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Introduction: Although Jordan has made significant progress toward expanding the utilization of facility‐based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors. Methods: Utilizing a pre–post design, quality gaps in intrapartum care were assessed among 959 women pre‐ and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions. Results: The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was −0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, −0.24 (±0.39) and −0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (β = 0.61), mode of birth (β = −0.60), admission timing (β = −0.41), continuity of midwifery care (β = −0.43), physician's gender (β = −0.62), active labour duration (β = 0.37), and pain management (β = −0.33) to be the key determinants of the overall quality gap in intrapartum care. Conclusion: Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan. Patient or Public Contribution: This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan. [ABSTRACT FROM AUTHOR]

Background: Evidence‐based practice involves the synthesis of multiple forms of evidence to inform clinical decision‐making and treatment evaluation. Practice‐ and patient‐based evidence are two forms of evidence that are under‐represented in the stuttering literature. The collection of such knowledge is essential to support the design and delivery of effective stuttering interventions for adults. Aims: To build stakeholder consensus on the core components of intervention for adults who stutter, and to establish a guiding framework for the design and development of evidence‐based interventions for adults who stutter. Methods & Procedures: Adults who stutter and speech and language therapists (SLTs) with experience in providing stuttering intervention participated in the three‐round e‐Delphi Survey focused on: (1) identifying key stuttering intervention components, including principles, practices, and structural and contextual elements; and (2) obtaining group consensus on stuttering intervention components. Statements were categorized using the International Classification of Functioning, Disability and Health (ICF) model adapted to the study of stuttering. Outcomes & Results: A total of 48 individuals agreed to participate: 48/48 (100%) completed the Round 1 questionnaire, 40/48 (83%) responded to Round 2 and 36/40 (90%) participated in Round 3. Following content analysis of Round 1, 101 statements were developed, and consensus was achieved on 89 statements perceived as representing the core components of stuttering intervention for adults. Categorization of these statements reflected the key stuttering intervention components relating to personal reactions to stuttering, limitations in life participation and environmental factors. Conclusions & Implications: Consensus on the core components of stuttering intervention was reached through engagement with key stakeholders. The evidence‐based framework presented highlights the range of key intervention components a clinician should consider when designing interventions for adults who stutter. What this paper adds: What is already known on the subject: Evidence‐based practice endorses the synthesis of multiple knowledge forms including research, practice and patient evidence to support clinical decision‐making and treatment evaluation. The stuttering literature is characterized by an over‐representation of efficacy evidence, with significantly less practice and patient evidence to guide clinical practice. What this paper adds to existing knowledge: This study adds valuable practice‐ and patient‐based evidence for effective stuttering intervention components for adults who stutter. These relate to personal reactions to stuttering, limitations in life participation and environmental factors. What are the potential or actual clinical implications of this work?: This research presents a stakeholder‐informed framework for stuttering intervention to guide SLTs working with adults who stutter in designing evidence‐based interventions. The framework supports the adoption of a person‐centred approach to intervention to ensure each client's unique needs, preferences, values and desired outcomes are explored and integrated into therapy. [ABSTRACT FROM AUTHOR]

Introduction: Mental health is a serious concern among novice school nurses in Japan. Numerous novice school nurses with various health problems experience high stress levels, affecting their mental health. They may be experiencing reality shock, a known risk factor for burnout and turnover, or its factor, the "reality gap." Objective: This study aimed to examine the hypothetical model by which the reality gap affects the mental health of novice school nurses. Methods: This cross-sectional study conducted a self-administered questionnaire survey, and responses were obtained from 102 novice school nurses. A path model was created based on a hypothetical model. Results: After several revisions on the hypothesis model, a modified path model was generated (CFI =.98, TLI =.93, RMSEA =.06). The path model showed that reality gaps negatively affected work engagement, work engagement positively affected intention to stay, and intention to stay positively affected mental health. Reality gap was also directly negatively associated with mental health. Having various support networks reduced the effects of reality gaps on mental health. Additionally, social support in the workplace boosted work engagement. Conclusion: Unique from other studies, this study contributed to understanding the effects of reality gaps on mental health. School managers and administrators should establish a support system that enables school nurses to receive various supports from within and outside the school. In addition, novice school nurses should take advantage of networks and support inside and outside school to reduce reality gaps and grow as professionals. [ABSTRACT FROM AUTHOR]

Prenatal depression affects approximately 10% to 15% of women. Guidelines recommend supporting women to make informed treatment decisions; however, minimal evidence exists regarding this decision-making process. This study aimed to develop a constructivist grounded theory of prenatal antidepressant treatment decision-making. Semi-structured interviews were conducted with purposively sampled women from the community or specialty clinics (N = 31). Iterative data collection and analysis, theoretical sampling, and member checking supported model sufficiency. In the Creating Comfort in Choice theory that we developed, participants were highly conscious of societal stigma toward mental illness and prenatal medication use, so fear, anxiety, and guilt dominated decision-making. Participants navigated dynamically among three clusters of decision-making activities: seeking information, making sense of information, and self-soothing. "Seeking information" included internal and external processes. In "making sense of information," participants appraised available evidence. In "self-soothing," participants engaged in coping strategies to try to alleviate painful emotions. The Creating Comfort in Choice theory can support patient-oriented decision-making regarding prenatal mental healthcare. [ABSTRACT FROM AUTHOR]

This study adds to a small body of Canadian literature investigating the ways that newcomer women experience, and are impacted by, intimate partner violence (IPV). The study involved qualitative interviews with 15 newcomer women who migrated to Saskatchewan, Canada, from 12 different countries. These findings provide insight into participants' complex lived experiences and illustrate how women's status as newcomers intersected with their experiences of IPV. As well as abuse related to language ability and immigration status, participants in our study described their experiences of physical; sexual; emotional; psychological; economic; and legal abuse; as well as coercive control; isolation; surveillance, stalking, and harassment while in the relationship and after separation; challenges with shared parenting; and the imposition of patriarchal values. Perpetrators of IPV maintained control by intentionally isolating survivors, and participants were also isolated due to their status as a newcomer and their limited English-language ability and social connections. [ABSTRACT FROM AUTHOR]

Aims: To explore how emerging adult‐aged women self‐manage their sexual and reproductive health and to generate a grounded theory of these self‐management processes. Design: Grounded theory methods using a constructivist approach. Methods: Between September 2019 and September 2020, 18‑ to 25‐years‐old women (n = 13) were recruited from a 4‐year university, a 2‐year community college, and neighbourhoods surrounding the institutions of higher education. Individual interviews were transcribed verbatim and qualitatively analysed using a constant comparative method and inductive coding. Results: The theory purports that core processes of sexual and reproductive health self‐management used by the women in this study included both passive and (re)active processes. These processes expanded upon and/or maintained the women's accessible sexual and reproductive health knowledge, behaviour and beliefs, defined as the sexual and reproductive health repertoire. The processes appeared to be cyclical and were often initiated by a catalysing event or catalyst and resulted in conversations with confidantes, or trusted individuals. A catalyst was either resolved or normalized by expanding or maintaining the sexual and reproductive health repertoire. Conclusion: The resulting theory, EMeRGE Theory, offers insight into the complex and cyclical processes emerging adult‐aged women use to simultaneously develop and adapt their foundational sexual and reproductive health knowledge, behaviours and beliefs. Implications for the Profession and/or Patient Care: This explication of emerging adult‐aged women's sexual and reproductive health self‐management processes can be used by nurses and nurse researchers to better address this population's unique health needs. Impact: The EMeRGE Theory provides valuable guidance for future exploratory and intervention research aimed at improving the health and well‐being of emerging adult‐aged women. Reporting Method: The authors adhered to the Consolidated Criteria for Reporting Qualitative studies (COREQ) in preparation of this publication. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Increasing compliance with isolation precautions is important in reducing hospital-acquired infections and their consequences. It is not possible to achieve and maintain nurse compliance through supervision, control, pressure, or training. Therefore, nurses must personally demand compliance with isolation precautions. This study aimed to determine the relationship between compliance with isolation precautions and the moral sensitivity levels of nurses who have just started working. Methods: This study employed a descriptive and cross-sectional research design. The study population consisted of 456 new nurses recruited during the pandemic. All of the new nurses who volunteered to participate in the study and completed the questionnaires completely were included in the study and 398 nurses constituted the sample of the study. Data were collected from 398 out of 456 novice nurses who agreed to participate in the study. The population coverage rate was 87.28%. Participants were selected using convenience sampling method. The data collection tools included an Introductory Information Form, The Isolation Compliance Precautions Scale (TIPCS), and the Moral Sensitivity Questionnaire (MSQ). Descriptive statistics, correlation analyses, and regression models were used to analyze data. Findings: The mean score of the MSQ was high (mean ± SD = 90.49 ± 25.94; median (P25-P75) = 84 (range, 74–97), and the score for TIPCS was high (mean ± SD = 79.29 ± 7.68; median (P25-P75) = 82 (range, 76–85)). No correlation was found between MSQ and TIPCS (p > 0.05). According to the regression analysis, although the MSQ did not correlate with TIPCS, compliance with isolation measures was found to increase as the conflict subscale of moral sensitivity increased (β= -0.36, CI= -0.55 to -0.16; p < 0.001). Choosing the profession willingly had a positive correlation with compliance with isolation measures (β = 5.3, CI = 2.4 to 8.3; p < 0.001). In addition, starting the profession at an early age had a positive correlation with compliance with isolation measures (β= -0.49, CI= -0.8 to -0.17; p = 0.002). Conclusion: The conflict sub-dimension of moral sensitivity is an important factor in nurses' compliance with isolation measures, and conducting necessary training and other studies to improve nurses' moral sensitivity may increase their compliance with isolation measures. [ABSTRACT FROM AUTHOR]

The sense of guilt in informal caregivers has been associated with lower levels of overall life-satisfaction, an increase in feelings of overwork, stress, and health problems, including anxiety and depression. Even though women who care for dependent relatives have higher levels of feelings of guilt than male caregivers, little research has been done on the dynamics of guilt from a gender perspective. This study examines the dynamics of this moral emotion in women caregivers' psychosocial health. This study is based on semi-structured interviews with nineteen Spanish women who are informal caregivers looking after dependent family members. The interviews were subsequently transcribed and subjected to thematic analysis. Three themes emerged from qualitative analysis: first, doing more for the people being cared for than for oneself; secondly, being demanding on oneself; and thirdly, controlling one's own desires. The results show dynamics of self-control that seem to function as mechanisms for the women caregivers to avoid feelings of guilt, but at the price of taking on greater caring responsibilities, denying their own desires, and endangering their psychosocial health. We consider that intervention to help women reduce anticipatory guilt is essential, as these feelings put women caregivers' psychosocial health at risk. [ABSTRACT FROM AUTHOR]

Dublin Anti-Bullying Self-Efficacy Scales aim to measure the effectiveness of school anti-bullying programs in promoting five steps that victims and bystanders take against online and offline bullying behaviors. These steps are anti-bullying self-efficacy beliefs to recognize bullying behaviors, comprehend emergency, take responsibility, know what to do, and intervene. However, when an anti-bullying program is very effective for the majority of participants who give high scores, a considerable number of participants who give low scores are very likely to be detected as outliers. This raises two measurement issues. First, high scores create highly negatively skewed data and lead to measuring a unidimensional rather than multidimensional construct. This could be one reason why recent research has been unclear about the extent to which the scales measure a unidimensional, multidimensional, or bifactor construct. Second, should outliers be removed or be considered as participants for whom the program was ineffective? If the scales had measurement invariance across the group of outliers and non-outliers or low and high self-efficacy, it could be concluded that the anti-bullying program was ineffective for some participants. The current research aims to address these issues by testing both measurement invariance as well as unidimensional and bifactor models of anti-bullying self-efficacy. Results of Pure Exploratory Bifactor (PEBI) Analyses and Item Response Theory (IRT) with Two-Parameter-Logistic (2PL) Models of data from a convenience sample of 14-year-old students in Ireland (N = 1,222) indicated sufficient psychometric properties of both unidimensional and multidimensional scales for victim offline, victim online, bystander offline, and bystander online. Further research can use these scales for measuring the bifactor model of anti-bullying self-efficacy as well as the cut-off score for distinguishing between low and high anti-bullying self-efficacy. [ABSTRACT FROM AUTHOR]

Introduction: Illness perception and self-efficacy in patients with coronary artery disease (CAD) may affect medication adherence, which is one of the most important challenges in disease management in this group of patients. Objective: The present study aimed to investigate the factors influencing medication adherence in CAD patients, especially the effect of illness perception and self-efficacy. Methods: This study was cross-sectional and conducted from April to September 2021. A total of 259 patients with confirmed CAD were selected by convenience sampling method based on inclusion criteria. Illness perception, self-efficacy, and medication adherence were investigated using Brief IPQ, SCSES, and MARS_10 questionnaires, respectively. The data were analyzed using the STATA software (version 14) and the regression path analysis method. Results: Patients had moderate illness perception and high self-efficacy, and 61.8 of them adhered to their medication regimen. Greater illness perception, better self-efficacy, and higher education had a positive effect on medication adherence, and increasing age had a negative effect on it. The final path model shows a good fit of the data in the model (χ2: 0.37, df: 274, χ2/df: 0.36, CFI: 1, IFI: 0.95, TLI: 1.07, and RMSEA: 0.00). Conclusion: The results of the present study suggest that patients' illness perception can play an important role in predicting self-efficacy in disease management and the level of medication adherence in patients with CAD. To improve self-efficacy and medication adherence, future intervention studies should focus on the patient's illness perceptions and their improvement. [ABSTRACT FROM AUTHOR]

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Treatment burden contributes to suboptimal adherence and lower health-related quality of life among people diagnosed with chronic conditions, but little is known about how the psychological process of emotional dysregulation influences treatment burden. To explore this relationship, we conducted a descriptive, cross-sectional study comprised of 149 men and women diagnosed with one or more Centers for Medicare and Medicaid Systems defined chronic conditions recruited from a single primary care setting. Multivariate analyses demonstrated emotional dysregulation as an independent factor contributing to total (p <.001), medication (p =.007), and dietary (p <.001) treatment burden, with model effect sizes ranging from large (.43) to moderate (.21), controlling for other known antecedent factors of treatment burden. Emotional dysregulation was not a factor contributing to exercise related treatment burden. Our findings indicated emotional dysregulation as an important factor contributing to higher levels of total, medication, and dietary treatment burden associated with daily self-management regimens. [ABSTRACT FROM AUTHOR]

Objective. This study expects to investigate and verify the intervention effect of the university's innovative teaching management model on college students' resilience by implementing the university's innovative teaching management model for college students with low psychological resilience. Method. The scientific scale is used to investigate the current level of college students' psychological resilience, and the development characteristics of college students' psychological resilience are obtained through statistical analysis. Based on the theoretical analysis of the application of psychological resilience intervention, combined with the theory of one-to-one tutoring and operational techniques, the university's innovative teaching management mode scheme is designed. The design adopts a quasi-experimental pre-experimental test to investigate and explore the intervention effect system of the university's innovative teaching management mode on college students' psychological resilience. In the intervention, each unit of activity is carried out in strict accordance with the established plan, and records and reflections are made at the end. One-to-one and face-to-face qualitative interviews were conducted with the subjects, and qualitative data were collected for qualitative analysis. Results/Discussion. Compared with the control group that did not receive the intervention, the psychological resilience of the subjects in the experimental group was significantly improved after receiving the intervention of the university's innovative teaching management model. The university's innovative teaching management model has a good intervention effect on the resilience of college students. The university's innovative teaching management model scheme compiled in this study integrates a variety of psychotherapy methods and combines one-to-one psychological counseling frameworks and techniques. It is an effective and easy-to-implement intervention scheme for college students' psychological resilience intervention. [ABSTRACT FROM AUTHOR]

Dating violence is a public health problem affecting people worldwide. This study evaluated the occurrence of different types of adolescent dating violence using a mixed analysis of each data source. The present study addresses the following research questions: does the occurrence of the types of violence analyzed in the quantitative phase match with the narratives obtained in the qualitative phase? and does the additional information obtained in the qualitative phase improve the understanding of the analyzed phenomenon? In the quantitative phase, 410 participants (aged 13 to 19 years) answered a questionnaire based on the Modified Conflict Tactics Scale, while in the qualitative phase, 26 participated in two focus groups. Data were collected from May to June 2019. Written informed consent was obtained from the parents or legal guardians of those who had agreed to participate. The present research was approved by the Human Research Ethics Committee of the Pontifical Catholic University of Ecuador. The results were divided on: prevalence of dating violence based on age groups and gender, management and resolution of dating conflicts, victimization and perpetration of intimate partner violence, factors favoring intimate partner violence and acceptance of abuse. The results were analyzed via triangulation and indicated thatadolescents were involved in the perpetration and victimization of psychological as well as mild and severe physical violence. An analysis of the contributing factors revealed a strong tendency toward the acceptance of the traditional gender model. Challenging these models is crucial to deconstruct hierarchical models, develop conflict resolution skills, and promptly identify abusive behaviors that affect emotional development. The combination of different methodological approaches improved the understanding of the phenomenon studied. [ABSTRACT FROM AUTHOR]

Background: Rates of participation in HIV care, medication uptake, and viral suppression are improving among persons living with HIV (PLWH) in the United States. Yet, disparities among African American/Black and Latino PLWH are persistent, signaling the need for new conceptual approaches. To address gaps in services and research (e.g., insufficient attention to structural/systemic factors, inadequate harm reduction services and autonomy support) and improve behavioral interventions, we integrated critical race theory, harm reduction, and self-determination theory into a new conceptual model, then used the model to develop a set of six intervention components which were tested in a larger study. The present qualitative study explores participants' perspectives on the study's acceptability, feasibility, and impact, and the conceptual model's contribution to these experiences. Methods: Participants in the larger study were African American/Black and Latino PLWH poorly engaged in HIV care and with non-suppressed HIV viral load in New York City (N = 512). We randomly selected N = 46 for in-depth semi-structured interviews on their experiences with and perspectives on the study. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis. Results: On average, participants were 49 years old (SD = 9) and had lived with HIV for 19 years (SD = 7). Most were male (78%) and African American/Black (76%). All had taken HIV medication previously. Challenging life contexts were the norm, including poverty, poor quality/unstable housing, trauma histories exacerbated by current trauma, health comorbidities, and substance use. Participants found the study highly acceptable. We organized results into four themes focused on participants' experiences of: 1) being understood as a whole person and in their structural/systemic context; 2) trustworthiness and trust; 3) opportunities for self-reflection; and 4) support of personal autonomy. The salience of nonjudgment was prominent in each theme. Themes reflected grounding in the conceptual model. Participants reported these characteristics were lacking in HIV care settings. Conclusions: The new conceptual model emphasizes the salience of systemic/structural and social factors that drive health behavior and the resultant interventions foster trust, self-reflection, engagement, and behavior change. The model has potential to enhance intervention acceptability, feasibility, and effectiveness with African American/Black and Latino PLWH. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the current situation and analyse influencing factors of resource utilisation in maintenance haemodialysis patients. Background: The self‐management level of patients undergoing maintenance haemodialysis in China is low. The applicability of the Chronic Illness Resources Survey in Chinese maintenance haemodialysis patients has been validated, and this survey can be used to assess the utilisation of self‐management support resources among haemodialysis patients. Determining the influencing factors of resource utilisation can help improve the self‐management behaviour of haemodialysis patients and control the progression of the disease. Design: A descriptive study design was chosen. Methods: A convenience sample of 314 patients undergoing haemodialysis was recruited from dialysis centres in three hospitals in western Xinjiang from June 2018–April 2019. SPSS19.0 software was used to describe the current situation of resource utilisation. Moreover, t test, analysis of variance and multivariate linear regression were applied to explore the influencing factors of patients' resource utilisation. Standards for observational studies STROBE Statement checklist‐v4 were chosen on reporting the study process. Results: The average score of the total resource utilisation was 2.95 ± 0.51. The average item score of seven dimensions from high to low was 3.46 for medical staff, 3.32 for personal, 3.22 for family and friends, 3.16 for work‐related, 3.12 for media policy, 2.55 for neighbourhood/community and 2.23 for organisation. Multiple linear regression showed that there have six main factors, which explained 65.4% of the variance of haemodialysis patients' resource utilisation. Conclusions: The personal, family and friends, work and media and policy subscales were rated the highest, with support from neighbourhood/community and organisation rated the lowest. In general, participants perceived moderate levels of support. Government and healthcare team should pay more attention on haemodialysis patients who had low level of education, poor economic conditions and poor mental condition. Relevance to clinical practice: ESRD has caused a burden on healthcare expenditure and has become a critical public health problem worldwide. Self‐management is particularly important for dialysis patients which have attracted extensive interest. In the future research, we can use this questionnaire to evaluate the related resources of disease management of dialysis patients, encourage patients to make full use of the resources around them and focus on those patients with low education and monthly income level and bad mental state. [ABSTRACT FROM AUTHOR]

Introduction: Medical tourism is developing more rapidly, particularly in developing countries, as a tool to enhance economic growth and achieve a competitive position. The present study aims to investigate and identify contributory factors to the competitiveness of Iran’s medical tourism using importance-performance analysis. Methods: This is an applied study with a descriptive nature conducted using field studies and surveys. A conceptual model was adopted and contributory factors were extracted from previous studies. A questionnaire was designed based on extracted factors and opinions of experts who are specialists in the field of medical tourism. The statistical population consisted of tourism experts, health experts, physicians, and medical staff working in hospitals with international units. Data analysis was performed using SPSS. Results: The results showed that “medical services” were more important than the two components “special factors of tourism” and “characteristics of medical tourism destinations”. It was also revealed that the current situation of “medical tourism destination characteristics” is unfavorable compared to the other two components. Conclusion: This study provided an insight into the importance and quality of performance of the factors affecting the competitiveness of medical tourism, which can be beneficial for managers and planners in Iran and other medical tourism destinations. [ABSTRACT FROM AUTHOR]

In this study, the constructive communication process of anti-vaccination advocates is explored to provide insight into the challenges of communicating with an engaged, educated public that is distrustful of mainstream medical and governmental organizations. Using the circuit of culture as a theoretical and methodological model, this article examines how anti-vaccination advocates use social media to construct and reinforce a belief system that counters dominate understandings of health. Findings show that, through online communication, anti-vaccination advocates create shared cultural constructs embracing the identity of health information crusader, critic, and expert. This community consumes, produces, and distributes information that reframes mainstream health information and reinforces shared values. The purposes of this study are to better understand the culture of anti-vaccination advocates, identify communication barriers, and offer practical implications for health care professionals. [ABSTRACT FROM AUTHOR]

Background: Developing a chronic disease, like heart failure in older adults disrupts the foundations of the family and imposes a heavy burden on family members. The aim of this study was to determine the effect of the Family-Centered Empowerment Model (FCEM) on the care burden of family caregivers of older adults with heart failure. Methods: It was a quasi-experimental study with a controlled before and after design, which was conducted on 80 primary caregivers of older adults with heart failure referring to health centers affiliated with Kashan University of Medical Sciences, Kashan, Iran. The subjects were nonrandomly assigned to either the control (n=40) or intervention (n=40) groups. The program was implemented based on the concepts of the model (perceived threat, self-efficacy, self-esteem, and evaluation) in eight 2-hour sessions, twice a week for four consecutive weeks. Both groups answered the Zarit Burden Interview (ZBI) in the beginning, in the end, and one month after the study. The data were analyzed by Chi-square, t-test, and the repeated measures ANOVA using SPSS v. 16 software. Results: There was no significant difference between the two groups regarding the pretest mean score of care burden (P>0.05). However, the groups' mean score of care burden was significantly different immediately after the intervention (P<0.05) and one month after the study (P<0.05). The repeated measures ANOVA illustrated a significant difference between the mean scores of care burden in the three measurement time points (P<0.0001). Conclusion: Implementation of the FCEM model reduces the burden of care in caregivers of older adults with heart failure. It is suggested that this model be used in training programs for older adults with heart failure and their caregivers. [ABSTRACT FROM AUTHOR]