Healthcare Access Worsened for Women in Precarious Housing During the COVID-19 Pandemic: A Qualitative Study.

This research aims to gain an in-depth understanding of precariously housed women's experiences related to health and access to health care during the COVID-19 pandemic using a grounded theory approach. Qualitative data were obtained through interviews with 17 precariously housed women from Izmir, Turkey. Poor health among most participants was primarily attributed to unfavorable living conditions and weakened community networks. The COVID-19 pandemic exacerbated existing health issues due to barriers in accessing basic needs. Food insecurity was widespread during the pandemic and the critical role of aid and the inadequacy of social assistance in securing food were emphasized. Women's health perceptions were significantly shaped by gender, and gendered caregiving duties have restricted women's healthcare access. Access to healthcare was also limited by financial challenges, with health insurance being a crucial determinant. Longer waiting times, often exacerbated by the appointment system, and language were significant barriers to healthcare access. The findings propose that the participants were precarized by the blindness of COVID-19 measures to vulnerabilities, which resulted in deeper inequalities in housing, food, employment, and healthcare access. This research addresses the political, commercial, and social determinants of precariously housed women's health. Improving precariously housed women's health and wellbeing requires implementation of public policies targeting to improve housing quality, provide targeted assistance to food insecurity, promote gender inclusiveness, and foster gender empowerment.

Postpartum family planning attitudes among Turkish women: development of a reliable and valid scale.

AIM: The aim of this study was to develop a scale based on the Health Belief Model (HBM) to assess the family planning (FP) attitudes of postpartum women with 0- to 12-month-old infants residing in eight neighbourhoods of the Bornova province, Izmir, Turkey. INTRODUCTION: Family planning is an integral component of maternal and infant health during the postpartum period and is a fundamental aspect of healthcare services in the prenatal and postnatal period. METHODS: The Postpartum Family Planning Attitude Scale (PFPAS) was developed in four stages: item pool development, content validity evaluation, pilot study, and reliability and validity assessment. The PFPAS was administered to 292 women. The developed scale comprised 27 items and six sub-dimensions. Cronbach's alpha coefficient was used to evaluate the reliability of the scale. Construct validity was evaluated using confirmatory factor analysis. FINDINGS: Cronbach's alpha coefficient was 0.88, indicating good reliability. Confirmatory factor analysis validated the structural validity of the scale, with a chi-square/degree of freedom ratio of 2.24, an RMSEA value of 0.068, and a CFI value of 0.95. The lowest and highest possible scores for the PFPAS were 27 and 135, respectively, with a mean total score of 105.32 ± 11.91.

Needs of family members of patients admitted to a university hospital critical care unit, Izmir Turkey: comparison of nurse and family perceptions.

PURPOSE: This study aims to compare the perceptions of nurses and families on the needs of the relatives of the patients in Intensive Care Unit (ICU). METHODS: This cross-sectional study was conducted in the ICU of a university hospital. The study comprised 213 critical care patients' relatives and 54 nurses working in the same ICU. Data were collected using the Turkish version of Critical Care Family Needs Inventory (CCFNI) and a questionnaire on the characteristics of the participants. The difference between the perceptions of families and nurses was analyzed using Student t-test. Results: CCFNI's assurance/proximity subscale mean scores ranked first among bothpatients and nurses. The item "To be assured the best care possible is being given to the patient" was the top priority for both groups. Mean assurance/proximity and information dimensions of relatives were significantly higher compared to nurses (p < 0.001). No significant difference was found between the perception of patient relatives and nurses related to support and comfort dimensions (p < 0.05). CONCLUSION: The needs of the relatives of patients are underestimated by nurses. This inhibited the performance of ICU nurses in line with the holistic care approach. Educational objectives that include the needs of ICU patients' relatives should be incorporated into the undergraduate and in-service training of nurses. Policies should be established to create space and time for effective relative-nurse communication.

Access to primary health care family planning services and contraceptive use in disadvantaged women: a qualitative study.

OBJECTIVES: The study aimed to provide a deeper understanding of the gender-related determinants and organisational structure of primary health care that shape contraceptive use among disadvantaged women living in a developing Islamic country where family planning services are affected by health care reforms. METHODS: A qualitative study was conducted in three disadvantaged neighbourhoods in the metropolitan district of Bornova, Izmir. A purposive sampling method with maximum diversity was used to obtain a study sample of 43 women. Data were collected through in-depth interviews and analysed using a coding paradigm of grounded theory. RESULTS: Three themes emerged from the analysis, namely, factors affecting participants' number of children, experiences with using contraceptive methods, and use of family planning services at family health centres. Despite a desire to limit their number of children and a positive view of contraception, women in the study faced gender-related barriers to accessing family planning services. Their statements indicate significant deficiencies in terms of provision of contraception and family planning consultations at family health centres. CONCLUSION: For disadvantaged women living in conservative areas, family planning is a fragile exercise. Gender-sensitive primary care services are essential to ensure access to everyone in the community.

Effects of an oral health program: Community-based education among mothers of young children living in socioeconomically disadvantaged neighborhoods.

INTRODUCTION: An oral health program for mothers starting from pregnancy in a disadvantaged district of Izmir was performed in 2013-2016. Dental behaviors and their determinants among intervention and control groups were compared in the third phase of the program. METHODS: This nonrandomized-controlled study was conducted in Phase 3. The intervention group began with 248 pregnant women; 69.4% (n = 172) of mothers with 6-9-month-old babies participated in Phase 2, 2014. At Phase 3 (18-24 months), 68.6% (n = 118) of mothers in the intervention group and 113 mothers living in another district as controls were included. Sociodemographic characteristics, determinants of behaviors, and outcomes defined as dental behaviors in the last week were assessed using a questionnaire. RESULTS: Regarding knowledge, perceived severity, and fatalistic beliefs, the intervention group had higher correct answer percentages. The percentage of mothers who could clean their children's teeth before sleep was higher in the intervention group (76.3%; P < 0.05), but the difference was lost by a child's resistance. The significant difference on avoiding bedtime nursing (65.3%) and sugary snacks (74.4%) in the intervention group disappeared with the obstacle of a child's protests or interference from relatives. In the intervention group, 32.2% of the mothers reported that they did not give any sugary snacks, 43.2% had never fed during sleep, and 26.3% cleaned their children's teeth during the last week. The results in the control group were 24.8%, 18.6%, and 8.8%, respectively (P < 0.05). CONCLUSIONS: The program improved the mothers' views regarding the determinants of dental behaviors, but greater support against obstacles was needed. Social environmental support is planned for the following stages of the program.

Unmet needs for family planning among married women aged 15-49 years living in two settlements with different socioeconomic and cultural characteristics: a cross-sectional study from Karabuk Province in Turkey.

AIM: The aim of the study was to investigate levels and related factors of the unmet needs for family planning among married women aged 15-49 years living in two settlements (rural and urban) having different economic, social and cultural structures in Karabuk, a province in north-western Turkey. METHOD: This cross-sectional study was conducted in the rural Cumayani village and the urban Emek neighbourhood between October 2016 and June 2017. The sample size was determined to be 289 married women aged 15-49 years from each settlement according to the effect size of 0.3, alpha error probability of 0.05 and power of 0.95. In the study, 594 currently married women (298 from Cumayani and 296 from Emek) were contacted. The dependent variable was the level of unmet need for family planning. The independent variables included the sociodemographic and reproductive characteristics of the women. The data were collected through face-to-face interviews. The characteristics of the two settlements were compared using the χ2 test. Bivariate and multivariate logistic regression analyses were carried out to examine the factors associated with the dependent variable. RESULTS: The comparison of the participants demonstrated that the education, employment and income levels of the rural women were lower than those of the urban women (p<0.001). The rural women had more pregnancies, miscarriages and stillbirths, and the mortality among their children was higher compared to the urban women (p<0.001). The level of unmet need for family planning in Cumayani village was about twice that of Emek neighbourhood (9.7% v 5.4%). The multivariate analysis was conducted separately for each settlement. Marrying by way of only a religious ceremony increased the level of unmet need for family planning by 4.61 times (95% confidence interval (CI) 1.3-16.1) (p=0.016) in Cumayani. The multivariate analysis of all the women participating in the study revealed that marriage by way of only a religious ceremony increased the level of unmet need by 4.96 times (95%CI 1.4-17.1) (p=0.011). CONCLUSION: The study showed the effects of socioeconomic and cultural factors on women's fertility behaviours and unmet needs for family planning to favour urban women. Not being married by civil marriage was a significant predictor of unmet need. These findings highlight a need for intervention, particularly for the empowerment of rural women, in order to improve reproductive health outcomes.

The PUFFinCA scale: development of an instrument for evaluating the primary care functions of family physicians in childhood asthma.

AimTo develop the Primary care fUnctions oF Family physicians in Childhood Asthma (PUFFinCA) scale for evaluating the cardinal process functions of primary care services (accessibility, comprehensiveness, continuity and coordination) provided by family physicians (FPs) in the management of childhood asthma. BACKGROUND: In the literature on the functions of primary care, there is no assessment tool focusing on children with asthma. Primary care assessment scales adapted to various languages are not suitable to adequately address the needs of special patient groups, such as children with asthma. METHODS: In this methodological study, the instrument development process was completed in four stages: establishing the pool of items, evaluating the content validity, applying the scale and statistical analysis. The scale was applied to 320 children who had asthma and received care in the clinic of the Department of Pediatrics, Division of Allergy and Pulmonology at Ege University School of Medicine, Turkey. The Cronbach's α and Spearman-Brown coefficient were calculated to determine the reliability of the scale. Principal component analysis was used to determine the construct validity of the scale.FindingsThe PUFFinCA scale was found to have four-factor structure and 25 items. Cronbach's α coefficient was 0.93. It has been determined that the reliability was excellent and the item-total correlation coefficients were >0.30 each. The factors were titled FP's 'functions of accessibility, first contact and continuity', 'functions of coordination and comprehensiveness of health services related to asthma management', 'provision of preventive care related to asthma' and 'provision of services for paid vaccinations'.

Comparison of standard agglutination tests, enzyme immunoassay, and Coombs gel test used in laboratory diagnosis of human brucellosis

Background/aim: It was aimed to evaluate the results of Rose Bengal (RB), ELISA total tests (IgM and IgG), and the Brucella Coombs gel test (BCGT), which are used as screening tests, with the combined results of a tube agglutination test (standard Wright test: SWT) and a tube agglutination test with antihuman globulin (AHG TAT). Materials and methods: Samples from 97 patients prediagnosed with brucellosis (age ≥18 years) were screened with RB, ELISA, and BCGT. SWT < 160 samples and RB-negative but ELISA- or BCGT-positive samples were tested by AHG TAT. SWT ≥ 160 or AHG TAT ≥ 160 was taken as reference. Results: Thirty-two of 56 RB-positive samples and one RB-negative but ELISA- and BCGT-positive sample were found to be ≥160 with SWT or AHG TAT. Sensitivity, specificity, accuracy, and agreement (kappa) values according to SWT ≥ 160 or AHG TAT ≥ 160 positivity were as follows, respectively: RB 96.9%, 62.5%, 74.2%, and 0.509; ELISA total 100%, 60.9%, 74.2%, and 0.515; BCGT test 97%, 70.3%, 79.4%, and 0.594. Conclusion: Sensitivities of the screening tests are similar, but positivities should be confirmed by more specific tests. Positive samples from screening tests should be tested with AHG if the SWT value is <160.

Comparison of Two Different Enteral Nutrition Protocol in Critically Ill Patients.

OBJECTIVE: In this study, two enteral nutrition protocols with different gastric residual volumes (GRVs) and different monitoring intervals were compared with respect to gastrointestinal intolerance findings in intensive care unit (ICU) patients. METHODS: The study was carried out prospectively in 60 patients in the anaesthesiology and reanimation ICU under mechanical ventilation support, who were scheduled to take enteral feeding. Patients were sequentially divided into two groups: Group 1, GRV threshold of 100 mL, and monitoring interval of 4 hours, and Group 2, GRV threshold of 200 mL, monitoring interval of 8 hours. To test the significant difference between the groups, Student's t test, chi-square text and Fisher exact test were used. RESULTS: In Group 1, 3.3% vomiting, 6.6% diarrhoea was observed; in Group 2, 16.6% vomiting, 10% diarrhoea. In terms of total intolerance (vomiting and/or diarrhoea) of the two groups, the incidence was significantly higher in Group 2 (33.3%) than in Group 1 (10%) (p=0.02). CONCLUSION: According to the results of the study, a lower gastrointestinal intolerance rate was detected in the GRV threshold 100 mL, monitoring interval for 4 hours protocol (Group 1) than in GRV threshold 200 mL, monitoring interval for 8 hours protocol (Group 2); Group 1 may be preferred renovation.

Adaptation of the Critical Care Family Need Inventory to the Turkish population and its psychometric properties.

In the complex environment of intensive care units, needs of patients' relatives might be seen as the lowest priority. On the other hand, because of their patients' critical and often uncertain conditions, stress levels of relatives are quite high. This study aims to adapt the Critical Care Family Need Inventory, which assesses the needs of patients' relatives, for use with the Turkish-speaking population and to assess psychometric properties of the resulting inventory. The study was conducted in a state hospital with the participation of 191 critical care patient relatives. Content validity was assessed by expert opinions, and construct validity was examined by exploratory factor analysis (EFA). Cronbach's alpha coefficient was used to determine internal consistency. The translated inventory has a content validity ratio higher than the minimum acceptable level. Its construct validity was established by the EFA. Cronbach's alpha coefficient for the entire scale was 0.93 and higher than 0.80 for subscales, thus demonstrating the translated version's reliability. The Turkish adaptation appropriately reflects all dimensions of needs in the original CCFNI, and its psychometric properties were acceptable. The revised tool could be useful for helping critical care healthcare workers provide services in a holistic approach and for policymakers to improve quality of service.

The influence of a market-oriented primary care reform on family physicians' working conditions: A qualitative study in Turkey.

BACKGROUND: Turkey has undergone a 'Health transformation programme' putting emphasis on the reorganization of primary care (PC) services towards a more market-oriented system. OBJECTIVES: To obtain a deep understanding of how family physicians (FPs) experienced the process of the reforms by focusing on working conditions. METHODS: This phenomenological and qualitative research used maximum variation sampling and 51 FPs were interviewed in 36 in-depth and four focus-group interviews. RESULTS: Thematic analysis of interviews provided seven themes: (1) change in the professional identity of PC physicians (physician as businessperson); (2) transformation of the physician-patient relationship in PC (into a provider-customer relationship); (3) job description and workload; (4) interpersonal relationships; (5) remuneration of FPs, (6) uncertainty about the future and (7) exhaustion. Most FPs felt that the Family medicine model (FMM) placed more emphasis on the business function of family practice and this conflicted with their professional characteristics as physicians. FPs complained that some of their patients behaved as extremely demanding consumers. Continuously increasing responsibilities and extremely high workload were commonly reported problems. Most participants described the negative incentives in the performance scheme as a degrading method of punishment. The main factor was job insecurity caused by contract-based employment. FPs described the point at which they are with terms such as exhaustion. CONCLUSION: By increasing workload and creating uncertainty about the future and about income, the PC reforms have led to working conditions, which has led to changes in the professional attitudes of physicians and their practice of medicine.

Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers.

BACKGROUND: A person-list-based family medicine model was introduced in Turkey during health care reforms. This study aimed to explore from primary care workers' perspectives whether this model could achieve the cardinal functions of primary care and have an integrative position in the health care system. METHODS: Four groups of primary care workers were included in this exploratory-descriptive study. The first two groups were family physicians (FP) (n = 51) and their ancillary personnel (n = 22). The other two groups were physicians (n = 44) and midwives/nurses (n = 11) working in community health centres. Participants were selected for maximum variation and 102 in-depth interviews and six focus groups were conducted using a semi-structured form. RESULTS: Data analysis yielded five themes: accessibility, first-contact care, longitudinality, comprehensiveness, and coordination. Most participants stated that many people are not registered with any FP and that the majority of these belong to the most disadvantaged groups in society. FPs reported that 40-60% of patients on their lists have never received a service from them and the majority of those who use their services do not use FPs as the first point of contact. According to most participants, the list-based system improved the longitudinality of the relationship between FPs and patients. However, based on other statements, this improvement only applies to one quarter of the population. Whereas there was an improvement limited to a quantitative increase in services (immunisation, monitoring of pregnant women and infants) included in the performance-based contracting system, participants stated that services not among the performance targets, such as family planning, postpartum follow-ups, and chronic disease management, could be neglected. FPs admitted not being able to keep informed of services their patients had received at other health institutions. Half of the participants stated that the list-based system removed the possibility of evaluating the community as a whole. CONCLUSIONS: According to our findings, FPs have a limited role as the first point of contact and in giving longitudinal, comprehensive, and coordinated care. The family medicine model in Turkey is unable to provide a suitable structure to integrate health care services.

Sociodemographic aspects of consanguineous marriage in an urban slum of a metropolitan area in Izmir, Turkey.

BACKGROUND: Consanguineous marriage is a common practice in Turkey. Sociodemographic and cultural factors associated with it are still unclear. AIM: The purpose of this study was to investigate the association between sociodemographic and fertility factors and consanguineous marriages in an urban slum of a metropolitan area in Turkey. METHODS: This community-based case-control study was conducted in Bayrakli Municipality health centres. Of the 1243 married women, 85 consanguineously married were included in the case group. A control group in non-consanguineous marriages consisted of 85 women matched to cases according to age and neighbourhood. Information about the subjects' sociodemographic features, fertility history and opinions about consanguineous marriage was collected. RESULTS: Factors that were associated with consanguinity included; having a low level of education (OR = 2.7, CI = 1.1-6.7), a brief duration time in Izmir after migration (OR = 4.7, CI = 1.9-11.6) and consanguineous parents (OR = 3.8, CI = 1.5-9.7). Despite the increased numbers in fertility features and higher perinatal mortality for first cousin marriages, there was no significant difference in the mean numbers of pregnancies, births, stillbirths and living children. CONCLUSION: Time after migration and educational background of women were the main factors associated with consanguineous marriages. Public health interventions to reduce consanguineous marriage in urban areas should target socioeconomically disadvantaged populations in cities.

Unintended pregnancy and prenatal care: a study from a maternity hospital in Turkey.

OBJECTIVES: To evaluate factors associated with pregnancy intention and its effects on source, content and adequacy of prenatal care for women who delivered in a large maternity hospital in Izmir, Turkey. METHODS: This cross-sectional survey was carried out using a questionnaire administered face-to-face to 351 women who had given birth in Konak Maternity Hospital in May 2002. RESULTS: Nearly half (47.3%) of the pregnancies were unintended: 31.3% were mistimed, and 16.0% unwanted. Women's and husbands' older age and lower education, lower social class, women's recent migration to Izmir, lower household income and absence of social security had a negative impact on pregnancy intention. Women with unwanted pregnancies had started procreating earlier; they had more pregnancies, deliveries, children and intentional abortions (p < 0.05). Number and contents of prenatal visits increased as intention status improved. When controlled for socio-demographic variables, women with unwanted pregnancies had less prenatal care, received less education during prenatal visits and had less iron and vitamin supplementation (p < 0.05) whereas mistimed pregnancies did not significantly differ from intended pregnancies. CONCLUSION: Unwanted pregnancies constitute a risk group that should be identified early in pregnancy. Ensuring an adequate and satisfactory prenatal care for all requires appropriate measures to be taken by public health authorities.

The effects of an educational program on knowledge of breast cancer, early detection practices and health beliefs of nurses and midwives.

AIM: To determine the effectiveness of an educational program concerning knowledge of breast cancer, early detection practices and health beliefs of nurses and midwives. BACKGROUND: Educational programs play an important role in breast cancer preventive behaviour. DESIGN: The study was designed as an experimental post-test only, control group design. The educational program was applied only to the experimental group. The study group included 157,134 nurses and midwives respectively in the experimental and the control group. METHODS: Participants in the experimental group received an educational program on the breast cancer. One year after the educational program was delivered, data were collected from the two groups using a personal data form and the Turkish version of Champion's Health Belief Model Scale. Descriptive statistics, paired samples t-test, chi-square test and Fisher's exact test were conducted in the course of the data analyses. RESULTS: The mean total knowledge score was significantly higher in the experimental group than in the control group. The application percentage of mammography and clinical breast examination was higher in the experimental group. There were no significant differences between two groups in performing breast self-examination. The experimental group was significantly more likely to feel confident and motivated, and their total score on the health belief scale was much better than that of the control group. CONCLUSIONS: The results of this study showed that educational intervention had a positive impact on knowledge of breast cancer, on practices related to breast cancer, on early detection and on the health beliefs in the experimental group. RELEVANCE TO CLINICAL PRACTICE: The educational programs, including techniques to increase the motivation and skills for early detection of breast cancer, should be made widespread in nursing and midwifery. Health beliefs should be considered in planning educational programs about breast cancer. Interventions should be designed to enhance nurses' and midwives' confidence and motivation.

Why are Turkish children at risk of exposure to environmental tobacco smoke in their homes?

OBJECTIVES: Children are at greater risk than adults to the effects of inhaling environmental tobacco smoke (ETS) especially in their homes. The aim of this study was to assess parents' knowledge regarding the risks of ETS to the health of their children and the barriers to reducing children's ETS exposure. METHODS: Qualitative research was performed for 50 households in which children were to exposed ETS were selected randomly from the questionnaire respondents for home-based interview. We conducted a total of 53 home-based interviews and collected information from parents regarding their knowledge of ETS effects, smoking behavior at home, barriers to quitting smoking or reducing ETS exposure, social attitudes toward parents who ban smoking, and the impact of the smoke-free legislation. RESULTS: Passive smoking was not a well recognized term but parents recognized that it causes harmful health effects. Some parents reported that their health care professionals did not inform them about the dangers of ETS. Parents restricted smoking in their homes, with a range of spatial restrictions which were frequently modified by family relation factors and the desire to be seen to act in socially and morally acceptable ways. The meaning of hospitality as social habits and traditions were important underlying factors. CONCLUSION: Knowledge levels, relationships with family and friends and the social and cultural context in which families live play important roles in the management of smoke exposure in Turkish homes. Despite these factors, awareness of the risks of ETS and smoke free legislation can provide opportunities to support people attain smoke-free homes.

Evaluation of an educational programme in Ege University, Turkey: medical student's home visits with midwife preceptors.

OBJECTIVE: to evaluate the efficiency of the midwife preceptors in teaching comprehensive health care for women and their families through exploring how they perceive their roles as educators and from the perspectives of medical students; to assess the number of educational goals achieved. DESIGN: for midwives, a quantitative method was used for pre- and post-evaluation of a 'Medical Students' Home Visits with Midwife Preceptors' course. Focus-group interviews were used to gather qualitative data. Students were evaluated after undertaking home visits with the midwives. SETTING: urban health centres in Western Turkey and Ege University Faculty of Medicine. PARTICIPANTS: a sample of four clusters of second year medical students (130 out of 284) and all midwives (n=32) linked with the health centres participated in the programme. FINDINGS: in general, both the midwives and the medical students found the programme useful. Students declared that they achieved their learning objectives and midwives stated that they had contributed to this achievement. Scores of eight of the 20 learning objectives significantly increased in the midwives' post-test evaluation. Midwives and students valued the effective communication they had with each other. All midwives participated in focus-group interviews, and reported that the course before the home visits was useful to them. Nearly all of the midwives suggested that the home visits course should be longer, repeated, or both. It was difficult to organise home visits for all of the medical students, and access to some households to enable students to gain training experience was refused. CONCLUSIONS: this programme encouraged the medical students to adopt broad public health approaches in assessing the health needs of defined communities. It also increased their awareness of the importance of multi-professional teamwork and comprehensive health care for women and their families. At the same time, the programme improved the professional knowledge of midwives, and they were able to appreciate their roles and functions in primary health care, and enhance their self-esteem. The findings also indicated that this programme is an effective way of promoting multi-professional education in medical schools.

Public health education in Ege University Medical Faculty: developing a community-oriented model.

BACKGROUND: Ege University Medical Faculty (EUMF) introduced a community-oriented curriculum in 2001. AIMS: To evaluate the new public health education program in EUMF curriculum. METHOD: The study adopted triangulated methods. Quantitatively, a comparison of the students who were exposed to a community-oriented curriculum (Year 4 in 2007) was made with the students who were exposed to the traditional curriculum (Year 4 in 2005) in terms of their assessment of their achievement of our learning objectives. A total of 255 students in 2005 (80.7%) and 243 students in 2007 (81.5%) were surveyed using a questionnaire. Qualitatively, five focus group- and five individual interviews were performed with the 2007 cohort. RESULTS: Except the one related to teamwork (p > 0.05) all learning objectives yielded significantly higher scores in the 2007 cohort than in the 2005 cohort (p < 0.05). The qualitative analysis supported the achievement of objectives in the 2007 cohort. The students appreciated the relevance of public health education with clinical subjects and interactive methods, but criticized didactic lectures and written assignments. CONCLUSIONS: A community-oriented approach is more effective in achieving a holistic approach to health problems. Improving community-based activities and assessment methods would be more successful in integrating population health into medical training.

Breast cancer awareness and practice of breast self examination among primary health care nurses: influencing factors and effects of an in-service education.

AIM: The purposes of this study were to identify the level of breast cancer and breast self examination practice knowledge of primary health nurses and the factors influencing breast cancer and breast self examination knowledge as well as to investigate the frequency of breast self examination practice of primary health nurses and influencing factors and to evaluate the effects of an in-service training program about breast cancer and breast self examination practice for primary health nurses. BACKGROUND: An increased awareness among nurses about breast cancer prevention would most likely result in a higher number of better educated women about breast cancer and also motivate adherence to screening recommendations. DESIGN AND METHODS: A pre-test and post-test design was implemented to evaluate the effectiveness of a Breast Cancer and Breast Self Examination Education Program for primary health nurses. The program was instructed to 192 of the 215 primary health nurses by two nurse trainers. Pre- and post-tests made available a quantitative evaluation of the level of improvement in breast cancer and breast self-examination knowledge. RESULTS: Mean of total breast cancer knowledge score of primary health nurses prior to the program was 58.51 SD 15.63 whereas, it increased to 75.96 SD 9.53, revealing a statistically significant escalation (p < 0.0001). A significant increase was detected in the number of primary health nurses practising breast self examination as a result of the significant improvement in the mean of self breast self examination practice knowledge score which rose evidently from 71.09 SD 19.31 to 85.02 SD 12.92 (p < 0.0001). CONCLUSION: The in-service education program improved the knowledge about breast cancer and practice of breast self examination in trained primary health nurses. The program model, which involved trained primary health nurse also represented an efficient use of the resources. RELEVANCE TO CLINICAL PRACTICE: It is important that primary health nurses have adequate breast cancer knowledge and practice of breast self examination to contribute effectively to primary health care. Findings of this study can be used to guide the planning efforts on continuous education of primary health nurses about breast cancer and breast self examination issues.