Barriers to Health Service Utilization Among Iranian Female Sex Workers: A Qualitative Study / 예방의학회지

OBJECTIVES: In most countries around the world, sex work is an illegal activity. Female sex workers (FSWs) in Iran hide their identities, and they are known to be a hard-to-reach population. Despite free access to HIV testing, fewer than half of FSWs receive HIV testing. The purpose of this study was to characterize the reasons for which FSWs do not seek testing at drop-in centers (DICs) and voluntary counseling and testing (VCT) centers in Iran. METHODS: A qualitative study was conducted in 2016. The participants were 24 FSWs who received services at VCT centers and DICs for vulnerable females in the north of Iran and 9 males who were the clients of FSWs. In this study, we made use of purposive sampling and carried out a thematic analysis. RESULTS: We found 4 major and 6 minor themes. The major themes were: fear of being infected (with HIV), stigma, indifference, and knowledge. CONCLUSIONS: Despite the significant efforts made by the government of Iran to establish and expand DICs for vulnerable females, the number of FSWs receiving services at these centers has not been very considerable. Consequently, by introducing and implementing training programs for peer groups, it may be possible to take steps toward establishing strategic programs for the control and prevention of HIV/AIDS.

Gaining comprehensive data about sexual knowledge through surveys

Background: delivery of sexual health services rely on rigorous facts extracted from surveys, but often those facts cannot be available due to the lack of culturallysensitive questionnaires

Objective: our aim was to show the validity and reliability of the Persian version of the Acquisition of Sexual Information Test [ASIT], a measure selected due to its assemblages with Iranian culture

Materials and Methods: forward-backward procedure was applied to translate the questionnaire. Cross-sectional study was carried out and psychometric properties of the Iranian version were tested in a thirty sample of reproductive-age women. Face validity was assessed by qualitative and quantitative methods. Content validity was also assessed by calculating two quantitative indicators as content validity index [CVI] and content validity ratio [CVR]. Reliability was assessed by test-retest analyses

Results: impact score was 1.5, the majority of participants [83.3%] stated that the overall level of questionnaire was high but some of the questions were irrelevant to sexual knowledge. Many questions [90%] gained a CVR less than 0.56, and all of them gained CVIs lower than 0.7. Correlation in test-retest reliability was 0.85

Conclusion: sexual knowledge questionnaire seems to be culturally inappropriate for Iranian women. Although, we need survey data for assessing the evidence-based needs for sexual health and best practice, but the questions addressing various dimensions of sexuality must be culturally sensitive, comprehensive and appropriate. Our findings suggest that ASIT as a well-known measure should be used in Iranian population with caution

Development and psychometric properties of the decision making on the type of delivery questionnaire in Iranian women

Background: A tool which can help to decide on the determinants in selecting the delivery type is an effective step towards the goals of the World Health. This study aimed to develop and evaluate the psychometric properties of a scale based on Iranian culture to make decision on the type of delivery

Methods: This is a methodological study using a questionnaire proposed by Schneider. The following steps were used to design the project. In the first step, perceptions and experiences of 45 pregnant women, postpartum women, midwives, gynecologists and non-pregnant women were determined based on interviews and observations using focused ethnography. In the second stage, the terms in the questionnaire based on qualitative study was assessed. Then, in the third stage, psychometric testing of the decision making on the type of delivery scale [DMTDS] based on the cultural concepts of decision making towards the type of delivery and its influencing factors based on focused ethnography using face validity, content validity, construct validity, internal consistency and reliability was done on400 pregnant and postpartum women

Results: The initially developed scale consisted of 60 items on a 5-point Likert scale, which reduced to 43 items following measurement of the face and content validity. The results of the exploratory factor analysis elicited 36 items and a seven-factor structure including motivational beliefs on vaginal delivery, social beliefs towards childbirth, motivational beliefs on cesarean delivery, personal beliefs, sources of information, catastrophic thinking and child birth experiences. Cronbach's alpha coefficient [0.80] confirmed the high internal consistency of the scale

Conclusion: The developed questionnaire appears to be a valid and reliable tool for health care providers to measure the women's decision making towards type of delivery. Therefore, this tool can be used in the Iranian community. The scale may help the midwives and obstetricians to be aware of the women's decision regarding their choice of delivery and as a result to plan appropriately in order to reduce unnecessary cesarean sections

Association between electromagnetic field exposure and abortion in pregnant women living in Tehran

Background: Health-related quality of life is affected by electromagnetic field exposure in each person everyday life. However, this is extremely controversial issue

Objective: Investigation of the associations between electromagnetic field exposure and miscarriage among women of Tehran

Materials and Methods: In this longitudinal study, 462 pregnant women with gestational age <12 wks from seven main regions of Tehran city in Iran with similar social and cultural status were participated. Women were interviewed face-to face to collect data. Reproductive information was collected using medical file recorded in those hospitals the subjects had delivery. The measuring device measured electromagnetic waves, Narda safety test solutions with valid calibration date at the entrance door of their houses

Results:A significant likelihood of miscarriage in women who exposed to significant level of electromagnetic wave. However, this association was not confirmed by Wald test

Conclusion: This study may not provide strong or consistent evidence that electromagnetic field exposure is associated or cause miscarriage. This issue may be due to small sample size in this study

Vaginal delivery vs. cesarean section: a focused ethnographic study of women's perceptions in the north of Iran

Cesarean section [C-section] in the North of Iran accounts for 70% of childbirths, which is higher than the national average of 55%. Understanding women's perceptions towards modes of delivery in different cultures can pave the way for promoting programs and policies in support of vaginal delivery. We aimed to investigate women's perceptions towards modes of delivery in the North of Iran. Using a focused ethnographic approach and purposive sampling, 12 pregnant women, 10 women with childbirth experience, nine non-pregnant women, seven midwives, and seven gynecologists were selected from hospitals, healthcare centers, and clinics of Tonekabon and Chaloos, Mazandaran, Iran, during 2012-2014. Data were collected through in-depth interviews and participant observation. Data analysis was performed using thematic analysis using MAXqda software. Two major themes emerged from the data including: "vaginal delivery, a facilitator of women's physical and mental health promotion", and "C-section, a surgical intervention associated with decreased labor pain". Six sub-themes subsumed within these major themes were: vaginal delivery as a safe mode of delivery, fullfilment of maternal instinct, a natural process with a pleasant ending, and C-section as a procedure associated with future complications, a surgical intervention and sometimes a life saving procedure, and a painless mode of delivery. In the North of Iran, women's justified cultural beliefs overshadow their micsconceptions, so it is hopped that through implementing appropriate training programs for raising awarness and correcting miscomceptions, vaginal delivery could be promoted even in regions with high rates of cesarean section

existing therapeutic interventions for orgasmic disorders: recommendations for culturally competent services, narrative review

In recent years, a growing number of interventions for treatment of female orgasmic problems [FODs] have emerged. Whereas orgasm is a extra biologically and learnable experience, there is a need for practitioners that to be able to select which therapy is the most appropriate to their context. In this critical literature review, we aimed to assess areas of controversy in the existing therapeutic interventions in FOD with taking into accounted the Iranian cultural models. For the present study, we conducted an extensive search of electronic databases using a comprehensive search strategy from 1970 till 2014. This strategy was using Google Scholar search, "pearl-growing" techniques and by hand-searching key guidelines, to identify distinct interventions to women's orgasmic problem therapy. We utilized various key combinations of words such as:[orgasm] OR [orgasmic],[female orgasmic dysfunction] OR Female anorgasmia OR Female Orgasmic Disorder, orgasmic dysfunction AND treatment, [orgasm AND intervention]. Selection criteria in order to be included in this review, studies were required to: 1 employ clinical-based interventions, 2 focus on FOD. The majority of interventions [90%] related to non-pharmacological and other were about pharmacological interventions. Self-direct masturbation is suggested as the most privilege treatment in FOD. Reviewing all therapies indicates couple therapy, sexual skill training and sex therapy seem to be more appropriate to be applied in Iranian clinical settings. Since many therapeutic interventions are introduced to inform sexually-related practices, it is important to select an intervention that will be culturally appropriate and sensitive to norms and values. Professionals working in the fields of health and sexuality need to be sensitive and apply culturally appropriate therapies for Iranian population. We further suggest community well defined protocols to screen, assessment and management of women' sexual problems such as FOD in the Iranian settings

Socio-cultural beliefs, values and traditions regarding women's preferred mode of birth in the north of Iran

Pregnant women rely heavily on informal information while making a decision about the mode of delivery they would rather have, either as normal vaginal delivery [NVD] or cesarean section [CS]. Through recognition of social attitudes towards different modes of delivery, societies can be directed towards a positive understanding of vaginal delivery, which can ultimately lead to maternal health promotion. Thus, this study aimed to explore the common beliefs, values and traditions surrounding women's preferred mode of birth in the North of Iran. Using a focused ethnographic approach, twelve pregnant women, 10 women with previous experience of childbirth, seven midwives, seven obstetricians, and nine non-pregnant women were included in this study through a purposeful sampling in health clinics of Tonekabon in the North of Iran. Semi-structured interviews and participant observations were used for data collection. Study rigor was confirmed through prolonged engagement, member check, expert debriefing, and thick description of the data. Data were analysed using Braun and Clarke thematic analysis [2006] and MAXqda software. Through analysis, three major themes and 10 subthemes emerged. They included: 1] sociocultural childbirth beliefs with five subthemes: a] CS as protector of genital tract integrity, b] blind imitation in choosing mode of birth, c] NVD as a low cost type of delivery, d] CS as a prestigious mode of birth and, e] NVD as a symbol of woman's power and ability; 2] traditional health beliefs with two subthemes: a] NVD as a guarantee for woman's health, b] traditional childbirth facilitators; 3] religious beliefs and values with three subthemes: a] NVD as a symbol of God's power, b] call for help from the Mighty God, and c] NVD as a sacred phenomenon. The results of this study indicated that cultural beliefs, values and traditions can significantly affect individuals' attitudes towards modes of delivery, their definitions of different modes, and the decisions they make in this regard. In order to develop a positive cultural and religious attitude towards vaginal delivery, women's awareness has to be raised through various ways and the existing misconceptions need to be corrected

Development, validity and reliability of sexual health measures for spinal cord injured patients in Iran

This study developed and validated a questionnaire to measure the sexual health of patients with spinal cord injuries [SCI]. This was a cross-sectional study conducted at the Brain and Spinal Injury Research Center [BASIR], Tehran, Iran. Extensive review of literature, expert opinions, and encounters with SCI patients were used to develop and validate the questionnaires. There were 40 [32 males, 8 females] patients with SCI that presented for treatment at BASIR who enrolled in the study. Participants completed the questionnaires while they were admitted for medical care and during treatment follow-up visits. Participants completed the questionnaires twice, at a 2-4 week interval. Reliability testing for each measure was performed separately. Cronbach's alpha was used for internal consistency and test-retest was used for reliability. An expert committee approved the face and content validities of the questionnaires, Internal consistency of our questionnaires, was acceptable according to Cronbach's alpha that ranged from 0.73 for the sexual activity measure to 0.90 for the sexual adjustment measure. Test-retest reliability was satisfactory. Intraclass Correlation Coefficient [ICC] of measures ranged from 0.65 for sexual function to 0.84 for sexual activity. The sexual health measures has provided a valid assessment of sexuality-related matters in this sample of patients with SCI, which suggests that evaluation of sexual well-being may be useful in clinical trials and practice settings. Overall, the sexual health measures shows good internal consistency and test-retest reliability

Reproductive factors associated to human papillomavirus infection in iranian woman

In recent years, humman papilomaviruses [HPV] infection is the most common type of sexual trasmitted diseases [STD] in majority of countries. It's a significant source of morbidity and mortality worldwide. In this study, we aimed to compare the history of reproductive disease between two groups of Iranian women with and without HPV infection through colposcopy precedure. This case - control study included 210 women reffered to a training gynecology hospital of Tehran University of Medical Science in Tehran. Case group was composed of 70 women with diagnosis of HPV infection, while control group was composed of 140 women with no sign of mentioned-infectious diseases of the control group. Reproductive history was prepared using the standard questionnaire, and obtianed data were analized by SPSS 20. Our findings showed that the risk factors for HPV infection were as follows: low parity [p = 0.000], reduction of number of weekly sexual intercourse [p = 0.000], no consumption of oral contraceptive pill [OCP] [p = 0.006], and history of withdrawal contraceptive method [p = 0.001]. Improvement of our knowledge about reproductive factors associated with HPV may help us to identify women at risk and to develope different methods of preventive interventions

What happens to sexuality of women during lactation period? A study from Iran

To compare the association of sexual activity and breastfeeding women within 2-6 months after child birth. This study was carried out in 2007. The sexual activity of 258 breastfeeding women was compared with 198 bottle-feeding women referred to a public maternity health care center in Tehran. Women in the age of 20-35 years were enrolled in the study after their first or second child and 2-6 months after birth. A self-structured questionnaire was used for data collection. Women were interviewed face-to-face by the first author. Of 456 respondents, 258 were currently breastfeeding and 198 were bottle feeding. Mean age of the mothers was 27 +/- 4.7 years. About 28.3% of breastfeeding women and 22.9% of non breastfeeding women had sexual intercourse within one month of postpartum period. No significant difference was found between breastfeeding and bottle-feeding women on sexual desire and satisfaction before pregnancy and in postpartum period [p: 0.1, p: 0.5].The orgasm experience did not have a significant difference between the two groups during postpartum [p: 0.4]. We did not find significant difference in sexual activity between breastfeeding and non-breastfeeding women. Sexual history taking and counseling in antenatal class as well as postpartum period are suggested for the clients

[ study of the relationship between sexual activity and breastfeeding]

Longterm breastfeeding is an important factor for women. Reverse effects of breastfeeding regarding sexual activities have been reported. However, the impact of breastfeeding, along with sexual activity of women during postpartum, is a debatable matter. This effect remains unknown in many societies such as Iran. Sexual activity during breastfeeding from women has not been studied. This study was carried out to compare the association of sexual activity of breastfeeding and non-breastfeeding women within 2-6 months after birth. In this historical cohort study, which was carried out in 2007, the sexual activity of breastfeeding women was compared with 198 bottle-feeds women, who were referred to a public maternity health care center in Tehran. Women were recruited within the age of 20-35, being their first or second child and in 2-6 months after birth. A self-structured questionnaire was used for data collection. Women were interviewed face-to-face by the first author. Of 456 respondents, 258 were currently breastfeeding and 198 were bottle feed. Mean age of the mothers was 27 +/- 4.7 years. 28.3% of breastfeeding women and 22.9% of non breastfeeding women had sexual intercourse within the one month of postpartum period. There was no significant difference between the time of resumption of sexual activity and being breastfeed or not [p<0.07]. Also, no significant difference was found between breastfeeding and bottle-feed women on sexual desire and satisfaction prior to pregnancy and in postpartum period [p<0.1, p<0.5]. In 49/8% of breastfeed and 43.3% of non breastfeed women, sexual desire was decreased and also in 32.6% and 33%, sexual satisfaction was decreased respectively. The orgasm experience did not have a significant difference between the two groups during postpartum [p=0.4] so that 65.7% of breastfeed women and 64% of non breastfeed women reached orgasm in postpartum period. We did not find a significant difference between breastfeeding and non breastfeed women. Sexual history taking and counseling in antenatal class as well as postpartum period are suggested for clients