Friday, 16 February 2018

To Develop Iranians’ Social Functioning Conceptual Framework and Indicators: A Mixed Method Approach

In the new public health, the concept of “social functioning” has received particular attention as both a social health asset and a determinant of physical and mental health, in despite the fact that the concept primarily derived from the works of sociologists and psychiatrists. Seeking care for nonpsychotic mental disorders as a consequence of problematic social relationships was one of the first reasons of paying attention to the concept of social roles and similarly, social functions. Several countries, especially developed, and international organizations have made attempts to develop their special indicators of social function. Most of them have integrated social functioning indicators into their health programs such as Americans’ healthy people 2020 program; OECD (Organisation for Economic Co-operation and Development) framework of monitoring health; framework of CIHI (Canadian Institute for Health Information).

A recently developed framework for monitoring social well-being in Iran, has considered ‘social functioning’ as a main component but there is no detailed indicators to monitor social functioning. In Iran, as a middle-income country, with rapid social, cultural, and political changes, and improvement in social function was increasingly emphasized by government and policy-makers in recent twenty years, following the evidence-based reports of diminishing trend of social health and capital and increasing trend of social problems such as drug abuse, violence, depression, relationship and family breakdown. The last report of global burden of diseases study regarding Iran situation, which estimated burden of 289 diseases with 67 risk factors, ranked drug use, intimate partner violence, and children sexual abuse as 10th, 13th, and 16th risk factor, respectively; and ranked major depressive disorder, anxiety disorder, drug abuse disorder, self-harm, and interpersonal violence as 4th, 10th, 12th, 23th, 25th of diseases, respectively. In addition the trend of divorce and sexual dysfunction among Iranian spouses has been increasing during recent decades. Taken together, the weight of problems with social aspect in Iranian health system is dramatic. Iran Supreme-leader has recently alarm and concern at the impact of social problems and emergent need for governmental interventions. For this reason, policy-makers in different organizations such as Ministry of State, Ministry of Social Affairs and especially Ministry of Health (MOH) made several attempts to deal with the problems. 

Establishment of Social Health Unit in MOH, conducting the first round of “Iranians’ social health survey”, and implementing provincial community-based initiatives to reduce social problems were a number of good illustrations. Following the mentioned attempts, Social Health Unit of MOH decided to develop an evidence-based conceptual framework and indicators to monitor social functioning as a major aspect of social health in national and provincial level since there is no a consensus among sociologists and public health scientists on the concept of social functioning. Indeed, developed indicators would be a valuable instrument in hands of policymakers in different levels to make most effective and efficient attempts. Therefore, the aim of our study was to contribute to this growing area by exploring framework of social functioning, and develop and prioritize indicators through a consensus-building approach.  

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