to consider all error sources simultaneously. To cope with this limitation, the GT specifies share of various sources of error based on the ANOVA models. This theory estimates reliability of tests and offers some recommendations for improving their generalizability.
In CTT, specification of effect of various sources of errors is not possible, whereas GT can be used to identify share of each error source. Hence, the test reliability coefficient can be estimated and also a more reliable test may be planned.

A main goal of organizations is to improve productivity of their staff to achieve effectiveness and efficiency of the organizations. The purpose of this study was to investigate the relationship between human resource development strategies and staff productivity in psychiatric hospitals.
This was a cross-correlational study. The study participants included 160 managers and supervisors of the health departments and hospital matrons at Iran University of Medical Sciences. Data were collected using a 30-item questionnaire designed by the researchers to measure human resource strategies and a 21-item questionnaire to measure employee productivity. Data were analyzed in the Amos-21 using the structural equation modeling.
The results of the study showed that there was a positive significant relationship between the human resource development strategies with employee productivity in hospitals (regression coefficient: 0.873).
Development of human resources strategies and implementation of strategic initiatives in areas such as decision-making and planning, human resources, supply manpower efficiency, effective employee performance evaluations, salary and bonus systems and manpower training was significantly related with efficiency improvement among the employees.

Hospital information system is an information technology tool that covers all diagnostic, therapeutic, administrative, financial and research functions and operations. This study aimed to assess the ability of various hospital information systems in Iran based on the general requirements of the country.
This study was a functional and descriptive study. The research population included hospital information systems of vendors of hospitals’ softwares. A researcher-made checklist was designed to collect the data. This checklist was designed using the standards of the Ministry of Health, data from Iranian companies; as well as, the list of requirements for hospital information systems, WHO, CCHIT, and scientific articles. The content validity of the checklist was assessed by experts. The test-retest procedure was used to determine the stability of the checklist. Data were collected using the checklist by observations and interviewing with hospitals` informatics staff. Data were analyzed in the SPSS 19. Those cases that were in harmony with the checklist were analyzed using the descriptive statistics (percentage, mean, and standard deviation).
The highest performance scores were obtained for the Tarasheh Hooshmand (330), Rayavaran (317) and Mashhad University of Medical Sciences (292). Regarding subcategories, Tarasheh Hooshmand had the highest score (98.4%) and Teb va Rayaneh had the lowest score (14.71%).
Since the number of applicants who wish to use the hospital information system has been increased, and there are shortcomings in some modules of the hospital information systems designed by the companies, there is a need to review and revise hospital information systems especially using benchmarking.

From beginning of the Fourth Development Plan in Iran, the policy of reducing public share of health spending was formally adopted by targeting the reduction of out of pocket payments to less than thirty percent. The policy was also considered in the Fifth Development Plan. However, during implementation of the program (2005 to 2013), out of pocket payments not only did not decrease but increased so far. This study aimed to investigate the reasons for failure of this policy.
In this qualitative study, 39 key informants were interviewed using purposive sampling method. Data were also gathered from related documents. Data were analyzed using the Walt and Gilson triangle model analysis.
The data were classified within four categories: 1) actors (including conflicts of interest and power installation; 2) content (including internal logic and cohesion objectives); 3) context (including political feasibility, environmental impact, resource and structure); and 4) process (including monitoring and evaluation, stakeholder involvement and stewardship and leadership).
The behavior of the main political actors, were influenced by individual and group factors such as conflicts of interest and power of discourse. This policy failed within the context of the government's lack of political commitment, economic shocks, and lack of social support from interaction of regulatory bodies.