ABSTRACT
BACKGROUND: Self-medication is described as the use of drugs without a physician's prescription to treat self-recognized illness or symptoms, and an important health issue among the elderly. Despite the wide range of different definitions, recognizing all forms of self-medication among older adults, particularly, in developing countries, help healthcare professionals and providers to reduce harmful effects of self-medication. The purpose of this study is to describe the practice of self-medication and its related factors among elderly people in Iran based on the experiences of people who are involved in this phenomenon. METHODS: This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until saturation. The participants were the elderly, their care-givers, physicians, and pharmacists. Data was collected using semi-structured interviews, and analysis was done using an inductive approach. The theory of planned behavior was used as a framework to explain the role of the emerged factors in the occurrence of self-medication behavior. RESULTS: Based on the expressed experiences of the participants, factors related to the practice of self- medication among the elderly in Iran fit in these 5 categories: "patient's attitudes towards disease, treatment, and physicians", "living with disease", "unfriendly environments", "enabling health system", and "influential others". CONCLUSIONS: Based on the results of this study, self-medication of the elderly in Iran has commonalities with many countries in regard to over-the-counter medications and complementary and alternative medicine; however, self-medication is also seen with drugs that require a prescription but can easily be obtained from pharmacies. Contributing factors, apart from the elderly themselves, include their families, caregivers, and social circle, the physical environment where they live, and the health system from which they receive services.
Subject(s)
Aging , Caregivers , Patient Harm/prevention & control , Self Medication , Adult , Age Factors , Aged , Aging/drug effects , Aging/psychology , Attitude of Health Personnel , Caregivers/classification , Caregivers/psychology , Caregivers/standards , Diagnostic Self Evaluation , Female , Health Knowledge, Attitudes, Practice , Humans , Iran/epidemiology , Male , Middle Aged , Needs Assessment , Qualitative Research , Self Medication/adverse effects , Self Medication/classification , Self Medication/psychology , Socioeconomic FactorsABSTRACT
OBJECTIVES: To introduce supported self-management (SSM) for depression, examine it through the use of a quality assessment framework, and show its potential for enhancing the Canadian health care system. METHOD: SSM is examined in terms of quality criteria: relevance, effectiveness, appropriateness, efficiency, safety, acceptability, and sustainability. Critical research is highlighted, and a case study is presented to illustrate the use of SSM with depressed patients. RESULTS: SSM is defined by access to a self-management guide (workbook or website) plus encouragement and coaching by health care provider, family member, or other supporter. It has high relevance to depression care in Canada, high cost-effectiveness, high appropriateness for most people with depression, and high safety. Acceptability of this intervention is more problematic: many providers remain doubtful of its acceptability to their poorly motivated patients. Sustainability of SSM as a component of mental health care will require ongoing knowledge exchange among policy-makers, health care providers, and researchers. CONCLUSION: The introduction of SSM represents a unique opportunity to enhance the delivery of depression care in Canada. Actively engaging the distressed individual in changing depressive patterns can improve outcomes without mobilizing substantial new resources. Over time, we will learn more about making SSM compatible with constraints on provider time, increasing access to self-management tools, and evaluating the benefit to everyday clinical work.
Subject(s)
Caregivers , Depressive Disorder , Health Promotion , Primary Health Care/methods , Self Care , Social Support , Canada , Caregivers/classification , Caregivers/education , Caregivers/psychology , Cost-Benefit Analysis , Delivery of Health Care, Integrated/organization & administration , Depressive Disorder/economics , Depressive Disorder/therapy , Female , Health Education/methods , Health Education/organization & administration , Health Knowledge, Attitudes, Practice , Health Services Accessibility/organization & administration , Humans , Male , Quality Improvement , Self Care/economics , Self Care/methods , Self Care/psychologyABSTRACT
Continuous labor support offers multiple benefits for mothers and infants. The type of caregiver that is the best support person in labor has not been identified. A critical review of the English language literature was conducted to describe the current state of knowledge on different types of labor support persons. Randomized trials and other published reports were identified from relevant databases and hand searches. Studies were reviewed and assessed by using a structured format. Eight randomized trials met the selection criteria for inclusion in this analysis. These trials investigated untrained and trained lay women, female relatives, nurses, lay midwives, and student lay midwives as labor support persons. Support by untrained lay women starting in early labor and continuing into the postpartum period demonstrates the most consistent beneficial effect on childbirth outcomes. However, more randomized controlled trials are warranted before firm conclusions may be drawn.
Subject(s)
Caregivers , Labor, Obstetric , Caregivers/classification , Female , Humans , Labor, Obstetric/psychology , Meta-Analysis as Topic , Midwifery , Postpartum Period/psychology , Pregnancy , Pregnancy Outcome , Randomized Controlled Trials as Topic , Social SupportABSTRACT
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