The challenges of the Iranian nursing system in addressing community care needs.

BACKGROUND: The nursing system is one of the major and important fields of health and medicine in every country, responsible for providing nursing care and addressing medical and health-related community care needs. The aim of this study was to explain the challenges of the Iranian nursing system in addressing community care needs. MATERIALS AND METHODS: A conventional content analysis method was performed in this exploratory qualitative study, and 27 participants were selected through a purposive sampling method based on the inclusion criteria. In-depth semi-structured interviews were conducted with the subjects, and data saturation was achieved in the 27th interview. The main interviews with the participants were individual, in person, and face-to-face, conducted at different times (morning and evening) in a peaceful environment and at the convenience of the participants. The interviews were recorded by the researcher with the participants' consent. The duration of the interviews ranged from 50 to 70 minutes, given the participants' energy and time. Data analyses were done using Graneheim and Lundman approach. RESULTS: After conducting the interviews and the simultaneous analysis, three themes were extracted, including the challenging structure in the internal environment, the operating environment, and the social environment, with seven main categories and 26 subcategories. An inadequate number of nurses given the real needs of society, the unbalanced proportion of employed clinical nurses to the real needs of society, poor presence of nurses in community-based nursing services, insufficient attention to the optimization of the work environment, the gap between education and clinical practice in the nursing system, poor mutual accountability of the community, and policies in the health system were seven main categories in this study. CONCLUSION: In general, the results showed that the Iranian nursing system faces many micro, meso, and macroscale challenges. It is necessary to plan properly to enhance the accountability of the nursing system to the current community care needs by improving the situation.

Investigating the association of physical and psychological problems with the levels of interleukin-1 and -6 in COVID-19 patients.

Introduction: The COVID-19 virus spreads at a high rate, exerting many physical, mental and psychological effects on patients. Patients with COVID-19 have been reported to have high levels of interleukin 1 and interleukin 6. Therefore, this study was conducted to determine the association of physical, mental, and psychological problems with the levels of interleukin-1 and -6 in COVID-19 patients. Methodology: This is cross-sectional descriptive-analytical research on 121 COVID-19 patients selected using simple random sampling method. The patients were hospitalized in university hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences and Amir al-Momenin Hospital. Data collection tools included the depression anxiety stress scale (DASS), a demographic questionnaire, and a checklist of physical problems. Blood sampling was also done to perform an ELISA test and measure the level of interleukin-1 and -6. Data were analyzed based on independent t-tests, chi-square, regression, and Pearson's correlation coefficient, using SPSS ver. 22. Results: The average age of the 121 patients participating in this study was 53.31 ± 14.09. A direct and statistically significant correlation was observed between body temperature on the first day and interleukin 1 level. A statistically significant negative correlation was observed between blood oxygen saturation level and interleukin-1 and -6 on the first, third and fifth days. Shortness of breath and coughing had a statistically significant correlation with the level of interleukin 1 on the third and fifth days. A direct and statistically significant correlation was observed between body temperature on the first, third and fifth days and interleukin 6 level. Coughing on the third and fifth days had a statistically significant relationship with interleukin 6 level. No direct and non-significant statistical correlation was found between depression and stress and the serum level of interleukin 1, but a significant correlation was observed between anxiety and serum level of interleukin 1. Finally, the results showed that depression, anxiety and stress had a direct and statistically significant correlation with the serum level of interleukin 6. Conclusion: Given the relationship between interleukin-1 and -6 and most physical and psychological problems, level of the inflammatory biomarkers interleukin-1 and -6 can be used to estimate the severity of physical and psychological symptoms in COVID-19 patients.

Effect of Nature-Based Sound Therapy on Stress and Physiological Parameters in Patients with Myocardial Infarction.

Background: Non-pharmacological interventions in clinical practice, such as Nature-Based Sounds (N-BS), can be an efficient way to reduce stress in patients with Myocardial Infarction (MI). This study was an attempt to investigate the effect of N-BS on stress and physiological parameters in patients with MI. Materials and Methods: This double-blind, randomized clinical trial was conducted on 80 patients with MI from two selected hospitals. Using headphones, the subjects in the intervention group listened to 30 minutes of N-BS twice a day for 3 days. The control group, on the other hand, wore headphones playing no sound. The data were collected using the Persian version of the Depression, Anxiety, and Stress Scale. The significance level was set at 0.05. Results: The repeated measure analysis showed that the within group effect is statistically significant for Systolic Blood Pressure (SBP) (F = 113.32, p < 0.001), Diastolic Blood Pressure (DBP) (F = 67.22, p < 0.001), Heart Rate (HR) (F = 28.52, p < 0.001), respiration rate (F = 36.41, p < 0.001), and stress (F = 102.82, p < 0.001). The reciprocal effect was statistically significant for SBP (F = 11.76, p < 0.001) and stress (F = 5.31, p < 0.001). Conclusions: N-BS can provide an effective, inexpensive, and non-invasive method of reducing stress in patients with MI. Nurses can incorporate N-BS intervention into the daily care of patients with MI in order to reduce their stress and lower their SBP and HR.

Investigating the effect of implementing a sensory stimulation program by family members on delirium status of brain injury patients hospitalized in the intensive care unit: A randomized clinical trial.

BACKGROUND: Delirium is the most common psychological disorder in brain injury patients hospitalized in the intensive care unit (ICU), one of the leading causes of which can be sensory deprivation or sensory overload. This study aimed to determine the effect of implementing a sensory stimulation program by family members on the delirium status of ICU-hospitalized brain injury patients. MATERIALS AND METHODS: In this randomized controlled clinical trial, 66 brain injury patients hospitalized in the ICUs were assigned to intervention and control groups using stratified random sampling. For the intervention group, a sensory stimulation program was implemented by family members for 1 h a day during the ICU stay. The control group received routine care. Patients' delirium status was assessed daily using the confusion assessment method for the intensive care unit (CAM-ICU). Data were analyzed by the SPSS software version 22, using Chi-square, independent t-test, and Binary logistic regression model tests, at a significance level of 0.05. RESULTS: Odds of delirium Incidence in the intervention group was 94% lower than in the control group (OR = 0.057, 95% CI 0.017, 0.19, P = 0.001). There is a significant difference between the two groups in terms of length of delirium (P = 0.001), stay in ICU (P = 0.001) and mechanical ventilation (P = 0.001). The mean of all three variables in the intervention group was lower than the control group. CONCLUSIONS: Implementing of sensory stimulation program by the family members, as a non-pharmacological method, can reduce the incidence of delirium in brain injury patients admitted to ICU.

Development and Psychometric Evaluation of the Clinical Nursing Cultural Competence Scale.

Background and Purpose: Cultural competence in clinical nurses can lead to comprehensive care for patients from different cultures. Currently, an appropriate instrument to assess cultural competence in clinical nurses is limited. This study aimed to design and determine the psychometric properties of the clinical nursing cultural competence scale (CNCCS). Methods: This methodological study was conducted in 2018-2019 in two phases. In the first phase, a literature review and semistructured interviews with 18 clinical nurses from Isfahan and Ahvaz were conducted, and the results were used for item generation. In the second phase, the face, content, construct validity, and reliability of the questionnaire were assessed. For construct validity assessment through exploratory factor analysis (EFA), 200 clinical nurses were purposefully recruited to fill out CNCCS. Results: In the first phase, 140 items were produced. In the second phase, the item number was reduced to 40 after the face and content validity assessment. In EFA for construct validity assessment, 13 more items were deleted, and the remaining 27 items were loaded on six factors. The Cronbach's alpha and the test-retest intraclass correlation coefficient were CNCCS 0.86 and 0.93, respectively. Conclusions: The CNCCS had acceptable psychometric characteristics in Iranian nurses and can be used for assessing cultural competence among clinical nurses. The use of this scale can help nursing policymakers and managers develop their understanding of nursing cultural competence and develop strategies for its improvement.

Psychometrics of the Persian version of the program in palliative care education and practice questionnaire (German revised - PPCEP-GR).

BACKGROUND: In order to improve the provision of palliative care by nurses, it is necessary to have a tool that measures different dimensions of palliative care and the knowledge and performance of nurses in this field. The Program in Palliative Care Education and Practice Questionnaire (German Revised) is psychometrically evaluated for the first time in Iran. METHODS: To measure the psychometric properties, 360 nursing students (BSc, MSc, PhD) and clinical nurses completed the questionnaire. Face and content (CVR and CVI) validity were checked by quantitative and qualitative approach. Construct validity was performed with exploratory and confirmatory factor analysis. The total variance explained was equal to 43%; the internal consistency reported a Cronbach's alpha of more than 0.7; and the composite reliability was greater than 0.7. RESULTS: After conducting construct validity and factor analysis, four factors (Knowledge and skill of managing patients' pain and symptoms, management of ethical and psychological issues in patients, communicating with patients and their families & management of patients' exposure to grief and attitudes towards death) were extracted. The total variance was equal to (%43) and coefficients of internal consistency were estimated more than 0.7. Also composite reliability was evaluated greater than 0.7. CONCLUSION: Persian version of the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PPCEP-GR) is a valid and reliable questionnaire that can be used to measure the knowledge and performance of nurses and nursing graduates in the field of palliative care.

King's Theory of Goal Attainment: Quality of Life for People With Myocardial Infarction.

The aim of this study was to evaluate the effects of a theory of goal attainment-based care plan on quality of life among patients with myocardial infarction. One hundred two patients were randomly assigned to two groups. The intervention group received a theory of goal attainment-based care plan during their hospital stay and a two-month follow-up assessment after hospital discharge. Quality of life was assessed using the Persian version of the MacNew Heart Disease Health-Related Quality of Life questionnaire. Despite no significant difference between the groups with respect to the pretest mean scores of quality of life and its dimensions (p > .05), the posttest mean scores of quality of life and its dimensions in the intervention group were significantly greater than those of the control group (p < .001). Moreover, while the mean scores of quality of life and its dimensions significantly increased in the intervention group (p < .001), they did not significantly change in the control group (p > .05), except for the mean score of physical functioning (p = .032).

Nursing students' learning strategies for e-learning during the Covid-19 pandemic in Iran: a qualitative study.

BACKGROUND: In response to the emergency brought about by the Covid-19 pandemic, many universities around the world had to change their teaching methods from in-person classes to e-learning. The purpose of this study was to identify the learning strategies of nursing students in e-learning during the pandemic. METHODS: This study had a qualitative design and used content analysis approach to collect and analyze the data. Sixteen semi-structured interviews were conducted with 12 Iranian undergraduate nursing students who were selected using purposive sampling method. RESULTS: Most nursing students in this study generally used two different strategies for e-learning, namely self-centered learning strategies and collaborative learning strategies. Some students, on the other hand, adopted a passive approach in which they did not take any effective action to contribute to their learning. CONCLUSION: In e-learning during the pandemic, students adopted different learning strategies. Therefore, designing teaching strategies tailored to the students' strategies can promote their learning and academic achievement. Also, knowledge of these strategies helps policy makers and nursing educators to take necessary measures in order to optimize and facilitate student learning in an e-learning environment.

The Effect of Thai Massage on the Severity of Pain in Patients with Unstable Angina: A Randomized Controlled Clinical Trial.

Introduction: Chest pain is an unpleasant and the most common symptom in patients suffering from unstable angina. This study was implemented to investigate the effect of Thai massage on severity of pain in patients with unstable angina. Methods: This study was a randomized controlled clinical trial that carried out on 70 patients with unstable angina who had been hospitalized in hospital affiliated to Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran. The participants were allocated randomly to either the intervention (n=35) or control group (n=35) between August 1, 2016 and April 30, 2017. The patients in the intervention group received routine care beside and Thai massage with the duration of 30 minutes in two consecutive days. The patients in the control group received routine care. The intensity of pain was assessed by using the numeric rating scale, five minutes before and immediately, 15, 30 and 60 minutes after the intervention. The independent t-test and repeated measures analysis of variance (ANOVA) were used to analysis data through SPSS 13. Results: After the intervention, the severity of pain was significantly diminished by about four measurement points (P=0.001) with the linear pattern of pain reduction. Nonetheless, in the control group, no statistically significant difference in the intensity of pain was found. Conclusion: This study showed that Thai massage as non-invasive approach, concomitant with standard nursing care, has the potential to decrease chest pain. Nurses should be taught about pain relief methods for improving the quality of patient care.

Comparing the Effects of Sesame Oil vs. Nitroglycerin Ointment on the Incidence of Chemotherapy-Induced Phlebitis: A Single Blind Clinical Trial.

BACKGROUND: Phlebitis is a severe inflammatory response in patients undergoing chemotherapy that can lead to complications and increased length of hospitalization. OBJECTIVE: This study was conducted to examine the effects of sesame oil and nitroglycerin ointment on the incidence of chemotherapy-induced phlebitis in patients with cancer.  Methods: This clinical trial study involved 138 cancer patients who were randomly assigned into three groups. The three groups received nitroglycerin ointment, sesame oil, or betadine alcoholic solution that were applied on the distal catheter area at a length of 1.5 centimeters and width of 2 × 4 cm using graded paper. The site was then dressed and fixed with anti-allergenic adhesives. The research samples were examined for 72 hours for the incidence of phlebitis. RESULTS: No statistically significant difference was observed between the incidence of phlebitis in the sesame oil, nitroglycerin ointment and alcohol-betadine groups in the first 24 hours (p=0.2), the second 24 hours (p=0.13) and the third 24 hours (p=0.13). CONCLUSION: External use of both sesame oil and nitroglycerin is effective in reducing chemotherapy-induced phlebitis. Due to its anti-inflammatory effect and low cost, however, using sesame oil is recommended.

The effect of an infection control guideline on the incidence of ventilator-associated pneumonia in patients admitted to the intensive care units.

BACKGROUND AND AIM: Standard airway care can reduce the incidence of ventilator-associated pneumonia (VAP). This study aimed to determine the effect of implementing infection control guidelines on the incidence of VAP in patients admitted to the intensive care unit (ICU). MATERIALS AND METHODS: In this clinical trial, 121 patients admitted to the intensive care units of Golestan and Imam Khomeini hospitals of Ahvaz, Iran who were under mechanical ventilation were assigned to two groups of control and intervention in non-randomly allocation. The study was conducted in two consecutive periods. In the intervention group, infection control guidelines were performed to prevent VAP and in the control group, routine care was performed. Data collection is done by used a three-part instrument. The first part included questions on the patients' demographics and clinical information. The second part was the modified clinical pulmonary infection scale (MCPIS) for the early detection of VAP. The third part of the data collection instrument was a developed checklist through literature review. The MCPIS was completed for all patients on admission and the 5th day of the study. RESULTS: The two groups were homogenous respecting their baseline characteristics (P > 0.05) including the mean MCPIS score (P > 0.05). However, the intervention group had lower body temperature (P < 0.001), lower white blood cell counts (P < 0.038), lower MCPIS score (P < 0.001), and higher PaO2/FIO2 (P < 0.013) at the end of the study. The incidence of VAP was significantly lower in the intervention group when compared to the control group (i.e. 30% vs. 65.6%, P < 0.001). CONCLUSIONS: The implementation of infection control guidelines could significantly reduce the incidence of VAP and its diagnostic indicators in patients admitted to the ICU. Nurses are advised to use these guidelines to prevent VAP in patients admitted to ICU.

Exploring the social accountability challenges of nursing education system in Iran.

BACKGROUND: Nursing education in Iran is one of the disciplines of medical sciences and it needs a design tailored to the community needs in terms of theoretical and clinical approaches. This system is currently faced with various challenges. This study aims to explore the challenges of Iranian nursing education system to address community needs. METHODS: A study was carried out through an exploratory descriptive qualitative design with content analysis method. In-depth semi-structured interviews were conducted with 21 participants from the nursing society, selected through purposive sampling. The interviews were continued until data saturation. Data analysis was performed simultaneous with data collection by using Graneheim & Lundman approach. RESULTS: Based on the interviews and simultaneous analyses, a total of 471 codes, 14 subcategories, six main categories, and two themes were extracted. The first theme, "system structure," consisted of three categories: "the need for ongoing revision of curriculum," "the need to recruit qualified students," and "the need for a proportionate educational environment." The second theme was "the education process" with three categories "the need for purposive educational design," "the need for purposive monitoring and feedback," and "the need for appropriate and early interaction with the community." The participants emphasized the continuous revision of the educational curriculum based on the current needs of the community and community-based nursing education. CONCLUSIONS: In general, the results showed that Iranian nursing education system is faced with many challenges in the educational system structure and processes. It is necessary to make appropriate plans to enhance the status of the educational system structure and develop educational designs to address community needs using a hospital/community-based approach.

Challenges in implementation of patient-centred care in cardiac care unit: A qualitative study.

AIM: This study aimed to explore the barriers to the implementation of patient-centred care (PCC) in the cardiac care unit (CCU) from the perspectives of patients, nurses, physicians and nursing managers. DESIGN: This study was performed with a descriptive qualitative study approach. METHODS: In this study, the data were collected through face-to-face in-depth semi-structured interviews with 10 cardiac care nurses, one assistant nurse, two cardiologists, seven patients admitted to the CCU and nine nursing managers and analysed by Graneheim and Lundman content analysis method. RESULTS: After analysing the data, eight subcategories and three main categories were extracted. The main categories included challenges related to: organization, healthcare providers and patients. This study demonstrated the barriers to the implementation of PCC in the CCU. Insights into these barriers can guide interventions aimed at improving the quality of PCC in the CCU, which in turn can lead to improved disease outcomes.

Hospice care delivery system requirements.

BACKGROUND: Hospice care is a perceived need in the Iranian health system. AIM: This qualitative study is explaining the stakeholders' perception of what is required to develop a hospice care system for patients living with cancer in Iran. METHODS: A total of 21 participants (specialists, policymakers, healthcare providers, cancer patients and family caregivers) were selected through purposeful sampling and interviewed in-depth in 2020. Interviews were analysed through directed content analysis. FINDINGS: A total of 1054 codes, 7 categories and 21 subcategories were extracted. The requirements include the need to provide: multiple settings and diverse services; participatory decision making; integration into the health system; specialised human resources; an organised system of accountability; the preparation of the existing health system; and wider capacity-building in existing Iranian society. CONCLUSION: It is essential that Iranian services create a participatory comprehensive care plan, utilise expert manpower, integrate hospice care into the existing health system and organise a system of accountability. Policymakers should focus on the preparation of the health system and capacity building in society.

Impact of a sensory stimulation program conducted by family members on the consciousness and pain levels of ICU patients: A mixed method study.

Background: The results of several studies show the different effects of a balanced sensory stimulation program (SSP) on patients with brain injury admitted to the intensive care unit (ICU), but these effects have been less studied based on mixed and comprehensive methods. Method: This mixed-method study involved 66 patients with brain injury admitted to the ICU who were allocated into intervention (n = 33) and control (n = 33) groups using random stratified sampling. Patients in the intervention group received a sensory stimulation program from family members for 1 h daily during ICU hospitalization, while the control group received only routine care. Patients' level of consciousness and pain intensity were measured immediately before and after the intervention using Glasgow Coma Scale (GCS) and Behavioral Pain Scale (BPS), respectively. In-depth unstructured interviews were conducted with the patients in the intervention group 3 months after discharge from the ICU. These interviews were analyzed following Graneheim and Lundman (2004) conventional content analysis method. Results: A significant difference was found between the study groups in terms of the mean difference of GCS (P =0.001) and BPS score (P = 0.001) before and after intervention. Patients in the intervention group had a higher mean GCS and a lower mean BPS than did patients in the control group. The main themes extracted from the qualitative analysis confirmed the results obtained from the quantitative phase of the study. Conclusion: The combination of the quantitative and qualitative findings suggested that amidst the many hardships and sufferings brain injury patients go through in the ICU, a sensory stimulation program offered by family members may have many benefits such as increased level of consciousness and reduced pain for these patients. Therefore, it is necessary to formulate a framework for this program and provide the needed facilities in order to benefit more from the capacity of such programs for ICU patients.

Community Health Nursing in Iran: A Review of Challenges and Solutions (An Integrative Review).

Background and Objective: In recent decades, nursing has witnessed many changes in Iran. Despite the numerous advances in nursing, the health system faces many challenges in community health nursing. This study aims to review the challenges in community health nursing in Iran and provide an evidence-based solution as well. Materials and Methods: This article is an integrated review of the literature regarding the challenges in community health nursing published between 2000 and 2021 in the databases Scopus, Medline, Cochrane Database of Systematic Reviews, Science Direct, Google Scholar, Scientific Information Database (SID). After performing searches, 20 articles were selected and studied. Data analysis was done using Russell approach (2005). Findings: The results of this study were summarized in 6 themes consisting of challenges in community health nursing education, practical challenges in community health nursing, policy-making challenges in community health nursing, management challenges in community health nursing, and infrastructural and cultural challenges. Solutions were also proposed to address each of the above issue. Conclusions: The results of the study showed that diverse challenges exist in community health nursing in Iran, considering that community health nurses play an important role in providing primary health care and community-based care. In order to solve these challenges, the authors have some recommendations: modifying the structure of the health system with the aim of moving toward a community-oriented approach from a treatment-oriented one, developing laws to support community health nurses, creating an organizational chart for nurses at the community level, modifying nursing students' training through a community-based approach, and covering community-based services and care under insurance.

Scope of Iranian community health nurses 'services from the viewpoint of the managers and nurses: a content analysis study.

BACKGROUND: Considering the need for nurses specializing in community health and in order to define professional duties for future planning towards creating the position of community health nurses in the primary health care system of Iran, this study aims to explain the range of services which can be provided by community health nurses from the perspective of the mangers and nurses. METHODS: The present qualitative study was conducted with the approach of contract content analysis in Iran in 2020. This study was conducted through in-depth and semi-structured interviews with 22 participants, including community health nursing faculty members, health deputies and managers, community health nurses working in health centers, and the care seekers visiting comprehensive health centers. The samples were selected through purposeful sampling. The interviews continued until data saturation. Data analysis was performed simultaneously with data collection. The interviews were recorded, transcribed, and analyzed through Graneheim & Lundman's content analysis method, and data management was done using MAXQDA software. To achieve data trustworthiness, the criteria presented by Lincoln and Guba were used. RESULTS: The obtained data were classified into the two main categories of service provision settings and service provision domains. The category service provision settings covered 7 subcategories including participation in the family physician plan, activities at the centers for vulnerable groups of the community, establishing private community health clinics, leading health promotion programs in the 3rd generation hospitals, activities in comprehensive health centers, follow-ups and home visits, and activities in schools' health units. Service provision domains consisted of 6 subcategories including participation in health planning, decision-making, and policymaking, research on the health system, health promotion, monitoring and coordination, providing care for the patients with non-communicable diseases and high-risk groups, and eldercare. CONCLUSIONS: From the participants' perspective, important services that can be provided by the community health nurse are health promotion, the management of chronic patients and the elderly, follow-ups, and home visits. Therefore, it is recommended that health policy makers pay attention to the service provision areas and the services providable by the community health nurse in their macro-planning, and to provide primary health care in comprehensive health centers using inter-professional care models, integrating the community health nurse into the care team.

Effect of end-of-life nursing education on the knowledge and performance of nurses in the intensive care unit: a quasi-experimental study.

BACKGROUND: End-of-life care education is required for nurses to acquire the clinical competence necessary for the improvement of the quality of end-of-life nursing care. The aim of this study was to determine the effect of nursing care education based on End-of-Life Nursing Education Consortium (ELNEC) on the knowledge and performance of nurses working in the intensive care unit (ICU). METHODS: This quasi-experimental study was conducted with a pretest-posttest design. From among nurses working in the ICU of Golestan and Imam Khomeini hospitals in Ahvaz, Iran, 80 nurses were selected based on the inclusion criteria. They were randomly assigned to the intervention and control groups (40 people in each group) using a table of random numbers. Data were collected using a demographic characteristics form, the ELNEC Knowledge Assessment Test (ELNEC-KAT), and the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PCEP-GR). RESULTS: A significant difference was observed between the intervention and control groups in terms of the average knowledge score in all 9 modules including nursing care, pain management and control, disease symptom management, ethical/legal issues, culture, communication with the patient and his/her family, loss and grief, death, and quality of life (QOL) (P < 0.001). Moreover, the average performance score of nurses in the fields of preparation for providing palliative care, self-assessment of ability to communicate with dying patients and their relatives, self-assessment of knowledge and skills in palliative care increased significantly in the intervention group compared to the control group (P < 0.001). CONCLUSIONS: End-of-life nursing education is recommended as an effective method for promoting knowledge, attitude, performance, and clinical competence among all nurses involved in end-of-life care.

A randomized trial of comparing video telecare education vs. in-person education on dietary regimen compliance in patients with type 2 diabetes mellitus: a support for clinical telehealth Providers.

BACKGROUND: Compliance to dietary recommendations by patients is the most difficult part of diabetes management. The nature of any educational method is to increase patients' awareness. But the question is, what is the effect of each method and for this purpose a comparative method should be considered. Therefore, this study was conducted to compare the effects of in-person education versus video tele-education on dietary regimen compliance in patients with T2DM. METHODS: In this trial, 378 patients with type 2 diabetes mellitus (T2DM) were random allocated into video tele-education, in-person education and control groups. The patients' weight and biochemical parameters were measured before educational programs and three-month later. RESULTS: The mean changes of patients' weight, glycemic parameters, and Lipid profiles decreased more in the two educational groups than the control group in a three-month period. There were no significant differences in the all study variables between the in-person and video education groups in post interventions except Total Cholesterol (TC). The pre- and post-intervention changes in the weight, TC, hemoglobin A1c, Triglyceride, and Very Low-density Lipoprotein Cholesterol were significant in both in-person group and video group. None of the educational programs had a significant impact on the Fasting blood sugar, Low-Density Lipoprotein Cholesterol, and High-Density Lipoprotein Cholesterol. DISCUSSION: Video tele-education was just as effective as in-person educational method on dietary regimen compliance among patients with T2DM in a three-month period. Therefore, it is recommended to use video tele-education in combination with or as an alternative to the in-person education method. This study provides support for diabetes educator. TRIAL REGISTRATION: This investigation was registered in the Iranian Registry of Clinical Trials Center ( IRCT20150302021307N4 ).