Government interventions and elderly health: a mixed-methods health impact assessment of a rural welfare program

Abstract Background This Health Impact Assessment (HIA) study aimed to explain and evaluate the impacts of the Shahid Rajaei plan (SRP) on rural older adult’s health in Piranshahr County, Iran, and offers recommendations for strengthening the plan and promoting the health of older adults. Method In this retrospective HIA study, a concurrent mixed-methods approach was conducted in three phases: (1) A quantitative phase consisted of a ten-year (2009–2019) trend analysis and a cross-sectional comparative study among covered / non-covered older adults to assess their health status. (2) A qualitative phase with a conventional content analysis approach to identify the perspectives of rural older adults and the SRP stakeholders about the weaknesses and strengths of the plan. (3) An integration phase with a comparative analysis approach to integrate quantitative and qualitative results to provide a set of recommendations to guide decisions and actions. Results Over the 10-year period, both groups experienced increasing trends in blood pressure, diabetes, depression, anxiety, and stroke. However, changes in blood pressure, diabetes, depression, and anxiety were significantly more pronounced in the non-covered group (P < 0.001), with respective risks 30, 10, 2.7, and 2.6 times higher than the SRP-covered group. Stroke trends did not differ significantly (P = 0.156). Cross-sectional analysis showed better perceived social support and general health in the non-covered group, while quality of life and social health were significantly higher in the SRP-covered group (P < 0.001).Qualitative content analysis led to the identification of two main categories “Advantages and strengths program” and “limitations and weaknesses” along with five subcategories. The integration phase combined the quantitative and qualitative findings for a comprehensive interpretation.The integration phase combined the quantitative and qualitative findings for a comprehensive interpretation. Conclusion Although the SRP has had positive effects on elderly health, certain limitations, such as restricted access to specialized services and unequal service distribution, have hindered its full potential in promoting health. The findings indicate that elderly health outcomes are influenced not only by healthcare interventions but also by broader economic and social factors. Therefore, improving living conditions and enhancing public welfare are essential steps toward achieving the SRP’s goals.