Journal of Education and Health Promotion

Abstract BACKGROUND: Hemodialysis patients suffer from mental disorders such as anxiety and depression.
One of the known nonpharmacological methods to eliminate these disorders is music therapy. The
present study aimed to investigate the effect of instrumental music on state depression and anxiety
in hemodialysis patients.
MATERIALS AND METHODS: This study was a clinical trial. The population was hemodialysis
patients in Hamedan in 2017 and 50 patients were selected and randomly divided into experimental
and control groups. The duration each time of the instrumental music intervention for the experimental
group was 3 weeks, 3 times a week for 20 min. Data were measured by beck depression inventory
and SpeilBerger State–Trait Anxiety Inventory‑Y1 before the intervention and immediately after
the last intervention and analyzed using Yates correction, Chi‑square test, Mann–Whitney U‑test,
independent t‑test, and Wilcoxon test.
RESULTS: No significant difference between the intervention and control groups was observed
before the study in terms of demographic variables (P > 0.05). In the intervention group, the mean
and standard deviation of the depression score before the intervention was 8.99 ± 23.68 and after
the intervention reached 7.54 ± 14.88, which shows that the variable was significant (P = 0.001);
however, no significant difference was observed in the control group. In the intervention group, the
mean of state anxiety before the intervention was 10.05 ± 53.76 and after the intervention reached
9.76 ± 42.48, which was statistically significant (P = 0.004), while no significant difference was
observed in the control group.
CONCLUSION: The results indicate the positive effect of instrumental music on reducing anxiety
and depression in hemodialysis patients. It is recommended that this therapy be used as a nursing
method to reduce state anxiety and depression in hemodialysis patients.

Abstract BACKGROUND AND AIM: Posttraumatic growth following traumas such as chronic illnesses can
occur in some people. The psychological factors, such as cognitive emotion regulation (CER), can
influence its formation. CER is a type of coping strategy that helps to efficiently deal with trauma.
Due to the importance of the topic and the lack of sufficient studies on posttraumatic growth and
CER in hemodialysis patients, this study aims to investigate the relationship between posttraumatic
growth and CER in hemodialysis patients.
METHODS: This is a descriptive study performed on hemodialysis patients in Bou Ali and Velayat
hospitals in Qazvin. One hundred and sixty-two patients were selected by the convenience sampling
method, and Garnefski Cognitive Emotion Regulation Questionnaire (α =0.92) and Tedeschi
Posttraumatic Growth Questionnaire (α =0.96) were used. Data were analyzed using Pearson
correlation and ANOVA tests.
RESULTS: The results showed that the majority of the hemodialysis patients experienced some
degree of posttraumatic growth. The participants achieved high scores in the domains of spiritual
development and communication with others. Moreover, posttraumatic growth was positively and
significantly correlated with CER (r = 0.67, P < 0.001).
CONCLUSIONS: Hemodialysis provides the basis for the positive mental reactions known as
posttraumatic growth in hemodialysis patients. Nurses and other authorities can use this phenomenon
to adapt to illness and care planning.

Abstract BACKGROUND: One of the main psychological problems in hemodialysis patients is hopelessness.
Spiritual health leads the patients toward hope and goal in life. Given the importance of the issue
and the little research in this area, this study aimed to assess hope and its relationship with spiritual
health on hemodialysis patients in Rasht Razi Hospital of Iran.
MATERIALS AND METHODS: This correlational study carried out on 103 patients who admitted
in Rasht Razi Hospital Hemodialysis Center by simple random sampling. The data were collected
through Snyder’s Hope Scale and Spiritual Health. The psychomotricity of these questionnaires has
been confirmed in domestic studies. The data were analyzed by using descriptive and inferential
statistics (Pearson correlation coefficient).
RESULTS: The majority of the patients were male (59.2%), in the age group of above 60 (46.60%),
married (83.5%), with low income (60.2%), and under diploma (53.4%). The mean of hope score
was 36.36 (±9.10) that showed the high level of hope in the majority of the patients. The mean of
the total spiritual health score was 227.93 (±19.01) that indicates the high level of spiritual health in
hemodialysis patients. There was a positive and significant correlation between spiritual health and
its dimensions and hope (P < 0.05).
CONCLUSIONS: The results of this study approve the importance of spiritual health as an effective
variable on hope among hemodialysis patients. Hence, health‑care providers and clinical experts
are recommended to focus on spiritual health to increase hope among such patients.

Abstract BACKGROUND: Hemodialysis patients experience many issues in self‑care behavior. Patients
require to control of manage the issue to improve the self‑care. Educational intervention to behavior
change can be effective on self‑care behavior. This study was conducted to investigate the effect of
an educational intervention, based on the self‑Efficacy theory on promoting self‑care in hemodialysis
patients.
MATERIALS AND METHODS: Seventy hemodialysis patients recruited in this study and divided
randomly into intervention group (n = 35) and control group (n = 35) with convenience sampling in
2016 from Qom city, Iran. Data were collected before and 3 months after education using demographic
questionnaire, self‑efficacy, a valid researcher‑made questionnaire regarding to awareness and
self‑care. The educational intervention was performed for the intervention group in 4 1‑h sessions
over 2 months. The data were analyzed through Paired t‑test, Independent t‑test, Chi‑square, and
Mann–Whitney at the significant level of 0.05.
RESULTS: While variables in two groups did not show significant difference before education (P > 0.05),
a significant increase was observed in variables of self‑efficacy (P < 0.001), awareness (P < 0.001),
and self‑care dimensions (P < 0.05) between two groups after 3 months education.
CONCLUSION: The results of this research suggested that employing educational programs based
on the self‑efficacy theory can lead to the improvement of the self‑care behaviors in hemodialysis
patients.

Abstract INTRODUCTION: Low quality of sleep is a common problem among hemodialysis patients. This
study was conducted to evaluate the effect of a cold dialysis solution on the quality of sleep in patients
undergoing hemodialysis.
METHODOLOGY: This double‑blind clinical trial was performed on 26 hemodialysis patients with
chronic renal failure and sleep disorders in the dialysis center of Sabzevar, Iran, in 2016–2017. Of the
26 patients, 13 each were allocated to the intervention and control groups. The patients in both groups
received 4 weeks of hemodialysis (3 sessions per week) using a standard solution with a temperature
of 37°C. In the next stage, the control group continued to receive the standard‑temperature dialysis,
while the intervention group received dialysis using a solution with a temperature of 35.5°C for
4 weeks (3 sessions per week). The Pittsburgh Sleep Quality Index was used to assess and compare
the quality of sleep before and after the intervention in the two groups. Data were analyzed using R
1.2.3 software, at 95% confidence level.
RESULTS: Although the mean scores of sleep quality were not significantly different between the
intervention (9.53 ± 3.12) and control (11.23 ± 3.37) groups at baseline, postintervention, significant
differences were observed (intervention group: 4.7 ± 4.55; control group: 10.61 ± 2.69; P < 0.001).
CONCLUSION: This study showed that dialysis with cold solution is a simple, cost‑effective, and
nonpharmacological method that can be used to improve sleep quality in patients undergoing
hemodialysis.

Abstract INTRODUCTION: Patients undergoing hemodialysis have a low level of health and mindfulness
technique in mind‑body medicine is used to help patients with chronic illness. Therefore, this clinical
trial was conducted to determine the effect of the mindfulness program on the general health of
patients undergoing treatment with hemodialysis.
METHODS: Sixty hemodialysis patients were selected through the convenient method and randomly
divided into experimental and control groups. Both groups completed demographic information
questionnaire and general health questionnaire. Then, the experimental group received 8 sessions of
mindfulness training and the control group received 8 sessions of education in relation to end‑stage renal
disease and hemodialysis. Educational sessions were performed for both groups in the second 30 min
after hemodialysis for 1 h in six individual sessions and two 1.5 h group sessions. Immediately after
and 1 month after the intervention, the General Health Questionnaire was completed by both groups.
RESULTS: Analysis of the findings showed no significant differences between the mean score
of general health disorder and its subscales before the intervention in to two groups (P > 0.05).
Nevertheless, after intervention in the experimental group, the mean of general health disorder score
decreased from 44.17 ± 12.32 to 21.9 ± 6.4 and 1 month after the intervention, the mean score
of this score was 23.6 ± 6.2. The mean score of physical symptoms, anxiety and sleep disorder,
social functioning deficiency, and depression were also significantly lower in the experimental group
immediately after intervention and 1 month after the intervention; however, there were no significant
differences between the mean of this score immediately and 1 month after the intervention. In addition,
the mean score of general health disorder changes immediately and 1 month after the intervention
in the experimental group was significantly more than the control group. In the control group, there
was no significant difference between the mean score of general health disorder and its subscales
before, immediately, and 1 month after the intervention (P > 0.05).
CONCLUSIONS: The results of this research showed that mindfulness has been effective in reducing
physical and anxiety symptoms, sleep disorder, social dysfunction, and depression symptoms.
Therefore, the use of mindfulness as a complementary treatment can improve the general health
level in these patients.

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.