Evidence Based Health Policy, Management and Economics

Ensuring Safe Nutrition for Arbaeen Pilgrims: The Role of Mawkibs

Ameneh Marzban — 2026-06-03

The Article Abstract is not available.

Evaluating the Implementation Challenges of the Student Social Care System in Iranian Schools: Policy Brief

Najmeh Baghian — 2026-06-03

Given the increasing prevalence of high-risk behaviors and social harms, the implementation of the Student Social Care System (NEMAD Project) is critical for student empowerment and harm mitigation. This policy brief synthesizes evidence and identifies key implementation challenges within the NEMAD project across various executive levels. Critical barriers highlighted include inefficient resource management, deficiencies in laws and regulations, lack of both internal and external coordination, and the absence of a structured evaluation system. Furthermore, the study determined that fostering strong executive commitment among officials is the single most crucial element for successful implementation. To enhance the NEMAD project’s effectiveness, the brief proposes a set of key strategies: establishing a sustainable funding source, designing performance-based budgeting for inter-agency resource allocation, launching an independent authority for school accreditation within the project framework, and fully incorporating the program into official school performance evaluation criteria.

Factors Associated with Discharge against Medical Advice among Patients Hospitalized in the Psychiatric Hospital of Yazd Province, Iran (2023–2024)

Elahe Salarikhah — 2026-06-03

Introduction: Patient satisfaction has increasingly become an important issue in the healthcare system. Discharge against medical advice (DAMA) is considered an important indicator of patient dissatisfaction and may negatively affect treatment outcomes while increasing hospital costs. This issue is particularly significant among psychiatric patients due to the chronic and vulnerable nature of mental disorders. Premature discharge in psychiatric patients can increase the risk of relapse, acute psychiatric crises, suicide, self-harm, or harm to others. From a healthcare system perspective, early discharge is associated with higher readmission rates, additional healthcare costs, and reduced efficiency of the healthcare system. Furthermore, due to the social stigma associated with mental disorders in Iranian society, patients and their families may experience additional pressure to leave the hospital prematurely. Therefore, identifying the factors influencing discharge against medical advice in psychiatric hospitals is essential not only for improving clinical outcomes but also for enhancing patient safety, optimizing healthcare resources, and improving the quality of care.

Materials and Methods: This analytical cross-sectional retrospective study was conducted from April 2023 to September 2024 among patients discharged against medical advice from the psychiatric hospital in Yazd Province, Iran. A list of patients who left the hospital against medical advice during the study period was prepared, and 156 patients were selected using simple random sampling.Data were collected through the Hospital Information System (HIS) and review of patients’ medical records and was analyzed through SPSS. In addition, telephone interviews with patients or their family members were conducted to validate the collected information and obtain additional details regarding the reasons for discharge.

Results: Among the 156 patients included in the study, the majority was male (67%). The highest proportion of patients belonged to the 30–39 age group. The most common reasons for discharge were fatigue from the hospital environment (23.1%), occupational and personal problems (20.5%), family dependency (17.3%), and perceived relative recovery (14.1%). Overall, 76.9% of the reasons were related to patient-related factors, while 23.1% were related to hospital-related factors.

Conclusion: The findings of this study indicate that most cases of discharge against medical advice in the psychiatric hospital of Yazd are primarily influenced by individual and psychosocial factors. Early discharge in psychiatric patients increases the likelihood of readmission and imposes significant costs on the healthcare system. Therefore, implementing early psychosocial interventions, improving hospital environmental conditions, and reducing social stigma toward mental illness are essential strategies for reducing DAMA rates.

Spatial Analysis of Access to Pharmacies and Medical Diagnostic Laboratories Using Geographic Information System (GIS): A Case Study of Yazd City

Elham Safi Najaf Abadi — 2026-06-03

Introduction: The unequal spatial distribution of healthcare services, such as pharmacies and diagnostic laboratories, is a major challenge in developing countries, leading to inequitable access. This study aimed to analyze the spatial distribution of these facilities in Yazd City using Geographic Information System (GIS) techniques to assess accessibility and equity.

Materials and Methods: This descriptive analytical cross-sectional study was conducted in 2022. Data on the locations of pharmacies, medical diagnostic laboratories, and population distribution in Yazd were collected and mapped using ArcGIS software. Standards and indicators were identified through document review, and data were analyzed using GIS models, including Hot Spot Analysis, Thiessen Polygon, Two-Step Floating Catchment Area (2SFCA), and Nearest Neighbor Distance (NND).

Results: The standard radius for medical laboratories is 700 meters and the accessibility score varies from 0 to 0.049. For pharmacies, the standard is one pharmacy per 7,000 people and the walking distance limit is 500 meters, with accessibility scores ranging from 0 to 1.47, indicating a slight difference in accessibility between the two uses. In fact, among the 57 diagnostic laboratories, the highest concentration was found in the historic district, which had a relatively low population density, indicating a random distribution. Pharmacies were mainly concentrated in District 2 and the historic districts. While the distribution in District 2 corresponded to population density, the historic district showed an oversupply of drugs relative to its population.

Conclusion: Access to health facilities in Yazd is spatially uneven. In order to promote social justice and improve the quality of life, urban planning should consider population distribution to promote equitable access and social justice in urban environments.

Exploring Organizational Deception among Community Nurses in Iran: A Grounded Theory Qualitative Study

Zahra Solati — 2026-06-03

Introduction: Although numerous news reports have surfaced regarding morally distressing situations in the workplace, little research exists on the topic of deception by organizational research professionals.

Materials and Methods: Data were collected through semi-structured interviews, and the relevant text was subsequently extracted and condensed using the method proposed by Strauss and Corbin. This study employed a qualitative grounded theory approach to examine how organizational deception manifests among Iran's Community nurses. The research sample consisted of 29 nurses working at public hospitals in Shiraz, Iran.

Results: Three categories of components affecting the Organizational Deception in Iran's Community nurses were identified. In the open coding stage, 40 concepts were obtained, which were finally reduced to 11 subcategories. Six contributing factors to workplace deception were identified and classified into one of two groups. Under the grouping of personality components, the identified organizational deception included: 1- antisocial attitudes, 2- Machiavellianism, and 3- passive-aggressive behavior. The remaining deception factors were categorized as cognitive elements: 1- seeking material and non-tangible benefits and 2- coercion in the workplace. The negative consequences of organizational deception were observed at individual (relational and psychological), group (interpersonal and external to the organization), and organizational levels. Moreover, managerial factors (management style) and organizational factors (organizational culture, workplace structure, and working conditions) were found to influence the issue of deception in the workplace. This study revealed the strategies used for deception in the workplace, which can include deception as a means of escape and a manipulative tool for handling information.

Conclusion: Deceptive actions by nurses harm not only their colleagues and patients but also the credibility of public sector hospitals, reducing citizens' trust in governments. Policymakers and health sector managers should prioritize ethical practices in their operations and consider preventive measures against deception in the workplace. Given the increased potential for communicable disease outbreaks in the world, the integrity and honesty of nurses worldwide during caregiving situations are critical.

Addressing Imbalances from Fixed Pricing, Subsidies, and Misused Discounts in Pharmaceutical Chains through Coordination

Farnoush Otrodi — 2026-06-03

Introduction: In regulated markets such as Iran, Canada, and Japan, fixed pricing policies, government subsidies, and misused discount practices contributed to financial instability and persistent medicine shortages. These regulatory constraints limited pricing flexibility, creating misaligned incentives among manufacturers, distributors, and retailers, which fueled competition and disrupted equitable access to essential drugs. The reliance on poorly designed discounts further complicated supply chain dynamics, leading to inefficiencies and reduced availability.

Materials and Methods: This study developed a practical decision-support framework, tailored to the Iranian context where perishability and financial challenges were prominent to address these issues. The framework optimized discount strategies to align with existing subsidy structures, fostering better coordination across supply chain actors. Various operational scenarios were evaluated using a mathematical model incorporating perishability dynamics and sensitivity analysis to assess impacts on supply chain performance.

Results: The findings revealed that, unlike the common practice of using discounts solely to boost sales while neglecting other supply chain members, potentially leading to their bankruptcy, this study’s coordinated approach enhanced overall supply chain profitability. This strategy balanced incentives across actors, mitigating financial strain and improving drug availability, particularly in underserved regions.

Conclusion: This study offered policymakers insights to refine subsidy allocation and enhance equitable healthcare access through infrastructure support. For managers, it provided actionable tools to boost supply chain resilience via coordinated discount practices and demand alignment. The approach tackled immediate challenges and laid a foundation for sustainable healthcare systems, advancing knowledge by integrating coordination into subsidized supply chain models

The Relationship between Occupational Stress and Quality of Work Life among Educational Administrative Staff at Zabol University of Medical Sciences

Mohammad Sarani — 2026-06-03

Introduction: Occupational stress and quality of work life (QWL) are key factors affecting employees’ well-being and organizational performance. Understanding their relationship among educational administrative staff can help design effective interventions. Theretofore, this study aimed to investigate the relationship between occupational stress and QWL among educational administrative staff at Zabol University of Medical Sciences.

Materials and Methods: This descriptive correlational study was conducted in 2022 among all educational administrative staff
(n = 120) in the educational sector of Zabol University of Medical Sciences. Participants completed a demographic questionnaire, Walton’s QWL questionnaire, and the Health and Safety Executive (HSE) Occupational Stress questionnaire. Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, and Pearson correlation in SPSS version 25. The significance level was set at p < 0.05.

Results: The mean age of participants was 34.5 ± 6.2, and the mean work experience was 9.4 ± 5.6. The mean QWL score was 110.2 ± 15.6, and the mean occupational stress score was 112.5 ± 14.3, indicating moderate levels of both variables. No significant differences were found in occupational stress or QWL based on gender or marital status. However, QWL significantly differed by education level (P = 0.008), with employees holding a master’s degree or higher reporting lower QWL. Pearson correlation analysis showed a significant positive relationship between QWL and occupational stress (r = 0.36, P-values < 0.001), indicating that lower stress is associated with higher QWL.

Conclusion: Educational administrative staff with lower occupational stress report higher QWL. These findings highlight the need for stress management and supportive workplace interventions to enhance QWL among university administrative staff.

A Narrative Review of Health Observatory: Framework, Challenges, and Future Prospects in National and Global Systems

Sakineh Saghaeiannejad-Isfahani — 2026-06-03

Introduction: In an era marked by global health crises and data-driven policymaking, timely and accurate health data are indispensable for assessing population health and achieving Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC). Health observatories serve as integrated platforms for collecting, analyzing, and disseminating health data, thereby enhancing evidence-informed decision-making and strengthening health systems.

Materials and Methods: This structured narrative review was chosen to accommodate the complexity and multidimensionality of health observatory systems. The PRISMA-ScR framework guided the review process, ensuring methodological rigor, transparency, and reproducibility.

Results: Findings were synthesized using an input–process–output–outcome framework across four dimensions: governance, technical, financial, and cultural–human. This model facilitated a comprehensive analysis of the structures, capacities, and challenges of health observatories, drawing on examples from national and global initiatives.

Conclusion: To ensure sustainability and effectiveness, countries must invest in robust governance, advanced data infrastructure, skilled human resources, and a culture of data-driven decision-making. Strengthening these pillars will accelerate progress toward UHC and SDGs, and foster resilient health systems worldwide.