The emergence and regression of political priority for refugee integration into the Jordanian health system: an analysis using the Kingdon's multiple streams model.

BACKGROUND: The prolonged presence of Syrian refugees in Jordan has highlighted the need for sustainable health service delivery models for refugees. In 2012, the Jordanian government adopted a policy that granted Syrian refugees access, free of charge, to the national health system. However since 2012, successive policy revisions have limited refugee access. This paper seeks to understand factors that initially put refugee integration into the health system on the policy agenda, as well as how these same factors later affected commitment to sustain the policy. METHODS: This paper draws on data from a document review of 197 peer-reviewed and grey literature publications, a media analysis of newspaper articles retrieved from four officially recognized newspapers in Jordan, and 33 semi-structured key informant interviews. We used Kingdon's Multiple Streams Model - a well-established tool for analyzing policy adoption - to understand how political priority developed for integration of refugees into the health system. RESULTS: We find that several factors helped bring attention to the issue, namely concerns over infectious disease transmission to host communities, high rates of chronic conditions among the refugee population and the increasingly urban and dispersed nature of refugees. At the outset of the conflict, the national mood was receptive to refugees. Politicians and government officials quickly recognized the crisis as an opportunity to secure material and technical support from the international humanitarian community. At the same time, global pressures for integrating refugees into national health systems helped move the integration agenda forward in Jordan and the region more broadly. Since 2012, there were several modifications to the policy that signal profound changes in national views around the continued presence of Syrian refugees in the country, as well as reduced external financial support which has undermined the sustainability of the policy. CONCLUSION: This case study underscores the dynamic nature of policymaking and the challenge of sustaining government commitment to the right to health among refugees. Our analysis has important implications for advocates seeking to advance and maintain momentum for the integration of refugees into national health systems.

Technological Challenges and Solutions in Emergency Remote Teaching for Nursing: An International Cross-Sectional Survey.

OBJECTIVES: With the sudden global shift to online learning modalities, this study aimed to understand the unique challenges and experiences of emergency remote teaching (ERT) in nursing education. METHODS: We conducted a comprehensive online international cross-sectional survey to capture the current state and firsthand experiences of ERT in the nursing discipline. Our analytical methods included a combination of traditional statistical analysis, advanced natural language processing techniques, latent Dirichlet allocation using Python, and a thorough qualitative assessment of feedback from open-ended questions. RESULTS: We received responses from 328 nursing educators from 18 different countries. The data revealed generally positive satisfaction levels, strong technological self-efficacy, and significant support from their institutions. Notably, the characteristics of professors, such as age (p = 0.02) and position (p = 0.03), influenced satisfaction levels. The ERT experience varied significantly by country, as evidenced by satisfaction (p = 0.05), delivery (p = 0.001), teacher-student interaction (p = 0.04), and willingness to use ERT in the future (p = 0.04). However, concerns were raised about the depth of content, the transition to online delivery, teacher-student interaction, and the technology gap. CONCLUSIONS: Our findings can help advance nursing education. Nevertheless, collaborative efforts from all stakeholders are essential to address current challenges, achieve digital equity, and develop a standardized curriculum for nursing education.

Genomic Literacy among Nurses in Jordan: A Population-based Study.

The current study aimed to measure genomic literacy among Jordanian nurses by evaluating their understanding of key genomic concepts and how they view genomics in nursing practice. Descriptive, Cross-sectional, and Correlational designs were used in this study. A descriptive design was used using the Genomic Nursing Concept Inventory (GNCI©), a 31-item instrument. Data were collected from a total of 751 participants. A total of 406 participants were female, and 395 (52.6%) were single. The mean score of the genome basics was 2.33, ranging from 0 to 13. The mean score of the knowledge about mutation was 0.57, ranging from 0 to 3. At the same time, the mean score for inheritance and genomic healthcare was 1.74 and 1.53, respectively. Nurses working in the oncology center had the highest genomic knowledge score (mean = 7.05, SD = 4.24) compared with nurses in other healthcare sectors (p = < .001). There is a low level of genomic literacy among Jordanian nurses. Nurses must have sufficient genomic literacy to provide the best nursing care to patients, their families, and the community. Jordanian nurse authorities must develop competencies representing a minimum standard of care to provide competent genomic and genetically focused care.

The Effectiveness of Serious Games in Alleviating Anxiety: Systematic Review and Meta-analysis.

BACKGROUND: Anxiety is a mental disorder characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the nonpharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety has been investigated by several systematic reviews; however, they were limited by design and methodological weaknesses. OBJECTIVE: This study aims to assess the effectiveness of serious games in alleviating anxiety by summarizing the results of previous studies and providing an up-to-date review. METHODS: We conducted a systematic review of randomized controlled trials (RCTs). The following seven databases were searched: MEDLINE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking for the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies. RESULTS: Of the 935 citations retrieved, 33 studies were included in this review. Of these, 22 RCTs were eventually included in the meta-analysis. Very low-quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on anxiety levels when compared with conventional exercises (P=.70) and no intervention (P=.27), respectively. Although 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy games on anxiety levels when compared with no intervention (P=.01), the quality of the evidence reported was low. Similarly, low-quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on anxiety levels when compared with conventional video games (P=.03). CONCLUSIONS: This review shows that exergames can be as effective as conventional exercises in alleviating anxiety; computerized cognitive behavioral therapy games and exergames can be more effective than no intervention, and biofeedback games can be more effective than conventional video games. However, our findings remain inconclusive, mainly because there was a high risk of bias in the individual studies included, the quality of meta-analyzed evidence was low, few studies were included in some meta-analyses, patients without anxiety were recruited in most studies, and purpose-shifted serious games were used in most studies. Therefore, serious games should be considered complementary to existing interventions. Researchers should use serious games that are designed specifically to alleviate depression, deliver other therapeutic modalities, and recruit a diverse population of patients with anxiety.

Nurses' Experiences of Caring for Patients with COVID-19: A Qualitative Study.

The purpose of this study was to explore nurses' experiences, abilities, and willingness to care for patients with Coronavirus Disease 2019 (COVID-19). A descriptive qualitative study was conducted among 12 nurses working with patients with COVID-19. Purposive sampling was used to recruit participants from two national hospitals in Jordan. Semi-structured interviews (45-90 minutes each) with open-ended questions were held via Zoom to collect data. Four major themes emerged from the data analysis. The first theme, uncertainty, consisted of two subthemes: new experience and lack of training. The second theme was related to social stigma by society and other staff members. The third theme of front-line fighters consisted of two subthemes: empowering the main health caregiver and community acknowledgment. The fourth theme was related to challenges and consisted of two subthemes: physical and psychological challenges. At the beginning of the outbreak of COVID-19, the nurses had experienced a lack of certainty, physical and psychological challenges, and social stigmatization, which had negatively affected their willingness and ability to fight the outbreak. However, the nurses reported growing professionally and psychologically with time and becoming more knowledgeable, skillful, powerful, and confident care providers during the pandemic. Being able to fulfill their responsibilities and being acknowledged by others gave the nurses a sense of achievement. Early education and training about COVID-19, clear infection control protocols and guidelines, psychological counseling, and adequate social support are essential steps for enhancing nurses' mental well-being and willingness and ability to fight COVID-19.

Impact of an Interventional Program on Improving Compliance of Hand Hygiene and Reducing Hospital-Acquired Infection in the Critical Care Unit.

INTRODUCTION: This study aimed to determine the effect of a hand hygiene (HH) and awareness campaign on knowledge and compliance with HH practices among health-care workers working staff in the main intensive care units and also to evaluate the rates of hospital-acquired infection (HAI) before and after the intervention. METHODS: A prospective, interventional, pre-post design was utilized and carried out in three phases: the first stage was a 1-month preintervention stage to develop the foundation of the compliance rate of handwashing; the second stage was the interventional handwashing campaign; the third stage was the postintervention stage to improve the compliance rate of handwashing. Two instruments were used in this study: the HH Knowledge Questionnaire developed by the World Health Organization to assess HH knowledge and the Handwashing Questionnaire developed to evaluate HH washing. RESULTS: HH knowledge has been increased from preintervention (M = 11.84, standard deviation [SD] = 2.41) to postintervention (M = 18.80, SD = 2.93), and the effective compliance with HH practice was as low as 49% in June 2017 to 75% in February 2018. In addition, the HAI rate was dropped from 13.2% in June 2017 to 9% in February 2018. An inverse association was recognized between HH compliance and HAI rates. CONCLUSIONS: These results recommend that reasonable approaches can decrease the HAI rate of intensive care units. A nationwide handwashing interventional program can be employed in all hospitals.

Nurses' Ethics in the Care of Patients During the COVID-19 Pandemic.

Working during an epidemic can be physically, emotionally, and morally demanding for nurses. In addition to caring for patients, nurses are also responsible for looking after themselves and their families. The current study aimed to explore nurses' ethics in the care of patients during the coronavirus disease 2019 (COVID-19) pandemic. A descriptive qualitative approach was adopted in order to gain an in-depth understanding of nurses' experiences of caring for patients with coronavirus. A purposive sample of 10 nurses working with patients with COVID-19 was recruited. Interviews were held with the nurses, and content analysis of the interviews was conducted. Each interview was transcribed, and the text was coded into manageable categories on the word, word sense, phrase, sentence, and theme levels before analysis. Three major themes related to the nurses' ethical commitments during the COVID-19 crisis emerged during the data analysis. These themes are as follows: the obligation of nurses to provide care for patients regardless of their medical diagnosis; the ethical dilemma faced by nurses of whether to care for patients or protect themselves from the virus; and finally, the responsibility of nurses to care for themselves.

Emergency Remote Learning in Nursing Education During the COVID-19 Pandemic.

Due to the corona (COVID-19) pandemic, several countries are currently conducting non-face-to-face education. Therefore, teachers of nursing colleges have been carrying out emergency remote education. This study developed a questionnaire to understand the status of Emergency Remote Learning (ERL) in nursing education internationally, translated it into 7 languages, and distributed it to 18 countries. A total of 328 nursing educators responded, and the most often used online methods were Social networking technology such as Facebook, Google+ and Video sharing platform such as YouTube. The ERL applied to nursing education was positively evaluated as 3.59 out of 5. The results of the study show that during the two semesters nursing college professors have well adapted to this unprecedent crisis of teaching. The world after COVID-19 has become a completely different place, and nursing education should be prepared for 'untact' education.

Barriers to implementing palliative care in intensive care units: perceptions of physicians and nurses in Jordan.

BACKGROUND: Palliative care (PC) aims to relieve a person's suffering and provide the best possible quality of life (QoL) to people with chronic illnesses. Despite the significant impact of PC services on the QoL of patients, barriers exist that prevent healthcare providers from facilitating PC in intensive care units (ICUs). AIM: The purpose of this study was to explore the perceived barriers to implementing PC in ICUs. METHODS: A qualitative approach was used to conduct 17 semi-structured interviews with clinicians across two ICUs (urban and suburban) in Jordan. Thematic analysis was used for the transcribed interviews. RESULTS: Five main themes emerged: the ICU is a demanding and complex care environment; lack of preparation to implement PC; PC is a nicety, not a necessity; healthcare system-related barriers; and lack of cultural acceptance of PC. Lack of knowledge and training was identified as a major barrier for the effective implementation of PC by both physicians and nurses. CONCLUSION: Equipping healthcare providers with the knowledge and expertise to provide PC is essential to dispel myths related to PC and facilitate PC provision. Developing an interdisciplinary care team will support the effective implementation of PC services in any setting. Establishing national PC policies will foster the ethical and legal practice of PC in Jordan.

The impact of a standard pain assessment protocol on pain levels and consumption of analgesia among postoperative orthopaedic patients.

BACKGROUND: Pain is a leading concern in post-surgical orthopaedic settings; andeffective pain assessment tools are important aspects of pain management. OBJECTIVE: This study assessed the effect of using standard pain assessment protocols (SPAP) on pain levels, pain management, and analgesia consumption among patients in the first 24 h following orthopaedic surgery. METHODS: In total, 101 patients were recruited and assigned to the comparison group (n = 50) and experimental group (n = 51). SPAP was used in the experimental group while the comparison group received routine care. Pain levels at rest and during movement and analgesic consumption were compared between the two groups. FINDINGS: There were significant differences in pain levels between the comparison and experimental groups. The experimental group consumed significantly less pain medication at 8-11 h of opioid medications and 12-15 h of non-opioid medications (P < .001). The use of non-pharmacological modalities was significantly higher in the experimental group compared to the comparison group (P < .001). CONCLUSIONS: Regular pain assessment and management using SPAP can promote pain management and reduce pain levels as well as reduce analgesia administration and promote the use of non-pharmacologic approaches. These outcomes can result in fewer side effects for patients. IMPLICATIONS: The findings suggest that using SPAP can result in improved outcomes as well as the use of non-pharmacologic approaches to pain management. This approach can result in better outcomes and increased communication between the nurse and the patient.

Impact of Structured Nurse Leader Rounds on Satisfaction With Nursing Care Among Patients With Cancer.

BACKGROUND: The patient satisfaction rate is considered a challenge for nurse leaders, especially among patients with cancer, due to the complexity of the disease, diagnostic procedures, and treatment. AIM: The purpose of this study was to evaluate the impact of structured nurse leader rounds (NLRs) on satisfaction with nursing care among patients with cancer. Moreover, we assessed the relationship among NLRs, patient satisfaction, and demographical variables. METHODS: A two-group posttest design was used in four adult inpatient oncology units in a specialized oncology center. A stratified random sampling technique was utilized to select 169 patients for the experimental group (80 patients) and control group (89 patients). Structured leader rounds were conducted by nurse leaders using a scripted nurse leader tool to standardize the rounds in the experimental group, while the unstructured leader round was conducted in the control group. Patient satisfaction was measured using the Patient Satisfaction with Nursing Care Quality Questionnaire. RESULTS: The findings revealed that there was a significant difference in total score of patients' satisfaction between study groups (t = -9.213, p > .001). Conversely, the structured leader round has a significant impact on the patient's experience with nurse concern and caring (t = -2.054, p = .042). CONCLUSIONS: Adoption of a structured NLR has a significant impact on improving patient satisfaction in an oncology setting where patients receive care from many disciplines, such as surgical, medical, radiotherapy, and radiology. CLINICAL RELEVANCE: Efficient structured NLRs of nursing professionals are important for enhancing the quality of nursing care and patient satisfaction.

Leadership styles' influence on the quality of nursing care.

PURPOSE: The purpose of this paper is to investigate managers' leadership styles, from the perspective of registered nurses, and its effects on the quality of nursing care in both the private and public healthcare sectors. An additional aim is to assess the relationship between leadership styles and particular organisational outcomes. DESIGN/METHODOLOGY/APPROACH: The sample for this quantitative research study was comprised of 400 respondents, among which 50 were nurse managers, 150 were staff nurses and the remaining respondents were patients. Two questionnaires were used in this study: the multi-factor leadership questionnaire (MLQ) 5X short and a patient satisfaction with nursing care quality questionnaire (PSNCQQ). FINDINGS: A positive correlation was found between the transformational leadership style with leadership outcomes and the quality of nursing care (r=0.811**, 0.759**, 0.789** and 0.877** for extra effort, job satisfaction, leader effectiveness and quality, respectively). PRACTICAL IMPLICATIONS: Although the sample study was extensive, a possible limitation is that the research utilised convenient sample who are working in the private and public healthcare sectors thus limiting the generalisability of the study. ORIGINALITY/VALUE: This study was proposed as a baseline for upcoming studies in areas of education, nursing practice, research and quality. Moreover, this study was expected to be imperative to the hospital's management, in order to improve the current level of leadership, education models and advancement programs for the healthcare sector's senior staff.

Relationship between Vitamin D Deficiency, Diabetes, and Obesity.

AIM: This study aimed to assess the prevalence of VDD in Saudi Arabia, revealing the lifestyle and nutritional habits; and assesses the association between VDD, Diabetes Mellitus, and obesity. METHODS: A descriptive, cross-sectional, and correlational design was used in this study. A convenience sampling method of 350 participants participated in the study. RESULTS: The results revealed that the probability of having vitamin D Deficiency was higher among females (OR = 2.06, p > .05); younger age-whereby with each one year decrease in age there was about 0.03 probability of having Vitamin D Deficiency (B = -0.03; p > .05); individuals with higher incomes (OR = 1.44, p > .05); smokers (OR = 0.08, p > .05); and a lack of exposure to the sun (OR = 8.50; p > .05). In addition, exercise is also a predictor of Vitamin D deficiency (OR = 3.8; p > .05). Moreover, less Vitamin D intake (OR 9.7; p > .05), less intake of Calcium (OR = 12.2, p > .05); In addition increase one unit in the BMI, cholesterol, LDL, HDL, and FBS increased the log odd of having liability of Vitamin D deficiency by 3.2; 1.9, 1.8, 1.0, and 2.4 (p > .05). CONCLUSION: Vitamin D Deficiency was prevalent in both males and females across different age groups in the citizens of Saudi. Because of the connection between Vitamin D Deficiency and main chronic disease, it is necessary to emphasize the need to recognize Vitamin D Deficiency screening for risk factors. It may be reasonable for the nutritionists, nurses, and physicians, to encourage the community on approaches to enhance dietary Vitamin D or suggest supplementation.

The role of electronic medical records in improving the quality of health care services: Comparative study.

PURPOSE: The purpose of this study is to identify the quality of health care services' differences between adopted Electronic Medical Record (EMR) and paper-based record hospitals. Moreover, to identify how the quality of electronic medical records affect the quality of health care services. METHODS: A cross-sectional, descriptive, and comparative design was utilized between two groups in this study. The study was conducted in two public hospitals in Jordan. One hospital which had adopted the EMR system in their works and another hospital that had paper-based record. A convenience sampling technique was used to select 410 health professionals from the selected hospitals (205 participants from each hospital). SERVQUAL and E-S-QUAL questionnaires were adopted to collect the data about the quality of EMR and quality of health care service. Statistical Package for the Social Sciences (SPSS) Version 21 was deployed to analyze the collected data. RESULT: The results indicate that the quality of health care services (expectation and perception) in EMRs adopted hospital is higher than the quality of health care services in the hospital using paper-based record. Quality of EMRs and its domains (efficiency, availability, fulfilment, and privacy) are high in both perception and expectation of health care professionals in EMR-adopted hospitals. Moreover, there is a significant relationship between the whole perception of the quality of electronic medical records and the quality of services, and between each domain of quality of EMRs and total perception of quality of services. CONCLUSION: Adoption of a high quality of EMR has a significant impact on improving the quality of health care services.

Impact of Obesity on Clinicopathologic Characteristics and Disease Prognosis in Pre- and Postmenopausal Breast Cancer Patients: A Retrospective Institutional Study.

Purpose: To investigate the association between obesity and breast cancer clinicopathologic characteristics at presentation along with prognostic impact among Jordanian breast cancer patients. Such data are lacking in Arabian countries. Methods: In this retrospective study, 348 breast cancer patients were included. Analyses were conducted for associations between body mass index (BMI) and age at diagnosis, tumor clinicopathologic characteristics, and molecular subtypes. Eight prognostic factors were considered, and total prognostic scores were calculated. The analysis was stratified by menopausal status. Multivariate logistic stepwise regression analysis was conducted to identify predictors for breast cancer recurrence and death. Results: Mean age at diagnosis was 50.98 ± 10.96 years. Mean BMI at diagnosis was 29.52 ± 5.32 kg/m2. Mean age at diagnosis was significantly higher for overweight and obese patients compared to underweight/normal patients (P < 0.001). A significant positive correlation was observed between patient age and BMI at diagnosis (r = 0.251, P < 0.001). Grade of carcinoma was significantly correlated with BMI in the whole population examined (P=0.003). Obese breast cancer patients had significantly higher prognostic scores compared to nonobese cases, indicating worse prognostic features at presentation (P=0.034). Stratification of data analysis based on menopausal status revealed significant associations between obesity and each of tumor stage and grade among postmenopausal but not premenopausal patients (P=0.019 and P=0.031, respectively). Similarly, postmenopausal obese patients had significantly higher prognostic scores compared to nonobese counterparts (P=0.007), indicating worse prognosis, a finding which was also absent among premenopausal breast cancer patients. No significant association between BMI with expression status of hormone receptors, HER2, lymphovascular invasion, and molecular subtypes was found among patients. BMI was a significant predictor for disease recurrence in which obese breast cancer patients had greater odds (2-fold) to develop locoregional and distant recurrence compared to nonobese cases (P=0.011). Conclusions: Obesity was associated with advanced stage and grade of breast carcinoma at diagnosis. The impact of BMI on clinicopathologic characteristics and prognosis was confined to postmenopausal cases. Jordanian obese breast cancer patients are at greater risk of breast cancer recurrence and reduced survival compared to their nonobese counterparts.

Quality of nursing documentation: Paper-based health records versus electronic-based health records.

AIMS AND OBJECTIVES: To assess and compare the quality of paper-based and electronic-based health records. The comparison examined three criteria: content, documentation process and structure. BACKGROUND: Nursing documentation is a significant indicator of the quality of patient care delivery. It can be either paper-based or organised within the system known as the electronic health records. Nursing documentation must be completed at the highest standards, to ensure the safety and quality of healthcare services. However, the evidence is not clear on which one of the two forms of documentation (paper-based versus electronic health records is more qualified. METHODS: A retrospective, descriptive, comparative design was used to address the study's purposes. A convenient number of patients' records, from two public hospitals, were audited using the Cat-ch-Ing audit instrument. The sample size consisted of 434 records for both paper-based health records and electronic health records from medical and surgical wards. RESULTS: Electronic health records were better than paper-based health records in terms of process and structure. In terms of quantity and quality content, paper-based records were better than electronic health records. The study affirmed the poor quality of nursing documentation and lack of nurses' knowledge and skills in the nursing process and its application in both paper-based and electronic-based systems. CONCLUSION: Both forms of documentation revealed drawbacks in terms of content, process and structure. This study provided important information, which can guide policymakers and administrators in identifying effective strategies aimed at enhancing the quality of nursing documentation. RELEVANCE TO CLINICAL PRACTICE: Policies and actions to ensure quality nursing documentation at the national level should focus on improving nursing knowledge, competencies, practice in nursing process, enhancing the work environment and nursing workload, as well as strengthening the capacity building of nursing practice to improve the quality of nursing care and patients' outcomes.

The Effectiveness of Hologram Bracelets in Reducing Chemotherapy-Induced Nausea and Vomiting Among Adult Patients With Cancer.

BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) affects cancer patients' quality of life, despite the provision of antiemetic medication. OBJECTIVES: The aim of this study is to assess the clinical effectiveness of the hologram bracelet in the management of CINV among adult patients with cancer. METHODS: An experimental, double-blinded design spanning 3 courses of chemotherapy was used; 175 oncology patients were randomly assigned to 3 groups: placebo (n = 53), control (n = 54), and intervention (hologram bracelet) (n = 68). Daily diaries were used to detect the severity and the frequency of CINV and to detect the frequency of using antiemetic medications. The Functioning Living Index-Emesis was used to examine the impact of CINV on the activities of daily living. RESULTS: Significant CINV differences existed between groups. The mean total Functioning Living Index-Emesis score was significantly lower in the intervention group for total vomiting and total nausea. CONCLUSION: Hologram bracelet use among patients with cancer had a positive effect on CINV. The level of CINV decreased and activity of daily living scores increased. However, effects varied among the types of CINV. IMPLICATIONS FOR PRACTICE: Further study is recommended to explore the benefits of the bracelet.

The effect of short message system (SMS) reminder on adherence to a healthy diet, medication, and cessation of smoking among adult patients with cardiovascular diseases.

BACKGROUND: Cardiovascular Disease is the leading cause of death worldwide. Non-adherence to a recommended regimen among patients with Cardiovascular Diseases represents a significant problem which could lead to an increase in Cardiovascular Diseases. PURPOSE: This study aimed to assess the effects of Short Message System (SMS) reminders on adherence to a healthy diet, medication, and cessation of smoking among adult patients with Cardiovascular Diseases. METHODS: Randomized controlled trial design with three groups was used for this study. A non-probability convenient sample of 160 patients was recruited in this study. The participants were assigned randomly to an experimental group (received SMS regarding adherence to a healthy diet, medication, and smoking cessation), placebo group (received general messages) and control group (routine care). Morisky 8-Item Medication Adherence Scale (MMAS), Mediterranean Diet Adherence Screener (MEDAS), and Readiness to Quit Ladder, were used to assess patients' adherence to medication, adherence to Mediterranean diet, and smoking cessation, respectively. The outcomes were assessed at the beginning of the study and three months later, following completion of the intervention. RESULT: One way ANONVA was used to assess the study hypothesis. Significant differences between study groups found in terms of adherence to medication (p=.001) and adherence to a healthy diet (p=.000); however, no significant difference was found between groups, in terms of intention to quit smoking, and/or the number of cigarettes smoked (p= .327), (p=.34), respectively. CONCLUSION: It is documented that SMS is effective in improving adherence to a healthy diet and medication. SMS could be a promising solution for management of different chronic diseases. IMPLICATION OF THE STUDY: It is recommended to apply Short Message System (SMS) via cellphone services to improve patient's adherence to a healthy diet and medication. However, further research is needed to support the effectiveness of SMS.

Health service access and utilization among Syrian refugees in Jordan.

BACKGROUND: The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system. Changing lifestyles and aging populations are shifting the global disease burden towards increased non-infectious diseases including chronic conditions, co-morbidities, and injuries which are more complicated and costly to manage. The strain placed on health systems threatens the ability to ensure the health needs of both refugees and host country populations are adequately addressed. In light of the increasing challenges facing host governments and humanitarian actors to meet health needs of Syrian refugees and affected host communities, this study was undertaken to assess utilization of health services among Syrian refugees in non-camp settings. METHODS: A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Differences in household characteristics by geographic region, facility type, and sector utilized were examined using chi-square and t-test methods. RESULTS: Care-seeking was high with 86.1 % of households reporting an adult sought medical care the last time it was needed. Approximately half (51.5 %) of services were sought from public sector facilities, 38.7 % in private facilities, and 9.8 % in charity/NGO facilities. Among adult care seekers, 87.4 % were prescribed medication during the most recent visit, 89.8 % of which obtained the medication. Overall, 51.8 % of households reported out-of-pocket expenditures for the consultation or medications at the most recent visit (mean US$39.9, median US$4.2). CONCLUSIONS: Despite high levels of care-seeking, cost was an important barrier to health service access for Syrian refugees in Jordan. The cessation of free access to health care since the time of the survey is likely to have worsened health equity for refugees. Dependence of refugees on the public facilities for primary and specialist care has placed a great burden on the Jordanian health system. To improve accessibility and affordability of health services in an equitable manner for both refugees and Jordanian host communities, strategies that should be considered going forward include shifting resources for non-communicable diseases and other traditional hospital services to the primary level and creating strong health promotion programs emphasizing prevention and self-care are strategies.

Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan.

INTRODUCTION: The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings. METHODS: A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. RESULTS: Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent care-seeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications. DISCUSSION: Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public sector services in Jordan to adequately meet expanding needs and ensure appropriate prevention and control of priority NCDs.