Persian version of thirst distress scale (TDS) in patients on hemodialysis: Factor structure and psychometric properties
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BACKGROUND: Patients on hemodialysis can experience thirst distress. However, there is no valid and reliable Persian instrument to measure this condition in such patients. The present study aims to determine the psychometric properties of the Persian version of the thirst distress scale (TDS) for patients on hemodialysis. MATERIALS AND METHODS: Our sample consisted of 142 hemodialysis patients completed the TDS Persian version. The face, content, and construct validity of the scale were ascertained. Reliability was also assessed using internal consistency, construct reliability, and intra-class correlation coefficient (ICC). RESULTS: Construct validity determined one factor with an eigenvalue greater than 0.7. The model revealed good fitness (χ2 (121, N = 142) = 269.32, p < 0.001; χ2df = 2.225, goodness of fit index (GFI) = 0.912, normed fit index (NFI) = 0.866, comparative fit index (CFI) = 0.926, incremental fit index (IFI) = 0.961, and root mean square error of approximation (RMSEA) = 0.089 (90% confidence interval = 0.069 - 0.109)). The internal consistency, construct reliability, and ICC were greater than 0.70. The scale's convergent validity was demonstrated. CONCLUSION: This study confirmed the acceptable psychometric properties and the factor structure of the TDS in Iranian patients on hemodialysis.
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Validity and Reliability of the Turkish Version of the Questionnaire for the Assessment of Dysphagia in Multiple Sclerosis.

INTRODUCTION: The aim of this study was to investigate the validity and reliability of the Turkish version of the Questionnaire for the Assessment of DYsphagia in MUltiple Sclerosis (DYMUS) that has been developed for evaluating dysphagia in patients with multiple sclerosis. METHODS: This methodological study was conducted in the neurology clinic and outpatient department of a training hospital between March 15 and September 15, 2015. The study included 117 patients aged 18 years and over who had a definite diagnosis of multiple sclerosis, could communicate in Turkish, and volunteered to be included. Data were collected using a descriptive information form, the DYMUS, and the Eating Assessment Tool (EAT-10). The scale was translated and back translated to determine the language validity, and a specialist was consulted to make sure the content was valid. We used the EAT-10 and Kurtzke's Expanded Disability Status Scale (EDSS) concurrently to test the criterion-related validity. The test-retest procedure was used at 1-week intervals for 37 patients in this study. Descriptive statistics, factor analysis, Kappa analysis, reliability analysis, and correlation analysis were used to analyze the data. RESULTS: Factor analysis revealed that the scale was bifactorial, and this was consistent with its original form. There were positive and statistically significant relationships between the DYMUS and EAT-10 (r=0.90, p<0.001) and the mean EDSS scores (r=0.49, p<0.001). The internal consistency of the total scale was high (Cronbach's alpha coefficient= 0.91). The Cronbach's alpha coefficients pertaining to dysphagia for solids and liquids were determined to be 0.88 and 0.83, respectively. The total scale and subscales demonstrated a high test-retest reliability (r=0.79-0.95, p<0.001). CONCLUSION: In this study, the Turkish version of the DYMUS was found to be a valid and reliable tool for evaluating dysphagia in patients with multiple sclerosis.

Health Beliefs Related to Salt-Restricted Diet and Associated Factors in Turkish Patients on Hemodialysis.

PURPOSE: To examine health beliefs related to salt-restricted diet, to investigate their associations with demographic/disease-related characteristics and family support, and to determine the need for tailored interventions in Turkish patients on hemodialysis. METHOD: A cross-sectional study was conducted among 200 patients on hemodialysis. Data were collected through an information form, the Perceived Social Support from Family Scale and the Beliefs about Dietary Compliance Scale, including two subscales: perceived benefits and barriers. Descriptive statistics, Student's t test, Pearson's correlation coefficients, and linear regression analysis were used for data analysis. RESULTS: The item mean perceived benefit score was higher than the item mean perceived barrier score. Limiting salt intake, family support, and the presence of residual urine output were associated with health beliefs. CONCLUSIONS/IMPLICATIONS: The likelihood of adherence to salt-restricted diet was high. A better understanding of health beliefs about salt-restricted diet and their related factors may facilitate the implementation of tailored interventions.

Self-Rated Health and Associated Factors in Older Turkish Adults With Type 2 Diabetes: A Pilot Study.

PURPOSE: To evaluate self-rated health (SRH) and determine its associations with participant characteristics, glycemic control, family support, and health-related quality of life in older Turkish adults with type 2 diabetes. METHOD: This cross-sectional study included 113 adults aged 60 years or older with type 2 diabetes. Data were collected by using an information form, the Perceived Social Support From Family Scale, and the Nottingham Health Profile. SRH was assessed by a single-item question. Glycemic control was measured by glycosylated hemoglobin levels. RESULTS: Ninety-seven patients (85.8%) evaluated their health as fair or poor. The glycemic target level (glycosylated hemoglobin <7.5%) was achieved in 47.8% of the patients. Female gender, a low or moderate family income, and lower levels of family support were associated with poorer SRH. CONCLUSIONS/IMPLICATIONS: The majority of the participants considered their health to be fair or poor. Better understanding of risk factors associated with SRH may provide more effective interventions to improve health outcomes.

Sleep Quality and Associated Factors in Older Turkish Adults With Hypertension: A Pilot Study.

PURPOSE: The purpose of this study was to evaluate sleep quality and to explore its associations with participant characteristics, anemia, excessive daytime sleepiness, and physical activity in older Turkish adults with hypertension. METHOD: This cross-sectional study included 128 adults aged 60 years or older with hypertension. Data were collected by using a personal information form, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the International Physical Activity Questionnaire. Anemia was assessed by hemoglobin levels. RESULTS: Eighty-one patients (63.3%) reported poor sleep quality. Anemia was present in 35.2% of the patients (defined as hemoglobin <13 g/dL for males and <12 g/dL for females). Female gender, the presence of anemia, and low levels of physical activity were associated with poor sleep quality. Conclusion/Implication: The majority of the participants had poor sleep quality. Better understanding of risk factors associated with poor sleep quality may contribute to more effective interventions to improve health and well-being.

Determinants of thirst distress in patients on hemodialysis.

PURPOSE: Thirst sensation can induce nonadherence with fluid restriction in patients on hemodialysis (HD) and may lead to large interdialytic weight gain (IWG). This study aimed to evaluate thirst distress and its determinants and to explore fluid management strategies used by patients on HD. METHODS: A cross-sectional study was conducted in a sample of 203 patients who were followed in three HD centers in Turkey, from January 2015 to June 2015. Data were collected by a personal information form, the Thirst Distress Scale (TDS) and the Visual Analogue Scale (VAS) for thirst and xerostomia. Data analysis was performed using descriptive statistics, Student's t test, the one-way analysis of variance, Pearson's correlation coefficients, and linear regression analysis. RESULTS: The mean TDS score was 20.71 ± 8.34, which is a higher than moderate level of thirst distress. The significant determinants of thirst distress of the patients were the VAS thirst score (unstandardized ß = 1.73, p < 0.001), the VAS xerostomia score (unstandardized ß = 0.42, p < 0.001), and the IWG values (unstandardized ß = 1.20, p = 0.003), after controlling for specific variables. The most common strategies used to reduce fluid intake or relieve thirst were avoiding salty foods (70.9 %), limiting salt on food (70.9 %), and spacing liquids over the entire day (57.6 %). CONCLUSIONS: Patients with higher levels of thirst and xerostomia and those with a high IWG were more likely to have higher thirst distress. A greater understanding of thirst distress and its related factors could contribute to more effective interventions that improve health and well-being in patients on HD.

Predictors of Health Behaviors in Turkish Female Nursing Students.

PURPOSE: This study was conducted to determine the health behaviors of Turkish female baccalaureate nursing students and to examine the impact of sociodemographic and health-related factors and their mothers' health behaviors on the health behaviors of nursing students. METHODS: This cross-sectional study included 337 nursing students and 337 mothers. Data were collected using self-administered questionnaires that included a personal information form, the Perception of Health Scale and the Health-Promoting Lifestyle Profile-II (HPLP-II). Descriptive statistics, one-way analysis of variance, Student's t test, Pearson's correlation coefficients and linear regression analysis were used for data analysis. RESULTS: The total HPLP-II mean score of the students was 131.98 ± 17.15 (item M = 2.61, SD = 0.33). Among the subscales of the HPLP-II, the spiritual growth had the highest mean subscale score, followed by the interpersonal relations subscale, while the physical activity had the lowest mean subscale score. Significant predictors of health behaviors of the students were school year (unstandardized ß = .09, p = .012), total score for the Perception of Health Scale (unstandardized ß = .02, p < .001), and the mothers' total HPLP-II score (unstandardized ß = .33, p < .001), after controlling for specific variables. CONCLUSIONS: This study demonstrated that the students who were attending the first-year program, those with higher levels of perceptions of health and those whose mothers had better health behaviors were more likely to have better health behaviors. The results of this study emphasize the importance of making culturally appropriate interventions by taking into account the factors contributing to the health behaviors of nursing students.

The efficacy of an educational intervention on health behaviors in a sample of Turkish female nursing students: a longitudinal, quasi-experimental study.

BACKGROUND: Unhealthy behaviors are a key factors leading to health problems. It remains unclear whether an educational intervention has a long term effect on health behaviors of nursing students. OBJECTIVES: The aim of this study was to evaluate the long term effect of an educational intervention on the health behaviors and examine predictors of change in these behaviors in Turkish female baccalaureate nursing students. DESIGN: Quasi-experimental design with one-group, pre- and posttest, and 3-year follow-up. SETTING: The study was conducted in a school of nursing in Turkey. PARTICIPANTS: One hundred-eight students participated in this study. METHODS: Data were collected before and after the implementation of the educational intervention by using the Health-Promoting Lifestyle Profile-I (HPLP-I). Descriptive statistics, the one-way analysis of variance for repeated measures and multiple linear regression analysis were used. RESULTS: There were significant differences among the three time points in terms of the HPLP-I total and subscales scores (self-actualization, health responsibility, exercise, nutrition and stress management), except for interpersonal support (p<.05). The positive effect of intervention on the HPLP-I total and health responsibility subscale scores was maintained during the 3-year follow-up period (p<.05). The amount of change from pretest to posttest in the total HPLP-I score was the only predictor of the 3-year change in the total scale score (unstandardized ß=0.538; p<.001), after adjustment for the potential confounding factors. CONCLUSIONS: The educational intervention was partially effective in improving all health behaviors of the nursing students over the long term. Nursing students who demonstrated higher levels of benefit from the intervention were more likely to have more positive health behaviors at the 3-year point. The findings of this study highlight the importance of the integration of health behaviors within the nursing curriculum.

Health Beliefs Related to Salt-Restricted Diet in Patients on Hemodialysis: Psychometric Evaluation of the Turkish Version of the Beliefs About Dietary Compliance Scale.

PURPOSE: The aim of this study was to evaluate the reliability and validity of the Turkish version of the Beliefs about Dietary Compliance Scale (BDCS-T). METHODS: This methodological study enrolled a sample of 140 patients. Data were collected by using a questionnaire form, the BDCS-T, and the Dialysis Diet and Fluid Restrictions Nonadherence Questionnaire. Descriptive statistics, the one-sample Kolmogorov-Smirnov test, Mann-Whitney U test, correlation coefficients, and psychometric tests were used for the analysis of data. RESULTS: The factor analysis confirmed that the BDCS-T had a two-factor structure (perceived benefits and perceived barriers) explaining 58.7% of the total variance. The BDCS-T had acceptable internal consistency (Cronbach's alpha coefficients: perceived benefits = .91; perceived barriers = .66), test-retest reliability (intraclass correlation coefficients: perceived benefits = .93; perceived barriers = .79), concurrent validity with the Dialysis Diet and Fluid Restrictions Nonadherence Questionnaire scores, and known group validity with intensity of diet nonadherence. CONCLUSIONS: The BDCS-T was found to be a reliable and valid tool for assessing the beliefs related to salt-restricted diet in patients on hemodialysis. IMPLICATIONS FOR PRACTICE: Nurses are recommended to make tailored interventions by taking the benefits and barriers that the patients perceive toward low-salt dietary adherence into account.

Validity and reliability of the Turkish version of the thirst distress scale in patients on hemodialysis.

PURPOSE: Thirst has been reported as an important source of distress for patients on hemodialysis. However, there is no instrument available that assesses thirst distress of Turkish patients on hemodialysis. Therefore, the aim of this study was to examine the psychometric properties of the Turkish version of the Thirst Distress Scale (TDS-T) for patients on hemodialysis. METHODS: This study was conducted methodologically. A convenience sample of 142 Turkish patients on hemodialysis participated in this study. Data were collected by using a questionnaire, the TDS-T and a visual analogue scale for thirst intensity. The analysis of data included descriptive statistics, the one-sample Kolmogorov-Smirnov test, Kruskal-Wallis test, Mann-Whitney U test, correlation coefficients and psychometric tests. RESULTS: The TDS-T demonstrated acceptable internal consistency (Cronbach's alpha coefficient = .81), good test-retest reliability (intraclass correlation coefficient = .88), and correlations with interdialytic weight gain values and thirst intensity scores (measured by visual analogue scale) indicating concurrent and convergent validity, respectively. Construct validity was supported by known-group comparisons. The results revealed a one-component structure of the instrument. CONCLUSIONS: The psychometric properties of the TDS-T were consistent with those reported in the original study. The TDS-T was found to be a valid and reliable tool for evaluating thirst distress in patients on hemodialysis.

Predictors of coping in a group of Turkish patients with physical disability.

AIM AND OBJECTIVE: To describe coping strategies used and determine the influence of demographic/health-related variables and perceived social support to the prediction of coping strategies in patients with physical disabilities. BACKGROUND: The period of psychosocial adaptation following a physical disability is very stressful. The use of effective coping strategies may be helpful in adapting to disability. However, no information is available about the coping strategies used by Turkish patients with physical disability. DESIGN: The study was designed as a cross-sectional survey. The data were obtained from 51 patients with physical disability in a rehabilitation centre in Ankara, Turkey between May 2004-September 2005. METHODS: Data were collected using a questionnaire form, the Multidimensional Scale of Perceived Social Support and the Coping Strategy Indicator. Descriptive statistics, reliability analysis, Mann-Whitney U tests, Kruskal-Wallis test, chi-square test, Pearson's correlation coefficients and stepwise multivariate regression analysis were conducted. RESULTS: The most frequently used coping strategy was problem-solving, followed by avoidance coping and seeking social support. Significant predictors of overall coping strategies were age, financial status, the caregiver's presence and perceived social support, after controlling for specific variables. CONCLUSIONS: This study demonstrated that patients who were older and had a caregiver were more likely to use problem-solving strategy. Seeking social support was more common among patients who had a caregiver and those with more perceived support from friends, whereas patients who had financial difficulties used more avoidance coping. RELEVANCE TO CLINICAL PRACTICE: Better understanding the coping strategies used by individuals with physical disabilities and factors affecting coping is provide interventions that reduce the stress and support their adaptation. Nurses should be aware of the factors that affect to coping strategies used to deal with stress.

The effect of the content of the knowledge on adherence to medication in hypertensive patients.

OBJECTIVE: It was suggested that knowledge might influence the adherence to treatment in hypertension. Accordingly, in this study, we investigated the effects of content of knowledge on medication adherence and knowledge-based predictors of adherence to treatment in hypertensive patients. METHODS: This cross-sectional study included 227 hypertensive patients (70% female;mean age: 57+/-12 years), who were followed by cardiology and internal medicine clinics. The patients were asked to fulfill a questionnaire including 40 items. Besides the demographic and disease-related questions, the patients were also asked (1) the name of the drug, (2) the duration of the drug use;(3) the reason of using the drug;(4) the cause of hypertension;(5) the target level of hypertension;(6) the result of hypertension;(7) the side effects of antihypertensive medicines. Statistical analyses were performed using Chi-square, Fischer exact, Mann Whitney U tests and logistic regression analysis. RESULTS: It was found that 163 (72%) were adherent and 64 (28%) were nonadherent to the treatment. Angiotensin-II receptor antagonist use (OR=4.405;95%CI: 1.561-12.365, p=0.022) and hypertension duration > or =5 years (OR=0.446;95%CI: 0.246-0.811, p=0.006) was found to be independently related to adherence. Among the knowledge-based variables, knowing the duration of use of the medicine (OR=6.822;95% CI: 1.478-31.241, p=0.075), the reason of use of medicine (OR=2.828;95% CI: 1.445-5.543, p=0.018), the cause of the hypertension (OR=3.447;95% CI: 1.889-6.290, p=0.037) and the target level of blood pressure (OR=12.859;95% CI: 5.045-32.640, p<0.001) significantly increased the adherence rates. On the other hand, knowing the name of the medicine (p=0.112) or the results of hypertension (p=0.719) had no effect on adherence, while knowing the side effects of the medicine (OR=0.607;95% CI: 0.340-1.084, p=0.005) had negative effect. The total number of correct answers was also higher in patients with adherence to treatment (p=0.002). CONCLUSION: Patient knowledge about hypertension and medications is associated with higher adherence rates. However, it should be taken into consideration that the possible effects of knowledge may differ according to its content.

The assessment of adherence of hypertensive individuals to treatment and lifestyle change recommendations.

OBJECTIVE: Most of studies about adherence in hypertension highlight the adherence to the medical treatment but do not include the adherence to the other recommendations, such as lifestyle modifications. The factors effective on adherence to each type of recommendation may differ. Accordingly, we aimed in this study to show that nonadherence to each recommendation should be assessed individually. METHODS: The study, which was designed as cross-sectional and descriptive, included 150 patients who were followed by the outpatient clinics for at least one year. A data collecting form with 44 questions was prepared by the investigators, and the patient adherence was assessed in five categories: medicine-related adherence, diet-related adherence, exercise-related adherence, measurement-related adherence and smoking related adherence. The face-to-face interview method was used to collect data. Statistical analysis was accomplished by Chi-square test and logistic regression analysis. RESULTS: Of 150 subjects included in the study, 94 (63%) were female and mean age was 56+/- 12 (20-81) years. Mean duration of drug use was 6.5+/- 6.5 years and the mean number of drugs used was 1.6+/- 0.8. The adherence to recommendations of medication, diet, exercise, home-blood measurement and smoking were 72%, 65%, 31% , 63% and 83%, respectively. Each patient was adherent to at least one recommendation, while 11% of patients were adherent to one recommendation, 23% - to two, 29% - to three, 24% - to four and 13% - to five. According to the regression analysis, factors effective on each type of adherence were found to be different from others. The presence of three or more types of adherence was related to income level (OR= 0.297; 95%CI - 0.132-0.666; <0.001) and presence of any other chronic disease (OR=2.329; 95% CI - 1.114-4.859; p=0.002). CONCLUSION: The rates of adherence to medicine and life-style changes were generally found to be low in hypertension. The cause of nonadherence is different according to the type of adherence. Each recommendation should be assessed individually in terms of adherence.

Herbal product use in a sample of Turkish patients undergoing haemodialysis.

AIM: To examine herbal product use among patients with end-stage renal disease undergoing haemodialysis. BACKGROUND: Herbal therapy is a very popular choice for many patients. However, little information is available about herbal product use in renal patients. DESIGN: The study was designed as a cross-sectional survey. The data were obtained from 114 end-stage renal disease patients in two haemodialysis centres in Ankara, Turkey between June-August 2007. METHODS: Data were collected through face-to-face structured interviews. Descriptive statistics and the chi-square test were conducted. RESULTS: Approximately one-third of the patients (28.1%) used a herbal product after the diagnosis of chronic kidney disease. Of these, 13.2% reported currently taking herbal products. A minority of participants (12.5%) informed their physician of herbal product use. Marital status was the only variable significantly associated with herbal product use. CONCLUSIONS: The results of this study showed that many patients used herbal products, but most did not disclose this use to their physician. Herbal product use was more prevalent among the participants who were married. RELEVANCE TO CLINICAL PRACTICE: Understanding the patterns and reasons of herbal use is beneficial in efforts to improve the care of patients with end-stage renal disease. Nurses should be aware of the potential health risks caused by herbal products and should educate the patient and the family.

Health beliefs and breast self-examination in a sample of Turkish nursing students and their mothers.

AIM: To describe health beliefs and breast self-examination practice of Turkish female nursing students and their mothers. BACKGROUND: Breast cancer is the most frequently diagnosed cancer and the second leading cause of cancer deaths among Turkish women. Breast self-examination is one of the primary methods for early detection of breast cancer in asymptomatic women. DESIGN: The study was designed as a cross-sectional and comparative survey. The data were obtained from 392 participants, including female nursing students (n = 196) and their mothers (n = 196) in Ankara, Turkey. METHODS: Data were collected by using a personal data form and the Champion's Health Belief Model Scale. Descriptive statistics, paired samples t-test, chi-square test, reliability analysis, Pearson correlation coefficients and logistic regression analysis were conducted. RESULTS: The percentage of nursing students who performed breast self-examination regularly was statistically higher than that of their mothers. The scores of health motivation, benefits and confidence were significantly higher in nursing students. The mothers' perceived susceptibility and barriers were significantly higher than their daughters. The frequency of breast self-examination practice was affected by the level of education, the mother's or daughter's monthly performance of breast self-examination and the level of perceived barrier to breast self-examination. CONCLUSIONS: There were differences in health beliefs related to breast self-examination and its practice between nursing students and their mothers. The results of this study showed that monthly performance of breast self-examination was more common among women who graduated from high school and university, whose mother or daughter performed breast self-examination regularly every month and those with lower levels of perceived barriers. RELEVANCE TO CLINICAL PRACTICE: It is essential that nurses be aware of the factors that contribute to monthly performance of breast self-examination. Cultural factors should be considered in planning educational programmes about breast self-examination practice. Interventions should be designed to enhance nursing students' proficiency in performing breast self-examination.

Nonadherence with diet and fluid restrictions and perceived social support in patients receiving hemodialysis.

PURPOSE: To describe nonadherence with diet and fluid restrictions and the level of perceived social support in hemodialysis patients. DESIGN: Descriptive survey. The data were obtained from 160 patients in three hemodialysis centers in Turkey between March 2006 and May 2006. Descriptive statistics, reliability analysis, correlations, and logistic regression analysis were conducted. METHODS: Data were collected by using a personal data form, the Dialysis Diet and Fluid Nonadherence Questionnaire, and the Multidimensional Scale of Perceived Social Support. RESULTS: Most patients showed nonadherence with diet and fluid restrictions. Family members were important providers of social support for patients. Significant factors affecting fluid nonadherence included age, marital status, and family and friend support. Marital status and family support were also the main variables affecting diet nonadherence. CONCLUSIONS: The results of this study showed that nonadherence was more common among younger, married patients, and those with lower levels of perceived social support.