ABSTRACT
Background@#This study aimed to estimate the prevalence of and determine the factors associated with antihypertensive medication (A-HTNM) non-adherence among hypertension care seekers attending primary health clinics in the Gaza Strip. @*Methods@#A cross-sectional survey was conducted as the recruitment phase of a clustered randomized controlled trial including 538 participants. The participants were randomly selected from 10 primary health care centers by two-stage cluster random sampling. A structured questionnaire was used to collect data through face-to-face interview. The questionnaire was developed based on the World Health Organization determinants for medication non-adherence and the Health Belief Model. The main outcomes of this study were the prevalences of A-HTNM non-adherence and its associated factors. Adherence status was assessed using the eight-item Morisky Self-Report Medication Adherence Scale. Data were analyzed by STATA ver. 14.0 (Stata Corp., College Station, TX, USA) using a standard complex survey, accounting for unresponsiveness and the clustering sampling approach. @*Results@#The overall prevalence of A-HTNM non-adherence was 65.8% (95% confidence interval [CI], 59.2–71.8). Among all studied predictors, only self-efficacy of participants (odds ratio [OR], 3.8; 95% CI, 1.79–2.84) and social support (OR, 2.26; 95% CI, 2.82–5.11) remained significantly associated with A-HTNM non-adherence after adjusting for age, education level, number and frequency of A-HTNM doses per day, and comorbidities. @*Conclusion@#The high prevalence of non-adherence highlights the need for serious intervention to enhance the adherence rate among hypertension patients. The associated factors can be considered when developing appropriate interventions.
ABSTRACT
Background@#This study aimed to estimate the prevalence of and determine the factors associated with antihypertensive medication (A-HTNM) non-adherence among hypertension care seekers attending primary health clinics in the Gaza Strip. @*Methods@#A cross-sectional survey was conducted as the recruitment phase of a clustered randomized controlled trial including 538 participants. The participants were randomly selected from 10 primary health care centers by two-stage cluster random sampling. A structured questionnaire was used to collect data through face-to-face interview. The questionnaire was developed based on the World Health Organization determinants for medication non-adherence and the Health Belief Model. The main outcomes of this study were the prevalences of A-HTNM non-adherence and its associated factors. Adherence status was assessed using the eight-item Morisky Self-Report Medication Adherence Scale. Data were analyzed by STATA ver. 14.0 (Stata Corp., College Station, TX, USA) using a standard complex survey, accounting for unresponsiveness and the clustering sampling approach. @*Results@#The overall prevalence of A-HTNM non-adherence was 65.8% (95% confidence interval [CI], 59.2–71.8). Among all studied predictors, only self-efficacy of participants (odds ratio [OR], 3.8; 95% CI, 1.79–2.84) and social support (OR, 2.26; 95% CI, 2.82–5.11) remained significantly associated with A-HTNM non-adherence after adjusting for age, education level, number and frequency of A-HTNM doses per day, and comorbidities. @*Conclusion@#The high prevalence of non-adherence highlights the need for serious intervention to enhance the adherence rate among hypertension patients. The associated factors can be considered when developing appropriate interventions.
ABSTRACT
There is an international emphasis on providing timely and high quality data to monitor progress of countries toward Millennium Development Goals. Iran's Multiple Indicator Demographic and Health Survey [IrMIDHS] aimed to provide valid information on population and health outcomes to monitor progress in achieving national priorities and health programs and to assist policy makers to design effective strategies for improving health outcomes and equity in access to care. A cross-sectional multi-stage stratified cluster-random survey is conducted through face-to-face household interviews. The sampling frame is developed using Iran's 2006 population and housing census. Provincial samples ranging are from a minimum of 400 households per province to 6400 households in Tehran province. Cluster size is 10 households. The target sample includes 3096 clusters: 2187 clusters in urban and 909 clusters in rural areas. IrMIDHS instruments include three questionnaires: Household questionnaire, women aged 15-54 questionnaire, children under five questionnaire, supervision and quality assessment checklists and data collection sheets and standard weight and height measurement tools for under-five children. A cascading decentralized training method is used for training data collection and supervision teams. Quality assurance procedures are defined for the five steps of conducting the survey including: Sampling, training data collection and training teams, survey implementation, data entry and analysis. A multi-layer supervision and monitoring procedure is established. All the questionnaires are double entered. IrMIDHS will provide valuable data for policymakers in Iran. Designing and implementation of the study involve contributions from academics as well as program managers and policy makers. The collaborative nature of the study may facilitate better usage of its results
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Low birth weight [LBW] is considered as an important outcome of birth and pregnancy, which is associated with long-term consequences and health-care problems. Maternal lifestyle and health care during pregnancy are powerful predictors of BW of infants. The purpose of this study was to assess the effect of a self-care educational program based on the Health Belief Model [HBM] on reducing LBW among a sample of pregnant Iranian women. In this randomized controlled trial, we recruited 270 pregnant women referred to prenatal clinics in the south of Tehran, Iran. The participants were randomly allocated to two intervention and control groups. Women in the intervention group received an educational program to promote self-care behaviors during pregnancy. The control group received routine care. BW was compared between the two groups. Baseline demographic characteristics and knowledge and attitude scores before the intervention in both groups were compared using the Chi-square test for categorical variables. Logistic regression analysis was conducted to control the effect of demographic variables on BW. The results showed that LBW was reduced significantly in the intervention group at the follow-up measurement [5.6 vs. 13.2%, P = 0.03]. After controlling for demographic characteristics, we found a significant decrease in the risk of LBW in the intervention group [odds ratio [OR]: 0.333; 95% confidence interval [CI]: 0.12-0.88, P = 0.02]. Implementation of a self-care educational program designed on the basis of an HBM on pregnant women was effective in reducing the rate of LBW
ABSTRACT
This article is a report of psychometric testing of the Farsi version of Resources and Support for Chronic Illness Self management [RSSM] scale. In this cross sectional study, a convenience sample of 160 patients with type 2 diabetes, registered with the Charity Foundation for Special Diseases' team focused diabetes clinic, were recruited [response rate=83.7%; n=134]. Participants older than 18 years who had active medical files in the system completed the questionnaire. Content validity was established using translation and back translation procedures, pilot testing of the instrument, and getting views of the expert panel. Construct validity was determined using explanatory factor analysis. Internal consistency was ascertained using Cronbach's alpha. The stability was confirmed using intra class correlation coefficients. Using exploratory factor analysis, a five factor model emerged, which explained 75.24% of the total variance. Internal consistency reliability was sufficient [alpha=0.70; range=0.66-0.87]. The intra class correlation coefficient was 0.74-0.81 for individual items. The RSSM Farsi seems to be a valid and reliable instrument to measure outcomes of diabetes self management education programs in Farsi. The RSSM Farsi version scale could be a useful, comprehensive, and culturally sensitive scale for assessing resources and support for self management between type 2 diabetic patients
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Appropriate physical activity help to promote women's health during pregnancy. Providing appropriate educational programs for pregnant women seems to be necessary. This study was carried out to assess the effectiveness of a group educational program on pregnant women's physical activity. This clinical trial was conducted among 280 nulliparous women. The participants were randomly divided into two experimental and control groups. Women in the experimental group participated in eight 90-minute group-based educational classes. Those in the control group received routine care. Data were collected at baseline and at the end of the educational program. Data were analyzed using the Chi-squared test and the t-test in the SPSS. There were no statistical differences on age, body mass index, education level, employment status, and physical activity between the two groups at baseline. The physical activity score was more in the experiment group [37.38 +/- 14.89] in compare with the control group [13.7 +/- 11.12] after the intervention [P<0.001]. The group-based educational program seems to promote physical activity during pregnancy. These kinds of programs should be implemented in prenatal clinics
Subject(s)
Humans , Female , Pregnancy , Education/methods , Motor Activity , Health PromotionABSTRACT
Dietary Guidelines are considered as a useful tool for the promotion of healthy dietary behaviors. In Iran, despite the development of the latest National Food-Based Dietary Guidelines, in 2006, it has not been introduced at the community level yet. The present study aims to evaluate the effectiveness of an intervention program to promote Iran's Food-Based Dietary Guidelines [IFBDGs] in urban adult women. A sample of 435 healthy women, aged 26 to 54 years, was randomly assigned to the intervention or control groups. The intervention group was designed based on the Health Belief Model [HBM]. Each subject in the intervention group received three sessions of group education on IFBDGs and the food guide pyramid and participated in a healthy cooking class. Dietary intake, cognitive outcomes related to the constructs of the HBM, physical activity, and the BMI were measured in both groups before, immediately, and one month after the intervention. The outcome measures were compared with the analysis of covariance [ANCOVA], by adjusting for baseline values. The intervention group had a significantly lower total daily energy intake than the control group after the intervention [P=.000]. The adjusted differences in the changes of body mass index from the baseline were significant in both post intervention measurements in the intervention group compared to the controls. The intervention designed based on the Health Belief Model was effective in improving the adherence to FBDGs and could serve as a basic model for the promotion of healthy nutrition behavior among women in the primary health care setting
Subject(s)
Humans , Female , Health Planning Guidelines , Delivery of Health Care , Body Mass Index , Motor Activity , FoodABSTRACT
Diet rich in fruits and vegetables is shown to be an important factor in prevention of chronic diseases. Adolescence is a critical period in adopting eating behaviors. Schools are important social environments in adolescents' lives; and are important settings for interventions that aim to improve eating behaviors, including fruit and vegetable intake. This study aimed to assess effectiveness of a school-based intervention based on social cognitive theory on fruit and vegetable [F and V] intake of female adolescents in Tehran. This experimental school based field trial was conducted on 296 female students aged 10-13 years old [157 in the intervention and 139 in the control groups]. The intervention included classroom nutrition education on F and V and increasing availability of Fand V through school buffet. Psychosocial characteristics of the students were assessed using a questionnaire and F and V intake were measured using 24-hr recall method, at baseline and after three months intervention. Descriptive and inferential statistics were used for data analysis. After the intervention, vegetable and fruit intake were 0.6 and 0.63 servings higher in the intervention group compared to the controls. Knowledge and self-efficacy scores were significantly higher in the intervention group compared to the control group. Home availability and observational learning scores were significantly decreased in the intervention group. Through the intervention process, many valuable experiences were gained to be used in future interventions