Journal of Education and Health Promotion

Abstract BACKGROUND: Health policymakers use a variety of policy tools. These policies are either based
on external factors or are based on paternal considerations; people may need to have help in the
selection of items that may be regretted about them in the future. However, recent research on
behavioral economics shows that major decision‑making mistakes are not only limited to vulnerable
groups but also are ubiquitous and systematic. The purpose of this study was on health policy making
with a behavioral economics approach in health promotion.
MATERIALS AND METHODS: The eligible studies were obtained from Medline (PubMed), Web of
Science, and Scopus databases. The search strategy uses a combination of keywords in the titles. The
keywords of behavioral economics along with the keyword of health have been used to find related articles.
RESULTS: After deleting duplicate articles, a total of 38 articles were identified. After reviewing
the title and abstract, 13 studies were omitted because they did not meet the inclusion criteria. Ten
articles were removed from the found articles due to the unavailability of the full text and four articles
were excluded because their method was quantitative. Finally, a total of 11 articles were eligible for
including this review study.
CONCLUSION: Recent research on behavioral economics shows that decision‑making errors are not
limited to vulnerable groups but are ubiquitous and systematic. Forgotten income or negligible income
is very high and is reasonably explained by transaction costs. Educational interventions often have
little effect and do not benefit from basic cost‑benefit tests. In addition, the seemingly insignificant
aspects of choice‑frameworks and assumptions‑often have a profound effect on behavior.

Abstract BACKGROUND: To ascertain the effectiveness of a collaborative model between the Department
of Community Medicine and state health department to improve MCH outcomes among the urban
poor in Chandigarh.
MATERIALS AND METHODS: A quasi‑experimental study was conducted from 2011–12 to 2015–16
in the intervention and control areas. A collaboration was established between the state health
department and the Department of Community Medicine of an autonomous institute. The intervention
and control areas were mainly inhabited by the poor migrant population. Critical elements of an efficient
collaboration such as the early engagement of partners, clearly stated purpose with common goals,
effective communication, and no financial conflict were implemented in the intervention area. MCH
program’s implementation was strengthened through supportive supervision, enhanced community
engagement, male partner involvement, tracking of high‑risk pregnant women, and identification of
problem families. Trend analysis of MCH indicators was done. The difference‑in‑difference (DID)
analysis was done to measure the net effect of the intervention.
RESULTS: All the MCH indicators improved significantly in the intervention area compared to the
control area (P < 0.05). DID analysis depicted a net increase in the early registration of pregnancies
by 18%, tetanus toxoid immunization by 9.2%, and fully immunized children by 8.6%. There was also
an improvement in the maternal mortality ratio by 121.1 points, infant mortality rate by 2.2 points,
and neonatal mortality rate by 2.6 points in the intervention area.
CONCLUSION: An innovative, collaborative model between the state health department and the
Department of Community Medicine effectively improved the MCH outcomes in Chandigarh.

Abstract BACKGROUND: Maternal knowledge is one of the indirect causes of maternal mortality in Indonesia. 
Maternal knowledge that mothers must possess includes knowledge about pregnancy, childbirth, and 
postpartum. Maternal knowledge should be provided during pregnancy. The aim of this study is to 
identify maternal knowledge in postpartum women who have a history of the frequency of pregnancy 
visits according to the minimum standard.
MATERIALS AND METHODS: A descriptive quantitative design was performed by assessing 
maternal knowledge to postpartum mothers using an online questionnaire which conducted in 2020 
at two public health centers of Surabaya, Indonesia. A sample of this research involved postpartum 
mothers who completed inclusion criteria, namely physiological postpartum mothers and had regular 
pregnancy at least 6 antenatal care (ANC) visits. In contrast, the exclusion criteria were postpartum 
mothers who were not included in the target areas of research. It uses random sampling techniques 
and performs an analysis using descriptive statistics.
RESULTS: Three research questions showed a large percentage of wrong answers, namely 
preparation to face complications (64%), contraceptive methods in breastfeeding mothers (50%) and 
the first time using contraception during childbirth (42%). Meanwhile, all the correct results (100%) 
are exclusive breastfeeding and supplementary feeding for babies.
CONCLUSION: Completing minimal standards of ANC visits cannot ensure adequate maternal 
knowledge, particularly crucial health information that influences maternal and neonatal health status.

Abstract BACKGROUND: Nongovernmental organizations (NGOs) as entities out of the health sector can 
play various roles and functions at different levels of the health systems. The present study was 
conducted to investigate NGOs’ potential and actual functions in Iran’s health system.
MATERIALS AND METHODS: This exploratory study was carried out in two parts from April 2020 
to December 2020 in Tehran, Iran. For the first part, the statute of 65 NGOs was used for document 
review, and in the second part, the required data were collected using semi‑structured interviews 
with 26 key informants from the governmental sector and NGOs. Data were analyzed using the 
framework analysis method and MAXQDA software.
RESULTS: According to data analysis, the results of this study were classified into two sections 
of NGOs’ current functions and expected functions in Iran’s health system. The current functions 
of NGOs in Iran’s health system include service delivery, educational, research, and information 
activities, financing, supportive and facilitation activities, and advocacy. Other functions in which 
NGOs could play a role include health system management, education, and service providing and 
support activities.
CONCLUSION: In this study, the various roles of NGOs in Iran’s health system were explained. 
NGOs can act actively as the consulting and executive hand alongside the public sector in the lowest 
to the highest levels of Iran’s health system. Hence, health sector managers and policymakers must 
facilitate NGOs’ involvement in the health sector and use their capacities and capabilities to improve 
health and increase public access to health‑care services.

Abstract BACKGROUND: Saudi Arabia aims to achieve Universal Health Coverage (UHC) by a combination
of free public healthcare and mandatory cooperative health insurance. To ensure the effectiveness
of UHC policies, every individual should have a strong knowledge of their health‑care rights and the
system that guarantees it.
OBJECTIVES: The aim of this study is to measure the knowledge of Alfaisal students and record
their perceptions and attitudes about Saudi Arabia’s basic health‑care coverage structure and UHC
policies.
MATERIALS AND METHODS: A cross‑sectional survey was developed with 22 items measuring
knowledge and 7 items evaluating perception and attitudes and distributed through E‑mail with a
consecutive sampling method at Alfaisal University to achieve the required calculated sample size
for March–April of 2020. The accumulated data were organized, tabulated, and statistically analyzed
using SPSS software. Comparison between two groups and more was made using the Chi‑square test.
RESULTS: Students’ self‑reported knowledge on the three main knowledge questions ranged from
30.6% to 57.7%, with medical students admitting to similar or worse knowledge compared to their
colleagues from other colleges. About 57.3% of our respondents believe the Saudi system provides
effective and sufficient healthcare to all, but only 42.7% believe that the system provides financial
protection to all.
CONCLUSION: The study showed a low level of knowledge about Saudi Arabia’s UHC policies
among Alfaisal students, especially among medical students, with a generally positive perception
and attitudes toward them, although with some serious misconceptions that should be addressed.

Abstract INTRODUCTION: It is less than a decade in Iran that integrated health kiosks have been limitedly
provided to public by private sector. Considering the significant benefits of them, this study aimed
to identify the barriers and facilitators for deploying kiosks in Iran’s formal health system in three
phases, “design and construct, implement, and use.”
MATERIALS AND METHODS: This was a qualitative study in Iran, and the data were collected
through 20 semi‑structured interviews with experts in 2019. Participants were selected by purposeful
method with the most diversity in terms of background and work experience; the interview texts were
coded in MAXQDA10 software and analyzed through framework analysis. Participants’ viewpoint
was used to verify the data and observers’ review to confirm them.
RESULTS: The barriers for designing and constructing kiosks were identified in the form of two main
themes: the overall structure of the country and the structure of the health system; the obstacles for
implementing were categorized in one main theme, lack of sources; and the barriers to use were also
fall into four themes related to people, policymakers, service providers, and designers of kiosks. The
facilitators at construction and implementation phases included the overall structure of the country
and the structure of health system. At the use stage, the facilitators related to people, health and
insurance policymakers, and owners and constructers were identified.
CONCLUSION: It is possible to deploy health kiosks in the Iranian formal health system, although
there are some time‑consuming and costly barriers which can be overcome by the strengths and
opportunities of the system.

Abstract INTRODUCTION: Health policymaking seems simple; in practice, but, it is very complex. However,
this study aimed to provide a framework to bridge the gap between policy and action in order to
present an interconnected model for developing countries.
MATERIALS AND METHODS: This was a qualitative study. Using desk search, different models
were searched from various scientific databases for formulation of an integrated policy‑making
framework. In next stage, the identified National upstream documents were analyzed to achieve
existing policymaking evidence. Then to determine the validity of the initial model and to gather the
views of key experts, two Delphi rounds were used. The tool used in Delphi method was a 9‑point
Likert questionnaire that was sent to the experts via E‑mail.
RESULTS:   This model, by employing integrated chain of visions and strategic targeting of
ultimate aims on the one hand and expected key functions and support functions for generating
output (operational goal) on the other, provides an extensive operable insight being influenced by
human‑Islamic principles and values, social, technological, economic, environmental, and political
for strategic as well as operational managers./Policy makers
CONCLUSION: This framework consisted of general, strategic, and executive levels. It creates
the needed institutional and structural capacity to achieve a comprehensive health approach for all
laws and policies to control social factors affecting health, improve health situation, and promote
the health of citizens.

Abstract CONTEXT: The success of the health system research and technology management in the 21st century
can play an important role in advancing the country toward becoming a scientific power.
AIMS: The study aimed to increase knowledge and identify factors affecting the health system
research and technology, as well as to provide solutions for improving the status of health science
and technology.
MATERIALS AND METHODS: This was an applied and descriptive study conducted in 2018 using
cross‑impact analysis. The factors affecting the Iranian Health System Research and Technology
Management and their influences on each other were identified using an expert panel. The key‑driven
factors were determined using the MICMAC software.
RESULTS: The input, stake, target, resultant, excluded, and regulating factors were identified. The
degree of fill rate the matrix was 58.9%. Financial annex of the health scientific map (S = 206),
roadmap (S = 206), governmental laws and regulations (S = 198), and sufficient governmental budget
allocation (S = 194) earned the highest potential influence scores by 2025. Furthermore, scientific
authority (S = 216), international communication (187), university relationship with industries (S = 187),
and competitive infrastructure (S = 178) obtained the highest potential dependence scores by 2025.
CONCLUSIONS: The success of the Iranian Health System Research and Technology Management
by 2025 requires the development of the financial annex of the comprehensive scientific health map,
the development of the road map, and the allocation of sufficient governmental budget for health
research. Policy‑making in health system research and technology management requires more
attention to these factors and the dynamics of relationships among factors in the model.

Abstract CONTEXT: Iranian National Health Scientific Map is a national plan the implementation of which
remarkably influences the progress of the country, though it is facing challenges in its implementation
phase.
AIMS: The present study has been conducted with the main aim of identifying the challenges facing
the comprehensive scientific health map of Iran.
SETTING AND DESIGN: This is an applied and qualitative study.
SUBJECTS AND METHODS: The study was done in 2017 with the content analysis approach
among experts of research and technology management. Some 18 people were selected and were
deeply interviewed, meanwhile observing the credibility of research.
STATISTICAL ANALYSIS USED: Data analysis was performed based on content analysis and
using ATLAS.ti software.
RESULTS: Data analysis resulted in the identification of 427 codes, 84 subthemes, and 12 themes.
Twelve themes were specified including policy‑making, management, university autonomy,
quantitative development, consideration of science production chain, designing and monitoring of
science map, finance, qualitative assessment, human resources, research ethics, as well as allocating
attention to the infrastructure and communication.
CONCLUSION: The scientific map of health challenges are indicative of the need for modification
of the scientific map and adhering to solutions in line with the removal of the identified challenges.
Today, paying attention to the solutions capable of meeting such challenges is a must.