Original Articles

BACKGROUND: The marginalization of Indigenous women in Canada has resulted in adverse pregnancy and infant health outcomes. While the epidemiological research focuses on statistical evidence, it fails to address the context and underlying causes, including social determinants of health. Despite clear evidence on how social determinants influence health, there is limited research on Indigenous women’s perspectives and experiences. Indigenous women’s narratives during pregnancy, birth and the early months of parenthood are critical to understand the underlying causes and proposed solutions. This research demonstrates how Indigenous women’s maternity experiences are embedded within their historical, social and cultural experiences, thus explaining the importance of addressing contexts related to social determinants of health. 

METHODS: Through an Indigenous and decolonized lens, maternity narratives from ten in-depth interviews were conducted with Indigenous birth mothers in British Columbia, Canada. Thematic content analysis findings contextualize Indigenous maternity experiences within proximal, intermediate and distal determinants of health.

RESULTS: The proximal determinates include barriers to education, employment, income, food (in)security and a lack of safe and affordable housing and homelessness due to urban migration and violent relationships. Intermediate experiences included barriers to accessing maternity healthcare, including geographic barriers and experiences of racism.  Distal determinants including traumatic narratives related to immediate and intergenerational impacts of colonialism, including the Indian residential school system and foster care, which has impacted mental health and addictions.

CONCLUSION: This research contributes to expanding research on culturally safe and improved maternal-child health, healthcare and maternity research, as well as highlighting the need to address and alleviate adverse social determinants. 

What Pakistan healthcare system can learn from France?

Saeed Sobhani

Social Determinants of Health, Vol. 4 No. 2 (2018), 24 July 2018, Page 68-77

  Background: Developing countries such as Pakistan are in deep need of assessing the performance of their health care systems by comparing their performance against that of other countries.

  Methods: Pakistan health care system was compared with France health care system as one of the best health care system in the world, based on Health Systems Performance Assessment (HSPA). We extracted the information content and potential performance measures, and indicated what can and cannot be inferred from our analysis.  

  Results: Based on our analysis, the top three performance gaps between Pakistan and France were human resources, service delivery, and financing. 

  Conclusion: Pakistan’s government needs to rise adequate, equitable funding to provide care that is easily accessible, efficient, and equitable for all citizens. The health worker shortage situation is also untenable, and affects the nation’s health services delivery. If Pakistan’s health system is to deliver these outcomes, the system must address its poor inputs across financing, human resources, and service delivery. The sweeping changes that we suggest require management level changes in the health sector. Some of this will come from the brief level of management training that we suggested as a part of the curriculum for professional institutions, but much of it will come from transparency and involvement of all peoples in health care improvement.

Effect of neurofeedback therapy based on virtual reality technology on anxiety in patients with anxiety disorder

Nassrin Rezaie Khosravi, Gelavij Mahmoodi

Social Determinants of Health, Vol. 4 No. 2 (2018), 24 July 2018, Page 78-83

Background and purpose: Neurofeedback method and virtual reality technology are used as a relatively new therapy approach for the treatment of diseases and disorders. The aim of this study was to investigate the effect of neurofeedback therapy based on the virtual reality technology on anxiety in patients with anxiety disorder.

Materials and methods: The present study was a semi experimental, pre-test, post-test and follow-up study with the control group. The statistical population of this study included adolescents with anxiety complaints to psychiatrists at the specialized clinic of Kermanshah health center in 2015 April and May. Method Available was used for sampling and the sample size included 5 people. Demographic and Beck Anxiety Inventories were used to collect the data. Participants were treated with neurofeedback based on virtual reality technology in three sessions. Data were analyzed using SPSS version 21 and Analysis of variance with repeated measurements.

Results: The results showed that there was a significant difference between the mean anxiety scores in the pre-test phase and the post-test scores at the level of p <0.001. After two months, the results of follow-up were sustained.

Conclusion: According to the results of this study, virtual reality technology based neurofeedback therapy reduces anxiety in people with anxiety disorder.

Men’s gender attitudes and their fertility intentions in Tehran

Hajiieh Bibi Razeghi Nasrabad, Fateme Modiri

Social Determinants of Health, Vol. 4 No. 2 (2018), 24 July 2018, Page 84-92

  Background: Total fertility rate has fallen below the replacement level in 2006 in Iran. In family demographic research, gender attitude is considered as an affecting factor to understand low fertility intention. The present study aimed to investigate the relationship between men’s gender attitudes and their fertility intention.

  Methods: The data were drawn from a survey entitled "Married Lifestyle and its Determinants in Tehran City in 2015" using multi-stage cluster sampling method and a structured questionnaire. 618 married men were selected with wives aged between 15 to 49 years. Crammers V estimate and logistic regression were used in bivariate and multivariable analysis in IBM SPSS Statistics for Windows, Version 22.0.

  Results: The results showed that 249 (40.3%) of the men in Tehran had egalitarian gender attitudes and 141 (22.8%) of them had traditional gender attitudes. The mean number of intended children in traditional men was 2.1, but 1.6 in egalitarian men. Multivariate logistic regression showed that gender attitudes had a significant impact on the intention to have a(nother) child only in one-child men. The odds ratio of intention to have a(nother) child was lower among egalitarian men (OR=0.271, P=0.016(.

  Conclusion: Men’s gender attitudes on their fertility intention vary across parities. In one-child men, egalitarian gender attitudes are related to low fertility intention.

Relationship between parents' child rearing style and emotion-regulation skills in adolescents: moderating role of parenting stresses

Mahdi Kheradmand, Raoofeh Ghayoomi, Toktam Ghahreman, Shahrbanoo Ghahari

Social Determinants of Health, Vol. 4 No. 2 (2018), 24 July 2018, Page 93-99

  Background: Adolescence is one of the most challenging periods in the life of humans during which the individual is faced with personal, social, occupational, and family problems as well as extensive physical and cognitive changes. Dealing with these problems and changes requires emotional regulation and management. Parents play a vital role in adolescences' coping styles with the mentioned problems and emotions. Hence, the present study aimed at examining the moderating role of parenting stress in the relationship between child rearing style and emotion regulation skills in adolescents.

  Methods: A correlational study was carried out. Statistical population consisted of all of adolescences in male and female schools in Tehran and their mothers in 2016. Of this population, 400 who had the inclusion criteria were selected using multistage cluster sampling method. To collect data, Parents' Stress Index, Parenting Style Questionnaire, and Emotional Regulation Checklist were used. The obtained data were analyzed using Pearson Regression Coefficient and stepwise multivariate regression.

  Results: In the present study, the mean age of participating adolescents and mothers were 16.55 and 38.83, respectively. Moreover, findings implied that parents' stress and authoritative parenting styles could predict 0.067 and 0.35 percentages of variances in the scores of emotional regulation in adolescences, respectively (P<0.05). Also, since R2 increased to 0.10, it can be stated that 0.135 of variance observed in emotion regulation scores gained by adolescents is explained by mediating role of parenting stress. 

  Conclusion: Parenting stress can moderate the relationship between child rearing style and emotion regulation skills in adolescents

Background and Aim: Communication skills are the ability to establish interpersonal relationships with others. Emotional intelligence is also the ability to increase their domination over time and their emotions and push them towards their goals and intentions. In this study, the relationship between emotional intelligence and communication skills in postgraduate students of Islamic Azad University was studied.

Materials and methods: In a cross-sectional study, 321 postgraduate students from Islamic Azad University, Tehran-North Branch were selected using simple stratified random sampling method. The data was collected using Brad berry and Greaves questionnaire of emotional intelligence that has 28 items. Reliability of this questionnaire has been confirmed by Cronbach's alpha of 0.88. To answer questions, the Likert Spectrum Scale (never-rarely-occasionally-usually- almost always-always) has been used.

Results: Subjects were % 48.6 male and 51.4 were female. There was a significant relationship between communication skills and emotional intelligence(r= 0.406, p <0.001), knowledge (r= 0.276, p <0.001), managerial variables (r=0.378, p <0.001), social awareness (r= 0.252, p <0.001), relationship management (r= 0.286, p <0.001) of students. Mean emotional intelligence of men is higher than women's (p <0.015). The mean of emotional intelligence of Ph.D. students is higher than in postgraduate students (p <0.036). Mean communication skills of men are higher than female (p <0.017). The mean of communication skills of PhD students is higher than postgraduate students (p <0.024).

Conclusion: Communication skills will increase through increasing students' emotional intelligence. In men communication skills and emotional intelligence are higher than women. And in Ph.D. students is higher than postgraduate degree.

Review Article

Comparison of social values in health priority setting: the experiences of seven countries

Hakimeh Mostafavi, Mahdi Mahdavi, Fariba Mollajafari, Seyed Hadi Mirhashemi

Social Determinants of Health, Vol. 4 No. 2 (2018), 24 July 2018, Page 105-114

Background: Priority setting is a key function to optimize the allocation of limited healthcare resources. Technical and judgmental criteria are used in priority setting decisions. The present study aims to compare the social values in some countries’ health care system based on Clark-Weale framework.

  Methods: We searched the PubMed and Scopus to find published studies on the role of social values in priority setting based on the Clark-Weale framework. We checked references in order to include landmark papers which were not found in the previous step. On the basis of this framework, we subsequently compared content and process values based on which priorities are set in identified studies.  

  Results: Our review showed that this framework is applied to describe social values in priority setting in Australia, England, China, Germany, Iran, Republic of Korea, Thailand, Latin American countries, and USA. Countries apply the social values in different ways. Some of them consider an extended range of values and some use only a limited number of values. Content values are often more reliable than process values. Contextual characteristics and having committees in operation to advise priority setting tasks had significant roles in taking social values into consideration in the process of health priority setting.

  Conclusion: It is difficult to examine how exactly health priority setting decisions are influenced by social values in health systems. However, a comparative picture of values and their relative importance can contribute to understand the status quo and under-represented values.