Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study.

Background and objectives: The chronic nature of heart failure requires long-lasting consumption of various medications. Despite the therapeutic benefits of heart failure medications, about 50% of patients with heart failure don't adequately adhere to their medications as prescribed globally. This study aimed to determine medication adherence levels among Jordanians with heart failure and its influencing factors. Materials and Methods: A cross-sectional study was conducted among 164 patients with heart failure attending cardiac clinics in the north of Jordan. The Medication Adherence Scale was used to measure medication adherence. Results: Overall, 33.5% of patients had high adherence, and 47% had partial to poor adherence. The proportion of patients with good to high adherence was significantly higher among patients younger than 60 years, having >high school level of education, being married, living with somebody, and having insurance. Conclusions: Patient-centered approach, targeting age, level of education, marital status, and health insurance coverage, should be developed using evidence-based guidelines to enhance adherence to medication and health outcomes in Jordanian patients with heart failure. The development and implementation of new and feasible strategies, particularly suited to Jordan's healthcare system capabilities, is important to improve medication adherence.

Tackling diabetes: how nurses can make the difference.

This year, World Diabetes Day on 14 November coincides with the International Year of the Nurse and the Midwife, and therefore focuses on highlighting the role of nurses in the prevention and management of diabetes.Diabetes is recognized as an important cause of premature death and disability globally and in the Eastern Mediterranean Region, where its prevalence has been steadily increasing since 1990. Although the annual decline of the risk of dying from a major noncommunicable disease between the ages of 30 and 70 years is slowing globally, diabetes is showing a 5% increase in attributed premature mortality. In 2016, diabetes was the direct cause of 1.6 million deaths globally and 43% of all deaths before the age of 70 years occur due to high blood glucose. Overweight and obesity are the strongest risk factors for type 2 diabetes. In addition, diabetes increases the risk of heart disease and stroke and is a leading cause of blindness, lower limb amputation and kidney failure. A study conducted in 35 countries indicated that people living with diabetes are more likely to experience catastrophic health expenditures with an estimated increase of 4% between diabetic and non-diabetic individuals, regardless of their insurance status.

2020 - the year of the nurse and midwife: a call for action to scale up and strengthen the nursing and midwifery workforce in the Eastern Mediterranean Region.

The World Health Organization (WHO) has declared 2020 as the Year of the Nurse and the Midwife. World Health Day on 7 April is dedicated to supporting nurses and midwives and highlights the central role of these professions in advancing universal health coverage, achieving health-related sustainable development goals, and the Eastern Mediterranean Region Vision 2023: Health for All by All.This year, we sadly mark World Health Day in the face of the devastating COVID-19 pandemic, which has brought to attention more than ever the crucial and invaluable role of health workers, who are working tirelessly day and night to care for patients and save lives. In fighting COVID-19, not only might they become infected and put their own lives at risk, but they also face distress and burnout because of long working hours. In addition, many health workers have to be away from their homes for prolonged periods, for fear of putting their own families at risk of acquiring the infection. Even before the pandemic, the safety and security of health workers in the Eastern Mediterranean Region has been a significant concern, as more than half of the countries of the Region face acute and protracted crises, and 70- 80% of total recorded attacks on health facilities globally occur in the Eastern Mediterranean Region.

Factors Associated with Cervical Cancer Screening Uptake: Implications for the Health of Women in Jordan.

Purpose: The existing factors that influence cervical cancer screening uptake worldwide do not necessarily reflect the situation in Jordan. Therefore, the aim of this study was to determine the factors associated with cervical cancer screening uptake among Jordanian women. Methods: In this cross-sectional study, 500 married Jordanian women aged 21 to 65 years were recruited from eight nongovernmental organisations and community settings in Amman. Data were collected with a self-administered questionnaire regarding sociodemographic and reproductive data, a health utilisation data form, and scales on the perceived benefits of screening, perceived barriers to screening, perceived susceptibility to cervical cancer, and perceptions regarding the severity of cervical cancer. Descriptive statistics, multivariate logistic regressions, and independent t-tests were used in the data analysis. Results: Among the 500 age-eligible women, only 156 (31.2%) had been screened for cervical cancer. Healthcare provider encouragement, years of marriage (odds ratio (OR) = 5.24, confidence interval (CI) = 95%, p = 0.00), and use of the private healthcare sector (OR = 2.20, CI = 95%, p = 0.012) were significant predictors of cervical cancer screening. Conclusion: Cervical cancer screening uptake among Jordanian women is significantly low; determining factors for the decision to undergo screening include encouragement from the healthcare provider, the number of years of marriage, and use of the private healthcare sector. To improve uptake, structured screening programmes need to be implemented in collaboration with national partners and institutions to decrease the incidence of cervical cancer in Jordan.

Exploring woman -Nurse interaction in a Jordanian antenatal clinic: A qualitative study.

BACKGROUND: Effective woman-nurse interaction is critical in providing quality nursing care and would improve the health outcomes and the level of women's satisfaction with health and nursing services. AIM: To explore how Jordanian nurses and pregnant women perceive their interaction during antenatal visits. METHODS: A descriptive qualitative study was conducted using a purposive sample of twelve pregnant women and twelve nurses. Data were collected through four focus group discussions organized at an antenatal clinic of a large hospital in Jordan. The data were analyzed using Giorgi's four stages of data analysis. FINDINGS: Approaches to interaction; barriers to interaction; quality of interaction were the main themes emerged from the data. Nurses and pregnant women also provided suggestions for strengthening the womannurse interaction during antenatal visits. CONCLUSION: The different aspects of interaction described by the participants of this study may raise awareness and appreciation of the important roles health care providers can play in promoting the health outcomes of pregnant women when effective interaction is built and strengthened. Relevant policies and guidelines on improving appointment systems, and continuing education on communication skills and health education would be needed. More attention is required to adopt appropriate antenatal clinical guidelines and protocols to meet women's needs in Jordan.

Exposure to verbal abuse and neglect during childbirth among Jordanian women.

Women's relationship with health care providers in maternity settings during childbirth has a significant impact on their wellbeing and lives. The current study aims to explore women exposure to neglect and verbal abuse during childbirth METHOD: a retrospective cross-sectional descriptive design was conducted at four governmental Maternal and Child Health Centers (MCHCs). A final sample of 390 Jordanian women who gave birth within the last 1-3 months was included in the study. Childbirth Verbal Abuse and Neglect Questionnaire (CVANQ) were developed to collect the data. RESULTS: women's age ranged between 18-45 years, and the mean age was 28 year. 32.2% women reported neglect during their last childbirth, 37.7% women reported verbal abuse during last childbirth. Women who reported being neglected also reported being verbally abused. An inverse relationship was found between age and neglect and verbal abuse. Neglect was significantly associated with women's receiving information regarding their rights and responsibilities, being attended by health care providers. Additionally, verbal abuse was significantly associated with being attended by health care provider. CONCLUSION: child birthing women participated in the current study was exposed to neglect and verbal abuse. This is the first study to report the prevalence of neglect and verbal abuse among child birthing women in Jordan. Research studies is needed to identify the consequences of exposure to neglect and verbal abuse during childbirth on women's psychological, emotional, and physical well being. Training classes and education for health care providers about how to care and communicate with child birthing women.

Delphi Survey of Clinical Nursing and Midwifery Research Priorities in the Eastern Mediterranean Region.

PURPOSE: As the shortage of nurses and midwives is expected to worsen in the Eastern Mediterranean region concomitantly with a growing focus on achievement of universal health coverage, nurses and midwives are expected to fill major gaps in health care. Hence, the need for a solid evidence base for nursing practice and a clear direction for clinical nursing research are paramount. Therefore, a Delphi survey was conducted to determine clinical (research focused on patient outcomes) nursing and midwifery priorities for research within this region. DESIGN: A Delphi survey, using iterative rounds of an online survey of regional clinical nursing and midwifery research experts, was conducted between January and April 2016. METHODS: Consensus was determined by percentage agreement on level of priority for topics as determined by participants. Additionally, results were compared between countries within the region by income and mortality levels using Kendall's tau. FINDINGS: Critical research topics were focused on public/community/primary care as well as emergency preparedness for disasters, and these priorities are well aligned with gaps in the literature for this region. There were statistically significant differences between priority level and country mortality group for geriatrics, self-management of disease, and sexually transmitted infections. CONCLUSIONS: Critical research priorities should focus on population-based health topics. Between-country differences should be analyzed further. A clinical research database for the region may help improve research access for nurses and midwives. CLINICAL RELEVANCE: Practicing nurses and midwives lack extensive evidence (including culturally relevant evidence) on which to practice. Increasing research in areas identified in this survey may improve patient outcomes and quality of care regionally.

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

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

Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan.

BACKGROUND: There are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan. METHODS: A cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian refugees outside of camps. To obtain information on chronic conditions, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences by care-seeking for these conditions were examined using chi-square and t-test methods and characteristics of interest were included in the adjusted logistic regression model. RESULTS: Among adults, hypertension prevalence was the highest (9.7%, CI: 8.8-10.6), followed by arthritis (6.8%, CI: 5.9-7.6), diabetes (5.3%, CI: 4.6-6.0), chronic respiratory diseases (3.1%, CI: 2.4-3.8), and cardiovascular disease (3.7%, CI: 3.2, 4.3). Of the 1363 NCD cases, 84.7% (CI: 81.6-87.3) received care in Jordan; of the five NCDs assessed, arthritis cases had the lowest rates of care seeking at 65%, (CI:0-88, p = 0.005). Individuals from households in which the head completed post-secondary and primary education, respectively, had 89% (CI: 22-98) and 88% (CI: 13-98) lower odds of seeking care than those with no education (p = 0.028 and p = 0.037, respectively). Refugees in North Jordan were most likely to seek care for their condition; refugees in Central Jordan had 68% (CI: 1-90) lower odds of care-seeking than those in the North (p = 0.047). CONCLUSION: More than half of Syrian refugee households in Jordan reported a member with a NCD. A significant minority did not receive care, citing cost as the primary barrier. As funding limitations persist, identifying the means to maintain and improve access to NCD care for Syrian refugees in Jordan is essential.

Sexual Offenses Among Children in the North of Jordan: An Exploratory Study.

Sexual offenses are an important global health problem threatening people of all age groups. There are no reported studies regarding sexual violence among children in Jordan. Therefore, this study aimed to examine the problem of sexual violence among children in the Northern region of Jordan. A retrospective design was adopted to review all reports from the Forensic Medicine Teaching Center of North of Jordan clinic on cases of sexual-related assaults that occurred between 2003 and 2007. Reports were reviewed for age, gender, toxicological analysis, and relevant information provided by victims and their relatives. Results indicated that 53% of the cases were male victims, with a male to female ratio of 1:1. Ages ranged from 3 to 18 years with a mean age of 12.5 years. Most cases were considered indecent assaults, while 37.1% were cases of rape. In most cases, offenders were strangers. It could be concluded that Jordanian children are as susceptible to sexual assaults as their counterparts worldwide. This study is the first to report sexual offenses among children in Jordan. As such, it provides baseline data that can be used to inform policy and prevention strategies focused on reducing sexual violence among this vulnerable segment of the Jordanian population.

Descriptive survey of the contextual support for nursing research in 15 countries.

BACKGROUND: Global research productivity depends on the presence of contextual factors, such as a doctorally prepared faculty, graduate programmes, publication options, that enable the conduct and publication of studies to generate knowledge to inform nursing practice. OBJECTIVES: The current study aimed to develop and test an instrument that measures the level of contextual support for nursing research within a specific country, allowing comparisons between countries. METHOD: After development of a 20-item survey with seven factors and 11 criteria based on a literature review, a quantitative descriptive e-mail survey design was used. RESULTS: Nurse researchers (N=100) from 22 countries were invited to participate. The response rate was 39% from 15 countries. Ethics approval was obtained by investigators in their country of origin. Results showed wide variation in the level of contextual support. The average total level of support across all countries was 26.8% (standard deviation [SD]=14.97). The greatest variability was in the area of availability of publishing opportunities (ranging between no suitable journals in a country to over 100). The least variability was in the area of availability of local enabling support (SD=7.22). This research showed wide differences in the level of contextual support for nursing research. CONCLUSION: The survey instrument can be utilised as a country assessment that can be used to strategically plan the building of infrastructure needed to support nursing research. Contextual support for nursing research is an antecedent of strong science. Building infrastructure for nursing science is a priority for global health.

Parenting from a Jordanian perspective: findings from a qualitative study.

PURPOSE: The main purpose of this qualitative descriptive study was to explore Jordanian parents understanding of parenting. METHODS: A convenient sample of 110 Jordanian parents recruited from four health centers participated in the study. A semi-structured one-on-one interview with open-ended questions was used to collect the data. RESULTS: Three thematic areas reflecting parent understands of parenting were identified; parenting as embraced by Islam, transferring of cultural values and traditions, and parenting as a challenge. CONCLUSIONS: Parenting behavior and its effectiveness are reflected by the strong interplay of Islamic teachings, socio-cultural values and traditions in addition to the challenges and difficulties of being a parent. CLINICAL RELEVANCE: As the ultimate goal of parenting is to promote the wellbeing and the development of children, it is crucial that health care providers involved in the design and delivery of family and children's services have a thorough understanding of how parents perceive parenting and how their understanding can be integrated in programs to enhance parental roles.

Adversities of being infertile: the experience of Jordanian women.

OBJECTIVE: To describe and interpret the experiences of and adversities faced by infertile Jordanian women as described from their own perspectives. DESIGN: A qualitative descriptive design. SETTING: The women were interviewed at a nonprofit women's organization in the north of Jordan. The organization focuses on empowerment and health issues. PATIENT(S): This study included a purposive sample of 25 infertile Jordanian women who were unsuccessfully trying to conceive for a minimum of 1 year, and who were receiving treatment for infertility. INTERVENTION(S): Face-to-face, in-depth, semistructured interviews were conducted, audiotaped, and transcribed using thematic analysis. MAIN OUTCOME MEASURE(S): Outcomes were measured using thematic analysis of the interview transcripts. RESULT(S): Four key adversity themes emerged from the data: the adversity of incomplete being, the social adversity of being infertile, the adversity of another wife, and the adversity of changes in the marital relationship. CONCLUSION(S): Jordanian women are seriously affected by infertility and experience personal, social, and marital adversities, which affect their well-being. These adversities need to be conceptualized within a framework that can be used to empower and counsel infertile women in all aspects of life.

Differences between patients' expectations and satisfaction with nursing care in a private hospital in Jordan.

A descriptive correlation study was conducted to describe the differences between patient expectations and satisfaction with nursing care, and to determine the relationships among patient's satisfaction with nursing care and selected sociodemographic variables. A convenience sample of 250 patients with different medical, surgical and gynaecologic diagnoses was recruited to participate in the study, which was carried out at a private hospital in Amman. Two research instruments and a sociodemographic data form were used for data collection: The Patient Expectations Questionnaire and Patient Satisfaction with Nursing Care Quality Questionnaire. The results indicated that patients were more satisfied with technical and ethical aspects of nursing care whereas they were less satisfied with nursing care during the night shift as well as with professional information provided by the nurses. The difference between patients' expectations and satisfaction was statistically significant. Patients' opinions regarding their expectations and their satisfaction with nursing care can be considered as an important opportunity for nurses to plan and implement appropriate strategies that improve the quality of nursing care.

Prevalence of violence during pregnancy: findings from a Jordanian survey.

BACKGROUND: Violence during pregnancy is a significant health and social problem. In the last few years several factors have contributed to the emergence of family violence as a high priority social and health issue in Jordan, and the acknowledgement that abuse during pregnancy is a harmful act to the mother and the fetus. The purposes of this study were to investigate the prevalence of physical, emotional, verbal, and sexual violence on pregnant women, and to describe the relationships between violence and selected study variables. METHODS: A descriptive study was conducted using a self-administered questionnaire. A convenience sample of 316 pregnant women was recruited from five Maternal and Child Health Centers, located in Irbid City in the North of Jordan. RESULTS: The prevalence of physical, emotional, verbal and sexual violence by husbands during pregnancy was 10.4%, 23.4%, 23.7%, and 5.7%, respectively. Prevalence of physical, emotional and verbal violence by a family member other than the husband was 1.9%, 11.1% and 13.9%, respectively, and most perpetrators were the mother in-law. Data also showed that there was a significant association between prevalence of violence and unplanned pregnancy, the pregnant women's perception of their husband's violent attributes and the women's low self-esteem. Pre- and post-natal visits should include assessment for family violence and intervention when violence or abuse is identified. The findings support continued public awareness of family violence to bring about social and political changes that increase reporting and reduce incidence of violence in Jordan.

Jordanian mother's report of their childbirth experience: findings from a questionnaire survey.

The main aim of this study is to document women's perceptions of the different aspects their childbirth experience including expectations, satisfaction and self-control. Other aspects of the labour process including length of labour, difficulty of labour, effectiveness of pain control, expectations of pain level, perception of level of involvement in decisions among other variables were also explored. A descriptive cross-sectional design was used to achieve the aim of this study. A convenience sample of 177 Jordanian mothers was used. They were recruited from three primary health-care centres located in Irbid, north of Jordan. Findings of the study indicated that women had a more painful labour than they expected, they were scared of the experience of labour, they went through different procedures during labour including induction and episiotomy, and perceived that they had an intense childbirth experience. The majority of participants reported that they were not satisfied with the different aspects of the childbirth experience and perceived that they had little control during childbirth. These findings should be considered by all health-care providers, hospital administrators and policy-makers to plan and implement appropriate strategies that could help women go through the childbirth experience with less fear and anxiety and empowered with coping mechanisms that could reduce their dissatisfaction with their childbirth experience and to help them regain more control during childbirth. Such strategies might include reconsidering staffing in the maternity units and patient nurse or midwife ratio.

Why do Jordanian women stay in an abusive relationship: implications for health and social well-being.

PURPOSE: The purpose of this study was to explore why Jordanian women stay with an abusive husband. DESIGN: The study used a qualitative approach to collect data from 28 abused women who were recruited through their community during the summer and fall of 2007. METHODS: Data were collected using an open-ended question through one-on-one in-depth interviews. FINDINGS: Results from analysis of the qualitative data revealed that abused Jordanian women identified five main reasons for staying with an abusive husband: the inherited social background, financial dependency, lack of family support, sacrificing self for the sake of the children, and the adverse social consequences of divorce. CONCLUSIONS: The results indicate that Jordanian women are strongly bound by traditions and cultural rules and lack all means of empowerment. Results of the study have implications for healthcare providers, social workers, policy makers, and educators to enhance the health and social well-being of Arab Muslim women in Jordan. The findings may also apply to Arab families immigrating to the United States, Canada, and Europe who tend to bring their cultural beliefs, values, and norms, and may help healthcare professionals dealing with violence against women in these countries. CLINICAL RELEVANCE: Healthcare professionals worldwide need to play an instrumental role in providing culture-specific and evidence-based care to empower women staying in abusive relationships, taking into consideration the influence of Arab Muslim culture.

Breastfeeding practices among Jordanian women.

The purpose of the study was to explore Jordanian women's breastfeeding beliefs and practices including exclusive breastfeeding. A descriptive cross-sectional design with a convenience sample of 200 Jordanian mothers was used. The majority of mothers were muliparous and were recruited from primary health-care centres within 6 weeks of a normal vaginal birth or an instrumental delivery. Eligible women, who met the inclusion criteria, were invited to participate in the study. A sociodemographic data form and a 14-item questionnaire concerning different aspects of breastfeeding beliefs and practices were developed for self administration. This study indicated high early initiation of breastfeeding. Most mothers gave supplements other than breastfeeding, including water without knowing that this supplementation could affect exclusive breastfeeding or the continuation of breastfeeding. Finding of this study shed some light on the current breastfeeding practices including exclusive breastfeeding among Jordanian women. Women need to be better educated about breastfeeding. Therefore, more efforts and resources should be put into providing opportunities for education to discuss breastfeeding during antenatal care. This Jordanian study could be relevant to Arabic women in the West, because cultural beliefs and practices are likely to be part of immigrant woman's perceptions about breastfeeding practices.

Violence against women: unveiling the suffering of women with a low income in Jordan.

The descriptive qualitative study documents experiences of Jordanian women abused by their husbands. Thirteen married women living with an abusive husband were recruited from a major primary healthcare center. The women described forms, intensity, and consequences of their husband's acts. Despite their anguish, women justified, normalized, and tolerated abuse; this acceptance reflected their cultural values and norms. Implications for nursing practice include (a) identifying abused women, (b) empowering them with knowledge to change their sociocultural perceptions of marital relationships, (c) designing interventions that address their needs, and (d) educating health care providers to take a role in addressing spousal abuse.