Comparative effect of physical health training and psychological training of the theory of reasoned action (TRA) model on the life quality of patients with diabetes in Tehran, Iran: utilization of message texting.

BACKGROUND AND PURPOSE: Providing physical health and mental health training promotion is necessary for a sustainable change in attitude and lifestyle of diabetic patients. The present study was conducted with the aim of comparing the effect of physical health training and psychological training of the theory of reasoned action (TRA) model on the life quality of patients with type 2 diabetes. METHODS: This experimental study was conducted in 2022 with two intervention groups and one control group consisting of 129 patients with type 2 diabetes who were referred to Imam Khomeini Hospital in Tehran. Over the course of one month, each individual in intervention group 1 received 15 text messages focusing on physical health, while intervention group 2 received 15 psychological text messages related to the TRA. The control group did not receive any text messages during this period. The data collection tool used was the "Audit of Diabetes-Dependent Quality of Life (ADDQoL)" questionnaire, which was completed by the participants before and after the intervention. The data were analyzed using SPSS version 16 software at a statistical significance level of 0.05. RESULTS: In the intervention-1 group, the average life quality score was 8.51 units (P < 0.001), while in the intervention-2 group, it was 19.25 units (P < 0.001) higher than the control group. The psychological training group had a 17.62 units (P < 0.05) lower average fasting blood sugar (FBS) and a 10.74 units (P < 0.001) higher average quality of life compared to the physical training group. CONCLUSION: The results of this study showed that the effectiveness of psychological training of the TRA model in improving life quality and reducing FBS in patients with diabetes is greater than physical health training. It is suggested that policy makers and health managers base future plans on physical health promotion training along with TRA model mental health training for the development of education in patients with diabetes. Specialists and healthcare workers can also act to improve personal health characteristics, especially those related to reducing FBS and increasing the quality of life of patients with diabetes, by using training through mobile phone text messages, particularly with psychological content TRA based.

Stigma and Quality of Life in Women With Breast Cancer: Mediation and Moderation Model of Social Support, Sense of Coherence, and Coping Strategies.

OBJECTIVES: The breast cancer stigma affects Health-related quality of life (HRQoL), while general resilience resources (GRRs), namely, sense of coherence (SOC), social support, and coping skills, are thought to alleviate this effect. The study aimed to explore the mediating/moderation role of GRRs in the relationship between stigma and HRQoL and its dimensions in Iranian patients with breast cancer. METHODS: In this cross-sectional study, Stigma Scale for Chronic Illness 8-item version (SSCI-8), SOC-13, Medical Outcome Survey- Social Support Scale (MOS-SSS), Brief COPE, and Functional Assessment of Cancer Therapy-Breast (FACT-B) were investigated in a convenience sample of Iranian women with confirmed non-metastatic breast cancer. Following the establishment of correlations using Pearson's correlation, single and parallel mediation analysis and moderation analysis were conducted to determine the extent to which each GRR might be impacted by stigma or decrease the adverse impact of stigma on HRQoL. RESULTS: An analysis of 221 women (response rate of 87.5%) with the mean age of 47.14 (9.13) showed that stigma was negatively correlated to all HRQoL's dimensions (r = -0.27∼0.51, p < 0.05), SOC (r = -0.26∼0.35, p < 0.01), social support (r = -0.23∼0.30, p < 0.01), and the bulk of coping skills. In the single mediation analysis, stigma affected all facets of SOC, all subscales of social support, and positive reframing, which partially reduced breast cancer HRQoL. Stigma affects general HRQoL through damaging meaningfulness, social support (except for tangible), and positive reframing. Meaningfulness was marked as the most impacted GRR in terms of all domains of HRQoL. In parallel mediation, reduced meaningfulness, total social support, and positive reframing were highlighted as the pathways of diminished breast cancer HRQoL. Moderation analysis indicated the higher levels of humor, behavioral disengagement, and use of instrumental support behaviors to be functional in protecting different dimensions of HRQoL, while the results were mixed for venting, especially in patients with mastectomy surgery. CONCLUSION: While GRRs may be impacted by stigma, they exert a relatively small protective effect against the impact of stigma on HRQoL. This study provides some novel findings, but longitudinal studies are needed to further verify these before any causal conclusion or recommendations for health policy can be drawn.

Body image, internalized stigma and enacted stigma predict psychological distress in women with breast cancer: A serial mediation model.

AIMS: To investigate the roles of total stigma, enacted stigma, and internalized stigma in the prediction of psychological distress among breast cancer patients, and to evaluate the mediating effect of body image in this process. DESIGN: Cross-sectional. METHODS: Between Oct-2014 to May-2015, a cross-sectional study was conducted with participation of 223 patients from three cancer centres located in Tehran, Iran. The study variables were assessed using the stigma scale for chronic illnesses 8-item version (SSCI-8), body image scale (BIS), and depression anxiety stress scale (DASS-21). Structural equation modelling using MLR estimator was employed based on the two-step procedure to validate both the full measurement models and the structural models. Five models were tested to determine predictability of all stigma constructs for psychological distress, including stress, anxiety, and depression, through the mediation of body image. Three equivalent models were further examined to re-evaluate the direction of the relationships. RESULTS: Psychological distress and body image were largely predicted by total stigma, enacted stigma, and internalized stigma. The effect of stigma on psychological distress was mediated through body image. In a serial mediation model, the significance of the pathway of enacted stigma > internalized stigma > body image > psychological distress was confirmed. The serial model in which internalized stigma precedes body image was also supported by the equivalent models. CONCLUSION: Stigma has been identified as a major source of psychological distress among women with breast cancer. Enacted stigma not only psychologically disturbs the patients but also triggers a chain of other identity transformations (i.e. internalization of stigma and distortion of body image), their ultimate result being a full-blown psychological distress. IMPACT: Both enacted and internalized stigma distorts breast cancer patients' perception of their body image, which in turn renders them psychologically distressed. The serial process of enacted stigma, internalized stigma, and body image plays an important role in perpetuating distress in these patients. To break this chain of psychological consequences and for interventions to have a greater impact on overall well-being of patients, the effect of enacted stigma on distress via the sequence of two mediators needs to be specifically targeted at each stage.

Which Domains of Social Support Better Predict Quality of Life of Women with Breast Cancer? A Cross-Sectional Study.

OBJECTIVES: The study aimed at investigating the specific role of social support types (SSTs) on quality of life (QoL) and its domains of women with breast cancer in Iran. METHODS: In this cross-sectional study, a number of 223 women with breast cancer visiting three cancer centers of Tehran, Iran, participated from October 2014 to May 2015. Medical Outcome Study-Social Support Scale and Functional Assessment of Cancer Therapy-Breast Cancer were used for data gathering. Backward multiple regression was utilized, adjusted by age, education, and family size. RESULTS: The study indicated positive correlations between all SSTs and QoL domains, whereas only positive social interaction (PSI) showed a significant association with physical well-being. PSI showed the only predictive performance in terms of all QoL outcomes, beyond the covariates. CONCLUSIONS: The study revealed the PSI as the most influential support type to enhance all domains of QoL of women with breast cancer.

Perceived social support, coping strategies, anxiety and depression among women with breast cancer: Evaluation of a mediation model.

PURPOSE: Depression and anxiety are now considered as common adverse reactions to cancer. Prior research has shown that social support and functional coping strategies alleviate depressive and anxious symptoms of cancer patients but the exact relationship between social support and coping strategies in amelioration of the symptoms is yet to be elaborated. METHODS: The current study examined the relationship between social support, coping strategies and depressive-anxious symptomatology and explored the possible role of coping strategies in mediating the relationship between social support, depression and anxiety in Iranian breast cancer patients (N = 221). Anxiety and depressive symptoms were measured using the Depression-Anxiety-Stress (DASS-21) scale, social support was measured using the Medical Outcome Survey, Social Support Scale (MOSS-SSS), and coping strategies were measured using the brief COPE. RESULTS: All of the social support subscales were negatively correlated with depression and anxiety. Most of the coping strategies were negatively correlated with depressive-anxious symptoms. When controlling for covariates, mediation analysis revealed that active coping, positive reframing and acceptance partially mediated the association of social support of different types with depression. Positive reframing also partially mediated the relationship of the total social support and positive social interactions with anxiety. CONCLUSIONS: High levels of social support may relieve depressive and anxious symptoms of breast cancer patients through functional coping. The management of breast cancer patients should also focus on providing patients with social support and educating them on the practice of functional coping strategies.

Sense of coherence and coping strategies: How they influence quality of life in Iranian women with breast cancer.

AIM: To investigate the mediation/moderation effect between Coping Behaviors (CBs) and Sense of Coherence (SOC) in the prediction of health-related quality of life (HRQoL) in breast cancer patients. DESIGN: Cross-sectional. METHODS: A total of 221 patients were included in this study. The 13-item Orientation to Life Questionnaire, Brief COPE and Functional Assessment of Cancer Therapy-Breast were investigated. Pearson's correlation coefficient and mediation/moderation analysis were performed. RESULTS: Significant correlations were observed for SOC, active coping, acceptance, positive reframing (PR), planning, use of emotional support (UES), use of instrumental support, behaviour disengagement and self-blame with HRQoL. Except for planning and acceptance, SOC partially mediated the CBs' effect on HRQoL. The UES and PR's effects on HRQoL were significant at lower SOC levels and diminished at higher SOC levels. CONCLUSION: Practitioners can incorporate SOC and adaptive CBs, including PR and UES, into the rehabilitation programmes to improve HRQoL in patients.

Translation and Factor Analysis of the Stigma Scale for Chronic Illnesses 8-Item Version Among Iranian Women With Breast Cancer.

BACKGROUND: Cancer stigma is rarely addressed among Iranian population and patients. The current study aimed at translating and examining the construct validity of the stigma scale for chronic illnesses 8-item (SSCI-8) among Iranian women with breast cancer. METHODS: In the current study, a total of 223 patients aged 19-75 years were recruited from three cancer centers in Tehran, Iran, from 2014 to 2015. Forward-backward translation method was used. The item-total correlation was evaluated. Exploratory factor analysis employing maximum likelihood method and direct Oblimin rotation was conducted. Reliability was assessed using composite reliability (CR). Average variance explained (AVE) was used for convergent/divergent validity. RESULTS: The items mean was 1.47 (0.19), the scale mean 11.75 (5.57); the inter-item correlations were positive and significant (P <0.0001). A two-factor solution with seven eligible items (five for enacted and two for internalized stigma) showed the model fitness. The CR for the total scale, as well as enacted and internalized facets was 0.78, 0.89, and 0.79, respectively; the AVE was 0.66 for each latent variable. CONCLUSION: The Persian version of SSCI-7 was found as a reliable and valid abbreviated instrument to assess experiences of enacted and internalized stigma among Iranian women with breast cancer.
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Religious Coping and Quality of Life in Women with Breast Cancer.

BACKGROUND: The aim of this study was to assess the predictive role of religious coping in quality of life of breast cancer patients. MATERIALS AND METHODS: This multi-center cross-sectional study was conducted in Tehran, Iran, from October 2014 to May 2015. A total of 224 women with breast cancer completed measures of socio-demographic information, religious coping (brief RCOPE), and quality of life (FACT-B). Data were analyzed using descriptive statistics and the t-test, ANOVA, and linear regression analysis. RESULTS: The mean age was 47.1 (SD=9.07) years and the majority were married (81.3%). The mean score for positive religious coping was 22.98 (SD=4.09) while it was 10.13 (SD=3.90) for negative religious coping. Multiple linear regression showed positive and negative religious coping as predictor variables explained a significant amount of variance in overall QOL score (R(2)=.22, P=.001) after controlling for socio-demographic, and clinical variables. Positive religious coping was associated with improved QOL (ß=0.29; p=0.001). In contrast, negative religious coping was significantly associated with worse QOL (ß=-0.26; p=0.005). CONCLUSIONS: The results indicated the used types of religious coping strategies are related to better or poorer QOL and highlight the importance of religious support in breast cancer care.