Social Determinants of Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.
Department of Health Education and Health Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
BMC Med Educ. 2022 Oct 27;22(1):743. doi: 10.1186/s12909-022-03807-8.
Health education is considered the most important component of primary health care. Paying attention to organizational factors can help to improve the quality of health education. Therefore, the present study was conducted to explain organizational factors affecting health education among health care providers.
This is a qualitative, descriptive, and phenomenological study that was conducted between 2020 -2022 on 50 health care workers who had been selected by purposeful sampling method in different settings including hospitals, GP office, behavioral disease counseling center, universities, and comprehensive health centers in the south and the center region of Iran. Data were collected by in-depth, semi-structured, and individual interviews, as well as focus group discussion, and continued until data saturation. Data were analyzed by MAXQDA software using qualitative content analysis in three stages: preparation, organization, and reporting. To evaluate the scientific accuracy of the findings in this study, 4 criteria of Lincoln & Guba were used.
The results revealed that every practice and policy in a health care organization from assessing needs, setting goals, planning activities, implementations and measurement outcome could affect health education practice and subsequently the health of population; nevertheless, the crucial role of health education practice is being neglected in health organizations. Organizational factors affecting health education were classified into three categories of planning, organizing, and also monitoring and evaluating. The category of planning had three subcategories of infrastructure planning, manpower planning, and design and planning for implementation of health education programs. The categories of organizing had two subcategories of coordination between different units of the Minister of Health and coordination between the health sector and other sectors of society. The categories of monitoring and evaluation had three subcategories of proper feedback, bureaucracy system, reward or reinforcement, failure to define health education as part of the job description, and the impact of electronic health records on the quality of evaluation.
The results offer expertise and preliminary tools to help with evidence-based health education program planning and evaluation. The Support of managers, like providing manpower in accordance with the target population and infrastructure, can improve health education in the health system. In addition, intra- and inter-sectoral coordination at different levels of the health system to implement tailored programs according to the needs of clients by health education professionals, and the use of health education theories seem necessary. It is also recommended to review the monitoring system with appropriate feedback, define health education as a healthy activity, and develop appropriate criteria for better implementation of health education.
健康教育被认为是初级卫生保健的最重要组成部分。关注组织因素有助于提高健康教育的质量。因此，本研究旨在解释影响卫生保健提供者健康教育的组织因素。
这是一项定性、描述性和现象学研究，于 2020 年至 2022 年在伊朗南部和中心地区的不同环境中，通过目的抽样法选择了 50 名卫生保健工作者进行，包括医院、全科医生办公室、行为疾病咨询中心、大学和综合保健中心。数据收集采用深度、半结构化和个人访谈以及焦点小组讨论的方式进行，并持续到数据饱和。使用 MAXQDA 软件对数据进行分析，采用定性内容分析的三个阶段：准备、组织和报告。为了评估本研究中发现的科学准确性，使用了林肯和古巴的 4 个标准。
结果表明，医疗保健组织中的每一项实践和政策，从评估需求、设定目标、规划活动、实施和测量结果，都可能影响健康教育实践，进而影响人口健康；然而，在卫生组织中，健康教育实践的关键作用被忽视了。影响健康教育的组织因素分为规划、组织和监测与评估三个类别。规划类别有基础设施规划、人力规划和健康教育计划的设计和规划三个子类。组织类别有两个子类，即卫生部不同单位之间的协调以及卫生部门与社会其他部门之间的协调。监测和评估类别有三个子类，即适当的反馈、官僚系统、奖励或强化、未能将健康教育定义为工作描述的一部分，以及电子健康记录对评估质量的影响。
研究结果提供了专业知识和初步工具，以帮助进行基于证据的健康教育规划和评估。管理者的支持，如根据目标人群和基础设施提供人力，可以改善卫生系统中的健康教育。此外，不同卫生系统级别的部门间和部门内协调，以便由健康教育专业人员根据客户需求实施量身定制的方案，以及使用健康教育理论似乎是必要的。还建议审查具有适当反馈的监测系统，将健康教育定义为健康活动，并制定适当的标准，以更好地实施健康教育。
