Journal of School of Public Health and Institute of Public Health Research

Evaluation of Iran's Health Financing System

Mahdieyh Heydari

Background and Aim: The health financing system is "the process of collecting, pooling and managing financial resources and purchasing healthcare services”. Iran's health financing system is facing challenges. The aim of this study was to evaluate the Iranian health financing system.
Materials and Methods: This descriptive study retrospectively evaluated the health financing system of Iran between 2000 and 2019 using archival data. Data were collected from the World Bank website and analyzed using the Excel software.
Results: Iran's health expenditure per capita increased by 3.7% annually between 2000 and 2019 and reached $868 (purchasing power parity) in 2019. Iran's total health expenditure increased from $32 billion in 2000 to $72 billion (purchasing power parity) in 2019 (5.9% annual increase). Iran accounted for about 0.6% of the world total health expenditure in 2019. In that year about 6.7% of the country's gross domestic product was spent on health, the global average being 9.8%, while the general government health expenditure (% of the then current health expenditure) in Iran and the world were 49.5% and 59.8%, respectively. Out-of-pocket expenditure (% of the then current health expenditure) decreased in the last decade in Iran, reaching 39.5% in 2019, compared to 18% worldwide.
Conclusion: Iran’s health system costs are increasing at a faster rate than the growth of its Gross Domestic Product (GDP). The country’s health expenditure (% of GDP) and, as a result, the general government health expenditure (% of general government expenditures) has decreased and out-of-pocket expenditure (% of current health expenditures) has increased. Therefore, reforms should be implemented to strengthen the country's health financing system.

The Extent of Preventive Behaviors Against Coronavirus and Factors Related to Them: Results of a Survey Among Adult Residents in Shiraz City, Iran

Serajeddin Mahmoudiani

Background and Aim: The pandemic of coronavirus can be considered as one of the most important issues in the world in the last two years. Undoubtedly, reducing the outbreak of coronavirus requires preventive behaviors. The purpose of this study was to investigate the status of preventive behaviors of people and its relationship with demographic and socio-economic variables.
Materials and Methods: A total of 385 residents aged 18 to 65 years in Shiraz City were surveyed using the cluster sampling method and a structured questionnaire. The SPSS.20 software was used to analyse the data.
Results: The findings showed that with increasing age and level of education preventive behaviors increased, while increasing income led to a decrease in such behaviors. Preventive behaviors were more common among women than men, and less common among employed people and housewives than students.
Conclusion: Preventive behaviors in connection the coronavirus are relatively acceptable but far from ideal. Men, young people and people with lower literacy levels should be given more attention in health-related teaching programs.

Community Health Assessment to Identify Problems and Develop Operational Plans to Promote Health in the Soufian District

Asghar Mohammadpoorasl

Background and Aim: The promotion of the health of the members of a society is based on the assessment of the situation of that society. This study was conducted in the Soufian district of Shabestar city with the aim of identifying and prioritizing its problems and needs with the direct participation of the people.
Materials and Methods: This was a cross-sectional study conducted in the Sufian District of Shabestar city in 2019, the methodology used being based the 8-phases model of North Carolina. The community health assessment was performed in 8 phases. The first seven phases included identifying and prioritizing the problems of the District, and the eighth was developing operational plans to solve its priority problems.
Results: A total of 23 different problems were identified. Prioritizing the problems according to the Hanlon method showed the ten main and priority problems to be, in a descending order, as follows: marriage of girls at an early age (21.01), excessive use of chemical fertilizers in farmlands (20.89), lack of social security clinics (20.51), unemployment (20.38), severe air pollution caused by incineration of industrial waste (20.01), accumulation of municipal waste in the city (19.89), high hardness of city water (19.76), lack of property deeds (19.63), lack of a specific unit in the industrial town to separate waste (19.38), and lack of a gas supply to Mehr Housing and lack of asphalted roads (19.28). Marriage of girls at an early age was identified as the main problem and with the first priority, and a general preliminary study was done on it; it was found that in about 43% of all marriages registered between 2014 and the first half of 2021 the ages of girls were under 18 years. Factors causing and increasing marriage of girls at an early age were identified to be as follows: low awareness of girls' families and girls themselves of the consequences of early marriage, social acceptance of early marriage in the area and low parental literacy.
Conclusion: In this study a wide range of social, cultural, economic and health problems were identified in the population studied. Marriage of girls at an early age is an important social problem with serious undesirable consequences. In an attempt to solve this problem it is essential to consider, in addition to legal and legislative strategies and actions, appropriate scientific, social, cultural and economic strategies and applied research.

Research Synthesis of the Educational Needs of Female-Headed Households

Mohammad Nourian

Background and Aim: Family female heads are one of the most vulnerable groups in the society and empowering them is essential. This research was a systematic study to design and develop a model of educational needs of female heads in the female-headed households.
Materials and Methods: This study was a qualitative applied research of a research synthetic type conducted using content-analysis and meta-analysis. The statistical population included all the relevant works published in Persian or English between 2012 and 2021 available in four reliable databases, namely, ERIC, Science Direct, PubMed and Google Scholar. Using the keywords "education of women-headed households, women's empowerment, women-headed households, and skills of women-headed households" and based on the inclusion criteria, initially 140 scientific articles were identified and finally, based on the exclusion criteria, 47 articles were selected for the final analysis. The Software MAXQDA 18 was used for the qualitative analysis of the articles.
Results: Analysis of the data obtained showed the educational needs of women-headed households as the main theme to consist of four subthemes including "knowledge and skills of desirable sexual orientation", "knowledge and skills of raising children", "knowledge and skills of occupation" and "individual and social development and empowerment”. Based on meta-analysis out of the four main themes 22 themes were extracted and a model was designed for educating female-headed households.
Conclusion: Considering that the educational needs of female-headed households have been identified, it is recommended that educational courses be designed in accordance with their educational needs.

Unwanted Pregnancies in the Southern Areas of Tehran: The Experiences of the Less Privileged Groups of the Society Regarding the Consequences of Population Increase Policies

Forouzandeh Jafarzadehpour

Background and Aim: Demographic policies are designed and implemented with the aim of creating a better life for individuals in the society as well as protecting national interests. However, whether the implementation of these policies has achieved this goal or has had other, possibly unwanted, consequences that would affect the lives of the citizens, especially vulnerable people, requires careful investigation. These policies have had profound effects on the family and the health of family members, especially women. The purpose of this research was to investigate the understanding and interpretations of women in the southern areas of Tehran who had experienced unwanted pregnancy regarding population increase policies and their effects on women and their family lives.
Materials and Methods: This research was a descriptive qualitative study. Data were collected through semi-structured in-depth interviews with 23 married women with a history of unwanted pregnancy referring to the comprehensive health centers in districts 16, 17 and 19 of South Tehran Health Network. Purposive sampling was continued until a theoretical saturation was reached, and data analysis was performed based on the foundation data theory.
Results: Out of the primary data consisting of a total of 850 open codes, 452 concepts, 15 main categories and 47 sub-categories were extracted. Finally, "dissatisfaction with interventionism" was chosen as the main phenomenon covering the rest of the categories.
Conclusion: The most important factors causing dissatisfaction with government intervention among the participants are imposing costs related to unwanted pregnancies and keeping and raising an unwanted child. The intervening conditions of this phenomenon are "poverty and high cost". The participants' strategies included suppressing their wants, regret and attempts to improve the situation and reducing sexual relations.

The Effect of the Coronavirus on the Extent of Domestic Violence: A Case Study of Women in Toos Boulevard District, Mashhad City, Iran

Khadijeh Jangi

Background and Aim: Domestic violence is one of the most important cases of hidden victimization influenced by different factors. This research aimed to investigate the effect of Corona as a medical crisis on the level of domestic violence.
Materials and Methods: This study was a descriptive research of the correlation type conducted on the statistical population of women in Mashhad City, the sample being 250 women in the outskirts of the city selected using the convenience sampling method. A researcher-developed questionnaire was used to get information related to the behavior of the husband when faced with different types of violence during a period of two years ─ one year before, and one year after, the corona virus outbreak. The Pearson's correlation coefficient method was used to find the semantic relationship of the variables. Results: The incidence of domestic violence has increased in the first year after the coronavirus outbreak. The highest and lowest shares of such violence were found to be related to emotional and verbal violence and sexual violence, respectively. The findings also showed a highly significant relationship between income and the increase in violence during the Corona era (P<0.01) but no statistically significant relationship between access to support services and increased violence. Finally, restricting access to gatherings was found to be the most important factor in increasing violence.
Conclusion: Based on the findings, it seems that policies related to imposing communication restrictions, home quarantine and the economic damage caused by them can be the main factors causing increased domestic violence due to coronavirus.

Knowledge, Attitude and Practice of Food Preparation and Distribution Handlers of Haraz Road Restaurants Regarding Food Safety and Hygiene

Shohreh Alian Samakkhah

Background and Aim: This was a 3-month cross-sectional study conducted from October to December 2021 on 170 people involved in food preparation and distribution in Haraz intercity road restaurants with the aim of measuring their knowledge, attitude and practice regarding food preparation and distribution.
Materials and Methods: The data collection tool was a questionnaire with two sections, that is, a researcher-made demographic questionnaire (age, gender, level of education, type of job in a restaurant, work experience, place of residence and history of attending training courses), and a section with questions about knowledge, attitude, and practice assessment based on the World Health Organization standards.
Results: Analysis of the data showed that 97.1%, 100% and 100% of the people had a good level of knowledge, a positive attitude and good practice, respectively. In addition, there were statistically significant relationships between knowledge and age, educational level and participation in educational courses.
Conclusion: The 25- to 40-year age group, people with university education and those with experience in participating in training courses were found to have the highest level of knowledge. The level of knowledge in key number four (keeping food at a safe temperature) and attitude and practice in key number 3 (full cooking) had the lowest averages. Also, considering that 82.4% of the people had not participated in any training courses, the need to hold appropriate training courses for them by the relevant agencies and motivate them to increase their knowledge and, subsequently, increase and improve their attitudes and practice can improve the situation.

Identifying the Components of Electronic Teaching and Learning in the Workplace

Azam Rastgoo

Background and Aim: The objective of this research was to identify the components of electronic foundation data theory teaching and learning in the workplace.
Materials and Methods: This research was conducted using qualitative content analysis with a conventional content analysis approach. The statistical population was comprised of two groups: 1.Three sources of information (a sample of 26 out of 317 textbooks, scientific articles and theses/dissertations) selected by judgment sampling; 2. Relevant specialists and experts (a sample of 22) selected according to the theoretical saturation technic. The methods and tools used to collect data and information included archival surveys and field studies (interviews and questionnaires).
Results: For the primary coding, 644 categories were identified and converted into 45 secondary categories based on common conceptual aspects, which were finally became nine (9) main themes in the axial coding phase; these themes were used to build the thematic network.
Conclusion: The research model shows that the following nine categories are involved in electronic teaching and learning in the workplace: 1). organization and management; 2). information and contents; 3). interaction and communication; 4). characteristics of the person who teaches; 5). effectiveness; 6). technical quality; 7). learning objectives; 8). learning requirements, and 9). electronic education dimensions.