Examining the association between emotional intelligence and chatbot utilization in education: A cross-sectional examination of undergraduate students in the UAE.

Background: While Emotional Intelligence (EI) demonstrably affects academic success, literature lacks exploration of how implementing chatbot in education might influence both academic performance and students' emotional intelligence, despite the evident potential of such technology. Aim: To investigate the associations between Emotional Intelligence (EI), chatbot utilization among undergraduate students. Methods: A cross-sectional approach was employed, utilizing a convenience sample of 529 undergraduate students recruited through online questionnaires. The participants completed the Trait Emotional Intelligence Questionnaire and modified and a modified versions of the unified theory of acceptance and use of technology (UTAUT) model. Results: of the 529 participants, 83.6 % (n = 440) of participants regularly used chatbot for learning. Students demonstrated a moderate average EI score (129.60 ± 50.15) and an exceptionally high score (89.61 ± 20.70) for chatbot acceptance and usage. A statistically significant (p < 0.001) positive correlation was found between chatbot usage frequency and EI total score. Gender and major emerged as significant factors, with female students (p < 0.05) and health science students (p < 0.05) utilizing chatbot less compared to male and other major students, respectively. A negative correlation (r = -0.111, p = 0.011) was observed between study hours and chatbot usage, suggesting students with higher study hours relied less on chatbot. Conclusions: The positive correlation between chatbot use and EI in this study sparks promising avenues for enhancing the learning experience. By investing in further research to understand this link and integrate AI tools thoughtfully, policymakers and educators can cultivate a learning environment that prioritizes both academic excellence and student well-being, reflecting the values and perspectives of UAE culture.

The lived experiences of healthcare professionals working in pre-hospital emergency services in Jordan: A qualitative exploratory study.

INTRODUCTION: Globally, injuries account for 9% of all deaths, with road accidents contributing to approximately a quarter of these fatalities. A major concern is the inadequacy of pre-hospital care (emergency medical services provided before arrival at a hospital) and delays in transportation to medical facilities, identified as leading causes of preventable injury-related deaths. This study explores the experiences of emergency health professionals (EHPs) in peri-hospital services (emergency medical services provided immediately upon arrival and within the hospital setting). METHODS: A qualitative exploratory design, underpinned by Van Manen's (1990) descriptive phenomenological principles, was used. Thirty EHPs from five central and southern Jordanian emergency departments were purposefully sampled, including physicians, nurses, and paramedics from both emergency departments and pre-hospital services. RESULTS: Two primary themes emerged: (1) In Search of Clarity: The Unsettled Journey of Pre-hospital Emergency Care Providers; (2) Frustrations on the Frontline: Role Ambiguity and Emotional Exhaustion in Trauma Care, with EHPs reporting fluid and unclear roles, physical and verbal abuse, and limited authority in critical interventions. CONCLUSION: The study highlights several service lapses in peri-hospital care that negatively impact healthcare professionals, posing risks to patient safety. These findings urge decision-makers to devise actionable strategies to rectify these deficiencies, enhancing care quality and thereby decreasing injury-induced mortality and morbidity.

The need of patients living with cancer for palliative care.

BACKGROUND: A comprehensive assessment of patients' problems and needs is essential for all patients with chronic diseases, including cancer. AIM: This study assesses the problems, unmet needs and requirement for palliative care (PC) among patients with cancer. METHOD: A descriptive cross-sectional design was employed using a valid self-reported questionnaire. RESULTS: On average, 62% of patients had problems that were unresolved. The need for patients to have more information about their health was identified (75.1%), followed by financial problems because of the illness and ability to afford healthcare (72.9%), and psychological issues, such as depression, anxiety and stress (67.1%). Patients stated that their spiritual needs were not being met (78.8%), and that they were experiencing psychological distress and problems with daily living that needed to be addressed through PC (78%, 75.1%, respectively). A chi-square test revealed that all problems are significantly associated with the need for PC (P<.001). CONCLUSION: Patients needed more assistance in psychological, spiritual, financial and physical domains, and this can be provided by palliative care. Palliative care in low-income countries is a human right for patients with cancer.

Experience of Health Professionals in Caring for Patients With Chest Trauma: A Qualitative Study.

BACKGROUND: The variation in the implementation of chest trauma (CT) management's guidelines led to inconsistent and mixed experiences toward CT management by the health care team. Moreover, there is a scarcity of studies exploring factors that enhance CT management experiences worldwide and in Jordan. OBJECTIVES: The aims of this study were (1) to explore emergency health professionals' attitudes and experiences toward CT management and (2) to understand factors that affect the care for patients with CTs among emergency health professionals. METHODS: A qualitative exploratory approach was adopted in this study. Individual, semistructured, face-to-face interviews were conducted with 30 emergency health professionals (physicians, nurses, and paramedics) from government emergency departments, military, private hospitals, and paramedics from the Civil Defense in Jordan. RESULTS: The results showed that emergency health professionals had negative attitudes toward caring for patients with CTs due to a lack of knowledge and clarity in their job description and duties assigned to them. Moreover, some organizational and training factors were discussed for their impact on the attitudes of emergency health professionals toward caring for patients with CTs. CONCLUSIONS: Lack of knowledge, absence of clear guidelines and job descriptions for dealing with traumas, and lack of continuous training on caring for patients with CTs were the most common reasons for negative attitudes. These findings can assist stakeholders, managers, and organizational leaders in understanding health care challenges and provoke a more focused strategic plan to diagnose and treat patients with CT.

Arab nursing students' perception of the emotional experience of patient care: A phenomenological study.

BACKGROUND: A shared emotional response helps with understanding what other people are feeling and/or thinking; and it is a vital skill in clinical settings. Collectivist communities place more emphasis on the emotional components of their feelings in comparison to the cognitive aspects of their emotions. PURPOSE: This study aimed to explore the emotions experienced by students at their first clinical placement. METHODS: A hermeneutic phenomenological approach was used among nine baccalaureate students. RESULTS: Three major themes emerged from the data: overwhelming emotions; unbalanced perception of professional identity; and adjustment and adaptation. CONCLUSIONS AND DISCUSSION: It is evident that nursing students from collectivist communities encounter challenges in dealing with their emotions and managing their patients' emotions; however, they were capable of empathizing with their patients using the two components of their empathy; affective (emotion) and cognitive (cognition), with prominence given to the affective part. As countries become increasingly multi-cultural, which in turn influences the characteristics of people entering pre-registration nursing programs, nursing leaders are invited to address both dimensions of empathy as part of the nursing curriculum. Attention should also be given in clinical settings to appropriate channeling of clinical empathy to cultivate a professional identity.

The impact of online teaching on stress and burnout of academics during the transition to remote teaching from home.

BACKGROUND: The higher education institutions worldwide have been transformed unexpectedly to online teaching. This sudden movement from blended learning or traditional face-to-face teaching has severely disrupted university activities and posed many challenges for teaching staff, who were asked to develop online versions of their courses overnight. This study explores the effect of the current changes in education style and working from home on the stress and burnout levels of teaching staff. METHODS: This study utilized a cross-sectional design, whereby 278 participants (faculty and course instructors) from 17 campuses of one of the largest colleges in United Arab Emirates completed a web-based survey. Numerous instruments were utilized to obtain the following data: participants demographics; their perceived stress during online teaching; their perception of the impact of teaching from home on their family's daily life, physical health, mental health and ability to cope with stress; burnout level; and their satisfaction with online teaching. RESULTS: Around 60% of participants reported moderate stress level during online teaching (moderate stress = 5 to 8) under COVID-19 (M 6.21 ± 2.26). An independent sample t-test and ANOVA tests revealed that participants with 7-10 years of online teaching experience reported more stress than participants who have 4-6 years online teaching experience (M 7.29, ±1.11 Vs. 5.30, ±2.69; P = 0.04). Moreover, multiple regression analysis showed that higher stress levels and lower satisfaction with the online teaching experience were associated with more significant personal and working burnout. Married participants with school-age children were at greater risk of personal burnout. CONCLUSION: The transition to remote education imposed mental burdens and stress on faculty members. Supportive professional development strategies to enrich faculty with online teaching skills are urgently required.

Mental health, learning behaviour and perceived fatigue among university students during the COVID-19 outbreak: a cross-sectional multicentric study in the UAE.

BACKGROUND: The rapid shift to online education due to COVID-19 quarantine challenged students' ability to accept pure online learning without negative consequences for their physical, emotional and mental health. Some educational institutions introduced new strategies to reduce the psychosocial burden associated with online learning during home confinement. Thus, the primary aims were to determine the consequences of COVID-19 for the psychological well-being and fatigue levels of higher education students and to explore the effects of a new academic assessment approach in reducing home confinement stress. METHOD: A cross-sectional online survey was conducted among students, from 30 August to 30 September 2020, of 7 disciplines in all 16 higher colleges of technology in the United Arab Emirates (UAE). The Mental Well-being and Learning Behaviours Scale and the modified Copenhagen Burnout Inventory were used to evaluate students' psychological well-being and fatigue levels. A Welch t-test and Welch ANOVA were performed to determine the differences in perceived psychological well-being associated with students' characteristics. Second, Kruskal_Wallis and Mann_Whitney were performed to determine the differences in fatigue level based on students' characteristics. RESULTS: One thousand four hundred students participated. The majority were female (78.5%) and aged from 21-25 years (58.1%). Around 14% of respondents were married with children. Nearly 40% were satisfied with the new assessment approach introduced during the COVID pandemic and 45.5% perceived it as having reduced their home confinement stress. The mean psychological distress score of 3.00 (SD ± 0.71) indicates a moderate impact of COVID-19 on psychological well-being. Students' psychological distress was positively correlated with fatigue level (0.256, p < 0.001) and negatively correlated with the perceived impact of the new assessment approach on student lifestyle (- 0.133, p < 0.001), physical health (- 0.149, p < 0.001) and coping with stress (- 0.125, p < 0.001). Male students experienced significantly lower fatigue and better psychological well-being than female students. CONCLUSION: The study reveals that new assessment approaches which emerged during home confinement reduced students' perception of stress and of impaired lifestyle. However, students still had a considerable burden of psychological distress, requiring further preventive measures to maintain their psychological well-being during future outbreak events. Educational institutions should consider additional strategies to improve students' preparedness for online teaching, which could help maintain their psychological well-being.

The Decisional Balance Toward Health Behaviors Among Patients With Hypertension.

The decisional balance is related to the transtheoretical model, and involves weighting the pros and cons of performing a behavior. The study aimed to assess hypertensive patients' decisional balances about smoking, weight control, and physical exercise. A cross-section descriptive correlation design was used, and 110 patients were recruited using convenience sampling in outpatient clinics. The decisional balance was measured using "Decisional Balance Scales," which assess an individual's decisional balance related to smoking, weight control, and physical exercise behaviors. The results predicted that Jordanian hypertensive patients with higher physical exercise decisional balance and higher weight decisional balance had lower smoking decisional behaviors. Nurses can foster health promotion and behavioral change by employing interventions that improve decisional balances. Improving the decisional balance of one behavior would have a positive impact on other behaviors. Thus, designing multidimensional interventions might be effective for modifying different types of health behaviors, and fostering health promotion practices.

The Effects of Oral Care Protocol on the Incidence of Ventilation-Associated Pneumonia in Selected Intensive Care Units in Jordan.

PURPOSE: This study aims to evaluate the effects of oral care protocol on the incidence of ventilator-associated pneumonia (VAP) at selected intensive care units (ICUs) in Jordan using clinical pulmonary infection score. METHODS: A quasi-experimental design was used, and 1 large teaching hospital from the Jordanian capital, along with 2 hospitals from the southern region, was selected. A total of 218 patients participated, among which VAP risk in 2 independent groups was evaluated through the Clinical Pulmonary Infection Score sheet. RESULTS: The VAP incidence rate was significantly lower in the intervention group (n = 102) as compared with control group (n = 116) (21.6 vs 35.3, respectively; P = .018); in addition, ICU stay and intubation period were significantly shorter among the intervention group. A higher risk of VAP was independently predicted by previous lung diseases (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.185-1.88), open suctioning system (OR, 2.536; 95% CI, 1.261-5.101), and duration of intubation (OR, 1.770; 95% CI, 0.845-2.220). The oral care protocol has effectively improved ventilated patients' oral health, which has statistically reduced the incidence of VAP. It occurred more frequently among patients who have lung disease and those who were intubated for more than 7 days and have an open suctioning system. CONCLUSION: Health care teams should ensure that effective care protocol is implemented among patients.

Health-related quality of life and associated factors in Jordanian cancer patients: A cross-sectional study.

Understanding the factors associated with patients' health-related quality of life along with their social networks can help identify who may benefit from supportive programmes. This study sought to evaluate the impact of a cancer diagnosis on Jordanian cancer patients' health-related quality of life and its relationship with social support and emotional status. A descriptive design was utilized, and 226 clients were participated. Participants completed European Organization for Research and Treatment of cancer quality of life questionnaire (EORTC-version 3), the Hospice Comfort Questionnaire, and the Hospital Anxiety and Depression scale. The results revealed that participants demonstrated unsatisfactory quality of life and many complained of fatigue. A multiple linear regression analysis revealed that social support, hospitalization readmission and being a nonsmoker were significant predictors for poor global quality of life score. In addition, a high educational level, less rehospitalization and high anxiety and depression scores were significant predictors for comfort level. In conclusion, patients with cancer are at an elevated risk of impaired physical functioning and report unsatisfactory quality of life, particularly if they are anxious, depressed and lack social support. The associated factors with decreased quality of life or low comfort level could be amenable to change with appropriate interventions.

Nurses' perception and attitudes towards oral care practices for mechanically ventilated patients.

OBJECTIVES: To explore the perception and attitudes of intensive care unit (ICU) nurses towards oral care practice for mechanically ventilated (MV) patients. METHOD: A descriptive cross-sectional design was used in this study. A convenience sample of 96 ICU nurses completed a questionnaire on their perception and  attitudes towards oral care. The study setting was 3 representative Jordanian hospitals in Al-Karak and the capital, Amman, over a 6-month period between February and September 2016. RESULTS: Ninety-six nurses participated in the study. The response rate was 76.8%. The results revealed that 65% only follow a specific oral care protocol. Nurses did not adhere to minimal standards. Although nurses' attitude towards oral care was strongly positive, 68% of them perceived it as an unpleasant task and 29% agreed that they had insufficient training; 78% agreed to learn more about the best way to perform oral care. Standard descriptive statistics were calculated for all baseline information (sociodemographic characteristics). Binary variables were expressed as proportions, and normally distributed continuous variables as means and standard deviations. CONCLUSION: The poor perception and attitudes of ICU nurses regarding oral care for MV patients require the urgent attention of clinical administrators. In-hospital training regarding oral care protocol could improve nurses' perception and attitudes.

The prevalence and predictors of emotional distress and social difficulties among surviving cancer patients in Jordan.

PURPOSE: This study examines the prevalence and degree of emotional distress, anxiety and depression, and social difficulties and their effect on cancer patients' quality of life (QoL). It describes the characteristics of patients who are at high risk of emotional distress. METHODS: A descriptive cross-sectional design was used. A total of 226 patients with cancer completed the Hospital Anxiety and Depression scale (HAD), social difficulties inventory, comfort scale and EORTC-QoL-C30. Anxiety and depression were identified using the internationally recognized cut-off points of HAD-A ≥ 8 and HAD-D≥ 8. Adjusted odd ratio was calculated using socio-demographic and clinical factors. RESULTS: Both anxiety and depression were common among Jordanian cancer patients, although depression was the main emotional problem with a higher prevalence than anxiety (67.6% vs. 43%). Patients with anxiety or depression were more likely to have lower QoL scores and higher scores for complaints about symptoms. They were more likely to have social difficulties in everyday life. The results of logistic regression indicated that a high depression score was predicted by older age, a poor QOL total score, and a high social difficulty score. A high anxiety score was predicted by advanced cancer stage, in female patients, hospital readmission and a poor QOL total score. CONCLUSION: The significant level of emotional distress among cancer patients highlighted the importance of early assessment and identification of patients at greater risk of emotional distress, those with an advanced stage of cancer, having a poor quality of life and serious social difficulties.

Pregnant women: What do they need to know during pregnancy? A descriptive study.

BACKGROUND: Antenatal education programs provide women with essential knowledge and skills in various aspects of maternal and fetal health. Antenatal education is based on improving women's health, reducing the risks of complications and enhancing couples' positive experience during childbirth. There is a lack of formal antenatal educational programs based on women's needs in Jordan. AIM: This study sought to identify and prioritize the learning needs for women during pregnancy. METHODS: A descriptive cross-sectional design was employed. The study sample was recruited from three maternal and child health centers. Data were collected from a convenient sample of 150 pregnant women during their antenatal visits. One hundred and twenty three participants (response rate=82%) completed the self-reported antenatal learning needs questionnaire. FINDINGS: Women identified their most important learning needs were related to managing major complications of pregnancy (mean=3.49, SD=0.78), investigations and physician follow-up visit during pregnancy (mean=3.42, SD=0.71), appropriate diet (mean=3.36, SD=0.84) and information about medication and supplements (mean=3.22, SD=0.97). Spearman correlation showed negative association between participants' age and physical (r=-0.536, p=0.015) and emotional concerns (r=-0.490, p=0.001). Women who had a diploma or higher degree reported greater concern regarding physical (median=4.00, IQR=3.00-4.00, p=0.047) and emotional changes (median=3.33, IQR=3.00-4.00, p=0.004). Finally, migrant participants showed greater significant concern regarding emotional changes and coping with minor complications. CONCLUSION: A large proportion of pregnant women in this study reported a high degree of importance of specific learning topics that were closely relevant to their current period of pregnancy. The lack of focusing on issues related to maternal emotional status and possible complications suggests a need for a national strategy to provide antenatal education based on women's perceptions of their needs.

Perceived learning needs according to patients who have undergone major coronary interventions and their nurses.

AIMS AND OBJECTIVES: The aim of this study was to identify the differences in perceived learning needs between cardiac patients who have undergone major coronary interventions and their nurses. BACKGROUND: The decrease in length of stay after cardiac interventions has signalled an urgent need to provide effective in-hospital health education. Therefore, the content of health education should bridge the gap between nurses' and patients' views of what information is important for ensuring patients' optimum recovery. DESIGN: A descriptive comparative design was employed. METHODS: Patients were invited to participate if they had undergone angioplasty or bypass surgery and were ready for discharge within 24-48 hours. A convenience sample of 365 cardiac patients and 166 cardiac nurses participated in this study. Baseline data on patients' and nurses' sociodemographics, clinical history and experience were collected through personal interviews. Then, participants completed the Patient Learning Needs Scale to identify their perceptions of the learning needs after cardiac interventions. RESULTS: The top-priority learning needs according to both patients and cardiac nurses was information on wound care and medication. In contrast, the lowest-priority learning need was physical activity. Nurses perceived information about physical activity as most needed to patients, whereas patients perceived information about medications, postintervention complications and postintervention concerns as mostly needed. CONCLUSION: The disparity between perceptions of patient and nurses on the essential content to be learned highlights the importance of considering both of these parties when establishing health education programmes. In addition, nurses should focus more on information related to the recovery period and immediate needs after discharge. RELEVANCE TO CLINICAL PRACTICE: Information about wound care, medication and potential complications should be the core of predischarge education programmes. In addition, nurses should focus on improve patients' awareness of secondary prevention and lifestyle modification, as patients pay less attention to these vital topics.

Illness perception and adherence to healthy behaviour in Jordanian coronary heart disease patients.

BACKGROUND: Patients diagnosed with coronary heart disease are strongly recommended to adopt healthier behaviours and adhere to prescribed medication. Previous research on patients with a wide range of health conditions has explored the role of patients' illness perceptions in explaining coping and health outcomes. However, among coronary heart disease patients, this has not been well examined. OBJECTIVE: The purpose of this study was to explore coronary heart disease patients' illness perception beliefs and investigate whether these beliefs could predict adherence to healthy behaviours. METHODS: A multi-centre cross-sectional study was conducted at four tertiary hospitals in Jordan. A convenience sample of 254 patients (73% response rate), who visited the cardiac clinic for routine review, participated in the study. Participants completed a self-reported questionnaire, which included the Brief Illness Perception Questionnaire, the Godin Leisure Time Activity questionnaire and the Morisky Medication Adherence Scale. RESULTS: Patients reported high levels of disease understanding (coherence) and they were convinced that they were able to control their condition by themselves and/or with appropriate treatment. Male patients perceived lower consequences (p<0.05) and had a better understanding of their illness than female patients (p<0.001). There were significant associations between increasing age and each of timeline (r=0.326, p<0.001), (r=0.146, p<0.024) and coherence (r=-0.166, p<0.010). Adjusted regression analysis showed that exercise adherence was predicted by both a strong perception in personal control (ß 2.66, 95% confidence interval 1.28-4.04), timeline (ß -1.85, 95% confidence interval 0. 8-2.88) and illness coherence (ß 2.12, 95% confidence interval 0.35-3.90). Medication adherence was predicted by perception of personal control and treatment control. Adherence to a low-fat diet regimen was predicted by perception of illness coherence only (odds ratio 12, 95% confidence interval 1.04-1.33). Finally, the majority of patients thought that the cause of their heart problem was related to coronary heart disease risk factors such as obesity and high-fat meals. CONCLUSION: Patients' illness beliefs are candidates for a psycho-educational intervention that should be targeted at improved disease management practices and better adherence to recommended healthy behaviours.

Effects of community based cardiac rehabilitation: Comparison with a hospital-based programme.

BACKGROUND: With typically fewer than 35% of eligible patients attending outpatient cardiac rehabilitation (CR), more accessible provision is required. Community-based cardiac rehabilitation is one option but its effects need to be compared with those of hospital-based CR. AIMS: The purpose of this study was to compare changes in health-related quality of life (HRQOL), anxiety and depression, and exercise and smoking rates, between attendees at community-based and hospital-based CR programmes. METHOD: A prospective comparative cohort design was used. Consecutive patients admitted to Aberdeen Royal Infirmary and eligible for CR were recruited and followed up by self-report questionnaire. Outcomes were health status (RAND-36), Hospital Anxiety and Depression Scale (HADS), Godin Leisure-Time Exercise and smoking status. RESULTS: There were 136 of 179 (75%) attenders at community-based CR, compared to 169 of 209 (80%) at hospital-based CR (p=0.242). In univariate analysis, there were no significant differences between the two groups in health status, HADS, and frequency or intensity of exercise immediately after the CR programme or six months later. Adjusting for other significant factors, patients who attended community CR reported higher RAND-36 energy scores at six months compared with attenders at hospital CR (p=0.020), but were less likely to undertake frequent exercise (p=0.041). CONCLUSIONS: Community-based CR appears to achieve similar attendance rates and effects on health status and health behaviour as hospital-based CR. This option might help overcome the poor attendance of patients with long travelling times to hospital-based CR.

Patients' Adherence to Healthy Behavior in Coronary Heart Disease: Risk Factor Management Among Jordanian Patients.

BACKGROUND: Poor adherence to risk factor management behaviors for coronary heart disease (CHD) patients increases the risk for a further cardiac event. There is a scarcity of literature about the level of adherence to risk factor management behaviors after CHD diagnosis in Jordan. OBJECTIVE: The aim of this study was to explore which demographic, psychosocial, and clinical factors predict better adherence to risk factor management behaviors, particularly smoking cessation, physical activity, healthy diet, and medication adherence. In addition, we sought to explore the association of poor adherence to hospital readmission. METHOD: A cross-sectional survey was performed using a sample of 350 patients who visited the outpatient clinics in 4 hospitals in Jordan. RESULT: Data were obtained from 254 patients (response rate, 73%). Most were overweight (47.8%) or obese (28.5%), and 30% remained smokers after CHD diagnosis; 53 (21.5%) described themselves as ex-smokers. One-third of participants (88, 34.8%) performed regular walking exercise. Only 16% of participants reported that they had been instructed to perform regular activity. Stepwise multiple regressions revealed younger age and lower body mass index as independent predictors for more physical activity. Only 51 (20.9%) reported always following a low-fat dietary regimen, and participants who received dietary recommendation advice were significantly more likely to be on a healthy diet (odds ratio, 10.3; 95% confidence interval, 3.79-30.80; P < .001). Most of the participants (183, 72%) reported low medication adherence (score ≤6), based on the Morisky scale, and only 5 (2%) reported a high adherence score (score = 8). Male gender and having chronic back pain were independent predictors for better medication adherence. About one-third of participants had been hospitalized for cardiac reason at last 2 times in the past 12 months. Rehospitalization was significantly more common among patients who were not following a dietary regimen (Mann-Whitney Z = -2.54, P = .011) or regular physical activity (Mann-Whitney Z = -3.60, P = .001) and in those who had more comorbidity diseases (r = 0.34, P = .001). CONCLUSION: Our findings highlight poor adherence to secondary prevention behaviors among Jordanian CHD patients. Most participants did not adopt healthy behaviors in managing their CHD risk factors and they demonstrated a higher risk of hospital readmission. There is an urgent need for aggressive and targeted strategies to enhance adherence levels.

Effectiveness of theory-based invitations to improve attendance at cardiac rehabilitation: a randomized controlled trial.

BACKGROUND: Despite well-established evidence of benefit from cardiac rehabilitation, typically fewer than 35% of eligible patients attend. OBJECTIVE: The purpose of this study was to evaluate whether theory-based invitations increase attendance at cardiac rehabilitation. METHOD: The study was a randomized controlled trial (RCT) with two by two factorial design. A total of 375 participants with acute myocardial infarction or coronary revascularization was recruited from medical and surgical cardiac wards at Aberdeen Royal Infirmary (ARI). They were randomly assigned to receive either the standard invitation letter or a letter with wording based on the 'theory of planned behavior (TPB)' and the 'common sense model of illness perception', and either a supportive leaflet with motivational messages or not. The primary outcome was one or more attendances at cardiac rehabilitation. RESULTS: The theory-based letter increased attendance at cardiac rehabilitation compared to the standard letter (84% versus 74%, odds ratio (OR) 2.93, 95% confidence interval (CI) 1.54-5.56), independent of age, gender, working status, hypertension, identity and TPB constructs. The number needed to treat (NNT) was 9 (95% CI 7-12). The motivational leaflet had no significant effect on attendance at rehabilitation (OR 1.02, 95% CI 0.57-1.83). CONCLUSIONS: The use of theory-based wording in invitation letters is a simple method to improve attendance at cardiac rehabilitation. Our letter, reproduced in this paper, could provide a template for practitioners and researchers.

Pressure ulcers in Jordan: a snapshot survey of a tertiary public hospital.

BACKGROUND: Patients are at risk of developing pressure ulcers while they are hospitalised. These risks need to be managed effectively to avoid harm and to minimise costs. OBJECTIVE: This study was aimed at determining the prevalence and incidence of pressure ulcers at selected acute clinical settings in central Jordan. DESIGN: A cross-sectional survey design. METHOD: An inpatient snapshot survey was conducted over 4 weeks in the two medical wards in a tertiary public hospital. RESULTS: 190 participants were surveyed, 30 cases were identified, 53% were male, and 75% were aged 60 years or older. Prevalence was 24%, approximately half of the cases were grade 2 and 23% were grade 3 and 4. Pressure ulcers were mainly found on the sacrum (43%), followed by the heel (24%). Over 4 weeks, 29 new pressure ulcer cases were identified; 55% were male, and 90% were aged 60 years or older. Pressure ulcers were mainly-in 38% of cases-identified with cerebral vascular accident patients. CONCLUSION: The results of the snapshot survey confirmed that there is a problem with maintaining patients' safety in terms of patients acquiring pressure ulcers in hospital. The number of pressure ulcers indicate less-than-optimal management of patient safety, which requires a more detailed investigation.

Improving uptake of cardiac rehabilitation: using theoretical modelling to design an intervention.

BACKGROUND: Attendance rates at cardiac rehabilitation remain low with typically fewer than 35% of eligible patients attending. Much of the poor attendance stems from invited patients failing to attend. AIM: To design a theoretically based intervention to improve attendance at cardiac rehabilitation. METHODS: Our methods followed recommendations that have been developed from the Medical Research Council (MRC) framework for the design of complex interventions. We conducted three processes that progressed simultaneously: 1) literature review for evidence on epidemiology, behavioural theory, and efficacy of interventions; 2) expert meetings on behavioural theory and to select target points for intervention; and 3) development and theoretical modelling of the intervention. RESULT: Our final interventions were a theoretically worded invitation letter and leaflet based on the Theory of Planned Behaviour and the Common Sense Model of Illness, designed to: a) motivate patients through professional recommendation; b) provide simple information on the contents of cardiac rehabilitation emphasising ease for participants; c) reassure participants that the programme is tailored to their personal needs in a safe supervised environment; and d) reinforce the benefits of attending cardiac rehabilitation. CONCLUSION: A theoretically worded letter and leaflet could be an inexpensive intervention to improve attendance at cardiac rehabilitation. The letters and leaflets will now be evaluated in a randomised trial.