Agenda Setting for the Safe Community Program in Iran: A Retrospective Policy Analysis Using Kingdon’s Multiple Streams Model

Background: Injuries and accidents are significant contributors to mortality and disability globally, highlighting the critical need for prevention and safety measures in public health. To address this issue, the Safe Community Program (SCP) was established as a focused initiative to promote injury prevention. This study delves into the program’s development, investigating how it gained traction among policymakers by emphasizing its direct link to injury prevention. It further examines the political and policy factors that shaped this agenda and the pivotal role of policy entrepreneurs in championing such programs. Methods: This study employed a qualitative analysis based on Kingdon’s multiple streams theory. A purposive sampling method with maximum variation was employed to select participants. 12 key informants participated in semi-structured interviews, supplemented by 21 document reviews conducted by Jupp’s criteria. Data were analyzed using directed content analysis with MAXQDA version 20, where the textual data were coded according to predefined categories from Kingdon’s theory. Subcategories were refined through continuous review and later grouped into broader categories, with any disagreements resolved collaboratively during team meetings. Results: The results yielded a total of four categories and 18 subcategories. These include four subcategories in the problem stream, seven subcategories in the policy stream, four subcategories in the political stream, and three subcategories related to policy entrepreneurs. The study highlighted that Iran’s safety issues, marked by high accident rates, necessitate an integrated safety policy. Policy entrepreneurs shaped the problem stream through key indicators, while the SCP for injury prevention must compete with other treatment-focused interventions. Nonetheless, policy entrepreneurs advocated for the SCP as essential for safety promotion. Additionally, the political stream significantly influenced the program’s agenda-setting, emphasizing the importance of political will and commitment. Conclusion: The SCP in Iran gained attention from policymakers and decision-makers due to the efforts of political entrepreneurs, who highlighted the intersection of problem, policy, and political streams, culminating in the opening of a policy window.