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. 2025 May 22;23(1):63.
doi: 10.1186/s12961-025-01300-4.

Identifying knowledge gaps in social determinants of health and related challenges in Iran; 2023

Ahad Bakhtiari  1   2 , Hakimeh Mostafavi  1   2 , Efat Mohamadi  1   2 , Fateme Yaftian  1   2 , Sahar Kargar  1   2 , Seyed Vahid Ahmady Tabatabaei  3 , Zainab Alimoradi  4 , Mahasti Alizadeh  5 , Ali Almasi  6 , Mostafa Amini-Rarani  7 , Morteza Arab-Zozani  8 , Nahid Ardian  9 , Ghorban Asgari  10 , Samad Azari  11 , Majid Babaei  12 , Narjes Bahri  13 , Masoud Behzadifar  14 , Sara Dadipoor  15 , Fatemeh Ghavidel  1   2 , Enayatollah Homaie Rad  16 , Zahra Jorjoran Shushtari  17 , Mahmood Karimy  18 , Ali-Asghar Kolahi  19 , Abdolhossain Madani  15 , Zohreh Mahmoodi  20 , Mohammad Moradi-Joo  21 , Masoud Motalebi Kashani  22 , Simin Mouodi  23 , Ali Asghar Najafpoor  24 , Majid Nakhaee  25 , Masoumeh Namadian  26 , Marzieh Nojomi  27 , Fatemeh Paknazar  28 , Bakhtiar Piroozi  29 , Mandana Saki  14 , Yaser Sarikhani  30 , Neda SoleimanvandiAzar  27 , Shahin Soltani  31 , Elahe Tavassoli  32 , Amin Torabipour  33 , Reza Vazirinejad  34 , Mehdi Vosoughi  35 , Amirhossein Takian  36   37   38 , Alireza Olyaeemanesh  39   40
Affiliations

Identifying knowledge gaps in social determinants of health and related challenges in Iran; 2023

Ahad Bakhtiari et al. Health Res Policy Syst. .

Abstract

Background: Socioeconomic determinants of health (SDH) account for about 40% of modifiable determinants of health, followed by health behaviours (30%), clinical care (20%) and physical environmental factors (10%). The "10/90 gap" is the idea that only 10% of global health research is devoted to conditions that account for 90% of the global disease burden. For over a decade, SDH research centres have been established in Iran to generate evidence and address SDH.

Objective: The purpose of this study was to evaluate the activities and challenges faced by SDH research centres and identify knowledge gaps.

Methods: We systematically categorized 759 approved projects (2012-2022) from 29 SDH centres using predefined themes (e.g. mental health, COVID-19, social inequalities). Interrater reliability was ensured through dual independent coding, with discrepancies resolved by consensus. In addition, a bibliometric analysis of 5892 PubMed-indexed articles was conducted using VOSviewer, a validated tool for mapping research trends and collaborations. This phase provided objective insights into publication patterns, keyword clusters and interdisciplinary networks. Finally, semi-structured surveys were conducted with SDH researchers to identify knowledge gaps and prioritize research areas. Prioritization criteria (e.g. disease burden, equity impact) were scored using a five-point Likert scale, and the results were validated through an expert panel to ensure alignment with real-world challenges.

Results: Out of the 759 approved research projects gathered from 29 reviewed centres, 79 projects were related to mental health, and 53 were related to coronavirus disease 2019 (COVID-19). A total of 5892 articles from 35 research centres obtained by searching PubMed were reviewed and analysed with VOS viewer software. The most frequently used keywords in the centres' published works are COVID-19, meta-analysis, systematic review, depression, anxiety, and quality of life. In 11 clusters, the 35 research centres under investigation collaborate with 82 additional research centres. Measuring different SDHs at the population level and carrying out related interventions cost far more than the centres' annual budget. Because of this and other factors stated in the results section, the research centres have shifted their focus to smaller research and more accessible and limited groups and subjects.

Conclusions: There is a mismatch between the subjects that the research centres' researchers believe should be studied and the approved projects of the centres, as is evident from a review of the centres' projects and their opinions. Numerous issues may be the root of these discrepancies, such as methods for ranking research subjects, methods for selecting study target groups, how to assess research centres and the different criteria set by colleges and universities.

Keywords: Iran; Knowledge management; Research priorities; Social determinants of health.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the ethical committee of the Tehran University of Medical Sciences. All methods were performed in accordance with the relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study phases and data used
Fig. 2
Fig. 2
Subjects of research that SDH centres focused on
Fig. 3
Fig. 3
The used keywords of 5892 articles from 35 research centres (left), keywords used in articles around inequality (right)
Fig. 4
Fig. 4
Collaborative clustering of research centres
Fig. 5
Fig. 5
The major challenges the centres had in determining and addressing SDH priorities
Fig. 6
Fig. 6
SDH factors in provinces that have a high impact on health inequalities
Fig. 7
Fig. 7
Prioritized research areas
See this image and copyright information in PMC

References

    1. Bhat AA, Rashid I, Hassan SU, Kansra P. Social determinants of health and health outcomes: a bibliographic review of the scientific literature from 2000 to 2021. Global Knowledge, Memory and Communication. 2023.
    1. Organization WH. Health in All Policies as part of the primary health care agenda on multisectoral action. World Health Organization; 2018.
    1. Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. The lancet. 2008;372(9650):1661–9. - DOI - PubMed
    1. Kontodimopoulos N. The association between social development and population health: a cross-sectional study across countries of different economic growth. Research in Health Services & Regions. 2022;1(1):2. - DOI - PMC - PubMed
    1. Islam MM. Social determinants of health and related inequalities: confusion and implications. Front Public Health. 2019;7:11. - DOI - PMC - PubMed

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