Designing Iranian Model to Assess the Level of Health System Responsiveness

Abstract

Background: Given the rapid pace of changes in community health needs and the mission of healthcare organizations to provide and promote the community's health, the growing need to increase health system responsiveness to people as a key element of observance and fulfillment of justice is felt more than ever. Objectives: This study was aimed at designing the native model of responsiveness for Iran and to validate the aspects of the proposed model. Materials and Methods: Our study had a cross-sectional design and was a validation study performed in 2014. In order to define and identify responsiveness model aspects, the first phase recorded the views of 200 key informants from 19 provinces of Iran. Snowball sampling was used to select experts (based on WHO guideline). Then, the opinions of 18 comments were received from service recipients in the form of three focus group discussions and were analyzed by the frame framework analysis (interviewed recipients were selected using the purposive sampling method). Finally, in order to confirm the model's efficacy, a responsiveness questionnaire with 7 aspects (domains) and 52 indicators (items) obtained from the initial proposed model was answered by 600 members of the selected families in the two provinces of Fars and Yazd. A multi-stage cluster sampling approach was used for the household survey. The results were analyzed by the Confirmatory Factor Analysis (CFA) test and through the use of Lisrel software. Results: Confirmatory Factor Analysis, based on the results of the key informant survey and group discussions, showed that according to quantities of GFI = 0.91, CFI = 0.93, NFI = 0.91, RMSEA = 0.074, SRMR = 0.061 and Hoelter (CN) = 178.54 in outpatient services and where GFI = 0.89, CFI = 0.91, NFI = 0.86, RMSEA = 0.064, SRMR = 0.053 and Hoelter (CN) = 158.93 for inpatient services, seven factors (F) (dignity, informed choice, confidentiality, patient training and informing, access to services, quality of basic amenities, and access to social support) are the main determinants of the responsiveness model and proposed model validity. Conclusions: Given the comprehensiveness of presented aspects and indicators in this proposed model and its validity test, the aforementioned responsiveness model can be considered a suitable model to use when assessing the levels of health system responsiveness in Iran.

Assessing Trend of Health System Responsiveness in Iran Using Household Survey (Before and After the Implementation of Health Transformation Plan)

“…Communication, quality of basic amenities, and prompt attention received the highest scores and autonomy received a lower score in terms of their importance. These findings have been repeated in several previous studies in Iran (4,(12)(13)(14). It means that service recipients kept their preferences about the importance of responsiveness domains.…”

“…Studies in South Africa and Iran showed different clustering patterns of responsiveness (12,21). For example, "autonomy" in these studies was not conceptualized as a unique domain.…”

What is health systems responsiveness? Review of existing knowledge and proposed conceptual framework

“…Subsequent studies have shown general agreement with the WHO elements, 35–38 though many proposed adaptations, for example additions of effective care, attention, access to care, 39 trust and coordination 34 and specified it for HIV or mental health. 40–42 Associations were also found between levels of reported responsiveness and type of health facility 37 43 or socioeconomic characteristics of patients, such as poverty, educational level and age, 23 40 42 44–46 echoing an argument that acceptability and trust barriers are disproportionately faced by socially disadvantaged groups.…”

Health system responsiveness: a systematic evidence mapping review of the global literature

“…Across items in this category, the WHO responsiveness tool has been validated and adaptations suggested – such as the addition of domains for education and information sharing [ 3 , 36 ], effective care [ 73 , 74 ], trust [ 73 , 75 ], coordination and responsibility [ 62 ]. Several authors have argued that the WHO’s conceptualization and tools have inherent inadequacies [ 69 , 76 , 77 ].…”