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Objective(s): To determine requirements for implementation of a total quality management system at Rasoul Akram Hospital. Methods: This cross-sectional study was conducted in 2003. All the supervisors (n=52) in different departments were included in the study. A 75-item questionnaire was used to gather data regarding leadership commitment, total quality management structure, consumer orientation, employee participation, communication, manpower involvement, organizational culture and teamwork. Data analysis was carried out using descriptive statistical procedures. Results: 67% and 59% of the respondents confirmed leadership commitment and total quality management structure respectively. Consumer orientation, employee participation, communication, manpower development, organizational culture, and teamwork (as viewed by supervisors) were implemented at levels of63%, 56%, 61%, 58% and 53%, 56% levels respectively. Conclusion: It seems that the hospital needs to improve with regard to all these requirements, particularly organizational culture, teamwork, employee participation, manpower development, and total quality management structure.

Background: Various studies have highlighted the usefulness of environmental scanning in assessing community needs and developing programs and policies. We aimed to find the most practical model of using such scanning in the healthcare literature., Methods: We conducted a scoping review based on the PRISMA guideline to ensure a comprehensive and systematic approach in 2023. To develop a comprehensive search strategy, we worked with experienced librarians and the research team. We then completed a search of five electronic databases, including Web of Science, PubMed, Scopus, Cochrane, and Embase databases. Two independent reviewers screened titles, abstracts, and full-text articles to select studies that met our inclusion criteria. The data was then analyzed and presented in a tabular format to facilitate easy interpretation and understanding., Results: We retrieved 7243 articles from various databases and sources. After removing 2755 articles due to duplication, we excluded 4380 more articles during the title and abstract screening phase. In the full-text review process, we ruled out an additional 103 articles. Finally, only 5 articles that were directly relevant to the study were included. The model that Bednar and colleagues have in their article is the latest model. Most studies propose six main steps to conduct an environmental survey in the healthcare system., Conclusion: Since the most important task of managers and policy makers of the health system is to make decisions, they can use our proposed model to collect, analyze and interpret data, identify important patterns and trends so that they can make evidence-based decisions., (Copyright© 2024 Kalavani et al. Published by Tehran University of Medical Sciences.)

Background: In Iran, the primary healthcare system is the front-line for society's encounter with healthcare. Health planners aim to enhance quality and administer an accreditation program. This study examined program administration prerequisites through systematic review and meta-synthesis., Methods: We conducted a systematic review and meta-synthesis of qualitative literature using Thomas and Hudson's framework. Peer-reviewed papers were searched in Scopus, PubMed, Web of Science, Google, and Google Scholar up to 2023., Results: The search found 1308 articles, with 37 relevant ones selected for review. Data extraction included setting, participants, study design, data collection, analysis, and themes. Thirteen qualitative subthemes were identified and were categorized under three elements of the Donabedian model., Conclusion: Before implementing a plan, it is crucial to consider its executive prerequisites. Revision and trial-and-error approaches can be costly and time-consuming, potentially hindering the plan's effectiveness and diverting organizations from their primary goal, leading to failure., (Copyright© 2024 Etemadi et al. Published by Tehran University of Medical Sciences.)

Background: Due to its ethical approach and its protection of patients and their interests, quaternary prevention can increase the quality-of-service provision and decrease costs and the wastage of resources. The present study used interpretive structural modeling (ISM) to classify the effective factors and determine a quaternary prevention model for Iran's Rural Family Physician Program., Methods: This study was a qualitative study with an ISM approach. Twenty-five health system experts and faculty members participated in the study. The interrelationships between the factors were determined using ISM, and after classification, the driving and dependence power of the factors were specified using MICMAC analysis., Results: The 20 factors were classified into five levels. The results indicated that patient interest and vulnerable groups had the highest effectiveness, and officials' and policymakers' commitment to providing serious support for family physicians had the highest affectability. The factors were placed into the two groups of linkage and dependence based on the MICMAC analysis., Conclusions: The new technologies are costly and sometimes only suitable for a specific group of patients. Costs and the issues of induced demand and defensive medicine necessitate a different view of health service distribution. The preventive and strategic view and the comprehensiveness of family physician services make quaternary prevention possible by providing high-risk and vulnerable groups with essential services based on patient needs and conditions with more benefit than harm., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 International Journal of Preventive Medicine.)

Background: Hospitals have a vital role in the future of health systems with upcoming structure, resources, and process changes. Identifying the potential aspects of change helps managers proactively approach them, use the opportunities, and avoid threats. This study presents a mind map of future changes in Iranian hospitals to develop a base for further related studies or prepare evidence for interventions and future-related decisions., Methods: This study is a qualitative-exploratory one, conducted in two phases. In the first phase, in-depth and semi-structured interviews were conducted to identify future hospital changes over 15 years. The interviews were analyzed using the content analysis method and MAXQDA 2018 software and holding two expert panels to develop the mind map using the 2016 Visio software., Results: In the first phase, 33 interviews led to 144 change patterns. In the second phase, a mind map of changes was drawn according to experts' opinions with ten categories: structure and role, knowledge management and research, service delivery, health forces, political and legal, economic, demographic and disease, technological, and values and philosophy, and environmental., Conclusions: Many changes affecting hospitals rooted in the past continue to the future, but the point is the increasing intensity and speed of changes. Healthcare systems need a systematic approach to monitoring the environment to be updated, agile and proactive. These monitoring systems are essential in providing evidence for Macro-level decision-makers., (© 2023. The Author(s).)

Background: Medical education system in Iran has an essential role in responding to scientific development targets from both education and research perspectives. Investigating future trends and analyzing how they interact with the medical education system helps increase awareness and give insight into the preferred future., Methods: The present qualitative study consists of Systematic reviews and interviews that have been analyzed using content analysis. Afterward, the themes and codes were visualized in the form of maps and presented in a focus group discussion of experts to define how medical education trends will impact scientific development., Results: The future trends of Iran's medical education system were classified into six groups: workplace changes, demographic changes, changes in concepts, the emergence of new players, structural changes in universities, and technology development. The next point is how they will influence science development. Their impact on science development is classified into five main groups or main streams of change of new financial models, open science, redesigning the research management, the role of universities, and capacity building., Conclusion: Our findings showed that redesigning the structure of medical education is the most important priority to make the system as agile as needed to capture the signs and act. New meanings and concepts should also be considered in restructuring, like power balance, competency-based and personalized education, cost-effectiveness, and openness., Competing Interests: The authors declare that they have no competing interests., (© 2023 Iran University of Medical Sciences.)

This study defines futures myocardial infarction landscapes and proposes a few policy options to reduce the burden of cardiovascular diseases using the scenario development method. We identified the effective drivers of myocardial infarction by reviewing the literature and completed the returned list with "experts" opinions. The results were classified using the STEEP (Social, Technological, Environmental, Economic, and Political) framework. We plotted the critical uncertainties in a two-dimensional ranking of "effect" and "uncertainty" levels. Eleven drivers with uncertainty and high potential impact were selected and categorized into three groups: Political Development, Access to health services, and Self-Care. Scenarios were developed, and 3 scenarios (optimistic, pessimistic, and possible) were selected based on scoring. For each scenario, policy options were formulated. Utilizing the capacity of Non-Governmental Organizations and charities and strengthening restrictive and punitive legislation was chosen as policy options for addressing possible scenarios. Building infrastructure and improving prevention services, designing and regenerating curative infrastructure were selected as optimal strategies for addressing issues related to the optimistic scenario. Strengthening restrictive and punitive legislation related to community health and population empowerment were proposed as critical policy options for health improvement regarding the pessimistic scenario. Increasing people's participation, strengthening infrastructure and punitive policies can be effective in Myocardial infarction mortality prevention policies in Iran., (© 2023. The Author(s).)

Background: The health research system (HRS) is an important national priority that requires a systematic and functional approach. Evaluating the HRS of Iran as a developing country and identifying its challenges reveals the stewardship-related role in how the whole system is operating well. This study aims to assess the HRS in terms of stewardship functions and highlight the enhancement points., Methods: This study was carried out between March 2020 and April 2021 using a systematic review and meta-synthesis of evidence to examine the Iranian HRS stewardship challenges and interview 32 stakeholders, using a critical case sampling and snowballing approach which included both semi-structured and in-depth interviews. The interviewees were selected based on criteria covering policy-makers, managers, research bodies and nongovernmental organizations (NGOs) in health research-related fields like higher education, research, technology, innovation and science. All data were analysed using content analysis to determine eight main groups of findings under three levels: macro, meso, and micro., Results: Analysis of the findings identified eight main themes. The most critical challenges were the lack of an integrated leadership model and a shared vision among different HRS stakeholders. Their scope and activities were often contradictory, and their role was not clarified in a predetermined big picture. The other challenges were legislation, priority-setting, monitoring and evaluation, networking, and using evidence as a decision support base., Conclusions: Stewardship functions are not appropriately performed and are considered the root causes of many other HRS challenges in Iran. Formulating a clear shared vision and a work scope for HRS actors is critical, along with integrating all efforts towards a unified strategy that assists in addressing many challenges of HRS, including developing strategic plans and future-oriented and systematic research, and evaluating performance. Policy-makers and senior managers need to embrace and use evidence, and effective networking and communication mechanisms among stakeholders need to be enhanced. An effective HRS can be achieved by redesigning the processes, regulations and rules to promote transparency and accountability within a well-organized and systematic framework., (© 2022. The Author(s).)

Background: Today, cardiovascular disease (CVD) is the leading cause of mortality in both sexes. There are several risk factors for heart diseases; some controllable, others not. However, socioeconomic, technological, and environmental factors can impact CVD as well as exclusive risk factors. Accurate identification and assessment of these factors are often difficult. In the present systematic review, we aimed to explore factors affecting CVD., Methods: Multiple databases (MEDLINE, Scopus, ISI Web of Science, and Cochrane) and gray literature were searched. The included studies described at least one determinant of CVD. The framework method was applied to analyze the qualitative data., Results: A total of 64 studies from 26 countries were included. The contextual determinants of CVD were categorized into 45 determinants, 15 factors, and 4 main social, economic, technological, and environmental categories. The 15 potentially reversible factors were identified as sociodemographic, violence, smoking, occupation, positive childhood experience, social inequalities, psychological distress, eating habits, neighborhood, family income, rapid technology, environmental pollution, living environments, noise, and disaster., Conclusions: Devolution and more efficient health policies are required to achieve further sustained reduction in CVD mortality, increase life expectancy, and reduce its associated risk factors. Policymakers should fully address the value of social, economic, technological, and environmental factors. In fact, a prevention agenda should be developed and updated collaboratively in terms of the determinant factors., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 International Journal of Preventive Medicine.)

As in most countries, patients, health care providers, and insurance organizations are key components of the health care system in Iran. High rates of growth and development in today's financial markets, have made the insurance industry with its unique calculations and models, a prominent player in this specialized economic sector., (Copyright © 2022 Journal of Insurance Medicine.)

Background: The financing function within a health system is considered inherently complex, so it is of utmost importance to design a suitable future for this system given uncertainties and complexities of the environment. With regard to the current and future complicated conditions, health system financing is also likely to succeed if it can anticipate the impacts of effective factors in the future and further plan appropriate interventions ahead of time. Thus, the purpose of this study was to develop scenarios for the health system financing in Iran., Methods: This mixed-design research of exploratory future studies type was conducted using the scenario method. In this respect, the key variables were evaluated using a questionnaire from two aspects of importance and uncertainty as well as formation of a future studies group (focus group). Finally, sensitivity analysis was carried out through cross-impact balance (CIB) analysis using the Scenario Wizard (Version 4.31) software., Results: A total of 25 factors were selected based on the type and the position of the variables (driving force, bi-dimensional, risk, secondary leverage or modifiable-to-secondary leverage) over the diameter of the MICMAC chart. Considering the degree of significance and uncertainty, eight variables including all four driving force variables (oil sales and economic blockade, leadership and advocacy, bureaucracy and corruption, and possibility of using information technology in providing services), as well as the variables of resource sustainability, natural disasters, regional security, and specialization culture were chosen. Then, five variables were finalized as the key changes that would create the scenario based on sensitivity analysis and final expert opinions. According to the defined conditions, 270 scenarios were developed, of which fourteen scenarios were identified as poorly adaptable and five cases as highly adaptable., Conclusion: The best scenario identified in this study based on the degree of adaptation included the use of massive technology and oil sales, mediocre economic conditions with high probability of occurrence, strong leadership and advocacy, high regional security, as well as bureaucracy and low corruption with medium probability of occurrence., (2022 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons. org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

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., (© 2021. The Author(s).)

Background: COVID-19 has a great impact on medical sciences education. Some researches have been conducted on the effects of the COVID-19 pandemic on medical sciences education in the world. The aim of this study was to identify the effects of this disease on medical sciences education in Iran., Materials and Methods: This futures study research was carried out using the future wheel method in Iran's University of Medical Sciences in the spring of 2020. A semi-structured interview was also conducted on the vice chancellors of medical sciences universities, faculty presidents, faculty vice chancellors, faculty members, medical education specialists, and university students, who were purposefully identified. The interview continued until achieving data saturation. Analysis of the interviews was performed by MAXQDA version 10 software., Results: The effects were presented at three levels including primary effects, secondary effects, and third effects. In addition, 16 primary effects, 51 secondary effects, and 24 tertiary effects were recognized. One primary effect of the coronavirus (COVID-19) pandemic on medical sciences education in Iran was fear, stress, and anxiety among students and faculty members as well as staffs to get the disease. In addition, rumor was circulated concerning the infection of some people, thus, there was a need for holding courses regarding stress management and rumor management. One secondary effect of the coronavirus (COVID-19) pandemic on medical sciences education in Iran was allocation of a number of educational hospitals to the referral hospitals of COVID-19. One tertiary effect of the coronavirus (COVID-19) pandemic on medical sciences education in Iran was increasing the number of virtual courses., Conclusions: The most important effect of this disease on medical sciences education is the postponement of practical and apprenticeship classes, and consequently the increased length of the academic term that leads to delay in the students' graduation, which can reduce the workforce. On the one hand, this disease causes death of a number of students, educational and medical staffs, and faculty members, as well as reduces the workforce. Also, lengthening the recruitment of faculty members will add to this challenge. In this regard, there is a need to plan to compensate for the shortage of required human resources., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

Background: Current Health care delivery systems are not effective for the elderly. Countries with high elderly populations are expected to design special models to serve their elderly population. The aim of this study is to investigate the models of health care delivery to the elderly in different countries. Methods: The present study is a systematic review based on PRISMA standard guidelines. The search for related studies was conducted in electronic databases (Cochran Library, Scopus, PubMed, Embase, Web of Science) and the Google Scholar search engine without time limits until May 2019. Keywords were extracted based on MeSH strategies. At first, 16243 articles were found. After the screening phase (elimination of duplicated articles, title screening, abstract screening, and full-text screening) 19 articles remained. Two articles deleted after text appraisal using the CASP checklist. In the next stage, after reviewing the gray literature and reviewing the references of remaining articles, three new articles were added (Included studies = 20). Results: Twenty articles (models) corresponding to the study objectives were finally extracted. These models are limited to nine countries and most have local scopes. These models mainly use a case manager, an intra- or inter-disciplinary team, and an elderly assessment tool in their structure. In addition to the use of an information system, these models provide a wide range of services to the elderly. Conclusion: Most of the models mentioned are local models. Smaller models to become applicable at the national level, they need to be reviewed and evaluated by policymakers and experts. Given the inefficiency of current systems in providing services to the elderly, it is recommended that countries use an integrated model of health care provision for the elderly., Competing Interests: Conflicts of Interest: None declared, (© 2021 Iran University of Medical Sciences.)

Background: Providing coordinated services and forming appropriate cooperation among the members of the health team have a significant impact on other aspects of service provision, including accessibility and continuity of services. Methods: In this study information was obtained from a national study titled, "Evaluation of Primary Health Care in Iran", and framework analysis was conducted from the perspective of interprofessional cooperation status using the Amour model based on 5 underlying concepts of sharing, partnership, power, interdependency, and process. This is a mixed-method study of the transformative sequential type. In this study triangulation method was used, and data were collected by the Primary Care Evaluation Tool (PCET), interviewing experts and executive directors, and systematic review of the Primary Health Care (PHC) challenges in Iran. Results: The challenges of the PHC system in Iran are analyzed for providing coordinated care in the form of multidisciplinary teamwork based on the Amour model. The corresponding solutions for improving challenges of the concept are also presented. Conclusion: Based on the findings of this study the followings are suggested: sharing a collective specialized outlook; designing an integrated information system; improving the educational system through providing on-the-need academic education; strengthening the cooperation of community representatives and people's trustees in providing care; developing interdepartmental partnerships with related organizations with collective interests; moderating the workload of human resources; using electronic health records and automated referral of individuals in addition to appropriate training and promoting the culture from the existing philosophy of primary health care; highlighting the role of service providers as members of the care team; eliminating factors causing instability of suppliers, plans, and programs; and stability in the management approach despite changes in senior management., Competing Interests: Conflicts of Interest: None declared, (© 2020 Iran University of Medical Sciences.)

Background: The natural childbirth instruction program, which aims to reduce the cesarean section (C-section) rates in the country and pay attention to demographic policies, has achieved significant accomplishments in the short time span since it was implemented throughout the country. In the present study, the advantages and challenges of the implementation of this program have been analyzed., Materials and Methods: This qualitative study carried out with the participation of 32 knowledgeable individuals who were selected using purposeful sampling and snowball sampling methods among the personnel of Kerman University of Medical Sciences, and it's affiliated educational (university) hospital. The data were collected through semi-structured interviews based on the research objectives, review of texts, and experts' experiences. Data analysis was performed using content analysis method in MaxQDA software., Results: Data analysis provided the 5 main categories of implementation instructions' strengths, implementation instructions' defects, implementation instructions' achievements, implementation instructions' challenges and threats, and suggestions., Conclusions: Accountability in the system that provides health care services for pregnant mothers in public hospitals has been created through the implementation of the natural childbirth promotion package. If managerial barriers and executive and legal inefficiencies are followed up and suitable measures are taken for solving the intra-system conflicts, we can hope that the package, which has been one of the most serious efforts made by the Ministry of Health over the past decades to reduce cesarean delivery, will achieve significant accomplishments., Competing Interests: Nothing to declare., (Copyright: © 2020 Iranian Journal of Nursing and Midwifery Research.)

Objective: To identify and explain the interactions and network of the relationship between influential factors of out-ofpocket payments for health services., Methods: This futures study was conducted in 2015 in Iran, and comprised experts of various sectors. At first, key factors and driven forces of out-of-pocket payments were detected; then, the factors were collected in the form of a square-matrix questionnaire; and completed based on impact of each factor on the occurrence probability of others, with collective agreement, so the role of any factor in forecasting out-of-pocket status in future was identified by cross-impact analysis. MicMac software was used for data analysis., Results: As many as 35 factors were identified which affected out-of pocket payments. The factors were categorised in four main roles, i.e. influencing, two-sided, dependent and independent. Some economic factors which had a higher impact on other system factors were influencing factors; they were the most critical components because the system changes were dependent on them. In contrast, some factors related to organising the health system were depending factors and were affected by the least changes in other factors. There are 10 factors in this group. These factors were mainly related to the utilisation of health services by a special look to the part of delivery (public or private)., Conclusions: Policymakers should consider interactions and influencing network of out-of-pocket payment factors and should understand how a change in one factor can have a series of changes.

Background: This study was conducted to synthesize the evidence on the dimensions of performance appraisal of the public health and primary care system through a scoping review and meta-synthesis., Methods: The review conducted systematically in 2018 with a scoping review approach. To identify pertinent studies, the following electronic databases were systematically searched until December 20, 2017: Cochrane, ISI Web of Science, PubMed, Scopus, Science Direct, and Embase. Reviewing the studies found on the search bases was carried out in three stages by two persons individually. According to refined studies, the data were extracted to meet the objectives and respond to the research questions. The thematic analysis was used to identify and categorize the dimensions of performance measurement., Results: Using this process, 20 studies were eligible for our research. The critical points in measuring the performance of the public health field were classified into eight main domains including leadership and stewardship, funding, resource generation, service delivery, quality, accessibility, efficiency/productivity, and community health status. The differences in measurement frameworks are inevitable. One reason for the differences in the health system performance measurement framework is the differences in the data or data collection, analysis, and reporting. Performance measurement in the field of health, especially primary care, was a multidimensional issue., Conclusions: Each of the main dimensions had several sub-criteria, indicating the broadness and complexity of the performance of first-level care providers. Single-dimensional performance measurement could underpin incorrect policies and decisions., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 International Journal of Preventive Medicine.)

Background : Specification of vaccination cost of children would help policymakers in determining the nation-wide budget needed for the maintenance of the vaccination program. The budget came these days under scrutiny due to the imposed sanctions tightening the public funds. This study aims at estimating the cost of vaccination in southeastern Iran for obtaining more accurate budget projections. Methods : Fifty-two healthcare centers from 10 cities in south-east Iran participated in using a quota sampling method for their selection. A bottom-up method determined the human resource use, the consumption, and the overhead costs to estimate the cost of vaccination. Data collection used a standard tool that was adjusted to local conditions. Sensitivity analyses were performed. Results : The overall vaccination cost for the region was estimated at around 5,984,000 USD for the year 2015. Salaries took the largest part of the cost estimate (64%), while vaccine cost and its equipment were much lower (22%). The average cost per vaccine dose administrated was 40.94 USD. Sensitivity analysis of the population and inflation rate indicates that the vaccination cost may fluctuate between 37% and 53% over 6 years (2021) from the data of 2015. Conclusion : Maintaining vaccination has a substantial cost. The results of the study will support the budget planning and decision making and will define more precisely the resource allocation needed for maintaining the vaccination at a high level across the country. It may also help to facilitate the assessment of cost-benefit and cost-effectiveness analysis when new vaccines should be introduced.

Background: Different factors affect Iran's health care financing system, and regardless of this impact, the future of this system will face fundamental challenges. In this environment, a health system is successful if it is able to anticipate the effects of these factors in the future of health care financing and preplan appropriate interventions towards health care financing system. The present study aims to identify these factors and trends. Methods: This study compiled a round view of the experts on the subject, with a future studies approach through a qualitative method. To collect data, a deep and semi-structured interview was performed. The results of the interviews were analyzed using content analysis method, and the primary and secondary themes were extracted using the Micmac software. Results: A total of 71 variables were identified in the form of 12 groups with titles of stewardship, service provision, resource gathering, purchasing and resource allocation, sociocultural, technological, environmental, economic, political, and managerial, and laws and values. Four variables, including distant-service provision, administrative bureaucracy, administrative focus and corruption, low-support decision-making, economic blockade, and sales of oil were among the influential factors and drivers. Conclusion: The findings showed Iran's financing system is relatively stable but fragile and 3 areas of technology, politics, and economics have the most impact on structuring Iran's financing system., Competing Interests: Conflicts of Interest: None declared, (© 2020 Iran University of Medical Sciences.)

Introduction: Internationalization of higher education involves mutual exchanges as well as a consensus based. Political, economic, sociocultural, and scientific reasons recommend the need to move toward the internationalization of higher education. The current study highlights the strengths of the internationalization of Iran's medical sciences education., Materials and Methods: This descriptive exploratory study was carried out in 2016-2017 in Iran. The techniques used for data collection included review of articles, interview with subject experts, and the focus group and the nominal technique group to explore the views of various stakeholders. The data were analyzed with the qualitative content analysis method., Results: The inductive qualitative content analysis of all data generated 13 categories and 88 subcategories. The categories were geographical and geostrategic position of Iran; the historical, cultural, religious, and tourist attractions of Iran; the security of Iran; priority to internationalization policies and programs in Iran's macro plans; the existence of regulations, laws, and approvals for international activities; same language with neighboring and regional countries; the low cost of studying and living in Iran; the ability of Iranian faculty members and experts for internationalization; the background, reputation, and the progress of medical education, health, and care in Iran; the cheaper forces of Iran and their welcome to foreigners; the existence of motivation, zeal, and belief for internationalization; the existence of proper infrastructure; and the existence of a suitable capacity for internationalization., Conclusions: Iran has some positive points that can be used to promote international activities, provided it does some good advertising in this regard. It is suggested that the challenges, opportunities, and threats to Iran's internationalization should be collated from the perspective of the various stakeholders., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Education and Health Promotion.)

Background: Primary healthcare system in Iran has played an extensive role in promoting people health in the past decades. However, regarding universal developments in the different global aspects effective on health, the performance of this system has been influenced significantly. The aim of the present research is to identify the future trends of the primary health care in Iran., Methods: The participants of this qualitative case study were experts in primary healthcare, which were selected and interviewed through purposive sampling method. The interview process was saturated after 25 interviews, so we stopped the process at this point. Framework analysis based on STEEP model used to analysis the interviews., Results: The most important social/value, technological, economic, environmental, and political future trends of primary healthcare in Iran included demographic transition, epidemiological transition, social and cultural changes, emergence of modern and advanced technologies, internet and cyberspace, budgeting limitations, resource management, changing paradigm from volume to value in providing health services, environmental pollutions, natural disasters, health governance, intellectual paradigm of senior officials, regional security, international development, and other internal factors of the health system., Conclusions: The identified factors can be turned into opportunities for Iran primary healthcare system if health planners and policymakers have a deep and accurate look at these influential factors and manage them properly., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 International Journal of Preventive Medicine.)

Background: Forecasting is the process of predicting future behavior. In reviewing databases, no predicted value associated with international collaboration publications in Iran was found. Thus, the present study aimed at forecasting Iran's international collaborative articles in medical sciences. Methods: The number of Iran's articles and international collaborative articles in medical sciences written over 56 years was extracted from SCOPUS. Data were extracted from 1960 up to 2016. The time series method was used for forecasting using the Minitab software Version 17. Results: There was no increase in the number of medical articles from Iran from 1960 to 2001. However, the data showed incremental growth between 2001 and 2016. This was similar to Iran's medical sciences international collaboration articles. In 2016, the percentage of Iran's international collaboration articles was 15.2, which is expected to reach 19.9 in 2025. Conclusion: An investigation was performed on the number of international collaboration articles in the field of medical sciences in Iran. Future trends show an incremental growth. The number of Iran's articles can be increased with international cooperation. However, an increase or decrease in Iran's articles without international cooperation has to be investigated., (© 2019 Iran University of Medical Sciences.)

Background: Health information systems offer many potential benefits for healthcare, including financial benefits and for improving the quality of patient care. The purpose of District Health Information Systems (DHIS) is to document data that are routinely collected in all public health facilities in a country using the system., Objective: The aim of this study was to examine the strengths and operational challenges of DHIS2, with a goal to enable decision makers in different counties to more accurately evaluate the outcomes of introducing DHIS2 into their particular country., Method: A review of the literature combined with the method of meta-synthesis was used to source information and interpret results relating to the strengths and operational challenges of DHIS2. Databases (Embase, PubMed, Scopus and Google Scholar) were searched for documents related to strengths and operational challenges of DHIS2, with no time limit up to 8 April 2017. The review and evaluation of selected studies was conducted in three stages: title, abstract and full text. Each of the selected studies was reviewed carefully and key concepts extracted. These key concepts were divided into two categories of strengths and operational challenges of DHIS2. Then, each category was grouped based on conceptual similarity to achieve the main themes and sub-themes. Content analysis was used to analyse extracted data., Results: Of 766 identified citations, 20 studies from 11 countries were included and analysed in this study. Identified strengths in the DHIS were represented in seven themes (with 21 categories): technical features of software, proper management of data, application flexibility, networking and increasing the satisfaction of stakeholders, development of data management, increasing access to information and economic benefits. Operational challenges were identified and captured in 11 themes (with 18 categories): funds; appropriate communication infrastructure; the need for the existence of appropriate data; political, cultural, social and structural infrastructure; manpower; senior managers; training; using academic potentials; definition and standardising the deployment processes; neglect to application of criteria and clinical guidelines in the use of system; data security; stakeholder communications challenges and the necessity to establish a pilot system., Conclusion: This study highlighted specific strengths in the technical and functional aspects of DHIS2 and also drew attention to particular challenges and concerns. These results provide a sound evidence base for decision makers and policymakers to enable them to make more accurate decisions about whether or not to use the DHIS2 in the health system of their country.