Customers' Satisfaction with primary health care: comparison of two district health centers with and without ISO certificate in Kerman University of Medical Sciences

Background and Aims: One of the principles of the quality management systems in organizations is attention to customer centered approach and one of the scales for evaluation of the efficacy of provided services is customer satisfaction. This research aimed to compare satisfaction levels of customers attending primary health care centers in Bardsir (with ISO certificate) and Zarand (without ISO certificate) districts affiliated to Kerman University of Medical Sciences. Material and Methods: This comparative and cross- sectional study was carried out in 2011 with 960 people (n= 480 in each district). The data gathering instrument was a validated self-construct questionnaire including two main parts of general and specialty services for evaluation of satisfaction rate. Data were analyzed through SPSS version 18.0 and using descriptive statistics, Chi-square, Pearson correlation and logistic regression model. Judgment criterion for desired satisfaction was attaining 75% of the score of each part. Results: The desired satisfaction level of customers of health centers affiliated to Zarand district was more than that of Bardsir district (83.3% vs. 70.2%, P <0.01). Moreover, there was a significant difference between two districts in regard to satisfaction levels of general services (P <0.05). Result of logistic regression model showed no significant relationship between total satisfaction and demographic variables. Discussion: As compared with Zarand district, implementation of ISO quality management system in the Bardsir district has not enriched total customers' satisfaction. Thus, the utilization of quality management approaches based on needs rather than organizational emotions and fashions are emphasized. Keywords: Satisfaction, Customer, ISO, Health centers, Health car

The relationship among mask-wearing, fatalism, and religiosity in a Muslim population: Implications for health education

Background: Understanding the relationship between religiosity and health behaviors helps us to tailor messages based on cultural beliefs. We conducted an online survey to find any relationship between fatalistic beliefs, religiosity, and mask-wearing in an Islamic context. Methods:The participants consisted of 503 subjects from the adult population of Kerman Province located in the Southeast of Iran. The measurement tool consisted of four sections; (A) demographic characteristics, (B) three items related to mask-wearing, (C) The God Locus of Health Control (G LHC) scale consisting of six items measuring fatalistic beliefs, (D) The Duke University Religion Index (DUREL) consisting of five items measuring religiosity.Results: The mean age of the participants was 36.5 ± 10.9 years, and females consisted 60% (n=302) of the sample. More than one-fifth (n=109) reported a history of COVID-19 infection. Approximately one-third of respondents (n=163) reported full mask adherence. Logistic regression model showed that there was no significant relationship between mask adherence and religiosity (odds ratio: 1.03; 95% confidence interval (CI): 0.99-1.08) and fatalistic beliefs (OR:1.01; 95% CI: 0.98-1.04 ).Conclusion:We found no association of fatalism and religiosity with the mask-wearing during COVID-19 in the Iranian Muslim population. So we can conclude that religious beliefs may have no place in cultural tailoring of health messages for promoting mask adherence

Economic burden of cardiovascular diseases before and after Iran’s health transformation plan: Evidence from a referral hospital of Iran

Background: Different countries have set different policies to control and decrease the costs of cardiovascular diseases (CVDs). Iran was aiming to reduce the economic burden of different disease by a recent reform from named as health transformation plan (HTP). This study aimed to examine the economic burden of CVDs before and after of HTP. Methods: This cross-sectional study was conducted on 600 patients with CVDs, who were randomly selected from a specialized cardiovascular hospital in the north-west of Iran. Direct and indirect costs of CVDs were calculated using the cost of illness and human capital approaches. Data were collected using a researcher-made checklist obtained from several sources including structured interviews, the Statistical Center of Iran, Iran’s Ministry of Cooperatives, Labor, and Social Welfare, the central bank of Iran, and the data of global burden of disease obtained from the Institute for Health Metrics and Evaluation to estimate direct and mortality costs. All costs were calculated in Iranian Rials (IRR). Results: Total costs of CVDs were about 5571 and 6700 billion IRR before and after the HTP, respectively. More than 62% of the total costs of CVDs accounted for premature death before (64.89%) and after (62.01%) the HTP. The total hospitalization costs of CVDs was significantly increased after the HTP (p = 0.038). In both times, surgical services and visiting had the highest and lowest share of hospitalization costs, respectively. The OOP expenditure decreased significantly and reached from 54.2 to 36.7%. All hospitalization costs, except patients’ OOP expenditure, were significantly increased after the HTP about 1.3 times. Direct non-medical costs reached from 2.4 to 3.3 billion before and after the HTP, respectively. Conclusion: Economic burden of CVDs increased in the north-west of Iran after the HTP due to the increase of all direct and indirect costs, except the OOP expenditure. Non-allocation of defined resources, which coincided with the international and national political and economic challenges in Iran, led to unsustainable resources of the HTP. So, no results of this study can be attributed solely to the HTP. Therefore, more detailed studies should be carried out on the reasons for the significant increase in CVDs costs in the region

Reasons for Discharge against Medical Advice: A Case Study of Emergency Departments in Iran

Background : Incomplete hospitalization is the cause of disease relapse, readmission, and increase in medical costs. Discharge Against Medical Advice (DAMA) in emergency department (ED) is critical for hospitals. This paper aims to explore the underlying reasons behind DAMA in ED of four teaching hospitals in Kerman, Iran. Methods : This was a cross-sectional study in which the samples were drawn from the patients who chose to leave against medical advice from the ED of teaching hospitals in Kerman from February to March 2011. The sampling was based on census. Data were gathered by a self-constructed questionnaire. The reasons for DAMA were divided into three parts: reasons related to patient, medical staff, and hospital environment. The questionnaire was filled out by a face-to-face interview with patient or a reliable companion. Results : There were 121 cases (5.6%) of DAMA out of the total admissions. The main reason of AMA discharges was related to patient factors in 43.9% of cases, while two other factors (i.e., hospital environment and medical staff ) constituded 41.2% and 35.2% of cases, respectively. The majority of patients 65.9% (80 cases) were either uninformed or less informed of the entailing side effects and outcomes of their decision to DAMA. Conclusion : In comparison to studies conducted in other countries, the rate of DAMA is markedly higher in Iran. The results revealed that patients awareness of the consequences of their decisions is evidently inadequate. The study suggests a number of recommendations. These include, increasing patient awareness of the potential side effects of DAMA and creating the necessary culture for this, improving hospital facilities, and a more careful supervision of medical staff performance

Public satisfaction with COVID-19 policy responses and their implementation: A cross-sectional study

Background The outbreak of coronavirus disease 2019 (COVID-19) has prompted significant changes in health policies worldwide. Policy-makers from various countries have responded by adopting and implementing diverse policy measures aimed at combating the spread and impact of COVID-19. The aim of this study is to assess people’s satisfaction with the primary policy responses and their perceptions of the success of their implementation and monitoring.Methods A cross-sectional online survey was conducted in Kerman, Iran, spanning the period of 2021–2022. The sample included adults aged 18 years and older who had access to the Internet and smartphone devices. An online platform was used to develop the questionnaire and collect the data. The face validity, comprehensibility and content validity of the questionnaire were tested and met. Descriptive statistics and multivariable logistic regression were conducted. Data were analyzed using STATA 14.0 software.Results In total, 3192 participants completed the questionnaire, resulting in a completion rate of 67%. More than half of the participants were female (55.51%), with a mean age of 37 ± 11.72 years, and the majority held an academic degree (74.97%). Overall, 54.79% of participants expressed satisfaction with the adopted policy responses, while 56.61% were dissatisfied with their implementation and monitoring. In multivariable logistic regression, factors positively associated with satisfaction included having a diploma [adjusted odds ratio (AOR) = 1.46; 95% confidence interval (CI) 1.05–2.04], an academic degree (AOR = 1.71; 95% CI 1.26–2.31) and middle socioeconomic status (AOR = 1.34; 95% CI 1.07–1.69). In contrast, being male (AOR = 0.68; 95% CI 0.58–0.79) and having high trust in others (AOR = 0.75; 95% CI 0.61–0.92) were associated with lower odds of satisfaction.Conclusions The results of the study showed that more than half of the participants expressed satisfaction with the adopted policy responses made by the National Committee to Combat COVID-19. However, it seems that the government has performed poorly in implementing and monitoring adopted policy responses, leadingto a decrease in people’s satisfaction

Cross-country Comparison of Treatment Policies Facing the Drug Abuse in Five Selected Countries

Background: Drug abuse is one of the main problems of human's life; thus communities have been thinkingabout the solution of this problem. The present study aimed to compare the general features of drug abusetreatment policies, war on drugs (WOD), and harm reduction (HR), in the selected countries.Methods: The present study was a comparative and desk research that sought to compare context,stewardship, financing, type of substance abuse treatment services, reasons of paradigm shift, and executivechallenges of treatment policies in the selected countries (China, Malaysia, Germany, Netherland, and Iran).The necessary data for comparison of the countries were collected through valid databases, review ofdocuments, and reports of international organizations.Findings: Context conditions were better in the HR countries. In most countries, the central governmentplayed a key role in the stewardship, financing, and service providing. In WOD countries, the presence ofjudicial structure was higher in the treatment of drug abuse. The policy-making approach was ideological inWOD countries, but evidence-based in HR countries.Conclusion: It seems that performance of HR countries is better than WOD countries

Oral Health-Related Quality of Life among Children Aged 11-14 Years Old with and without Parental Care in South-East of Iran

Objective:&nbsp;To measure the Oral Health-Related Quality of Life (OHRQoL) and compare children with and without parental care. Material and Methods:&nbsp;This cross-sectional study was conducted on 160 schoolchildren with parental care and 100 orphans in Kerman, Iran. After fulfilling the questionnaire voluntarily, a clinical examination was performed, and indices such as decayed, missing, and filled teeth (DMFT), molar-incisor hypoplasia (MIH), modified gingival index (MGI), traumatic dental injury (TDI), and malocclusion were recorded. Data were statistically analyzed using SPSS version 25 via the ANOVA, Pearson\u27s correlation coefficient test, Chi-Square test, and descriptive statistics.&nbsp;Results:&nbsp;Children without parents scored poorly for OHQRoL items compared to those with parents (p&lt;0.001). DMFT was not significantly related to OHRQoL; however, missing teeth were correlated with the CPQ11-14 overall. Also, the TDI index had a significant relationship with CPQ mean score (p=0.02). Moreover, the difference in the mean CPQ11-14 score in children with TDI in the two groups was significant regarding the quality of life (0.031).&nbsp;Conclusion:&nbsp;OHRQoL differed significantly between children in the two groups, which can be influenced by gender and habits. Due to the vulnerability of welfare-supported children without parental care, these findings emphasize the value of preventive and health-promoting measures for this group of children

A study protocol for the macro-analysis of Iran's health system with system dynamics approach

Background: The health system (HS) is characterized by its complexity and the interconnectivity of its various components, which can lead to unpredictable outcomes when faced with changes in the environment. Understanding these interactions is crucial for effective management and improvement of the system. To navigate this complexity, this study emphasizes the importance of adopting a real-world perspective and utilizing system modeling techniques. These approaches allow for a thorough analysis of the current state of the HS and enable the testing of different policy alternatives to identify potential improvements. Ultimately, the aim of the research is to pinpoint the key components and drivers within the HS. By modeling the dynamics of these elements, the study aims to provide insights that can inform better decision-making and enhance the overall effectiveness of health care delivery. Methods: We designed a mixed methods study in 4 phases, consisting of sequential quantitative and qualitative analyses. In the first phase, to create a comprehensive and holistic view, we will identify key variables and indicators in the HS within the framework of the Balanced Scorecard framework (BSC), which includes population & population health; service delivery; financing; growth & development; and governance & leadership, through a review of documents and a scoping review. In the second and third phases of the study, using a foresight and systemic approach, expert opinions will be purposefully gathered through cross-impact analysis (CIA) and scenario writing to identify key drivers and levers of Iran's HS and obtain compatible future scenarios. Finally, in the quantitative phase of the study, based on the outputs of the previous phases, a dynamic model of the HS will be designed in the Vensim software, and the current situation along with other possible scenarios for the system will be examined for a period of 10 years. Conclusion: It is anticipated that the results of this study could offer a methodological foundation for formulating the health component of the Islamic Republic of Iran’s economic, social, and cultural development plan, intended for use by the Ministry of Health, Treatment, and Medical Education

Factors Associated With Unhealthy Snacks Consumption Among Adolescents in Iran’s Schools

Background: Well-informed interventions are needed if school-based health promotion is to be effective. Among other aims, the Iranian Health Promoting School (IHPS) program that was launched in 2011, has an important aim of promoting dietary behaviors of adolescents. The present study, therefore, aimed to investigate the factors affecting unhealthy snacking of adolescents and provide evidence for a more effective IHPS program. Methods: In a cross-sectional study design, 1320 students from 40 schools in Kerman city were selected using a proportional stratified random sampling method. A modified qualitative Food Frequency Questionnaire (FFQ) was used to gather data about unhealthy snacking behavior. Data about intrapersonal and environmental factors were obtained using a validated and reliable questionnaire. A mixed-effects negative-binomial regression model was used to analyze the data. Results: Taste and sensory perception (prevalence rate ratio [PRR]=1.18; 95% CI: 1.09-1.27), being a male (PRR=1.20; 95% CI: 1.05-1.38) and lower nutritional knowledge (PRR=0.96; 95% CI: 0.91-0.99) were associated with higher weekly unhealthy snaking. Perceived self-efficacy (PRR=0.95; 95% CI: 0.91-1.00) negatively influenced the frequency of unhealthy snaking, with this approaching significance (P<.06). In case of environmental factors, high socio-economic status (SES) level (PRR=1.45; 95% CI: 1.26-1.67), single-parent family (PRR=1.14; 95% CI: 1.01-1.30), more social norms pressure (PRR=1.08; 95% CI: 1.01-1.17), pocket money allowance (PRR=1.21; 95% CI: 1.09-1.34), easy accessibility (PRR=1.06; 95% CI:1.01-1.11), and less perceived parental control (PRR=0.96; 95% CI: 0.92-0.99) all had a role in higher consumption of unhealthy snacks. Interestingly, larger school size was associated with less unhealthy snacking (PRR=0.79; 95% CI: 0.68-0.92). Conclusion: Unhealthy snacking behavior is influenced by individual, socio-cultural and physical-environmental influences, namely by factors relating to poor parenting practices, high SES level, family characteristics, improper social norms pressure, and less knowledge and self-efficacy of students. This evidence can be used to inform a more evidencebased IHPS program through focusing on supportive strategies at the home, school, and local community level