Psychological predictors of quality of life among Jordanian cancer patients' caregivers.

OBJECTIVE: The caregivers who provide care for patients with cancer often experience emotional and psychological stressors and burdens that could be influenced by several factors, including the cultural context. This study examines the level of emotional distress and burden and their effect on the quality of life (QOL) of Jordanian cancer patients' caregivers. METHODS: A cross-sectional survey was conducted among 257 family caregivers of patients at various stages of cancer. RESULTS: The average age of caregivers was 37.5 years (SD = 12.2). Most caregivers (145; 59.2%) were female and married (168; 68.6%). About a quarter were partners (32.2%) and lived with their patients (137; 55.9%). Caregivers with a reduced overall Caregiver Quality of Life Index-Cancer (CQOLC) score were more likely to be older, the parents of the patients, and living with patients in the same house. A significant negative relationship was found between caregivers' CQOLC and Zarit Burden Interview (r = -0.7, p = 0.001), anxiety (r = -0.69, p = 0.001), and depression (r = -0.42, p = 0.03) scores. Multiple linear regression analysis revealed that burden, anxiety, and depression scores were independent predictors and explained 63% of the variance in the total CQOLC score of caregivers. CONCLUSION: Cancer caregivers are at elevated risk of poor QOL. Despite participants' low perception of the burden level, this study provides preliminary results for policymakers and medical practitioners to foster a comprehensive platform supporting cancer caregivers. Moreover, identifying the caregivers' readiness to provide the needed care and the availability of supportive resources, as a clinical routine, is strongly recommended.

Mental health, learning behaviour and perceived fatigue among university students during the COVID-19 outbreak: a cross-sectional multicentric study in the UAE.

BACKGROUND: The rapid shift to online education due to COVID-19 quarantine challenged students' ability to accept pure online learning without negative consequences for their physical, emotional and mental health. Some educational institutions introduced new strategies to reduce the psychosocial burden associated with online learning during home confinement. Thus, the primary aims were to determine the consequences of COVID-19 for the psychological well-being and fatigue levels of higher education students and to explore the effects of a new academic assessment approach in reducing home confinement stress. METHOD: A cross-sectional online survey was conducted among students, from 30 August to 30 September 2020, of 7 disciplines in all 16 higher colleges of technology in the United Arab Emirates (UAE). The Mental Well-being and Learning Behaviours Scale and the modified Copenhagen Burnout Inventory were used to evaluate students' psychological well-being and fatigue levels. A Welch t-test and Welch ANOVA were performed to determine the differences in perceived psychological well-being associated with students' characteristics. Second, Kruskal_Wallis and Mann_Whitney were performed to determine the differences in fatigue level based on students' characteristics. RESULTS: One thousand four hundred students participated. The majority were female (78.5%) and aged from 21-25 years (58.1%). Around 14% of respondents were married with children. Nearly 40% were satisfied with the new assessment approach introduced during the COVID pandemic and 45.5% perceived it as having reduced their home confinement stress. The mean psychological distress score of 3.00 (SD ± 0.71) indicates a moderate impact of COVID-19 on psychological well-being. Students' psychological distress was positively correlated with fatigue level (0.256, p < 0.001) and negatively correlated with the perceived impact of the new assessment approach on student lifestyle (- 0.133, p < 0.001), physical health (- 0.149, p < 0.001) and coping with stress (- 0.125, p < 0.001). Male students experienced significantly lower fatigue and better psychological well-being than female students. CONCLUSION: The study reveals that new assessment approaches which emerged during home confinement reduced students' perception of stress and of impaired lifestyle. However, students still had a considerable burden of psychological distress, requiring further preventive measures to maintain their psychological well-being during future outbreak events. Educational institutions should consider additional strategies to improve students' preparedness for online teaching, which could help maintain their psychological well-being.

Nurses' perceived knowledge and benefits of artificial nutrition and hydration for patients nearing death: A survey among Jordanian nurses.

OBJECTIVE: Existing research highlights the importance of nurses' knowledge and attitudes towards the provision of artificial nutrition and hydration (ANH) for patients with advanced cancer; however, the perspectives of Arabic and Islamic nurses have not yet been investigated. Therefore, we aimed to examine Jordanian nurses' knowledge, attitudes and perceived benefits in providing ANH for patients with advanced cancer. METHOD: A descriptive cross-sectional design was employed. RESULTS: Participants comprised 183 nurses (93.5% response rate). Around 80% received no training on ANH. Nurses had poor knowledge regarding ANH, with a mean score of 5.12 (SD=2.27) out of 15. Overall, nurses had positive attitudes towards ANH care (M = 3.09, SD = 0.29); however, the subscale analysis showed that nurses held inconspicuous beliefs about ANH benefits (M = 2.67, SD = 0.71) and strongly believed that ANH places a high burden on patients (M = 3.50, SD = 0.69). Nurses from government hospitals showed significantly higher ANH knowledge, as well as positive beliefs regarding ANH benefits, compared to less educated nurses. CONCLUSION: Jordanian nurses have limited knowledge of ANH. Their positive attitude regarding ANH for terminally ill patients could be driven by cultural norms and beliefs, rather than education. Introducing ANH in nursing curricula and in-hospital services could have a positive impact on nurses' knowledge.

Assessment of the Awareness, Perception, Attitudes, and Preparedness of Health-care Professionals Potentially Exposed to COVID-19 in the United Arab Emirates.

BACKGROUND: Since COVID-19 surfaced in December 2019, health-care organizations across the globe have struggled to maintain the safety and well-being of health-care professionals (HCPs). PURPOSE: This study investigates the HCPs' general understanding of the health risks of COVID-19 and to what extent they are equipped with the knowledge to protect themselves and others against this contagion. METHODS: This cross-sectional study used a web-based structured questionnaire posted on the UAE government electronic survey portal. A collection of 941 HCPs from diverse general and specialty hospitals in the UAE responded to an electronic participation invite. RESULTS: Our analysis showed that the majority of HCPs (97.6%) had updated information about COVID-19 modes of transmission, risks of contamination, high-risk groups, and the potential consequences of testing positive. Furthermore, the results of the chi-squared testing revealed that the HCPs' confidence and vigilance of the COVID-19 threats were significantly increased (p< 0.01) by being experienced, having had infection control training, or/and having undergone COVID-19 education. CONCLUSION: We conclude that HCPs have an evidence-based understanding of the ways their own health is at risk while they are performing their duties in hospital setups. Further, the study found that HCPs who undergo special infection control training and who are kept posted on the official updates on COVID-19 are more likely to remain vigilant at all times to minimize the risks to themselves and their patients. Although the generalizability of the study findings should be considered with caution, the results could be generalizable to health-care professionals who received similar COVID-19 related training in the UAE or other regional countries.

Sexual educational needs of Jordanian women after giving birth.

BACKGROUND: Pregnancy and birth entail many bodily changes, including changes in sexual activity. The postpartum period is a time of considerable recovery and adaptation for women, yet women do not always receive adequate information, especially in countries where such topics may be considered taboo. The purpose of this project was to explore the sexual educational needs of Jordanian women after giving birth. METHODS: A qualitative, phenomenological approach was used. A purposive sample of 25 women were recruited from two health care centers. Semi-structured, in-depth interviews were conducted in person in Arabic between August and November 2015. Transcripts were independently analyzed and coded by each researcher. RESULTS: Two major themes with six subthemes emerged. Theme 1, sexual education, included discussions about the women's needs for scientific information and the husband's involvement, and their psychological needs. Theme 2, professional approaches, involved discussions about the most appropriate person to deliver education, preferred place and time for education, and effective educational approaches to be used. DISCUSSION: Congruent with previous studies, findings indicated that issues related to sexuality are often ignored in this population. CONCLUSIONS: Jordanian women have many unmet educational needs with respect to sexuality after giving birth. More efforts are needed from health care professionals and other stakeholders to help improve Jordanian women's sexual health education after giving birth. These should include greater access to classes, websites with scientific information, and informational handouts that target husbands, and postpartum women themselves.

A phenomenological study of Jordanian women's experience of sexual intercourse after giving birth.

AIM: to explore the sexual experiences of Jordanian women on the first occasion after giving birth. METHODS: phenomenological qualitative research. Twenty-five Jordanian women were purposively recruited from two maternal health centres and interviewed. FINDINGS: four themes emerged: "culture and religion v/s health professionals in resumption of sexual intercourse"; "enduring physical and psychological discomforts"; "husbands' role in resumption of sexual intercourse"; and "newborn babies' role in the experience of sexual intercourse". CONCLUSION: health professionals need to adopt appropriate maternal clinical guidelines to meet women's needs. There is a need to give greater emphasis on sexual health care provided to women during pregnancy and after giving birth.

"Resumption of Sexuality and Health Education in Postpartum Period: From Jordanian Health Care Professionals' Perspectives".

Objective: to explore Jordanian health care professionals' perspectives about sexual education after giving birth. Methods: a descriptive qualitative approach was used to address the study aim. A purposive sampling method was used to recruit seven midwives, 13 nurses and two obstetricians from three Primary Health Centres. The inclusion criteria were: midwives, nurses or obstetricians with at least two years' experience and currently working at a maternity health centre. Focus group discussions were used to collect data. A manual Thematic Content Analysis Tool was used to analyse the data. Results: five major themes emerged. Silence; resumption of sexuality after giving birth/area of conflict; men's authority in resumption of sexuality; the importance of sexual education (what, when and whom) and suggestions for sexual education approaches. Conclusions: Healthcare professionals were hesitant to open sexuality topic with the women during antenatal and postnatal visits due to cultural limitations and lack of knowledge. Therefore, in a time of global migration, the healthcare professionals have the need to understand cultural differences in attitude towards health care issues involving sexuality.

"Being relieved and puzzled": A qualitative study of first time fathers' experiences postpartum in Jordan.

BACKGROUND: Although the transition to fatherhood is a point of attention for researchers, little is known about the first time father's postpartum experience. This study aims to explore the first time fathers postpartum experience in the country of Jordan. METHODS: An exploratory qualitative design was used. Semi-structured interviews were conducted with a purposive sample consisting of twelve first time fathers. The study was conducted in a public university in Jordan. The data was collected in 2017 and was thematically analysed using the colour and file index method. RESULTS: The analysis revealed two main themes. The first theme centred around a feeling of relief which can be further divided into two sub-themes of self-actualisation and continuation of the family line. The second theme centred around the feeling of puzzlement, and this can also be further divided into two sub-themes of feeling unable to deal with a newborn baby and struggling to care for a recovering wife. The study identified fathers as willing to engage in the private care of their new babies and recovering wives but at a limited level of engagement. The fathers verbalised the lack of knowledge and exhibited sociocultural stereotypes related to masculinity and the role of the man in the family. CONCLUSIONS: The first time fathers' experiences ranged from feelings of relief to puzzlement. The fathers experiences were shaped by religion, culture, and masculinity which suggests education during antepartum may enhance the experience.

Are users of modern and traditional contraceptive methods in Jordan different?

BACKGROUND: The level of current use of modern family planning is the most widely used indicator for evaluating the success of national family planning programmes. Recently the prevalence of traditional methods has increased in Jordan, which may lead to undesired pregnancy. AIMS: The main objective of the study was to assess the trends of modern and traditional contraceptive use in Jordan with a focus on examining the differences between the users of each method. METHODS: A secondary data analysis of the Jordan 2012 Population and Family Health Survey data was carried out. The survey used a multistage cluster random sample. Bivariate analysis was conducted to identify the difference between modern and traditional contraceptive users. A logistic regression model was used to study significant covariates. RESULTS: Among 10 801 currently married women aged 15-49 years surveyed, 38.8% were not using any contraceptive method, 18.9% used traditional methods, and 42.3% relied on modern contraceptive methods. Logistic regression analysis revealed 4 significant predictors of using modern contraceptive methods: location in Central Region, residence in urban areas, age and parity. CONCLUSION: Women, particularly those resident in the southern region, should be encouraged to use modern contraceptive methods and this may be achieved by empowering them with more information about sources of these methods that are available to them. Family planning interventions should focus on younger and high parity women as they were more likely to use traditional methods.

Implementation of a childbirth preparation program in the maternal and child health centres in Jordan.

OBJECTIVE: To investigate the feasibility and outcomes of introducing childbirth preparation programs in a sample of Maternal and Child Health centres in Jordan. DESIGN: An exploratory, descriptive design, and practice- research engagement was used to implement and evaluate the proposed childbirth preparation program. Face to face interviews and field notes were used to collect data. Outcomes of pregnancy and birth were collected from interviews with women using a structured format. SETTING AND PARTICIPANTS: Three Maternal and Child Health centres were randomly selected from the three main regions of Jordan. A convenience sample of 107 primigravid women was recruited for the implementation process. Six health staff (3 doctors and 3 midwives) also participated. FINDINGS: The practice- research engagement approach assisted the researchers and care providers in dealing with problems that arose during the implementation of the program. Out of the 107 women initially recruited, only 36 women completed the implementation program, with attrition rate of 65%. The main reasons for poor attendance included: difficulty in keeping contact with participants, transportation difficulties, duration of the program, health problems, antenatal follow up at a private clinic, and not having permission from husbands to attend. The effectiveness of the program was noticed through some improved pregnancy outcomes for the participants and the high satisfaction of the health professionals and women who participated. The program was effective in increasing knowledge and understanding of women regarding the different aspects of pregnancy, birth, and postnatal periods. It helped promote a trusting relationship between health professionals and women; and increased staff self confidence in providing specific and essential information to women. Women seemed to have an increased sense of control over the childbirth process, and it reinforced benefits and duration of breastfeeding and knowledge of family planning. Challenges identified by health professionals and women included: women's commitment and capacity to attend the scheduled sessions and shortage of qualified staff. KEY CONCLUSIONS: Implementing a childbirth preparation program in a developing country appears possible, successful, and effective if logistical and cultural requirements can be better addressed. This was evidenced with a high rate of participants' satisfaction (women and health care providers), and suggestions of improved pregnancy outcomes. IMPLICATIONS FOR PRACTICE: It is necessary to address some logistical issues of delivery and recognise the importance and limitations of current human resources. Policy makers in the Ministry of Health should consider implementation of a childbirth preparation program, as there are no existing programs. Clinical leaders, supported by researchers, should jointly consider reframing the program into a shorter more logistically acceptable delivery mode. This could be tested and evaluated.

Understanding maternal postpartum needs: A descriptive survey of current maternal health services.

AIM AND OBJECTIVE: To assess mothers' learning needs and concerns after giving birth and to examine whether these needs were met at 6-8 weeks postpartum. BACKGROUND: Women experience many physiologic and psychological changes during postpartum period, which is considered a vital transitional time. Exploring and meeting women's needs help woman to pass this period with little complications and enhance healthcare provider's ability to provide appropriate care following childbirth. DESIGN: A prospective cohort design was employed in this study. METHODS: A prospective cohort design was employed. A convenience sample of 150 postpartum women have completed perceived leaning needs scale prior to hospital discharge, at southern region of Jordan, and have completed perceived met learning needs scale at 6-8 weeks after giving birth. RESULTS: Women reported a high level of concern across all eight learning needs subscales. The most common concerns were related to new baby care, episiotomy care and breastfeeding. At 6-8 weeks postpartum, the primary unmet learning needs postpartum were danger signs post-Caesarean section, physical changes, breastfeeding and new baby care. Attending postpartum check-up clinic was found as a significant predictor for postpartum meeting women's needs, particularly emotional changes and family planning-related information. CONCLUSIONS: The current maternal health services are not at the optimum level to meet women's individual needs and concerns, which could increase the risk for postpartum complications. Some women's characteristics, such as employment status and educational level, have increased women's concerns and unmet needs in some of the learning needs. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers and policymakers should consider women's concerns and needs at early postpartum period to establish patient-centred postpartum care that is based on women's needs and concerns during this transitional period, with a focus on newborn baby care, episiotomy care and breastfeeding.

Pregnant women: What do they need to know during pregnancy? A descriptive study.

BACKGROUND: Antenatal education programs provide women with essential knowledge and skills in various aspects of maternal and fetal health. Antenatal education is based on improving women's health, reducing the risks of complications and enhancing couples' positive experience during childbirth. There is a lack of formal antenatal educational programs based on women's needs in Jordan. AIM: This study sought to identify and prioritize the learning needs for women during pregnancy. METHODS: A descriptive cross-sectional design was employed. The study sample was recruited from three maternal and child health centers. Data were collected from a convenient sample of 150 pregnant women during their antenatal visits. One hundred and twenty three participants (response rate=82%) completed the self-reported antenatal learning needs questionnaire. FINDINGS: Women identified their most important learning needs were related to managing major complications of pregnancy (mean=3.49, SD=0.78), investigations and physician follow-up visit during pregnancy (mean=3.42, SD=0.71), appropriate diet (mean=3.36, SD=0.84) and information about medication and supplements (mean=3.22, SD=0.97). Spearman correlation showed negative association between participants' age and physical (r=-0.536, p=0.015) and emotional concerns (r=-0.490, p=0.001). Women who had a diploma or higher degree reported greater concern regarding physical (median=4.00, IQR=3.00-4.00, p=0.047) and emotional changes (median=3.33, IQR=3.00-4.00, p=0.004). Finally, migrant participants showed greater significant concern regarding emotional changes and coping with minor complications. CONCLUSION: A large proportion of pregnant women in this study reported a high degree of importance of specific learning topics that were closely relevant to their current period of pregnancy. The lack of focusing on issues related to maternal emotional status and possible complications suggests a need for a national strategy to provide antenatal education based on women's perceptions of their needs.

Perceived learning needs according to patients who have undergone major coronary interventions and their nurses.

AIMS AND OBJECTIVES: The aim of this study was to identify the differences in perceived learning needs between cardiac patients who have undergone major coronary interventions and their nurses. BACKGROUND: The decrease in length of stay after cardiac interventions has signalled an urgent need to provide effective in-hospital health education. Therefore, the content of health education should bridge the gap between nurses' and patients' views of what information is important for ensuring patients' optimum recovery. DESIGN: A descriptive comparative design was employed. METHODS: Patients were invited to participate if they had undergone angioplasty or bypass surgery and were ready for discharge within 24-48 hours. A convenience sample of 365 cardiac patients and 166 cardiac nurses participated in this study. Baseline data on patients' and nurses' sociodemographics, clinical history and experience were collected through personal interviews. Then, participants completed the Patient Learning Needs Scale to identify their perceptions of the learning needs after cardiac interventions. RESULTS: The top-priority learning needs according to both patients and cardiac nurses was information on wound care and medication. In contrast, the lowest-priority learning need was physical activity. Nurses perceived information about physical activity as most needed to patients, whereas patients perceived information about medications, postintervention complications and postintervention concerns as mostly needed. CONCLUSION: The disparity between perceptions of patient and nurses on the essential content to be learned highlights the importance of considering both of these parties when establishing health education programmes. In addition, nurses should focus more on information related to the recovery period and immediate needs after discharge. RELEVANCE TO CLINICAL PRACTICE: Information about wound care, medication and potential complications should be the core of predischarge education programmes. In addition, nurses should focus on improve patients' awareness of secondary prevention and lifestyle modification, as patients pay less attention to these vital topics.

Illness perception and adherence to healthy behaviour in Jordanian coronary heart disease patients.

BACKGROUND: Patients diagnosed with coronary heart disease are strongly recommended to adopt healthier behaviours and adhere to prescribed medication. Previous research on patients with a wide range of health conditions has explored the role of patients' illness perceptions in explaining coping and health outcomes. However, among coronary heart disease patients, this has not been well examined. OBJECTIVE: The purpose of this study was to explore coronary heart disease patients' illness perception beliefs and investigate whether these beliefs could predict adherence to healthy behaviours. METHODS: A multi-centre cross-sectional study was conducted at four tertiary hospitals in Jordan. A convenience sample of 254 patients (73% response rate), who visited the cardiac clinic for routine review, participated in the study. Participants completed a self-reported questionnaire, which included the Brief Illness Perception Questionnaire, the Godin Leisure Time Activity questionnaire and the Morisky Medication Adherence Scale. RESULTS: Patients reported high levels of disease understanding (coherence) and they were convinced that they were able to control their condition by themselves and/or with appropriate treatment. Male patients perceived lower consequences (p<0.05) and had a better understanding of their illness than female patients (p<0.001). There were significant associations between increasing age and each of timeline (r=0.326, p<0.001), (r=0.146, p<0.024) and coherence (r=-0.166, p<0.010). Adjusted regression analysis showed that exercise adherence was predicted by both a strong perception in personal control (ß 2.66, 95% confidence interval 1.28-4.04), timeline (ß -1.85, 95% confidence interval 0. 8-2.88) and illness coherence (ß 2.12, 95% confidence interval 0.35-3.90). Medication adherence was predicted by perception of personal control and treatment control. Adherence to a low-fat diet regimen was predicted by perception of illness coherence only (odds ratio 12, 95% confidence interval 1.04-1.33). Finally, the majority of patients thought that the cause of their heart problem was related to coronary heart disease risk factors such as obesity and high-fat meals. CONCLUSION: Patients' illness beliefs are candidates for a psycho-educational intervention that should be targeted at improved disease management practices and better adherence to recommended healthy behaviours.