How Iranian families response to the conditions affecting elderly primary health care.

In response to the need for effective elderly primary health care programs in the Islamic Republic of Iran, the present study sought to determine the nature of family's caring behaviors related to the elderly primary health care in an urban area in Iran. A qualitative research was conducted through 24 in-depth interviews, 4 focus groups (8 participants in each group) and participants observation. The following 2 main categories emerged from the analysis to describe family's caring behaviors: internal responses and external responses. This qualitative study has gathered data that could be used by policy makers and health care providers and researchers concerned with elderly health and their quality of life. Based on these findings, it is recommended that providing primary health care for the elderly should be embedded in a comprehensive approach which aims to change the conditions affecting the elderly primary health care in urban areas

The Impact of Adolescent Friendships on Unhealthy Eating Behaviors of Overweight and Obese Adolescents: A Qualitative Study

Background: Childhood obesity has reached epidemic proportions and become one the most important public health issues globally. One of the significant determinants of childhood obesity-related behaviors such as poor dietary habits relates to role of friends and peers. This study aimed toexplore the role of interaction within the social network of friends on unhealthy eating behaviors of overweight and obese adolescents. Materials and Methods: This qualitative study was conducted between 2016 and 2017 in Mashhad and Isfahan, two large cities of Iran. Ten parents and 52 overweight and obese adolescents were selected through purposeful sampling. To obtain perceptions and experiences regarding the role of adolescent friendships on unhealthy eating behaviors, in-depth semi-structured interviews and focus group discussions were conducted. Data were analyzed based on conventional content analysis. Results: Six themes which contributed to following unhealthy dietary habits when adolescents are in the friend networks were identified: "Eating in the peer networks as a usual way for social interaction", "Peers’ pressure to have unhealthy dietary habits", "High availability and accessibility to unhealthy foods", "Lack of nutritional knowledge", "Neglectful parenting style", and "Passive interaction in the friendship networks". Conclusion: Our findings indicate that peer support along with appropriate parenting style are necessary to affect adolescent eating behaviors when they are in the friend social networks, but are not sufficient per se. Being a confident, decisive and self-determined adolescent and owing a high level of behavioral confidence and self-esteem might reduce the impact of friends for adhering to unhealthy dietary habits in youth

Caring Behaviors for the Elderly in Primary Health Care Centers in Urban Isfahan, Iran

Against the background of increasing proportion of older persons in Iran, a qualitative research with a purpose of exploring the nature of caring behaviors among the elderly at urban health care centers in Isfahan was undertaken. Using a grounded theory approach, the study was guided by three questions: 1) - What is the nature of caring behaviors? 2- What are the conditions that contribute to the present state of caring behaviors?, and 3- What possible intervening conditions may improve the state of caring behaviors? Twenty five elderly respondents, their family members, and health care providers and managers were interviewed in-depth using topics related to issues affecting caring behaviors. Observations, focus group discussions, official documents, and researcher’s field notes and memos formed other sources of the data. The researcher used constant comparative method of data analysis to discover the reality of behaviors of individuals, family members and health care providers, and processes involved. From the data analysis a so-called theory of "Walking a Line between Despair and Hope" had emerged. This theory adequately explains reasons for the elderly’s negative attitude toward the health care system, their family’s barriers in supporting their older parents, and the health care providers’ constraints in delivery of services for the elderly primary health care. As a result of macro and micro conditions (contributing conditions), elderly, their families and health care providers were in reality were making adjustments to what they felt about health care. Despite their desperations at the state of services available, they were hopeful that things would improve. The internal responses included categories depicting ‘accepting conditions as the only way’, ‘feeling of being at the end of the way’, ‘death expectation in spite of potential abilities’, and ‘motivational weakness’. There were also categories that reflected relational-societal processes such as ‘accepting reduction and interruption of communications in old age’, ‘reaction to losing of one's roles’, ‘conformity with others' in order to establish communication’, and ‘accepting others' disinterest to have relations with the elderly’. External responses manifested as behaviors of elderly participants were ‘non-adoption of healthy lifestyle’ and ‘non-adoption of proper caring behaviors’. Internal responses of elderly families consisted of ‘considering the elderly as children’, ‘emotional escape’ and ‘feeling of inability to care’. ‘Pseudo care’ and ‘imperfect care’ were the external responses of elderly families to conditions. Health care providers' internal response included ‘feeling of distress and incapability in offering services’, ‘motivational weaknesses’, ‘considering offering services to the elderly as an additional task’, and ‘compassion and compulsion in offering services’. ‘Perfunctory care’ was manifested as external response of health care providers to conditions. Despite the strong effect of macro and micro conditions on elderly primary health care process, the presence of some factors could be interpreted as signs of despair in some elderly, their families and health care providers. Nevertheless, there were intervening factors such as ‘reinforcing factors’, ‘individuals' characteristics’, ‘perceived concepts of health’, and ‘adaptation mechanisms’ that acted to either mitigate the negative state or influence a positive orientation. This qualitative study has gathered data that could be used by policy makers and health care providers and researchers concerned with elderly health and their quality of life. Particularly for researchers, this study can be used to develop theories on elderly primary health care

A Nutrition Education Intervention Trial for Adolescent Girls in Isfahan: Study Design and Protocol

BackgroundNutrition behaviors of adolescent girls is of serious health concerns. Although nutrition education interventions in Iran have met with some success, most of them could not promote nutrition behavioral changes. The aim of our study is to determine a school-based nutrition education intervention to improve adolescents’ nutrition behaviors and behavioral mediators based on the social cognitive theory (SCT).Materials and MethodsThis study is a single-blind randomized controlled trial. Eligible participants will be all student girls in grade 6 and 7, their parents and teachers in Isfahan governmental schools. This multi com­ponent school-based intervention include adolescents’ nutrition education package, parents’ nutrition massages, participatory homework, parents and teachers nutrition education package, supportive group, and collaboration with decision makers. Changing in nutrition behaviors including breakfast, fruit and vegetable, snack and fast food consumption will be examined, as primary outcome. Secondary outcome will be behavioral mediators such as knowledge, self-efficacy, intention, situation, self-regulation, social support, outcome expectations and expectancies, in adolescent girls. The outcomes will be assessed at baseline, and after 3 and 6-month follow-up.DiscussionThis study evaluates a school-based, guided SCT intervention, designed to improve healthy dietary behaviors, nutrition knowledge of adolescent girls. Few behavioral interventions have targeted this high-risk population in Iran. The intervention seems to be promising and has the potential to bridge the gap of the limited program outcomes of nutrition education in Iranian adolescents

Cultural adaptation and psychometric properties of the persian version of self-efficacy in chronic disease patients

Introduction: Self-efficacy is an essential factor for effective self-management in chronic-disease patients. Therefore, the measurement of self-efficacy with a valid and reliable instrument is required. In this study, cultural adaptation and psychometric properties of the Persian version of “Self-Efficacy for Managing Chronic Disease” (SES6G) are illustrated in a sample of Iranian chronic-disease patients. Materials and Methods: This was a cross-sectional study in which translation and backward translation was performed by bilingual translators. The final version of the Persian scale was assessed to determine the content validity index (CVI) and the content validity ratio (CVR). A panel of experts reviewed items of the scale. Factor analysis was performed for the final version of the Persian scale to assess internal consistency and construct validity among chronic-disease patients attending government health care centers from March 2015 to June 2015 in Isfahan, Iran (n = 483). Results: CVI and CVR scores were 0.87 and 0.89, respectively. There were no eliminated items in the cross-cultural adaptation process. Internal consistency met the criterion for a reliable measure (Cronbach's alpha = 0.89). An initial factor analysis produced a one-dimensional scale (6 items) with Eigenvalues more than 1 that explained 69.49% of the extracted variance. Conclusions: The SES6G is a reliable and valid instrument to assess patients' self-efficacy for managing chronic diseases in Persian language. Because the self-efficacy score determines the educational strategies to have effective educational programs, the use of this simple and brief scale could be considered among Persian patients

The impact of educational intervention on self-care behaviors in overweight hypertensive women: A randomized control trial

BACKGROUND: The improper control of self-care in hypertension imposes a lot of financial burden on the health-care system. On the other hand, the importance of participatory care and high effectiveness of self-management programs have been confirmed. This study was aimed to examine the effect of an educational intervention on self-efficacy, self-care behaviors and blood pressure (BP) of hypertensive obese or overweight women in the primary health-care setting in Isfahan, Iran. METHODS: This randomized controlled trial was an educational intervention program. It was performed among 146 hypertensive women of 30-65 age range who referred to 6 health care centers of Isfahan that randomly assigned to a control and intervention groups. The interventional group participated in the 6 weekly sessions including exercises, weight control, medication adherence, and home self-monitoring based on goal setting, and promotion of self-efficacy. The control group received routine care from health-care center and any special intervention has been done for the control group. Output variables were analyzed after intervention, and 6-month follow-up. RESULTS: There are no significant differences between age, weight, body mass index and BP and biochemical variables except lipids as well as behavioral factors at the baseline. After 6 months intervention self-efficacy (&lt; 0.001) and physical activity (&lt; 0.001) improvement of in the intervention group was significantly different in comparison with the control group. After 6 months, there was a significant reduction in systolic (P &lt; 0.001) and diastolic BP (P = 0.010) in the intervention group. CONCLUSION: Participatory method of education could help us to convince patients to have better self-care to control disease. Furthermore, since adherence to the treatment of hypertensive patients in our society is low, organizing such courses can teach essential knowledge and skills to lifestyle change and prevention of complications. Performing these courses is recommended for other chronic disease patients in health-care centers to assess self-management programs on self-care behavior.</div