Department of Public Health, Sirjan School of Medical Sciences, Sirjan, Iran.
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
BMC Public Health. 2022 Jun 8;22(1):1149. doi: 10.1186/s12889-022-13571-5.
Social determinants have a significant impact on children's development and their abilities and capacities, especially in early childhood. They can bring about inequity in living conditions of children and, as a result, lead to differences in various dimensions of development including the social, psychological, cognitive and emotional aspects. We aimed to identify and analyze the social determinants of Early Childhood Development (ECD) in Iran and provide policy implications to improve this social context.
In a qualitative study, data were collected through semi-structured interviews with 40 experts from October 2017 to June 2018. Based on Leichter's (1979) framework and using the deductive approach, two independent researchers conducted the data analysis. We used MAXQDA.11 software for data management.
We identified challenges related to ECD context in the form of 8 themes and 22 subthemes in 4 analytical categories relevant to the social determinants of ECD including: Structural factors (economic factors: 6 subthemes, political factors: 2 subthemes), Socio-cultural factors (the socio-cultural setting of society: 6 subthemes, the socio-cultural setting of family: 4 subthemes), Environmental or International factors (the role of international organizations: 1 subtheme, political sanctions: 1 subtheme), and Situational factors (genetic factors: 1 subtheme, the phenomenon of air pollution: 1 subtheme). We could identify 24 policy recommendations to improve the existing ECD context from the interviews and literature.
With regard to the challenges related to the social determinants of ECD, such as increasing social harms, decreasing social capital, lack of public awareness, increasing socio-economic inequities, economic instability, which can lead to the abuse and neglect of children or unfair differences in their growth and development, the following policy-making options are proposed: focusing on equity from early years in policies and programs, creating integration between policies and programs from different sectors, prioritizing children in the welfare umbrella, empowering families, raising community awareness, and expanding services and support for families, specially the deprived families subject to special subsidies.
社会决定因素对儿童的发展及其能力有重大影响，尤其是在儿童早期。它们会导致儿童生活条件的不平等，进而导致发展的各个方面出现差异，包括社会、心理、认知和情感方面。我们旨在确定并分析伊朗幼儿发展的社会决定因素，并提出改善这一社会环境的政策建议。
在一项定性研究中，我们于 2017 年 10 月至 2018 年 6 月期间通过与 40 名专家进行半结构化访谈收集数据。基于 Leichter（1979）的框架并采用演绎方法，由两名独立研究人员进行数据分析。我们使用 MAXQDA.11 软件进行数据管理。
我们确定了与 ECD 背景相关的挑战，形式为 8 个主题和 22 个子主题，分为 4 个与 ECD 的社会决定因素相关的分析类别，包括：结构因素（经济因素：6 个子主题，政治因素：2 个子主题）、社会文化因素（社会的社会文化背景：6 个子主题，家庭的社会文化背景：4 个子主题）、环境或国际因素（国际组织的作用：1 个子主题，政治制裁：1 个子主题）和情境因素（遗传因素：1 个子主题，空气污染现象：1 个子主题）。我们可以从访谈和文献中确定 24 项改善现有 ECD 背景的政策建议。
鉴于与 ECD 的社会决定因素相关的挑战，例如社会危害增加、社会资本减少、公众意识薄弱、社会经济不平等加剧、经济不稳定，这些因素可能导致儿童受到虐待和忽视，或在其成长和发展方面出现不公平的差异，我们提出了以下决策选项：在政策和方案中从幼儿时期开始关注公平，在不同部门的政策和方案之间建立整合，将儿童置于福利保护伞的优先地位，增强家庭能力，提高社区意识，并扩大对家庭，特别是接受特别补贴的贫困家庭的服务和支持。
