Study designThe present study was an applied research conducted in 2022, consisting of five stages with no interventional or clinical trial method. All methods in this research were carried out by the relevant guidelines and regulations and the study protocols were approved by by the Ethics Committee of Ahvaz Jundishapur University of Medical Science, Iran with the reference number of IR.AJUMS.REC.1400.153. In the first phase, the necessary information was gathered by visiting relevant centers, observing and reviewing the process of recording and reporting infectious data, and interviewing the experts responsible for this matter. Then, the data collected from the previous stage was analyzed by the expert panel using a Likert scale. The following explains the step-by-step process of completing the work.Review of data sourcesThis study was conducted in Bushehr province in the southern region of Iran by collecting information from healtcare system. For this purpose, as a first step, all registration and reporting procedures (paper and electronic) were observed and all forms and policies for communicable diseases reporting protocol, especially COVID-19, were reviewed in the health and treatment departments of the University of Medical Sciences, including Vice-Chancellor of Health, Vice-Chancellor of treatment, Counties Health and Treatment Network, university hospital considered the main hospital for admitting patients with COVID-19, Comprehensive Urban Health Centers, Reference laboratories to perform COVID-19 diagnostic tests, Health houses and Private Centres. All identified weaknesses and strengths were documented. During this stage, in order to identify the main weaknesses and strengths, an interview was held at this stage with the experts responsible for collecting and reporting the data.Participants included: communicable disease control experts (working in the headquarters of the Vice President of Health, Counties Health and Treatment Network and Comprehensive Urban Health Centers) and managers working in Vice President of Treatment (Department of Statistics and Medical Records) of Bushehr and Ahvaz Universities of Medical Sciences. They were not only familiar with healthcare system but also had sufficient experience at different levels of the healthcare system system and infectious diseases (at least 2 years of work experience). At this stage, sources were continuously reviewed and experts were interviewed until data saturation was achieved and no new strengths or weaknesses emerged from the sources or the experts’ discussions.In this step, the method of purposive sampling was applied. This method is used when the researcher intends to include the views, opinions and attitudes of specific individuals in the resulting information. At this stage, 12 people were interviewed according to the criteria. In-depth semi-structured interviews were conducted to collect data. After informed and verbal consent was obtained from the participants and the objectives of the research were explained, a face-to-face interview was conducted at the participants’ workplace at an agreed time. The interviews were recorded using a digital recorder. They lasted between 30 and 45 min and the data was collected over a period of three months. The information from the interviews was then analysed using content analysis.After the weaknesses and strengths were fully extracted, a group discussion was held in two sessions with four experts and faculty members of Ahvaz University of Medical Sciences (PhD in Health Information Management, PhD in Medical Informatics, PhD in Public Health Science and Infectious specialist) to reach a complete overview and consensus.Questionnaire developmentThe sources review provided a working basis for developing a questionnaire to elicit the expert panel’s individual opinions about strengths and weaknesses of the health information management system. The experts who participated in the survey were asked to assign a priority value to each of the questionnaire items using a five-point Likert scale. Based on this scale, a score of 0 represented the “Strongly disagree” and a score of 4 represented the “Strongly agree”. Finally, participants were asked to suggest new items that were not listed. The face validity of the questionnaire was confirmed by experts. For this purpose, the questionnaire was given to two experts with a doctorate in health information management. In order to determine the content validity, it was given to 13 experts, including academic teachers, epidemiologists, specialists and experts in infectious diseases from different levels of the healthcare system, including the Ministry of Health, the deputy healthcare of universities, the headquarters of the provincial health network of cities and provinces. After collecting opinions and calculating the content validity index (CVI) and content validity ratio index (CVR) of the questionnaire, the content validity of the questionnaire was confirmed. Reliability of each section of the questionnaire was also confirmed by Cronbach’s alpha of 0.84, 0.84, and 0.89 for the three dimensions of weaknesses (a, b, and c), respectively, and 0.73 and 0.89 for the two dimensions of strengths (d and e), respectively. The proposed questionnaire contained tree parts: the first part of the questionnaire collected the personal characteristics of the participants, including sex, age, educational level, field of study, place of work, and work experience. The questionnaires were anonymous and the participants’ identification information (name and ID code) were not asked. The second part of the questionnaire focused on weaknesses of the system, which included three main dimensions: a) Registration and reporting policies, b) Design of current information systems for registration and reporting, and c) Training and supervision of people in charge of data registration and reporting. In the third part of the questionnaire, the strengths were asked, which included two main dimensions: d) Registration and reporting policies and e) Design of current information systems for registration and reporting. The two later parts included 54 items. For each item in the questionnaire, five columns of “Strongly disagree”, “Disagree”, “I have no opinion” , “Agree” and “Strongly agree” with a score of 0–4, respectively, were considered. At the end of each dimension, a blank row was provided for experts to add suggestions. The final questionnaire was designed electronically on an Iranian platform, used for creating electronic questionnaires, called “Porsline”.Selection of participantsAccording to the study’s objectives, participants were selected for opinion polls based on their specialized knowledge, work experience during the COVID-19 pandemic, and their organizational position within Iran’s health system. Therefore, it was necessary to select individuals who are most familiar with the system for registering and reporting infectious diseases with pandemic potential in Iran. To identify these participants, we utilized the experiences of three specific groups directly involved in collecting and reporting patient data or controlling outbreaks during the COVID-19 pandemic:
1.
The executive team of the COVID-19 registry system in Khuzestan province:
The registry system was implemented in Khuzestan province from April 2020 to September 2022. The details related to it have been mentioned in previous studies23,30.
2.
Members of the provincial headquarters for the management of COVID-19:
The coordination between organizations and macro-policy making in response to the COVID-19 situation in each province was assigned to the provincial COVID-19 management headquarters. This headquarters was established under the supervision of the governor of each province, with the participation of the leaders of all organizations directly and indirectly involved in the management of COVID-19. In the present study, assistance was sought from some former members of the provincial COVID-19 management headquarters in Khuzestan province to select participants.
3.
Members of the intra-university committee for the management of COVID-19 in medical sciences universities:
According to the structure of the health system in Iran, which is centered on medical sciences universities31, each province, in addition to the provincial headquarters for COVID-19 management, also had a dedicated committee within the relevant university/universities of medical sciences for controlling COVID-19. This committee was responsible for coordinating the activities of various vice-chancellors of the university, different health service centers, and health planning in response to the COVID-19 situation in the covered geographical area. Additionally, this committee reported to the provincial headquarters for the management of COVID-19. In this study, the recommendations of some former members of the intra-university committee for the management of COVID-19 at Ahvaz Jundishapur University of Medical Sciences address were used to select the participants.
Based on their opinions, a list of target experts was selected to participate in the study (Table 1).Table 1 Experts selected to participate in the study and inclusion and exclusion criteria for their selection.After identifying the desired experts to participate in the study, the next step involved sending questionnaires to these individuals. During summer 2022, the questionnaires were sent to the healthcare employees at different levels via email, WhatsApp or Telegram. The researcher obtained verbal and written consent from the participants to take part in the study. Obtaining verbal consent to send the questionnaire was achieved by explaining the objectives and benefits of the research in person to the participants, as well as by sending voice messages in online groups. At the beginning of the online questionnaire, the statement “I am participating in this research with full knowledge and consent” was provided, along with the options to select “Yes” or “No” to obtain written consent. In this manner, participants who responded positively were able to access the questionnaire content and complete it. Participants who selected “no” exited the software without viewing the questionnaire content. Therefore, informed consent was obtained from all participants for their participation in the study. At the end, 100 participants completed questionnaires. There was no response from 50 participants. Table 2 shows the demographic characteristics of the study participants.Table 2 The demographic characteristics of the study population.Survey of participantsTo calculate the total score, the mean scores for each section’s strengths and weaknesses were calculated separately. The resulting number was then converted into a percentage according to the following equation:Mean/4*100After the initial ranking, if the percentage is less than 50 (average less than 2), the items were removed from the questionnaire. At this stage, all items received a percentage above 50% and all of them remained in the study.Statistical analysisThe collected data were input into Microsoft Excel 2019 software, used for the statistical analyses. The results were described using descriptive statistics, including mean ± standard deviation (SD) for quantitative variables and frequency (percentage) for categorical variables.