Journal of Education and Health Promotion

Abstract BACKGROUND: Financial management system acts as a driving force and the first important principle
of health sector reform. This study aimed to prepare a framework for new financial management
system in Iran health sector.
MATERIALS AND METHODS: This qualitative study was conducted by content analysis approach
and 15 key informant participants selected through purposive sampling consisted of three minsters of
Ministry of Health and Medical Education (MOHME), three vice‑chancellors in the Center of Resource
Development and Management, Two members of the Health Assembly of the Islamic Consultative,
four Medical Sciences university’s presidents, and three managers in Budgeting and performance
Monitoring Center of MOHME in 2017. Data were collected through semi‑structured interviews and
they were analyzed using Atlas T6
 software.
RESULTS: Six main themes were emerged as follow: “legal reform,” “removing barriers to set up
accrual accounting,” “cost price calculation,” “operational planning and budgeting,” “human resources’
organization, recruitment, and moderation,” and “financial system output utilization (management
accounting techniques) as the base for evidence‑based policymaking and decision‑making practices.”
CONCLUSION: Any efforts for improving the current situation and reducing of mentioned limitations
could be useful in providing required space for future phases of reforms and calculation of unit cost,
operational budgeting, and management of cost and productivity. This can be achieved through an
integrated system of recording and producing standard and accrual financial information. Furthermore,
changing the accounting process and the financial system that complies with one single encoding
in the country is a key issue.

Abstract BACKGROUND: Induced demand is a major challenge for financing health promotion, whereby
providers exploit patients’ information gap to manipulate their demand for health care. The purpose
of this study was to identify the factors associated with induced demand for health‑care services in
hospitals affiliated with Iran University of Medical Sciences (IUMS) in 2018.
MATERIALS AND METHODS: In this qualitative study, semi‑structured interviews were conducted
with 20 participants from IUMS hospitals, including faculty members, physicians, public hospital
managers, patients, and researchers with academic and practical experience. Inductive content
analysis was used to analyze the data.
RESULTS: Overall, 24 subthemes or factors were identified and classified into the health system,
the insurer, health‑care provider, and health‑care recipient themes. Poor monitoring and control,
the fee‑for‑service payment system, limited role of insurance companies, insufficient monitoring of
insurance companies, the educational nature of our health centers, health‑care providers’ interests,
and patients’ information gap were some important factors in induced demand for health‑care services.
CONCLUSION: Our results showed that there are many factors that contribute to induced demand for
health care. Given the four levels of factors identified in this study, health policymakers and managers
must develop strategies at each level to reduce induced demand for health care.

Abstract Fire buildings is considered as one of the most common and the most devastating disasters and
emergencies. Saving school buildings against incidents such as fire is very important since students
are so vulnerable to incidents especially fire. The most school classes were devoid of safety
conditions and oil‑burning heaters were used. Such a condition has increased the risk of disaster
and is considered as a serious menace for students’ lives. The present study conducted with aim of
review the Health, Safety and Education Measures for Fire in Schools. To this purpose, we selected
suitable keywords some articles published in Scientific Information Database of PubMed, Web of
Science, Scopus, and ProQuest were searched. The search was limited to reviewed articles in English
and Persian language published between 1970 and 2019, based on inclusion and exclusion criteria.
Furthermore, the selected articles were reviewed for relevant citations. The reviewing of articles was
conducted by two member of research team independently. The primary search found 194 relevant
studies. After eliminating the duplicates and articles which were not related to the review of the abstract,
51 references were identified for inclusion. Finally, 13 articles were selected after screening and
evaluated by two authors to final review main factors and dimensions of schools’ health, safety and
education include the rules and laws, allocating sufficient budgets, education the teachers, students
and their families, exercise, risk analysis, intersectional relations, fire extinguishing equipment, early
warning system, and also optimization and reformation of heating system. Applying these new
approaches prevents disasters and increases the level of preparedness in case of fire occurrence.

Abstract BACKGROUND: Disaster risk is a product of a combination of hazard, exposure, and vulnerability.
Governance in the health system is a multifaceted sphere, with political, economic, and legal
dimensions. Disaster risk governance is an analytical framework employed for assessing the
capacity of institutional governance. This study has been conducted to investigate the current
status of national strategy documents concerned with disaster risk governance in Iran through
document analysis.
MATERIALS AND METHODS: The investigated documents were collected through requests from
the secretariat and the archives. 102 documents were analyzed. Twelve documents in the domain
of accountability, 7 in participation, 9 in state and nonstate actor, 14 in knowledge sharing, 21 in
sustainable developments, and 19 documents in integrated risk management were analyzed. The
process of analysis included selecting documents and evaluating and analyzing them by content
analysis method.
RESULTS: Documents coded according to the main areas of policymaking in disaster risk governance
were analyzed, and sub‑component and related topics were deduced in each domain. The acquired
themes include unity of command, trustee, commitment, capacity prosperity, align strategy, information
synergy, knowledge enhancement, sustainable security, justice clarity, land use planning, climate
change adaptation, environment reform, wisdom, environment, diplomacy, capacity and coherence.
CONCLUSIONS: Disaster good governance is strengthened by the trustee, commitment, capacity
prosperity, align strategy, and organize. Information synergy and knowledge enhancement are
effective in the culture of prevention. Collective wisdom, diplomacy, and capacity coherence raise
the alignment of public organizations and the government in the risk management process.

Abstract Introduction: Today, the role of people in crisis management plans is of particular importance due
to the prepared community approach. It is difficult or impossible to attract public involvement due
to the low level of public perception of risk. Therefore, it is necessary to discover the status of risk
perception and its affecting factors. This study was conducted to investigate factors affecting the
strategies of disaster risk perception improvement.
Materials and Methods: This systematic review study was conducted in 2017 using extensive
electronic and library literature searches in the Web of Science, Scopus, and PubMed electronic
databases. The preliminary findings included 1030 studies. Out of 941 retrieved references, 925
references were excluded because they did not meet the objectives of this review or did not focus
directly on general population. Finally, 16 articles were selected for further investigation.
Results: The extracted variables were divided into four general domains: personal, psychological,
socioeconomic, and cultural factors. Personal characteristics included sex, age, marriage, level of
education, personal knowledge, and disaster personal experience. Psychological factors comprised
emotions (fear and insecurity), mental images (beliefs, attitudes), and internal and external control.
Cultural factors such as, belief, values, norms, faith, religious, and protective spirit were effective in
general perception of disasters risk. Socioeconomic factors such as, income, livelihood, insurance
coverage, trust, and fair access to land and resources were also influential. The strategies to improve
public disaster risk perception were educational, participatory, incentive, confidence building,
supportive, managerial and cultural ones. A family‑centered approach is recommended for the better
implementation of strategies.
Conclusion: The improvement of risk perception requires government planning in different fields
such as education, research, health, and culture, with an emphasis on social groups especially family.

Abstract INTRODUCTION: Perception the risk of disasters, is mainly of universal and theoretical nature
and is a means of achieving risk understanding/knowledge. In Sendai Framework, the focus is on
increasing risk understanding plans in order to achieve community resilience. Therefore, to achieve
greater public participation in planning for disaster risk reduction (DRR), this study was conducted
primarily to clarify people’s expectations from disaster risk management authorities in order to
approach managers’ and experts’ views to people’s views.
MATERIALS AND METHODS: This qualitative study was conducted through semi‑structured
interviews with 22 participants, who were selected using a purposive sampling technique, in three
provinces of Iran. Data analysis was performed by qualitative content analysis using open coding,
classifying, and abstracting.
RESULTS: By constant, comparison of data, classes, and subcategories were defined. Knowledge,
beliefs, practical obligation, respect for human beings, endeavoring for systemic actions in terms
of planning, implementation, and evaluation classes. In three more abstract categories, personal,
interpersonal, and social commitments were defined.
CONCLUSION: At the preparatory stage, disaster managers need the maximum participation of
people in DRR programs. They, in addition to understanding the importance of their managerial
positions at individual levels and social interactions, are committed to reducing risk.

Abstract INTRODUCTION: This study was designed and implemented with the purpose of identify and analyze
the stakeholders in Iran’s Health Insurance System (HInS).
MATERIALS AND METHODS: This study was a mixed method study. The study setting was in the
field and consists of all organizations in the HInS. The study steps designed according to the Kammi
Schmeer stakeholder analysis model. The information was collected through semi‑structured and
structured interviews with 16 stakeholder representatives. The data collection tool was checklist
and matrixes that determined the characteristics of the stakeholders. Analysis of data was done by
Maxqda10 and Mactor software.
RESULTS: A total of 34 stakeholders were identified that were involved in nine main activities of
HInS. Major stakeholders have governmental nature. The Government, the Planning and Budget
Organization, the Ministry of Health, the Welfare Ministry, the Higher Health Insurance Council,
and the Medical Council were stakeholders who have high financial, decision‑making, and political
power simultaneously. The Parliament and the Health Commission, the Government, the Planning
and Budget Organization, and the Ministry of Health were stakeholders that had the most influence
on other stakeholders. Most of stakeholders have same position to the objectives of the HInS. The
insurer organizations had opposed position with the objective of integrity of the funds.
CONCLUSIONS: Stakeholders of Iran’s HInS are multiple and involved in various activities that
sometimes they are overlapping and parallel.  Regarding the same position of the majority of
stakeholders to the objectives, reforms are possible, provided that influential stakeholders participate
in policies making.

Abstract INTRODUCTION: For many years, numerous researches and risk reduction activists have
emphasized the importance of public awareness and education for disaster risk reduction (DRR).
These needs, due to human natural manipulation, have increased. The present study was aimed to
assess and determine the evidence on the strategies for education of DRR.
MATERIALS AND METHODS: This study was a systematic review of publications and gray literatures
regarding to strategies for education of DRR conducted in December 2016. Fifteen articles and
dissertations published during January 1, 2000 to December 31, 2016 were extracted through PubMed,
Scopus, ProQuest, Web of Science, ScienceDirect, Ovid, Google Scholar, Scientific Information
Database, Magiran, and Irandoc with the inclusion criteria of English and Persian language. Thematic
analysis technique was used to analyze the articles.
RESULTS: The thematic analyses revealed eight major categories of DRR educational strategies
such as raising knowledge, educational needs assessment, educational planning, educational
approaches, educational content, educational tools, involved organizations, and educational learning
barriers and challenges.
CONCLUSIONS: Most countries have launched DRR education activities, but these actions are
not enough, and there are some gaps between what is it and what should be. More effective and
efficient teaching and learning strategies are needed to increase the effectiveness of preparedness
and DRR activities at all levels of community.