ArticleBMC public health2025
Translating policy into health outcomes: a mixed-methods health impact assessment of the family physician program in Bonab County, Iran.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe Family Physician Program (FPP) represents a crucial reform in the primary healthcare system. Assessing its impact is essential to inform evidence-based policy decisions and to enhance its effectiveness in improving population health. This study employed a Health Impact Assessment (HIA) framework to evaluate the influence of the FPP on key health outcomes in Iran and to generate actionable recommendations for optimizing its implementation.
methodA retrospective HIA using the Merseyside guidelines was conducted with a concurrent mixed-methods design across three phases. Phase I involved a quantitative analysis employing Interrupted Time Series Analysis (ITSA) over a 14-year period (2008-2021) to assess changes in health indicators following FPP implementation. Phase II used qualitative content analysis with interviews of 12 healthcare recipients and 7 providers from Bonab, Iran's urban health centers, exploring program strengths, limitations, and health impacts. Phase III entailed a comparative integration of quantitative and qualitative findings to derive comprehensive policy and practice recommendations.
resultsAccording the quantitatve analysis, the Total Fertility Rate (TFR) initially exhibited a significant increase post-implementation (p = 0.007), followed by a gradual decline (p = 0.016). Modern contraceptive use declined (MCU) post-intervention, though likely influenced by unrelated national policy changes. The Infant Mortality Rate (IMR) experienced a marked immediate decline (p = 0.009), though the downward trend moderated over time (p = 0.045). Other maternal and child health indicators did not demonstrate statistically significant changes attributable to the intervention. Qualitative content analysis led to the identification of five main categories "Changes in Health-Oriented Beliefs and Behaviors of Service Recipients", "Quantitative and Qualitative Enhancement of Service Delivery", "socio-cultural and economic challenges", "interpersonal communication" and "inefficient management". The integration phase combined the quantitative and qualitative findings for a comprehensive interpretation.
conclusionWhile the FPP improved some health indicators, its overall effectiveness was constrained by socio-economic inequities, cultural barriers, and managerial inefficiencies. Strengthening the program requires systemic reforms, capacity-building, and addressing social determinants of health. Beyond Iran, this study offers a valuable framework for other low- and middle-income countries facing similar challenges in implementing large-scale primary care reforms, providing insights for optimizing program design and ensuring long-term sustainability.
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