The challenges of urban family physician program over the past decade in Iran: a scoping review and qualitative study with policy-makers

Introduction: Despite all the advantages of urban family physician program (UFPP), there is still a gap between UFPP and what is actually achieved by the community after its implementation in Iran. In response, this study attempted to review published studies related to the barriers to the implementation of the UFPP in Iran as well as potential solutions to improve it. Further, a qualitative study was conducted to learn the perspectives of experts at the national level and in the Fars province in order to better understand the program's challenges. Methods: This study was conducted in two phases. First, a scoping review was done, aiming to identify the common barriers and potential solutions to implementing UFPP in Iran. Second, a qualitative study using semi-structured interviews was conducted to investigate the views of decision- and policy-makers regarding barriers to and solutions for implementing the UFPP in the Fars province over the last decade. The findings were classified using the five control knobs framework (Organization, financing, payment, regulation, and behavior).  Results: The most common barriers to UFPP were: 1) organization (ununited stewardship function of the Ministry of Health, weak management and planning, inadequate training of human resources, and a weak referral system); 2) financing (fragmented insurance funds, insufficient financial resources, and instability of financial resources); 3) payment (inappropriate payment mechanisms and delay in payments); 4) regulation (cumbersome laws and unclear laws); and 5) behavior (cultural problems and conflict of interests). On the other hand, several solutions were identified to improve the implementation of UFPP, including: enhancing the role of government; improving the referral system; providing comprehensive training for UFPP providers; considering sustainable financial resources; moving towards mixed-payment mechanisms; employing appropriate legal and regulatory frameworks; enhancing community awareness; and elevating incentive mechanisms. Conclusion: Our research found that, despite the UFPP having been in place for a decade in Iran, there are still significant challenges in all five components. Therefore, the promotion of this program requires solving the existing implementation challenges in order to achieve the predetermined goals. The ideas in this study can be used to improve the current program in Fars Province and bring it to other cities in Iran

The comparison of the effectiveness of contingency management and trans-theoretical model on the risk of sexual behaviors in cocaine users: A short report study

BACKGROUND: A transtheoretical model (TTM) can be considered as a cognitive and motivational view, a component which plays a significant role in addiction. Further, the theoretical basis of contingency management (CM) treatment is the origin of behaviorism and relies on operant conditioning. The present study is performed aiming to determine the effectiveness of TTM and CM on cocaine use and sexual risk behaviors in cocaine users.METHODS: In this randomized clinical trial with 6-month follow-up, which was performed from 15 December 2014 to 20 November 2015, 75 male cocaine users were selected based on a respondent-driven sampling (RDS) method and were randomly divided into three groups by block randomization. The experimental group received a 12-week CM protocol and TTM and the control group was placed on the waiting list. Pre-test, post-test (after 12 weeks of training), and follow-up (six months) were administered. Data analysis was carried out using repeated measures analysis of variance (ANOVA), Scheffe’s post hoc test, and chi-square test through SPSS software.RESULTS: The mean age of the CM group, TTM group, and control group was estimated 26.12, 25.31, and 23.91, respectively. The primary outcome showed that CM and TTM had a significant effect on decreasing the sexual thoughts, sexual hyperactivity, and high risk behaviors. This effectiveness was stable until six months (P = 0.008), however there was not a significant difference between the two treatments (P = 0.200). The secondary outcome showed that in the changing stages, TTM (F-72%) and CM (F-60%) had a significant effectiveness which maintained until the follow-up stage.CONCLUSION: The findings more enhance the hope to integrate the theoretical approaches into the clinical interventions

The Relationship between Spiritual Health and Public Health Aspects among Patients with Breast Cancer

For downloading the full-text of this article please click here.Background and Objective: Spiritual well-being is one of the fundamental concepts in chronic diseases and is considered an important approach to improve public health among individuals. Given the importance of spiritual well-being and its role in the promotion of mental health, the present study was conducted with the aim of evaluating spiritual well-being and mental health in patients with breast cancer who visited a center for cancer control at the University of Medical Sciences.Method: This cross-sectional study was conducted on 122 patients with breast cancer in 2015. The data were collected through self-administered 20-item Paloutzian & Ellison’s Spiritual Well-Being Scale and a 28-item questionnaire of mental health after determining their validity and reliability. The collected data were then analyzed using ANOVA and Pearson correlation and linear regression.Results: The results show that most patients had moderate spiritual health (37.8%), and most of them suffered mild mental health problems. (50 percent). Furthermore, there was a significant relationship between mental health and demographic characteristics (Marital status, education, income, physical activity). There was also a significant relationship between mental health and spiritual health.Conclusion: According to the findings, to prevent mental suffering among patients with breast cancer, promoting spiritual health of patients should be regarded as one of the priorities of health care professionals.For downloading the full-text of this article please click here

Behavioral Effective Factors of Adopting Online Shopping in the Airline Industry

Today, online purchasing of airline ticket experience substantial growth in Iran in which understanding customer behavior about this technology is necessary for airlines to improve marketing and sales strategies that enable them to retain and attract customers. So, the present study aimed to gain more insight into the most important factors affecting air travelers’ acceptance to use online reservation system of airline ticket. Hence, this paper is application and descriptive–correlation in terms of purpose and methodology. The statistical population includes departure passengers of Mashhad int’l airport in domestic flights of September and sample size calculated for 215 passengers. In addition the data gathered by questionnaire about conceptual model that including trust, price, perceived risk, usefulness and website quality; were analyzed using structural equation analysis and Lisrel8.8 Software. The findings indicate that the three factors namely website quality, usefulness and trust directly and perceived risk indirectly affect the willingness of online shopping. Moreover, significant effect of price on the willingness of air travelers to shop online has not been confirmed

Knowledge and practice of people toward their rights in urban family physician program: A population-based study in Shiraz, Southern Iran

Background: Urban family physician program has been launched as a pilot in Fars and Mazandaran provinces of Iran since 2012. Attitudes of policy makers and people toward urban family physician program have become challenging. This study shows what people know and practice toward this program. Methods: This cross-sectional population-based study was conducted by a multistage randomized sampling in Shiraz, Southern Iran. Knowledge and practice of adults toward urban family physician program were queried through filing the questionnaires. Single and multiple variable analyzes of data were performed. Results: Participation rate was 1257 of 1382 (90.9%), and the mean age of the respondents was 38.1 ± 13.2 years. Of 1257, 634 (50.4%) were men and 882 (70.2%) were married. Peoples′ total knowledge toward urban family physician program was 5 ± 2.7 of 19, showed that 1121 (89.2%) had a low level of knowledge. This was correlated positively and in order to being under coverage of this program (P < 0.001), being under coverage of one of the main insurance systems (P = 0.04) and being married (P = 0.002). The mean score of people′s practice toward the program was 2.3 ± 0.9 of total score 7, showed that 942 (74%) had poor performance, and it was correlated positively and in order to being under coverage of this program (P < 0.001) and having higher than 1000$ monthly income (P = 0.004). Correlation of people′s knowledge and practice toward the program was 24%. Conclusions: Current evidences show a low level of knowledge, poor practice and weak correlation of knowledge-practice of people toward urban family physician program

Environmental sustainability in hospitals: Dual analysis of electrical consumption and pollutant emissions

The emission of pollutants following electricity consumption is significant, and hospitals are major contributors to energy consumption. Hence, the aim of this study was a survey of electrical consumption rate and environmental pollutants emissions in selected hospitals. This descriptive-analytical and cross-sectional study was conducted over three years and based on electricity bills and bed indicators in selected hospitals in Tehran, Iran. Emissions Calculator software was used to calculate the emission of pollutants caused by electricity consumption. Kolmogorov Smirnov, Least Significant Difference (LSD), and one-way ANOVA tests were used to analyze the data. Results showed that the total average electricity consumption for each active day bed and occupied day bed was 9.6 and 13.6 times higher than the recommended standards. The average electricity consumption for each active day bed in hospitals A, B, and C was 13.7, 10.2, and 5 times higher than the standard value, respectively, while for occupied day beds, the consumption was 17.3, 15.1, and 8.5 times higher than the standard value, respectively. Additionally, the total electricity consumption in these hospitals resulted in the emission of 41837100 kg of CO2, 124815 kg of SO2, 103699 kg of NOx, 9769 kg of CO, 4885 kg of PM10, and 757 kg of VOCs into the environment. Based on the monthly active bed index and occupied day bed, there was a significant difference in the average electrical consumption among A, B, and C hospitals (p = 0.0001). Electricity consumption in the studied hospitals exceeds standards. Implementing optimal designs for lighting, heating, and cooling, along with energy optimization training, technical audits, and inspections are essential for both economic benefits and reducing environmental pollutants

Observance of Hospital Rules and Nurses Rights by Patients\' Companions After Health System Reform: Results of Hospital Based Study in Shiraz, Iran

Background & Objective: Health system reform confronts hospitals with a lot of patients and their companions. This study aimed to determine the knowledge, attitude and practice of patients’ companions toward hospitals rules and nurses’ rights. Material & Methods: This descriptive-analytic cross-sectional study was conducted through a multistage cluster random sampling of patients’ first degree relatives who had accompanied their patients in main public hospitals of Shiraz, Iran. Valid and reliable questionnaire was filled for each interviewee by a face to face interview. Data were analyzed using SPSS. Results: Mean age of 423 interviewees was 36.7±11.7 years with female to male ratio of 1.29. 292(67.4%) were educated until the end of high school, while 264(61.1%) had a kind of job. Knowledge, attitude and practice toward hospitals’ rules and nurses’ rights were inappropriate in 61(14.1%), 84(19.4%) and 221(51.2%) respectively. Moreover, Sum score of these variables was inappropriate in 102(23.6%). Correlation between knowledge and practice was 0.44(p<0.001). Total score of knowledge, attitude and practice had a significant association with the kind of hospital, gender, level of education, marital status, being bread-winner of family, having a job, patients’ finance providing, cohabitation with patient in the same place, admission ward of patient, last time of interviewee’s admission in hospital and amount and source of information about hospitals rules and nurses’ rights. Conclusion: Inappropriate practice of patients’ companions toward hospitals rules is associated with violence against nurses, their burnout and decreasing quality of hospital services. Therefore, following health system reform in Iran and increasing trend of referrals to hospitals, efficient interventions to improve this index is recommended

Five years after implementation of urban family physician program in fars province of Iran: Are people's knowledge and practice satisfactory?

Introduction: Urban family physician program (UFPP) was launched in Fars province of Iran in 2012. We aimed to assess the knowledge and practice of people toward this 5-year-old program. Methods: In this population-based study, through a multistage random sampling from 6 cities of Fars province, 1350 people older than 18 years were interviewed. For data collection, a questionnaire consisting of sociodemographic characteristics and items about knowledge and practice toward UFPP was used. Results: The mean age of the interviewees was 42.4 ± 14.2 years; male (674; 49.9%)-to-female (651; 48.2%) ratio was 1.03. Mean score of knowledge was 4.2 ± 1.7 (out of 14), while 961 (71.1%) had < 50% of the desirable knowledge. Mean score of practice was 4.4 ± 1.3 (out of 9), while only 443 (32.8%) had a good performance toward this program. Knowledge and practice did not show a significant correlation (r = 0.06, P = 0.05). Among cities, the highest and the lowest mean of knowledge belonged to Pasargad (5.6 ± 2.1) and Lar (3.0 ± 1.0) (P < 0.001), respectively. Pasargad (4.8 ± 1.4) had also the highest level of practice compared to Farashband (3.8 ± 1.4) which had the lowest score (P < 0.001). Multivariable analysis showed that supplemental insurance coverage (odds ratio [OR] = 2.5, %95 confidence interval [CI]: 1.6–3.9), female gender (OR = 1.9, %95 CI: 1.2–2.9) and higher level of education (OR = 1.7, %95 CI: 1.1–2.5) were the significant determinants of knowledge, while practice in those who were not covered by supplemental insurance was better (OR = 1.6, 95% CI: 1.2-2.5). Conclusions: After 5 years of implementation of UFPP, knowledge and practice of people toward UFPP are not satisfactory. This finding calls for a serious revision in some aspects of UFFP