Needs Assessment and the Identification of Palliative Care Dimensions of the Essential Service Package for the Elderly with Alzheimer's Disease: A Mixed Exploratory Study.

AIM: This study was conducted with the aim of assessing the needs and determining the care dimensions of the essential palliative care service package for the elderly with Alzheimer's disease. METHOD: The mixed exploratory study was conducted in three phases. The first phase of the study was conducted in the form of a qualitative study and a literature review. This qualitative research was done through in-depth and semi-structured interviews with 19 qualified caregivers (11 informal caregivers and 8 formal caregivers) The samples were selected using the purposive sampling method by referring to hospitals, nursing homes, and active branches of the Alzheimer's Association in some provinces. In the second phase, the dimensions of palliative care were codified, and in the third phase, the prioritization and the validation of the dimensions of palliative care were performed in the form of two Delphi rounds. RESULTS: Based on the results of the first phase of the study, the care dimensions of the service package were placed in eight categories based on National Consensus Project. In the second phase, the needs of Alzheimer's patients were arranged in the form of a questionnaire consisting of 8 parts, with 180 indicators. Then, in the third phase, the dimensions of the palliative care essential package were designed with 74 items in the form of 4 dimensions. CONCLUSION: The dimensions of the essential service package of palliative care included a series of interventions as well as physical, psychological, cognitive, and spiritual support.

Investigating the predictive role of spiritual health, social support, and quality of life in self-care behaviors among heart failure patients.

BACKGROUND: Self-care behaviors, which have a vital role in the management of heart failure disease, are influenced by several factors that are of paramount importance. This study aimed to determine the predictive role of spiritual health, social support, and quality of life in self-care behaviors among heart failure patients. MATERIALS AND METHODS: This descriptive-analytical study was conducted from July to September 2021 on 203 patients with heart failure. Samples were selected by convenience sampling method from six centers in Ahvaz city. Data were collected using a clinical-demographic information questionnaire, the European Heart Failure Self-care Behavior Scale (EHFScBs), the Multidimensional Scale of Perceived Social Support (MSPSS), the 12-Item Short Form Health Survey (SF-12), and Paloutzian and Ellison's Spiritual Well-being Scale. Data analysis was performed with SPSS 16 using descriptive and analytical statistical methods including Pearson's correlation coefficient, regression analysis, independent t-test, and analysis of variance. RESULT: The mean and standard deviation of the age of the female and male participants were 63.54 ± 14.03 and 62.34 ± 13.79, respectively. The majority of the participants (54.2%) were female, had primary education (23.2%), and were married (82.8%). Statistically significant relationships were observed between perceived social support and self-care (r = -0.22, P < 0.01), between spiritual health and self-care (r = -0.39, P < 0.01), and between the quality of life and self-care (r = 0.62, P < 0.01). However, no such relationship was found between demographic characteristics and self-care. CONCLUSION: Considering the predictive role of spiritual health, social support, and quality of life in self-care behaviors, it is necessary for planners to pay special attention to these factors when designing educational-supportive programs for these patients.

Predictors of Adherence to Treatment in Hemodialysis Patients: A Structural Equation Modeling.

Background: Non-compliance to the treatment is a major problem in hemodialysis patients. This study aimed to determine factors predicting adherence to treatment in hemodialysis patients in selected cities of Khuzestan province, Iran. Methods: This cross-sectional study was conducted on 500 patients undergoing hemodialysis in Ahvaz, Shush, Shushtar, and Dezful cities. The data collection tools were ESRD-AQ, perceived health, perceived social support, Beck Depression, self-efficacy, and demographic and clinical factors questionnaires. Data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson's correlation coefficient. Structural equation modeling (SEM) was employed to analyze the relationship between various exogenous and endogenous or mediating variables. Results: The results showed that all predicting variables of perceived social support, depression, self-efficacy, and perceived health had been associated with the variable of adherence to treatment. Accordingly, there was a reverse correlation between social support and depression (p< 0.001, r= -0.94), as well as depression and self-efficacy (p< 0.001, r= -0.87). There was a direct correlation between self-efficacy and perceived health (p< 0.001, r= 0.79), perceived health and adherence to treatment (p< 0.001, r= 0.72). Fitness indices also indicate the adequacy of the proposed model (X2/df= 4.94, CD=0.937, SRMR=0.076, TLI= 0.870, CFI= 0.873, RMSEA= 0.071). Conclusion: The results showed that high social support, low level of depression, high perceived self-efficacy, and high perceived health predicted better compliance with the treatment in hemodialysis patients. The proposed model can be used as a framework to improve adherence to treatment regimens in hemodialysis patients.

Psychosocial Experiences of Older Women in the Management of Urinary Incontinence: A Qualitative Study.

Introduction: Urinary incontinence is a prevalent disorder amongst older women. Identifying the psychosocial experiences of older women in disease management can improve the patient care process. Hence, the present study aimed to determine the psychosocial experiences of older women in the management of urinary incontinence. Methods: This qualitative study was conducted using conventional content analysis. The study data were collected via unstructured in-depth face-to-face interviews with 22 older women suffering from urinary incontinence selected via purposive sampling. Sampling and data analysis were done simultaneously and were continued until data saturation. The interviews were recorded, transcribed, and analyzed using the method proposed by Graneheim and Lundman. Results: The results indicated that the older people with urinary incontinence had various psychosocial experiences while living with and managing this disease. Accordingly, four main themes were extracted from the data as follows: "problem incompatibility with the disease," "mental impasse," "facing social restrictions," and "concealment and social escapism." Conclusion: The findings demonstrated that older people with urinary incontinence experienced significant psychosocial pressures while living with this disorder, which affected their psychosocial well-being. Thus, paying attention to these psychosocial experiences while supporting and taking care of these patients can positively impact their psychosocial health and quality of life.

Explain the Experience of Family Caregivers Regarding Care of Alzheimer's Patients: A Qualitative Study.

Introduction: Due to the long-term and progressive nature of Alzheimer's disease, these patients need caregivers who will be responsible for their long-term care and who may then experience an increasing burden related to the progressive disease course, so it is important to understand the experiences of caregivers. The aim of this study was to explain the experience of family caregivers regarding care of Alzheimer's patients. Methods: The present qualitative study employed a conventional content analysis approach and was conducted in Iran in 2020. This research was done through in-depth and semi-structured interviews with 11 qualified caregivers enrolled in a purposive sampling method. Interviews continued until data saturation. Data analysis was performed simultaneously with data collection. Interviews were recorded, transcribed and analyzed through Graneheim and Lundman style content analysis and data management was done with MAXQDA software. In order to achieve the accuracy and validity of the study, the Four-Dimensions Criteria (FDC) by Lincoln and Guba, credibility, dependability, confirmability, and transformability were considered and used. Results: A total of 11 caregivers with mean age and standard deviation 48, ±26.12 participated in the study. The acquired data were put in two main categories of "burnout and exhaustion" with six subcategories and "excellence and personal growth" with three subcategories. Conclusion: In this study, we found that perceptions of caregivers' role were not the same among study participants, who experienced both positive and negative dimensions of care provision to AD patients. The care experience has a spectrum that, in some people, leads to positive outcomes such as growth. A major part of caregiver challenges is related to the burden of caregiving strain and the erosive nature of the disease. Therefore, health planners should identify the challenges, pain and suffering of caregivers and seek to address them through appropriate strategies.

Explaining Caregivers' Perceptions of Palliative Care Unmet Needs in Iranian Alzheimer's Patients: A Qualitative Study.

Introduction: The needs of Alzheimer's patients are very complex and diverse and many of them are considered unmet needs. Understanding and responding to the unmet and complex needs of Alzheimer's patients can affect the quality of care. Therefore, the present study aimed to explain the perception of formal and informal caregivers of the unmet needs of Iranian Alzheimer's patients. Methods: The present qualitative study employed a Directed Content Analysis approach and was conducted in Iran in 2020. This research was done through in-depth and semi-structured interviews with 19 qualified caregivers enrolled (11 informal caregivers and 8 formal caregivers) with the mean age of 46.05 ± 10.98 years in a purposive sampling method. Interviews continued until data saturation. Data analysis was performed simultaneously with data collection. After recording and transcribing, the data were analyzed using the Elo and Kyngas method based on the National Consensus Project framework (NCP). Data management was done with MAXQDA software. In order to achieve the accuracy and validity of the study, the criteria presented by Lincoln and Guba Credibility, Dependability, Confirmability, and Transformability were considered and used. Results: The mean age of participants was 46.05 ± 10.98. Participants in this study acknowledged that Alzheimer's patients need comprehensive needs management with a holistic approach to increase quality of life. This theme based on the NCP framework consists of seven main categories including "Structure and processes of care," "Physical aspects of care," "Psychological and psychiatric aspects of care," "Social aspects of care," "Cultural aspects of care," "Care of the patient nearing the end of life," and "Ethical and legal aspects of care" with 16 subcategories. Conclusion: The findings of this study provide a deep understanding of the unmet needs of Alzheimer's patients in Iran. Identifying the unmet needs of patients can pave the way for the treatment team to provide effective solutions to meet the needs and empower caregivers to provide comprehensive care for patients.

Experiences of Urinary Incontinence Management in Older Women: A Qualitative Study.

INTRODUCTION: Older women have various experiences regarding the management of urinary incontinence depending on the societies they live in and their cultural backgrounds. The present study aimed to determine older women's experiences in urinary incontinence management. METHODS: The present qualitative study employed a conventional content analysis approach and was conducted in Iran from 2019 to 2020. In this research, the data were collected through face-to-face unstructured in-depth interviews with 22 older women suffering from urinary incontinence selected via purposeful sampling. The interviews were continued until reaching the data saturation point. Data analysis was performed simultaneously with data collection. The interviews were recorded, transcribed, and analyzed through Graneheim and Lundman style content analysis, and data management was done using the MAXQDA software. In order to achieve the accuracy and validity of the study, the Four-Dimensions Criteria (FDC) by Lincoln and Guba, namely credibility, dependability, conformability, and transformability, were considered and used. RESULTS: This study was conducted on 22 older women suffering from urinary incontinence with the mean age of 66.54 ± 5.76 years. The acquired data were put in four main categories of "resilience" with three subcategories, "change in lifestyle" with six subcategories, "attempt for treatment of the condition" with three subcategories, and "receiving support" with two subcategories. CONCLUSION: The study results indicated that the older women suffering from urinary incontinence were resilient against the condition, had changed their lifestyles to manage the condition, and sought treatment. In addition, receiving support from the family and the society played a significant role in the follow-up and management of the condition. The present study findings can help healthcare team members focus on urinary incontinence, design care programs for older women with this condition, and improve their quality of life. Furthermore, focusing on young and middle-aged women's health, providing them with the necessary training for taking care of the genitourinary system, and raising their awareness for preventing urinary incontinence during old ages can be helpful. Moreover, increasing the healthcare team's sensitivity and following the patients up can help diagnose, manage, and treat the condition before exerting adverse impacts on their quality of life.

The Effects of a Training Program Based on the Health Promotion Model on Physical Activity in Women with Type 2 Diabetes: A Randomized Controlled Clinical Trial.

BACKGROUND: Physical activity among women with type 2 Diabetes Mellitus (DM) is an undesirable level. This study aimed to determine the effect of a training program based on the Health Promotion Model (HPM) on physical activity in women with type 2 DM. MATERIALS AND METHODS: This randomized clinical trial was performed on 128 women with type 2 DM, who were randomly assigned to control and intervention groups. Data were collected using the Baecke Physical Activity Questionnaire (BPAQ) and a researcher-made questionnaire designed based on the HPM constructs before and 2 months after the intervention. The training was carried out in four sessions in the intervention group and the control group received regular education at the clinic. Data were analyzed using Chi-square, Fisher's exact test, paired t-test, independent t-test, and Mann-Whitney and Wilcoxon tests in Statistical Package for the Social Sciences (SPSS) software. RESULTS: The findings showed that the mean [Standard Deviation (SD)] of physical activity in the intervention and control groups before the intervention was 6.52 (0.86) and 6.56 (1.07), respectively, and there was no significant difference between the groups (p = 0.95). However, after the intervention, the mean (SD) of physical activity in the intervention and control groups was 8.04 (0.92) and 6.33 (1.60), respectively, which showed a significant difference (t126= 9.71, p < 0.001). CONCLUSIONS: The findings of this study revealed that the training program based on the HPM has a positive effect on improving physical activity in women with type 2 DM.

Experience of Uncertainty in Patients with Thalassemia Major: A Qualitative Study.

Background: Uncertainty leads to a stressful situation in patients with thalassemia major that can dramatically affect their psychosocial coping ability, treatment process and disease outcomes, and reduce patients' quality of life. As one of the important factors affecting the health of thalassemia patients, understanding the concept of uncertainty is of major importance to health care providers especially nurses as the first line of exposure to these patients. The present study aimed to explore the experiences of uncertainty in patients with thalassemia major. Materials and Methods: The present qualitative study was conducted through in-depth face-to-face semi-structured interviews held with 18 patients with major thalassemia selected through purposive sampling. Interviews continued until saturation of data. All interviews were recorded, transcribed and analyzed with conventional content analysis method of Landman and Graneheim using MAXQDA10 software. Results: Two main themes, including 'living in the shadow of anxiety' and 'coping with uncertainty' emerged from patients' experiences of illness uncertainty of thalassemia. 'Living in the shadow of anxiety' included four categories of 'fear of complications', 'contradictory views on treatment', 'unknown future' and 'stigma'. 'Coping with uncertainty' included three categories of 'spiritual coping', 'psychosocial coping' and 'knowledge acquisition'. Conclusion: According to the results of this study, uncertainty is a major psychological stress in patients with thalassemia major. Healthcare providers should therefore consider the challenges and concerns faced by patients and, through utilizing appropriate training and communicational practices, plan interventions and strategies to empower patients for coping with uncertainty.

Comprehensive physical domain care needs of burn patients: a qualitative study.

INTRODUCTION: Burn patients have various physical needs. To provide full care for such patients, we need a broad range of services. The current study aims at showing the physical needs of burn patients. METHODS: The current qualitative study has been done through content analysis. The data were collected from 20 in-depth, unstructured individual interviews with hospitalized patients with burns on more than 25% of their body, nurses, physiotherapists, and psychologists. The participants were selected by purposive sampling. The data were analyzed with a conventional content analysis approach using the Elo and Kyngas method. RESULTS: By analyzing the data, 7 main categories were obtained from 932 primary codes: the necessity to provide optimal physiotherapy, the necessity of the patient's overall physical assessment, the necessity of monitoring and coordination in care, healthy nutrition for burn patients, the need for pharmacotherapy, the need for pain reliefs, and finally the theme for comprehensive physical care needs in burn patients. CONCLUSION: According to the findings, by applying the extracted categories, it is possible to provide quality care based on the patient's individual needs. This can help speed up the treatment and shorten the length of hospitalization significantly.

The Effect of a Training Program Based on the PRECEDE-PROCEED Model on Lifestyle of Adolescents with Beta-Thalassemia: A Randomized Controlled Clinical Trial.

Background: Lifestyle is a key issue in the concept of health promotion. Lifestyle includes all activities that encourage optimum physical, spiritual, and mental functions. The aim of this study was to determine the effect of a training program based on PRECEDE-PROCEED Model on lifestyle of adolescents with beta thalassemia. Materials and Methods: In this clinical trial study, 64 adolescents (age 16-20) who referred to the Thalassemia Center of Ahvaz (2015) were selected and randomly divided into two groups: experimental and control group. The components of the PRECEDE-PROCEED Model were used for planning, implementation and evaluation of the program. Changes in predisposing, reinforcing, enabling factors and lifestyle were immediately and a month after the intervention were assessed by a questionnaire based on PRECEDE-PROCEED Model and the Health-Promoting Lifestyle Profile. Results: The intervention had significantly positive effect on predisposing, enabling and reinforcing factors immediately and a month after the intervention (P < 0.05). Repeated measures analysis of variance showed a significant positive increase in the six dimensions of lifestyle score in the experimental group from baseline to one-month follow-up (P < 0.05). Conclusion: This study showed that the theory-based training program in adolescents suffered from beta thalassemia disease could improve the adolescent's awareness and attitude of healthy lifestyle.

The Relationship between Health Literacy and Health Promoting Behaviors in Patients with Type 2 Diabetes.

BACKGROUND: Health promoting behaviors are known to be a key factor in managing type 2 diabetes and improving the quality of life in diabetic patients. However, there is little known about the factors influencing these behaviors in diabetic patients. This study aimed to find the relationship between the health literacy and health promoting behaviors in patients with type II diabetes. METHODS: This correlational study was conducted from August to September 2016 on 175 eligible diabetic patients (20 to 65 year-old) who referred to the selected centers of diabetes control in Ahvaz City. Patients were chosen using convenience non-probable sampling. Data were collected by diabetic patients' health promoting behaviors' questionnaire and health literacy questionnaire. Data were analyzed using SPSS 22, descriptive statistics and Pearson's correlation coefficient. RESULT: The mean scores for health promoting behaviors and health literacy were determined 100.45±19.82 and 76.14±15.26, respectively. The highest and lowest scores in health promoting behaviors belonged to nutrition (26.11±6.85) and physical activity (6.70±2.75), respectively. There was a significant relationship between all dimensions of health promoting behaviors and health literacy (P<0.05). CONCLUSION: Since health literacy has a positive relationship with health promoting behaviors in diabetic patients, health care providers need to concentrate on increasing the health literacy of their patients rather than solely concentrating on increasing their knowledge, thereby facilitating the development of health promoting behaviors in patients.

Effect of Education Based on Health Belief Model on the Behavior of Breast Cancer Screening in Women.

OBJECTIVE: The purpose of this study was to determine the effect of education based on health belief model (HBM) on the behavior of breast cancer screening (bCS) in women. METHODS: This quasi-experimental study was conducted on 226 women who were selected with cluster sampling method from those referred to Dezful health centers. Data collection tool was a researcher-made questionnaire. Demographic questionnaire bCS- scale, and the Knowledge about questionnaire, all given before and 3 months after the intervention. RESULTS: According to the findings of the study, there was a significant relationship between women's performance and variables of knowledge, perceived sensitivity, perceived benefits, perceived barriers, self-efficacy, and cues to action. CONCLUSIONS: Poor knowledge of women indicates a crucial need for formal educational programs to sensitize women regarding the importance of bCS. These educational programs should consider factors affecting bCS behaviors.

The Relationship between Health Locus of Control and Health Behaviors in Emergency Medicine Personnel.

BACKGROUND: Health locus of control defined as individual beliefs based on past experiences in health issues and having external or internal control over them, could affect health. Health locus of control plays a role in health behaviors. We aimed to investigate the relationship between health locus of control and health behavior in emergency medical personnel in Ahvaz during 2016. METHODS: This is a cross-sectional descriptive study, which began in August 2016 for a period of six months on 215 emergency medical personnel in Ahvaz who were selected randomly. The data were collected by a demographic questionnaire, Rotter's locus of control questionnaire, and health behavior questionnaire and analyzed using SPSS software, version 22. The correlation between variables was estimated by Pearson's correlation coefficient and independent t test. The level of significance for all statistical tests was set at 0.05. RESULTS: We found no significant relationship between health locus of control (external and internal) and health behavior (P>0.05).Health behaviors were very good in terms of personal health (86.5%), nutrition (53%), and sleep and rest (48.4%), and poor in terms of physical activity (52.6%) and stress management (79.5%). Furthermore, 79.5% of the emergency personnel, in general, had poor heath behaviors. CONCLUSION: Leaders and officials in the field of health must necessarily design programs in relation to health locus of control and the factors developing and affecting it as well as the role of health locus of control in doing correct behaviors.

Iranian women and care providers' perceptions of equitable prenatal care: A qualitative study.

BACKGROUND: Equity as a basic human right builds the foundation of all areas of primary healthcare, especially prenatal care. However, it is unclear how pregnant women and their care providers perceive the equitable prenatal care. OBJECTIVE: This study aimed to explore Iranian women's and care providers' perceptions of equitable prenatal care. RESEARCH DESIGN: In this study, a qualitative approach was used. Individual in-depth unstructured interviews were conducted with a purposeful sample of pregnant women and their care providers. Data were analyzed using inductive content analysis method. PARTICIPANTS AND RESEARCH CONTEXT: A total of 10 pregnant women and 10 prenatal care providers recruited from six urban health centers across Ahvaz, a south western city in Iran, were participated in the study. ETHICAL CONSIDERATIONS: The study was approved by the Ethics Committee affiliated to Ahvaz Jundishapur University of Medical Sciences. The ethical principles of voluntary participation, confidentiality, and anonymity were considered. FINDINGS: Analysis of participants' interviews resulted in seven themes: guideline-based care, time-saving care, nondiscriminatory care, privacy-respecting care, affordable comprehensive care, effective client-provider relationships, and caregivers' competency. CONCLUSION: The findings explain the broader and less discussed dimensions of equitable care that are valuable information for the realization of equity in care. Understanding and focusing on these dimensions will help health policy-makers in designing more equitable healthcare services for pregnant women.