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

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.