The functional, communicative, and critical health literacy (FCCHL) scales: Cross-cultural adaptation and the psychometric properties of the Iranian version

Background: Patients today are required to understand more and more complex health information, and to navigate increasingly complex health systems. As a result, they need to develop skills such as finding, processing, understanding, and applying information about health issues, which has been conceptualized as health literacy (HL). Assessing HL is critical to providing meaningful health information to patients. Objectives: This study aimed to examine the cultural adaptation and the psychometric properties of the Iranian version of the functional, communicative and critical health literacy (FCCHL) scales measuring three aspects of HL among type 2 diabetic patients. Patients and Methods: We conducted a methodological survey of 187 patients with type 2 diabetes using a cross-sectional design. The study was carried out in two phases: the first phase was designed to obtain a cross-cultural equivalent of the FCCHL scales, based on Beaton’s guidelines. In the second phase, a cross-sectional study was conducted to evaluate the psychometric properties of the questionnaire. Results: Exploratory factor analysis (EFA) identified three main factors with 27.07%, 22.46%, and 16.23% of extracted variance, respectively. Confirmatory factor analysis (CFA) completely supported the three-factor model of the HL scales. Internal consistency was approved for the total scale (� = 0.82) and for the functional, communicative, and critical subscales (� = 0.91, 0.80, and 0.76, respectively). Convergent validity analysis indicated a significant positive correlation (r = 0.45; P < 0.01) between the scores on the functional HL scales and the Iranian version of the Short Test of Health Literacy in Adults (S-TOFHLA), which was to be expected. Conclusions: We concluded that the FCCHL scales are valid and reliable, and can be used to measure health literacy among Iranian diabetic patients. However, further research is needed to establish stronger psychometric properties for the use of this questionnaire in Iran

Effects of an Educational Intervention on Self-Care and Metabolic Control in Patients With Type II Diabetes

Background: Although compliance with all self-care behaviors is necessary for successful management of diabetes, patients with diabetes often refuse favorable self-care. This article is aimed to test the effects of a theory-related intervention to conduce self-aid adherence and metabolic curb in patients having type-2 diabetes. Methods: In this randomized controlled trial, 80 patients suffering from type-2 diabetes were arbitrarily allotted to intervention and control group. The intervention group attended six sessions in a batch and one-on-one consultation and received an education on self-efficacy and outcome expectations on improving the strategies. Self-efficacy, outcome expectations, self-care behaviors and HbA1c were measured and compared in two groups in the starting, after three and six-months of the interventions. “Intention to treat” analysis was used. Data were analyzed using t test and ANOVA for repeated measures. Results: Mean score of self-efficacy, outcome expectations and self-care behaviors revealed significant differences between two groups in the results of three and six months after the intervention (P < 0.01). A major fall in HbA1c was noted in the intervention group. The mean scores of the HbA1c showed a significant difference between two groups, six months after the intervention (P < 0.05). After the intervention diet, physical activity and foot care improved significantly in the intervention group (P < 0.001). No significant improvement occurred in self-monitoring of blood glucose and medication adherence between two groups after the intervention Conclusion: It is concluded that implementing educational interventions based on the self-efficacy model and related strategies can be effective for patients with type-2 diabetes and is recommended to be used for patient education in the field of metabolic control

Impact of Health Literacy, Self-efficacy, and Outcome Expectations on Adherence to Self-care Behaviors in Iranians with Type 2 Diabetes

Objectives: Diabetic patients with higher health literacy (HL) may feel more confident in their ability to perform self-care behaviors and may have strong beliefs that diabetesrelated behaviors will lead to specific outcomes. Our study aimed to document the relationships between HL, self-efficacy, outcome expectations, and diabetes self-care of patients with type 2 diabetes mellitus (T2DM) in Iran. Methods: We conducted a crosssectional observational study of 187 patients with T2DM. Participants completed the Functional Communicative and Critical Health Literacy scale, the Summary of Diabetes Self-Care Activities, the Diabetes Management Self-Efficacy Scale, Outcome Expectations Questionnaire, and a demographic questionnaire. Results: Participants who received diabetes education (t = 5.79, p<0.001) and were married (F = 3.04, p<0.050) had better diabetes self-care behavior. There was a significant positive correlation between self-care behaviors and communicative HL (r = 0.455, p<0.010), critical HL (r = 0.297, p<0.010), self-efficacy (r = 0.512, p<0.010) and outcome expectations (r = 0.387, p<0.010). Diabetes education and marital status accounted for 16.9% of the variance in diabetes self-care. Self-efficacy, outcome expectations, communicative, and critical HL explained 28.0%, 1.5%, 3.7%, and 1.4% of the variance, respectively. Conclusions: This study revealed that the potential impact of self-efficacy, outcome expectations, communicative, and critical HL should be considered in the education program for patients with diabetes. We found self-efficacy to be the most important predictor of diabetes self-care. Therefore, the use of self-efficacy theory when designing patient education interventions could enhance diabetes self-care. It is essential that health care providers assess patient’s HL levels to tailor health-related information specific to a domain of HL. This would fully inform patients and promote empowerment rather than simple compliance

The Effects of an Educational Program Based on Social Cognitive Theory in Adopting Behaviors to Prevent Excessive Consumption of Sugar-Sweetened Beverages in Children: Application of Shad Social Network Software

Background: Excessive consumption of Sugar-Sweetened Beverages (SSBs) is a health problem in most societies today, which has adverse consequences in health, social and economic areas. The aim of this study was to investigate the effect of the application of social cognitive theory (SCT) in the design and evaluation of an educational intervention in order to adopt behaviors to prevent excessive consumption of SSBs in students. Methods: The current research was a quasi-experimental study. Using multistage sampling, 100 Junior High-school students in Urmia, Iran in 2021 were selected and assigned to two groups, namely intervention (n=100) and control (n=100). To collect the study data, the researchers utilized a researcher-made questionnaire including items about demographic information and SCT constructs such as awareness, outcome expectations, self-regulation, self-efficacy, social support , barriers and Preventive behaviors, which was completed in two stages before and three months after the last training session; the data were analyzed using the SPSS software version 25.0. Results: The mean age of the participants in the intervention and control groups was 13.71 ± 0.71 and 13.84 ± 0.81, respectively. Before the intervention, the mean scores of social cognitive theory structures and desired behavior were not significantly different between the two groups. But three months after the intervention, the mean scores of knowledge constructs, outcome expectations, self-regulation, self-efficacy, social support, perceived barriers, and desirable student behavior showed a significant difference between the two groups (P<0.001). Conclusion: The results of the study revealed that social cognitive theory can be used as a theoretical basis for designing and evaluating interventions to encourage people to follow a proper diet and reduce the consumption of SSBs

Being Single as a Social Barrier to Access Reproductive Healthcare Services by Iranian Girls

Background: Iranian single women are deprived of reproductive healthcare services, though the provision of such services to the public has increased. This study aimed to explore the experiences of Iranian single women on their access to reproductive health services. Methods: A qualitative design using a conventional content analysis method was used. Semi-structured interviews were held with 17 single women and nine health providers chosen using the purposive sampling method. Results: Data analysis resulted in the development of three categories: ‘family’s attitudes and performance about single women’s reproductive healthcare,’ ‘socio-cultural factors influencing reproductive healthcare,’ and ‘cultural factors influencing being a single woman.’ Conclusion: Cultural and contextual factors affect being a single woman in every society. Therefore, healthcare providers need to identify such factors during the designing of strategies for improving the facilitation of access to reproductive healthcare services

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

Program to reduce empowerment barriers hindering mothers to contribute to speech skills of hearing-impaired children with cochlear implant

Background and aims: Given the importance of reducing barriers hindering the empowerment of mothers from contributing to the rehabilitation of hearing-impaired children with cochlear implants, the present study points to the direction of designing, adopting, and assessing a program that would lessen such barriers. Methods: In this randomized controlled trial (RCT), participants were consecutively selected from individuals referring to speech-therapy centers serving hearing-impaired children in the Town of Shiraz (Iran). Intervention and control groups were established using randomized block selection (35 individuals per group). The parent-based intervention was adopted in 6 training sessions, each session lasting 80 minutes. A researcher-made questionnaire was employed to investigate empowerment barriers, while children’s speech skill was assessed using the Newsha scale. Results: Data collected from 35 intervention and 33 control group members were examined. Evaluation of primary and interactional effects of "time" and "group" shows time to have a meaningful effect on "parental discord" and "empowerment barrier" variables (P<0.001). Time-group interaction also proved significant regarding effects on "difficulty working with hearing-impaired child" and "parents’ false beliefs". Compared to the control group, the intervention group shows significant improvement across all variables at studied different time periods. Not to forget the immediate effects of time and group on the "speech skill" variable, which also proved significant (P=0.001). Conclusion: The results denote the effectiveness of the parent-based intervention on mothers’ empowerment and speech improvement in children with impaired hearing

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

Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method: A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services

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