Developing practical strategies to reduce addiction-related stigma and discrimination in public addiction treatment centers: a mixed-methods study protocol.

BACKGROUND: People with substance use disorders (SUDs) have restricted engagement with health-care facilities and describe repeated experiences of stigma, discrimination, and mistreatment when receiving care at health-care and public addiction treatment centers (PATCs). The purpose of the current study is to design practical cultural-based strategies to reduce addiction-related stigma and discrimination at PATCs. METHODS/DESIGN: The present study will use a mixed-methods design with an explanatory sequential approach. Phase 1 of the study will combine a cluster sampling technique combined with a cross-sectional survey of Patients with Substance Use Disorders (SUDs) in Mazandaran, Iran. A total of three hundred and sixty individuals with SUDs will be selected to assess their experiences of stigma and factors predicting stigma. Phase 2 will involve qualitative study aimed at exploring participants' perceptions regarding the aspects and determinants of their stigma experience. The participants will include two groups: people with SUDs and staff/health-care providers at PATCs. Participants for Phase 2 will be purposively sampled from those involved in Phase 1.Qualitative data will be collected using in-depth semi-structured interviews and focus group discussions and analyzed using content analysis with a conventional approach. Phase 3 will focus on the development of new strategies to reduce the experiences of stigma among people with SUDs at PATCs. These strategies will be formulated based on the findings derived from the qualitative and quantitative data obtained in Phases 1 and 2, a comprehensive review of the literature, and expert opinions gathered using the nominal group technique. DISCUSSION: This is one of the few studies conducted within the domain of stigma pertaining to individuals who use drugs within the context of Iranian culture employing a mixed-methods approach, this study aims to develop culturally sensitive strategies to reduce such problems from the perspective of Iranian people who use drugs. It is anticipated that the study will yield evidence-based insights and provide practical strategies to reduce the stigma and discrimination experienced by people who use drugs at PATCs. Such outcomes are important for informing policymaking and designing healthcare interventions tailored to the needs of individuals grappling with substance dependency.

Profile of Cigarette and Drug Use Status in Population of Tabari Cohort Study.

Background: The study of the smoking and drug use profile of the Tabari cohort enrolment phase, the outcomes of which will be evaluated in the coming years, has proper comprehensiveness. Therefore, the present study aimed to determine the cigarette and drug use status in the population of the Tabari cohort study (TCS). Methods: In this study, the profile of cigarette and drug use in the TCS was evaluated. Data analysis was performed in SPSS version 24 using percentage, mean, and standard deviation, chi-square, and independent t test. Findings: The frequency of daily smoking in the entire population was 9.1%, and the frequencies in men and women were 21.5% and 0.6%, respectively (P<0.001). The frequency of exposure to smoking in the home, at present or in the past, in the entire population was 30.5%, and in the populations living in urban and mountainous areas were 35.4% and 19.8%, respectively (P<0.001). The mean age at first use of cigarettes in the entire population was 20.50±7.61, whereas the mean age of regular smoking was 23.19±8.02. Furthermore, the frequency of experiencing drug abuse in the total population was 6.1%, and the frequencies in men and women were 14.1% and 0.7%, respectively. Conclusion: According to the results of this study, cigarette smoking and drug use are significant in men, and overall exposure of the Tabari cohort population to tobacco and drugs in the home is high. If effective prevention is not on the agenda, a significant proportion of the future outcomes in this population may be attributable to these risk factors.

The Iranian version of theory-based intention for cesarean section (IR-TBICS) scale: development and first evaluation.

BACKGROUND: The rate at which mothers experience a cesarean section in the absence of medical signs is growing worldwide. Women's beliefs and intentions play an essential role in the request or choice of a delivery method. At present, there is no comprehensive, validated scale for assessing pregnant women's beliefs about cesarean section in the Iranian population. This study was performed to develop and assess the validity and reliability of the intention-based cesarean section scale using the theory of reasoned action (TRA) constructs as a theoretical framework for measuring intention toward the selection of a delivery method. METHODS: In this cross-sectional validation study, 480 pregnant women were recruited from Sari, in northern Iran, through a multistage random sampling approach. Content validity was examined using the content validity index (CVI) and content validity ratio (CVR). Furthermore, both exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were applied to assess the construct validity of the developed scale. Reliability was measured by internal consistency and the intraclass correlation coefficient (ICC). Quality criteria for floor and ceiling effects were derived from existing guidelines and consensus within our research group. RESULTS: The results obtained from the factor analysis showed that the data were fit to the model (χ2 = 2298.389, P < 0.001). The TRA comprised 24 items assessing five domains, which described 62.46% of the common variance. The CFA showed a model with suitable fitness for the data. Cronbach's alpha coefficient for the domains of the scale ranged from 0.609 to 0.843, and the ICC value ranged from 0.71 to 0.84, which is within the satisfactory range. The IR-TBICS scale had no floor or ceiling effect on the total score or any of the dimensions. CONCLUSIONS: The belief-based cesarean section scale appears to be a reliable instrument. It is considered suitable and can be applied in other research in Iran.

Drug Abstinence Self-Efficacy Scale (DASES): psychometric properties of the Farsi version.

BACKGROUND: Research has demonstrated that therapeutic interventions based on the self-efficacy theory produce positive outcomes for people who exhibit addictive behaviors, such as alcohol and drug use. Several questionnaires based on self-efficacy theory have been developed to evaluate the extent to which intervention programs can modify behavior. The present study describes the psychometric properties of the Farsi version of the Drug Abstinence Self-Efficacy Scale (DASES). DESIGN AND METHODS: The forward-backward approach was employed to translate the DASES from English into Farsi. A cross-sectional study was conducted, and the psychometric properties of the Farsi version of the DASES were measured. Using a cluster sampling method, 400 male people who use drugs aged 20 years or older were selected from 10 addiction treatment clinics in Mazandaran, Iran. The internal consistency and test-retest methods were used to measure the reliability of the DASES. Face and content validity were measured, and the construct validity of the DASES was assessed through both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The data were analyzed using SPSS and AMOS. RESULTS: The results of the EFA indicated a four-factor solution for the DASES that accounted for 64.72% of the observed variance. The results obtained from the CFA demonstrated that the data fitted the model: the relative chi square (× 2/df) equaled 1.99 (p < 0.001), and the root mean square error of approximation equaled 0.071 (90% CI = 0.059-0.082). All the comparative indices of the model were equal to or greater than 0.90 (0.91, 0.93, 0.94, 0.93, and 0.90, respectively). The Cronbach's alpha ranged from 0.90 to 0.93, proving a satisfactory reliability. Additionally, the intraclass correlation coefficient ranged from 0.75 to 0.98, which is an acceptable result. CONCLUSIONS: This study's results show that the Iranian version of the DASES has good psychometric properties and is appropriate for assessing substance use behaviors among Iranian addicted persons.

Evaluation of the Psychometric Properties of the Lebanon Waterpipe Dependence Scale in a Sample of Iranian Waterpipe Smokers.

BACKGROUND: Waterpipe tobacco smoking (WTS) has recently increased in Iran. There is no valid instrument to measure the level of nicotine dependence among its consumers. This study was aimed to investigate the validity and reliability of the Lebanon Waterpipe Dependence Scale-11 (LWDS-11). METHODS: A cross-sectional study was conducted in the year 2017 whereby 367 waterpipe smokers were recruited from Golestan Province of Iran. LWDS-11 scale is composed of 4 subscales: 1) nicotine dependence, 2) negative reinforcement, 3) psychological craving, and 4) positive reinforcement. The validity of the questionnaire was examined using construct validity. Reliability of this scale was examined using test-retest reliability and internal consistency. FINDINGS: The four-factor model for LWDS [comparative fit index (CFI) = 0.985, Tucker-Lewis index (TLI) = 0.979, standardised root mean residual (SRMR) = 0.059, root mean square error of approximation (RMSEA) = 0.049 (0.031, 0.061)] demonstrated good fit to this data. Cronbach's α was 0.825 for total scale and it was 0.818, 0.746, 0.624, and 0.670 for each individual subscale. The test-retest reliability of the scale was 0.925. CONCLUSION: All goodness of fit indices (GFIs) represented a good fit of model. The LWDS-11 scale had an appropriate remarkable validity and reliability for waterpipe consumers to measure the level of nicotine dependence and it appeared to be likely useful for utilizing in the clinical and epidemiological studies.

Psychometric properties of fertility desire scale (FDS) developed for Iranian parents.

BACKGROUND: Fertility choice is a critical women's right. Although researchers have studied the positive effects of fertility desire, its different components have, unfortunately, been neither established nor implemented for parents. A reliable and valid scale is required to measure this vital aspiration of a couple. This study aims to develop and evaluate the psychometric properties of the Fertility Desire Scale (FDS), which is designed to assess fertility desire among Iranian parents. METHODS: A multi-phase instrument developmental approach was used to develop this scale in 2017. The items for the questionnaire were generated using three approaches: a qualitative study, an interview with an expert panel, and a comprehensive literature review. To provide a draft form of the questionnaire, we performed face and content validity analyses. The questionnaire validation was conducted on a sample of married women and men, recruited from public places affiliated with the Mazandaran province. Finally, measurement and analyses of exploratory and confirmatory factors, internal consistency reliability, item-scale correlation, and test-retest reliability of the questionnaire were performed to complete the validation process. RESULTS: Thirty-five items were initially developed on the basis of the interviews with the expert panel and the literature review. The questionnaire was subsequently reduced to include 27 items after performing the content and face validity testing. The exploratory factor analysis (EFA) identified four factors (positive childbearing motivations, preferences, childbearing worries, and social beliefs) comprising 19 items that jointly accounted for 55.44% of the observed variance. The confirmatory factor analysis (CFA) also revealed the suitable model fit for the data. The Cronbach's alpha coefficient for the subscales ranged from .83 to .86, and the intraclass correlation coefficient (ICC) ranged from .88 to .92; these coefficients are well above the acceptable thresholds. CONCLUSION: Results from this validation study demonstrated that the FDS is a valid and reliable questionnaire for measuring fertility desire that can be used in clinical practice, as well as in similar future studies.

Analyzing Short Message Services Application Effect on Diabetic Patients' Self-caring.

BACKGROUND: Diabetes is the most prevalent metabolic disease with a growing spread rate in word wide. Short message service (SMS) is of the most common public communication networks, which have brought about a broad spectrum of applications like social, cultural and service products in the late decade. The objective of this research is, the investigate of using SMS on diabetes patients self-caring. METHODS: In an interventional study, 228 diabetes patients have been selected from a community charity. With using of random sampling method, they were divided into two groups of 114 subjects as the control and case. The case group was sent messages reminding them about sports, caring foot, taking insulin and oral tablet for 4 weeks via mobile phone. After 4 weeks, a posttest questionnaire was completed. The data analysis was performed using a descriptive statistic, Chi-square, independent t-test, and paired t-test. RESULTS: There are not significant differences between case and control groups before intervention by studied dependent variables (P > 0.05). Performance score mean of taking care of foot, sport and taking oral tablet and insulin in case group before intervention were 29.90, 10, 11.16 and 3.75 respectively and after intervention were 20.11, 41.36, 13.09 and 4.90, respectively. Furthermore, the performance scores mean difference after intervention, taking care of foot (P < 0.001), sport (P < 0.001), taking oral tablet (P = 0.020) was meaningful in case and control groups. CONCLUSIONS: Regarding the study results on using cell phone, to utilize virtual training methods is recommended as an appropriate procedure for different health care, self-caring and follow-up training plans for various groups in society, especially diabetic and chronic patients.