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Background & Aim: In recent years, significant changes have occurred in the dynamics of childbearing within familial context. Notably, Iranian families have witnessed a noticeable decline in the desire for childbearing and having additional children. The aim of this study was to explore the determinants of childbearing decision-making among women and men of reproductive age. Methods & Materials: This study adopts a qualitative research design using the conventional content analysis approach in 2023. The participants comprised 19 married women and men of reproductive age living in Zanjan, who were purposively selected to ensure maximum variation. After obtaining informed consent, the participants were invited to participate in individual, semi-structured interviews. Data collection continued until data saturation was reached, with concurrent analysis conducted throughout the process. The textual data were managed using MAXQDA software, version 2020. Results: Throughout the inductive data analysis process, seven main categories emerged as determinants of decision-making about childbearing. These categories included social role modeling, reflection within family structure, social and economic requirements, contemporary concerns in parenting, avoidance of responsibility and comfort-seeking, unpleasant past experiences and age-related challenges. Among these categories, social and economic requirements emerged as the most prevalent concept across all interviews, with a total of 505 open codes associated with this category. Conclusion: The normalization of reduced childbearing rates within the society, accompanied by shifting values and attitudes towards the significance of children, as well as economic and social problems have contributed to an increasing preference for smaller families. Furthermore, the desire for fewer children can be viewed as a response to the individualistic tendencies of women and men, as well as a means of avoiding parenting concerns.

BackgroundOlder adults with polypharmacy are more prone to medication errors. People with low educational attainment have more difficulties in taking their medications.ObjectivesThis study aimed to identify the extent of medication self-administration errors (MSEs) and the contributing factors among illiterate and low-literate community-dwelling older adults with polypharmacy.MethodThe present cross-sectional study was conducted among people aged 60 and above. The data were collected using the sociodemographic, clinical, and Belief about Medicines Questionnaires (BMQ). To determine the extent of MSE, a medication error checklist was used. The negative binomial hierarchical regression model in the five blocks was performed.ResultsThe final sample size was 276 people. The frequency of MSEs in the last 6 months was 69.2%. Sixteen percent of participants had made four or more mistakes. The most common MSEs were forgetting, improper taking of medications with food, improper timing, incorrect dosage (lower dose), and forgetting the doctor's instructions. Near 18% of participants reported adverse events following their mistakes. The significant predictors of MSEs were being completely illiterate (p = 0.021), the higher number of doctor visits per year (p = 0.014), irregularly seeing doctors (p < .001), the higher number of medications (p < .001), and having poor medication beliefs (p < .001).ConclusionDespite the high prevalence of MSEs among older patients, practical strategies to deal with them at their homes have not been established among health systems. MSE as a multifactorial event can be caused by a collection of internal and external factors. Further studies to identify the role of patients, clinicians, procedures, and systems in developing MSEs as interconnected components are needed.

Objectives: Social isolation of older adults is one of the major global concerns associated with widespread negative outcomes. The present study aims to investigate the psychometric properties of the Persian version of the social disconnectedness and perceived isolation scales in Iranian older adults. Methods & Materials: The translation/back-translation process was performed based on the standard protocol of world health organization. Face and content validities were assessed based on the opinions of a panel of experts. The content validity of the scales was evaluated by calculating the content validity ratio (CVR) and content validity index (CVI). Internal consistency, reliability, and construct validity were evaluated using Cronbach’s alpha, test-retest method, and factor analyses, respectively. Factorial structure of the scales was tested using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling in a sample of 390 community-dwelling older adults aged ≥ 60 years residing in Tabriz, Iran. Data analysis was performed in SPSS software, version 26 and AMOS version 24. Results: For the social disconnectedness scale, CVR‌=‌0.98 and CVI‌=‌0.91; for the perceived isolation scale, CVR‌=‌0.91 and CVI‌=‌0.96. The EFA with the varimax rotation identified new factors in both scales. Cronbach’s alpha of 0.64 for the social disconnectedness scale and 0.76 for the perceived isolation scale showed that their internal consistency was acceptable. The number of factors in the social disconnectedness scale changed from two to three factors, and the number of factors in the perceived isolation scale changed from two to four factors in the Persian versions. The CFA and SEM confirmed the three-factor solution of the Persian version of the social disconnectedness scale (RMSEA=0.050, GFI=0.951, CFI=0.950, and TLI=0.955) and the four-factor solution of the Persian version of perceived isolation scale (RMSEA=0.045, GFI=0.955, CFI=0.955, and TLI=0.950). Conclusion: Although the structures are different from those of the main versions, the Persian versions of the social disconnectedness and perceived isolation scales have acceptable reliability and validity to be used in Iranian older adults.

Background & Aim: The Covid‐19 pandemic has posed numerous ethical challenges to nurses and has exacerbated moral distress in clinical settings. Hence, due to the important role of nurses in pandemics, this study was conducted to investigate the severity and frequency of moral distress among nurses working in clinical settings at Maragheh teaching hospitals during the outbreak of COVID-19. Methods & Materials: This was a cross-sectional study conducted on 174 nurses working in surgical-medical, intensive care, pediatric and emergency wards of Maragheh hospitals in 2020-2021. Data were collected using a demographic form and the Corley’s Moral Distress Scale. Results: The median (Interquartile Range (IQR) = Q3 − Q1) of the severity and frequency of moral distress experienced were 54 (44-59) and 52 (43-58), respectively. The median of moral distress experienced in the intensive care and emergency wards were 56 (51-59) and 46 (43-51), which was more severe than that of in other wards. The median of frequency and severity of moral distress in men were 48 (41-59) and in women 50 (43-59), respectively, which was significantly higher than that of in women (P0.05) so that with increasing age and work experience, the severity and frequency of moral distress decreased. Conclusion: Given the high frequency of moral distress among nurses during the COVID-19 pandemic in specific clinical settings, the use of management strategies in order to improve working conditions and create a positive setting can be helpful. It seems that holding courses on coping with moral distress in nurses in the context of the COVID-19 pandemic is an appropriate practical solution.

Background: Despite the intention to perform physical activity (PA), a number of individuals cannot manage to have PA program on a regular basis. In this study we explored the barriers of regular PA behavior among healthy adults in Tabriz, Iran. Methods: This qualitative study with a conventional content analysis approach, was carried out from June to September 2020. Nineteen 30-59 years old individuals, were purposefully (purposive sampling) selected to participate in the study. The participants were formerly registered as "physically inactive" in the health records of Tabriz Health System. Individual semi-structured interviews were conducted until data saturation. Data were managed using MAXQDA-10 software. Results: The barriers of regular PA that emerged from our data were being listless and lethargic, non-supportive environment, disintegration in PA education chain, and restrictive social norms. Conclusion: Our findings uncover several PA barriers that are less discussed in the literature. Poor level of regular PA among adults in Iran, as a developing context, is rooted in perceptions with social and economic origins, which should be taken into account by public health policy makers while planning PA promotion programs in such communities. To promote regular PA among healthy adults in developing countries, regular PA programs should be tailored to bridge the gap between their recognition of PA barriers and subsequent behavior change through creating group dynamics highlighting the measures to diminish the behavior.

Introduction: Clinical decision-making is a key component of clinical practice that affects the quality of providing patient services. The explosion of medical knowledge and the need for autonomy of residents' performance has made clinical decision making more difficult for residents. This study explores the experiences of medical residents from clinical decision making. Methods: A qualitative content analysis approach was adopted. Individual semi-structured interviews with medical residents were done. The participants were the medical residents from the hospitals of Tabriz University of medical sciences. Purposive sampling method with the maximum variation was employed. Data collected by individual semi-structured interviews until data saturation and concurrently analyzed. MAXQDA 10 was used to manage the textual data. Results: Three main categories emerged from the experiences of medical residents including, inadequacy of clinical decision making requirements, decision making based on the prevailing conditions in the clinical setting and lack of supportive professional relations. Conclusion: Given that clinical decision making is formed in a structure consisting of the climate of clinical setting, available facilities and equipment as well as professional relationships in workplace; therefore, elimination of barriers requires improving the cultural, educational, professional settings and interpersonal relationship.

Abstract Background e-health literacy can facilitate the uptake of benefits of health for older adults. In this review, we aimed to tabulate the types and outcomes of the theory-based e-health interventions that had been applied to improve the e-health literacy of older adults. Methods In this systematic review, theory-based e-health literacy interventions that published up to April 2020 were retrieved from several online electronic databases, including Medline via PubMed, Cochrane Library, ProQuest, and EMBASE. The published papers were included in this study, if the study had been conducted on older adults, a theory-based intervention aimed at promoting e-health literacy, and had been written in English language in the timeframe of 2008–2020. Results A total of 1658 records were identified initially, of which, 12 articles met the inclusion criteria. The systematic review identified the using of variety of intrapersonal, interpersonal, and societal level conceptual models in enhancing of e-health literacy in older adults, and the concept of self-efficacy was applied in the most of interventions as the main conceptual theoretical framework. Conclusions Despite the paucity of conceptual models, which are specifically designed for e-health literacy interventions, based on our findings, we recommend self-efficacy as a powerful concept that can play an important role in improving e-health literacy in older adults.

Abstract Background Pedestrian-vehicle collision is one of the most common traffic injuries worldwide. This study aimed to investigate the determinants of pedestrians’ road crossing beliefs and behaviors in potentially risky situations using the Theory of Planned Behavior among Iranian young adults. Methods This was a population-based study on a sample of 562 young adults aged 18 to 25 years living in Tehran, Iran. Data were collected by using a self-administered validated questionnaire including constructs of the theory of planned behavior and items of perceived risk and severity. The data were analyzed using independent t-test, analysis of covariance and multivariate analysis of variance. Results From all the respondents, 17.8% reported that they had previous experience of vehicle-collision. Among the participants, those who had previous experience of vehicle-collision reported less safety behaviors in crossing the road than those who had not experience an accident. It was found significant differences between participants with and without a history of vehicle-collision for perceived risk (mean difference, adjusted multivariate P-value: − 5.77, 0.027) and perceived severity (− 6.08, 0.003), attitude toward traffic regulations (− 6.34, 0.006), attitude toward behavior (− 7.56, 0.005), perceived behavioral control (− 5.20, 0.018), behavioral intention (− 5.35, 0.046) and road crossing behavior in potentially risky situations (− 5.37, 0.004). Conclusions Previous unpleasant experience of vehicle-collision is not the only determinant of self-protective behaviors in road- crossing which indicate the role of cognitive and motivational factors such as, subjective norms, attitudes towards risk, feelings of invulnerability in case of facing with vehicle collision.

BackgroundProviding lonely older adults with informal home care services is important to improving their health and quality of life. The study aims to evaluate the feasibility of design, implementation and evaluation of an informal home care support intervention program (HoSIP) for community-dwelling lonely older adults in Gorgan, Iran.Method/designThis feasibility study is a mixed-method with a concurrent nested design. Lonely older adults will be enrolled as the HoSIP intervention group and will receive 12-weeks of informal home care service by peer supporters. The purpose of this feasibility study is to determine the recruitment capability and resulting sample characteristics, data collection procedure and outcome measures, the acceptability and suitability of the intervention and study procedures, the resource and ability to manage the study and intervention, and preliminary evaluation of participant response to intervention. Primary outcomes including participant feelings of loneliness, quality of life, general health, social network, social support, and self-care ability, will be assessed at baseline and post-intervention for the intervention and control groups. Semi-structured interviews will be conducted immediately after the intervention using content qualitative approach to describe participants' experiences with HoSIP.DiscussionThrough this study we will examine the feasibility of delivering informal home care services to community-dwelling lonely older adults in a developing country through employing a concurrent nested mixed-method design.Trial registrationIRCT20190503043455N.

Abstract Background Adherence to HIV medication is necessary for long-term HIV disease management. The objective of this study was to develop and examine the psychometric properties of a scale for measuring the barriers of antiretroviral medication adherence among Iranian Patients. Method This was a sequential, exploratory mixed methods investigation composed of two phases. In the qualitative phase, item pool generation and questionnaire designing was carried out through in-depth individual interviews and group discussions; in the quantitative phase, psychometric properties of the questionnaire were assessed. In both phases, the participants were people who were living with HIV/AIDS and were taking antiretroviral medications. Results In the first phase, an item pool containing 181 statements related to barriers of adherence to antiretroviral medication was generated. In the second phase, item reduction was applied, and a questionnaire containing 30 items was developed. The psychometric properties of the questionnaire were assessed, which indicated good validity and reliability of the instrument. In exploratory factor analysis, the items were loaded on six factors that altogether explain for 61.98 of the variance. The Cronbach’s alpha and the intra class correlation coefficient of the questionnaire was 0.91 and 0.80, respectively. Conclusion This study provided a reliable and valid instrument to identify the barriers of adherence to antiretroviral medication in patients with HIV/AIDS. Identify these barriers and design of interventions to eliminate or reduce of barriers can be an effective means of enhancing adherence to antiretroviral medication among these patients.

Objectives: Although effective performance in clinical settings requires the integration between theory and practice, there is a gap between theoretical knowledge as taught in the classroom and what the students experience in clinical settings. This study aimed to elicit and explore the barriers of utilizing theoretical knowledge in clinical settings. Methods: A qualitative study was adopted with a conventional content analysis approach. Fifteen nursing and paramedic's students, faculty members and experienced nursing staff participated in the study. Data were collected by semi-structured individual interviews until data saturation and concurrently analyzed via MAXQDA 10. Results: Five main categories emerged as barriers of utilizing theoretical knowledge in the clinical settings i.e. non-standard practices in clinical settings; lack of trust in clinical competence; lack of perceived professional support; insufficiencies in teaching and learning process; and differences between doing things in simulated and real clinical situations. Conclusion: Transferring theory into practice in a structured manner requires professional support in the workplace, trust and the opportunity for direct experience, using valid and up-to-date knowledge by clinical staff and bridging the simulated situations with real life scenarios. Keywords: Clinical competence, Medical education, Knowledge, Practice, Qualitative research, Transfer

Background: Although pedestrian-vehicle accidents are often the results of risky behaviors during road crossings, there is limited evidence concerning the risky road crossing behaviors of pedestrians. This study was aimed at eliciting and exploring the reasons that can help explain why young pedestrians take risky road crossing behaviors. Methods: A qualitative content analysis approach was conducted on purposefully selected young individuals who had the experience of vehicle-collision accident. Data collected by in depth, semi-structured interviews until data saturation and concurrently analyzed, assisted by MAXQDA 10. Results: Three main categories emerged as social reasons for risky road crossing behaviors of the young pedestrians including ‘conformity with the masses/crowds’, ‘lack of social cohesion and sense of belonging in social relations’ and ‘bypassing the law/ law evasion’. Conclusion: The risky road crossing behaviors of young pedestrians are found influenced by the pedestrian attitudes towards the political, social, cultural and economic condition of the society.Moreover, popular culture and collective behaviors in crossing the roads influenced the risky behaviors. Hence, personal, cultural and social interventions could be effective in promoting the young pedestrians’ behavior.

Background & Aim: Pedestrians are the most vulnerable road users. In many cases, pedestrian-vehicle crashes are often the result of their risky road crossing behaviors. So, this qualitative study aimed to explore the reasons for risky road crossing behaviors among young people. Methods & Materials: The current study was designed as a qualitative content analysis. Twelve males and females who had a car-accident were purposefully selected with maximum variation sampling. Data were collected and analyzed by semi-structured individual interviews. Results: Conformity with the masses including “conformity with peers and conformity with the public space of society”, and anomie emerged as the most important social reasons for young pedestrian’s risky road crossing behaviors. Conclusion: According to the results of this study, young pedestrian’s risky road crossing behaviors are affected by conformity with the masses and peers and as well as anomie so that risky behaviors have been commonplace and inevitable and a part of their lifestyle.

Objective To explore the obstacles of community participation in rural health education programmes from the viewpoints of Iranian rural inhabitants.Design This was a qualitative study with conventional content analysis approach which was carried out March to October 2016.Setting Data collected using semistructured interviews that were digitally recorded, transcribed and analysed until data saturation. MAXQDA 10 software was used to manage the textual data.Participant Participants were twenty-two seven clients from a rural community in Ardabil, Iran who were receiving health services from health centres.Result The main obstacles to participate in health education programmes in rural settings were ‘Lack of trust to the rural health workers’, ‘Adherence to neighbourhood social networks in seeking health information’ and ‘Lack of understanding on the importance of health education’.Conclusion Rural health education programmes in Iran are encountered with a variety of obstacles. We need to enhancing mutual trust between the rural health workers and villagers, and developing community-based education programmes to promote health information seeking behaviours among villagers. The finding of this study will be a referential evidence for the qualitative improvement of local health education programmes for rural inhabitants.

Objective (s): Health literacy is a relatively new emerging concept in public health. It is also a new area for research with links to communication. It has been suggested that poor health literacy poses a major barrier to public’s health and might represent a major cost to health care system. The aim of this study was to review instruments that measure health literacy. Methods: A review was undertaken of all the full publications in the English language biomedical journals between 1993 and 2012. The search included the combination of keywords ‘health literacy’, and ‘tool’, or ‘instrument’, or ‘scale’, or ‘questionnaire’, or ‘measure’, that appeared in the titles/abstracts of the publications. In addition, a manual search was performed to include additional papers of potential interest. Results: In all 1788 citations were identified. After screening, 1265 duplicate citations were excluded. The remaining 523 citations were further examined and 438 citations were found irrelevant. Finally the full texts of 85 papers were assessed. Of these 42 papers were found to be relevant and were included in this systematic review. We identified 23 instruments that were used to measure health literacy. These all were introduced. Conclusion: Lack of comprehensive instrument to measure health literacy was evident. Thus, developing a new instrument seems necessary. A new tool should be simple, short, and inclusive.

In the original publication of this article [1] the author pointed out the name of author Minasadat should be ‘Mina Hashemiparast’, not ‘Minasadat hashemi parast’.

Background: Beliefs and emotions could effect on functional status, quality of life, and mortality amongst patients who are suffering coronary heart disease (CHD). Current study examined the role of anxiety: trait/ state, self-efficacy, health beliefs, and functional status among patient with history of CHD. Method: In this correlational study, 105 hospitalized and outpatients patients suffering CHD in Tehran Heart Center Hospital participated by using convenience sampling method in 2012. Cardiac self-efficacy, Seattle Angina, and research- designed health beliefs questionnaires were used to gather data. Results: The functional status in CHD patients showed significant relationships with gender, job, and type of medical insurance of the participants (All ps