Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, Iran.
Menzies Centre for Health Policy, School of Public Health, Sydney Medical School, the University of Sydney, Sydney, Australia.
BMC Public Health. 2015 Apr 9;15:335. doi: 10.1186/s12889-015-1698-1.
Health impact assessments (HIA) of policies and projects are conducted differently in different contexts although there has been less HIA research to date in non-western countries. Global HIA research has however suggested that the technical conduct of HIAs is tied to broader conditions and influences to do with decision making and policy development. This study was conducted to develop a conceptual framework for progressing HIA in Iran including all factors influencing HIA planning and practice.
A comprehensive review of the international HIA literature identified core characteristics and principles. Then key informant interviews (n = 14) identified Iranian perspectives about factors influencing HIAs practice. These two stages resulted in a conceptual framework for HIA planning and practice including influencing factors and HIA content that was confirmed by our participants using e-Delphi technique.
91 HIA characteristics were organized into 20 categories. The interviews showed that four core concepts i.e. context, actors, HIA principles and policies and HIA capacities influence HIA practice in Iran. Comprehensive content of HIA considering all health dimensions and health determinants, assessing health inequalities, appropriate HIA type, quantification and participation is formed under influence of the above mentioned four factors. The study also demonstrated need to redefine the HIA principles and make decision about integration of HIA in Environmental Impact Assessment and also about the level of HIA before implementing HIA. The e-Delphi resulted in expert consensus on the variables, concepts, and their relations in proposed framework.
Progressing HIA practice in Iran is perceived locally as subject to similar contextual conditions to those identified in the international literature. Further we have demonstrated the utility of mixed methods to progress HIA implementation in differing country contexts.
尽管迄今为止在非西方国家进行的健康影响评估（HIA）研究较少，但不同背景下的政策和项目 HIA 开展方式却大不相同。然而，全球 HIA 研究表明，HIA 的技术实施与更广泛的条件和影响有关，这些条件和影响与决策和政策制定有关。本研究旨在为伊朗的 HIA 推进制定一个概念框架，其中包括影响 HIA 规划和实践的所有因素。
对国际 HIA 文献进行全面审查，确定了核心特征和原则。然后，通过关键知情人访谈（n=14）确定了伊朗人对影响 HIA 实践因素的看法。这两个阶段产生了一个 HIA 规划和实践的概念框架，其中包括影响因素和 HIA 内容，我们的参与者使用电子德尔菲技术对其进行了确认。
91 个 HIA 特征被组织成 20 个类别。访谈表明，伊朗的 HIA 实践受到四个核心概念的影响，即背景、参与者、HIA 原则和政策以及 HIA 能力。全面考虑所有健康维度和健康决定因素、评估健康不平等、适当的 HIA 类型、量化和参与的 HIA 内容是在上述四个因素的影响下形成的。研究还表明，需要重新定义 HIA 原则，并决定将 HIA 纳入环境影响评估以及在实施 HIA 之前的 HIA 级别。电子德尔菲技术在拟议框架中就变量、概念及其关系达成了专家共识。
在伊朗，推进 HIA 实践被认为受到与国际文献中确定的类似背景条件的影响。此外，我们还展示了混合方法在不同国家背景下推进 HIA 实施的实用性。
