Journal of Education and Health Promotion

Abstract BACKGROUND: Natural disasters always have significant effects on social infrastructures, living
conditions, and health care systems. This study aims to explain the needs of victims in the west of
Iran for primary health care services.
MATERIALS AND METHODS: This thematic content analysis and qualitative study was done
from September 2020 to June 2021 in the west of Iran. Participants were selected using purposive
sampling method. The data were extracted through semi‑structured interviews with 17 earthquake
victims and then examined through thematic content analysis.
RESULTS: By analyzing and coding the data, the primary needs of victims post an earthquake in the
west of Iran were classified into four main categories) health services, mental health, social health,
and health management (and 14 subcategories.
CONCLUSION: Regarding the primary needs (health services, mental health, social health, and
health management), establishing a headquarters to meet the immediate and special health care
needs seems to be required. It was recommended to create institutions for monitoring and supporting
the health care needs at the level of the community and even policymaking, as well as guiding
earthquake‑stricken areas such as the eco‑village.

Abstract BACKGROUND: The outbreak of COVID‑19 pandemic has made it difficult for older adults to utilize
ordinary elder services. This cross‑sectional study investigated the status of feeling the need, seek,
and utilization of health promotion services among older adults in Ardabil, Iran, covered by the
country’s comprehensive health system during the pandemic.
MATERIALS AND METHODS: This descriptive‑analytical and cross‑sectional study was conducted
on 739 elderly people in Ardabil province. Cluster random sampling method was used for sampling.
Data were gathered by referring trained individuals to the place of residence of the selected older
adults Questionnaires were consisted of three parts: demographic information, household’s economic
status, and feeling the need, seek, and utilization from health promotion services. Multivariate logistic
regression was used to separately model the need, seeking for, and utilization of health promotion
services in STATA ver. 14.
RESULTS: The mean age of the older adults in this study was 68.88 ± 4.72 years. The results
indicate that men showed significantly greater need, seek for, and utilization of health promotion
services during COVID‑ 19 than women. According to the results, people over the age of 80 had
4.08 times (95% confidence interval [CI]: 1.99–12.60) more need and utilization of health services
than the older adults under 65 years. The results also indicate that use of health promotion services
was significantly associated with being married (3.74, 95% CI: 1.22–2.62), having primary insurance
and supplementary insurance (1.92, 95% CI: 1.21–3.12), and obesity (2.05, 95% CI: 1.13–3.76) in
P < 0.05 level. Based on the results, people with chronic disease and obesity were more likely to
utilize health promotion services.
CONCLUSION: Findings suggest that the access and utilization of inpatient and outpatient health
services by the elderly in the COVID‑19 pandemic has somewhat decreased, which could be due
to the fear of the disease being referred to health centers by the elderly. Hence, enabling conditions
such as parental health care were major factors affecting health‑seeking habits among the Iranian
elder population.

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: Nowadays, for various reasons, the prevalence of heart diseases has increased in
women during reproductive age. These diseases can lead to serious reproductive and sexual‑related
complications in the affected women. This study will conduct to develop a reproductive health
promotion program for women with heart diseases.
MATERIALS AND METHODS: This is an exploratory sequential mixed methods study that will
be conducted in four phases. The first phase is a qualitative research that is done using content
analysis method and semi‑structured individual interviews. The experiences of women with heart
disease and health providers’ team in educational hospitals, health centers, and private offices of
physicians about reproductive health need will be explored. Purposive sampling will be continued
until data saturation is reached and the conventional content analysis method will be used. In the
second phase, the studies published from 2000 to 2020 will be reviewed by the matrix method and
then will be analyzed by using thematic analysis. Integrating the results of these two stages, the draft
of the program will be designed. In the third phase, the validation of the program will be checked by
using the two‑round modified Delphi method. In the fourth phase, the program will be implemented
by the health system and its process will be monitored.
CONCLUSION: A life cycle reproductive health program for women with heart disease can help
improve their preconception health, fertility planning, and sexual health and promote the well‑being
of these women in the long run.

Abstract INTRODUCTION: Iran’s Health System Reform Plan (HSRP) were initiated in public and hospitals
affiliated to Medical Sciences Universities in June 2015. The purpose of the present paper is to
provide a critical analyse of the HSRP and its outcomes.
METHODS: The study was carried out as a review critical analyse in 2019. The pertinent articles
were searched for in Science Direct, PubMed, Ovid, and Google Scholar using keywords “health
sector,” “reform plan,” “health system reform,” “health services,” “health care system,” and “Iran.”
Published articles in scientific national and international journals in Persian and English language,
of which the full‑texts were available, were entered into the study. Finally, from a total of 75 articles
obtained, 45 studies were carefully reviewed.
RESULTS: Several factors, which impact in the success of Iran’s HSRP such as social‑economic and
political outlooks, lack of official information and a comprehensive management system, in addition
to failure to extend continuous performance control, economic sanctions against Iran. Other factors
are limitations on financial transactions between Iran and the rest of the world due to the sanctions,
relying merely on a few instructions, and negligence of the required infrastructures. In terms of
advantages of the plan, relative decrease in patient’s share in medical expenses, improvement of
emergency wards, and relative decrease in the rate of C‑section operations are notable.
CONCLUSION: Better implementation of Iran’s HSRP entails the provision of resources and facilities
such as stable and adequate resources, proper management of available resources, payment
mechanisms reform, attracting, and facilitating private sector’s participation.

Abstract INTRODUCTION: The healthcare program has opponents and supporters with its multiple policies
and also its difficult implementation, which requires that its barriers and problems be addressed
comprehensively and extensively. This study was conducted aimed to determine the service
provision challenges by healthcare providers, from their point of view, in selected comprehensive
health centers of Isfahan.
MATERIALS AND METHODS: The present study is a descriptive‑analytic one. One‑hundred
and ninety‑seven healthcare providers were selected by census sampling method from the
population of female healthcare providers in Isfahan comprehensive health centers in 2017. The
data collection tool was a researcher‑made questionnaire in the field of individual–professional,
managerial–organizational, and executive challenges. Data analysis was done by repeated measures
ANOVA and post hoc test.
RESULTS: The findings indicated that there was a significant difference between the mean score
of individual–professional, managerial–organizational, and executive challenges (P < 0.001) from
the point of view of healthcare providers. According to least significant difference post hoc test, the
mean score of individual challenges was significantly lower than that of managerial and executive
challenges (P < 0.001). However, there was no significant difference between the mean score of
managerial–organizational and executive challenges (P = 0.46).
CONCLUSION: Based on the results, healthcare providers have put forward several challenges during
the implementation of the healthcare program. Meanwhile, executive and managerial challenges
have been considered more than individual challenges. Considering that this could lead to improper
service provision to the clients, the role of policymakers in this program to remove obstacles and to
provide satisfaction to healthcare providers is emphasized.

Abstract BACKGROUND AND AIM: Customer’s satisfaction is one of the main goals of the health system
because it is effective on the desire of external customers for using the services of the health system
and also the quality and quantity of the provided care for the internal customers and eventually the
health of the society. Considering the importance of the subject, the present study was designed
to determine the customers’ satisfaction with the health system reform plan in the field of health.
MATERIALS AND METHODS: Participants in the present content analysis qualitative study were 22
technical and operational managers and 118 health‑care providers, and 15 recipients of health services
referring to the health centers in Qom; who individually answered the questions of the interview
guide. The gathered qualitative data were analyzed using conventional qualitative content analysis.
RESULTS: Customers’ satisfaction with the health system reform plan was categorized into six
themes of decreased trust of the caregivers, wasting caregivers’ time in the health units, increased
provision of services to the caregivers, decreased motivation for work, occupational burnout, and a
sense of petition in the care providers.
CONCLUSIONS: Although external customers were satisfied with some services of the health
system reform such as providing various free services, follow‑up the patients, and beautification
the environment of the health centers; but there are multiple weaknesses in this plan that would
cause dissatisfaction in the external and internal customers. More studies seem necessary to better
determine the different aspects of the satisfaction in the caregivers and care.

Abstract BACKGROUND AND AIM: Considering that the Qom University of Medical Sciences was a pioneer
to implement the health system reform (HSR) in the domain of health services and the lack of a
study that has addressed the challenges and strategies to promote the HSR in the health domain,
this study was designed to explain the structural challenges and its solutions in the health domain
of the HSR in the city of Qom, Iran, 2017.
MATERIALS AND METHODS: This study was a qualitative research. The health managers, the
health‑care providers, and the recipients of health services referring to the health centers in Qom were
the participants in this study who were selected using the convenience sampling method. The data
were collected using individual interviews and with the guidance of a semi‑structured questionnaire.
Collected data were analyzed by the qualitative content analysis method with an inductive approach.
After extracting the challenges of the HSR in the health domain through a qualitative approach, these
challenges were prioritized through Delphi’s technique in terms of relevance and resolving strategies.
RESULTS: From the perspective of the study participants, the structural challenges of HSR in the
health domain in order of importance and priority included problems due to the SIB system, defects in
the instructions, the disruptions caused by multitasking, poor service coverage, incomplete health‑care
packages, and the shortage of resources.
CONCLUSION: According to the findings of this study, we hoped that the HSR in the health area
can be improved to increase its success by modifying the guidelines and the coverage of services,
modifying the SIB system, providing requires resources, completing the service packages, and
solving the multitasking problem.

Abstract Background: Primary healthcare (PHC) providers play a major role in provision of public health
in rural areas in Iran. They are considered as the key elements of health development in rural
population. There is limited research on clarification of their experiences from provision of health
services in their working conditions. This study aimed to clarify the experience of PHC providers
from working conditions in giving primary health services in health houses (district branches of
rural health care centers). Materials and Methods: This is a content analysis qualitative study,
conducted through personal and group interviews with 12 health workers working in health
care centers in rural areas in Isfahan province, 2010. Sampling continued until data saturation.
Data were analyzed through conventional content analysis and constant comparative method.
Results: Data analysis led to extraction of 11 categories, and finally, four themes of “ignoring
the rights,” “causing tension in working climate,” “pressure or overload of expectations beyond
the power,” and “occupational worn out” were yielded from the categories. These themes reveal
the concepts and nature of PHC providers’ experiences from giving health care at health houses
as the first level of PHC centers. Conclusion: The results of the present study showed that the
PHC providers work in a tense condition in health houses. Although they devote themselves
to the health of society members, their own health is neglected. Policy makers and authorities
should amend working conditions of PHC providers through modification of resources and
making supportive and collaborative strategies to improve the quality of services and promote
the health level of the service receivers.

Abstract Background: Multiple sclerosis (MS) is a chronic disease prevalent in young and middle‑aged
people. Patients with MS often have numerous complicated needs and, consequently, require
a broad range of health services. Results of a number of studies indicate that patients’ needs
are only partially met. Aims: This study was conducted to explore the challenges of healthcare
delivery to patients with MS in Iran. Materials and Methods: In this qualitative case study,
43 participants selected through purposeful sampling were interviewed using semi‑structured
method in the cities of Isfahan and Tehran in 2012–2013. Besides the interview, documentations
relevant to healthcare delivery were collected from different sources, including websites of
all Iranian universities of medical sciences, insurance organizations, patients’ weblogs, news
agencies, the MS Center forum for MS patients, and MS Payam bimonthly. The data were
analyzed through the constant comparative analysis. Results: The data were categorized
into four main categories, including functional challenges (diagnosis problems, failure to
pay attention to patient needs, failure to follow‑up, and miscommunication), administrative
challenges (resource allocation and supervision), policy‑making challenges (lack of
comprehensive services, bureaucracy, and problems in provision of medications), and structural
challenges (difficult access to services, lack of comprehensive centers, space limit, and long
wait). Conclusion: Despite all attempts of governmental and nongovernmental organizations
for healthcare delivery to MS patients, these services cannot satisfy all needs of the patients.
In this regard, service providers and administrators should pay more attention to the needs
and expectations of patients and their families.

Abstract Purpose: Outsourcing in healthcare is a cost-effective strategy that can lead to increase services
quality. The aim of this study was to determine the types of services that have been outsourced
in educational hospitals in Isfahan and to investigate managers’ view about the impact of
Outsourcing. Design/Methodology/Approach: A descriptive-survey study carried out in 2010.
Our samples consisted of 100 educational hospital and treatment deputy senior managers of
Isfahan University of Medical Sciences and 53 usable questionnaires were received. Survey
instrument main points were the extent to which educational hospital outsource services and the
impact of Outsourcing. Reliability and validity of the questionnaire have been verified. Data are
analyzed with SPSS18 software. Findings: The results for medical-diagnostics services showed
physiotherapy, radiology, and ultrasound that have the highest rate (33%) of being outsourced.
Between logistic and administrative activities, housekeeping, and facility engineering maintenance
services are the highest rate of outsourced (100%) and green space, CSR, laundry, and medical
records are the lowest rate of outsourced (16%). In managers’ view, in relation to advantages
of outsourcing, pay more attention to internal and external customers in private sector (57.2%)
was the highest. In relation to disadvantages of outsourcing, costs increase for the patients
(45.6%) was the highest. In relation to barriers of outsourcing, forgetting the goal of outsourcing
(efficiency) (60.6%) was the highest. Conclusion: Finally, managers’ views about outsourcing
in health services organizations were rather acceptable, but in their views, there are barriers in
implementation of outsourcing and they are focused on removing the barriers before outsourcing.
Fundamental infrastructure developments as making competing market, promoting of cultures,
education, modifying the management attitude and approach, and establishing incentive policies
are emphasized for successful implementation of outsourcing.