Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 7 4 2023 12 1 Rural Development for Healthy Communities: Nurturing Vital Connections 254 256 EN Mohammadreza Sheikhy-Chaman Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran UrmiaLord@gmail.com N 0000-0002-7381-2005 Neda Hoseini Abforosh Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran nd.hosseini@yahoo.com N 0009-0000-4583-1615 Khashayar Eshtiaghi Department of Business Management and Engineering, Iran University of Science and Technology, Tehran, Iran kh.eshtiaghi@gmail.com Y 0000-0003-3678-2166 10.18502/jebhpme.v7i4.15475 In recent years, migration of rural populations to urban centers has become more prevalent due to the industrialization of countries and social inequities. Rural areas are an essential component of health for the community through four key dimensions: ensuring food security, environmental protection, preventing slum formation, and addressing population aging. This article provides a brief overview of each dimension, emphasizing the need for policymakers and managers to prioritize preserving rural areas and improving the livelihood of rural residents, demonstrating a strong commitment.   Social Equity, Rural Development, Rural Health, Healthy Communities http://jebhpme.ssu.ac.ir/article-1-468-en.html http://jebhpme.ssu.ac.ir/article-1-468-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 7 4 2023 12 1 Measuring and Comparing Service Delivery Time in Government and Outsourced Health Posts Affiliated with Tehran University of Medical Sciences 257 266 EN Seyed Hadi Hosseini Department of Healthcare Services Management, School of Health, Alborz University of Medical Sciences, Karaj, Iran hadihosseini@live.com Y 0000-0002-4529-7683 Mitra Rahimzadeh Department of Epidemiology and Biostatistics, Social Determinants of Health Research Center, School of Health, Alborz University of Medical Sciences, Karaj, Iran rahimi_1351@yahoo.com N 0000-0002-9863-5949 Ali Hosseini Student Research Committee, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran N 0009-0007-7854-1869 Arash Shirdel Department of Health Information Technology, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran N 0000-0002-9322-9917 Seyedeh Sedreh Hosseini Department of Exceptional Student Education, General Department of Education of Alborz Province, Karaj, Iran N 0000-0003-0078-3589 Mohammad Amerzadeh Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran N 0000-0003-2251-8786 10.18502/jebhpme.v7i4.15476 Background: The duration of healthcare services has a significant impact on the quality of care and patient's satisfaction. Having information on service delivery time in both government and outsourced Health Posts (HPs) can contribute to evidence-based policymaking and better resource management. Therefore, this study aims to estimate and compare service delivery time in government and outsourced HPs. Methods: This descriptive-analytical cross-sectional study was conducted in six affiliated HPs under Tehran University of Medical Sciences in 2019–2020. Data were collected through a census using a stopwatch and a time recording form during one working week. The average duration of each service (in minutes) was obtained. The results were reported using descriptive statistics and were analyzed using SPSS24 software and multivariate analysis of variance (ANOVA). Results: The total mean of duration of services provided in government HPs (777.6 minutes) was greater than that in outsourced HPs (788.5 minutes). Among the 10 services provided, the average duration of services for adolescents (20.4±4.5 minutes), young adults (20.5±5.6 minutes), middle-aged adults (26.1±10.4 minutes), and elderly individuals (24.3±13.6 minutes) in government HPs was significantly longer than in outsourced HPs (p<0.05). Additionally, the average duration of health education services (23.1±10.5 minutes) and health ambassador training (36.1±13.7 minutes) in private HPs was significantly longer than in government HPs (p<0.05). Conclusion: In outsourced HPs, it is important to focus on creating a balance between the number of visits and the staff available for services which target adolescents, young adults, middle-aged adults, and elderly individuals. In government HPs, emphasis should be placed on increasing the time allocated for educational and promotional health services. By considering the importance of service delivery time and the observed differences in findings of this study, it is crucial to prioritize the duration of service delivery as an important performance measure when comparing government and outsourced HPs. Primary Healthcare, Duration, Government Health Post, Outsourced Health Post, Tehran. http://jebhpme.ssu.ac.ir/article-1-473-en.html http://jebhpme.ssu.ac.ir/article-1-473-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 7 4 2023 12 1 Estimating the Health Care Providers’ Number Needed in Northwest Health Service Centers of Tehran Based on Workload Index 267 272 EN Mobarakeh Alipanah Dolatabad Department of Health Services Management, School of Management and Medical Informatics, Iran University of Medical Sciences, Tehran Iran mobarakeh.alipanah@gmail.com N 0000-0002-3710-5821 Shabnam Izadi Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran N 0000-0002-9644-5105 Pedram Nourizadeh Tehrani Department of Management Sciences and Health Economics, School of Health, Tehran University of Medical Sciences, Tehran, Iran N 0000_0002_8952_258X Hamid Pourasghari 1 Department of Health Services Management, School of Management and Medical Informatics, Iran University of Medical Sciences, Tehran Iran hamid.pourasghari@gmail.com Y 0000-0002-5148-2869 10.18502/jebhpme.v7i4.15477 Background: One of the major challenges of primary health care (PHC) in developing countries is supplying the growing needs of the populations with sufficient and skilled health workers. In this context, use of a simple and relevant workforce planning method such as Workload Indicators of Staffing Need (WISN) could help authorities allocate adequate number of professionals to health centers to meet the health needs of target populations. Methods: This was a descriptive-analytical study, and WISN methodology was used at 48 Comprehensive Health Centers (CHC) located in the northwest of Tehran, in 2022. The present study was conducted in 7 steps and included measures such as the available work Stime, initial and final required manpower, extracurricular activities and their coefficients, standard work activity and workload, and scheduling activities. Results: According to the collected data, the total number of health care workers needed for the covered population was calculated to be approximately 1018 people, and the ratio of available manpower to the required manpower was reported as 24%; this indicated a 76% difference in the number of health care providers regarding the implementation of complete service package. Conclusion: The results of the research showed that if all the referrals are made through network, the network would likely have a shortage of human resources. Although the standard workload in most cases is lower than anticipated based on the reviewed performance regarding the health care provided, this can be caused by not going to the center to receive services, going to the private sector, and also not knowing about the services that can be provided.   Healthcare Worker, Healthcare Provider, Workload Index, Manpower Estimation, Health Services Centers, Tehran http://jebhpme.ssu.ac.ir/article-1-472-en.html http://jebhpme.ssu.ac.ir/article-1-472-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 7 4 2023 12 1 Factors Affecting the Resilience of Nurses in the COVID-19 Crisis: A Mixed Method Study from West of Iran 273 282 EN Jamil Sadeghifar Department of Health Economics and Management, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran jamil.sadeghifar@gmail.com N 0000-0002-9422-7403 Hassan Rashidi Department of Management, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran dr_hassanrashidi@yahoo.com N 0000-0003-1026-4280 Khalil Momeni Department of Health Economics and Management, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran khalilmomeni1365@gmail.com. N 0000-0002-8374-8721 Seyyed Mahmoud Mirahmadi Khorasgan Branch, Islamic Azad University, Isfahan, Iran mirahmadi14@yahoo.com N 0009-0008-0160-6676 Ardeshir Ahmadi Valiasr Dareh Shahr Hospital, Ilam University of Medical Sciences, Ilam, Iran Ahmadi.ard1351@gmail.com Y 0000-0003-2783-8455 10.18502/jebhpme.v7i4.15478 Background: The widespread outbreak of the COVID-19 virus has resulted in an increase in hospitalizations and mortality in healthcare centers, directly affecting healthcare personnel, especially nurses. Resilience stands for one of the key non-cognitive skills that can ensure nurses’ optimal performance during crises. Hence, the present research was aimed at identifying the status of factors affecting resilience among nurses involved in the COVID-19 crisis at Shohada Hospital in Dehloran (Iran). Methods: This mixed-method study (qualitative-quantitative) was conducted in 2021 (Solar year 1400). Respectively in qualitative and quantitative parts, the research sample consisted of 18 academic members and executive managers in the healthcare sector and 118 nurses at Shahid Dehloran Hospital in Ilam province (Iran). Data collection was performed using semi-structured interviews and questionnaires. Qualitative data analysis was conducted using MAXQDA2020 software, and quantitative data analysis was performed using confirmatory factor analysis, AMOS 26, and SPSS 26. Results: The factors influencing the resilience of nurses were categorized into three main themes: personal factors (motivation, stress, personal life, Becoming obsessed, balance in personal life, resilience in personal life challenges), organizational factors (mental and psychological health, organizational leaders’ responsiveness), and environmental factors (lack of cooperation, lack of facilities and equipment). According to the results, among personal factors, motivation (R=0.88), among organizational factors, mental and psychological health (R=0.83), and among environmental factors, the lack of facilities has the most significant effect on nurses’ resilience (R=0.75). Conclusion: The findings highlight the considerable and significant impact of personal, organizational, and environmental factors on enhancing nurses’ resilience. Based on the research results, the proposed conceptual model can serve as a suitable mechanism for hospital managers to enhance the healthcare staff’s resilience.   Resilience, Nurse, Hospital, Pandemic, COVID-19 http://jebhpme.ssu.ac.ir/article-1-471-en.html http://jebhpme.ssu.ac.ir/article-1-471-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 7 4 2023 12 1 Disaster Mitigation and preparedness from the Perspective of Holy Quran 283 291 EN Abbas Ostadtaghizadeh Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ostadtaghizadeh@gmail.com N 0000-0002-1173-6852 Mohsen Nouri Spiritual Health Research Center, Mental Health Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran m61nooori@gmail.com Y 0000-0003-4849-8568 Hamidreza Aghababaeian Department of Medical Emergencies, Dezful University of Medical Sciences, Dezful, Iran hamidrezaaghababaeian@yahoo.com N 0000-0003-3339-5507 Ahad Roohani-Majd Department of Education, Faculty of Basic Sciences, Sahand University of Technology, Tabriz, Iran roohani@sut.ac.ir N 0000-0003-0914-0117 Sayyed Ziaoddin Olyanasab Department of Education, Faculty of Basic Sciences, Sahand University of Technology, Tabriz, Iran z.olyanasab@hmu.ac.ir N 0000-0001-5939-8795 Saber Azami-Aghdash Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran s.azami.a90@gmail.com N 0000-0003-1244-359X Mahdi Nateghpour Research Center of Quran, Hadith and Medicine, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran nateghpourm@tums.ac.ir N 0000-0002-8403-8190 Seyed Jamal Khalesinejad Research Center of Quran, Hadith and Medicine, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran s64mouri@gmail.com N 0000-0003-0763-4375 Mehdi Asghari Jighe Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran mzasghari96@gmail.com N 0000-0003-1737-0692 10.18502/jebhpme.v7i4.15479 Background: Different religions have tackled the issue of natural disasters, considering them the result of people’s sins, holy action, and tools used by God to punish people. These beliefs will keep people reluctant to do anything to respond well to disasters since they believe that nothing could or should be done. Of course, the Holy Quran advises believers to stay cautious about disaster risks and try to lessen them. Thus, this research aims to investigate the verses of the Holy Quran about disaster risk management to correct religious beliefs about this topic. Methods: A qualitative study was conducted. First, verses of Holy Quran related to disasters were identified through a search in Quran’s text, translation, and interpretation. Data were analyzed using qualitative content analysis. Results: 82 of verses were included in the analysis after evaluating their content. The results were divided into two categories: readiness, and prevention and vulnerability reduction. Conclusion: This research confirms that Islam has paid much attention to disaster readiness and prevention. This issue has been stated in Holy Quran with many examples and suggestions. Precise reflection in these verses can have a notable influence on changing the views and beliefs of society members, and these verses are proof of the policies, actions, and plans that humanity has reached after years of experience against hazards.   Disaster, Mitigation, Preparedness, Holy Quran http://jebhpme.ssu.ac.ir/article-1-470-en.html http://jebhpme.ssu.ac.ir/article-1-470-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 7 4 2023 12 1 Institutional Ownership and Concentration of Capital in Pharmaceutical Companies: Evidence from Iran 292 304 EN Rouhollah Yaghoubi Department of Health Management, Policy and Economics, School of public Health, Tehran University of Medical Sciences, Tehran, Iran yaghoobi.ru@gmail.com N 0000-0003-4417-9148 Sara Emamgholipour Department of Health Management, Policy and Economics, School of public Health, Tehran University of Medical Sciences, Tehran, Iran s-emamgholipour@tums.ac.ir Y 0000-0001-8654-6554 Amin Mohammadi Department of Health Management, Policy and Economics, School of public Health, Tehran University of Medical Sciences, Tehran, Iran N 0000-0002-1888-1411 Bashir Azimi Nayebi School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran N 0000-0002-4702-2755 Abdoreza Mousavi Department of Health Management, Policy and Economics, School of public Health, Tehran University of Medical Sciences, Tehran, Iran N 0000-0001-8786-7309 Fakhraddin Daastari School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran N 0000-0002-4426-0600 10.18502/jebhpme.v7i4.15480 Background: Institutional owners influence the direction of policy and the performance of owned companies. This research was motivated by the presence of pharmaceutical companies in the Tehran Stock Exchange and the uncertainty surrounding the extent and influence of institutional owners on the policy direction and performance of the companies. Methods: This was a descriptive-analytical and cross-sectional study. The descriptive phase of the study involved measuring sales figures, market value, and market share of pharmaceutical companies listed on the stock exchange. In the analytical phase, the network of shareholders' relationships was analyzed with Gephi version 0.1 and Microsoft Excel version 2016, followed by the calculation of the capital concentration index and market share. Results: Estimates indicated that approximately 45% of the pharmaceutical companies in Iran were publicly traded in stock exchange. In 2020, the total value of these companies in the Iranian capital market reached 9.79 billion USD. Out of this amount, 45% (equivalent to 4.4 billion USD) was offered in Tehran Stock Exchange. The concentration of final shareholders, with a Herfindahl–Hirschman index(HHI) index of 0.036, signified a monopolistic competition market. On the other hand, the pharmaceutical capital market could be classified as an oligopoly market (with a CR4 value of 58.3) when analyzing only the direct shareholders at level 2. Additionally, the six main holding companies at this level collectively possess 67% of the pharmaceutical capital market. Conclusion: Based on the results, the importance of institutional owners, such as the Social Security Organization (SSO), in the decision-making process regarding the Iranian pharmaceutical market can be acknowledged. The decisions about integration and supply chains which aimed at improving the productivity of the pharmaceutical market, need to be thoroughly examined by the institutions mentioned in this research.   Securities, Network Analysis, Herfindahl–Hirschman index, Concentration Ratio, Medicine http://jebhpme.ssu.ac.ir/article-1-467-en.html http://jebhpme.ssu.ac.ir/article-1-467-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 7 4 2023 12 1 Strategies for Changing the Approach of Health Promoting Hospitals Based on the Importance-Performance Model: A Case Study in Yazd Hospitals in 2022 305 314 EN Roohollah Askari Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran r.asqari@gmail.com Y 0000-0003-2239-6344 Zahra Afkhami Ardakani Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran N 0009-0000-3409-0831 Motahareh Sadat Pourrazavi Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran N 0000-0007-6098-7379 Zeinab Alizadeh Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran N 0009-0000-0944-1177 10.18502/jebhpme.v7i4.15481 Background: Considering the key role of hospitals in improving the level of health, staff and community, implementing standards and promoting activities in hospitals is necessary to realize this important goal. Therefore, the purpose study to examine the strategies for changing the approach of health hospitals based on the importance-performance model. Methods: The present descriptive and cross-sectional study was conducted in 2022 in selected hospitals of Yazd province, Iran. 56 hospital managers and officials were selected by census method. Data was collected using the World Health Organization (WHO) questionnaire regarding HPH (health promoting hospital) standards which contains 69 questions. The data was analysed using SPSS26, and mean score and standard deviation of importance and performance of HPH standards were calculated. The status of HPH standards in the studied hospitals was investigated using the importance-performance analysis matrix. Results: The results showed that HPH standards had a moderate importance from the point of view of the studied people (3.89±0.76) and in the examination of the performance of the studied hospitals regarding HPH standards, the researchers implemented the standards in a moderate level (3.28±0.51). All the standards were identified as the points for keeping up the good work points based on importance-performance analysis matrix in the studied hospitals. Conclusion: In order to fully achieve the standards and improve the condition of hospitals, changing the views of hospital managers and health service policy-makers towards the HPH plan, creating specific and consistent policies and guidelines in the field of training and interventions provided to patients and employees is necessary and effective. Health Promotion, Hospital, Standard, Importance-Performance Matrix http://jebhpme.ssu.ac.ir/article-1-476-en.html http://jebhpme.ssu.ac.ir/article-1-476-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management & Economics 2538-5070 2538-4716 7 4 2023 12 1 Evaluating the Effectiveness of Using Virtual Reality Interventions on Children and Adolescents with Autism Spectrum Disorder: A Systematic Review 315 328 EN Ghasem Alizadeh-Dizaj 1 Health Information Technology Department, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran alizadeh.gasem@gmail.com N 0009-0008-6794-5443 Samira Raoofi Research Center for Evidence-Based Health Management, Department of Healthcare Management, Maragheh University of Medical Sciences, Maragheh, Iran samira.raoofi@gmail.com N 0000-0002-3321-6305 Shiva Khoshsirat Health Information Technology Department, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran N 0009-0008-8651-4569 Shahla Damanabi 1 Health Information Technology Department, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran damanabi46@gmail.com Y 0000-0002-2964-8682 10.18502/jebhpme.v7i4.15482 Background: Autism spectrum disorder (ASD) is a Psychopathic disorder characterized by abnormal communication and verbal behaviors. ASD is very common in children, affecting about 1 in 160 individuals, and the symptoms of this disorder appear before the age of three, and the main cause is still unknown. The effectiveness of this technology on the abilities required for people with ASD to communicate in a social setting has been the subject of several systematic and comprehensive studies.  Methods: A systematic review by searching in PubMed, EMBASE and CINAHL for publications was conducted from 1 January 2012 to 30 May 2021 involving use of virtual reality interventions on children and adolescents with autism spectrum disorder in which autism, autism spectrum disorder, ASD, virtual reality, VR keywords were utilized. Three reviewers independently investigated search results for inclusion in analysis and resolved disagreements by consensus. Results: Literature research of databases specifies a total of 808 records. According to the abstract and the full text of the studies, after applying the inclusion and exclusion criteria and eliminating duplicates and screening articles, 15 articles were selected for final review based on the PICO criteria (population, intervention, comparison and results). The studies focused on the five topics of emotion and social interaction, social communication, daily life skills, specific fears and anxieties, physical activity, and attention. Conclusion: According to reports, the findings rightly claim that the use of virtual reality technologies not only improves the social and communication skills of children with ASD, but also provides them with an engaging and enjoyable experience. Moreover, Parents indicated high satisfaction with VR applications and this technology can contain many benefits in the treatment of ASD.   Virtual Reality, Augmented Reality, Autism, Autism Spectrum Disorder http://jebhpme.ssu.ac.ir/article-1-479-en.html http://jebhpme.ssu.ac.ir/article-1-479-en.pdf