Development and validation of a supportive programme for family caregivers of children suffering from cystic fibrosis: protocol for a sequential exploratory mixed-methods study.

INTRODUCTION: Families with children who have cystic fibrosis (CF) face a multitude of challenges. They require complex and time-consuming daily care, various forms of knowledge and intricate care responsibilities. One of the most critical challenges that Iranian families of children with CF face is the lack of adequate support from health teams in the early stages of diagnosis, frequent hospitalisation and the postdischarge process. Unfortunately, limited studies have been conducted in this field, and the Iranian society lacks a comprehensive support programme for these families after leaving treatment centres or home care teams. Therefore, it is necessary to identify and redefine the needs of these families for better care and support in Iran. METHODS AND ANALYSIS: A mixed-method research design with an exploratory sequential approach will be used in this study. The study consists of three stages: stage (1) the qualitative phase (conventional content analysis and scoping review); stage (2) the programme design phase (development of a support programme) and stage (3) the quantitative phase (validation of the programme through the Delphi method). In the first stage, data will be collected through interviews. Key concepts, evidence and gaps in research will also be identified, collected and analysed through a scoping review. In the second stage, a support programme will be designed based on the results of the content analysis of interviews and the findings from the scoping review. In the final phase, the study will aim to validate the designed programme through a Delphi study. ETHICS AND DISSEMINATION: This study formed part of a Ph.D. degree and was approved by the ethics committee of Tabriz University of Medical Sciences (IR.TBZMED.REC.1402.395). Informed consent will be obtained from all study participants. Findings will be published in a peer-reviewed journal.

Development and psychometric properties of Iranian Women's Quality of Life Instrument (IWQOLI): mixed exploratory study.

BACKGROUND: To determine the health needs and promote women's health, their quality of life should be investigated. For this purpose, a valid tool is needed, that has credible validity and reliability, and its concepts are clearly defined and culturally appropriate. This study aimed to develop and assess the psychometric properties of "Iranian Women's Quality of Life Instrument (IWQOLI)". METHODS: The items of "IWQOLI" were generated from themes extracted (150 items) from a content analysis approach with the participation of 40 women. Face validity of the questionnaire with the participation of 10 women and content validity by 10 experts was approved. To determine the domains of the questionnaire, exploratory factor analysis (principal component extraction method) was performed. Internal consistency and test-retest reliability methods with 14-day intervals (30 women) were used to assess the reliability of WQOLI. RESULTS: After performing the face and content validity, 32 items were deleted. S-CVI/Ave was obtained for the instrument (0.93). The factor structure of the inventory was identified by undertaking a principal component analysis in a sample of 590 women. Five factors were extracted with a total variance account of 56.24% and 28 items dropped at this point. The IWQOLI score was significantly correlated with the SF-36 (r = 0.717, p < 0.001). Reliability was demonstrated with Cronbach's alpha coefficient of 0.919 for the entire scale (90-item). Consistency of the instrument was established with test-retest reliability with an interval of 2 weeks (intra-cluster correlation = 0.889, P < 0.001). CONCLUSIONS: The Iranian women's Quality of life Instrument "IWQOLI", consisting of 90 items representing 5 domains (sense of peace in life, sense of security, health responsibility, pleasant communication, received comprehensive support), demonstrated excellent psychometric properties, so it may be used for measuring women's QOL in practical research.

Lived sexual experience of health workers on the Iranian frontline of the fight against the COVID-19 pandemic: A qualitative content analysis.

Background: Lifestyle changes due to the COVID-19 pandemic may affect individuals' sexual lives and probably their sexual function. The present study aimed to explain the sexual lived experiences of health workers on the Iranian frontlines of the fight against the COVID-19 pandemic. Materials and methods: The present study was qualitative research using the conventional qualitative content analysis method. It was conducted in the city of Ramsar, Iran, in 2022. The data were collected using 12 in-depth personal interviews and a purposive sampling method. Lundman and Granheim's method was used to analyse the data. Results: The analysis of the data in the first phase of the research led to 60 initial codes, 7 subcategories, 3 main categories (concerns about health risks, sexual dissatisfaction, and sexual facilitators and barriers), and one theme (unhealthy lifestyle due to sexual dissatisfaction). Conclusion: The present study revealed new and different dimensions of the sexual experiences of health workers on the frontlines of the fight against the COVID-19 pandemic [concerns about health risks, sexual dissatisfaction, sexual facilitators, and sexual inhibitors]; these dimensions are based on the Iranian context and culture that can be considered to enhance sexual pleasure and the physical and mental health of health professionals that have an impact on improving patients' and people's health status in society.

The Effectiveness of Implementing Family-Centered Empowerment Model on Irrational Thoughts of Iranian Infertile Women: A Randomized Clinical Trial.

Introduction: Infertility is one of the main problems of the family and is one of the factors that determine the identity and personality of Iranian infertile women. Family-centered empowerment model is a step toward increasing the self-efficacy of patients and enabling them to take responsibility of their illness. This study aimed to determine the effectiveness of applying family-centered empowerment model on irrational thoughts of Iranian infertile women. Methods: This study was a randomized clinical trial conducted on 80 infertile women and their husbands that were randomly divided into two intervention and control groups. Irrational Parenthood Cognitions questionnaire was given to the intervention and control groups to complete before and 3 months after the intervention. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, IL, USA). Results: The mean (SD) of irrational thoughts' scores in the control group before and after the study were 33.92 (5.98) and 33.20 (6.83) respectively, and in the intervention group were 34.55 (5.61) and 19.97 (3.52), respectively. The result of independent t-test showed a significant reduction in irrational thoughts of women in the intervention group after the family-centered empowerment model intervention. Conclusion: The family-centered empowerment model after three months of continuous implementation was able to effectively reduce the irrational thoughts about having children in infertile women.

Improve the cervical cancer prevention behaviors through mobile-based educational intervention based on I-CHANGE model: study protocol for a randomized controlled trial.

BACKGROUND: Applications of mobile technologies (mHealth) have the potential to reduce health inequalities, give patients more control over their health, and improve health care's cost-effectiveness. The widespread use of mobile phones offers us a new way to prevent cervical cancer. The objective of the study was to design and develop a mobile phone application (app) that aims to conduct a behavioral intervention for women and to evaluate the efficacy of the app-based intervention. METHODS: This study involves 5 phases. In the first phase, understanding women's perspectives will be identified using a qualitative approach based on the I-Change model. In phase 2, the results from the qualitative approach and requirement prioritization through providing experts' perspectives will be done. The main outputs of this phase will be resulted in prioritizing the main measurable effective variables of the I-Change model. Phase 3 will be processed for the development and psychometric of an assessment tool regarding selected constructs. In phase 4, the App framework and content development will be performed. In phase 5, a three-armed, parallel-design randomized controlled trial will be conducted on women. Two hundred ten women will be randomly assigned to three groups including two intervention groups and one control group. The intervention groups included the following: (1) a mobile application and (2) a digital book. The data will be evaluated using tools designed and constructed in phase 3 of the study at baseline in 3-month follow-up assessments. The impact of the two interventions on cervical cancer prevention behaviors through mobile-based educational intervention will then be evaluated. DISCUSSION: A theory-based health education program using a mobile app to improve cervical cancer-preventive behaviors will be implemented for the first time in Iran. With an effective health mobile-based educational design, it is very important to determine whether Iranian women will be motivated to adhere to preventive behavior related to CC. TRIAL REGISTRATION: Iranian Clinical Trial Register IRCT20181205041861N3. Registered V2.0 on 26 October 2021.

The effect of family-centered empowerment model on the quality of life of adults with chronic diseases: An updated systematic review and meta-analysis.

BACKGROUND: Family-centered empowerment model (FCEM) is a concept that strengthens the family to help a chronic patient to obtain a better quality of life (QoL). The effects of FCEM on QoL of chronic patients are still inconclusive. Therefore, this meta-analysis was conducted to evaluate the effect of FCEM on QoL of adult patients with chronic diseases. METHODS: Following an online search PubMed/MEDLINE, Scopus, Web of Science, ProQuest, OVID, EMBASE, EBSCO, PsycINFO and Persian databases (Irandoc, IranMedex, SID and MagIran), all studies that tested the impact of FCEM on QoL of patients with chronic diseases were included. Cochrane Risk of Bias Tool was used to assessment the quality of included randomized clinical trials (RCTs) and before/after studies. Analyses were conducted by STATA16. RESULTS: Six hundred and ninety-seven studies were identified for screening. After screening process, 11 eligible studies were included in this meta-analysis. There were significant intervention effects in all QoL dimensions, physical and mental subscales and QoL total score (All P < 0.05). The minimum lower bound for SMD was 0.61 (95%CI: 0.96 to 1.66), indicating an increasing effect of the intervention on all QOL dimensions. The results showed substantial heterogeneity between the studies for all QoL dimensions, physical and mental subscales and QoL total scores (P < 0.001). CONCLUSION: FCEM is an appropriate model with a simple and effective application for families with a patient suffering from a chronic illness. Nursing education planners and healthcare providers could benefit from this model for improving the nursing education curriculum and accrediting programs.

Women's Quality of Life in Iran: A Mixed Method Study.

BACKGROUND: Quality of life drives from the individuals' perceptions of their position in life long and allows holistic assessment of the effects of health conditions beyond the symptoms, signs, and complications. This study aimed to assess the quality of life and recognize females' point of view about the quality of life aspects. Hence, perhaps it could be a step toward improving women's health status. MATERIALS AND METHODS: This study was an explanatory mixed method research one which was conducted in the two following steps. In the quantitative step, five hundred women aged 15-49 years were selected from varied zone of Tehran Province, using cluster random sampling method. In order to assess the quality of life, Short Form SF-36 instrument was used. In the qualitative step, forty women were selected by purposive sampling in a different range of quality of life based on the result of the first step. Data were collected through semistructured, in-depth individual interviews, which continued up to data saturation point. Data analysis was performed through conventional content analysis. RESULTS: Among different aspects of quality of life, the highest and the lowest means (SD) were related to physical functioning mean (SD) 70.58 (24.52) and general health 67.72 (27.66), and mental health 55.27 (30.22) and social functioning 57.02 (30.62), respectively. From the interviews, three main themes were extracted as the following: (i) financial support, (ii) informational support, and (iii) service-based social support. CONCLUSIONS: The present study revealed that Tehranian women do not have high experience related to the quality of life; however, a sense of receiving support from different sources could help them to wrestle with a complicated condition in everyday life.

Exploring the concept of social support as a key factor in young women's quality of life.

BACKGROUND: According to the fact that women make up half the population of each community and are considered as a family health center, exploring the factors promoting their quality of life and health must be prioritized. OBJECTIVE: This study aimed to understand the meaning of social support in young women's life. METHODS: Participants were 40 Iranian youth women who were selected by purposive sampling from the capital of Iran, Tehran. Interviews were carefully recorded and concurrent with data collection, analysis was done using conventional content analysis method. After securing the data saturation, interviews were finished and data were categorized by eight stages of zhang technique. RESULTS: From the interviews three main themes were identified: (i) financial support; (ii) informational support, and (iii) service-based social support. DISCUSSION: Awareness about aspects of social support in women' life could help health care providers and politicians in Iran to provide more effective programs to promote QOL and as a result total health of women.

Practical intervention on quality of life of anemic girls and their mothers.

BACKGROUND: Anemia is the most prevalent disease in teenage girls and like other chronic diseases not only affects different aspects of their quality of life (QOl) but also quality of life of their parents. OBJECTIVE: The aim of present study is investigating the effectiveness of family centered empowerment model (FCEM) on adolescent girls with anemia and their mother's quality of life. METHODS: Semi-experimental practical research is performed by choosing 60 girls with anemia and their mothers classified in two case and control groups based on random allocation in Tehran city. The eight sessions of educational program based on educational needs of girls & mothers in case group done for two months. The post test was carried out 1/5 month after the end of intervention through QOl questionnaire in case and control groups. Data analysis was performed using statistical methods including t-test, paired t-test. RESULTS: There was no significant difference in the QOl in adolescent girls and their mothers between the two case and control groups before intervention (P=0/473 & P=0/94 respectively). While, after the intervention independent t-test showed a significant difference between the two case and control groups (P>0/001). CONCLUSIONS: Findings showed that the FCEM promote the QOl in adolescent girls with anemia and their mothers. It is recommended that extensive studies be performed on the effectiveness of this model for other chronic diseases in different age groups.

Self-Efficacy of People with Chronic Conditions: A Qualitative Directed Content Analysis.

BACKGROUND: Given the increasing prevalence of chronic illnesses and their complications, supporting and empowering chronically ill patients seems crucial. Self-efficacy is considered as a predictor for empowerment. The purpose of this study to explore of different aspects of self-efficacy among persons with chronic physical conditions based on the Family-Centered Empowerment Model (FCEM). METHODS: this qualitative study is part of a larger study; sequential exploratory mixed-method for designing an instrument for the FCEM was conducted from May 2015 to March 2016 in two university hospitals. The sample was 22 participants, including chronically ill patients, family caregivers, and nurses. Data were collected through personal semi-structured interviews. Data analysis was performed concurrently with data collection through directed qualitative content analysis. RESULTS: after determining the self-efficacy attributes in the family-center empowerment model, a category matrix was developed and the codes are placed in subcategories of the matrix. Most participants were female (58.0%), with a mean age of 49.50 years. The final analysis yielded a total of 247 units of analysis dispersed in eight subcategories belonging to four generic-categories. CONCLUSIONS: the findings of this study represent the dimensions of chronically-ill individuals' self-efficacy that can be used to develop and implement programs for empowering chronic ill patients.

The financial transaction between counseling and nursing care service centers (CNCSCs) and their clients: a qualitative study.

BACKGROUND: Community-oriented nursing care is an important model of nursing care. Counseling and Nursing Care Service Centers (CNCSCs) have been providing these private services to the Iranian community for nearly two decades. Resource management, cost-benefit analysis and affordability are important steps in providing these services. The present study was conducted to explore the challenges of financial transactions between CNCSCs and their clients. METHODS: This study has a qualitative design and was conducted on a total of 30 participants, consisting of CNCSC managers, staff, physicians and clients who were selected through purposive theoretical sampling. Data were collected through in-depth interviews and direct observations and were analyzed using conventional qualitative content analysis. RESULTS: The analysis of the data led to the extraction of three main categories, including the flaunted atmosphere due to direct financial transaction, instability in determining tariffs for nursing services and the use of strategies for cost-effective services and client satisfaction. CONCLUSION: To increase affordability and satisfaction and expand private community-based nursing. Services, appropriate financial policies should be designed and applied that can lead to transparent and simple financial transactions with the clients by way of indirect monetary exchanges. These policies should be designed in a systematic manner with integrity, facilitate inter-sectorial cooperation in the health sector and be cost-effective for the clients, insurance companies and the health system.

Exploring nurses' experience about facilitating factors in medication administration based on clinical judgment of nurses: A content analysis.

BACKGROUND: Clinical judgment of nurses to conduct medication orders is based on patient assessment, medication knowledge, observation, and interpretation of the data collected. This process is influenced by many factors. OBJECTIVE: This study aims to explore nurses' experience about facilitating factors in medication administration based on clinical judgment of nurses. METHODS: This qualitative study was part of an approved project research of the Iranian National Institute of Health Research, which was conducted in Kurdistan University of Medical Sciences in 2015. Based on purposive sampling of 18 participants, 26 open and semistructured interviews were conducted. Based on conventional content analysis method and using MAXQDA2010, coding and categorizing the data were applied. During the analysis, data collection continued until saturation. RESULTS: Analysis of the data led to the emergence of five themes, including the implementation of evidence-based medication orders, situational-based medication orders, medication orders in critical condition, educational interventions in medication orders, and supporting the nurses as facilitator of the implementation of medicinal orders based on clinical judgment of nurses. CONCLUSION: In response to constraints such as the routines, clinical crisis and lack of evidence in medicinal orders, nurses used following ways to fix these barriers and facilitators. Combining evidence such as clinical guidelines, physician's views based on patients, and clinical conditions proved the best facilitator. It is recommended that, using these results, a perfect background for the proper administration of medication orders by nurses should be provided.

Experiences of Iranian Nurses on the Facilitators of Pain Management in Children: A Qualitative Study.

Background. Despite decades of research and the availability of effective analgesic approaches, many children continue to experience moderate-to-severe pain after hospitalization. Greater research efforts are needed to identify the factors that facilitate effective pain management. The aim of this study was to explore the perceptions of Iranian nurses on facilitators of pain management in children. Materials and Methods. This qualitative study collected the data profoundly through unstructured interviews with 19 nurses in Amirkola Children's Hospital in Babol and Children's Medical Center in Tehran, during 2013-2014. Purposeful sampling and analysis of the data were conducted using conventional qualitative content analysis. Results. Four themes were extracted through data analysis: mother and child participation in diagnosis and pain relief, the timely presence of medical staff and parents, proper communication, and training and supportive role of nurses. Conclusion. Mother and child participation in the report and diagnosis of pain and nonpharmacological interventions for pain by the mother, the timely presence of medical team at the patient's bedside, and proper interaction along with the training and supportive role of a nurse enhanced the optimal pain management in hospitalized children.

Nurses' Clinical Judgment Development: A Qualitative Research in Iran.

BACKGROUND: Clinical judgment development is necessary because it leads to appropriate nursing diagnoses, clinical decision-making and health promotion. OBJECTIVES: In this study we explored the process of Iranian nurses' development in clinical judgment. PATIENTS AND METHODS: This qualitative study was conducted in 2013 at hospitals of Kurdistan University of Medical Sciences, located in the Sanandaj city of Iran. The data were collected based on semi-structured interviews and the study included 24 participants. Data analysis was carried out concurrently with data collection using the grounded theory method. RESULTS: The study participants' main concern was 'being non-professional in clinical judgment'. In response to this concern, they were struggling for gaining professional autonomy, striving for integrating clinical judgment skills, scrambling to make effective educational interventions and striving for professional and inter professional collaboration in clinical judgment. The core category was 'struggling for becoming professional in clinical judgment development'. When nurses were supported professionally, they were able to develop their professional clinical judgment. CONCLUSIONS: The findings of this study provided critical information about nurses' professionalization in clinical judgment. Accordingly, the participants adopted different strategies to develop their clinical judgment ability. Integrating these strategies into nursing theory and clinical education can improve nurses' clinical judgment ability.

Relationship Between Low Back Pain With Quality of Life, Depression, Anxiety and Stress Among Emergency Medical Technicians.

BACKGROUND: Musculoskeletal disorders have become increasingly common among healthcare providers. They have become the most common cause of work-related disabilities among nurses. OBJECTIVES: The current cross-sectional study aimed to measure the prevalence of back pains among emergency medical technicians (EMTs), and association of back pain with quality of life, depression, anxiety and stress. MATERIALS AND METHODS: One hundred and eighty registered nurses working as EMTs at the Hamadan Emergency Medical Center were selected by consensus. Data collection tools were Demographic, Perceived Quality-of-Life, Short Form Health Survey (SF-36), and Depression Anxiety Stress Scales (DAS21) and pain scale measurements. RESULTS: Data showed that while 50.7% of the participants had an average awareness of the basic principles of back care, the majority (71.8%) had at least one type of back pain. There were associations between the prevalence of pain and depression (P = 0.049), pain and awareness (P = 0.035), and stress and job satisfaction (P = 0.024). CONCLUSIONS: A large number (about two-thirds) of EMTs had some sort of back pain; it is highly recommended to promote the attitude and motivation of the individuals to take care to prevent back injury and inform them of the principles of back care. Implications for primary prevention and care practice include encouraging EMTs to apply accurate principles of back care.

An empowering approach to promote the quality of life and self-management among type 2 diabetic patients.

Type 2 diabetes is one of the most serious health concerns and policy agendas around the world. Epidemiological evidence suggests that it will likely continue to increase globally. Diabetes is strongly associated with the patients' unhealthy lifestyle and behavioral patterns and socio-economic changes. New model of thinking is required to recognize whether the patients are in control of and responsible for the daily self-management of diabetes. Such a new approach should be based on 'empowerment and involvement' to be more applicable to daily activities in diabetic patients. Rapid changes toward patient empowerment and increasing involvement of patients in their care plan indicate more emphasis on disease prevention and health promotion and education than on mere disease and its treatment. Such changes make a step toward pervasive sense of responsibility among patients about their illness for their daily activities. Using the empowerment approach, healthcare professionals would help patients make informed decisions in accordance with their particular circumstances. Patient empowerment implies a patient-centered, collaborative approach that helps patients determine and develop the inherent capacity to be responsible for their own life. Empowerment is something more than certain health behaviors. Empowerment is more than an intervention, technique or strategy. It is rather a vision that helps people change their behavior and make decisions about their health care. It has the potential to improve the overall health and well-being of individuals and communities, and to change the socio-environmental factors that cause poor health conditions. The main concept of this change is the tendency to change.

Analysis of some predictive factors of quality of life among type 2 diabetic patients.

INTRODUCTION: Considering the chronic nature of diabetes and its significant effect on quality of life of patients, the present study was conducted to evaluate predictors of quality of life in these patients in order to facilitate planning health promotion intervention programs. MATERIALS AND METHODS: The present study was designed as a cross-sectional study on 140 type 2 diabetic patients of Om-ol-Banin Diabetes Center of Isfahan. Data collection tool was a multidimensional questionnaire including demographic and disease related data (12 items), the standard scale for diabetes distress (17 items), the standard scale for self-efficacy in diabetic patients (8 items), and standard scale for specific quality of life of diabetic patients (15 items). Collected data were evaluated by SPSS version 11.5 using the Chi-square test, Independent T-test, ANOVA, Pearson correlation and multivariate regression analysis. RESULTS: Results showed that the quality of life of diabetic patients had a statistically significant correlation with diabetes distress variable (P < 0.001) and self-efficacy variable (P < 0.001). In this study R(2) (predictive power) was 0.66. Multivariate regression model indicated diabetes distress (ß = -0.277, P = 0.01) and self-efficacy (ß = -0.161, P < 0.001) as variables influencing adjusted self-management for other variables. CONCLUSION: The result of the present study urges that in planning health promotion interventions in the field of diabetes, more attention be paid to self-efficacy and diabetes distress variables in order to improve the efficiency and effectiveness of the interventions carried out.

A survey on the effect of implementation of a family-centered empowerment model on blood pressure and empowerment dimensions in the elderly people with hypertension.

BACKGROUND: Noncommunicable diseases such as Hypertension are among the important factors of mortality and morbidity of the elderly people. The family-centered empowerment model (FCEM) has not been performed for elderly people with hypertension. SETTINGS AND DESIGN: This clinical trial study was carried out on 62 elderly people with hypertension under the coverage of the Lenjan Health Network in 2013. After performing the sampling by using the cluster-randomized method, the samples were divided randomly into the experimental and control groups. METHODS: For the experimental group, the (FCEM) was implemented based on the four steps. For the control group, it was only implemented the usual care and one training session. Research tools included questionnaires of demographic data, empowerment assessment and a blood pressure-measuring device. The post-test was performed 1 week later. The blood pressure was recorded, and it was followed 1.5 month later again. STATISTICAL TESTS: Statistical tests for data analysis included χ(2)-test, independent t-test, Mann-Whitney, analysis of variance, and SPSS 20. RESULTS: 1 week later and 1.5 month after the intervention, the mean blood pressure was significant in both groups (P < 0.001). also, the difference in the mean score of empowerment dimensions was significant in the experimental group 1 week later and 1.5 month after the intervention (P < 0.001). CONCLUSION: Implementation of the FCEM for elderly people with hypertension has been possible from a practical point of view, and it has been associated with controlling and improving the blood pressure.

Design and development of a scale of perceived barriers to self-care in patients with type 2 diabetes mellitus: an exploratory factor analysis.

INTRODUCTION: Despite the importance of perceived barriers against self-care in diabetic patients, the role of this factor is rarely addressed in the improvement of self-care behaviors of Iranian patients. The lack of appropriate instruments that fit demographic properties of Iranian society is one reason. The aim of this study was to develop and validate the scale of perceived barriers to self-care in patients with type 2 diabetes mellitus. METHODS: This cross-sectional study conducted on 400 patients with type 2 diabetes who were covered by the health centers in Isfahan (Iran) in 2015. A 22-item, researcher-made instrument was designed; the face and content validities of the instrument were examined through obtaining the opinions of an expert panel before administering the instrument in the study. Also, the exploratory factor analysis was used to investigate the instrument's validity. Cronbach's alpha was employed to measure its internal consistency (reliability). To examine the validity of the final scale, the mean scores of perceived barriers in patients with appropriate and inappropriate self-care behaviors were compared. RESULTS: The research sample was comprised of 240 women (60%) and 160 men (40%). The mean value of the content validity index was 0.84. The results of factor analysis confirmed the validity of the 11 items and 3 factors of the developed scale. The factor loading ranged from 0.46 to 0.78. These three factors together explained 40.28% of the total variance. The overall reliability coefficient of the instrument was 0.79, ranging from 0.82 to 0.93 for three factors. CONCLUSION: According to the results, the developed scale was a valid and reliable instrument for examining the barriers perceived by the patients. The findings of this research can help health policy makers in planning to facilitate the self-care behaviors as the most vital factor in diabetes control.

The Impact of Multimedia Education on Knowledge and Self-efficacy among Parents of Children with Asthma: A Randomized Clinical Trial.

INTRODUCTION: Asthma is one of the most common chronic disease among children, and is considered as a global health problem. According to the guidelines of childhood Asthma, parental education in order to improve their knowledge and self-efficacy should be considered in clinical care. Therefore, this study was performed with the purpose of investigating the influence of multimedia education on knowledge and self-efficacy of the parents of children with Asthma. METHODS: This study is a clinical trial which was carried out on 50 parents of children with Asthma. Data collection instrument included the demographic questionnaires, assessing knowledge and self-efficacy of the parents of children with Asthma. Reliability and validity of the instruments were assessed and the multimedia education was carried out for the experimental group. Data analysis was done using SPSS 13 and descriptive inferential statistical tests (independent t-test and Mann-Whitney). RESULTS: History of Asthma was present in majority 52% of the families of the children and 54% reported smoking in their home. The average scores of knowledge and self-efficacy of the study samples in the experimental group showed an increase after multimedia education methods, so that there was a statistically significant difference between the experimental and control groups. CONCLUSION: The results obtained in this study also demonstrate that educating parents through multimedia technology increase their knowledge and self-efficacy in their care of children.