تحلیل میدان نیروی ارتقای ظرفیت اجرای خط‌مشی‌های بهداشتی کشور

عباس  ابول زاده; محمد ضیاء الدینی; مصطفی  هادوی نژاد

Authors

Abbas Abolzadeh Department of Management, Raf.c., Islamic Azad university , Rafsanjan , Iran Author https://orcid.org/0009-0009-9600-6362
Mohammad Ziaaddini Department of Management, Raf.c., Islamic Azad university, Rafsanjan, Iran https://orcid.org/0000-0001-7764-3387
Mostafa Hadavinajad Associate Professor, Department of Management, Faculty of Administrative Sciences and Economy, Vali-e-Asr University of Rafsanjan, Rafsanjan, Iran Author https://orcid.org/0000-0003-4496-6774

Keywords:

Policy Implementation, Health Policies, Force Field Analysis, Implementation Capacity, Fuzzy Cognitive Mapping, Health System

Abstract

This study aimed to analyze the driving and restraining forces affecting the capacity for implementing national health policies and to explain the relationships among factors that reduce barriers and strengthen implementation drivers. This qualitative study was conducted in two stages. In the first stage, force field analysis was used to identify driving forces, restraining forces, factors reducing restraining forces, and factors strengthening driving forces. Participants included 16 academic and executive experts in health policy and the health system who were selected through purposive and snowball sampling. Data were collected through semi-structured interviews, document review, and a force-intensity assessment questionnaire and analyzed using qualitative content analysis and mean expert scores. In the second stage, a matrix questionnaire based on fuzzy cognitive mapping was used to assess the direction and intensity of relationships among the identified factors. Expert judgments were converted into fuzzy values, defuzzified, and relationships below the 0.65 threshold were excluded. The major restraining forces included inadequate managerial knowledge and meritocracy, systemic coordination problems, conflicts of interest, resource shortages, weak infrastructure, insufficient organizational support, ineffective leadership, and resistance to change. The principal driving forces included continuous education, merit-based management, decentralization, stronger resources, access to credible evidence, effective leadership, organizational support, and policy institutionalization. Fuzzy cognitive mapping identified five central components: valid knowledge and information; human, financial, and infrastructural resources; organizational culture and leadership; planning structure and implementation coordination; and organizational institutionalization and adaptability. Enhancing health policy implementation capacity requires simultaneous and multidimensional intervention in knowledge, resources, leadership, coordination, and institutionalization, while the concurrent management of driving and restraining forces can improve the sustainability and effectiveness of policy implementation.

Downloads

Download data is not yet available.

References

Abolhasani, M., Zarea, H., & Zanganeh, Z. (2024). Health Policy Implementation in Iran: A Scoping Review of Success and Failure Factors. Journal of Research and Health, 14(4), 316-329. https://tkj.ssu.ac.ir/browse.php?a_id=1278&sid=1&slc_lang=fa&html=1

Al-Meslamani, A. Z. (2024). Why are digital health policies crucial? Journal of Medical Economics, 27(1), 167-169. https://doi.org/10.1080/13696998.2024.2302254

Ansah, J. P., Eberlein, R. L., Love, S. R., Bautista, M. A., Thompson, J. P., Malhotra, R., & Matchar, D. B. (2014). Implications of long-term care capacity response policies for an aging population: a simulation analysis. Health policy, 116(1), 105-113. https://doi.org/10.1016/j.healthpol.2014.01.006

Aslan, E. Ç. (2024). Artificial Intelligence in Public Health and Health Policies. 227-240. https://doi.org/10.1201/9781003495406-11

Blanchet, K., Nam, S. L., Ramalingam, B., & Pozo-Martin, F. (2017). Governance and capacity to Manage Resilience of Health systems: towards a new conceptual Framework. International Journal of Health Policy and Management, 6(8), 431-435. https://doi.org/10.15171/ijhpm.2017.36

Forest, P., Denis, J., Brown, L. D., & Helms, D. (2015). Health Reform Requires Policy Capacity. International Journal of Health Policy and Management, 4(5), 265-266. https://doi.org/10.15171/ijhpm.2015.85

Hosseini, S. S., & Taghvaei, M. (2021). Compilation and Evaluation of Indexes for the Development of Health Villages by Taking a Medical Tourism Development Approach towards Service Integration in Iran (A Qualitative & Quantitative Study). Human Geography Research, 53(3), 1015-1034. https://doi.org/10.22059/jhgr.2020.300901.1008107

Inayat, S., Younas, A., & Ali, P. (2024). “Patriarchy Permeating Health Policymaking”: Influence of Gender on Involvement in Health Policymaking From Nurse Leaders' Perspective. World Medical & Health Policy, 16(4), 677-691. https://doi.org/10.1002/wmh3.631

Khatri, R. B., Endalamaw, A., Mengistu, T., Erku, D., Wolka, E., & Nigatu, F. (2025). A scoping review of knowledge translation in strengthening health policy and practice: Sources, platforms, tools, opportunities, and challenges. Archives of Public Health, 83, Article 78. https://doi.org/10.1186/s13690-025-01567-7

Khodayari-Zarnaq, R., Mobasseri, K., Ghasemyani, S., Sadeghi-Ghyassi, F., Naghshi, M., & Kabiri, N. (2024). Challenges and Weaknesses of Leadership and Governance-related Health Policies in Iran: A Systematic Review. Archives of Iranian Medicine, 27(9), 508-521. https://doi.org/10.34172/aim.28907

Klenk, T. (2025). Towards Digital Era Governance? Examining Health Policy Through the Lens of Public Administration / Digital Era Governance in Der Gesundheitspolitik? Eine Analyse Von Gesundheitsreformen Aus Verwaltungswissenschaftlicher Perspektive. Der Moderne Staat – Zeitschrift Für Public Policy Recht Und Management, 17(2-2024), 263-282. https://doi.org/10.3224/dms.v17i2.05

Narayan, J. (2023). The Role of Healthcare Executives in Influencing Environmental Health Policies. Health Leadership and Quality Of Life, 2, 306. https://doi.org/10.56294/hl2023306

Nazemipour, B., Rabiei Mandajin, M. R., Givorian, H., & Momeni, M. (2026). Factors influencing organizational health policy in the national banking system. Economic Geography Research, 6(19).

Odilibe, I. P., Akomolafe, O., Arowoogun, J. O., Anyanwu, E. C., Onwumere, C., & Ogugua, J. O. (2024). Mental Health Policies: A Comparative Review Between the Usa and African Nations. International Medical Science Research Journal, 4(2), 141-157. https://doi.org/10.51594/imsrj.v4i2.766

Rahmani, F., Fathi Rad, N., Madahian, S., Zayandeh Rudi, A., & Derakhshan, A. (2023). Presenting a Model for Evaluating Health Policies in the Administrative System Based on Upstream Documents: A Study in the Ministry of Economic Affairs and Finance. Journal of Management and Sustainable Development Studies, 3(1).

Raymond, K., Nathan, S., Harrison, R., & Meyer, L. (2023). Health Policy Evaluation in Rural and Remote Australia: A Qualitative Exploration and Lessons From the Northern Territory. Australian Health Review, 47(2), 197-202. https://doi.org/10.1071/ah22255

Saheb, T., & Saheb, T. (2024). Digital Health Policy Decoded: Mapping National Strategies Using Donabedian's Model. Health policy, 147, 105134. https://doi.org/10.1016/j.healthpol.2024.105134

Sapkota, S., Rushton, S., van Teijlingen, E., Subedi, M., Balen, J., Gautam, S., & Marahatta, S. B. (2024). Participatory Policy Analysis in Health Policy and Systems Research: Reflections from a Study in Nepal. Health Research Policy and Systems, 22(7). https://doi.org/10.1186/s12961-023-01092-5

Schrijvers, K., Willems, B., Buyl, A., Deforche, B., & Dierckens, M. (2026). Mental Health Policies in Secondary Schools and Their Impact on Student Well-Being and Perceived School Climate. School Mental Health. https://doi.org/10.1007/s12310-026-09861-7

Tenbensel, T., & Silwal, P. R. (2023). Cultivating Health Policy Capacity through Network Governance in New Zealand: Learning from Divergent Stories of Policy Implementation. Policy and Society, 42(1), 49-63. https://doi.org/10.1093/polsoc/puab020

Velarde Crézé, C., Duperrex, O., Lebon, L., Faivre, V., Pasche, M., & Cornuz, J. (2024). A Multi-Stage Approach to Support Timely Health Policy Decisions during Crisis: The Fast-Track Delphi. BMC public health, 24. https://doi.org/10.1186/s12889-024-20903-0

Zhang, X., & Lu, F. (2025). Enhancing Public Health Policy Communication Through Government-Citizen Social Media Interactions: The Impact of Replying Agents, Inquiry Tone, and Institutional Trust. Policy & Internet, 17(1). https://doi.org/10.1002/poi3.70000