Stress Factors, Stress Levels, and Coping Mechanisms among University Students.

Aims: To explore university students' levels of stress, stressors, and their coping style. Methods: A cross-sectional correlational design with a convenience sample (n = 676) of university students who completed the Student-Life Stress Inventory (SSI) and Coping Strategies Indicator (CSI) was used. Findings. Overall, two-thirds of the participant reported moderate levels of stress. Students with chronic illness, living alone, low CGPA, and having exams today experienced a statistically higher mean level of stress. Students who are living alone used the "avoidance" method more significantly and the "social support" method significantly less compared with students who are living with their families and friends. Conclusion: This study concurs with others that university students are prone to distress. To our knowledge, this is the first study in the region to explore the students' coping skills. Some of the employed coping and associated factors could be used to lay the groundwork for evidence-based prevention and mitigation.

Prevalence and Predictors of Loneliness Among Youth During the Time of COVID-19: A Multinational Study.

BACKGROUND: Given the restrictions associated with COVID-19, feelings of loneliness among youth may increase. AIMS: The aims of the current study were to assess the prevalence of loneliness among young people at the time of COVID-19 and to identify whether selected variables related to the pandemic predicted the level of loneliness. METHOD: A cross-sectional study using WhatsApp and Facebook social media platforms was conducted to survey 1,057 young people aged 15 to 24 years from six Middle Eastern countries. Participants completed survey items including demographic and COVID-19-related questions; the Depression, Anxiety and Stress Scale (DASS); the Satisfaction With Life Scale (SWLS); and the UCLA Loneliness Scale. RESULTS: The prevalence of experienced loneliness was 1 (0.1%), 625 (59.1%), 429 (40.6%), and 2 (0.2%), reflecting low, moderate, moderately high, and high experiences for loneliness, respectively. History of depression or anxiety, being dissatisfied with life, and having depression at the time of COVID-19 were significant predictors of loneliness among youth. The model was significant (F = 44.95, p < .05) and accounted for 29.8% of the variance in UCLA Loneliness Scale scores. CONCLUSIONS: We found that the high prevalence rate of loneliness during the COVID-19 pandemic was correlated with depression and impaired life satisfaction among Middle Eastern youth. Thus, special attention and interventional action plans need to be developed taking into consideration the youths' special situation during COVID-19.

Determinants of health-related quality of life among Omanis hospitalized patients with cancer: a cross-sectional study.

PURPOSE: This study aimed to examine the difference in HRQoL by participants' characteristics and to investigate the determinants of health-related quality of life HRQoL among Omani hospitalized patients with cancer. METHODS: This cross-sectional study was conducted in two oncology centers in Oman. Omani hospitalized patients with breast, thyroid, colorectal, stomach, and prostate cancer were recruited using convenience sampling. Participants completed Arabic versions of Pittsburgh Sleep Quality Index to measure sleep quality, Brief Fatigue Inventory scales to measure fatigue, and Functional Assessment of Cancer Therapy to measure HRQoL. Descriptive and inferential statistics were performed. T-test, ANOVA, and multiple linear regression analysis were utilized to determine predictors of HRQOL. RESULTS: In total, 275 participants were recruited (Meanage = 52 years). About 64% of the participates reported poor sleep and 18.5% reported severe cancer-related fatigue. Younger patients who had good sleep quality and less cancer-related fatigue and had prostate and thyroid cancer demonstrated better HRQoL [F (5, 269) = 26.26, p < 0.000]. The model explained 33% of the variances in the HRQoL (R2 = .328). CONCLUSIONS: This study highlights the impact of age, cancer type, sleep quality, and cancer-related fatigue on the HRQoL in hospitalized patients with cancer. Thus, sleep quality and cancer-related fatigue should be assessed routinely during the hospitalization of oncology patients with unique attention to patients' age and cancer type.

Development, feasibility and acceptability of a self-efficacy-enhancing smartphone application among pregnant women with gestational diabetes mellitus: single- arm pilot clinical trial.

BACKGROUND: There is growing attention to the use of mHealth technologies to promote glycemic control for women with GDM around the world, but research on promoting a change in health behaviors is lacking. This study aimed to document the process of designing, developing, and testing the feasibility and acceptability of the SEESPA. METHODS: This single-arm pilot clinical trial study included 15 pregnant women with GDM. Following SEESPA development (e.g., goal setting and action plan, role modeling, motivational messages, mastery of experiences, and tracking healthy behaviors), all participants were provided access to use the SEESPA for 4 weeks. Feasibility outcomes assessed were rates of recruitment, retention rate, success rate of transmitting motivational text messages, rate of participants acknowledging receipt of text messages, and success rate of recording healthy behaviors. Acceptability outcomes were determined by asking open-ended questions through telephone interview at 4-week post-intervention. RESULTS: Fifteen randomly selected women consented to participate in the study, with a 60.0% (n = 9) retention rate at post-trial intervention and 40.0% (n = 6) trial dropout. Two motivational text messages per week were sent to all participants. Of these, 68.1% were acknowledged by the participants. Study participants reported that SEESPA is useful, effective, and they felt satisfied about it. In addition, they brought few suggestions that will be integrated on the final version of the app. CONCLUSIONS: and Clinical Relevance. The developed innovative SEESPA is a feasible and acceptable intervention for behavioral modifications among women with GDM, and is ready to be tested in a larger RCT study which is expected to inform the health policymakers to integrate SEESPA with the antenatal health care practice of women with GDM, specifically in developing countries where there is a greater risk of developing GDM complications among mothers and their infants. TRIAL REGISTRATION: The study is registered on September 16, 2019 (ACTRN12619001278123p) by the Australian New Zealand Clinical Trials Registry.

Facilitators and barriers of mental health help-seeking behaviours among adolescents in Oman: a cross-sectional study.

OBJECTIVES: This study aimed to explore and identify facilitators and barriers to help-seeking behaviours among adolescents in Oman, by exploring the relationship between knowledge, attitude, and behaviour towards mental health help-seeking. METHODS: A cross-sectional descriptive study was used and 424 adolescents were recruited to participate in the study. Participants were asked to complete five self-reported questionnaires, including two open-ended questions about the main motivations and barriers to seeking professional help for mental problems. RESULTS: It was found that those with positive help-seeking attitudes towards mental health were more knowledgeable about mental health, had more positive attitudes towards mental illness, and had higher intention to help seeking. On the contrary, those with higher help-seeker stereotypes had more negative attitudes towards mental illness. Having an adequate support system, being positive and knowledgeable about mental illness, and the reputation of mental health are the main factors facilitating seeking professional help. However, fear, lack of family support, and the time-consuming procedures were the main barriers emerging from the open-ended questions. CONCLUSIONS: This study contributes by identifying facilitating factors as well as barriers in an Arabic context (Oman) to fill the exiting knowledge gap; both need to be considered when planning interventions targeting the younger individuals in this society.

Development and validation of the nursing clinical assessment tool (NCAT): a psychometric research study.

OBJECTIVES: The aim of this pilot psychometric study was to develop and assess the reliability, validity, and applicability of a nursing clinical assessment tool (NCAT) to assess students' clinical performance in the clinical training. METHODS: Total of 325 forms were completed by 36 clinical raters for undergraduate nursing students who were selected using convenience sampling. International quality and safety education for nurses (QSEN) and Benson and Clark's (Benson, J., & Clark, F. (1982). A guide for instrument development and validation. The American Journal of Occupational Therapy, 36(12), 789-800) model guided the construction of the NCAT. Following literature review, a cross-cultural adaptation and psychometric testing were used. RESULTS: This newly developed tool showed substantial overall internal consistency reliability (Cronbach's alpha = 0.74). Three factors (i.e. Care Provider, Leadership & Team Work and Professionalism and Ethical Considerations) were identified for construct validity using exploratory factor analysis (EFA). CONCLUSIONS: This study suggests that the NCAT is a reliable, valid and applicable tool. It can be used in clinical and educational settings. Further testing of the tool in similar and different cultures is recommended.

The Lived Experience of Parent Caregivers of Adolescents with Mental Illness: A Phenomenological Study.

Background: The challenges faced by parents of adolescents with mental disorders are profound and multifaceted. Therefore, this study aimed to explore the lived experiences and concerns of parents of adolescents with mental disorders in Oman. Methods: Interpretative phenomenological analysis was employed in this study. In-depth interviews were done with twenty caregivers from June 2021 to the end of December 2022. Data collection continued until saturation was reached, ensuring a thorough understanding of the phenomena under investigation, and thematic analysis was applied to identify and examine the recurring patterns within the data. Results: Three primary themes emerged from the data analysis including Emotional Burden and Guilt, Treatment Concerns, and Fear of the Future. Parents' experiences during their adolescents' diagnosis revealed a profound emotional struggle, encompassing anxiety, frustration, and occasional confusion as they grappled with understanding their children's illness and navigating unpredictable behaviors. The exploration of seeking treatment highlighted the complexity of their experiences. However, a persistent sense of uncertainty regarding their children's future was a consistent thread irrespective of the chosen treatment path. Conclusion: This study aimed to investigate the complex challenges faced by caregivers of adolescents suffering from mental disorders, underscoring the vital need for tailored interventions and robust support systems to address these intricate issues. The findings highlight the importance of heightened awareness, improved access to psychotherapeutic resources, and comprehensive caregiver support.

Burden levels and predictive factors among caregivers of hemodialysis patients: a cross-sectional study in Oman.

BACKGROUND: Caring for individuals with chronic kidney disease (CKD) is a highly demanding task that can adversely affect the physical and psychological well-being of caregivers. OBJECTIVE: This study aimed to investigate the burden experienced by caregivers of patients undergoing hemodialysis (HD) in Oman and explore the factors associated with this burden, including demographic and medical characteristics. METHODS: A descriptive cross-sectional was employed. Caregiver burden was assessed, and demographic and medical variables were examined among caregivers of HD patients. A total of 326 unpaid family caregivers completed the Zarit Burden Interview scale, demographics and some medical variables. Linear multiple regression analyses were conducted to identify factors linked to caregiver burden. RESULTS: Of the caregivers, 62.9% reported a minimal burden, 21.8% experienced mild-to-moderate burden, 8.6% faced moderate-to-severe burden, and 6.7% encountered a severe burden. The final multiple regression model demonstrated statistical significance compared to the constant (F = 8.68, p < 0.001), with eight predictors explaining 18% of the variance, and caregivers' satisfaction with health emerged as the only significant predictor. CONCLUSION: A substantial portion of caregivers reported minimal burden. These findings suggest the need for further in-depth investigations into factors contributing to this favourable outcome. Furthermore, caregivers' satisfaction with health was the only significant predictor of their burden. Healthcare providers need to give special attention to this point and conduct periodic assessments of the primary caregivers' health. Implementing improvements in the healthcare system based on these findings could enhance the overall caregiving experience for HD patients and their caregivers.

Adherence to gestational diabetes mellitus (GDM) management plan among pregnant women in Oman: Predictors, barriers, and motivating factors.

OBJECTIVES: This study examined the predictors, the barriers, and the motivating factors of adherence to the gestational diabetes mellitus (GDM) management plan among Arab pregnant women with GDM. METHODS: This cross-sectional study was conducted in the Antenatal Clinics of three major tertiary hospitals in Oman. Total of 164 Arab pregnant women with GDM were recruited using a convenience sampling technique. The measurement scales included Diabetes Self-Management Questionnaire- Revised, Diabetes Management Self-Efficacy Scales, and Social Support Survey. Multiple-choice questions were used to assess barriers to and motivators of adherence. The analytical tools included multiple linear regression and descriptive statistics. RESULTS: Findings from stepwise regression analysis revealed three models with three significant predictors, including self-efficacy, previous history of GDM, and the type of GDM management. The major barriers to adherence were family, especially kids' responsibilities, time constraints, home responsibilities, and working status. Moreover, participants indicated their concern about maternal and neonatal GDM-related complications and husband encouragement as the main motivating factors for adherence. CONCLUSIONS: and Clinical Relevance: Our findings suggest that antenatal healthcare providers should implement strategies that enhance self-efficacy and engage families in health education programs. The study also recommends collaboration between health policy makers in the Ministries of Health, Consumer Protection Agency, and the Ministries of Municipality to ensure the availability of healthy food choices in the public areas. Additionally, flexible working conditions and an environment conducive to a healthy and active lifestyle should be made available to pregnant women with GDM.

Translating and Testing the Validation of the Arabic Peer Mental Health Stigmatization Scale.

Objective: Attitudes toward mental difficulties are influenced by culture, and different cultural backgrounds have different effects on people's behavior. This study aimed to prepare the Arabic version of the Peer Mental Health Stigmatization Scale (PMHSS) and validate it among Omani adolescents. Method : The study was conducted from October 2020 to the end of February 2021. The 24-items PMHSS was translated into Arabic and tested in a sample of 369 adolescents from different governmental schools in Oman. Both exploratory factor analysis (a principal component analysis (PCA) technique with Varimax rotation) and confirmatory factor analysis were performed to examine the construct validity of the PMHSS. Results: Confirmatory factor analysis was performed to examine the construct validity of the PMHSS. Cronbach's α was 0.86 for the total scale and 0.84 and 0.81 for awareness and agreement, respectively. Therefore, the goodness-of fit-indicators support the two-correlated factor 16-item model to measure stigma (χ2 / df = 2.64 (p > 0.001), GFI = 0.92, AGFI = 0.89, CFI = 0.90, IFI = 0.90, RMSEA = 0.067). Conclusion: The Arabic version of the Peer Mental Health Stigmatization Scale (PMHSS) could assess adolescents' stigmatizing attitudes toward various types of mental health problems within the Arabic context, and it can be utilized by researchers in Arab countries to screen for stigmatizing attitudes and to suggest suitable, effective, and outcome-focused interventions based on its results.

Do Health Literacy and Awareness of Polycystic Ovary Syndrome Predict the Lifestyle Choices of Arabic-Speaking Female University Students.

Background: Considering the increasing prevalence of Polycystic Ovarian Syndrome (PCOS) and its related complications-such as obesity, cardiovascular diseases, and infertility-in the Middle East, it is imperative to create sufficient public awareness about this issue. Accordingly, the potential link between PCOS awareness and health literacy level with the lifestyle choices of Arabic-speaking female university students was examined in this cross-sectional study. Materials and Methods: This research was conducted in the Sultanate of Oman and involved 446 Arabic-speaking female university students, who completed a self-administered online questionnaire, Single Item Literacy Screener, and PCOS Awareness Tool. Results: The findings showed that, while 53.50% of the study participants had inadequate health literacy, 79.80% demonstrated an acceptable level of PCOS awareness. However, this did not seem to influence their lifestyle, given that 59.20% of the respondents were physically inactive and 83.30% regularly consumed fast food. Regression analysis results nonetheless revealed that health literacy and PCOS awareness were significant predictors of lifestyle choices (F2,44 = 5.98, p < 0.05, 95% CI [4.44-5.35]). Conclusions: The Arabic-speaking female university students' health literacy level and PCOS awareness are significant predictors of their lifestyle choices. Thus, the policymakers in the Arab region need to develop effective strategies aimed at PCOS prevention, focusing specifically on raising public awareness about PCOS and its negative consequences on female reproductive health. In addition, university administrators should ensure the availability of healthy food choices at their campuses as well as opportunities for physical activity to promote healthy lifestyle among all students.

The lived experience of Omani adolescents and young adults with mental illness: A qualitative study.

There is currently limited knowledge about the firsthand experiences of adolescents and young adults with mental health problems and the meanings they ascribe to these experiences, particularly within Arab countries. This study, therefore, aimed to explore the lived experience of Omani adolescents and young adults with a mental health problem. A sample of 15 participants aged 13-22 diagnosed with a range of mental health problems took part in the study. A qualitative interview guide consisting of open-ended questions was used to allow participants to speak in-depth about their experiences. Using the thematic analysis approach to uncover patterns in the data, three major themes emerged: "living in darkness", "perilous journey" and "uncertain future". Results show that the progress of adolescents and young adults with mental health problems is characterized by several challenges; the most significant of which is having insufficient knowledge about their illness, leading to unnecessary delays in their treatment. These findings shed light on the breadth and depth of the experience of adolescents and young adults with mental health problems and lay the groundwork for further examinations. Implications lie in the development of approaches for preventing or mitigating difficulties faced by adolescents and young adults with mental health problems.

Self and public stigma towards mental illnesses and its predictors among university students in 11 Arabic-speaking countries: A multi-site study.

This study aimed to explore self and public stigma towards mental illness and associated factors among university students from 11 Arabic-speaking countries. This cross-sectional study included 4241 university students recruited from Oman, Saudi Arabia, the United Arab Emirates (UAE), Syria, Sudan, Bahrain, Iraq, Jordan, Lebanon, Palestine and Egypt. The participants completed three self-administrative online questionnaires-Demographic Proforma (age, gender, family income, etc.), Peer Mental Health Stigmatization Scale and Mental Health Knowledge Questionnaire. There was a significant difference in the average mean between the 11 countries (p < 0.01) based on stigma agreement (self) and stigma awareness (public). The mean stigma agreement towards mental illnesses among university students was 19.7 (SD = 6.0), with the lowest in Lebanon, 15.9 (SD = 5.1) and the highest in UAE, 24.1 (SD = 5.6). The factors associated with stigma agreement included poor knowledge, being male, high family income, age, weak cumulative grade point average (cGPA), mothers with primary education, an unemployed parent, students in scientific colleges and fathers who completed secondary or university degrees. Furthermore, the factors associated with stigma awareness included good knowledge, acceptable cGPA and having a father who has a low income and is illiterate. Stigma towards mental illness varies among university students across Arabic-speaking countries. There is a need to sensitize youngsters to the need for a humanitarian approach in society to individuals affected by mental health concerns. Major governmental reforms must be initiated for the provision of mental health services for individuals with mental illnesses.

Gestational diabetes and determinants of adherence to healthy behaviors.

BACKGROUND: Previous studies on (GDM) focused on finding new strategies to decrease the incidence of its complications; however, there is insufficient evidence that investigate the influencing factors of adherence to healthy behaviors. This study examined the influencing factors of adherence to healthy behaviors among pregnant women with gestational diabetes (GDM). METHODS: Descriptive cross-sectional design was used among pregnant women with gestational diabetes. The study participants completed study instruments twice (pre-test & post-test), with a four-weeks gap. The measurement scales included summary of diabetes self-care activities measure (SDSCA), diabetes management self-efficacy scales (DMSES) and open-ended questions to assess barriers and motivators of adherence. The analytical tool was multiple linear regression. RESULTS: The results from multiple regression indicated that 20.0% of the total variation in the adherence to healthy behaviors was explained by women's perceived self-efficacy and the overall relationship was significant [F (1, 88) =23.60, P<0.000]. From the demographic variables, only, the gestational age at delivery was found to be a significant predictor of adherence to healthy behaviors (t=-3.1, P<0.05), adjusted R-square =15.6. Physical limitation and time constraints (40%) were the most reported barriers for adherence. Participants' concern of GDM-related complications (94.4%) and family moral support (52.2%) were the main identified motivators for adherence. CONCLUSIONS: The importance of assessing determinants, barriers and motivators of adherence to healthy behaviors should be considered before planning any antenatal health promotion interventions designed for women with GDM. The study findings have implications for research, practice, policy advisors and public health. For practice, maternal nurses should consider the identified barriers in this study in any health education intervention and provide solutions and resources to the pregnant women to overcome these barriers. Policy advisors need to take into considerations providing pregnant women with flexible working hours that could encourage them maintaining healthy lifestyle behaviors during the pregnancy period. Researchers interested in GDM should examine in the upcoming studies different self-efficacy enhancing strategies among pregnant women with GDM.

Objective structured clinical examination vs traditional clinical examination to evaluate students' clinical competence: A systematic review of nursing faculty and students' perceptions and experiences.

BACKGROUND: Assessment of clinical competence of nursing students is an essential requirement in professional nursing education. This article summarizes the current published evidence indicating the nursing faculty and students' perceptions and experiences on benefits of OSCE over TCE. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Electronic databases including Scopus, Medline, Science Direct, CINAHL, EBSCO, PsychINFO, and Pubmed Central were used to identify relevant articles. The studies published between January 1, 2010 and December 31, 2020 and fourteen full-text articles that met all the inclusion criteria were included in the review. RESULTS: The review identified five themes namely: a) Student's perception of OSCE; b) student's satisfaction regarding OSCE as an examination approach; c) students' perception of TCE as an examination approach; d) student's level of stress and anxiety towards OSCE vs TCE; and e) faculty member's perception and experience of OSCE. CONCLUSION: We conclude that OSCE is a more credible assessment format to evaluate the clinical competence of undergraduate nursing students compared to the TCE method.

Nursing Students' Perception and Attitude towards Objective Structured Clinical Examination in Oman.

Objectives: This study aimed to explore undergraduate nursing students' perception and attitude towards the Objective Structured Clinical Examination (OSCE). Methods: This cross-sectional descriptive study was conducted between April-May 2020 among undergraduate nursing students at the College of Nursing at Sultan Qaboos University, Muscat, Oman. Two self-administered questionnaires were utilised to obtain data on students' perception and attitude towards OSCE. Students' feedback on OSCE was collected using open-ended questions about OSCE strengths, weaknesses and recommendations for improvement. Survey responses were based on a five-point ordinal scale, ranging from strongly disagree to strongly agree. Students' feedback on OSCE was analysed as descriptive data by identifying the common themes and categorising them in groups. Results: A total of 160 students completed the study questionnaires. Most did not find the atmosphere of OSCE to be pleasant (66.3%) and preferred more modes of practical examination (40.6%). Moreover, 64.4% believed the time limitation to be inadequate. The data depict that 33.1% of the examinees deemed the OSCE more stressful than the full practical examination. In addition, a few students confirmed that the OSCE improved their communication skills and confidence in nursing skills. Conclusion: The findings of this study appear alarming in regard to students' perception regarding the overall process and validity of OSCE as an assessment method. Nursing educators must consider further evaluation and improvement of the OSCE in order to improve students' acceptance and appreciation of OSCE as an important form of clinical learning and assessment.

A comparison of knowledge and attitude toward mental illness among secondary school students and teachers.

AIM: The current study aimed to assess and compare the level of knowledge and attitude towards mental illness between secondary school students and their teachers in Oman. METHODS: An online survey was carried out to collect data from 400 students and 411 teachers about their knowledge and attitudes toward people with mental illness. Two independent case studies about depression and schizophrenia were also tested. RESULTS: Students have a poor knowledge of mental illness compared with their teachers, as more than half scored less than 60% compared with 16.5% of the teachers. More than two-thirds of the students (80%) and teachers (76.4%) have a low or minor positive attitude toward people with mental illness. The study identified significant differences in knowledge in favour of teachers, although the opposite was found regarding attitudes. CONCLUSIONS: Since students spend a significant amount of time in school, bridging the gap between teachers' and students' knowledge and attitudes toward mental illness is an essential part in enhancing the knowledge and attitudes of the students. In addition, knowledgeable teachers with positive attitude can assist in early identification of mental illnesses and help students when needed. In turn, students who possess knowledge and positive attitude toward mental illness can share their concerns with their teachers. In the presence of such accepting and cooperative environment, the stigma can be decreased and early detection of mental illness and help-seeking behaviour can be promoted.

Maternal and Neonatal Outcomes of Healthy Pregnant Women With COVID-19 Versus High-risk Pregnant Women: A Multi-Center Case-Control Comparison Study.

The purpose of this retrospective, matched case-control study (two controls [healthy control and high- risk control] vs. COVID-19 cases) was to compare the maternal and neonatal outcomes of pregnant women with and without COVID-19. A total of 261 pregnant women from three different countries with and without COVID-19 were included in this study. Several pregnancy complications were more common in high-risk pregnant women compared to COVID-19 cases and healthy pregnant women. These include preeclampsia (p < .01), vaginal bleeding (p < .05), preterm labor (p < .05), premature rupture of membrane (p < .01), requiring induction of labor (p < .05), have lower gestational age on delivery (F (2) = 3.1, p < .05), requiring cesarean section (p < .01), neonatal admission in the NICU (p < .01), and low neonatal Apgar score (p < .01). Nurses are advised to provide equal attention to pregnant women with underlying health issues and to pregnant women infected with COVID-19 in terms of the risk assessment, health care, and follow-up for optimal maternal and neonatal outcomes.