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Background Suicide remains a leading cause of death worldwide and a critical global public health concern. Although the majority of suicides occur in low- and middle-income countries (LMICs), prevention in these contexts is often hampered by limited mental health infrastructure, entrenched stigma, and systemic barriers. In Iran, although the national suicide mortality rate remains comparatively low, a growing trend in suicide attempts—especially among youth—has raised concern. However, little is known about the sociocultural and structural drivers of suicidal behavior in underserved regions such as southeastern Iran. This study aimed to explore the underlying causes of suicide attempts among individuals served by health services affiliated with Bam University of Medical Sciences. Methods This qualitative case study was conducted with 54 individuals who had previously attempted suicide. Participants were recruited through purposive and snowball sampling. Data were collected using semi-structured interviews and analyzed thematically using MAXQDA version 2022. Data saturation was reached during the analysis. Results Thematic analysis identified four major themes and seventeen subthemes: (1) Limited resilience (family/friend conflict, grief, emotional collapse); (2) Contextual stressors (economic hardship, hopelessness, mandatory military service, gender identity-related stigma, environmental trauma); (3) Distressed marital experiences (forced marriage, divorce, family interference, spousal abuse, fear of social judgment and honor-based pressure); and (4) Psychological problems, including depression, psychological stress, lack of access to mental health services, and spiritual crisis. Many participants described a buildup of diverse stressors—emotional, relational, and contextual—indicating that suicide risk arose from compounding life adversities rather than a singular cause. Cultural norms—such as gender roles, stigma around mental illness, and restricted marital autonomy—exacerbated these vulnerabilities and discouraged help-seeking. These intersecting factors often compounded one another, illustrating that suicidal behavior in this population emerged from a layered accumulation of distress rather than any single cause. Conclusion Suicidal behavior in this population is shaped by a complex interplay of psychological distress, social adversity, and entrenched cultural norms. Culturally informed mental health services are essential, particularly for high-risk groups including youth, women, and gender minorities. Structural reforms—such as improving economic conditions, revising conscription policies, addressing stigma, and expanding access to counseling—are necessary to strengthen suicide prevention in similar sociocultural settings.

Background The COVID-19 pandemic is a global crisis, and health systems worldwide have faced numerous challenges in containing it. This study aimed to identify the challenges faced by the Iranian health system in controlling the COVID-19 pandemic. Methods A conventional content analysis approach was employed in this qualitative study. The research sample included experts responsible for managing, making decisions about preventing COVID-19, and caring for and treating patients. The purposive sampling technique was used to select the participants. Data saturation was achieved after 29 interviews. Additionally, conventional content analysis was applied for data analysis. Results The participants in this study identified the most significant challenges faced by Iran's health system in controlling the COVID-19 pandemic, including issues related to human resources, physical and organizational structures, financial resources, inter-sectoral collaboration, personal protective equipment (PPE), social responsibility, and information services. Conclusions Identifying these challenges can help health system managers prioritize the most critical issues. Addressing these challenges requires more than just the efforts of health systems; cooperation at the macro governance level is essential. Governments should start planning to formulate appropriate strategies.

Introduction Academic performance is one of the indicators of the success of educational systems in achieving their goals, influenced by various factors. The aim of this study was to examine the status of academic performance and predict it based on the variables academic identity, academic excitement, and academic enthusiasm among students of Jiroft University of Medical Sciences in southern Iran in 2024. Methods This descriptive-analytical cross-sectional study was conducted on 290 students. Data were collected using standardized questionnaires on academic identity, academic excitements, academic enthusiasm, and academic performance. The data were analyzed using t-tests, ANOVA, Pearson correlation coefficients, and multiple linear regression at a significance level of 0.05. SPSS version 23.0 was utilized for data analysis. Results The mean scores for academic identity, positive academic excitement, negative academic excitement, academic enthusiasm, and academic performance of the studied students 112.45 ± 9.38 out of 195, 56.66 ± 8.34 out of 110, 199.38 ± 9.34 out of 265, 40.41 ± 6.32 out of 75, and 136.35 ± 6.85 out of 240, respectively. A statistically significant correlation was observed between academic performance and academic identity ( r  = 0.576, P  < 0.001), positive academic excitements ( r  = 0.627, P  < 0.001), negative academic excitements ( r = -0.635, P  < 0.001), and academic enthusiasm ( r  = 0.656, P  < 0.001). The correlation between academic performance with academic identity, positive academic excitements, and academic enthusiasm was in a direct direction and inversely correlated with negative academic excitements. According to the results of multiple linear regression, the components of academic identity (academic commitment; β = 0.648, future orientation; β = 0.643, personal agency; β = 0.638, belonging academic; β = 0.631, self-concept; β = 0.629), positive (hope; β = 0.669, enjoyment; β = 0.665, pride; β = 0.647) and negative (hopelessness; β= − 0.657, fatigue; β= − 0.653, anxiety; β= − 0.641, shame; β= − 0.632, anger; β= − 0.531) academic excitements, and academic enthusiasm (cognitive enthusiasm; β = 0.662, behavioral enthusiasm; β = 0.659, emotional enthusiasm; β = 0.652) were identified as predictors of students’ academic performance ( P  < 0.05). Conclusion Academic Identity, positive and negative academic excitements, and academic enthusiasm were identified as predictors of students’ academic performance. Therefore, it is recommended that senior educational managers of the university facilitate the improvement of academic identity, positive excitements, and academic enthusiasm, while controlling negative excitements among students by organizing relevant courses and workshops, to witness the growth and enhancement of their academic performance. In addition, faculty members’ capacity and role can be leveraged to shape and strengthen students’ academic identity. Moreover, fostering vibrant cultural, social, and academic environments within universities is recommended to boost positive academic excitement, reduce negative academic excitement, and cultivate academic enthusiasm. Clinical trial number Not applicable.

Background This study aims to identify policy content challenges related to high-risk sexual behaviors, stimulant drugs, and alcohol consumption in Iranian adolescents. Methods This qualitative study analyzed high-level and national documents pertaining to adolescent health, high-risk sexual behaviors, stimulant, and alcohol consumption in adolescents. The documents, which were published by public organizations between January 1979 and February 2023 and publicly available, were complemented by interviews with policymakers and executives. The study involved reviewing 51 papers and conducting interviews with 49 policymakers and executives at the national, provincial, and local levels who were involved in addressing adolescent behaviors related to high-risk sexual behaviors, stimulant, and alcohol consumption. The data collected was analyzed using conventional content analysis. Results The study’s results involved examining policy content and identifying challenges related to policy content. The analysis revealed that from the beginning of the Iranian revolution in 1979 until the late 1990s, the dominant approach in Iran was to deny the existence of high-risk behaviors among adolescents. However, in the early 2000s, the country began to adopt a new approach that acknowledged the social harms and ineffectiveness of previous strategies. As a result, a new policy framework was introduced to address high-risk behaviors among adolescents. The study’s interviews with policymakers and executives identified 12 challenges related to policy content, including parallel programs, lack of institutional mapping, lack of evidence-based policymaking, lack of integrated approach regarding training, late parent training, lack of consideration of all occurrence reasons in adolescents’ high-risk behaviors policymaking, and the existence of many abstinence policies regarding high-risk behaviors. Conclusions The study’s findings suggest that high-risk behaviors among adolescents in Iran are primarily a health issue, rather than a social or ideological one. Unfortunately, ideological approaches, stigma, and policymaking based on anecdotes rather than evidence have had a significant impact on this area. To improve policymaking in this domain, it is crucial to address these challenges by tackling stigma, adopting an integrated and holistic approach, and implementing evidence-based policies that consider all relevant aspects, including adolescents’ subcultures and policy audiences. Such an approach can also be useful for other countries facing similar conditions.

Background The aim of this study was to present challenges of implementing the accreditation model in university and military hospitals in Iran. Methods In this qualitative study, purposive sampling was used to select hospital managers and implementers of the model working in 3 hospitals affiliated to Kerman University of Medical Sciences and in 3 military hospitals in Kerman, Iran. A total of 39 participants were interviewed, and semi-structured questionnaires and thematic analysis were used for data collection and analysis, respectively. Results In this study, 5 major codes and 17 subcodes were identified: (1) perspectives on accreditation model with 5 subcodes: a difficult and time-consuming model, less attention to the patient, accreditation as a way of money acquisition, not being cost-effective, and accreditation means incorrect documentation; (2) absence of appropriate executive policy, with 3 subcodes: lack of financial funds and personnel, disregarding local conditions in implementation and evaluation, and absence of the principle of unity of command; (3) training problems of the accreditation model, with 2 subcodes: absence of proper training and incoordination of training and evaluation; (4) human resources problems, with 3 subcodes: no profit for nonphysician personnel, heavy workload of the personnel, and physicians’ nonparticipation; (5) evaluation problems, with 4 subcodes: no precise and comprehensive evaluation, inconformity of authorities’ perspectives on evaluation, considerable change in evaluation criteria, and excessive reliance on certificates. Conclusions This study provided useful data on the challenges of implementing hospitals’ accreditation, which can be used by health policymakers to revise and modify accreditation procedures in Iran and other countries with similar conditions. The accreditation model is comprehensive and has been implemented to improve the quality of services and patients’ safety. The basic philosophy of hospital accreditation did not fully comply with the underlying conditions of the hospitals. The hospital staff considered accreditation as the ultimate goal rather than a means for achieving quality of service. The Ministry of Health and Medical Education performed accreditation hastily for all Iranian hospitals, while the hospitals were not prepared and equipped to implement the accreditation model.

Background Substance use disorder is a persistent public-health challenge in Iran, where multiple treatment settings operate in parallel. This study assessed within-modality changes over 12 months among clients in Methadone Maintenance Treatment (MMT), Drop-in Centers (DICs), Therapeutic Communities (TCs), compulsory (Article 16) treatment. Methods A prospective, naturalistic cohort was conducted across 15 routine-care centers in Kerman Province (May 2023–May 2024). Of 493 enrolled, 470 completed follow-up (MMT/DIC at 12 months; TC/compulsory at end-of-treatment [EOT]). MMT/DIC were assessed at baseline, 2 months, and 12 months; TC/Article 16 at baseline and EOT. Outcomes were assessed using the Maudsley Addiction Profile (MAP). Within-modality changes from baseline were estimated with mixed-effects models in Stata 15, using two-sided tests (α = 0.05). Results MMT was associated with reductions in alcohol, opium, and heroin use, lower odds of interpersonal conflicts, fewer physical/psychological problems, and fewer days of illness-related unemployment. DIC showed decreases in physical/psychological problems, drug-related harms (e.g., dealing), and fighting; changes in spouse/relative/friend-conflict indicators were not statistically significant. TC showed short-term reductions in several substances; employment decreased during the residential phase (a programmatic constraint rather than a change in employability). Article 16 showed declines in selected substances and health problems during observation; durability post-discharge remains uncertain. Conclusions Findings indicate domain-specific, within-modality changes rather than comparative effectiveness between settings. In TCs, short-term within-modality declines were observed in alcohol and selected illicit opioids at EOT alongside limited employment opportunities during residence due to programmatic restrictions. Within MMT, improvements were observed in selected psychosocial indicators at follow-up, consistent with stabilization during ongoing care. Within DICs, reductions were observed in health problems and certain risk behaviors, aligning with their harm-reduction and linkage role. Within Article 16, short-term declines were observed in selected substances and health problems during observation; durability after discharge is uncertain without structured aftercare. Overall, no single modality appears universally superior; matching clients to treatment according to target outcomes, and implementing stepped-care or blended pathways with robust post-treatment supports—particularly following compulsory programs—may optimize long-term impact.

Background Substance use remains a pressing global public health concern and has shown a marked increase in recent years. This study investigates the characteristics and risk behaviors of individuals who use substances across various treatment centers in the city of Kerman, Iran. Methods This descriptive cross-sectional study was conducted in May 2023 across multiple treatment centers in Kerman. A total of 470 participants were recruited from Methadone Maintenance Treatment (MMT) centers, Therapeutic Community (TC) centers, Article 16 compulsory treatment centers, and Drop-in Centers (DICs). Data were collected using the Maudsley Addiction Profile (MAP) questionnaire and laboratory tests, and analyzed using STATA software. Results Ninety percent of participants were male, with the most common age range being 26 to 45 years. More than 70% reported initiating substance use after the age of 18. Approximately 64.89% had attempted to stop using substances fewer than two times, while 13.62% had made more than six unsuccessful attempts. Patterns of alcohol, opium, and methamphetamine use varied across treatment settings. The highest rates of syringe sharing, unprotected sexual activity, and criminal activity were reported in the Article 16 center, whereas MMT centers reported the highest levels of spousal conflict. TC centers had the lowest levels of methamphetamine and morphine use. Conclusion The majority of participants were male and began using substances after the age of 18. Patients in the Article 16 center exhibited the highest levels of high-risk behaviors, including injection-based substance use, unprotected sexual activity, and criminal involvement. In contrast, MMT centers showed the highest levels of familial conflict, and TC centers had the lowest prevalence of methamphetamine and morphine use. These findings highlight the need for context-specific harm reduction and treatment strategies tailored to the distinct substance use patterns and risk profiles within each treatment setting. Given the structural and demographic differences—such as voluntary enrollment in MMT versus mandated treatment in Article 16—comparative interpretations should remain descriptive and cautious.

Background Drug use is one of the most common public health problems globally. This study was done to analyze the agenda-setting of policies related to substance use disorder treatment in Iran since 1979. Methods The current qualitative study was done through document review and interviews with policymakers and executives. Purposive sampling with snowball strategy was considered for sampling. Semi-structured interviews were done. A total of 22 documents were examined, and the data were saturated with 32 interviews. Kingdon's Multiple Streams Framework was used to analyze the data. Results The results indicated the intersection of problem stream, policy stream, political stream, and opening the opportunity window. In the problem stream, the rapid growth of AIDS among people who inject drugs (PWID), the decrease in the average age of first drug use, the increase in the prevalence of substance use disorder in women, the ineffectiveness of compulsive treatment, and criminological perspectives played key roles. The policy stream included criminological perspective and war on drugs, and harm reduction. The political stream included announcing general anti-narcotics policies by the Supreme Leader of Iran and understanding the need for treatment, rehabilitation, harm reduction, and social support for substance use disorder by officials and policymakers. Conclusions For a long time in Iran, policies based on the war on drugs were the dominant approach, and then, policies based on harm reduction and patient-centeredness were considered. The ideology and political parties influenced the executive apparatus's policy stream in this area. In countries with an ideological approach, the political stream plays a critical role in setting issues on the agenda. Therefore, policy entrepreneurs can put the points on the agenda by attracting the attention of political forces to the issue.

Background Different countries, including Iran, have implemented various policies to address substance use disorder. This study aims to describe the policies related to substance use disorder treatment and identify challenges related to these policies in Iran since the beginning of the Iranian Revolution in 1979. Methods This qualitative study utilized document analysis and interviews with policymakers and implementers. We reviewed a total of 22 documents related to substance use disorder treatment and harm reduction. The results from document analysis complemented and validated the interview data. The research population comprised policymakers and implementers, including individuals directly involved in formulating and implementing substance use disorder treatment policies. Purposive sampling was employed, with a snowball strategy utilized to maximize diversity. Data saturation was achieved after conducting 32 semi-structured interviews. Conventional content analysis was used for data analysis. Results In general, the policy landscape for substance use disorder treatment in the Islamic Republic of Iran can be divided into two periods: the “Moral Model” era (1979–1993) and the “Disease Model” era (1993–present). Challenges within the content of substance use disorder treatment policies in Iran encompass the lack of law revisions, existence of contradictions in laws and nature of disease, the absence of evidence-based policymaking, and an inadequate comprehensive perspective on the phenomenon of substance use disorder. Conclusions The presence of multiple authorities with different perspectives on substance use disorder and its treatment, coupled with the application of personal preferences in policymaking and the absence of evidence-based policymaking, have contributed to weaknesses in decision-making and policy formulation. The true philosophy of Disease Model appears not to have been fully grasped by health policymakers in Iran, as all Disease Model policies have been pursued with an emphasis on abstinence and quitting. Iran and other nations facing similar challenges should place more reliance on evidence-based approaches and shift away from the “Moral Model” paradigm to develop more effective substance use disorder treatment policies.

Background This research article retrospectively analyses the agenda-setting approach of policies concerning high-risk sexual behaviours, stimulant and alcohol abuse among Iranian adolescents. Methods This qualitative case study policy analysis involved analysing 51 national documents and conducting interviews with 49 policy-makers and executives. Purposive sampling with a snowball strategy and semi-structured interviews were used. The data was analysed using the framework analysis method, with Kingdon’s multiple streams framework serving as the analytical framework. Results The study has identified the confluence of several factors, including the problem stream, the policy stream and the political stream. Within the problem stream, several factors contributed, such as the prevalence of high-risk behaviours, strong scientific evidence on these behaviours, changes in human immunodeficiency virus (HIV) transmission patterns, increased statistics of poisoning and deaths related to alcohol abuse, and the visit of Iran’s supreme leader to the slums of Mashhad city. The policy stream has two periods of denial and acceptance. The denial period includes considering these high-risk behaviours to be the consequences of western culture, emphasis on the religious aspects and sinfulness of these behaviours, resisting the prevalence of anomalous behavioural patterns, abstinence and religious obligation of chastity, and avoiding ethical corruption. The acceptance period includes adolescents training, fear messages, promotional and cultural activities, parent training, school staff training, providing psychiatric services for withdrawal, counselling and reference to receive specialized services. The political stream involves global attention towards non-communicable diseases and high-risk behaviours, and the significant impact of preventing these behaviours during adolescence on the health status of society. Also, the supreme leader’s attention to social harms, and the establishment of the National Committee for Prevention and Control of Alcohol, have played significant roles. Conclusions While the problem stream helped to highlight the problem and increase policy-makers’ attention, the politics stream played a significant role. Despite international evidence on the effectiveness of training in sexual issues in reducing high-risk behaviours, it did not succeed in being added to the agenda. The policy stream was heavily influenced by ideology and the political parties in power, affecting evidence-based policy-making. In countries with an ideological approach, the political stream plays a vital role in setting problems on the agenda.