伊朗的丙型肝炎感染：运用金登的多源流框架进行议程设置的政策分析。
The hepatitis C infection in Iran: a policy analysis of agenda-setting using Kingdon's multiple streams framework.
机构信息
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
出版信息
Health Res Policy Syst. 2019 Mar 27;17(1):30. doi: 10.1186/s12961-019-0436-z.
BACKGROUND
Hepatitis C virus (HCV) infection causes a large number of deaths annually worldwide. Policies play an important role in regulating healthcare agendas and prioritising of health-related issues. Understanding these priorities is very important in health. The objective of this study was to investigate HCV-related issues and their influence on agenda-setting in Iran.
METHODS
A qualitative design was used. Data were collected by carrying out a review of documents and interviews. A comprehensive search was conducted to identify documents related to HCV-related policies in Iran. Semi-structured interviews were conducted with both purposive and snowball sampling of 14 interviewees related to the HCV programme in Iran, including government officials, civil society, development partnership members and academicians. Documents and interview data were analysed manually and using MAXQDA Version 10 software. Kingdon's multiple streams framework was used to guide data analysis.
RESULTS
The factors which influenced HCV-related agenda-setting were lack of proper information of the HCV epidemiology before the 1990s, lack of diagnostic facilities, neighbouring countries with high HCV prevalence, the stigma of HCV, high prevalence in prisoners, international evidence and high costs generated by HCV. The factors related to policy were effective treatment methods, drug production inside Iran, Iran Hepatitis Network, support outside government group elites and academicians. The factors related to political will were international influence, changes in the government and parliament support.
CONCLUSION
The findings of this study showed that there are various national and international factors that play a role in shaping HCV-related policies. It seems that, if HCV is put into the agenda, it can be eliminated in Iran by 2030 by supporting and implementing appropriate programmes from decision- and policy-makers.
背景
丙型肝炎病毒（HCV）感染每年在全球范围内导致大量死亡。政策在调节医疗保健议程和优先考虑与健康相关的问题方面发挥着重要作用。了解这些优先事项在卫生保健中非常重要。本研究的目的是调查与 HCV 相关的问题及其对伊朗议程设置的影响。
方法
采用定性设计。通过对文件进行审查和访谈收集数据。对伊朗与 HCV 相关政策的文件进行了全面搜索。对与伊朗 HCV 方案相关的 14 名受访者进行了半结构式访谈，包括政府官员、民间社会、发展伙伴成员和学者，采用了目的抽样和滚雪球抽样。对文件和访谈数据进行了手动分析和使用 MAXQDA 版本 10 软件分析。采用金登的多流框架指导数据分析。
结果
影响 HCV 相关议程设置的因素包括：20 世纪 90 年代之前缺乏 HCV 流行病学的适当信息、缺乏诊断设施、邻国 HCV 流行率高、HCV 的耻辱感、囚犯中流行率高、国际证据和 HCV 产生的高成本。与政策相关的因素包括有效的治疗方法、伊朗国内的药物生产、伊朗肝炎网络、政府外支持团体的精英和学者。与政治意愿相关的因素包括国际影响力、政府和议会的支持变化。
结论
本研究的结果表明，有各种国家和国际因素在塑造 HCV 相关政策方面发挥作用。如果将 HCV 纳入议程，通过决策者的支持和实施适当的方案，到 2030 年，伊朗可以消灭 HCV。
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