In the global aging population, elderly isolation emerges as a silent epidemic, particularly within kinship networks, those intricate webs of family ties that traditionally provide emotional, social, and practical support.
Background:Psychosocial support is known as a crucial coping mechanism. This qualitative study aims to explore experiences of women with recurrent miscarriage (RM) regarding psychosocial support. Methods:This qualitative study utilized a content analysis approach and involved 12 women with a history of RM. Participants were recruited from health centers affiliated with Ahvaz Jundishapur University of Medical Sciences, Iran, between October 2024 and January 2025. Also, to further enrich the study data, interviews were conducted with healthcare providers (n=11) and family members (n=4). Twenty-seven semi-structured individual interviews focusing on the psychosocial support of women with RM were conducted. The participants were selected through a purposive sampling method. Interviews were recorded and transcribed verbatim in Persian and analyzed using conventional qualitative content analysis with MAXQDA 2020 software. Results:Data analysis led to the extraction of three main categories, including interpersonal support in building resilience, structural support for psychological well-being, and educational support for psychological wellbeing. Conclusion:Enhancing psychosocial support is essential for women who have experienced RM. These women require comprehensive support from their husbands, families, peers, and healthcare providers. Therefore, future research is recommended to develop a targeted psychosocial intervention program designed to meet their specific needs.
Thalassemia is a hereditary blood disorder transmitted through mutated genes and is highly prevalent in Southeast Asia and Mediterranean regions, constituting a major public health challenge
Introduction: Osteoarthritis is a leading cause of disability among the elderly, characterized bychronic pain and functional limitations. This study aimed to evaluate the impact of a peer-led, nonpharmacologicalpain management program on pain-related self-efficacy and chronic pain severity inolder adults with osteoarthritis.Methods: A quasi-experimental study was conducted in 2020 in two healthcare centers in Mashhad, Iran.Sixty elderly individuals with chronic osteoarthritis were assigned to intervention (n=30) and control (n=30)groups. The intervention group received four 90-minute peer-led training sessions over two weeks, facilitatedby trained elderly peers under the researcher’s supervision. Pain intensity and pain-related self-efficacy weremeasured using the McGill Pain Questionnaire and the Pain Self-Efficacy Questionnaire at baseline andat 8-week follow-up after completion of the intervention. Data analysis was performed using paired andindependent t-test in SPSS version 21. A P value of less than 0.05 was considered statistically significant.Results: Two months after the intervention, between-group comparison showed that there is astatistically significant difference in terms of pain-related self-efficacy (P<0.001). Two months afterthe intervention, between-group comparison in terms of total pain score (P<0.001) and the scores of itsdimensions including sensory-discriminative (P=0.009) and affective (P<0.001) showed a statisticallysignificant difference.Conclusion: The peer-led pain management program effectively reduces pain and enhances self-efficacyin elderly individuals with osteoarthritis in the intervention group. Implementing such programs,which promote mental control and social engagement, is recommended for improved outcomes.
Background: The global aging population has intensified the urgency to design age-friendly citiesthat ensure equitable access to services and foster active participation among older adults. Despiteextensive research on age-friendly initiatives, there remains a notable gap in studies exploring olderadults’ experiences of such environments. This study aimed to explore older adults’ experiences ofage-friendliness of Kashan City.Methods: This qualitative conventional content analysis was conducted from January to August 2024in Kashan, Iran. Twenty in-depth semi-structured interviews with 18 older adults living in Kashan wereperformed using a purposive sampling method. Data collection was continued up to data saturation.Data collection and analysis were performed simultaneously, using MAXQDA version 2020. Interviewswere analyzed using Graneheim and Lundman’s method, with trustworthiness ensured by Lincoln andGuba’s criteria.Results: The central theme “a city with forgotten older people” emerged, along with 18 subcategoriesand 5 main categories: inadequate open and closed public spaces, transportation and safety concerns,challenges in social participation, and difficulties with technology.Conclusions: Kashan faces challenges in becoming an age-friendly city, as older adults are oftenexcluded from urban planning. A community-based approach emphasizing participation, social ties,and local capacity can improve their quality of life. Beyond infrastructure, policy reforms, caregivertraining, and support networks are needed. It is suggested that further studies should explore vulnerableseniors’ experiences and Iran’s diverse regional and cultural contexts.
Background: Adolescence drinking behavior is steadily increasing while the mean age of first- time drinkershas decreased. The aims of this study were to examine the potential effect of the “Teenagers Don’t Drink”application on preventing alcohol use among Thai adolescents.Methods: This quasi-experimental design with cluster-level allocation was conducted among adolescents aged10-14 years in Chiang Mai, Thailand, between March and May 2022. A total of 50 adolescents were recruitedbased on the calculated sample size; 25 participants who met the inclusion criteria were selected by simplerandom sampling for each group. The intervention group received the mobile application “Teenagers don’tdrink”. The control group received an adolescence drinking prevention manual. The data was gathered usingAlcohol Use Disorders Identification Test (AUDIT), Alcohol Knowledge, Attitude towards Drinking, DrinkingRefusal Self-efficacy, Parental control and support regarding alcohol consumption, and Intention to not DrinkAlcohol Questionnaires before and one month after the intervention. Data were analyzed using descriptivestatistics, Wilcoxon Matched Signed Rank Test, Paired T-test, Mann-Whitney U Test, and Independent t-testwith STATA version 15. A significance level of less than 0.05 was considered.Results: Between groups score comparisons showed a statistically significant differences in terms of knowledgeabout alcoholic beverages (P=0.003), attitude towards drinking (P<0.001), drinking refusal self-efficacy(P=0.003), parental control and support regarding alcohol consumption (P=0.003), and intention to not drinkalcohol (P<0.001) after the intervention.Conclusion: The “Teenagers Don’t Drink” application may improve adolescents’ comprehension of alcoholicbeverages, pertinent laws and regulations, and life skills associated with alcohol use prevention. The program seemscapable of aiding initiatives to avoid or diminish alcohol intake among adolescents in communal environments.
Background:To effectively deliver palliative care within community settings, nurses must possess adequate competencies. Regarding the few review studies in this field, the present study aimed to explore the necessary qualifications required for nurses providing home-based palliative care to patients with incurable diseases. Methods:This scoping review was performed during 2024 based on the Cochrane methodology using the methodological framework of Arksey and O'Malley in six steps. A comprehensive literature review was conducted on databases of Web of Science, Scopus, PubMed/Medline, EBSCO, as well as Cochran library. Articles published in English between 1990 and 2024 were screened, and the textual narrative synthesis was used for data analysis. Results:The extracted data were organized into three main competencies including knowledge (knowledge of the philosophy of palliative care, familiarity with incurable diseases, and awareness of the structure of the healthcare system), attitude (interprofessional and intersectoral cooperation, cultural competence, and adherence to ethical principles), and skills (physical care, psychological care, spiritual care, social support, medication administration, care of dying patients, and communication skills). Conclusion:Community health nurses must possess sufficient knowledge, appropriate attitudes, and essential clinical competencies to deliver effective communitybased palliative care for patients with lifelimiting illnesses. The necessary competencies to provide home-based palliative care should be integrated into the nursing education program.
Background:Antenatal care (ANC) is crucial for reducing maternal and neonatal mortality by detecting and managing pregnancy complications. In Indonesia, a policy mandating at least six ANC visits (K6) per pregnancy has been introduced, yet factors influencing adequate ANC under this new policy remain unevaluated. This study examines the national and sub-national prevalence of adequate ANC visits as well as its associated geographic and socioeconomic factors. Methods:This cross-sectional study analyzed data from the 2023 Indonesian Health Survey, which included 70,916 women of reproductive age. Logistic regression was used to assess predictors of ANC adequacy, such as age, education, marital status, health insurance, employment, urbanicity, economic status, and travel time to healthcare facilities. The data were analyzed through SPSS version 23 using descriptive statistics, chi square test, and multiple logistic regression. Final regression model was based on significant predictors only with calculated adjusted odd ratios and 95% confidence interval (CI) with a significance level of 0.05. Results:The national prevalence of adequate ANC visits was 38.65%. However, a significant disparity was observed between provinces, with eastern areas showing much lower prevalence than provinces in western Indonesia. ANC adequacy was highest among women aged 25-29 and lowest among those under 20. Higher education (aOR=1.45, P<0.001), combined health insurance (aOR=2.84, P<0.001), employment (aOR=1.07, P<0.001), urban residence (aOR=1.24, P<0.001), and higher economic status (aOR=1.60, P<0.001) were positively associated with ANC adequacy. Conversely, being divorced (aOR=0.76, P<0.001) and widowed (aOR=0.74, P=0.004), and longer travel times to primary healthcare center negatively affected compliance (aOR=0.68, P<0.001). Conclusion:Addressing geographic and socioeconomic barriers through improved healthcare infrastructure, transportation support, and expanded insurance coverage is essential for increasing ANC utilization and improving maternal health in Indonesia.
Background: Pre-procedural anxiety in patients with intravitreal injections shows a significant negative association with vision-related quality of life. This study determines the effect of telenursing with self-care education podcasts on anxiety and quality of life in patients with diabetes undergoing intravitreal injections.Methods: A randomized clinical trial was conducted in 2022 in Mashhad, Iran on 68 patients assigned to two groups. After informed consent were obtained, patients completed a demographic questionnaire, the Spielberger State-Trait Anxiety Inventory, and the SF-36 quality of life questionnaire. Relevant podcasts were delivered individually via WhatsApp once a week over an 8-week period to the intervention group (n=34), while the control group (n=34) received routine education via pamphlets. Anxiety levels were measured before the commencement of the intervention and each injection; the quality-of-life questionnaire was administered before and after the completion of the intervention. Data were analyzed using SPSS version 26. The statistical tests included the t-test, Chi square, repeated measures ANOVA, ANCOVA, and Mann-Whitney U test.Results: The intervention group demonstrated a significantly greater reduction in both state anxiety (P<0.001) and trait anxiety (P<0.001) over the eight-week study period compared to the control group. Furthermore, the intervention group comparison with the control group showed statistically significant improvement in the total score of quality-of-life (P<0.001).Conclusion: A telenursing program delivered via self-care podcasts, a feasible task for community nurses, significantly reduced anxiety and improved quality of life in patients with diabetic retinopathy undergoing intravitreal injections. Trial Registration Number: IRCT20220611055134N1
Background: Childbearing has declined in all countries worldwide, and Iran is no exception. According to the United Nations report, nearly half of the world’s population live in countries with fertility rates below the replacement level. Therefore, providing reproductive health services is of paramount importance. In this regard, utilizing the potential of midwifery care to improve fertility services is significant. This study aims to explore the role of midwives in promoting childbearing from the perspective of couples.Methods: This qualitative study employed content analysis and involved couples attending healthcare centers and hospitals affiliated with Jundishapur University of Medical Sciences in Ahvaz between July to November 2024. Purposive sampling was conducted until data saturation was reached. Data were collected through semi-structured, in-depth interviews with 15 couples (30 individuals) who met the inclusion criteria. Analysis was performed using MAXQDA (version 20) software following the conventional content analysis method of Graneheim and Lundman.Results: The results included 4 main categories: “Empowering couples,” “Creating Motivation for Having Children,” “Preparing for Parenthood,” and “Supporting the Overcoming of Childbearing Barriers” and one main theme as “Midwife as a Key Supporter in Promoting Childbearing”.Conclusion: The couple experiences highlight midwives as pivotal figures in promoting healthy childbearing through a multifaceted approach. Future research should explore the role of midwives in promoting childbearing from the perspectives of midwives and policymakers using qualitative approaches, followed by quantitative studies to assess the impact of these efforts.
Background: Birth Preparedness and Complication Readiness (BPCR) is a key strategy for reducing maternal and neonatal mortality, particularly in resource-limited settings. Midwives are central to BPCR implementation, but their perspectives on BPCR structure remain underexplored in Nigeria. This study explored midwives’ perspectives on BPCR structure in resource-limited environments.Methods: A qualitative exploratory study was conducted over three months, from February to April 2025, using semi-structured interviews with 14 purposively selected midwives from primary, secondary, and tertiary healthcare facilities in Ogbomoso, Oyo State, Southwest Nigeria. Data collection was continued till data saturation. Data were analyzed thematically using Braun and Clarke’s six-phase framework. Rigor was ensured through strategies addressing credibility, transferability, dependability, and confirmability, and ATLAS.ti version 25 was used for data analysis.Results: Three themes emerged from the data analysis: 1) Provide education and planning prerequisites, 2) Institutional support for midwives, and 3) Supportive network for pregnant women. Three subthemes emerged under providing education and planning requisites: complication orientation, detailed information access, and proper planning. Two subthemes were identified under institutional support for midwives: professional development and collaborative support. Two subthemes emerged under supportive network for pregnant women: emergency preparedness infrastructure and community-based support networks.Conclusion: Midwives in the resource-limited setting perceived BPCR as a comprehensive framework encompassing education about complications, detailed information provision, and practical planning with families, alongside the dual nature of support institutional mechanisms for providers and community networks for pregnant women.
Background:Heart failure is a clinical syndrome that has a large financial burden on the health care system and communities. One of the types of care provided to these patients is home care. The present study aimed to determine the effect of mental health education on resilience and psychosocial adjustment among patients with heart failure under the care of Home Counseling and Nursing Services. Methods:This randomized controlled clinical trial was conducted on 24 patients with heart failure referred to Shahid Rajaei Heart Center, Tehran, Iran in April to June 2020. Patients eligible to enter the study were divided into two intervention and control groups by permuted block randomization. The demographic form, resilience and psychosocial adjustment to illness scale were completed. The intervention group received mental health education in the patients' houses for 6 weeks (one session each week). Each session lasted 60 minutes. The post-test was done two weeks after the end of the study. The control group received routine care. Data analysis was performed using through SPSS software version 19 using Chi-square test, paired sample t-test, and independent samples t-test. P<0.05 was statistically significant. Results:Comparison of the mean of psychosocial adjustment total score between the intervention and control groups after the intervention showed statistically significant differences (P=0.02). Also, there was a significant difference between the two groups in the mean of resilience total score after the intervention (P=0.001). Conclusion:The results indicated that mental health education in patients with heart failure who had received home care nursing could enhance their resilience and psychosocial adjustment.Trial Registration Number: IRCT20200215046493N.
Background:Heart failure (HF) is a prevalent chronic condition that requires ongoing self-management. This study aimed to evaluate the effects of mobile videocast-based self-management education on self-care behaviors, quality of life, and hospital readmission in patients with HF. Methods:A randomized clinical trial was conducted from December 2019 to January 2021, involving 38 patients with HF who were referred to Imam Khomeini Hospital in Tehran. Participants were allocated to control (n=19) and intervention (n=19) groups using block randomization. Demographic data form, the nine-item European Heart Failure Self-care Behavior scale, the Minnesota Living with Heart Failure Questionnaire, and a form to record readmission were used for data collection. Both groups received routine care; additionally, the intervention group received four weekly videocasts. Self-care behaviors and quality of life were measured in the baseline and two months after completion of the intervention. The readmission occurrence was checked two months after completing the intervention. Data were analyzed using chi-square, Fisher's exact test, Paired t-test, independent t-test, and Mann-Whitney U test in SPSS version 25. In all tests, p value less than 0.05 was considered statistically significant. Results:Data from 35 participants (18 control, 17 intervention) were analyzed. Post-intervention, a statically significant difference was observed in self-care behavior scores (Intervention: 17.70±4.51 vs. Control: 27.66±8.19; P=0.001) and quality of life scores (Intervention: 20.76±14.63 vs. Control: 42.00±24.32; P=0.004). During the two-month follow-up, 27.78% of the control group patients were hospitalized compared to none in the intervention group (RR 2.30, 95% CI: 1.53-3.47). Conclusion:Self-management education in patients with HF via videocasts can improve self-care, quality of life, and lower readmission rates in these patients. Accordingly, the use of videocast-based self-management education is recommended as a supportive strategy to improve self-care and quality of life and potentially reduce readmission rates.Trial Registration Number: IRCT20190717044249N1.
Background:Mild cognitive impairment (MCI) presents growing challenges for older adults, particularly in Thailand. This study aimed to examine the effects of board games with mobile applications on cognition in older adults with MCI. Methods:A quasi-experimental study was conducted in Suphan Buri Province, Thailand (August-October 2024). Forty-four participants were allocated to the intervention group (N=22) or the control group (N=22). The intervention group received MCI education and participated in a hybrid cognitive-training program consisting of four face-to-face board-game sessions and four home-practice modules delivered via a game-based mobile application. The control group received MCI education and access to the mobile application but did not participate in any face-to-face sessions. Outcomes were assessed at baseline and 8 weeks post-intervention using the Montreal Cognitive Assessment (MoCA), Cognitive Impairment Knowledge Assessment Questionnaire, and Cognitive Failures Questionnaire-Thai version (CFQ-Thai). Data were analyzed using Jamovi software version 2.3.28. Descriptive statistics, Shapiro-Wilk tests, chi-square tests, independent t-tests, and paired t-tests were used. The significance level of P<0.05 was considered. Results:Eight weeks after the intervention, the experimental group, in comparison to the control group, demonstrated significantly higher MoCA scores (23.73±4.54 vs. 20.05±1.36, P<0.001) and MCI knowledge scores (13.55±1.34 vs. 11.55±1.01, P<0.001), with significantly lower CFQ-Thai scores (23.14±8.69 vs. 43.86±7.61, P<0.001). Conclusion:Board Games with a mobile-app cognitive-training program could improve cognitive function among older adults with MCI. Healthcare professionals can implement this accessible intervention to address the growing challenge of cognitive decline in aging populations, particularly in resource-limited and rural settings.
Background:Delayed breast cancer diagnosis in low- and middle-income countries (LMICs) reduces the survival rates. This review identifies the causes of these delays to inform strategies for improving early detection. Methods:This scoping review followed the Arksey and O'Malley framework to explore the factors contributing to delayed breast cancer diagnosis in LMICs. Seven databases, including PubMed, Scopus, Web of Science, Cochrane Library, ProQuest, Embase, and Magiran, were searched for English and Persian studies published between January 2000 and September 2024. The search combined the keywords (e.g., "diagnostic delay," "missed diagnosis," "breast cancer," "late-stage," "barriers"), using Boolean operators. To focus on LMICs, we applied country filters, where available, and supplemented the search with manual screening of reference lists from the included studies. Results:The initial database search identified 5,313 records. After removing 1,036 duplicates, 4,277 studies were screened based on title, abstract, and country of origin. Of these, 4,217 were excluded for reasons including irrelevance to delayed breast cancer diagnosis, study design, population, setting (e.g., high-income countries), or publication date (outside 2000-2024). The remaining 60 studies met the inclusion criteria and were included in the narrative synthesis. Extracted data were organized and interpreted using the revised Penchansky framework (accessibility, availability, acceptability, affordability, accommodation, awareness). Additional themes included misdiagnosis, competing priorities, and personal factors. Conclusions:Multiple modifiable factors contribute to diagnostic delays in LMICs. Addressing them can accelerate diagnosis, improve outcomes, and reduce harm. Targeted improvements in these areas offer significant potential to enhance breast cancer care and save lives in LMICs.
Background:Peer support groups play a crucial role in enhancing the psychosocial well-being of people living with HIV (PLHIV), and understanding their experiences is essential for optimizing their impact. This review aimed to identify, explore, and synthesize the experiences of PLHIV participating in peer support groups. Methods:A systematic review and meta-synthesis were conducted using the thematic synthesis approach developed by Thomas and Harden. Comprehensive searches were performed in PubMed, Scopus, CINAHL, Cochrane, and Web of Science up to December 2024, using Boolean combinations of keywords related to HIV, peer support, and qualitative research. Studies were included if they used qualitative methods with a focus on PLHIV's experiences in peer support groups and published in English. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Research Checklist. The review is registered in PROSPERO (CRD42025637718). Results:Out of 1,956 records identified, 20 qualitative studies met the inclusion criteria. The included studies demonstrated substantial geographical diversity, with representation from Africa, North America, Asia, Europe, and Australia. The analysis revealed three main themes: (1) Motivations for Joining Peer Support Groups; (2) Positive Impacts; and (3) Challenges in Participation. Conclusion:Peer support groups help PLHIV gain motivation, emotional strength, and a sense of belonging. Despite these benefits, challenges such as stigma and confidentiality concerns must be addressed through sustainable programs and strong health-community partnerships.
Background: Mothers with High-risk pregnancies (HRPs) face a combination of health risks,individual factors, and contextual diseases that limit their abilities to address favorable situations andtheir desires. This study aimed to explore the desires of these mothers.Methods: This qualitative content analysis was conducted from July 2018 to December 2020 in theteaching hospitals of Mashhad and health centers. Data were collected via semi-structured, face-tofaceinterviews with 25 outpatient mothers with HRPs until saturation was reached. Data analysis wasperformed using Elo and Kingas approach through MAXQDA software version 10.Results: The analysis identified four main categories and nine subcategories. (I) fulfillment ofthe desire to have children: Childbearing to propagate religion, Childbearing until achieving thedesired family composition, Strengthening the marital bond through childbearing, (II) Maintainingroutine life despite the risk of pregnancy: Maintaining daily activities during a high-risk pregnancy,Maintaining normal marital relations despite risk factors, (III) More support and interaction of thehealthcare provider: More support for peace of mind, Responsive and friendly healthcare provider, and(IV) Comprehensive and confidential medical care: Comprehensive medical care without wandering,confidential medical care.Conclusion: Childbearing while maintaining marital and daily life was the desire of mothers withHRPs in Iran. Healthcare providers should offer friendly, holistic support that respects the mothers’goals to fulfill their desires. Investigating the views of women with HRPs can aid in developingprenatal interventions that address their holistic care needs.
Childbirth is often defined as a natural and physiological process; however, this definition has been challenged and complicated by increasing medical interventions.
By improving health outcomes for patients and reducing the risk of physician-induced demand, patient-centered care can benefit both patients and health insurance systems.
Background: Male involvement in childbirth can enhance communication and strengthen familybonds. However, understanding men’s perceptions and preferences regarding this participation islimited. This study explores men’s perceptions of participating in the natural childbirth process.Methods: A qualitative content analysis was conducted on 15 male participants, using face-to-face, in-depth, semi-structured interviews in Ahvaz health centers from June 2024 to November 2024. These men have had experience accompanying their wives in prenatal care. The sampling was purposive, and interviews continued until saturation was reached. The conventional content analysis framework of Granheim and Landman was also used to analyze the data manually.Results: Four main categories including “Weaknesses of men’s awareness of participation inchildbirth”, “Men’s fear of participating in childbirth”, “Men’s willingness to learn and participate inchildbirth” and “Strategies to improve men’s participation in childbirth” emerged, and we abstracted them in the theme “Willingness to participate in the aura of fears and weaknesses”.Conclusion: This study shows that lack of the participants’ awareness, and fear often prevents their participation. Increasing education and awareness of their roles during pregnancy and childbirth by building social networks and improving cultural programs is important to encourage men to participate in the birth process.
