Search Strategies and Information Search Tools Used by Pharmacy PhD Students: A Qualitative Study

Objectives: This study aimed to investigate search tools and strategies of PhD students to access required information. Methods: Semi-structured interviews with pharmacy Ph.D. students in Tabriz University of Medical Sciences were conducted. We used MaxQDA software to analyze the content of the interviews. Results: Scopus and Google Scholar were the most popular search tools used by participants. These databases were also recognized as the most common starting points for searches among participants. Participants’ search strategies were categorized into two themes (search tools and search strategies) and six subthemes which include: search start up tools, search tools used, reasons to use, keyword selection and modification, type of search and field searching. Conclusion: Google Scholar has become a serious alternative for specialized databases such as Web of Science, Pubmed and Scopus. The results of this study would be benefit for policy makers and information suppliers in academic settings

Determining factors in the retention of physicians in rural and underdeveloped areas : a systematic review

Background: Imbalance in distribution of Health Care Workers (HCWs) in a country is a global challenge. Almost all of the rural and underdeveloped areas are struggling with the shortage of HCWs, especially physicians. Therefore, this study aimed to identify factors governing the retention of physicians in rural and underdeveloped areas. Methods: International databases including Scopus, PubMed, Web of Science, Proquest, and Embase were searched using Mesh terms in order to find peer-reviewed journal articles addressing physicians’ retention factors in rural and underdeveloped areas. The records were screened, and any duplicate results were removed. The quality of the studies was assessed according to the Critical Appraisal Skills Program developed for different types of studies. Then, through content analysis, the related factors were identified from finally selected papers, coded, and categorized. Results: The initial search resulted in 2312 relevant articles. On the basis of specific selection criteria, 35 full-text articles were finally reviewed.. The major affecting factors in physicians’ retention in rural and underdeveloped regions were classified into the following six categories: 1) financial; 2) career and professional; 3) working conditions; 4) personal; 5) cultural; and 6) living conditions factors. Conclusion: There is a complex interplay of factors governing physicians’ retention in rural and underdeveloped areas. If health organizations are concerned with physicians’ retention in deprived areas, they should take into account these main factors. Moreover, they should develop policies and strategies to attract and retain physicians in rural and underdeveloped areas

The experience of implementing the board of trustees’ policy in teaching hospitals in Iran: an example of health system decentralization

Background: In 2004, the health system in Iran initiated an organizational reform aiming to increase the autonomy of teaching hospitals and make them more decentralized. The policy led to the formation of a board of trustees in each hospital and significant modifications in hospitals’ financing. Since the reform aimed to improve its predecessor policy (implementation of hospital autonomy began in 1995), it expected to increase user satisfaction, as well as enhance effectiveness and efficiency of healthcare services in targeted hospitals. However, such expectations were never realized. In this research, we explored the perceptions and views of expert stakeholders as to why the board of trustees’ policy did not achieve its perceived objectives. Methods: We conducted 47 semi-structured face-to-face interviews and two focus group discussions (involving 8 and 10 participants, respectively) with experts at high, middle, and low levels of Iran’s health system, using purposive and snowball sampling. We also collected a comprehensive set of relevant documents. Interviews were transcribed verbatim and analyzed thematically, following a mixed inductive-deductive approach. Results: Three main themes emerged from the analysis. The implementation approach (including the processes, views about the policy and the links between the policy components), using research evidence about the policy (local and global), and policy context (health system structure, health insurers capacity, hospitals’ organization and capacity and actors’ interrelationships) affected the policy outcomes. Overall, the implementation of hospital decentralization policies in Iran did not seem to achieve their intended targets as a result of assumed failure to take full consideration of the above factors in policy implementation into account. Conclusion: The implementation of the board of trustees’ policy did not achieve its desired goals in teaching hospitals in Iran. Similar decentralization policies in the past and their outcomes were overlooked, while the context was not prepared appropriately and key stakeholders, particularly the government, did not support the decentralization of Iran’s health system

Exploring nationwide policy interventions to control <scp>COVID</scp> ‐19 from the perspective of the rapid learning health system approach

Abstract Introduction The health systems needed to improve their learning capacities during the COVID‐19 pandemic. Iran is one of the countries massively struck by the pandemic. This study aimed to explore whether and how the policy interventions made by Iran's policymakers at the national level to control COVID‐19, could improve the rapid learning characteristics of the health system. Methods A guide to clarify rapid learning health system (RLHS) characteristics was developed. The guide was used by two independent authors to select the policy interventions that could improve RLHS characteristics, then, to analyze the content of the selected policy interventions. In each stage, results were compared and discussed by all three authors. Final results were presented based on different RLHS characteristics and the potential mechanisms of contribution. Results Five hundred policy interventions were developed during the first 7 months of the outbreak. Thirty‐one policy interventions could potentially improve RLHS characteristics (6.2%). Two characteristics, such as the timely production of research evidence and the appropriate decision support were addressed by selected policy interventions. Policies, that could improve learning capacities, focused on decision‐maker groups more than user groups or researcher groups. Conclusions Most of the developed policy interventions during the first months of the epidemic did not address the learning capacities of the health system. To improve health system functions, improving RLHS characteristics of the health system, especially in patient‐centered and data linkage characteristics, is recommended

Strategies to strengthen non-governmental organizations' participation in the Iranian health system

Background: Non-governmental organizations (NGOs) added a new dimension to intersectoral action for health. Involving the NGOs in health system strengthening could lead to a more efficient, equitable, and better-governed healthcare system. This qualitative study explored effective strategies for NGO participation in the Iranian health system to achieve broader health system goals. Method: We conducted 33 semi-structured interviews with health policymakers and planners, NGO actors at the national and provincial levels, and other key informants. The qualitative data were analyzed through a thematic analysis approach. Trustworthiness in the study was observed at all stages of the study. Result: Four main themes- were identified: empowerment for learning leadership and management skills, creating active participation in policy-making, capacity building for participation, clarifying participation process, falling into 17 sub-themes. Along with the government and health sector policymakers, NGOs may have a significant role in improving health system goals and increasing equity, social responsiveness, financial risk protection, and efficiency. Conclusion: The participation of NGOs in the Iranian health system is a complex process. All elements and dimensions of this process need to be considered when developing a platform for the appropriate participation of NGOs in the health system functions. Evidence-informed strategies for strengthening the participation of NGOs in the health system should be used to utilize NGOs potential to the fullest

The Barriers to Implementation of New Public Management Strategies in Iran’s Primary Health Care: A Qualitative Study

INTRODUCTION: New Public Management (NPM) is a special management philosophy used by governments. OBJECTIVES: The aim of NPM is to increase efficiency, effectiveness and cost saving in public sector through employing private sector characteristics and market mechanisms. Therefore, objective of this study is to identify barriers and challenges to understand the limitations of implementing the NPM model. STUDY DESIGN: A qualitative study STUDY SETTING: Managers of primary health care (PHC), East Azerbaijan, Iran. METHODOLOGY: The researchers performed a series of semi-structured interviews with health managers (n=30) and three focus group discussions with policy makers and district health managers (n=9) in 2016. A questionnaire was used for collecting demographic characteristics and managers’ perspectives. RESULTS: Lack of authority, executive bureaucracy, traditional budgeting system, poor payment systems, inadequate resources were considered to be the most common managerial barriers to the implementation of NPM. From the experts' view, the other factors that can affect poor implementation of NPM reforms in public health complexes are as follow: a shortage of trained managers, centralized decision-making process, organization's unwillingness to compete, lack of customer-oriented culture, lack of supervisor support and feedback, disharmony between employee needs and appraisal goals, absence of clear and independent performance dimensions, and biases in the process of evaluation. CONCLUSION: Designing and implementing an NPM reform need to be based on the operational reality and conditions of every country because most of the NPM programs in different countries are suffering from non-implementation syndrome. Therefore, before implementing this reform, identifying managerial barriers and challenges helps managers to execute the NPM in their desired sector properly

Analysis and evolution of health policies in Iran through policy triangle framework during the last thirty years: a systematic review of the historical period from 1994 to 2021

Background: Health policy analysis as a multi-disciplinary approach to public policy illustrates the need for interventions that highlight and address important policy issues, improve the policy formulation and implementation process and lead to better health outcomes. Various theories and frameworks have been contributed as the foundation for the analysis of policy in various studies. This study aimed to analyze health policies during the historical period of the almost last 30 years in Iran using policy triangle framework. Method: To conduct the systematic review international databases (PubMed / Medline, Scopus, Web of Sciences, CINAHL, PsycINFO, Embase, The Cochran Library) and Iranian databases from January 1994 to January 2021 using relevant keywords. A thematic qualitative analysis approach was used for the synthesis and analysis of data. Results: Out of 731 articles, 25 articles were selected and analyzed. Studies used health policy triangle framework to analyze policies in the Iranian health sector has been published since 2014. All the included studies were retrospective. The main focus of most of studies for the analysis was on the context and process of polices as the elements of the policy triangle. Conclusion: The main focus of health policy analysis studies in Iran over the last thirty years was on the context and process of polices. Although range of actors within and outside the Iran government influence health policies but in many policy processes the power and the role of all actors or players involved in the policy are not recognized carefully. Also, Iran's health sector suffers from lack of a proper framework for evaluating various implemented policies

Individual and institutional capacity-building for evidence-informed health policy-making in Iran: a mix of local and global evidence

BACKGROUND: Providing valid evidence to policy-makers is a key factor in the development of evidence-informed policy-making (EIPM). This study aims to review interventions used to promote researchers' and knowledge-producing organizations' knowledge and skills in the production and translation of evidence to policy-making and explore the interventions at the individual and institutional level in the Iranian health system to strengthen EIPM. METHODS: The study was conducted in two main phases: a systematic review and a qualitative study. First, to conduct the systematic review, the PubMed and Scopus databases were searched. Quality appraisal was done using the Joanna Briggs Institute checklists. Second, semi-structured interviews and document review were used to collect local data. Purposive sampling was used and continued until data saturation. A qualitative content analysis approach was used for data analysis. RESULTS: From a total of 11,514 retrieved articles, 18 papers were eligible for the analysis. Based on the global evidence, face-to-face training workshops for researchers was the most widely used intervention for strengthening researchers' capacity regarding EIPM. Target audiences in almost all of the training programmes were researchers. Setting up joint training sessions that helped empower researchers in understanding the needs of health policy-makers had a considerable effect on strengthening EIPM. Based on the local collected evidence, the main interventions for individual and institutional capacity-building were educational and training programmes or courses related to the health system, policy-making and policy analysis, and research cycle management. To implement the individual and institutional interventions, health system planners and authorities and the community were found to have a key role as facilitating factors. CONCLUSION: The use of evidence-based interventions for strengthening research centres, such as training health researchers on knowledge translation and tackling institutional barriers that can prevent well-trained researchers from translating their knowledge, as well as the use of mechanisms and networks for effective interactions among policy-makers at the macro and meso (organizational) level and the research centre, will be constructive for individual and institutional capacity-building. The health system needs to strengthen its strategic capacity to facilitate an educational and training culture in order to motivate researchers in producing appropriate evidence for policy-makers