A study of family health problems in Iran from the stakeholders' perspective
Nikoo Yamani1, Alireza Yousefy1, Habib Rezaei1, Gholamreza Sharifirad2
1 Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Health Education, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||28-Mar-2012|
Associate professor, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan
Source of Support: None, Conflict of Interest: None
Background: Family health is one of the World Health Organization's (WHO) programs concerning individuals' and families' health and development. If properly implemented, family health may ensure the health of human beings and support their self-fulfillment; and may pave the way for bringing up a healthier and better generation by achieving two important and specific quantitative and qualitative results. This study aims at establishing the existing problems in the medical education system with respect to family health, which may be managed by the family health professional if a Masters' course educational program is developed.
Materials and Methods: In this cross-sectional, descriptive study, five Type-1 and four Type-2 and Type-3 universities were randomly selected. Then, the faculty members of health services/public health departments, health managers, health and treatment networks managers, personnel of provincial health centers in family health units, and also public health B. S. students were surveyed on the existing problems in the national health system which can be solved by family health professional. A questionnaire containing one open-ended and several demographic questions was sent by mail for some and personally handed over to some others. Since the data were of a qualitative nature, first the categories were specified through content analysis and then the opinions of each category of individuals were differentiated based on the relevant categories. Results: Results obtained from the comments of the study population led to specification of problems in health system, which could be solved by the family health senior expert. Such problems were categorized into six groups as: Planning and implementation, research, education, management, service-providing, and cultural problems. Conclusion: Given the problems in our nation concerning various family health issues, the field of family health in the levels of associate and bachelor degrees cannot respond to all public requirements, and health personnel in these levels do not possess various professional, planning, research, and educational skills required to analyze family health problems. Therefore, it is suggested that a Masters' course educational program be developed.
Keywords: Family health, health, health problems, health system
|How to cite this article:|
Yamani N, Yousefy A, Rezaei H, Sharifirad G. A study of family health problems in Iran from the stakeholders' perspective. J Edu Health Promot 2012;1:5
|How to cite this URL:|
Yamani N, Yousefy A, Rezaei H, Sharifirad G. A study of family health problems in Iran from the stakeholders' perspective. J Edu Health Promot [serial online] 2012 [cited 2019 Sep 18];1:5. Available from: http://www.jehp.net/text.asp?2012/1/1/5/94413
| Introduction|| |
Family, as the first and the most essential social institution, consists of a gathering of two or more people who are biologically related by family ties or consanguinity, and live under a roof, and is formed of a parent/parents and his/her/their child (ren), and individuals' health is affected by its principles, communications, social evolution, and economic and cultural conditions. How family influences individuals and/or vice versa is better determined by paying attention to natural evolutionary changes in individuals throughout awareness of risk factors in the family. To know the family better, it must be considered as the first care unit. Decision on an individual, especially a patient, will be dangerous if made without consideration of his/her family and his/her role in connection with other family members. A healthy family, among theirs, is characterized by its ability to adapt with natural changes in life, including birth, presence of a child in a family, new relationships, separation of young children from the family, aging, and death. 
Health is a basic individual and social right. A healthy human being is a fundamental keystone for progress and social development, so provision of physical and psychological health is instrumental to human fulfillment and is of a considerable importance in terms of economic and social development. 
Family health is a World Health Organization (WHO) funded program concerning individuals' and families' health and people's development and includes mother and child health, human fertility, nutrition, and basic health care program.  If properly implemented, family health may guarantee the health of human beings and support their self-fulfillment; and by achieving two important and specific quantitative and qualitative results, may prepare the ground for bringing up a healthier and better generation. 
Any effort to dynamicize health and treatment centers must be toward giving an appropriate response to society changes and its necessary interventions; in other words, recognition of needs and giving direction to variable service demands, intervention in service process and aligning it with society needs, flexibility in supporting processes to increase service productivity, and ultimately relying on standard results and service receiver are the fundamental points that require necessary interventions to be performed coordinately in all its components. 
Studies in foreign countries suggest the presence of a number of family health-related problems, some of which are indicated below.
In a study in Vietnam, newborns' low levels of breastfeeding and low quality of children's complementary nutrition are pointed out as a problem. Also, this study emphasized on low levels of health staff awareness in this respect.  In another study in Brazil, risks during pregnancy and newborn death are indicated, and prenatal cares in the form of health programs are suggested as a solution. ,
A review study pointed out the post-delivery depression as an important public health issue, with significant effects on mothers, newborns, and family, and must be particularly considered in post-delivery cares. 
In Iran, different aspects of family health have been studied. Each of these studies has considered some of family health problems some of which are mentioned as follows:
In a study in Qazvin, it was recommended that national health and education policy makers should consider adolescents' health requirements more than before through education and service, planning, and implementation, so that we will have a productive, future-building generation. Simbar and colleagues indicated that students believed that family planning services were not effectively sufficient. In Borromand Far's research, knowledge and performance problems of health staff on consultation about nutrition during pregnancy were pointed out and it was recommended that educational planners should pay more attention to pregnancy-related qualitative and quantitative education. ,,
A study on susceptibility of Iran's health systems shows that incidence of malnutrition, mortality rate of children below 5 years old, and crude death rate have had the highest effect on Iran's heath system efficiency, respectively. Thus, one may conclude that investments toward reduction of annual mortality rate, improvement of nutritional status, and ultimately enhancement of childbirth standards and vaccinating children in rural areas will lead to increased efficiency of health system. 
Given the foregoing, it seems evident that family health-related problems must be identified through a comprehensive plan, if a step is to be taken toward enhancement of families' health. The aim of the present study was to identify family health problems of the health system, which may be managed by the family health professional if a Masters' program is developed.
| Materials and Methods|| |
In this cross-sectional descriptive study, five Type-1 medical science universities, including Tehran, Shiraaz, Tabriz, and Mashhad, and four Type-2 and -3 universities, including Yassoj, Booshehr, Araak, and Bandar-Abbas, were randomly selected. Health vice-managers and managers of health and treatment networks, family health unit's staff at health centers of the province, professors, and students in these provinces were selected by census and were surveyed.
Questionnaires were personally handed to public health B. S. students (preferably discontinuous 2 nd semester or continuous 6 th semester students) and were collected after 10 days. In the universities where 2 nd semester students were not available, higher semester students were included. Discontinuous 2 nd semester students were used because this enabled us to use them in further stages of the study and certainly they would have more experience than lower semester students.
Entry criteria for family heath unit staff of provincial health centers were having a work experience of more than 3 years and giving their informed consent for participation. Questionnaires were also given to them and collected after 10 days.
Questionnaires were personally handed over to faculty members and collected after 10 days, too. In universities with public health departments, professors from the same departments were surveyed, and in those universities without such a department, professors from health services departments were surveyed. Questionnaires were mailed to professors at medical science universities of Tehran, Mashhad, and Tabriz. Also, health managers' questionnaires were sent by mail. Necessary follow-up was done to guarantee return of the questionnaires.
At first, a questionnaire containing an open-ended and several demographic questions was sent/delivered to the study population and the comments were categorized after data collection.
Individuals' comments were extracted from respective questionnaires. Since the data were qualitative in nature, their categories were specified first using content analysis and then the comments from each category of individuals were differentiated according to the respective categorizations and placed under a related category.
| Results|| |
Our total study population included 248 individuals, 8 of which were absent from work on the day of questionnaire distribution/collection for travel, leave, or other reasons. One hundred and fifty-six individuals completed the questionnaires. Those completing the questionnaires from different groups included: 5 health vice-managers (83%), 30 family health unit employees (90%), 75 students (88%), 24 professors (40%), and 22 health network managers (34%).
Extracted problems were categorized into five groups: Planning and implementation, education, research, service provision, and cultural problems. Service-provision problems were divided into seven subcategories as follows: children's, mothers', family planning, problems related to elderly, school health, psychological health, and other problems [Table 1].
|Table 1: Family health problems in iran in the view of vice-managers, managers, faculty members, employees, and students|
Click here to view
| Discussion|| |
The present study aims to derive the existing problems related to family health from different stakeholders' perspective. Observed problems have been categorized into various scopes to achieve the proper groundwork for scholars' educational training course intended to provide services for promoting family health.
Given the results of this study, there are some problems related to family health and health systems which may be solved by family health personnel with a master's degree and they can make further advances. We can point out some of these problems such as planning, education, research, management, cultural, and service-providing problems. One of the family health problems, which all stakeholders are concerned about, is the problem related to children, mothers, and family planning. These results are in conformity with the results obtained in Ghonabad.  Despite the fact that one of the main strategies for improving mother's/children's health is prenatal care, this medical care is not followed to a good extent in health and treatment centers.  Unintentional pregnancy and abortion are the main issues in pregnancy health scope internationally, and concurrence of these issues is a reason of shortcoming in family planning services.  The results of present research are in conformity with the results of the study performed by Simbar and colleagues entitled, "The requirements for health in pregnancy by Ghazvin University students". The research shows that 78% of students acknowledged the lack of sufficient health care services during pregnancy.  The result also is in compliance with the result of a study done by Broomandfar and colleagues, which shows that service provider personnel in health and treatment centers do not possess proper knowledge to perform tasks concerning pregnancy nutritional consultation and it has been suggested that educational planners pay more attention to qualitative and quantitative related training issues in the pregnancy period. 
The results of this study are also in conformity with the result of a study done in urban health centers of Shahid Beheshti University of Medical Science which evaluated quality of family planning services, and showed that these services tend to have low quality and also that people's knowledge about family planning methods are insufficient or moderate.  But the results of the present research are not in compliance with those of the research done by Pakghohar and colleagues showing that the quality of family planning consultation is moderate and sufficient concerning primary interaction of personnel and history taking done by health workers (health graduates with an associated degree), and selecting the proper method and choosing the follow-up appointments by majority of assisted individuals were average.  This lack of conformity may be caused by research experimental environment. Other reasons for this lack of compliance may be derived from the different sets of standards in the research.
Another problem is lack of formulated plans about unintentional pregnancy from stakeholders' perspectives. On a yearly basis, out of every 210 million pregnancies in the world, 100 (47%) are considered unwanted. Despite the widespread use of contraception methods in Iran, the rate of unwanted pregnancy is very high. Unintentional pregnancy ranges between 18 and 32% in Iran. ,,, The results of this study also are in conformity with the results of studies done by Sanaienasab, Mansouri, and Mohammabaiggie, which point out that unintentional widespread level of pregnancy is high and requires interventional planning such as proper education about birth control. ,,, In another study, it has been pointed out that undoubtedly, one of the important health priorities is population growth control and prevention of unintentional pregnancy in our country. The needs assessment in Ghonabad presents the same results. ,
Another problem from stakeholders' perspective that should be pointed out is psychological health problems such as family splitting up, mental-psychological problems among the women referred, divorce, and social dissatisfaction. In the country that we live, spread out of psychological problems is so high that some of the psychological health professionals named this century as the century of mental hunger. Based on a report by WHO, depression in the year 2020 possibly will rank the second disorder among the world population. Beck reported that depression has spread out extensively in the last decades and considers it one of the worrisome problems. ,, A study performed in Indian American Tulsa region of United States of America shows that one of the most important problems among them is psychological health problems such as depression and stress. In our country, the rate of psychological disorders is increasing very fast. In the needs assessment performed in Ghonabad, psychological health problems were pointed. ,,
One of the other problems is incorrectness of some health information and surveys. In one research, it has been noted that in many countries some key leaders are worrying because of weak documentation of health-related files and also other false and imprecise information.  The results of this research are also in conformity with the results of a study by Arshi and colleagues from Ardebil province, which mentioned insufficient information and expertise among health personnel in completing related statistical forms and also the result of weak statistical reports on family health.  The results of Farahbaksh's study show that analysis and preparation of information of country's standard instruction applications do not exist, and dissemination of health information is based on bias and personal preferences.  Another study in our country has reported that registered information concerning mortality causes is not precise, while the accuracy in England health information is about 95%. This lack of consistency can be a result of standardized instruction related to educating sufficient personnel for completing the forms and allocation of information based on standards. ,
Performed research shows that educational programs about family health problems are not likely to answer all family health problems. One of these studies done by Ojaghi and colleagues in Kermanshah shows that current educational programs are not completely in concordance with experimental and practical courses for student education. 
A research by Ali Shahidzadeh et al. mentions the need for substantial review in family health care programs and emphasizes on skills training (in general, obtaining technical skills and communication skills) and not only passing the courses. 
Considering the various health problems such as family planning, nutritional issues, pregnancy care, and other health problems, it seems the current educational programs are incapable of addressing these problems. Current graduate programs cannot provide sufficient training necessary for tackling these various problems. Family health graduates (Bachelors and Associate Degree holders) do not receive enough instruction, due to the length and level of the programs, to be well equipped to handle these problems. The necessity of developing higher level educational programs for training higher educated workforce is felt. Development of Masters' degree programs for family health, with regard to the national health mission for training professional health staff, seems necessary.
| Acknowledgments|| |
We express our gratitude to Isfahan Medical Education Development Center, Vice-chancellors for Health, Health Network Managers, family health staff of Isfahan Province, faculty members, and the students participating in the study, and all others who supported us to conduct this research.
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