# Empowerment of individuals in Iranian health systems: a qualitative study using the Z-cognitive map approach

## TL;DR

This study explores how to empower individuals in Iran's healthcare system using a cognitive mapping approach to identify key factors and strategies.

## Contribution

The paper introduces a novel combination of Z-number and cognitive mapping methods to model empowerment in healthcare.

## Key findings

- Insurance participation was identified as the most effective empowerment strategy.
- The appropriate component for individuals scored highest in the centrality index.
- The model helps inform policy-making in medical insurance.

## Abstract

The empowerment of people is considered as one of the most effective approaches in national healthcare systems. Identifying the effective criteria for this empowerment approach can be useful for planning enhancements. Therefore, studying and researching different aspects of people empowerment, and identifying the various relationships among related factors are of great importance. In this study – after identifying and extracting the effective factors in empowering individuals/insured persons, and interviewing health insurance and healthcare experts through content analysis – a causal model examining variables and their impact intensity through cognitive mapping is designed and drawn up. In modeling the concept of empowerment, to cover the ambiguity of expert comments, a combination of the Z-number approach with cognitive mapping has been used. Results demonstrate how various factors relate to insured empowerment. According to the results of empowerment strategies, the insurance participation strategy with the highest central index was determined as the most effective strategy, and the appropriate component for individuals gained the highest score in the centrality index. The results of this article help a lot to policy making in medical insurance.

The online version contains supplementary material available at 10.1186/s12913-024-10866-8.