بررسی نقاط ضعف و چالش‌های برنامه‌های ارتقای سلامت اجتماع محور در سه دهه‌ی اخیر: راهکارهایی برای آینده

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار، گروه بهداشت عمومی، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی شهید بهشتی،‏ تهران، ایران

2 کارشناس ارشد، مرکز توسعه، هماهنگی و ارزیابی تحقیقات، معاونت تحقیقات و فناوری، وزارت بهداشت، درمان و آموزش پزشکی، تهران، ایران

3 کارشناس ارشد، بازنشسته وزارت بهداشت، درمان و آموزش پزشکی، تهران، ایران

چکیده

مقدمه: ابتکارات اجتماع محور شامل مداخلات ارتقای سلامت اجتماع محور، در ایران بیش از سه دهه سابقه دارند. هر چند‏ به دلیل انتشار ناکافی گزارش‌ها، اطلاعات محدودی از تجزیه و تحلیل این مداخلات در دسترس محققین و تصمیم‌گیران در سطح ملی و بین‌المللی قرار دارد. این مقاله به گزارش بخشی از یافته‌های یک مطالعه وضعیت‌سنجی بر روی مداخلات ارتقای سلامت اجتماع محور در ایران می‌پردازد که به سفارش دفتر سازمان جهانی بهداشت در ایران انجام گردید.روش‌ها: روش‌های متفاوتی برای جمع‌آوری داده‌ها مانند استفاده از گزارش‌ها،‏ کتب، منابع الکترونیک و تارنمای رسمی سازمان‌‌ها به کار گرفته شد. داده‌ها با روش‌های کیفی، مورد تجزیه و تحلیل قرار گرفت تا نقاط ضعف،  قوت، تهدید‌ها و فرصت‌های موجود شناسایی شود.یافته‌ها: صد‌ها نوع برنامه‌ی ارتقای سلامت اجتماع محور شناسایی شد که در 10 طبقه‌ی بزرگ گروه‌بندی گردیدند. انتشار ناچیز اطلاعات مرتبط با تجارب این مداخلات، ارتباط ضعیف بین دانشگاه و سازمان ‌های مجری این برنامه‌ها، فقدان ارزشیابی کافی این مداخلات، ایجاد توقعات غیر واقعی در اجتماع و محدودیت منابع، از جمله ضعف‌ها و تهدید‌های شناسایی شده بودند. حمایت سازمانی و سیاسی قوی و ایجاد ساختار‌های فیزیکی، از جمله نقاط قوت و فرصت‌های این برنامه‌ها بودند.نتیجه‌گیری: مداخلات ارتقای سلامت اجتماع محور در آینده باید مبنای علمی قوی‌تری داشته باشد و از مشارکت مؤثرتر اعضای اجتماع سود ببرند. همچنین باید به اشتراک گذاشتن تجارب موجود مورد توجه جدی قرار گیرد.

کلیدواژه‌ها

عنوان مقاله [English]

Exploring Challenges and Weaknesses of Community-Based Health Promotion Programs in Past Three Decades in Iran: The Way Forward

نویسندگان [English]

  • Nastaran Keshavarz-Mohammadi 1
  • Farah-Sadat Bahraini 2
  • Safoora Degpasand 3
1 Assistant Professor, Department of Public Health, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Center of Research Development, Coordination and Evaluation, Office of Undersecretary for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
3 Retired, Ministry of Health and Medical Education, Tehran, Iran
چکیده [English]

Background: Community-based initiatives including community-based health promotion (CBHP) programs have more than three decades of history in Iran. However, due to inadequate dissemination of the reports of such interventions, there is limited information or analysis of them accessible easily for health researchers and decision-makers at national or international level. This study, partially reported here, aimed to perform a situation analysis of community-based health promotion programs and interventions in Iran commissioned by WHO office in Tehran.Methods: Different data collection strategies were utilized to collect the relevant published and unpublished data such as the reports, papers, books and also electronic data available on the website of the funding organizations. Data were analyzed using qualitative analysis techniques such as thematic analysis to provide answer for research questions. ‏‏‏A SWOT (strengths, weaknesses, opportunities, and threats) analysis conducted to identify the overall situation of community-based health promotion programs in Iran.Findings: There were hundreds of different types of community-based health promotion programs in different communities across the country which the researcher categorized them in 10 major groups. Little dissemination of the information regarding the process and the outcome of the programs, weak link between academia and the programs, and the lack of adequate evaluation of the majority of the programs, and also limited resources ad creation of unrealistic expectation of country participants were among the identified weaknesses and threats of community-based health promotion programs in Iran; while the strong organizational and political supports and developed structures due to these programs were identified to be among strengths and opportunities.Conclusion: Future community-based health promotion programs in Iran should benefit from a stronger scientific base and more effective participation of community members. Sharing the existing experiences should be paid attention.

کلیدواژه‌ها [English]

  • Community-based
  • Health Promotion
  • Interventions

مراجع

  1. Laverack G. Health Promotion Practice: Building Empowered Communities: Building Empowered Communities. New York, NY: McGraw-Hill International; 2007.
  2. Keshavarz Mohammadi N, Bahraini F, Degpasand S. Situation assessment of community based health promotion programs in Iran. Tehran, Iran: WHO/EMRO; 2009.
  3. Iranian health houses open the door to primary care. Bull World Health Organ 2008; 86(8): 585-6.
  4. Ansarifar M. Several years report of qualified volunteers. Shiraz, Iran: Arista Publishing Co; 2009.
  5. Asaei E. Iran’s excellent primary health care in Iran [Online]. [cited 2009]; Available from: http://www.unicef.org/iran/media_4427.html/ [In Persian].
  6. Hoodfar H (1998).Volunteer health workers in Iran as social activists: Can "governmental non-governmental organizations be agents of democratisation? [Online]. [cited 1998]; Available from: URL: http://www.worldvolunteerweb.org/fileadmin/docdb/pdf/2006/1998_wluml.pdf/
  7. Ghaffari M, Sholayeh B, Salimi Z. Programs and achievements of community based initiatives in Iran. Tehran, Iran: Nour Danesh Publication; 2009.
  8. WHO. Community Based Initiatives & Health for Sustainable Development [Online]. [cited 2008]; Available from: URL: http://whoiran.com/CBI_activities_Farsi.htm/
  9. Asadi-Lari M, Farshad AA, Assaei SE, Vaez Mahdavi MR, Akbari ME, Ameri A, et al. Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience. Public Health 2005; 119(6): 474-82.
  10. Majdzadeh R, Setareh Forouzan A, Pourmalek F, Malekafzal H. Community-Based Participatory Research; an approach to Deal with Social Determinants of Health. Iranian J Publ Health 2009; 38(1): 50-3.
  11. Bahreini F, Jamshidi E, Shahandeh K. Participatory community based research: the review of an experience in Iran. Tehran, Iran: Ministry of Health and Medical Education, Deputy of Research Publications; 2008. [In Persian].
  12. United Nations Information Centre. Establishment of Drug abuse prevention NGOs [Online]. [cited 2010 Jan 12]; Available from: URL: http://www.unic-ir.org/pr/farsi/142011.html/.
  13. Congress 60. A Revolution in drug treatment and recovery [Online]. [cited 2003]; Available from: http://www.congress60.org/EnUS/
  14. Drug Prevention Committee. Drug abuse prevention [Online]. [cited 2002]; Available from: URL: http://www.dchq.ir/
  15. The General Bureau Welfare of Iran. Guidelines for establishment of social health centers [Online]. [cited 2008]; Available from: URL: http://www.behzisti-fars.ir/portal/show.aspx?page=17449/
  16. Drug Prevention Committee. Establishment of 160 social health centers [Online]. [cited 2009]; Available from: URL: http://www.dchq.ir/html/modules.php?op=modload&name=News&file=article&sid=8777&mode=thread&order=0&thold=0/
  17. Amiri M, Emami S, Nabipour I, Nosraty A, Iranpour D, Soltanian A, et al. Risk factors of cardiovascular diseases in Bushehr Port on the basis of The WHO MONICA Project The Persian Gulf Healthy Heart Project. Iran South Med J 2004; 6(2): 151-61. [In Persian].
  18. Abadipour F, Abadipour M, Abadi H, Ayatinejad Kh, Ehteshmi F, Isfahani Sh, et al. Effects of a community-based healthy heart program on increasing healthy women's physical activity: a randomized controlled trial guided by Community-based Participatory Research (CBPR). Iran South Med J 2006; 9(2): 190-9. [In Persian].
  19. Isfahan Heart Research Center. Isfahan healthy heart program [Online]. [cited 1999]; Available from: URL: http://ihhp.mui.ac.ir/ihhp/display.aspx?id=1573&language=Farsi/ [In Persian].
  20. Sarraf-Zadegan N, Sadri G, Malek AH, Baghaei M, Mohammadi FN, Shahrokhi S, et al. Isfahan Healthy Heart Programme: a comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience. Acta Cardiol 2003; 58(4): 309-20.
  21. Sarrafzadegan N, Baghaei A, Sadri G, Kelishadi R, Malekafzali H, Boshtam M, et al. Isfahan healthy heart program: Evaluation of comprehensive, community-based interventions for non-communicable disease prevention. Prevention and Control 2006; 2(2): 73-84.
  22. Salamati P, Abolhassani F, Shariati B, Kamali M. Alehossein SM. Home based training: main strategy of community based rehabilitation in Iran. Pak J Med Sci 2009; 25(3): 462-7.
  23. Masoudi Alavi N, Ghofranipour F, Larijani B, Ahmadi F, Rajab A, Babaei Gh. Evaluation of effectiveness of community based interventions on controlling diabetes mellitus in Tehran, 2003. Iran J Diabetes Lipid Disord 2004; 3(2): 185-93. [In Persian].
  24. Norouzi K, Abedi HA, Maddah Sadat SB, Mohammadi E, Babaee Gh. Development of a Community- based Care System Model for Senior Citizens in Tehran. Internet Journal of Advanced Nursing Practice 2006; 8(1): 2.
  25. Minaee M. Measures of Ministry of Health for reduction of nutritional poverty in disadvantaged families [Report]. Tehran, Iran: Department of Health Office of Community Nutrition, Ministry of Health and Medical Education; 2009.
  26. Malekafzali H, Abdollahi Z, Mafi A, Naghavi M. Community-based nutritional intervention for reducing malnutrition among children under 5 years of age in the Islamic Republic of Iran. East Mediterr Health J 2000; 6(2-3): 238-45.
  27. National Welfare Organization. Community based rehabilitation [Online]. [cited 2009]; Available from: URL: http://blog.behzistitehran.org.ir/
  28. Mohaggeg Moeen MH. Community based empowerment [Online]. [cited 2005]; Available from: URL: http://www.moein.net/viewblog.asp?bid=174
  29. Vice Chancellor for Education. Curriculum for PhD degree of Health education and promotion [Online]. [cited 2010]; Available from: URL: http://education-old.tums.ac.ir/content/?contentID=131/ [In Persian].
  30. Laverack G, Keshavarz MN. What remains for the future: strengthening community actions to become an integral part of health promotion practice. Health Promot Int 2011; 26(Suppl 2): ii258-ii262.
مجله دانشکده پزشکی اصفهان
دوره 31، شماره 261 - شماره پیاپی 261
آذر و دی 1392
صفحه 1855-1864

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سابقه مقاله

  • تاریخ دریافت: 19 اسفند 1391
  • تاریخ بازنگری: 04 اردیبهشت 1403
  • تاریخ پذیرش: 17 فروردین 1401

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