The range and diversity of providers’ viewpoints towards the Iraqi primary health care system: an exploration using Q-methodology

BMC International Health and Human Rights

Egbert Sondorp²  Tariq S Al-Hadithi¹  Namir G Al-Tawil¹  Nazar P Shabila¹ 

[1] Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq;London School of Hygiene and Tropical Medicine, London, UK

关键词: Assessment;    Providers;    Q-methodology;    Primary health care;   

Others  :  855254
DOI  :  10.1186/1472-698X-13-18

 received in 2012-04-29, accepted in 2013-03-15,  发布年份 2013

【 摘 要 】

Background

The increasingly recognized need for reorganizing the primary health care services in Iraq calls for a comprehensive assessment of the system to better understand its problems and needs for development. As part of such comprehensive assessment and due to the important role of primary health care providers in adopting any change, we ought to explore the range and diversity of viewpoints of primary health care providers towards the Iraqi primary health care system.

Methods

This explorative study was carried out in Erbil governorate, Iraq from May to July 2011. Data were collected from primary health care providers using Q-methodology to elicit subjective viewpoints and identify shared patterns among individuals. Forty primary health care providers representing eight primary health care centers sorted 41 statements reflecting different aspects of the Iraqi primary health care system into a distribution on a scale of nine from “disagree most” to “agree most”. By-person factor analysis was used to derive latent viewpoints through centroid factor extraction and varimax rotation of factors.

Results

Analysis of the participants’ Q-sorts resulted in four distinct viewpoints among primary health care providers toward the current primary health care system. One factor emphasized positive aspects of the current primary health care system that is content with the current primary health care system. The other three factors highlighted the negative aspects and they included (i) professionally-centered viewpoint, (ii) comprehensive perception and problem-based solutions and (iii) critical to leadership/governance aspects of the system.

Conclusions

This study revealed diverse viewpoints of primary health care providers toward the current Iraqi primary health care system and recognized the particular issues related to each viewpoint. The findings can contribute to a better understanding of health policy makers and primary health care managers concerning the problems facing the primary health care system that might contribute to change in the management of this system.

【 授权许可】

   
2013 Shabila et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Ghobaraha HA, Huthb P, Russett B: The post-war public health effects of civil conflict. Soc Sci Med 2004, 59:869-884.
• [2]Nelson BD, Simic S, Beste L, Vukovic D, Bjegovic V, VanRooyen MJ: Multimodal assessment of the primary healthcare system of Serbia: A model for evaluating post-conflict health systems. Prehosp Disast Med 2003, 18(1):6-13.
• [3]Ali MM, Shah IH: Sanctions and childhood mortality in Iraq. Lancet 2000, 355(9218):1851-1857.
• [4]Alwan A: Health-sector funding: options for funding health care in Iraq. East Mediterr Health J 2008, 14(6):1372-1379.
• [5]WHO: Iraq Health System Profile. Cairo: EMRO; 2006.
• [6]Webster P: lraq’s health system yet to heal from ravages of war. Lancet 2011, 378:863-866.
• [7]Alwan A: Health in Iraq: The current situation, our vision for the future and areas of work. 2nd edition. Baghdad: Ministry of Health; 2004.
• [8]Tawfik-Shukor A, Khoshnaw H: The impact of health system governance and policy processes on health services in Iraqi Kurdistan. BMC Int Health Hum Rights 2010, 10:14. BioMed Central Full Text
• [9]Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp E: Iraqi primary care system in Kurdistan region: Providers’ perspectives on problems and opportunities for improvement. BMC Int Health Hum Rights 2012, 12:21. BioMed Central Full Text
• [10]Godichet O, Ghanem V: Iraqi system of Primary Health Care: A communitarian system of family medicine under a dictatorship framework. Contemp Nurse 2004, 17(1–2):113-124.
• [11]Peschke LA, Mohammed AH, Al-Dabbagh AS: Patient satisfaction in Duhok, Kudistan region of Iraq: Family medicine center vs. primary health care centers. DMJ 2009, 3(1):51-63.
• [12]Al-Dabbagh SA: Specialization in family medicine: a necessity or a fashion. DMJ 2007, 1(1):1-3.
• [13]Shabila NP, Al-Taweel N, Tahir R, Shwani FH, Saleh AM, Al-Hadithi T: Iraqi health system in Kurdistan region: medical professionals’ perspectives on challenges and priorities for improvement. Conf Health 2010, 4:19. BioMed Central Full Text
• [14]Vekov TY: Medical doctors’ opinion of healthcare reforms in Bulgaria. World Hosp Health Serv 2009, 45(1):9-14.
• [15]Keyhani S, Federman A: Doctors on coverage-physicians’ views on a new public insurance option and medicare expansion. N Engl J Med 2009, 361(14):e24-e24.
• [16]Van Exel NJA, De Graaf G: Q methodology: A sneak preview. 2005. [http://qmethod.org/articles/vanExel.pdf webcite]
• [17]Shinebourne P, Adams M: Q-methodology as a phenomenological research method. Existential Analysis 2007, 18(1):103-116.
• [18]Stenner P, Stainton Rogers R: Q methodology and qualiquantology: The example of discriminating between emotions. In Mixing methods in psychology. Edited by Tod Z, Nerlich B, McKeown S, Clark D. London: Routledge; 2004:101-120.
• [19]Akhtar-Danesh N, Baumann A: Q-methodology in nursing research: A promising method for the study of subjectivity. West J Nurs Res 2008, 30(6):759-773.
• [20]Smith NW: Current systems in psychology: history, theory, research, and applications. Belmont, CA: Wadsworth; 2001.
• [21]Webler T, Danielson S, Tuler S: Using Q method to reveal social perspectives in environmental research. Greenfield MA: Social and Environmental Research Institute; 2009.
• [22]Brouwer M: Q is accounting for tastes. J Advertising Res 1999, 39(2):35-39.
• [23]Stainton Rogers R: Q methodology. In Rethinking methods in psychology. Edited by Smith JA, Harre R, Van Langenhove L. Thousand Oaks, CA: Sage; 1995:178-192.
• [24]Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp E: A qualitative assessment of the Iraqi primary health care system. World Health Popul 2012, 13(3):18-27.
• [25]Khudhairi JM: Evaluation of primary health care system as a prerequisite for Iraqi health system reform. : University of Mustansiriya, College of Medicine; 2005. [PhD thesis]
• [26]WHO: Everybody’s business: Strengthening health systems to improve health outcomes: WHO’s Framework for Action. Geneva: World Health Organization; 2007.
• [27]Schmolck P: PQMethod software. 2002. [http://schmolck.userweb.mwn.de/qmethod/ webcite]
• [28]Shinebourne P: Using Q method in qualitative research. IJQM 2009, 8(1):93-97.
• [29]Lipsky M: Street-Level Bureaucracy: Dilemmas of the Individual in Public Services. New York: Russell Sage; 1980.
• [30]Smith J, Laverentz M, Liu X: Primary health care quality: What can Iraq learn from international experience?. USA: Abt Associates Inc; 2003.
• [31]Gadallah M, Zaki B, Rady M, Anwer W, Sallam I: Patient satisfaction with primary health care services in two districts in lower and upper Egypt. East Mediterr Health J 2003, 9(3):422-430.
• [32]Sohrabi MR, Albalushi RM: Clients’ satisfaction with primary health care in Tehran: A cross-sectional study on Iranian Health Centers. J Res Med Sci 2011, 16(6):756-762.
• [33]Sadrizadeh B: Primary health care experience in Iran. Med J Iran Red Crescent 2004, 7(1):79-90.
• [34]Bjerregaard D: Quality assurance in the Jordan primary health care system: Best practices. Amman: Primary Health Care Initiatives; 2004.
• [35]Chuma J, Musimbi J, Okungu V, Goodman C, Molyneux C: Reducing user fees for primary health care in Kenya: Policy on paper or policy in practice? Int J Equity Health 2009, 8:15. BioMed Central Full Text
• [36]Wahab MA: Distribution of doctors workforce in Erbil governorate. Hawler Medical University, College of Medicine; 2010. [MSc thesis]
• [37]WHO: Evaluation of the organizational model of primary care in Turkey. Denmark: WHO Regional Office for Europe; 2009.
• [38]Brown SR: A primer on Q methodology. Operant Subjectivity 1993, 16(3/4):91-138.
• [39]Brown SR: Q methodology as the foundation for a science of subjectivity. Operant Subjectivity 1995, 18(1/2):1-16.
• [40]Amin Z: Q methodology-A journey into the subjectivity of human mind. Singapore Med J 2000, 41(8):410-414.
• [41]Thomas DB, Baas LR: The issue of generalization in Q methodology: "reliable schematics" revisited. Operant Subjectivity 1992, 16(1/2):18-36.