Translation and validation of a lifestyle questionnaire related to prostate cancer.

BACKGROUND: Valid and reliable instruments are needed to measure prostate cancer-related lifestyle changes, plan evidence-based interventions to modify lifestyle, and improve treatment outcomes. Due to the lack of appropriate instruments, this study was conducted to translate the Effects of Prostate Cancer upon Lifestyle Questionnaire (EPCLQ) into Persian and examine its psychometric properties in a sample of Iranian older adults with prostate cancer. METHODS: This methodological study was carried out between 2021 and 2022. Initially, the EPCLQ, comprising 36 items, was translated into Persian through a meticulous translation and back-translation procedure. Subsequent steps involved the assessment of face validity, qualitative content validity, content validity index, content validity ratio, construct validity via confirmatory factor analysis, and reliability testing of the Persian version of the EPCLQ. RESULTS: The psychometric evaluation led to the exclusion of 4 items from the EPCLQ. The refined model demonstrated satisfactory fit indices (PCFI = 0.732, PNFI = 0.696, CMIN/DF = 2.29, RMSEA = 0.072, IFI = 0.920, CFI = 0.919, and GFI = 0.971), indicating an appropriate fit of the final model. The internal consistency, as measured by Cronbach's alpha, was 0.67, and the intraclass correlation coefficient for the questionnaire was 0.938, reflecting high reliability. CONCLUSIONS: The Persian version of the EPCLQ, now consisting of 32 items, has been validated and is reliable for assessing the impact of prostate cancer on lifestyle among older adults. Its simplicity and the clarity of the items make it suitable for use in clinical settings or during home visits for follow-up assessments.

Cardiovascular disease risk factors and frailty syndrome in community-dwelling older adults: Results from the Amirkola Health and Aging Project Cohort Study.

BACKGROUND: Early diagnosis and control of risk factors affecting frailty syndrome (FS) in older adults may lead to changes in the health/disease process, prevention of disability and dependency in the older adults, and reduction of health care costs and mortality rates. The aim of this study was to determine the predictive role of CVD risk factors and FS in community-dwelling older adults of Amirkola city in Iran. METHODS: This descriptive-analytic cross-sectional study is part of the second phase of the Amirkola Health and Aging Project (AHAP) cohort study conducted since 2011 on all individuals ≥ 60 years in the city of Amirkola in northern Iran. Totally, 1000 older adults were included in the study and divided into three groups: frail (n = 299), pre-frail (n = 455), and non-frail (n = 246) older adults. In the present study, age ≥ 60 years, female sex, fasting blood sugar (FBS) ≥ 126 mg/dl, affected diabetes mellitus (DM), body mass index (BMI) ≥ 27 kg/m², waist circumference (WC) or abdominal obesity > 102 cm in men and > 88 cm in women, low-density lipoprotein (LDL) > 100 mg/dl, triglyceride > 150 mg/dl, cholesterol > 200 mg/dl, high-density lipoprotein (HDL) < 40 mg/dl and blood pressure (BP) > 90/140 mmHg, uric acid > 7 mg/dl and a positive smoking history were considered CVD risk factors. RESULTS: The results showed that with each centimeter increase in WC, the odds of frailty compared with non-frailty was 79% higher, and the odds of frailty compared with pre-frailty was 1.43 times higher in older adults. In addition, the prevalence of pre-frailty compared with non-frailty, pre-frailty, and non-frailty was 10.59 times, 6.08 times, and 73.83 times higher in older individuals > 84 years old, respectively. The results of the present study indicated that the prevalence of pre-frailty compared with non-frailty, frailty compared with pre-frailty, and frailty compared with non-frailty was 2.86 times, 3.01 times, and 14.83 times higher in older adults women, respectively. The comparison between frail and non-frail groups represented that in DM older adults, the prevalence of frailty compared with non-frailty was 1.84 times higher and that of frailty compared with pre-frailty was 98% higher. The older adults with an FBS ≥ 126 mg/dl were 53% more likely to become frail, and with each unit increase in uric acid, the odds of becoming frail increased 2.05 times compared with non-frail older adults, and pre-frail compared with non-frail increased 99%. CONCLUSION: The results demonstrated that CVD risk factors predictive of FS included central obesity, age > 84 years, female sex, DM, FBS ≥ 126, and uric acid > 7. This problem highlights the need for preventive strategies in the older adults who are simultaneously vulnerable to CVD and frailty.

Risk factors and the psychological impacts of the COVID-19 outbreak: perspectives and experiences of Iranian healthcare workers on the frontline.

Frontline healthcare workers (HCWs) looking after COVID-19 patients are at high risk of developing mental health problems. Both preventive and interventional initiatives are essential, therefore, to maintain and improve the mental health of HCWs and ultimately to enhance the quality of care that they provide. This qualitative content analysis study, conducted in Iran between September 2020 and February 2021, involved the gathering of data on the issue through face-to-face interviews with 22 HCWs working directly with COVID-19 patients. Data analysis led to the generation of 163 codes, 45 categories (16 risk factors and 29 consequences), and 9 themes. Overall, the results suggest that caring for a patient with COVID-19 is associated with positive and negative psychological impacts. Measures such as increasing sensitivity to crisis situations, self-adjustment skills training, and identifying signs of job burnout owing to moral conflicts can reduce or eliminate the risk of negative psychological consequences among HCWs.

Design and psychometric evaluation of epilepsy-related apathy scale (E-RAS) in adults with epilepsy: a sequential exploratory mixed methods design.

BACKGROUND: Apathy in patients with epilepsy is associated with a wide range of consequences that reduce the patient's ability to perform social functions and participate in self-care and rehabilitation programs. Therefore, apathy is one of the important diagnoses of the healthcare team in the process of caring for epileptic patients and its dimensions need to be examined and recognized. Therefore, appropriate instruments with the sociocultural milieu of each community should be provided to health care providers. The aim of the present study was to design and measure epilepsy-related apathy scale (E-RAS) in adults with epilepsy. METHODS: This study of sequential exploratory mixed methods design was conducted in Iran from April 2019 to December 2019. In the Item generation stage, two inductive (face-to-face and semi-structured interviews with 17 adult epileptic patients) and deductive (literature review) were used. In item reduction, integration of qualitative and literature reviews and scale evaluation were accomplished. For Scale Evaluation, face, content, construct [exploratory factor analysis (EFA) (n = 360) and confirmatory factor analysis (CFA) (n = 200)], convergent and divergent Validity and reliability (internal consistency and stability) were investigated. RESULTS: The results of EFA showed that E-RAS has four factors, namely, motivation; self-regulatory; cognition and emotional-effective. These four latent factors accounted for a total of 48.351% of the total variance in the E-RAS construct. The results of CFA showed that the 4-factor model of E-RAS has the highest fit with the data. The results of convergent and divergent validity showed that the values of composite reliability (CR) and average variance extracted (AVE) for the four factors were greater than 0.7 and 0.5, respectively, and the value of AVE for each factor was greater than CR. The Cronbach's alpha coefficient for the whole scale was obtained 0.815. The results of the test-retest showed that there was a significant agreement between the test and retest scores (P < 0.001). CONCLUSION: E-RAS is a multidimensional construct consisting of 24 items, and has acceptable validity and reliability for the study of epilepsy-related apathy in adult epileptic patients.

Structural equation model of affecting factors on elder abuse to patients under hemodialysis by family caregivers.

BACKGROUND: The objectives of the present study were to determine the prevalence of older adults with hemodialysis (HD) abuse by family caregivers and the factors affecting it. METHOD: This is a correlational-causal study, which is conducted in 2018 in Iran. The sample size was 367 in both groups (the older adults and their family caregivers). Data collection was done using an individual-social information questionnaire for the older adults under hemodialysis and their family caregivers, the questionnaire of elder abuse by family caregivers to the older people under hemodialysis, Zarit Burden Interview and the scale of instrumental activities of daily living (IADL). Data were analyzed by the structural equation model (SEM) method. The Fitness of proposed pattern was measured using the following indexes: chi-square/degree of freedom ratio (CMIN/DF), Normed Fit Index (NFI), comparative fit index (CFI), goodness of fit index (GFI), and standardized root mean squared residual (SRMR). The significant level in this study was considered p < 0.05. RESULTS: The results of the present study showed that more than 70 % of the older adults suffer from elder abuse by family caregivers on average. The highest median elder abuse was related to emotional misbehavior (21.46 ± 6.09) and financial misbehavior (19.07 ± 5.33), respectively. Moderate care burden was experienced by 63.2 % of caregivers. The percentage of older women and men, who needed help with daily activities was 81.4 and 80.5 %, respectively. The results showed that the caregivers' level of education and care burden with standard beta coefficient of -0.251 and 0.200 and the educational level of older adults and IADL with the best beta coefficient of -0.299 and - 0.234, had the highest regression effect on elder abuse respectively. According to the results, the model-fit indices of the hypothesized model was meet the criteria, with the NFI = 0.951, GFI = 0.970, CFI = 0.967, and SRMR = 0.041. The outcome was suitable for the recommended level, so the hypothetical model appeared to fit the data. CONCLUSIONS: The results of the present study showed that the prevalence of elder abuse by family caregivers among the older adults under hemodialysis is high. Providing psychological counseling can reduce the consequences of elder abuse.

Designing and psychometric evaluation of disease-related fear scale (D-RFS) in adults with epilepsy: A sequential exploratory mixed methods design.

BACKGROUND: Disease-related fear is one of the important diagnoses of healthcare providers in caring for people with epilepsy whose conceptual dimensions should be discovered and investigated. To this end, it is necessary to provide healthcare providers with appropriate tools to assess fears related to the disease in accordance with the sociocultural milieu of each community. AIM: The purpose of this study was to design and psychometrically evaluate the disease-related fear scale (D-RFS) in adults with epilepsy. METHODS: This study was of a sequential exploratory mixed methods design conducted in Iran in 2019. In the item generation phase, inductive (face-to-face, semi-structured interviews with 14 adult patients with epilepsy) and deductive (literature review) were used. In the item reduction, integration of qualitative and literature reviews and scale evaluation were performed. For the scale evaluation, face validity, content validity, construct validity [exploratory factor analysis (EFA) (n = 367) and confirmatory factor analysis (CFA) (n = 250)], and convergent and divergent validity and reliability (internal consistency and stability) were investigated. RESULTS: After the qualitative phase and literature review, 40 items were codified. After investigation of the qualitative and quantitative face validity, 7 items were deleted. Two items were deleted due to content validity ratio (CVR) of less than 0.56 and one item due to content validity index (CVI) of less than 0.78. Finally, a 30-item scale was obtained, and its construct validity was assessed. Kaiser-Meyer-Olkin (KMO) index was 0.85, and Bartlett's test of sphericity was 7237.504, P < 0. 001. The results of CFA showed that the bivariate model of the D-RFS (fear of seizure consequences and fear of the disease's long-term consequences) had the most appropriate fitness to the data. Convergent and divergent validity results showed that the values of composite reliability (CR) and average variance extracted (AVE) for the two factors were greater than 0.7 and 0.5, respectively, and the AVE for each factor was greater than CR. Internal consistency of the first and second factors were obtained 0.891 and 0.910, respectively. Cronbach's alpha coefficient for the total scale was obtained 0.921. The results of test-retest reliability showed that there was a significant agreement between the scores of the test and retest (P < .001). CONCLUSION: The D-RFS has an acceptable factorial structure, and its internal consistency was confirmed by different approaches. This scale is a valid and reliable tool for assessing disease-related fear in patients with epilepsy. The simplicity of the items and the appropriate time to complete the scale can be considered as its strengths.

Investigating the needs of family caregivers of older stroke patients: a longitudinal study in Iran.

BACKGROUND: The high burden of care associated with older stroke patients is a factor that threatens the health of family caregivers. Identifying the needs of family caregivers in this group of patients can help provide effective solutions. The present study aimed to determine the needs of family caregivers of older stroke patients. METHODS: The sample size of this longitudinal study included 200 family caregivers of older stroke patients from two hospitals in Iran. Data collection included demographics, responses to family caregivers' needs questionnaires, and the Barthel Index which was taken in four stages including admission time, pre-discharge, two weeks and 12 weeks post-discharge. RESULTS: The results showed that all participants at all stages of the study identified "respect for the patient when providing education, treatment, or rehabilitation" as one of their needs. There was a statistically significant relationship between the older adult survivor's age and the number of family caregivers' needs two weeks post-discharge (p = 0.012) and 12 weeks post-discharge (p = 0.008). There was a significant relationship between the patient's hospitalization period and the number of caregivers' needs three months after the patient's discharge (p = 0.028), and a significant statistical relationship between the pre-discharge physiotherapy of the patients and the number of their caregivers' needs during the two weeks post-discharge (p = 0.018). There was also a statistically significant relationship between the patient's level of dependence and the number of caregivers' needs (p = 0.0001). On the contrary, there was no significant relationship between the sex, place of living, and underlying disease history of the patient and the number of caregivers' needs (p > 0.05). CONCLUSION: The results of the present research indicate that the total number of caregivers' needs decreases with increasing duration of the disease. However, respite and care provision planning by other family members, seeking assistance from professional caregivers, and the search for community support resources can help reduce the burden of care of caregivers and give them the opportunity to meet their needs in different dimensions of patient care provided.

Development and psychometric evaluation of the women shift workers' reproductive health questionnaire: a sequential exploratory mixed-method study.

BACKGROUND: There is no standard and comprehensive questionnaire for reproductive health assessment among women shift workers. This study aimed at the development and psychometric evaluation of the Women Shift Workers' Reproductive Health Questionnaire. METHODS: This sequential exploratory mixed-method study was conducted in a qualitative (item generation) and a quantitative (psychometric evaluation) phase. In the qualitative phase, the primary item pool of the questionnaire was generated based on the findings of the qualitative content analysis of 21 interviews held with 21 women shift workers as well as the findings of a literature review. In the quantitative phase, the face, content, construct, convergent, and discriminant validity and the reliability of the questionnaire were assessed. For construct validity assessment through exploratory and confirmatory factor analyses, 620 women shift workers were conveniently selected to fill out the questionnaire. Reliability assessment was done through assessing internal consistency, stability, and composite reliability. RESULTS: The primary item pool contained 88 items. During face and content validity, item number was reduced to 55. Construct validity assessment through factor analysis revealed that 56.50% of the total variance was explained by five factors with 34 items. The factors were named motherhood, general health, sexual relationships, menstruation, and delivery. Confirmatory factor analysis confirmed the fit of the five-factor model. The Cronbach's alpha and the composite reliability value of the questionnaire were more than 0.7. CONCLUSION: The Women Shift Workers' Reproductive Health Questionnaire is a valid and reliable instrument and can be used for reproductive health assessment among women shift workers.

Development and psychometric evaluation of the Perceived Social Stigma Questionnaire (PSSQ-for adults with epilepsy): A mixed method study.

BACKGROUND: Stigma is a subjective and multidimensional concept that is dependent on the understanding of individuals and social culture potentially influencing treatment and health in various aspects. The study of patient beliefs about epilepsy can help design preventive interventions. This study was conducted to develop and psychometrically evaluate the Perceived Social Stigma Questionnaire (PSSQ-for adults with epilepsy). METHODS: This mixed method study of sequential exploratory quantitative-qualitative design was conducted within the framework of instrument development variant. The qualitative section consisted of item development and scale development. In the quantitative section (item analysis), the instrument was validated by investigating face, content, and construct validity and its reliability by internal consistency and stability. CONCLUSION: The PSSQ-for adults with epilepsy is a culturally appropriate measure with strong psychometric properties. The tool developed in this study can measure the perceived social stigma of epilepsy. However, more information on the scale is needed before it is adequately improved to test interventions, including concurrent validity and sensitivity to change.

Effects of Motivational Interviewing on Adherence to Treatment Regimens Among Patients With Type 1 Diabetes: A Systematic Review.

BACKGROUND: Motivational interviewing (MI) is a strategy for promoting adherence to treatment regimens among patients with diabetes. However, limited evidence exists regarding its effectiveness in reducing A1C. OBJECTIVE: To identify and synthesize evidence about the effectiveness of patient, provider, and health system interventions to improve diabetes care among patients with type 1 diabetes. DESIGN: This was a systematic review of randomized controlled trials. METHODS: A search was conducted of the scientific databases MEDLINE, Elsevier, CINAHL, Google Scholar, ProQuest, Ovid, and PubMed without imposing any time limit. Only four documents met the inclusion criteria and were included in the final analysis. The methodological quality of these four articles was reviewed by three reviewers using the Jadad Scale. The main intervention and the primary outcome in this study were MI or motivational enhancement therapy and A1C, respectively. RESULTS: The retrieved studies reported that MI promotes self-monitoring of blood glucose and reduces A1C. CONCLUSION: MI is effective in enhancing patients' adherence to the treatment regimen and thereby decreasing A1C. Given the fact that the reviewed studies had not eliminated the effects of confounding factors, further studies are needed to assess the pure effects of MI on adherence to treatment regimens and A1C levels.

Cardiac patients' beliefs about their illness and treatment: A sequential exploratory mixed methods design.

Background: Cardiac patients' beliefs about illness and treatment can disturb their treatment process, treatment regimen adherence, and daily activities. Exploring these beliefs by the use of appropriate, valid, and accurate scales can be helpful in false beliefs reforming by nurses and finally, result in life quality promotion. Therefore, this study is conducted to design and psychometry a questionnaire probing about cardiac patients' beliefs about illness and treatment. Methods: The sequential combination exploratory mixed methods design was used to develop the questionnaire format, which involved two sections: the quantitative and qualitative step. The qualitative step included probing the role of cultural beliefs about illness and treatment in two steps, including the literature and related tools review and fieldwork (semi-structured interviews with cardiac patients). Seventeen studies were checked in the literature review. Twenty-two cardiac patients were selected and interviewed by purposive sampling. The interviews continued up to the data saturation. The data analysis was conducted in both steps using conventional content analysis and textual content analysis. The quantitative step was a methodology study accomplished in two parts. The questionnaire items were formed using the data and items pool in the first part while the psychometric properties of the questionnaire were checked using face, content and construct validity and the reliability was probed using internal consistency and stability in the second part. The data were transferred into SPSS software program, version 18.0 for Windows (α<0.05). Results: 319 codes were extracted from the analyzing phase which formed 6 categories including prognosis, prevention, contexts, treatment efficiency, mentality and lifestyle as well as 9 sub-categories including understanding the danger, attitude toward disease, attitude toward treatment, society's culture, feeling hopeless, treatment regimen ignorance, self-curing, trying to survive and physical outcomes. The items pool was formed using literature reviews and interviews. A 30-itemed questionnaire was formed after the psychometric process. The Kaiser-Meyer-Olkin (KMO) index and the Bartlett's test of sphericity showed good results. Six components from the exploratory content analysis including prognosis, prevention, contexts, treatment efficiency, mentality, and lifestyle gained 51.7% variance totally. The interclass correlation coefficient was 0.83 in responding to the items for two times. Conclusion: This study developed a questionnaire about cardiac patients' beliefs regarding their illness and treatment. It can be used for the educational, research, and treatment purposes as a questionnaire with short, easy, and grammatically simple items that have appropriate validity and reliability. Using this scale can be helpful in evaluating clients' beliefs and recognize their educational needs.

Development and psychometric evaluation of a women shift workers' reproductive health questionnaire: study protocol for a sequential exploratory mixed-method study.

BACKGROUND: Although shift works is a certain treat for female reproductive health, but currently, there is no standardized instrument for measuring reproductive health among female shift workers. This study aims to develop and evaluate the psychometric properties of a Women Shift Workers' Reproductive Health Questionnaire (WSW-RHQ). METHODS: This is a sequential exploratory mixed-method study with a qualitative and a quantitative phase. In the qualitative phase, semi-structured interviews will be held with female shift workers who live in Mazandaran Province, Iran, additionally, the literature review will be performed by searching electronic databases. Sampling will be done in different workplaces and with maximum variation respecting female shift workers' age and job and educational and different economic situation. Interview data will be analyzed using conventional content analysis and then, the primary item pool for the questionnaire will be developed. In the quantitative phase, we will evaluate the psychometric properties of the questionnaire, i.e. its face, content, construct as well as reliability via the internal consistency, stability. Finally, a scoring system will be developed for the questionnaire. DISCUSSION: The development of WSW-RHQ will facilitate the promotion and implementation of reproductive health interventions and assessment of their effectiveness. Other scholars can cross-culturally adapt and use the questionnaire according to their immediate contexts.

Experiences of substance abusers from methadone maintenance therapy.

Background: Substance abusers are not able to withdraw drugs eternally despite the abundance of different treatments; therefore, withdrawal programs are not quite successful and notwithstanding all the successes of methadone maintenance therapy, there are some defects found in the manner this treatment is applied. Thus, this study was conducted to explore the experience of drug abusers regarding methadone maintenance therapy. Methods: This is a qualitative study using content analysis methodology. The research community includes drug abusers admitted to the treatment centers of the western cities of Mazandaran Province, Iran in 2016. The sampling was purposive and the data were collected by face-to-face single interviews with 20 patients. The interviews were continued up to data saturation. Finally, the Lundman and Grenheim method was used to analyze the interviews and the four criteria of Guba and Lincoln were applied to check data integrity. Results: "Buying time," "methadone dependence," and "looking from a narrow view to the patient" were the main three categories that fit the results. Conclusion: Governmental free services for drug abusers; paying attention to different aspects of treatment such as mental, emotional, and social recovery; lifelong support of the family and society members; and balance in prescribing and following the treatment process prescribed by health care providers can enhance both the quality and safety of the treatment process. Psychological consultation alongside social services can facilitate the recovery process in methadone maintenance therapy.

Nurses' experiences of humour in clinical settings.

BACKGROUND: Providing holistic nursing care when there is a shortage of personnel and equipment exposes nurses to stress and a higher risk of occupational burnout. Humour can promote nurses' health and influence nursing care. The aim of this study was to describe nurses' experiences of humour in clinical settings and factors affecting it. METHODS: This qualitative study investigated nurses' experiences of humour. Five hospitals affiliated to Tehran University of Medical Sciences provided the setting for this study. The participants comprised of 17 nurses with master's and Baccalaureate degrees (BSN) in nursing. These nurses worked at educational hospitals affiliated to Tehran University of Medical Sciences and had minimum work experience of 12 months in various clinical wards. Nurses from all wards were invited to participate in this study. The data were collected through semi structure interviews using guides comprising probing questions. Telephonic interviews were used to further supplement the data. The data were analysed using conventional content analysis. RESULTS: The data were classified into five themes including the dynamics of humour, condition enforcement, Risk making probability, Instrumental use and Change: opportunities and threats. CONCLUSION: Understanding nurses' perceptions and experiences of humour helps identify its contributing factors and provides valuable guidelines for enhancing nurses and patients' mental, emotional and physical health. Spreading a culture of humour through teaching methods can improve workplace cheerfulness and highlights the importance of humour in patient care in nurses and nursing students.

Opium addiction in patients with coronary artery disease: a grounded theory study.

BACKGROUND: There are widespread misconceptions about the positive effects of opium on coronary artery disease (CAD). Thus, we performed a study to explore the opium addiction process contributing factors among CAD patients using a grounded theory approach. METHODS: The sample comprised 30 addicted CAD patients and their family members, physicians, nurses and friends. Purposive and theoretical sampling was employed; semi-structured interviews were conducted. Coding and constant comparative analysis techniques were as proposed by Strauss and Corbin (1998). RESULTS: The core category was 'Fighting for Survival', comprising three main themes, namely, 'the gateway', 'blowing into the fire' and 'getting stuck in the mud'. CONCLUSION: Increasing knowledge about the adverse effects of opium on the cardiovascular system would reinforce prevention and rehabilitation measures. Involving patients' family-members in addiction prevention and rehabilitation programs and referring patients to specialized rehabilitation centres could help patients quit opium. Healthcare providers (HCPs) should notice to the effects of opium consumption among CAD patients; nursing care must be holistic in nature. Although opium is stigmatised in Iran, HCPs must treat addicted CAD patients similar to other patients. Nursing students' must be aware of the negative effects of illegal drugs on CAD patients and the misconceptions regarding the positive effects thereof. Any misconceptions must be probed and clarified. Rehabilitation centres must be supervised by cardiologists and HCPs.

Exploring Iranian nurses' experiences of missed nursing care: a qualitative study: a threat to patient and nurses' health.

BACKGROUND: The main objective of nursing is to provide comprehensive nursing care that is appropriate to patients' needs. However, the incidence of missed nursing care compromises the provision of comprehensive and safe care and threatens patients' lives. Thus, this in-depth qualitative study aimed to explore nurses' experiences of missed care and factors affecting it. The aim of this study was to describe nurses' experiences of missed care in clinical practice. METHODS: In this study, qualitative research methodology, with a content analysis approach was used. The sample included 23 nurses in referral teaching hospitals. Data were collected through focus group discussions, face-to-face and telephonic interviews, using semi-structured questions. RESULTS: Three themes, comprising several sub-themes, emerged, and included contextual conditions, coercion, and deprivation. CONCLUSION: The results indicated that organizational and personal factors facilitate the incidence of coerced, missed nursing care. High quality of care, the prevention of missed care incidences and patient safety depend on the provision of adequate staff, appropriate equipment and a sense of responsibility for patients' care needs among nurses.

Development and psychometric evaluation of uncertainty about disease and treatment scale in hemodialysis patients: a sequential-exploratory mixed-method study.

BACKGROUND AND OBJECTIVE: The need for long-term treatment and frequent visits to treatment centers for hemodialysis can lead to psychological problems such as Uncertainty about Disease and Treatment (UC about D&T) in patients with chronic kidney failure. In order to understand uncertainty about disease and treatment and to plan for preventive measures and care interventions in various dimensions, there is a need for reliable and valid tools. The present study was conducted to design and psychometrically evaluate the Uncertainty about Disease and Treatment Scale (UC about D&TS) in patients undergoing hemodialysis. METHODS: This study is of a methodological type and conducted in two stages. The first stage included a deductive (literature review) and an inductive approach (face-to-face interviews). In the second stage, psychometric indices of the UC about D&TS, including face validity (qualitative-quantitative), content validity (qualitative-quantitative), construct validity (exploratory factor analysis), and reliability (using Cronbach's alpha and McDonald's omega) were examined. RESULTS: In the literature review stage, 66 items were extracted, and in the qualitative stage, 48 items were extracted. After merging similar items, 29 items were entered into the psychometric process. No items were removed in the face and content validity stages. In the construct validity stage, five factors were extracted, including self-uncertainty, uncertain situation, uncertain future, uncertainty of treatment outcomes, and information uncertainty, which constituted a total of 82.16% of the total variance. In this stage, five items were removed from the study due to a corrected item-total correlation below 0.32, and four items were removed due to cross-loading. The α and Ω were calculated as 0.828 and 0.818, respectively. The measurement stability and standard error of measurement were estimated at 0.977 and 2.019, respectively. CONCLUSION: The results showed that the UC about D&TS is a valid and reliable measure for patients undergoing hemodialysis. This scale is specifically designed to measure UC about D&T in hemodialysis patients, and it is recommended that healthcare providers (Hcps) use this scale in follow-up visits.

Development and psychometric evaluation of the questionnaire on the contributing factors of tendency towards voluntary single-childedness and childlessness: a mixed method study.

Couples' tendency towards voluntary single-childedness and childlessness (VSCC) has turned into a major challenge in all societies and led to different problems such as population aging. A key step to VSCC management is to determine its contributing factors through valid and reliable instruments. This exploratory sequential mixed method study (qualitative-quantitative) was conducted in 2020-2021. Phases of qualitative consists of all couples aged 15-49 in Babol, Iran, who were single or childless. Sampling is based on the purpose, and the number of samples is 20 couples. To collect data, face-to-face and semi-structured interviews were conducted with the participants. Sampling continued until data saturation. The data were analyzed by the conventional content analysis method and quantitative phase. Initially, a qualitative study was conducted on twenty couples, and were analyzed through conventional content analysis. Findings were used to develop QFT-VSCC and then, the face, content, and construct validity as well as reliability were assessed. Construct validity was assessed through exploratory and confirmatory factor analyses and reliability was assessed through internal consistency and stability assessments. The results of the qualitative part analysis consist of 140 codes, 30 primary categories, and nine main categories and two themes (individual limitations and social limitations). The primary QFT-VSCC had 78 items. Fifty-eight items were omitted during validity assessment and the remaining twenty-two items were loaded on five factors during factor analysis. These factors were threatened priorities, inappropriate familial context for childbearing, sense of occupational and social insecurity for the child, social modeling of childlessness, and tendency towards change or stability in marital life. The five factors explained 52.56% of the total variance. All model fit indices in confirmatory factor analysis were acceptable and the Cronbach's alpha values of QFT-VSCC and all its factors were more than 0.70. The results of convergent validity analysis revealed that all factors had an AVE value greater than 0.5, and the HTMT index for all factors was less than 0.85. This indicated that discriminant validity had been achieved. QFT-VSCC is a simple valid and reliable instrument for VSCC assessment among both men and women.

Development and psychometric evaluation of the epilepsy lifestyle questionnaire.

Epilepsy, particularly in older people, is associated with significant changes in physical activities, social and occupational functions, and diet. It is associated with significant changes in physical activities, social and occupational functions, and diet. Valid and reliable instruments are needed to assess these changes. This study aimed to develop and validate a questionnaire to assess lifestyle in older people with epilepsy, named the Epilepsy Lifestyle Questionnaire (ELQ). This methodological study was conducted in 2022. The primary ELQ items were generated through reviewing the literature. Then, its face, content, construct, convergent, and discriminant validity, internal consistency, and test-retest stability were evaluated. Older patients aged ≥ 60 years were recruited from the Iranian Epilepsy Association to assess construct validity using confirmatory factor analysis (CFA). Data were analyzed using the SPSS (v. 26.0), AMOS (v. 24.0), and JASP software. The primary ELQ had 99 items with five subscales, namely health-oriented self-care, risk-averse behavior, emotional and psychosocial adaptation, epilepsy stigma, and intimacy and sexual behaviors. Sixty five items were deleted during psychometric evaluation. CFA showed the good fitting of the five-factor structure of the 34-item ELEQ (PCFI = 0.741, PNFI = 0.693, CMIN/DF = 0.073, IFI = 0.917, CFI = 0.916, AND GFI = 0.902). The values of internal consistency based on Cronbach's alpha and test-retest reliability based on intraclass correlation coefficient (ICC) of ELQ were 0.89 and 0.95, respectively. The ELQ is a valid and reliable self-report instrument. The results suggest that the ELQ is a useful clinical tool for assessing the lifestyle of patients with epilepsy.

Effects of Frailty Syndrome on Osteoporosis, Focusing on the Mediating Effect of Muscle Strength and Balance in Community-Dwelling Older Adults (≥60 years) in Iran: Results From the Amirkola Health and Aging Project Cohort Study.

Introduction: For older adults, maintaining muscle strength and balance is crucial to preserve an upright posture and independently manage their basic activities of daily living (ADL). This study aimed to examine whether muscle strength and balance mediate the relationship between frailty syndrome (FS) and osteoporosis in a large sample of community-dwelling older adults. Material and Methods: This cross-sectional study is part of the second phase (2016-2017) of the Amirkola Health and Ageing Project (AHAP), a cohort study conducted on all elderly aged 60 and over in Amirkola, Northern Iran, since 2011. Data from 2018 older adults were collected by a trained person using bone mineral density (BMD), frailty index, activities of daily living (ADL), instrumental activities of daily living (IADL), handgrip strength (HGS), quadriceps muscle strength (QMS), Berg Balance Scale (BBS), and Timed Up and Go test (TUG test) and analyzed using analysis of variance, chi-square, and path analysis tests. Results: The mean indices of femoral neck BMD and lumbar spine BMD, HGS, QMS, BBS, ADL, and IADL were lower in the frail older adults than in the pre-frail and non-frail older adults. In addition, the mean TUG test level was higher in the frail older adults than in the non-frail and pre-frail older adults. The results of the present study have indicated that frailty is significantly related to osteoporosis, and that balance and muscle strength can predict osteoporosis; these variables play a mediating role in the relationship between frailty and osteoporosis. Conclusion: From the results of the present study, it can be concluded that frailty may increase the odds of osteoporosis. The results of the current study have indicated that balance (BBS and TUG test) and muscle strength (HGS and QMS) are associated with osteoporosis and these variables play a mediating role in the relationship between frailty and osteoporosis.