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Abstract Background Concerning maternity service, the mother’s quality assessment is central because emotional, cultural, and respectful support is vital during labour and the delivery process. Studies concerning the perceived quality of maternity services from the perspective of mothers have rarely been carried out in Iranian hospital settings. Therefore, this study aimed to measure the gap between the expectations of patients with maternity services and their perceptions of the service and identify associated factors at a maternity hospital in northwest Iran using service quality (SERVQUAL) and health quality (HEALTHQUAL) questionnaires. Methods This cross-sectional study consists of 350 randomly selected participants visiting a maternity hospital in Tabriz, Iran between November 2022 and February 2023. Admitted patients responded to two questionnaires adopted from the SERVQUAL and HEALTHQUAL instruments. The questionnaire was provided on hospital admission for expectation and before hospital discharge for perception. The quality gaps between the expectations and perceptions of participants were analyzed. Data were analyzed using SPSS (Version 24) through descriptive analyses, paired t-tests, and multivariate linear regression. Results Based on the SERVQUAL questionnaire, the overall score for expectation and perception were 3.69 and 4.15, respectively and the overall gap in service quality was − 0.45. Similarly, according to the HEALTHQUAL questionnaire, the overall score for expectation and perception were 3.66 and 4.53, respectively, and the overall gap in service quality was − 0.87. In addition, the results indicated that the highest gap was observed for the Effectiveness and Assurance dimensions with gap scores of − 1.20 and − 0.69, respectively. Older patients, having an academic education, women who were residents in urban and those who visited for the first time were found to have significantly higher expectations compared with their perceived quality of care (P

Background: Given the impact of high intake of sugar-sweetened beverages on type 2 diabetes, intervention to reduce their consumption can be a top priority for any health system. Thus, the purpose of the present study is to simulate the impact of policy options related to reduce consumption of sugar-sweetened beverages (SSBs) on the prevalence and mortality of type 2 diabetes in Iranian men and women. Methods: A discrete event simulation (DES) model was used to predict the effect of several policy options on the prevalence and death from type 2 diabetes in Azar Cohort Databases. Population age- and sex-specific prevalence and incidence rate of diagnosed diabetes were derived from the national health data. The Preventable Risk Integrated Model (PRIME) model was used for coding the input parameters of simulation using R and Python software. Results: The prevalence and mortality rate of type 2 diabetes under the scenario of reduced consumption of SSBs indicated that the highest and the lowest prevalence and mortality rates of type 2 diabetes for men and women were related to no policy condition and replacing SSBs with healthy drinks, like water, respectively. Also, the maximum "number of deaths postponed/ prevented" from type 2 diabetes was related to replacing SSBs with water (n=2015), and an integration of reformulation and applying 10% tax on SSBs (n=1872), respectively. Conclusion: Simulating the effect of different policy options on reducing the consumption of SSBs showed "replacing of SSBs with water" as the most effective policy option in Iranian setting.

Objective(s): The healthcare environment should provide the highest level of safety for staff and clients. This study aimed to assess the structural and non-structural safety status of Tabriz primary health care centers. Methods: This cross-sectional study assessed 40 comprehensive healthcare centers in Tabriz, Iran in 2019. The data collection instrument was a self-designed questionnaire We assessed the compliance of comprehensive healthcare centers with the standards checklist through conducting interviews, considering observations, and reviewing the documents. The descriptive results for qualitative data were reported as frequency (percentage) and for quantitative data as mean (standard deviation). Furthermore, to evaluate the association between contextual variables and physical safety status of centers, t-test, ANOVA, and Tukey’s post hoc tests were used as appropriate (structural or non-structural). Results: The results of the study showed that the level of structural, non-structural, and total safety for the physical space of the centers was 48.2%, 37.4%, and 43%, respectively. Accordingly, based on cutting points, the level of structural safety and total safety was identified as moderate, and the level of non-structural safety was identified as low. In addition, descriptive results showed that there is a statistically significant relationship between urban area and non-structural safety so that non-structural safety of centers located in zone 4 was significantly higher than the safety of centers located in zone 10 (P = 0.011). Conclusions: Based on the findings, the safety status of Tabriz health centers was identified as unfavorable and will not able to provide proper services to their covering population in serious hazards.

Abstract Background Medical services are among the most urgent needs of the disaster-affected population. Consequently, hospital preparedness -as the main health services provider- is one of the vital factors in effective response to disasters. The present study aims to explore the perspectives of study participants about the influential factors of hospital functional preparedness in a lower middle-income country. Methods In this qualitative study, data were collected through 17 semi-structured interviews with disaster management authorities selected by purposive sampling. Content-Analysis was used to analyze the data. Results 138 codes were developed and categorized into ten categories and 34 subcategories. The main categories were: 1- leadership, command, and coordination (4 subcategories); 2- risk assessment (3 subcategories); 3- legislating and developing protocols, guidelines, and programs (3 subcategories); 4- estimating and storing the necessary supplies and equipment (3 subcategories); 5- human resource management (4 subcategories); 6- education, training, and development of staff (6 subcategories); 7- vital routes and facilities (3 subcategories); 8- communication (3 subcategories); 9- security, safety and locating of safe zones (3 subcategories); 10- underlying disaster risk factors (2 subcategories). Conclusion According to the participants of this study, ten categories of factors can affect hospitals’ functional preparedness; hospital managers and decision-makers can consider these factors to ensure the proper provision of medical services during disasters.

Abstract Background Health-promoting behaviors have been noticed recently as one of the most critical factors in raising life expectancy, which can be formed during adolescence. Thus, the current scoping review aimed to identify the key factors affecting health-promoting behaviors among adolescents. Methods In this scoping review, we searched multiple English online databases, including PubMed, Web of Science, Science Direct, ProQuest, and Scopus, for articles published between 1977 and 2020. All eligible studies describing health-promoting behaviors in adolescents were included. We followed the JBI guideline for conducting a scoping review and increasing the study’s rigor. Extracted data were synthesized through inductive approaches. Results A total of 3199 articles were identified during the first phase. After the screening process, 20 articles were found eligible for final inclusion. Educational factors (individualized education and school health promotion programs), Economic factors (income, economic incentives and national health insurance), Social factors (support system, responsibility and peers), Spiritual, Psychological and Personal factors (gender, family structure, patterns of living, and medical problems) were found effective in health-promoting behaviors among adolescents. Conclusions Health-promoting behaviors among adolescents require careful consideration. The current review identified some fundamental factors affecting health-promoting behaviors in adolescents. Based on the findings, it is recommended that policymakers and healthcare providers develop several interventions based on identified factors to increase adolescent’s health-promoting behaviors among adolescents.

Objective: This study aimed to comprehensively determine the factors that affect the hospitals’ functionalpreparedness in response to disasters.Methods: A systematic review of studies published in English and Persian up to the end of 2022 was performedby searching PubMed Central, Web of Science, Scopus, ProQuest, SID, and Elmnet databases. Articles thatassessed hospitals’ functional preparedness were searched by using a combination of medical subject headingterms and keywords including disaster, emergency, preparedness, hospital preparedness, health care facilitiespreparedness, hospital functional preparedness, health care facilities functional preparedness, readiness, andeffective factors. Additionally, journals and gray literature were manually searched. Two independent reviewersscreened the eligible papers. The inclusion criteria were the full text should be published up to the end of 2022,in both Persian and English, and focus on hospital preparedness. The extracted data were manually analyzed,summarized, and reported using the content analysis method.Results: Of the 3465 articles, 105 studies were eventually included in the final analysis. Eighty-two influentialfactors were identified and classified into seven categories: government, coordination, control, and commanding(7 factors), existing guidelines and preparedness plans (12 factors), regulations (6 factors), supplying of resources(37 factors), education and training (8 factors), multi-layered information management and communicationsystems (8 factors), and contextual factors (4 factors).Conclusion: There are different dimensions of hospital preparedness for disasters, each of which is influencedby several independent factors. Addressing these factors will enhance the actual functional preparedness ofhospitals encountering disasters.

Abstract Background Desired health outcomes are more achievable through strong Primary Health Care (PHC). Using comprehensive and scientific tools, decision-makers are guided to formulate better PHC reforms and policies. This study introduces a sub-national framework based on the World Health Organization (WHO) proposed frameworks for the PHC performance measurement. Method By a mixed-method and qualitative approach, the Iranian sub-national PHC Measurement Framework (PHCMF) was developed through a review of the WHO’s PHC measurement conceptual framework (for selecting Key Performance Indicators (KPIs)), literature review (academic database), PHC-related national documents, consultations with an advisory committee of national experts (6-meetings), and the Delphi technique for finalizing the framework. Results The Iranian sub-national PHCMF was finalized with 100 KPIs in three components including Health systems determinants, Service Delivery, and Health system objectives. Based on the result chain domain, most KPIs were related to the output (24 KPIs) and the least were related to the input and the process (9 KPIs). Conclusion Regarding the comprehensiveness of the developed measurement framework due to its focus on all PHC operational levers and key aspects of PHC systems’ performance, it can be used as a practical tool for assessing and improving the Iranian sub-national PHC system.

Abstract Introduction Community participation is one of the principles of primary health care (PHC). However, it has not been adequately institutionalized due to numerous barriers. Therefore, the present study is conducted to identify barriers to community participation in primary health care in the district health network from the perspectives of stakeholders. Methods This qualitative case study was conducted in 2021 in Divandareh city, Iran. A total of 23 specialists and experts experienced in community participation, including nine health experts, six community health workers, four community members, and four health directors in primary health care programs, were selected using the purposive sampling method until complete saturation. Data was collected using semi-structured interviews and analyzed simultaneously using qualitative content analysis. Results After data analysis, 44 codes, 14 sub-themes, and five themes were identified as barriers to community participation in primary health care in the district health network. The themes included community trust in the healthcare system, the status of community participation programs, the community and system’s perception of participation programs, health system management approaches, and cultural barriers and institutional obstacles. Conclusion Based on the results of this study most important barriers to community participation relate to community trust, the organizational structure, community and the health profession’s perception regarding the participatory programs. It seems necessary to take measures to remove barriers in order to realize community participation in primary healthcare system.

Introduction: Today, the main strategy of countries to improve the health status of people is primary health care (PHC). The present study has two main objectives: 1) scoping review and mapping of the characteristics of innovative PHC models in different countries, 2) developing and validating a model for innovative PHC considering the PHC conditions and challenges of the Islamic Republic of Iran. Methods: The study will be performed in five phases. In this regard, first, a scoping review will be conducted to investigate the characteristics of innovative PHC. Second, a qualitative study will be performed on the PHC challenges in Iran. Third, another qualitative study will be conducted to identify the appropriate components for Iran's innovative PHC system, using the opinions of experts in this field. In the fourth phase, using the panel of experts, a suitable model will be designed for the Iranian PHC system. Eventually, in the fifth phase, the goals and components of the model developed by experts will be evaluated through a Delphi study, and the validity of the model will be measured using appropriate criteria. Results: The findings of this research provide considerable insight into how Iran's PHC system will be able to consider innovative models and changes in response to a new context and newly emerged problems. Conclusion: Given the importance of PHC in the present era and the need to pay more attention to and strengthen it for all communities, it seems necessary to conduct studies and provide appropriate conditions for the development of PHC.

Abstract Background Despite significant achievements in the prevention and control of NCDs in Iran, these conditions are still the biggest challenges to Iran's healthcare system and are estimated to account for 78.1 percent of all deaths. Therefore, this study aimed to reflect on the potential challenges standing in the way to implement the relevant policies, empower the dimensions of governance, and react in an effective and timely manner by Iran's healthcare system to NCDs. Methods This study was conducted with a qualitative approach using the conventional content analysis method. A total of 46 senior managers involved in the prevention and control of NCDs at the medical sciences universities across Iran were recruited through the purposive sampling method and were interviewed via semi-structured interviews. Graneheim and Lundman's approach was utilized to analyze the data. Results According to the analysis of the senior managers' viewpoints, current challenges to implement the program for the prevention and control of NCDs in Iran could be placed into six main categories, including financing, human resources, infrastructure and inputs, legal, executive, administrative, as well as inter-sectoral collaboration, and management and policy-making challenges with their own sub-categories. Conclusion The results revealed that financing was the biggest challenge to successfully implementing the program for the prevention and control of NCDs in Iran. However, strengthening Iran's healthcare system in the field of the prevention of NCDs demanded more innovative measures and strategies, such as the empowerment of human resources, the effective use of intra- and inter-sectoral collaboration, and non-governmental organizations and charities, along with the exploitation of evidence-based studies during policy-making and decision-making processes, with no need for financial resources.

Abstract Background Numerous nutrition-related policy options and strategies have been proposed to tackle hypertension and other risk factors of non-communicable diseases (NCDs). In this study, we developed a comparative analysis using a multi-criteria decision-making (MCDM) model for prioritizing population-based nutrition-related interventions to prevent and control hypertension in Iran. Methods We employed a combination of Delphi technique and Analytic Hierarchy Process (AHP) method as the methodological tool to prioritize decision alternatives using multiple criteria. The prominent assessment criteria and intervention strategies were derived using a literature review, focus group discussion (n = 11), and a 2-round modified Delphi technique with specialists and experts involved in different stages of health policy-making (round 1: n = 50, round 2: n = 46). Then, the AHP was used to determine the weightage of the selected interventions and develop the decision-making model. The sensitivity analysis was performed to test the stability of the priority ranking. Results Nine alternative interventions were included in the final ranking based on eight assessment criteria. According to the results, the most priority interventions to prevent and control hypertension included reformulation of food products to contain less salt and changing the target levels of salt in foods and meals, providing low-sodium salt substitutes, and reducing salt intake through the implementation of front-of-package labeling (FOPL). The results of the sensitivity analysis and a comparison analysis suggested that the assessment model performed in this study had an appropriate level of robustness in selecting the best option among the proposed alternatives. Conclusion MCDM techniques offer a potentially valuable approach to rationally structuring the problem, along with the opportunity to make explicit the judgments used as part of the decision-making model. The findings of this study provide a preliminary evidence base to guide future decisions and reforms aiming to improve appropriate population-based interventions for tackling hypertension and other risk factors of NCDs.

Background. Primary health care system provides appropriate prevention and primary mental care services only for rural population. Therefore, the Community Mental Health Center (CMHC) was developed to provide mental health services in urban areas. The present study aimed to outline the performance, achievements, and challenges of CMHC in Tabriz, Iran. Methods. This was a qualitative pilot study with in-depth interview approach. The outcomes, implications, and challenges of CMHC in Tabriz city were evaluated from 2015 to 2019 using three methods, including conducting in-depth interviews with two executive managers, holding focus group discussion (FGD) with managers and mental healthcare providers, and collecting mental health care indicators from the patients’ health records. After evaluating the challenges, appropriate recommendations to improve mental health services in urban areas were presented. Results. A total of 17 specialists and general medical doctors collaborated in this study. During the study, 1053 initial visits and/or screenings and 2313 patients with psychological disorders were identified and recorded. Moreover, a total of 988 mental training sessions were held for patients and their families. Five main themes, including the necessity for establishment and objectives, implementation process, achievements, challenges, and recommendations, were identified during in-depth interviews and FGDs. Conclusion. It seems that CMHC is an appropriate strategy and model for providing basic mental health services, especially in metropolitan cities. Longitudinal studies with a randomized controlled trial design as well as cost-effectiveness evaluation studies are required to confirm CMHC in the Iranian context

Background. Suicide is recognized as a public health issue in Malekan County through a health community assessment. A community-based suicide prevention program was conducted during 2014-2017. Methods. This health system research was conducted in seven steps, including conducting systematic reviews, gathering expert opinions, improving the coverage of suicide attempt records, conducting research to identify regional risk factors, conducting follow ups and managing the individuals attempting suicide, training health gatekeepers, and launching public awareness campaigns. Our goal was to lower the rates of suicide, and suicide attempt by 15% and 20%, respectively. Multiple logistic regression was calculated to estimate the adjusted odds ratios and the 95% confidence intervals. Result. 821 suicide attempts and 32 suicides had been recorded in the county. 70% of the suicides had been committed by men while the majority of attempters were females (64%). Most of the suicides (18cases-56.25%) had occurred in the spring while the majority of suicide attempts (288cases-35.8%) had been recorded in the summer. The common methods (62%) suiciders used were hanging and poisoning, which increased death risk significantly (OR: 8.5, 95% CI: 2.9–76.99). The incidence rates of suicide and suicide attempts reduced from 11.22, and 203 per 100,000 in 2013 to 2.63, and 157 in 2017, respectively. Suicide re-attempts also diminished from 12% in 2013 to 6.7% in 2017. Conclusion. Suicide, SA, and re-attempt were lowered by 75%, 22%, and 42%, respectively. Practical Implications. The practical framework that emerged out of the present study can be used for generating future suicide prevention strategies. Furthermore, our study highlights the need to consider a wide range of contextual factors when developing suicide prevention programs.

Background. From the start of the COVID-19 pandemic in February 2019 in Iran, the Iranian health system, following its mission, began planning with the goal of pandemic prevention and control. Various steps were taken, and the program of National Mobilization against COVID-19 was devised to provide services for individuals in the community, mainly the sick and vulnerable, and promote people's knowledge and skills regarding the crisis. Given the role of Community Health Workers (Behvarzes and Moragheb-e-Salamats) in preventing and controlling infectious diseases, this study was carried out to investigate their role in the COVID-19 pandemic. Material. The present study is a descriptive cross-sectional study. The census method was used to study 30034 Behvarzes and 22573 Moragheb-e-Salamats working in medical universities. The required data were extracted using the integrated health system and the portal of the Ministry of Health and Medical Education's Primary Health Network Management Center and were analyzed using descriptive and analytical statistical methods. Results. More than 78 million people were screened during the first step of the national mobilization against COVID-19, more than 42 million during the second step, and more than 59 million during the third step. In addition, by the end of the fourth step of the national mobilization, 4,278,899 people who had come into close contact were screened. According to the health system's report, these community health workers had injected 28,073,777 vaccines since the implementation of the fifth step (until 04.09.2021). Conclusion. Considering the facilities and capabilities of primary health care networks in providing prevention, diagnostic, and treatment services, the activity of the primary health network management center and all affiliated units in the implementation of the National Mobilization against COVID-19 program has been significant since the beginning of this pandemic. Inadequacies in healthcare human resources, financial resources, and training planning should all be considered.

Background. COVID-19, caused by a new beta-coronavirus called SARS-CoV-2, started in China in late December 2019. Its outbreak was officially announced in Iran on February 19, 2020. The official report of the virus spread throughout the country was announced in mid-March 2020. While expanding the coverage of the "Each Home as a Health Post" program, universities gathered and trained health messengers and health volunteers with the educational content "A Guide to Live with COVID-19". Methods. This study is a cross-sectional descriptive study. The sampling method was the census method. The required data were extracted using the integrated health system and the portal of the Ministry of Health and Medical Education’s Primary Health Network Management Center. They were analyzed using descriptive and analytical statistical methods. Results. The numbers of household health messengers and health volunteers were 11134290 and 280619, respectively. The highest total number of health volunteers and health messengers with 824803 people were in Shahid Beheshti University and the lowest with 7088 people in Gerash. Households with health messengers were 11656389, covering 50.1% of Iranian households. The national average score of trained messengers in the COVID-19 training course was 79.2%. In 22 universities/colleges, 100% of the health messengers passed the COVID-19 training course. Conclusion. Implementing the "Each Home as a Health Post" program has effectively controlled COVID-19 spread by increasing awareness and promoting self-care in the community. Health messengers and health volunteers were the essential elements of the "Each Home as a Health Post" program. They identified and referred patients to selected COVID-19 centers, improving care and services such as interceptions and support.

Background. In December 2019, a new disease was reported in China that spread rapidly worldwide. This disease is called COVID-19, a viral infection of the coronavirus family. COVID-19 has caused health, social and economic problems around the world. In Iran, the first disease cases were reported in February 2020. This article aimed to describe the results of the fourth step of the National Mobilization Plan against COVID-19 pandemic. Methods.The information used in this cross-sectional-descriptive study is based on the data recorded in the computer program (Portal) of the Network Management Center of the Ministry of Health and Medical Education.The fourth step was devised to manage and control the COVID-19 pandemic with public participation and coordination between departments. It was formed of four teams, including contact tracing, home care, supervisory, and support teams. Excel 2016 software was used to analyze the present study's data, and ArcMap software version 10.8 was applied to draw thermal maps. Results. In this study, there were 3.2 members per contact tracing team. This number was equal to 3.2, 2.9, and 3.8 people per team for supportive, home care, and supervisory teams, respectively. Also, on average, the contact tracing teams tracked 135.9 cases per team. This number was 518.6 visits per team for supervisory teams, 75.3 for home care teams, and 52.2 households for support teams. During the program's implementation, 3065.3 PCR tests and 3596.7 rapid tests were taken per 100,000 population, of which 15.5% were positive. The average contact tracing in people with close contact with the infected people was 4.87 per patient with a positive test. Conclusion. The COVID-19 pandemic challenged all political, economic, social, and health policies and exposed the weaknesses of the governments. According to statistics and information, the measures taken to manage and control COVID-19 in Iran have been valuable and effective. Still, the continuation of this process depends on the persistence of policies and protocols by the government and people in the society.

Background. In late 2019, the outbreak of COVID-19 disease, with symptoms similar to the common cold or severe respiratory illness, created a global public health crisis. In order to control and manage this disease, countries and the World Health Organization have adopted various strategies and decisions.This study aims to describe the initial measures of the Ministry of Health and Medical Education of the Islamic Republic of Iran with the focus on the Deputy Minister of Health in the framework of the national mobilization plan to combat COVID-19. Methods. A mixed method study including reviewing the documents of different departments of the Deputy Minister of Health in the management and control of the COVID-19 epidemic (qualitative) and descriptive cross-sectional (quantitative) study was conducted between March 2020 and April 2020. In this study, data and information related to all 63 universities / medical schools in the country were collected from the electronic health record systems and the portal of the Network Management Center and analyzed using EXCEL software.Results. In the first step of the national mobilization against COVID-19, about 1200 selected comprehensive health centers of COVID-19, salamat.gov.ir self-assessment system and COVID-19 distance counseling and training telephones (406-190-1666) were launched. About 98% of the people registered in the electronic health record systems (78,315,029 people) were orally screened and evaluated, of which 6,220,603 were elderly, 262,717 had diabetes, and 3,356,131 had high blood pressure, 29,201 obease people, 517,696 pregnant mothers and 2,722,659 foreign nationals. Another important result of the implementation of the first step of the national mobilization was a significant reduction in the burden of hospitalization and management of outpatients in the first level of the health system (primary health care). Conclusion. The COVID-19 epidemic created a crisis in the world, the management of which became the top of the world's health activities. The health sector of Iran, using the capacity of the health network system structure and service providers, developed appropriate policies for the management and control of this disease. One of these policies is the verbal screening to combat COVID-19, which has led to the optimal management of this epidemic.

Background. As an emerging disease, COVID-19 is considered more than just a health crisis, as it socially affects communities. Therefore, community-oriented solutions via the primary health care system can better manage and control this pandemic. The Ministry of Health and Medical Education, and the executive branch of the Deputy Minister of Public Health, played an influential role in controlling the epidemic with the community-based and network-based interventions in the National Mobilization Plan against COVID-19. Methods. A cross-sectional descriptive study was conducted. The data from portal of Network Management Center, Centers for Disease Control and Prevention (CDC), CLIS system, Reference Health Laboratory, and electronic record systems of the public health networks of all universities across the country were used to assess the second step of the National Mobilization Plan against COVID-19. Data was collected from April 13 to August 11, 2020, and was analyzed using SPSS software. Results. During the second phase, more than 42 million people were screened by health care providers. About 98.4% of this population were diagnosed with no problems, and 0.4% were referred to the selected COVID-19 comprehensive health centers for examination and medical procedures by physicians. Of all the direct and referred patients of the selected COVID-19 comprehensive health centers, 55.3% had no problems, 37.8% needed to be tested, and 3.6% needed to be referred to a hospital, and 3.3% received outpatient care. In the first days of laboratory screening, 11% of PCR were positive. By the end of the second step of the National Mobilization Plan against COVID-19, this rate had increased to 25%. Conclusion. In times of crisis and epidemic conditions, the health network system and the primary health care providers can effectively manage outpatients and reduce the burden of hospitalization. Only 3.6% of outpatients in the network system were referred to hospitals. The rest were cared for and followed up by the primary health care providers. Therefore, strengthening the network system structure and primary health care should be further considered.

Background. In order to respond the people in the COVID-19 crisis, a number of comprehensive urban health centers in the primary health care system converted to the selected COVID-19 centers in 2020. Considering the importance of evaluating the performance of the mentioned centers and ensuring the continuity of the services provided in accordance with the rules and instructions, the performance evaluation of the mentioned units began from July 2020 to march 2021 in three levels: self-evaluation (first level evaluation), university evaluation (second level evaluation) and the evaluation of the experts of the Ministry of Health and Medical Education (third level evaluation). Material. A cross-sectional descriptive-analytical study was conducted in all selected COVID-19 centers including 978 in all 63 universities / medical schools across the country in 2020. The sample was selected by census sampling method and includes a total of 978 centers. In this study, 28 main criteria in the fields of education and information, staff and client safety by observing social distance and using personal protective equipment, supplying manpower, equipment, disinfection and work processes and 91 sub-criteria were determined by using Delphi Technique. Results. With the criteria and sub-criteria defined in the areas of "education and information of the people", staff training, observance of social distance, facilities, waste management, manpower supply, supply of medical equipments and work processes , it was identified that in the self-evaluation ( first level evaluation), the criterion with the lowest score was "staff training". The lowest score in the evaluation of the level of universities / medical schools (second level evaluation) was related to the observance of social distance in the centers and the highest score in both evaluation levels was related to the criterion of "providing necessary education to patients regarding prevention and control of COVID-19". Conclusion. Establishment and setting up of selected COVID-19 centers has been one of the effective measures in controlling and managing COVID-19, which was created as a result of changing the structure of the primary health care system. Continuity of service quality of selected centers requires continuous monitoring and evaluation of their performance.

Background. COVID-19 is a global pandemic and has plagued many countries with unprecedented management problems. The rapid spread of COVID-19 around the world has reduced the ability of countries to address and respond to essential health services. Most countries have taken steps to prevent the spread of COVID-19 and improve essential services. The National Mobilization Plan against COVID-19 in Iran’s healthcare system was implemented in 5 stages until the September of 2021. This study aimed to assess and review medical universities' performance in the third step of management and control of COVID-19 to provide documents and reports to be used in similar experiences. Methods. This research is a cross-sectional descriptive study. Data were obtained from electronic records at the primary health care facilities. Data were analyzed and reported using descriptive statistical methods, including comparative tables and graphs. In order to prepare the report, Excel 2016 software was used. The third step of the National Mobilization Plan against COVID-19 was implemented from August 10, 2020, to November 10, 2020. In this step, while re-emphasizing the importance and necessity of verbal and laboratory screening of COVID-19, essential health services provision was highlighted as "in person and remote services" for the covered population. Results. In the third step of national mobilization, 59,109,413 people were screened for COVID-19. During the third step, non-COVID essential services increased compared to the previous three months, with the most significant increase in middle-aged care. Conclusion. After implementing the third step of National Mobilization Plan against COVID-19 in Iran, the number of delivered services in all target groups has increased. This indicates the effectiveness of the third step in the fight against COVID-19 and has increased the provision of Essential Health Services.

Introduction: Evidence on the impacts of accreditation on primary health care (PHC) services is inconsistent. Thus, this study aimed to assess the impacts of accreditation on the performance of PHC centres. Methods: This study systematically reviewed articles published from 2000 to 2019 in the Web of Science, Scopus, ScienceDirect, Springer, PubMed and ProQuest. The following keywords were used: ((primary care OR primary health care) AND (accreditation) AND (impact OR effect OR output OR outcome OR influence OR result OR consequences)). The database search yielded a total of 41256 articles, among which 30 articles were finally included in the review. Results: Accreditation showed the most positive impacts on the quality, effectiveness, human resource management and strategic management of PHC services. Accreditation also positively affected safety, responsiveness, accessibility, customer satisfaction, documentation, leadership, efficiency and continuity of care. Few negative impacts were noted, including the possibility of accreditation being used as a bureaucratic tool, high cost of acquiring accreditation, difficulties in understanding the accreditation process, high staff turnover rate in accredited PHC centres and weak sustainability of some accreditation programmes. Conclusion: Given its numerous positive impacts, accreditation could be used to effectively improve the performance of PHC centres.

The Health System (HS) in the Islamic Republic of Iran is designed in three levels: the first level (Primary Health Care (PHC) system), second level (specialized polyclinics/clinics, general and specialized hospitals), and the third level including sub-specialized hospitals. Iran's HS has passed evolutionary and progressive stages since 1984, thus becoming a comprehensive, people-centered, responsive, and low-cost system, based on the available evidence.

Abstract Background The Astana Declaration on Primary Health Care reiterated that PHC is a cornerstone of a sustainable health system for universal health coverage (UHC) and health-related Sustainable Development Goals. It called for governments to give high priority to PHC in partnership with their public and private sector organisations and other stakeholders. Each country has a unique path towards UHC, and different models for public-private partnerships (PPPs) are possible. The goal of this paper is to examine evidence on the use of PPPs in the provision of PHC services, reported challenges and recommendations. Methods We systematically reviewed peer-reviewed studies in six databases (ScienceDirect, Ovid Medline, PubMed, Web of Science, Embase, and Scopus) and supplemented it by the search of grey literature. PRISMA reporting guidelines were followed. Results Sixty-one studies were included in the final review. Results showed that most PPPs projects were conducted to increase access and to facilitate the provision of prevention and treatment services (i.e., tuberculosis, education and health promotion, malaria, and HIV/AIDS services) for certain target groups. Most projects reported challenges of providing PHC via PPPs in the starting and implementation phases. The reported challenges and recommendations on how to overcome them related to education, management, human resources, financial resources, information, and technology systems aspects. Conclusion Despite various challenges, PPPs in PHC can facilitate access to health care services, especially in remote areas. Governments should consider long-term plans and sustainable policies to start PPPs in PHC and should not ignore local needs and context.

Abstract Background Measuring self-care ability in elderly people needs specific instruments. The Self-care Ability Scale for Elderly (SASE) is one of the common instruments used for assessing self-care ability. The aim of this study was to assess the psychometric properties of the SASE among Iranian elderly population. Methods This cross-cultural adaptation study was carried out at Shahid Chamran and Shadpour Health Complex in Tabriz, Iran. The forward-backward procedure was applied to translate the SASE from English into Persian. Then, it was completed to 220 elderly people. A systematic random sampling method was used for sampling. Content validity was calculated through modified Kappa coefficient (modified CVI) based on clarity and relevance criteria. Reliability was measured by internal consistency and test-retest analysis. The construct validity also was assessed using Exploratory Factor Analysis (EFA). All the statistical analyses were performed using SPSS 21 statistical software package. Results The mean of self-care ability was 61.14 ± 21.08. The CVI and modified kappa were 0.91 and 0.92 for relevance and clarity, respectively. The Cronbach’s alpha coefficient was 0.73 and Intra-class correlation coefficient was 0.97. The results of EFA revealed a three-factor solution (‘ability to take care of personal responsibility’, ‘ability to take care for the goals’, and ‘ability to take care of the health’) that jointly explained for 64.61% of the total variance. Conclusion Results of the study showed that the Iranian version of the SASE has good psychometric properties and can be used in assessing the self-care ability of elderly people.

Abstract Background Considering the low frequency of dairy intake in the population, interventions aiming to increase its consumption can be a priority for any health system. Objective This study aims to summarize community-based interventions for improving dairy consumption and their effectiveness to help policy-makers in designing coherent public health strategies. Methods This study was conducted in 2019, using PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, ProQuest, and Google Scholar. Two independent reviewers selected the eligible studies, and the outcomes of interest were extracted. The quality of eligible studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for randomized controlled trials and quasi-experimental studies. Results Out of 521 initially identified articles, 25 studies were included. Interventions reported in 19 studies were effective in increasing dairy consumption. Interventions in high-income countries were more effective than those in middle- and low-income countries. Interventions in health centers and supermarkets were more effective than the community and school-level interventions. Interventions in supermarkets and adolescents as target groups were more effective than children, middle-aged people, and the elderly. Also, educational interventions and changing buying/selling pattern were more effective than multiple interventions. Interventions longer than 24 and 48 weeks were more effective than shorter interventions. Conclusion Three policy options including educational interventions, multiple interventions, and changing the purchase pattern are suggested. It seems that applying all of the interventions together can be more effective. Also, long-term and well-designed future studies in different settings are recommended to confirm these results.

Abstract Background Primary Health Care (PHC) was introduced as the first level of health services delivery after Alma-Ata declaration. However, after forty years, it needs to be more trustful to achieve its predefined objectives. Public trust in PHC is one of the neglected issues in the context. The aim of this study is to evaluate public trust in PHC in Iran. Methods The present investigation is a household survey conducted in East Azerbaijan Province, Iran. Two-stage cluster sampling method with Probability Proportional to Size (PPS) approach was used. Totally, 1178 households were enrolled in the study. PHC trust questionnaire and Ultra-short version of Socio-Economic Status assessment questionnaire (SES-Iran) was used for data collection. Data were analyzed using STATA software (version 15) through descriptive statistics and linear regression. Results The mean ± SD age of the participants was 41.2 ± 15.1 and most (53.7%) were female. Mean score of PHC trust was 56.9 ± 24.7 (out of 100). It was significantly different between residents of Tabriz (the capital of province) and other cities in the province (p

Background: Highly necessary to evaluate the effectiveness of preventive interventions to prioritize them at the community level. We aimed to systematically investigate the related studies on the effects of fluoride varnish and fissure sealant on dental caries in 6-12 children. Methods: We searched PubMed, EMBASE, Web of Science, Cochrane Library and Scopus databases using Fluoride Varnish, Fissure Sealant, Caries, and Oral Health keywords. The timeframe selected to search for articles is from 2000 to Dec 2020. CMA software: 2 (Comprehensive Meta-Analysis) was used to perform the meta-analysis. The intervention groups in this study were fluoride varnish and fissure sealants, each of them compared to the control groups. Results: We included nine studies. In the intervention group 84,380 and control group 11,254 individuals were studied. Eight of the studies were Randomized Clinical Trial (RCT) and Field RCT, and two was non-RCT. In the overall Fluoride Varnish efficacy study, 4 were fully effective, 1 was ineffective, and all 4 were completely effective for Fissure Sealant. There was a significant difference between decayed, missing, and filled permanent teeth (DMFT) and decayed, missing, and filled primary teeth (dmft) indices in both interventions and comparison groups. Moreover, the mean difference of DMFT for Fluoride Varnish and Fissure Sealant in the intervention and control groups were -0.55 and -0.29, respectively (P=0.00). Conclusion: Due to the efficacy of fissure sealant and fluoride varnish in preventing dental caries in children aged 6-12 yr, these interventions can be considered as health priorities of societies and health systems interventions in countries.

Background Excessive salt intake results in hypertension (HTN), which is a major risk factor for cardiovascular disease (CVD). This review and meta-analysis aimed to evaluate the effect of salt reduction interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods Studies were identified via systematic searches of the databases, including PubMed, Embase, Scopus, and Web of Science. All the studies examining the effectiveness of salt reduction interventions on blood pressure (BP), regardless of age, sex, and HTN status, were included in the systematic review, and eligible studies were used in the meta-analysis. A random-effect model was applied for quantitative data synthesis. Results A total of 50 trials extracted from 40 articles (21 trials on nutrition education,10 on self-help materials,17 on salt substitutes, and 2 on food reformulation) were included in the systematic review. The pooled results of 44 eligible trials showed that salt substitution and nutrition education interventions had significant effects on both SBP (WMD: -7.44 mmHg, PConclusion Our results supported that salt substitution and nutrition education are effective nutrition strategies to lower BP. It seems that multi-component approaches could be more effective in improving BP status. However, further trials are required.

Abstract Iran is amongst the countries that have achieved the fifth goal of the United Nations Millennium Development Goal. The maternal mortality ratio (MMR) in Iran has declined from 48 cases per 100,000 in 2000 to 16 cases per 100,000 in 2017, showing an annual decline rate of about 6.3%. In the International Year of the Nurse and the Midwife (year 2020), this commentary highlights two decades of Iranian midwives' activities as a health care provider under supervision in a multidisciplinary team in reducing maternal mortality.

Abstract Background Finding the relationship between the major dietary patterns and cardiometabolic phenotypes could be used for planning prevention programs based on the cultural and dietary habits to prevent transient from a metabolically healthy state to an unhealthy state. So, we aimed to assess the association between dietary patterns and cardiometabolic phenotypes in the northwestern population of Iran. Method In the present cross-sectional and population-based study, 504 adults sampled by cluster sampling in East-Azerbaijan, Iran. Factor analysis was used for determining the dietary pattern. Metabolic phenotypes were determined according to body mass index (BMI) cut–off point (25 kg/m2), and the presence of the metabolic syndrome. The independent sample t-test, one-way ANOVA, chi-square, and multinomial regression were used for statistical analysis. Results In both adjusted (OR: 2.24, 95% CI: 1.17, 4.31) and unadjusted models (OR: 3.14, 95% CI: 1.54, 5.42), the last tertile of the animal dietary pattern was associated with metabolically healthy obese (MHO) phenotypes. After adjusting, the last tertile of the animal dietary pattern was significantly associated with an increase of metabolically unhealthy obese (MUHO) phenotype (OR: 2.61, 95% CI: 1.18, 5.76). Conclusion In the present study, the animal dietary pattern was associated with MHO and MUHO phenotypes. It is suggested that some measures should be taken to strengthen nutrition education for the population and advocate a balanced diet to improve the condition.

Background and Objectives: The aim of this study was to assess the performance of Social Emergency Referral System (SERS) in Tabriz. Material and Methods : This was a mix-method study (quantitative and qualitative). The opinions of the experts regarding SERS were summarized by interview and semi-structured questionnaire and analyzed by content analysis method. Performance indicators and service provision were extracted based on recorded data in the health center of Shahid Chamran and the health center of East Azerbaijan province and presented in descriptive statistics. Results : According to the findings of the study, among vulnerable people, 84% were related to addiction and 16% were other problems. Of the 11 detected social harms, after drug addiction, the highest rates refer to divorce, spouse abuse and students who dropeed out of schools and was the largest share of referrals to the welfare organization. The most important strengths of the SERS were identifying vulnerable people and guding them to receive support services and activation of NGOs and the most important weaknesses were the weak cooperation of organizations. Also, for SERS progress, the potential of close cooperation of welfare organization, the Red Crescent and the Relief Committee and the lack of cooperation between provincial government and the municipality should be considered. Conclusion : According to the study findings, in order to improve the performance and expansion of the SERS in Tabriz, one of the most important issues that should be considered, is to improve the participation and cooperation of all stakeholders and related organizations in order to increase public trust in the program and improving its performance .

Background: AIDS is an emerging disease, and despite the fact that it has not been recognized for the first half-century since its inception, it has been known as a century-old disaster. This disease, by proliferation in immune cells and ultimately by weakening the immune system, makes people vulnerable to diseases. Our study seeks to examine existing cases of HIV/AIDS patients in East Azerbaijan province in Iran and provides useful guidance for patient diagnosis, treatment, and care. Methods: This is a descriptive-analytic study in which the target group includes all HIV-positive or AIDS patients identified or reported from 2004 to 2014 in Tabriz Medical Sciences or Health Centers of East Azerbaijan province. The demographic information of all patients were recorded by a researcher-made questionnaire during visiting the disease-management counseling centers. All data including transmission of the illness (including all possible ways), the diagnostic date, the onset of treatment and the date of death were collected, and then entered into the software Stata, version 11.0 (Stata Corp., College Station, TX, USA). The information were imported in the ArcGIS software, version 10.7.1 (ESRI Inc., Redlands, CA, USA), maps were created, and geographic and spatial data were analyzed. Results: According to the results of this study, most patients with 89.9% were male, 28.9% were under the age of 36 years, 32.3% had elementary education, and the most common way of transmission with 42.3% is through the shared infusion. Conclusion: According to the results of this study, the highest prevalence of AIDS in East Azerbaijan province was observed in men under the age of 36 years and primary and lower secondary education in Tabriz and Maragheh cities.

The Relationship of Quality of Services Provided to Type 2 Diabetic Patients with Self- assessment in Comprehensive Health Service Centers Daneshkohan Abbas1, Zarei Ehsan1, Sadegh Tabrizi Jafar2, Ranjbar Fatemeh3* 1. Assistant Professor, Department of Health Management, Policy and Economics, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Professor, Department of Health Services Management, Faculty of Management and Medical Informatics, Tabriz Health Services Management Research Center, Tabriz, Iran 3. MSc in Health Service Management, Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran * Corresponding Author: Fatemeh Ranjbar Address: Shahid Beheshti University of Medical Sciences, School of Public Health, Chamran Shahid Highway, St. Yemen, Tehran, Iran Tel: 00982122432040 Email: fatemeh_ranjbar@sbmu.ac.ir Abstract: Background & Objectives: Ensuring high quality care for diabetic patients is a challenge for healthcare systems throughout the world. The aim of this study was to evaluate the relationship of quality of services provided to type 2 diabetic patients with self- assessment in comprehensive health service centers. Methods: This descriptive-analytic cross-sectional study was conducted on 203 patients with type 2 diabetes referred to ten comprehensive health service centers of south Tehran/ Iran in 2018 selected through convenience sampling method. Data collection tool was a questionnaire for comprehensive assessment of quality of health services. Data were analyzed through SPSS22 and using t-test, ANOVA and logistic regression statistical tests. Results: From the perspective of patients, mean score of quality of services was 7.47. Among different health services, the highest mean score of quality was related to trust and continuity of service while, support and prevention gained the lowest mean score of quality. There was a significant statistical relationship between the quality of service and self-assessment of diabetes control in the past 12 months (P= 0.007). Also, a significant relationship was found between the quality of service and diabetes complication (P = 0.04). With each unit increase of the quality of service, the odds of a standard visit increased by 27% (P = 0.013). Conclusion: Design and implementation of interventions in order to increase the social support of patients and sharing their experiences with each other as well as improving the dimensions of prevention and safety in care are essential. Key­words: Service quality, Type 2 diabetes, Comprehensive health service centers, Importance, Performance ­Citation: Daneshkohan A, Zarei E, Sadegh Tabrizi J, Ranjbar F. The Relationship of Quality of Services Provided to Type 2 Diabetic Patients with Self- assessment in Comprehensive Health Service Centers. Journal of Health Based Research 2019; 5(2): 187-201. [In Persian]

Background: Identifying and prioritizing the most appropriate policies for enhancing nutritional habits are vital for the prevention and control of non-communicable diseases (NCDs). This study was conducted to prioritize the nutritional policies in Iran. Methods: A cross-sectional survey applying the two-round Delphi technique was used to prioritize policy options in preventing the burden of NCDs. In the first round, the experts in health and nutrition policy were asked to prioritize 21 policy options on a 5-point Likert scale. After analyzing the first-round questionnaire, the highest mean and lowest dispersion index were calculated as an indicator of high-priority options. In the second round, the policy options suggested by the participants were added to the second-round questionnaire. Finally, the questionnaires were sent to all the participants in case they desired to change their opinions. Results: The expert achieved consensus on "principles of healthy eating" courses in the curriculum of students as a high-priority policy option. In this regard, "promoting community education and customizing healthy food choice" was the next high priority policy option. On the other hand, the lowest policy priority option was "sending free/low-price healthy drinks at home". The three high priority policy categories were reformulating the content of food, enhancing the consumers’ knowledge, and food labeling, respectively. Conclusion: Our findings showed that reformulation, food promotion, and food labeling had the highest priorities for preventing NCDs in Iran. Although food provision policies were cost effective in developing countries such as Iran, it is essential to provide sub-structures for the reformulation of food products.

Abstract Background Trust has been introduced as the cornerstone of the public and health providers’ relation. Public trust in primary health care (PHC) is crucial and must be measured. The aim of this study was to develop and validate PHC trust measurement tool. Methods This was a psychometric study to develop PHC trust measuring tool done in Tabriz, East-Azerbaijan with participation of 600 households in 2016. Item generation was done through literature review and experts opinions. The content validity, reliability and construct validity of the PHC trust tool were assessed using several statistical methods including modified Kappa, Kendall’s Tau and intra-class correlation coefficient (ICC) as well as exploratory factor analysis (EFA). Data were analyzed using STATA 14 statistical software package. Results A 30-item questionnaire was developed. The Modified Kappa coefficient as an indicator of content validity assessment was 0.94. With respect to reliability assessment, a high internal consistency was observed with 0.98 Cronbach-Alpha score and the test–retest reliability for overall scale (assessed by ICC) was 0.94 (CI: 0.87–0.97). Exploratory factor analysis emerged 2 factors. Factor 1 consisted of 25 items accounting for 74.1% of the variance (eigenvalue = 22.47) followed by Factor 2 consisting of 5 items accounting for 19.2% of the variance (eigenvalue = 1.6). Conclusion PHC trust measuring tool could be used as a valid and reliable tool by health systems in Iran and similar contexts to investigate how they are trustful from the public viewpoint.

Abstract Background Providing comprehensive and high-quality services is one of the most important goals of the health systems and a basic principle for Universal Health Coverage (UHC). Fulfilling this important task would be feasible through continuous evaluation and improvement of the health services quality. The aim of this study was to develop a framework for quality assessment of Primary Health Care (PHC) in Iran’s health system. Methods This study is a literature review which continued by a qualitative research. The extracted quality dimensions and indicators for initial screening were reviewed and discussed in two panel meetings attended by the experts with regard to the current package of health system in Iran. Using Delphi method, the dimensions and Quality Indicators(QIs) were evaluated and approved by 39 national health professionals in two rounds. Finally, after 4 panel sessions at ministerial level, the selected QIs were categorized in form of the final dimensions of the quality of care. Results The literature review emerged 13 Primary Health Care Quality Assessment Frameworks (PHCQAF) including 20 and 698 QIs. Delphi study resulted in developing Iranian PHCQAF comprising 7 dimensions and 40 QIs. Among these, 8 QIs of the dimension of access and equity, 5 QIs of safety dimension, 2 QIs of efficiency dimension, 13 QIs of effectiveness dimension, 2 QIs of patient-centeredness dimension, 3 QIs of governance dimension and 7 QIs of appropriateness dimension were presented. Conclusions The presented PHCQAF can be used as a comprehensive and practical tool for continuous improvement of the quality of PHC services at local, national and regional levels. Moreover, it can give some useful information to the health managers and policy makers on how the services are provided.

Background and Objectives: Health promoting behaviors are formed during adolescence and often remain until adulthood. This study aimed to explore related factors to health promoting self-care behaviors among adolescents. Material and Methods: A cross-sectional study was conducted in 2016 among 426 adolescents living in Tabriz. Adolescent Health Promotion (AHP) questionnaire was used to collect data. Data were analyzed using descriptive statistics, t-test, Pearson and Spearman correlation coefficients applying SPSS v.16. Results: The mean score of the health promoting behaviors was 69.83. Among six health-promoting behaviors, physical activity and health responsibility were not in good conditions among the students. Adolescents had a high score in the dimension of life appreciation (80.62). There was a significant difference in self-care score between male and female participants (p≥0.05). There were no significant relationships between self-care with age, family size, and birth rank (p≥0.05). There was a significant difference between father education level and family size with nutritional behaviors of the adolescents (p≥0.05). Conclusion: This study showed that the health responsibility among adolescents was low and their physical activities were not sufficient. These results are a warning to policy-makers to pay attention seriously to promoting school health programs in order to promote self-care behaviors among adolescents.

Background: Given the importance of proper management of Health Care Waste Management (HCWM), comprehensive information on interventions in this field is necessary. Therefore, we aimed to systematically review and meta-analysis of characteristics and results of interventions in the field of HCWM. Methods: The required data were gathered through searching the keywords such as waste management, biomedical waste, hospitals waste, health care waste, infectious waste, medical waste, Waste Disposal Facilities, Garbage, Waste Disposal Facilities, Hazardous Waste Sites in PubMed, Scopus, EMBASE, Google scholar, Cochrane library, Science Direct, web of knowledge, SID and MagIran and hand searching in journals, reference by reference, and search in Gray literatures between 2000 and 2019. CMA software: 2 (Comprehensive Meta-Analysis) was used to perform the meta-analysis. Results: Twenty-seven interventions were evaluated. Most of the studies were conducted after 2010, in the form of pre and post study, without control group, and in hospital. Interventions were divided into two categories: educational interventions (19 studies) and multifaceted managerial interventions (8 studies). The most studied outcome (in 11 studies) was KAP (knowledge, attitude and practice). The mean standard difference of interventions on KAP was estimated 3.04 (2.54–3.54) which was significant statistically (P

Background: Given the challenges of governments to deliver primary health care (PHC), engaging private sector in the form of public-private partnership (PPP) can be effective policy. The aim of present study is to review the experiences of implementing PPP policy in PHC. Methods: This scoping review study was conducted in 2019 using the framework proposed by Arkesy and O’Malley. Required data were collected through search the related keywords in databases, manual search of some journals, websites, and other sources of information and through references check, from January 2000 to May 2019. All studies, which focused on the results of PPP in PHC, and published in English or Persian were included in the study. Results: A total of 108 articles were included in the study. The studies were mostly conducted in low- and middle-income countries. The quantitative studies have demonstrated the success of this policy in improving PHC indicators. Based on the qualitative studies PPP in PHC has many benefits, including access improvement, economic benefits, and service quality enhancement. Conclusions: The present study provides useful information on the experiences of different countries in the field of PPP in PHC that can be used by experts and decision makers to decide whether to engage the private sector in the form of PPP model.

Abstract Background Successful implementation of pay-for-quality (P4Q) programs mostly depends upon a valid, timely, and reliable data about quality measures generated by providers, and interpreted by payers. The aim of this study was to establish a data reporting method for P4Q program through an action research. Methods Qualitative method was used to align theory with action through a three-cycle action research. The study was conducted in September 15, 2015 to March 15, 2017, in East-Azerbaijan, Iran. The purposeful sampling was used to select participants. The participants included healthcare providers, staff in district health centers (DHC), experts, and managers in the provincial primary health center (PPHC). Data was collected by interviews, focus group discussions, and expert panels. Content analysis was used to synthesize the data. In each step, decisions about data reporting methods were made through a consensus of expert panel members. Results The most important dimensions of data reporting method were data entry and accuracy, data reporting, data analysis and interpretations, the flexibility of method, and training. By establishment of an online data reporting system for the P4Q program, a major improvement was observed in the documentation of performance data, the satisfaction of health care providers and staff (e.g. either in DHCs or PPHC), improvement of the P4Q program and acceptance of the P4Q program by providers. Following the present study, the online system was expanded in Iran’s public health system for data collection and estimating the amount of incentive payments in P4Q program. Moreover, more improvements were achieved by linking the system to EMRs and also, providing automated feedback to providers about their own performance. Conclusions A web-based computerized system with the capability of linking medical record and also its ability to provide feedback to healthcare providers was identified as an appropriate method of data reporting in the P4Q program from the viewpoints of participants in this study.

According to the World Health Organization’s report, tobacco use is the first preventable leading cause of deaths in the world.While the prevalence of tobacco use is declining in high-income countries, this prevalence is increasing in the low-income and middle-income countries. Daily, 205 thousand USD and 386 million USD annually spent on cigarette purchasing in Iran, and the health system of the country pays about 1 billion and one hundred and sixty million USD to cure the complications of cigarette smoking. The present study aimed at determination of effective programs and interventions applied in prevention and reduction of tobacco use in societies. Medical databases were searched, related studies retrieved and their content reviewed and classified. According to the results of this study, programs and interventions for prevention and reduction of tobacco use were categorized in six domains including: "studies at different levels of age and groups," "studies in the physical and community environment," "tax and price studies," "electronic cigarette smoking studies," "harm reduction studies," and "interventions facilitating solutions." The results of the study, suggests the followings as appropriate strategies that fit the culture and abilities of the Iranian health system: "culture, the establishment and application of rules", "interventions with a focus on specific groups", "education at all levels and interventions," "organizing training courses and emphasizing the role of the family in protecting adolescents" and “free drug therapy ".

Alcoholic beverages consumption affects all body organs and causes wide range of diseases such as cancers, psychopathy and violent behaviors. There is no precise statistics on alcohol consumption prevalence in Iran. Nevertheless, it is estimated that there are more than one million abusers of alcoholic beverages in the country. Various programs and interventions have been conducted to prevent and reduce alcohol consumption in different nations. The current narrative review study aimed at determining the effective strategies and programs applied in other societies and identifying appropriate approaches to the current situation of Iran. National and international databases were assessed by the research team and related studies were retrieved and categorized after quality assessment. Results of this study indicated that effective programs in prevention and reduction of alcohol consumption can be categorized in six general parts as follows: education and training, health-sector programs, community programs, regulations and policies regarding driving under the influence of alcohol, access-related policies and harm-reduction programs.

Background: Considering the lack of accreditation models for health education and promotion(HEP) activities in the Iranian primary health care (PHC) system we conducted the present study to develop a national accreditation model for HEP actions in the Iranian PHC system.Methods: After a comprehensive review on the accreditation models in PHC field, especially those concentrated on the HEP programs, an initial HEP accreditation model was developed.Then, applying the Delphi technique, 18 experts in the Iranian PHC system with field experience in HEP programs were invited to assess the initial model. In the two-round Delphi study,aggregation was provided on the opinions and the standards and indicators were finalized.Conventional content analysis was applied to make sense of the data collected in the study.Results: The developed HEP accreditation model encompassed 62 indicators and five standards.The standards were as follow: "resources for HEP programs", "educational needs assessment of the target groups", "methods of providing a community with education", "management of health volunteers’ actions" and "evaluation of HEP programs".Conclusion: The standards and indicators found in the present study may serve as an educational rationale for health educators while designing high-quality health education/promotion programs. This model may be helpful for health policy-makers and stakeholders while planning to assess the continuous quality improvement of HEP services delivered in the PHC systems.

Objective: Service quality (SQ) generally refers to the non-clinical aspects of health services and primarily focuses on the relationship between the care provider and the customers, and the environment in which care services are delivered. The aim of this study was to assess the SQ provided for myocardial infarction (MI) from the patients' perspective. Methods: A cross-sectional study was conducted with 164 patients with MI at the Tabriz Shahid Madani cardiology clinic. Study participants were selected using convenience sampling. SQ was measured using a validated Comprehensive Quality Measurement in Healthcare SQ questionnaire. The reliability was confirmed based on Cronbach's alpha coefficient (α=0.81). SQ was calculated using the formula SQ=10–(importance × performance), based on the importance and performance of non-health-related aspects from the customers' perspective. Importance scores ranged from 1 to 10 and performance was scored between 0 and 1. Results: Of 164 participants, about 75% were men and almost 44% were between 51 and 65 years of age. From the customers' perspective, the total SQ score was 6.80 (0-10 scale), and the individual scores for all SQ aspects were below an acceptable level. Confidentiality, dignity and continuity were given the highest scores, while availability of support groups had the lowest score. Conclusion: The study findings revealed an opportunity to improve SQ. Patient and provider participation in quality improvement activities could be an effective strategy to improve the aspects of health care quality that were most important to the customers and those with low scores, such as availability of support groups.

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.

Background: Poor nutritional habits along with physical activity levels are among the main causes of obesity and overweight in children and teenagers. Considering the importance of school health and nutrition for children and teenagers, this study was conducted to assess school health activities and programs in the field of healthy diet and nutrition. Methods: This cross-sectional and applied study was conducted in 2017. The statistical population consisted of all school health principals and teachers in Tabriz city. Sampling was done in the first stage by stratified method and in the second stage; a simple random sampling was utilized on 93 schools. The data collection tool was the school health principals and teachers profile. Data were analyzed by SPSS 22 software using descriptive statistics (percentage and frequency/mean ± SD) and analytical tests (U Mann Whitney and Kruskal-Wallis Tests). Results: According to the findings, 84.9 percent of schools had a store, dining room or buffet for snacks, drinks, and other meals. Promotional activities such as encouraging students to drink water (94.6 %), promoting the use of fruits and vegetables in schools, and providing useful and necessary information for students and their families (76.3 %) were conducted by most schools. 90.3 % of schools prevented the advertisement of candy, sweets, fast food and carbonated soft drinks in the school environment, and 75.3 % prevented the advertisement of candy, sweets, fast food and carbonated drinks in publications and school curriculum. Conclusion: Most schools do not have much activity in providing healthy food and allocating space for breakfast and meals. Most schools have a good performance profile in terms of educational and training activities, the prohibition of harmful food promotions, and the availability of clean drinking water. Findings of this study can help health managers and health authorities to take the necessary steps to solve the problems based on the status quo.

Introduction: The role of scrub in the prevention of post-surgery infections is well-known. This study aimed to investigate the inputs and process of surgical scrub in operating rooms of the largest heart hospital of northwest Iran. Methods: This study took place with a before-after design as a clinical audit in 2014. A check list developed based on national and international standards of surgical hand scrub was used as the study instrument. Checklists were completed by observation of surgical team scrubbing in real situation. Descriptive statistics and graphs were used to describe the results. Results: A compliance degree with the standards for prerequisites, equipment, general items, process and time of scrub was observed as 58%, 55%, 33%, 68% and 22%, respectively. The compliance degree after the intervention was 72%, 66%, 66%, 85% and 61%, respectively. Improvement was observed in all studied aspects of scrub. The total score of compliance with the standards changed from 47% to 70%. The main issues were incorrect order of scrubbing the areas of the hands, incorrect way of scrubbing the arms, insufficient scrubbing the arms (not above elbow), and lack of awareness about hospital’s policy on scrub time. Conclusion: The results showed defects in the surgical scrub of the studied hospital and that the compliance with the standards can be improved by simple interventions. Periodical audit and observation of the scrub and then feedback is recommended.

Background & Objectives: Licensure is a healthcare evaluation approach which has particular importance in compliance with minimum requirements of healthcare centers for getting started and continuing their performance. The aim of this study was auditing of Tabriz general dentistry offices based on licensure standards. Methods: This descriptive- analytical study was done in 197 general dentistry offices in Tabriz city selected randomly. The required data were gathered using a researcher-made checklist with 75 questions in 7 main dimensions including physical environment, medical equipment, nonmedical equipment, human resources, medical records and informatics, policy consideration, and hygiene and infection control. Data analysis was done using t-test, ANOVA and Tukey statistical tests and through SPSS19 software package. Results: The total rate of compliance with licensure standards in Tabriz dentistry offices was 78.5%. The highest and lowest rates of compliance were respectively in dimensions of “medical records” (92.3%) and “non-medical equipment” (66.4%). There was significant relationship between “job experience of dentists” and standards compliance score in “law and policy consideration” and “hygiene and infection control” dimensions; so that, more job experience was associated with higher compliance score in these dimensions. Conclusion: Despite acceptable status of the assessed dentistry offices in regard to licensure requirements, there are still shortcomings in some dimensions. No doubt, the obtained results could help authorities to improve the status of dentistry offices and increase community satisfaction. Keywords: Licensure, Audit, office, General dentists. Citation: Tabrizi SJ, Gharibi F, Kamkari M. The Auditing of Tabriz General Dentistry Offices Based on Licensure Standards. Journal of Health Based Research 2017; 3(2): 115-126.

Non-communicable diseases (NCDs) have become a major public health problem not only in developed countries, but also in developing countries; as cardiovascular disease is considered to be the leading cause of death in the world. Unhealthy diet, insufficient physical activity and smoking are the main determinants of NCDs in the world. According to the reports, daily intake of salt in Iran is above the recommendations of the World Health Organization (WHO), while taking too much salt affects the human health negatively and WHO regards reducing population salt intake as one of the most cost-effective measures to improve public health. Despite the fact that reducing salt intake in the population is difficult, but with specific actions and strategies, reducing most of the populations' salt intake is possible. These actions and strategies include: 1) sodium-restricted diet and monitoring sodium content of foods, 2) awareness campaigns (media and communications strategy), 3) labeling and development of symbols identifying low-salt products, 4) United Kingdom strategy-gradual reduction of sodium, 5) food industry strategy (re-formulation), and 6) taxation on and rising prices of unhealthy food. Successful countries in reducing salt intake have followed these practices.