Journal of Education and Health Promotion

Early warning system‑related challenges in health sector: A qualitative content analysis study in Iran

Document Type : Original Article

Authors

. Seyed Hossein Hosseini 1
. Hamid Reza Khankeh 2
. Mehrdad Farrokhi 3
. Mohammad Ali Hosseini 4
. Pirhossein Koolivand 5
. Mohammad Raeiszadeh 6

1 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

2 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden

3 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,

4 Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

5 Resource Development of Shafa’ (Healing) Neuroscience Research Center

6 Trauma Research Center, Baqiyatallah University of Medical Sciences, Department of Surgery, Baqiyatallah University of Medical Sciences, Tehran, Iran

Abstract
CONTEXT: Iran’s health system has always faced many challenges in the field of disaster risk
management. The establishment of early warning systems in countries has been identified as an
important component of preparedness and risk reduction.
AIMS: This study aims to extract the experiences of those involved in the field of risk management
in relation to the challenges and problems of early warning system establishment in the Iran’s health
system.
SUBJECTS AND METHODS: This was a qualitative study, which has been conducted using a content
analysis method. Data were collected through semi‑structured interviews with 16 individuals who
had at least one disaster management experience at the emergency operation centers. Sampling
was done purposefully. The data were then analyzed using the Grenheim method.
RESULTS: Nine subcategories of data were analyzed that included legal vacancies, challenges
related to protocols and guidelines, weaknesses in the prediction infrastructure, weaknesses in
the communication infrastructure, poor coordination, scarcity of resources, inadequate education,
information management challenge, and evaluation challenge, and three main categories were
extracted that included policy challenges, infrastructure challenges, and management challenges
that represented the issues experienced in establishing an early warning system in the Iranian
health system.
CONCLUSION: Policy‑makers and managers of health system need to pay special attention to
improve the legal framework and standard protocol, strengthening infrastructures, increasing
management performance in the field of coordination, education, allocation of resources, flow of
information, and evaluation system.

Keywords

Challenge
content analysis
early warning system
health sector
1. Centre for Research on the Epidemiology of Disasters.EMDAT:
OFDA/CRED. Brussels. Belgium: University Catholique;
2019. Available from: http://www.cred.be. [Last accessed on
2019 Apr 01].
2. Tschoegl L, Below R, Guha‑Sapir D. An Analytical Review of
Selected Data Sets on Natural Disasters and Impacts: Brussels,
Belgium: Centre for Research on the Epidemiology of Disasters;
2006. Available from: http://emdat.be/sites/default/files/
TschoeglDataSetsReview.pdf. [Last accessed on 2019 May 15].
3. UnitedNations Office for the Coordination of Humanitarian. https://
www.unocha.org/middle‑east‑and‑north‑africa‑romena/
iran. [Last accessed 2019 Sep 20].
4. Salazar MA, Pesigan A, Law R, Winkler V. Post‑disaster health
impact of natural Hazards in the Philippines in 2013. Glob Health
Action 2016;9:31320.
5. United Nations Office for Disaster Risk Reduction. Sendai
Framework for Disaster Risk Reduction 20152030. 3rd ed.
United Nations World Conference on DRR. Sendai, Japan:
United Nations Office for Disaster Risk Reduction; 2015.
6. Aitsi‑Selmi A, Murray V. The sendai framework: Disaster risk
reduction through a health lens. Bull World Health Organ
2015;93:362.
7. Salvati P, Petrucci O, Rossi M, Bianchi C, Pasqua AA, Guzzetti F.
Gender, age and circumstances analysis of flood and landslide
fatalities in Italy. Sci Total Environ 2018;610‑611:867‑79.
8. Ibrion M, Mokhtari M, Nadim F. Earthquake disaster risk
reduction in Iran: Lessons and “lessons learned” from three large
earthquake disasters – Tabas 1978, Rudbar 1990, and Bam 2003.
Int J Dis Risk Sci 2015;6:415‑27.
9. Khankeh HR, Khorasani‑Zavareh D, Johanson E, Mohammadi R,
Ahmadi F, Mohammadi R. Disaster health‑related challenges and
requirements: A grounded theory study in Iran. Prehosp Disaster
Med 2011;26:151‑8.
10. Djalali A, Khankeh H, Öhlén G, Castrén M, Kurland L. Facilitators
and obstacles in pre‑hospital medical response to earthquakes:
A qualitative study. Scand J Trauma Resusc Emerg Med
2011;19:30.
11. Ardalan A, Rajaei MH, Masoumi G, Azin A, Zonoobi V, Sarvar M.
2012‑2025 roadmap of I.R.Iran’s disaster health management.
PLoS Curr 2012;4:93‑97.
12. Alfieri L, Cohen S, Galantowicz J, Schumann GJ, Trigg MA,
Zsoter E. A global network for operational flood risk reduction.
Environ Sci Policy 2018;84:149‑58.
13. Hyogo Framework for Action 2005‑2015: building the Resilience
of Nations and Communities to Disasters; Geneva: United Nations
Office for Disaster Risk Reduction; 2007. Available from: http://
www.unisdr.org/files/1037_hyogoframeworkforactionenglish.
pdf. [Last accessed on 2019 Jun 10].
14. Sufri S, Dwirahmadi F, Phung D, Rutherford S. Progress in the
early warning system in Aceh province, Indonesia since the 2004
earthquake‑tsunami. Environ Hazard 2019;13:1‑25.
15. Atreya A, Czajkowski J, Botzen W, Bustamante G, Campbell K,
Collier B, et al. Adoption of flood preparedness actions:
A household level study in rural communities in Tabasco, Mexico.
Int J Dis Risk Reduct 2017;24:428‑38.
16. United Nations International Strategy for Disaster Risk
Reduction (2012) Terminology. UNISDR Geneva: United Nations
International Strategy for Disaster Risk Reduction. Available from:
http://www.unisdr.org/we/inform/terminology.[Last accessed
on 2019 Jun 01].
17. Qassemi F, Khankeh H, Delshad V, Hosseini M. The effects of
implementing and activating the early warning system on the
preparedness of Sari Imam Khomeini hospital (RH) in disasters
and incidents. Health Emerg Dis 2016;2:19‑24.
18. Delshad V, Borhani F, Khankeh H, Abbaszadeh A, Sabzalizadeh S, Moradian MJ, et al. The effect of activating early warning system
on motahari hospital preparedness. Health Emerg Dis 2015;1:3‑8.
19. Moradian MJ, Rastegarfar B, Rastegar MR, Ardalan A.
Tehran dust storm early warning system: Corrective
measures. PLoS Curr 2015;7. doi: 10.1371/currents.dis.
14f3c645eb2e2003a44c6efd22c23f5e
20. Sorani M, Tourani S, Khankeh HR, Panahi S. Prehospital
emergency medical services challenges in disaster; a qualitative
study. Emerg (Tehran) 2018;6:e26.
21. PolitDF, BeckCT. Nursing Research: Principles and Methods. 7th ed.
Philadelphia: Lippincott Williams & Wilkins; 2004. p. 315‑37.
22. Corbin J, Strauss A. Basics of Qualitative Research. 4th ed.
Thousand Oaks. CA: Sage Publications; 2015. p. 17‑30.
23. Streubert HJ, Carpenter DR. Qualitative research in nursing. 5th ed.
Philadelphia: Lippincott Williams & Wilkins; 2011. p. 33‑52.
24. Graneheim UH, Lundman B. Qualitative content analysis in
nursing research: Concepts, procedures and measures to achieve
trustworthiness. Nurse Educ Today 2004;24:105‑12.
25. Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and
authenticity in naturalistic evaluation. New Dir Program Eval
1986;1986:73‑84.
26. Golnaraghi M. Institutional Partnerships in Multi‑Hazard Early
Warning Systems: A Compilation of Seven National Good
Practices and Guiding Principles. 1st ed. Geneva Springer Science
and Business Media; 2012.
27. Ardalan A, Holakouie Naieni K, Kabir MJ, Zanganeh AM,
Keshtkar AA, Honarvar MR, et al. Evaluation of Golestan
Province’s early warning system for flash floods, Iran, 2006‑7.
Int J Biometeorol 2009;53:247‑54.
28. Allahbakhshi K, Ghomian Z, Jazani RK, Khorasani‑Zavareh D.
Preparedness challenges of the Iranian health system for dust and
sand storms: A qualitative study. J Educ Health Promot 2019;8:114.
29. United Nations International Strategy for Disaster Risk Reduction.
Global Survey of Early Warning Systems An Assessment
of Capacities, Gaps andopportunities Toward Building a
Comprehensive Global Early Warning System for all Natural
Hazards. United Nations International Strategy for Disaster Risk
Reduction; 2006. Available from: https://www.unisdr.org/we/
inform/publications/3612. [Last accessed on 2019 May 02].
30. Khorasani‑Zavareh D, MohammadiR, Khankeh HR, Laflamme L,
Bikmoradi A, Haglund BJ. The requirements and challenges in
preventing of road traffic injury in Iran. A qualitative study. BMC
Public Health 2009;9:486.
31. Moret ES. Humanitarian impacts of economic sanctions on Iran
and Syria. Eur Secur 2015;24:120‑40.
32. Tabrizi A, Santini R. EU Sanctions against Iran: New wine in old
bottles? ISPI Anal 2012;97:1‑7.
33. Gorji A. Sanctions against Iran: The impact on health services.
Iran J Public Health 2014;43:381‑2.
34. United Nations International Strategy for Disaster Risk
Reduction. Progress and Challenges in Disaster Risk Reduction.
United Nations International Strategy for Disaster Risk Reduction;
2015. Available from: https://www.unisdr.org/files/40967_
40967progressandchallengesindisaste.pdf. [Last accessed on
2019 May 27].
35. Blashki G, Armstrong G, Berry HL, Weaver HJ, Hanna EG, Bi P,
et al. Preparing health services for climate change in Australia.
Asia Pac J Public Health 2011;23:133S‑43.
Journal of Education and Health Promotion
Volume 10, Issue 2
February 2020
Pages 1-7

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us