مجله تصویر سلامت
سال چهاردهم شماره 4 (زمستان 1402)

The financing process of the health system includes the collection, accumulation, and management of financial resources to purchase health services. Sustainable financing of the health system is a core function, which can enable progress towards universal health coverage (UHC).
There are multiple funding sources to finance health care services in Iran, including out-of-pocket payment, government funds, general taxation, health insurance, and individual donations.
Inefficiency in health insurance systems has led to an increase in out-of-pocket payments, and ultimately catastrophic expenditures. According to the results of the household income-expenditure survey in 2017, about 17% of the population faced catastrophic expenditures by spending more than 10% of their total consumption expenditure on health, and 75% of exposure to catastrophic expenditures (equivalent to 13% of population) was only due to paying out of pocket to receive medical services. (1)
According to the health insurance coverage in 2010, about 84% of the total population in Iran was covered by various insurance plans and supplementary health insurance included 20% of the total population. (2)
After the recent reforms entitled as the "Health Transformation Plan" launched in 2014, more than 90% of the population was covered by health insurance. However, the services were not fully covered by insurance benefits and only included inpatient health services. In addition, the insurance share was free for patients, which increased moral hazard from patients and induced demand from providers. Finally, this reform plan was stopped due to the instability of resources.
Among the disadvantages of this type of insurance, the following can be mentioned:1. All people could register in this insurance without any limitation.
2. The insurance premium was very small and negligible. So, it was not considered as an insurance because there was not the accumulation of risk, which is one of the main characteristics of any insurance industry.
3. Considering that many people were covered in this type of insurance, the depth and level of service coverage were reduced due to limited resources.
In this insurance type, financing was from the government and there was no assessment for individuals; and it was a kind of support fund or support package. So, it was stopped at some point after the health transformation plan.
Although Article 10 of the General Insurance Law in Iran refers to determining the scope and medical services and drugs, (3) there are no criteria to evaluate the covered packages. Despite the UHC's goal of increasing the number and variety of services for patients, many services for specific diseases, palliative care, etc. are not covered by the basic insurance. Also, some services such as dental and optometric services are considered a luxury service and are not covered by basic insurance.
The lack of resources to provide proper services to the insured people and the impossibility of receiving the services from the private sector using health insurance benefits are other challenges of this type of insurance.
Finally, Iran has not been able to achieve UHC due to the lack of proper management capacity in the insurance sector.
To realize universal health coverage and improve outcomes, policymakers must consider several demand and supply factors. In this regard, expansion of infrastructure, human resources, and health services can be effective from the supply perspective. Meanwhile, increasing health insurance coverage, expanding health benefits package, and reducing the contribution of people in paying expenses using payment methods with a certain ceiling such as per capita and quality-based payment can be effective from the demand perspective.
Also, the existence of comprehensive and transparent information systems, especially the system for identifying vulnerable and low-income groups, can greatly contribute to the successful implementation of UHC. Finally, designing suitable financial and non-financial incentives can also lead to increasing the satisfaction of professionals and health sector employees.

Employees are critical assets of an organization, and it is necessary to investigate and identify factors affecting their performance and productivity. This study aimed to determine the relationship between job stress and job productivity in university settings.

This cross-sectional study included 124 employees of Ahvaz Jundishapur University of Medical Sciences (AJUMS) based on Cochran's formula. Data collection instruments included the standard occupational stress questionnaire of the England Institute (HSE) and Echio’s productivity questionnaire. The validity and reliability of the instruments have been confirmed. Statistical analyses were performed using SPSS 22 software.

The mean score of job stress and job performance was 119.75 (±17.49) and 103.3 (±21.47), respectively, and their level was estimated as average. Findings indicated a significant negative correlation between job stress and performance (r = -0.59, P<0.001). In addition, three variables, including employee position, management support, and change were identified as the main predictors of employee productivity based on linear regression. There was a significant relationship between some demographic variables (age, gender, and education level) and occupational stress.

According to our results, there was a significant negative correlation between occupational stress and staff productivity. These findings can be generalized to university administrative personnel. Three occupational stress components, including management support, change, and employee position, were identified as main predictors of productivity. Therefore, in order to improve productivity, managers need to consider more independence and support for personnel, as well as reduce the changes’ rate.

The main influencing factor in the success of the crisis management process is the group's readiness to deal with the crisis. Training models are a tool to maintain the preparation of personnel, increase their ability to achieve certain goals, and help them acquire information, skills, and ways of thinking. This research aimed to design and validate a training model for the staff of the hospital incident command system.

The research method was a qualitative-quantitative (mixed method) approach. The statistical population in the qualitative part included experts in the field of incident command system, and in the quantitative part included managers and staff of this system in the hospitals of Guilan province in Iran. The sampling method in the qualitative part was the judgmental forecasting method. Also, the sampling method was cluster random in the quantitative part. According to the data saturation principle, the sample size in the qualitative section was 15 people, and in the quantitative section, 226 people were selected based on Cochran's formula. The data collection tool in the qualitative part was a semi-structured interview and in the quantitative part was a questionnaire extracted from the interview.

After analyzing the categories resulting from interviews with 15 experts, 43 open codes and 12 central codes were determined. Also, five selection codes were obtained as follows: design, analysis, evaluation and feedback, policymaking and determination of strategies, and implementation and support dimension. The findings showed that the design dimension had a more significant effect on designing the training model (path coefficient = 0.987 and t = 176.713). Also, all components had a significant relationship in pattern design. For data analysis, we used the MAXQDA2020 and SmartPls3 software in the qualitative part, and SPSS26 software in the quantitative part.

The results of this research showed that effective command in possible incidents depends on the effective training of employees with a new and up-to-date model.

Considering the widespread influence of mobile phones in life and its various features, it is necessary to use value-added services of mobile phones in the field of treatment and health. This study aimed to identify and categorize the factors affecting the use of mobile value-added services in the field of health.

This qualitative research was conducted using thematic analysis. A total of 74 articles were extracted from scientific databases. Next, 51 related articles were fully reviewed using thematic analysis method. After that, basic, organizing, and inclusive themes were extracted, and the model was implemented. Validity of the research was confirmed by experts according to the degree of connection between the components and the mobile value-added services model in the field of health. The reliability coefficient was 97%, which indicated a high reliability.

Based on the review and analysis of the articles, the final model consisted of 64 basic themes, 16 organizing themes (understanding benefits, understanding well-being, user values, customer outcomes, community outcomes, organizational outcomes, technology infrastructure, reducing fear of technology, learning and development, occupational factors, support and incentives, technical reliability, human reliability, risk reduction, attitude, and expectation), and six global themes (user understanding, effects and consequences, technology development, environmental influencing conditions, reliability, and mindset and expectations).

According to the factors identified in this research, policy makers and health managers can have the right planning for the use of mobile value-added services in the field of health.

Hospitals, patients, researchers, and healthcare organizations are producing enormous amounts of data in both the healthcare and drug detection sectors. With continued development of cheap data storage and availability of smart devices in the world, the influence of big data (BD) will continue to grow. This influence has also carried over to healthcare. The volumes of data available in the fields of pharmacology, toxicology, and pharmaceutics are constantly increasing. Therefore, the present study aimed to identify the applications of big data technology in the field of pharmaceutics.

Using the mixed methods approach, this study was conducted in two phases in winter 2023. In the first phase, the applications of big data technology were identified by library search and assessed by content analysis. In the second phase, applications were ranked by a panel of experts, including 17 experts who worked in the Iranian pharmaceutical industry. The stepwise weight assessment ratio analysis (SWARA) method was used for ranking the application of big data in pharmaceutics.

The present study examined the importance of big data applications in pharmaceutics. The results showed that drug discovery (0.263) and clinical study analysis (0.224) had the highest importance, followed by drug efficacy and performance (0.197), drug safety (0.170) and drug personalization (0.146).

The present study detailed a substantial attempt to review the existing literature regarding the implementation of big data and to rank big data applications in the pharmaceutical industry. Big data can help researchers to better discover and develop drugs and understand the effects of drugs and other chemicals on the human body. As a result, it can help improve the safety and efficacy of drugs and other chemicals. Also, big data can help to improve the accuracy of predictions regarding the effects of drugs and chemicals, which can improve safety in drug development and help to avoid potential adverse drug interactions. The applications considered in this study are ultimately necessary for humanity, and big data may significantly impact the betterment of these domains. Big data has a revolutionary potential, providing new ways to understand and predict the effects of drugs. BD will possibly play an important role in pharmaceutics in future, critically helping to drug discovery and improve drug safety and efficacy.

In order to adopt an educational program to promote students' environmental culture, the status of students’ environmental conservation literacy should be determined. Hence, this research aimed to evaluate the environmental conservation literacy and its relationship with environmental ethics among secondary education schools students, as young generation, in a Middle East country.

This descriptive survey was conducted in Khoy, a city in the central district of Khoy County, West Azerbaijan province, Iran, in 2022. The sample size was determined using Cochran's statistic and comprised of 350 individuals selected in two stages from a pool of 14,000 students. The data collection tool was a researcher-made questionnaire about environmental knowledge, attitude, performance, and ethics. Three environmental and three education specialists used the content validity rate (CVR) assessment form to assess the validity of the questionnaire; the questionnaire validity index was calculate 0.79. The reliability of the questionnaire was also conducted through pilot research, and its value was calculated using Cronbach's alpha test as 0.76. The data was analyzed with nonparametric statistical tests such as the Mann-Whitney test in SPSS version of 22.

The average scores of environmental knowledge, attitude, performance and ethics were respectively: 87.6, 84.5, 50.6 and 82%. Between these four variables, there is a significant correlation with the correlation coefficients of knowledge and attitude 0.51, knowledge and behavior 0.2, knowledge and ethics 0.36, attitude and behavior 0.47, attitude and ethics 0.51, and behavior and ethics 0.47 was obtained. With the increase of the educational level, the knowledge score increased, but it had no effect on the other three variables. The variable of education level of students' parents showed a positive effect only on the knowledge component. The difference in the knowledge, attitude and ethics scores of boys and girls was not significant, but the behavior score of boys was 5% higher. There was no significant relationship between the scores of all four variables and the financial status of the student’s family.

The first secondary school students of Khoy city had a relatively favorable level of knowledge, attitude and ethics (score 85%), but the level of environmental performance was weak (50.6%). Therefore, it is inferred that the acquired knowledge and attitude is not deep and effective to lead to the desired improvement of environmental conservation behavior. So, it is necessary to be cultured children's environmental literacy from the preschool and elementary school levels.

Hypertension is one of the most common and preventable diseases worldwide. The most effective way to control blood pressure is the patient's adaptation to self-care behaviors. In this regard, teaching the principles of self-care without considering the challenges of behavior change cannot be effective enough. Considering that most previous studies have been limited to self-care education, ignoring effective psychological approaches in behavior change, this study aims to design a blood pressure management protocol based on transtheoretical model and determine its effectiveness in patients with high blood pressure.

This study will be conducted in two stages. In the first stage, the management protocol of blood pressure will be designed based on the transtheoretical model using the literature review and expert panel opinions. Then the content of the educational package will be compiled. The second stage will include the intervention and evaluation of the effectiveness of the self-care protocol, self-efficacy, and health-related quality of life in patients with hypertension, which will be conducted through including two intervention and control groups. The information will be collected using questionnaires related to self-care, stages of change, quality of life, and self-efficacy. Data will be analyzed using SPSS version 22 software.

In Iranian society, adherence to treatment in patients with hypertension is low. Thus, implementing a self-care protocol based on the comprehensive theory of changing behavior such as transtheoretical model can be effective in improving self-efficacy, self-care, and quality of life in patients with hypertension.

Today, the participation of local levels in the health policy process is emphasized, which can be used as a means to more appropriately solve the problems of local communities and support the health system in achieving its goals. This study aimed to design a health policy model based on participation at the local level.

This multi-method study was conducted to design a model for participation in health policymaking at the local level during three phases of systematic review, semi-structured in-depth interview, and Delphi technique. The purpose of the systematic review was to identify the factors affecting this participation, which was done by searching for suitable keywords in English and Persian databases. The objective of the qualitative phase was to identify the barriers and facilitators of participation. To this end, 16 people were selected by purposive sampling method and semi-structured interviews were conducted. The elements and components of the initial model were provided to experts in this field through the Delphi technique to confirm the items and validate them, so that the final model could be designed.

The influential factors for participation included individual, environmental, and contextual factors, which were identified from a systematic review of 21 articles. Facilitators obstacles, challenges, advantages, and disadvantages of local level participation in the policymaking process were identified through the results of a qualitative study, which were categorized into three main themes, including the participation process, the beneficiaries of the process, and the strategies to facilitate participation. Finally, the health policy model based on participation at the city level was validated and finalized using the opinion of experts.

Participation in the health policy process requires the use of facilitators and the removal of obstacles. Local levels in terms of health issues in Iran involve complex and diverse challenges that can be solved through real participation.