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Introduction: Understanding health service user perceptions of the quality of care is critical to developing measures to increase the utilisation of healthcare services. To relate patient experiences to a common set of standards, the World Health Organization (WHO) developed the concept of health system responsiveness. This measures what happens during user’s interactions with the system, using a common scale, and requires that the user has had a specified encounter, which they evaluate. The concept of responsiveness has only been used in a very few studies previously to evaluate healthcare sub-systems, such as mental healthcare. Since the concept of responsiveness had not been previously applied to a middle income country, such as Iran, there is a need to investigate its applicability and to develop a valid instrument for evaluating health system performance. The aim of this study is to assess the responsiveness of the mental healthcare system in Tehran, the capital of Iran, in accordance with the WHO responsiveness concept. Methods: This thesis is a health system research, based on qualitative and quantitative methods. During the qualitative phase of the study, six focus group discussions were carried out in Tehran, from June to August 2010. In total, 74 participants, comprising 21 health providers and 53 users of the mental healthcare system, were interviewed. Interviews were analysed through content analysis. The coding was synchronised between the researchers through two discussion sessions to ensure the credibility of the findings. The results were then discussed with two senior researchers to strengthen plausibility. Responses were examined in relation to the eight domains of the WHO’s responsiveness model. In accordance with the WHO health system responsiveness questionnaire and the findings of the qualitative studies, a Farsi version of the Mental Health System Responsiveness Questionnaire (MHSRQ) was tailored to suit the mental healthcare system in Iran. This version was tested in a cross-sectional study at nine public mental health clinics in Tehran. A sample of 500 mental health services patients was recruited and subsequently completed the questionnaire. The item missing rate was used to check the feasibility, while the reliability of the scale was determined by assessing the Cronbach’s alpha and item total correlations. The factor structure of the questionnaire was investigated by performing confirmatory factor analysis (CFA). To assess how the domains of responsiveness were performing in the mental healthcare system, I used the data collected during the second phase of the study. Utilising the same method used by the WHO for its responsiveness survey, we evaluated the responsiveness of outpatient mental healthcare, using a validated Farsi questionnaire. Results: There were many commonalities between the findings of my study and the eight domains of the WHO responsiveness model, although some variations were found. Effective care was a new domain generated from my findings. In addition, the domain of prompt attention was included in two newly labelled domains: attention and access to care. Participants could not differentiate autonomy from choice of healthcare provider, believing that free choice is part of autonomy. Therefore these domains were unified under the name of autonomy. The domains of quality of basic amenities, access to social support, dignity, and confidentiality were considered important for the responsiveness concept. Some differences regarding how these domains should be defined were observed, however. The results of the qualitative study were used to tailor a Farsi version of the MHSRQ. A satisfactory feasibility, as the item missing value was lower than 5.2%, was found. With the exception of the access domain, the reliability of the different domains in the questionnaire was within a desirable range. The factor loading showed an acceptable uni-dimensionality of the scale, despite the fact that the three items related to access did not perform well. The CFA also indicated good fit indices for the model (CFI = 0.99, GFI = 0.97, IFI = 0.99, AGFI = 0.97). The results of the mental healthcare system responsiveness survey showed that, on average, 47% of participants reported experiencing poor responsiveness. Among the responsiveness domains, confidentiality and dignity were the best performing factors, while autonomy, access to care and quality of basic amenities were the worst performing. Respondents who reported their social status as low were more likely to experience poor responsiveness overall. Autonomy, quality of basic amenities and clear communication were dimensions that performed poorly but were considered to be highly important by the study participants. Conclusion and implications: This is the first time that mental healthcare system responsiveness has been measured in Iran. Our results showed that the concept of responsiveness developed by the WHO is applicable to mental health services in this country. Dignity and confidentiality were domains which performed well, while the domains of autonomy, quality of basic amenities and access performed poorly. Any improvement in these poorly performing domains is dependent on resources. In addition, attention and access to care, which were rated high in importance and poor in performance, should be priority areas for intervention and the reengineering of referral systems and admission processes. The role of subjective social status in responsiveness should be further studied. These findings might help policymakers to better understand what is required for the improvement of mental health services.

The advent of the hordes of HUlegU Khan into Persia in the mid thirteenth century marked not only a new era for the peoples of the Iranian plateau and the surrounding lands but for the invaders and settlers themselves, The coming of HUlegU Khan was in sharp contrast to the visitations of his father, Tolui Khan, and grandfather, Chinggis Khan, and the two generals, lebei and SUbodei, some three decades earlier This dissertation explores the establishment and development of the early ll-Khanate concentrating on the period of HUlegU and his son Abaqa's reign from 1256 until 1282, roughly covering the period of the luwaynis' ascendancy After a survey and review of the primary sources used in researching this dissertation, chapters two three and four look at the main events of the first two ll-Khans' reigns and the problems they faced as their armies moved west Chapters five and six deal with the threats that the emerging kingdom suffered from fellow Mongols in the north and in the east, and how these tensions and conflicts were indicative of events and developments elsewhere in the Mongol Empire, Chapters seven, eight and nine deal respectively with the semi-autonomous provinces of Kirman, Shiraz, and Herat Each of these provinces dealt with the central Mongol power in a different way and these contrasting relationships is examined. Chapter ten is concerned with a phenomenon often associated with the later thirteenth century, namely the growth in the incidence of Sufis, Qalandars, and poets, all of whom flourished under the II-Khans This chapter creates a picture of a world not always associated with Mongol Iran. The final chapter summarises the conclusions drawn from the preceding chapters and attempts to portray a fresh, more positive image of these early II-Khanid rulers and paint a more balanced and less cynical picture of conditions under HUlegU and his son Abaqa. The illustrations are intended more for their aesthetic appeal than their historical revelations.

In the last 30 years, Iran has experienced mounting environmental problems, such as air and water pollution, that are perceived as in need of redress. In order to address and confront these problems, Iran has recently adopted the language and framework of ecological science. Subsequently, the prestige of science in the country has been growing through extensive applications of ecological science at various levels of Iranian society. Viewing this development as a socio-cultural process of modernity in Iran, this dissertation addresses two major issues: First, it investigates the discursive historical conditions of Iran in which modern science, including ecological science, has been developed and practiced since the nineteenth century. Second, it explores the cultural dimensions of environmentalism in Iran through examining its reception by Iranian environmentalists, researchers, and non-expert citizens in Tehran and their attitudes toward it. The analyses of the genealogies of science in Iran show that modern science has provided Iranians with a conceptual framework through which to govern the objects that state authorities, with accuracy and efficiency, wish to identify, analyze, and organize. I argue that the "population" has been a prominent object in the governance of Iran in the nineteenth and twentieth centuries and that, more recently, "the environment" has become such an object. Scientific knowledge and management have played a vital role in establishing these mechanisms of governance, thereby the status of science is kept intact in Iran. Drawing on thirteen months of fieldwork in Tehran, I also examine the recent development of environmentalism in urban Iran through changing conceptions of "nature." With Iran's utilization of ecological science, a new conception of nature is recently introduced to society: a scientific formulation of nature. I demonstrate how this notion of nature has become influential along with growing environmental discourses in Iran, and yet, argue that another conception of nature--relating to Iranian nationhood--also makes a key contribution to Iranian environmentalism. In particular, I engage the anthropological perspectives of "materiality" and "heteroglossia" to highlight this point.