Alavi Manijeh, Khodaie Ardakani Mohammad Reza, Moradi-Lakeh Maziar, Sajjadi Homeira, Shati Mohsen, Noroozi Mehdi, Forouzan Ameneh Setareh
Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Research and Technology Department, Ministry of Health and Medical Education, Tehran, Iran.
Front Public Health. 2018 Nov 14;6:317. doi: 10.3389/fpubh.2018.00317. eCollection 2018.
Responsiveness as a non-medical, non-financial goal of the health system is of special importance to people with physical disability. The current study assessed the experiences of people with physical disabilities when they encounter rehabilitation centers in Tehran. This cross-sectional study was conducted in Tehran, the capital of Iran. The sample consisted of 610 people with physical disabilities referred to 10 comprehensive rehabilitation centers (CRCs) selected by Quota sampling. Data were collected by a standard responsiveness questionnaire proposed by the World Health Organization (WHO) and were analyzed by a standard protocol. Blinder-Oaxaca analysis was done to explain the inequality in performance of public and private sectors. Study participants included 298 (48.7%) women and 312 (51.3%) men. The mean age of the respondents was 46.3 ( = 14.3) for women and 45.6 ( = 15.4) for men. Prompt attention (33.3%) and confidentiality (1.3%) were the most and least important reported domains, respectively. Overall poor responsiveness was reported by 20.9% of respondents. Private rehabilitation centers showed significantly better performance in communication, basic amenities and autonomy compared to public centers ( ≤ 0.05). Perceived social class explained 76% of the inequality in autonomy in the private and public sector ( ≤ 0.05). Improving overall responsiveness in domains that are of high importance from the respondents' viewpoint but are performing poorly-areas such as prompt attention and basic amenities-is essential. Additionally, interventions are needed to improve the performance of the public centers and providers in the areas of participation of service users in all social classes in their rehabilitation decisions and procedures, clear communication, and basic amenities.
作为卫生系统的一个非医学、非财务目标，响应性对身体残疾者尤为重要。本研究评估了身体残疾者在德黑兰遇到康复中心时的经历。这项横断面研究在伊朗首都德黑兰进行。样本包括通过配额抽样选取的10家综合康复中心转介的610名身体残疾者。数据通过世界卫生组织（WHO）提出的标准响应性问卷收集，并按照标准方案进行分析。采用布林德 - 奥瓦卡分析来解释公共部门和私营部门在绩效方面的不平等。研究参与者包括298名（48.7%）女性和312名（51.3%）男性。女性受访者的平均年龄为46.3岁（标准差 = 14.3），男性为45.6岁（标准差 = 15.4）。及时关注（33.3%）和保密性（1.3%）分别是报告中最重要和最不重要的领域。20.9%的受访者报告整体响应性较差。与公共中心相比，私营康复中心在沟通、基本设施和自主性方面表现明显更好（P≤0.05）。感知到的社会阶层解释了私营部门和公共部门在自主性方面76%的不平等（P≤0.05）。从受访者的角度来看，在那些重要性高但表现不佳的领域，如及时关注和基本设施方面，提高整体响应性至关重要。此外，需要采取干预措施来提高公共中心和服务提供者在服务使用者参与其康复决策和程序的所有社会阶层、清晰沟通以及基本设施等方面的表现。
