تحلیلی بر اثربخشی سمن‌ها و خیریه‌ها در بهبود تاب‌آوری نیازمندان درمانی (موردمطالعه: مؤسسه مکسا)

Abstract
The aim of the present study is to evaluate the effectiveness of the Iranian Cancer Control Charity (MACSA) in improving the resilience of those in need of treatment in Isfahan. The present study was conducted with a mixed method and a sequential exploratory design. Considering the social construction of resilience and to prevent the imposition of preconceived concepts in other cultural contexts, a qualitative study was first conducted to understand the meaning and concept of resilience with 10 treatment clients referring MACSA. These clients were from the deprived and underprivileged classes of Isfahan and were selected for interviews using a purposive sampling method. Subsequently, based on the themes obtained, a quantitative study was conducted in the form of a face-to-face survey among 150 of the clients. Resilience for the clients is characterized by concepts such as the meaning and concept of illness, the struggle for survival, hope, reliance on social support, psychological reactions to illness, maintaining dignity and self-reliance, the ability to accept and adapt, and reliance on spirituality. In addition, from the clients’ perspective, the services provided by MACSA had a great impact on improving their resilience components. NGOs and charities active in the field of treatment should continuously evaluate the effectiveness of their services in order to increase accountability and transparency and improve performance. In this regard, in addition to paying attention to the treatment, they should pay attention to improving the clients’ resilience and increasing their individual (mental and physical) and social abilities to adapt to the illness and improve the quality of life.
Keywords: Efficacy, Resilience, Those in Need of Treatment, Cancer Patients, MACSA (Iranian Cancer Control Center).
 
1. Introduction
Nonprofit organizations (NGOs) are conceptualized as autonomous, private entities established with the primary aim of enhancing the quality of life of disadvantaged individuals. Beyond their nonprofit orientation, NGOs frequently embody a broader social mission that reflects the values of their governing members and supporters (Fuseini et al., 2022). Despite the proliferation of NGOs and charitable entities, the discourse among social scientists and donors interested in philanthropy has predominantly centered on the volume of charitable contributions rather than the quality or efficacy of such giving (Caviola et al., 2020). Over the past two decades, there has been mounting pressure on NGOs and charities to substantiate their effectiveness (Beamon and Balcik, 2008). Concurrently, instances of corruption and mismanagement in certain sectors have intensified calls for enhanced transparency and accountability concerning the societal role of “nonprofit organizations” (Liket & Maas, 2015).
In Iran, charitable organizations are relatively nascent and in the initial phases of their development and maturation. According to the Director General of Charitable Affairs at the Ministry of Health, approximately 3,000 charitable organizations collaborate with the Ministry of Health across various health sectors, with approximately 60 of these organizations actively engaged in the field of cancer (Borneh News Agency, February 1403). The prevalence of cancer in Iran and globally, along with the significance of preventive and therapeutic interventions, accounts for a substantial number of charities dedicated to this cause. Resilience is a critical issue for patients, particularly those with cancer. Resilience is crucial for patients because of its fundamental role in managing stress, adapting to changes, enhancing social relationships, boosting self-confidence, and developing coping skills. MACSA (Iranian Cancer Control Institute) is a non-governmental and public organization operating in the cancer sector. Our study indicates a lack of specific research on the effectiveness of therapeutic associations and charities in Iran, leaving the impact of their services on enhancing client resilience unclear. Consequently, this research seeks to address two primary questions: first, what is the clients’ understanding of resilience when receiving services from MACSA, and second, to what extent have these services been effective in enhancing their resilience?
 
2. Materials and Methods
The methodology employed in this study was a mixed-method research approach. Specifically, we utilized a sequential exploratory design (Tashakkori & Teddlie, 1998:46) from among the various available designs. Given the abstract, multidimensional, and context-dependent nature of the concept of resilience, coupled with the characteristics of the participants (who are relatively undereducated and underprivileged), it was not feasible to directly inquire about their understanding of “resilience”. Consequently, we developed a series of questions grounded in the conceptual model of previous studies on resilience (Bennett, 2010; Lopez-Fuentes & Calvete, 2015; Takahashi et al., 2016). This model delineates resilience through internal factors (such as calmness, a positive attitude towards life, meaningfulness, and self-reliance), external factors (including social and environmental support), and existential factors (spiritual faith). Data collection was conducted through semi-structured interviews, and data analysis was performed using Brown and Clarke’s (2013) six-step method to identify themes.
In selecting participants, we conducted ten interviews with purposefully chosen clients, adhering to the recommendations of researchers such as Onwuegbuzie and Leech (2007), who suggested that six to ten interviews are adequate for small-scale projects. Each interview lasted approximately 40 minutes and was conducted at the institution, specifically in the counseling room. With the respondents’ consent, the interviews were recorded using a voice recorder, and pseudonyms were employed to ensure anonymity. Prior to conducting the interviews, we obtained ethics code number IR.UI.REC.1403.108 from the Ethics Committee of the University of Isfahan. Consequently, we utilized an informed consent form for participation in the research project, and informed participants of their right to withdraw from the interview at any point should they feel unable to continue. In accordance with the framework proposed by Lincoln and Guba (1985), we employed various strategies to ensure the credibility, transferability, reliability, and verifiability of this study.
The quantitative component of the study, a survey, was designed to assess the external effectiveness of the services provided to clients, utilizing themes identified from qualitative interviews. The sample was selected through convenience sampling, whereby the second author was present at the treatment center for a duration of one month, distributing questionnaires to 150 clients who sought services at the center and consented to participate. Based on the themes derived from the qualitative study, various items were initially developed and, following preliminary testing and confirmation of their validity and reliability, completed by the clients. Data collection was conducted using a self-report questionnaire that included items created by the researchers. To evaluate the validity of the questionnaire, face and convergent validity were employed, and reliability was assessed using Cronbach’s alpha coefficients.
 
3. Discussion
The objective of the current study was to examine the external efficacy of this institution in enhancing client resilience. Given that resilience is an abstract and context-specific construct, this study initially sought to explore clients’ perceptions of this concept. Through interviews with ten clients, eight components of resilience were identified: the meaning and concept of illness, the struggle for survival, hope, reliance on social support, psychological reactions to illness, maintaining dignity and self-reliance, the ability to accept and adapt, and reliance on spirituality. The findings from the quantitative and survey components indicated that, according to clients, receiving various services (including education, counseling, support, family care, and disease process management) from MACSA positively influenced the enhancement of various resilience components. The provision of free medical services by MACSA Charity significantly alleviated patients’ concerns regarding their illness, facilitating improvements in their physical condition and enabling them to better endure the challenges of their illness while reducing financial concerns related to their treatment. Many cancer patients experience medical poverty due to the high costs associated with treatment.
By covering a portion of medical expenses, particularly for clients with limited financial resources, MACSA has significantly reduced economic strain, allowing these individuals to prioritize their health. Most participants acknowledged that the medical services offered by the MACSA Institute played a crucial role in enhancing their physical wellbeing. They noted that without these services, their health conditions might have deteriorated, making it difficult to cope with the challenges posed by their illnesses. Moreover, MACSA Charity, through the provision of personalized clinical and spiritual counseling services (conducted by a clergyman), has supported participants in addressing spiritual concerns, managing fears and anxieties, and strengthening resilience and morale. Additionally, by facilitating access to information and offering specialized counseling and guidance, MACSA Charity instilled realistic hope among participants and clients regarding their potential to return to normalcy and regain their health. The services provided by MACSA Charity empowered most clients to enhance their self-reliance and strive to reintegrate into their regular lives.

5. Conclusion
Organizational effectiveness is often regarded as “slippery concept” and is inherently subjective (Halvorsen et al., 2024). Nonetheless, assessing the effectiveness of NGOs and charities enables donors to make informed decisions regarding the allocation of financial resources. This assessment also enhances awareness of the actual impact of donations, facilitates the identification of more effective organizations, and helps avoid support for poorly performing or non-transparent institutions. Furthermore, it fosters trust and long-term commitment to foundations, as objective evidence of effectiveness substantiates their involvement. In recent years, the global prevalence of cancer has led to the establishment of numerous NGOs aimed at treating underprivileged patients, enhancing their quality of life, and alleviating their disease burden. MACSA has implemented various initiatives to support patients with cancer, alleviate psychological stress on families, improve patients’ quality of life indicators, and raise public awareness about cancer. The study’s findings indicate that resilience is not solely an individual psychological phenomenon but is intricately linked with external resources and social support within the immediate environment, such as family, friends, and even governmental support organizations including NGOs and charities. Additionally, MACSA has successfully enhanced its clients’ resilience to a satisfactory level by offering a diverse range of services.