Use of focus groups to assess the health needs of the
community for priorities in health research in Bushehr Port/I.R.
Priorities in health research is
critical as conducting the research itself. In attempting to find out
priorities in health research in Bushehr Port/I.R. Iran, a needs assessment was
undertaken using focus group discussion. The participants were 99 invited
persons in various age categories. Twelve focus group sessions were conducted to reveal determinants of
health and factors to promote health. Non-communicable diseases including
cardiovascular diseases were the major concerns of the groups. Unhealthy
nutrition, mental health problems, and substance abuse were noted as the health
determinants. They requested educational issues in healthy lifestyle, substanse
abuse, mental problems and HIV/AIDS. In conclusion, there is an urgent need to
establish behavioral risk factor surveillance systems to plan interventional
research for healthy heart in
Introduction
Health research is essential to improve the design of health interventions, policies and service delivery. Priority setting is also as critical as conducting the research itself. Yet there is no simple way to set priorities. Failure to establish a process for this has contributed much to a situation in which only about 10% of health research funds from public and private sources are devoted to 90% of the world’s health problems. This is what is called ‘the 10/90 gap’(1).
Funding for research is limited and a rational priority-setting process is therefore required. This should be based on sound methods, scientific process and in-built mechanisms to reinforce and strengthen the links between research, action, policy and practice, so that health policy, practice and action is firmly based on the best available scientific evidence.
A number of models and methods for setting health research priorities has been emerged. The ‘Ad Hoc Committee on Health Research’ report of 1996 reinforced the importance of setting health research priorities . Using a systemic approach to the allocation of health research funds the report outlined a five step strategy. Applying this strategy, four key investments were identified. These health research challenges represented : maternal and child health; continually changing microbial threats, non-communicable illnesses and injuries, and health policy and systems (2). This approach nicely structures consideration of a wide range of potential health research, but has serious shortcoming (3).
Priority setting must include a multidisciplinary and participatory process. The mode of operation in the Essential National Health Research (ENHR) is inclusiveness, involving all stakeholders, including research scientists, policy-makers, programme managers and communities (5).
Assessment the areas of greatest need in the community, as well as the resources and other strengths that could be tap into to address those areas is essential in priority-setting methodologies. As a part of complexity approach for priority-setting, we conduct a needs assessment in topic of health in the community using focus groups.
In attempting to find out the
major health determinants and factors to promote health in
Results
All the groups were, in general, informative about global view of health and defined it a state of complete physical, mental, and social well-being.
There was a strong feeling in the groups, that the major determinants for health were mental problems, unhealthy nutrition, physical inactivity, smoking and substance abuse and blood cholesterol.
More than half the persons also noted to environmental quality as an important determinant.
The invited subjects stated to
the causes of mortality in
The subjects suggested the public educational issues-included risk factors for prevention of myocardial infarction , healthy nutrition, mental problems for promotion of health. More than half of the persons also recommended educational needs about HIV/AIDS.
The subjects identified several issues with respect to health care providers. First, they felt that health care providers were outdated or ineffectual, thus leading the need for updating of information. Second, they stressed the need for urban health centers to provide educational issues for healthy lifestyle and health nutrition. The major change that they wanted was periodic public health examinations including for hypertension and blood cholesterol. Third, however they were, in general, understanding and supportive of the efforts made for them by health care providers, but also had significant problem mostly arising from communication issues. They wanted more humanistic contacts of health care providers.
Use of focus groups to assess the health needs of the community in Bushehr Port, in order to determine priorities in health research revealed that all the groups recognized the concept of health as defined by WHO as ‘a state of complete physical, mental and social well being and not only the absence of disease and infirmities’ (1).
Therefore, for human health protection, internal market, social affairs, research & development, agriculture, trade, development policy and environment must be appraised for its potential impact on the health (5) .
Most determinants of health are systemic located within complex, dynamic and interactive social relationships which themselves are determined by social institutions and organizations including families, communities, workplaces-indeed the health care system itself. Determinants of population health are mediated through social systems but are determined by social relationships within those systems (6).
The expansion of the focus from disease burden to risk factors (determinants) is an important step for future improvements in policies. However, this shift produces other challenges of its own, the main one being the selection of risk factors to be studied. The focus group in this study noted important health determinants for the community including overweight and obesity, physical inactivity, addiction and tobacco use, unsafe water, sanitation & environmental quality and risk-taking behaviours.
According to these risk factors and health determinants, a population’s health is more affected by developments outside the health care sector including social and economic changes that improve the quality of people’s lives.The US Surgeon General, addressing this issue, has listed the general causes of premature death and disability as: 10% due to inadequate access to medical care, 20% genetic, 20% due to environmental factors, 50% due to behavioral and lifestyle factors. So, a population’s health is more affected by developments outside the health sector (7). Therefore, motivating non-health sectors to act on just one of the heath determinants can have a profound effect on increasing the quality and years of healthy life and on eliminating health disparities- in the community. Overall, research into determinants can identify interventions to prevent disease or premature death.
Throughout the world, chronic disease-including non-communicable diseases (e.g. cardiovascular diseases), long term mental disorders, and persistent communicable diseases such as tuberculosis and HIV/AIDS- present a huge challenge to health (8).
Our focus groups noted the needs to promote their health knowledge for addiction, HIV & mental health problems and healthy lifestyle including nutrition, in order to prevent the cardiovascular diseases. They requested education in healthy heart, healthy nutrition and healthy lifestyle by health care providers. The factors underlying the major non-communicable diseases (heart disease, stroke and diabetes) have their origin in human behavior, such as smoking, unhealthy food habits, lack of physical exercise and stressful lifestyles. As a result of this fact, professionals in public health have increasingly focused on ways to help people to change behaviors and reduce their risk of cardiac diseases and health.
The groups also stated that
population screening for individuals at high risk of getting coronary heart
disease should be a major task in primary care in
The national service framework
for coronary heart disease recommends that general practitioners and primary
healthcare teams should identify all people at significant risk of
cardiovascular disease, but who have not yet developed symptoms, and offer them
appropriate advice and treatment to reduce their risk (9). The prevalence of possible myocardial infarction and ischemic
resting electrocardiographic abnormalities in men and women aged 30-64 years in
Lifestyle patterns for unhealthy
lifestyle in cardiovascular diseases have not get been well studied and
documented in the region of the Persian Gulf and this places a major limitation
on developing healthy lifestyle policies, strategic plans and programmes. To
order to accomplish this task, we need behavioral risk factor surveillance
systems in the
Table 1: Key questions in focus groups
Goal 1 (Health and its determinants)
1) What is the definition of Health?
2) What are the determinants (risk factors) of Health?
3) What are the causes of death in Bushehr port?
Goal 2 (Health Promotion)
1) What are the needs in health knowledge of the people for a healthy life?
2) What are the needs of the community from health care providers in order to promote the health?