Proposing a framework for Health Impact Assessment in Iran

BACKGROUND Health impact assessments (HIA) of policies and projects are conducted differently in different contexts although there has been less HIA research to date in non-western countries. Global HIA research has however suggested that the technical conduct of HIAs is tied to broader conditions and influences to do with decision making and policy development. This study was conducted to develop a conceptual framework for progressing HIA in Iran including all factors influencing HIA planning and practice. METHODS A comprehensive review of the international HIA literature identified core characteristics and principles. Then key informant interviews (n = 14) identified Iranian perspectives about factors influencing HIAs practice. These two stages resulted in a conceptual framework for HIA planning and practice including influencing factors and HIA content that was confirmed by our participants using e-Delphi technique. RESULTS 91 HIA characteristics were organized into 20 categories. The interviews showed that four core concepts i.e. context, actors, HIA principles and policies and HIA capacities influence HIA practice in Iran. Comprehensive content of HIA considering all health dimensions and health determinants, assessing health inequalities, appropriate HIA type, quantification and participation is formed under influence of the above mentioned four factors. The study also demonstrated need to redefine the HIA principles and make decision about integration of HIA in Environmental Impact Assessment and also about the level of HIA before implementing HIA. The e-Delphi resulted in expert consensus on the variables, concepts, and their relations in proposed framework. CONCLUSIONS Progressing HIA practice in Iran is perceived locally as subject to similar contextual conditions to those identified in the international literature. Further we have demonstrated the utility of mixed methods to progress HIA implementation in differing country contexts.