Barriers to and Facilitators of Adjustment Among Iranian Multiple Sclerosis Patients: A Qualitative Study.

Patients with multiple sclerosis (MS) experience various physical symptoms and psychosocial problems that disrupt their normal life, and adapting to these conditions is vital for them. Many factors that serve as facilitators of and barriers to achieving adjustment should be identified to be able to help the patients. This study was conducted to explain the experiences of patients with MS regarding the facilitators of and barriers to adjustment using conventional content analysis. The participants consisted of 18 patients, one nurse, one physician, and one patient companion, who were selected from the Multiple Sclerosis Clinic of BouAli, northern Iran, through purposive sampling. Data were collected through individual, in-depth, and semi-structured interviews and analyzed using the method recommended by Elo and Kyngäs (2008). The data analysis generated five subcategories as facilitators and five subcategories as barriers. The subcategories of facilitators included family's appropriate behavior with the patient, occupation, studying and information gathering, religious beliefs, and turning attitude into disease simplification and optimism. The subcategories of barriers were concerns about the uncertain future of the disease, physicians' poor communication and behavior, society's poor attitude, economic problems, and unsatisfactory support by the government and insurance companies. The results showed that a set of individual, environmental, and social factors serves as facilitators of or barriers to the process of adjustment to MS in patients. Gaining knowledge about these factors in congruence with the sociocultural context of the society, as derived from people's real experiences, can help healthcare staff and the family of these patients provide more efficient assistance to the patients for achieving adjustment earlier.

Culture of discrimination in healthcare: A grounded theory.

BACKGROUND: Discrimination in health care is an international challenge and a serious obstacle to justice and equality in health. RESEARCH OBJECTIVE: The purpose of this study was to design a grounded theory of discrimination in health care based on the experiences and perceptions of Iranian healthcare providers and patients. RESEARCH DESIGN: This qualitative study was conducted using by the grounded theory method. PARTICIPANTS AND RESEARCH CONTEXT: Data were collected through semi-structured interviews with 18 healthcare providers including 11 nurses, two physicians, two nurse's assistants, and three patients in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling and analyzed simultaneously using the Corbin and Strauss (2015) approach. ETHICAL CONSIDERATIONS: The study was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics code: IR.USWR.REC.1398.023). Also, after explaining the objectives of the study, all the participants completed and signed the written consent form. FINDINGS: The "culture of discrimination" was the study's core category, reflecting the nature of discrimination in health care. The theory of "culture of discrimination in health care" is the result of five main categories: "individual social stimuli," "culture of discrimination," "unintentional discrimination," "conflict with discrimination," and "dissatisfaction with discriminatory behavior." These categories cover the underlying factors, strategies, and outcomes of the discrimination process in health care. DISCUSSION: The results of the study showed that nurses and other health care providers experience unintentional discrimination. Unintentional discrimination refers to discriminatory behaviors and practices of health care providers. CONCLUSION: The theory of culture of discrimination in health care can be used as a practical guide to describe and understand the role of health care providers, especially nurses. Further studies with a quantitative approach to applying this theory in medical settings are recommended.

Defining the concept of family caregiver burden in patients with schizophrenia: a systematic review protocol.

BACKGROUND: Since the deinstitutionalization policy, in psychiatric hospitals, the care of patients with schizophrenia was left to their families which has been imposing a heavy burden on them. Family caregiver burden could have consequences for caregivers, patients, and the society. There is very little consensus on the definition and dimensions of the caregiver burden, which leads to a lack of consistency in the results of research. Thus, the present study was aimed to redefine the family caregiver burden of patients with schizophrenia. METHODS: The databases PubMed, Scopus, Web of Science, MEDLINE (Via Ovid), ProQuest, SCI, Magiran, SID, and IranDoc will be searched from 1940 to 2018 using subject headings and appropriate terms in both Farsi and English languages. Also, gray literature and the reference list of included articles will be used to offer an appropriate definition of the family caregiver burden in patients with schizophrenia. Two independent reviewers will participate in study selection, data collection, and quality assessment steps. The result will be presented in tabular form, and meta-synthesis will be performed. DISCUSSION: The result of this systematic review will help present the comprehensive definition of the family caregiver burden in patients with schizophrenia according to its evolutionary trend. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018099372.

Study protocol for promoting physical activity among women based on the MAPP process.

BACKGROUND: The participation of all stakeholders is necessary when a community-based intervention is designed. For running a practical intervention, it is necessary to have a framework to design the programme while considering all stages of planning, implementation and evaluation. AIMS: To describe a study protocol based on the MAPP process (Mobilizing for Action through Planning and Partnerships) for promoting physical activity (PA). METHODS: This protocol is implemented in 6 distinct phases. The goal of the first and second phase is to organize the programme and increase participation, and to determine the vision of the programme, respectively. The third phase provides a comprehensive picture of a community. The fourth and fifth phases identify strategies for the programme. The sixth phase is about the action cycle. CONCLUSION: The framework considers all factors on PA improvement and, consequently, results in a culture-based programme for women.

Experiences of Cigarette Smoking among Iranian Educated Women: A Qualitative Study.

BACKGROUND: Smoking is a well-known public health problem in women as well as men. In many countries including Iran, there is an increase in tobacco use among women. Exploring the experience of smoking by educated women in order to develop effective tobacco prevention programs in these women is necessary. This study aimed to explore the experiences of smoking among Iranian educated women. METHODS: This study used a method of qualitative content analysis with the deep individual, semi-structured interviews on a sample of 14 educated female smokers, selected purposefully. Data were analyzed using qualitative content analysis with conventional approach while being collected. RESULTS: The data analysis led to 16 subcategories which were divided into four main categories: (1) Personal factors including subcategories of imitation, show-off and independence, inexperience and curiosity, personal interest and desire, improved mood, and social defiance; (2) family factors including smokers in the family, intrafamily conflicts, and family strictures and limitations; (3) social factors including subcategories of effects of work and school environment, gender equality symbols, peer pressure, and acceptance among friends; and (4) negative consequences of smoking including subcategories of a sense of being physically hurt, psychological and emotional stress, and being looked upon in a negative and judgmental manner. CONCLUSIONS: The findings of this study showed that smoking among Iranian educated women is a multifactorial problem. Thus, it is necessary to address smoking among educated women in a holistic approach that focuses on different determinants including personal, family, and social factors particularly the gender roles and stereotypes.

Clinical nurses' perceptions of the opportunities for using complementary therapies in Iranian clinical settings: A qualitative study.

Nurses need to use complementary therapies in their clinical practice in order to fulfill community's needs. There are potential opportunities for using complementary therapies in different clinical settings. This study was done to explore nurses' perceptions of these opportunities in Iranian clinical settings. In this qualitative study, sampling was done purposively and ended after reaching data saturation. Semi-structured interviews were done with fifteen nurses. The data were analyzed via the conventional content analysis approach. The participants' perceptions fell into three main categories of 'consumer demand', 'environmental potentials', and 'optimal official regulations' from which, the main theme of 'A potentially-supportive environment' was abstracted. The context of Iranian clinical settings is appropriate for using complementary therapies in nursing practice. A potentially-supportive environment automatically directs nurses towards using such therapies. These findings can be used by nursing managers to integrate complementary therapies into nursing practice.

Iranian adolescents' insufficient physical activity: a mixed methods explanatory sequential study.

BACKGROUND: Adolescents' physical activity decreases from the stage of childhood to adulthood. This study was addressed to explain adolescents' insufficient physical activity (IPA) and its related factors. The subjects were 1201 adolescents in the quantitative phase and 25 adolescents in the quantitative phase. METHODS: An explanatory sequential mixed methods design with follow-up explanations variant was used, which involved collecting quantitative data (1201 adolescents) first and then explaining the quantitative results with in-depth interviews and written narrative (25 adolescents) during a qualitative study. RESULTS: The quantitative results showed that 98.8% of adolescents did not have the recommended physical activity. Five themes were extracted in the qualitative phase including the inhibitory effect of the school environment and peers, as well as the inhibitory effect of the family environment, lack of availability and cultural barriers for the presence of girls in the community, the effect of self-feeling and self-understanding, and physical and mental exhaustion and permutation. According to the qualitative findings of the study, physical and mental exhaustion expressed the fact that, although adolescents had an unfavorable sense of IPA, they were under the effects of the intrinsic and extrinsic factors. CONCLUSION: The comparison of these themes indicates that this behavior is imposable but not optional.

Association between social capital and health in women of reproductive age: a population-based study.

Women's health is a public health priority. The origins of health inequalities are very complex. The present study was conducted to determine the association between social capital and health status in reproductive-age women in Tehran, Iran. In this population-based, cross-sectional study, the Social Capital Integrated Questionnaire, the SF-36 and socio-demographic questionnaires were used. Analysis of data by one-way ANOVA test and stepwise multiple linear regression showed that the manifestation dimensions of social capital (groups and networks, trust and solidarity, collective action and cooperation) can potentially lead to the outcome dimensions of social capital (social cohesion and inclusion, and empowerment and political action), which in turn affect health inequities after controlling for socio-demographic differences.

The Social Determinants of Health in Association with Women's Health Status of Reproductive Age: A Population-Based Study.

BACKGROUND: Prioritizing women's health helps achievement of the 4(th) and 5(th) goals of Millennium Development Program. This study aimed to investigate association between social determinants of health and women's health of reproductive age. METHODS: This population-based cross-sectional study, using multi-stage sampling procedure was conducted on 770, 15 to 49-year-old women residing in any one of the 22 municipality zones across Tehran, Iran. Eligible women were interviewed at home with SF-36 (Short Form Health Survey) and socio-demographic questionnaires. Social determinants of health contains; ethnicity, education, job, income, and crowding index. Data were analyzed by ANOVA and Multiple Linear Regression using SPSS-16. The threshold of P.V was considered 0.05. RESULTS: Overall, 770 women with mean age 33.9±9.3 years were interviewed. Majority of them were married (72.27%), housewives (62.2%), of Persian ethnicity (64.3%), and educated to high school level (43.8%). Age with dimensions of health except role emotional, mental health, and social functioning had significant association with B from -0.65 to -0.16.educational level with dimensions of health except role emotional andsocial functioning had significant association with B from 3.61 to 6.43 (P<0.05). Income with dimensions of health except role physical had significant association with B from -9.97 to -4.42. CONCLUSION: Reflection of unfavorable economic conditions and low education level on negative women' health experiences are alarming. Interaction between social determinants of health and health status must be considered in policymaking, and there is a need for policies that would enhance health of women in the low education and income brackets.

Social capital in association with health status of women in reproductive age: study protocol for a sequential explanatory mixed methods study.

BACKGROUND: Women's health is a general health priority. Preserving and improving women's health is not only a basic human right, but it is also essential for the health of all nations. Women's health in Reproductive age affects long-term health of theirs, their family members, and community. Origins of health inequalities are very complicated. Health outcomes are influenced by biological, social and political factors, so to improve women's health it is necessary to recognize all these factors. Social capital is one of the social determinants of health that might play a considerable role in health inequalities. The association between social capital and health varies according on the sample studied, the type of health outcome and the context in which it is studied. This mixed methods study was designed to determine and explore of relationship between social capital and health status of women of reproductive age in Tehran (capital city of Iran) with its specific social-cultural characteristics. METHODS/DESIGN: This study is sequential explanatory mixed methods study, follow-up explanations variant, with two strands (phases). This design will be implemented in two distinct phases. The first phase is a population-based cross-sectional survey on 770 women of reproductive age residing in any of the 22 municipal districts across Tehran. Based on a need to further understand the quantitative results, researchers will implement a second qualitative phase that is designed to help explain the initial quantitative results. Finally, the researchers will present an interpretation about explanation of quantitative results using the qualitative data. DISCUSSION: This study promotes women's health by determining the priorities and designing evidence-based interventions founded on the basic and insightful information provided on social capital and the status of the health of women.

Expert approaches to promote adolescent physical activity in Iran: development of the promoting strategies using the Nominal Group Technique meeting.

BACKGROUND: Several studies have shown that physical activity decreases as the age increases. This study was for evaluating the perspectives of health sciences specialists or informants on the strategies for increasing physical activity among Iranian adolescents using Nominal Group Technique (NGT). METHODS: a semiquantitative/qualitative methodology research using NGT for prioritizing the strategies for alleviating the physical activities among Iranian adolescents based on the opinions of health sciences experts. This study conducted in Tehran, Iran, 2011. RESULTS: Overall, 16 items received scores from 2-29 and were further listed as the accepted strategies for promoting physical activity among adolescents. The most and least recommended strategies were respectively in the categories of school, neighborhood and family. This study findings show 'the constructionist activities or strategies (eg, claim-making, image-making, myth-constructing and framing) among adolescents using main claim-makers of Iranian society, including the state-sponsored media.,' received the highest score by all the participants of NGT. CONCLUSIONS: The interesting finding of this study is the special view point of the specialists to role of socioecological factors in promoting physical activity in the context of Iranian society.

Health-promoting behaviors and social support in Iranian women of reproductive age: a sequential explanatory mixed methods study.

OBJECTIVES: The aim of this study was to determine health-promoting behaviors and their determinants including social support and sociodemographic characteristics as well as to explore women's experience of health-promoting behaviors. METHODS: This sequential explanatory mixed methods study was conducted in two phases. The first phase was a cross-sectional study conducted on 1,359 women. Questionnaires, including items on sociodemographic characteristics, the HPLP-II and the PRQ85-Part2, were completed by interview. In the second phase, 15 women who were identified as extreme cases participated in individual in-depth interviews. RESULTS: The results of the quantitative phase showed that women obtained the highest scores on interpersonal relations and the lowest scores on physical activity. Scores on the HPLP-II and all its subscales correlated significantly with the level of social support. In the qualitative phase, factors affecting health-promoting behaviors were explored and grouped into four main categories that included personal and socio-environmental barriers as well as personal and socio-environmental facilitators. CONCLUSIONS: The findings from this study confirm the importance of social support and modifiable variables (sociodemographic) that play a role in the health-promoting behaviours of women. These results will be useful in designing suitable interventions and strategies for the promotion of women's health.

Barriers to and factors facilitating empowerment in elderly with COPD.

BACKGROUND: Empowerment of elderly people with chronic obstructive pulmonary disease (COPD) can increase their quality of life and feeling of well-being. However, few researches focused on the obstacles and factors facilitating empowerment in elderly people with COPD; and an adequate determining of these factors need an in-depth understanding of the meaning of these factors which influences empowerment. The objective of this study was to explore the barriers to and factors facilitating empowerment in elderly people with COPD. METHODS: This study was conducted with a qualitative approach using content analysis. Twenty- four participants were selected based on purposeful sampling. Data were collected through conducting in-depth semistructured interviews and making filed notes. Data analysis was performed according to the proposed steps by Granhym & Lund man (2004). RESULTS: The potential to empower the elderly with COPD was influenced by mediating factors; the nature of aging, the difficult nature of COPD, fear and hopelessness, the cultural values and beliefs, poor formal support systems and poor economic status were found to be the barriers; and incentive, trust to health care providers, the educable status of the elderly and increased experience were found to be facilitating factors. CONCLUSION: It seems that empowerment of the elderly with COPD was affected by many factors which mainly rooted in social factors, health care systems and personal resources.

Facilitators and Inhibitors of Health-promoting Behaviors: The Experience of Iranian Women of Reproductive Age.

BACKGROUND: There is scant information on the facilitators and inhibitors of health-promoting behaviors among reproductive-aged Iranian women. This study aims to explore the experience of factors influencing health-promoting behaviors among Iranian women of reproductive age from a qualitative perspective. METHODS: This study was performed in Tehran in 2011, over about 8 months. Qualitative methods, specifically in-depth interviews, were used to gather data on 15 women of reproductive age. Data continued to be collected until introduction of new information ceased. The interviews were recorded, transcribed verbatim, and analyzed by conventional content analysis. RESULTS: The reported factors were categorized into four main groups and 12 subgroups: (1) personal barriers (lack of time, school or work duties, lack of preparation or motivation, physical disability); (2) socio-environmental barriers (family responsibilities, environmental pressures, high-costs and financial pressures); (3) personal facilitators (personal interest and motivation, experience of disease); and (4) socio-environmental facilitators (family and social support networks, encouraging and motivating environment, media, and public education). CONCLUSIONS: In these women's experience, factors influencing health-promoting behaviors were either facilitators or inhibitors; most were inhibitors. The findings of this study show that, in addition to personal factors, the pursuit of health-promoting behaviors is affected by socio-environmental factors. These results will be useful in designing interventions and plans for women's health promotion that focus on the improvement of their environment and the modification of social factors.

Social support for women of reproductive age and its predictors: a population-based study.

BACKGROUND: Social support is an exchange of resources between at least two individuals perceived by the provider or recipient to be intended to promote the health of the recipient. Social support is a major determinant of health. The objective of this study was to determine the perceived social support and its associated sociodemographic factors among women of reproductive age. METHODS: This was a population-based cross-sectional study with multistage random cluster sampling of 1359 women of reproductive age. Data were collected using questionnaires on sociodemographic factors and perceived social support (PRQ85-Part 2). The relationship between the dependent variable (perceived social support) and the independent variables (sociodemographic characteristics) was analyzed using the multivariable linear regression model. RESULTS: The mean score of social support was 134.3 ± 17.9. Women scored highest in the "worth" dimension and lowest in the "social integration" dimension. Multivariable linear regression analysis indicated that the variables of education, spouse's occupation, Sufficiency of income for expenses and primary support source were significantly related to the perceived social support. CONCLUSION: Sociodemographic factors affect social support and could be considered in planning interventions to improve social support for Iranian women.

Patients' perception of dignity in Iranian healthcare settings: a qualitative content analysis.

PURPOSE: The importance of recognising patient dignity has been realised in recent years. Despite being a central phenomenon in medicine, dignity is a controversial concept, the definition of which in healthcare centres is influenced by a multitude of factors. The aim of this study was to explore the perspective of Iranian patients on respect for their dignity in healthcare centres. METHODS: With the use of purposeful sampling, 20 patients were interviewed over an 11-month period in three educational hospitals affiliated with the government. They were questioned about experiences related to respect for their dignity during their hospital encounter. Data were processed by qualitative content analysis. RESULTS: Data analysis identified nine categories and four themes. Respondents expressed their expectations and attitudes about dignity by the following themes: seeking a haven; disrespecting privacy; communicating in a vacuum; and disregard for secondary caregivers. They described how respect for their privacy, effective communication, access to facilities, and a regard for the requirements of their companions made them feel that their dignity had been conserved. CONCLUSIONS: The findings indicate that almost no patient is satisfied with the quality of services with respect to maintenance of their dignity. Regardless of their hospital location and state of health, most participants had common complaints. These findings agree with the literature and confirm that grounds should be provided for conserving dignity in the healthcare system. To reach this goal, healthcare professionals should be aware of the factors that violate or preserve dignity from the patient's perspective.

Prevalence of water pipe use and its correlates in Iranian women of reproductive age in Tehran: a population-based study.

OBJECTIVE: The objective of this study was to determine the prevalence of water pipe smoking and its associated sociodemographic factors among Iranian women of reproductive age in Tehran. SUBJECTS AND METHODS: This was a population-based cross-sectional study of 1,359 Iranian women aged 15-49 years. The multistage random cluster technique was used to obtain the sample. Questionnaire-based interviews with questions relating to water pipe smoking and sociodemographic variables were used to collect the data. The multivariate logistic regression model was used to analyse the relationships between the dependent variable (water pipe smoking) and the independent variables (sociodemographic characteristics). RESULTS: The prevalence of water pipe smoking was 6.3% among Iranian women. Water pipe smoking was more likely in the age range of 15-24 years [odds ratio (OR) = 4.8, 95% confidence interval (95% CI) = 2.7-8.6] compared to the age range of 35 years or older, in women with a university education (OR = 1.9, 95% CI = 1.3-3.0) compared to women with a high-school diploma or lower, and in women with an average crowding index score (OR = 4.7, 95% CI = 2.1-10.6) compared to women living in small families. CONCLUSION: The findings of this study show that Iranian women with a university education and the younger age group (15-24 years) were at most risk of water pipe smoking. The findings of this study about associated factors may contribute to the development of efficient health promotion programmes for the prevention and cessation of water pipe smoking.

Nursing image: an evolutionary concept analysis.

A long-term challenge to the nursing profession is the concept of image. In this study, we used the Rodgers' evolutionary concept analysis approach to analyze the concept of nursing image (NI). The aim of this concept analysis was to clarify the attributes, antecedents, consequences, and implications associated with the concept. We performed an integrative internet-based literature review to retrieve English literature published from 1980-2011. Findings showed that NI is a multidimensional, all-inclusive, paradoxical, dynamic, and complex concept. The media, invisibility, clothing style, nurses' behaviors, gender issues, and professional organizations are the most important antecedents of the concept. We found that NI is pivotal in staff recruitment and nursing shortage, resource allocation to nursing, nurses' job performance, workload, burnout and job dissatisfaction, violence against nurses, public trust, and salaries available to nurses. An in-depth understanding of the NI concept would assist nurses to eliminate negative stereotypes and build a more professional image for the nurse and the profession.

Struggling to create new boundaries: a grounded theory study of collaboration between nurses and parents in the care process in Iran.

AIM: To develop a substantive grounded theory of nurse-mother interaction in the care of chronically ill children in hospital setting. BACKGROUND: Interaction between nurses and parents is critical in paediatric hospital settings. This area of practice in developing countries has been under-researched. METHOD: The qualitative research design of grounded theory methodology was used to develop a theory of nurse-parent interaction within the child care. Registered Nurses (n=17) and mothers of chronically ill children (n=14) from two central paediatric hospital in Iran participated in this study. In-depth interviews with nurses and mothers were conducted using theoretical sampling between July 2007 and August 2008. The data were analysed using constant comparative analysis. FINDINGS: 'Struggling to create new boundaries' as a core variable was a dominant socio-psychological process that was manifesting itself within three stages: facing up to and perceiving the environmental pressures, balancing nurse's duties, and controlling the nurse-parent boundary in the care. CONCLUSION: It is concluded that nurses and parents need a care model, which addresses their collaboration and improved interpersonal relationship and clearly defines the boundary of their roles based on the needs of both sides while allowing parents to choose their role in these defined boundaries and providing parent education with aim to empower them for care at home.

The nature nursing quality of work life: an integrative review of literature.

Studies that have examined the nursing quality of work life (QWL) have not been systematically reviewed in the recent years. Thus, the current study was aimed to identify the predictors of the nurses' QWL and determine the definitions of QWL for nurses. The authors used an integrative review of the literature and identified six themes as the major predictors of the nurses' QWL: leadership and management style/decision-making latitude, shift working, salary and fringe benefits, relationship with colleagues, demographic characteristics, and workload/job strain. Although different researchers had varied perspectives on the QWL in nursing, most viewed QWL as a subjective phenomenon that is influenced by personal feeling and perceptions. A closer review of definitions of QWL indicated that some authors considered QWL as an "outcome," whereas others saw it as a "process." Further research needs to be conducted to determine the relative importance of QWL predictors, and implementation programs to improve the QWL.