Barriers To Accessing Mental Health Services Among Syrian Refugees: A Mixed-Method Study. / Suriye Kökenli Siginmacilarin Ruh Sagligi Hizmetlerine Ulasmasini Engelleyen Etmenler: Karma Yöntemli Bir Çalisma.

OBJECTIVE: Although Syrian refugees have high rates of mental health problems due to war trauma, little is known on their degree of need for and contact with mental health services. Using a population sample of Syrian refugees living in Ankara, we assessed the perceived need for and contact with mental health services, as well as the barriers to access these services. METHOD: This was a cross-sectional mixed-method study of 420 Syrian refugees living in Ankara city center, using face to face interviews administered at the respondents' home by trained, Arabic-speaking interviewers. PTSD and depression were assessed using Harvard Trauma Questionnaire and Beck Depression Inventory, respectively. RESULTS: Of all the refugees in our sample, 14,8% (N=62) stated that they felt the need for mental healthcare since arriving in Turkey. The actual number contacting any mental health service was very low (1,4%, N=6). The most important barriers to accessing mental health services were reported by the respondents to be language problems and lack of information on available mental health services. Service providers and policymakers also reported similar topics as the most important barriers: low awareness about mental health problems, daily living difficulties, and language and cultural barriers. Multivariate analyses revealed that presence of medical or mental disorders and female gender predicted the perceived need for contacting services. CONCLUSION: Our results show that, although refugees report high rates of mental health problems, the perceived need for and actual contact with services are very low. To address this treatment gap, and to provide adequate care for refugees with mental health problems, common barriers (language and awareness) should be identified and dealt with.

Body image dissatisfaction among school children in Turkey and its potential effect on body esteem.

BACKGROUND: This study aimed to validate the Turkish version of Collins` Body Figure Perceptions and Preferences (BFPP) scale. The second aim of this study was to investigate the relationship between body image dissatisfaction (BID) and body esteem (BE), and between body mass index (BMI) and BID, among Turkish children. METHODS: A descriptive cross-sectional study was conducted among 2066 4th grade children (mean age was 10.06 ± 0.37 years) in Ankara, Turkey. The Feel-Ideal Difference (FID) index from Collins` BFPP was used to assess the degree of BID. FID ranges from -6 to +6, with scores below or above 0 indicating BID. Collins` BFPP`s test-retest reliability was evaluated in a subset of 641 children. The Turkish version of the BE Scale for Adolescents and Adults was used to evaluate the children` BE. RESULTS: More than half of the children were dissatisfied with their own body images (57.8% of girls vs. 42.2% of boys, p < .05). The lowest BE score in both genders was among adolescents who desired to be thinner (p < .01). The criterion-related validity of Collins` BFPP, in relation to BMI and weight, was at an acceptable level in girls (BMI rho= 0.69, weight rho= 0.66) and boys (BMI rho= 0.58, weight rho= 0.57), and was statistically significant in all cases (p < .01). The test-retest reliability coefficients of Collins` BFPP were found to be moderately high for both girls (rho=0.72) and boys (rho=0.70). CONCLUSIONS: Collins` BFPP scale is a reliable and valid tool for Turkish children aged 9-11 years. This study demonstrates that more Turkish girls than boys were dissatisfied with their bodies. Children who were affected by overweight/obesity and underweight had a higher BID than those with a normal weight. It is important to evaluate adolescents` BE and BID in addition to their anthropometric measurements during their regular clinical follow-up.

Peekbank: An open, large-scale repository for developmental eye-tracking data of children's word recognition.

The ability to rapidly recognize words and link them to referents is central to children's early language development. This ability, often called word recognition in the developmental literature, is typically studied in the looking-while-listening paradigm, which measures infants' fixation on a target object (vs. a distractor) after hearing a target label. We present a large-scale, open database of infant and toddler eye-tracking data from looking-while-listening tasks. The goal of this effort is to address theoretical and methodological challenges in measuring vocabulary development. We first present how we created the database, its features and structure, and associated tools for processing and accessing infant eye-tracking datasets. Using these tools, we then work through two illustrative examples to show how researchers can use Peekbank to interrogate theoretical and methodological questions about children's developing word recognition ability.

Measurement of Disaster Literacy in Turkish Society: Disaster Literacy Scale (DLS) Design and Development Process.

OBJECTIVE: This study aimed to design and develop a self-report Disaster Literacy Scale (DLS) tool that could evaluate the knowledge and skills of an individual specific to Turkish society. METHOD: Item development, expert opinions, language control, pilot study and field testing processes were monitored in the measurement tool based on a conceptual model and recognition. RESULTS: 23 items were taken out since their common variance values (>0,508, >0.500, >0.500, >0.400, respectively) and factor load relationship (>0.46, >0.50, >0.50, >0.50 and >0.55, respectively) in the mitigation, preparedness, response and recovery phases of the Exploratory Factor Analysis were insufficient. The Cronbach Alpha value of the remaining 61 items in the Disaster Literary Scale is 0.954 and between 0.83-0.88 in lower dimensions. DLS scoring was standardized between 0-50 points. CONCLUSIONS: The objectives, scopes, limitations and steps of the design and development process of the Disaster Literacy Scale were given in detail and made understandable for other societies. The Disaster Literacy Scale was developed as a self-report scale that could evaluate the knowledge and skills of Turkish society in disasters. The Disaster Literacy Scale is, therefore, expected to be accepted in more countries to improve the understanding of disaster literacy in different societies.

COVID-19 Survivors' Intensive Care Unit Experiences and Their Possible Effects on Mental Health: A Qualitative Study.

ABSTRACT: It is known that being hospitalized in the intensive care unit (ICU) for any reason is a risk factor for future psychiatric problems. This qualitative study aims to identify the experiences of coronavirus disease 2019 (COVID-19) ICU survivors and provide insights for relevant mental health problems after being discharged. Participants were COVID-19 patients discharged from ICUs of a secondary care hospital. The experiences of 21 ICU survivors were evaluated using Colaizzi's 7-step approach, which were determined by the purposeful sampling method. There were three themes generated from the interviews as "emotions on COVID-19 diagnosis," "feelings about ICU stay and health care providers," and "life in the shadow of COVID-19." Two subthemes for every single theme were generated, and a total of 19 codes were extracted. It is essential to understand the individual's unique experiences in designing preventive interventions and apply individual preventive mental health interventions during ICU stay.

Perspectives of physicians and pharmacists on rational use of antibiotics in Turkey and among Turkish migrants in Germany, Sweden and the Netherlands: a qualitative study.

BACKGROUND: Antimicrobial resistance may result from inappropriate use of antibiotics in health care. Turkey is one of the countries with the highest antibiotic consumption in the world. Considering the role of transnational ties between Turkish migrants and their social contacts in Turkey, the attitudes and behaviors relating to rational antibiotic use in Turkey can also affect the use of antibiotics by Turkish migrants residing abroad. This study explores physicians' and pharmacists' experiences and perspectives on rational antibiotic use among Turkish adults in Turkey and among Turkish migrants in Germany, Sweden, and the Netherlands, three European countries with large populations of Turkish migrants. METHODS: Following a qualitative study design using convenience and snowball sampling, in-depth interviews with 21 family physicians and 24 pharmacists were conducted in the aforementioned countries. We transcribed all interviews verbatim and performed content analysis separately in the countries, followed by translation, pooling and joint interpretation of the findings. RESULTS: Physicians and pharmacists encountered irrational use of antibiotics among their patients in Turkey. Physicians interviewed in the three European countries explained that Turkish migrants differ from non-migrants with respect to their attitudes towards antibiotics, for example by more often expecting to be prescribed antibiotics. All physicians and pharmacists in the selected countries reported to inform their patients on how to use antibiotics upon prescription; however, Turkish migrants' poor language proficiency was considered as a substantial communication barrier by the physicians and pharmacists interviewed in the European countries. CONCLUSIONS: The study illustrated some aspects of irrational antibiotic use among the population in Turkey and Turkish migrants in selected European countries. It emphasized the need for closer community participation, adequate information campaigns, as well as in-service training of health care providers in Turkey. The strategies and interventions on rational antibiotic use should also be supported and encouraged by health care providers, who need to reach out to people with various cultural backgrounds.

Structural equation model of physical activity in Turkish schoolchildren: an application of the integrated behavioural model.

OBJECTIVES: Childhood obesity is increasingly prevalent in the developing world including Turkey. This study examined constructs of the integrated behavioural model associated with physical activity in a sample of schoolchildren in Ankara, Turkey using structural equation modelling. DESIGN: Cross-sectional survey by probability sampling. SETTING: Fifteen schools of different socioeconomic strata in Ankara, Turkey with grade 4 students. PARTICIPANTS: 2066 (969 girls and 1097 boys) grade 4 schoolchildren and their parents selected using a probability-based sampling frame. PRIMARY OUTCOME MEASURES: Three primary outcomes were used: moderate-to-vigorous physical activity, team sport participation, sedentary behaviour. RESULTS: Data were collected from 2066 fourth-grade children from schools of three socioeconomic strata. Missing data were imputed using multiple imputation. To examine the integrated behavioural model, a structural equation model containing latent constructs for physical activity outcome expectancies, self-efficacy, home environment and social norms were fitted with the three outcomes above. Adequate model fit was achieved in the structural equation model (χ2=1821.97, df=872, p<0.001, Comparative Fit Index=0.91, Tucker Lewis Index=0.91, root mean square error of approximation=0.02, standardised root mean square residual=0.04). All scale items were significantly associated with their respective latent constructs (all p<0.001). Several significant pathways between latent constructs and outcomes of interest were observed (p<0.05). Self-efficacy was positively associated with moderate-to-vigorous physical activity (p<0.001) and team sport participation (p<0.001) and negatively associated with sedentary behaviour (p<0.001). Negative outcome expectancies were negatively associated with moderate-to-vigorous physical activity (p<0.01) and sedentary behaviour (p<0.01) while positive outcome expectancies were positively associated with team sport behaviour (p<0.001) and negatively associated with sedentary behaviour (p<0.05). Home support was positively associated with moderate-to-vigorous physical activity (p<0.01) and team sport participation (p<0.05). Finally, physical activity social norms were negatively associated with sedentary behaviour only (p<0.05). CONCLUSIONS: This study supported the extension to Turkish children of the integrated behavioural model in relation to physical activity behaviours. Results illustrate multiple targets for interventions to increase physical activity.

Challenges and lessons learned in mental health research among refugees: a community-based study in Turkey.

BACKGROUND: Turkey hosts nearly four million refugees and 99% live in urban areas. Research in urban settings pose different challenges and opportunities than research in refugee camps. In this article, we aimed to share the challenges and experiences we encountered in a mixed-methods study to assess mental health problems and barriers to accessing mental health care among refugees in urban areas of Turkey. DISCUSSION: In our case, the main challenges in conducting research with refugees were collecting data from a highly traumatized population, difficulties with contacting undocumented asylum seekers including trust issues and the fear of deportation, the risk of secondary traumatization among data collectors, and the bureaucracy during study approval processes. Targeting a representative sample was not feasible, because of the lack of publicly available demographic data on a district level, presence of undocumented asylum seekers and high mobility among the refugees. Although respondents with significant psychological symptoms were routinely referred to available mental health services, we were able to do less for unregistered refugees with problems in accessing health care. Language/alphabet differences and differing dialects of Arabic posed another challenge in both translation and administration of the scales. Based on cultural characteristics, a gender-balanced team was used and the interviewers were gender-matched whenever needed. Also, the research team had to work after work hours and during weekends to be able to interview male refugees, since most refugee men were at work during working hours and most days of the week. CONCLUSIONS: The research team's experience showed that refugee population characteristics including level of trauma, language, culture, gender, legal status, and urban setting characteristics including places of living, mobility, availability of publicly available demographic data, and outreach-related barriers lead to different challenges and ethical responsibilities of researchers and affect the research costs in terms of time, human resources and finance. Even in a host country with geographical, religious and cultural proximity to the refugees, profound challenges exist in conducting mental health research in urban settings. Learning from previous experience and collaborating with local researchers and institutions are vital for better public health research and practice outcomes.

The impact of community pharmacists on older adults in Turkey.

OBJECTIVE: This study aimed to evaluate the impact of theory-based, structured, standardized pharmaceutical care services led by community pharmacists (CPs) on patient-related outcomes in older Turkish adults. PRACTICE DESCRIPTION: This prospective, quasi-experimental pilot study was conducted at the national level at community pharmacies in Turkey. After virtual training of CPs, pharmaceutical care services including medicine bag check-up, medication review, patient medicine card, patient education, and counseling services (including motivational interviewing) were delivered to promote medication adherence in older adults. PRACTICE INNOVATION: Theory-based, structured, standardized pharmaceutical care services addressing medication adherence problems in older Turkish adults with noncommunicable diseases. EVALUATION METHODS: Descriptive data (including demographic and clinical data, medication-related problems by using the DOCUMENT classification, potential inappropriate prescribing by using the Ghent Older People's Prescriptions Community Pharmacy Screening- (GheOP3S) tool, and pharmacy service satisfaction) were presented. Pre- and post-evaluation were compared by using the Wilcoxon test (for continuous variables) and McNemar's or McNemar-Bowker chi-square test (for categorical variables). RESULTS: One hundred and thirty-eight medication-related problems were identified among 52 older adults. The medication adherence rate was significantly increased from 51.9% to 75%, and the mean of total quality of life (QoL) score rose significantly from 51.7 to 53.4 (P < 0.05). There was a statistically significant change in the median of necessity-concern differential (baseline: 7 [2.2-10.0] vs. final: 8.0 [5-11]; P < 0.05). At baseline, all patients had at least 1 potential inappropriate prescribing according to the GheOP3S tool, and the rate was 73.1% at the final assessment. CONCLUSION: Community pharmacist-led pharmaceutical care services significantly improved patient-related outcomes (such as medication adherence, beliefs about medication, and QoL) in older adults with noncommunicable diseases. No statistically significant change was detected in their lifestyle behaviors (such as physical activity and diet program) or health awareness.

I'm a mother, therefore I question": Parents' legitimation sources of and hesitancy towards early childhood vaccination.

This study was conducted with mothers living in Ankara and registered in the year 2019 with the Immunization Services Unit of the Provincial Directorate of Health as cases of vaccine refusal. This qualitative study used semi-structured interviews to understand how mothers decide about child vaccination and the attitudes, perceptions, and beliefs underlying these decisions. A total of 23 interviews were conducted by two of the authors between March and September 2019. Each of the 23 participants had at least one child aged five years or younger and were living in Ankara. The study shows that mothers with vaccine hesitancy constitute a heterogeneous group whose members have differing levels of hesitation and concern about the vaccination of their children. It is also observed that the most important factor that affects their decisions is related to trust.

Change in the geographic distribution of human resources for health in Turkey, 2002-2016.

INTRODUCTION: Turkey, which suffers from both undersupply of physicians, nurses and midwives and imbalanced distribution of healthcare personnel, has been developing and implementing various policies to solve these problems. The Ministry of Health launched the Health Transformation Program in 2003 for effective, efficient and fair provision of healthcare services for all people. This study aimed to take a closer look at the impact of policies implemented to reduce the imbalance of the distribution of human resources for health for the past 15 years in Turkey. METHODS: Data for the distributional imbalance obtained from Ministry of Health registries was analysed by using Lorenz curves and Gini coefficient for the years 2002, 2005, 2008, 2012 and 2016. RESULTS: Geographical imbalances for healthcare professions decreased distinguishably during the 15 years. Gini coefficient was 0.33 for specialist distribution in 2002, and decreased gradually to 0.26 in 2008 and finally 0.21 in 2016. Similarly, Gini coefficients were 0.18, 0.20 and 0.25 for general practitioners, nurses and midwives, respectively, in 2002. In 2012, Gini coefficients for the same professionals were calculated as 0.09, 0.11 and 0.19, respectively. CONCLUSION: The findings indicate that the policies targeting the distribution of healthcare personnel in Turkey have yielded positive results. Yet it is evident that these results are not due to a single action. It is essential to improve existing implementations, identify the instruments and factors that satisfy and motivate healthcare personnel, and continue developing and implementing comprehensive policies.

Disaster Literacy and Public Health: A Systematic Review and Integration of Definitions and Models.

OBJECTIVE: The aim of this study is to develop an integrated definition and a conceptual model covering the dimensions of disaster literacy. METHODS: A systematic literature review was conducted to identify the definitions and conceptual frameworks of disaster literacy. The content analysis of definitions and conceptual frameworks were conducted to identify the central dimensions of disaster literacy and to develop an integrated model. RESULTS: In this study, 8 disaster literacy definitions and 4 conceptual model studies related to disasters were found. In line with these studies, a comprehensive definition of disaster literacy was presented. In addition, based on content analysis, a 16-matrix integrative conceptual model of the mitigation, preparedness, response and recovery dimensions of disaster literacy, and the access, understanding, appraisal, and application areas of disaster information processing were developed. CONCLUSIONS: In this study, a comprehensive definition and conceptual framework of disaster literacy were presented in an integrated model. By using this model, practices that are special to the phases of a disaster can be identified and supported in society. In addition, the model can contribute to empirical studies by providing the basis for the development of tools to measure disaster literacy.

The validity and reliability of the Turkish version of the Body Esteem Scale for Adolescents and Adults (BESAA) for children

Background/aim: Body esteem (BE) is defined as the self-evaluation of one's own body or appearance. The Body Esteem Scale for Adolescents and Adults (BESAA)consists of three subscales: BE-appearance, BE-weight, and BE-attribution. Though initially developed for adolescents and adults, the use of the scale has recently increased in health-related research on children. This study aimed to assess the validity and reliability of the Turkish version of the BESAA for children. Materials and methods: The participants in the study were 4th grade children (aged 9­10 years) in Ankara, Turkey. The validity of the scale was evaluated through exploratory and confirmatory factor analyses. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and Spearman's rho correlation coefficient, respectively. Results: The Turkish version of the BESAA for children includes BE-weight, BE-appearance, and BE-attribution subscales. The scale demonstrated good model fit statistics (chi-square/df = 3.41, P < 0.001) and good internal consistency for BE-weight (α = 0.85), BE-appearance (α = 0.76), and BE-attribution (α = 0.69). According to our findings, test-retest reliability of the three subscales was in the moderate/acceptable range for children (r = 0.57­0.68, P < 0.01). Conclusion: The Turkish version of the BESAA can be used to measure BE in terms of appearance, weight, and attribution in children.

Turkish validity and reliability of Multidimensional Health Locus of Control Scale Form A.

AIM: The aim of this study was to assess the validity and reliability of the Turkish version of Multidimensional Health Locus of Control Scale Form A. METHODS: The research is a methodological instrument validation study, and the study sample consisted of 275 participants. The data collection phase of the study was completed between 15 July and 15 September 2016. The study used data collection tools including a Personal Information Form, the Multidimensional Health Locus of Control Scale Form A, and the Internal-External Locus of Control Scale. Data on sociodemographic variables are presented as percentages and means. Confirmatory factor analysis and correlation analyses were used. RESULTS: The Cronbach α values of the subdimensions of the Multidimensional Health Locus of Control Scale Form A were determined as acceptable for the internal control, the chance, and powerful other subscales. The confirmatory factor analysis showed acceptable values and acceptable fit for the model fit statistics. CONCLUSION: The Turkish version of Multidimensional Health Locus of Control Scale Form A was accepted as valid and reliable.

[Rational Use of Antibiotics Among Turkish Migrants In Germany: Knowledge, Attitudes and Interaction With Physicians and Pharmacists]. / Antibiotikanutzung bei Menschen mit türkischem Migrationshintergrund ­ Wissen, Einstellungen und Interaktion mit ÄrztInnen und ApothekerInnen.

OBJECTIVES: Due to strong transnational ties, the use of and demand for antibiotics among Turkish migrants in Germany may be influenced by cultural aspects of antibiotic use in Turkey. Research on the use of antibiotics among Turkish migrants in Germany, however, is scarce. The aim of this study was to find out how Turkish migrants in Germany use antibiotics, whether and how knowledge, underlying motives and attitudes influence demand and how Turkish migrants interact with medical professionals. MATERIALS AND METHODS: Using a qualitative approach, behavioural patterns and logic of action of adult Turkish migrants were identified. We carried out semi-structured focus group interviews with adults of Turkish origin residing in Germany and expert interviews with family physicians and pharmacists. The interviews were analysed by means of content analysis. RESULTS: While younger migrants had a generally positive, but cautious attitude towards the use of antibiotics, older migrants often showed exaggerated, unrealistic expectations resulting from a lack of factual knowledge. Overall, participants adopted a passive role in the patient-provider relationship. This led to a perpetuation of significant knowledge gaps. CONCLUSIONS: Older Turkish migrants who have less factual knowledge show exaggerated expectations concerning the effectiveness of antibiotics. In conjunction with a passive patient role, resulting in information needs not being satisfied, this can affect the patient-provider relationship. A more active communication by physicians and information materials sensitive to the needs of migrants can positively influence the interaction between migrant patients and medical professionals.

Posttraumatic Stress and Depression Among Syrian Refugees Living in Turkey: Findings From an Urban Sample.

Although most of the 3.6 million Syrian refugees in Turkey live outside refugee camps, most mental health research is on camp residents and few are on those living in cities. We aimed to assess the prevalence and predictors of posttraumatic stress disorder (PTSD) and depression in Syrian refugees living in an urban area in Turkey. A total of 420 adult Syrians living in Ankara were assessed using the Harvard Trauma Questionnaire and the Beck Depression Inventory. Probable PTSD and depression rates were 36.5% and 47.7%, respectively. Female sex, physical illness, and greater number of potentially traumatic events predicted both PTSD and depression. PTSD was additionally predicted by past psychiatric illness, and depression was predicted by lower economic status. Interestingly, lower economic status predicted depression among men, but not among women. Studies on refugees should be sensitive to factors that could have a significant effect on mental health such as sex or residence.

Prevalence of childhood obesity and related parental factors across socioeconomic strata in Ankara, Turkey.

BACKGROUND: Among low- and middle-income nations, the highest prevalence of child overweight and associated metabolic disorders has been found in Middle Eastern and Eastern European countries. Obesity has been on the rise in Turkey and past research has shown regional variations among adults. However, the prevalence of childhood obesity in different socioeconomic groups in the largest metropolitan areas in the country has not been reported. AIMS: This study aimed to investigate the prevalence of child obesity with a population-representative, SES-stratified random sample with objective measures of body mass index (BMI) in the capital city of Turkey. METHODS: Weight status was measured by the WHO growth curve and analyzed by socioeconomic status (SES), sex, and parental factors in a population-representative sample of 2066 parent-child dyads. Chi-square and logistic regression were conducted. RESULTS: Rates of overweight and obesity were 21.2% and 14.6% (35.8% combined) but significantly higher in high (24.5% and 18.9%) vs. low SES (20.1% and 13.8%) (P = 0.02). Boys were at higher risk for obesity than girls, especially in high vs. low SES (Odds Ratio [OR] = 3.0 [95% CI: 1.4-6.5] vs. 1.7 [95% CI: 1.2-2.5]). Having both parents being overweight or obese increased the risk for obesity, particularly in medium and high SES (OR = 5.8 [95% CI: 2.3-14.1]) and 6.3 (95% CI: 1.5-26.2). CONCLUSIONS: Higher maternal education was a risk factor in low-to-medium but not high SES. In Ankara, child overweight and obesity appears to be 1.5 times more prevalent than national estimates. Higher SES may signify greater exposure to an obesogenic environment and greater obesity risk.

Perceptions of Obesity Prevention Policies: Socioeconomic Assessment in the Turkish Capital.

PURPOSE: The purpose of this study was to inform public policy opportunities to reduce childhood obesity by identifying parents' perceptions of factors contributing to childhood obesity, attribution of responsibility, and the extent of their support for public prevention policies with attention to socio-economic status. DESIGN AND METHODS: In 2015, 2066 parent-child dyads across socio-economic strata from 43 randomly selected schools in Ankara completed surveys and measurements to examine perceptions, attribution, and prevention policies related to childhood obesity. RESULTS: Parents across the socio-demographic spectrum recognized obesity as a serious problem. Unhealthy food availability was identified as the leading cause of while industry and media were credited with having the greatest responsibility for childhood obesity. There was strong public support for policy strategies targeting schools, marketing, and the built environment, though support tempered as socio-economic status and parental education decreased. CONCLUSIONS: This survey provided insight into parents' knowledge and beliefs surrounding childhood obesity as well as their endorsement of related prevention strategies. Educational messages that address variations in SES to describe the causes of childhood obesity and connect those causes to actionable community prevention strategies may improve community support for enhanced policy actions within and beyond school settings.

Assessing the validity and reliability of family factors on physical activity: A case study in Turkey.

BACKGROUND: Childhood obesity rates have been rising rapidly in developing countries. A better understanding of the risk factors and social context is necessary to inform public health interventions and policies. This paper describes the validation of several measurement scales for use in Turkey, which relate to child and parent perceptions of physical activity (PA) and enablers and barriers of physical activity in the home environment. METHOD: The aim of this study was to assess the validity and reliability of several measurement scales in Turkey using a population sample across three socio-economic strata in the Turkish capital, Ankara. Surveys were conducted in Grade 4 children (mean age = 9.7 years for boys; 9.9 years for girls), and their parents, across 6 randomly selected schools, stratified by SES (n = 641 students, 483 parents). Construct validity of the scales was evaluated through exploratory and confirmatory factor analysis. Internal consistency of scales and test-retest reliability were assessed by Cronbach's alpha and intra-class correlation. RESULTS: The scales as a whole were found to have acceptable-to-good model fit statistics (PA Barriers: RMSEA = 0.076, SRMR = 0.0577, AGFI = 0.901; PA Outcome Expectancies: RMSEA = 0.054, SRMR = 0.0545, AGFI = 0.916, and PA Home Environment: RMSEA = 0.038, SRMR = 0.0233, AGFI = 0.976). The PA Barriers subscales showed good internal consistency and poor to fair test-retest reliability (personal α = 0.79, ICC = 0.29, environmental α = 0.73, ICC = 0.59). The PA Outcome Expectancies subscales showed good internal consistency and test-retest reliability (negative α = 0.77, ICC = 0.56; positive α = 0.74, ICC = 0.49). Only the PA Home Environment subscale on support for PA was validated in the final confirmatory model; it showed moderate internal consistency and test-retest reliability (α = 0.61, ICC = 0.48). DISCUSSION: This study is the first to validate measures of perceptions of physical activity and the physical activity home environment in Turkey. Our results support the originally hypothesized two-factor structures for Physical Activity Barriers and Physical Activity Outcome Expectancies. However, we found the one-factor rather than two-factor structure for Physical Activity Home Environment had the best model fit. This study provides general support for the use of these scales in Turkey in terms of validity, but test-retest reliability warrants further research.

Equity in access to care in the era of health system reforms in Turkey.

OBJECTIVE: To evaluate access to healthcare from an equity perspective on the way toward Universal Health Coverage in Turkey. METHODS: The country representative data from 2006 to 2013 Turkey Income and Living Conditions Surveys were analyzed. Private household residents aged fifteen and older were asked for self-reported unmet need for medical care in the past twelve months. The dependent variable had three categories: no unmet need, unmet need due to cost, and unmet need due to availability (waiting list and distance problems). Predictors of unmet need were assessed by a multinomial logistic regression analysis. FINDINGS: The prevalence of unmet need declined between 2006 and 2013. While educational inequalities in declared unmet need also decreased, the income gradient becomes more important. In 2013, controlling for other factors, the propensity to report unmet need was 10 times higher for those in the poorest-income quintile compared to the richest (versus 7 times in 2006). CONCLUSION: Overall access to healthcare has gradually improved in Turkey in the health reform process, but 9% of people still declared unmet need due to cost in 2013, after the implementation of Universal Health Insurance. This was nearly four times the EU average. Unfavourable economic and labour market conditions can be challenges for effective universal health coverage.