Volume 18, Issue 1 (Spring 2023)                   Salmand: Iranian Journal of Ageing 2023, 18(1): 14-31 | Back to browse issues page

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Soleimani Kebria F, Sum S, Tirgar A, Pourhadi S, Delbari A, Shati M et al . Explanation of the Structural-functional Challenges of Comprehensive Health Centers in Babol City, Iran, Based on the Guidelines of the World Health Organization’s Elderly-friendly Centers. Salmand: Iranian Journal of Ageing 2023; 18 (1) :14-31
URL: http://salmandj.uswr.ac.ir/article-1-2361-en.html
Explanation of the Structural-functional Challenges of Comprehensive Health Centers in Babol City, Iran, Based on the Guidelines of the World Health Organization’s Elderly-friendly Centers
Fatemeh Soleimani Kebria1 , Shima Sum * 2, Aram Tirgar1 , Samaneh Pourhadi1 , Ahmad Delbari3 , Mohsen Shati4 , Elaheh Sadeghi5
1- Master Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran.
2- Master Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran. , sumshima@yahoo.com
3- Research Center on Ageing, University of Social Welfare and Rehabilitation Sciences, Iran.
4- Clinical Trial Center, Iran University of Medical Sciences, Tehran, Iran.
5- Department of Health, Office of the Aged, Babol University of Medical Sciences, Babol, Iran.
Keywords: Elderly, Structural fitness, Functional fitness, Elderly friendly, Comprehensive health center
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Introduction
Elderly people need to receive excellent care services for their health problems, while the national healthcare policies are not enough to provide services to solve these problems [1]. In the meantime, as the first line of contact with health care, primary care services should be available and provided according to the needs of elderly people [2]. It is estimated that 80% of healthcare is provided in comprehensive health service centers [3], however, without knowing the basic needs of the elderly and the challenges to access health services in these centers, it is impossible to plan accurately in line with the health and social welfare of this group. Therefore, it is essential to assess the appropriateness of the way of providing services for this population group, which is one of the most vulnerable classes of society. This study aims to explain the structural and functional challenges of comprehensive health centers based on the guidelines of the World Health Organization’s (WHO) elderly-friendly centers.
Methods
The present study was a descriptive qualitative study using the content analysis method with a conventional approach. The location of the research was comprehensive health centers in Babol City, Mazandaran Province, Iran, where experts and doctors providing care to the elderly, as well as the elderly covered by all 15 urban and urban-rural centers, entered the study as the research population and participated in the study in the relevant centers during office hours. Sampling was performed in a purposive way until data saturation. A total of 23 elderly people, 5 elderly family members, 7 doctors, and 7 elderly caregivers participated in the study. The methods of data collection were quasi-structured interviews and the interviews were continued until reaching information saturation so that the development of the concept was well done and the continuation of the interview did not add any new data to the previous data. The questions asked were based on the review of the texts and documents available in the guide of elderly-friendly health centers of the WHO and the duration of the interview was between half an hour and 45 minutes.
All the interviews were recorded with the permission of the participants, and immediately after the completion of each interview, the full text of the interview along with the feelings of the participants was made available. The collection of information and the process of analysis were done alternately and in parallel. Each interview was saved in a separate file in Word and named according to the interview code. In addition to the principle of setting and constant comparison, coding was done through three stages, open coding, axial coding, and selective coding. Then, the codes were re-read to replace them in the main classes and sub-classes based on the semantic similarity, and finally, the researcher and the participants reached a shared meaning about the classes. To determine the validity of the data, the criteria of acceptability, reliability, verifiability, and transferability were used [4].
Results
The result of the analysis of the obtained data was 420 codes from the elderly and 380 codes from the staff of the centers. The obtained codes were placed in 5 classes and 12 sub-classes, which are:
Structural factors: One of the vital classes was challenges related to structural factors, which were divided into three sub-classes, construction, facilities, and equipment.
Behavioral factors: Another class was the behavioral and communication challenges that the elderly and staff were dealing with, with three sub-classes of staff/service providers (health care providers and doctors), communication/interactions and the elderly.
Educational characteristics: The third class extracted from the present study was the critical subject of education with two sub-classes for employees/service providers and for the elderly.
Social support: Emerged with three sub-classes, financial/economic, social communication, and voluntary service.
Functional challenges: The last class was identified with two crucial sub-classes, service, and motivation.
Discussion
Since primary care is the first main interface of health services for the elderly to maintain and improve their health, it is essential to evaluate the appropriateness of how to provide services for this population group. According to the guidelines of the WHO, in the toolkit used for elderly-friendly healthcare, it is necessary to have the following areas, and these dimensions are also evident in the emerging classes of this qualitative study, the structure of the health center and universal design (class of structural factors), the functional status of the system in terms of the screening protocol, information-advisory-educational system, appointment of the elderly, referral system, as well as the protocol of examinations and counseling of the elderly (classes of behavioral problems and educational characteristics) as well as how to manage community-based health care and the competence of caregivers and health managers (classes of social support and functional challenges) [5, 6]. Planning to solve the identified components may be effective in identifying, prioritizing, and choosing the type of interventions.



Ethical Considerations
Compliance with ethical guidelines
This research was approved by the Ethics Committee of Babol University of Medical Sciences (Code: MUBABOL.HRI.REC.1400.036).

Funding
The financial support of this study was carried out by the research deputy of Babol University of Medical Sciences.

Authors' contributions
All the authors participated in the design, execution, and writing of all parts of this research.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
We appreciate all the dear elderly and respected personnel who helped us in conducting this study, especially answered the interview questions with patience. In addition, we thank the efforts and cooperation of the relevant officials at Babol University of Medical Sciences, undoubtedly, this study would not have been conducted without their support.
 
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Type of Study: Research | Subject: gerontology
Received: 2021/11/29 | Accepted: 2022/03/08 | Published: 2023/03/30
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