Models and components in disaster risk communication: A systematic literature review.

BACKGROUND AND AIM: Risk communication is considered a major factor in disaster risk management by the concerned policymakers and researchers. However, the incoherence of variables affecting risk communication in various studies makes it difficult to plan for disaster risk communication. This study aims to identify and classify the influential components in disaster risk communication. MATERIALS AND METHODS: This systematic review was conducted in 2020. Databases included PubMed, Scopus, and Web of Science. In searching for articles, there was no limit on the date of publication and the language of the article. The research addressed both natural and man-made disasters. The Preferred reporting items for systematic review and meta-analysis protocols (PRISMA) checklist was followed throughout the research, and the quality of the papers was assessed using the mixed methods evaluation tool (MMAT). RESULTS: In searching the articles, 3956 documents were obtained, of which 1025 duplicated articles were excluded. The titles and abstracts of the remaining documents (2931) were examined, of which 2822 were deleted, and the full text of 109 documents was studied for further assessment. Finally, after applying the inclusion and exclusion criteria and reviewing the full texts, 32 documents were considered to extract the data and for quality assessment. On studying the full text of the obtained documents, 115 components were found, which were classified into five groups (message, message sender, message receiver, message environment, message process) and 13 subgroups. In addition, the obtained components were classified as those proposed by the authors of the article and those obtained from disaster risk communication models. CONCLUSION: Identifying the effective components in the disaster risk communication gives a more comprehensive view of risk communication to the disaster managers and executives and provides the decision-makers with an important platform to be able to use the components of risk communication and increase the impact of messages and ultimately increase people's preparedness for disasters in planning operations for the risk communication.

A comprehensive health-promoting neighborhood intervention to improve health care seeking behavior among reproductive age Iranian women.

BACKGROUND: Women's health care seeking delays remains an unresolved major public health problem in developing and underdeveloped countries. This study aimed to evaluate a health-promoting neighborhood intervention to improve health care seeking behavior (HCSB) among reproductive age Iranian women using Health Promotion Model (HPM). METHOD: This randomized controlled trial was conducted on 160 women of reproductive age in two groups: experimental and control. Data were collected by self-administered questionnaire based on HPM constructs and a medical symptom checklist. A health-promoting neighborhood intervention was performed in seven sessions for the experimental group. HCSB and HPM constructs were measured before and 3 months after intervention in the two groups. p < 0.05 was considered significant level. RESULTS: The average mean age of participants was 30.45 ± 7.80 years. After intervention, the mean score of self-efficacy, interpersonal influences, commitment to plan and HCSB was increased significantly in women in the experimental group, while negative constructs such as perceived barriers, negative activity-related affect, and immediate competing demands and preferences significantly decreased (p < 0.05). In addition, the mean score of referring for symptoms such as excessive sweating, persistent fatigue or weakness, headache, bleeding or spotting between periods, vaginal itching and irritation, unusual vaginal discharge, flashing, chest pain, rapid heartbeats, aching muscles or joints, urinary problems and some mental disorder was increased significantly in experimental group compared to control group (p < 0.05). CONCLUSIONS: The results of study show that an intervention based on the HPM have a positive impact on HCSB and its associated factors and can help improve women's health behaviors and health outcomes.

Religious and Spiritual Coping Elements in Dealing with Chronic Diseases: A Qualitative Exploration of the Perspectives of Older Iranian Zoroastrians.

Religiosity is a desirable alternative coping strategy for many people when facing negative life events including age-related infirmities and stressors. Religious coping mechanisms (RCMs) have been investigated meagerly with regard to religious minorities around the world and, to the best of current knowledge, no study has been conducted on Iranian Zorostrians to explore their religious coping mechanisms in dealing with age-related chronic diseases. This qualitative research, therefore, was aimed to canvas perceptions about RCMs that are utilized by Iranian Zoroastrian older adults to deal with chronic diseases in the city of Yazd, Iran. Semi-structured interviews were conducted with purposefully selected fourteen Zoroastrian older patients and four Zoroastrian priests in 2019. The main extracted themes included performing certain religious behaviors and having sincere religion-based beliefs as employed mechanisms for better coping with their chronic diseases. Prevalent dilemmas/barriers with mitigating impact on the coping capacities in dealing with a persistent illness was another predominant identified theme. Identification of RCMs that religious and ethnic minorities are using to better confront diverse life events, such as chronic diseases, could pave the path to expand new approaches in planing sustainable disease management and proactive quality of life improvement initiatives.

Urinary incontinence and related quality of life among elderly women in Tabas, South Khorasan, Iran.

BACKGROUND: Urinary incontinence (UI) is one of the most common problems in old age that is often seen in women, which causes not only physical problems but also psychological, social, economic problems and poor quality of life. The aim of the present study was to evaluate the UI and related quality of life (QoL) in elderly women. METHODS: This cross-sectional study enrolled 369 women over 60 years old and living in Tabas city, Iran who were selected by cluster random sampling method. The instruments included the International Consultation on Incontinence Questionnaire-Short Form, the International Consultation on Incontinence Questionnaire Urinary Incontinence Quality of Life Module, and a demographic questionnaire. Data analysis was carried out using independent t-test, chi-square, and logistic regression in SPSS software. RESULTS: The UI prevalence among participants was 24.9% and stress urinary incontinence was the most common type (40.2% of all elderly patients). The mean UI-related QoL score was 38.04 ± 11.67 from the score range of 22-76. There was a significant positive correlation between UI-related QoL score and UI score (r = 0.585, p < 0.001). Age, body mass index (BMI), constipation, history of cesarean section, hypertension, and the use of angiotensin receptor blockers are factors increasing the odds of having UI in this study population. CONCLUSION: Aging, some chronic diseases, high BMI, and the use of some drugs are related to UI prevalence. Also, it is associated with lower QOL among elderly women. Designing appropriate intervention programs, controlling chronic diseases, training in the proper use of drugs, and also some physical exercises can be effective in controlling and improving this common syndrome of old age and promoting their QoL.

Psychometric Properties of the Mobile Health Literacy Scale in the Workers of an Automotive Metal Sheet Factory in Shahrekord, Iran.

BACKGROUND: Mobile health (mHealth) literacy refers to the ability to use mobile devices to search, find, understand, evaluate, and use health information to identify or solve a health problem. Health literacy skills are important for improving health information interventions and it will not be possible to investigate this skill unless a valid and reliable tool is developed. OBJECTIVE: This study aimed to investigate the psychometric properties of the Persian version of the mHealth Literacy Scale in the workers of an automotive metal sheet factory in Shahrekord, Iran. METHODS: After forward and backward translation of the scale and ensuring the accuracy of the translation, qualitative face validity was examined by an expert panel and quantitative face validity by 10 workers using the item impact score. Content validity index (CVI) and content validity ratio were investigated by seven experts on health education. To investigate construct validity, the scale was completed by 200 workers. One-factor and two-factor structures of the measure were studied using confirmatory factor analysis and the reliability was evaluated using Cronbach's alpha coefficient. KEY RESULTS: The CVI for each of the three parameter (relevance, clarity, simplicity) was rated 0.75 to 1 for each item. Confirmatory factor analysis showed that the one-factor model had a better fit to the data than the two-factor model [goodness of fit index = 0.985(>0.90), comparative fit index = 0.999 (>0.90), Tucker-Lewis index = 0.996 (>0.90), normed fit index = 0.994(>0.90), root mean square error of approximation = 0.038(< 0.08)]. Furthermore, the scale had an acceptable internal consistency (Cronbach's alpha = 0.964). CONCLUSION: The Persian version of mHealth Literacy Scale has satisfactory reliability and validity and could be used as an effective tool to evaluate mHealth literacy among Iranian workers. [HLRP: Health Literacy Research and Practice. 2022;6(4):e257-e261.] Plain Language Summary: This cross-sectional study was conducted on 200 workers of an automotive metal sheet factory in southwest Iran to investigate the psychometric properties of the Persian version of the mHealth Literacy Scale. The results demonstrated that one-factor structure was more appropriate for evaluating mHealth literacy among Iranian workers.

Nutrition literacy and its related demographic factors among workers of Taraz Steel company, Chaharmahal and Bakhtiari, Iran.

Background: Nutrition is critical to prevent some chronic diseases. Nutrition literacy refers to ability to gain, understand and evaluate nutrition facts to choose appropriate foods. Nutrition literacy has recently drawn the attention of professionals with respect to health promotion. The purpose of this study was to investigate nutrition literacy and potentially related demographic factors among workers of a steel company in Chaharmahal and Bakhtiari province, southwest Iran. Methods: In this descriptive-analytical study in 141 workers of Taraz Steel company in 2021, participants were selected by convenience sampling and a self-report nutrition literacy scale nativized to Iranians was used to collect data. Data were analyzed by SPSS 22 using Mann-Whitney U test, Kruskal-Wallis test and Spearman's correlation coefficient. Results: About 75% of workers had adequate nutrition literacy and around 24% inadequate nutrition literacy. The highest percentage of mean score was obtained for determination of food groups (85.4%) and the lowest for calculation of food units (47%). The mean score of nutrition literacy was significantly higher in people with higher education (P = 0.020). Also, people with adequate monthly salary attained a higher mean score on determination of food groups (P = 0.021) and higher overall nutrition literacy (P = 0.003) compared to other people. No relationship was observed between nutrition literacy and body mass index as well. Conclusion: Most workers have adequate nutrition literacy but their scores on calculation of food units are relatively low. It is essential for policymakers to collect information on the level of nutrition literacy in different populations, especially Iranian workers, to reduce the prevalence of nutrition-related chronic diseases.

Psychometric properties of the physical environment problems and barriers scale in older adults' homes using an ergonomic approach.

BACKGROUND: As older adults prefer to live in their homes, it is of paramount importance to examine the adaptation of the environment to the older adults' capabilities. OBJECTIVE: The aim of this study was to develop and evaluate psychometric properties of a scale to measure physical environment problems and barriers in older adults' homes using an ergonomic approach in Iran. METHODS: This mixed-method investigation was conducted in two stages in Yazd, Iran. The primary 71-item version of the questionnaire was developed according to qualitative findings and a thorough review of the literature. Then the psychometric characteristics, including face, content, construct validity, were assessed. Content validity was also assessed using CVI and CVR. Finally, its reliability and construct validity were confirmed by composite reliability (CR), Fornell-Larker matrix, and confirmatory factor analysis (CFA) using Smart PLS software version 3. RESULTS: The face validity of the developed scale was acceptable, and the mean scores of CVI and CVR were 0.78 and 0.84, respectively. The preliminary draft of the scale was categorized into seven dimensions. Factor validity and reliability were confirmed by acceptable factor loadings, and desirable realms of composite reliability (>0.7) average variance extracted (>0.5). The cross-loading method and the Fornell-Larker matrix were used to evaluate the divergent validity of the scale, and the results confirmed its acceptable fit. CONCLUSIONS: The findings indicated that reliability reached acceptable values, and different aspects of validity were almost confirmed. Accordingly, the questionnaire was to measure physical environment problems and barriers in older adults' homes; however, it requires further validation for future use in other contexts.

Psychometric properties of the Persian version of abridged Connor-Davidson Resilience Scale 10 (CD-RISC-10) among older adults.

BACKGROUND: Resilience is an ability of an individual to respond positively to environmental challenges. This ability could help elderly people to better cope with their age-related changes and diseases. The aim of this study was to examine the psychometric properties of Persian version of abridged Connor- Davidson scale of resilience among Iranian elderly people with chronic diseases. METHODS: Standard translation/back-translation procedure was applied to prepare the Persian version of abridged Connor-Davidson scale of resilience (CD-RISC 10-P) and its face and content validity were examined by an expert panel. The internal consistency and reliability of the drafted CD-RISC 10-P were investigated using the Cronbach's alpha and intra-class correlation coefficients. A sample of 400 Muslim and Zoroastrian Persian older adults residing in the city of Yazd, Iran was recruited to assess factor structure of CD-RISC 10-P using the confirmatory factor analysis. RESULTS: The calculated values of the Cronbach's alpha (0.89) and ICC (0.90) coefficients were in the within of acceptable range. The confirmatory factor analysis outputs also confirmed the unidimensionality of the CD-RISC 10-P (RMSEA = 0.073, SRMR = 0.030). CONCLUSIONS: The study findings showed that the CD-RISC 10-P is a valid and reliable scale to measure resilience with age-related challenges of chronic diseases among Persian-speaking elderly people. Cross-cultural adaptability of the CD-RISC 10-P is recommended to be assessed in different subgroups of the Iranian elderly people and possibly in other Persian-speaking populations of different countries.

Predictors of regular physical activity behavior and quality of life in post-menopausal Iranian women based on the multi-theory model.

This research aims to identify the predictive factors related to the initiation and sustaining of regular physical activity behaviors and their influence in adapting to menopausal symptoms. The study uses the multi-theory model (MTM) as the conceptual framework. The descriptive cross-sectional research was conducted on 200 post-menopausal women aged 45-55 years. All participants were referred to health centers, where they completed a three-part questionnaire involving: demographic information, a questionnaire on the influence of regular physical activity on the onset and sustaining of menopause using the MTM, and a standard questionnaire of menopausal quality of life. Data were collected, managed, and analyzed using SPSS 20 and AMOS 23 software. This study reveals that behavioral confidence and changes in the physical environment with coefficients of 0.55 and 0.14 respectively had a direct and significant impact on the initiation of regular physical activity-related behaviors during menopause. The construct of participatory dialogue had no significant impact on the initiation of regular physical activity-related behaviors and menopause. Regarding the sustainability of regular physical activity, the emotional transformation construct with a coefficient of 0.73 and change in social environment construct with a coefficient of 0.11 directly and significantly impact keeping regular physical activity behaviors due to menopause. Therefore, interventions based on the MTM can prove very useful for this specific population. In addition, the use of constructs validated by this study will especially be useful in producing evidence-based intervention for the target population.

Identifying barriers and problems of physical environment in older adults' homes: An ergonomic approach.

BACKGROUND: The main purpose of ergonomics is environment adaptation to humans, and the root cause of the barriers and problems of the older adults is the mismatch between the home environment and their limitations. OBJECTIVE: The present study aimed to identify and explain physical environment barriers and problems among older adults' homes in Yazd, Iran. METHODS: This qualitative study was conducted as conventional content analysis. In total, 53 participants including 36 older adults and 17 caregivers were enrolled in the study. The participants were selected using convenience and purposive sampling methods, while the data collection method was a semi-structured interview. The interviews were recorded and transcribed, and then analyzed using MAXQDA11 software. RESULTS: Following data analysis, 268 initial codes were extracted. They were classified into three major categories and 31 sub categories. The main categories are "barriers and problems associated with older adults' sensory limitations," "barriers and problems associated with older adults' motor limitations," and "barriers and problems associated with older adults' cognitive limitations." CONCLUSIONS: Although the data collected from the older adults and their caregivers are in many cases similar, caregivers can provide reasons for the barriers and problems as well as solutions better than the older adults. The data also indicate that most of the problems and barriers are related to motor limitations.

Effect of the fourth generation multi-theory model intervention on the quality of life in Iranian postmenopausal women: A randomized controlled trial.

OBJECTIVES: Menopause is a natural part of women's lives and is associated with a series of complications that can impair their quality of life. This study was conducted to determine the effect of specific educational interventions on the quality of life among postmenopausal women. METHODS: This randomized controlled trial was conducted on 80 menopausal women who met the inclusion and exclusion criteria and were selected through the multi-stage stratified random sampling method. The participants were randomly allocated to either the control or intervention group (40 per group). The intervention comprised 5 × 45-min educational sessions based on the Multi-Theory Model on the predetermined days of the week. The scores of the quality of life level were collected at baseline, immediately, and 3 months after the intervention using the Menopause-Specific Quality of Life questionnaire (MENQOL). The control group received a health advice. RESULTS: Analysis of variance of repeated measures showed a significant interaction between time and intervention. The comparison between the mean score of quality of life of the "before," "immediately after intervention," and "3 months after the intervention" showed a significant difference between the two groups. The intervention group quality of life improved significantly as the intervention went on compared to the control group. CONCLUSION: Structured simple educational programs based on the Multi-Theory Model could be used as a simple and noninvasive intervention that help menopausal women improve their quality of life through menopausal symptoms relief. Further interventions with larger trials may be required to confirm these findings.

The effectiveness of intervention based on the transactional model on improving coping efforts and stress moderators in hemodialysis patients in Tehran: a randomized controlled trial.

BACKGROUND: Present study was conducted to determine the effect of training on coping efforts and stress moderators, based on transactional model of Lazarus and Folkman, in hemodialysis patients. METHODS: This is a randomized controlled clinical trial on 116 hemodialysis patients referred to dialysis centers in Tehran from May to August 2018. The patients were assigned to two experimental and control groups using a simple randomization method. The intervention included 6 training sessions in the form of coping efforts and moderators of transactional model. Data were collected before and 3 months after the intervention. Data were analyzed using SPSS 16. RESULTS: After 3 months training intervention, there was significant increase in the intervention group in the mean scores of coping efforts (P < 0.001), moderators and subscales of emotional regulation from 51.18 ± 20.42 to 64.87 ± 13.18 (P < 0.001), dispositional coping style from 45.56 ± 19.45 to 55.84 ± 18.03 and social support from 49.61 ± 20.14 to 55.55 ± 17.35 (P < 0.005). CONCLUSION: The training based on transactional model was successful in the increase of social support, dispositional coping style and emotional regulation in hemodialysis patients. Therefore, Nurses and healthcare providers can use this program to help hemodialysis patients to increase their adaptation to the illness and reduce stress. TRIAL REGISTRATION: IRCT registration number: IRCT20180524039814N1 ; Registration date: 13-08-2018; Registration timing: retrospectively registered: Last update: 13-08-2018.

Motivation System of Healthy and Safe Nutrition in Iranian Adolescent Girls: A Qualitative Study.

OBJECTIVE: Motivation determines the possibility of an individual's intention to accept health-related behaviors. Despite the important role of the motivational system in conducting healthy and safe nutrition behavior, this issue has not been adequately addressed. The purpose of this qualitative study was to explain the healthy and safe nutrition motivation system among Iranian adolescent girls. METHOD: In this qualitative study, conventional content analysis was used and participants were selected using the purposive sampling method. Semistructured in-depth interviews were conducted with 42 adolescent girls in Shiraz, Iran. The interviews continued until data saturation was obtained. Qualitative data were analyzed using the Graneheim and Lundman qualitative content analysis by MAX-Q-DA (version 10) software. RESULTS: The data analysis resulted in three main categories for the participants' motivational factors for healthy and safe nutrition: (1) maintaining health and social functions, (2) maintaining the family's mental and economic health, and (3) achieving goals and success in life. The first category included two subcategories: "desire to have an appropriate look and appearance" and "fear of diseases and their complications." The second category included two subcategories of "maintaining the family's mental health" and "maintaining the family's economic health." The third category consisted of two subcategories: "desire to form a family and be successful in life" and "achieving the future career goals." CONCLUSION: The motivation to maintain health and social functions, to maintain the family's mental and economic health, and to achieve goals and be successful in life has a powerful impact on the decisions and behaviors of adolescent girls to have safe and healthy nutrition. Therefore, recognizing the motivational system, as a key and determinative factor in developing the adolescents' intention to adopt health-related behaviors, is an effective step to design and develop successful interventions in promoting nutritional behaviors.

The Effect of Integrated Intervention Based on Protection Motivation Theory and Implementation Intention to Promote Physical Activity and Physiological Indicators of Patients with Type 2 Diabetes.

Despite benefits of physical activity, the level of physical activity is not desirable in patients with type 2 diabetes. The aim of this study is the using of integration of intervention based on the theory of protection motivation and implementation intention in order to improve the level of activity in patients with diabetes. This field trial study has been performed on 125 patients with type 2 diabetes. Samples have been randomly selected, and they are divided into two intervention and control groups. In the intervention group, training sessions were conducted based on the protection motivation theory and implementation intention. Physical activity levels, VO2 max, and hemoglobin A1C were measured before and three months after the intervention in the two groups. Data were analyzed by using SPSS 18, and independent t-test, paired t-test, and equivalent nonparametric tests were used for analyzing abnormal data. The results of this study showed that the level of physical activity was higher in the intervention group (p = 0.02). Also, the amount of hemoglobin A1c in the intervention group has been decreased significantly three months later (p < 0.001). In this study, VO2 max and blood lipids were not significantly different in the two groups. However, there was higher VO2 max compared to before the intervention in the intervention group. The present study showed that combining motivational interventions and implementing intention intervention can be effective in promoting the physical activity of patients with type 2 diabetes.

Psychometric Rigor of the Brief Religious Coping Measure (RCOPE) in Persian-Speaking Older Adults.

Religious coping to deal with negative life events has gained considerable attention in recent years. This study was conducted to investigate psychometric properties of the Persian version of Brief RCOPE measure (RCOPE-P). The RCOPE-P was devised using a standard translation/back-translation procedure and its internal consistency and test-retest reliability were estimated using Cronbach's alpha and intraclass correlation coefficients. The instrument's factor structure was appraised in a sample population of 400 older adults with chronic diseases. Positive and negative subscales of the RCOPE-P indicated acceptable internal consistency (0.74, 0.80) and test-retest reliability (0.89, 0.91). Confirmatory factor analysis confirmed fitness of the original 2-factor model (root mean square error of approximation (RMSEA) = 0.046, CFI = 0.967, Tucker-Lewis index (TLI) = 0.953, and standardized root mean square residual (SRMR) = 0.052) to the data obtained from the study. The findings endorsed applicability of the RCOPE-P for the Persian-speaking older adults but its adaptability in other Persian-speaking population subgroups must be further examined.

The effect of education based on PEN-3 cultural model on students' menstrual health behaviors: a mixed method study.

Menstruation is a natural process in girls, but sometimes it is accompanied by beliefs and behaviors with cultural roots that result in poor health consequences; this study aimed to consider perceptions of individual, families and community to current cultural beliefs, and to determine the effect of education based on the PEN-3 cultural model on students' menstrual health behaviors in Iran. Study had a mixed method design. In the qualitative phase, data were collected from students, their mothers and teachers through focused group discussion and in-depth interviews. In the quantitative phase, training was done in four 2-h sessions for intervention group. The data were collected immediately and 2 months after the training by a questionnaire and they were analyzed by Friedman and Wilcoxon non-parametric tests. Training was effective on all of the model structures and significantly increased mean score of the health behavior after training and 2 months later by 8.74 and 13.86, respectively, in intervention group (P<0.05). The perception and behavior of the others and access to sanitary services and products, especially cultural factors affect girls'' menstrual health behaviors, therefore, it is necessary to design the health plans regarding each of these factors, and the cultural context of each community.

Predictors in Initiating and Maintaining Nutritional Behaviors to Deal With Menopausal Symptoms Based on Multi-Theory Model.

This cross-sectional study was conducted in 2019 on 204 postmenopausal women aged 45-55 years who referred to Yazd health centers to determine the predictors in initiating and sustaining nutritional behaviors to deal with menopausal symptoms based on the multi-theory model (MTM). The participants were required to complete the demographic information questionnaire and a researcher-made questionnaire over the effective nutritional behaviors in menopause based on the MTM. The data were summarized and analyzed using SPSS 18 and AMOS23 by running descriptive indicators and path analysis. Behavioral confidence (ß = 0.61, P < 0.001) had a higher predictive power in initiating a nutritional behavior compared to the changes in the physical environment (ß = 0.13, P < 0.05) and participatory dialogue (ß = 0. 10, p < 0.05). Among the behavior-related constructs, only emotional transformation (ß = 0.78, P < 0.001) could predict the behavioral sustaining. A positive and significant association was observed between nutritional behavior sustaining and quality of life (ß = -0.41, P < 0.001). The MTM is an appropriate model for predicting the initiation and sustaining of the nutritional behaviors in dealing with menopause. The behavioral confidence, changes in physical environment, and participatory dialogue constructs played a significant role in predicting the initiation of behavior. The emotional transformation construct was also an important predictor in maintaining nutritional behaviors to deal with menopausal symptoms. So, future researchers are recommended to conduct MTM-based investigations according to the predictive constructs among menopausal women.

Perceived Threats toward Esophageal Cancer among Immediate Relatives of Sufferers: a Qualitative Study.

PURPOSE: Considering life-threatening nature of cancer and the problems that it causes for patients and families, recognizing their perspectives toward this issue is important. Therefore, the aim of this study was to determine perceived threats by immediate relatives of patients with esophageal cancer. METHODS: Using content analysis approach, the present qualitative study was conducted in Golestan Province (north of Iran) in 2018. Through purposive sampling, 23 immediate relatives of patients with esophageal cancer were included in the study. The research techniques included semi-structured and deep interviews. We continued data collection to ensure data saturation was achieved. All interviews were recorded, transcribed, and then analyzed with Graneheim and Lundman's approach of conventional content analysis. The MAXQDA 11 software was applied to conduct the coding process. RESULTS: Following data analysis, two main categories including "perceived susceptibility" and "perceived severity" were identified for perceived threats. The main category of "perceived susceptibility" comprised of four subcategory, namely, perception of individual, environmental, psychological, and nutritional predisposing factors to the disease. Four subcategories were also extracted for the "perceived severity," including perception of physical, psychological, therapeutic, and social consequences of the disease. CONCLUSIONS: Immediate relatives of patients with esophagus cancer perceived high severity and susceptibility toward this disease and considered themselves vulnerable to this disease. Hence, they suffered from a lot of psychological stress. Development of appropriate interventions regarding the effects of disease-related individual and environmental factors and empowerment of individuals with regard to preventive disease behaviors can be an important step for improving the health of this group. REGISTRATION NUMBER: IRCT20180725040588N1, date registered: 2 October 2018.

Readability and suitability assessment of educational materials in promoting the quality of life for postmenopausal women.

INTRODUCTION: Educational materials are frequently used by health providers to inform postmenopausal women about menopause acceptance behavior. However, little attention has been paid to the readability and suitability of these educational materials. The study aimed to determine the readability and suitability of educational materials in promoting the quality of life for postmenopausal women. MATERIAL AND METHODS: Multiple instructional materials and books were used for the design and preparation of educational materials and were then tailored to the target group. Readability was measured by using the readability assessment of materials (RAM); and suitability was determined by the suitability assessment of materials (SAM) that considers characteristics such as content, graphics, layout/topography, and cultural appropriateness. Twenty reviewers, including 10 postmenopausal women, 5 postmenopausal women family members, and 5 health experts scored the educational materials. RESULTS: The mean readability score ±standard deviation (SD) of the educational materials was10 ±1.6 and 8 ±1.4, for the pamphlet and daily activities' booklets, respectively, which were increased to 14 ±0.6 and, 16 ±1.3, after tailoring the content. The average SAM scores before and after tailoring the content were 45% for the pamphlet, which was increased to 81%; 45% for the daily activities' booklets, which was increased to 86%. The increase in all scores was significant (p < 0.001). The final tailored educational material was rated "superior media" on the SAM ratings. CONCLUSIONS: Given that most of the printed materials are suitable for people with higher education levels, health providers are strongly advised to prepare simple and understandable education materials that may increase the likelihood of consumer perception and recall.

Prevalence of complicated grief and related factors in elderly individuals in Sabzevar City, Iran.

AIM: Although often undiagnosed and untreated, prolonged grief and its conversion to complicated grief (CG) can lead to functional impairment. Given the impact of CG on mortality and quality of life in elderly individuals, this study aimed to determine the prevalence of CG and its related factors among the elderly in the city of Sabzevar in Iran. METHODS: The subjects of this cross-sectional study were elderly individuals aged 60 years and older who lived Sabzevar in 2019. Participants were randomly selected in two stages. First, the grief experience of 823 elderly individuals was investigated. Second, the 247 individuals who met the inclusion criteria and had experienced grief were assessed for CG. Data were collected with a demographic information questionnaire, the Brief Grief Questionnaire, and the Geriatric Depression Scale. RESULTS: The prevalence of CG among the participants who had experienced grief was 18.6%. Significant differences in CG prevalence were observed among participants according to age, gender, marital status, occupation, and relationship to the deceased person (P < 0.05). The prevalence of CG was also significantly associated with the deceased person's age, gender, and cause of death; the participant being the deceased's primary caregiver and the participant being with the deceased at the time of death(P < 0.05). Furthermore, CG was significantly higher in people with mild or severe depression than in non-depressed participants (P = 0.01). The odds of CG and sub-threshold CG incidence were 2.94 times higher in women than in men and 3.64 times higher in participants with severe depression than in non-depressed participants. CONCLUSION: Complicated grief is relatively prevalent among the elderly, and it is associated with age, gender, marital status, depression status, and some variables related to the deat time of the deceased. Given the negative effects of CG on individuals and the community, appropriate planning is needed to reduce its incidence in elderly individuals who have experienced grief.