Exploring Health Providers' Perspective Regarding the Needs of Adolescent Mothers During Breastfeeding: A Qualitative Study

Background

The prevalence of breastfeeding is less common among adolescent mothers than adult mothers. These mothers experience various issues during breastfeeding. The present study aimed to explore the normative needs of adolescent mothers during breastfeeding from health care providers' perspective.

Methods

This qualitative content analysis study was conducted from October 2022 until June 2023. 14 health care providers who had worked in the field of breast milk were purposefully selected with maximum variation. Face-to-face semi-structured interviews were conducted and sampling continued until data saturation. Data analysis was performed using Graneheim and Lundman's method with MAXQDA software version 10.

Results

The main concepts obtained from the data were classified into one theme entitled, "comprehensive support", and seven categories including "need to correct wrong traditional beliefs", "educational and counseling needs", "providing quality services", "need for psychological support", "need for protective laws", "financial needs", and "the need for social network support".

Conclusion

Adolescent mothers in Iran have various needs during breastfeeding, and they require the assistance of their families, healthcare providers, and the government to fulfill them. Therefore, it is also recommended that policymakers in the health system should design policies to accommodate the requirements of this group of mothers. In addition to policy development in the health system, the infrastructure required for policy and law to be executed should be considered.

Evaluation of the primary health care expansion program with public-private partnership in slum areas from the perspective of stakeholders: a qualitative study

BACKGROUND

Today, economic and social determinants of health in slum settlements are at the policymakers' center of attention. Iran has had an excellent experience in the Primary Health Care Program. This study aimed to evaluate the Primary Health Care Expansion Program with public-private partnerships in slum areas of Iran from the perspective of stakeholders in 2022.

METHODS

This qualitative study was conducted using the framework content analysis method. Participants were 17 experts and health managers involved in The Primary Health Care Expansion with Public-Private Partnerships in the suburban areas at the medical universities of Khorasan Razavi province in the east of Iran, who were selected through purposive sampling via snowball method. For data collection, a semi-structured interview was done and framework content analysis was used for data analysis and results categories based on the SWOT.

RESULTS

The study identified 23 main themes and 112 sub-themes, which were then grouped into four main categories - strengths, weaknesses, opportunities, and threats using the SWOT model.

CONCLUSION

Results of the study showed the internal and external factors affecting Primary Health Care Expansion with Public-Private Partnerships in suburban areas. This situational analysis can help health policymakers to better understand the performance of health facilities.

Evaluating children's rights in the hospital setting of Afghanistan

PURPOSE

Children's rights must be realized in all children-related settings, such as hospitals. This study aimed to assess children's rights in hospital settings in Afghanistan in 2021.

DESIGN AND METHODS

A cross-sectional survey using the World Health Organization questionnaire was conducted. It was distributed among the randomly selected healthcare providers in the studied hospital. One hundred forty-two hospital managers, physicians, and nurses participated in the study. Descriptive and analytical statistics were used to analyze the results in SPSS.

RESULTS

In this study, 54.2% of participants were men, 59.9% had a bachelor's degree, and most were 20-30 years old (56.7%). The total score of the hospital in fulfilling children's rights was 1.71 ± 0.46. Among different children's rights, "equality and non-discrimination" received the highest score (2.01 ± 0.59), and the lowest was for "play and learning" (1.1 ± 0.46). There was a meaningful relationship between education level, years of work experience, and the scores given to children's rights. Various dimensions of the rights had significant relationships (p < 0.05).

CONCLUSION

The hospital has taken action to fulfill children's rights. The main gaps include the lack of adolescent-friendly health services, opportunities to play and learn, and child protection. Hospital managers, staff, and the public should be educated on children's rights. Moreover, protocols for improving children's rights and a monitoring system are needed.

PRACTICAL IMPLICATIONS

Children's rights should receive special attention in hospitals. Educating children, parents, service providers, health policymakers, and society about children's rights is essential. They should know their responsibilities regarding children.

Why healthcare providers are not vaccinated? A qualitative study during the COVID-19 pandemic in Iran

BACKGROUND

Vaccination has been effective in controlling contagious diseases, especially among high-risk groups such as medical staff. Their unwillingness to be vaccinated might adversely affect individual and public health. This study aimed to explore the factors related to the refusal of COVID-19 vaccines among health service providers.

METHODS

A qualitative study was conducted on 28 healthcare providers in Mashhad, Northeast of Iran from March to June 2022. The method of data collection was face-to-face interviews. The purposive method was used for sampling. Data collection continued until the saturation was reached. To analyze the data, the content analysis method was applied, and Maxqda (version 10) software was used.

RESULTS

By analyzing interview transcripts, six themes and ten sub-themes were extracted. Factors that explained employees' reluctance to be vaccinated against COVID-19 were the opinion of peers, lack of trust in vaccines, fear of vaccination, mistrust to the government and health authorities, low perceived risk of coronavirus disease, and the contradictions of traditional and modern medicine in their approach to controlling the disease.

CONCLUSIONS

Among healthcare workers, concerns about the side effects of vaccines were the most influential factors in refusing vaccination. Providing reliable information about vaccines and their safety is key to increasing the trust of health workers in vaccination and facilitating its acceptance.

Men's involvement in family planning programs and associated factors from the perspective of women in Afghanistan; a case study

OBJECTIVES

Family planning is a cornerstone to the achievement of Sustainable Development Goals. However, men's involvement in family planning has been a challenge in many countries. This study aimed to investigate the participation of men in the family planning programs and related factors from the perspective of women referring to family planning organizations in Herat, Afghanistan 2021.

METHODS

The study had a cross-sectional design. The participants of the study consisted of 544 married women aged 15-49 years selected by simple random sampling. The data collection tool was a valid and reliable questionnaire to assess the participation of men in family planning programs. To analyze the data, descriptive statistics and analytical methods including Mann-Whitney and Pearson Chi-Square tests were applied in SPSS 21. The answers to the open-end questions were analyzed, coded and classified in two main categories.

RESULTS

The average age of study participants was 28(±10) years and a significant proportion of them were illiterate (48.5%). Most of the participants were housewives (83.6%) and their husbands were non-professional workers (39.9%). The husbands participated in family planning programs by choosing the type of contraception (29.2%), provision of contraceptives (29.6%) and supporting their wives using them (49.3%). There were statistically significant relationships between women's and their husband's education level, and husband's employment status with the type of participation in family planning. The main incentives for Afghan men to participate family planning were the increased attention of families to the education and needs of children and the health and welfare of the wives. However, cultural norms supporting larger families, the desire for having boy children, the fear of contraception's side effects and religious prohibitions discourage them in using family planning methods.

CONCLUSION

A large number of the respondents stated that their spouse participated in family planning programs. It shows the importance and success of family planning centers in promoting sexual and reproductive health and family planning. Study showed that various factors affected men's participation in family planning programs. Recognition of these factors can help policy makers in designing behavioral interventions based on social marketing, and enhancing the effectiveness of these programs.

The challenges of telephone consultation program during severe acute respiratory syndrome-coronavirus-2 epidemic in Iran: A qualitative study

Introduction

With the spread of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) disease and its potential risks for vulnerable groups such as the elderly with chronic diseases, telehealth appointments gained more attention around the world. However, using such a system brought about challenges to patients and service providers that need to be addressed by policymakers for system improvement.

Purpose

The present study was conducted with the aim of investigating the challenges of the telephone consultation program, which was run by the Social Security Insurance Organization of Iran during the epidemic of SARS-CoV-2.

Methods

This qualitative study was conducted through semi-structured interviews with physicians who participated in the program, using a purposive sampling approach. The interviews were recorded, transcribed verbatim, and analyzed through conventional content analysis by ATLAS.ti9 software.

Findings

Based on the results of the qualitative content analysis, the challenges in three categories, including program development, implementation, and evaluation and monitoring, and with 10 themes (planning challenges, infrastructure provision, education and culture building, legal issues, motivational mechanisms, effective communication, efficiency, and effectiveness of care, organization, monitoring, and evaluation) and 26 sub-themes were extracted.

Conclusion

Telephone appointments allow medical centers to serve some patients better. However, properly implementing the telephone consultation program requires better planning, training, appropriate infrastructure, and continuous evaluation and improvement of processes.

Availability and affordability of cardiovascular medicines in a major city of Afghanistan in 2020

PURPOSE

Affordable access to quality medicines is a critical target of global efforts to achieve universal health coverage. The aim of this study is to measure the affordability and accessibility of cardiovascular medicines in the city of Herat, Afghanistan.

METHODS

The price, affordability, and availability data for 18 most sold generic (MSG) and lowest priced generic (LPG) products were collected from public and private pharmacies located in Herat city in Afghanistan in 2020, which in each area, six pharmacies were randomly selected from a combination of public and private ones based on the standardized methodology developed by WHO/HAI. According to this methodology on Medicine Prices, Accessibility, and Affordability, the minimum daily wage of an unskilled governmental worker, and the price of each type of cardiovascular medicines for one-month use were calculated separately. If the cost of the treatment was more than the minimum daily wage, the medicine was considered unaffordable.

RESULTS

The mean availability score for lowest price generic (LPG) in public and private pharmacies and based on the countries of origin including Iran, Pakistan, and India was 60%, 46%, and 31%, respectively. Of the 18 medicines surveyed, just Atenolol (Iranian brand) was found in all 30 pharmacies on the day of data collection. All Indian- brand medicines were less than fifty percent available in any of the surveyed public and private pharmacies. Among the medicines exported to Afghanistan, the population of Herat used more medicines made by Pakistan compared to India and Iran (MSG). Indian medicines were the most expensive ones and the Iranian medicines were the cheapest. A wage of less than one day was enough to afford one-month supply of generic medicines at the lowest price.

CONCLUSION

Access of patients to cardiovascular medicines in Afghanistan was 46% in this study which is regarded as low access. Most of available cardiovascular medicines in the market of this country were made in Iran, Pakistan and India. Although the Iranian ones were the cheapest, but people used more Pakistani medicines. LPG products were affordable to the studied population.

A scoping review of public hospitals autonomy in Iran: from budgetary hospitals to corporate hospitals

BACKGROUND

Organizational reforms of hospitals in Iran are mainly aimed at improving efficiency, reducing government spending on health care, and improving the quality of services. These reforms began with hospital autonomization and have continued with other initiatives such as formation of board of trustees, independent and corporatized hospitals.

OBJECTIVE

The purpose of this scoping review was to summarize and compare the results of studies conducted on organizational reform of hospitals in Iran to paint a more clear picture of the status quo by identifying knowledge gaps, inform policymakers, and guide future studies and policies.

METHOD

This review's methodology was inspired by Arksey and O'Malley's methodological framework to examine the extent, range, and nature of research activity about organizational hospital reforms in Iran. A literature search was performed using PubMed, Scopus, Web of Science, and Google Scholar for English papers as well as SID, IranDoc, Magiran, and the Social Security Research Institute Database for Persian papers from 1991 to April 2020.

RESULTS

Twenty studies were included in the review. Studies were grouped by the types of organizational reform, study's objective, setting, methodology, data collection and analysis techniques, and key findings. Thematic construction was used based on the types of organizational reform to present a narrative account of existing literature.

CONCLUSIONS

The autonomy granted to the hospitals was unbalanced and paradoxical in terms of key effective dimensions. Poor governance and regulatory arrangements, low commitment to corporate governance, Inappropriate board composition, weak internal controls, unsustainable financing and inefficient payment mechanisms, poor interaction with stakeholders and ignoring contextual factors have been cited as the main reasons for the failure of organizational reforms in Iran. The limited use of evidence and research was obvious at different stages of policymaking, especially in the policy formulation phase and evaluation of its results.

Assessment of Patient Safety Culture Among Doctors, Nurses, and Midwives in a Public Hospital in Afghanistan

INTRODUCTION

The first step to improve the safety of patients in hospitals is to evaluate safety culture. Therefore, the patient safety culture in doctors, nurses and midwives should be reviewed regularly. The aim of the study was to determine the current state of patient safety culture among physicians, nurses and midwives at the Estiqlal Hospital in Kabul to promote an effective safety culture.

METHODS

This cross-sectional descriptive study was conducted from January to March 2020 among doctors, nurses, and midwives at the Esteqlal Specialized Hospital in Kabul. In that study, the data were collected through a survey of hospital. Among the 267 employees invited to participate, 267 (100%) completed the surveys. Descriptive statistics have been used to adjust frequency distribution tables and inferential statistics to identify differences in variable relationships. The independent sample T-test and one-way 'ANOVA ' were used to check variations between groups, and SPSS version 25 was used for data analysis.

RESULTS

The findings of this study have shown that organizational learning and non-punitive response to errors have had the highest and lowest scores. Eight out of 12 dimensions of patient safety culture scored lower. Four dimensions of patient safety culture scored the highest. Overall, patient safety culture dimensions were low and poor (44%). This means the patient safety culture at the hospital was poor.

CONCLUSION

The safety culture of the patients at the hospital was inappropriate, particularly in the eight dimensions of the patient safety culture, immediate intervention was necessary. The study emphasizes the creation of a desirable organizational climate, the need for staff involvement in various levels of decision-making, the creation of a culture of error reporting and recognizing the causing factors, and promoting a patient safety culture.

Living with Discordance: A Qualitative Description of the Challenges Faced by HIV Negative Married Women

Background:

Serodiscordant couples are faced with many social, sexual and relationship challenges in all aspects of their lives. The sources of conflicts could be disease acquisition, transfer of HIV to the uninfected partner, and fertility decisions. The current qualitative study was designed to explore the challenges faced by HIV negative women in serodiscordant relationships.

Methods:

This qualitative description was conducted in Mashhad, Northeast of Iran, between October 2018 and June 2019. 15 HIV-negative women who were living with their HIV-positive husbands were selected through purposive sampling method. The data were collected using semi-structured interviews. Data were analyzed using conventional content analysis adopted by Graneheim and Lundman. MAXQDA version 12, was used for data organization. Components of rigor including credibility, dependability, confirmability and transferability were considered.

Results:

The main overarching theme which emerged from the qualitative study was “threats to family life”, consisting of five categories along with their subcategories. These categories included stigmatic reactions followed by disclosure of the status, social misconceptions and limitation of information sources, psychological disruptions, hard decision making for fertility, and role conflict in the family.

Conclusion:

This study provides an insight into different aspects of challenges faced by Iranian women in HIV-serodiscordant relationships. Also, our study supports the view of other investigators who believe that there is an urgent need for provision of counseling and empowerment interventions for HIV- serodiscordant couples.

Prohibiting physicians' dual practice in Iran: Policy options for implementation

BACKGROUND

In Iran, based on the recent national policy documents, physician dual practice (PDP) has been prohibited. This study aimed to develop policy options (POs) to implement physicians' dual practice prohibition law in Iran.

METHODS

International evidence published in English and local documents published in Persian about PDP analyzed and results (advantages, disadvantages, challenges and requirements to ban PDP, and applied policies to limit the dual practice) were extracted. Results discussed among the research team in 5 rounds of meetings. In each meeting, any possible PO to limit PDP in Iran was proposed based on brainstorming technique and 12 POs were developed. These 12 POs and their advantages and disadvantages were discussed in a focus group discussion attended by 14 informed policy makers, and 3 additional POs were added.

RESULTS

Fifteen POs were developed. Each PO has its own advantages and disadvantages. It is worth to highlight that not only are the proposed POs not mutually exclusive but they are also mutually reinforcing; that is, each of these POs can be applied alone or they can be implemented alongside each other simultaneously.

CONCLUSION

No single optimal PO exists for dealing with the dual practice in Iranian health system. Implementing a mix of POs could reduce possible complications of each PO and increase the chance of successful implementation of the law. It is advisable to follow a conservative and incremental approach and start with POs that will cause less resistance and political challenges.

Technical efficiency of teaching hospitals in Iran: the use of Stochastic Frontier Analysis, 1999-2011

BACKGROUND

Hospitals are highly resource-dependent settings, which spend a large proportion of healthcare financial resources. The analysis of hospital efficiency can provide insight into how scarce resources are used to create health values. This study examines the Technical Efficiency (TE) of 12 teaching hospitals affiliated with Tehran University of Medical Sciences (TUMS) between 1999 and 2011.

METHODS

The Stochastic Frontier Analysis (SFA) method was applied to estimate the efficiency of TUMS hospitals. A best function, referred to as output and input parameters, was calculated for the hospitals. Number of medical doctors, nurses, and other personnel, active beds, and outpatient admissions were considered as the input variables and number of inpatient admissions as an output variable.

RESULTS

The mean level of TE was 59% (ranging from 22 to 81%). During the study period the efficiency increased from 61 to 71%. Outpatient admission, other personnel and medical doctors significantly and positively affected the production (P< 0.05). Concerning the Constant Return to Scale (CRS), an optimal production scale was found, implying that the productions of the hospitals were approximately constant.

CONCLUSION

Findings of this study show a remarkable waste of resources in the TUMS hospital during the decade considered. This warrants policy-makers and top management in TUMS to consider steps to improve the financial management of the university hospitals.

Equity in Distribution of Health Care Resources; Assessment of Need and Access, Using Three Practical Indicators

BACKGROUND

Equitable distribution of health system resources has been a serious challenge for long ago among the health policy makers. Conducted studies have mostly ever had emphasis on equality rather than equity. In this paper we have attempted to examine both equality and equity in resources distribution.

METHOD

This is an applied and descriptive study in which we plotted Lorenz and concentration curves to describe graphically the distribution of hemodialysis beds and nephrologists as two complementary resources in health care in relation to hemodialysis patients. To end this, inequality and inequity were measured by calculating Gini- coefficient, concentration and Robin Hood indices. We used STATA and EXCEL software to calculate indicators.

RESULTS

The results showed that inequality was not seen in hemodialysis beds in population level. However, distribution of nephrologists without considering population needs was accompanied with some sort of inequality. Gini- coefficient for beds and nephrologists distribution in population level was respectively 0.02 and 0.38. Hence, calculation of concentration index for distribution of hemodialysis beds and nephrologists with regard to population needs indicated that unlike beds distribution, equity gap between nephrologists distribution against patients distribution among the provinces was considerably significant again.

CONCLUSION

Our results imply that although hemodialysis beds in Iran have been distributed in connection with the population need, nephrologists' distribution is not the same as hemodialysis beds one and this imbalance in complementary resources, can affect both efficiency and equitable access to services for population.

Assessment of patient safety culture among personnel in the hospitals associated with Islamic Azad University in Tehran in 2013

Background:

Patient safety is an essential element in the quality of healthcare, and a clear knowledge of its culture in healthcare organizations will lead to both improved healthcare and patient safety. The aim of this study was to assess the patient safety culture at Islamic Azad University hospitals in Tehran, Iran, in 2013.

Methods:

This cross-sectional study was conducted on clinical and diagnostic staff in all Islamic Azad University hospitals in Tehran in June 2013. The international “Hospital Survey on Patient Safety Culture” questionnaire was used as the measurement tool.

Results:

In these hospitals, the overall positive score of patient safety culture was 35%. “Teamwork within units” (48% positive) was evaluated as reflecting the most knowledge of the aspects of patient safety culture, and “non-punitive response to error” (12% positive) was evaluated as reflecting the least knowledge of the aspects of patient safety culture.

Conclusion:

The patient safety culture in the hospitals that were studied should be improved. This goal could be achieved by reinforcing the basics of patient safety culture by teaching the staff members about the aspects of a positive patient safety culture and encouraging them to incorporate these aspects in their day-to-day activities.

Application of WHO model for evaluating Patient Safety Friendly Hospital Initiatives (PSFHI) in an Eye hospital in Tehran, Iran

Background:

Patient safety is one of the major issues concerning the medical community and the World Health Organization (WHO) in most countries. This study aimed to evaluate the patient safety status in an Eye Hospital in Tehran, using the WHO model for Patient Safety Friendly Hospital Initiatives (PSFHI) in 2012.

Methods:

This Cross-Sectional study was done in an Eye Hospital in Tehran. Measurement tool was a checklist related to the PSFHI, including 140 standards in three groups of critical, core and developmental. It was covering five domains of: a) Leadership and management, b) Patient and public involvement, c) Safe evidence-based clinical practices, d) Safe environment, and e) Lifelong learning.

Results:

Compliance with critical, core and developmental standards were 77.78%, 75.29%, and 21.42% respectively. The Rates of Meeting Standards in the leadership and management, patient and public involvement, safe evidence-based clinical practices, secure environment and for lifelong learning were 66.89%, 42.85%, 75.68%, 73.68%, and 63.63% respectively.

Conclusions:

The PSFHI standards play important role in improving patient safety using leadership, safety practices and creating good working conditions and environment for the staff. So focus on these standards is essential in improving the patient safety in hospitals in Iran.

The Psychometric Properties of the Farsi Version of "Hospital Survey on Patient Safety Culture" In Iran's Hospitals

BACKGROUND

If you want to start a long journey towards patient safety, you should create a good culture of patient safety among employees alongside structural interventions. The first step in doing so is the assessment of current culture in the organization using different tools. One of the most commonly used instruments of measuring patient safety culture is Hospital Survey of Patient Safety culture (HSOPS). The aim of this study was to assess the validity and reliability of Farsi version of this questionnaire for the first time in Iran's hospitals.

METHODS

We purposefully selected four hospitals out of seven general Tehran University of Medical Sciences affiliated hospitals. Then a 420 sample of staff of these hospitals were taken randomly. Staff was asked to complete the questionnaire. Confirmative factor analysis, correlation coefficient, Cronbach's alpha were employed in statistical analyses.

RESULTS

Factor loadings for almost all questions were acceptable. Factors jointly explained 77.8% of the variance in the responses. The Cronbach's alpha coefficient was between 0.57 and 0.8. The study revealed that over 70% of employees were working at their hospitals more than 40 hours a week and also more than half of the employees were not reporting errors.

CONCLUSION

Farsi version of HSOPS with 12 dimensions and 42 questions is a valid and reliable questionnaire to measure patient safety culture for the first time in Iran hospitals. This tool will be helpful in tracking improvements and in heightening awareness on patient safety culture in Iran.