title: Designing Iranian Model to Assess the Level of Health System Responsiveness.
abstract: BACKGROUND
  Given the rapid pace of changes in community health needs and the mission of healthcare organizations to provide and promote the community's health, the growing need to increase health system responsiveness to people as a key element of observance and fulfillment of justice is felt more than ever.
  
  
  OBJECTIVE
  This study was aimed at designing the native model of responsiveness for Iran and to validate the aspects of the proposed model.
  
  
  METHODS
  Our study had a cross-sectional design and was a validation study performed in 2014. In order to define and identify responsiveness model aspects, the first phase recorded the views of 200 key informants from 19 provinces of Iran. Snowball sampling was used to select experts (based on WHO guideline). Then, the opinions of 18 comments were received from service recipients in the form of three focus group discussions and were analyzed by the frame framework analysis (interviewed recipients were selected using the purposive sampling method). Finally, in order to confirm the model's efficacy, a responsiveness questionnaire with 7 aspects (domains) and 52 indicators (items) obtained from the initial proposed model was answered by 600 members of the selected families in the two provinces of Fars and Yazd. A multi-stage cluster sampling approach was used for the household survey. The results were analyzed by the Confirmatory Factor Analysis (CFA) test and through the use of Lisrel software.
  
  
  RESULTS
  Confirmatory Factor Analysis, based on the results of the key informant survey and group discussions, showed that according to quantities of GFI = 0.91, CFI = 0.93, NFI = 0.91, RMSEA = 0.074, SRMR = 0.061 and Hoelter (CN) = 178.54 in outpatient services and where GFI = 0.89, CFI = 0.91, NFI = 0.86, RMSEA = 0.064, SRMR = 0.053 and Hoelter (CN) = 158.93 for inpatient services, seven factors (F) (dignity, informed choice, confidentiality, patient training and informing, access to services, quality of basic amenities, and access to social support) are the main determinants of the responsiveness model and proposed model validity.
  
  
  CONCLUSIONS
  Given the comprehensiveness of presented aspects and indicators in this proposed model and its validity test, the aforementioned responsiveness model can be considered a suitable model to use when assessing the levels of health system responsiveness in Iran.
authors.affiliation: Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran; Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Roohollah
authors.initials: R
authors.lastname: Askari
authors.affiliation: Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Arab
authors.affiliation: Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran.
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
authors.affiliation: Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran; Utilization Research Center, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Akbari-Sari
authors.affiliation: Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Seyed Mostafa
authors.initials: SM
authors.lastname: Hosseini
authors.affiliation: Health Center of Hamedan, Hamadan University of Medical Sciences, Hamadan, IR Iran.
authors.forename: Hojat
authors.initials: H
authors.lastname: Gharaee
keywords: Health System Responsiveness; Inpatient Services; Iran; Outpatient Services