Authors

1 Department of Nursing, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran

2 Child Health Promotion Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan,

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.

Keywords

1. Walley J, Lawn JE, Tinker A, de Francisco A, Chopra M, Rudan I,
et al. Primary health care: Making Alma‑Ata a reality. Lancet
2008;372:1001‑7.
2. Ahmad Kiadaliri A, Najafi B, Haghparast‑Bidgoli H. Geographic
distribution of need and access to health care in rural population:
An ecological study in Iran. Int J Equity Health 2011;10:39.
3. Sohrabi MR, Heidarnia MA, Mehrabi I, Abolhasani F. Evaluation
of the coverage of National Hypertension Prevention and Control
Program in Damavand. Research in Medicine 2007;3:255‑61.
4. Malakouti SK, Nojomi M, Salehi M, Bijari B. Job stress and burnout
syndrome in a sample of rural health workers, behvarzes, in Tehran,
Iran. Iran J Psychiatry 2011;6:70‑4.
5. Javanparast S, Heidari G, Baum F. Contribution of Community Health
Workers to the Implementation of Comprehensive Primary Health
Care in Rural Settings, Iran; 2011.
6. Villela WV, Araújo EC, Ribeiro SA, Cuginotti AP, Hayana ET,
Brito FC, et al. Challenges in primary health care: The experience
in Vila Mariana District, São Paulo, Brazil. Cad Saude Publica
2009;25:1316‑24.
7. Manuwa‑Olumide A. Addressing the Human Resource Challenges
in Primary Health Care in Nigeria. 2009. p. 67. [An invited paper
presented on the 9th June at the National Health Conference on
Primary Health Care in Nigeria 30 years after Alma‑Ata, in Uyo,
Akwa‑Ibom State, Nigeria].
8. Manongi RN, Marchant TC, Bygbjerg IC. Improving motivation
among primary health care workers in Tanzania: A health worker
perspective. Hum Resour Health 2006;4:6.
9. Nasrollahpour‑Shirvani D, Ashrafian AH, Motlagh ME, Kabir MJ,
Maleki MR, Shabestani MA, et al. Evaluation of the function of
Referal system in family physician program in Iran: 2008. J Babol
Univ Med Sci 2010;11(6):46‑52.
10. Arab M, Pourreza A, Akbari F, Ramesh N, Aghlmand S. Job
satisfaction on primary health care providers in the rural settings.
Iran J Public Health 2007;36(3):64‑70.
11. Kebriaei A, Moteghedi MS. Job satisfaction among community
health workers in Zahedan District, Islamic Republic of Iran. East
Mediterr Health J 2009;15:1156‑63.
12. Javanparast S, Coveney J, Saikia U. Exploring health stakeholders’
perceptions on moving towards comprehensive primary health care
to address childhood malnutrition in Iran: A qualitative study. BMC
Health Serv Res 2009;9:36.
13. Ahmadnia SH, Salehi N, Madaanipour A. A Nationwide
gender‑sensitive survey of Iranian behvarzes (health workers),
their job satisfaction and motives. Soc Welfare 2009; 8: 117‑42.
14. Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health
services research: Developing taxonomy, themes, and theory.
Health Serv Res 2007;42:1758‑72.
15. Steve S. An overview of content analysis. Practical Assessment,
Research and Evaluation, Vol. 7; 2001. Available from: http://
www.PAREonline.net/getvn.asp?v=7 and n=17. [Last retrieved on
2014 Oct 15].
16. Gerrish K, Lacey A, editors. The Research Process in Nursing. 6th ed.
Chichester, West Sussex; Ames, Iowa: Wiley‑Blackwell; 2011.
17. Scheufele B. Content Analysis, Qualitative. In: Donsbach W, ed.
The International Encyclopedia of Communication. Malden, Mass.;
Oxford: Blackwell Pub. 2008; p.537.
18. Elo S, Kyngäs H. The qualitative content analysis process. J Adv
Nurs 2008;62:107‑15.
19. Qualitative Research in Nursing Date of Last Revision. Available
from: http://www.nursingplanet.com/research/qualitative_research.
html. [Last accessed on 2013 Sep 18].
20. Manuwa‑Olumide A. Addressing the Human Resource Challenges
in Primary Health Care in Nigeria. In National Health Conference
(NHC 2009); 2009. p. 67.
21. Tourangeau AE, Cummings G, Cranley LA, Ferron EM, Harvey S.
Determinants of hospital nurse intention to remain employed:
Broadening our understanding. J Adv Nurs 2010;66:22‑32.
22. Nasiripour A, Raeissi P, Shabanikiya H. Occupational Stress among
Rural Health Workers in Mashhad District, Northeast Iran. J Res
Health Sci 2009;9:21‑9.
23. Glasberg AL, Norberg A, Söderberg A. Sources of burnout among
healthcare employees as perceived by managers. J Adv Nurs
2007;60:10‑9.
24. Losa Iglesias ME, Becerro de Bengoa Vallejo R, Salvadores Fuentes P.
Reflections on the burnout syndrome and its impact on health care
providers. Ann Afr Med 2010;9:197‑8.
25. Talaei A. MNMSA. Burnout in staffs of health care centers
in Mashhad. The Quarterly J Fundamentals Mental Health
2010;8:133‑42.
26. Abdulla L, Al‑Qahtani DM, Al‑Kuwari MG. Prevalence and
determinants of burnout syndrome among primary healthcare
physicians in Qatar. S Afr Fam Pract 2011;53:380‑3