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Showing 352 results for Type of Study: Original Article
Mehdi Hosseini, Ahad Norouzzadeh, Fatemeh Hosseini,
Volume 23, Issue 4 (2-2025)
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: The integration of digital technologies—computer-based systems, devices, and methods—is transforming organizational activities within the healthcare sector. However, research on the adoption of these technologies in healthcare remains limited, with a predominant focus on structural rather than behavioral factors. As the successful implementation of technology ultimately depends on the workforce, behavioral aspects play a decisive role. Therefore, this study aims to identify the principal behavioral barriers to the adoption of digital technologies in the healthcare sector.
Methods: This applied research utilized a three-stage survey methodology. The stages included: (1) identifying the most significant behavioral barriers to digital technology adoption through a literature review and expert opinions; (2) developing a hierarchical model of these barriers using Interpretive Structural Modeling (ISM); and (3) testing the hypotheses derived from the model with a sample of 302 healthcare professionals.
Results: The ISM model identified a hierarchy of six key behavioral barriers: lack of digital literacy, low perceived value, high perceived risk, negative attitude, resistance to change, and ultimately, non-adoption of digital technology. Based on this model, six research hypotheses were formulated. Regression analysis was conducted to test these hypotheses, and the results indicated that all six were statistically supported.
Conclusion: The findings establish that a lack of digital literacy is the most fundamental barrier to digital technology adoption in the healthcare sector. To address this primary obstacle, the study recommends targeted interventions, such as conducting national assessments of digital literacy levels among healthcare staff and implementing tailored training programs to enhance their technological competencies.
Fateme Mohammadi, Hossein Dargahi, Sara Emamgholipour Sefiddashti, Mohammad Mehdi Aladdin,
Volume 23, Issue 4 (2-2025)
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: The healthcare sector is undergoing a profound transformation driven by rapid scientific, economic, and social advancements. The World Health Organization (WHO) emphasizes the necessity of medical equipment and supplies for reducing health disparities and achieving strategic health system objectives. However, there is a notable gap in the literature regarding this cost component within the Iranian health system. This study, therefore, aims to quantify the share of pharmaceutical and medical consumable costs in Iran's total health system expenditure.
Methods: This retrospective, cross-sectional study analyzed outpatient and inpatient medical records from 2018 to 2020. Data on the costs of pharmaceuticals and medical consumables were extracted from Iran's National Health Accounts (NHA) and the SPAS dashboard. The collected data were statistically analyzed to determine the proportional costs of these items relative to total national health expenditure.
Results: Between 2018 and 2020, inpatient pharmaceutical and medical consumable costs constituted 12% of the total health expenditure, demonstrating an annual decrease of 1.8%. In contrast, outpatient costs accounted for 19.5% of the total, with an annual increase of 0.7%. Basic health insurance allocated approximately 10.3% of its budget to cover these items, which corresponds to 31.5% of the nation's total healthcare spending.
Conclusion: The findings highlight the critical need for strategic interventions within Iran's health system. Key implications include the necessity for effective supply chain management, strategic planning to reduce import dependency, and robust mechanisms for monitoring prices. Mitigating the adverse effects of inflation and sanctions is paramount. Furthermore, increasing the healthcare budget's share of the Gross Domestic Product (GDP) and expanding insurance coverage are essential for ensuring financial protection for the population and advancing towards Universal Health Coverage (UHC).
Newsha Poursaadat, Mohammad Ali Cheraghi, Maryam Esmaeili, Fatemeh Hajibabaee,
Volume 24, Issue 1 (5-2025)
Volume 24, Issue 1 (5-2025)
Abstract
Background and purpose: A key aesthetic dimension of nursing leadership involves embedding aesthetic principles into the formulation of organizational documents and artifacts. These elements embody beauty in both visual design and semantic content within the healthcare environment, created by providers and perceived by all stakeholders. This study aimed to explore the role and manifestation of aesthetics in such organizational materials from the perspective of nursing leaders at Tehran University of Medical Sciences.
Methods: This qualitative study, conducted in 2023, utilized a conventional content analysis methodology guided by the Graneheim and Lundman approach. The participants were nursing managers and leaders from hospitals affiliated with Tehran University of Medical Sciences. A total of 28 participants were recruited via purposive and snowball sampling. Data were collected through in-depth, semi-structured interviews, supplemented by photovoice and field observations, to explore the guiding principles and prevailing atmosphere shaping organizational aesthetics.
Results: The analysis of the data yielded 191 initial codes, which were abstracted into six main themes: (1) Preservation and Maintenance, (2) Standardization, (3) Cleanliness and Beautification, (4) Order and Arrangement, (5) Organization, and (6) The Sublime.
Conclusion: The study concludes that the aesthetic vision championed by nursing leaders—as manifested in organizational documents and the workplace environment—is palpable to all stakeholders. This perceived aesthetic fosters a sense of grace and compassion in the thoughts, speech, and actions of both care providers and recipients. Ultimately, it facilitates a more holistic form of "aesthetic nursing care" and helps to create a comforting, home-like atmosphere for patients.
Sara Emamgholipour, Fateme Mohammadi, Behzad Raei,
Volume 24, Issue 1 (5-2025)
Volume 24, Issue 1 (5-2025)
Abstract
Background and purpose: Evaluating hospital efficiency serves as a critical tool for assessing the preparedness and responsiveness of health systems in times of crisis. Accordingly, this study examines the performance of hospitals affiliated with Tehran University of Medical Sciences in response to the COVID-19 pandemic during the years 2019 to 2022.
Methods: This analytical study assessed hospital efficiency using the Pabon Lasso model over the period 2019–2022. Additionally, statistical correlation analysis was employed to explore the relationship between changes in COVID-19 admissions and variations in hospital expenditures, revenues, average length of stay, and bed occupancy rates.
Results: The outbreak of COVID-19 led to a temporary improvement in performance indicators and more optimal utilization of hospital resources. However, following the subsidence of the crisis, hospitals reverted to their previous inefficient structures. In 2022, the operational structure of hospitals returned to pre-pandemic conditions, with only 14% of hospitals falling within the efficient zone. Compared to 2019, a 33% increase in hospitals located in Zone 1 and a 17% decrease in those in Zone 4 indicated a lack of progress in enhancing systemic efficiency. Moreover, the rise in COVID-19 admissions was associated with increased expenditures and subsidies, yet had no significant impact on hospitals’ direct income from patients. Functional effects were limited to a slight reduction in average length of stay and a modest increase in bed occupancy rates.
Conclusion: The findings highlight the absence of mechanisms necessary to sustain crisis management achievements and promote long-term efficiency. Health system preparedness for future crises requires continuous integration of crisis experiences, proactive planning, resource allocation, and the establishment of frameworks to maintain and enhance productivity under all conditions. Therefore, crisis management should not be viewed as a temporary response but rather as an integral component of the strategic and permanent structure of healthcare organizations.
Majid Safaei Lari, Ali Akbar Mohammadi, Hamid Raeisi, Zakiyeh Raeisi,
Volume 24, Issue 1 (5-2025)
Volume 24, Issue 1 (5-2025)
Abstract
Background and purpose: The Student Welfare Fund of Iran's Ministry of Health is a public institution tasked with providing financial aid to medical students. Amid growing demand for these services and constrained government resources, a comprehensive analysis of the full cost of loan disbursement is crucial for ensuring operational efficiency and financial sustainability.
Methods: This applied, descriptive study conducted a retrospective cost analysis from the perspective of the Student Welfare Fund. The study population comprised all student loan records processed during the 2024 fiscal year. A hybrid top-down and bottom-up costing methodology was employed to determine the full cost of the loan disbursement process. Data were extracted from the Fund's internal financial records, annual reports, and publicly available price lists for equipment and consumables, and subsequently analyzed using Microsoft Excel.
Results: The full cost per loan processed was lowest for single-student academic and essential-needs loans, at IRR 33,538,137, and highest for housing deposit loans, at IRR 56,743,475. The total cost for all student loans disbursed during the 2024 fiscal year amounted to IRR 124,222,283,295.
Conclusion: Processing times were shortest for academic loans and longest for housing deposit loans. Human resources constituted the largest cost component in the disbursement process. Despite the significant personnel costs, a comparison between the full costs and the service fees collected suggests that the Fund's operational processes and staff performance are acceptably efficient.
Fateme Tavallaei, Fattah Sharifzade, Reza Vaezi, Seyed Jalalodin Faraji,
Volume 24, Issue 1 (5-2025)
Volume 24, Issue 1 (5-2025)
Abstract
Background and purpose: Non-communicable diseases (NCDs) account for 76% of mortality in Iran, where effective management hinges on community empowerment and integrated service delivery. Co-production, an innovative strategy involving shared power between service users and providers, is a promising approach for addressing the multifaceted needs of patients with chronic conditions. This study aimed to develop a context-sensitive framework for implementing and evaluating co-produced NCD management programs. We achieved this by integrating the core principles of co-production with a realist evaluation lens, drawing on the perspectives of senior healthcare managers.
Methods: Employing a qualitative methodology, this study conducted a thematic analysis of data derived from a comprehensive literature review and semi-structured interviews. A cohort of 17 senior healthcare managers, selected via purposive sampling in 2025, participated as key informants.
Results: The analysis yielded a hierarchical thematic structure comprising 71 basic themes, 20 organizing themes, and 6 overarching global themes. These global themes, which form the core of the proposed framework, are: (1) Developing Participatory Clinical Processes, (2) Establishing Equity-Oriented Support Services, (3) Recognizing Diverse User Groups, (4) Enhancing Provider Capabilities, (5) Understanding User Responses, and (6) Fostering Mutual Benefits among Stakeholders. The dynamic interplay of these themes is crucial for operationalizing effective NCD co-production.
Conclusion: By innovatively integrating co-production principles with a realist evaluation framework, this study offers a context-sensitive model that clarifies theoretical concepts for practical application in NCD management. A key implication is the necessity for monitoring systems that track both clinical and well-being outcomes, supported by multi-level incentive structures. This research provides a foundational model for policymakers to develop, implement, and evaluate more effective and equitable co-produced healthcare programs. Further longitudinal research is recommended to assess long-term outcomes and incorporate patient perspectives.
Karen Fatahi,
Volume 24, Issue 1 (5-2025)
Volume 24, Issue 1 (5-2025)
Abstract
Background and purpose: Nurse's thermal comfort in a clinical setting directly impacts their performance and the quality of patient care. This study investigates how two key environmental factors—ambient light intensity and Correlated Color Temperature (CCT)—influence this perception of thermal comfort.
Methods: This experimental study was conducted in a controlled laboratory setting with 60 healthy female nurses over four months (December 2024–March 2025). We assessed the effects of light intensity (at two levels: 300 and 750 lux) and CCT (at three levels: 2700 K, 4000 K, and 7800 K) on perceived thermal comfort. Data were analyzed using a two-way Analysis of Variance (ANOVA).
Results: Light intensity, CCT, and their interaction all had a statistically significant effect on nurses' perceived thermal comfort (p < .05). Optimal thermal comfort was reported at a CCT of 4000 K under both 300 and 750 lux intensities. At a warm CCT (2700 K), comfort was maintained at 300 lux but not at 750 lux. Conversely, at a cool CCT (7800 K), the 300 lux condition was perceived as uncomfortable, while the 750 lux condition was reported as comfortable.
Conclusion: This study demonstrates a significant interaction between light intensity and CCT in shaping thermal perception in a clinical context. The findings suggest that lighting design in healthcare facilities must consider both metrics simultaneously to optimize the work environment. A neutral CCT of 4000 K appears to be the most robust for maintaining thermal comfort across different light levels, highlighting its potential as a design standard for healthcare settings.
Mahmoud Zivari Rahman, Javad Siahmoshtei, Niloofar Mikaeili,
Volume 24, Issue 2 (9-2025)
Volume 24, Issue 2 (9-2025)
Abstract
Background and purpose: Early Maladaptive Schemas (EMSs) are pervasive cognitive patterns that can detrimentally affect the well-being of individuals with chronic illnesses. This study aimed to investigate the structural relationship between EMSs and Health-Related Quality of Life (HRQoL) in cancer patients, with a specific focus on the mediating role of health literacy.
Methods: This descriptive-analytical study utilized a correlational design based on Structural Equation Modeling (SEM). The statistical population comprised all cancer patients aged 20 to 60 years referring to private oncology centers in [City Name] in 2025. A total of 665 participants were recruited using convenience sampling. Data were collected using the Young Schema Questionnaire (YSQ), the Health Literacy for Iranian Adults (HELIA) questionnaire, and the Health-Related Quality of Life questionnaire. Data analysis was performed using SPSS (v.25) and AMOS (v.24) software, with the significance level set at 0.05.
Results: The path analysis revealed that EMSs had a significant direct negative effect on both health literacy (β =-0.85, P< 0.001) and HRQoL (β= -0.56, P<0.001). Conversely, health literacy showed a significant positive effect on HRQoL (β=0.51, P<0.001). Furthermore, health literacy significantly mediated the relationship between EMSs and HRQoL (β=0.26,P<0.001). The goodness-of-fit indices confirmed the model's optimal fit (X2/Df = 3.94, GFI = 0.913, IFI = 0.903, CFI = 0.901, RMSEA = 0.067)
Conclusion: The findings suggest that Early Maladaptive Schemas significantly compromise the quality of life in cancer patients. However, health literacy acts as a protective buffer, mediating this negative impact. Therefore, interventions aimed at enhancing health literacy could be an effective strategy to mitigate the adverse effects of maladaptive schemas and improve the HRQoL of cancer patients.
Ali Modabber, Habib Jalilian, Behnam Gholizadeh, Esmaeil Mousavi Asl, Farzad Faraji-Khiavi,
Volume 24, Issue 2 (9-2025)
Volume 24, Issue 2 (9-2025)
Abstract
Background and purpose: Ensuring continuous access to healthcare services is critical for patients with hypertension, particularly during pandemics and public health crises. This study aimed to evaluate the resilience of service delivery by Primary Healthcare Centers (PHCs) to hypertensive patients during such emergencies.
Methods: This descriptive cross-sectional study was conducted in 2023 across 10 PHCs in Markazi Province, Iran. A total of 250 patients with hypertension were recruited using a systematic random sampling method. Data were collected using a researcher-designed questionnaire assessing four dimensions of resilience: quality, accessibility, continuity, and coordination. Data were analyzed using descriptive statistics and multiple linear regression in SPSS software (version 24).
Results: The overall service resilience score was 2.95 (±0.32), indicating a "relatively weak" level of resilience. The mean scores for the dimensions were: Accessibility 3.08 (±0.28), Coordination 3.03 (±0.76), Quality 2.93 (±0.41), and Continuity 2.88 (±0.35). Multiple regression analysis revealed that these four dimensions collectively explained 96.1% of the variance in service resilience. Accessibility (β = 0.478) was the strongest predictor, followed by Quality (β = 0.379), Continuity (β = 0.352), and Coordination (β = 0.178).
Conclusion: The resilience of services provided by PHCs to hypertensive patients during pandemics was assessed as suboptimal. These findings highlight an urgent need for strategic operational planning by health policymakers. Developing protocols to ensure service continuity and expanding infrastructure for remote care (telemedicine) are recommended as key priorities to enhance system resilience.
Yousef Hamidzadeh Arbabi, Mohammad Panahi Tosanloo, Rohqayeh Farrokhi, Amin Ahmadi,
Volume 24, Issue 2 (9-2025)
Volume 24, Issue 2 (9-2025)
Abstract
Background and purpose: Workplace Violence (WPV) is a significant occupational hazard and is increasingly recognized as a critical crisis within the healthcare sector. Due to the inherent nature of their services, healthcare organizations are more susceptible to this phenomenon than other sectors. This study aimed to investigate the prevalence of workplace violence and its role in predicting the job satisfaction of healthcare workers in Ardabil.
Methods: This descriptive-analytical cross-sectional study was conducted in 2024. A total of 300 employees working under the auspices of the Ardabil Health Center were selected using stratified random sampling. Data collection utilized two standardized instruments: the Minnesota Satisfaction Questionnaire (MSQ) and the Workplace Violence in the Health Sector Questionnaire. Data were analyzed using SPSS software (version 20) via descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and linear regression analysis.
Results: The overall job satisfaction rate was calculated at 58.75%. In terms of prevalence, 63.8% of the participants reported experiencing workplace violence at least once during the past year. The mean score of experienced violence was 27.35%. Psychological violence was the most frequent form (51.5%), while physical violence was the least frequent (9.4%). Significant statistical relationships were observed between demographic characteristics, workplace violence, and job satisfaction (P<0.05). Linear regression analysis identified workplace violence (β = 0.181) as the third most influential predictor of job satisfaction, following the payment system (β = 0.482) and advancement opportunities (β = 0.312).
Conclusion: The findings suggest that healthcare workers may have normalized workplace violence as an inherent part of their professional environment. Consequently, their job satisfaction appears to be more heavily influenced by economic factors—specifically the compensation and payment system—than by the adverse effects of occupational violence.
Alireza Rahimi,
Volume 24, Issue 2 (9-2025)
Volume 24, Issue 2 (9-2025)
Abstract
Background and purpose: Pre-hospital Emergency Medical Services (EMS) play a pivotal role in managing life-threatening conditions. However, evidence suggests that the Iranian EMS system faces multifaceted challenges across human, managerial, and infrastructural dimensions. This study aimed to conduct a comprehensive meta-synthesis to identify and analyze the challenges characterizing pre-hospital EMS in Iran, based on research evidence published between 2014 and 2025.
Methods: This study employed a meta-synthesis approach utilizing the seven-step framework by Sandelowski and Barroso (2006). A systematic search of major domestic and international databases using relevant keywords yielded 414 initial records. Following a rigorous screening process based on inclusion/exclusion criteria and quality appraisal, 25 articles were selected for the final analysis. Data were synthesized and categorized using thematic analysis.
Results: The findings revealed that the challenges facing the Iranian pre-hospital EMS can be categorized into six main themes: human resources, logistics and infrastructure, organizational and managerial barriers, socio-cultural issues, and educational deficits. A deeper analysis highlighted the multifaceted and intertwined nature of these obstacles. The results indicate that these challenges do not exist in isolation but are interconnected within a complex network of cause-and-effect relationships.
Conclusion: The findings confirm that the challenges within Iran's emergency system mirror global trends and overlap significantly with issues reported in other low- and middle-income countries (LMICs). Addressing these problems requires a holistic and systemic approach that simultaneously targets human, logistical, organizational, and socio-cultural dimensions, while ensuring system preparedness for potential accidents and disasters.
Beheshteh Jebelli, Mohammad Varahram, Fatemeh Keyvani Rad, Solmaz Zarrineh, Elham Ghazanchaei,
Volume 24, Issue 2 (9-2025)
Volume 24, Issue 2 (9-2025)
Abstract
Background and purpose: Hekmat (Wisdom) implies deep knowledge, understanding, and sagacity. Hospital services are uniquely dependent on human resources; therefore, beyond technical expertise, staff commitment is essential for maximizing efficiency and effectiveness. A "Hekmat-based hospital" is defined as an institution delivering care founded on three pillars: human dignity, medical knowledge/wisdom, and Islamic ethics. This study aims to identify the key factors influencing hospital accreditation through the lens of the Hekmat-based hospital approach.
Methods: This qualitative study employed conventional content analysis based on the Graneheim and Lundman approach. Data were collected through purposive sampling and semi-structured interviews with 62 participants (32 physicians and 30 patients) from various departments until data saturation was reached. Additionally, a comprehensive review of 20 upstream documents related to health, medicine, education, and culture within the Iranian health system (post-1979 Revolution) was conducted to supplement the field data.
Results: The analysis of interviews yielded 10 main categories representing the components of accreditation in a Hekmat-based context. These categories included: social, cultural, and religious issues; facilities, equipment, and human resources; communication skills; patients' financial and livelihood challenges; knowledge and education; tangible environmental factors; economic factors; cultural dynamics; patients' psychological resilience; and service reliability.
Conclusion: The findings suggest that mutual understanding of emotions and beliefs, patience, reciprocal respect, and effective knowledge exchange are core expectations shared by both physicians and patients. Addressing these primary and secondary needs is a prerequisite for achieving a standardized hospital model aligned with the vision of Hekmat-based medicine.
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