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.
 
References
  1. Kinsella KG, Phillips DR. Global aging: The challenge of success. Washington, DC: Population Reference Bureau; 2005. [Link]
  2. Lloyd-Sherlock P. Population ageing in developed and developing regions: Implications for health policy. Social Science & Medicine. 2000; 51(6):887-95. [DOI:10.1016/S0277-9536(00)00068-X] [PMID]
  3. McNicoll G. United Nations, Department of Economic and Social Affairs: World economic and social survey 2004: International migration. Population and Development Review. 2005; 31(1):183-5. [Link]
  4. Goharinezhad S, Maleki M, Baradaran HR, Ravaghi H. A qualitative study of the current situation of elderly care in Iran: what can we do for the future? Global Health Action. 2016; 9(1):32156. [DOI:10.3402/gha.v9.32156] [PMID] [PMCID]
  5. Taraghi Z, Ilali ES. A comparison of older adults’ and managers’ attitudes towards age-Friendly City indexes. Iranian Journal of Ageing. 2018; 13(2):236-49. [DOI:10.32598/sija.13.2.236]
  6. Jacelon CS. Maintaining the balance: Older adults with chronic health problems manage life in the community. Rehabilitation Nursing. 2010; 35(1):16-22. [DOI:10.1002/j.2048-7940.2010.tb00026.x] [PMID]
  7. Alhamdan AA, Alshammari SA, Al-Amoud MM, Hameed TA, Al-Muammar MN, Bindawas SM, et al. Evaluation of health care services provided for older adults in primary health care centers and its internal environment: A step towards age-friendly health centers. Saudi Medical Journal. 2015; 36(9):1091. [DOI:10.15537/smj.2015.9.11789] [PMID] [PMCID]
  8. Samouei R, Keyvanara M. [Explaining the challenges of the Iranian health system in the face of future aging: Qualitative study (Persian)]. Salmand: Iranian Journal of Ageing 2022; 16 (4):608-23. [Link]
  9. Mirzaie M, Darabi S. Population aging in Iran and rising health care costs. Iranian Journal of Ageing. 2017; 12(2):156-69. [DOI:10.21859/sija-1202156]
  10. Hoontrakul D, Sritanyarat W, Nuntaboot K, Premgamone A. Development of age-friendly primary health care: case study of one primary care unit. Pacific Rim International Journal of Nursing Research. 2008; 12(2):131-41. [Link]
  11. de Boer AG, Wijker W, de Haes HC. Predictors of health care utilization in the chronically ill: A review of the literature. Health Policy. 1997; 42(2):101-15. [DOI:10.1016/S0168-8510(97)00062-6] [PMID]
  12. Lawton MP, Nahemow L. Ecology and the aging process. 1973. [DOI:10.1037/10044-020]
  13. WHO. Towards age-friendly primary health care. Geneva: World Health Organization; 2004. [Link]
  14. Lui CW, Everingham JA, Warburton J, Cuthill M, Bartlett H. What makes a community age-friendly: A review of international literature. Australasian Journal on Ageing. 2009; 28(3):116-21. [DOI:10.1111/j.1741-6612.2009.00355.x] [PMID]
  15. WHO. Integrated care for older people: Guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva: WHO; 2017. [Link]
  16. WHO. WHO called to return to the Declaration of Alma-Ata. Geneva: WHO; 1987. [Link]
  17. Chiou ST, Chen LK. Towards age-friendly hospitals and health services. Archives of Gerontology and Geriatrics. 2009; 49:S3-6. [DOI:10.1016/S0167-4943(09)70004-4] [PMID]
  18. Woo J, Mak B, Yeung F. Age-friendly primary health care: an assessment of current service provision for older adults in Hong Kong. Health Services Insights. 2013; 6:HSI-S12434.[DOI:10.4137/HSI.S12434] [PMID] [PMCID]
  19. Cloos P, Allen CF, Alvarado BE, Zunzunegui MV, Simeon DT, Eldemire-Shearer D. ‘Active ageing’: A qualitative study in six Caribbean countries. Ageing & Society. 2010; 30(1):79-101. [DOI:10.1017/S0144686X09990286]
  20. Farid TM, Al Jaziri AMSA, Abdelal SA, Alshaali AJ, Taryam MMO, Monsef NAK, et al. Perspective of elderly on age-friendliness of services provided in primary healthcare centers of dubai health authority: Focus groups discussions. Advances in Aging Research. 2018; 7(06):132. [DOI:10.4236/aar.2018.76011]
  21. Pretto R, Neves M, D’ávila O, Martins A, Hugo F. Are the physical structures of health units and the primary health care teams adequate to receive and provide care for the elderly. Journal of Dental Health, Oral Disorders & Therapy. 2017; 8(6):00306. [DOI:10.15406/jdhodt.2017.08.00306]
  22. Phillips DR. Ageing in the Asia-Pacific region: Issues, policies and future trends. Oxfordshire: Routledge; 2002. [DOI:10.4324/9780203463086]
  23. Gómez F, Curcio CL, Duque G. Health care for older persons in Colombia: A country profile. Journal of the American Geriatrics Society. 2009; 57(9):1692-6. [DOI:10.1111/j.1532-5415.2009.02341.x] [PMID]
  24. Akanji BO, Ogunniyi A, Baiyewu O. Healthcare for older persons, a country profile: Nigeria. Journal of the American Geriatrics Society. 2002; 50(7):1289-92. [DOI:10.1046/j.1532-5415.2002.50319.x] [PMID]
  25. Ruza J, Kim JI, Leung I, Kam C, Ng SYM. Sustainable, age-friendly cities: An evaluation framework and case study application on Palo Alto, California. Sustainable Cities and Society. 2015; 14:390-6. [DOI:10.1016/j.scs.2014.05.013]
  26. WHO. Age-friendly PHC centres toolkit. Geneva: World Health Organization; 2008. [Link]
  27. Mayring P. Qualitative content analysis. A companion to Qualitative Research. 2004; 1(2):159-76. [Link]
  28. Adib Haj Bagheri M, Parvizi S, Salsali M. [Qualitative research methods (Persian)]. Tehran: Boshra Publications; 2011.
  29. Richardson A, Potter J, Paterson M, Harding T, Tyler-Merrick G, Kirk R, et al. Office design and health: A systematic review. New Zealand Medical Journal. 2017; 130(1467):39. [Link]
  30. Rahmanpour MS, Tirgar A, Ebadi A, Sum S, Nikpour M. Determining the components of the structural characteristics assessment tool for the age-friendly hospitals. Journal of Gerontology. 2019; 4(2):1-0. [DOI:10.29252/joge.4.1.1]
  1. Alizadeh M, Fakhrzadeh H, Sharifi F, Zanjari N, Ghassemi S. Comparative study of physical and mental health status of old people in aged groups of 60-64 and 65-69 years old in Tehran metropolitan area. Iranian Journal of Diabetes and Metabolism. 2014; 13(1):50-61. [Link]
  2. Safi MH, Fereydounfar AA, Arshi S. Quality of primary health Services in the Clinics of Shomal health Center of Tehran. Community Health. 2014; 1(1):54-61. [Link]
  3. Motaghed Z, Monfared ED, Torabi SM, Mousavi A, Eshraghi R, Nemati I, et al. Assessment of quality of services in health centers from the perspective of clients by SERVQUAL method. Health Research. 2016; 2(1):49-55. [DOI:10.18869/acadpub.hrjbaq.2.1.49]
  4. Cameron K, Morris A. Creating a senior-friendly pharmacy. The Consultant Pharmacist. 2008; 23(12):962-75. [DOI:10.4140/TCP.n.2008.962] [PMID]
  5. Bayati A. [Reviewing patients satisfaction of provided services for them hospitals subsidiary to the Arak Medical Sciences University (Persian)]. Journal of Arak University of Medical Sciences. 2000; 3(4):6-11. [Link]
  6. Rezaie R, Hosseini SJ, Valaie N. [Communication skills of doctors and their attitudes in Shiraz (Persian)]. KAUMS Journal (FEYZ). 2001; 4(4):19-26. [Link]
  7. World Health Organization (WHO). WHO medicines strategy: Framework for action in essential drugs and medicines policy 2000-2003. Geneva: WHO; 2000. [Link]
  8. Delshad Noghabi A, Darabi F, Baloochi Beydokhti T, Shareinia H, Radmanesh R. Irrational use of medicine status in elderly population of Gonabad. Quarterly of the Horizon of Medical Sciences. 2014; 19(5):297-304. [Link]
  9. Eftekhari Gol R, Mousa Farkhani E, Yousefi B. [Assessment of drug prescriptions based on WHO indicators in Family Physician Program in Razavi Khorasan Province, Iran (Persian)]. Journal of Mashhad Medical Council. 2015; 19(1):6-10. [Link]
  10. Kennedy J. Herb and supplement use in the US adult population. Clinical Therapeutics. 2005; 27(11):1847-58.[DOI:10.1016/j.clinthera.2005.11.004] [PMID]
  11. Arcury TA, Grzywacz JG, Bell RA, Neiberg RH, Lang W, Quandt SA. Herbal remedy use as health self-management among older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2007; 62(2):S142-S9. [DOI:10.1093/geronb/62.2.S142] [PMID]
  12. Aghabagheri H, Mohaghar A, Kazemi A, Mahmoodabad SS. Patients Satisfaction from the appointment schedule; A case study in Shahid Sadoughi Specialized Clinic in Yazd. The Journal of Tolooebehdasht. 2020; 19(1):48-57. [DOI:10.18502/tbj.v19i1.2816]
  13. Reed J, Clarke CL. Nursing older people: Constructing need and care. Nursing Inquiry. 1999; 6(3):208-15. [DOI:10.1046/j.1440-1800.1999.00033.x] [PMID]
  14. Hughes M, Heycox K. Promoting reflective practice with older people: Learning and teaching strategies. Australian Social Work. 2005; 58(4):344-56. [DOI:10.1111/j.1447-0748.2005.00231.x]
  1. Hughes LC, Hodgson NA, Muller P, Robinson LA, McCorkle R. Information needs of elderly postsurgical cancer patients during the transition from hospital to home. Journal of Nursing Scholarship. 2000; 32(1):25-30. [DOI:10.1111/j.1547-5069.2000.00025.x] [PMID]
  2. Hosseini J. Programs of continuing medical education programs of community health needs. Journal of Research in Medical Sciences. 1998; 1(3):39-43. [Link]
  3. Anbari Z. [Study the factors of establishing motivation in general physicians in order to enter into continuous education programs in Arak University of Medical Sciences in 2002 (Persian)]. Journal of Arak University of Medical Sciences. 2002; 5(2):20-3. [Link]
  4. Lang AJ, Stein MB. Anxiety disorders. How to recognize and treat the medical symptoms of emotional illness. Geriatrics (Basel, Switzerland). 2001; 56(5):24-7. [Link]
  5. Miller CA. Nursing for wellness in older adults. Philadelphia: Lippincott Williams & Wilkins; 2009. [Link]
  6. Gallagher LP, Truglio-Londrigan M. Community support: Older adults’ perceptions. Clinical Nursing Research. 2004; 13(1):3-23. [DOI:10.1177/1054773803259466] [PMID]
  7. Kwong EWY, Kwan AYH. Stress-management methods of the community-dwelling elderly in Hong Kong: Implications for tailoring a stress-reduction program. Geriatric Nursing. 2004; 25(2):102-6. [DOI:10.1016/j.gerinurse.2004.02.007] [PMID]
  8. Seyfzadeh A, Haghighatian M, Mohajerani A. Perceived social support and social isolation in the older adults. Depiction of Health. 2019; 10(4):300-9. [Link]
  9. Hosseini Ramaghani N, Mir Drikvand F, Panahi H. The role of communication skills, social support and daily spiritual experiences in predicting loneliness feeling of the elderly. Journal of Gerontology. 2017; 1(4):47-57. [DOI:10.18869/acadpub.joge.1.4.47]
  10. Hosseini A, Majdi AA, Esmaili AA. [The role of social support in the general health of the elderly (Persian)]. Journal of Health System Research. 2017; 13(1):52-7. [Link]
  11. Asefzadeh SA, Rezapour AZ, Shabani GH, Sarchami R. [Assessing the information management from the health houses to the health centers of Qazvin Province (2008) (Persian)]. Journal of Inflammatory Diseases. 2011; 14(4):57-63. [Link]
  12. Khayati FA, Saberi MH. [Primary Health Care (PHC) an ever strategy for health equity extension (Persian)]. Journal of Health Administration. 2009; 12(35):33-40. [Link]
  13. Macinko J, Almeida C, De Sá PK. A rapid assessment methodology for the evaluation of primary care organization and performance in Brazil. Health Policy and Planning. 2007; 22(3):167-77. [DOI:10.1093/heapol/czm008] [PMID]
  14. Holtz C. Global health care: Issues and policies. Burlington: Jones & Bartlett Publishers; 2013. [Link]
  15. Dehdari T, Delvarianzadeh M, Ariaeean N, Khosravi F, Bahar A. [Nutritional status and its related factors in older people residing in nursing homes in Semnan province, Iran, 2017 (Persian)]. Iranian Journal of Ageing. 2019; 14(2):224-35. [Link]
  1. Borhaninejad V, NaghibzadehTahami A, Nabavi H, Rashedi V, Yazdi-Feyzabadi V. The utilization of health services and its influences among elderly people in Kerman. Repository of Research and Investigative Information. 2015; 7(2):229-40. [DOI:10.29252/jnkums.7.2.229]
  2. Gholami M, Nasiripoor AA, Maleki MR. The relation between social determinant of health with access to health services in Gonbad Kavoos. 2016. [Link]
  3. Tajik F, Ferdosi M, Rejaliyan F. Determining the socio-economic inequalities in health services utilization among Ischemic Heart Disease patients; case of Falavarjan city. Health Research. 2016; 2(1):9-16. [DOI:10.18869/acadpub.hrjbaq.2.1.9]
  4. Tajvar M, Mosadeghrad A, Yaseri M, Mohammadi M. [Utilization of inpatient services by older people in Iran and its determinants (Persian)]. Journal of School of Public Health and Institute of Public Health Research. 2020; 17(4):337-50. [Link]
  5. Hasanvand S, Imani-Nasab MH, Birjandi M, Omidifar R, Sadegifar J. [Utilization of health services among the elderly at Lorestan province: a cross-sectional study (Persian)]. Yafteh. 2019; 21(3):48-65. [Link]
  6. Bahadori M, Raadabadi M, Teymourzadeh E, Yaghoubi M. Confirmatory factor analysis of the herzberg job motivation model for workers in the military health organizations of Iran. Journal of Military Medicine. 2015; 17(2):65-71. [Link]
  7. Dugani S, Afari H, Hirschhorn LR, Ratcliffe H, Veillard J, Martin G, et al. Prevalence and factors associated with burnout among frontline primary health care providers in low-and middle-income countries: A systematic review. Gates Open Research. 2018; 2. [DOI:10.12688/gatesopenres.12779.3] [PMCID]

 
Type of Study: Research | Subject: gerontology
Received: 2021/11/29 | Accepted: 2022/03/08 | Published: 2023/03/30
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