The relationship between fatigue, pruritus, and thirst distress with quality of life among patients receiving hemodialysis: a mediator model to test concept of treatment adherence.

Hemodialysis is a conservative treatment for end-stage renal disease. It has various complications which negatively affect quality of life (QOL). This study aimed to examine the relationship between fatigue, pruritus, and thirst distress (TD) with QOL of patients receiving hemodialysis, while also considering the mediating role of treatment adherence (TA). This cross-sectional study was carried out in 2023 on 411 patients receiving hemodialysis. Participants were consecutively recruited from several dialysis centers in Iran. Data were collected using a demographic information form, the Fatigue Assessment Scale, the Thirst Distress Scale, the Pruritus Severity Scale, the 12-Item Short Form Health Survey, and the modified version of the Greek Simplified Medication Adherence Questionnaire for Hemodialysis Patients. Covariance-based structural equation modeling was used for data analysis. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. QOL had a significant inverse association with fatigue, pruritus, and TD and a significant positive association with TA. TA partially mediated the association of QOL with fatigue, pruritus, and TD, denoting that it helped counteract the negative association of these complications on QOL. This model explained 68.5% of the total variance of QOL. Fatigue, pruritus, and TD have a negative association with QOL among patients receiving hemodialysis, while TA reduces these negative associations. Therefore, TA is greatly important to manage the associations of these complications and improve patient outcomes. Healthcare providers need to assign high priority to TA improvement among these patients to reduce their fatigue, pruritus, and TD and improve their QOL. Further studies are necessary to determine the most effective strategies for improving TA and reducing the burden of complications in this patient population.

Farsi Version of the Body Image Concern Inventory in Iranian Hemodialysis Patients: Validity and Reliability.

Background and Purpose: Patients on hemodialysis often struggle with their body image. This study was conducted with the aim of investigating the validity and reliability of the Persian version of the body image concern questionnaire for the first time in hemodialysis patients in Iran. Methods: In this cross-sectional study, 400 hemodialysis patients from Iran were assessed using the Body Image Concern Inventory (BICI). By using exploratory factor analysis (EFA; with Maximum Likelihood Factor Analysis and Promax Rotation) and confirmatory factor analysis, the construct validity of BICI was assessed. To check for internal consistency, the average interitem correlation, Cronbach's alpha, and McDonald's omega coefficients were used. Stability was assessed with intraclass correlation coefficient (ICC). Results: The participants' average age was 53.2 (SD = 13.2) years, and more than half of them were women (54.60%). Four factors extracted from exploratory factor analysis (EFA) show that the total cumulative variance explained by these factors was 44.46% of the total variance. Item factor loadings varied between 0.415 and 0.970. Internal consistency coefficients were considered acceptable (>0.7). Also, stability was evaluated as good (ICC = .839). Conclusions: The Farsi version of the BICI scale as a self-report measure of concerns about dysmorphic appearance has 19 items and shows acceptable reliability and validity. Consequently, the scale can be used by nurses to evaluate body image among Farsi-speaking hemodialysis patients, which can help them to take necessary actions to decrease the level of concerns in these patients.

Cross-Cultural Evaluation of the Psychometric Properties of the Spiritual Well-Being Scale: A Systematic Review.

Since spiritual well-being has a significant role in individual and social health, using a valid scale to identify these properties is essential. Comparing factor structure and differences in the number of dimensions and items of subscales could be an indicator of differences in individuals' attitudes toward spirituality among diverse cultures. The present review was performed for psychometric evaluation of the spiritual well-being measures. A systematic review of international databases and Iranian databases was conducted to evaluate studies published between January 1, 1970, and October 1, 2022. QUADAS-2, STARD, and COSMIN scales were used for risk of bias assessment. Following two rounds of screening, 14 articles entered quality assessment. According to the results, studies examining the factor structure of the spiritual well-being scale (SWBS) instrument have been conducted for the years 1998 to 2022. The mean age of the participants in these studies ranged from 20.8 to 79.08 years. During the process of exploratory factor analysis, the researchers reported the presence of two to five latent factors, and the range of explained variance was between 35.6 and 71.4%. However, most of the reports indicated the existence of two or three latent factors. The findings of the present study provide an image of the psychometric status of the SWBS for researchers and clinicians in this field and can help them make optimum decisions in selecting a scale or conducting additional psychometric studies or adopting this scale for studies in new populations.

Development and validation of care stress management scale in family caregivers for people with Alzheimer: a sequential-exploratory mixed-method study.

BACKGROUND: Caring for a person with Alzheimer's disease is stressful for caregivers. So that, considering all the emotional and financial costs imposed on the families of Alzheimer's patients, stress from caring is an issue that cannot be ignored and plans need to be developed to help these caregivers to manage the care properly. The current study was designed to develop a valid and reliable care stress management scale for family caregivers of patients with Alzheimer's. METHODS: This study is a methodological study with a sequential-exploratory mixed-method approach that was performed in two-phase: develop the caring stress management scale and evaluate the psychometric properties of the scale. In the first phase, 14 semi-structured face-to-face interviews were performed with family caregivers of patients with Alzheimer's. The interviews were transcribed immediately and an item pool with 275 items was prepared. After removing the duplicate or overlapping code, the initial format of the caring stress management scale (CSMS) was designed. In the second step, the items of the CSMS were evaluated using face and content validity. After that, the construct validity was evaluated using exploratory factor analysis, confirmatory factor analysis, and convergent and divergent validity respectively. Finally, the reliability was assessed by stability and internal consistency. The sample size was 435 and data was gathered via an online form questionnaire. RESULTS: This study designed the CSMS with two factors including emotional-focused coping (4 items) and problem-focused coping (4 items) that explained 51.00% of the total variance. The results of the confirmatory factor analysis showed a good model fit. Furthermore, the internal consistency and stability of this scale were acceptable. CONCLUSION: The results showed that the care stress management scale has two factors in Iranian family caregivers and it is valid and reliable and can be used by therapists and researchers.

A Patient-Centered Self-Management Intervention to Improve Glycemic Control, Self-Efficacy and Self-Care Behaviors in Adults with Type 2 Diabetes Mellitus: A SPIRIT Compliant Study Protocol for Randomized Controlled Trial.

Background: The rising burden of type 2 diabetes mellitus (DM) and its associated complications is affecting the functional capacity of the individuals, their quality of life and demand for healthcare services with significant economic impact on health care systems and the national economies. Given the enormous health and economic impact, preventing type 2 DM progression and reducing the risk of complications require immediate attention. Evidence from western countries suggests that self-management can slow the progression of type 2 DM and minimize the risk of major complications lowering health-care costs. Effective self-management, however, demands patients' confidence and their full commitment to perform self-care tasks necessitating a patient-centered approach. This study aims to test the efficacy of a patient-centered self-management intervention to improve glycemic control, self-efficacy and self-care behaviors in adults with type 2 DM. Patients and Methods: The study will be carried out as a parallel arm, randomized, controlled trial in four public tertiary care hospitals in Faisalabad, Pakistan. A total of 612 patients with type 2 DM will be recruited and randomly assigned to two groups: a control and an intervention group. The intervention group will receive a patient-centered self-management intervention for eight weeks duration. Subjects will be followed up for three months. The primary outcome will be glycemic control (HbA1c), and secondary outcome variables will include self-efficacy and self-care behaviors all measured at three points in time (baseline, at the end of intervention and at three months follow-up). Discussion: This randomized controlled trial will provide critical information about the efficacy of patient-centered self-management intervention in improving HbA1c, self-efficacy and self-care behaviors. If successful, this evidence-based care intervention may be provided to all DM patients by updating hospital policies. Trial Registration: NIH: US National Library of Medicine clinicaltrials.gov Identifier: NCT05491252, Shifa Tameer e Millat University Protocol Record: 335-21. Registration date: August 08, 2022. Recruitment began: April 21, 2022. Recruitment completed: July 27, 2022. URL http://www.clinicaltrials.gov.

Psychometric evaluation of the Connor-Davidson Resilience Scale among Iranian population.

BACKGROUND: The resilience construct is considered a personal trait composed of multiple aspects. Connor-Davidson Resilience Scale is a standard tool composed of five factors and 25 items. This study aimed to determine the psychometric properties of this scale. METHODS: In this cross-sectional study, after the scale translation, the factorial structural validity was assessed via the confirmatory factor analysis with 70 180 samples. Internal consistency, composite reliability, convergent validity were assessed by calculating Cronbach's alpha, composite reliability, maximum reliability, and Average Variance Extracted. The discriminant validity was assessed using Heterotrait-monotrait ratio of correlations matrix and also, measure invariance was evaluated. RESULTS: The original five-factor model had good model fit indices but due to low factor loading of item 2 and 20, the model was modified. The Cronbach's alpha and composite reliability for four factors were above 0.7 (except for factor 5). The convergent validity for all five factors were achieved. Between factors 1 with 2 and 4, 2 with 3 and 4 discriminant validity was not established (correlations > 0.9) and the results suggested that there might be a second-order latent construct behind these factors. Therefore, a second-order assessment was performed. The results of the second-order latent construct assessment showed a good goodness-of fit and strong measurement invariance for both men and women. CONCLUSION: The 23-item version of Connor-Davidson Resilience Scale is a reliable and valid scale to measure resilience as a complex construct in the Iran context.

The Farsi version of meaning of life in Iranian patients with cancer: A psychometric study.

BACKGROUND: Having meaning in life is a protective factor for psychological well-being. Accurate assessment of this construct needs a valid and reliable tool. PURPOSE: This study aims to evaluate the psychometric properties of the Farsi version of the meaning of life questionnaire in patients with cancer. METHOD: In this cross-sectional study, after translating the questionnaire to Farsi, in a sample of 212 patients with cancer, feasibility, content and convergent validity, exploratory and confirmatory factor analysis, internal consistency, stability, and responsiveness were evaluated. RESULTS: The results show that the content validity ratio of all ten items was greater than 0.49. Also, the modified Kappa coefficient of each item was greater than 0.6. The maximum likelihood exploratory factor analysis extracted one factor, which explains 76.13% of the total variance of the sample. Item nine was removed. The confirmatory factor analysis results show that the one-factor model had good fit indices. The Cronbach's alpha, McDonald's omega, composite reliability, MaxR, and intraclass correlation coefficient were 0.96, 0.96, 0.96, 0.96, and 0.98, respectively. The questionnaires had responsiveness and its response time was 3 s. CONCLUSION AND POLICY SUMMARY: The nine-item Farsi version of the meaning of life questionnaire has good validity and reliability and responsiveness.

Retaining nurses via organizational support and pay during COVID-19 pandemic: The moderating effect between intrinsic and extrinsic incentives.

AIM: There has been growing concern about the nurses' turnover intention as well as life satisfaction during COVID-19 pandemic in Iran. The past research has provided evidence on the effect of organizational support on nurses' job satisfaction and turnover intention. However, little is known about the underlying mechanism behind these associations. DESIGN: A cross-sectional survey was undertaken. METHODS: An online survey was conducted in Iran from May to June 2020 through Google Docs Forms. In total, 305 nurses were participated and completed the online survey. Data were analysed using structural equation modelling through (AMOS). This study was checked with the STROBE checklist. RESULT: The results showed that nurses' perception of organizational support was positively related to their job satisfaction which in turn decreases the turnover intention. Likewise, the job satisfaction partially mediated the relationship between organizational support and nurses' life satisfaction.

The Psychometric Properties of the Fear of Progression Questionnaire (FoP-Q) for Cancer Patients in Iran.

PURPOSE: Fear of progression or recurrence is assumed as a rational response to the threat of cancers and types of cancer treatment. However, the elevated levels of fear in cancer patients can become dysfunctional. Therefore, a valid and reliable questionnaire is unquestionably required for this purpose. This study aimed to translate the Fear of Progression Questionnaire and evaluate its psychometric properties for patients with gastrointestinal cancers in Iran. METHODS: In this study with a methodological research design, a total number of 430 patients affected with gastrointestinal cancers referring to Northern Iran completed the 43-item Fear of Progression Questionnaire. The psychometric properties of the questionnaire were evaluated, including the face validity and content validity. Then construct validity was assessed using exploratory and confirmatory factor analyses. Finally, the reliability was assessed using internal consistency (Cronbach's alpha) and stability (intraclass correlation coefficient). RESULTS: Based on the result of the face and content validity, no items were revised and removed. The five extracted factors included were emotional response, employment, and loss of independence, economy/family, and coping. These factors explained 37% of the total variance of Fear of Progression Questionnaire. Reliability (by Cronbach's alpha) and stability (test retest was evaluated by intraclass correlation coefficient) were more than 0.7. CONCLUSION: The study results revealed that the Persian version of the Fear of Progression Questionnaire had acceptable reliability and validity for cancer patients in Iran. Emotional responses explained the most variance of the concept of fear of progression among cancer patients.

The effectiveness of patient-centered care vs. usual care in type 2 diabetes self-management: A systematic review and meta-analysis.

Background: Patient-centered care in diabetes self-management might be a significant factor in improving health outcomes of adults with type 2 diabetes, yet the supporting evidence is inadequate. This review aimed at assessing the effectiveness of patient-centered self-management care interventions on glycemic control (HbA1c) and self-care behaviors compared with usual care. Methods: CINAHL, PubMed, Cochrane Library, Google Scholar, and the HEC Digital Library were searched for studies in English language that assessed patient-centered self-management educational and/or behavioral interventions in adults aged 18 years or older with type 2 diabetes from 2005 to 2020. Interventional studies with at least 3 months of follow-up and reporting on self-care outcomes such as glycemic control (HbA1c) and self-care behaviors including diet control, physical activity, foot care, and medication adherence were included. Results: Of 168 identified records, 24 were found eligible comprising 20 RCTs and four QESs with total 4,083 participants. The meta-analysis involved 19 RCTs that provided enough information for a pooled estimate of HbA1c. Compared with the control group, patient-centered self-management interventions significantly lowered HbA1c, -0.56 (95% CI -0.79, -0.32). Stratified analysis for HbA1c with respect to various aspects of intervention showed larger effects in interventions employing both educational and behavioral components, -0.66 (95% CI -0.97, -0.34); spanned over shorter (<03 months) duration, -0.85 (95% CI -1.28, -0.43); administered by nurses, -0.80 (95% CI -1.44, -0.16); and delivered in community settings -0.70 (95% CI -1.14, -0.26). Conclusion: This systematic review provided evidence supporting the effectiveness of patient-centered self-management care interventions in improving glycemic control and self-care behaviors in adults with type 2 diabetes and identified key features of intervention contributing toward success.

Evaluation of Psychometric Properties of Hardiness Scales: A Systematic Review.

Background: Hardiness is one of the personality traits that can help individuals in stressful situations. Since human beings are constantly under stressful situations and the stresses inflicted on people in each situation are different, various scales have been developed for assessing this feature among different people in different situations. Hence, it becomes necessary for researchers and health workers to assess this concept with valid and reliable scales. This systematic review aims to rigorously assess the methodological quality and psychometric properties of hardiness scales. Method: In the first step, the databases including Scopus, PubMed, Web of science, and Persian databases were searched using suitable keywords without limitation time. We select eligible suitable studies after screening titles and abstracts. The quality of studies was evaluated using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the Terwee quality criteria. Result: Of the 747 articles identified, 33 articles were entered in this study. Based on the COSMIN checklist, the most reported properties were as following structural validity (84%), hypothesis testing (56%), content validity (42%), and internal consistency (39%). Furthermore, 12 studies reported cross-cultural validity, three studies criterion validity, and one study reported measurement error. Conclusion: The "family caregivers' hardiness scale," "Japanese Athletic Hardiness Scale," "Occupational Hardiness Questionnaire," and "Children's Hardiness Scale" are the best tools for assessing hardiness in family caregivers, athletes, employees, and children respectively. In addition, the "Dispositional Resilience Scale" (DRS-15) and The Personal Views Survey (PVS III-R) are the most frequently used scales with suitable features for measuring hardiness in the general population.

Evaluation of Psychometric Properties of NutriCHEQ in Iranian Toddlers.

Background: Although poor dietary habits have a great effect on the health status of children, especially in toddlers, a few questionnaires exist for the assessment of dietary imbalances. This study aims to assess the validity and reliability of the NutriCHEQ in Iranian healthy toddlers. Methods: In this cross-sectional study, first, the NutriCHEQ was translated to Persian and culturally adapted by the forward-backward translation technique. In order to assess the face validity, we used a cognitive interviewing technique of 25 parents/caretakers of healthy toddlers. In the next step, experts assessed content validity, respectively. One item was removed during the content validity process. Then, a blueprint of NutriCHEQ was distributed among 156 parents/caretakers of healthy toddlers in different focal points in Tehran for assessing construct validity by nonlinear principal components analysis. In addition, the anthropometric indices checklist and Food Frequency Questionnaire (FFQ) were filled out for toddlers. Then, construct validity was assessed. The Varimax rotation ran for two sections separately. The four-factor structure was confirmed. Results: The model showed a good fit, and all the extracted variance of four factors were satisfactory (F1 = 20.77; F2 = 22.30; F3 = 14.75; and F4 = 13.71). All of the extracted items of the NutriCHEQ in two parts showed 71.53% cumulative variance. For criterion-related validity, there was a statistically significant positive correlation between the NutriCHEQ and Z-score (rho = 0.632, P < 0.001). The Bland-Altman result indicates 95% limits of agreement between the NutriCHEQ questionnaire and Z-score. Conclusions: Therefore, we concluded that NutriCHEQ is a valid, reliable, and convenient instrument to identify the Iranian toddlers' nutritional status. Therefore, it can be used for research and clinical settings.

The Relationship Between Self-Care Behavior and Concerns About Body Image in Patients Undergoing Hemodialysis in Iran.

Background and Aim: Hemodialysis treatment saves the life of people with end-stage renal disease (ERDS), but does not prevent the suffering of the disease, anxiety, hopelessness, and so on. Many studies have been performed on self-care behaviors as well as body image in different patients, but so far, no research has been done to investigate the relationship between self-care behavior and body image concerns in hemodialysis patients. Therefore, the aims of this study are to determine the relationship between self-care behavior and body image concern in patients undergoing hemodialysis. Materials and Methods: A cross-sectional design was used to evaluate Self-care Behavior and Concerns about Body Image in a convenience sample of 280 patients with ERDS. Measures included demographic factors, health characteristics, and validated instruments of the study constructs Body Image Concern Questionnaire (BICI) and Assessment of self-care behaviors with arteriovenous fistula (ASBHD-AVF). Results: This study showed that self-care behaviors have the ability to predict body image concerns. There was a negative and significant relationship between self-care behavior and body image concern (B = -0.162, ß = -0.140, p = 0.020). These variables explain 7.5% of predictors. Conclusion: Although the findings of the present study showed that increasing age and improving the level of self-care behaviors in patients undergoing hemodialysis reduces body image anxiety, but women were the strongest predictor of body image anxiety.

A time-series prediction model of acute myocardial infarction in northern of Iran: the risk of climate change and religious mourning.

BACKGROUND: Although various studies have been conducted on the effects of seasonal climate changes or emotional variables on the risk of AMI, many of them have limitations to determine the predictable model. The currents study is conducted to assess the effects of meteorological and emotional variables on the incidence and epidemiological occurrence of acute myocardial infarction (AMI) in Sari (capital of Mazandaran, Iran) during 2011-2018. METHODS: In this study, a time series analysis was used to determine the variation of variables over time. All series were seasonally adjusted and Poisson regression analysis was performed. In the analysis of meteorological data and emotional distress due to religious mourning events, the best results were obtained by autoregressive moving average (ARMA) (5,5) model. RESULTS: It was determined that average temperature, sunshine, and rain variables had a significant effect on death. A total of 2375 AMI's were enrolled. Average temperate (°C) and sunshine hours a day (h/day) had a statistically significant relationship with the number of AMI's (ß = 0.011, P = 0.014). For every extra degree of temperature increase, the risk of AMI rose [OR = 1.011 (95%CI 1.00, 1.02)]. For every extra hour of sunshine, a day a statistically significant increase [OR = 1.02 (95% CI 1.01, 1.04)] in AMI risk occurred (ß = 0.025, P = 0.001). Religious mourning events increase the risk of AMI 1.05 times more. The other independent variables have no significant effects on AMI's (P > 0.05). CONCLUSION: Results demonstrate that sunshine hours and the average temperature had a significant effect on the risk of AMI. Moreover, emotional distress due to religious morning events increases AMI. More specific research on this topic is recommended.

Psychometrics of Persian version of the 11 items De Jong Gierveld loneliness scale among an Iranian older adults population.

BACKGROUND: Older adults duo to circumstances of aging such as relationship losses, medical morbidities, and functional declines, are prone to social isolation and loneliness more than any other age group. Furthermore, with The recent outbreak of the COVID-19 pandemic and the need to quarantine, the possibility of feelings of loneliness, especially in older adults, became an important nursing priority. Therefore, it is important to quickly identify loneliness and respond appropriately to prevent, reduce, or treat it. The aim of this study was to translate the De Jong Gierveld loneliness scale into Persian for older adults. METHODS: The sample was 400 adults aged 65 and older with a mean age of 71.32 (SD= ± 6.09) years. Recruitment and data collection was done via online methods. The original scale was translated into Persian using the World Health Organization (WHO) protocol of forward-backward translation technique. Face validity and content validity; was followed by exploratory and confirmatory factor analysis. Lastly, reliability was assessed using the Average Inter-Item Correlation, Cronbach's alpha, and McDonald's Omega. RESULTS: The results showed that the Persian version of the loneliness scale had two factors namely social loneliness (5 items) and emotional loneliness (3 items) and the combined score explained 45.66% of the total variance of this scale. In addition, all goodness of fit indices confirmed a two factors model fit and all of the reliability indices were excellent. CONCLUSIONS: The Persian version of the loneliness scale is useful and suitable for detecting social loneliness and emotional loneliness in older Iranian adults.

Predictors of Persistence of Anxiety, Hyperarousal Stress, and Resilience During the COVID-19 Epidemic: A National Study in Iran.

Background: The coronavirus pandemic can cause unprecedented global anxiety, and, in contrast, resilience can help the mental health of people in stressful situations. This study aimed to assess anxiety, hyperarousal stress, the resilience of the Iranian population, and their related factors during the coronavirus disease 2019 (COVID-19) epidemic. Methods: A cross-sectional study was conducted in 31 provinces in Iran between March 18 and 25, 2020. A four-part questionnaire, including the demographic information, the State-Trait Anxiety Inventory (STAI-y1-a 20-item standard questionnaire for obvious anxiety), the Connor-Davidson Resilience Scale (CD-RISC-a 25 item standard questionnaire), and the stress hyperarousal subscale from the Impact of Event Scale-Revised (IES-R), was used to collect data. The ordinal multivariable generalized estimating equation (GEE) model was used to identify correlates of the psychological factors mentioned above. The Fisher exact test was used to investigate the relationship between anxiety, stress, resilience, and the COVID-19 outbreak. All analyses were conducted with SPSS 26 and GIS 10.71. Results: The findings show that most people had moderate-to-severe anxiety (80.17%) and a high level of resilience (96.4%) during the COVID-19 epidemic. The majority of participants had a moderate level of stress (58.9%). The lowest and highest prevalences of psychiatric disorders were in Sistan and Baluchestan (3.14 cases per 100,000 people) and Semnan (75.9 cases per 100,000 people) provinces, respectively. Men and unmarried people were the only variables significantly associated with anxiety and resilience. Age, gender, and education were significantly associated with hyperarousal stress. Conclusion: The high and moderate levels of anxiety and stress in Iranians can have negative effects on the well-being and performance of the people and can lead to serious problems. Also, high resilience during negative life events (such as the COVID-19 pandemic) is associated with the well-being in the lives of people. The results of this study can be used in interventions and other psychological studies.

Psychometric Evaluation of the Persian Version of Religious Orientation Scale in Iranian Patients with Cancer.

This paper reports on the psychometric properties of the Religious Orientation Scale (ROS) with a sample of 311 Iranian patients who were suffering from cancer between September and December 2020. A cross-sectional study design was used, and convenience sampling was employed. Reliability was evaluated by internal consistency Cronbach's alpha, McDonald's omega, and average inter-item correlation. The exploratory factor analysis showed that the ROS had 15 items and two factors (religious identity and personal identity) that explained 43.2% of the total variance of religious orientation in Iranian patients with cancer. Construct validity was assessed by means of confirmatory factor analysis. The internal consistency and composite reliability were acceptable. The results indicate that the ROS can produce reliable and valid data on religious orientation in a sample of Iranian patient with cancer.

The Lived Experience of Jordanian Parents of Children with Cystic Fibrosis: Qualitative Study.

BACKGROUND: Cystic fibrosis (CF) is a common autosomal recessive disease with an incidence of 1:2560 live births in Jordan. It affects the quality of life for both the child and the parents. In Jordan knowledge about parents' experience with children diagnosed with CF is limited. PURPOSE: The purpose of this study was to describe and explore the lived experience of parents of children with CF, and the difficulties and challenges they face. DESIGN AND METHOD: A qualitative phenomenological method was used. Twenty-five parents of children with CF were interviewed. The Scribber thematic analysis was used in data analysis. RESULTS: Four themes emerged. First, "Falling into the circle of suffering", Second, "The circle of suffering", with two sub-themes: the challenges, and the limitations in daily life. Third, "Coping within the circle of suffering", with four sub-themes: focus on problems, focus on emotions, social and economic factors, and spirituality. Fourth, "Future outlook", with two sub-themes: optimism about the future, and pessimism about the future. CONCLUSION: Parents of children with CF suffer from difficulties and challenges that limit their daily lives. PRACTICE IMPLICATIONS: Education is needed for health care providers, society and parents about CF; and parents need support to improve their quality of life.

Resilience in Iranian adolescents during the COVID-19 pandemic: Psychometric Evaluation of the Connor-Davidson Resilience Scale.

Background: Resilience is a measure of the ability to cope with stress and the accurate measurement of it is critical. This study aimed to translate and evaluate the psychometric properties of the Connor-Davidson Resilience Scale in Iranian adolescents during the Coronavirus Disease (COVID-19) pandemic.Methods: In this cross-sectional study, after the scale translation, the content and construct validity were assessed using exploratory and confirmatory factor analysis. Moreover, internal consistency, composite reliability, and invariance measurement were evaluated.Results: The content validity ratio was greater than 0.49, and the modified kappa coefficient for all items was higher than 0.6. With exploratory factor analysis, two factors were extracted consisting of 16 items and explaining 43% of the total variance. The results of confirmatory factor analysis indicated a good fit for the model. Cronbach's alpha and composite reliability for both factors were greater than 0.7. Although there is no significant difference (p = 0.09) in the average resilience of adolescents in different provinces, boys (42.64 ± 10.90) had a significantly (p < 0.001) higher resilience score than girls (40.10 ± 11.92).Conclusion: The study results showed that the Persian 16-item version of the Connor-Davidson Resilience Scale has acceptable reliability and validity in the Iranian adolescent population.