مجله تحقیقات نظام سلامت حکیم
سال بیست و دوم شماره 4 (پیاپی 87، زمستان 1398)

Nowadays, health inequalities are emerging at short geographic distances, even among the districts of a city in developed and developing countries. In response to these conditions, it is important to study the role of socioeconomic structures and factors in the incidence and distribution of health outcomes. In a five-level framework, the knowledge network of the Commission on Social Determinants of Health clarifies the mechanism of the effect of social determinants on the creation of differences and inequalities in the health of different population groups. The present paper examines the evidence of health inequalities at international and regional levels and explains its reasons.

Formulation of the National Nutrition and Food Security Document (NNFSD) is an important effort in the field of operationalizing Iran’s upstream food and nutrition documents. This study aimed to assess and analyze the performance of the Specialized Nutrition and Food Security Working Group in achieving strategic goals of NNFSD.

Qualitative content analysis was carried out on existing documents of the Supreme Council of Health and Food Security. The executive quality of the sessions was assessed on the basis of three indicators, including existence of evidence-based reports, clear approvals, and follow-up of approvals. The main themes were presented separately for the strategic objectives in the form of three broad categories, including challenges, approaches, and related actions. The qualitative analysis of data was performed using MAXQDA software.

Most of the Specialized Working Group’s sessions only focused on five of the seventeen strategic goals, including decreasing the main risk factors of agricultural and food products, decreasing the amounts of salt, sugar, and fats in foods and drink, while increasing average intake of the basic items in food basket, stablishing food fortification, and increasing nutritional literacy of target groups. Of 71 sessions held, the quality of 16 sessions (22.5%) was acceptable and only 43 approvals (31.2%) out of 138 in working group’s sessions were followed up and performed.

The need for serious and documented follow-up of approvals, improving presented reports with referring to sufficient evidence, and also more comprehensive coverage of issues and problems in the field of food and nutrition confirms the necessity of revision, strengthening performance and management of the mentioned working group.

Information asymmetry leads to less informed patients in choosing healthcare providers. Therefore, countries have moved forward to increase providers’ transparency, information symmetry and patients’ power. This study was designed to compare countries’ experiences about hospitals’ transparency.

The list of countries in this comparative study was prepared with the help of the Global Open Data Index and Open Data Barometer. Searching for official websites with keywords like “hospital transparency” and “hospital comparing tool,” the final websites were obtained. Finally, indicators and types of organization of these websites were compared.

Websites from eight countries were selected. The number of indicators for comparing hospitals was variable, from 17 in Australia to 195 in the UK. Type of indicators could be categorized into several groups, including waiting times, length of stay, patients’ experience, staff’s experience, treatment outcomes, infection control, and price of care. Studied experiences showed that countries developed hospitals’ transparency due to their needs and limitations. Some countries like the UK and the US were pioneers but there is a global trend to develop transparency in the health system.

By increasing public awareness, governments moved forward to develop transparency and the health sector was not an exception. Although private companies and startups are engaged in these innovations, governments have the main role to build the legal, political, and data infrastructures. Therefore, it is recommended that Iranian policymakers and politicians develop transparency of hospitals and health systems gradually using global experiences and considering domestic conditions and capacities.

Donors can contribute to the funding, resource generation, and provision of healthcare services in the Iran health system. Several factors can influence the donors’ contribution to the health system. This study aimed to explain and predict the donors’ participation in the Iran health system.

A qualitative and inductive study was performed using semi-structured interviews with 38 donors and 26 policymakers and managers in the Social Affairs Department of the Ministry of Health and the Universities of Medical Sciences in 2018. The interviewees were recruited using a purposeful and snowball method. The thematic content analysis method was used for data analysis. All major ethical considerations were observed in this research.

Healthcare donors followed a purposeful and planned behavior for contributing to the health system. Nine factors can influence a donor’s charitable behavior in the health system, including goal, intention, attitude, norms (ethical, descriptive, and subjective norms), personal characteristics, background knowledge, experience, past behavior, and control of perceived behavior. The donors’ participation in the health system is a function of their goals, intentions, attitudes, and their control of perceived behavior. The donors’ attitude is shaped by their characters, background knowledge, experience, past behavior, and ethical, descriptive, and subjective norms.

The purposeful and planned behavior model developed in this study guides healthcare managers and policymakers in explaining and predicting the donors’ charitable behavior in the health system.

Medicine and related subjects are fundamental pillars of the development of modern humanities, as humanities have been able to provide a good basis for explaining health issues. The goal of this study was to explore the challenges facing medical humanities in Iran.

This exploratory research aimed to assess the challenges facing the development of medical humanities in Iran. This qualitative research used a triangulation method for data collection. The participants’ observations in one session for making disciplines in the Ministry of Health and 12 interdisciplinary science development discussions in the Southern Medical Education Region comprised the data of the present study. Based on Bourdieu and Foucault’s theories, data were analyzed using the directed qualitative content analysis method.

The study showed that the field of medical education is heavily dominated by the knowledge and power of biomedical discourse. This dominant, hegemonic, and non-homogeneous discourse takes the bulk of the field so that it does not communicate with other fields of knowledge. Nevertheless, marginal discourses also pursue a kind of resilience ethos and this resistance ethics has managed to fulfill part of its goals in the short term. The formation of medical humanities in the field of medical education depends on the resilience continuity of resistance morality in academic discourses.

The development of medical human medicine is one of the requirements of medical education in Iran, which is proposed to be pursued at the policy and intellectual levels.

Choosing appropriate content is one of the important issues in developing a curriculum and, at the same time, a solution to solve the associated problems. The present study evaluated the content of the pre-marriage education program provided by the State Welfare Organization of Iran to revise and update the program.

This is an applied, descriptive-survey, and mixed-method study. The statistical sample consisted of 25 marriage experts and 22 educators of the pre-marriage education program that were selected by a non-random purposive sampling method. The research instrument was created according to content selection principles. It had 31 items, answered on a four-point Liker scale, and four open-ended questions. The content validity index was above 0.79 for each item and whole items.

Based on the standard score of correction, the principles of validity and interest, utility, learnability and feasibility and significance, and finally the knowledge structure had priorities of 2, 3, 4, and 5, respectively, for content correction. The inter-rater reliability score of the expert and educator groups was 0.68 on the utility of the program. Also, the selective coding of the open-ended questions showed the values of 9, 11, 10, and 8, respectively, for questions about deleting content, preserving content, adding content, and suggesting a scientific resource.

The results indicated that the quality of the content could improve by focusing on updating and scientific validation of the content, fitting the program content with requirements and characteristics of the target group, fitting the content with the community atmosphere, and choosing an appropriate method of teaching. Also, according to the inter-rater reliability score, it can be concluded that the content has the highest and lowest levels of suitability in terms of significance and interest, respectively.

Owing to the importance of oral health and the high cost of dental care, receiving cost information and calculating the cost of types of dental services at the Comprehensive Health Center can be effective in resource allocation, tariff reform, and insurance coverage of this type of service. This study aimed to calculate the cost of all types of dental services delivered at the Farman Farmaeian Comprehensive Health Services Center.

The present study is a descriptive, practical, and retrospective cost-accounting study. In this research, the cost of nine dental services in the dental unit of Farman Farmaeian Comprehensive Health Service Center of Tehran University of Medical Sciences was calculated using a cost-based method based on the activity. The data were analyzed based on the various stages of activity-based costing.

The price of all types of dental services in this study was more than the tariffs of 1397. The largest cost share of dental services provided at this center was for composite restorations (1,593,640 Rials) and the lowest was the cost of fluoride therapy (210,170 Rials). The total costs related to the dental unit, staffing with 61.6% had the highest share of costs, and after that, the cost of consumable materials, shared costs, depreciation of equipment and office supplies, and maintenance had the largest shares, respectively.

The present study shows that there is a difference between the actual price of the services of the unit studied and the tariffs for those services. Also, owing to the high share of staffing and dental consumable materials, it is possible to take effective steps to increase the efficiency and reduce costs by using domestic-made and high-quality consumable materials and hiring compulsory designed manpower.

Successful control of hospital infections requires appropriate preventive measures, achieved when hospital staff meets the principles of infection control. The present study was conducted to determine the rate of compliance with infection and sterilization control standards in limited surgical centers of Tehran University of Medical Sciences.

A descriptive-analytical cross-sectional study was conducted in all active limited surgical centers affiliated to the Tehran University of Medical Sciences (eight centers). The standard measures of infection control and sterilization were assessed in four domains including standard precautions, hand hygiene, disinfection and sterilization of equipment, and environmental health.

The rate of compliance with infection and sterilization control standards was 74% in the limited surgical centers. The rate of compliance was 55% for standard precautions, 30% for hand hygiene, 67.5% for equipment disinfection and sterilization, and 64.6% for environmental health.

The infection control and sterilization standards for hand hygiene are less adhered to in limited surgical centers. Therefore, it is necessary to provide complete, correct training on hospital infections and the ways of control for promoting the performance of staff.

The government’s ability to allocate additional resources to the health sector depends on the country’s macroeconomic condition. The concept of fiscal space helps put health in the broader context of the economic and financial environment. In this study, we explored the fundamentals of the concept of fiscal space for health and provided a brief overview of the different methods for the expansion of fiscal space for health in Iran.

This review study, by using reports and articles published in internal and external databases, examines the theoretical foundations and different methods of fiscal space expansion in health generally and for Iran’s health system specifically.

Fiscal space for health is the availability of budgetary room that allows a government to provide resources for desired public purposes without impairing fiscal sustainability. This space can be generated by a variety of sources, which can broadly be categorized into five categories, including conducive macroeconomic conditions, a re-prioritization of health within the government budget, an increase in the health sector-specific resources, foreign aid, and an increase in the efficiency of existing government health outlays.

The use of fiscal space analysis can help sustainable health financing and increase the alignment of health financing with the goals of the public financial management system.

The board of trustees is in the decision-making structure of universities of medical science. The law enforcement of the board of trustees began at universities and higher education institutes in 1991. Studies of the trusteeship board and its various dimensions were detected at home and abroad. The purpose of this study was to provide a conceptual map for the promotion of the board of trustees from the viewpoint of experts.

The present study was based on an applied purpose, and the methodology was based on a qualitative design with the content analysis approach. The number of interviewees was 14. In collaboration with the group of researchers, the analysis of the text of the interviews took place. Then, the Delphi Phase I Questionnaire was designed based on theme and sub-theme. After receiving expert opinions, the second phase of Delphi was designed and implemented.

The important challenges to the excellence of the board of trustees from the viewpoint of experts in eight themes are noteworthy, including: (1) the process of appointing trustees; (2) lack of attention in the ongoing assessment of trustees; (3) review of the continuous training of the board of trustees based on the needs for the assessment of education; (4) choosing the secretary of the board of trustees and the head of the institute (Meritocracy); (5) lack of adequate motivation in the members of the board of trustees; (6) lack of transparency in the roles of the board of trustees; (7) lack of transparency in the roles of the Ministry of Health and Medical Education related board of trustees; and (8) non-accountability to stakeholders.

Promoting board of trustees requires the following items: modifying the appointment process and motivating members; internal and external evaluation of performance; redesign of the roles of the Ministry of Health and universities; revision of the role-based authority law; and legalization of trustee accountability to stakeholders.

The use of medicinal plants in treatment has a long history, and now medicinal plants are of great importance. However, no study has been done on the problems of groceries. Due to the widespread activity of groceries to apply medicinal plants for treating health problems, this study aimed to investigate the problems with groceries in cities of West Azarbaijan province.

This is quantitative research in terms of nature, applied in terms of purpose, and descriptive-survey research in terms of the data collection method. The statistical population of the study consisted of 20 groceries in the cities of West Azerbaijan province. The data were collected in a questionnaire. The validity of the questionnaire was determined by content validity and its reliability by Cronbach’s alpha. SPSS software version 11.5 was used for data analysis.

The presence of some dangerous drugs in groceries (mean: 4.78 and standard deviation: 0.53), provision of fake samples in groceries (mean: 4.57 and standard deviation: 0.96), and not checking handmade medicines in groceries (mean: 4.31 and standard deviation: 0.88) ranked the first to third problems and challenges according to the view of groceries in West Azarbaijan province.

The main problem of groceries is the lack of observance of professional ethics, which is the biggest problem affecting the health of the consumer and job security of groceries in the long run.