Midwives’ Experiences in Adjusting to their New Role as Healthcare Provider in Health Transformation Plan in Iran: A Qualitative Study

Document Type : Original Research Article

Authors

1 Assistant Professor, Department of Midwifery, Ur.C., Islamic Azad University, Urmia, Iran

2 Professor, Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 a) Professor, Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran b) Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Professor, Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran

5 a) Associate Professor, Social Determinant of Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran b) Department of Biostatistics & Epidemiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

10.22038/jmrh.2024.82059.2460

Abstract

Background & aim: Midwives as healthcare providers, in their new role in Iran’s health care system, to provide services for several aspects of primary health care, face numerous intricacies after the implementation of the health transformation plan. This role shift compels them to fulfill their responsibilities in their new positions despite its incompatibility with their academic training and nature of profession. The present study was conducted to explain the midwives’ experiences in adjusting to their new role as healthcare provider in the health transformation plan in Iran.
Methods: In this qualitative content analysis, data were collected through in-depth semi-structured interviews with 18 midwives selected via purposive sampling with maximum variation working in the healthcare centers of Urmia in West Azerbaijan, Iran from April to October 2023. Data were analyzed using Zhang and Wildemuth’s eight-step conventional content analysis approach run in the MAXQDA software.
Results: Data analysis led to the emergence of two themes and seven main categories. The first theme, namely ‘efficient adjustment’, encompassed two main categories: ‘providing high-quality services’ and ‘inner satisfaction’, and the second theme, i.e., ‘inefficient adjustment’, was explained by five main categories, including ‘low-quality services’, ‘reduced utilization’, ‘emotional fatigue’, ‘systemic bullying’, and ‘changes in social expectations’.
Conclusion: It seems that midwives’ satisfaction with providing services to all clients as well as accountability are the paramount factors associated with their  adjustment. Midwives’ job satisfaction depends on the specialty of delegated responsibilities, correction of the rules in health transformation plan, and preservation of midwives’ dignity and career grace.

Keywords

Main Subjects

References

  1. Mahdavi M, Parsaeian M, Jaafaripooyan E, Ghaffari S. Recent Iranian health system reform: an operational perspective to improve health services quality. International Journal of Health Policy and Management. 2018; 7(1): 70.
  2. Ghasemyani S, Raoofi S, Hamidi H, Khodayari-Zarnaq R. Iran’s Health Transformation Plan; Main Issues and Opportunities for Improvement: A Systematic Review. Iranian Journal of Public Health. 2022; 51(9): 1977.
  3. Nabilou B, Yusefzadeh H, Salem Safi P. Performance assessment of health system reform plan in the hospitals affiliated with urmia university of medical sciences. The Journal Urmia Nurse Midwifery Faculty. 2017; 14(11): 896-905.
  4. Bahadori M, Babaei M, Mehrabian F. Prioritization factors influencing job motivation in employees of a military center using analysis hierarchy process (AHP). Journal of Military Medicine. 2013; 14(4).
  5. Novin Anarjan B, Elmi M. Examination of social factors related to organizational commitment of employees of Melli Bank. Sociological Studies. 2015; 7(25): 7-23.
  6. Malmir A, Abbassi H, Sarihi R, Alavi Sb. Investigating the Relationship between Strategic Management of Human Resources and the Performance. International Journal of Business Management and Entrepreneurship. 2022; 3(10): 55-74.
  7. Ameryan H, Fahimi Nezhad A, Morsal B, Siavashi M. A Structural Equation Modeling of Toxic Leadership and Organizational Trauma and Organizational Inertia Considering the Role of Social Loafing among the Ministry of Sport and Youth Staff. Strategic Studies on Youth and Sports. 2023; 22(59): 431-450.
  8. Kabir MJ, Rabiee S, Ashrafian Amiri H, Nasrollahpour Shirvani S, Hoseini S, Keshavarz A. Health Care Providers, Satisfaction in The Urban Family Physician Program Of Iran. The Journal Urmia Nurse Midwifery Faculty. 2018; 16(2): 92-100.
  9. Mikaniki E, Ashrafian Amiri H, Nasrollahpour Shirvani S, Kabir M, Jafari N, Nahimi Tabiei M, et al. Satisfaction of family physicians (FPs) about the effective factors on activation of FP program and rural insurance in the Northern Provinces of Iran. Journal of Babol University of Medical Sciences. 2014; 16(1): 7-15.
  10. Ministry of Health and Medical Education DoH, Network Management Center Plan to expand primary health care to achieve universal health coverage in urban areas. Amendment of the executive instructions of the suburbs and cities with more than 20,000 people. Available from: https://phcmuiacir/sites/phc/files/users/user54/%D9%86%D8%B3%D8%AE%D9%875_1pdf. 2019.
  11. Moradali MR, Hajian S, Majd HA, Rahbar M, Entezarmahdi R. Job Satisfaction and its Related Factors in Midwives Working in the Health Services System in Iran: A Systematic Review. Journal of Midwifery & Reproductive Health. 2023; 11(2).
  12. Elmas-Atay S. Work values fit and subjective career success: The moderating role of work engagement. International Review of Management and Marketing. 2017; 7(3): 113-120.
  13. Rahimi-Dadkan N, Nastiezaie N. Relationship among Occupational Adjustment, Psychological Empowerment and Job Burnout in Faculty Members. Research in Medical Education. 2016; 8(4): 19-28.
  14. Doshmangir L, Moshiri E, Mostafavi H, Sakha MA, Assan A. Policy analysis of the Iranian Health Transformation Plan in primary healthcare. BMC Health Services Research. 2019; 19(1): 1-8.
  15. Ravanipour M, Ostovar A, Darabi H, Pouladi S. Challenges of Health System Reform Plan in Bushehr: A Qualitative Study. Iranian South Medical Journal. 2020; 22(6): 415-431.
  16. Shojaie B, Ferdosi M, Keyvanara M, Yarmohamadian MH. The Overt and Covert Effects of Iranian Health Transformation Plan on Medicine and Medical Supplies. Health Scope. 2018; 7(S: e68047): 1-6.
  17. Bagheri A, Nasiri S, Simbar M, Saberi F. Challenges of midwifery services in the health reform plan in Iran: A qualitative study. Health Science Monitor. 2022; 1(1): 53-63.
  18. Ghérissi A, Brown JM. A situational analysis of the status of midwifery in North Africa and the Middle East. International Journal of Childbirth. 2014; 4(2): 69-76.
  19. Sadrkhanlou M. Occupational burnout among midwives working in health centers in Urmia and its relationship with their working status in 2010. Journal of North Khorasan University of Medical Sciences. 2013; 5(1): 115-124.
  20. Hajiesmaello M, Hajian S, Riazi H, Majd HA, Yavarian R. Secondary traumatic stress in iranian midwives: stimuli factors, outcomes and risk management. BMC Psychiatry. 2022; 22(1): 56.
  21. Nourani Saadoldin S, Kohansal Daghian Z, Esmaily H, Hooshmand E. The relationship between organizational citizenship behavior, job satisfaction, and occupational stress among midwives working in healthcare centers of Mashhad, Iran, 2014. Journal of Midwifery and Reproductive Health. 2016; 4(2): 622-630.
  22. Gheshlagh RG, Rezaei H, Parizad N. The prevalence of occupational stress among Iranian midwives: a systematic review and meta-analysis. British Journal of Midwifery. 2021; 29(11): 634-640.
  23. Moradali MR, Hajian S, Majd HA, Rahbar M, Entezarmahdi R. Job adjustment predictive factors of healthcare midwives in health system reform in Iran. Archives of Public Health. 2023; 81(1): 181.
  24. Polit DF, Beck CT. Is there still gender bias in nursing research? An update. Research in Nursing & Health. 2013; 36(1): 75-83.
  25. Creswell JW, Clark VLP. Designing and conducting mixed methods research)3rd ed. Sage publications; 2018.
  26. Wildemuth BM. Applications of social research methods to questions in information and library science: Bloomsbury Publishing USA; 2016; P: 562-566.
  27. Guba EG, Lincoln YS. Competing paradigms in qualitative research. Handbook of Qualitative Research. 1994; 2(163-194): 105.
  28. Devkota G, Basnet P, Thapa B, Subedi M. Factors affecting utilization of mental health services from Primary Health Care (PHC) facilities of western hilly district of Nepal. PloS One. 2021; 16(4): e0250694.
  29. Simar L, Wilson PW. Technical, allocative and overall efficiency: Estimation and inference. European Journal of Operational Research. 2020; 282(3): 1164-1176.
  30. Dawis RV, Lofquist L, England G. The Minnesota theory of work adjustment. Career Development. 2005; 1: 1993-2012.
  31. Soltaniyan MA, Aminbeidokhti AA. The role of sport on job burnout of employees. Koomesh. 2009; 10(4): 281-286.
  32. Lubbadeh T. Job burnout: A general literature review. International Review of Management and Marketing. 2020; 10(3): 7.
  33. Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. 2016; 15(2): 103-111.
  34. Shirtaheri A, Nami A, Ansari MS. Investigating the relationship between reducing burnout and employee stress. Journal of Accounting and Management Vision. 2020; 3(33): 32-61.
  35. Jaskyte K. The impact of organizational socialization tactics on role ambiguity and role conflict of newly hired social workers. Administration in Social Work. 2005; 29(4): 69-87.
  36. De Cieri H, Sheehan C, Donohue R, Shea T, Cooper B. Workplace bullying: an examination of power and perpetrators. Personnel Review. 2019; 48(2): 324-341.
  37. Elmerstig E, Thomtén J. Vulvar pain—Associations between first-time vaginal intercourse, tampon insertion, and later experiences of pain. Journal of Sex & Marital Therapy. 2016; 42(8): 707-720.
  38. Khadivzadeh T, Ardaghi M, Mirzaii K, Mazloum SR. The effect of interactive educational workshops with or without standardized patients on the self-efficacy of midwifery students in sexual health counseling. Journal of Midwifery and Reproductive Health. 2016; 4(2): 562-570.
  39. Motlagh M, Torkestani F, Ashrafian Amiri H, Agajani Delavar M, Radpooyan L, Nasrollahpour Shirvani S. Factors affecting the adequacy of prenatal care utilization index in the first level of network system in Iran. Journal of Babol University of Medical Sciences. 2021; 23(1): 76-83.
  40. Ziaee V, Ahmadinejad Z, Morravedji AR. An evaluation on medical students’ satisfaction with clinical education and its effective factors. Medical Education Online. 2004; 9(1): 4365.
  41. Bayrami R, Ebrahimipour H, Vafaee Najar A. Voices of midwives working in family physician 45 regarding their challenges and blessings: A qualitative study. Journal of Midwifery and Reproductive Health. 2018; 6(1): 1170-1178.
  42. Mostafavi F, Piroozi B, Mosquera P, Majdzadeh R, Moradi G. Assessing horizontal equity in health care utilization in Iran: a decomposition analysis. BMC Public Health. 2020; 20: 1-9.
  43. Masoumi Ganjgah P, Geranmayeh M, Haghani S. The Influential Factors in the Job Motivation among Midwives as the Healthcare Providers in the Iranian Health Sector Evolution Plan. Iran Journal of Nursing. 2020; 33(125): 13-27.
  44. Enteshari Z, Yamani N, Omid A. Assessment of knowledge and skills training needs among employed midwives in health and medical centers, compared to expected duties as a part of Health System Reform Program, 2019. Journal of Education and Health Promotion. 2020; 9(164).
  45. Khalajinia Z, Gaeeni M. Challenges in implementation of health care reform in the area of treatment qom city. Management Strategies in Health System. 2018; 3(3): 212-224.
  46. Hajiesmaello M. Explaining midwives' experiences regarding secondary traumatic stress and analysis of related factors based on results. PhDs thesis. Shahid Beheshti University of Medical Science School of Nursing and Midwifery. 2022: 147-149.
  47. Mohammad Mosadeghrad A. Occupational stress and its consequences: Implications for health policy and management. Leadership in Health Services. 2014; 27(3): 224-239.
  48. Bayati A, Ghanbari F, Maleki A, Hosseini S, Shamsi M. Exploring the Experiences of Midwife Regarding the Family Medicine Program. Nursing and Midwifery Journal. 2016; 13(10): 843-852.
  49. Hadjigeorgiou E, Coxon K. In Cyprus,‘midwifery is dying’. A qualitative exploration of midwives' perceptions of their role as advocates for normal childbirth. Midwifery. 2014; 30(9): 983-990.
  50. Hadjigeorgiou E, Kouta C, Papastavrou E, Papadopoulos I, Mårtenson LB. Women’s perceptions of their right to choose the place of childbirth: a qualitative study. International Journal of Childbirth. 2012; 2(4): 230-240.
  51. Kabir MJ, Ashrafian Amiri H, Rabiee SM, Hosseini S, Nasrollahpour Shirvani SD. Satisfaction of urban family physicians and health care providers in Fars and Mazandaran provinces from integrated health system. Journal of Health and Biomedical Informatics. 2018; 4(4): 244-252.
Journal of Midwifery and Reproductive Health
Volume 14, Issue 2
April 2026
Pages 5395-5410

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