Home-based supportive and health care services based on functional ability in older adults in Iran.

BACKGROUND: Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults. MATERIALS AND METHODS: In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson's and Spearman's tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022. RESULTS: A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men (P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency (P < 0.05). CONCLUSION: Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended.

COVID-19 stress and coping strategies among older adults: a systematic review of qualitative evidences.

BACKGROUND: The COVID-19 pandemic has brought about far more stressful conditions for people worldwide. As a vulnerable group, older adults have suffered various psychological problems, such as stress, because of this pandemic and have applied various strategies to cope with the dire consequences. This study aimed to synthesize qualitative evidence regarding coping strategies for stressful situations among older adults throughout the COVID-19 pandemic. METHODS: We searched electronic databases, including Scopus, Embase, PubMed, ProQuest, and the Cochrane Library, based on PRISMA standards. The protocol of this systematic review was registered on the PROSPERO (registration code: CRD42022364831). All relevant English-language articles published between 2019 and November 10, 2022, were searched. We reviewed the reference lists for all the included studies and key references. Two reviewers conducted screening, data extraction, and quality appraisal independently, with disagreements resolved by consensus with all team members. The Joanna Briggs Institute (JBI) checklist was used to assess the quality of studies. A thematic synthesis of the selected studies was conducted. RESULTS: We included 13 studies in our review. Most studies were conducted in the early months of the COVID-19 pandemic. The stress caused by the COVID-19 pandemic was classified into six categories: health management challenges, stress caused by quarantine, economic challenges, media and bad news stress, virus threats, and challenges related to the use of communication technologies. The strategies used by older adults to cope with these challenges were categorized into five categories: protective strategies, avoidance strategies, maintaining social connections, meaning-based strategies, and fun strategies. This research showed that depending on the situation and conditions, older adults use various strategies to cope with COVID-19. CONCLUSION: Older adults experience much stress during the COVID-19 pandemic. In most cases, older adults can cope with these challenges with simple strategies from previous experiences and learnings. Older people require educational interventions in some cases, such as those involving communication skills. A better understanding of older adults coping strategies may enable policymakers to develop more effective policies and manage the problems of older adults in post-COVID situations.

Developing a comprehensive model of home-based formal care for elderly adults in Iran: A study protocol.

BACKGROUND: Due to the increasing Iran's aging population, designing a home care model is necessary. However, the data on designing the home care model for elderly adults among developing countries are limited. This study will be carried out to develop a formal home-based care model for elderly adults in Iran. METHODS: This multi-method study will include three phases: First, Mixed-methods sequential explanatory study including two steps: One, survey to determine the prevalence of dependence on formal and informal caregivers among people aged ≥ 60 years living in Tabriz metropolis; and two, content analysis approach includes face-to-face, semi-structured interviews with the older adults receiving formal care at home, their caregivers and relevant key informants on the characteristics of care and caregiver, challenges and expectations of standard care. In phase 2, a scoping review will be used to find out the components of home care in other countries, such as care provider organization, caregivers training, and financing. PubMed, Scopus, Web of Science, EMBASE, Google scholar databases and grey literature will be run to retrieve relevant evidence using proper MeSH terms. In phase3, the triangulation method (using the results of the previous phases, reviewing national upstream documents and the focus group discussion) will be done to reach consensus and design the initial model for the Iranian context. In the following, a Delphi study will be conducted on the validation and feasibility of the developed model. DISCUSSION: The current health infrastructure in Iran is focused on caring for younger people, despite the near future population aging. Most studies have addressed the challenges of geriatric care, but no study has addressed the various dimensions of home care in Iran and how to provide this service to elderly adults. Providing a comprehensive model of home care for the elderly can improve the quality of life and satisfaction of the elderly and their caregivers.

The Prevalence of Andropause and Its Relationship With Sexual Quality of Life Among Older Iranian Men.

Available evidence indicates insufficient knowledge about the status of andropause and sexual quality of life among Iranian older men. The study aimed to investigate the prevalence of andropause and its relationship with sexual quality among older adults. This descriptive-analytical study was conducted among 576 older people referred to urban health centers in Mashhad, Iran. The eligible samples were selected through the cluster sampling method. To collect data, the male andropause symptoms' self-assessment questionnaire and the sexual quality of life-male were used. Forty-seven of the respondents (n = 271) were diagnosed with a "moderate" level of andropause. A strong negative correlation was identified between the sexual quality of life and the severity of andropause (r = -.366, p < .001). Sexual quality of life and andropause was also affected by age, marital status, health status, and exercise. Thirty-six percent of the changes in the quality of sexual life of older men were influenced by the independent variables (adjusted R2 = .36; R2 = .40; R = .63). The findings indicated that andropause has highly prevailed among the participants. There was a meaningful association between andropause and sexual quality of life among older men. Further studies are recommended to investigate sexual orientation qualitatively and to discover other factors influencing andropause among adult men.

Profile of Tabriz Older People Health Survey (TOPS-2019): a representative community-based cross-sectional study.

Population aging and its consequences are a substantial global concern. The growth in the number of older people is one of the most important factors increasing the burden of non-communicable diseases (NCDs) on society. The Tabriz Older People Health Survey aimed to understand the socio-demographics, health-related behaviors, and health profile of older adults. This cross-sectional study was conducted on a representative sample of 1362 community-dwelling older adults in Tabriz, the most populated city in northwest Iran. The study used probability proportionate to size sampling and the data collection was undertaken in each participants' place of residence from July 2019 to January 2020. Trained interviewers administered the questionnaire, which measured each participant's socio-demographics, health-related behaviors, and health profile. The sample of 1362 participants consisted of 56.4% women and 54.4% were young older people (60-69 years old). Almost half of the sample were completely illiterate. There was no daily walking in 13.3% of the sample, with women reporting a more sedentary lifestyle than men. Almost 10% of the participants (n = 135, 9.9%) were current smokers, which was higher among men (20.9% vs. 1.5%) and women made up over 88% of those living alone. In terms of sleep quality score (men: 4.63 ± 2.70, women: 5.97 ± 2.93), anxiety (men: 5.79 ± 4.70, women: 7.59 ± 5.51), depression (men: 9.54 ± 3.20, women: 10.63 ± 3.09), and social support (men: 23.65 ± 4.50, women: 22.69 ± 4.77), men were significantly better than women. There were also significant sex differences between women and men in the prevalence of diabetes (31.6% vs. 19.5%) and hypertension (86.5% vs. 73.4%). Furthermore, overall hypertension was the most common underlying disease (81.0%). Older women were significantly worse off than older men, in terms of social and disability-related, as well as having a higher burden from several NCDs. The results of this study might help regional health policymakers to identify targets for improving the health status among community-housed geriatrics.

Why do older people not use the public health services of the integrated aging program? A multidimensional approach in a qualitative study.

OBJECTIVES: The world's population is aging rapidly and a huge amount of services are being provided to meet the needs of the older people. Identifying the factors affecting the non-attendance of the older people to health care centres is of particular importance. We focused on the reasons why older people do not use the services of the integrated aging program in Iran from the perspective of the older people, general practitioners, and primary health providers. METHODS: A qualitative study in Ghaemshahr (IRAN) carried out during 2021. Data were collected through semi-structured interviews in two groups with the participation of 29 older adults and 18 employees of the health centres Purposeful sampling and sample size were determined based on data saturation. Data were analyzed manually using conventional content analysis. RESULTS: Potential barriers to and challenges of older adults were generally categorized into four main themes including individual, systemic-structural, environmental, and social factors. CONCLUSIONS: Both groups agreed on many aspects, including lack of education of the patients and lack of proper medical services. Existing problems in health care relate to both medical and non-medical factors. Improvement in health care delivery requires a deliberate focus on the patients' specific needs.

The contribution of social isolation and loneliness to sleep disturbances among older adults: a systematic review.

A large number of older people encounter both objective and subjective types of social isolation and sleep disorders. Social isolation increases a person's risk of a wide range of adverse health outcomes and premature death. Social isolation can cause poor sleep quality that has been proposed as one of the possible mechanisms by which social isolation affects people's health and quality of life. The present study was conducted to determine the relationship between objective and subjective social isolation with sleep difficulties among older adults. All articles in PubMed, Web of Science, Scopus, Embase, PsycInfo, and Social care online databases published by December 2020 were systematically searched for relevant published articles. Two authors separately checked the acceptability and quality of the studies using the Newcastle Ottawa checklist. Any disagreement was resolved by consulting the third author. According to the inclusion criteria, 11 studies were systematically reviewed, of which five were cross-sectional, and six were longitudinal studies. No meta-analysis was performed due to the high heterogeneity of the studies. Based on the present study results, both objective and subjective social isolation are related to sleep disturbance in older people. This systematic review showed that objective and subjective social isolation are associated with low sleep quality. It is recommended to investigate the causal relationships and possible pathways that affect the studied variables in future studies.

Factors Affecting Aggressiveness among Young Teenage Girls: A Structural Equation Modeling Approach.

Adolescence is a period of transition for developmental and social domains that may also be accompanied by behavioral problems. Aggressive behavior may be a mental health concern for young teens and is defined as a behavioral and emotional trait that may be distressing for others. This study aimed to understand the factors associated with aggressiveness among young teenage girls. A cross-sectional study was conducted among a sample of 707 female middle school-aged students using multistage random sampling in Tabriz, Iran. The variables of interest were aggressiveness, general health status, happiness, social acceptance, and feelings of loneliness. Structural equation modeling was employed to analyze the data. Low parental support, low satisfaction with body image, high sense of loneliness, and lower perceived social acceptance were found to be the factors influencing aggressiveness. The current study found that the school environment, home environment, individual and interpersonal factors all play a part in aggressiveness. As a result, the contributing elements must be considered when creating and executing successful interventions to improve this population's psychological well-being.

The Effectiveness of Health Belief Model Initiative in Breast Cancer Screening Behaviors among Women Health Volunteers.

Knowledge of screening methods and regular diagnostic tests play an important role in reducing the incidence of cancers and their mortality. We investigated the effectiveness of health belief model initiative in breast cancer screening behaviors among women health volunteers. A quasi-experimental design and non-probability sampling technique was conducted during 2019 in Abhar, Iran. Two out of six health centers were approached and each was recruited in either experimental or control group. Based on the Iranian and standardized version of the Champion's Health Belief Model Scale, the different domains of the scale and breast cancer screening behaviors of eligible women health volunteers (n = 72) were evaluated. Then, seven training sessions were designed and implemented for the intervention group using local language and different educational approaches. The participants were reevaluated according to the same questionnaire three months after the intervention. There was a meaningful difference regarding breast self-exam, knowledge, perceived susceptibility, perceived severity, perceived benefits, and perceived barriers among both the control and intervention groups before and after the intervention. Training programs using health belief model are crucial in developing breast cancer screening behaviors for women health volunteers. Thus, it is recommended that training programs should be conducted using individual behavioral models.

The Iranian Protocol of Group Reminiscence and Health-Related Quality of Life Among Institutionalized Older People.

PURPOSE: Reminiscence has a positive role in improving memory performance. It may increase the attention of the older adults to themselves, helping them to cope with the crises and the process of aging. We aimed to investigate the impacts of memory recalling, sharing life experiences and stories confidently from the past on promoting numerous domains of quality of life (QoL), among institutionalized older people in the Ilam province of Iran. METHODS: The study was carried out, using a quasi-experimental approach (a pre- and post-one group design). The statistical population consisted of all older people who were institutionalized in nursing homes. Based on inclusion and exclusion criteria, 43 potential participants were recruited, and the status of QoL was assessed, using the Iranian short-form health survey (SF-36) and face to face interviews. Then, eight sessions were designed and implemented. The participants expressed their memories such as bitter and sweet memories at various periods of life, and finally, the QoL of the participants was re-evaluated according to the same questionnaire, three months after the intervention. RESULTS: There was a significant difference between the scores of pre- and post-intervention in most of the sub-scales of QoL, including physical functioning, role limitations due to physical health and emotional problems, emotional well-being, social functioning, and general health. CONCLUSION: Reminiscence may, in certain circumstances, be an effective care option for people living in long-term care with the potential to impact positively on the QoL of residents.

Life satisfaction and its contributors among noninstitutionalized older people in Tabriz, Islamic Republic of Iran.

BACKGROUND: With the rising growth of the older population, the well-being of older people is an important objective for both economic and health policy. AIMS: This study investigates levels of life satisfaction among older people living at home and the factors that influence it. METHOD: Applying probability proportional to size, a cross-sectional survey was conducted of 1067 older people living in Tabriz, Islamic Republic of Iran. The Satisfaction with Life Scale and the Multidimensional Scale of Perceived Social Support questionnaires were administered. The data were analysed using chi-squared tests and logistic regression. RESULTS: More than half of the participants were dissatisfied with their lives. Female, educated, and active older people reported greater satisfaction than others. CONCLUSION: The significant positive effects of perceived social support and physical activity rate indicated that social interaction may be as vital as physical activity for the well-being of older people, and that these qualities should be actively promoted among older people in the Islamic Republic of Iran.

The Role of a Community-Based Intervention in Promoting Helmet Use in a Non-probability Sample of Rural Motorcyclists in Iran.

Although the use of helmets is known to prevent the majority of mortalities by head injuries, it is ignored by a large number of motorcyclists. The present study was conducted to promote helmet use in an attempt to reduce injuries among motorcyclists in a rural area by adopting a community-based participation approach. The one-group pretest-posttest pre-experimental design was conducted in northwest Iran. The study was conducted in three phases: (1) baseline measurement, (2) implementation of the intervention, and (3) assessment of the outcomes. The intervention included the distribution of learning tools, education of various community groups, tightening of driving laws for offending motorcyclists, promotional programs at community level, and utilizing all opportunities to discuss the benefits of helmets. Due to the non-experimental nature of the study, no causal inferences were drawn. After the intervention, the percentage of the awareness of the benefits of helmet use was increased by 28%, positive attitudes towards benefits of helmet use was increased by 32.6%, and supporting helmet use was increased by 58.6%. Moreover, helmet sale and use increased by 147.0% and 32.0%, respectively. Additionally, motorcycle accidents, head injuries, and mortalities were decreased by 71.8, 55.5, and 60.0%, respectively. Community-based participation approach may positively influence health promoting behaviors and motorcyclists' decisions to wear helmet in rural areas.

Elder abuse and its sociocultural factors from the perspectives of Kurdish rural older people: Does gender matter?

We aimed to explore the meaning of elder abuse and its sociocultural factors from the perspectives of Kurdish older people. We purposively selected the participants, 38 female and 17 male, from a rural area in Boukan country, Iran. Data were collected using semi-structured interviews and focus group discussions and were analyzed applying conventional content analysis. Researchers finally characterized viewpoints of the participants into two themes including structural changes in family interactions and changes in sociocultural values. Public education about moral norms and enactment of supportive laws for elderly people may help minimize elder abuse.

Personal, Interpersonal, and Organizational Predictors of the Mode of Delivery Among Urban Women: A Prospective Study With Socio-Ecological Approach.

The aim of this prospective study was to investigate the predictors of choosing mode of delivery (MOD) among Iranian urban women applying the socio-ecological model. In 2015, a convenient sample of 530 pregnant women in urban regions of Urmia, Iran, was recruited to complete a socio-ecological approach-based questionnaire. Then, 1 week after childbirth, the women were followed up by telephone to be asked about their MOD (response rate = 81.88%). Logistic regression analysis showed that the odds of cesarean section (CS) among the women with university education, whose husbands were an employee in a governmental organization, who preferred a private hospital for delivery, and who selected the CS as the preferred MOD during pregnancy were significantly higher than their counterparts. Among all the factors, the socioeconomic status of the families was more influential in predicting the MOD among women. The cognitive factors like fear of childbirth may not be determinants for MOD if women are from privileged families.

Why People Choose to Volunteer? Women Health Volunteers' Activities, Reasons for Joining and Leaving.

Introduction: Women health volunteers are the link between people and healthcare workers. They play an important role in health education activities, following up families under coverage, and updating the demographic data to health centers. This study was performed to uncover women health volunteers' activities, reasons for joining and leaving from the program. Methods: A qualitative study design was used to conduct the study. Through purposive sampling technique, twenty -four in-depth semi-structured individual interviews and two focused group discussions with women health volunteers and their supervisors were conducted in Tabriz, Iran. Data analysis implemented thematic analysis, using MAXQDA10. Results: The findings were generally categorized into three major themes, participation in promoting health, perceived benefit, and perceptual- environmental inhibitors. Participation in promoting health consisted of the sub-themes participation in educational programs, participation in health care. The sub-themes of perceived benefit included benefits from health care services and interest in having an active role in the community. The theme perceptual- environmental inhibitors involved the subthemes participation barriers and lack of innovation and inconsistency with social changes. Conclusion: Culture-building about the role of health volunteers, the valuing on their activities in the community, and informing program supervisors about the health volunteer's duties would help to retain health volunteers and also sustain their activities at the community level.

Successful recruitment and retention strategies for women health volunteers: viewpoints of the volunteers' supervisors and relevant researchers.

BACKGROUND: Women health volunteers (WHVs) are a link between people and healthcare workers. Despite their key role in promoting community health, strategies are rarely designed to keep them volunteering. The aim of this research was to find successful strategies to overcome barriers to recruitment and retention of the volunteers in assigned activities. SUBJECTS AND METHODS: A three-round online national Delphi technique was used to ask the opinions of Iranian health volunteers' supervisors and the relevant researchers. At the first round, the participants were asked ten open-ended questions across four barriers: inadequate capability of the volunteers and trainers, inadequate acceptance of the volunteers, restrictive social norms, and organizational problems. At the second round, with the questionnaire consisting of closed-ended questions, the experts were asked to rank the feasibility of each strategy using a seven-point Likert scale. Items along with the feedback received from the second round were included in the third-round questionnaire. Strategies with a median of 6 or higher and with an interquartile range ≤1 were regarded to be feasible. RESULTS: Consensus was obtained on 100 of the 133 strategies. A mixture of improving group work, implementing motivation tactics, assessing the needs of people/WHVs, reforming policy, monitoring and evaluation of WHVs/trainers, mobilizing the community, empowering WHVs/trainers, rationalizing WHVs/trainers/people, improving intersectional collaboration, implementing problem-based approaches, allocating proper resources, appropriate recruitment of WHVs, using social networks, and information dissemination were found to be the effective strategies to overcome the barriers to active participation. CONCLUSION: The highest consensuses among experts were on implementing motivation tactics and mobilizing the community. It seems that community mobilization, incentives, and logistical supplies such as providing prizes and transportation facilities for volunteers are mechanisms that can help retain WHVs and also overcome barriers to their active participation.

The "Cooperative-Supportive" Intervention for Improving Mental Health Status among Pregnant Women.

Introduction: Maternal mental health during pregnancy has a major impact on fetal growth and consequently, child health. The objective of this study was to assess the effect of "Cooperative-Supportive" Intervention Program on Pregnancy. Methods: The present before and after interventional research was conducted on 114 pregnant women referring to Khoy health centers in 2014. Pregnant women were randomly divided into intervention (n=57) and control groups (n=57). The data collection tool in this research was the researcher-made questionnaire based on the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model which assessed the participants' predisposing, enabling, and reinforcing factors. The educational interventions for enhancing pregnant women's stress controlling skills were conducted and also practical pacifying lessons were held for the intervention group during five weeks with relaxation exercises. In order to assess health status among pregnant women, knowledge, attitude, depression, anxiety and self-efficacy were investigated by applying different scales and questioners. The questionnaires were completed before and after the interventional program. The data were analyzed, using suitable statistical tests. Results: After the intervention, the mean score of PRECEDE major components significantly increased and the total anxiety and depression scores decreased in the intervention group in comparison to those of the control group. Conclusion: The present study showed the positive impact of educational intervention programs based on PRECEED model and major components on reducing anxiety and depression, and finally mental health promotion in the studied population.

Analysis of the third-grade curriculum for health subjects: Application of Health Education Curriculum Analysis Tool.

PURPOSE: Applying the Health Education Curriculum Analysis Tool (HECAT), the third-grade curriculum was assessed in accordance with health-related items. METHODS: A multimethod research was used to investigate the student textbooks and three modules including healthy eating, physical activity, and safety. Based on purposive sampling, curriculum committees were made up of teachers, elementary school principals, members of the parents-teachers' associations, and health care experts. RESULTS: Data obtained from the group discussion were analyzed based on the conventional content analysis approach. All modules received coverage percentages of <34%. The highest mean coverage percentage belonged to the safety module (25.59%) and the lowest to healthy eating (12.78%). CONCLUSION: Suggested solutions were classified based on three general themes such as clarifying and determining healthy dietary behaviors and actions, educating life skills and adopting healthy diet behaviors, and finally utilizing social norms for adopting with healthy diet patterns.

Barriers to Women's Participation: Experiences of Volunteers and Community Healthcare Authorities.

Along with health development in general terms, women's involvement in health programs can be effective in raising their self-confidence and their health promotion. This study was carried out to unveil the barriers to and challenges of the health volunteers and to present the solutions to its promotion using active women participants' experiences and the authorities of the program. The study was carried out using qualitative method along with content analysis in city of Tabriz East-Azerbaijan province, Iran. Data collection was conducted utilizing semistructured individual interviews and focus group discussions with the participation of 29 health volunteers and responsible authorities. The participants were selected using purposive sampling with maximum variation. Data analysis implemented conventional content analysis using MAXODA. Barriers to and challenges of health volunteers were generally categorized into four main themes including volunteers and trainers' inadequate capabilities, inadequate acceptance of the volunteers, restrictive social norms, and organizational problems. It seems that interaction among health system, people, and health volunteers should be improved. Holding training programs about the activities of health volunteers at the society level leads into the better utilization of society sources in health programs.

Effectiveness of self-management program on arthritis symptoms among older women: A randomized controlled trial study.

We aimed to determine the effectiveness of a self-management program amongst older women with rheumatoid arthritis. The intervention group (n = 40) received a six-week arthritis self-management program. Assessments were recorded prior to and after the program using a demographic questionnaire, Visual Analogue Scale, Arthritis Self-Efficacy Scale, and self- reported questions regarding mobility. Significant improvements in self-efficacy for functional ability and pain management were found in the intervention group compared to those before the intervention and the control group. Our trial indicates that the program used in conjunction with exercise interventions for aged patients may lead to benefits perceived self-efficacy.