Evidence Based Health Policy, Management and Economics

Medical Education Quality in the COVID-19 Era: A Policy Brief on Lesson Learned and Recommendations

Majid Heydari — 2024-12-09

Following the COVID-19 pandemic, numerous studies have been conducted to evaluate the quality of medical education in Iran, with a particular emphasis on virtual training. The results of these studies varied. A review of evidence suggests that the pandemic has affected the quality of medical education. Quality management of medical education during critical conditions such as the COVID-19 pandemic is far from what occurs in routine medical education processes. In order to prevent a decline in the quality of education during crises, it is necessary to adapt educational structures flexibly, particularly in healthcare delivery settings such as hospitals and comprehensive health centers. This policy brief proposes several recommendations in the area of learning environment, educational governance, developing and supporting learners and supervisors, delivering programs and curricula and developing a sustainable workforce. These recommendations can be implemented both before and during a crisis. In addition to all these suggestions, the key policy recommendation is to create and implement an Education Incident Command System (EICS). The design of an EICS is warranted to keep medical education processes active and preserve the quality of medical education before, during, and after a crisis. The EICS operates with command, control, and coordination of key players in medical education in response to emergency situations by facilitating flexible changes in medical educational processes

Assessing the Psychometric Properties of Academic Engagement Questionnaire in Nursing Students

Jamil Sadeghifar — 2024-12-09

Background: Academic Engagement is considered as one of the important factors related to the learners’ academic achievement. It is known as a significant research issue in higher education. The present study aimed to make an instrument for investigating academic engagement among nursing students of Ilam University of Medical Sciences.

Methods: The present study is a methodological and cross-sectional research. To localize the academic engagement questionnaire, first, it was translated into Persian using forward-backward method. Then, its content and face validity were evaluated and approved. In order to determine the validity and reliability, the questionnaire was delivered to 120 nursing students and their comments were collected and analyzed. SPSS and AMOS software, statistical tests of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used for data analysis.

Results: According to the results, the internal consistency of the questionnaire was confirmed by calculating Cronbach's alpha coefficient (α = 0.906). The EFA and CFA were used to examine the dimensionality of three domains of vigor, dedication, and absorption. Values of Goodness of Fit Index (GFI), Non-Normed Fit Index (NFI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA) indices were 0.89, 0.92, 0.90 and 0.97, respectively

Conclusion: The reliability and validity of the translated academic engagement questionnaire were relatively acceptable in reviewing the academic engagement of medical students, especially nursing students. Future studies should focus on more samples and examine the impact of nurses' background and educational variables on academic engagement.

Public Preferences and Willingness to Pay for Social Health Insurance in Iran: A Discrete Choice Experiment

Mohammad Ranjbar — 2024-12-09

Background: Current health insurance programs in Iran suffer from low enrolment and are not sufficient to attain the country to universal health coverage (UHC). The study hypothesized that improving the enrollment rate and moving towards more sustainable UHC can be achieved by improving the benefit package and providing new incentives. The objective of this study is to assess public preferences and willingness to pay (WTP) for social health insurance (SHI) in Iran.

Methods: A discrete choice experiment (DCE) was conducted in 2022, using a self-administered questionnaire on 500 participants to estimate WTP and determine individual’s preferences for the SHI plan. Respondents were presented with an eight choice set, and asked to select their preferred one. In each choice set, scenarios were described by eight attributes with varying levels. The conditional logit regression model was used to analyze the participants preferences. WTP for each attribute was also calculated by STATA₁₃.

Results: Most of the included attributes were significant predictors of health insurance package selection. The maximum coverage of hospitalization costs in the private sector, ancillary services such as glasses, canes etc., as well as coverage for hospitalization costs in the public sector and drug costs, were the most important determining factors for this choice. Coverage of preventive dental care did not significantly affect respondent choices. Estimating WTP showed that individuals are willing to pay more for higher financial protection, particularly against private sector costs; the WTP to increase the coverage of hospitalization costs in the private sector from 50% to 90% is estimated at 362,068 IR, Rials per month.

Conclusion: This study identifies the key factors that the population value with regard to health insurance and the tradeoffs they are willing to make between them. Hospitalization, drugs and ancillary services were the most important determining factors for their choice. The data suggests that additional resources coming into the Iranian health system might best be prioritized to covering hospitalization and drug costs and those associated with ancillary services.

Presenting a Qualitative Model for the Implementation of Transformational Leadership in the Form of an Interactive Leadership Framework (Case Study: Hospitals in Zanjan Province)

Soheila Alavi — 2024-12-09

Background: The method of choosing the leadership style of an organization is very important in the success of the organization in gaining a competitive advantage in society, and on the other hand, the method of managing and creating change and innovation is also considered necessary for the success of the organization as these factors dynamically affect each other. Some create obstacles on the way and some strengthen each other.

Methods: The statistical population considered for this research in the qualitative part included participants, some of whom were academic professors, and some were managers of high managerial and organizational levels who were proficient in management topics in medical sciences hospitals. In terms of method, this research had a mixed approach. In other words, a combination of quantitative and qualitative methods was used. In data collection, in general, documentary studies and field method using MAXQDA software were used.

Results: The results of the evaluation showed that the observed correlation between the examined components and the transformative leadership variable was completely significant. Therefore, it was concluded that the model examined in this research had a sufficient level of significance to be used as a guide to increase the transformation of the organization by relying on the role of interactive leadership in the hospitals of Zanjan province.

Conclusion: One of the important and influential factors of an organization's success is how to apply management and effective leadership styles of managers of that organization. There are managers who can choose different styles in directing human resources. Their appropriate behavior patterns in any organization cause strong morale and motivation among employees, -and subsequently, increase the motivation of employees, their level of satisfaction and the level of productivity.

Program Evaluation of the Clinical Education Based on Four-Component Instructional Design (4C/ID) Model

Parvaneh Rashidpour — 2024-12-09

Background: Clinical education is a key step in medical education. The study aimed to evaluate clinical education in undergraduate medical education programs based on the Four-Component Instructional Design (4C/ID) model.

Methods: The cross-sectional study was conducted at Shahid Sadoughi University of Medical Sciences in 2023-2024. Fifteen departments where medical students studied the clerkship and internship courses were evaluated. An evaluation checklist was used including four domains, 23 questions, and 100 items. The evaluation was implemented in three steps including "Preparation of evaluation", "Execution of evaluation" and "Preparation of evaluation report and application of results". Data were analyzed using descriptive tests (mean, standard deviation, SD, and frequency).

Results: The findings showed that the status of the departments in the "educational goals and learning tasks" domain in the clerkship and internship courses were 48.33 and 49.26, which achieved the highest level of compliance. The lowest compliance reported in the domain of "practice opportunities" was 14.30 and 15.77 in the clerkship and internship courses. The compliance in the domain of "procedural information in educational events" in the clerkship courses was 33.15 and in the internship courses was 36.17 and in the domain of "supportive information" in the clerkship courses was 24.36 and internship was 23.46, indicating a medium to a low level of compliance.

Conclusion: Clinical learning is recognized as a complex learning, which requires supportive information and practice opportunities for learning. The results showed that lower compliance was reported in the domains of "practice opportunities" and "supportive information" in the educational department clerkship and internships. Therefore, it is recommended to plan for the development of support resources on various platforms. It also requires an appropriate educational design to deliver practice opportunities in simulation and workplace environments in undergraduate medical education.

Validity and Reliability Evaluation of the Dietary Habits Scale for Adults (25-55 years old) Derived from Iranian Traditional Medicine

Hossein Abolhosseini — 2024-12-09

Methods: This cross-sectional study was designed to develop the dietary habits scale and evaluate its validity and reliability. The scale was drafted with two subscales including eating manners and drinking manners based on the principles of Iranian medicine. Afterward, to determine the construct validity and reliability of the scale, it was administered to 40 people aged 25 to 55 years. Data were analyzed using SPSS21 and AMOS software.

Results: The content validity ratio (CVR) and content validity index (CVI) were 0.99 and 0.79, respectively. The confirmatory factor analysis (CFA) test was used to evaluate its dimensionality. The CFMIN/DF was 1.80, and RMSEA, GFI, and CFI were 0.05, 0.91, and 0.93, respectively. The internal consistency of the scale was confirmed by calculating the Cronbach's alpha coefficient (α = 0.805).

Conclusion: The eating habits scale developed based on the Iranian medicine has acceptable reliability and validity for its administration on the participants. In future studies, researchers are recommended to focus on different demographic groups and examine the impact of contextual and clinical variables.

A Scoping Review of Cloud Computing Solutions in Enhanced Dialysis Information Exchange

Asghar Ehteshami — 2024-12-09

Background: Dialysis, a critical treatment for kidney failure, faces challenges related to patient safety, treatment efficiency, and overall care quality. Despite advancements in technology, improved information exchange is essential to overcome limitations of traditional sharing methods, which often lack accessibility and security. Cloud computing offers a promising solution with its scalability and efficiency, potentially revolutionizing dialysis information exchange and leading to improved patient outcomes and enhanced healthcare delivery.

Methods: This scoping review aimed to synthesize research on cloud computing solutions for improving dialysis information exchange by conducting a systematic search across five databases (PubMed, Web of Science, Scopus, Embase, and ProQuest) using relevant keywords. The review included observational studies published from 2010 to the present, and employed a rigorous selection process to ensure the studies were pertinent to dialysis care while excluding irrelevant articles.

Results: Six key areas where cloud computing can enhance dialysis information exchange were identified: telemedicine, cloud computing infrastructure, clinical information systems, information management, standards and models, and associated challenges. It emphasizes the potential of cloud-based solutions to improve patient care through remote monitoring, data analytics, and improved communication among healthcare providers.

Conclusions: Cloud computing solutions present a promising opportunity to enhance dialysis information exchange by improving security, transparency, cost-effectiveness, and efficiency. This review highlights the potential of cloud-based platforms to streamline data management, facilitate communication, and enhance patient care. However, realizing these benefits requires addressing challenges such as data security, establishing unified standards, and ensuring interoperability. By integrating advanced technologies like blockchain, attribute-based encryption, and federated learning, and prioritizing research on data privacy concerns, the advantages of cloud computing in dialysis care and improve patient outcomes. Can be further unlocked.

Economic Impact of Government Interventions during the COVID-19 Pandemic in Iran: A Systematic Review and Content Analysis

Ali Mohammad Latifi — 2024-12-09

Background: Iran is one of the hardest hit countries by COVID-19 and has witnessed a high incidence and prevalence of mortality and morbidity cases. This study generally aims to highlight the main economic aspects of government responses to the COVID-19 outbreak in Iran.

Methods: In order to benefit from a comprehensive tool to evaluate direct and indirect costs of approvals, a preliminary systematic review was conducted. Qualitative content analysis and simplified method of activity-based costing (ABC) were used in order to calculate the aggregate cost of a given set of activities. The direct and indirect costs of approvals based on the aggregated costs of categorized activities were analyzed. All costs were converted into US dollars using the monthly mean exchange rate.

Results: Totally, 164 publications were included in the systematic review. Designed tool was approved by expert opinions (met CVI>0.79 and CVR≥0.6) and seven aspects of economic consequences of COVID-19 interventions were assessed. The overall tangible and calculable costs were estimated about 25,755,700,000 US$. Direct support and compensation for losses of industries and companies accounted for the largest costs (41%) related to COVID-19 interventions (10,587,000,000 US$).

Conclusion: Establishing economic security for industries, rapid and simultaneous measures of prevention, treatment and vaccination, and increasing household income can significantly reduce the costs of controlling similar diseases in the future.