Transgender women sex workers' experiences accessing sexual health care in Iran: a qualitative study.

BACKGROUND: This study aimed to examine the experiences of transgender women who work in the sex industry regarding their access to health care facilities for sexual health. Transgender women sex workers are recognised worldwide as a high-risk group for HIV and sexually transmitted infections (STIs). METHODS: In Iran, between January and May 2022, we employed a snowball sampling technique to recruit a diverse group of 22 transgender women sex workers aged 19-42 years. Semi-structured interviews were conducted with these participants to provide insights into their experiences with accessing sexual health care. RESULTS: The data was analysed using thematic analysis, revealing four overarching themes: experiences of violence, contextual barriers to health, socioeconomic challenges and HIV/STI risk practices, and 11 sub-themes. The results demonstrate that many participants experienced difficulties in accessing sexual health services due to violence, discrimination, financial difficulties and lack of awareness about STIs. CONCLUSION: Sex workers face extraordinarily challenging occupational risks, including sexual and physical abuse, mental health issues, and HIV and STIs. Targeted public intervention programs and research for this group are urgently needed. Outreach programs engaging with underserved transgender women sex workers have the potential to enhance access to healthcare services, and contribute to the reduction of HIV transmission rates.

Ethical Climate in the Delivery Wards of Educational Hospitals in Southeast Iran.

Ethical climate is one of the important factors in the working climate of the hospital. Considering the difference in the Ethical climate in different departments of the hospital and the importance of the ethical climate in the delivery ward, this study aimed to assess the characteristics of hospital ethical climate in delivery ward of educational hospitals in southeast Iran. This descriptive and multi-center study was conducted from 2020 to 2021 in educational hospitals in southeast Iran. Two hundred forty midwives working in delivery wards, midwifery instructors, and midwifery students were included in the study by census method. Data collection tools included a demographic information form, Olson's Hospital Ethical Climate Survey, completed using the self-report method. The mean ethical climate in the midwifery group (3.82 ± 0.63 out of 5) was higher than in the instructors' and students' groups. The lowest mean score obtained from the ethical climate questionnaire of participants was associated with the inability to use their experiences in the delivery ward. The lowest mean of ethical climate from the midwives' point of view is the Physicians' dimension and the patient's dimension from the instructors' point of view. The highest mean score belonged to the ethical climate of the supervisors. According to the results of the present study, it is suggested to implement protective laws to support the higher independence of midwives to improve the ethical climates by using their experiences in the delivery department.

Help-seeking challenges for female sexual concerns: a qualitative study from Iran.

BACKGROUND: To effectively manage sexual health, people must have access to sexual health services. A small percentage of women with sexual concerns seek professional help. Hence, the need to explain the help-seeking challenges is felt from the perspective of women and health care providers. METHODS: This study explored Iranian women's challenges when seeking help for sexual concerns. Using a purposive sampling method, 26 in-depth interviews were conducted in Rasht in 2019-2020. The participants included sexually active women of reproductive age over 18 years old and 8 health care providers. The recorded interviews were transcribed and analyzed through content analysis. RESULTS: From the description of 17 subthemes provided by the participants, two main themes were achieved, "Unfavorable sexuality development context" and "Inefficient sexual health services." CONCLUSIONS: According to the results, it is suggested that policymakers pay more attention to the challenges women and health care providers face in help-seeking and promote sexuality education and sexual health services to achieve a higher level of help-seeking among women.

The effect of e-health interventions on meeting the needs of individuals with infertility: a narrative review.

Background: The mental health and well-being of millions of people worldwide are negatively impacted by infertility. A promising solution to meet the needs of people suffering from infertility is e-health interventions, such as online counseling and support groups. This study aims to review the current literature on e-health interventions and how they impact people with infertility. Main body of the abstract: Relevant studies were searched in PubMed, Web of Science, and Scopus databases. Articles were entered into the EndNote software and screened for duplicates and relevance. Two authors then reviewed full-text articles independently, with a third person resolving any disagreements. Thirteen studies conducted between 2007 and 2022 were identified. The interventions aimed to meet various needs, including training on drug use (n = 23), lifestyle modifications (n = 1), periconceptional behavior modifications (n = 1), drug management (n = 1), IVF training (n = 4), psychological support to reduce distress (n = 4), and promoting a positive sexual self-concept (n = 1). Short conclusion: The limited number of e-health interventions for infertile patients, the heterogeneity of interventions, and the lack of long-term effectiveness data make it challenging to compare e-health interventions to nonelectronic alternatives. However, the increasing use of technology in healthcare, especially during and after the Covid-19 pandemic, suggests that e-health educational interventions such as those using the Internet, psychological support, and patient interaction will continue to play a crucial role in healthcare. Supplementary Information: The online version contains supplementary material available at 10.1186/s43043-023-00137-7.

Women's Help-Seeking Behaviors for Sexual Health Issues and the Related Factors: A Cross-Sectional Study from Iran.

Delay in help-seeking for sexual health issues may lead to relationship discord and impact the quality of life. The study aimed to explore the factors related to HSBs (help seeking behaviors) for sexual health issues and to determine the role of negative attitudes relating to sexual concerns in the HSBs of Iranian women. This cross-sectional study was performed in 2020. Participants were 390 randomly selected women from Rasht, Iran. The data were collected using a demographic and a sexual history checklist, the Female Sexual Function Index-6-item (FSFI-6), the Attitudes-related Sexual Concern Scale (ASCS), and a help-seeking behavior questionnaire. Formal help-seeking in women with sexual concern was 16.2% and 48.6% engaged informal HSB. Informal HSB was associated with younger age (OR = 0.93; CI = 0.89-0.97), having a university degree (OR = 3.42; CI = 1.89-6.18), sexual abuse in adulthood (OR = 2.59; CI = 1.07-6.26) and lower negative attitudes-related sexual concerns (OR = 0.53; CI = 0.32-0.87). Formal HSB was related to having a university degree (OR = 3.03; CI = 1.32-6.98) and history of a chronic disease (OR = 3.43; CI = 1.68-6.98). Negative attitudes relating to sexual concerns greatly impact informal HSBs of women, so it should be considered in their health care programming.

A systematic review and meta-analysis on dropout of infertility treatments and related reasons/factors.

Dropout of infertility treatments is a common phenomenon and many patients avoid continuing infertility treatments. Determining the total rate of treatment dropout, and related factors was the objective of the present systematic review and meta-analysis study. We performed an electronic literature search in Web of Science, Scopus, Embase, Cinhal, ProQuest and Medline databases and a manual search in Google scholar by using a set of Standard keywords. We included descriptive studies in English or Persian, from August 2000 to 2019. Finally, we extracted data of 25 papers for systematic review and 11 papers for meta-analysis. Data analysed by RevMan software. The results of the meta-analysis analysed by the random-effects model and studies heterogeneity analysed using the I2 calculation index. We tried to control high heterogeneity (because of the small amounts of p value and chi-square and large amount of I2) with statistical methods such as subgroup analysis and using random-effects model. The results showed that factors related to treatment, psychological and demographic/personal factors are the most common factors for dropout. It seems that educational and supportive programs on psychological, financial, therapeutic, demographic and personal factors can play an important role in reducing the incidence of infertility treatment's drop out before completing the course of treatment.

Design and psychometric properties of a questionnaire for assessing sexual and reproductive health needs of married adolescent women: an exploratory sequential mixed methods study.

To date, there is no valid and reliable instrument to specifically evaluate married adolescent women's sexual and reproductive health (SRH) needs. Hence, the aim of this study was to develop and evaluate the psychometric properties of a questionnaire for assessing married adolescent women (MAW)'s SRH needs. The current exploratory sequential mixed method study was performed in two phases. In the first phase, a preliminary questionnaire was developed based on in-depth interviews with 34 MAW and four key informants as well as a comprehensive literature review. In the second phase, validity of the questionnaire was assessed using face, content, and construct validity and reliability of the questionnaire was assessed using internal consistency and test-retest reliability. Based on qualitative content analysis and literature review, 137 items were extracted. After several modifications of the generated items, a 108-item questionnaire was prepared for the psychometric process. After checking face and content validity, 85 items remained in the study. In the exploratory factor analysis, 11 items were removed and the remaining 74 items were categorised into nine factors. Cronbach's alpha coefficient and the intraclass correlation coefficient were found to be 0.878 and 0.99 for the whole scale, respectively.Impact StatementWhat is already known on this subject? Sexual and reproductive health (SRH) needs of married adolescent women (MAW) are different from those of married adult women or unmarried, sexually active adolescents. However, there are to date no valid and reliable instruments to specifically evaluate the SRH needs of this group of women.What do the results of this study add? The final version of questionnaire consists of 74 items in nine domains including need to improve MAW's sexual quality of life, promote MAW's SRH self-care, improve MAW's SRH self-efficacy, increase MAW's SRH knowledge, increase husband's involvement in MAW's SRH, improve the performance of health care providers, strengthen the family support to married adolescent women, improve family involvement in SRH education of MAW, and provide specific premarital counselling to MAW.What are the implications of these findings for clinical practice and/or future research? The 74-item questionnaire has acceptable validity and reliability. Therefore, it can be used by researchers and policymakers as an appropriate instrument for assessing MAW's SRH needs.

Factors influencing stress, anxiety, and depression among Iranian pregnant women: the role of sexual distress and genital self-image.

BACKGROUND: Pregnancy is a unique period with the increased likelihood of psychological changes and emotional disturbances such as depression, anxiety, and stress. In this study, we investigated the factors influencing depression, anxiety, and stress in pregnancy and identify their associations with Sexual Distress (SD) and Genital Self-Image (GSI). METHODS: This was a descriptive, correlational, cross-sectional study performed using the two-stage cluster sampling method between September 2019 and January 2020. Overall, 295 pregnant women completed a demographics and obstetric information checklist, Depression Anxiety and Stress Scale-21 (DASS-21), Female Genital Self-Image Scale (FGSI), and Female Sexual Distress Scale-Revised (FSDS-R). RESULTS: Analysis of Variance (ANOVA) showed significant differences in the mean scores of SD between the groups with varying degrees of depression, anxiety, and stress (P <  0.001) and in the mean score of GSI between the groups with varying degrees of depression (P = 0.01) and anxiety (P <  0.001). In multivariate linear regression analysis, higher (worse) depression, anxiety, and stress scores were found in women with more advanced age and higher SD scores; however, these scores were lower (better) in those with increased gestational age. Lower depression and anxiety scores were associated with moderate satisfaction with income, moderate satisfaction with BI in pregnancy, and lower stress and depression scores were linked to planned pregnancy. Higher (better) GSI score was a predictor of lower depression score, complication in a previous pregnancy was a predictor of higher stress score, and finally, fear of fetal abortion and being a housewife were predictors of a higher anxiety score. CONCLUSION: Various factors contribute to the development of antenatal depression, anxiety, and stress. A positive correlation was found between SD and the severity of depression, anxiety, and stress, while a negative correlation was noted between GSI and the severity of depression and anxiety. Therefore, raising awareness regarding SD and GSI through screening and counseling sessions can have beneficial effects for mothers and their fetuses.

Dropout of infertility treatments and related factors among infertile couples.

BACKGROUND: Dropout of infertility treatments is a global issue and many factors play role in this phenomenon. It is one of the most challenges in life of infertile couples. The purpose of this study was to determine dropout rate and related factors/reasons in the world and in Iran. METHODS: We will conduct a mixed method study with sequential exploratory design (systematic review, qualitative and quantitative phase). In the first stage a systematic review on dropout rate of infertility treatments and related factors will be done. In second stage (quantitative-qualitative study), a retrospective cohort study will be conducted on infertile couples to determine dropout rate of infertility treatments. The follow-up period to assess the discontinuation of treatment in patients, who have discontinued the treatment, will be considered 6 months after the treatment cessation. Data would be analyzed by descriptive statistics. We want to determine proportion and percentage of discontinuation rate among different groups with different causes of infertility. Then, we also will use Chi-square test to compare discontinuation rates among these groups. In qualitative section of second stage, semi-structured interviews would be performed with infertile female who had the history of infertility treatments failure. In this stage, participants will be selected using purposeful sampling method with maximum variation in terms of age, education, occupation, type of infertility, type of treatments, number of unsuccessful treatment and infertility duration. Data would be analyzed using conventional content analysis. DISCUSSION: Determining dropout rate and its related factors/reasons would be helpful for future studies to plan suitable interventions for supporting infertile couples. It also helps politicians to have a better understanding of infertility and its consequences on infertile couple's life. In today's world, infertility is a common phenomenon due to postponement of childbearing following the older age of marriage, tendency to reach higher educational level, economical problems and etc. Infertility brings many challenges and stresses to the individuals by itself and it is very hard to cope with. The problem gets worse, when it is associated with failure in treatments. Many of infertile couples cannot tolerate this failure and may decide to discontinue treatments before achieving pregnancy for ending many stressors which are associated with treatments. As we know, childbearing and having at least one child has important position in some societies such as Iranian culture; so ending the treatment before achieving optimal result may have some adverse consequences in the families such as divorce, remarriage, family conflicts, et. Absolutely many factors play role in dropout of infertility treatments, and many studies around the world have suggested many factors/reasons in dropout of infertility treatments, but there are still many gaps about this subject, especially among Iranian society. This study would be conducted in three consecutive stages, in the first stage; we will do a complete review of existing studies of the world to find out related factors/reasons of dropout in detail. In second stage, dropout rate of infertile couples (380 couples) after at least one unsuccessful cycle of treatment would be achieved by assessing medical records and telephone interview. Data of the first and second stage will help us to have better vision about the issue of dropout and would be used to construct a semi structured interview for the last stage. And finally in the third stage, reasons of dropout would be asked by an in depth interview from infertile couples. We hope the information from this study will help politicians better understand and plan for dropout of treatment.

Infidelity and Its Associated Factors: A Systematic Review.

BACKGROUND: Infidelity can be facilitated and/or inhibited as a result of interrelations among multilevel contexts. Despite the existence of numerous studies about infidelity, there is no developmental model that considers multilevel contexts of factors associated with infidelity. AIM: To review published articles addressing factors associated with infidelity and to apply the ecological model to these factors. METHODS: A systematic review of the literature was conducted using the PubMed, Scopus, Web of Science, and PsychoInfo. Literature search was restricted to articles published in English up to June 2018. All quantitative and full-text studies that addressed associated factors with infidelity were included. This study was conducted following PRISMA guidelines. MAIN OUTCOME MEASURES: This article reports a review of the literature on the factors associated with infidelity based on the ecological model. RESULTS: We retrieved 5,159 titles, of which 82 were qualified after the qualitative synthesis. The Ecological Couples Systems Diagram (ECSD) is proposed as a developmental model similar to Bronfenbrenner's Bioecological Systems Model. There was an inconsistency between variables of microsystem and infidelity engagement. However, the results of some studies indicated the impact of demographic factors, personality traits, and sexual information on infidelity, considering partner characteristics. Variables belonging to a mesosystem had a more stable association with infidelity than those from other systems. In addition, the review reveals the complexity of infidelity, associated with following factors: 68.3% (n = 56) of the studies were based on microsystem variables, 48.8% (n = 40) used mesosystem variables, 19.5% (n = 16) used exosystem variables, 26.8% (n = 22) used macrosystem variables, 6.1% (n = 5) used chronosystem variables, and 50% (n = 41) included variables from 2 or more levels. CLINICAL IMPLICATIONS: The ECSD can be used not only for assessing couple compatibility in premarital counseling, but also for consulting couples who want to have a long-term romantic relationship. As a potential clinical application, therapists can use the ECSD to assess unfaithful clients and their partners, improving the quality of counseling. STRENGTHS & LIMITATIONS: This study reveals different environmental layers of various variables related to infidelity. Determining the effect size of variables associated with infidelity was not possible due to the heterogeneity of infidelity assessment tools and test analysis. CONCLUSION: Apparently, incompatibility of interpersonal characteristics is more likely associated with infidelity than incompatibility of intrapersonal characteristics. It is important to consider couple compatibility before starting an exclusive relationship, such as marriage, for individuals who intend to maintain a long-term exclusive romantic relationship. Haseli A, Shariati M, Nazari AM, et al. Infidelity and Its Associated Factors: A Systematic Review. J Sex Med 2019;16:1155-1169.

Effect of Brief Cognitive Behavioral Counseling and Debriefing on the Prevention of Post-traumatic Stress Disorder in Traumatic Birth: A Randomized Clinical Trial.

OBJECTIVE: Planning to promote the health of mothers in postpartum is important in all countries. This study aimed to determine the effectiveness of two counseling method on prevention of post-traumatic stress after childbirth. METHODS: In this clinical trial, 193 of mothers who had experienced a traumatic birth were randomly assigned to three groups. Participants were assessed using IES_R questionnaire at 4-6 weeks and 3 months after delivery. RESULTS: Debriefing and brief cognitive behavioral counseling (CBC) significantly improved the symptoms of postpartum traumatic stress disorder. After 3 months, CBC had a significant effect on the symptoms. CONCLUSION: Screening of traumatic childbirth, implementation of supportive care, and early counseling prior to the initiation of post-traumatic stress are recommended. TRIAL REGISTRATION NUMBER: IRCT2015072522396N2. http://en.search.irct.ir/view/24735 .

Desired Care for Perinatal Bereavement: Meeting the Needs of Mothers After Discharge From the Hospital-a Qualitative Study.

This study aimed to investigate the understanding and experiences of mothers who have suffered perinatal loss regarding their needs after being discharged from the hospital. Data were collected through semi-structured face-to-face and telephone interviews using purposive sampling with maximum diversity. The sample included 15 mothers and 6 midwives who had experienced fetal loss and perinatal bereavement. The interviews were audio-recorded and transcribed verbatim. Conventional content analysis was used to analyze the data. Sampling was conducted from July 2022 to March 2023, continuing until data saturation was reached. The study identified 2 main categories of needs for mothers who have experienced perinatal loss: continuous healthcare (including the Comprehensive Mother Tracking System, provision of psychological welfare, and educational needs) and provision of a support network, including "spouse and family support" and "peer and colleague support." The primary theme of this study was "Deliberating Care for Grieving Mothers." The study results indicate that mothers who experience perinatal loss require continuity of care after being discharged. Psychological screening and counseling support are essential for both parents. Considering the significant impact of spousal, familial, and community support on an individual's life, it is crucial to prepare the community to comprehend and embrace grieving parents.

Effect of alternative and complementary medicine on male infertility: An umbrella review.

Background and Aims: There is increasing interest worldwide in using alternative and complementary approaches for treating male infertility. This interest has spawned a multitude of published systematic reviews and meta-analyses. The aim of this Umbrella review was to consolidate the available evidence regarding the effect of complementary and alternative medicine on male infertility to inform clinical decision-making processes. Methods: A comprehensive search was conducted to identify systematic reviews and meta-analyses pertaining to the effects of complementary and alternative medicine on male infertility. This search encompassed various databases including MEDLINE, CINAHL, PubMed, Scopus, Proquest, Google Scholar, SID, EMBASE, Magiran, Cochrane Library, Iranmedex, ScienceDirect, SAGE. Subsequently, two researchers independently extracted the data from the selected meta-analyses and systematic reviews, and evaluated their methodological quality using the assessment of multiple systematic reviews 2 (AMSTAR2). Results: This analysis encompassed 11 studies, with four originating from Iran, two from Korea and five from China. The results regarding the effectiveness of complementary and alternative medicine are controversial, indicating a need for further research. The methodological quality of the systematic reviews and meta-analyses appraised by AMSTAR 2 was rated as low or critically low. This assessment is attributed to inadequate examination of publication biases in the reviews and a lack of discussion regarding the effect of risk of bias. Conclusion: The existing evidence regarding the effectiveness of alternative and complementary medicine in addressing male infertility is limited. Furthermore, the overall methodological quality of the published systematic reviews and meta-analyses may have been underestimated as the use of AMSTAR2 appears to be a more precise appraisal instrument compared to its predecessor.

Barriers and Facilitators to Accessing Sexual and Reproductive Health Services Among Transgender People: A Meta-Synthesis.

The availability and accessibility of sexual and reproductive health (SRH) services for transgender individuals are crucial. This population is deprived of health care due to rejection, stigma, gender-based discrimination, confidentiality, and violence. This review attempts to provide readers with an account of the fundamental problems that the transgender population faces regarding experiences of SRH. This meta-synthesis review applied the Social-Ecological Model (SEM) to address trans individuals' SRH factors. The databases were searched using "SRH" and "transgender" keywords. Fifty studies were finally selected. All studies were qualitative, including 36 semi-structured/ in-depth interviews, two focus group studies, and 12 interviews and focus group studies. The Social-Ecological Model application illustrates the impact of individual, interpersonal, institutional, and social factors on the condition of SRH among transgender individuals. This meta-synthesis reinforces multiple levels of factors that influence the SRH of transgender individuals. These include limited information, lack of awareness, low socioeconomic status, stigma and discrimination, and social deprivation. Interventions are urgently needed to provide better sexual and reproductive well-being for transgender individuals.

Sexual dysfunction and divorce in Iran: A systematic review.

Introduction: One of the causes of dissatisfaction between couples is sexual dysfunction that sometimes leads to divorce. The present systematic study was conducted to evaluate the factors affecting sexual dysfunction and divorce in Iran. Method: A comprehensive search, including keywords of sexual dysfunction, emotional divorce, breakaway, separation, conflict, and Iran, was conducted on the databases of Scopus, MEDLINE/PubMed, CINAHL, Web of Science, Magiran, IranMedex, and SID. Out of the total number of reviewed articles, 16 articles met the inclusion criteria. No time limit was considered for our research and all published articles up to November 2021 were reviewed. Results: Based on the results of the present study, in all of the reviewed articles, sexual problems and dissatisfaction were among the effective factors in the occurrence or request of a formal divorce or an emotional divorce. The data also demonstrated that weakness in arousal and sexual desire, weakness in sexual function, sexual disorders, orgasm problems, and pain were among the problems of people on the verge of divorce. Conclusion: Due to the importance of this issue, recognizing the effective and influential factors of divorce is one of the priorities of mental health. Dissatisfaction with sexual relations in both or one of the spouses is found to be one of the most important factors involved in divorce. If there are problems such as sexual dysfunction between the couples, they may still live together due to cultural and social conditions; however, they may experience emotional divorce. Therefore, there is an urgent need for effective counseling and treatment programs in this regard.

Investigating the effect of educational interventions on maternal competence: A systematic review and meta-analysis.

There have been many studies on maternal competence, but in the studies conducted in this field, different methods have been applied to educate mothers on maternal competence, which do not have a unified approach. This study aims to investigate the effect of educational interventions on maternal competence using a meta-analysis method. In this meta-analysis, a search was made in MEDLINE, CINAHL, PubMed, Scopus, Proquest, Google scholar, SID, and Magiran databases using Mesh and non-Mesh keywords between January 1992 and September 2022. The inclusion criteria included: Studies in which educational and counseling interventions on maternal competence have been investigated, studies that have used the Parenting Sense of Competence Scale (PSOC), RCT or interventional studies, participants who were primiparous women, articles that were published in English and Farsi, studies that reported sample size, mean and standard deviation of maternal competence scores in the intervention and control groups, and studies that scored at least 3 on the Jadad scale. Data were analyzed using Review Manager 5 (RevMan 5.3). In this meta-analysis and systematic review, finally, seven articles met the criteria for entering the research. The number of samples in the intervention group was 430 and in the control group was 429. The average maternal competence score with a 95% confidence interval was 3.51. This meta-analysis showed that educational interventions during pregnancy and after delivery could affect improving the competence of primiparous mothers. Education has increased the maternal competence score in the intervention group by 3.51 units compared to the control group.

Effect of couples' online training on maternal-fetal attachment in pregnant women.

BACKGROUND: Due to the importance of maternal fetal attachment (MFA) in women mental health improvement and considering the fathers' role in MFA promoting, this study conducted to investigate the effect of couple education on maternal fetal attachment. MATERIALS AND METHOD: This randomized controlled trial was conducted on 100 pregnant women and their husbands referred to six health centers in Sari from May to June 2021. The sampling method was stratified random sampling. Data collection tools included demographic information form and the Cranley MFA Scale with 24 questions. The intervention group took part in four session's weekly training about spouse support, attachment behaviors, and gender preference of parents, while the control group received only the routine antenatal care. Both groups completed Cranley's questionnaire before and 4 weeks after the intervention. Data were analyzed using Chi-square test, Fisher's exact test, paired and independent t-test by SPSS 21. RESULTS: MFA mean scores, pre-training and post-training in intervention group were 3.27 (0.54) and 3.75 (0.42), respectively; in the control group, were, 3.24 (0.49) and 3.21 (0.48). There was a significant difference between the two groups' MFA mean scores after intervention (P < 0.001). CONCLUSION: The findings of this study revealed that couple training regarding spouse support, attachment behaviors, and gender preference during pregnancy can promotes MFA even online training.

Maternal Health Literacy, Health information-seeking Behavior and Pregnancy Outcomes Among Iranian Pregnant Women: A Cross-Sectional Study.

Background: Maternal health literacy (MHL) and health information-seeking behavior (HISB) could impact maternal health and pregnancy outcomes.Purpose and Research Design: This cross-sectional study investigated MHL, HISBs, and pregnancy outcomes in Iranian pregnant women. This study was also aimed to determine the predictors of MHL and pregnancy outcomes.Study smple and Data Collection: In this study, 337 randomly selected postpartum women completed three questionnaires, including a demographics form, an obstetrics history checklist, and the Maternal Health Literacy and Pregnancy Outcome Questionnaire (MHLAPQ).Results: The mean MHL and pregnancy outcome scores were 60.80 ± 9.91 and 49.88 ± 5.69, respectively. Of the participants, 56% adopted both formal and informal HISB. Education and internet HISB was associated with the odds of being in the group with higher MHL. Participants with high MHL had more than twice higher odds for better pregnancy outcomes (OR = 2.25, p < 0.004).Conclusions: Continued efforts are required to make health information sources more accessible to pregnant women to improve their health literacy and pregnancy outcomes.

Designing and implementing an OMMID midwifery professional competence mixed test: A multimethod, multiphasic study.

The assessment of professional competence is essential to ensure the achievement of competence standards. The goal of this study is to design and implement a professional competence test model to make the test unified, comprehensive, and fair. This research was a multimethod, multiphasic study. The first qualitative phase of the nominal group technique was conducted to design the test model with specific guidelines. The second phase was a mixed-method parallel field trial conducted on 161 senior midwifery bachelor students in universities of Iran. The test was conducted following the traditional method in the control group and OMMID model in the intervention group. This model consists of three parts: the MCQs (multiple choice questions), OSCE (objective structured clinical examination), and clinically-oriented tests, which included Mini-CEX (mini-clinical evaluation exercise) and DOPS (direct observation of procedural skills). Data were collected using questionnaires and interviews, and the results were assessed qualitatively and quantitatively. The OMMID model and the associated guideline were designed. Qualitative data analysis resulted in six main themes, including organizing, structure, tension due to change, fairness, unification, and outcome. The OMMID model did not increase students' anxiety and stress and did not decrease their satisfaction. The merits of this model include having a centralized guideline, using multiple evaluation methods, comprehensive evaluation of necessary skills, promotion of fairness, and increased student satisfaction.

Psychosexual counseling intervention to improve women's genital self-image: Study protocol for a randomized controlled trial based on a multistage mixed method design.

Background: Genital self-image (GSI) is a major barrier to reproductive and sexual health for women. This practical randomized trial aims to evaluate the effect of psychosexual counseling based on a cognitive-behavioral approach to promoting GSI for reproductive-age married Iranian women. Methods: Married women aged 15-49 years under the coverage of health centers will be invited to join the study. The study will be conducted using a multistage mixed method design in three phases. In the first phase, semi-structured interviews with women and key informants will be conducted to understand better the GSI concept, the factors influencing it, and the interventions promoting it. Simultaneously, a literature review will be conducted by searching electronic databases to find the factors influencing GSI and the interventions to enhance it.In the second phase, the GSI-related factors, sexual and reproductive health outcomes correlated with GSI, and intervention programs for promoting GSI in women will be extracted from the integration of qualitative study and literature review. Then, based on the expert panel's priority, a suitable program will be prepared.In the third phase, at first, a cross-sectional study will be conducted to identify women with poor GSI and the factors relating to GSI, and then psychosexual counseling intervention will be performed. For the randomized controlled trial study, participants will be randomly allocated into two groups: (1) the intervention group and (2) the control group. Data will be collected using the Female Genital Self-Image Scale and sexual and reproductive health outcomes correlated with GSI at baseline, immediate, and 2-month follow-up assessments. The impact of the intervention on the promotion of GSI will be evaluated. Discussion: This study provides a counseling program for promoting GSI. If this interventional program is successful, it has practical potential to be generalized for Iranian Women with poor GSI.