Dejman M¹ (MD, MPH, PhD), Falahat K² (MSc),Baradaran Eftekhari M² (MD, MPH, PhD), Mahmoodi Z^1,3 (PhD), Forouzan AS¹ (MD, MPH), Jorjoran shushtari Z¹ (MSc), Malekafzali H⁴* (MD, PhD)

¹ Social Determinant of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

²Undersecretary for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran

³Social Determinant of Health Research Center,Albourz University of Medical Sciences, Karaj, Iran

⁴Department of Epidemiology & Biostatistics, School of Public Health,

Tehran University of Medical Sciences, Tehran, Iran

Original Article

Received:6 Nov 2014, Accepted:4 Feb 2015

Abstract

Introduction:Nowadays, healthcare systems has encountered challenges due to rapid changes in socioeconomic status, urbanization, changes in diseases' patterns and burden of chronic diseases. Health systems should be revised using a social approach to promote equity in health in communities. The purpose of this study was to revise Iran's existing primary health care network addressing social determinants of health approach and to design and propose a model with necessary structures, duties and intersectoral relationships.

Methods:This qualitative study with content analysis was conductedusing purposive sampling methodin 2011. The data were gathered using semi-structured interviews (11 interviews) and focus group discussions (5 FGDs) with experts, policymakers and managers of Iran's healthcare system.

Results:Data analysis revealed three main themes including "national level"، "provincial level"، and "district level"، and two subthemes including "revising existing structure" and "proposed structure". The "revising existing structures"included "country healthcare network" and "intersectoral decision making councils". The "proposed structures"included "community empowerment, intersectoral cooperation and equity in health". Finally, the proposed model of healthcare network in Iran based on the social determinants of health was developed.

Conclusion:Considering the importance of social determinants of health in community health promotion, it is essential to provide necessary infrastructures in order to revise the healthcare network based on the social determinants of health.

Keywords:primary healthcare, social determinants of health, community participation, intersectoral collaboration, equity in health

Please cite this article as follows:

Dejman M, Falahat K,Baradaran Eftekhari M, Mahmoodi Z, Forouzan AS, Jorjoran shushtari Z, et al. Addressing Social Determinant of Health in Iranian Healthcare Network- A proposed Model.Hakim Health Sys Res 2015 18(1): 14- 25.

Forouzan AS (PhD)¹, Baradaran Eftekhari M (PhD)²*, Mirabzadeh A (PhD)¹, Malekafzali H (PhD)³, Dejman M (PhD)¹, Sajadi H (PhD)¹, Mohammadi F (PhD)¹, Rafiee H (PhD)¹, Rajabi M (MSc)⁴, Mottaghian L (MSc)⁴, Habibi E (MSc)², Falahat K (MSc)²

¹ Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

² Undersecretary for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran

³ Department of Biostatics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

⁴ Department of Psychology, School of Psychology, Islamic Azad University, Tehran, Iran

Original Article

Received: 10 Nov 2014, Accepted: 17 Feb 2015

Abstract

Introduction: Mental health has a main role in social productivity. Mental disorders are more prevalent among women. This study aimed to assess the effect of a community-based intervention on mental health in women.

Methods: This was a community-based participatory research in which the participants included married women aged 18-65 years, lived in the district 22 of Tehran. The experiences of the participants on the processes, structures and concepts of women's mental health were investigated using the grounded theory. Experts' views were asked to identify the needs and priorities. The effectiveness of the designed intervention was assessed using a before-after study with one control group (n=200).

Results: The main theme identified through the grounded theory was "seeking comfort”. Identified action-interactions to promote mental health were as "strengthening human essence", "life skills development", and "help seeking". The extracted needs were classified in three groups consisted of structural, context, and process factors. The main priority for developing interventions was “training coping mechanisms to deal with stress". The interventions were implemented through training sessions, booklet, and books within three months. After implementing of participatory intervention, the results showed that the target group used more problem-based coping ways and the mean score of the planned problem-solving method in the intervention group increased from 11.7 (±3.3) to 14.3 (±1.6) after the intervention. The intervention group showed higher score in the quality of life domains especially mental domain in comparison to the control group.

Conclusion: Using qualitative study, we had a deep understanding of mental health promotion processes. Implementation of a community-based participatory approach for needs assessment, priority setting, designing and conducting the intervention helped us to promote mental health in women.

Key words: social determinants of health, community-based participatory approach, mental health, married women

Please cite this article as follows:

Forouzan AS, Baradaran Eftekhari M, Mirabzadeh A, Malekafzali H, Dejman M, Sajadi H, Mohammadi F, Rafiee H, Rajabi M, Mottaghian L, Habibi E, Falahat K. Hakim Health Sys Res 2015 18(1): 26- 33.