Religious and Spiritual Coping Elements in Dealing with Chronic Diseases: A Qualitative Exploration of the Perspectives of Older Iranian Zoroastrians.

Religiosity is a desirable alternative coping strategy for many people when facing negative life events including age-related infirmities and stressors. Religious coping mechanisms (RCMs) have been investigated meagerly with regard to religious minorities around the world and, to the best of current knowledge, no study has been conducted on Iranian Zorostrians to explore their religious coping mechanisms in dealing with age-related chronic diseases. This qualitative research, therefore, was aimed to canvas perceptions about RCMs that are utilized by Iranian Zoroastrian older adults to deal with chronic diseases in the city of Yazd, Iran. Semi-structured interviews were conducted with purposefully selected fourteen Zoroastrian older patients and four Zoroastrian priests in 2019. The main extracted themes included performing certain religious behaviors and having sincere religion-based beliefs as employed mechanisms for better coping with their chronic diseases. Prevalent dilemmas/barriers with mitigating impact on the coping capacities in dealing with a persistent illness was another predominant identified theme. Identification of RCMs that religious and ethnic minorities are using to better confront diverse life events, such as chronic diseases, could pave the path to expand new approaches in planing sustainable disease management and proactive quality of life improvement initiatives.

Urinary incontinence and related quality of life among elderly women in Tabas, South Khorasan, Iran.

BACKGROUND: Urinary incontinence (UI) is one of the most common problems in old age that is often seen in women, which causes not only physical problems but also psychological, social, economic problems and poor quality of life. The aim of the present study was to evaluate the UI and related quality of life (QoL) in elderly women. METHODS: This cross-sectional study enrolled 369 women over 60 years old and living in Tabas city, Iran who were selected by cluster random sampling method. The instruments included the International Consultation on Incontinence Questionnaire-Short Form, the International Consultation on Incontinence Questionnaire Urinary Incontinence Quality of Life Module, and a demographic questionnaire. Data analysis was carried out using independent t-test, chi-square, and logistic regression in SPSS software. RESULTS: The UI prevalence among participants was 24.9% and stress urinary incontinence was the most common type (40.2% of all elderly patients). The mean UI-related QoL score was 38.04 ± 11.67 from the score range of 22-76. There was a significant positive correlation between UI-related QoL score and UI score (r = 0.585, p < 0.001). Age, body mass index (BMI), constipation, history of cesarean section, hypertension, and the use of angiotensin receptor blockers are factors increasing the odds of having UI in this study population. CONCLUSION: Aging, some chronic diseases, high BMI, and the use of some drugs are related to UI prevalence. Also, it is associated with lower QOL among elderly women. Designing appropriate intervention programs, controlling chronic diseases, training in the proper use of drugs, and also some physical exercises can be effective in controlling and improving this common syndrome of old age and promoting their QoL.

Psychometric properties of the Persian version of abridged Connor-Davidson Resilience Scale 10 (CD-RISC-10) among older adults.

BACKGROUND: Resilience is an ability of an individual to respond positively to environmental challenges. This ability could help elderly people to better cope with their age-related changes and diseases. The aim of this study was to examine the psychometric properties of Persian version of abridged Connor- Davidson scale of resilience among Iranian elderly people with chronic diseases. METHODS: Standard translation/back-translation procedure was applied to prepare the Persian version of abridged Connor-Davidson scale of resilience (CD-RISC 10-P) and its face and content validity were examined by an expert panel. The internal consistency and reliability of the drafted CD-RISC 10-P were investigated using the Cronbach's alpha and intra-class correlation coefficients. A sample of 400 Muslim and Zoroastrian Persian older adults residing in the city of Yazd, Iran was recruited to assess factor structure of CD-RISC 10-P using the confirmatory factor analysis. RESULTS: The calculated values of the Cronbach's alpha (0.89) and ICC (0.90) coefficients were in the within of acceptable range. The confirmatory factor analysis outputs also confirmed the unidimensionality of the CD-RISC 10-P (RMSEA = 0.073, SRMR = 0.030). CONCLUSIONS: The study findings showed that the CD-RISC 10-P is a valid and reliable scale to measure resilience with age-related challenges of chronic diseases among Persian-speaking elderly people. Cross-cultural adaptability of the CD-RISC 10-P is recommended to be assessed in different subgroups of the Iranian elderly people and possibly in other Persian-speaking populations of different countries.

Psychometric Rigor of the Brief Religious Coping Measure (RCOPE) in Persian-Speaking Older Adults.

Religious coping to deal with negative life events has gained considerable attention in recent years. This study was conducted to investigate psychometric properties of the Persian version of Brief RCOPE measure (RCOPE-P). The RCOPE-P was devised using a standard translation/back-translation procedure and its internal consistency and test-retest reliability were estimated using Cronbach's alpha and intraclass correlation coefficients. The instrument's factor structure was appraised in a sample population of 400 older adults with chronic diseases. Positive and negative subscales of the RCOPE-P indicated acceptable internal consistency (0.74, 0.80) and test-retest reliability (0.89, 0.91). Confirmatory factor analysis confirmed fitness of the original 2-factor model (root mean square error of approximation (RMSEA) = 0.046, CFI = 0.967, Tucker-Lewis index (TLI) = 0.953, and standardized root mean square residual (SRMR) = 0.052) to the data obtained from the study. The findings endorsed applicability of the RCOPE-P for the Persian-speaking older adults but its adaptability in other Persian-speaking population subgroups must be further examined.

Social participation and loneliness among older adults in Yazd, Iran.

Social participation among older people is associated with more practice of physical activities, improvement of cognitive skills and less feeling of loneliness. The primary purpose of this cross-sectional study was to examine the social participation and sense of loneliness among older adults in Yazd, an Iranian city that is known for its traditional values and religious people. The non-probability sample consisted of 200 elderly people. Data collection tool was a questionnaire, which was completed by a trained interviewer through face-to-face interview. The mean scores of social participation and loneliness feeling among participants were 17.29 ± 5.62 (8-40) and 38.02 ± 7.91 (16-80), respectively. From the participants, 79.8% had not participated in educational cultural and activities. Mostly reported barriers to social participation included transportation-related issues (57%), diseases and health problems (43.5%) and personal or family responsibility (36%). The best predictors of loneliness were demographic characteristics, followed by the total number of diseases/problems and the total number of barriers to social participation. Social participation itself was not a statistically significant predictor of loneliness. Theoretical and practical implications were discussed.

Cross-cultural adaptation and psychometric validation of the World Health Organization quality of life-old module (WHOQOL-OLD) for Persian-speaking populations.

BACKGROUND: Reliable quality of life assessment is important for identification of health problems, evaluation of health interventions and planning of optimal health policies and care packages. Due to lack of a psychometrically robust measurement tool for quality of life appraisal among the Iranian older population, this study was aimed to investigate psychometric properties of the Persian version of the World Health Organization quality of life-old module (WHOQOL-OLD-P) for use on the Iranian and other Persian-speaking aged populations. METHODS: The standard translate/back-translate procedure was applied to convert the English version of the WHOQOL-OLD into Persian. The face and content validities were assessed by a panel of experts including 15 specialists in geriatrics and allied fields. The Cronbach's alpha and intra-class correlation (ICC) coefficients were estimated to assess internal validity and reliability of the translated version. Factorial structure of the WHOQOL-OLD-P was also tested using confirmatory factor analyses in a sample of 400 Persian-speaking older adults (aged 60 years of old and above) residing in the city of Yazd, the capital city of Yazd province, center of Iran. RESULTS: The internal consistency and reliability indices of the WHOQOL-OLD-P were in the vicinity of acceptable range (Cronbach's alpha: 0.65-0.82 and ICC: 0.90-0.98). The confirmatory factor analysis outputs confirmed the six-factor solution of the WHOQOL-OLD-P (RMSEA = 0.04, CFI = 0.94, TLI = 0.93, SRMR = 0.06). CONCLUSION: The study findings support validity and reliability of the WHOQOL-OLD-P for use on Iranian and possibly other Persian-speaking older populations. Further cross-cultural and comparative multinational studies are recommended to provide more vigorous evidence about feasibility and acceptability of the translated tool in diverse and multicultural Persian-speaking communities.

Cognitive determinants of self-care behaviors among patients with heart failure: A path analysis.

Background: Heart failure (HF) is a common clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of ventricles to fill with or eject blood.Our aim in this study was to examine the possible direct/indirect effects of health belief model(HBM) constructs on self-care behaviors among HF patients. Methods: A secondary analysis was conducted on an HBM-based data set collected from 180 patients with HF who were recruited from a heart hospital in Tehran, Iran, during a prospective experimental study in 2008. A regression-based path analysis was conducted to examine the relationships between HBM constructs (as independent variables) and self-care behaviors (as dependent variable). Results: A conceptual path model was identified for the cognitive determinants of self-care behaviors among HF patients. Knowledge (ß = 0.399), perceived barriers (ß = 0.315) and susceptibility (ß = 0.165) had direct effects on self-care (R2 = 0.512, P < 0.001). Perceived benefits, self-efficacy, severity and threat, locus of control and cues to action had indirect effects on self-care through the first three variables. Conclusion: HBM was found to be helpful in understanding direct and indirect associations between the cognitive determinants and self-care behaviors among HF patients. Based on this challenging path analysis, HF patients' knowledge and perceived barriers and susceptibility are suggested as the most core categories while designing HF educational programs. Better understanding on such associations may lead nurses and health practitioners in designing properly informed stage-specific educational interventions aiming to foster self-care behaviors among HF patients.

Domestic elder abuse in Yazd, Iran: a cross-sectional study.

BACKGROUND: Social changes due to urbanism, acculturation, and fading of values have led to some challenges in family relationships, including domestic elder abuse. This study was conducted to determine elder abuse status in Yazd, Iran. METHODS: This cross-sectional study was conducted on 250 elderly people over 60 years in Yazd in 2014-2015. Clustered random sampling was used to recruit the participants from 10 clusters in Yazd (25 individuals from each cluster). The data were gathered by the 49-item,Iranian Domestic Elder Abuse Questionnaire which was filled out through private interviews with the participants. RESULTS: Mean score of elder abuse was 11.84 (SD: 12.70) of total 100. Of the participants,79.6% (95% CI: 74.5-84.6) experienced at least one type of abuse. Emotional neglect was the most reported abuse and physical abuse was the least reported. Abuse score was associated with age, education level, living status, and insurance status of elders. Further, those who reported history of gastrointestinal problems, dyslipidemia, respiratory diseases, sleep disorders, audiovisual problems, joints pain, hypertension, dental/oral problems, cardiovascular disease,urinary incontinence and disability, reported a statistically significant higher abuse score. CONCLUSION: Despite overall low rate of domestic elder abuse, its high prevalence indicates that some interventions are necessary to decrease domestic elder abuse. Emotional neglect of elders should be addressed more than other abuse types.

Determinants of Self-Care in Diabetic Patients Based on Health Belief Model.

INTRODUCTION: The aim of this study was to determine self-care predictors in diabetic patients based on health belief model. MATERIALS & METHODS: The cross-sectional study was conducted on 110 diabetic patients referred to health service centers in Ardakan city, Yazd, Iran. The data was collected by a questionnaire including perceived benefits, barriers, severity, susceptibility, self-efficacy, social support, self-care behaviors and demographic variables. RESULTS: Regularly medicine use (mean=6.48 times per week) and shoes checking (mean=1.17 times per week) were reported as the highest and the lowest self-care behaviors respectively. Health belief model constructs including perceived benefits, barriers, severity, susceptibility, self-efficacy and social support predicted 33.5% of the observed variance of self-care behaviors. Perceived susceptibility and self-efficacy had positive effect on self-care behavior; whereas perceived barrier's has negative effect. Self-efficacy, perceived susceptibility and barriers were most powerful predictor respectively. CONCLUSION: The findings approved the efficiency of health belief model in prediction of self-care behaviors among diabetic patients. The findings realized the health belief model structure; therefore, it can be used as a framework for designing and implementing educational interventions in diabetes control plans.

Unlicensed motorcycling of high school adolescents in Dehaghan county (Isfahan Province of Iran).

BACKGROUND: Unlicensed motorcycling increases the chances of accidents in adolescents. There are many behavioral and non-behavioral factors involved in adolescents' unlicensed motorcycling which were not addressed in research yet completely. METHODS: The cross-sectional study aimed to determine prevalence and related factors of unlicensed motorcycling on 500 unlicensed male high school adolescents in Dehaghan, who entered in the study by census. Demographic and motorcycling information were collected via self-report questionnaire, and its content validity was approved by a panel of experts. The statistical analyses of the data included Pearson Correlation Coefficient, chi-square, independent samples t-test and ANOVA with Tukey post hoc test. RESULTS: The prevalence of unlicensed motorcycling among participants was 74.2% and mean age at first motorcycling experience was 11.97±1.97 years ranged from 8 to 17. Of the motorcyclist participants, 59.6% owned their personal motorcycle. Most motorcycle passengers (62.8%) were adolescent's friends, and the most frequently expressed reason for use of motorcycle was fun and entertainment (54.2%). Age at first motorcycling experience was lower among rural adolescents than urban adolescents. However, unlicensed motorcycling was more prevalent among urban adolescents than rural ones. The relationship between living status, father's job, mother's job and age at first motorcycling experience was insignificant (P>0.05). However, mean age at first motorcycling experience among students of humanities, technical disciplines, and general first year was lower than that among students of natural sciences and math. CONCLUSION: High prevalence of unlicensed motorcycling and significant role of family and social environments on adolescents' high-risk motorcycling without license, is indicative of the need for interventions at all levels of peers, family, and schools and also establishing new driving regulations in Iran.