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Open Access Research article

The range and diversity of providers’ viewpoints towards the Iraqi primary health care system: an exploration using Q-methodology

Nazar P Shabila1*, Namir G Al-Tawil1, Tariq S Al-Hadithi1 and Egbert Sondorp2

Author Affiliations

1 Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq

2 London School of Hygiene and Tropical Medicine, London, UK

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BMC International Health and Human Rights 2013, 13:18  doi:10.1186/1472-698X-13-18

Published: 21 March 2013

Abstract

Background

The increasingly recognized need for reorganizing the primary health care services in Iraq calls for a comprehensive assessment of the system to better understand its problems and needs for development. As part of such comprehensive assessment and due to the important role of primary health care providers in adopting any change, we ought to explore the range and diversity of viewpoints of primary health care providers towards the Iraqi primary health care system.

Methods

This explorative study was carried out in Erbil governorate, Iraq from May to July 2011. Data were collected from primary health care providers using Q-methodology to elicit subjective viewpoints and identify shared patterns among individuals. Forty primary health care providers representing eight primary health care centers sorted 41 statements reflecting different aspects of the Iraqi primary health care system into a distribution on a scale of nine from “disagree most” to “agree most”. By-person factor analysis was used to derive latent viewpoints through centroid factor extraction and varimax rotation of factors.

Results

Analysis of the participants’ Q-sorts resulted in four distinct viewpoints among primary health care providers toward the current primary health care system. One factor emphasized positive aspects of the current primary health care system that is content with the current primary health care system. The other three factors highlighted the negative aspects and they included (i) professionally-centered viewpoint, (ii) comprehensive perception and problem-based solutions and (iii) critical to leadership/governance aspects of the system.

Conclusions

This study revealed diverse viewpoints of primary health care providers toward the current Iraqi primary health care system and recognized the particular issues related to each viewpoint. The findings can contribute to a better understanding of health policy makers and primary health care managers concerning the problems facing the primary health care system that might contribute to change in the management of this system.

Keywords:
Primary health care; Q-methodology; Providers; Assessment