Adopting strategies with menopausal experiences: A systematic review.

Background and Aims: Menopause is one of the most significant stages in women's life. It is accompanied by many complications and a serious challenge. This study aimed to assess the menopause experiences of Iranian women and compatibility strategies. Methods: We searched PubMed, Web of Science (ISI), Scopus, Ovid, and the Iranian Clinical Trial Registry and Magiran, SID, from January 1990 to January 2021. Results: Psychological effects, sexual disorders, physical problems, bone pain, insomnia, fatigue, and hot flashes are all menopause experiences. Cultural factors, lifestyle, social factors, education level, employment and economic status, marital status, and the number of pregnancies and births can influence this experience. It is important that menopausal women are aware how menopausal compatibility and prepare for this period. Many factors have affected menopausal adopting strategies. Negative emotions, negative attitudes, worry, and anxiety, and their psychological effects exacerbate the annoying experiences of menopause and decelerate menopausal adoption. Conclusions: Social support and educational intervention were the practical menopausal adopting strategies. It will guarantee the health of menopausal women in the last third of their lives.

Socio-ecological factors of girl child marriage: a meta-synthesis of qualitative research.

BACKGROUND: Child marriage of girls is one example of human rights violations, and is increasingly recognized as a key obstacle to global public health. Given the importance of a comprehensive understanding of the motivations for child marriage, this study aimed to identify socio-ecological factors contributing to gills child marriage. METHODS: A comprehensive search was conducted of all English-language studies measuring causes of child marriage between 2000 and October 2022 in the Web of Science, PubMed, Scopus, PsycInfo, ProQuest, Poplin and Google Scholar databases. Girl child marriage is defined as a marriage under the age of 18. In this study, the CASP evaluation checklist was used to collect data. Two independent reviewers reviewed all articles. RESULTS: A total of 34 eligible qualitative articles were included. The most salient causes of child marriage among girls include low skills and knowledge, internal and external beliefs and motivations, and physical advantages at the individual level. Family characteristics and structure contribute to child marriage at the interpersonal level, while environmental and economic factors play a role at the community level. Social factors and cultural norms, as well as the shortcomings and weaknesses of legislation, are also contributing factors at the society level. CONCLUSION: The results showed that cultural beliefs supporting gender inequality and economic status were the most important causes of child marriage. These results can help policymakers and decision-makers implement strategies to reduce gender inequality to prevent child marriage.

Design and validation of a Questionnaire on the factors influencing self-care behaviors in patients with Multiple sclerosis (QFASMS).

BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system (CNS). Since MS does not have a definitive cure, individuals affected by it need to adapt and coordinate with their chronic illness in order to fulfill their duties and responsibilities. The first step in helping patients to better care for and manage their illness is to engage in self-care behaviors. This study was conducted with the aim of design and validation of a questionnaire on the factors influencing self-care behaviors in patients with Multiple sclerosis. METHODS: This cross-sectional study was conducted on Multiple sclerosis patients in Iran in 2023. The age range of patients varied between 22 and 52 years. Having MS disease, passing one year of the disease duration, living in Mashhad city, having informed consent to participate in the study and not completing the questionnaire were the entry and exit criteria of the study. RESULTS: This study was conducted on 500 patients with multiple sclerosis. Based on the results of psychometrics (face, content and construct validity), the number of questions was reduced from 120 to 47 questions and 73 questions were eliminated. Finally, the questionnaire was approved with 47 questions and 4 subscales of understanding the symptoms of the disease (9 questions), tendency to conscious and targeted care (21 questions), laziness in care (8 questions) and tendency to receive therapy services (9 questions). Cronbach's alpha and McDonald's omega index for all questionnaire questions were 0.877 and 0.881, respectively. CONCLUSIONS: Based on the results of this questionnaire, 47 questions and 4 subscales can be used to measure the factors influencing the adoption of self-care behaviour's in patients with multiple sclerosis.

Prevalence of Gestational Diabetes in Iran: A Systematic Review and Meta-analysis.

Background: Pregnant women who have gestational diabetes mellitus (GDM) are more prone to adverse pregnancy outcomes. We estimated the prevalence of GDM in Iran. Methods: Web of Science, Scopus, PubMed, Google Scholar, and Persian databases (SID, Magiran, Irandoc, and) were searched using the MeSH and non-MeSH terms in abstract, title, or keywords of articles until June 2021, with no limitation in time. Random effects models were applied to summarize the GDM prevalence in Iran. The obtained data were quantitatively analyzed to determine an effect size for each paper. The pooled effect size was introduced as prevalence and 95% confidence interval. Sensitivity analyses and subgroup analyses were done to determine heterogeneity. Publication bias was assessed by the classic fail-safe N and Egger test. Results: A total of 53 papers were considered for meta-analysis, involving 56,521 Iranians. The total GDM prevalence in Iran was 7.6% (95% CI, 6.1%-9.4%). Conclusion: This meta-analysis was the newest to estimate the GDM prevalence among Iranian women. Our results suggest a high prevalence of GDM in Iran, showing that Iran might have many GDM patients.

Prevalence and factors associated with child marriage, a systematic review.

BACKGROUND: Girl child marriage is increasingly recognized as a critical barrier to global public health and gender discrimination. There are still more gaps in the global rate of child marriage and the underlying factors. Thus, the present systematic review aimed to explore the prevalence of child marriage and the underlying factors. METHODS: A comprehensive search was conducted for all English-language studies that measured the prevalence of child marriage and its correlates from 2000 to March 2022, indexed in PubMed, Scopus, Web of Science, Poplin, and Google Scholar databases. Child marriage is defined as marriage under the age of 18. In the present study, Joanna Briggs' quality assessment checklist was used for data collection. Two independent reviewers reviewed all the articles. RESULTS: In total, 34 eligible prevalence articles and 14 trend articles were included in the study with data from 127,945 participants. The prevalence of child marriage ranged between 1.8% to 90.85%. In most studies, the trend of child marriage was decreasing. The most important individual factors include the respondent's education and occupation, interpersonal factors such as the education and occupation of parents and husband, family size and type. Community factors include socioeconomic status, region, residence, ethnicity, and religion at the social level. CONCLUSION: Despite a central focus of research and policies on interventions that decrease child marriage, this phenomenon is still prevalent in many places. Therefore, further specific interventions are required to improve education, reduce poverty and inequality. This may help achieve the 2030 Sustainable Development Goals.

Examining health literacy and self-efficacy levels and their association with preventive behaviors of urinary tract infection in Iranian pregnant women: across sectional study.

OBJECTIVE: Urinary tract infection (UTI) is assumed to be associated with the risk of fetal and maternal mortality and morbidity during pregnancy. The potential effect of health literacy and self-efficacy on UTI preventive behaviors among pregnant women has not yet been fully studied. Our objectives were to determine the level of health literacy, self-efficacy, and UTI prevention behaviors in pregnant women, and whether health literacy and self-efficacy are associated with UTI prevention behaviors in pregnant women. DESIGN: A cross-sectional study was conducted, from November 2020 to December 2020, through a multi-stage sampling design on 235 pregnant women aged between 18 and 42 years in Mashhad, Iran. Data were collected through valid and reliable questionnaires including the Test of Functional Health Literacy in Adults (TOFHLA), General Self-Efficacy Questionnaire (GSE), and research made-preventive behaviors recommendations for UTI disease. RESULTS: The level of UTI prevention behaviors scores is moderate (71.39 ± 8.58) among women during their pregnancy. Insufficient health literacy and self-efficacy were observed in 53.6% and 59.3% of participants, respectively. The regression model highlighted that 21.20% of the total variance of UTI preventive behaviors was predicted by sociodemographic characteristics, while 40.81% of the variance of UTI preventive behaviors was predicted by health literacy and self-efficacy. CONCLUSION: It has been observed that health literacy and self-efficacy are main determinants to improve UTI preventive behaviors. Focusing on an intervention based on health literacy skills may be a practical strategy to promote a healthy lifestyle in this population.

Explaining the burden of psychosocial factors on the worsening symptoms of MS: a qualitative study of patients' experiences.

BACKGROUND: This study was conducted with the aim of identifying the burden of psychosocial factors on the worsening symptoms of multiple sclerosis. METHODS: This as conducted with a qualitative approach and conventional content analysis among patients with Multiple sclerosis in Mashhad. Data were collected through semi-structured interviews with patients with Multiple sclerosis. Twenty-one patients with Multiple sclerosis were selected through purposive sampling and snowball sampling. The data were analyzed using Graneheim and Lundman method. Guba and Lincoln's criteria were used for evaluating research transferability. The data collection and management was performed by using the MAXQADA 10 software. RESULTS: In explanation of the psychosocial factors of patients with Multiple sclerosis, one category (psychosocial tensions) and three subcategories of stress (physical symptoms, emotional symptoms, and behavioral symptoms), agitation (family disorder, treatment-related concerns, and social relationship concerns), and stigmatization (social stigma and internalized stigma) were extracted. CONCLUSION: The results of this study show that patients with Multiple sclerosis are faced with concerns such as stress, agitation, and fear of stigma, and need support and understanding from the family and community to overcome these concerns. Society must base its health policies on addressing the challenges faced by patients. Accordingly, the authors argue that health policies, and consequently, healthcare systems, need to address patients' ongoing challenges as a priority in caring for patients with Multiple sclerosis.

Stakeholders' Experiences and Perspectives Regarding Care Quality for Women With Breast Cancer: A Systematic Review.

BACKGROUND: The considerable growth in the number of patients with breast cancer leads to substantial pressure on healthcare services; however, the main measures that will evaluate what is important to the key stakeholders in improving the quality of breast cancer care are not well defined. OBJECTIVE: This study aimed to synthesize providers' and patients' experiences and perspectives regarding barriers and quality breast cancer care in health services. METHODS: PubMed, Scopus, MEDLINE, Web of Knowledge, and the Cochrane Library databases were searched, and articles published in English up to August 2020 were screened. Two reviewers independently screened all articles. Data were obtained directly from different stakeholder groups including patients, health providers, and professionals. RESULTS: The search strategy identified 21 eligible articles that met inclusion criteria and reported perspectives of 847 health providers and 24 601 patients regarding healthcare quality. Health providers and patients with breast cancer noted information needs, psychosocial support, responsibility for care, and coordination of care as important quality improvement characteristics of the healthcare system. CONCLUSION: Shifting to high-quality breast cancer care would likely be a complicated process, and there is a need for the cancer care services to consider important characteristics of quality cancer care as a care priority, that is, to be responsive. IMPLICATION FOR PRACTICE: Breast cancer survivorship care programs and interventions may need to consider the barriers or common challenges to care noted in this review, especially regarding information sharing and the need for social support and care cooperation.

Colorectal Cancer Awareness and Related Factors Among Adults Attending Primary Healthcare in North-Eastern of Iran: A Cross-sectional Study.

BACKGROUND: Colorectal cancer (CRC) is the third most prevalent cancer in Iran. This study aimed to assess the level of awareness regarding CRC warning signs, risk factors, screening program, and related factors among adults in North-Eastern Iran. Study Design: A cross-sectional study. METHODS: The multi-stage sampling method was used to survey 2614 participants attending primary healthcare centers in Mashhad, Iran. The data collection tools were the demographics section and Bowel/ CRC Awareness Measure (Bowel/Colorectal CAM). The data were analyzed by SPSS, version 25. The significance level of the data analysis was less than 0.05. RESULTS: Mean awareness for CRC warning signs and CRC risk factors were 2.85±2.13 and 3.63±1.85, respectively. Most participants (97.2%) had no awareness of the CRC screening program. There was a significant association between marital status, education, job, income, and family history of CRC with awareness of warning signs (P<0.001); moreover, there was a significant association between age, education, job, income, and family history of CRC with awareness of risk factors (P<0.001). The results of logistic regression indicated that there was a significant association between age (P=0.022, OR=1.794, 95% confidence interval [CI]: 1.087, 2.962), gender (P=0.005, OR=0.488, 95% CI: 0.296, 0.803) and warning sign awareness (P<0.001, OR=1.278, 95% CI: 1.124, 1.454) with awareness of the CRC screening program. CONCLUSION: In this study, most of the participants had low awareness of CRC. More aimed educational interventions are needed to promote Iranian adults' awareness of CRC.

A Systematic Review for Evaluation of Specialized Programs for Addressing Young Women with Breast Cancer Problems.

INTRODUCTION: Breast cancer (BC) is one of the most common health concerns among women and is the leading cause of cancer-related death around the world. Women, in particular young women, face unique and complex problems with BC. Physical, psychological, emotional, educational, and long-term BC-related problems have been recognized for these vulnerable populations. Besides BC patients, their families and relatives challenge with various problems such as financial and supportive issues in supporting these patients. METHODS: The main objective of the present study was to evaluate the BC patient's major problems and describe current supportive initiatives and programs that support these patients, their advancements to date, existing challenges, and possible future actions. Data collection took place by conducting a comprehensive search on the Internet, Medline, PubMed, and Google Scholar databases. We also discuss the contingency options, which lead to improving medical and supportive care, as well as overcoming barriers to providing comprehensive and optimal care and support for these unique groups of patients. RESULTS: The result revealed that several comprehensive and well-developed BC programs and initiatives have been established around the world for providing and focusing on BC patient's clinical care, supportive care, education, survivorship, navigation, and research. However, despite considerable advancement in this area, there are still significant challenges in addressing the BC patient's needs. CONCLUSION: Evaluation of the current situation of BC patient's treatment and quality of life highlighted the importance of developing and implementing the new and most efficient healthcare programs and protocols, as well as improving and optimizing the existing ones to improve and enhance the survival rate and quality of life of BC patients.

Exploration factors on smoking among female adolescents based on the viewpoints of Iranian adolescent girls.

BACKGROUND: In recent years, the prevalence of smoking in women has increased significantly. This study aimed to explain the effective factors in the tendency to smoke in female adolescents, employing a qualitative method of content analysis in Mashhad, Iran. METHODS: The data for this conventional content analysis were obtained by conducting semi­structured interviews with 20 female adolescent smokers. For open coding, integrating codes, creating main category and subcategories, and extracting quotation associated with codes and subcategories, MAXQDA software version 10 was used. RESULTS: Based on the results of the study, one main category and six subcategories were identified to influence the decision to smoke. The main category was interconnection of psychological and gender experiences. The subcategories included self-management weakness, ignoring the side effects, gender orientation, negative psychological experiences, the attraction of cigarettes, and positive psychological experiences. CONCLUSION: Psychological and gender factors play an important role in initiating people's behavior and tendency to smoke and smoking prevention programs in educational settings need to focus efforts around what is known about young women smokers.

Attributes of Organizational Health Literacy in Health Care Centers in Iran: A Qualitative Content Analysis Study.

Organizational Health Literacy (OHL) is described as a new concept to remote health organizations to implement practices, policies, and systems that make it easier for patients to use, understand, and navigate health information to take care their own health. In Iran, there is no consensus on the attributes of OHL, and its practical implications and scope have not been evaluated. This manuscript is one of the first attempts to explain the attributes of the OHL in health care centers in Iran. This study is a content analysis survey, which was guided by the attributes of the OHL provided by Brach et al. and 26 semi-structured interviews were conducted with Iranian health professionals and employees of healthcare organizations from June 2020 to January 2021. A data analysis was performed using the MAXQDA 10 software. Across the study, ten sub-themes, 21 subcategories, and 67 codes emerged. The 10 main attributes of OHL were management, integration of health literacy in the organization, workforce, participation, range of HL skills, HL strategies, access, media variety, the role of the organization in crisis, and costs. These attributes may guide the planning of health care centers improvements and have the potential to promote health service reforms and public health policy.

Exploration the role of social, cultural and environmental factors in tendency of female adolescents to smoking based on the qualitative content analysis.

BACKGROUND: The aim of this study was to explain the socio-cultural and environmental factors of smoking tendency in female adolescents. METHODS: This qualitative content analysis study was conducted among Iranian female adolescents in Mashhad, Iran. The data was collected through semi-structured interviews with 20 female smokers. The duration of each interview varies from 30 to 70 min. Data collection and management of data were done using MAXQADA software version 10. RESULTS: In exploration the effective socio-cultural and environmental factors in the tendency of female adolescents to smoking, six subcategories of role modeling of friends, membership in groups, parenting patterns, family modeling, the predisposing community, and the negative impact of the media were extracted. CONCLUSIONS: The results obtained in this study indicated that there is a need to formulate policies and adopt environmental and social laws to reduce smoking. The results also showed the effective role of parents in improving personal skills, creating a stress-free environment in the family, and controlling adolescent behavior. Therefore, it is necessary to pay attention to all social and cultural aspects in order to make the smoking prevention programs.

Design and evaluation of psychometric properties of cigarette smoking tendency questionnaire for female adolescents (CTQFA).

BACKGROUND: The tendency of women to smoke has increased in recent years and the prevalence of smoking among women is increasing. The purpose of this study was to design and evaluation the psychometric properties of the smoking tendency questionnaire for Iranian female adolescents. METHODS: This cross-sectional study was performed on 604 female adolescents in Iran in 2021. The bank of questions was designed based on the qualitative study concepts and review of the literature. To perform the psychometric evaluation, steps such as face validity (qualitative), content validity (qualitative and quantitative) and construct validity (confirmatory factor analysis) were performed. The reliability of the instrument was assessed using McDonald's omega coefficient and Cronbach's alpha coefficient. RESULTS: Based on the results of psychometrics (face, content, and construct validity), the number of questions was reduced from 102 to 52, and 50 questions were removed. Finally, a questionnaire with 52 questions and 5 subscales of the tendency to experience smoking (14 items), re-experience smoking (8 items), cigarette dependence (9 items), intention to quit smoking (9 items), and smoking cessation (12 items) was approved. The content validity ratio (CVR) and content validity index (CVI) for all questions were 0.770 and 0.938, respectively. The Cronbach's alpha and McDonald's omega coefficients for all questions were 0.903 and 0.904, respectively. CONCLUSION: Based on the results of this questionnaire, 52 questions, and 5 subscales can be used to assess the tendency of female adolescents to cigarette smoking.

The Status of Health Literacy in Students Aged 6 to 18 Old Years: A Systematic Review Study.

BACKGROUND: Adolescents and children are a core target population for health literacy (HL) studies and practice. There is limited knowledge regarding the HL skills and abilities that help young people and children in making health decisions. This study aimed to evaluate the status of HL in ongoing school students. METHODS: Literature searching was performed using nine databases (Web of Science, PubMed, Scopus, Google Scholar, Iranmedex, Magiran, Scientific Information Database) without restriction in time until January 2019, and database searches were supplemented with reference hand searches and gray literature. Cross-sectional and experimental studies with focuses on validated measures of HL in ongoing students were included. RESULTS: This systematic review of identified 17 studies and 199714 samples specifically studied on ongoing school students aged 6-18 years. Students and their mothers have a moderate level of HL in four dimensions of menstrual health, physical activity, breast self-test, and iron deficiency anemia, and most of them have a high level of HL only in terms of nutrition. The relationship of HL with health outcomes, health promotion behaviors, self-efficacy, self-mutilating behaviors, and self-care abilities was statistically significant. HL status is related to parents' education level, socio-economic determinants (culture, family income, and environmental contextual factors), age groups, and media/digital communication channels. CONCLUSION: This review identified seven main determinates that significantly affect HL status in the target group. This systematic review shows most of the ongoing school students had an inadequate level of HL skills. HL strategies have a potential impact on improving students' health behaviors and life quality.

The Health Literacy Status and Its Role in Interventions in Iran: A Systematic and Meta-Analysis.

There are increasing calls for public health policies to realize the visions of a health literate society and health literacy on a global scale. However, there are still more gaps in what researchers recognize and what steps they should take to improve health literacy (HL) skills. This review aimed to measure the HL status of the Iranian population and the effect size of the underlying association between HL and other health outcomes, and to examine the effectiveness of HL interventions on improving the functional dimension of HL, self-efficacy, and health-promoting behaviors. All full text published articles written in English and Persian language were included from inception until January 2019, but the type of study is not limited. A total of 52 potentially relevant articles with data on 36,523 participants were included in this review. In the population with health conditions, the average HL score was 62.51 (95% CI: 59.95-65.08), while in the patient population, the HL score was 64.04 (95% CI: 60.64-67.45). Health literacy was positively and significantly correlated with self-care behaviors 0.42 (95% CI; 0.35-0.49), self-efficacy 0.35 (95% CI; 0.26-0.43), knowledge 0.50 (95% CI; 0.44-0.55), communication skills 0.33 (95% CI; 0.25-0.41), and health promotion behaviors 0.39 (95% CI; 0.35-0.44). The meta-analyses showed that overall, HL interventions significantly improved HL status, self-efficacy, and health promotion behaviors. Results indicate that HL status was in the range of marginal HL level in the Iranian population. Our finding highlights the beneficial impact of HL intervention on health-promoting behaviors and self-efficacy, particularly in low literacy/socioeconomic status people.

Impact of an Educational Training on Behavioral Intention for Healthcare Waste Management: Application of Health Action Model.

Inappropriate healthcare waste management (HCWM) may lead to health hazards through the release of toxic and infectious agents into the environment. This study aimed to assess the appropriateness of a Health Action Model (HAM) operationalized in a training intervention to promote behavioral intent towards HCWM practice among hospital staff. This was a quasi-experimental intervention study of 128 hospital staff attending a training intervention in Sabzevar Hospital, Iran. Four training intervention was carried out using potential constructs of the HAM model to compare the quality of HCWM process and behavioral intent of hospital staff before and after a training session. A questionnaire based on HAM and multiple statistical analyses were used to assess the effectiveness of the training intervention. The average age of the eligible participants was 35.05 ± 9.4 years. A majority of the participant was married (88%), nursing staff (54%) and possessed a bachelor's degree (66%) or diploma (18%). After the intervention, a significant change (p < 0.05) was observed in the intervention group compared to the control group in staff knowledge, attitude, self-efficacy, belief, and motivation. Further, our result showed a significant improvement from 53.6 ± 24.3 to 83.6 ± 11.5 in the behavioral intention toward HCWM practice. This work provides evidence of the effectiveness of the HAM as a guide in which the potential determinates that influence an individual's behavioral intention toward medical waste practice were identified and described. This model help promote behavioral intention at a variety of target audiences and setting in waste management practice.

National, regional, and global prevalence of cigarette smoking among women/females in the general population: a systematic review and meta-analysis.

BACKGROUND: This systematic and meta-analysis review aimed to provide an updated estimate of the prevalence of ever and current cigarette smoking in women, in geographic areas worldwide, and demonstrate a trend of the prevalence of smoking over time by using a cumulative meta-analysis. METHODS: Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies published on the prevalence of ever and current cigarette smoking in women. We searched PubMed, Web of Science (ISI), Scopus, and Ovid from January 2010 to April 2020. The reference lists of the studies included in this review were also screened. Data were reviewed and extracted independently by two authors. A random effects model was used to estimate the pooled prevalence of ever and current cigarette smoking in women. Sources of heterogeneity among the studies were determined using subgroup analysis and meta-regression. RESULTS: The pooled prevalence of ever and current cigarette smoking in women was 28% and 17%, respectively. The pooled prevalence of ever cigarette smoking in adolescent girls/students of the school, adult women, pregnant women, and women with the disease was 23%, 27%, 32%, and 38%, respectively. The pooled prevalence of ever cigarette smoking in the continents of Oceania, Asia, Europe, America, and Africa was 36%, 14%, 38%, 31%, and 32%, respectively. CONCLUSIONS: The prevalence of cigarette smoking among women is very high, which is significant in all subgroups of adolescents, adults, and pregnant women. Therefore, it is necessary to design and implement appropriate educational programs for them, especially in schools, to reduce the side effects and prevalence of smoking among women.

Review of Organizational Health Literacy Practice at Health Care Centers: Outcomes, Barriers and Facilitators.

The term organizational health literacy (OHL) is a new concept that emerged to address the challenge of predominantly in patients with limited health literacy (HL). There is no consensus on how OHL can improve HL activities and health outcomes in healthcare organizations. In this study, a systematic review of the literature was conducted to understand the evidence for the effectiveness of OHL and its health outcome, and the facilitators and barriers that influence the implementation of OHL. A literature search was done using six databases, the gray literature method and reference hand searches. Thirteen potentially articles with data on 1254 health organizations were included. Eight self-assessment tools and ten OHL attributes have been identified. Eleven quality-improvement characteristics and 15 key barriers were reviewed. Evidence on the effectiveness of HL tools provides best practices and recommendations to enhance OHL capacities. Results indicated that shifting to a comprehensive OHL would likely be a complex process because HL is not usually integrated into the healthcare organization's vision and strategic planning. Further development of OHL requires radical, simultaneous, and multiple changes. Thus, there is a need for the healthcare system to consider HL as an organizational priority, that is, be responsive.

Health Literacy in Iranian Women: A Systematic Review and Meta-Analysis.

BACKGROUND: Inadequate health literacy (HL) is associated with poorer health outcomes and worse health care. Up to one-half of Iranian women have difficulty in interpreting medical information, and national HL assessment has been limited in Iran. We have undertaken a systematic review of the literature and used a meta-analysis to examine the situation of HL status in Iranian women, and determine the relationship between HL and self-efficacy, and self-care behaviors. METHODS: Six databases (PubMed, Web of Science, Scopus, Google Scholar, Scientific Information Database) and other non-indexed citations were searched using a variety of keywords regarding HL and Iranian women. The bias risk was decreased by the involvement of two independent reviewers assessing study quality and eligibility of included articles. RESULTS: The average HL scores were in the range of marginal or limited (63.08; 95% CI, 59.83-66.32) in the Iranian women. The HL score was significantly higher among pregnant women (67.55; 95% CI, 32.54-82.57) and was lower in women with chronic disease (57.79; CI, 48.34-67.24). There was a significant association between HL and self-efficacy and self-care behaviors. CONCLUSION: The average level of HL in the period of the review was marginal among Iranian women. The relationship of HL with self-efficacy and self-care behaviors was statistically significant but moderate.