Challenges and lessons learned in mental health research among refugees: a community-based study in Turkey

Background Turkey hosts nearly four million refugees and 99% live in urban areas. Research in urban settings pose different challenges and opportunities than research in refugee camps. In this article, we aimed to share the challenges and experiences we encountered in a mixed-methods study to assess mental health problems and barriers to accessing mental health care among refugees in urban areas of Turkey. Discussion In our case, the main challenges in conducting research with refugees were collecting data from a highly traumatized population, difficulties with contacting undocumented asylum seekers including trust issues and the fear of deportation, the risk of secondary traumatization among data collectors, and the bureaucracy during study approval processes. Targeting a representative sample was not feasible, because of the lack of publicly available demographic data on a district level, presence of undocumented asylum seekers and high mobility among the refugees. Although respondents with significant psychological symptoms were routinely referred to available mental health services, we were able to do less for unregistered refugees with problems in accessing health care. Language/alphabet differences and differing dialects of Arabic posed another challenge in both translation and administration of the scales. Based on cultural characteristics, a gender-balanced team was used and the interviewers were gender-matched whenever needed. Also, the research team had to work after work hours and during weekends to be able to interview male refugees, since most refugee men were at work during working hours and most days of the week. Conclusions The research team’s experience showed that refugee population characteristics including level of trauma, language, culture, gender, legal status, and urban setting characteristics including places of living, mobility, availability of publicly available demographic data, and outreach-related barriers lead to different challenges and ethical responsibilities of researchers and affect the research costs in terms of time, human resources and finance. Even in a host country with geographical, religious and cultural proximity to the refugees, profound challenges exist in conducting mental health research in urban settings. Learning from previous experience and collaborating with local researchers and institutions are vital for better public health research and practice outcomes

Determinants of pre-lacteal feeding practices in urban and rural Nigeria; a population-based cross-sectional study using the 2013 Nigeria demographic and health survey data.

Background: Prelacteal feeding (PLF) is a barrier to exclusive breast feeding. Objective: To determine factors associated with PLF in rural and urban Nigeria. Methods: We utilized data from the 2013 Nigerian Demographic and Health Survey. Bivariate and multivariate analyses were used to test for association between PLF and related factors. Results: Prevalence of PLF in urban Nigeria was 49.8%, while in rural Nigeria it was 66.4%. Sugar or glucose water was given more in urban Nigeria (9.7% vs 2.9%), plain water was given more in rural Nigeria (59.9% vs 40.8% ). The multivariate analysis revealed that urban and rural Nigeria shared similarities with respect to factors like mother\u2019s education, place of delivery, and size of child at birth being significant predictors of PLF. Mode of delivery and type of birth were significant predictors of PLF only in urban Nigeria, whereas, mother\u2019s age at birth was a significant predictor of PLF only in rural Nigeria. Zones also showed variations in the odds of PLF according to place of residence. Conclusion: Interventions aimed at decreasing PLF rate should be through a tailored approach, and should target at risk sub -groups based on place of residence

Assessing the validity and reliability of family factors on physical activity: A case study in Turkey

Background: Childhood obesity rates have been rising rapidly in developing countries. A better understanding of the risk factors and social context is necessary to inform public health interventions and policies. This paper describes the validation of several measurement scales for use in Turkey, which relate to child and parent perceptions of physical activity (PA) and enablers and barriers of physical activity in the home environment. Method: The aim of this study was to assess the validity and reliability of several measurement scales in Turkey using a population sample across three socio-economic strata in the Turkish capital, Ankara. Surveys were conducted in Grade 4 children (mean age = 9.7 years for boys; 9.9 years for girls), and their parents, across 6 randomly selected schools, stratified by SES (n = 641 students, 483 parents). Construct validity of the scales was evaluated through exploratory and confirmatory factor analysis. Internal consistency of scales and test-retest reliability were assessed by Cronbach\u27s alpha and intra-class correlation. Results: The scales as a whole were found to have acceptable-to-good model fit statistics (PA Barriers: RMSEA = 0.076, SRMR = 0.0577, AGFI = 0.901; PA Outcome Expectancies: RMSEA = 0.054, SRMR = 0.0545, AGFI = 0.916, and PA Home Environment: RMSEA = 0.038, SRMR = 0.0233, AGFI = 0.976). The PA Barriers subscales showed good internal consistency and poor to fair test-retest reliability (personal α = 0.79, ICC = 0.29, environmental α = 0.73, ICC = 0.59). The PA Outcome Expectancies subscales showed good internal consistency and test-retest reliability (negative α = 0.77, ICC = 0.56; positive α = 0.74, ICC = 0.49). Only the PA Home Environment subscale on support for PA was validated in the final confirmatory model; it showed moderate internal consistency and test-retest reliability (α = 0.61, ICC = 0.48). Discussion: This study is the first to validate measures of perceptions of physical activity and the physical activity home environment in Turkey. Our results support the originally hypothesized two-factor structures for Physical Activity Barriers and Physical Activity Outcome Expectancies. However, we found the one-factor rather than two-factor structure for Physical Activity Home Environment had the best model fit. This study provides general support for the use of these scales in Turkey in terms of validity, but test-retest reliability warrants further research

The construct validity and reliability of the Turkish version of Spreitzer's psychological empowerment scale

<p>Abstract</p> <p>Background</p> <p>Today, many organizations have adopted some kind of empowerment initiative for at least part of their workforce. Over the last two decades, two complementary perspectives on empowerment at work have emerged: structural and psychological empowerment. Psychological empowerment is a motivational construct manifested in four cognitions: meaning, competence, self-determination and impact. The aim of this article is to examine the construct validity and reliability of the Turkish translation of Spreitzer's psychological empowerment scale in a culturally diverse environment.</p> <p>Methods</p> <p>The scale contains four dimensions over 12 statements. Data were gathered from 260 nurses and 161 physicians. The dimensionality of the scale was evaluated by exploratory factor analyses. To investigate the multidimensional nature of the empowerment construct and the validity of the scale, first- and second-order confirmatory factor analysis was conducted. Furthermore, Cronbach alpha coefficients were assessed to investigate reliability.</p> <p>Results</p> <p>Exploratory factor analyses revealed that four factors in both solutions. The first- and second-order factor analysis indicated an acceptable fit between the data and the theoretical model for nurses and physicians. Cronbach alpha coefficients varied between 0.81-0.94 for both groups, which may be considered satisfactory.</p> <p>Conclusions</p> <p>The analyses indicated that the psychometric properties of the Turkish version of the scale can be considered satisfactory.</p

Lot quality survey: an appealing method for rapid evaluation of vaccine coverage in developing countries – experience in Turkey

<p>Abstract</p> <p>Background</p> <p>Vaccine-preventable diseases cause significant morbidity and mortality worldwide and in developing countries in particular. Information on coverage and reasons for non-vaccination is vital to enhance overall vaccination activities. Of the several survey techniques available for investigating vaccination coverage in a given setting, the Lot Quality Technique (LQT) remains appealing and could be used in developing countries by local health personnel of district or rural health authorities to evaluate their performance in vaccination and many other health-related programs. This study aimed to evaluate vaccination coverage using LQT in a selected semi-urban setting in Turkey.</p> <p>Methods</p> <p>A LQT-based cross-sectional study was conducted in Kecioren District on a representative sample of residents aged 12–23 months in order to evaluate coverage for routine childhood vaccines, to identify health units with coverage below 75%, and to investigate reasons for non-vaccination.</p> <p>Results</p> <p>Based on self-reports, coverage for BCG, diphtheria-pertussis-tetanus (DPT-3), oral polio-3, hepatitis-3, and measles vaccines ranged between 94–99%. Coverage for measles was below 75% in five lots. The relatively high educational and socioeconomic status of parents in the study group alone could not minimize the "considerable" risk of vaccine-preventable diseases in the District and dictates a continuity of efforts for improving vaccination rates, with special emphasis on measles. We believe that administrative methods should be backed up by household surveys to strengthen vaccination monitoring and that families should be trained and motivated to have their children fully vaccinated according to the recommended schedule and in a timely manner.</p> <p>Conclusion</p> <p>This study identified vaccine coverage for seven routine vaccines completed before the age of 24 months as well as the areas requiring special attention in vaccination services. The LQT, years after its introduction to health-related research, remains an appealing technique for rapid evaluation of the extent of a variety of local health concerns in developing countries, in rural areas in particular, and is very efficient in determining performance of individual subunits in a given service area. Training of local health personnel on use of the LQT could expedite response to local health problems and could even motivate them in conducting their own surveys tailored to their professional interests.</p

The Impact Of Standardized Patient Feedback On Student Motivational Levels

Objective: The impact of standardized patient feedback on the motivational levels of learners for learning communication skills was examined in the study. Material and Methods: Control group post-test design was used and 284 of Year-I students took part in the study (87%). Both groups were randomly organized. The students had two standardized patient encounters in addition to training and debriefing sessions. The study group students received face-to-face feedback after the first encounters; but not the control group. We used the motivation dimension of Motivated Strategies for Learning Questionnaire and t-test to evaluate the,differences between the average scores of motivational levels of both groups for all sub-dimensions. Results: After the first encounters, there is a significant difference between study and control groups in the sub-dimension of test anxiety (p=0.028). After the second encounters, the students of the study group who received feedback after the first encounters, got lower scores in the sub-dimension of test anxiety (p=0.016), and got higher scores in the sub-dimension of self-efficacy (p=0.027). Conclusion: We found out that the students who received feedback had lower levels of test anxiety, and higher levels of self-efficacy. Those results showed that standardized patient feedback eafected student motivational levels in two sub-dimensions.WoSScopu

Risky Behaviors of University Students: A Cross-Sectional Study

Objective: This study aimed to identify certain risky behavior patterns (unsafe sex, tobacco and drug use, and binge drinking) and the factors affecting these behaviors among first- and third-year students in a university. Method: The study included a total of 8407 students enrolled as first- (4392) and third- (4015) year students. A self-administered questionnaire was used for data collection. In data analysis, respecting sampling weights, models were formed by logistic regression method to determine factors that affect the risky behaviors. Results: 731 male–1114 female students from the first year and 560 male–1096 female students from the third year were interviewed. Male students were found to be engaged in risky behaviors more frequently than females. Logistic models of the study indicated that gender, place of residence, relationship with parents, and socialization with friends have profound effects on risky behaviors. Conclusion: After leaving home, young people develop their own lifestyles, and this study demonstrates that lifestyle is the main effective factor for risky behaviors in this group. Universities need to assume more responsibility to guide students’ lives and to provide the facilities and opportunities that encourage and facilitate their adoption of a healthy lifestyle.   Key Words: University students, risky behaviours Bir Üniversitede Öğrencilerin Riskli Davranışları: Kesitsel Bir Çalışma Amaç: Bu çalışmanın amacı, bir üniversitenin birinci ve üçüncü sınıf öğrencileri arasında bazı riskli davranış modellerini (güvensiz seks, tütün ve uyuşturucu kullanımı ve aşırı alkol) ve bu davranışları etkileyen faktörleri saptamaktır. Yöntem: Araştırmanın evrenini birinci (4392) ve üçüncü (4015) sınıflarda kayıtlı 8407 öğrenci oluşturmaktadır. Veri öğrencilerin gözlem altında doldurdukları anket aracılığı ile toplanmıştır. Riskli davranışları etkileyen faktörleri belirlemek için lojistik regresyon yöntemi modellemesi kullanılmıştır. Bütün istatistiksel analizlerde ağırlıklı yüzdeler dikkate alınmış ve kullanılmıştır. Bulgular: Çalışmada birinci sınıflardan 731 erkek–1114 kadın veüçüncü sınıflardan 560 erkek–1096 kadın öğrenci yer almıştır. Araştırmada erkek öğrencilerin kadınlara göre daha fazla riskli davranışlarda bulunduğu saptanmıştır. Çalışma verilerinin lojistik regresyon modellemesinde cinsiyet, aile ile ilişkiler, arkadaşlar ile sosyalleşme ve yaşam koşulları ile öğrencilerin riskli davranışları ile anlamlı düzeyde ilişkili olduğu saptanmıştır. Sonuç: Evden ayrıldıktan sonra, genç insanlar kendi yaşam tarzlarını geliştirmektedir. Bu çalışma bu grupta yaşam tarzının riskli davranışları etkileyen temel bir faktör olduğunu göstermektedir. Gençlerin yaşamlarına rehberlik etmek ve sağlıklı yaşam tarzını geliştirici ve benimsenmesini kolaylaştırıcı olanakların ve fırsatların sağlanması için üniversitelerin daha fazla sorumluluk üstlenmesi gerekmektedir. Anahtar Kelimeler: Üniversite öğrencileri, riskli davranışlar</p

Vaccine Coverage Rates Among 12-23 Month Old Children Living In Four Selected Provinces Of Turkey: Results Of A Lot Quality Survey

Objective: The aim of the study is to evaluate the coverage rates for routine childhood vaccines at the provincial-level and to identify the districts with "unacceptably low" coverage rates. Material and Methods: A Lot Quality Technique -based cross-sectional study was conducted in four selected provinces, on a representative sample of residents aged 12-23 months in order to evaluate coverage for routine childhood vaccines [Bacille Calmette-Guerin (BCG), diphtheria, tetanus, pertussis, polio & Haemophilus influenzae type b (DTaPHibIPV3), oral polio vaccine (OPV), Hepatitis B3 and measles, mumps & rubella (MMR)], to identify the districts with coverage rates below 75%, and to investigate reasons for non-vaccination. Results: A total of 1640 children were included in the survey. Based on self-reports, the percentage of fully immunized children ranged between 88.6% and 98.1% in the four provinces. The percentage of timely vaccinations varied from 71.5 to 78.4, according to the type of the vaccine and overall coverage rates were below 75% in four lots. Potential associations between children's "fully and timely vaccination" status and some socio-demographic characteristics were examined with logistic regression modeling. The results have shown that the estimated risk of improper/inadequate vaccination is affected positively by having an employed mother, a primary school graduate or less educated mother and mother's age but is negatively affected by the child's age. Conclusion: This study identified vaccine coverage for ten routine vaccines that should be completed before the age of 24 months and the areas that need a special attention in vaccination services.WoSScopu