Designing and validating of a questionnaire measuring perceived self-care ability (PSCA) in chronic stroke patients at home.

BACKGROUND: Patients with a stroke often cannot care for themselves after hospital discharge. Assessment of their self-care ability is the first step in planning post-discharge home care. This study aimed to design and validate a measure of perceived self-care ability (PSCA) in stroke patients. METHODS: A sequential-exploratory mixed method was conducted in Tehran, Iran, in 2020-2021. The qualitative phase involved in-depth semi-structured interviews with 12 participants. Transcripts were content analyzed. The results guided the development of 81 items. psychometric properties such as face validity (Impact Score > 1.5), content validity ratio (CVR > 0.63), content validity index (Item Content Validity Index: ICVI > 0.78, Scale Content Validity Index/Average: SCVI/Ave > 0.8) and Kappa value (Kappa > 0.7), internal consistency (Cronbach's alpha > 0.7), relative reliability (ICC: inter class correlation coefficient), absolute reliability (Standard Error of Measurement: SEM and Minimal Detectable Changes: MDC), convergent validity (Correlation Coefficient between 0.4-0.7), interpretability, responsiveness, feasibility, and ceiling and floor effects were assessed. RESULTS: Content analysis of the qualitative interviews yielded 5 major categories and 9 subcategories that reflected "Perceptual stability", "Cognitive fluctuations", "Sensory, Motor and Physical health"," The subjective nature" and "The dynamic nature" of PSCA. Results of face and content validity reduced the number of items to 32, capturing three dimensions of PSCA in chronic stroke patients; these dimensions included perceptual ability, threatened health status, and sensory, motor, and cognitive ability. The findings supported the reliability and validity of the measure. CONCLUSIONS: The PSCA questionnaire was developed and validated within the Iranian culture. It is useful in assessing the self-care of patients with stroke and in informing practice.

Developing post-stroke psychometric properties for an Adherence to rehabilitation regimen scale: A sequential exploratory mixed-method study.

INTRODUCTION: Adherence to rehabilitation in patients post-stroke plays a significant role in the effectiveness of rehabilitation and patient recovery. This study aimed to design and determine the psychometric properties of a scale for measuring adherence to the rehabilitation regimen in patients post-stroke in the Iranian community. METHODS: The present study used a sequential exploratory mixed method and was conducted in two phases (phase one qualitative and phase two quantitative). Participants in the first phase were patients post-stroke, caregivers, and rehabilitation team members (n=20). The second phase was conducted on patients post-stroke (n=198), and the psychometric steps, including face, content, and construct validity, as well as reliability, were assessed. RESULTS: The Adherence to Rehabilitation Regimen Scale (ARRS)was designed with 26 items and four factors of participation: 1) physical exercises, 2) following prescribed regimens, 3) performing the activities of daily living, and 4) psychological follow-up. The internal consistency was 0.96 by calculating Cronbach's alpha coefficient. The Interclass Correlation Coefficient was 0.99 with a confidence interval of 0.96-0.99. CONCLUSION: The scale measuring adherence to the rehabilitation regimen in patients post-stroke has optimal psychometric properties. Therefore, as the first specific scale to measure the degree of rehabilitation regimen adherence in patients post-stroke, this tool may be beneficial for other rehabilitation programs interested in managing and improving program adherence.

The experience of stigma in family caregivers of people with schizophrenia spectrum disorders: A meta-synthesis study.

Introduction: Schizophrenia is a chronic disabling and the most stigmatizing mental disorder worldwide. The stigma experienced by family caregivers impacts their lives in different ways. This study reports the results of qualitative synthesis to understand the perceptions and experiences of stigma in families of people with schizophrenia spectrum disorders across various socio-cultural contexts. Methods: An initial comprehensive search was performed in databases like Web of Science, PsycINFO, CINAHL, Scopus, and Ovid-based MEDLINE. By searching, 3560 studies were found, of which 16 articles were included in the present study. A meta-synthesis was done according to the meta-ethnographic approach. Result: Three themes were generated: perpetuated stigma by general misunderstandings about schizophrenia, mental health inequality contributes to structural stigma, and long-term family caregiving stigmas, attitudes, and coping strategies. These themes indicated the essential experiences of stigma in families of people with schizophrenia, which appeared due to unknown and socio-cultural misconceptions of schizophrenia that led to emotional challenges for family caregivers. Conclusion: This study addresses stigma-related issues, and coping strategies used almost exclusively by family caregivers. Health policymakers and healthcare professionals working in mental health institutions should consider this data. Substantial steps must be taken to combat stigma, with education initiatives topping the list.

Instability of emotional relationships and suicide among youth: a qualitative study.

BACKGROUND: Interpersonal problems are one of the factors for understanding the complex issues that result in suicide attempts and self-injury by poisoning. The quality of familial relationships is a predictor of the occurrence and outcome of suicide attempts. This study aimed to explore motives for self-poisoning suicide attempts amongst young adults. METHOD: This research was a qualitative study conducted using semi-structured interviews in 2019 in Kermanshah Province, Iran. Eighteen participants who had attempted suicide by self-poisoning were interviewed, and information was collected until data saturation was achieved. The interviews were recorded and transcribed, and the data were analyzed through content analysis. RESULTS: The results included the category of instability in emotional relationships with the three sub-categories of 1- Emotional failure, 2- Emotional trauma, and 3- Loss of emotional resilience (caused by emotional failure and emotional trauma within the previous few months). Instability in emotional relationships creates feelings of disgrace, humiliation, burdensomeness, worthlessness, and insignificance, which increases the chances of attempting suicide. CONCLUSION: The study results provided an in-depth understanding of romantic, and unstable familial relationships as a significant factor in suicide attempts, demonstrating the role of emotional stress in attempting suicide. The present study provided information on the risk factors and warning signs for psychiatrists and nurses dealing with suicidal patients to take effective measures to prevent suicide through social support.

Stroke Survivors and Their Family Caregivers' Experiences of Health Information Seeking: A Qualitative Study.

Background: Stroke is a significant and unpredictable event that affects physical and mental functions. A useful approach to returning to a normal life is to seek out health information. This study aimed to explore the experiences from health information seeking in the stroke survivors and their family caregivers. Methods: This study was carried out using qualitative content analysis. Participants included five stroke survivors and fifteen family caregivers who were selected purposively from the Rofideh Rehabilitation Center and private physiotherapy centers in Tehran. Data were collected from semi-structured interviews. Data analysis was performed using Graneheim and Lundman's method manually in Word software. Sampling was carried out in 2021. Results: Two main categories were extracted 1): adapting and learning resulting from awareness including optimization of living environment and disease management, and 2) fear and inquietude on the information way including confused and insolvent in receiving information, and doubts about the accuracy of information. Conclusion: The health information seeking created adaptability and relative stability in some stroke survivors and their family caregivers. However, in others, there was still a sense of anxiety and uncertainty. Thus, understanding health information seeking experiences helps health policymakers and administrators to provide information and training based on evidence and individual needs of the client and family.

Prevalence of Workplace Violence Against Healthcare Workers During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

Background: A large number of anxious and concerned people refer to health centers during the COVID-19 pandemic, increasing the workload of healthcare workers (HCWs) and violence against these professionals. The present study aimed to estimate the prevalence of workplace violence (WPV) against HCWs during the COVID-19 pandemic. Methods: This systematic review and meta-analysis was conducted via searching in databases such as Scopus, PubMed, and Web of Science, and observational articles reporting the prevalence of WPV against HCWs were selected. Heterogeneity between the studies was assessed using Cochran's Q test. A random-effects model was used to estimate the prevalence of WPV. Data analysis was performed in the Stata software version 16. Results: In the initial search, 680 articles were identified and screened based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) steps. In total, 17 studies with a sample size of 17,207 HCWs were analyzed. The total prevalence of violence was estimated at 47% (95% CI: 34-61%). In addition, the prevalence of physical and psychological violence was 17% (95% CI: 6-28%) and 44% (95% CI: 31-57%), respectively. The prevalence of WPV was higher among physicians (68%; 95% CI: 31-95%) compared to other HCWs. The WPV in the America and Asia was 58 and 44%, respectively. Conclusion: According to the results, WPV against nurses is prevalent during the COVID-19 pandemic, and intervention measures are required to protect the nursing staff against such violence.

Family and Rehabilitation of Children with Cochlear Implant: A Qualitative Study.

AIM: This study was conducted to explain the role of families in rehabilitating children with cochlear implants based on the participants' experiences and perceptions. METHOD: This research is a qualitative study based on the method of contract content analysis, and it is conducted with semi-structured interviews to collect information in Iran in 2018-2019. The interview was conducted with 12 participants, including caregivers (child caregivers with a cochlear implant), and the process of data collection continued until saturation. Interviews were recorded and transcribed, and the data were analyzed using Gran Haim and Landman content analysis. This study was guided by consolidated criteria for reporting qualitative (COREQ). RESULTS: The results of the study were formed in the main class titled the family, the effective rehabilitation factor, and two sub-classes titled supportive family and continuing professional and non-professional rehabilitation. CONCLUSION: The findings of this study indicated that the rehabilitation process in these children will be incomplete without the presence and support of the family.

Psychometric Properties of Persian Version of the Bakas Caregiving Outcomes Scale.

Background: Caregivers of stroke patients have many problems due to caring for patients. This study aimed to evaluate the psychometric properties of the Persian Version of the Bakas Caregiving Outcomes Scale (BCOS) in caregivers of stroke patients. Materials and Methods: This methodological study was conducted in 2018 with 191 caregivers of stroke patients. In order to assess the scale validity and reliability, the face, content, internal consistency, stability of the scale, and construct validity (exploratory and confirmatory factor analysis) were done. Results: The scale face and content validity qualitatively were checked and confirmed by caregivers' and experts' opinions. In the reliability, Cronbach's alpha was obtained to be 0.93. The test-retest was conducted on 30 participants and showed good stability after 2 weeks. The Intraclass Correlation Coefficient (ICC) for the total scores was reported to be 0.94. The Kaiser-Meyer-Olkin p value was 0.90, Bartlett's sphericity test was significant (p < 0.001), in the exploratory factor analysis, 2 factors with 14 items were extracted. The confirmatory factor analysis confirmed the appropriate model with 14 items (removal of item 13) with two factors at the expected level. Conclusions: The Persian version of the 14 items of the BCOS indicates satisfactory reliability, and validity in the Iranian caregivers of stroke patients.

Rehabilitation of children with cochlear implant in Iran: A scoping review.

Background: Recovery of children does not appear on its own after cochlear implantation. Coherent, thoughtful, and comprehensive rehabilitation is needed to achieve complete success. The purpose of this study was to identify the types of rehabilitation interventions for children with cochlear implants that have been performed in Iran. Methods: A scoping review study was conducted. An electronic search was carried out both in English and Persian. In English, the following keywords were used: cochlear implantation, child, cochlear implants, auditory rehabilitation, deaf, hearing loss, comprehensive, interventions, rehabilitation, and telerehabilitation and a combination of them in ProQuest, PubMed, Science Direct, and Scopus databases, Web of Sciences, Medline and Embase. Persian electronic search was conducted in the Scientific Information Database (SID) of Jihad Daneshgahi, Iran Journals Database (MagIran), and Islamic World Science Citation Database (ISC). Searches were done using articles published until September 25, 2020, and a total of 902 articles were found, of which 14 were directly related to the purpose of the study. Interventional studies were included in the study, and the quality of studies was measured using the Structured Effectiveness Quality Evaluation Scale. Results: The results showed that using music and rehabilitation equipment, different methods of speech therapy and auditory training, story-based instruction, creative play, family-centered instruction, and occupational therapy are interventions in cochlear implant rehabilitation. Speech therapy accounts for 54% of the rehabilitation share. The mean number of rehabilitation sessions was 26. These interventions were all somehow effective in children with cochlear implantation; the longer the training duration, the better the results. Conclusion: The process of cochlear implant rehabilitation in children is multi-professional; auditory training and speech therapy possesses the highest share of rehabilitation. Therefore, it is recommended to develop speech therapy centers in Iran.

Exploring Facilitators of Regaining Autonomy in People with Spinal Cord Injury: A Qualitative Study.

BACKGROUND: One of the most important aims of rehabilitation in Spinal Cord Injuries (SCI) is regaining autonomy, which can affect individuals' Quality of Life (QOL). This study was conducted to understand the experiences of individuals with SCI in terms of regaining autonomy during transition from hospital to community. MATERIALS AND METHODS: The present study was conducted using a qualitative research design. In this study, 15 semi-structured, in-depth interviews were conducted with individuals with SCI in Spinal Cord Injury (SCI) Association of Arak, Iran, from June 2018 to May 2019. The interviews were analyzed using the conventional content analysis method. RESULTS: Data analysis emerged four core categories of "self-management" (adaptation to a new life, self-care, responsibility, and seeking information), "social support" (family and friends' support, health care providers' support, and peer support), "access to facilities and resources" (home modification, use of various rehabilitation techniques, and use of mobility equipment), and "spiritual and religious beliefs" (believing in divine destiny and performance of religious rites). CONCLUSIONS: The present study showed that several factors influenced the regaining of autonomy in individuals with SCI. It is important to consider the impact of these factors during transition from hospital to community. Health service providers can use the findings of this research to help these individuals regain their autonomy.

Validation of the Persian version of the Compassionate Care Assessment Tool.

OBJECTIVES: The present study aimed to translate and determine the psychometric properties of the Persian version of the Compassionate Care Assessment Tool (CCAT) ©. METHODS: The study was carried out to translate and validate of the CCAT©. After securing permission from the designer of the tool and translating it, the psychometric properties were determined through examining face validity, construct validity, internal consistency, and test/retest reliability. With regard to construct validity, confirmatory factor analysis was used so that 300 patients in internal and surgery wards were selected by a simple random sampling method from three hospitals. Data were analyzed using SPSS (v.24.0) and LISREL statistical software version 8.8. RESULTS: The results of the confirmatory factor analysis supported the validity and reliability of the Persian version of the CCAT© and its four factors. The reliability of the tool and internal consistency were confirmed through test/retest method with two weeks' interval. At the two areas of importance and provision of compassionate care, Cronbach's α coefficient equaled to 0.918 and 0.933 and intraclass consistency equaled to 0.848 and 0.907 respectively. CONCLUSION: The results showed that the Persian version of the CCAT© was adequately valid and reliable for Iranian patients. Given the acceptable psychometric parameters of the tool, using it in future studies to measure importance and provision of compassionate nursing care to Iranian patients at internal and surgery wards is recommended.

A study of handwashing training effects on awareness, attitude, and handwashing skills of third grade elementary school students.

BACKGROUND AND AIMS: Hands are the first way of which many infectious diseases are transmitted. Hand hygiene is a means of infection control in schools. Close consideration of handwashing in educational units is important to control and prevent infection transmission. The present study aimed to determine the effect of handwashing education on awareness, attitude and handwashing skills of third-grade elementary school students in Tehran. METHODS: In this study, 76 third grade students of elementary schools located at district 1 of Tehran with the mean age of 9 years were randomly divided into intervention and control groups using pre-test and post-test. Data collection for intervention and control groups was done using a researcher-made awareness- and attitude-gauging questionnaire, along with a checklist of handwashing performance which was completed in cooperation with the health instructor. RESULTS: The results of this study showed that there was a significant difference between the awareness of 3rd-grade students in intervention (69.79 ± 1.61) and control (49.03 ± 1.18) groups (P < 0.05). Moreover, students' attitude toward handwashing improved as a result of education, and the intervention group (62.37 ± 0.65) had a more positive attitude toward hygiene and handwashing compared to the control group (48.45 ± 0.73) (P < 0.05). In the case of handwashing performance, the intervention group (56.76 ± 1.33) had better health performance compared to the control group (40.08 ± 0.67) (P < 0.05). CONCLUSION: Practical training, preparation of educational posters and videos can enhance awareness, attitude and handwashing performance.

Caregiving burden in family caregivers of patients with schizophrenia: A qualitative study.

INTRODUCTION: After the psychiatric revolution and implementation of deinstitutionalization policies, caring for people with a mental health condition shifted from psychiatric hospitals to their families. In this way, family caregivers were forced to take full responsibility for taking care of the patients that lead to the occurrence of challenges for them. Only a few studies have investigated the caregiving challenges of family caregivers in patients with schizophrenia. AIM: This study aimed to gain a better understanding of caregiving burden in family caregivers of patients with schizophrenia and its related factors. MATERIALS AND METHODS: This qualitative study was performed based on 12 family caregivers of schizophrenia patients visiting a psychiatric hospital in Tehran in 2018. Sampling was carried out based on the purposive sampling method and was continued until data saturation. All interviews were recorded, transcript, and imported into the MAXQDA software. Then, qualitative content analysis was conducted based on Graneheim and Lundman's five-step method. RESULTS: One theme, two main categories, and five subcategories were identified from the continuous analysis and data comparison. The "Perceived objective burden" as theme included two main categories: "Heavy involvement of caregivers" and "Challenges of the healthcare system". CONCLUSION: The results of this study indicate that the family caregivers of the patients with schizophrenia encounter many problems related to multiple responsibilities in the caring process and challenges in the provision of mental health-care services. This finding could improve psychiatric and mental health nurses' knowledge and awareness about caregiving challenges in family caregiver of patients with schizophrenia and related factors.

Adherence to a Rehabilitation Regimen in Stroke Patients: A Concept Analysis.

BACKGROUND: Adherence to rehabilitation regimens is a major issue in the treatment of stroke. Despite the agreement on the importance of adherence, there is still no clear definition of this concept in rehabilitation. The aim of this study was the concept analysis of the concept of adherence to rehabilitation regimens in stroke patients. MATERIALS AND METHODS: This qualitative concept analysis was performed using Walker and Avant's method. English and Persian articles were searched using keywords such as "adherence", "compliance", "rehabilitation", "stroke", and other related keywords among articles published from 1997 to 2018 in PubMed, Scopus, Web of Science, Google Scholar, Iranmedex, Magiran, and Scientific Information Database (SID). Related textbooks were also searched and all articles containing definitions, attributes, antecedents, and consequences of the concept were included in the study. RESULTS: The attributes of the concept included complex, multidimensional, and dynamic behavior in the treatment process, personal experience, and adaptive behavior in patients, changeable, situational, voluntary, and collaborative behavior, and active communication between the patient and the healthcare provider. Common antecedents of the concept of adherence to the rehabilitation regimen were classified into patient-related and environmental-related categories and the consequences were classified into the three categories of patient-related, healthcare professional-related, and healthcare system-related. CONCLUSIONS: This concept analysis can be useful in eliminating any ambiguity of the concept of adherence to rehabilitation regimens. It helps clarify the vague concepts used in nursing rehabilitation instead of adherence. The results of this study can be helpful for researchers for further studies in this context.

Factors affecting adherence to rehabilitation in Iranian stroke patients: A qualitative study.

Adherence to rehabilitation has significant effects on patient outcomes. This study aimed to explore factors affecting adherence to rehabilitation in Iranian stroke patients. This is a descriptive, qualitative study. This study was conducted in 2018. Participants were stroke patients, family members, and rehabilitation team members-20 in total. They were purposively recruited from Rofaideh inpatient rehabilitation center in Tehran, and the outpatient physiotherapy center of Poursina hospital in Rasht. Data collection was performed through semistructured interviews and was continued up to data saturation. Data were analyzed by content analysis technique. Factors affecting adherence to rehabilitation in stroke patients were categorized into four main categories, namely patients-related, rehabilitation team, rehabilitation systems, and insurance and social support systems factors. Health care providers can promote patients' adherence to rehabilitation, involvement in the process of treatment, and their quality of life through broadening patients' knowledge about rehabilitation effectiveness, strengthening communication with health care providers, and adequate insurance and social support.

Defining the concept of family caregiver burden in patients with schizophrenia: a systematic review protocol.

BACKGROUND: Since the deinstitutionalization policy, in psychiatric hospitals, the care of patients with schizophrenia was left to their families which has been imposing a heavy burden on them. Family caregiver burden could have consequences for caregivers, patients, and the society. There is very little consensus on the definition and dimensions of the caregiver burden, which leads to a lack of consistency in the results of research. Thus, the present study was aimed to redefine the family caregiver burden of patients with schizophrenia. METHODS: The databases PubMed, Scopus, Web of Science, MEDLINE (Via Ovid), ProQuest, SCI, Magiran, SID, and IranDoc will be searched from 1940 to 2018 using subject headings and appropriate terms in both Farsi and English languages. Also, gray literature and the reference list of included articles will be used to offer an appropriate definition of the family caregiver burden in patients with schizophrenia. Two independent reviewers will participate in study selection, data collection, and quality assessment steps. The result will be presented in tabular form, and meta-synthesis will be performed. DISCUSSION: The result of this systematic review will help present the comprehensive definition of the family caregiver burden in patients with schizophrenia according to its evolutionary trend. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018099372.

The Importance and Extent of Providing Compassionate Nursing Care from The Viewpoint of Patients Hospitalized in Educational Hospitals in Kermanshah - Iran 2017.

AIM: This study is an attempt to determine the importance and extent of providing compassionate nursing care from the hospitalised patients' viewpoint in educational hospitals in Kermanshah-Iran 2017. METHODS: The study was carried out as a descriptive, analytical work in the hospitals affiliated to Kermanshah University of Medical Sciences on 300 patients in 2017. The patients were selected through convenient sampling, and Burnell Compassionate Care Scale was filled by the participants. The collected data was analysed in SPSS (v.20) using descriptive and inferential statistics. RESULTS: The results showed that the mean and standard deviation score of importance and extent of compassionate care were 3.27 ± 0.526 and 2.80 ± 0.647 respectively. There was a significant difference between these two scores (p < 0.001). About all the factors in compassionate nursing care, there was a significant difference between the importance and extent of compassionate nursing care. The mean score of the importance of compassionate nursing care from female patients' viewpoint was higher than that of men (p = 0.032). The observers with college educations perceived the extent of compassionate nursing care less than the other groups of participants (p = 0.008). CONCLUSIONS: There was a significant difference between the importance and extent of compassionate nursing care from the patients' point of view. This highlights negligence by the nurses of this critical aspect of care. It is recommended, therefore, to add compassionate nursing care to nursing programs and commission more research works on other groups of health care personnel.

Exploring fair decision-making rules in nursing: A qualitative study.

BACKGROUND: The decision-making process should be done according to a set of rules and principles so as to be fairly understood. OBJECTIVES: The aim of this study was to identify the basic principles and rules used by nurses to understand justice in nurse managers' decision-making processes based on a procedural justice model. Research design and participants: This research was a qualitative study based on directed content analysis, which was performed on a group of 15 nurses working in different hospitals in Tehran, Iran. An in-depth semi-structured interview was used as the method of data collection for this study. Ethical consideration: This research has been approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences. The respondents were informed about the aim of the study, about voluntary participation, anonymity and confidentiality. FINDINGS: The results of this study showed that in order to understand procedural justice, nurses use several rules, including: duties organization, managerial support, consistency, bias-suppression, accuracy, correctability, representativeness, and ethicality. CONCLUSION: Nursing leaders must consider the importance of justice rules as one of many strategies to ensure the nurses' perception of fairness in decision-making processes.

Effect of Telenursing on Levels of Depression and Anxiety in Caregivers of Patients with Stroke: A Randomized Clinical Trial.

BACKGROUND: Telenursing is a low-cost, highly accessible method that can lead to increased awareness on the principles of care, and may eventually help reduce the stress experienced by caregivers of patients with stroke. The present study aimed to investigate the effect of telenursing through phone consultation on the levels of depression and anxiety in family caregivers of patients with stroke. MATERIALS AND METHODS: This was a randomized clinical trial including 152 caregivers of stroke patients discharged from Mohammad Vase'ee Hospital in Sabzevar in 2016. Participants were recruited through purposive sampling method and were randomly assigned to control (n = 76) and intervention (n = 76) groups. The intervention consisted of 32 sessions of phone consultation. Research tools included demographic characteristics form, needs assessment questionnaire, Beck Depression Inventory, and Beck Anxiety Inventory. Data were analyzed with independent t test using SPSS, version 23. RESULTS: Mean (SD) post-intervention anxiety scores for the intervention and the control group were statistically significant (t = 3.51, p = 0.001). However, the difference in mean depression scores after intervention was not significant (p = 0.70). CONCLUSIONS: Telenursing can be employed to facilitate the care of chronic patients as well as increase the psychological well-being of the caregivers through providing practical and specialized information.

How did older adults respond to challenges after an earthquake? Results from a qualitative study in Iran.

OBJECTIVES: In many areas, natural disasters are a major challenge for life and property of people. Earthquake is one of the most devastating natural disasters. This study aimed to explore how older adults responded to challenges after the earthquake in Iran. METHODS: This study was based on qualitative analysis. Data were collected through in-depth and semi-structured interviews. 29 participants including 18 older adult survivors of the earthquake-stricken areas, four lay caregivers, and three health professionals in disasters, one social worker, two relief worker and one disaster psychologist were interviewed. The interviews were recorded and transcribed. The transcribed texts were analyzed using inductive qualitative content analysis recommended by Graneheim and Lundman (2004). RESULTS: The study explored two main categories regarding older adults' responses to challenges after the earthquake: adaptive and maladaptive responses. Adaptive response has been developed by four factors including; religious coping, sharing feelings and information, coping with new activities, roles and place. Also, maladaptive response was included; the lack of motivation to search for relief supplies, undue dependency, and decrease of social activities. CONCLUSION: Service providers are recommended to identify the patterns of vulnerability and cultural sensitivities in older adults' responses to manage the negative consequences of disasters on older adults. Furthermore, older adults can make a substantial contribution in recovery programs based on the adaptive responses, such as helping in the rescue efforts and psychological support from family and community after disasters.