The range and diversity of providers’ viewpoints towards the Iraqi primary health care system: an exploration using Q-methodology

Abstract

BackgroundThe increasingly recognized need for reorganizing the primary health care services in Iraq calls for a comprehensive assessment of the system to better understand its problems and needs for development. As part of such comprehensive assessment and due to the important role of primary health care providers in adopting any change, we ought to explore the range and diversity of viewpoints of primary health care providers towards the Iraqi primary health care system.MethodsThis explorative study was carried out in Erbil governorate, Iraq from May to July 2011. Data were collected from primary health care providers using Q-methodology to elicit subjective viewpoints and identify shared patterns among individuals. Forty primary health care providers representing eight primary health care centers sorted 41 statements reflecting different aspects of the Iraqi primary health care system into a distribution on a scale of nine from “disagree most” to “agree most”. By-person factor analysis was used to derive latent viewpoints through centroid factor extraction and varimax rotation of factors.ResultsAnalysis of the participants’ Q-sorts resulted in four distinct viewpoints among primary health care providers toward the current primary health care system. One factor emphasized positive aspects of the current primary health care system that is content with the current primary health care system. The other three factors highlighted the negative aspects and they included (i) professionally-centered viewpoint, (ii) comprehensive perception and problem-based solutions and (iii) critical to leadership/governance aspects of the system.ConclusionsThis study revealed diverse viewpoints of primary health care providers toward the current Iraqi primary health care system and recognized the particular issues related to each viewpoint. The findings can contribute to a better understanding of health policy makers and primary health care managers concerning the problems facing the primary health care system that might contribute to change in the management of this system.

Assessment of women’s perspectives and experiences of childbirth and postnatal care using Q-methodology

“…Different factor solutions were examined and the solution where all the factors had at least 2 defining sorts and had eigenvalues more than 1.00 was selected (23). Interpretation of each factor was done subjectively through examining the characterizing statements (those with a rank value of +4, +3, -3, -4) and the distinguishing statements (a statement whose score on that factor is significantly different from its score on any other factor) (7,17).…”

“…This is particularly true when the respondents receive maternity services at different service delivery points with different quality of care and health professional with different skills. Q-methodology can help in uniquely identifying and highlighting such differences in a new and insightful way (7,10). There can be many possible reasons for differences between the respondents in their experience of care.…”

Introduction of an Appointment System in Primary Health Care Setting in Baghdad: Views of Patients and Health Care Providers

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