Predictors of colorectal cancer screening intention among Iranian adults: an application of the preventive health model

Objective: Colorectal cancer is the third most common cancer among adults in Iran. Colorectal cancer screening is the effective way in reducing deaths from this cancer. However, the screening rate of colorectal cancer is very low among Iranian adults. This study investigated predictors of Iranian average-risk adults ' intention to take up colorectal cancer screening with fecal occult blood test using a mediator model.Methods: Participants of this cross-sectional study were comprised of 478 average-risk adults who were selected using a national sampling frame in Hamadan city, west of Iran. The data gathering instrument was a questionnaire based on the preventive health model constructs. Structural equation modeling (SEM) was employed to test the relationship using Smart PLS 2.0 softwareResults: All measures were robust in terms of its reliability and validity. Benefit (b= 0.12, p<0.01), self efficacy (b= 0.36, p<0.01), social support (b= 0.12, p<.05) and barriers (b= -0.14, p<.01) predicted the intention to be screened for CRC. Self efficacy partly mediated effects of social support and perceived barriers on intention. The study model explained approximately 24% of the variance in CRC screening intention with fecal occult blood testConclusion: Our findings indicated that the preventive health model constructs such as self efficacy, social support and barriers are useful in understanding CRC screening intentions and can help health planners in developing effective interventions for encouraging Iranian adults to undergo CRC screening

Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis

Item does not contain fulltextBACKGROUND: Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES: (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS: We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA: We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS: We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS: We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced thei

Factors Associated With Unhealthy Snacks Consumption Among Adolescents in Iran’s Schools

Background: Well-informed interventions are needed if school-based health promotion is to be effective. Among other aims, the Iranian Health Promoting School (IHPS) program that was launched in 2011, has an important aim of promoting dietary behaviors of adolescents. The present study, therefore, aimed to investigate the factors affecting unhealthy snacking of adolescents and provide evidence for a more effective IHPS program. Methods: In a cross-sectional study design, 1320 students from 40 schools in Kerman city were selected using a proportional stratified random sampling method. A modified qualitative Food Frequency Questionnaire (FFQ) was used to gather data about unhealthy snacking behavior. Data about intrapersonal and environmental factors were obtained using a validated and reliable questionnaire. A mixed-effects negative-binomial regression model was used to analyze the data. Results: Taste and sensory perception (prevalence rate ratio [PRR]=1.18; 95% CI: 1.09-1.27), being a male (PRR=1.20; 95% CI: 1.05-1.38) and lower nutritional knowledge (PRR=0.96; 95% CI: 0.91-0.99) were associated with higher weekly unhealthy snaking. Perceived self-efficacy (PRR=0.95; 95% CI: 0.91-1.00) negatively influenced the frequency of unhealthy snaking, with this approaching significance (P<.06). In case of environmental factors, high socio-economic status (SES) level (PRR=1.45; 95% CI: 1.26-1.67), single-parent family (PRR=1.14; 95% CI: 1.01-1.30), more social norms pressure (PRR=1.08; 95% CI: 1.01-1.17), pocket money allowance (PRR=1.21; 95% CI: 1.09-1.34), easy accessibility (PRR=1.06; 95% CI:1.01-1.11), and less perceived parental control (PRR=0.96; 95% CI: 0.92-0.99) all had a role in higher consumption of unhealthy snacks. Interestingly, larger school size was associated with less unhealthy snacking (PRR=0.79; 95% CI: 0.68-0.92). Conclusion: Unhealthy snacking behavior is influenced by individual, socio-cultural and physical-environmental influences, namely by factors relating to poor parenting practices, high SES level, family characteristics, improper social norms pressure, and less knowledge and self-efficacy of students. This evidence can be used to inform a more evidencebased IHPS program through focusing on supportive strategies at the home, school, and local community level

The Effects of Social Support on Pregnant Women's Choice of Delivery Method: Application of an Expanded Theory of Planned Behavior

Objectives: The theory of planned behavior (TPB) has been used in pregnant women’s choice of delivery method and other health-related behaviors. This study extended TPB to predict the role of social support in pregnant women’s choice of delivery method. Materials and Methods: This prospective cohort study was conducted on pregnant women referred to Fatimah hospital in Hamadan, Iran, from 2015 to 2016. A total of 206 nulliparous pregnant women, who referred to Fatimah hospital, completed a self-report questionnaire including measures of intentions, attitudes, subjective norms, perceived behavioral control and social support. These women were followed up until the end of their pregnancy. Results: On the basis of structural equation modeling, adding social support variable improved the indices of the model slightly, but this variable cannot be regarded as a predictor of behavior. A gap between intention and behavior and other factors together with social factor may be the reason. The perceived behavioral control of the individuals was a signifcantly effective predictor for selecting the type of delivery. Conclusions: Attitude, subjective norms, perceived behavior control, and social support were distinguished as signifcant predictors of the choice of delivery type. Therefore, it seems that designing an intervention with emphasis and focus on making changes in these variables and considering different dimensions of social support can increase people’s intention towards natural delivery by providing facilities in the childbirth environment

Cochrane Effective Practice and Organisation of Care (EPOC) Qualitative Evidence Syntheses, Differences From Reviews of Intervention Effectiveness and Implications for Guidance

Systematic reviews of qualitative research (‘qualitative evidence syntheses’) are increasingly popular and represent a potentially important source of information about people’s views, needs and experiences. Since 2013, Cochrane has published qualitative evidence syntheses, and the Cochrane Effective Practice and Organisation of Care group has been involved in the majority of these reviews. But more guidance is needed on how to prepare these reviews in an environment that is more familiar with reviews of quantitative research. In this paper, we describe and reflect on how Cochrane qualitative evidence syntheses differ from reviews of intervention effectiveness and how these differences have influenced the guidance developed by the EPOC group. In particular, we discuss how it has been important to display to end users, firstly, that qualitative evidence syntheses are carried out with rigour and transparency, and secondly, that these quality standards need to reflect qualitative research traditions. We also discuss lessons that reviews of effectiveness might learn from qualitative research

Qualitative Evidence Syntheses Within Cochrane Effective Practice and Organisation of Care: Developing a Template and Guidance

A growing number of researchers are preparing systematic reviews of qualitative evidence, often referred to as ‘qualitative evidence syntheses’. Cochrane published its first qualitative evidence synthesis in 2013 and published 27 such syntheses and protocols by August 2020. Most of these syntheses have explored how people experience or value different health conditions, treatments and outcomes. Several have been used by guideline producers and others to identify the topics that matter to people, consider the acceptability and feasibility of different healthcare options and identify implementation considerations, thereby complementing systematic reviews of intervention effectiveness.Guidance on how to conduct and report qualitative evidence syntheses exists. However, methods are evolving, and we still have more to learn about how to translate and integrate existing methodological guidance into practice. Cochrane’s Effective Practice and Organisation of Care (EPOC) (www.epoc.org) has been involved in many of Cochrane’s qualitative evidence syntheses through the provision of editorial guidance and support and through co-authorship. In this article, we describe the development of a template and guidance for EPOC’s qualitative evidence syntheses and reflect on this process

Regular Breakfast Consumption and its Predictors Based on the Social Cognitive Theory in Female Students of Hamadan University of Medical Sciences

Background and Objectives: Despite associating regular breakfast consumption habits with a range of health benefits, the rate of skipping the meal is high. The present study was conducted to determine the factors associated with breakfast consumption among female students of Hamadan University of Medical Sciences based on the Social Cognitive Theory (SCT). Materials and Methods: The present cross-sectional study was carried out on 423 female students in different faculties of Hamadan University of Medical Sciences. Participants were selected through multistage random sampling. The frequency of breakfast consumption and SCT variables, including knowledge, hope, outcome expectancies, observational learning, social support and self-efficacy, was measured using a self-administered questionnaire. Data were analyzed in SPSS-16 using the chi-square test, the correlation test and the linear regression analysis. Results: 24% of the students stated that they always ate breakfast. 10% of the students skipped breakfast. On average, the students ate breakfast 4.2 times a week. Self-efficacy (p<0.001) and social support (p<0.001) were good predictors of breakfast consumption in the students. These two variables were able to predict 64% of the variance in breakfast habits. Conclusion: The results show that self-efficacy and social support should be targeted in the design of interventions intending to increase breakfast consumption among female university students

Assessment of Dental Care and its Related Barriers in Pregnant Women of Hamadan City

Background and Objectives: Oral health behaviors of pregnant women are important due to their effects on mother and child’s health. The objective of this study was to investigate dental care and its related barriers among pregnant women in Hamadan city, Iran. Materials and Methods: This cross-sectional study was carried out on 280 pregnant women in Hamadan city in 2012. We used stratified cluster sampling to select the subjects and a researcher-made questionnaire was used. The questionnaire included demographic information, common dental problems, visit of a dentist during pregnancy and tooth brushing, as well as the perceived barriers of these two behaviors. The reliability and validity of the tool were evaluated using estimates of internal consistency and the opinions of a panel of experts, respectively. Data were analyzed in SPSS-16 using logistic regression test. Results: The mean age of pregnant women was 27.2 ± 4.88 years. Tooth brushing after each meal and use of mouthwash rates were 12% and 20%, respectively. Half of the participants had not seen a dentist during their current pregnancy. The most important barriers to brush twice a day were impatience and lack of energy. Dental visit barriers were cost, low priority, and stress related to dentistry. Factors associated with no dental visit included poor economic status (P= 0.011) and working outside of home (P= 0.045). Conclusions: Given the important adverse outcomes associated with poor oral health on mothers and babies, interventions to reduce the barriers of dental cares are crucial

Effectiveness of interventions to promote pesticide safety and reduce pesticide exposure in agricultural health studies: A systematic review.

ObjectiveThere is a relationship between pesticide exposure and farmworkers' health. Well-conducted evaluations can provide an insight into how to develop and implement more effective interventions to prevent farmers and farmworkers' exposure to pesticides. This review aimed to summarize the literature on the effectiveness of interventions to promote pesticide safety and reduce pesticide exposure among farmers and farmworkers.MethodsA comprehensive search on PubMed, Embase, ISI Web of Science, Scopus, Science Direct, Agricola, NIOSHTIC, and Agris databases was performed to identify relevant studies published from 2000 to 2019. Randomized controlled trials (RCTs) and quasi-experimental studies assessing the effectiveness of interventions on a variety of outcomes related to pesticide exposure were considered. The searches were restricted to articles written in English. The methodological quality of included reviews was appraised using the Effective Public Health Practice Project quality assessment tool (EPHPP).ResultsThe initial search led to 47912 records, 31 studies of which including nine RCTs and twenty-two quasi-experimental studies met the criteria. The majority of the included studies focused on the educational/ behavioral approach. The studies that applied this approach were effective in improving the participants' knowledge and attitude; however, these interventions were less effective in terms of making changes in participants' behaviors and their risk of exposure to toxic pesticides. Multifaceted interventions were moderately effective in terms of improving farmers' and farmworkers' behaviors and reduction in exposure to toxic pesticides. We did not find any studies that had evaluated the effectiveness of engineering/technological, and legislation/enforcement interventions.ConclusionsAlthough the majority of studies were based on an educational/behavioral approach and did not assess the effect of interventions on objective measures, the results of this review highlight the significant effectiveness of educational programs and some potential key elements of these interventions. These findings may inform policymakers to develop interventions to reduce pesticide exposure among farmers and farmworkers

Medication Adherence and its Related Factors in Patients with Type II Diabetes

Background and Objectives: Low levels of medication adherence in patients with type 2 diabetes is one of the greatest challenges in the treatment and control of diabetes. This study was designed to determine medication adherence and its related factors in patients with type II diabetes. Materials and Methods: In this cross-sectional study, a total of 300patients with type 2diabetes records in the health centers of Tuyserkan city were randomly selected in 2015. Data collection instrument was a self-made questionnaire, which consisted of factors related to the medication adherence. Questionnaires were completed after confirmation of validity and reliability, by interviews. To analyze the data, descriptive and inferential statistics (T-test, AnOVA, Simple and multiple linear regression) were applied, using SPSS software, version 19. Results: Overall, %26.3 of patients were male and %73.7 were female. Also, %65 of patients were illiterate, %24 had some degree of symptoms, and %59.4 had poor medication adherence. There was a significant relationship between age, education, patient care and treatment expenditure, health care team and health system, therapy-related factors and condition-related factors, beliefs about illness, efficacy, and concerns about drugs and medication adherence (P < 0.05). Conclusions: This study showed that medication adherence in patients with diabetes was not suitable and individual, economical and social factors were influential.Therefore, the role of these factors must be considered when designing intervention programs