alireza mahdavi hazaveh

Despite the achievements of the national program for the prevention and control of diabetes (NPPCD) over the past two decades, the available evidence indicates a high prevalence of this disease in Iran. This qualitative study aims to investigate barriers to the NPPCD by pursuing the perspectives of relevant policy-makers, planners, and healthcare workers.

A grounded theory approach was used to analyze participants’ perceptions and experiences. Semistructured interviews (n=23) and eight focus groups (n=109) were conducted with relevant policy-makers, planners, and healthcare workers in charge of Iran’s national diabetes management program. Of the 132 participants, ages ranged from 25 to 56 years, and 53% were female. Constant comparative analysis of the data was conducted manually, and open, axial, and selective coding was applied to the data.

Two main themes emerged from data analysis: implementation barriers and inefficient policy-making/ planning. Insufficient financial resources, staff shortage and insufficient motivation, inadequate knowledge of some healthcare workers, and defects in the referral system were recognized as the NPPCD implementation barriers. Inappropriate program prioritizing, the lack of or poor intersectoral collaboration, and the lack of an effective evaluation system were the inefficient policy-making/planning problems.

Current results highlighted that inefficient policy-making and planning have led to several implementation problems. Moreover, the key strategies to promote this program are prioritizing the NPPCD, practical intersectoral collaboration, and utilizing a more efficient evaluation system to assess the program and staff performance.

This review study aims to shade light on the effects of carrying out interventions and policies in order to reduce the incidence and prevalence of non-communicable diseases (NCDs) and their behavioral risk factors (i.e., unhealthy diet, insufficient physical activity and smoking) and strategies and approaches to reduce their attributed burden.

In this research, the documents and reports available in the Ministry of Health, developed action plans, recommendations of national and international organizations, evidence gathered from monitoring and evaluations and the "National Action Plan and Control of Non-Communicable Diseases and Related Risk Factors in the Islamic Republic of Iran, 2015-2025" were investigated with respect to  each of the three main risk factors of NCDs, including unhealthy diet, insufficient physical activity, and smoking (harmful consumption of alcohol has been reviewed in another article). Each risk factor has been discussed separately in the sections describing the current situation, policies and implemented interventions, findings, and future plans.

The implemented interventions and policies to achieve the goals stated in the "National Action Plan and Control of Non-Communicable Diseases and Related Risk Factors in the Islamic Republic of Iran, 2015-2025" in the field of unhealthy nutrition, resulted in revising the food standards. Interventions in the field of physical activity have caused a 1.5% reduction in the relative prevalence of sedentary behavior in the society. Our research also revealed that interventions in the field of tobacco consumption have led a total decrease of 7.44% among Iranian people over 18 years of age, but a decrease in the use of hookah is not recorded, and its consumption has increased by 28% in 2021 compared to 2011.

According to the findings, the goals stated in the aforementioned document have not been fully achieved, so new interventions and policies should be used by those involved.

 Given the importance of appropriate response to prevent and manage Non-Communicable Diseases (NCDs), this study aimed to analyze the state of NCDs services at the level of the PHC system during the COVID-19 pandemic and to determine the main strategies.

 In this qualitative study, first, the circulars and guides in Iran's PHC system from the beginning of the pandemic to the end of September 2020 were retrieved manually and by searching the internal websites of the Ministry of Health. All documents about decision-making or governance and coordination mechanisms for the provision of NCDs services were enrolled and analyzed. In the second phase, the status of service delivery for major NCDs was presented in a model, and finally, SWOT analysis was used to analyze the situation and determine the main strategies. 

 25 out of 199 circulars and guides were eligible and analyzed. In the crisis phase, most risk assessment, screening, and diagnosis services for NCDs have been suspended, and follow-up and care of patients with major NCDs were done by telephone. In the reopening phase, the general strategies and strategies to increase capacity and provide delayed care were adopted, and the PHC model of the provision of essential services for the major NCDs was developed in low-risk, intermediate and high-risk pandemic conditions. Finally, 16 main strategies were determined with the approach of integrating and focusing on essential services, considering vulnerable groups and the use of E-health technologies.

 The results indicate on interruption of NCDs services in the crisis phase while adopting strategies for responding to the pandemic. Revision of the COVID-19 guides with a particular focus on NCDs is recommended.

The high prevalence of diabetes in Iran and other developing countries is chiefly attributed to urbanization. The objectives of the present study were to assess the prevalence of self-reported diabetes and to determine its associated risk factors. This study is a part of the national noncommunicable disease risk factor surveillance, conducted in 31 provinces of Iran in 2011. First, 10069 individuals, between 20 and 70 years old (3036 individuals from rural and 7033 from urban areas), were recruited. The major risk factors were studied using a modified WHO STEPS approach. Diabetes was considered based on self-reported diabetes. The prevalence of self-reported diabetes was 10% overall. The prevalence in the rural and urban settings was 7.4% and 11.1%, respectively. Moderate physical activity (OR=0.45, 95% CI=0.29–0.71) and family history of diabetes) OR=6.53, 95% CI=4.29–9.93) were the most important risk factors among the rural residents and systolic blood pressure (OR=1.01, 95% CI=1–1.02), waist circumference (OR=1.02, 95% CI=1.01–1.03), and overweight (OR=1.36, 95% CI= 1–1.84) were significantly associated with self-reported diabetes in the urban residents. The prevalence of self-reported diabetes in the urban setting was higher than that in the rural setting. Physical inactivity, abdominal obesity, and high blood pressure were the most important risk factors associated with self-reported diabetes in Iran.