The effectiveness of court-mandated compulsory treatment in promoting abstinence among people with substance use disorders in Iran

BACKGROUND

In Iran, people living with substance use disorders who engage in public drug use may be subjected to court-mandated treatment in compulsory drug detention and rehabilitation centers (CDDRC). This study aims to assess residential CDDRC's effectiveness in promoting sustained abstinence among people who use drugs (PWUD) in Kerman, Iran.

METHODS

Between October 1, 2021, and September 30, 2022, 1,083 adult male PWUD with a diagnosis of substance use disorders and a history of engagement in public drug use were admitted to the CDDRC in Kerman. They were followed-up for 12 months after discharge. The relationship between baseline variables and abstinence, assessed using rapid urine tests, was examined using crude logistic regression models.

RESULTS

Most PWUD were 30 or older (n = 876, 80.9 %) and had a history of previous CDDRC admission (n = 638, 58.9 %). At the end of the 12-month follow-up, only 2.6 % (95 % confidence intervals: 1.7-3.7) were abstinent. Individuals with limited education (Odds ratio [OR] = 3.43; 1.50-7.95) and those with a prior history of admission to the CDDRC (OR = 3.73; 1.55-9.89) had increased odds of relapse.

CONCLUSIONS

The effectiveness of CDDRC in promoting abstinence among the participants was minimal. This highlights the necessity of reassessing support and investment in these interventions and considering more evidence-informed alternative approaches in Iran.

Correlates of quality of life and mental health among youth experiencing homelessness in Iran

BACKGROUND

Quality of life (QOL) and mental health among marginalized populations, including people experiencing homelessness in Iran, are understudied. We assessed the QOL and mental health status as well as their associated factors among youth experiencing homelessness in Kerman, Iran.

METHOD

We recruited 202 participants using a convenience sampling method from 11 locations, including six homeless shelters, three street outreach sites, and two drop-in service centers, from September to December 2017. Data were collected using a standardized questionnaire that included QOL, mental health, demographics, drug use, and sexual behaviors questions. Scores in each domain were indexed with a weight of 0-100. The higher score indicated a higher QOL and mental health status. Bivariable and multivariable linear regression models were performed to examine correlates of QOL and mental health.

RESULT

The mean (SD) score of QOL and mental health were 73.1 (25.8) and 65.1 (22.3), respectively. Multivariable analysis showed that youth experiencing homelessness who were aged 25-29 years old (β = -5.4; 95% CI: -10.51; -0.30), and lived on the streets (β = -12.1; 95% CI: -18.19; -6.07) had a lower mental health score. Moreover, those who had higher education (β = 5.4; 95% CI: 0.58; 10.38), had no history of carrying weapons (β = 12.8; 95% CI: 6.86; 18.76), and had a higher QOL score (β = 0.41; 95% CI: 0.31; 0.50) had a higher mental health score.

CONCLUSION

This study highlights that QOL and mental health among youth experiencing homelessness in Iran are concerning, particularly among those who were older, were less educated, were living on the street, and had a history of carrying a weapon. Community-based programs, including mental health care and affordable housing are needed to improve QOL and mental health among this population in Iran.

Investigating the relationship between high-risk behaviors and mental health in adolescents in Rabor city, Iran

OBJECTIVES

High-risk behaviors (HRBs) represent significant health threats for adolescents and significantly affect adolescents' mental health. Adolescents often engage in risky behaviors. The present study was conducted to investigate the relationship between high-risk behaviors (HRBs) and mental health in adolescents in Rabor.

CONTENT

The present study was a cross-sectional analytical study that was performed on 334 girl and boy students aged 12-18 years in Rabor city in 2021. In this study, adolescents answered high risk behaviors and mental health questionnaires. Data were analyzed using SPSS-26 software and the spearman correlation coefficient and linear regression analysis (univariate and multivariate analysis) were used to analyze the data.

SUMMARY AND OUTLOOK

In this study, the mean age was 15.25 ± 1.78. The findings indicate that smoking and hookah use were higher in boys than girls. Among the demographic variables, age and level of education had a positive and significant relationship with HRBs and mental health (p<0.05). The mean score of total mental health for all subjects was 12.83 ± 10.82. The variables of age, sex, marital status of parents, the number of children in the family, educational level, smoking, hookah, and alcohol have been determined as influential and facilitating factors in HRBs of adolescents. Father's literacy was considered as a facilitator and age variables, alcohol consumption and parents' marital status were considered as deterrents to mental health. The present study showed that the male gender is one of the risk factors for alcohol, smoking and other substances, the tendency to high-risk sexual behaviors, depression, and suicide in adolescents. Among the determinants of the tendency to HRBs in adolescents, psychological variables are of particular importance at the individual, social, and family levels. Good mental health can improve quality of life, while poor mental health can make it worse.

Factors related to earthquake preparedness of households based on social-cognitive theory constructs: A systematic review

Background

Earthquakes cause many casualties worldwide. Taking preventive measures and improving community preparedness is critical to reducing earthquake damage. The social cognitive theory explains how individual and environmental factors cause behavior. This review was conducted to identify the social cognitive theory structures, in research on the preparedness of households against earthquakes.

Materials and methods

This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted from January 1, 2000, to October 30, 2021 in Web of Science, Scopus, PubMed, and Google Scholar. Studies were selected based on inclusion and exclusion criteria. The initial search yielded 9,225 articles, and finally, 18 articles were selected. Articles were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

Results

Eighteen articles about disaster preparedness behaviors based on the socio-cognitive constructs were identified and reviewed. The essential constructs used in the reviewed studies included self-efficacy, collective efficacy, knowledge, outcome expectations, social support, and normative beliefs.

Conclusion

By identifying the dominant structures that have been used in studies related to the preparedness of households against earthquakes, researchers can implement appropriate and more cost-effective interventions by focusing on improving suitable structures.

Teacher violence from the perspectives of teachers and students and related factors: A survey in Southern Iran

INTRODUCTION

Teacher violence is defined as the intentional use of power by teachers against students in a variety of ways, including physical, verbal, psychological, and sexual assault. Victims of school violence are more anxious and insecure than other students. An in-depth and comprehensive study on the prevention of violence in schools is urgent and necessary. We conducted this study to determine teacher violence from the perspectives of schoolteachers and students and related factors.

METHODS

We conducted this descriptive-analytical study on 313 teachers and 400 students in Ardestan, southern Iran, in 2019. We selected teachers and students using a census method and stratified random sampling, respectively. The research instrument was the school violence questionnaire.

RESULTS

From the perspective of teachers, the mean score of teacher violence (5.7) was significantly lower than that of students (18.3). Male, young, single teachers with diploma and less work experience had significantly higher violence scores than other teachers (P < 0.001). We witnessed this trend in public boys' schools as well (p < 0.001). The total mean score for teacher violence was not significantly different between male and female students. From the perspective of students, the mean score of teacher violence was significantly different (P < 0.001).

CONCLUSION

Our results suggest that education authorities and school principals should supervise public school teachers with less education, younger students, and boys' schools and provide practical training to improve the communication and emotional skills among these teachers.

Communication barriers to education to referrals from the perspective of referrals to health centers and health care providers

Introduction

One of the most important factors affecting the increase of clients' satisfaction is how health care providers (HCP) communicate with clients. On the other hand, different factors can hinder proper communication and thus education, which is one of the main tasks of HCP. Therefore, the purpose of this study was to investigate communication barriers to education to referrals from the perspective of referrals to health centers (RHC) and HCP.

Method

This descriptive-analytical study was conducted on RHC and HCP in Kerman in 2021. Using a multi-stage sampling method, 162 HCP and 414 RHC were included in the study. The data collection tool was two researcher-made questionnaires. Data were analyzed using SPSS 16.

Findings

From the perspective of RHC and HCP, most communication barriers were related to environmental and then socio-cultural factors. Among the demographic variables of HCP, level of education showed a significant relationship with the physical-psychological, verbal-non-verbal, and informational domains. And in relation to RHC, a significant relationship was found between education and job in the socio-cultural field and environmental barriers (p < 0.05).

Conclusion

HCP face a variety of barriers in educating people, most of which are related to environmental factors. Given the cost-effectiveness of education to the public, it is essential that planners and policymakers use strategies to eliminate environmental factors as well as the placement of indigenous HCP in health facilities to reduce communication barriers.

Lonely, harassed and abandoned in society: the lived experiences of Iranian homeless youth

Introduction

Homelessness is increasing among young adults in large cities. According to the United Nations, there are more than one billion absolute or relative homeless people in the world. This study was conducted to explain the lived experiences of homeless youth in southeastern Iran.

Materials and methods

In this qualitative study, we recruited 13 participants in a big city, southeast Iran, in 2020. The participant was young homeless adults aged 18–29 years who were using homeless shelters provided by the municipality, sleeping in parks or on streets. Data were collected through in-depth and semi-structured interviews and three focus group discussions. Data were analyzed by conventional qualitative content analysis.

Results

The main category of “lonely, annoyed, and abandoned in society” and three subcategories of avoidance of/by society, comprehensive harassment, and lack of comprehensive support were extracted. The experiences of young homeless adults showed that they escaped from the community due to addiction, feeling like a burden to others, and social isolation, and not only have they been left without support in society, but they have also suffered from all kinds of physical and psychological harassments.

Conclusion

The lived experiences of homeless people show that in addition to appropriate facilities and living conditions, they require respect, reduced social stigma, discrimination, and favorable conditions for a return to life. Therefore, authorities should identify and settle their problems and needs.

Breastfeeding Duration and Its Effective Factors in Kerman Province, Iran

Introduction

Complete cessation of breastfeeding (CCB) at the right time is as important as starting breastfeeding, as well as identifying the factors that affect the duration of breastfeeding, so that breastfeeding promotion programs focus on these causes, to increase mothers’ ability and desire to breastfeed. This study aimed to determine the time of CCB and its related factors.

Methods

This analytical cross-sectional study was conducted in 2020. This study was performed at all health centers and health homes affiliated to Kerman University of Medical Sciences, in Kerman province, Iran. A total of 802 urban and rural mothers with children aged from 30 to 36 months completed the questionnaire. The validity and reliability of the questionnaire were confirmed by Cronbach’s alpha of 85%. Data were analyzed using SPSS software version 16.

Results

The mean time of breastfeeding was 19.23 ± 7.09 months and the median was 22-month-year. About 41% of children were breastfed until 24-month. There was a significant relationship between the time of CCB with contraception, number of households, place of residence, and weight at 6-month at the level of 0.05.

Conclusion

Duration of breastfeeding is influenced by some demographic and cultural factors. The timing of the CCB is near to the suggestions of the World Health Organization (WHO) and religious teachings.

Development and Validation of HIV/AIDS Stigma and Discrimination Scale in Southeast Iran: The General Population Viewpoint

Stigma and discrimination are one of the important challenges in coping with HIV infection. Stigma and discrimination are universal phenomenon for the epidemic of HIV and exposure to people with HIV. The present study aimed to develop and measure psychometrically the HIV/AIDS Stigma and discrimination scale from the general population viewpoint in southeast Iran. Data collection lasted from May to September 2016. The results showed that the "HIV/AIDS Stigma and discrimination scale" had an acceptable internal consistency and stability (Cronbach's alpha coefficient = 0.69, omega coefficient = 0.7, and r = 0.57, p = 0.001). The scale had acceptable content and face validities. The Principal Axis Factoring (PAF) with varimax rotation analysis shows that the scale has 4 dimensions: "patient social position" (5 items), "social support" (4 items), "social disease perspective" (7 items), and "social harassment" (2 items). In general, the psychometric properties of "HIV/AIDS Stigma and discrimination scale" are acceptable, and this scale can be used in studies.

Self-Care Practices and Related Factors in Patients with Multiple Sclerosis (MS) Based on the Health Belief Model

Introduction: Self-care programs can raise health in patients with Multiple Sclerosis (MS). This study aimed to identify the self-care behaviors and determinants in patients with MS according to the Health Belief Model (HBM). Methods: In this cross-sectional study, we included 280 MS patients through convenience sampling method. The collection tool was a self-administered questionnaire based on HBM. The participants were the members of MS society in Kerman, Iran. The data were analyzed using descriptive statistics, path analysis, and multivariable linear regression in SPSS software Version 22. Results: The mean (SD) score for self-care practices was 2.86 (0.64), and medication adherence was the most conducted practice. The perceived benefits and cues to action exerted positive influence on self-care practices. The most frequent symptoms experienced by the participants were fatigue (82.5%), visual impairment (76.4%), headaches (72.1%), and muscle weakness (71.4%). The most important cues to action for self-care behavior were the physician (77%), media (52%), and other MS patients (32%). Conclusion: The quality of life (QOL) of MS patients is heavily influenced by self-care behaviors. In this study, only about half of the patients accomplished self-care behaviors, which seems to be insufficient. Since the perceived benefits and cues to action are the main predictors of self-care practices, intervention based on these two constructs can be utilized to promote self-care programs and QOL in MS patients. Health-care providers should pay more attention to these factors for promoting self-care behaviors.

Sex out of marriage and condom use among homeless youth in Iran

OBJECTIVES

Sexual behaviors of homeless youth in Iran have not been well studied. This study aimed to measure the frequency and associated factors of sex out of marriage and condom use among homeless youth in Kerman, Iran.

STUDY DESIGN

In this cross-sectional study, we recruited 202 homeless youth (age: 15-29 years who experienced 30 or more days of homelessness in the last 12 months) from 11 street locations between September to December 2017.

METHODS

Of 202 participants, 169 (83.7%) reported sex in the last 12 months and were include in this analysis. We assessed the prevalence of sex out of marriage in the last 12 months, condom use in last sex, and then evaluated their covariates in multivariable logistic regression analysis.

RESULTS

The prevalence of sex out of marriage was 19.6% (95% confidence intervals [CIs]: 13.8%, 26.3%) and the prevalence of condom use was 43.8% (95% CI: 36.2%, 51.6%). Sex out of marriage was significantly correlated with male gender (adjusted odds ratio [AOR]: 24.38; 95% CI: 3.1-192.1) and being unmarried (AOR: 5.94; 95% CI: 2.3-15.5). Condom use was significantly correlated with male gender (AOR: 2.16; 95% CI: 1.1-4.2) and higher educational status (AOR: 4.30; 95% CI: 2.1-8.8).

CONCLUSION

Our findings indicate that one in five homeless youth had sex out of marriage, and less than half did no use condom. These should be addressed by adapting education and harm reduction programs targeting this specific population in Iran.

"Students in public and private schools-which are at higher risk of drug use?": a survey from Iran

BACKGROUND

Recent evidence from Western countries suggests that private school students are more prone to drug use. Such an evidence is lacking in Muslim countries. The aim of this study was to examine whether the risk of drug use is higher in private schools than public schools.

METHODS

This cross sectional study was conducted on 650 tenth grade students of Kerman city, the center of largest province of Iran using cluster sampling. Well-validated questionnaires regarding current, lifetime substance use, and perceived use by classmates were utilized. Substances included in the questionnaire were waterpipe, cigarette, alcohol, marijuana, opium, methamphetamine, and Naas. Drug Use Tendency Scale was used to measure the attitudes of students towards drug use.

RESULTS

The response rate was 93.7%. More than 82% of sample were public school students (n = 504). Current use of cigarette and marijuana was higher in private schools (12.2 and 3.0%, respectively) than public schools (4.4 and 0.5%, respectively) (P < 0.05). Perceived prevalence of cigarette smoking by classmates was higher among private school students.

CONCLUSION

Despite the popular belief that private schools are better than public schools regarding the risk of substance use, students who attend private schools may be at a higher risk of turning to some drugs comparing to public schools in Iran.

Gender-based differences in risk-taking behaviors among high school students in Southeast Iran

OBJECTIVES

Risk-taking behaviors among adolescents can negatively affect different dimensions of their health. This study was conducted to identify the gender-based differences in risk-taking behaviors among high school students in a Muslim population.

METHODS

Grade 10 students studying in high schools located in Kerman Province, Iran were enrolled through cluster sampling (n=2,676), and data were collected using a well-validated questionnaire about violence, sexual behaviors, and traffic-related conduct over the past 12 months. The tool also consisted questions regarding drug use over the past 30 days and over lifetime (i. e., current and ever use of drugs, respectively).

RESULTS

The number of female participants was 1,407 (52.6%). The boys who had girlfriends (33.0%) were almost twice as many as the girls who had boyfriends (17.1%). Among the respondents, 27.8 and 12.0% of the boys and girls engaged in physical fighting, respectively. Overall, the prevalence of water pipe use in the last 30 days (18.7%) and over lifetime (43.5%) was higher than that of the consumption of other substances. The second and third most popular substances used in the past 30 days among boys and girls were alcohol and cigarettes and cigarettes and alcohol, respectively. On the whole, marijuana figured in the lowest lifetime use among the respondents.

CONCLUSIONS

The rate of risk-taking behaviors in female students was lower than in males, and this difference was more evident than in Western countries. This discrepancy seems to be more obvious in cases where the religious prohibition of a behavior is greater such as extramarital intimacy.

HIV-Related Stigma Among Healthcare Providers in Different Healthcare Settings: A Cross-Sectional Study in Kerman, Iran

Background: Stigmatizing attitudes among healthcare providers are an important barrier to accessing services among people living with HIV (PLHIV). This cross-sectional study aimed to assess the status and correlates of HIV-related stigma among healthcare providers in Kerman, Iran.

Methods: Using a validated and pilot-tested stigma scale questionnaire, we measured HIV-related stigma among 400 healthcare providers recruited from three teaching hospitals (n=363), private sectors (n=28), and the only voluntary counseling and testing (VCT) center (n=9) in Kerman city. Data were gathered using self-administered questionnaires at participants’ workplace during Fall 2016. To examine the correlates of stigmatizing attitudes, we constructed bivariable and multivariable linear regression models.

Results: The mean ± standard deviation (SD) of stigma score was 25.95 ± 7.20 out of the possible 50, with higher scores reflecting more stigmatizing attitudes. Paramedics, nurses’ aides, and housekeeping staff had the highest, and VCT personnel had the lowest average stigma scores, respectively. Multivariable regression analyses showed that prior experience of working with PLHIV (β=-2.48; P=.03), exposure to HIV-related educational courses (β=-2.03; P=.02), and <10 years of work experience (β=-2.70; P<.001) were associated with lower stigma scores.

Conclusion: Our findings highlight the need for health managers to provide training opportunities for healthcare providers, including programs that focus on improving HIV-related knowledge for healthcare providers. Enforcing policies that aim to reduce HIV-related stigma and discrimination among healthcare providers in Iran are urgently needed.

Health literacy among Iranian adults: findings from a nationwide population-based survey in 2015

Background

Health literacy is one of the most important determinants of noncommunicable diseases prevention. Health literacy is associated with elevated risks for poorer access to care, adverse health outcomes, and increased hospitalization and health costs.

Aims

This study aimed to determine the level of health literacy among the general adult population in the Islamic Republic of Iran.

Methods

Using a cross-sectional study during 2014-2015 with a multistage cluster sampling approach, we administered a pilot-tested standardized questionnaire to assess different domains of health literacy (i.e., reading, comprehension, communication/decision-making and Interpretation/judgment skills, individual and social empowerment, health information access and health information use) among 8439 (3935 males) individuals aged 18-60 years. Data were collected through face-to-face interviews. Descriptive statistics and multivariable linear regression method using SPSS (20) were applied to identify the factors associated with health literacy among Iranian adults.

Results

The mean health literacy level was 10.2±3.8 (out of 20). Only 18% (95% confidence interval [CI]: 17.15-18.78) of the participants had adequate health literacy, while 45.7% (95% CI: 44.64-46.78) had inadequate, and the 36.3% (95% CI: 35.21-37.33) had moderate health literacy. In the adjusted linear regression model, education level (the smallest β = 4.35, P < 0.001), age (β = 0.01, P = 0.002), female sex (β = 0.45, P < 0.001), residency in rural areas (β = 0.26, P < 0.001) and having permanent job (β = 1.03, P < 0.001) were significantly associated with more health literacy.

Conclusion

Our findings highlighted that the Iranian adult population has an insufficient level of health literacy, which calls for comprehensive education planning to improve the levels, with special attention to certain subpopulations (e.g. illiterate populations) and domains (e.g. individual empowerment).

Prevalence of elder abuse and associated factors among community-dwelling older adults in Iran

The aim of this study was to investigate the prevalence of elder abuse and associated factors among community-dwelling older adults Kerman province, Iran. In this cross-sectional descriptive study, 200 elderly people in Kerman were included using multi-stage sampling. 51.4% of the elderly reported abuse. 17.5% reported physical abuse, 20.9% reported verbal abuse, and 26.4% reported non-verbal abuse. Also, 11.5% reported self-neglect and 6.5% were neglected by others. 11.4% of the elderly reported abandonment and 14.9% reported financial abuse. There was a significant relationship between economic stress and neglect (P = .01), the risk of abuse in the elderly with a very good health status was about 50% less than that in others (P < .001). Elderly experience different types of abuse. Therefore, proper knowledge of elder abuse, especially emotional abuse and its related factors, including economic stress and health status, can increase knowledge and sensitivity of society, in order to avoid this dilemma.

Application of Social Cognitive Theory to Prevent Waterpipe Use in Male High-school Students in Kerman, Iran

BACKGROUND

The growing supply and prevalence of waterpipe (WP) smoking among Iranian adolescents have become a concern for both families and policymakers. The aim of this study was to determine the factors underlying WP use and also to design an intervention program based on social cognitive theory (SCT) aimed to reduce the demand for WP smoking among male adolescents.

METHODS

This quasi-experimental study involved 189 high-school students in Kerman, Iran, who were split into two groups, an intervention group and a control group. A validated questionnaire based on SCT constructs was used to collect data. The intervention was performed over four sessions with a focus on preventing WP smoking.

RESULTS

Before intervention, the lifetime and current-use prevalence of WP smoking across both groups was 48.5% and 20.2%, respectively. In the intervention group, the most change was related to knowledge score from 10.70 ± 4.38 to 16.52 ± 3.89 (P < 0.0001) and outcome values score from 12.40 ± 3.81 to 13.53 ± 4.23 (P = 0.007); however, in the control group, no significant changes were seen in posttest scores. The scores for self-efficacy (P = 0.21), outcome expectations (P = 0.09), and environment constructs (P = 0.06) did not show any statistically significant changes after the intervention in both groups. Overall, there was no significant difference in the rate of WP smoking after the intervention.

CONCLUSIONS

Based on the results of this study, although some construct scores showed significant differences after the intervention, there was no significant change in the prevalence of WP smoking. More effective educational interventions based on this theory but with a greater focus on self-efficacy and environmental influences may be warranted.

Risk factors for fall in elderly with diabetes mellitus type 2

AIMS

Diabetes mellitus type 2 (DMT2) is a major chronic condition that also common in older people, and associated with an increased risk of falling. This study aimed to determine the risk factor of fall in elderly with DMT2.

METHODS

In this cross-sectional study, 220 elderly diabetic patients who had referred to diabetes center in Kerman were chosen via convenience sampling method. To collect data, Semi-structured Fall Risk questionnaire and the Pittsburgh Sleep Quality Index (PSQI) were used.

FINDINGS

The mean age was estimated to be 69.82 (SD: 9.9) years. Among the participants, 38.5% suffered falls in the past one year. Good sleep quality (OR = 0.45, 95% CI = 0.1-0.85) and appropriate environment (OR = 0.6, 95% CI = 0.1-0.77) were significantly associated with a lesser odd of having recurrent falls. Gait problem (OR = 1.8, 95% CI = 1.1-4.9), balance difficulties (OR = 2.1, 95% CI = 1.24-7.12), hypotension (OR = 1.7, 95% CI = 1.2-5.6), and medication above three medicine (OR = 1.55, 95% CI = 1.12-6.34) were significantly associated with a greater odd of having recurrent falls.

CONCLUSION

It would therefore appear that older diabetic patients would be a suitable target group for a strategy aimed at preventing falls. Early recognition of the multiple causes of falls in the older diabetic patient and prompt referral of this group of patients to a specialist falls clinic is recommend.

A Successful implementation of an idea to a nationally approved plan: Analyzing Iran's National Health Roadmap using the Kingdon model of policymaking

Introduction: Hospital beds, human resources, and medical equipment are the costliest elements in the health system and play an essential role at the time of treatment. In this paper, different phases of the NEDA 2026 project and its methodological approach were presented and its formulation process was analysed using the Kingdon model of policymaking. Methods: Iran Health Roadmap (NEDA 2026) project started in March 2016 and ended in March 2017. The main components of this project were hospital beds, clinical human resources, specialist personnel, capital medical equipment, laboratory facilities, emergency services, and service delivery model. Kingdon model of policymaking was used to evaluate NEDA 2026 development and implementation. In this study, all activities to accomplish each step in the Kingdon model was described. Results: The followings were done to accomplish the goals of each step: collecting experts' viewpoint (problem identification and definition), systematic review of the literature, analysis of previous experiences, stakeholder analysis, economic analysis, and feasibility study (solution appropriateness analysis), three-round Delphi survey (policy survey and scrutinization), and intersectoral and interasectoral agreement (policy legislation). Conclusion: In the provision of an efficient health service, various components affect each other and the desired outcome, so they need to be considered as parts of an integrated system in developing a roadmap for the health system. Thus, this study demonstrated the cooperation process at different levels of Iran's health system to formulate a roadmap to provide the necessary resources for the health sector for the next 10 years and to ensure its feasibility using the Kingdon policy framework.

A Population-Based Survey to Determine Association of Perceived Social Support and Self-Efficacy With Self-Care Among Elderly With Diabetes Mellitus (Kerman City, Iran)

This survey examined association between social support and self-efficacy with self-care in elderly with diabetes. A total of 374 subjects were identified in Kerman city, Iran who responded to questionnaires on self-care, social support, and self-efficacy. Data were analyzed by using SPSS. Along with customary descriptive statistics, we also determined group difference for self-care, and Pearson correlation, and prediction value of various variables by using hierarchical multiple regression. And 67.37% of subjects were classified as poor adherence to self-care; 55.9% patients reportedly had good foot care habits, while 68.4% patients were not taking adequate physical activity. There was a significant correlation between self-care with social support and self-efficacy. Independent variables accounted for 44.3% of the variance in self-care. Diabetes care programs should aim to implement (a) weekly free-of-cost mass physical activity programs, (b) mass education adapted for gender- and age-based needs, and

Predictors of Self-care among the Elderly with Diabetes Type 2: Using Social Cognitive Theory

INTRODUCTION

Diabetes is one of the most common chronic diseases among the elderly and is also a very serious health problem. Adopting theory-based self-care behaviors is an effective means in managing such diseases. This study aimed to determine the predictors of diabetes self-care in the elderly in Kerman based on a social cognitive theory.

MATERIAL AND METHODS

In this cross-sectional study, 384 elderly diabetic patients who had referred to health screening centers in Kerman were chosen via cluster sampling. To collect information about self-care and its predictors, Toobert Glasgow's diabetes self-efficacy scale as well as a questionnaire was used which was based on social cognitive theory constructs. The validity and reliability of the questionnaire was confirmed. The data were analyzed using Pearson correlation and linear regression analysis in SPSS software 17.

FINDINGS

Among the subjects, 67.37% (252) had poor self-care ability; 29.14% (109) had average ability, and 3.40% (13) enjoyed a proper level of self- care ability. There was a significant relationship between the constructs of the social cognitive theory (knowledge, self- efficacy, social support, outcome expectations, outcome expectancy and self-regulation) and the self-care score. Furthermore, the mentioned constructs could predict 0.47% of the variance of the self-care behaviors.

CONCLUSION

self-care behaviors in this study were poor. Therefore, it is necessary to develop an educational intervention based on cognitive theory constructs with the goal of properly managing diabetes in the elderly patients.

Development of Risk-Taking Tendency Tool for High School Students

BACKGROUND

Adolescence is the age of increased sensation-seeking and risk-taking. To prevent such behaviors, the adolescent tendency to engage in high-risk behaviors must be measureable. This study aimed to develop a questionnaire about risk-taking tendencies among Iranian students.

METHODS

This study was conducted using cluster sampling of the tenth-grade students in three cities in Kerman province, Iran. The students were assured that the questionnaires would remain anonymous and unlinked. Construct validity was assessed using exploratory factor analysis (EFA) and comparison of known groups. Corrected item-scale correlation and Cronbach's alpha were calculated to evaluate reliability.

FINDINGS

A total of 551 high school students participated in this study. Of these, 57 were excluded after checking the "non-existent drug" item (10.3%). Girls accounted for 49.2% of the sample. Of the 33 initial questions, 13 were removed due to factor loading of less than 0.5. Two factors were extracted using the scree plot ("drug abuse tendency" and "other risky behavior tendency"). The tendency toward high-risk behavior was significantly higher in male students than in female ones (P < 0.001). This indicates the known group validity of the questionnaire. The Cronbach's alpha of the above-mentioned factors were 0.93 and 0.83, respectively.

CONCLUSION

The questionnaire measuring the tendency toward high-risk behavior among students showed acceptable validity and reliability.

The Prediction of the Risk Level of Pulmonary Embolism and Deep Vein Thrombosis through Artificial Neural Network

Background:

Venous thromboembolism is a common cause of mortality among hospitalized patients and yet it is preventable through detecting the precipitating factors and a prompt diagnosis by specialists. The present study has been carried out in order to assist specialists in the diagnosis and prediction of the risk level of pulmonary embolism in patients, by means of artificial neural network.

Method:

A number of 31 risk factors have been used in this study in order to evaluate the conditions of 294 patients hospitalized in 3 educational hospitals affiliated with Kerman University of Medical Sciences. Two types of artificial neural networks, namely Feed-Forward Back Propagation and Elman Back Propagation, were compared in this study.

Results:

Through an optimized artificial neural network model, an accuracy and risk level index of 93.23 percent was achieved and, subsequently, the results have been compared with those obtained from the perfusion scan of the patients. 86.61 percent of high risk patients diagnosed through perfusion scan diagnostic method were also diagnosed correctly through the method proposed in the present study.

Conclusions:

The results of this study can be a good resource for physicians, medical assistants, and healthcare staff to diagnose high risk patients more precisely and prevent the mortalities. Additionally, expenses and other unnecessary diagnostic methods such as perfusion scans can be efficiently reduced.

Pattern of Substance Use and Related Factors in Male Prisoners

BACKGROUND

Prisoner's addiction is one of the major problems in many countries which imposes very high medical costs and social harm to communities. This study investigated the pattern of substance use and related factors in male prisoners in one of the prisons in southeastern Iran.

METHODS

This cross-sectional study was carried out in 2016. The study population was inmates of a prison in southeast Iran. Sampling was carried out randomly according to the list of prisoners. Data were collected using a form and were analyzed with statistics software SPSS.

FINDINGS

More than four-fifths (75.3%) of the subjects consumed at least one substance (alcohol, tobacco and other drugs), 74.4% were smoking, 73.2% used a narcotic substance, and about one-fifth (19.3%) reported drinking alcohol. With a frequency of 62.0%, opium was the most frequently utilized narcotic substance. Poppy juice (31.6%), cannabis (29.8%), crystal (16.9%) and tramadol (16.9%) were the next frequent substances used. A percentage of 41.5% subjects reported using two or more drugs. A percentage of 80.7% subjects reported substance use among their friends, 39.2% by siblings and 37.2% by father. Regression analysis showed predictor variables of substance use were education, substance use by prisoner before being imprisoned, substance use by father, friends and siblings.

CONCLUSION

This study showed a remarkable prevalence of substance use in prisons, which was more than general population. Therefore, it is necessary to consider alternative penalties of imprisonment due to the factors associated with substance use. Screening of people at high risk for substance use should be considered on admission to prison, and primary prevention measures should be focused on them.

Iranian Health Literacy Questionnaire (IHLQ): An Instrument for Measuring Health Literacy in Iran

BACKGROUND

Promoting Health Literacy (HL) is considered as an important goal in strategic plans of many countries. In spite of the necessity for access to valid, reliable and native HL instruments, the number of such instruments in the Persian language is scarce. Moreover, there is no good estimation of HL status in Iran.

OBJECTIVES

The aim of this study was to provide a valid, reliable and native instrument to measure and monitor community HL in Iran and also, to provide an estimation of HL status in two Iranian provinces.

PATIENTS AND METHODS

By applying the multistage cluster sampling, 1080 respondents (540 from each gender) were recruited from Kerman and Mazandaran provinces of Iran, from February to June 2014 to participate in this cross-sectional study. The development of the Iranian Health Literacy Questionnaire (IHLQ) was initiated with a comprehensive review of the literature. Then, face, content and construct validity as well as reliability were determined.

RESULTS

Internal consistency and test-retest reliability (ICC) of the factors was in the range of 0.71 to 0.96 and 0.73 to 0.86, respectively. In order to construct validity, Exploratory Factor Analysis (EFA) Kaiser-Meyer-Olkin (KMO) = 0.95 and Bartlett's test result of 3.017 with P < 0.001) with varimax rotation was used. Optimal reduced solution, including 36 items and seven factors, was found in EFA. Five of the factors identified were reading/comprehension skills, individual empowerment, communication/decision-making skills, social empowerment and health knowledge.

CONCLUSIONS

It was concluded that IHLQ might be a practical and useful tool for investigating HL for Persian language speakers around the world. Since HL is dynamic and its instruments should be regularly revised, further studies are recommended to assess HL with application of IHLQ to detect its potential imperfections.

Validity and reliability of the Persian versions of WOMAC Osteoarthritis Index and Lequesne Algofunctional Index

The WOMAC Osteoarthritis Index and Lequesne Algofunctional Index have not been translated and validated for Iranian patients with osteoarthritis (OA) of the knee or hip. The aim of this study was to validate the Persian form of WOMAC OA Index and Lequesne Algofunctional Index and to assess their test-retest reliability and convergent validity. Forward/backward translations and consensus panels were conducted to obtain the Persian versions of WOMAC OA Index and Lequesne Algofunctional Index. A non-probability sample of 116 patients with knee/hip osteoarthritis was asked to complete the WOMAC OA Index and Lequesne Algofunctional Index as well as Medical Outcomes Study-20-Item Short Form (SF-20) questionnaires, a visual analogue scales (VAS) of pain and demographic information form. Internal consistency (using Cronbach's alpha) and convergent validity (by examining the Pearson's correlation coefficients) were evaluated to determine the psychometric properties of the questionnaires. In order to evaluate test-retest reliability, 20 randomly selected patients completed the questionnaires, on a second occasion, 7-10 days later. Cronbach's alpha coefficients and intraclass correlation coefficients for the WOMAC OA Index and Algofunctional Index subscales ranged from 0.63 to 0.94 and from 0.53 to 0.96, respectively. Statistically significant correlations were found between WOMAC OA Index, Algofunctional Index and SF-20 subscales and VAS for pain. The Persian version of WOMAC demonstrated a more acceptable validity, internal consistency and reliability compared with the Lequesne Algofunctional Index. However, both indices are valid and reliable instruments for evaluating the OA severity of knee/hip in Iran.