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An Evidence-Informed and Key Informants-Appraised Conceptual Framework for an Integrated Elderly Health Care Governance in Iran (IEHCG-IR).

ABSTRACT: Purpose:Population ageing has been steadily rising in Iran and in the over 60-year-old population, the ratio increased from 5.4% in 1986 to 8.6% in 2016 which represents an increase of 4.3 million over the past three decades. The inevitable impacts of a growing elderly population on the demand-side of the health care provision (HCP) equilibrium call for an urgent revision of the current arrangements of the Iran's National health care system (INHS). The main aim of this study was to scrutinize the best available scientific evidence on the international integrated elderly health care governance (HCG) models to revamp health care practice and policy-making processes in Iran. Materials and Methods:This multiphasic study consists of a scoping review of existent HCP modalities for the elderly population worldwide, and the disposition of an optimal HCP scheme for the elderly population and its application for the detection of the gaps in Iran. The final stage includes a Delphi-based consultation and consensus process which was reciprocated in three rounds and the key subjects were requested to give their judgment on the eventuated HCP layout designed to serve the ageing Iranian population. Results:The yielded model (IEHCG-IR) included four dimensions consistent with the four levels of prevention along with social support services. The structure and feasibility of the preliminary framework were approved by 83.6% of the study participants. Conclusion:The study findings could have important implications for future policy making in the INHS and the suggested healthcare framework for the elderly Iranian population could be a preliminary model for health system re-engineering.

SUBMITTER: Abbasian M

PROVIDER: S-EPMC7468414 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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An Evidence-Informed and Key Informants-Appraised Conceptual Framework for an Integrated Elderly Health Care Governance in Iran (IEHCG-IR).

Abbasian Mehdi M Shaghaghi Abdolreza A

Risk management and healthcare policy 20200827

<h4>Purpose</h4>Population ageing has been steadily rising in Iran and in the over 60-year-old population, the ratio increased from 5.4% in 1986 to 8.6% in 2016 which represents an increase of 4.3 million over the past three decades. The inevitable impacts of a growing elderly population on the demand-side of the health care provision (HCP) equilibrium call for an urgent revision of the current arrangements of the Iran's National health care system (INHS). The main aim of this study was to scrut ...[more]

PMID: 32943954

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Project description:BACKGROUND:Health research has scientific, social and political impacts. To achieve such impacts, several institutions need to participate; however, health research funding institutions are seldom nominated in the literature as essential players. The attention they have received has so far focused mainly on their role in knowledge translation, informing policy-making and the need to organise health research systems. In this article, we will focus solely on the governance of national health research funding institutions. Our objectives are to identify the main functions of governance for such institutions and actionable governance functions. This research should be useful in several ways, including in highlighting, tracking and measuring the governance trends in a given funding institution, and to forestall low-level governance. METHODS:First, we reviewed existing frameworks in the grey literature, selecting seven relevant documents. Second, we developed an integrated framework for health research funding institution governance and management. Third, we extracted actionable information for governance by selecting a mix of North American, European and Asian institutions that had documentation available in English (e.g. annual report, legal status, strategy). RESULTS:The framework contains 13 functions - 5 dedicated to governance (intelligence acquisition, resourcing and instrumentation, relationships management, accountability and performance, and strategy formulation), 3 dedicated to management (priority-setting, financing and knowledge transfer), and 5 dedicated to transversal logics that apply to both governance and management (ethics, transparency, capacity reinforcement, monitoring and evaluation, and public engagement). CONCLUSIONS:Herein, we provide a conceptual contribution for scholars in the field of governance and health research as well as a practical contribution, with actionable functions for high-level managers in charge of the governance of health research funding institutions.

Project description:ObjectiveThe COVID-19 pandemic exposed significant gaps in Iran's and other health systems' risk communication. The accompanying infodemic undermined policy responses, amplified distrust in government and reduced adherence to public health recommendations among the Iranian population. This study aimed to develop a conceptual framework for health risk communication and infodemic management (RCIM) during epidemics and health emergencies in Iran that could have potential applications in other contexts.DesignThis study was designed in two phases. Phase 1 involved semistructured qualitative interviews with key informants to explore effective RCIM strategies across public health settings in Iran and to develop a conceptual framework. Phase 2 involved revising the framework based on feedback from an online expert panel regarding its comprehensiveness and validity.SettingProvincial/national public health settings in Iran.ParticipantsTwenty key informants from provincial and national public health authorities who contributed to COVID-19 response programmes participated in interviews. Nine experts from diverse academic disciplines, provincial and national settings, and geographical locations participated in an online expert panel.ResultsThe conceptual model was created based on qualitative interviews and expert panel discussions and was structured according to six pillars of the WHO health system framework: leadership and governance, information, health workforce and financial resources, along with media and community. Leadership and governance, including trustworthy leaders, were recommended as the foundation for developing RCIM in Iran. Developing an official strategy with information infrastructures, including high-quality surveillance systems, identified personnel and training for specialists among the health workforce, financial resources, communication channels and community engagement were recognised as other dimensions for developing health risk communication in Iran.ConclusionThe proposed framework represents a step toward establishing a national RCIM strategy in Iran. Further validation of the conceptual framework and experiments on how it could potentially influence policy and practice is recommended. This model has the potential to be applied in other contexts in its current form or as the foundation for customised local versions.

Project description:In recent years there has been a trend to view the Citizens' Observatory as an increasingly essential tool that provides an approach for better observing, understanding, protecting and enhancing our environment. However, there is no consensus on how to develop such a system, nor is there any agreement on what a Citizens' Observatory is and what results it could produce. The increase in the prevalence of Citizens' Observatories globally has been mirrored by an increase in the number of variables that are monitored, the number of monitoring locations and the types of participating citizens. This calls for a more integrated approach to handle the emerging complexities involved in this field, but before this can be achieved, it is essential to establish a common foundation for Citizens' Observatories and their usage. There are many aspects to a Citizens' Observatory. One view is that its essence is a process that involves environmental monitoring, information gathering, data management and analysis, assessment and reporting systems. Hence, it requires the development of novel monitoring technologies and of advanced data management strategies to capture, analyse and survey the data, thus facilitating their exploitation for policy and society. Practically, there are many challenges in implementing the Citizens' Observatory approach, such as ensuring effective citizens' participation, dealing with data privacy, accounting for ethical and security requirements, and taking into account data standards, quality and reliability. These concerns all need to be addressed in a concerted way to provide a stable, reliable and scalable Citizens' Observatory programme. On the other hand, the Citizens' Observatory approach carries the promise of increasing the public's awareness to risks in their environment, which has a corollary economic value, and enhancing data acquisition at low or no cost. In this paper, we first propose a conceptual framework for a Citizens' Observatory programme as a system that supports and promotes community-based environmental governance. Next, we discuss some of the challenges involved in developing this approach. This work seeks to initiate a debate and help defining what is the Citizens' Observatory, its potential role in environmental governance, and its validity as a tool for environmental research.

Project description:BACKGROUND:Prognostic research has many important purposes, including (i) describing the natural history and clinical course of health conditions, (ii) investigating variables associated with health outcomes of interest, (iii) estimating an individual's probability of developing different outcomes, (iv) investigating the clinical application of prediction models, and (v) investigating determinants of recovery that can inform the development of interventions to improve patient outcomes. But much prognostic research has been poorly conducted and interpreted, indicating that a number of conceptual areas are often misunderstood. Recent initiatives to improve this include the Prognosis Research Strategy (PROGRESS) and the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) Statement. In this paper, we aim to show how different categories of prognostic research relate to each other, to differentiate exploratory and confirmatory studies, discuss moderators and mediators, and to show how important it is to understand study designs and the differences between prediction and causation. MAIN TEXT:We propose that there are four main objectives of prognostic studies - description, association, prediction and causation. By causation, we mean the effect of prediction and decision rules on outcomes as determined by intervention studies and the investigation of whether a prognostic factor is a determinant of outcome (on the causal pathway). These either fall under the umbrella of exploratory (description, association, and prediction model development) or confirmatory (prediction model external validation and investigation of causation). Including considerations of causation within a prognostic framework provides a more comprehensive roadmap of how different types of studies conceptually relate to each other, and better clarity about appropriate model performance measures and the inferences that can be drawn from different types of prognostic studies. We also propose definitions of 'candidate prognostic factors', 'prognostic factors', 'prognostic determinants (causal)' and 'prognostic markers (non-causal)'. Furthermore, we address common conceptual misunderstandings related to study design, analysis, and interpretation of multivariable models from the perspectives of association, prediction and causation. CONCLUSION:This paper uses a framework to clarify some concepts in prognostic research that remain poorly understood and implemented, to stimulate discussion about how prognostic studies can be strengthened and appropriately interpreted.

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Dataset Information

An Evidence-Informed and Key Informants-Appraised Conceptual Framework for an Integrated Elderly Health Care Governance in Iran (IEHCG-IR).

Publications

An Evidence-Informed and Key Informants-Appraised Conceptual Framework for an Integrated Elderly Health Care Governance in Iran (IEHCG-IR).

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