Background The family physician program was launched in 2005 in rural areas of Iran and then piloted in 2012 in the cities of Fars and Mazandaran provinces due to insufficient health coverage in these cities. However, despite its pivotal role in the health system, this program has not progressed according to the policies. This study aimed to explain the underlying factors and challenges of implementing the urban family physician program in Iran. Methods This qualitative study was conducted on 44 policy-makers and managers at national and provincial levels selected via snowball and purposive sampling with maximum variation. The data were managed in MAXQDA 2020 and analyzed by directed content analysis. A triangulation method was adopted for this purpose. Results A total of 10 categories, 18 sub-categories, and 29 codes were formed. Most challenges related to underlying factors included precipitancy, economic sanctions, belief in traditional medicine, belief in the expertise of previous physicians, and global ranking of countries. For program implementation, most challenges included a diversity of insurance organizations, budget allocation, referral system, electronic file, educational system, and culture building. Conclusions The major challenges pertaining to underlying factors included international pressure for reforms and precipitancy in program implementation due to management changes. The challenges associated with program implementation included budget provision and interaction with insurance organizations. Therefore, to expand this program to other provinces in Iran, the identified factors should be carefully considered so that sufficient confidence and commitment can be guaranteed for all stakeholders.

IntroductionOne of the important causes of medical errors and unintentional harm to patients is ineffective communication. The important part of this skill, in case it has been forgotten, is listening. The objective of this study was to determine whether managers in hospitals listen actively.MethodsThis study was conducted between May and June 2014 among three levels of managers at teaching hospitals in Kerman, Iran. Active Listening skill among hospital managers was measured by self-made Active Listening Skill Scale (ALSS), which consists of the key elements of active listening and has five subscales, i.e., Avoiding Interruption, Maintaining Interest, Postponing Evaluation, Organizing Information, and Showing Interest. The data were analyzed by IBM-SPSS software, version 20, and the Pearson product-moment correlation coefficient, the chi-squared test, and multiple linear regressions.ResultsThe mean score of active listening in hospital managers was 2.32 out of 3.The highest score (2.27) was obtained by the first-level managers, and the top managers got the lowest score (2.16). Hospital mangers were best in showing interest and worst in avoiding interruptions. The area of employment was a significant predictor of avoiding interruption and the managers’ gender was a strong predictor of skill in maintaining interest (p < 0.05). The type of management and education can predict postponing evaluation, and the length of employment can predict showing interest (p < 0.05).ConclusionThere is a necessity for the development of strategies to create more awareness among the hospital managers concerning their active listening skills.

IntroductionIran introduced the urban family physician reform, based on the primary healthcare (PHC) approach, in 2012. The reform is restricted to two pilot provinces, which are Fars and Mazandaran and its policymakers request evidence of the reform progress. The study aimed to determine the accessibility of health care in the two pilot sites.MethodsA cross-sectional study using Primary Care Evaluation Tool (PCET) questionnaires was performed with a multistage stratified cluster sample of the family physicians (n=141) and patients (n=710) in the two provinces between September 2015 and March 2016. The questionnaires contained essential dimensions of health accessibility: organizational, financial, geographical, and cultural access. The data were analyzed by IBM-SPSS software and the descriptive statistics.ResultsWith an average population of 2,332, the main daily task for family physicians was patient visits (n=39). Most patients were satisfied with the current hours (80%) but visiting a family physician on holidays or after working hours were only rarely possible. The co-payment was an inconvenience to access health services in getting medicines, getting paraclinic exams and a visiting specialist. At least 70% of patients could receive their preferred healthcare facilities within 40 minutes. The majority of FPs (64%) believed there were some cultural characteristics in the population that made a limited role for providing better health services.ConclusionIn the reform the providers were geographically well distributed and some features of the organizational access were relatively high. However there were some difficulties in the financial, cultural, and other features of organizational access.

Background Self-medication in students, as educated people, is one of the most important health issues. It is known that inappropriate self-medication is harmful for individuals as it has potential risks, disrupts the drug market and increases the per capita financial drug consumption. Thus, the aim of this study is to investigate the habits related to drug use and the prevalence of self-medication practices among university students. Methods This cross-sectional study was conducted in 2021 at Jahrom universities/Iran, using an electronic “self-medication practices and medication habits” questionnaire. A total of 848 students from four healthcare and non-healthcare universities participated in the study. Results The prevalence of self-medication among students was 44.8%. The most common medicines used for self-medication included cold remedies and sedatives that were used by 33% of the students. About 47% of students stated that they have used antibiotics without a physician’s prescription. The internet and social networks were the source of information on self-medication in about 40% of students. There was no significant difference in self-medication between medical and non-medical students (OR = 0.865, 95% CI: 0.659–1.134). Self-medication in students with underlying disease was higher than students without underlying disease (OR = 2.8, 95% CI: 1.39–5.60). Conclusions Self-medication had a high prevalence among students. The best strategy to reduce or eliminate self-medication is to raise students’ awareness and knowledge about potential risk of self-medication practices.

Background: Breastfeeding affects long-term child health and improves the quality of their lives. This study sought to compare educational interventions based on the theory of planned behavior (TPB) in pregnant women and individuals influential to their exclusive breastfeeding (EBF) in the first six months of an infant’s life. Methods: This quasi-experimental study was performed from 2020 to 2021 on pregnant women, who were at their>30 weeks of pregnancy, and relatives influential in their life in Jahrom, southern Iran. Sampling was conducted by the stratified random method, and the sample size was determined as 90 (30 cases in each group). The study consisted of two intervention groups and a control group. Data collection tools included the demographic questionnaire and the standard TPB questionnaire for EBF. In the first stage, the questionnaires were completed by all three groups. The second stage involved an educational intervention. The training lasted five weeks. In the third stage, the questionnaire was completed again six months later. The collected data were analyzed by SPSS 21 using one-way ANOVA, chi-square, Mann-Whitney, Wilcoxon, and Kruskal-Wallis tests. Results: Based on the results, a significant difference was observed in intervention group 1 in terms of the attitude construct (P=0.009) before [Median (IQR)=34.5 (6)] and after [Median (IQR)=36 (5.25)] the educational intervention. Similarly, a significant difference was found in intervention group 2 regarding the subjective norm construct (P<0.001) before [Median (IQR)=25 (4.25)] and after [Median (IQR)=30 (4)] the educational intervention. Conclusion: Overall, in addition to pregnant women, their subjective norms should be considered in health education and promotion programs to improve EBF.

BACKGROUND: Osteoporosis is one of the major problems associated with aging and is more common among women than men. This study was designed to modify osteoporosis-related behaviors in female students based on the transtheoretical model (TTM). MATERIALS AND METHODS: This quasi-experimental study was conducted on female secondary school students. The sample size was determined 100 by using Altman's nomogram, including 50 cases and 50 controls. Participants were completed the Demographic Information and Osteoporosis-Related Behavior Questionnaire based on TTM. Evaluation of the data showed that each participant was at what stage of change in physical activity and preventive dietary behavior of osteoporosis. The content of the training package was designed, and for the intervention group, 2-h training sessions were held weekly by the instructor in accordance with the stage of change for 2 months, and the booklet was provided with the appropriate contents of the stage of change. Three months after the completion of training, the questionnaires were completed by intervention and control groups. Statistical analysis was performed using SPSS 23 software. RESULTS: Concerning the stages of change in physical activity and nutrition, a significant difference was before and after the intervention in the intervention group ( P < 0.001), while no significant difference was observed in the control group. After the intervention, there was a significant difference in the self-efficacy and some subconstruct of processes of change, but there wasnot a significant difference in the decisional balance. CONCLUSION: Educational intervention based on TTM has been successful in achieving the goal of modifying osteoporosis-related behaviors in female students. The results of this study can be used by health planners to plan and implement health promotion interventions that will undoubtedly help reduce the burden of disease.

Background: Irrational use of drugs is a serious global problem, especially in developing countries. Scientific evidence has announced albumin and intravenous pantoprazole as expensive drugs, i.e., relatively irrationally applied in hospitals without following the guidelines.  Objectives: Considering health cost management policy in Iran, this study aimed to evaluate the effects of implementing pharmaceutical guidelines to rationalize and reduce the use of albumin and intravenous pantoprazole and the related inappropriate costs. Methods: This quasi-experimental study was conducted from January 2016 to October 2018 in two teaching Hospitals in Jahrom City, Iran. Pharmaceutical guidelines were implemented throughout the physical training as well as a pharmacist-led intervention and supervising. All inpatient prescriptions of the studied medicines were evaluated.  Results: Before conducting the intervention (June 2016), an average of 357 albumin vials were monthly used; after performing the interventions, 166 and 167 vials were used in 2017 and 2018, respectively. Reduced albumin use rate equaled 48%, i.e., significant (P=0.002). Annual cost-saving was estimated to be 25000 USD. In comparison to the previous year, there were 46% and 70% reductions in the mean number of pantoprazole vials prescribed in 2017 and 2018, respectively (P=0.005).Consuming pantoprazole was measured to be 1457 vials per month in 2017 and 795 in 2018, i.e., significant (P=0.002). Cost-Saving in intravenous pantoprazole was estimated to be 16000 USD in 2017 and 25000 USD in 2018.  Conclusion: Prescription strategies, such as pharmaceutical guidelines with educational measures, pharmacist-led intervention, monitoring the prescribing drug, and feedback to prescribers can significantly decrease the inappropriate use of expensive drugs and their costs.

Background: Women of reproductive age have important responsibilities such as pregnancy, breastfeeding, and children raising. This study aimed at surveying the effect of educational interventions, based on the health belief model (HBM), in the prevention of self-medication (SM) in women of reproductive age. Methods: This quasi-experimental study was performed on women of reproductive age in Jahrom in 2019 (January-September). Simple multi-stage random sampling was used to select the participants, and the sample size was determined 60 people for both intervention and control groups. Data collection tool was a questionnaire including demographic information and HBM construct questions. The questionnaire was completed in person by both groups before and three months after the educational intervention. The educational intervention was performed based on the HBM in the intervention group, including holding 4 educational sessions each lasting 60 minutes. The data were analyzed by SPSS 21 software using the chi-square test, paired t test, and independent t-test. Results: The results showed a significant difference between intervention and control groups in terms of knowledge, perceived severity, benefits, and barriers, as well as cues to action on the correct use of drugs after the intervention (P<0.05). Three months after the intervention, the practice mean of women in the intervention group was significantly decreased compared with the control group (P<0.001). Conclusion: Overall, educational intervention based on HBM was effective in preventing SM, but the extent of this effect varied for different HBM constructs. Nonetheless, measuring the effectiveness of the intervention based on the HBM in preventing SM behaviors requires studies with a long follow-up period.