Scoping review of outpatient health services utilization among women.

BACKGROUND: Health services utilization, as one of the mechanisms of the health system, guarantees a healthy life and improves well-being for everyone. AIMS: The aim of this study was to identify factors affecting the use of outpatient health services among women. METHODS/DESIGNS: This scoping review examined the studies related to outpatient health services utilization (OHSU) and its determinants among women. This review was conducted on English language studies published between 2010 and 2023 (All searches were conducted on 20 January 2023). Studies available in databases such as Web of Science, MEDLINE (PubMed), Scopus, Wiley library, Proquest, and Google Scholar were searched manually. Selected keywords and their equivalents were used to search for related articles in each database. RESULTS: A total of 18 795 articles were identified, of which 37 met the inclusion criteria. Findings showed that age, marital status, level of education, employment status, income level, socioeconomic status, rape experience, health insurance, health status, ethnicity, living in rural areas, quality of services, area of residence, having a purpose in life and access to health services affect OHSU among women. CONCLUSIONS: The results of the present review showed that in order to achieve the universal goals of health services coverage and health service utilization, it is necessary for countries to provide insurance coverage to the maximum number of people. Also, policies should change in favor of the elderly, poor and low-income, low-educated, rural, ethnic minority, and chronically ill women and provide them with free preventive health services.

Inequality in the Experience of Stressful Psychological Events: Evidence from a Regional Survey in Tehran.

Background: Socioeconomic status is one of the most important social determinants of the formation of stressful events. The purpose of this study was to estimate the amount of inequality in experiencing stressful events among higher and lower socio-economic groups and zones of Tehran citizens. Methods: The study was descriptive-analytical and cross-sectional. Through a multistage sampling method, 5895 adult residents in Tehran were selected. The research tool was a researcher-made questionnaire designed to measure stressful events in Tehran, which includes 11 dimensions of stressful factors. Concentration index and concentration curves were used to analyze the data. Results: Among the 11 stressful life events, 6 of them were significant. Stress by the neighborhood problems (CI = -0.47, 95% CI: -0.66, -0.28) and living problems (CI = -0.50, 95% CI: -0.68, -0.32) was pro-rich, and these two dimensions formed the greatest inequality between the poor and the rich. The other 3 dimensions of stress caused by housing problems, political problems and fear of the future were also pro-rich. Only educational problem stressors were pro-poor. Stressful life event experience was concentrated on residents of low-development areas (zones 1 and 2). Conclusion: Residents of Tehran experience stressful events unequally, and this inequality exists both within and between social groups. Most stressful events were observed among the poor and less developed zones.

Drug injection and associated factors among the elderly living with HIV/AIDS in Tehran, Iran.

Background: Injection of drugs is one of the most serious health problems among Iranian living with HIV/AIDS. The injection of drugs, accounting for the transmission of more than two-thirds of HIV infections. HIV remains a major concern around the world and is expected to be the third leading cause of mortality worldwide. Thus, the aim of this study was to explore the predictors of injection drug use in the elderly patients living with HIV/AIDS. Methods: This was a cross-sectional study executed in Tehran City, Iran, in 2018. A total of 160 individuals aged 60 years and older with HIV from different counseling centers were selected by convenience sampling. Data were collected using questionnaires including a positive state of mind, coping, social support, and a checklist of demographical variables. Bivariate analysis and multiple logistic regression using SPSS software version 21.0 were employed to determine factors associated with drug injection. The statistical tests were performed with a significance level of 5% (p≥0.05). Results: The study participants' mean(SD) age was 65.6(±6.6) years. In total, 33 people (20.6%) of the samples reported injection drug use. The frequency of injection drug use was greater among men (AOR: 2.28, 95% CI 2.2-22.8; p=0.010), those reporting a monthly income of ≥30000000 Rials (AOR: 31.56, 95% CI 2.95-338; p=0.004), subjects with past experience of drug use (AOR: 7.11, 95% CI 2.18-23.2; p=0.001), those with ≥2 years past from their HIV diagnosis (AOR: 4.04, 95% CI 1.12-14.58; p=0.033), and those living with more than two people in one residential place (Household size AOR: 5.9, 95% CI 1.64-21.24; p=0.007). Conclusion: It seems that the design and implementation of harm reduction programs among the elderly with HIV/AIDS who inject drugs are essential and should be considered as an agenda of policymakers and health professionals.

The Association of Oral Health Status and socio-economic determinants with Oral Health-Related Quality of Life among the elderly: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to determine the relationship between poor Oral Health-Related Quality of Life (OHRQoL) and oral health determinants (eg being 75 years of age or greater, marital status, smoking status, denture wearing, depression, low educational level (≤8th grade), poor general health, caries history, tooth-induced pain, decayed, missing filled teeth (DMFT) scores and periodontal diseases) among the elderly. METHODS: Formal search strategies in PubMed, Scopus, Cochrane and Web of Science were performed to identify studies in English published before 1 December 2019. We assessed the impacts of the oral health determinants including being 75 years of age or greater, marital status, smoking status, denture wearing, depression, low educational level (≤8th grade), poor general health, caries history, tooth-induced pain, DMFT scores and periodontal diseases) on OHRQoL among elderly individuals. The data were analysed using Stata 12.0 software. RESULTS: In total, 19 publications met the inclusion criteria of this meta-analysis. Findings indicate a positive association between low educational level (ie ≤8th grade), marital status, depression, smoking status, denture wearing, poor general health, tooth-induced pain, periodontal diseases and poor OHRQoL among the elderly. We also observed a negative association between DMFT, being older than 75 years of age on poor OHRQoL among the elderly. CONCLUSIONS: This review identified that several oral health determinants were associated with poor OHRQoL. The efficacy of preventive measures and the economic aspects of tooth replacement approaches should be explored in the future. Developing oral healthcare plans and policies with the specific aim of improving OHRQoL among this group is essential.

Explaining Experiences, Challenges and Adaptation Strategies in COVID-19 Patients: A Qualitative Study in Iran.

OBJECTIVE: Getting COVID-19 makes a person confront numerous individual, physical, psychological, family and social challenges. Therefore, the present study was conducted to explain the experiences, challenges and adaptation strategies in patients with COVID-19 in Tehran, Iran. METHODS: The present study was performed with a qualitative approach and phenomenological method among 33 patients with COVID-19. From July 20 to September 21, access to participants and data collection were done in person (15 people) and by phone (18 people) through targeted sampling and snowball and semi-structured interviews. Data management was carried out using MAXQDA-2018 software and its analysis was done by the Colaizzi analysis method. Guba and Lincoln's criteria were also observed to improve the quality of results. RESULTS: After analyzing the data, two main categories and 17 subcategories were obtained, including (1) experiences and challenges (ignoring the disease, blaming, physical health disorders, mental problems, guilt, and remorse, being blamed, living a life of disappointment and ambiguity, emotional challenges, frustrating reactions from others, helplessness and limitation) and (2) disease adaptation strategies (spirituality, learning about COVID-19, doing valuable and fun activities, participating in treatment, strengthening one's spirit and hope, trying to make up for past mistakes and virtual communication). CONCLUSIONS: Based on the results, interventions and policies such as increasing people's health knowledge and literacy to get acquainted with the symptoms of the disease and prompt referral for diagnosis and treatment, teaching stress and psychological pressure management techniques, instructing families to continue emotional and social support for patients and strengthening and reproducing the strategies patients use, along with teaching disease coping skills, harnessing the potential of cyberspace and the media can make it easier to tolerate illness and get back to life.

Experiences and challenges of Prostitute Women in Iran: A phenomenological qualitative study.

BACKGROUND: Prostitutes in Iran are faced with many challenges and problems that pose risks to their health. OBJECTIVE: The present study is an attempt to identify and narrate the challenges and experiences of Iranian prostitutes based on a qualitative approach. METHODS: This qualitative study was conducted with a phenomenological approach in (2018) in Tehran, Iran. The data were collected through semi-structured interviews with 22 prostitutes who were selected using a snowball sampling method and analyzed with Colaizzi's method. In order to examine the quality of findings, Guba and Lincoln's measures were used. RESULTS: Data analysis results were classified into five main categories and 14 subcategories. The main issues are: The experience of violence, Heath risk, social ostracism, objectifying, and lack of social and legal supporting structures. CONCLUSION: Prostitutes in Iran experience numerous problems at personal and social levels. By providing social, economic, and legal supports for them such as social services (e.g. educations on how to use contraceptives, how to have safe sexual intercourse, and free counseling services for mental support), we can improve their health and welfare.

Barriers to Condom Use Among Female Sex Workers in Tehran, Iran: A Qualitative Study.

BACKGROUND: There are many barriers for condom use, which was one of the most important methods to prevent the transmission of HIV among female sex workers. Therefore, the aim of the present study was to identify the barriers to condom use among female sex workers in Tehran, Iran. METHODS: This study was conducted with a qualitative approach and conventional content analysis among female sex workers in Tehran. Twenty-two female sex workers were selected through snowball sampling and purposive sampling. The data gathering method was a semi-structured interview and the data were analyzed using Graneheim and Lundman method. Guba and Lincoln criteria were used for evaluating research transferability. RESULTS: The results of data analysis were categorized in three categories and seven sub-categories included 1) individual factors (not knowing HIV/AIDS properly, anti-loyalty and love, and personality traits), 2) structural factors (partner's desire, problems with condom availability), and 3) cultural factors (cultural taboos, following the models). CONCLUSION: The results showed that lack of condom use is the consequence of different individual, structural, and cultural factors. So, it can be useful to take some initiatives at the individual level by raising awareness and understanding of female sex workers about HIV at the structural level by lowering the price of condoms and providing them extensively and at the societal level, by changing the beliefs and taboos about condoms.

Challenges and opportunities confronting female-headed households in Iran: a qualitative study.

BACKGROUND: Female-headed households are one of the most vulnerable groups of society that confront many problems and challenges. Therefore, the present study aimed to explore the challenges and opportunities confronting female-headed households in Iran. METHODS: This qualitative study was conducted among female-headed households in Kermanshah, West of Iran, in 2019. The data were collected through Semi-structured interviews with 26 female-headed households who were selected by purposeful and theoretical sampling. Data analysis was done through conventional qualitative content analysis, and the software MAXQDA-12 was used for the management of data. The four criteria of Goba and Lincon, including credibility, confirmability, dependability, and transferability, were observed to evaluate the quality of research results. RESULTS: After analyzing the data, 4 main categories and 13 subcategories were obtained as follows: individual problems (role overload, role conflict, end of love, psychological problems), intra-family problems (declined independence, intra-family tension, poverty reproduction and family disability), social problems (stigma of being unattended, social insecurity, social isolation, social exclusion), positive outcomes (positive self-concept, social maturity). CONCLUSION: Female-headed households face many challenges that can become a big threat or an opportunity. Therefore, their health improvement can be achieved through training and helping them to adapt to new and multifaceted roles, providing more economic support and helping them raise their social status.