Exploring the barriers to Pap smear test compliance: A qualitative study for improving cervical cancer screening in the primary health care.

Background: Cervical cancer in Iran ranks as the fourth most frequent cancer among women. Pap smear (PS) is the best standard for detecting cervical cancer, but many people, even healthcare providers (HCPs), do not maintain it. HCPs play a critical role in promoting PS uptake. The purpose of the study was to explore barriers to cervical cancer PS screening compliance from the HCPs' perspective. Methods: The present qualitative content analysis was conducted through semi-structured in-depth interviews. A total of 28 HCPs were interviewed between July and August 2020. A diverse sample of HCPs was selected using purposive sampling. Data analysis was based on the five steps proposed by Graneheim and Lundman. MAXQDA (2020) was used for data analyzing. Results: Ten key sub-categories were identified and organized into three categories: individual, environmental, and socio-cultural factors. The sub-categories included inadequate risk perception, inappropriate attitude, low commitment, emotional factors, low priority over health, requirements and consequences of the test, deficiencies of health centers, organizational factors, traditions and religious believes. Conclusion: HCPs face multiple barriers for PS. Exploring and decreasing barriers of PS in HCPs may increase compliance in them and their clients because they play an influential role in instructing and persuading women to take the PS. There is need to explore these barriers and identify possible interventions to change them. Insights from this study are useful for developing policies around national PS programs, too.

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.

Body image perception and physical activity behavior among adult population: Application of trans-theoretical model of behavior change.

BACKGROUND: The human body changes during life, but research on how sociodemographic characteristics and physical activity (PA) related to all aspects of body image are still unclear and there is conflict in the relevant results. This study aims to examine gender-specific body image perception and physical activity in relation to BMI and sociodemographic characteristics among health employees who worked in health and medical care centers. METHODS: The study was a population-based cross-sectional survey of 170 health employees (55 men and 115 women) in Binaloud, Iran. Participants completed a self-administered questionnaire, which consisted of a self-administered Multidimensional Body-Self Image Questionnaire (MBSRQ) and stages of change scales. The full version of Marcus-TTM based on the stages of physical activity changes was used based on 5 items related to regular physical activity behavior and intentions. RESULTS: There were no significant differences between men and women in total body image score, body area satisfaction, and attitude. Disease orientation (p = 0.02) and health orientation (p = 0.05) were the only significant differences between men and women. The number of children, level of education, BMI, and PA had a stronger influence on body image concerns and body dissatisfaction. PA and 7 of the 10 subclasses of MBSRQ (appearance evaluation, fitness evaluation, fitness orientation, health evaluation, health orientation, and illness orientation) showed a significant difference (P<0.05) between participants in the five TTM stages. CONCLUSION: The ideal body image and body satisfaction may differ by the number of children, level of education, gender, BMI, and PA. Evidence from this study supports that participants' stages of change affect their physical activity and body image perception. This result suggests a need for conducting work/home place intervention to promote adults' body image perception and body area satisfaction based on the usage-specific stage under consideration.

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.

Nutrition self-efficacy intervention to improve nutritional status of Iranian older adults.

OBJECTIVES: Older adults are a vulnerable group that is at risk of poor nutritional status, which can lead to disease and increase their healthcare costs. Our study aimed to investigate the impact of a self-efficacy intervention on the nutritional status of older adults. METHODS: A controlled before and after study was conducted on 110 older adults in the Mashhad, Iran, from 2020 to 2022. Participants were randomly allocated to the intervention (n = 55) and control groups (n = 55). Participants in the intervention group received educational training that was based on the self-efficacy theory. The control group received the routine care. Data collection tools included demographic information questionnaire, Mini Nutritional Assessment Questionnaire, and standard self-efficacy questionnaire. The questionnaires were completed at baseline (before intervention), instantly after the intervention, and at 3-months follow-up by participants in both groups. Data were analyzed using SPSS version 25 and the significance level was considered less than 0.05. RESULTS: The Mean of nutritional status in the intervention group, at the baseline, immediately after intervention and 3 months of follow-up were 25.1 ± 2.3, 28.3 ± 5.2 and 27.6 ± 6., respectively. This increase was significant (p < 0.001). Our findings revealed that self-efficacy among participants in the intervention group significantly changed (P < 0.001) across time from baseline through follow-up. There was no significant difference in the mean of self-efficacy and nutritional status in the control group during the study period (P > 0.05). CONCLUSION: This current study provided a basis to examine in the effectiveness of such intervention using a properly powered randomized controlled study. Therefore, it can be concluded that self-efficacy interventions are a promising approach to improving the nutritional behaviors of the older adults. TRIAL REGISTRATION: IRCT20160619028529N9.

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.

Women's perception of barriers and facilitators of cervical cancer Pap smear screening: a qualitative study.

OBJECTIVE: Although Pap smear (PS) is considered the best standard in detecting cervical cancer, adherence to timely and regular PS is often lower than global standards in developing countries. Thus, the present study aimed to identify barriers and facilitators of adherence to cervical cancer screening in Mashhad, Iran. DESIGN: A qualitative content analysis was done from July to December 2022 using semistructured in-depth interviews. SETTING: The study was conducted in health centres in Mashhad, Iran. PARTICIPANTS: A sample of 36 married women aged 18-70 years was selected using a purposive sampling, with maximum diversity. RESULTS: The mean age of participants was 42.8±7.6 years. Among all, 66.7% had the PS test at least once; only 8.3% regularly had the test. The qualitative content analysis led to the extraction of four major themes: (1) individual challenges, (2) environmental limitations, (3) individual motivators, and (4) supportive and efficient environments. The most significant barriers were psychological stress, unhealthy attitudes, insufficient information, cultural issues and insufficient healthcare services. Facilitators included an active and efficient healthcare system, advice and support of important others, and positive emotions and individual beliefs. CONCLUSIONS: Participants' perceptions showed that the main factors influencing the PS testing were supportive environments, individual motivators, individual challenges and environmental limitations. To encourage women to take the PS and reduce barriers, it may be necessary to revise current health system policies, promote individual and public awareness, reduce psychological stress and correct negative beliefs and attitudes.

Perceptions and determinants of oral health care among Iranian pregnant women: a qualitative study.

OBJECTIVES: This study aimed to gain a comprehensive understanding of the determinants that influence oral healthcare behaviours among Iranian pregnant women. STUDY DESIGN: Qualitative study. SETTING: Comprehensive health service centres. PARTICIPANTS: A sample consisting of all people involved in the process of oral care during pregnancy, 18 pregnant women, 7 midwives/healthcare workers, 3 supervisors of prenatal care services and 3 dentists) were purposefully sampled in terms of demographic characteristics. METHODS: The qualitative content analysis study conducted 31 semistructured individual interviews in 2022, utilising MAXQDA V.10. RESULTS: The participants identified 3 main categories and 11 subcategories: individual and physiological determinants (care needs, perceived importance, motivation, oral health literacy and inherent pregnancy limitations), organisational determinants (costs, access to equipment and services, review of service delivery process and professional behaviour) and social-cultural determinants (educational services and support from family and friends). CONCLUSIONS: The results can be used in interventions to improve oral healthcare for pregnant women. This study highlights the importance of addressing individual, organisational and social-cultural determinants to improve oral healthcare during pregnancy.

The influence of emotional intelligence on academic stress among medical students in Neyshabur, Iran.

BACKGROUND: Although, several novel strategies related to coping with stress dominate the possible vicissitudes that may occur, academic stress and its mental and physical outcomes remain a serious public concern among college students. Available data on how/where intervention-based novel strategies and emotional intelligence skills can influence students' ability to deal with stress and crisis situations is still unclear. This study aims to investigate the effectiveness of an educational intervention based on emotional intelligence on the level of academic stress components among Iranian medical students. METHODS: This research has been done in two descriptive and quasi-experimental sections in the academic year 2018-2019. To determine the effect of emotional intelligence components on stress levels, this descriptive study was performed on 200 students. Then, a quasi-experimental study was then conducted to determine the impact of an emotional intelligence component-based educational intervention on academic stress-coping skills. Data were collected through a personal information questionnaire, Bradbury and Graves's emotional intelligence questionnaire, and Gadzella's academic stress questionnaire. RESULTS: Most of the participants were female (72.3%) married (72%), non-native (62.1%), and second or third academic years (78.5%). The mean number of academic years of employment was 9.5. The mean age of students were 23 ± 3.5 years old. Intervention based on emotional intelligence significantly (p < 0.05) improved students' emotional intelligence skills and decreased their academic stress and reactions to stressors in the intervention group. CONCLUSION: It appears that emotional intelligence training is a feasible and highly acceptable way to develop coping skills with academic stress; therefore, such training is essential to be considered as part of university education to improve students' education quality and their skills to study without academic stress.

Educational intervention based on health action model to promote safe behavior of hospital service workers.

BACKGROUND: Hospitals are considered to be one of the most hazardous environments to work in, and their service workers are exposed to many serious risks. So The purpose of this study was to investigate the effect of educational intervention based on the Health Action Model to promote the safe behavior of hospital service workers. METHODS: In this quasi-experimental study, 45 workers in each of the control and experimental groups participated. Demographic information and data related to Health Action Model constructs were collected through a questionnaire and a checklist, immediately and three months after the intervention. Cronbach's alpha coefficients were used to confirm the properties of the tools. Educational intervention accompanied was applied in the form of four training classes. The data were analyzed using SPSS 20 software. RESULTS: Before the intervention, there was no significant difference between the two groups in terms of demographics and the study's main variables. results showed significant changes in mean scores of safe behavior, Attitude, norms, belief, intention, knowledge in the experimental group three months after the intervention (P < 0.001). CONCLUSIONS: The research results show that Health Action Model educational intervention can change workers' awareness, attitudes, norms, beliefs, and intentions toward unsafe behavior and improve their safety performance. TRIAL REGISTRATION: IRCTID: IRCT20160619028529N7.

Translation and localization the Persian version of diabetes distress scale among type 2 diabetes.

INTRODUCTION: The aimed of this psychometric cross-sectional research was translation and localization the Persian version of diabetes distress scale in type 2 diabetes. METHODS: This psychometric cross-sectional research was translation and localization the Persian version of diabetes distress scale among 1028 type 2 diabetes in Mashhad city, Iran, 2022. Cluster sampling method was used for selection the participants. The validity and reliability of diabetes distress scale designed and evaluated by Polonsky was assessed in this study. The validity of diabetes distress scale was evaluated by face validity, content validity, and structural validity. Twenty-six type 2 diabetes were selected for evaluation the reliability of scale. RESULTS: The factor loading of all questions of diabetes distress scale were more than 0.4 and the results of goodness-of-fit indexes showed acceptable values (for example: RMSEA = 0.076, IFI = 0.909, AGFI = 0.819, PNFI = 0.758). Cronbach's alpha coefficient, McDonald omega coefficient and Intraclass Correlation Coefficient (ICC) showed a value of 0.950, 0.955, and 0.903, respectively for all items of diabetes distress scale. Cronbach's alpha coefficient, McDonald omega coefficient and ICC showed a value of 0.914, 0.917, and 0.893, respectively for Core Level of Distress (8 items). Also, Cronbach's alpha coefficient, McDonald omega coefficient, and ICC showed a value of 0.920, 0.928, and 0.884, respectively for all factors of Sources of Distress (21 items). CONCLUSION: The Persian form of diabetes distress scale with 29 items and two parts of Core Level of Distress with 8 items and Sources of Distress with 21 items and 7 factors (Hypoglycemia with 3 items, Long-term Health with 3 items, Healthcare Provider with 3 items, Interpersonal Issues with 3 items, Shame/Stigma with 3 items, Healthcare Access with 3 items, and Management Demands with 3 items) is a good scale to evaluation the status of diabetes distress in Iranian type 2 diabetes.

Using social marketing theory as a framework for understanding barriers and facilitators of human papillomavirus screening in women: A qualitative study.

BACKGROUND: Human papillomavirus (HPV) is known as the common sexually transmitted disease and the cause of cervical cancer. The HPV test is being proposed as the primary screening tool for cervical cancer. This study aimed to identify barriers and facilitators of screening based on the social marketing model in designing interventions and planning to increase HPV screening. MATERIALS AND METHODS: This qualitative directed content analysis was conducted between December 2020 to September 2021 to identify the key concepts of social marketing theory (i.e., the four P's: product, price, place, and promotion) in Mashhad, Iran. Semistructured interviews were fulfilled with 24 individuals (10 women with HPV and 14 key informants) after obtaining participants' consent, who were initially purposively sampled and snowball sampling was then used to facilitate further recruitment. Data analysis was carried out simultaneously with data collection. RESULTS: Following the code extraction, four main categories (themes) and 10 subcategories extracted. Subcategories included knowledge on screening, screening benefits, and motivational factors for screening (product), individual inhibitors, environmental inhibitors, and facility problems related to price, place of service delivery, and service delivery channels (place) and health promotion and education. DISCUSSION: Lack of knowledge about HPV and screening, negative attitudes toward sexually transmitted diseases, taboo about sexual issues in society, fear of the reaction of spouse and family members, lack of proper policies and information and communication challenges, high costs of screening, access barriers to facilities such as difficult transportation have been challenges of health systems. It is suggested that HPV screening as a standard method for detection of cervical cancer be considered and the barriers to access are removed.

Evaluation of the barriers and facilitators of iron supplementation program among adolescent females.

BACKGROUND & AIMS: Iron deficiency anemia is a major health problem in female adolescents; so, the iron supplementation program has been implemented in Iranian female high school students for nearly two decades. This study aimed to assess the barriers and facilitators of the program. METHODS: This cross-sectional study was conducted by cluster random sampling with a sample size of 399 high school girls from the northern, southern, eastern, western and central regions of Iran. To collect data, we applied valid and reliable researcher-made questionnaires. Data were analyzed by SPSS version 22 software using the chi-squared test. RESULTS: From the students' point of view, the most important reasons for not taking iron supplements were the bad taste of iron supplements, nausea after consumption, and not prescription of the iron supplement by physicians. Most the students believed that inviting health care professionals and movies or clips had the greatest impact on encouraging students to take supplements. About 45% of students reported that educational programs were not held for them, and only 28% of students received educational content/educational media about iron supplement. Also, 71% of students reported that there are not enough glasses for the consumption of supplement iron. There were significant relationships between iron supplements distributors (deputy assistant: 22.6% vs. 14.1%, P = 0.045), allocated enough time to intake iron supplements (72.0% vs. 37.1%, P < 0.001), implemented the educational program in schools (61.8% vs. 33%, P < 0.001), and the educator person of the program (health teachers: 42.7% vs. 35.7%, P = 0.039) with consumption of iron supplement by the students. CONCLUSION: To achieve the goals of the program, it is necessary paying attention to various aspects of the program such as providing better quality iron supplements, providing more appropriate environmental conditions, designing more attractive training programs, strengthening general announcement, and employing more experienced executive staff.

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.

The evaluation of the role of diabetes health literacy and health locus of control on quality of life among type 2 diabetes using the Path analysis.

Quality of life (QOL) in patients with diabetes is affected by multiple factors, and this study aimed to determine the effect of health locus of control points (HLOC) and diabetes health literacy (DHL) on QOL in Iranian patients with type 2 diabetes. This cross-sectional study was conducted between October 2021 and February 2022 among 564 people with type 2 diabetes. Patients were selected using proportional stratified sampling and simple random sampling methods. Data were collected using three questionnaires: (1) Multidimensional Health Locus of Control scale (form C), (2) World Health Organization Quality of Life Scale, and (3) Diabetes Health Literacy Scale. Data were analyzed by software's of SPSS V22 and AMOS V24. There was a positive and significant correlation between DHL and QOL. There was a positive and significant correlation between the subscales of internal HLOC, and doctors HLOC with QOL. According to the Path analysis results, all variables showed 58.93% of the direct effects and 41.07% of indirect effects of the final model. Numerate health literacy, informational health literacy, communicative health literacy, internal HLOC, other powerful people HLOC, chance HLOC, and doctors HLOC were able to predicted 49% variance of diabetes QOL (R2 = 0.49). The subscales of communicative health literacy, informational health literacy, internal HLOC, doctors HLOC, and chance HLOC had the greatest impact on QOL of people with diabetes. Based on the results of Path analysis, diabetes health literacy and HLOC play an effective role in QOL of diabetic. Therefore, there is a need to design and implement programs to improve the health literacy of patients as well as HLOC to improve QOL of patients.

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.

Use and perception of complementary and alternative medicine among Iranian psychologists.

OBJECTIVES: The seeking and use of Complementary and Alternative Medicine (CAM) modalities by people to treat mental disorders has increased and it is necessary for psychologists to have the necessary information in this field. This study aims to evaluate the use and perception of CAM by Iranian psychologists. METHODS: This cross-sectional study was conducted on 100 psychologists selected by the census in 2019. Data collection tools consisted of four sections of the demographic section, the CAM questionnaire for psychologists, awareness of CAM, and use of CAM. The validity and reliability of this questionnaire were confirmed. RESULTS: The mean (standard deviation) scores of attitude and educational needs were 40.45 (11.36) and 33.93 (5.96), respectively. Only 19.25% of psychologists had sufficient knowledge of CAM, and most of them (56.34%) reported that there is an educational need for CAM. In this study, 64% of psychologists used CAM for themselves. There was a significant relationship between the attitude toward CAM modalities and the suggestion of CAM to the clients (p=0.025). There was also a significant relationship between the use of CAM by psychologists and the suggestion of these modalities to their clients (p<0.001). CONCLUSIONS: Psychologists had not sufficient awareness about CAM and had a moderate attitude. Most of the psychologists reported that there is educational need for CAM. Therefore, it is necessary to design and implement appropriate training courses for psychologists toward CAM modalities.

Quality of life and life satisfaction among university students: Exploring, subjective norms, general health, optimism, and attitude as potential mediators.

OBJECTIVE: This study aims to examine the association of quality of life (QOL) with life satisfaction, subjective norms, general health, optimism, and attitude among university students. PARTICIPANTS: Respondents include 632 university students (Mage=21.36, SD = 2.86). METHODS: This cross-sectional study was conducted on university students in Torbat Heydariyeh, Iran. Several statistical models were tested, including hierarchical regression and path analysis, to examine the direct or indirect association between a set of important variables. RESULTS: According to the results of path analysis, constructs of subjective norms, general health, positive attitude, optimism, and life satisfaction were significant predictors of students' QOL. Compared with other constructs, general health status (p < 0.001, R2 = 0.548) and life satisfaction (p < 0.001, R2 = 0.253) showed the strongest association with QOL. CONCLUSIONS: The results indicate that efforts to improve life satisfaction by targeting general health, subjective norms, optimism, and attitudes may provide promising ways to improve QOL.

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.

The prevalence of electronic cigarettes vaping globally: a systematic review and meta-analysis.

BACKGROUND: The purpose of this systematic review study was to determine the national, regional, and global prevalence of electronic cigarettes (e-cigarettes) vaping. METHOD: The articles were searched in July 2020 without a time limit in Web of Science (ISI), Scopus, PubMed, and Ovid-MEDLINE. At first, the titles and abstracts of the articles were reviewed, and if they were appropriate, they entered the second stage of screening. In the second stage, the whole articles were reviewed and articles that met the inclusion criteria were selected. In this study, search, selection of studies, qualitative evaluation, and data extraction were performed by two authors independently, and any disagreement between the two authors was reviewed and corrected by a third author. RESULTS: In this study, the lifetime and current prevalence of e-cigarettes vaping globally were 23% and 11%, respectively. Lifetime and current prevalence of e-cigarettes vaping in women were 16% and 8%, respectively. Also, lifetime and current prevalence of e-cigarettes vaping in men were 22% and 12%, respectively. In this study, the current prevalence of e-cigarettes vaping in who had lifetime smoked conventional cigarette was 39%, and in current smokers was 43%. The lifetime prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 24%, 26%, 16%, and 25%, respectively. The current prevalence of e-cigarettes vaping in the Continents of America, Europe, Asia, and Oceania were 10%, 14%, 11%, and 6%, respectively. CONCLUSIONS: Based on the results of this study, it can be concluded that the popularity of e-cigarettes is increasing globally. Therefore, it is necessary for countries to have more control over the consumption and distribution of e-cigarettes, as well as to formulate the laws prohibiting about the e-cigarettes vaping in public places. There is also a need to design and conduct information campaigns to increase community awareness about e-cigarettes vaping.