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β-Thalassemia (β-thal) is a chronic illness and its complications make the patient less compliant with the treatment protocol. This study aimed to evaluate the effect of a support-training system of peer group on promotion of self-care in β-thal major (β-TM) patients. In this semi-experimental study, 112 β-TM were randomly selected and assigned to the study and control groups. Seven β-TM patients, who were physically, mentally and socially normal, were selected and trained as the peer group. Eight training sessions over 4 months were done by the peer group. The questionnaire with 50 questions was scored using the Likert scale, always with 1 point, sometimes 0.5 point and never 0 points. In the study group, before intervention, the mean score of the patients was 29.84 ± 6.16, which, after intervention, increased significantly to 37.14 ± 4.35

Background: Family is one of the early systems of human societies. Inappropriate performance of family in taking care of children, especially nutritional care, leads to irreparable damages to their development and growth. Accordingly, the present study aimed to investigate the nutrition care of children under the age of six in Abadan. Methods: This descriptive-analytic study was carried out on 406 families with children under the age of six in Abadan city. The families were selected using the cluster sampling method. The data collection tools were a researcher-made questionnaire and direct interview. Furthermore, descriptive and analytical tests such as single sample t-test were used using the SPSS. Results: The results of this study showed that 60 percent of children under one year of age and 32.7 percent of 1-3 year old children were breastfed. Conclusion: The family care function was not satisfactory in regarding the nutrition status of 1-3 year old children. This suggests the necessity of education on breastfeeding by the end of the 2-year period.

Introduction: Self-care is the core concept of health care and may be considered as one’s stabilization, and restoration as well as the improvement of his/her health and well-being. Looking at the process of Self-care from patients’ perspective who suffer from thalassemia may assist the nurses and health care providers to facilitate the health process. Thus this study was conducted to discover the process of self-care in patients with major thalassemia. Methods: This qualitative study was conducted with grounded theory approach. 21 patients with major thalassemia from a Medical Research Center, supervised by Kerman Medical University, were selected through purposeful and theoretical sampling. Data were collected by unstructured interviews which lasted 30-60 minutes. These data were analyzed using the method of Corbin and Strauss. Results: The main theme of "struggling to improve life quality" that included the sub-themes of "focus on needs of illness, "activating resources" and "restoring a new identity with thalassemia" were extracted from the data. This theme implies that participants endeavor to strengthen their self- efficacy via thalassemia. "Looking for strengthening self-efficacy in light of thalassemia" was the core theme in this study. Conclusion: Facilitating the process of self-care in patients with major thalassemia requires that they be helped so that their self-efficacy, influenced by real life conditions, might be strengthened in light of thalassemia. Increasing public awareness and social support may affect the recognition of individual, family and society.

Background Patients with multiple sclerosis practice help-seeking behaviors largely because of the progression of this physically exhausting disease, which has far reaching psychosocial consequences and requires hospitalization during severe disease exacerbations. Purpose The aim of this study was to describe the perspectives and experiences of Iranian patients with multiple sclerosis regarding help-seeking behaviors. Methods A qualitative design, based on the content analysis approach, was used. Data were drawn from unstructured interviews that were held with 23 participants, who were referred from two teaching hospitals and from the Multiple Sclerosis Society in Ahvaz, Iran. Results During the data analysis, four main themes emerged, including "reliance on God and recourse to the imams," "striving to gain caring knowledge," "a need for comprehensive support," and "attention to spiritual care." Conclusions/implications for practice Healthcare team members, especially nurses, should pay attention to perspectives of patients with multiple sclerosis and try to address these patients' help-seeking behaviors to provide high-quality care.The authors hope that the findings of this study will inform the construction of interventional strategies to improve nursing care and facilitate the provision of better support services for people with MS.

Background & Aims: Respect for the human dignity as a moral principle is the professional responsibility of each nurse. Studies indicate the fact that the dignity of patients in care is neglected by healthcare professionals. This study aimed to determine the status of dignity in the hospitalized patients from the perspective of nurses in Iran. Material & Methods: In this cross-sectional study which conducted from 2012- 2013 in Isfahan’s hospitals, 368 nurses were selected by cluster sampling method. Data were gathered through a questionnaire with Likert scale in the dimensions of “respecting privacy”, “promotiong autonomy” and “nurse- patients respectful interaction” and were analyzed using descriptive and analytical statistics with SPSS software version 16. Results: Based on the findings from this study nurses were more satisfied with the patient's autonomy and the respectful communication and these componnets had the most mean (0.53 ± 2.43, 0.35 ± 2.40) and score (82%, 79%) respectively. Privacy of the patients had the lowest mean and scores (0.52 ± 2.43, 76%). Conclusion: This study showed the importance of being polite and respectful. A respectful tone of voice, using simple and understandable language, respond to every patient’s question and pay attention to gender of the nurse when the patient prefers a nurse of the same gender is so important in good communication between nurses and patients and require special attention.

Introduction: Drug overuse is a serious problem for health care, and one of the biggest problems for the socio- economic well-being of different communities. The elderly tend to use more drugs due to changes in their cognitive and physiological factors. One of the best ways to evaluate the health level of elderly people is to evaluate their self-medication. This study was conducted to investigate self-medication among the elderly in Shahr-e-Kord. Methods: This cross-sectional study was conducted on 350 people older than 65 in Shahr-e-Kord in 2015. Sampling was done in two stages. In the first stage, the city of Shahr-e-Kord was divided into four areas using geographical maps. Eighty-eight people were selected from each area. The research instrument was a questionnaire called the Health Belief Model (HBM). The data were analyzed using SPSS version 20, the chi- squared test, the independent-samples t-test, and the Pearson correlation coefficient. Results: No significant relationship was observed between the prevalence of self-medication with demographic variables and level of awareness. But there was a significant difference between sensitivity, perceived severity, and perceived barriers and educational level. There also was a significant difference between the perceived benefits and their income level. There also was a significant difference between the level of awareness, sensitivity, severity, benefits, and barriers of people with and without a history of self-medication (p < 0.05). Conclusion: Due to the adverse effects of self-medication and the high prevalence of this activity among the elderly, it is recommended that a training program be developed and implemented to change the knowledge and beliefs of the elderly about self-medication

Background: Reaching geriatric period is one of the greatest successes in human Beings.The older adults are predisposed to risk of many diseases and disabilities, and physical activity is one of the most efficient methods to prevent geriatric period disorders. Therefore, the present study aimed define the effect of an empowerment program on physical activity of the elderly residing in Shahid Rezaian health care center in 2014. Materials and Methods: This quasi-experimental study was conducted on 70 older adults, age 65 years and over, selected through convenient sampling and assigned to groups of study and control. Study group was divided into 5 seven-member subgroups and a one-hour session of physical exercises was administrated for them once a week for eight sequential weeks. All subjects evaluated before and after intervention by International Physical Activity Questionnaire. Subjects’ physical activity was scored, based on the personal activity protocol,and the results were compared. Significance level was considered as P

The aim of this study was to create a deeper understanding of the variables that may restrain or progress spiritual care in Iran. This manuscript provides an in-depth description of barriers to delivering spiritual care by nurses as well as patients' compensatory mechanisms against deprivation from spiritual care termed "self-preservation in both sides" emerged from an empirical study. It brings issues such as structural, hierarchical, social and personal concerns, which may prevent advancing spirituality within health care, to light. Thirty-five participants, nurses (n = 10), patients (n = 22) and their relatives (n = 3), took part in this study, and data were analyzed using qualitative content analysis method. Being aware of these results may help nurses and healthcare professionals to engage with and overcome some of the structural, hierarchical and social variables affecting spiritual care.

Background: Equity as a basic human right builds the foundation of all areas of primary healthcare, especially prenatal care. However, it is unclear how pregnant women and their care providers perceive the equitable prenatal care. Objective: This study aimed to explore Iranian women’s and care providers’ perceptions of equitable prenatal care. Research design: In this study, a qualitative approach was used. Individual in-depth unstructured interviews were conducted with a purposeful sample of pregnant women and their care providers. Data were analyzed using inductive content analysis method. Participants and research context: A total of 10 pregnant women and 10 prenatal care providers recruited from six urban health centers across Ahvaz, a south western city in Iran, were participated in the study. Ethical considerations: The study was approved by the Ethics Committee affiliated to Ahvaz Jundishapur University of Medical Sciences. The ethical principles of voluntary participation, confidentiality, and anonymity were considered. Findings: Analysis of participants’ interviews resulted in seven themes: guideline-based care, time-saving care, nondiscriminatory care, privacy-respecting care, affordable comprehensive care, effective client–provider relationships, and caregivers’ competency. Conclusion: The findings explain the broader and less discussed dimensions of equitable care that are valuable information for the realization of equity in care. Understanding and focusing on these dimensions will help health policy-makers in designing more equitable healthcare services for pregnant women.

Background: The use of long-term care services has risen and this trend is expected to continue as the population reaches old age. Objectives: This study was performed to assess the caring conditions in nursing homes. Patients and Methods: This study was conducted with a qualitative approach using conventional qualitative content analysis. The study was conducted on 23 Iranian participants including 14 elders and 9 caregivers. Data was collected with unstructured interviews and continued to the point of data saturation. Analysis of data was performed continually and concurrently with data collection through a comparative method. Results: Three themes emerged from 595 open codes including care as unpleasant task, sustained care and insufficient resources. Ten subthemes indicated participants’ experiences and understanding of caring conditions in a nursing home. Conclusions: The prevailing given care was the routine one with a focus on physical aspects, although there was some psychological care given to the older people. The findings of this research are guidelines for managers and care planners in nursing homes who should pay attention to physical and psychological care needs of older people. In addition, it is important to pay close attention to the needs of caregivers and provision of instructions for treatment, supervision and education of caregivers and medical students to provide a better care.

Introduction: Parents who care for Thalassemia children tolerate a great burden. Understanding these sufferings seems necessary in order to provide appropriate care. This study was aimed to explore the experiences of parents who have children with thalassemia. Method: A qualitative approach was used to obtain rich data. Twenty-two parents were recruited purposefully from one charity clinic in South East of Iran. Semi-structured interviews were used. Data were analyzed by Lundman and Granheim's content analysis method. Results: Data analysis led to form one main theme including “Parents’ Burden of care”. Within this theme the following categories created: immersion in suffering, stigma and social death, uncertainty about future, and absence of a support network. Conclusion: The findings of this study showed that Caring for children with thalassemia have a significant impact on the lives of caregivers and alleviating caregivers’ burden is critical to managing parents. This research may be useful in terms of increasing information about thalassemia and raising consciousness of nurses and other health care providers.

This study aims to explore the life experiences of Iranian leprosy patients in health, family and economic dimensions. Mycobacterium leprae is responsible for leprosy, a type of chronic inflammatory disease that existed from ancient times, still hearing the name of leprosy creates an awful imagination of cutting the organ, blindness and isolation and it has still remained as a serious social problem. The patients are confronted with particular problems physically and mentally. The phenomenological tradition was used to gain knowledge of the leprosy patients lived experiences. Data analysis method was based on Colaizzi's approach. This is a qualitative research using purposeful sampling, interviewing the leprosy patients referring to a contagious diseases department of the Health Network of Nourabad Lorestan City. Data were collected by interviews those were analyzed in Colaizzi's Methods to extract the conceptual codes. Some concepts obtained from the analysis of data in the study such as physical, psychological, social, family, economic experiences, cultural beliefs of society, the context for tendency toward defect and disability and social stigma. These findings suggest that health care professionals should pay attention not only to leprosy patients to reduce their physical and psychological but also to the community and public culture to reduce the leprosy patients suffering from social stigma. The results of the present study can help us in a better understanding of all aspects of patients' lived experiences.

Background: Individuals’ experiences following addiction abstinence may have different meanings from the former addict’s perspective, demanding careful scrutiny to understand such experiences. Objectives: This study aimed to explore and explain the meaning of the lived experiences of addicts after sobriety. Patients and Methods: This descriptive phenomenological study aimed to describe the experiences of individuals who had stopped using drugs. The participants were 10 members of narcotics anonymous (NA) in Lenjan, Iran, who were recruited using the purposive sampling method. To gather the data, unstructured, in-depth interviews were carried out. The interviews were recorded on cassette tapes with the consent of the participants, and the collected data were analyzed using Colaizzi’s method. Results: The results of this study were presented in the form of 48 codes and included the four main themes of detour, gateway, metamorphosis, and leadership. These represent the general structure of the individuals’ lives after recovery. Conclusions: Our findings revealed that specific factors, such as recall of sustained suffering in the course of recovery, members’ contribution, being part of a community, participation in collective classes, feelings of equality and co-leveledness, observation of others’ success, and rethinking, played significant roles in addiction recovery.

Background Psoriasis is a chronic mental and physical disease that leads to many challenges for people along their lives so that its compatibility and acceptance by the patient is hardly possible. Objectives The objective of the present study was to describe and explain the experienced coping strategies by patients with Psoriasis. Methods The present study was a qualitative phenomenological interpretation, which was conducted on people with psoriasis, who had referred to Imam Khomeini hospital of Ahvaz during June and March 2014. In this study, 15 people with psoriasis were selected based on purposive sampling and they were asked to express their life experiences regarding coping strategies. Data were collected through a deep and unstructured interview, and the method of Diekelmann et al. (1989) was used for data analysis. Results After analysis of the texts of interviews, the main theme, which was attempt to cope with disease and four sub-themes namely “disease, the reason for spiritual promotion”, “intellectual insight”, “supporting behavior” and “concealing disease” were extracted, which indicated the patients’ experiences when coping with psoriasis. Conclusions The results of the present study showed that people with psoriasis experienced many challenges in order to cope with this disease, and accurate identification of these challenges and real understanding of their experiences by health professionals, and reflecting positive experiences such as spiritual promotion via their disease to other patients are recommended.

Background: Psoriasis is a common, chronic skin disease that causes challenges such as stigma and labeling from both the community and individuals due to its effects on appearance. Objectives: The objective of this study was to describe and explain the social stigma and rejection experienced by patients with psoriasis. Patients and Methods: The present research is a qualitative study with a hermeneutic phenomenological approach conducted among psoriasis patients referring to the dermatology clinic and ward of Imam Khomeini hospital in Ahvaz, Iran between June and December 2014. In this study, 15 patients with psoriasis were selected by purposeful sampling, and they were asked to express their experience of stigma and rejection. The data were collected through in-depth semi-structured interviews, and Diekelmann and colleagues’ method was used for data analysis. Results: After analysis of interviews, four themes were extracted: lack of social support, unrealistic and inappropriate labeling, rejection and isolation, and feeling of absurdity and futility. These can be indicative of the patients’ experience from social stigma and rejection phenomena. Conclusions: Patients’ experiences of stigma and rejection phenomena indicated that all aspects of their lives are affected. Moreover, these findings highlight the significance of stigma and rejection concepts in providing better care to these patients.

In response to the need for effective elderly primary health care programs in the Islamic Republic of Iran, the present study sought to determine the nature of family's caring behaviors related to the elderly primary health care in an urban area in Iran. A qualitative research was conducted through 24 in-depth interviews, 4 focus groups (8 participants in each group) and participants observation. The following 2 main categories emerged from the analysis to describe family's caring behaviors: internal responses and external responses. This qualitative study has gathered data that could be used by policy makers and health care providers and researchers concerned with elderly health and their quality of life. Based on these findings, it is recommended that providing primary health care for the elderly should be embedded in a comprehensive approach which aims to change the conditions affecting the elderly primary health care in urban areas.

BACKGROUND: Road traffic injuries (RTIs) are a major public health problem and the most important cause of disability, morbidity and mortality worldwide. Early rehabilitation can play a significant role in minimizing complications, morbidity and mortality. OBJECTIVES: The aim of this study was to describe perceptions of barriers precluding provision of early rehabilitation care for RTI victims. PATIENTS AND METHODS: A qualitative content analysis was carried out on 15 nurses with at least one year experience caring for RTI victims. The nurses were selected from various wards (emergency, orthopedic, neurosurgery, and clinic) of Sina and Imam Khomeini Hospitals via targeted sampling. Data were collected through semi-structured interviews and targeted sampling until data saturation. Data were analyzed and assessed. RESULTS: After continuous analysis and comparison of data, major causes precluding nurses from early rehabilitation of RTI patients were retrieved. These barriers included: (a) lack of insight, (b) lack of comprehensive care (c) excessive costs; facilitating factors included (d) training for cooperation and (e) support for coping. CONCLUSIONS: The findings of this study show that the need for early rehabilitation in the hospital phase of care for RTI victims is needed. Knowledge about the barriers precluding nurses from early rehabiltiation of RTI patients and facilitators that can help health care workers and policy makers eliminate the barriers precluding early rehabilitation can help health care workers, especially nurses enable patients get over their disability and gain social and family support. Language: en

Background: Having a patient in a vegetative state in the family is a complicated and stressful experience. Caring for such patients with complete disability at home is very challenging. Objectives: The present study aimed to explore the outcomes of caring for patients in a vegetative state for families and caregivers at home. Patients and Methods: In this qualitative study, 16 vegetative patients’ caregivers were selected through purposive sampling. Unstructured interviews and observations were used for data gathering. Data collection was continued until saturation of data and emergence of the main themes. Data analysis was performed by the content analysis method. Results: The analysis of the gathered data led to three themes: “lost main caregiver”, “affected caring partner” and “affected family”. Each theme had some subthemes and subcategories. Conclusions: The three emerged themes in this study showed that all the family members of vegetative patients, depending on their responsibilities, were affected by physical, mental, social and economic issues.

Introduction: Heart transplantation is considered as a golden standard of treatment for advanced heart failure. After - transplantation health of patients is influenced by numerous issues which many of them are unknown to the treatment team including nurses. This research - with the aim of describing the life experiences of heart transplant patients - help us to get close to the patients private life and gain comprehensive and a general understanding of all aspects of their life. Methods: This study applied qualitative approach using phenomenology method. The purposive sampling was conducted and continued with 9 participants until information reached saturation point. The participants are the heart transplant recipients who had surgery in Esfahan's Heart Surgery Center of Shahid Chamran. Results: The extracted interviews were analyzed through Colaizzi method: The eleven extracted main concepts were included: Belief, tendencies of the recipient and family of donor, bewilderment, moment of facing with transplantation, satisfaction, vital organ, support, temperament, physical effects of transplantation, mental changes, paradox of life and death. Conclusion: In heart transplant patients, being in touch with peers and family support have an important role in putting up with the transplantation issue. Lack of social situation and social support were among the patients distresses. Lack of the necessary information about transplantation made patients dissatisfied with the heart transplantation. Regarding the research findings, training received by patients would not be suffice and lack of information has been made them face with problems; therefore, the nurse team of transplantation should play more an active role in training the patients.

Background Complications and diabetes-related difficulties such as fatigue are among the major hindrances in improving health behaviors such as the participation in diabetes self-care programs. Objectives This study investigates the factors influencing fatigue levels in type two diabetes patients given the significance of fatigue and its consequences on controlling diabetes as well as regarding the significant role of the community health nurses in treating and educating patients. Patients and Methods The present study is a quantitative research with a descriptive design. The participants of the study were 195 patients with type two diabetes supported by Isfahan Endocrine and Metabolism Research Centre. They were selected via available sampling method. The instrument of data collection was a written questionnaire that consists of two-part demographic information section and a short form of the Multidimensional Fatigue Symptom Inventory (MFSI-SF). The collected data were analyzed using SPSS (ver 16). The significance value for all the tests in the study was P ˂ 0.05. Results There were significant statistical differences (P ˂ 0.05) between the mean fatigue scores for females (23.22 ± 17.49) and males (13.24 ± 17.73). Among the investigated factors, there was a significant statistical association among the fatigue mean total score and body mass index, (F = 9.521, df = 2, P ˂ 0.05), physical activity (t = 3.90, df = 190, P ˂ 0.05), and complications such as nephropathy, neuropathy, and foot ulcer history. Conclusions Fatigue in diabetes is a complex and multifaceted phenomenon, which can be controlled and treated effectively, if it is evaluated appropriately, and the factors that cause it are investigated.

One of the shared common goals of World Hypertension League (WHL) and World Health Organization (WHO) is the control of hypertension. Despite many local and international interventions, the goal has not been achieved. This study evaluated an intervention based on the partnership care model to control hypertension in a rural population in the north of Iran. The results showed that the intervention was effective in decreasing systolic and diastolic blood pressure and in increasing the rate of controlled hypertensives (based on criteria of WHO/WHL). The intervention also had positive effects on health-related quality of life, body mass index, anxiety, high density lipoprotein level and compliance score. Based on these results, the partnership care model is effective in hypertension control and is recommended as a model to replace previous approaches in hypertension control.

The function of every family has a significant impact on the health of its members. Thalassemia is a chronic disease and, as the most common genetic disorder in the world, affects different aspects of life, including emotional well-being. The purpose of this study was to determine the relationship between well-being in children with a Thalassemia major and the function of their families, in Isfahan, Iran, in 2013. This was a cross sectional study and census sampling was used to collect the data. The study sample consisted of 97 children with thalassemia at the age of 10-16 years who referred to the clinic of Imam Reza, Seyed-al-Shohada Hospital in Isfahan. The subjects were evaluated using the Adolescent Psychological Wellbeing Scale and Family Functioning Questionnaire. Data were analyzed using SPSS software. The Pearson correlation coefficient showed that there was a reverse relationship between the overall score of family functioning and illness score of children with thalassemia (r=-0.377, P

Background Cardiovascular diseases are the most common cause of mortality in Iran. A six-year, comprehensive, integrated community-based demonstration study entitled Isfahan Healthy Heart Program (IHHP) conducted in Iran, and it started in 2000. Evaluation and monitoring are integrated parts of this quasi-experimental trial, and consists of process, as well as short and long-term impact evaluations. This paper presents the design of the "process evaluation" for IHHP, and the results pertaining to some interventional strategies that were implemented in workplaces Methods The process evaluation addresses the internal validity of IHHP by ascertaining the degree to which the program was implemented as intended. The IHHP process evaluation is a triangulated study conducted for all interventions at their respective venues. All interventional activities are monitored to determine why and how some are successful and sustainable, to identify mechanisms as well as barriers and facilitators of implementation. Results The results suggest that factory workers and managers are satisfied with the interventions. In the current study, success was mainly shaped by the organizational readiness and timing of the implementation. Integrating most of activities of the project to the existing ongoing activities of public health officers in worksites is suggested to be the most effective means of implementation of the health promoting activities in workplaces. Conclusion The results of our experience may help other developing countries to plan for similar interventions.

This study uses grounded theory methodology to generate a substantive theory that describes and explains the problem of high blood pressure control among Iranian patients. High blood pressure control is a major world health problem on which many studies have been carried out. Most of these studies have been done by quantitative research methods. The main purpose of this qualitative research was to determine the essential structure of high blood pressure control in an Iranian hypertensive population and to identify a theoretical explanation for this problem. Four interrelated concepts: 'non-compliance', 'lack of knowledge', 'lack of effective caring relationship', and 'necessity of partnership' were identified. Based on these processes, a partnership care theory was developed that provides an appropriate context for the active participation of patients, nurses and physicians in the control of hypertensive disease. This theory can be utilized in the control of hypertension as well as other chronic diseases.

An examination of what constitutes assessment would help to clarify those aspects which are essential for establishing a suitable nursing plan for clients. There is no consensus on one assessment tool in nursing, and many methods are used. The important areas in a comprehensive assessment (physiological, mental, social and environmental factors) which need to be addressed are covered by the Omaha Classification Scheme (OCS). This paper discusses the application of a research tool (OCS) for assessing the health needs of a given population. The primary focus of this paper is upon the methodology used in the study. A random sample of 500 elderly people was drawn from all elderly people aged 65 years and over, who lived in the rural areas of Isfahan province, Iran. Data were collected to identify the health needs of the population under study using the OCS. The reliability of this research tool was tested for quantitative scores using Cronbach's alpha test. The results showed an acceptable score for reliability (r = 0.78).

Studies have shown that methadone maintenance treatment (MMT) is effective in improving the client's quality of life and physical health. This study aimed to describe the nature and structure of drug dependents' experiences and the physical effects of MMT. The present study is a qualitative and a phenomenology study on 32 clients referred to methadone clinics in the city of Kerman in 2008. Colaizzi's method was used for data analysis and to evaluate the data, validity and reliability criteria were used. Encoded concepts were categorized in general groups of effectiveness on general health, sleep, appetite and weight, sexual desire, appearance and other effects. These six categories showed the main structure of experience and physical effects of MMT. The clients' viewpoints towards this treatment had a role in their experience expression and feelings, but MMT had an overall positive physical effect on the clients.

Background This study reports the results of the qualitative process evaluation (PE) of the Isfahan Healthy Heart Program (IHHP), an integrated community-based trial for prevention and control of non-communicable diseases in Iran. Methods The study explored the overall quality of program implementation. The participants, including designers of IHHP, stakeholders and community members (n = 60) were purposefully recruited from the intervention areas. Data collected from semi-structured interviews and field notes were analyzed using a modified thematic analysis. Results Four main themes were identified. Our findings highlighted the key role of the resources as both facilitating and hindering factors. IHHP directors faced incompatibilities arising from negative perceptions/attitudes which resulted in decreased adherence to the program. Hence various strategies were used to motivate, strengthen and organize the human workforce implementing the program. Conclusion Recommendations arising from evaluation of the program were used in subsequent stages of implementation. Qualitative research is an important component of community trials which can improve their implementation.

Background Until the last 2 decades, spiritual care was a vital, but invisible, aspect of nursing care. Spirituality and spiritual care have entered the mainstream, and the literature in this area has burgeoned. In addition, there is minimal information in the literature documenting the expressed spiritual needs of patients in general and specific subgroups of patients in particular, thus this article aimed to present spiritual needs of Iranian Muslim patients. Therefore, this study is of significance to nursing in general and to transcultural nursing in particular because of the high priority associated with increasing the nursing knowledge through research that investigates and describes care practices in diverse cultures.

Address: 1Lorestan Medical Sciences University, Lorestan, Iran, 2Faculty of Nursing & Midwifery, Islamic Azad University, Khorasgan Branch And Medical Education Research Centre (MERC) of Isfahan University of Medical Sciences, Iran, 3School of Nursing and midwifery, Esfahan Medical Sciences University, Iran and 4School of Nursing and midwifery, Ardabil Medical Sciences University, Iran * Corresponding author