Health system responsiveness for outpatient care in people with diabetes Mellitus in Tehran

Fatemeh Sajjadi, Maziar Moradi-Lakeh* (Corresponding Author), Marzieh Nojomi, Hamid R. Baradaran, Fereidoun Azizi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)
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Background: World Health Organization (WHO) defines three goals to assess the performance of a health system: the state of health, fairness in financial contribution and responsiveness. We assessed the responsiveness of health system for patients with diabetes in a defined population cohort in Tehran, Iran. Methods: Total responsiveness and eight domains (prompt attention, dignity, communication, autonomy, confidentiality, choice, basic amenities and discrimination) were assessed in 150 patients with diabetes as a representative sample from the Tehran Glucose and Lipid Study (TLGS) population cohort. We used the WHO questionnaire and methods for analysis of responsiveness. Results: With respect to outpatient services, 67% (n=100) were classified as Good for total responsiveness. The best and the worse performing results were related to information confidentiality (84% good responsiveness) and autonomy (51% good responsiveness), respectively. About 61% chose "communication" as the most important domain of responsiveness; it was on the 4th rank of performance. The proportions of poor responsiveness were higher in women, individuals with lower income, lower level of education, and longer history of diabetes. "Discrimination" was considered discrimination as the cause of inappropriate services by 15%, and 29% had limited access to services because of financial unaffordability. Conclusion: Health system responsiveness is not appropriate for diabetic patients. Improvement of responsiveness needs comprehensive planning to improve attitudes of healthcare providers and system behavior. Activities should be prioritized through considering weaker domains of performance and more important domains from the patients' perspective.

Original languageEnglish
Article number293
Number of pages13
JournalMedical Journal of the Islamic Republic of Iran
Early online date15 Nov 2015
Publication statusPublished - 2015

Bibliographical note

We would like to thank the people who have collaborated in this study: Mr. K. Ahmadi, Iran's permanent representative at the UN Office in Geneva, Naidoo Nirmala Devi at the WHO, Dr Seyyed Mohammad Sajjad, Dr Sarah Shakerian the Department of Social Medicine.


  • Delivery of healthcare
  • Diabetes mellitus
  • Iran
  • Patient satisfaction
  • Responsiveness


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