Journal of Education and Health Promotion

Abstract BACKGROUND: Family caregivers of hemodialysis patients experience various physical,
psychological, social, economic, and spiritual problems that reduce their quality of life. The present
study aimed to determine the effect of a family‑centered education program on the quality of life of
family caregivers of patients undergoing hemodialysis.
MATERIALS AND METHODS: This was a randomized controlled trial that was performed on 70
caregivers of patients undergoing hemodialysis in the medical centers of Hazrate Ali Asghar and
Hazrate Zahraye Marzieh in Isfahan. Caregivers were randomly divided into experimental and control
groups, and the experimental group received an eight‑session family‑centered education program.
Data were collected using the Quality of Life Scale (QOLS)‑short form immediately after and 1 month
after the intervention. Data analysis was performed using the Statistical Package for the Social
Sciences (SPSS) software version 18 and analysis of variance and covariance.
RESULTS: The results showed that both experimental and control groups were homogeneous in
terms of demographic information and there was no significant difference between them in this regard.
Analysis of data on quality of life and its four domains showed that the mean scores of quality of
life (P = 0.089) and its four domains including physical health (P = 0.367), mental health (P = 0.429),
community relations (P = 0.132), and environmental health (P = 0.232) increased significantly
immediately after and 1 month after the intervention (P < 0.001 in all cases).
CONCLUSION: Educational programs can improve the quality of life of family caregivers of
hemodialysis patients. Therefore, it is recommended that programs be developed and evaluated in
various studies in the future.

Abstract BACKGROUND: Advanced stages of dementia interfere with elderly self‑care. Consequently, they
need caregivers who take responsibility for their care in the long‑term. Restrictions to the caregiver’s
access to information, resources, and organizational support have created problems in their caregiver
role, which is why the World Health Organization (WHO) emphasizes caring for caregivers by providing
evidence‑based information and training programs. As there is no clinical practice guideline for home
care in the Islamic Republic of Iran, this study aims to develop a home health care guideline for the
elderly with dementia.
MATERIALS AND METHODS: The ADAPTE process provided by the Guidelines International
Network was considered as the basis. In order to identify the care needs of Iranian patients with
dementia, semi‑structured interviews were added to this guideline.
DISCUSSION: The identification and implementation of the perspectives of patients and caregivers
during the process of guidelines adaptation increase the applicability of the guidelines. Improved
quality of life for the patients in their place of residence is one of the expected consequences of this
guideline’s implementation. The developed guidelines will be used at home health care centers, and
dementia and Alzheimer’s associations in Iran.

Abstract BACKGROUND: Living with children with autism spectrum disorder (ASD) can affect different
aspects of parents’ physical and mental health and quality of life. This study aimed to identify parents’
perceptions of their quality of life and factors influencing such perceptions and investigate how they
cope with difficulties in their daily lives.
MATERIALS AND METHODS: This study was conducted using a qualitative research design to gain
insight into how children with ASD may influence their parents’ quality of life. A total of 31 parents
and school counselors were selected by the snowball sampling method in autism schools in Tehran
in the academic year 2018–2019. Semi‑structured interviews were used to collect the data. Each
interview was held based on a preprepared guideline by the researchers. In‑depth questions were
also asked as needed. Finally, the data were analyzed using the content analysis approach.
RESULTS: The participants reported a variety of difficulties and crises to cope with in their daily
lives. The factors reported to decrease the quality of life were categorized into six main themes and
20 subthemes. The main themes included “family interactions,” “parenting,” “daily living,” “health,”
“financial issues,” and “community‑related.”
CONCLUSIONS: Due to the diversity and multilevel factors affecting the quality of life of parents
having children with ASD, it is essential to adopt a comprehensive approach with the participation
of all stakeholders in the development, design, and implementation of future interventions.

Abstract BACKGROUND : The complex, multifaceted care environment and the threatening situation of caring
for hemodialysis patients cause tension in their family caregivers. Due to the severe tension, family
caregivers are likely to ignore their basic needs and only pay attention to the patient’s needs and
related issues. This study was conducted with the aim of designing and evaluating the Perceived
Care tension Questionnaire for Caregivers of Hemodialysis Patients (PCTQHFC).
MATERIALS AND METHODS: The present study was a sequential exploratory mixed methods
study of scale development variant conducted in two phases: qualitative and quantitative. This study
was conducted in 2019 in Shahrekord. The qualitative phase included item development and scale
development. In the quantitative phase (Item Analysis), the validation characteristics of the tool were
examined using face, content and construct validity, and its reliability by internal consistency and
stability. Findings were performed using software SPSS 18.
RESULTS: Principal components analysis with orthogonal rotation to generate factors, showed that
five factors, namely emotional exhaustion, inadequate social support, care burden, confusion and
ambiguity and lack of adaptability skills had an eigenvalue of higher than 1, so that they explained,
respectively, 75.98%, 61.36%, 72.49%, 76.33%, and 70.31% of the total variance. The internal
consistency was obtained 0.811 and the inter‑class correlation coefficient for the whole instrument
0.832.
CONCLUSION: PCTQHFC is a culturally appropriate measure with strong psychometric properties.
The instrument designed in this study measures the care tension of hemodialysis patients. Therefore,
researchers, health‑care providers, and community health policymakers can plan and implement
interventions to reduce the tension of caregivers of hemodialysis patients by analyzing and identifying
the tensions of caregivers.

Abstract BACKGROUND: Timely and appropriate follow‑up appointments for infants at risk for retinopathy of
prematurity (ROP) are very important to prevent blindness. Caregivers are important members of the
ROP team, and their involvement is essential in ensuring optimal visual outcomes. This paper aimed
to develop health information materials on ROP by a systematic process for better comprehensibility
by the target audience of low literacy.
MATERIALS AND METHODS: It was a methodological study conducted at the neonatal intensive care
unit of a tertiary care hospital, North India. The development and validation of educational materials
was conducted in six steps. The study focused on both the knowledge of the target audience and
on the validation of the educational materials by experts and caregivers of ROP eligible infants.
RESULTS: Most of the items (content, language, layout, motivation, and cultural appropriateness)
were in either a suitable or adequate category. Only one item illustration was in the nonsuitable
category. The mean final score of the leaflet after revision by experts was 9 (maximum score = 10).
Regarding readability, The Flesch Reading Ease Score, Flesch‑Kincaid Grade Level, and gunning
fog index were found to be 72.5, 7.4, and 6.2, respectively. The leaflet was found to be suitable for
the seventh grader. The mean knowledge score of the parents was 4 (maximum score‑5).
CONCLUSION: The study showed satisfactory acceptance of the developed ROP information
materials by caregivers and experts. A similar approach could be adopted for the development of
other health information materials.

Abstract Inflammatory bowel disease (IBD), including Crohn’s and ulcerative colitis diseases, is characterized
by clinical periods of remission and relapse. Excessive care stress can have long‑term negative
physical and psychological consequences not only for caregivers but also for the recipients of care.
This integrative review aims to identify, describe, and synthesize the results of current available
research focused on the burdens of IBDs on family caregiver. An integrative review was performed
using Whittemore and Knafl methodology. A systematic search of electronic databases including
Web of Science, PubMed, Embase, and Scopus from January 2000 to October 2019 was conducted.
Articles were included if published in English and focus on IBD burden on family caregivers. Of 730
records, 16 articles with quantitative, qualitative, and Q methodology study designs were eventually
included in the review. The synthesis of these articles led to the identification of four key types of
effects: biopsychosocial, daily life activities, physical health, and financial. The chronic and relapsing
nature of IBD exposes family caregivers to considerable risk. Thus, the care burden of IBD patients’
caregivers needs to be evaluated continuously and relieved through family‑centered interventions.

Abstract BACKGROUND: Caregiver stress is harmful to the health of both caregivers and people living with
Alzheimer’s disease or other dementias. The present study was conducted to assess stress and its
predictors of people living with Alzheimer’s disease or other dementias’ caregivers.
METHODS: The present descriptive, analytical, cross‑sectional study was conducted in December
2017–June 2018 in Isfahan, Iran. Data were collected by interviewing 99 caregivers had at
least 6  months of experience caring for a patient diagnosed with Alzheimer’s disease, through
questionnaires developed by the researcher. A convenience sample (easy access) of caregivers was
recruited from calling the home of formally diagnosed with Alzheimer’s patient, that have registered in
educational hospitals affiliated to Isfahan University of Medical Sciences and psychiatrists’ office both
paid caregivers (formal) and unpaid caregivers (family). All caregivers provided informed consent.
The type and severity of the relationship between the dependent (stress) and independent variable
were assessed using Pearson’s and Spearman’s correlation coefficients, the independent t‑test, and
the multivariate regression analysis.
RESULTS: The caregivers’ mean stress score was 25.4 ± 10.9 (range: 4–54). About 80% of the
caregivers were female. Age and stress score was correlated (P = 0.004), the mean stress score was
significantly higher in female caregivers (P = 0.04), informal caregivers (P < 0.001), and significantly
lower in the caregivers with previous experience of caring for Alzheimer’s patients (P = 0.02) or those
introduced by service companies (P = 0.005). Variables including the family relationship with the
patient (P = 0.01), kind of caregiving (P = 0.03), and previous experience of caring for Alzheimer’s
patients (P = 0.04) were stronger predictors of the stress score.
CONCLUSION: Stress is a challenge in promoting mental health among dementia caregivers.
Providing social support with an emphasis on physical, mental, and social health is mandatory,
especially for female and family caregivers, to promote stress management, mental health in this
group, and enable optimal and purposeful care.

Abstract BACKGROUND: Previous studies showed that family caregivers of hemodialysis patients have low
level of quality of life. However, these caregivers are mostly neglected, and no studies are available
on improving their quality of lives. Therefore, this study aimed to examine the effects of supportive
educative program on the quality of life in family caregivers of hemodialysis patients. Materials and
METHODS: A randomized controlled clinical trial was conducted on 76 family caregivers of
hemodialysis patients referred to Shahid Hasheminejad Hemodialysis Center in Tehran, Iran in 2015.
The subjects were equally allocated into two groups of 38. Caregivers of patients were randomly
assigned into the intervention group and the control group. The intervention group received six training
sessions on supportive educative program. Both groups answered demographic information and short
form‑36 questionnaires before and 6 weeks after the intervention. Descriptive statistics, Chi‑square
and Fisher exact tests, independent samples t‑test, and t‑couple, was used to analyze the data.
RESULTS: No significant difference was found between the baseline mean scores of “quality of life”
of the intervention and the control groups (P = 0.775). However, the mean scores of quality of life
of the intervention group increased at the end of the study, and the two groups were significantly
different in this regard (P < 0.001).
CONCLUSIONS: Supportive educative program improved the quality of life in caregivers of
hemodialysis patients. Therefore, it is suggested that health system managers encourage their staff
to implement such programs for improving the health status of the caregivers.