Sustainable political commitment is necessary for institutionalizing community participation in health policy-making: Insights from Iran.

Background: Community participation is currently utilized as a national strategy to promote public health and mitigate health inequalities across the world. While community participation is acknowledged as a civic right in the Constitution of Iran and other related upstream documents, the government has typically failed in translating, integrating and implementing community participation in health system policy. The present study was conducted to determine the level of public voice consideration within the health policy in Iran and address fundamental interventions required to promote the public voice in the context of Islamic Republic of Iran (IRI). This study has originality because there is no study that addresses the requirements of institutionalizing community participation especially in low-middle-income countries, so Iran’s experience can be useful for other countries. Methods: Methodologically, this study utilized a multi-method and multi-strand sequential research design, including qualitative, comparative and documentary studies. In the first phase, the current level of community participation in the health policy cycle of Iran was identified using the International Association for Public Participation (IAP2) spectrum. In the second phase, a comparative study was designed to identify relevant interventions to promote the community participation level in the selected countries under study. In the third phase, a qualitative study was conducted to address the barriers, facilitators and strategies for improving the level of public participation. Accordingly, appropriate interventions and policy options were recommended. Interventions were reviewed in a policy dialogue with policy-makers and community representatives, and their effectiveness, applicability and practical feasibility were evaluated. Results: Based on the IAP2 spectrum, the level of community participation in the health policy-making process is non-participation, while empowerment is set at the highest level in the upstream documents. Moreover, capacity-building, demand, mobilization of the local population, provision of resources and setting a specific structure were found to be among the key interventions to improve the level of community participation in Iran’s health sector. More importantly, “political will for action” was identified as the driving force for implementing the necessary health interventions. Conclusions: To sum up, a paradigm shift in the governing social, economic and political philosophy; establishing a real-world and moral dialogue and communication between the government and the society; identifying and managing the conflicts of interest in the leading stockholders of the healthcare system; and, more importantly, maintaining a stable political will for action are integral to promote and institutionalize participatory governance in the health sector of Iran. All of the above will lead us to scheme, implement and institutionalize suitable interventions for participatory governance in health and medicine

Aspects Influencing Access to HIV/AIDS Services among Afghan Immigrants in Iran: A Qualitative Study.

Background: A successful response to the risk of human immunodefficiency virus (HIV) infection among immigrants requires improved access to HIV prevention, diagnosis, and treatment services. However, most immigrants face significant challenges in accessing HIV/AIDS services. The aim of this study was to explore the aspects influencing access to HIV/AIDS services among Afghan immigrants in Iran. Methods: This was a qualitative study using conventional content analysis that was conducted from June 2018 to April 2020 in Tehran, Iran. Purposeful sampling method was performed. We conducted 25 semi-structured interviews with three groups of stakeholders including Afghan immigrants infected with or at risk of HIV (n=8), service providers (n=8), and policymakers/managers/experts (n=9). Inductive qualitative content analysis was applied according to the Granheim and Lundman method. Data were analyzed using Open Code software version 4.03. Results: Aspects influencing access to HIV/AIDS health services were categorized into 3 themes (that were extracted from 9 categories): 1. Cultural aspects (cultural similarities and differences, values and beliefs); 2. Psychosocial aspects (social support, stigma and discrimination); and 3. Service delivery related aspects (awareness, health services coverage and integrity, health services financing, accessibility, and continuity of care). Conclusion: The findings suggest that efforts to improve Afghan immigrants’ access to HIV/AIDS health services in Iran need to consider the cultural aspects, increasing HIV awareness, providing support, reducing stigma and discrimination, and improving health services coverage, integrity, financing, and continuity of accessible services

Sin and suffering: Pregnant women's justifications for deciding on pregnancy termination due to beta-thalassemia major in Southeast of Iran

Background: Religious restrictions and moral grounds, such as fear over committing a sin, are the major causes of opposing therapeutic abortions. Objectives: This study aimed to describe pregnant women's justifications for deciding on pregnancy termination due to beta thalassemia major (β-TM) in the sociocultural context of Sistan and Baluchestan province, Iran.Methods:In this qualitative study, in-depth semi-structured interviews were conducted with 27 pregnant women and their husbands. Purposive sampling was used to recruit pregnant women who were able to speak and understand Persian, had no known mental illnesses or psychiatric problems and had fetuses with β-TM. Data were analyzed using narrative thematic analysis. Results: At the time of receiving, the results of chorionic villus sampling for β-TM screening, the age and the gestational age ranges of the participants were 19-42 years and 11-18 weeks, respectively. Women's justifications for deciding on pregnancy termination due to β-TM were explained in three main themes, namely, child's physical suffering, negative psychological consequences, and attempting to be good parents. Conclusion: Providing families with information about the long-term effects of β-TM on the child and family members can help them make informed decisions on pregnancy continuation or termination

Ups and downs of addiction harm reduction in Iran: key insights and implications for harm reduction policy and policing

Abstract Drug use is a critical behavioral disorder or a delinquency behavior (in the judiciary system's words) that comes with a burden at multiple levels: individual, community, public, and global. These social structures apply different interventions to reduce this burden in their field. Given the society as a whole, these structures must be harmonious and synergistic to optimize these endeavors in terms of cost–benefit. In practice, however, reducing the burden of addiction is followed by conflicting approaches by different organizations, in terms such as “eradicating drugs,” “eliminating drug users,” “obliterating addiction,” and ultimately, drug use harm reduction. In the harm reduction philosophy, drug use is recognized as an inescapable fact in human societies, and tries to control its personal and public consequences in different dimensions (health, economic, and social). Therefore, this approach includes broad measures such as: changing the pattern of consumption (from high-risk substances to less dangerous substances) through modification of the laws and law enforcement measures, distributing disposable syringes to prevent HIV transmission, providing basic life needs such as shelter for street-based drug users to reduce the social consequences like homelessness, prescribing substitute agonists to reduce the committing crime to obtain the needed drugs, and even the drug court program, which prevents the exacerbation of complications in a person with a chronic and relapsing disorder, due to the imposition of inappropriate sentences (like incarceration in unacceptable conditions). It is contrary to the approaches that aim to reduce the drug supply rate and drug use incidence and prevalence to zero. As a result of the conflict of interests, goals discrepancies, and differences in organizational culture, these approaches may contrast with each other. We see this in the harm reduction between the health system and law enforcement. Different factors affect the harmony or conflict between these two structures. This article addresses the impact of ideology, social conditions, and bureaucratic administration on the relationship between the health system and the police in drug use harm reduction in Iran

Food Choice as a Social Problem: A Reflection on the Socio-cultural Determinants of Food Choice

Background and Objective: Food choice similar to other human behaviors is influenced by various factors. Along with biological and physiological determinants, various factors may affect food choice including individual, environmental, cultural, social and behavioral factors. Therefore, the purpose of this study was to review the determinants of food choice especially in reference to socio-cultural factors. Materials and Methods: This review study was conducted based on articles published from 1995 to 2017. Firstly, search was conducted by keywords in PubMed, Google scholar, Science Direct, Scopus, SID, Irandoc, Magiran and health science databases to find full text or abstract of publications. The initial search key words were "food choice" and "determinants", which were later refined by searching for particular terms like "culture" and "social". Finally, 22 articles including 6 quantitative articles and 16 qualitative articles in Persian and English were selected. Results:  The concepts extracted as food choice determinants included nutritional self-effectiveness; media; socio-economic factors; social contexts; literacy; family dimension; social inequality; occupation; taste; ease of access; habits; food preferences; knowledge; friends, peers and parents influences; parental education; cooking skills; nutritional quality; life course; ideals; resources; food abstinence; past experiences; health; ethnicity customs; time; enjoyable experiences from foods; and satiety. Conclusion: Adding up studies showed the importance of socio-cultural variables as food choice determinants among different groups to design and implement interventions to modify the eating behaviors. Thus, it is necessary to carry out research on the basis of socio-cultural factors for food programming

Psychological impact of infertility among infertile women

AbstractBackground and aim:  Infertility is a important life event which it and its treatment can affect livesof couples. Infertility can cause various psychological-emotional disorders or consequences. The aim of this study was to explore psychological experiences of infertility and its treatment in infertile women attending to Vali-e-Asr Fertility Health Research Center Tehran,Iran. Methods:  This qualitative study was carried out on 15 women with primary and secondaryinfertilityThe study was conducted in Vali-e-Asr Fertility Health Research Center in Tehran. A judgemental method was used to recruit participants in the study. Data were collected using semi-structured interviews and continued until data saturation. Simultaneously in process of data collection, the data analysis phase was performed with conventional content analysis method. Findings:  main concepts emerged from the data were categorized into four main themes and theirsub-categories include: 1. Cognitive reactions of infertility 2. Cognitive reactions to therapy process 3. Emotional–affective reactions of infertility 4. Emotional–affective reactions to therapy process. Conclusion:  This study showed that the infertility and its treatment process for Iranian infertilewomen is a source of psychological suffering with devastating effects on psychological well-being of infertile couples. The results also showed that one of the major causes of psychological distress is the social pressure by community members, while is less attention is paid to the sociocultural dimensions and consequences of infertility. Keywords: infertility; psychological; seeking treatment; content analysis REFERENCES Berek JS (2007). Berek & Novak’s Gynecology . 14th edition. Lippincott Williams and Wilkins, Philadelphia. Bliss C (1999).     The Social Construction of Infertility by Minority Women . (Dissertation). Available at: http:// gerrystahl.net/personal/family/dissertation.pdf/.Accessed Nov 5, 2012.   Cousineau TM, Domar AD (2007).       Psychological impact of infertility. Best Practice & Research Clinical Obstetrics & Gynaecology       . 21(2) 293- 308. Cwikel J, Gidron Y, Sheiner E (2004). "Psychological interactions with infertility among women: Review".     European Journal of Obstetrics & Gynecology and Reproductive Biology   . 117(2) 126-31. Domar AD, Gordon K (2011)."The Psychological Impact of Infertility: Results of a national survey of men and   women".   Fertility and Sterility . 95(4)S17.  Dyer SJ (2009). "Psychological and social aspects of infertility in developing countries". International Journalof Gynecology & Obstetrics   . 107 (Supplement 2):S25-S26.Dyer SJ et al (2002). "Men leave me as I can not have childern: women’s experiences with involuntary childlessness".  Human Reproduction. 17 (6)1663-1668.Gameiro S et al (2012). "Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment".  Human Reproduction Update.18(6) 652- 669.Gannon K, Glover L, Abel P (2004). "Masculinity, infertility, Stigma and media reports".   Social Science &Medicine   . 59(6) 1169-75.Greil AL, Blevins KS, McQuillan J (2010). "The experience of infertility: A review of recent literature".  Sociology of Health & Illness . 32(1)140–162.Guerra D et al (1998). "Psychiatric morbidity in couples attending a fertility Service". Human Reproduction.13(6) 1733–1736.  Hammerli K, Hansjorg Z, Barth J (2009). "The efficacy of psychological interventions for infertile patients: Ameta-analysis examining mental health and pregnancy rate".Human Reprod Update.15(3) 279-295.Hart VA (2002). "Infertility and the role of psychotherapy".  Issues in Mental Health Nursing. 23(1) 31- 41.Inhorn MC, Birenbaum-Carmeli D (2008). "Assisted reproductive technologies and culture change".   AnnualReview of Anthropology   . 37: 96-177.Latifnejad R (2008).   How religious faiths and spiritual beliefs affect the experiences of infertile women seekinginfertility treatments: A feminist grounded theory approach   . (Dissertation). Guildford, University of Surrey.2008.  Lechner L, Bolman C, van Dalen A (2007). "Definite involuntary childlessness: Associations between coping,social support and psychological distress".Human Reproduction. 22(1) 288-94.Noorbala A et al(2009)."[Prevalence of psychiatric disorders and types of personality in fertile and infertile women".  Journal Reprod Infertil. 9(4) 350-360.(Persion).Polit DF, Beck CT (2006).  Essentials of Nursing Research Methods, Appraisal and Utilization. 6th edition.Philadelphia:Lippincott Williams Wilkins. Sami N, Tazeen S.A. "Perceptions and Experiences of Women in Karachi- Pakistan Regarding Secondary Infertility: Results from a Community-Based Qualitative Study".   Obstetrics and Gynecology International Volume 2012. [ on line].< http://www.hindawi.com/journals/ogi/2012/108756>. [4 Nov 2012].Slade P et al (2007). "The relationship between perceived stigma, disclosure patterns, support and distress innew attendees at an infertility clinic".Oxford Journals, Medicine, Human Reproduction. 22(8) 2309-2317.Spannagel C, Gläser-Zikuda M, Schroeder U . "Application of qualitative content analysis in user-program interaction research".  Forum Qualitative Social Research.2005, 6(2). [ on line].< http://www.qualitativeresearch.net/index.php/fqs/article/view/469>. [13 Oct 2012]. Vahidi S, Ardalan A, Mohammad K (2009). "Prevalence of primary infertility in the Islamic Republic of Iran in 2004-2005".  Asian Pacific Journal of Public Health. 21(3) 287-293. (Persian).Van Balen F, Gerrits T (2001). "Quality of infertility care in poor-resource areas and the introduction of new reproductive technologies".  Human Reproduction. 16(2) 215-219. Vayena E, Rowe PJ, Griffin PD . "Current Practices and Controversies in Assisted Reproduction". WorldHealth Organization.[ on line].< http://www.imamu.edu.sa/Scientific _selections/files/DocLib/report.pdf>.Published 2002. [13 Oct, 2012].Wiersema NJ et al. "Consequences of infertility in developing countries: Results of a questionnaire andinterview. Survey in the South of Vietnam".Journal of Translational Medicine. Published online 2006; 4:54. [ on line]. <http://link.springer.com/article/10.1186%2F1479-5876-4-54#page-1>. [5 Nov 2012]. Wischmann T (2008). "Psychosocial aspects of infertile couples  ". Psychosocial Gynakol Geburtsmed GynakolEndokrinol   . 4(3) 194–209. Psychological impact of infertility among infertile womenseeking treatment: A qualitative studySyede Batool Hasanpoor–Azghdy1, Masoumeh Simbar2,Abouali Vedadhir  3, Batool Hossein Rashid4 1. PhD Alumni of reproductive health, Department of Reproductive Health and Midwifery, Faculty of nursing and midwifery, Shahid BeheshtiUniversity of Medical Science. Tehran, Iran.2. PhD, Associate professor in Reproductive Health, The Research Center for Safe Motherhood , Department of Reproductive Health and Midwifery,Faculty of nursing and midwifery, Shahid Beheshti Medical Sciences University. Tehran, Iran.3. PhD, Assistant Professor, Department of Anthropology, Faculty of Social Sciences, University of Tehran, Tehran, Iran.4. PhD, Associate professor in Obstetrician & Gynecologist , Department of Obstetrician & Gynecologist, Valie-Asr Reproductive Health ResearchCenter, Tehran Medical Sciences University. Tehran, Iran.Corresponding author: Masoumeh Simbar; msimabr@ yahoo.comAbstractBackground and aim:  Infertility is a important life event which it and its treatment can affect livesof couples. Infertility can cause various psychological-emotional disorders or consequences. The aim of this study was to explore psychological experiences of infertility and its treatment in infertile women attending to Vali-e-Asr Fertility Health Research Center Tehran,Iran. Methods:  This qualitative study was carried out on 15 women with primary and secondaryinfertilityThe study was conducted in Vali-e-Asr Fertility Health Research Center in Tehran. A judgemental method was used to recruit participants in the study. Data were collected using semi-structured interviews and continued until data saturation. Simultaneously in process of data collection, the data analysis phase was performed with conventional content analysis method. Findings:  main concepts emerged from the data were categorized into four main themes and theirsub-categories include: 1. Cognitive reactions of infertility 2. Cognitive reactions to therapy process 3. Emotional–affective reactions of infertility 4. Emotional–affective reactions to therapy process. Conclusion:  This study showed that the infertility and its treatment process for Iranian infertilewomen is a source of psychological suffering with devastating effects on psychological well-being of infertile couples. The results also showed that one of the major causes of psychological distress is the social pressure by community members, while is less attention is paid to the sociocultural dimensions and consequences of infertility. Keywords: infertility;psychological; seeking treatment; content analysis.REFERENCESBerek JS (2007).Berek & Novak’s Gynecology. 14th edition. Lippincott Williams and Wilkins, Philadelphia.Bliss C (1999).  The Social Construction of Infertility by Minority Women. (Dissertation). Available at: http://gerrystahl.net/personal/family/dissertation.pdf/.Accessed Nov 5, 2012. Cousineau TM, Domar AD (2007).   Psychological impact of infertility. Best Practice & Research ClinicalObstetrics & Gynaecology   . 21(2) 293- 308.Cwikel J, Gidron Y, Sheiner E (2004). "Psychological interactions with infertility among women: Review".  European Journal of Obstetrics & Gynecology and Reproductive Biology . 117(2) 126-31.Domar AD, Gordon K (2011)."The Psychological Impact of Infertility: Results of a national survey of men and women". Fertility and Sterility. 95(4)S17. Dyer SJ (2009). "Psychological and social aspects of infertility in developing countries". International Journalof Gynecology & Obstetrics   . 107 (Supplement 2):S25-S26.Dyer SJ et al (2002). "Men leave me as I can not have childern: women’s experiences with involuntary childlessness".  Human Reproduction. 17 (6)1663-1668.Gameiro S et al (2012). "Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment".  Human Reproduction Update.18(6) 652- 669.Gannon K, Glover L, Abel P (2004). "Masculinity, infertility, Stigma and media reports".   Social Science &Medicine   . 59(6) 1169-75.Greil AL, Blevins KS, McQuillan J (2010). "The experience of infertility: A review of recent literature".  Sociology of Health & Illness . 32(1)140–162.Guerra D et al (1998). "Psychiatric morbidity in couples attending a fertility Service". Human Reproduction.13(6) 1733–1736.  Hammerli K, Hansjorg Z, Barth J (2009). "The efficacy of psychological interventions for infertile patients: Ameta-analysis examining mental health and pregnancy rate".Human Reprod Update.15(3) 279-295.Hart VA (2002). "Infertility and the role of psychotherapy".  Issues in Mental Health Nursing. 23(1) 31- 41.Inhorn MC, Birenbaum-Carmeli D (2008). "Assisted reproductive technologies and culture change".   AnnualReview of Anthropology   . 37: 96-177.Latifnejad R (2008).   How religious faiths and spiritual beliefs affect the experiences of infertile women seekinginfertility treatments: A feminist grounded theory approach   . (Dissertation). Guildford, University of Surrey.2008.  Lechner L, Bolman C, van Dalen A (2007). "Definite involuntary childlessness: Associations between coping,social support and psychological distress".Human Reproduction. 22(1) 288-94.Noorbala A et al(2009)."[Prevalence of psychiatric disorders and types of personality in fertile and infertile women".  Journal Reprod Infertil. 9(4) 350-360.(Persion).Polit DF, Beck CT (2006).  Essentials of Nursing Research Methods, Appraisal and Utilization. 6th edition.Philadelphia:Lippincott Williams Wilkins. Sami N, Tazeen S.A. "Perceptions and Experiences of Women in Karachi- Pakistan Regarding Secondary Infertility: Results from a Community-Based Qualitative Study".   Obstetrics and Gynecology International Volume 2012. [ on line].< http://www.hindawi.com/journals/ogi/2012/108756>. [4 Nov 2012].Slade P et al (2007). "The relationship between perceived stigma, disclosure patterns, support and distress innew attendees at an infertility clinic".Oxford Journals, Medicine, Human Reproduction. 22(8) 2309-2317.Spannagel C, Gläser-Zikuda M, Schroeder U . "Application of qualitative content analysis in user-program interaction research".  Forum Qualitative Social Research.2005, 6(2). [ on line].< http://www.qualitativeresearch.net/index.php/fqs/article/view/469>. [13 Oct 2012]. Vahidi S, Ardalan A, Mohammad K (2009). "Prevalence of primary infertility in the Islamic Republic of Iran in 2004-2005".  Asian Pacific Journal of Public Health. 21(3) 287-293. (Persian).Van Balen F, Gerrits T (2001). "Quality of infertility care in poor-resource areas and the introduction of new reproductive technologies".  Human Reproduction. 16(2) 215-219. Vayena E, Rowe PJ, Griffin PD . "Current Practices and Controversies in Assisted Reproduction". WorldHealth Organization.[ on line].< http://www.imamu.edu.sa/Scientific _selections/files/DocLib/report.pdf>.Published 2002. [13 Oct, 2012].Wiersema NJ et al. "Consequences of infertility in developing countries: Results of a questionnaire andinterview. Survey in the South of Vietnam".Journal of Translational Medicine. Published online 2006; 4:54. [ on line]. <http://link.springer.com/article/10.1186%2F1479-5876-4-54#page-1>. [5 Nov 2012]. Wischmann T (2008). "Psychosocial aspects of infertile couples  ". Psychosocial Gynakol Geburtsmed GynakolEndokrinol   . 4(3) 194–209.