rahim khodayari zarnaq

Maternal health indicators, especially for pregnant mothers, are among the most important health indicators for any country. Given the implementation of the health transformation plan in the service delivery system in Iran, it was expected that there would be a significant improvement in the quality and quantity of services provided to mothers in recent years. Therefore, the aim of this research was to investigate the effect of implementing healthcare reform on maternal health indicators in East Azerbaijan province, Iran.

This was a quasi-experimental study. The research population consisted of people living in villages in East Azerbaijan province - Tabriz district, Iran; with active health centers from 2007 to 2016, including a sample size of 200 mothers per year. Villages were randomly selected as clusters. Data collection tool was a questionnaire and all data were analyzed by SPSS version 22 statistical software.

The findings showed that the mean age of mothers during the study period ranged from 25 to 27 years. The number of pregnancies before the reform was 1.39 and after the reform, it was 1.20 which was statistically significant. Examination of the insurance status of pregnant mothers showed that before the reform, 6.4% of rural residents were uninsured, while after the reform, all of them were covered. In terms of laboratory services, 97.7% of mothers underwent routine tests in the first trimester, and 90.5% underwent routine tests in the second trimester. Additionally, over 99% of mothers had undergone at least one ultrasound, with an average of 2.56 ultrasound appointments.

The implementation of the healthcare reform increased the insurance coverage of pregnant mothers and the utilization of services such as ultrasound. This initiative led to a reduction in maternal and neonatal mortality rates and a decrease in the rate of natural childbirth.

The total fertility rate (TFR) is a key indicator of population dynamics and health. It shows the average number of children a woman would have in her lifetime, based on the current fertility rates for different age groups. Various factors affect the TFR, such as social, economic, political, technological, environmental, and health factors. By analyzing these factors and how they influence the TFR, policymakers and planners can design and implement interventions to achieve optimal population and health outcomes.

We searched PubMed, Scopus, ISI Web of Science, and ProQuest databases, as well as the Google Scholar search engine systematically. We searched for studies from 13 December 2021 - 20 May 2022, without time limits. We included studies that described at least one driver of TFR. We applied the STEEPH framework (social, technology, environmental, economic, political, and health) method to analyze the qualitative data.

We included 64 studies from 26 countries. We identified 410 drivers of TFR, and classified 181 drivers into six main categories: Social, technological, environmental, economic, political, and health. The main factors that lower the fertility rate are education, aging, poverty, postponing marriage (social), exposure of women to mass media (technology), type of residence and living in urban areas, road accidents (environmental), income and economic situation (recession and inflation), unemployment, debt, women’s employment (economic), government policies (political), use of anti-fertility drugs (health). The main drivers that raise the fertility rate are having first child girls, women’s proximity to their workplace (social), use of assisted reproductive technology (technology), living in rural areas and natural and unnatural disasters (environmental), improvement in men’s labor market conditions, employment opportunities (economic), increased parental leave (political), high infant mortality (health).

We identified a comprehensive list of effective drivers that have increased or decreased TFR in different parts of the world. It is necessary to review these drivers considering the specific conditions and social, cultural, economic, and political coordinates of each country. This review should inform policymakers' actions in this area.

Universities have established a system of periodic evaluation and accreditation in order to manage the quality of education, enhance their physical resources and educational equipment, and improve their human resources. This study aimed to conduct an analysis of second-generation institutional accreditation standards for medical sciences universities from the experts' perspective.

The present research was a qualitative study with an inductive approach conducted at Tabriz University of Medical Sciences between the years 2019- 2022. The sampling method was purposeful, and data were collected through semi-structured interviews with 34 managers, officials of development offices, and experts involved in the accreditation programs of educational institutions. As for study validation, the four criteria of Guba and Lincoln (i.e., credibility, dependability, confirmability, and transferability) were used. As for data analysis, MAXQDA 20, a software program designed for computer-assisted qualitative and mixed-methods data analysis, was used. The interview texts were analyzed using the content analysis method.

The results of the content analysis identified 204 initial codes, 9 subcategories, and 2 main categories (the strengths and weaknesses of the content). The subcategories of strengths included standardization, improvement of educational processes, development of assessment areas, restructuring of educational structure, benchmarking global experiences, and transparency in criteria. The subcategories of weaknesses included structural weaknesses, lack of validity, and ambiguity in criteria.

The process of analyzing the content of accreditation standards for educational institutions periodically and obtaining regular feedback will lead to the enhancement of the standards and the realization of activities, ultimately resulting in the improvement of educational quality and the dynamism of the community.

 A better understanding of health system performance requires evaluating achievements and challenges, thereby providing a basis for effective reforms. This systematic review aims to investigate the challenges and weaknesses of leadership and governance-related health policies in Iran.

 In this qualitative systematic review, we followed the instructions of the Joanna Briggs Institute (JBI). It encompassed qualitative studies assessing challenges and weaknesses of leadership and governance-related health policies. Thematic synthesis was conducted in three stages to identify common themes.

 The primary database search yielded 1890 records, of which 152 were fully assessed, resulting in the inclusion of 57 studies in this review. Thematic synthesis produced 157 structured codes and identified 11 main descriptive themes of challenges in leadership and governance-related health policies. These themes included hospital autonomy policy, challenges to the entire health system, governance of medical universities, healthcare payment systems, sustainable universal health insurance coverage, informal payments, insurance systems, induced demand, strategic purchasing of health services, the family physician program, family physician and rural health insurance programs, and primary healthcare human resources.

 The identified challenges underscore the urgent need for strategic reforms and interventions to overcome the complex issues plaguing the healthcare system. By addressing these challenges, policymakers and top healthcare managers might ensure that the population have access to high-quality care in a more responsive healthcare system.

As physical inactivity is presently a global concern, encouraging people to engage in physical activity (PA) is a public health policy priority. This study was conducted to analyze the process of change in the adoption of policies which aim at promoting PA in setting the policy agenda. This qualitative study was conducted using document reviews and semi-structured interviews. A total of 23 key informants from different sections of the policymaking process for PA promotion programs in Iran participated in the study. Purposeful sampling with a maximum variation was used to identify the key informants. Analysis of documents and interviews was conducted on the basis of Kingdon’s multiple streams Framework (MSF): problems, policies, and political streams. The MAXQDA-10 software was used to manage the data analysis process. The problem stream was found to be “the high prevalence of physical inactivity, perceived subjective barriers, and contextual factors for PA” throughout the country. The policy stream focused on integrating PA services into primary health care, scheduling national and global calendar campaigns and events, and using the existing legal structures to promote PA in communities. At the political stream, support for policy documents and various legislative and governing authorities, as well as international support, particularly the World Health Organization 2018–2030 agenda, provided a favorable environment for this issue. Despite the opening of a policy window for developing policies to promote PA, several challenges may hinder the policy implementation process, including a lack of health promotion approach in the health system, lack of inter-sectoral cooperation, COVID-19 pandemic-associated restrictions, and management and structural issues. As the policy window is not being used appropriately, the policymakers must review the policies, with particular attention to the feasibility of policies, the organizational culture of the different ministries, and the mediating and advocating roles of the health sector in operationalizing the policies.

Identifying different groups of customers and their preferences and needs enable countries to gain a competitive advantage in the medical tourism market. We aimed to segment medical tourists from West Asian countries seeking medical services in Iran.

This cross-sectional study was conducted on 596 medical tourists who sought medical services in Iran in 2021. Data were collected using a valid questionnaire. Segmentation was performed based on medical tourism attributes (medical, destination, and tourism attributes), using cluster analysis methods; wards, and K means. The segments ' evaluation and profiling were conducted using discriminant analysis, chi-square, and one-way ANOVA tests.

Our study divided the market into five segments: health seekers (3.8%), health and destination seekers (8.9%), tourism seekers (17.8%), infrastructure seekers (10.23%), and perfectionism (59.45%). In all segments, the health attributes were of high importance. The perfectionism segment registered the highest score in all three attributes (more than 5 of 6).

Improving health attributes and offering luxurious medical services can be the main strategy for Iran to attract the most medical tourists and achieve a good position in this marketplace. The implication of this study is policymaking for targeting the most profitable segment of this marketplace.

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.

Understanding the value and willingness to pay (WTP) for services is crucial for decision- making.

This study aimed to measure the level and factors affecting households’ WTP for dental services using the doublebounded dichotomous choice approach.

This cross- sectional study collected data through a questionnaire- based interview with 300 households in the city of Tabriz, Iran, in 2019. The double- bounded dichotomous choice approach was used to estimate WTP, and factors related to WTP were calculated using an internal regression model, and data were analyzed using Stata 14.

The households’ mean WTP for fissure sealant, fluoride therapy, scaling, and removable orthodontics were $8.96, $4.36, $16.00, and$47.38, respectively. Household income, education level, age, regular dental visits, andhaving elderly people in the family were found to be factors affecting WTP for dental services.

The study found that household income was a significant factor affecting WTP for dental services. Not using dental services is often due to low household income and high service prices. Therefore, policymakers should consider setting dental service prices based on income levels to ensure access to services for all income groups.

In addition to being responsible for the death and infection of millions of people around the world, COVID-19 also created a range of social, economic, environmental, and mental health challenges. This study was conducted with the aim of investigating various dimensions, challenges, and effects of the pandemic in the aforementioned areas.

The present scoping review was conducted in 2022. All published articles in the field of aforementioned dimensions were searched from the beginning of 2020 to the end of April 2022. Searches were made in English language databases including Medline through PubMed, Scopus, Web of Sciences and also manual search in Persian language databases including SID and Magiran. After reviewing gray and manual texts, finally 84 final articles were selected. The data were analyzed and classified using the content analysis method using the "framework of structural and intermediate determinants of health" of the World Health Organization.

Cases such as the reduction of the gross national product, the imbalance of supply and demand, the urgent need to strengthen social protection systems, the increase in inequality, the reduction of the social rights of women and children, and the reduction of access to health services are among structural factors and cases such as tourism damages, decrease in mental well-being, increase in irritability, anger and tension, fear of COVID-19 in the elderly and exposure to the spectrum of mental problems were among the intermediate determinant factors that have led to direct and indirect effects on the justice, health, and well-being of societies.

The COVID-19 pandemic and the subsequent actions of the governments, such as nationwide quarantines and the creation of numerous restrictions, have led to a wide range of social, economic and environmental effects on societies. Countries need effective and extensive measures in determinant factors to get rid of the negative effects of the spread of this disease on the health and well-being of people in the long run.

Tobacco use is the fifth risk factor for non-communicable diseases in Iran. This study aimed to analyze the policies and measures of tobacco control in Iran in the last four decades (1983-2021).

The present study is a retrospective policy analysis that used a case study plan based on the Walt and Gilson triangle policy analysis framework to examine the content of tobacco control policies in Iran. Data were collected using tobacco use policies and legal documents and analyzed using documentary analysis. MAXQDA 11 software was used to categorize and analyze the findings.

The policies include setting prices and taxes on tobacco to reduce demand; protecting the public from second-hand smoke; controlling the composition of tobacco products; setting regulations on the disclosure of information about tobacco packaging and labeling; educating the public about the dangers of tobacco use; advertising, promotion, and financial support of tobacco; setting measures to encourage smoking cessation and reduce the demand and dependence on tobacco; banning illegal tobacco product trading; banning youngsters from tobacco trading; financially supporting the practical alternatives such as economic activities and research; setting monitoring and evaluation systems; and enhancing the exchange of information.

Strengthening the government's tobacco control capacity and formulating a clear and coherent national tobacco control strategy and roadmap, including a mechanism for practical cross-sectoral cooperation between different actors, can reduce conflicts of interest between the actors involved and determine the country's current and future tobacco control policies.

 Hospitals play a crucial role in providing medical services to medical tourists and their satisfaction; however, they face many problems in this field.

 This study aimed to explain hospitals’ challenges in providing healthcare services to medical tourists.

 In this qualitative-phenomenological study conducted in 2021, data were collected through semi-structured interviews, purposive sampling, and the participation of 21 key informants involved in hospitals and medical tourism industries in six large cities in Iran. They were then analyzed using the thematic analysis method with the MAXQDA-10 software.

 Hospital challenges were included in 165 final codes. The six main ones were governance and leadership, financing, human resources, technology-equipment-medicine, information systems, and service delivery. Three categories of structure, process, and outcomes related to medical tourism were also identified.

 Improving the information and communication infrastructure, developing the activities of facilitator companies, updating the standards of the International Patient Department (IPD), compiling guidelines related to insurance, and setting tariffs are suggestions that can help reduce the existing challenges.

Hypertension is one of the most important risk factors of cardiovascular morbidity and mortality that holds a unique place in population health and health care.

Given the exponential rise of high blood pressure as one of the major health problems, this study aimed to investigate the current situation and provide a strengths, weaknesses, opportunities, and threats (SWOT) analysis in the management of hypertension.

A qualitative study of 12 interviews was conducted with policymakers and managers. The sampling method was purposive sampling. Data collection was performed from January to July 2020. A thematic approach was used to analyze the data. The consolidated criteria for reporting qualitative research 32-item (COREQ-32) checklist was applied to ensure quality control in the study design, analysis, and data reporting.

A total of 12 factors were identified as SWOT. The most important strengths included universal coverage of health services, provision of team-based care, and self-care training. The weaknesses were related to the therapeutic approach, long-term planning, and continuity of programs. Cooperation of other sectors with the health system and the existence of health management training centers were noted as opportunities to better implement hypertension management programs and confront threats such as conflicts of interest between guilds and organizations and crises.

High blood pressure can be prevented. The present direction toward health-oriented policies can be changed in all sectors by taking advantage of the existing strengths and opportunities.  

The Health Transformation Plan (HTP), as the latest reform of Iran's health system, has been implemented gradually in several phases to facilitate the achievement of universal health coverage. We aimed to identify the achievements and challenges of the HTP from the beginning of its implementation in Iran health system.

In this qualitative systematic review, English papers were searched in PubMed, Scopus, Web of science, and Google Scholar search engines in addition to Persian databases such as Magiran and SID from 2014-2020. The Mixed-Methods Appraisal Tool (MMAT) checklists were used to assess the quality of the studies. Study selection, quality assessment, data extraction, and data analysis were done independently by two people. For analyzing the data, the Framework Analysis Method, based on the health system function framework of the WHO, was used.

Overall, 32 papers were included based on the inclusion criteria. The results were divided into four main themes: stewardship, financing, resource generation and service delivery, and20 sub-themes in the form of achievements and challenges. Regulatory and standardization, service packages, medical equipment and supplies, and the quality of health services were more repetitive. Considering the challenges of HTP, purchase process, motivational factors, and health services capacity were more repetitive.

The administrative challenges in the implementation of the HTP have prevented the sustainability of the outcomes and their main goals. The use of strategic dynamic planning, anticipating sustainable financial resources, and strengthening the monitoring mechanisms could lead to further achievements.

The under-five mortality rate is one of the most important indicators of sustainable development, and accidents and injuries are the leading causes of child mortality.

The purpose of this study was to investigate the factors affecting child mortality from road traffic accidents in Ardabil province, Iran.

This descriptive-analytical study investigated all mortalities of children under 5 years from road traffic accidents and injuries that occurred in Ardabil within 2013 and 2021. Standard questionnaires of the Child Health Department of the Iran Ministry of Health and Medical Education were used to collect data. Based on the Haddon matrix, the data were classified into three groups, namely Pre-event, Event, and Post-event. P-charts were used in statistical process control to control the care process in the system and identify specific and general causes. The data were analyzed in SPSS software (version 24).

A total of 64 mortalities occurred in the period under review. According to the Haddon Matrix analysis, environmental factors had the greatest impact in the Pre-event phase (41.6%); nevertheless, human factors had the greatest impact in the Event phase (62%) and the Post-event phase (46.8%).

Given that road traffic accidents are the leading cause of accidents and unintentional injuries in Iran, with a rate of 38.3%, it is necessary to enhance safety-related knowledge and skills, develop safe streets and roads, ensure child safety in cars, and promote safe vehicle use. As for the regulatory bodies, enforcing strict driving rules and regulations, providing necessary monitoring and control, and facilitating access to emergency centers should be the top priorities.

The implementation of WHO safe surgery checklist (SSC) was proposed by the Ministry of Health and Medical Education in the operation rooms of Iranian hospitals in 2011, but was canceled after several years due to some challenges in implementation.

This study aimed to investigate the barriers and facilitators of the effective implementation of the SSC.

This cross-sectional study was performed in public hospitals of Tabriz city in 2019. The study population consisted of operation room working staff, and the purposive sampling was used. The research tool was a researcher-made questionnaire designed through literature review and included three parts of demographic variables, barriers, and facilitating factors. Data were analyzed with SPSS-22.

The mean of barriers to implementation of the SSC was 3.03 out of 5. The most important barrier to implementing the checklist was the weakness in team working (3.18), while checklist barriers were the least important (2.98). The mean score of facilitating factors was 3.46. Among the facilitators, the highest score was for team working facilitators with a score of 3.47 and the lowest score was for the facilitators associated with the checklist with a score of 3.37.

This is one of the first studies that explored the barriers and facilitators of SSC implementation in Iranian hospitals. We identified weak team working as the most important barrier to implementing the checklist. These results help policymakers and hospital managers to implement the checklist more effectively.

Today, cardiovascular disease (CVD) is the leading cause of mortality in both sexes. There are several risk factors for heart diseases; some controllable, others not. However, socioeconomic, technological, and environmental factors can impact CVD as well as exclusive risk factors. Accurate identification and assessment of these factors are often difficult. In the present systematic review, we aimed to explore factors affecting CVD.

Multiple databases (MEDLINE, Scopus, ISI Web of Science, and Cochrane) and gray literature were searched. The included studies described at least one determinant of CVD. The framework method was applied to analyze the qualitative data.

A total of 64 studies from 26 countries were included. The contextual determinants of CVD were categorized into 45 determinants, 15 factors, and 4 main social, economic, technological, and environmental categories. The 15 potentially reversible factors were identified as sociodemographic, violence, smoking, occupation, positive childhood experience, social inequalities, psychological distress, eating habits, neighborhood, family income, rapid technology, environmental pollution, living environments, noise, and disaster.

Devolution and more efficient health policies are required to achieve further sustained reduction in CVD mortality, increase life expectancy, and reduce its associated risk factors. Policymakers should fully address the value of social, economic, technological, and environmental factors. In fact, a prevention agenda should be developed and updated collaboratively in terms of the determinant factors.

This qualitative systematic review was conducted to summarize the policies for prevention of common gastrointestinal cancers worldwide. This study was conducted using PubMed, Web of Science, SCOPUS, and ProQuest databases. Two independent reviewers assessed included studies for methodological quality and extracted data by using standardized tools from Joanna Briggs Institute (JBI). Primary study findings were read and reread to identify the strategies or policies used in the studies for prevention of gastrointestinal cancers. The extracted findings were categorized on the basis of their similarity in meaning. These categories were then subjected to a meta‑synthesis. The final synthesized findings were graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis. From the nine included studies in this review, 39 findings were extracted and based on their relevance in meaning were aggregated into 12 categories. Four synthesized findings were developed from these categories. We used World Health Organization report on 2000 for synthesizing the findings. The four synthesized findings were “service provision”, “resource generation”, “financing”, and “stewardship”. In order to reach a comprehensive evidence informed policy package for the prevention of gastrointestinal cancers, there should be a great communication among the interventions conducted directly on patients, health system infrastructures, and resources.

Despite the intention to perform physical activity (PA), a number of individuals cannot manage to have PA program on a regular basis. In this study we explored the barriers of regular PA behavior among healthy adults in Tabriz, Iran.

This qualitative study with a conventional content analysis approach, was carried out from June to September 2020. Nineteen 30-59 years old individuals, were purposefully (purposive sampling) selected to participate in the study. The participants were formerly registered as “physically inactive” in the health records of Tabriz Health System. Individual semi-structured interviews were conducted until data saturation. Data were managed using MAXQDA-10 software.

The barriers of regular PA that emerged from our data were being listless and lethargic, non-supportive environment, disintegration in PA education chain, and restrictive social norms.

Our findings uncover several PA barriers that are less discussed in the literature. Poor level of regular PA among adults in Iran, as a developing context, is rooted in perceptions with social and economic origins, which should be taken into account by public health policy makers while planning PA promotion programs in such communities. To promote regular PA among healthy adults in developing countries, regular PA programs should be tailored to bridge the gap between their recognition of PA barriers and subsequent behavior change through creating group dynamics highlighting the measures to diminish the behavior.

During the COVID-19 Pandemic, political elites in Iran have tried to use social media to express their views, influence public opinion or criticize the government's performance in managing Covid-19 disease. The aim of this study was to investigate and analyze the tweets related to this Pandemic that were tweeted by Iranian political elites.

This qualitative study is conducted based on the method of content analysis. A list of political elites likely to run for presidency in 1400 presidential election was selected by referring to public and specialized political news websites, their Twitter accounts were identified and all their Persian and English tweets about COVID-19 until the end of 2020 were collected and reviewed. Content analysis method was used for analyzing the tweets.

More than 2,800 tweets from 27 political elites were reviewed. About 18% of the total tweets during this period were related to health and about 84% of the health tweets had COVID-19 content. All tweets related to COVID-19 were categorized under six main themes; notices; policy recommendation; criticism of government performance; situation analysis and future forecasting; warnings and Macroeconomic, social and political issues.

In recent years, the use of Twitter among Iran's political elites has increased significantly. It seems that the tweets of the political elites can influence the public’s views and behaviors as well as the government performance in a major way, leading the government to be more accountable in responsible management of the COVID-19 pandemic. The health system can also make more use of the social network's capacity to inform programs, attract support and disseminate health and prevention perspectives.

Curriculum revision with a new perspective on knowledge, skills, and learning is a step towards evolving and updating pedagogical content. This study endeavored to review PhD curriculum of health policy based on the required capacities for graduates.

This study was conducted at Tabriz University of Medical Sciences (in the academic years 2016-2018) based on Dennis Modified Model. We used a set of methods such as review of documents, comparative study, interview, focus-group discussion and panel of experts for gathering data. The study was conducted in four stages including need analysis, explaining the required competencies, modifying, adapting, and rewriting the initial curriculum, and finalizing the curriculum. Finally, the final curriculum was sent to the Ministry of Health and Medical Education. Data were analyzed through a conceptual framework approach and through content analysis.

The content of the course was designed based on the outcomes of the course and the plans and tasks of the graduates of this field. Graduates' abilities were extracted in 5 areas including policy making, policy analysis, leadership and social communication, as well as education and research. Some lessons were removed and some were added. Besides, the change in the content of specific courses was emphasized given the approval of similar disciplines and attention to optional courses in order to Specializing the course.

Reviewing the curriculum of the doctoral program in health policy and its implementation can lead to develop the more purposeful teaching-learning process, implementing the capability-based training and responsive education, increasing the specialized knowledge and technical skills of graduates, that enhance their success possibility in the future job. It is suggested that special attention has been paid to this issue and the requirements, challenges and appropriate strategies for precise and scientific review of various fields in medical and paramedical education be examined.

Human life is tied with the stress caused by economic, political, social, and cultural problems, which may lead to physical and mental diseases. In such stressful conditions, people make lifestyle changes that put themat high risk for developinghypertension.

Accordingly, this study investigated the prevention and management of hypertensionas a major public health challenge in Iran.

Semi-structured interviews were conducted with managers, health policymakers, social medicine specialists, and faculty members. All interviews were recorded, transcribed verbatim, and analyzedusingthematic content analysis.The MAXQDA18 software was applied to facilitate the organizationof codes and themes.

Interviews were conducted with 17 participants. The analyses resulted in five themes including, educationalpolicies,cultural policies,urban transport policies,organizational policies,and economic policies. A total of 13 subthemes were also extracted from the data.

Findings have indicated the stressors factors, stemming from macro-policies and mismanagement of government.To reduce the burden of hypertension and improve people's living conditions, health-oriented policies should be designed and implemented in all sectors.

Schools play a crucial role in developing a healthy lifestyle and community participation, especially family participation, which is essential to schools’ success in achieving this role. This study aimed to examine the family/community involvement in schools’ health planning and policymaking from the principal and lead health education teacher in Tabriz, Iran.

This cross-sectional study was conducted in 2016. The statistical population included all school principals and lead health education teachers in Tabriz, Iran. A total of 93 schools were included. A systematic random sampling method was used for data collection. Data were collected using the School Health Profiles. The content validity of the profile was revised by an expert involved in school health. The questionnaire’s reliability was calculated by internal consistency and Cronbach’s alpha coefficient. Data were analyzed using SPSS22. Mann-Whitney and Kruskal–Wallis tests were applied to examine the difference between the type of school (in terms of ownership, gender, and grade) and the school’s percentage that attracts family/community participation.

According to the results, only 53.80 % of schools actively collaborated with students’ families in developing and implementing policies and programs related to health school. The majority of schools (83.30 %) provided parents with educational content on nutrition and healthy eating, while only 40 % of them provided parents with educational content on HIV prevention, STD prevention, teen pregnancy prevention, and asthma. Moreover, more than 50 % of schools worked with other staff groups about health education activities. In most schools (73.30 %), health education teachers worked with physical education staff, while in 53.30 % of them, health education teachers worked with nutrition or service staff on health education activities.

Given a low percentage of school and family/community partnerships in school health-promotion programs in most dimensions, comprehensive and integrative planning must be implemented to create engagement and collaboration with other community sectors.

The Health Transformation Plan (HTP), the latest reform in Iranchr('39')s health system to achieve the 3 main goals of financial protection, equity, and quality of health care, was started on May 5, 2014. This study aimed to review all available literature regarding the achievements and outcomes of this reform after 6 years of its implementation.

The 5 English databases were examined by using appropriate keywords to find documents published on the HTP between June 5, 2014, and the end of April 2020. Out of 532 recovered articles, 137 were included in the study. The studychr('39')s organization was based on the Arkesy and Ochr('39')Malley framework and data analysis was done using the content analysis method. 

The findings of the study were divided into 11 sections. Studies on the planchr('39')s impact on financial protection (22.6%), performance indicators (14.5%), and natural delivery promotion (14.5%) were the most frequent, respectively. Regarding the impact of the HTP on patient satisfaction ,performance indicators, and efficiency, mostly positive results have been obtained. However, in terms of the impact of the HTP on financial protection and informal payments, the outcomes have been different, contradictory, and sometimes negative.

Although the HTP has successfully achieved a number of its goals, in some of the goals, the results are not significant. Given the changing health conditions and funding constraints, it is better to consider measures to fundamentally review the HTP and executive packages.

The level of physical activity (PA) among middle-aged Iranians is less than optimal. This study will be carried out to analyze and recommend policy options to promote PA among urban middle-aged adults in Tabriz, one of the metropolitan cities in Iran.

This multi-method policy analysis study will include the following four phases: First, a qualitative content analysis to explore the reasons for lack of PA. Second, a comparative study of successful PA programs and policies in Iran and other similar developing countries. Third, a qualitative thematic analysis based on the policy triangle to analyses PA promotion policies using the key informants’ views. Fourth, analysis and prioritizing the policy options suggested by a panel of experts using the analytical hierarchy process (AHP) techniques.

Prospective policy analysis promises the systematic process of selecting potentially effective policy options to promote PA in metropolitan settings of developing countries. The results of this study will provide a comprehensive vision of the most appropriate policy options based on the criteria of acceptability, effectiveness, and feasibility for addressing PA at the local and national levels. Considerations on the challenges of PA policymaking cycle and the barriers to the implementation of current policies in the Iranian context will also be identified.