there are many challenges in reproductive health and it is necessary to train experts to manage them . the aim of this study was to define the tasks of master of science ( msc ) graduates in reproductive health through comprehensive needs assessment to establish the course .
the study comprised of three steps . in the first step , through literature review , the draft and basic fields of main tasks were defined . in the second step , by establishing a focus group of 10 experts , the tasks were extracted on the basis of the country s needs . in the third step ,
a delphi study was carried out among 51 experts who were selected to finalize the list of tasks and their priorities using three criteria of  importance  ,  feasibility  and  availability  .
57 tasks were extracted with regard to the four main functions of management and planning , education , consultation , and screening in reproduction age of men and women . according to delphi s results and their priorities , 45 tasks were important and feasible but not available , and they were higher - priority tasks .
the tasks extracted are consistent with the framework of reproductive health provided by the world health organization ( who ) and the american guideline of educational planning . however , considering the differences of problems in iran comparing with other countries , the list is not exactly similar to any list prepared for other countries . therefore , it is necessary to consider the results of this research in university curriculums .
reproductive health is an important health topic , adolescence , and puberty of men and women
. it also influences the health of future generations . by expansion of science , particularly medical sciences , and considering the importance of health ,
reproductive health is one of the appropriate indices in evaluation of countries development , especially for developing countries . according to the definition provided by who
, reproductive health is a state of complete physical , mental , and social wellbeing in reproduction process and function throughout one s life .
therefore , all people should have a healthy and satisfactory sexual life , and be able to freely make decision about the time and method of bearing their child . in this regard
, all people should have the right to access information , facilities and the highest standards of reproductive and sexual health without any discrimination , obligation or violence .
contrary to the definition of reproductive health and the policies of the united nations population fund , most countries , including the usa , canada , and japan , mostly rely on the traditional approach of mother and child health , based on the susceptibility of women in reproduction and fertility roles and paying special attention to the physiologic characteristics of women and their needs . in this
regard , ministry of health is responsible for policy - making and general planning for men and women in various aspects .
it should be noted that in recent years , application of the gender equality policies and the working plan of the women s world conference in beijing have caused considerable development in health sector and the policies and plans of ministry of health on topics , such as sexual health and aids , screening of cancers , mental health , and prevention of domestic violence .
our society also faces some challenges in reproductive health , which should be fundamentally addressed .
moreover , by following the health and education regulations , these problems can be prevented or treated , or their rehabilitation be facilitated .
some of these problems to consider are infertility , breast cancer , prostate cancer , puberty health , sexual dysfunction , illegal abortions , menopause , health care in these stages of life and new fatal sexually transmitted diseases , such as aids .
for instance , breast cancer is among the most common cancers in iranian women . by increasing the general knowledge , timely diagnosis and effective treatment , more than 50% of the cancer patients would experience a long life .
therefore , organized educational , health , and therapeutic plans on prevention of breast cancer are required to increase the knowledge level and attitude of women toward breast cancer , and consequently promoting their participation in the screenings . with regard to abortion , the statistics published in 2008 indicated that the global rate of unsafe abortion increased from 19.7 million cases in 2003 to 21.8 million cases in 2008 , which mostly occur in third world countries .
this is while the rate was expected to reduce , owing to the improvement in health facilities and conditions .
, almost one fourth of iranian women experience primary infertility in their married life , with the incidence rate of 3.4% .
the couples age , health , treatment modalities , the age of marriage , and fertility potential are important factors in interpretation of the prevalence of primary infertility . by providing training and access to appropriate consultation
considering the problems exist in sexual and reproductive health , it is necessary to establish an applied major , which directly deals with the problems of reproduction in the society . in this regard , defining the tasks of graduates in this major in iran as the first step of educational planning is necessary .
occupational analysis is usually the first step in educational planning to determine what students should learn .
occupational analysis of educational planning is fragmentation of the learning items that the students are expected to learn about how to do the job .
occupational analysis helps us to define the skills required for students in learning the prerequisites .
therefore , it is necessary to consult the specialist in the field and those who may involve in the process in this respect .
the aim of this study was to define the tasks of the msc graduates of reproductive health by experts .
web services have been used in some vast needs assessment programs in the world . considering the extension and distribution of the study population , this method was more appropriate for the study .
the study comprised of three steps . in the first step , through literature review , the draft and basic fields of main tasks related to the job of msc graduates of reproductive health were defined .
then , in the second step and by establishing a focus group of 10 experts of various specialties , the fields and tasks were extracted on the basis of the country s needs .
the group consisted of two faculty members of midwifery , four phd students of reproductive health with the career in being faculty members , two obstetricians , one geneticist and one urologist .
the group members had a history of working in this field and some of them were involved in curriculum planning .
then , small groups of three experts were formed to discuss the list of the major s establishment objectives and its tasks , and finally they achieved consensus on the items . to make sure about the tasks that were extracted by the focus group of experts
, the tasks were sent for the representative of each group , and some required modifications were done and returned back to them ; ultimately the approved tasks were determined to be used for opinion poll of other experts . in the third step ,
delphi study was carried out using the web to finalize the list of tasks and their priorities . at this step ,
it was necessary to perform priority setting of the tasks and the opinions of experts were obtained .
the sampling was goal oriented , and the experts were selected among the iranian obstetrics and gynecology specialists , phd students of reproductive health , the professionals in the field , faculty members of reproductive health , mother and child health , and midwifery .
the faculty members were selected from the medical universities with msc courses , such as isfahan , ahwaz , tabriz , tehran , shiraz , and mashhad , and the medical universities which served as the referral centers of some provinces , including yazd , kermanshah , mazandaran , golestan , guilan , and sistan - va baluchestan .
the aims of the study and the method of opinion poll were described on a website .
the questionnaire included the items on tasks extracted in previous steps , which were presented along with the opinion poll guideline and priority - setting criteria .
furthermore , the website guideline with illustrations and examples was prepared and mailed to the participants . to avoid problems related to it
priority setting was performed according to a method of altschuld s book , with the three criteria of  importance  , 
feasibility was defined as the level the task could be fulfilled by a reproductive health msc graduate and availability was the fact that this service is now provided or not .
availability was scored in a 1 - 3 range ; if the service is now completely provided , it scored 3 , if it is not provided at all , it scored 1 , and if it is provided to some extent , it scored 2 . accordingly , the  importance  factor was scored in a 1 - 5 range , and the  feasibility  was scored between 1 and 3 , and the participants scored the items according to the lowest and highest scores . the items that obtained scores less than the median value ( 3 for 5-point scale and 2 for 3-point scale ) were considered to be less important or unavailable or infeasible
all priority conditions of the tasks in the opinion poll webpage , the participants could write down their comments on each task in specific boxes . the comments were reachable for the researcher as they were sent .
after performing the opinion poll , the scores of each priority - setting criterion and the mean score for each task were calculated .
in the first step , the draft of tasks in 19 main areas was obtained using literature review . then , in the second step , the tasks were completed and modified by evaluation of the focus group . then they were categorized on the basis of the four main stages of reproduction and its four subsidiary classifications .
57 tasks were extracted with regard to the four main functions of management and planning , education , consultation , and screening in reproduction age of men and women ; that is , before and during puberty , before marriage , reproduction ( pre- pregnancy , pregnancy , post - pregnancy and infertility ) , and menopause and older age . in the third step , to achieve the best possible results from the opinion poll , we tried to make use of the comments of experts and health managers from ministry of health and different universities , who were scientifically competent and had enough experience in this field .
of those who attended the study , 33% were specialists in the field of mother and child health , and 29% in the field of reproductive health .
the 57 tasks and their mean scores assigned to priority- setting criteria are provided in table 2 .
results of priority setting of the tasks with regard to table 2 , tasks no .
18 , 22 , 26 , 35 , 36 , 37 , 38 , 41 , 42 , 43 , and 44 obtained the mean importance score above the median score 3 , the feasibility score above the median score 2 , and the availability scores above the median score 2 .
this shows that the item is important , feasible , and available , and further action is not required for it ; thus , the item can be eliminated , or has a low priority .
as can be observed , the tasks deal with topics , such as high - risk pregnancy , breast feeding , and family planning .
the remaining tasks ( 45 tasks ) are the needs ; we should focus on meeting them . with regard to the results obtained and considering the viewpoints of the needs assessment team ,
22 , 18 , 26 , 38 , 43 , and 44 to the major , and as the needs assessment team agreed , these items were not eliminated , but received lower priority in educational planning .
we took advantage from expert s opinions in evaluating the tasks of msc graduates of reproductive health . in this respect ,
the tasks extracted were consistent with the framework of reproductive health provided by the who and the american guideline of educational planning . however , according to the differences in problems of our country with those of the others , the list of tasks was not exactly similar to any list prepared for other countries .
altschuld method was used to perform the priority- setting in needs assessment , because the major did not exist before .
thus , it was not possible to determine the gap between the present and desirable states . moreover , there are currently other specialties that provide services in the same field in the health system .
so , in needs assessment , the importance of tasks defined for meeting the needs of people s reproductive health were considered , as well as the unavailability and feasibility of the services .
the results showed that in experts opinion , all the tasks extracted were important for the graduates , and most of the tasks , 46 out of 57 , were not currently provided .
these tasks were related to management and planning , education and consultation about the puberty and pre- puberty health and the issues related to them , sexual health , elderly health , menopause , empowerment of women , and participation of men .
the experts believed that the items were important ( all scored above 4 ) , and were not available for the people . according to the experts , of the tasks proposed 10 items
these items were feasible ; however , since they were available and were provided by graduates of other specialties , the items were not given high priorities .
the needs that do not require further action  according to the priority - setting scale .
thus , it is not necessary to train new specialists to provide these services . with regard to the remaining tasks
, the experts believed that the services were not provided at all or provided to degrees less than  somehow  .
moreover , except for  management and planning for changing of gender beliefs and superstitions of families and the society  , on which the experts did not agree , all other items were feasible .
therefore , these services should necessarily be provided by some individuals or systems . in this regard ,
general evaluation of the tasks extracted indicated that the process of defining tasks of reproductive health was performed multi dimensionally and accurately .
the tasks defined cover all stages of reproductive age and all feasible duties in the field of health .
reproductive health for the two ends of reproduction age , that is , adolescence and higher ages , are important issues in iranian reproductive health .
this is because although almost 34% of the current iranian population is young , the elderly population in urban areas has been grown fourfold in the past 30 years .
furthermore , in near future , a high percentage of the population would be old , and consequently the reproductive health needs associated with these ages would become important .
management and planning , consultation , education and other items related to reproductive health in older age groups of men and menopause of women were of the main tasks defined for the major .
these tasks can be of the current and future tasks , which should receive appropriate attention .
this is due to the increasing growth in elderly population in iran , as it is estimated that in 2031 , elderly population boom will occur in iran , and 25%-30% of the population will then be above 50 years of age .
the tasks related to sexual health were among the tasks that were considered in all stages of life . in spite of obtaining high scores ,
the tasks of education and consultation about the gender and sexual roles were defined in this regard .
many studies have been carried out on adolescents , and showed that the adolescents were unfamiliar with sexual issues , and there is a need for education and consultation of adolescents in this respect.[1821 ] some researchers have evaluated gender roles of men and women and found the problems of this field . they recommend that by pre and post marriage consultation , the couples should become familiar with mental schema and cultural clich , and the influence of these factors on mental assessment of sexual arousal and satisfaction with sexual relationship .
moreover , the importance of these factors should be taught to decrease the problems of married life .
considering the tasks defined for the major , the graduates can more specifically meet the needs of the society in this respect .
a branch of this item is  violence against women  , which is a topic proposed by the who as an item for assessment and follow up in reproductive health .
some researchers believe that violence against women and children within the families has decreased ; however , the problems require education with the aim of changing the behavior .
department of reproductive health in the who with the aid of the united nations population fund ( unfpa ) and human reproduction program ( hrp ) has defined the main topics of reproductive health .
these topics would be helpful in research on reproductive health and making the policy makers , scientists , health care providers , physicians , consumers , and representatives of the society aware of the research priorities in development of reproductive and gender health .
the topics were namely , older age and reproductive and gender health , family planning , women s circumcision , and other harmful practices , infertility , mothers health and abortion , urinary tract infections , sexually transmitted diseases , aids , relationship between reproductive health and aids , unsafe abortions , and violence against women . considering the health state of our society and frequency of the problems ,
however , some less frequent topics in our country , such as women s circumcision , were not placed among the main topics , and considering the young population of iran , some topics such as those related to adolescents were mentioned as the main topics in reproductive health needs . some limitations of the study were obligation in selection of the participants from the specialists of the field , because they were mostly busy and did not have enough time to answer the questions . to overcome this problem , the study was better to be performed in a larger time interval and during academic off day .
considering the results obtained , the authorities should develop the reproductive health major in subgroups , such as sexual health , research in reproductive health , and reproduction rights , and also modify the curriculum of courses related to the field for students of medical sciences .
furthermore , researchers should carry out more studies on the neglected tasks of physicians in reproductive health .
 background : reproductive health is an important health topic . 
 there are many challenges in reproductive health and it is necessary to train experts to manage them . the aim of this study was to define the tasks of master of science ( msc ) graduates in reproductive health through comprehensive needs assessment to establish the course.materials and methods : the study comprised of three steps . in the first step , through literature review , the draft and basic fields of main tasks were defined . in the second step , by establishing a focus group of 10 experts , the tasks were extracted on the basis of the country s needs . in the third step , 
 a delphi study was carried out among 51 experts who were selected to finalize the list of tasks and their priorities using three criteria of  importance  ,  
 feasibility  and  availability.findings:57 tasks were extracted with regard to the four main functions of management and planning , education , consultation , and screening in reproduction age of men and women . according to delphi s results and their priorities , 
 45 tasks were important and feasible but not available , and they were higher - priority tasks.conclusions:the tasks extracted are consistent with the framework of reproductive health provided by the world health organization ( who ) and the american guideline of educational planning . 
 however , considering the differences of problems in iran comparing with other countries , the list is not exactly similar to any list prepared for other countries . 
 therefore , it is necessary to consider the results of this research in university curriculums . 