Caregiver burden among parents of children with chronic diseases: A cross-sectional study.

AIMS AND OBJECTIVES: This study aimed to assess the perceived caregiver burden among parents of chronically ill children in Jordan. BACKGROUND: Although there are few studies on the accurate prevalence of chronic diseases among Jordanian children, there are a few on the burden of caregiving, which is important because most children with chronic illness rely on their caregivers to perform their daily tasks. In Jordan, little is known about the caregiver burden associated with caring for children with chronic diseases. DESIGN: A cross-sectional design was reported in line with the STROBE guidelines. METHODS: The Katz Index of Independence was used to determine the children's level of dependence, and the Burden Scale for Family Caregivers was used to measure the caregivers' level of burden. RESULTS: Nearly, 49.3% of caregivers had a very severe burden, 31.2% of children had a severe functional impairment, 19.6% had a moderate impairment, and 49.3% had full functionality. Based on their children's dependency, caregivers' subjective burden varied greatly (p < .001). Fully functional children had a far lower disease burden than severely and moderately disabled children (p < .001). The caregiver burden score differed significantly across chronic disease categories (p < .001). Unemployed caregivers had a far higher subjective burden than working caregivers (p = .009), and single (divorced/widowed) caregivers had higher burdens than married caregivers. CONCLUSIONS: Various factors can increase caregiver burden. Therefore, healthcare providers must plan holistic and family-centred interventions to reduce the caregiving burden. RELEVANCE TO CLINICAL PRACTICE: There is a need to establish support programs to help reduce the level of burden among caregivers of children with chronic diseases.

The effect of health literacy in explaining medication adherence among patients with hypertension: A cross-sectional study of Syrian refugees in Jordan.

BACKGROUND: Poor medication adherence is a concern among patients with hypertension. However, few studies have assessed the effect of health literacy on medication adherence among refugee patients. AIM: The aim was to examine the effect of health literacy and associated factors in explaining medication adherence among Syrian refugee patients with hypertension. METHODS: A cross-sectional study was used, recruiting 150 Syrian refugees with hypertension in February 2020. The Hill-Bone scale and the Health Literacy Questionnaire were used to collect data, which were analysed using descriptive and inferential statistics. RESULTS: Participants had low levels of medication adherence and had low mean scores in eight of nine subscales of the health literacy scale, except in the appraisal of health information subscale. Factors including patient's age, marital status, the number of medications and co-morbid diseases were significantly associated with medication adherence. Age, understanding written health information and ability to engage with healthcare providers were predictive of medication adherence. CONCLUSION: To increase medication adherence among refugee patients with hypertension, nurses need to improve patients' health literacy and understanding of health information about their disease.

Prevalence of Adverse Childhood Experiences and Their Relationship with Self-esteem Among School-Age Children in Jordan.

This study aimed to assess the prevalence of adverse childhood experiences and their relationship with self-esteem among secondary school students in Jordan. A cross-sectional, retrospective design was utilized using a convenience sample of 559 secondary school children (grades 7-11). Results showed that among the participating students, emotional abuse was the most commonly reported type of abuse (59.6%), followed by household violence (52.2%), bullying (44.7%), physical abuse (31.7%), emotional neglect (26.3), physical neglect (12.7%), and parents' separation (5.2%). Male students reported significantly more physical abuse than female students (37.5% vs 26.2%, p < 0.001), and significantly more physical neglect than female students (18.2% vs 7.6%, p < 0.001). However, female students reported significantly more household violence than male student (60.0% vs 43.9%, p < 0.001). Self-esteem scores were lower for students who reported physical abuse (d = 0.38, p < 0.001), household violence (d = 0.25, p < 0.003), emotional neglect (d = 0.45, p < 0.001), physical neglect (d = 0.58, p < 0.001), and bullying (d = 0.29, p = 0.001). Self-esteem was best predicted by physical abuse (ß = - 0.114, p = 0.009), emotional neglect (ß = - 0.169, p < 0.001), and physical neglect (ß = - 0.148, p < 0.001). Efforts should be exerted to prevent violence against children. National programs and community awareness campaigns should focus on the violence's detrimental effects on children.

Caregivers Help-Seeking Behaviors for Postdischarged Neonates from Neonatal Intensive Care Units: A Jordanian Study.

PURPOSE: This study will explore and describe help-seeking behaviors and decision-making processes of Arab Muslim caregivers in Jordan when seeking help for their sick neonates after discharge from Neonatal Intensive Care Units (NICU). This study which will contribute to the global discussion on the reasons/conditions contributing to neonatal mortality. DESIGN AND METHODS: A descriptive cross-sectional survey was used. Two research assistants interviewed 275 identified neonate caregivers by telephone from May 1 to August 30, 2019. Data were analyzed using SPSS version 25. RESULTS: Caregivers who had a neonate who had been discharged from a NICU were surveyed about the types of condition for which they would seek medical help. The vast majority (98.2%) stated that they would seek help if their child was unconscious and 95.3% reported that they would do so if their child experienced a convulsion. Fewer caregivers (43.3%) stated that abdominal distension (43.3%) would cause them to seek help immediately. CONCLUSION: Recognition of danger signs during the neonatal period was considered poor among neonate caregivers. Using self-management treatments and home remedies delayed appropriate medical treatment for neonate illnesses. Lack of money was identified as the most common reason for delaying going to or not using health facilities. This study highlights the need to create a specialized program to focus on interventions that could reduce neonatal deaths and improve families' help-seeking behaviors in Jordan. IMPLICATIONS FOR PRACTICE: Nurses are required to be well-trained to support caregivers to prioritize neonatal issues (pre and post discharge) that require quick action (minutes versus hours) and which most commonly lead to mortality. Nurses are required to provide appropriate education for caregivers pre-discharge and such teachings could be reinforced during home visits.

The Effect of Short Duration Skin to Skin Contact on Premature Infants' Physiological and Behavioral Outcomes: A Quasi-Experimental Study.

PURPOSE: This study aimed at assessing the effect of short duration Skin to skin contact (SSC) (5 days) on premature infants' short-term physiological and behavioral outcomes. DESIGN AND METHODS: A quasi-experimental control group design was utilized. 89 stable premature infants were allocated to either an interventional or control group. RESULTS: Results showed that in comparison to the control group, newborns in the SSC group demonstrated higher weight gain (g/day) from day 3-5 of practicing SSC (53.7 g Vs. 32.6 g; P < .05), experienced significantly fewer numbers of apneas (48% Vs. 33.3%; P = .001), and were less likely to use formula feeding (60% Vs. 90%) and more likely to use mixed feeding (formula and breastfeeding) at discharge (33.3% Vs. 10%). Significant differences were also found in the crying, and sleeping patterns of the infants; infants of mothers who practiced SSC were less likely to cry in a continuous pattern and more likely to experience good sleep than infants in the control group. CONCLUSIONS: The study highlights the importance of the early and short duration of SSC for premature infants. PRACTICE IMPLICATIONS: The initiation of SSC in the first few days of life may have a significant influence on the newborn's short-term outcomes.

Neonatal nurses' knowledge and beliefs about kangaroo mother care in neonatal intensive care units: A descriptive, cross-sectional study.

The aim of this study was to assess Jordanian neonatal nurses' knowledge and beliefs toward the application of kangaroo mother care in the neonatal intensive care unit. A cross-sectional, descriptive survey was performed using a convenience sample of 229 nurses. The findings revealed that the majority of the nurses agreed that kangaroo mother care was beneficial to both mothers and infants; however, 47.2% believed that it was not feasible for all preterm infants. The majority of nurses believed that kangaroo mother care should be restricted to infants on intravenous treatment, intubated, or with an umbilical catheter. The majority of the nurses correctly answered questions regarding kangaroo mother care. A significant relationship was found between the nurses' knowledge and their beliefs toward kangaroo mother care. The findings of this study provide insights into Jordanian nurses' knowledge and beliefs toward the kangaroo mother care approach. If addressed, these findings will help improve the practice and nursing care for preterm infants.

Parents' Knowledge and Beliefs about the Impact of Exposure to Media Violence on Children's Aggression.

The current study aimed to assess Jordanian parents' knowledge and beliefs about the effects of violent media on children's aggressive behavior. A sample of 262 parents of children aged 6-11 years completed a Media Quotient questionnaire about children's media habits, media effects, and children's aggressive behavior. Parents reported that their children spend an average of 4.83 h (SD = 2.12) watching TV, 3.20 h (SD = 2.29) playing video games, 1.07 h (SD = 0.88) listening to music, and only 0.52 min (SD = 0.67) reading for pleasure per day. Parents have a moderate level of knowledge about the media effect (M = 15.49, SD = 3.439). Children of parents who have adequate knowledge about the media effect, spend less time watching TV (r = -.355, p < .001), playing video games (r = -.265, p < .001), and listening to music (r = -.347, p < .001). Ninety-two percent (n = 241) of parents were concerned about the amount of sexual and of violent content their children see in movies or on TV. Children who spend more time playing video games (r = -.201, p = .004) show aggressive relational behavior. This study suggests that increasing parents' knowledge of media of evidence-based programs may have a protective effect on children's behavior.

Students' Perceptions of Characteristics of Victims and Perpetrators of Bullying in Public Schools in Jordan.

BACKGROUND: School bullying is the most common school violence among adolescents and has become a global concern. Little is known about the characteristics associated with bullies and victims among Jordanian students. OBJECTIVES: The aim of the study was to examine student perceptions of school bullying-specifically, the characteristics of perpetrators and victims and how to stop bullying-and assess differences in perceptions between boys and girls. METHODS: Cross-sectional study, using self-reported questionnaires, was employed to collect data from eighth-grade students (N = 913; 51% male) from a mixed rural and suburban area in northern of Jordan during the 2013-2014 school year. Descriptive statistics were used to summarize item responses. Chi-squared tests were performed to compare responses between the male and female students. RESULTS: Most of the students described a bully as one who is a coward underneath (78.9%), lacks respect for other people (70%), wants to show power (67.5%), wants to impress others (60.8%), and wants to feel superior (59.6%). Students perceived victims of bullying as having low self-esteem (68.2%), talking or sounding different than others (50.9%), shy (35%), and having no friends (27.1%). Students suggested that, to stop bullying, the victim should stand up for himself (75.4%), should become psychologically stronger (75.1%), and should involve adults (teachers, family, or others; 45.9%). There was a significant gender difference, in which boys and girls were describing victims and bullies differently. DISCUSSION: A significant percentage of students relate bullying and victimization characteristics to psychosocial characteristics and less to physical characteristics. The results offer valuable information necessary to design and implement school bullying prevention and intervention programs.

The impact of training program on nurses' attitudes toward workplace violence in Jordan.

BACKGROUND: Nurses' attitudes toward workplace violence are still inadequately explored, and possess an impact in preventing, and managing the violent incidents and the quality of nursing care. Creating a demand for an effective intervention program to improve nurses' knowledge of and attitudes toward workplace violence. OBJECTIVE: To study the impact of the training program on nurses' attitudes toward workplace violence in a military hospital in Jordan. METHODS: One group before-after design was employed. A stratified random sample of 100 nurses working in three shifts was recruited. Data were collected earlier and after the preparation program using the Attitudes Toward Patient Physical Assault Questionnaire. "The Framework Guidelines for addressing workplace violence in the health sector", was adopted in this work. The preparation sessions were for one day each week over five weeks. The post-test assessment was over five weeks using the same questionnaire. RESULTS: A total of 97 nurses completed the survey. The outcomes demonstrated the significant impact of the training program on nurses' attitudes towards workplace violence (t=6. 62, df=96, p=0.000). The prevalence of verbal abuse by patients and visitors was 63.9% and for physical abuse, 7.2% were from patients and 3.1% of visitors. Most violent incidents occurred during day duty and during delivering nursing care (40.2% and 32%, respectively). Major source of emotional support for abused nurses was from the nursing team (88.7%), while the legal support was from nursing management (48.5%). CONCLUSION: The study highlights a general concern among nursing staff about workplace violence. Confirming that violence prevention education for staff is a necessary step forward to deescalate the problem. A significant effect of the training program was evident in this study.

Female public Jordanian university undergraduate students' intentions and attitudes toward breastfeeding: application of self-objectification theory.

BACKGROUND: Breastfeeding is the natural way of feeding infants and an important public health issue. Representation women as sexual objects by highlighting their bodies as mainly for the desire of men causes women to prioritise their physical appearance and internalise sexual objectification of their bodies. Such ideologies make women less comfortable to accept other functions of their bodies such as the reproductive functions, including breastfeeding and childbirth. OBJECTIVES: To describe, in a sample of female undergraduate students, attitudes toward breastfeeding, level of self-objectification and to examine whether women's attitudes and the intention of breastfeeding is related to the level of self-objectification. METHODS: An exploratory, cross-sectional design was used. All female undergraduate university students, attending a large university in the Northern part of Jordan were eligible to participate. A convenience sample of 600 female students from both health professional and non-health professional schools were invited to complete a self-administered questionnaire designed to collect data on students' intentions and attitudes toward breastfeeding and self-objectification, with a response rate of 82.6% (n=496). Ethical approval was obtained from the Scientific Research Board of the Jordan University of Science and Technology prior to the start of the study. RESULTS: The majority of the students gave favourable responses towards the attitude statements and reported a commitment to breastfeeding Students' attitudes toward breastfeeding correlated significantly with self-objectification. Participants with negative attitudes towards breastfeeding were more likely to internalise and accept the socio-cultural attitudes towards appearance (r = -0.098, p = 0.029). Participants' intention to breastfeed correlated negatively with self-objectification and those who intended to breastfeed were more likely to reject the socio-cultural attitudes towards the "apearance" subscale (r = 0.097, p = 0.031). CONCLUSION: The results of this study support the relationship between self-objectification and Jordanian young women's attitudes and intention to breastfeed and reinforce that in a culture where breastfeeding is encouraged, accepted and widely practised, positive attitudes to breastfeeding intention prevail.

Assessment of food consumption, smoking, alcohol use, and physical activity by sex and major of study among a sample of college students in Jordan.

This study aimed to assess the food frequency and health-related risk behaviors based on gender and major of study (health and non-health majors) in a sample of undergraduate university students. A cross-sectional study was conducted among 708 undergraduate university students (37.4% males; 62.6% females) with a mean age of 20.88(SD = 2.20), ranging from 18 to 37 years from five universities. A self-reported questionnaire was administered in the university classrooms to collect data. Results showed that 47.3% of students reported consuming fruits and vegetables (38.1%), and 54% reported consuming unhealthy foods at least once in the preceding 24 h. About 16% of the students were cigarette smokers, 17% were waterpipe smokers, and slightly more than 4% were alcohol consumers. Significant associations were found between the participants based on their sexes, and study majors (P < 0.001). Male students smoked and consumed alcohol at significantly higher rates than female students. As with regards to the physical activity in the preceding week, students had not carried out any stretching activities (52.8%), strengthening activities (62.4%), cycling (35%), or taken part in any physical activity classes (68.4%). The rates of physical activity were significantly higher among male students than female students (p < 0.001). The results showed that non-health major students differ from those in health majors in the consumption of cigarettes (p < 0.001) and waterpipe smoking (p = 0.027). Students in non-health majors were more likely than students in health majors to have carried out stretching activities (p = 0.021) and participated in physical activity classes (p = 0.02). Our findings highlighted the importance of identifying health-related risk behaviors among university students to develop a health-promoting intervention tailored to a specific group of students considering their sex and study majors.

Rapidly adapted community health strategies to prevent treatment interruption and improve COVID-19 detection for Syrian refugees and the host population with hypertension and diabetes in Jordan.

BACKGROUND: We evaluated community health volunteer (CHV) strategies to prevent non-communicable disease (NCD) care disruption and promote coronavirus disease 2019 (COVID-19) detection among Syrian refugees and vulnerable Jordanians, as the pandemic started. METHODS: Alongside medication delivery, CHVs called patients monthly to assess stockouts and adherence, provide self-management and psychosocial support, and screen and refer for complications and COVID-19 testing. Cohort analysis was undertaken of stockouts, adherence, complications and suspected COVID-19. Multivariable models of disease control assessed predictors and non-inferiority of the strategy pre-/post-initiation. Cost-efficiency and patient/staff interviews assessed implementation. RESULTS: Overall, 1119 patients were monitored over 8 mo. The mean monthly proportion of stockouts was 4.9%. The monthly proportion non-adherent (past 5/30 d) remained below 5%; 204 (18.1%) patients had complications, with 63 requiring secondary care. Mean systolic blood pressure and random blood glucose remained stable. For hypertensive disease control, age 41-65 y (OR 0.46, 95% CI 0.2 to 0.78) and with diabetes (OR 0.73, 95% CI 0.54 to 0.98) had decreased odds, and with baseline control had increased odds (OR 3.08, 95% CI 2.31 to 4.13). Cumulative suspected COVID-19 incidence (2.3/1000 population) was suggestive of ongoing transmission. While cost-efficient (108 US${\$}$/patient/year), funding secondary care was challenging. CONCLUSIONS: During multiple crises, CHVs prevented care disruption and reinforced COVID-19 detection.

Resilience of patients with coronary heart diseases in Jordan: A cross-sectional study.

OBJECTIVES: This study aimed to assess the level of resilience and related factors among patients with coronary heart disease. METHODS: A cross-sectional was used to determine the factors associated with the level of resilience. A convenience sampling technique was used to recruit 134 patients with coronary heart disease who attended the out-patients cardiology clinics at two leading public hospitals in Jordan from July to September 2017. The Connor-Davidson Resilience Scale (CD-RISC) was used to collect the data via a face-to-face structured interview. Mann-Whitney U test and Kruskal Wallis test were used to analyze the data. RESULTS: The results showed a moderate level of resilience among patients with coronary heart diseases. Patients who reported having no history of a cardiac procedure reported a higher total resilience score (69.50 [63.25, 75.00] vs. 65.50 [58.00, 72.00]) and a higher score in dimension 1,"personal competence, high standards, and tenacity" than their counterparts (22.00 [18.50, 26.00] vs. 21.00 [15.75, 23.00]) (P < 0.05). Dimension 3 "positive acceptance of change and secure relationships" score was higher for employed patients than retired patients (15.00 [14.00, 16.00] vs. 14.00 [12.00, 15.00]) (P < 0.05). However, no significant associations were found between other socio-demographic characteristics and resilience levels across the five dimensions. CONCLUSION: Identifying the resilience level and related factors among patients with cardiac problems should be integrated into the comprehensive plan of care to improve patient quality of life, enhance effective coping strategies, improve mental health and well-being, and prevent further disease complications.

Determinants of husbands' violence against women in Jordan.

BACKGROUND: Intimate partner violence (IPV) is the most common form of abuse against women. It comes in the form of physical, sexual, emotional, and controlling behaviors abuse, and affects women's physical and psychological well-being. Perceived social support decreases IPV risk. PURPOSE: This study explores the determinants of IPV in J society. METHOD: One hundred and eighty-seven women exposed to IPV were recruited from J Women Unions to take part in this cross-sectional prospective quantitative design, administering the Arabic version of the Multidimensional Scale of Perceived Social Support (AVMSPSS) to 187, who also answered the demographic characteristics data sheet. RESULTS: Almost 83% of participants perceived that they received lower to moderate PSS. Based on multiple regression, determinants of IPV were PSS, followed by participant education, husband education, participant age, and financial income (p < .001). The number of children and parental level of education showed no statistical significance. CONCLUSION: The findings highlight the importance of social support systems among IPV women. Alongside socioeconomic development continuing to increase education among both men and women, there is a need to increase societal awareness and foster social support systems to prevent violence against women and offer resources to affected women, targeted at the most at-risk age groups.

Mediating role of resilience on the relationship between stress and quality of life among Jordanian registered nurses during COVID-19 pandemic.

Rationale: Registered nurses are struggling on the front line to manage patients with COVID-19 and other illnesses, placing them at increased risks for severe perceived stress. Although perceived stress has often been considered a significant risk factor for impaired quality of life among registered nurses, having resilience has been generally shown to be associated with better quality of life. Purpose: This study aimed to investigate the mediating effects of resilience on the relationship between perceived stress and quality of life in Jordanian clinical registered nurses during the COVID-19 pandemic. Methods: The study used a cross-sectional correlational design with an online survey and adhered to the STROBE guideline for cross-sectional studies. A total of 550 registered nurses working in 6 hospitals were conveniently selected. Data were collected via a demographic questionnaire, the Perceived Stress Scale (PSS), the Connor-Davidson Resilience Scale (CD-RISC), and the WHOQOL scale. Descriptive, Pearson correlation, t-test, one-way ANOVA, and hierarchical linear regression analyses were used to analyze the data. Results: The results indicated that resilience was negatively correlated with perceived stress and quality of life. Further, resilience was found to play a partial mediating role in the relationship between perceived stress and quality of life. Therefore, the results partially supported our study hypotheses. Conclusion: Health policy makers and administrators in Jordan should be aware of the importance of assessing and improving nurses' resilience to decrease devastating effects of stress on quality of life.

Integrating community health volunteers into non-communicable disease management among Syrian refugees in Jordan: a causal loop analysis.

OBJECTIVES: Globally, there is emerging evidence on the use of community health workers and volunteers in low-income and middle-income settings for the management of non-communicable diseases (NCDs), provision of out-of-clinic screening, linkage with health services, promotion of adherence, and counselling on lifestyle and dietary changes. Little guidance exists on the role of this workforce in supporting NCD care for refugees who lack access to continuous care in their host country. The goals of this work were to evaluate the current roles of community health volunteers (CHVs) in the management of diabetes and hypertension (HTN) among Syrian refugees and to suggest improvements to the current primary care model using community health strategies. SETTING AND PARTICIPANTS: A participatory, multistakeholder causal loop analysis workshop with representatives from the Ministry of Health of Jordan, non-governmental organisations, United Nations agencies, CHVs and refugee patients was conducted in June 2019 in Amman, Jordan. PRIMARY OUTCOME: This causal loop analysis workshop was used to collaboratively develop a causal loop diagram and CHV strategies designed to improve the health of Syrian refugees with diabetes and HTN living in Jordan. RESULTS: During the causal loop analysis workshop, participants collaboratively identified and mapped how CHVs might improve care among diagnosed patients. Possibilities identified included the following: providing psychosocial support and foundational education on their conditions, strengthening self-management of complications (eg, foot checks), and monitoring patients for adherence to medications and collection of basic health monitoring data. Elderly refugees with restricted mobility and/or uncontrolled disease were identified as a key population where CHVs could provide home-based blood glucose and blood pressure measurement and targeted health education to provide more precise monitoring. CONCLUSIONS: CHV programmes were cited as a key strategy to implement secondary prevention of morbidity and mortality among Syrian refugees, particularly those at high risk of decompensation.

Health Promoting Behaviors, Health Needs and Associated Factors among Older Adults in Jordan: A Cross-Sectional Study.

BACKGROUND: Several factors affect older adults' engagement in HPBs. This study aimed to examine HPBs, health needs, and associated factors among older adults in Jordan. METHODS: A cross-sectional study was conducted on 220 older adults at one governmental and one university hospital, which were selected using convenience sampling for geographical closeness to the researchers. All older adults with no cognitive or communication problems who attended the outpatient clinics of the two hospitals from December 2018 to April 2019 were included in the study. This time period was chosen based on the convenience of the participants and researchers. Data were collected by An Arabic version of the Health-Promoting Lifestyle Profile (HPLP) and a demographic questionnaire. The Statistical Package for Social Science (SPSS) 25.0 software was used for the descriptive and inferential analysis of the study data. The level of significance was set at P<0.05. RESULTS: The mean score of the total HPLP was 125.33±19.09. The marital status and educational level of the participants were associated with the total HPLP (P<0.001) in all its dimensions, except for the dimension of interpersonal relations. Participants with chronic diseases had lower scores than those without diseases for the total HPLP (P<0.001) in all the six dimensions. Family income was positively correlated with the dimensions of nutrition (P=0.007) and exercise (P=0.002). CONCLUSION: Despite the good overall mean score of older adults for total HPLP and some of its subscales, their levels of exercise and physical activity need to be promoted. The scores of older adults were related to various demographic and clinical factors.

Testing the Effectiveness of Cognitive Behavioral Therapy in Relieving Nurses' Ageism Toward Older Adults: A Randomized Controlled Trial.

BACKGROUND: Although cognitive-behavioral therapy (CBT) techniques are well known for targeting psychological distresses, to date, no study has investigated their effectiveness in relieving death anxiety and ageism among nurses. METHODS: A parallel randomized controlled trial was conducted according to the CONSORT guidelines during October 2019 at the university hospital. A total of 110 nurses were selected through proportional stratified sampling and randomly assigned to the experimental and control groups. The intervention consisted of six two-hour training sessions delivered over five modules with the integration of different CBT exercises. The effect of CBT was assessed by measuring the differences in the students' responses to a series of validated questionnaires of study variables pre-test (before the training sessions) and post-test (after the training sessions). Clinical registration was completed at ClinicalTrial.gov (ID: NCT04319393). RESULTS: Overall, using CBT techniques led to significant improvements in the study outcomes. At postintervention, the nurses who had received CBT training had significantly better self-esteem and interpersonal relationships, a greater sense of symbolic immortality, and less death anxiety and ageism than the nurses in the control group. CONCLUSIONS: CBT is an effective evidence-based psychological intervention for relieving nurses' ageism towards older adults. The psychological well-being of nurses caring for older adults is crucial, and new techniques should be adopted to relieve nurses' accumulated stress and decrease their death anxiety. Future studies which investigate the effectiveness of CBT on other forms of discrimination, such as racism and sexism in healthcare settings, are recommended.

Access to Care and Prevalence of Hypertension and Diabetes Among Syrian Refugees in Northern Jordan.

Importance: The management of noncommunicable diseases in humanitarian crises has been slow to progress from episodic care. Understanding disease burden and access to care among crisis-affected populations can inform more comprehensive management. Objective: To estimate the prevalence of hypertension and diabetes with biological measures and to evaluate access to care among Syrian refugees in northern Jordan. Design, Setting, and Participants: This cross-sectional study was undertaken from March 25 to April 26, 2019, in the districts of Ramtha and Mafraq, Jordan. Seventy clusters of 15 households were randomly sampled, and chain referral was used to sample Syrian households, representative of 59 617 Syrian refugees. Adults were screened and interviewed about their access to care. Data analysis was performed from May to September 2019. Exposures: Primary care delivered through a humanitarian organization since 2012. Main Outcomes and Measures: The main outcomes were self-reported prevalence of hypertension and diabetes among adults aged 18 years or older and biologically based prevalence among adults aged 30 years or older. The secondary outcome was access to care during the past month among adults aged 18 years or older with a diagnosis of hypertension or diabetes. Results: In 1022 randomly sampled households, 2798 adults aged 18 years or older, including 275 with self-reported diagnoses (mean [SD] age, 56.5 [13.2] years; 174 women [63.3%]), and 915 adults aged 30 years or older (608 women [66.5%]; mean [SD] age, 46.0 [12.8] years) were screened for diabetes and hypertension. Among adults aged 18 years or older, the self-reported prevalence was 17.2% (95% CI, 15.9%-18.6%) for hypertension, 9.8% (95% CI, 8.6%-11.1%) for diabetes, and 7.3% (95% CI, 6.3%-8.5%) for both conditions. Among adults aged 30 years or older, the biologically based prevalence was 39.5% (95% CI, 36.4%-42.6%) for hypertension, 19.3% (95% CI, 16.7%-22.1%) for diabetes, and 13.5% (95% CI, 11.4%-15.9%) for both conditions. Adjusted for age and sex, prevalence for all conditions increased with age, and women had a higher prevalence of diabetes than men (adjusted prevalence ratio, 1.3%; 95% CI, 1.0%-1.7%), although the difference was not significant. Complications (57.4%; 95% CI, 51.5%-63.1%) and obese or overweight status (82.8%; 95% CI, 79.7%-85.5%) were highly prevalent. Among adults aged 30 years or older with known diagnoses, 94.1% (95% CI, 90.9%-96.2%) currently took medication. Among adults aged 18 years or older with known diagnoses, 26.8% (95% CI, 21.3%-33.1%) missed a medication dose in the past week, and 49.1% (95% CI, 43.3%-54.9%) sought care in the last month. Conclusions and Relevance: During this protracted crisis, obtaining care for noncommunicable diseases was feasible, as demonstrated by biologically based prevalence that was only moderately higher than self-reported prevalence. The high prevalence of complications and obese or overweight status, however, suggest inadequate management. Programs should focus on reinforcing adherence and secondary prevention to minimize severe morbidity.

Development and psychometric evaluation of Nurses and Midwives' Perceptions of their Roles in Primary Healthcare.

OBJECTIVE: This study aimed to develop Nurses and Midwives' Perceptions of their Roles in Primary Healthcare (NMPR-PHC) and evaluate its psychometric properties. METHODS: A cross-sectional survey was performed to recruit a convenient sample of 150 registered nurses and midwives from various primary healthcare settings in Jordan. Reliability was evaluated by examining the internal consistency and split-half reliability of the item. A exploratory factor analysis was performed to assess the factor structure of the NMPR-PHC. RESULTS: The final version of NMPR-PHC contained 18 items. Exploratory factor analysis revealed six factors (care coordination and interprofessional collaboration, workplace facilitators of the primary healthcare, management of care, research, workplace constraints of primary healthcare, and advanced education) for the questionnaire which explained 66.49% of the total variance. The Cronbach's α of the total scale was 0.834, the subscales Cronbach's α were ranging between 0.662 and 0.770, and the split-half reliability of the total scale was 0.734. CONCLUSION: The overall performance of the questionnaire showed promising sound psychometric properties. The NMPR-PHC can be recommended for use as a tool for the assessment of nurses and midwives' perceptions of their roles in primary healthcare.