Factors Related to Health Literacy Among the Iranian Population: A Scoping Review

Background

The identification of the determinants of health literacy is an essential prerequisite for developing health literacy promotion programs. While these factors have been reported in previous studies, there is a lack of a comprehensive review specifically focused on the Iranian population. Therefore, this review aimed to identify the factors related to health literacy in Iran.

Methods

This scoping review used the Arksey and O'Malley methodological framework and the Joanna Briggs Institute framework. A search was performed in English-language databases-Web of Science, Scopus, and PubMed-using the MeSH keyword of "health literacy," and in Persian-language databases-Magirean and SID-using the related keywords. A narrative synthesis was conducted to describe all included studies' characteristics and explore factors associated with health literacy.

Results

A total of 76 studies were included. Based on the results of the study, related factors included personal factors-including sex, age, education level, field of study, parents' education level, marital status, occupation, work experience, employment status, ethnicity, income, socioeconomic status, medical history, duration of disease, addiction, number of children, media literacy, information literacy, computer literacy, and self-efficacy-situational factors-including use of the internet, use of social networks, social support, source of information, and participation in health education classes-and societal and environmental factors-including place of residence and type of insurance.

Conclusion

Modifiable factors identified in this study were self-efficacy, social support, information sources, media literacy, information literacy, computer literacy, internet or social networks, and participation in health education classes. Planners can consider these factors when developing interventions to promote health literacy.

Coping Strategies with Genito-Pelvic Pain/Penetration Disorder: A Qualitative Study

Background

Genital/pelvic pain penetration disorder (GPPPD) decreased mental and physical functioning, reduced quality of life, and reduced feelings of inadequacy and worthlessness, all of which impair the ability of women with GPPPD to enjoy sex. This qualitative study was conducted to identify which factors can reduce sexual stress and help Iranian women cope with GPPPD.

Methods

This qualitative study was conducted through the participation of 18 women with GPPPD diagnosed by a sexologist and using DSM-IV diagnostic criteria from March to July 2022, Iran. The samples were selected using the purposive sampling method and considering the maximum variation. The semistructured question guide was used as a data collection tool and data collection continued until data saturation was reached. The collected data were analyzed using conventional content analysis approach.

Results

Data analysis led to the emergence of three main themes: "problem-focused coping" which included the three categories of received social support, problem self-control, and penetration replacement; "emotion-focused coping" which included three categories: a couple's negative reaction to the problem, attachment disorder, and surrendering the problem; and "treatment-seeking" which consisted of searching and choosing a therapist to solve the problem, ineffective medical approaches, and ineffective nonmedical approaches.

Conclusion

Coping strategies in women with GPPPD were classified as "problem-focused coping," "emotion-focused coping," and "treatment-seeking." These findings indicate a need for GPPPD information and education, as well as a need for healthcare professionals to actively inquire about sexual problems and commit to serious treatment efforts. Cultural interventions that promote sexual pleasure can aid in the management of GPPPD.

Sexual health literacy and its related factors among couples: A population-based study in Iran

Sexual health literacy is one of the factors that affect sexual health. Several factors can influence sexual health literacy. As a result, the current study was carried out to determine sexual health literacy and its associated factors among Iranian couples. In 2022, 410 couples of reproductive age were referred to comprehensive health service centers and private clinics in Kerman city for the descriptive-analytical study. The study questionnaires included sexual health literacy for adults, sexual knowledge and attitude scale, marital intimacy scale, sexual intimacy scale, depression anxiety stress scale, sexual self-efficacy, the multidimensional scale of perceived social support, and socioeconomic status. Finally, multiple linear stepwise regression models were used to determine the factors related to sexual health literacy using the SPSS software version 22. According to the findings of this study, the mean(SD) of sexual health literacy in couples was 68.76(12.96), which was a desirable level. Furthermore, the findings revealed that sexual self-efficacy (B = 0.649، P<0.001), sexual knowledge and attitude (B = 0.217، P<0.001), the ability to identify reliable and non-reliable sources (B = -3.116، P<0.001), feelings of shame and embarrassment for obtaining sexual information (B = 1.860، P = 0.011), social support (B = 0.127، P<0.001) and the obscenity of sexual issues in family (B = 1.764، P = 0.015) were the final predictors of sexual health literacy in couples. It is suggested that researchers and health managers consider these factors when designing interventions to promote sexual health literacy.

Component of sexual health services for vaginismus management: A qualitative study

BACKGROUND

Provision of sexual health services requires gender-sensitive management, facilities, and staff, as well as planning for gender-sensitive caregivers and education. Couples suffering from vaginismus face many types of barriers to accessing sexual health services. This qualitative study was conducted to explain the needs of sexual health services in women with primary vaginismus in Iran.

METHODS

This qualitative study was conducted through the participation of 20 participants including service providers, women with vaginismus and their husbands in 2022, Iran. The samples were selected using purposive sampling method and considering the maximum variation. For data collection, in-depth semi-structured individual interviews were conducted and continued until data saturation was reached. The collected data were analyzed in MAXQDA10 software using conventional content analysis approach based on the criteria proposed by Graneheim and Lundman.

RESULTS

Data analysis led to the emergence of three main themes: 1) Comprehensive preventive sex education which included the three categories of sex education in the education system, premarital sex education through the health system, and sex education through the media with scientific content; 2) Efficient sexual health clinics which included three categories of therapist's skills, empowerment of sexual therapist, and structural features of sexual health clinics and cultural considerations in establishing sexual health clinics; and 3) Protocol for management and treatment of sexual problems which consisted of sexual education and counseling content, treatment requirements, and sex education approaches.

CONCLUSION

Based on the results of the study, comprehensive preventive sex education through the education system and the Ministry of Health can improve the attitudes of adolescents and young people. Moreover, it can take a fundamental step in solving sexual problems by providing the infrastructure necessary for the establishment of efficient sexual health clinics and protocols required to manage and treat such problems.

Sexual function among women with vaginismus: a biopsychosocial approach

BACKGROUND

Vaginismus is known as a type of sexual pain disorder. Regarding the multifactorial nature of vaginismus, the biopsychosocial model is one of the best models to describe this sexual disorder.

AIM

The present research was conducted to study the determinants of sexual function in women with and without vaginismus based on the biopsychosocial model.

METHODS

This case-control study was conducted in Iran on 420 women with and without primary vaginismus who met the inclusion criteria. All eligible people were included in the research once their eligibility was verified and their informed permission was acquired; convenience and purposive sampling techniques were used continually. Data collection tools included the demographic and obstetric information form and multiple published scales and questionnaires. Structural equation modeling with LISREL 9.2 software (Scientific Software International) was used to evaluate the determinants of the sexual function of vaginismus.

OUTCOMES

Participants rated their determinants of sexual function based on the biopsychosocial model.

RESULTS

The mean ages of the case and control groups were 27.67 and 28.44 years, respectively. The direct, indirect, and total effects of the dimensions of sexual health on sexual function and the diagnostic score of vaginismus of the women with vaginismus were significant (P < .001). Furthermore, based on the results, the diagnostic score of vaginismus in women with vaginismus was significantly affected by the direct, indirect, and cumulative impacts of vaginal penetration cognition and fear of sex (P = .016, P = .005). Women with and without vaginismus were able to accept the models' excellent fit.

CLINICAL IMPLICATIONS

This study helps inform health planners and policy makers about the sexual function of women with vaginismus, the factors related to this disorder, and the multidimensional nature of this sexual problem.

STRENGTHS AND LIMITATIONS

This study attempted to offer a more comprehensive and complete view of present knowledge via surveying different aspects of sexual health and by means of valid and reliable tools and path analysis. The study's merits include the use of the biopsychosocial model to evaluate sexual function in women with vaginismus, the use of a variety of questionnaires to compare women with and without vaginismus, and the size of the sample. The research was limited by the fact that electronic sampling was conducted because of the COVID-19 epidemic.

CONCLUSION

Based on the findings of the present study for the group of women with vaginismus, the direct, indirect, and overall effects of the majority of dimensions of sexual health were significantly correlated with sexual function and vaginismus.

The role of the Coronavirus pandemic on childbearing intentions in Iranian women based on path analysis: A cross-sectional study

Background

The Coronavirus disease (COVID-19) may lead to couples not being physically and mentally ready to assume a parenting role.

Objective

Given the changes in reproductive behaviors and the lack of accurate information about childbearing factors during the Coronavirus pandemic, this study was conducted to investigate the role of the COVID-19 pandemic in Iranian couples' childbearing intentions based on the theory of planned behavior model.

Materials and Methods

This cross-sectional study was conducted on 400 married Iranian women from July to October 2020 using official online popular social networks. Data were collected using a demographic checklist and the researcher-made questionnaire, which was designed based on the main constructs of the planned behavior model.

Results

Testing the indirect relationships of the mediation model effect showed a positive relationship between knowledge (β = 0.226, p < 0.001) and subjective norms (β = 0.155, p = 0.001) about COVID-19. Anxiety about COVID-19 mediated the relationship of knowledge (β = 0.105, p = 0.009), attitude (β = -0.125, p = 0.002), subjective norms (β = 0.238, p < 0.001), and perceived behavioral control (β = 0.513, p < 0.001) about COVID-19 with childbearing intentions.

Conclusion

The results showed that COVID-19-induced anxiety can affect the relationship between the components of the theory of planned behavior model and childbearing intentions. Therefore, it is suggested that by designing appropriate interventions through anxiety-reducing and relaxation techniques, a fundamental step can be taken in increasing childbearing desires.

Development and psychometric properties of Female Infertility Stigma Instrument (ISI-F): A sequential mixed method study

BACKGROUND

Infertility stigma is a hidden burden that overshadows the dimensions of reproductive and sexual health in infertile women. The aim of this study was to develop and evaluate the psychometric properties of the Female Infertility Stigma Instrument (ISI-F).

METHODS

This mixed method study with sequential exploratory design was conducted in qualitative and quantitative phases. In the first phase, the initial item pool of the Female Infertility Stigma Instrument (ISI-F) was generated using in-depth interviews. In the quantitative phase, psychometric properties of the ISI-f including content, face and construct validity, as well as reliability (internal consistency and stability) were assessed. Exploratory factor analysis was performed on the collected data from 300 infertile women for evaluation of construct validity. Data was analyzed using SPSS version 20. This study has followed the Mixed Methods Article Reporting Standards checklist.

RESULTS

The final version of ISI-F had 20 items. Total CVI and CVR were 0.94 and 0.87, respectively. Explanatory factor analysis identified 3 main factors that explained 54.013% of the variance. These factors consisted of stigma profile (7 items), self-stigma (6 items) and escaping from stigma (7 items). Internal consistency and stability of the ISI-F has been approved by Cronbach's alpha, McDonald's Omega (0.909, 0.916) and Intraclass Correlation Coefficient (ICC = 0.878).

CONCLUSION

The Female Infertility Stigma Instrument (ISI-F) is a valid and reliable tool for evaluation of the perceived female infertility stigma, that was developed in this study.

The Maternal Postpartum Quality of Life Instrument (MPQOL-I): development and psychometric evaluation in an exploratory sequential mixed-method study

Background

“ Postpartum quality of life” refers to women’s satisfaction of their position in life, based on cultural status, expectations, values, attitudes, goals, and living standards. Hence the need to pay attention to more specific dimensions of quality of life in the postpartum period is being sensed. This study was conducted to develop the Maternal Postpartum Quality of Life Instrument (MPQOL-I) and assess its psychometric properties.

Methods

This methodological study was conducted in 2019–2020. This exploratory, sequential mixed-method study was conducted in two phases. The first phase is MPQOL-I development and the second phase is psychometric evaluation of the developed scale. In the quantitative (psychometric evaluation) phase, face, content, construct, convergent, and discriminant validity and reliability of the scale were tested.

Results

In this study, 5 factors were extracted from items through exploratory factor analysis: (1) received support, (2) sexual relations, (3) bonding with newborn, (4) breastfeeding and newborn care, and (5) the transition period. These factors accounted for 53.26% of the total variance. The results of the confirmatory factor analysis suggested the goodness-of-fit indices was acceptable. Furthermore, the internal consistency and composite reliability indices of factors were greater than 0.7.

Conclusion

The sixteen-item Persian language MPQOL-I is a valid and reliable instrument for postpartum quality of life assessment. It includes items from different aspects of postpartum quality of life and can be used for the early diagnosis of impaired postpartum quality of life. Further studies are needed to assess the psychometric properties of MPQOL-I in different cultures and communities.

Evaluation of the Predictors of the Quality of Life in the Postpartum Period: A Cross-Sectional Study

BACKGROUND

It is necessary to study the predictors of life quality in the early postpartum period. Early diagnosis, timely care and intervention can improve the health of mother and baby. We aimed to evaluate the predictors of the quality of life in the postpartum period.

METHODS

This cross-sectional study was conducted on 407 eligible women aged 18 to 47 yr, in the postpartum period, selected from clinics affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran in 2018. Data were collected using a demographic and obstetric questionnaire and Maternal Postpartum Quality of Life (MAPP-QOL) with Cronbach's alpha coefficients of 0.96 to assess personal details and postpartum quality of life. Data analyzed using SPSS. Linear regression analysis was performed to examine the relationship between maternal predictors and quality of life in the postpartum period.

RESULTS

The postpartum quality of life had a significant relationship with income status (P<0.001), Number of Children (P=0.031), mother's education(P=0.009) and maternal complications (P<0.001).

CONCLUSION

This study confirmed the relationship between maternal predictors and the postpartum quality of life. It could facilitate clinicians and educators to improve the quality of life for postpartum women.

The translation and psychometric assessment of the SCOFF eating disorder screening questionnaire: the Persian version

BACKGROUND

Eating Disorders (EDs) are defined by abnormal eating habits. The SCOFF (Sick-Control-One stone-Fat-Food) is a simple screening questionnaire for EDs. This study was conducted to translate and evaluate the psychometric properties of the SCOFF questionnaire in Iranian university students.

METHODS

A total of 310 Iranian students of the Shahid Beheshti University of Medical Sciences completed a test battery of questionnaires including the well-known screener of eating disorder symptoms, the SCOFF. All measures were presented to the participants in Persian. The 5-item SCOFF questionnaire was translated to Persian using the forward-backward method. The face, content, criterion, and construct validity of the Persian version of the SCOFF were assessed. The validity and reliability of the Persian version of the SCOFF was assessed and factor analysis was conducted.

RESULTS

All five items of the translated questionnaire were approved after face validity. Content validity ratio was 0.73 (range 0.66-0.83) and content validity index was 0.96 (range 0.91-1), so all items were approved. Exploratory factor analysis revealed a 2-factor structure, which explained 52.47% of the variance. Confirmatory factor analysis showed a very good goodness-of-fit for the 2-factor model. 2-factor and 1-factor models indicate a very good goodness-of-fit in females and adequate goodness-of-fit in males. Criterion validity showed an acceptable correlation between the SCOFF and the EDE-Q. Reliability was acceptable based on the stability [ICC = 0.905(95% CI .760-.962 p < 0.001)] and the internal consistency (KR20 = 0.4).

CONCLUSION

Appropriate psychometric properties of the 5-item Persian version of the SCOFF (both models) were confirmed, suggesting its use as a valid questionnaire in EDs screening.

Diagnostic accuracy of first and early second trimester multiple biomarkers for prediction of gestational diabetes mellitus: a multivariate longitudinal approach

BACKGROUND

Gestational Diabetes Mellitus (GDM) is an underlying cause of maternal and newborn morbidity and mortality all around the world. Timely diagnosis of GDM plays an important role in reducing its adverse consequences and burden. This study aimed to determine diagnostic accuracy of multiple indicators in complete blood count (CBC) test for early prediction of GDM.

METHODS

In this prospective cohort study, the data from 600 pregnant women was analyzed. In the study sample, the two-step approach was utilized for the diagnosis of GDM at 24-28 weeks of gestation. We also used the repeated measures of hemoglobin (Hb), hematocrit (Hct), fasting blood sugar (FBS) and red blood cell count (RBC) in the first and early second trimesters of pregnancy as the longitudinal multiple indicators for early diagnosis of GDM. The classification of pregnant women to GDM and non-GDM groups was performed using a statistical technique based on the random-effects modeling framework.

RESULTS

Among the sample, 49 women (8.2%) were diagnosed with GDM. In the first and early second trimester of pregnancy, the mean HcT, Hb and FBS of women with GDM was significantly higher than non-GDMs (P < 0.001). The concurrent use of multiple longitudinal data from HcT, Hb, RBC and FBS in the first and early second trimester of pregnancy resulted in a sensitivity, specificity and area under the curve (AUC) of 87%, 70% and 83%, respectively, for early prediction of GDM.

CONCLUSIONS

In general, our findings showed that the concurrent use of repeated measures data on Hct, Hb, FBS and RBC in the first and early second trimester of pregnancy might be utilized as an acceptable tool to predict GDM earlier in pregnancy.

Bio-psychosocial factor of vaginismus in Iranian women

Background and aim

Various physical, psychological, social and cultural factors contribute to vaginismus. Therefore, given the multidimensionality of this disorder and the need to pay more attention to all biological, psychological and social dimensions in its treatment, the present study was conducted to investigate the bio-psychological factors contributing to vaginismus.

Methods

This descriptive cross-sectional study was conducted on 180 Iranian women with vaginismus who had been referred to sexual health clinics of Tehran province in 2020. Multistage random sampling method was used in this study, and vaginismus was diagnosed in women by a specialist through using a questionnaire. Data collection tools included demographic and obstetric information form, valid and reliable Sexual Function Questionnaire, Depression Anxiety Stress Scales (DASS), Sex Fear Questionnaire, Vaginal Penetration Cognition Questionnaire, Sexual Self-Efficacy Scale, Sexual Knowledge and Attitude Scale, Sexual Quality of Life-Female, Inventory of Sexual Satisfaction, ENRICH Marital Satisfaction Scale, Sexual Intimacy Scale and Questionnaire for Diagnosis of Vaginismus. In order to determine the factors related to vaginismus, multiple linear regression model was used through SPSS software version 25 (SPSS Inc., Chicago, IL).

Results

Based on the results of the present study, the mean age of women and the mean duration of their marriage were 27.77 ± 5.36 and 4.07 ± 3.87 years respectively. As the results of multiple linear regression revealed, the variables of fear of sex (B = 0.141, P = 0.036), positive cognition (B = 0.197, P = 0.046), self-image (B = 0.651, P = 0.001), sexual intimacy (B = -0.116, P = 0.021), quality of sexual life (B = 0.115, P = 0.002) and education (B = 2.129, P = 0.024) from the bio-psychosocial model were the final predictors of vaginismus diagnosis score in women with this disorder. According to the results of multiple linear regression, 45.5% of the variance of vaginismus diagnosis total score was explained by these variables (R = 0.706, R2 = 0.498 and ADJ.R2 = 0.455).

Conclusion

The results of the present study showed that the variables of fear of sex, positive cognition and negative self-image, sexual intimacy, quality of sexual life and education were the final predictors of vaginismus diagnosis score. This disorder is, thus, considered to be multidimensional.

As a sexual dysfunction, Vaginismus prevents sexual penetration through involuntary and frequent spasms of the muscles in the one-third of vagina's outer part. Factors such as negative beliefs about sex, cultural factors, fear of pain, injury, bleeding and so forth play significant roles in the prediction of vaginismus. Therefore, given the multidimensionality of vaginismus and the need to pay attention to all biological, psychological and social dimensions in treating it, and since the bio-psychosocial model is a strong framework for the factors contributing to sexual problems whose recognition will lead to the design of multidimensional treatments, the present study was conducted on 180 Iranian women with vaginismus to investigate the bio-psychological factors associated with vaginismus. The present study showed that the fear of sex, positive cognition and negative self-image, sexual intimacy, quality of sexual life and education from the bio-psychosocial model were the final predictors of vaginismus diagnosis score. Therefore, this model can be used in designing interventions for the treatment of vaginismus, especially in the psychological and interpersonal domains.

Psychometric properties of vaginal penetration cognition questionnaire (VPCQ) in Iranian women with sexual pain disorders

Aim

The aim of this study was to investigate the psychometric properties of the Persian version of the Vaginal Penetration Cognition Questionnaire (VPCQ).

Design

Cross‐sectional study.

Methods

This research was conducted in two phases from June 2019 to February 2020. Phase I: The World Health Organization Protocol of forward–backward translation and an expert panel in order to determine face and content validity. Phase II: Survey development with 352 eligible women with sexual pain disorders, construct validity, internal consistency and construct reliability were evaluated.

Results

The exploratory factor analysis showed that the Persian version of VPCQ has three factors that explained 53.94% of the total variance. Confirmatory factor analysis also confirmed the fit of the three‐factor model. Convergent and divergent validity were confirmed for all factors. The average measure ICC was 0.99 (95% CI 0.98 to 0.99). The absolute reliability with estimated SEM of 2.67 and MDC% of 28% approved the reliability of the questionnaire.

Infertility Stigma: A Qualitative Study on Feelings and Experiences of Infertile Women

Background:

Infertility stigma is a phenomenon associated with various psychological and social tensions especially for women. The stigma is associated with a feeling of shame and secrecy. The present study was aimed to explore the concept of infertility stigma based on the experiences and perceptions of infertile women.

Materials and Methods:

This qualitative conventional content analysis study was conducted in Isfahan Fertility and Infertility Center, Iran. Data were collected through in-depth interviews with 17 women who had primary infertility. All the interviews were recorded, transcribed and analyzed according to the steps suggested by Graneheim and Lundman. The Standards for Reporting Qualitative Research (SRQR) checklist was followed for this research.

Results:

Eight hundred thirty-six initial codes were extracted from the interviews and divided into 25 sub-categories, 10 categories, and four themes. The themes included “stigma profile, self-stigma, defensive mechanism and balancing”. Stigma profile was perceived in the form of verbal, social and same sex stigma. Self-stigma was experienced as negative feelings and devaluation. Defensive mechanism was formed from three categories of escaping from the stigma, acceptance and infertility behind the mask. Two categories; empowered women and pressure levers, created a balancing theme against the infertility stigma.

Conclusion:

Infertile women face social and self-stigma which threatens their psychosocial wellbeing and self-esteem. They use defensive response mechanisms and social support to mitigate these effects. Education focused on coping strategies might be helpful against infertility stigma.

Psychometric properties of the Persian translation of maternal postpartum quality of life questionnaire (MAPP-QOL)

Background and objective

Many studies have been conducted in Iran on the postpartum quality of life, and the majority have used the general quality of life questionnaire. With a specific tool in this context, the dimensions of maternal postpartum quality of life can be more accurately determined. The present study was conducted to determine psychometric properties and validate the Persian version of the Maternal Postpartum Quality of Life Questionnaire (MAPP-QOL).

Materials and methods

The present methodological study was conducted in 2018. The original version of MAPP-QOL was translated into Persian by both forward and backward translation. In a cross-sectional study, the Persian version was completed by 407 eligible postpartum women aged 18 to 47 and living in Tehran. Reliability of the questionnaire was assessed using Cronbach's alpha coefficient and test–retest. For construct validity, exploratory and confirmatory factor analyses were used.

Results

The MAPP-QOL showed good content validity; content validity ratio (CVR) ranged from 0.6 to 1.00, and content validity index (CVI) ranged from 0.7 to 1.00. Using exploratory factor analysis, five factors, including Socioeconomic; Relational/Family-Friends; Psychological/Baby; Health & functioning; and Relational/Spouse-Partner, were extracted, which together explained 78.84% of the total variance. After modifications of CFA, the confirmatory factor analysis showed an acceptable goodness-of-fit. AVE value Above 0.5 exhibited appropriate convergent validity, and AVE greater than MSV confirmed divergent validity. The Cronbach's alpha, McDonald's Omega, Composite reliability and maximum reliability H of the five extracted factors were excellent (> 0.9). Also, the AIC values of the factors were good (between 0.721 to 0.859).

Conclusion

The 38-item Persian version of the postpartum quality of life questionnaire is adequately reliable for postpartum women in Iran. Given its appropriate psychometric properties, this scale is fit to be used in future studies on postpartum women.

Sources of get information and related factors during pregnancy among Afghan migrant women in Iran

AIM

The present study aims to investigate the sources of information and its related factors among pregnant Afghan migrant women who reside in southeast Tehran Province, Iran.

DESIGN

Cross-sectional study.

METHODS

A total of 280 pregnant Afghan women who received care at the prenatal clinics of selected healthcare centres in southeast Tehran Province (Iran) in 2018 enrolled in this study. Data were collected by continuous sampling by a questionnaire that asked about demographic, obstetric and sources of information used during pregnancy.

RESULTS

The most important sources of information accessed by pregnant Afghan women were healthcare providers (65.1%), family and friends (47.55%), the Internet (32.1%) and media (18.9%). There was statistically a significant relationship between sources of information and education level, number of children, length of residence in Iran, place of birth and insurance status.

Psychometric properties of the Iranian version of Birth Satisfaction Scale-Revised

Background:

The precise measurement of childbirth satisfaction demands a reliable tool specifically designed for maternal care and birth satisfaction. It was designed to measure the degree of women's satisfaction with childbirth. The purpose of the present study was to translate and analyze the psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R) in Iranian women.

Materials and Methods:

This is a methodological cross-sectional study. Five health centers in various regions of Kashan were affiliated to Kashan University of Medical Sciences, Kashan, Iran. Two hundred and twelve mothers who were referred to the health centers and had childbirth during the last year were included. The face and content validity were obtained after backward–forward translation of the Iranian version of BSS-R by 12 faculty board members in midwifery and reproductive health fields. The construct validity of the tool was determined using confirmatory factor analysis on 212 women in the postpartum period. The internal consistency and reliability of the tool was evaluated by Cronbach's alpha coefficient and intraclass correlation coefficient (ICC). The collected data were analyzed in SPSS (version 16.0) and EQS 6.1.

Results:

The result of face and content validity was minor modifications in some words. Confirmatory analysis results indicated that there was an acceptable fit with a three-factor model. Cronbach's alpha was estimated for the whole tool 0.74, and the alpha of the three subscales ranged from 0.698 to 0.801. ICC for determining reliability was 0.77.

Conclusion:

The Iranian version of BSS-R was a reliable and valid tool for assessing the women's satisfaction with their childbirth care.

Predictors of physical activity following gestational diabetes: Application of health action process approach

Aim

Regular physical activity can reduce the chance of developing type 2 diabetes in women with a history of gestational diabetes. The present study investigated the relationship between the constructs of the health action process approach and regular physical activity in women with a history of gestational diabetes.

Design

This was a cross-sectional study.

Methods

A total of 150 women who had given birth 6-24 months prior to the study and had experienced gestational diabetes in their recent pregnancy were selected using multistage cluster sampling. Data were collected from December 2018 to May 2019 using a researcher-made questionnaire including constructs of health action process approach.

Results

The common fit indices revealed that health action process approach had an acceptable fit to the observations (root mean square error of approximation = 0.054, Tucker-Lewis index = 0.95, comparative fit index = 0.955). The model's constructs predicted 48% of intention variance and 35% of physical activity variance. Action self-efficacy and coping planning were the most important predictors of intention and behaviour, respectively.

Diagnostic accuracy of maternal serum multiple marker screening for early detection of gestational diabetes mellitus in the absence of a gold standard test

Background

Gestational diabetes mellitus (GDM) is associated with adverse diabetic complications for both mother and child during pregnancy. The common Gold Standard (GS) for diagnosis of GDM is 75 g oral glucose tolerance test (OGTT) during 24–28 gestational weeks which seems a little late for any proper intervention. This study aimed to employ the Bayesian latent class models (LCMs) for estimating the early diagnostic power of combination of serum multiple marker in detecting GDM during 14–17 weeks of gestation.

Methods

Data from a sample of 523 pregnant women who participated in gestational diabetes screening tests at health centers affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran from 2017 to 2018 were used. The beta-human chorionic gonadotropin (β-hCG), unconjugated estriol (uE3), and alfa-fetoprotein (AFP) values were extracted from case records for all participants. The Bayesian LCMs were applied for estimating sensitivity, specificity, and area under receiver operating characteristic curve (AUC) of combining the three biomarkers’ results in the absence of GS, adjusting for maternal age and body mass index.

Results

The mean (standard deviation) maternal age of the participants was 28.76 (±5.33) years. Additionally, the mean (standard deviation) BMI was 24.57 (±3.22) kg/m². According to the Bayesian model, the cSensitivity, cSpecificity, and cAUC for the optimal composite diagnostic test were estimated as 94% (95% credible interval (CrI) [0.91–0.99]), 86% (95% CrI [0.80–0.92]), and 0.92 (95% CrI [0.87–0.98]), respectively.

Conclusions

Overall, the findings revealed that the combination of uE3, AFP, and β-hCG results might be considered as an acceptable predictor for detecting GDM with a rather high level of accuracy in the early second trimester of pregnancy without a GS.

The translation and psychometric assessment of the perception of empowerment in midwifery scale: the Persian version

Background

A major part of midwifery care involves the empowerment of women and their families for the control of factors affecting their health. To this end, midwives should experience their own empowerment first. The present study was conducted to translate and determine the psychometric properties of the Perception of Empowerment in Midwifery Scale among Iranian midwives.

Methods

A total of 380 people participated in this cross-sectional study. A demographic questionnaire and the 22-item Perception of Empowerment in Midwifery Scale were sent to the participants online. The validity of the scale and the analysis of its main components were carried out through exploratory factor analysis with Varimax rotation and confirmatory factor analysis. The reliability of the scale was assessed using the internal consistency method with Cronbach’s alpha coefficient, average inter-item correlation (AIC) and McDonald’s omega.

Results

Seventeen scale items were retained after the exploratory factor analysis, and five factors were extracted, including “effective management”, “professional practice”, “authority”, “advocacy”, and “professional informant”, with factor loadings ranging from 0.489 to 0.899. The five latent factors explained 53.07% of the overall variance of the scale. The confirmatory factor analysis showed an acceptable goodness of fit. The internal consistency of the scale was confirmed with a Cronbach’s alpha above 0.7.

Conclusion

The Persian version of the Perception of Empowerment in Midwifery Scale with 17 items has adequate reliability for midwives working in Iran. Given its appropriate psychometric properties, this scale is fit to be used among midwives in future studies.

Development and psychometric evaluation of the female infertility stigma instrument (ISI-F): protocol for a mixed method study

Background

Infertility stigma is one of the greatest challenges in most societies for reproduction and sexual health of infertile women. Since no specific tool exists for assessing the infertility stigma in women, this study would be conducted to develop and evaluate the psychometric properties of Female Infertility Stigma Instrument (ISI-F).

Methods

This is a mixed method study with sequential exploratory design (qualitative and quantitative phase). In the first qualitative phase, semi-structured interviews would be performed with infertile female who had experienced infertility whithout any psychological disorder. Women who are eligible for participating in the study will be selected using purposeful sampling method with maximum variation in terms of age, education, occupation and infertility duration. Data would be analyzed using conventional content analysis and in this phase the primary item pool will be developed for the Female Infertility Stigma Instrument (ISI-F). In the quantitative phase, the psychometric properties of the Instrument would be evaluated, including the content, face and construct validity as well as reliability via the internal consistency and stability. The psychometric properties described in the COSMIN checklist will be utilized for designing the instrument.

Discussion

Developing a valid and reliable scale for Female Infertility Stigma Instrument (ISI-F) would be helpful for future studies to assess the status of this situation. It also helps planning interventional studies for improvement of the reproductive health of infertile women.

Comparing the quality of life of women suffering from breast cancer receiving palliative care and ordinary care

Introduction: Breast cancer is the most prevalent cancer and leading cause of women’s mortality due to malignancy. Treatment increases the survival however it is associated with poor quality of life and bringing the patients toward palliative care. Objectives: This study was conducted to compare the quality of life in patients with breast cancer receiving palliative care and ordinary care. Patients and Methods: This descriptive-analytical study was carried out in Tehran hospitals (February to August 2017). The sample consisted of 220 breast cancer women who had completed the therapy four weeks prior to the study. The European Organization for Research and Treatment of Cancer quality of life Questionnaire (EORTC QLQ-C30), its supplementary breast cancer questionnaire (QLQ-BR23) and International Physical Activity Questionnaire (IPAQ) were applied to assess the quality of life of patients who received palliative care (n=110) and ordinary care (n=110). Descriptive and inferential statistics (t test and Mann-Whitney U test) were applied to analyze the data through SPSS 21. Results: The palliative care group demonstrated higher quality of life compared to the ordinary care group. Scores in functioning and global health were higher in the palliative care group than the ordinary care group. The palliative care group also had higher scores in sexual functioning, body image, future perspective, physical activity and lower scores in symptom scales, arm symptoms and hair loss than the ordinary care group (P<0.001). Conclusion: Palliative care provides more desired quality of life than ordinary care in breast cancer women and can be effective to improve the quality of life in these patients.

The effect of an educational intervention based on the theory of planned behavior on childbearing intentions in women: A quasi-experimental study

BACKGROUND

Childbearing is an important biological and social event in the life of most women. It is a voluntary behavior that can be affected by many factors. Behavioral theories are a potential path way to study and influence childbearing behavior. The present study was conducted to determine the effect of an educational intervention based on the theory of planned behavior (TPB) on childbearing intentions in women presenting to premarital counseling centers in Tehran.

MATERIALS AND METHODS

This randomized controlled quasi-experimental study was conducted on 150 women aged 20-35 years presenting to premarital counseling centers. The participating women were randomly divided into an intervention (n = 75) and a control (n = 75) group using randomized sampling in Excel. The intervention group received two 90-min sessions of training. The effect of training was assessed 6 weeks after the intervention using the researcher-made questionnaire based on the components of the TPB. The questionnaires included subjects' demographic details, knowledge (11 items), attitude (13 items), subjective norms (10 items), perceived behavioral control (8 items), and behavioral intention (4 items). Data were analyzed by SPSS software (version 22) and independent t-test, Chi-square, Mann-Whitney U-test, and Wilcoxon test. P <0.05 was considered statistically significant.

RESULTS

There were significant differences between the intervention and control group after the intervention in the Mean ± SD scores of knowledge (6.73 ± 2.63 vs. 4.73 ± 2.85, P = 0.001), attitude (48.23 ± 7.19 vs. 40.13 ± 5.80, P = 0.001), perceived behavioral control (33.19 ± 5.28 vs. 23.59 ± 3.47, P = 0.001), and behavioral intention (13.84 ± 2.95 vs. 11.77 ± 2.12, P = 0.027).

CONCLUSION

The findings showed that an education based on the TPB increased women's childbearing intentions by affecting their knowledge, attitude, perceived behavioral control, and intention. It is therefore essential to implement better public policies, create a more conducive educational setting for women of different age groups, and build a social support system.

Quality of life questionnaire for women with gestational diabetes mellitus (GDMQ-36): development and psychometric properties

Background

Gestational diabetes mellitus carries serious risks to mother and fetus and causes social, mental, and psychological consequences which can affect mothers’ quality of life. Accordingly, this study aims to develop and assess the psychometric properties of quality of life questionnaire for women with gestational diabetes mellitus.

Methods

A methodological study of sequential exploratory mixed method was developed and implemented. It included qualitative (development of a quality of life questionnaire for mothers with GDM) and quantitative (assessment of psychometric prosperities of quality of life questionnaire for mothers with GDM) phases.

Results

Based on the findings of the qualitative phase and literature review, the primary questionnaire was prepared with 142 items. The outcome of face validity and content validity assessment was a 67-item questionnaire. S-CVI and S-CVR turned out to be 0.92 and 0.68, respectively. The results of exploratory factor analysis yielded an instrument with 36 items in five domains including concerns about high-risk pregnancy, perceived constraints, disease complications, medication and treatment, and support. Five factors explained 46.68% of the total variance of the questionnaire. The results indicated a moderate and significant correlation between the questionnaire of “Diabetes Clients Quality Of Life” and the researcher-made questionnaire (r = 0.63). Cronbach’s alpha coefficient for the entire scale was 0.93 and the intra-class correlation coefficient was 0.95.

Conclusion

Quality of life questionnaire for mothers with GDM is a valid and reliable tool capable of measuring the quality of life of women with GDM.

Iranian version of Pelvic Girdle Questionnaire: Psychometric properties and cultural adaptation

Background

The Pelvic Girdle Questionnaire (PGQ) is a tool designed to evaluate pain and disability in pregnant women with pelvic girdle pain (PGP). This study was conducted with the aim of translating and determining the psychometric properties of PGQ in pregnant women in Iran.

Materials and Methods

The present methodological cross-sectional study was conducted on 150 pregnant women living in Tehran in 2017. The original English version of PGQ was translated into Persian version after the permission of the tool designer using the back-translation method. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) methods were used to determine the construct validity, as well as Cronbach's alpha and intraclass correlation coefficient (ICC) to determine the reliability of the questionnaire.

Results

The results of factor analysis showed that the study of this scale consists of two extracted subscales as activities and symptoms. EFA and CFA confirmed two factors that determined 70.22% variance. Furthermore, findings showed that high internal consistency with Cronbach's alpha = 0.961, for the total score of instrument and for the factors, ranged from 0.87 to 0.91. Cronbach's alpha symptoms and activities and total were 0.91, 0.87, and 0.87, respectively. ICC of symptoms and activities and total was 0.91 (95% confidence interval [CI]: 0.88-0.93), 0.81 (95% CI: 0.66-0.92), and 0.83 (95% CI: 0.68-0.93), respectively.

Conclusion

The Persian version of PGP, as a valid and reliable tool, has the potential for studying and evaluating the activity and symptoms of PGP in pregnant women in Iran.

Development and psychometric properties of the female adolescents' sexual reproductive self-care scale

INTRODUCTION

The aim of this study was to design and evaluate the psychometric properties of an instrument for understanding female adolescents' reproductive and sexual self-care behaviors.

METHODS

A methodological study was conducted. In the qualitative phase, individual in-depth interviews were performed to develop the initial questionnaire. In the quantitative part, the psychometric properties of the questionnaire were evaluated.

FINDINGS

The initial questionnaire with 128 items was reviewed by the research team and taking into account the cut-off point 1.5 for the item impact and 0.62 for the content validity ratio (CVR), the number of questions fell to 82 items. S-CVR and S-content validity index (CVI) rations were 0.83 and 0.91, respectively. Exploratory factor analysis led to 74 items in seven dimensions. The alpha Cronbach's coefficient for the whole questionnaire was 0.895 and the intra-cluster correlation coefficient was 0.91.

CONCLUSION

The questionnaire developed in this study is reliable and valid for assessing female adolescents' sexual and reproductive self-care.

Translation and Psychometric Testing Persian Version of Breast Cancer Screening Belief Questionnaire (BCSBQ) in Iranian Women

Introduction: Women's screening beliefs play an important role in their performance. Since a short form questionnaire is necessary in the assessment of screening beliefs in Iranian society, this study was conducted with the aim of psychometric evaluation of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ) among Iranian women.

Methods: In this cross-sectional methodological study, 300 Iranian women who were aged 18 years or older, and who were attending healthcare centers of Shahid Beheshti University of Medical Sciences, were selected in 2017-18. After a backward-forward translation procedure of BCSBQ was carried out, the face, content and construct validity of breast cancer-screening beliefs questionnaire were evaluated. In addition, the reliability was measured using the Cronbach's alpha and intra class correlation coefficients.

Results: The results of the exploratory and confirmatory factor analysis were used to extract three distinct factors, including: attitude, knowledge, and barriers to screening. The three-factor model fit was accepted for all factors based on standard indices (RMSEA = 0.12, χ² = 2.832, GFI = 0.87, AGFI = 0.8, CFI = 0.94, NFI = 0.92). In addition, the instrument’s reliability was measured using the Cronbach's alpha coefficient. The instrument had an appropriate Cronbach alpha (0.78). The interclass correlation coefficient was obtained to be 0.93 within a range of 0.83-0.97.

Conclusion: The three-factor structure of the BCSBQ-12 had appropriate validity and reliability among Iranian women. Considering its appropriate psychometric properties, this instrument can be employed in subsequent studies to measure women's breast cancer screening beliefs in Iran.

Strategies to improve menopausal quality of life: A systematic review

BACKGROUND

Menopause and its complications could disturb the sense of well-being and health and affect the quality of life. The present study was performed to review the conducted interventional study related to the quality of life in menopausal women in Iran.

METHODS

In the present systematic review, to achieve the intended studies, Iranian Registry for Clinical Trials and Magiran, SID, Google Scholar, Scopus, PubMed, Proquest, ScienceDirect, and Web of Science databases were searched using: menopause" and "quality of life" keywords without any time limitations. Based on Jadad criteria, studies with a score of 3 or more were enrolled in the study.

RESULTS

From all the achieved studies at primary search, 12 were selected and enrolled in the study. Reviewing the results of the studies showed that participating physical exercise, using products containing phytoestrogens and isoflavones and participating in educational and counseling sessions have an effective role in the improvement of quality of life in menopausal women.

CONCLUSIONS

Evidence indicated that from the existing strategies to improve the menopausal quality of life, using complementary medicine is an efficient method and could be more effective when consumed along with performing physical exercises and participating in educational programs.

Evaluation of reproductive health status among women referring to rural healthcare centers in Neyshabur (Iran) in 2017

Background

Reproductive health is one of the most important aspects of life. Moreover, rural women constitute the largest demographic in society who are deprived of health services.

Objective

To determine the reproductive health needs of rural women of reproductive age.

Methods

This cross-sectional study was conducted on 405 rural women referring to the rural healthcare centers of Neyshabur, Iran, in 2017. The study population was selected through random multistage sampling technique. Data collection was carried out using a standardized questionnaire, evaluating sexual and reproductive health needs. Data analysis was performed using descriptive statistics in SPSS version 17.

Results

According to the results, 99.2% and 95.5% of the females received prenatal and postpartum healthcare, respectively. In addition, the rate of cesarean section was 30.25% among the rural women. The contraceptive pill was the most known birth control method (88.9%), whereas coitus interruptus was the most frequently used method (28.5%). Moreover, 59.8% of the rural women married at the age of ≤ 18 years. The most known sexually transmitted disease for these women was HIV/AIDS (81.7%), and just more than half of them had a history of colored vaginal discharge over the past 12 months (56.8%). Furthermore, these women reported 33.1% domestic violence over the past year.

Conclusion

The findings of the present study revealed the urgent need for planning programs to improve the reproductive health of rural women.

Exploring the perception of women with epilepsy about pregnancy concerns: a qualitative study

Background and aim

Epilepsy is a common neurological disorder in pregnancy, which is associated with increased maternal and fetal adverse outcomes. This study aimed to explore the reproductive healthcare needs of women with epilepsy before, during and after childbirth.

Methods

This was a qualitative study using a content analysis method. The study population was marital women with epilepsy in reproductive age (15–45 years) referred to Imam Hossein Hospital, Tehran, Iran. Participants were 16 women chosen using purposive sampling with the consideration of maximum variation in sampling. Semi-structured interviews were held with the participants until data saturation was reached. The data were analyzed using the content analysis method. The MAXQDA software, version 2010, was used for the management of data.

Results

The data analysis led to the development of two categories. The first one is named ‘resilience against threats to safe pregnancy’ and has the following subcategories: (1) real physical complications and perceived (mental) conditions due to unwanted pregnancies, (2) the predisposing factors of anxiety related to safe pregnancy, (3) perceived consequences of pregnancy’, and (4) the approach to encounter perceived consequences of pregnancy. The second category is called ‘adverse experiences under inefficient supportive systems’ and has the following subcategories: (1) the insufficiency of reproductive healthcare services for women with epilepsy, (2) doubt about the advantages and disadvantages of breastfeeding, (3) stigma as a block to the treatment of the postpartum depression, and (4) playing the motherhood role under the shadow of self-esteem to lack of self-esteem.

Conclusion

In the prenatal, natal and postnatal duration, because of supportive system disruption and not receiving proper consultation, participants were often worried about not being able to get favorable conditions for safe pregnancy and controlling process of their pregnancy. Therefore, they often experienced unwanted pregnancy. They were also concerned about the adverse fetal outcomes. In postpartum period, they often experienced postpartum depression and were very doubtful about breastfeeding.

Educational Interventions for Cervical Cancer Screening Behavior of Women: A Systematic Review

Background:

Cervical cancer is the second most common cancer in women worldwide; early detection can play a key role in reducing the associated morbidity. The objective of this study was to systematically assess the effects of educational interventions on cervical cancer screening (CCS) behavior of women.

Methods:

In this review the Cochrane library, Web of Science, Science Direct, PubMed, Scopus and search engine of Google scholar were searched for all interventional studies (trails, pre- and post-test or quasi-experimental) published in 2000-2017 for a systematic review, The search was based on the following keywords: cervix cancer, uterine cervical neoplasms, screening, prevention and control, Papanicolaou Test, pap test, pap smear, education, intervention, systematic review. Due to the heterogeneity of the data, a qualitative analysis was performed.

Results:

Thirty seven articles with 15,658 female participants in different parts of world were included in the review. About three quarters of the articles covered behavior change interventions. About one fourth of the articles were based on health education methods. The heath belief model is the most popular used framework for cervical cancer screening interventions. The results of our study showed that different health education methods (such as calls, mailed postcards, mother/daughter education. consultation sessions, picture books, videos, PowerPoint slides, small group discussions, educational brochures, radio broadcast education, lecture presentations, tailored counseling and a fact sheet, Self-learning package, face-to- face interviews and etc) are effective in modifying cervical cancer screening behavior of women.

Conclusions:

Our results showed that the different interventions and health behavior change frameworks provide an effective base for cervical cancer prevention. Heath providers can chose educational methods based on the particular client situations.

Effect of Hydroalcoholic Extracts of Capsella Bursa-Pastoris on Heavy Menstrual Bleeding: A Randomized Clinical Trial

OBJECTIVES

Heavy menstrual bleeding (HMB) is one of the leading causes of low quality of life and iron deficiency anemia in women. This study aimed to determine the effect of hydroalcoholic extracts of Capsella bursa-pastoris on HMB.

DESIGN

This study is a triple-blinded, randomized clinical trial.

SETTING

The study was conducted in gynecology clinics affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran.

SUBJECTS

Our patients affected to a complaint of HMB. After obtaining a complete medical history of the women and filling out the demographic forms, the participants were assigned randomly into the experimental (n = 42) and control groups (n = 42).

INTERVENTION

The eligible participants were given a pictorial blood loss assessment chart (PBLAC) to confirm HMB during the menstrual cycle. The experimental group received two capsules of mefenamic acid (500 mg) every 8 h and two Capsella bursa-pastoris capsules every 12 h. The intervention started from the first day of menstruation to the end of this period up to 7 days for two consecutive cycles. In the control group, the patients received mefenamic acid and placebo instead of Capsella bursa-pastoris capsules.

OUTCOME MEASUREMENTS

The PBLAC score and number of bleeding days, incidence of any possible problems, as well as participant satisfaction were measured. The data were analyzed using t-test, Chi-square, repeated-measures ANOVA, and ANCOVA tests in PASW Statistics ver. 18.

RESULTS

After the intervention, there was observed significant decrease in the amount of menstrual bleeding in both groups. However, the mean decrease in the amount of bleeding was significantly more in the Capsella bursa-pastoris group (p < 0/001).

CONCLUSION

Compared with control group, hydroalcoholic extracts of Capsella bursa-pastoris capsule appeared to be effective in reducing menstrual bleeding in this study. Further research regarding the efficacy and safety of Capsella bursa-pastoris is required.

The impact of social capital and social support on the health of female-headed households: a systematic review

Background and aim

Social capital and social support as determinants of health play an important role in the health of female heads of households. Considering the increasing number of female-headed families in Iran and the world, this study was conducted to systematically review the impact of social capital and social support on the health of female heads of households.

Methods

This study was conducted as a systematic review in September 2016. Its data were collected from available papers in different databases including Iranmedex, Magiran, Scientific Information Database (SID), Irandoc, Scopus, Science Direct, PubMed and Google Scholar. Using advanced search, all published papers from 2000 to 2015 with full text were selected using related keywords. After reviewing by browsers and adapting to the inclusion and exclusion criteria, 15 papers were entered into the study. The Strengthening the Reporting of Observational Studies in epidemiology (STROBE) checklist was used to evaluate the quality of papers.

Results

Based on the findings of these studies, there was a significant relationship between social capital and its components (trust, sense of belonging and social participation) as well as all aspects of health. Additionally, social support and its dimensions (emotional, instrumental and informational) affected health; however, among these dimensions, instrumental support of a stronger predictor was concerned with health, especially mental health.

Conclusion

Social factors such as social capital and social support are effective on human health, particularly health of female-headed households, since they affect proactive identity and increase information resources, collaboration as well as collective decisions and actions. Furthermore, they provide emotional and instrumental support to group members and prevent further health problems.

The effect of green tea ointment on episiotomy pain and wound healing in primiparous women: A randomized, double-blind, placebo-controlled clinical trial

The delayed healing of episiotomy wound and its associated pain is a major problem in obstetrics. Because green tea has analgesic and wound-healing properties, the present study was conducted to determine the effect of green tea ointment on episiotomy pain and wound-healing. The green tea extract was also standardized by measuring its Phenolic and flavonoid compounds, antioxidant activity, and one of its active components, that is, Epigallocatechin gallate. The present clinical trial was conducted on 99 primiparous women visiting Afzalipour Hospital in Kerman in 2015. The subjects were randomly divided into 3 groups, including a green tea ointment group, a placebo ointment group, and a routine care group. The 2 ointment groups smeared 2 cm of the green tea or placebo ointments onto their sutured area twice daily for a total of 10 days. The severity of pain was assessed in the subjects using the visual pain scale and wound-healing using the Redness, Edema, Ecchymosis, Discharge, Approximation (REEDA) scale before the intervention and on the 5th and 10th days after delivery. To standardize the extract, Epigallocatechin gallate was measured by high-performance liquid chromatography (HPLC). Phenolic and flavonoid compounds, as well as antioxidant activity of the extract were also determined by spectrometry methods. Before the intervention, no significant differences were observed between the 3 groups in terms of their personal and obstetric details (p > .05), the severity of pain (p = .118), and the REEDA score (p = .212). On the 5th and 10th days after delivery, the severity of pain was significantly lower in the green tea group than in the other 2 groups (p < .0001). The mean REEDA score on the 5th and 10th days showed a better and faster healing in the green tea group compared to the other 2 groups (p < .0001). Total content of phenolic and flavonoids contents of green tea were 74.2 mg/g Gallic acid equivalent and 16.3 mg/g Rutin equivalent, respectively, and its antioxidant capacity was 46% of b-carotene. Green tea ointment appears to be effective in relieving episiotomy pain and improving wound-healing in this study. Further studies are recommended to be conducted on the effectiveness and safety of the different doses of green tea ointment.

Empowerment of Adolescent Girls for Sexual and Reproductive Health Care: A Qualitative Study

Adolescent girls should be empowered to acquire the ability to take care of their sexual and reproductive health. The present study aimed to improve the understanding of the factors affecting the empowerment of Iranian adolescent girls in terms of taking care of their sexual and reproductive health (e.g. pubertal and menstrual health, preventing high risk sexual behaviors, treatment seeking for sexual and reproductive complaints such as dysmenorrhea, genitalia infection). The present qualitative study was performed using conventional content analysis method. Eight key informants were purposively selected and interviewed. Data collection was performed through unstructured and in-depth interviews. The qualitative content was analyzed simultaneously with data collection based on Graneheim and Lundman method using MAXQDA 2010 software. Data analysis led to the emergence of the main theme of empowerment for care with four classes of reinforcing the foundations of sexual and reproductive health, providing services in health system, reinforcing educational institutions, and consolidating the interaction between adolescent and family, as well as thirteen sub-classes. Results of the present study showed the need for inter-sectional interaction and collaboration among authorities of health systems, education systems, and policymaking institutions to achieve a model for empowering adolescent girls via a multi-level and comprehensive approach.

Exploring factors behind pregnant women's quality of life in Iran: a qualitative study

BACKGROUND AND OBJECTIVE

Pregnancy-related physiologic and psychosocial alterations can impact on the body and cause symptoms which may affect quality of life. Since qualitative studies can provide more in-depth understanding of quality of life and its determining factors, this study was conducted with the aim of exploring factors affecting pregnant women's quality of life.

METHODS

A qualitative descriptive study with conventional content analysis approach was made using the conventional content analysis approach on a purposeful sample of sixteen pregnant Iranian women in Hamadan, Iran from May 2015 to December 2015. Sampling was continued until data saturation. Data were collected through in-depth semi-structured personal interviews, and were analyzed using the conventional content analysis approach.

RESULTS

Data analysis resulted in three main categories, namely, the effects of pregnancy on different aspects of health (including psychological disorders, impaired interactions, disturbances in doing daily activities, disturbed body image, alterations in sexual relationships, physical disorders, and alterations in dietary habits and treatment regimens), pregnancy-related concerns (regarding the gender of the fetus, financial problems, childbirth, health, and the future), and coping with pregnancy (through strategies such as spirituality, positive attitude toward pregnancy, distraction and imagination, and support).

CONCLUSIONS

This study showed that different factors can affect pregnant women's quality of life. Nonetheless, prenatal care services are mainly focused on pregnancy-related physical problems, and other aspects of care are usually taken for granted. Consequently, healthcare professionals need to pay greater attention to pregnant women's quality of life and its contributing factors.

The effect of Saqez (Pistacia atlantica) ointment on the treatment of nipple fissure and nipple pain in breastfeeding women

BACKGROUND

Nipple fissure is a common problem in breastfeeding women, and the main reason for the early discontinuation of breastfeeding.

OBJECTIVE

To determine the effect of Saqez (Pistacia atlantica) ointment on the treatment of nipple fissure and nipple pain in breastfeeding women.

METHODS

This randomized clinical trial was conducted on 100 subjects admitted to the health centers in Tehran, Iran from mid-July to mid-November 2015. The subjects were randomly divided into two equal groups of 50 for the Saqez ointment group and the control group. The subjects were divided into the two groups through random allocation in Excel. The subjects were monitored on day 1, 3 and 7. Data were analyzed in SAS using the Cumulative Logit model and in SPSS-21 using Mann-Whitney, independent-samples t-test, the Chi square and Fisher's exact test.

RESULTS

No significant differences were observed between the two groups in terms of their demographic and fertility characteristics. The Cumulative Logit model showed that high levels of nipple fissure and pain were significantly less frequent in the Saqez group compared to the control group (p<0.001). There was about 83% reduction in the severity of fissure and 85 %in the severity of pain in the Saqez group compared to the control group (p<0.001).

CONCLUSION

Saqez ointment is more effective in the treatment of nipple fissures and pain than breast milk. As this study was done for the first time, judgment about the conclusive efficacy of Saqez ointment on the nipple fissure, needs further similar studies.

TRIAL REGISTRATION

The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015080723535N1.

FUNDING

The authors received no financial support for the research, authorship, and/or publication of this article.

Disorders Affecting Quality of Life During Pregnancy: A Qualitative Study

INTRODUCTION

Pregnancy is a special condition which results in unique physiological responses which is more than any other physiological event and it increase stress in women's body. Information about the changes experienced by pregnant women in physical, psychological, and social areas is limited, indicating that the quality of life and changeable areas in pregnant women require more attention.

AIM

This study was aimed to identify the disorders affecting the quality of life during pregnancy.

MATERIALS AND METHODS

A qualitative study was performed with the conventional content analysis approach. Participants included 16 pregnant women who were recruited using purposive sampling and performed with maximum variety. The semi-structured in depth interview started face to face with the general question and was followed with specific questions. The interviews were conducted in Fatemieh Hospital in Hamadan, Iran. Data analysis and data collection were conducted concurrently and the interviews were continued until achieving data saturation.

RESULTS

Five main categories emerged in this study including "psychological disorders of pregnancy", "disorders of activities", "body-image disorder", "disorders in sexual intercourse" and "physical disorders" that were analyzed revolves common around of disorders affecting quality of life.

CONCLUSION

Pregnancy can have undesirable effects on various aspects of women's lives in their point of view and lead to a decreased life quality. Therefore, it is essential in prenatal care. In addition to addressing the physical aspects of maternal health, other aspects are also evaluated, and in case of any disorder, the necessary consultation should be done.

Preparation for sexual and reproductive self-care in Iranian adolescent girls: a qualitative study

Background Adolescence is one of the most important stages in every individual's life. Pubertal changes and acquiring reproduction capability require adolescents to perform special health care processes. Also the possibility of involvement in high-risk sexual behaviors endangers adolescent girls' sexual and reproductive health. Objective Increase and deepen the understanding and knowledge of the factors affecting Iranian adolescent girls' readiness to take care of their sexual and reproductive health. Materials and methods The present qualitative study was conducted using conventional content analysis method. The participants included 18 adolescents who were aged 13-19 years old, single, studying at high school, art school, or university and had no history of chronic medical or psychological diseases; further, most of them had the experience of menstruation. Purposive sampling was initiated and continued until data saturation. Data collection were performed using in-depth and unstructured interviews. Qualitative content analysis of the interviews was conducted simultaneously with data collection using the Graneheim and Lundman approach .MAXQDA 2010 software was used for storage, retrieval, and management of the data. Findings Preparation for care was the main theme that emerged in this study along with 19 subcategories and four main categories, including desirable interaction between families and adolescents, readiness for puberty and menstruation, life skills and spiritual self-monitoring. Conclusion The education and health care systems' authorities of the country can exploit the results of this study for making policies and interventions expedient to the society's cultural conditions in order to improve the reproductive and sexual self-care status of adolescents' girls.