A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran

Delavari, Sajad,Arab, Mohammad,Rashidian, Arash,Nedjat, Saharnaz,Souteh, Rahmatollah Gholipour The Korean Society for Preventive Medicine 2016 Journal of Preventive Medicine and Public Health Vol.49 No.6

Objectives: General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. Methods: A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran's health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. Results: Iran's medical education is faced with several challenges that were categorized in four main themes including student selection, medical students' perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. Conclusions: Challenges that were found could have negative effects on retention. Modification in student's perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas.

Assessing Breast Cancer Risk among Iranian Women Using the Gail Model

Khazaee-Pool, Maryam,Majlessi, Fereshteh,Nedjat, Saharnaz,Montazeri, Ali,Janani, leila,Pashaei, Tahereh Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.8

Background: Breast cancer risk assessment is a helpful method for estimating development of breast cancer at the population level. Materials and Methods: In this cross-sectional study, participants consisted of a group of 3,847 volunteers ($mean{\pm}SD$ age: $463{\pm}7.59$ years) in a convenience sample of women referred to health centers affiliated to Tehran University of Medical Sciences in Tehran, Iran. The risk of breast cancer was estimated by applying the National Cancer Institute's online version of the Gail Risk Assessment Tool. Results: Some 24.9% of women reported having one first-degree female relative with breast cancer, with 8.05% of them having two or more first-degree relatives with breast cancer. The mean five-year risk of breast cancer for all participants was $1.61{\pm}0.73%$, and 9.36% of them had a five-year risk of breast cancer >1.66%. The mean lifetime risk of breast cancer was $11.7{\pm}3.91%$. Conclusions: The Gail model is useful for assessing probability of breast cancer in Iranian women. Based on the their breast cancer risk, women may decide to accept further screening services.

A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran

Sajad Delavari,Mohammad Arab,Arash Rashidian,Saharnaz Nedjat,Rahmatollah Gholipour Souteh 대한예방의학회 2016 Journal of Preventive Medicine and Public Health Vol.49 No.6

Objectives: General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. Methods: A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran’s health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. Results: Iran’s medical education is faced with several challenges that were categorized in four main themes including student selection, medical students’ perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. Conclusions: Challenges that were found could have negative effects on retention. Modification in student’s perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas.

Exploring Reproductive Health Education Needs in Infertile Women in Iran: A Qualitative Study

Zohreh Khakbazan,Raziyeh Maasoumi,Zahra Rakhshaee,Saharnaz Nedjat 대한예방의학회 2020 Journal of Preventive Medicine and Public Health Vol.53 No.5

Objectives: An inadequate understanding of infertility can affect individuals’ self-efficacy and ability to perform self-care; thus, reproductive health education is an important part of infertility treatment. The present qualitative study aimed to explore the experiences and educational needs of infertile women with regard to reproductive health. Methods: In this qualitative study, we utilized a content analysis approach. Purposive sampling was performed to ensure maximum diversity. In total, 23 individual interviews were conducted with 20 Iranian women with infertility and 3 key informants between July 2018 and February 2019 in northern Iran. Data were collected through in-depth, semi-structured interviews. Data analysis was performed using a conventional content analysis approach. Results: Reproductive health education needs were identified by analyzing interview data from 4 main categories: familiarity with the fertility process and preparation for pregnancy, recognition of infertility and expectations around seeking treatment, recognition of preventive actions associated with reproductive health, and correction of false beliefs. Recognizing the causes of infertility and understanding the different approaches to infertility treatment are among the most important educational needs of infertile women. The potential for neglect of health-related issues due to concerns about fertility and the maternal experience necessitates education about preventive measures for cervical cancer, breast cancer, and sexually transmitted infections. Correcting misconceptions, including those related to contraceptives and traditional medicine, can also help promote reproductive health. Conclusions: In infertile women, the educational needs associated with reproductive health are multifaceted. Satisfying these needs can help achieve optimal treatment results and promote reproductive health.

Psychometric Properties of the Persian Version of Satisfaction with Care EORTC-in-patsat32 Questionnaire among Iranian Cancer Patients

Pishkuhi, Mahin Ahmadi,Salmaniyan, Soraya,Nedjat, Saharnaz,Zendedel, Kazem,Lari, Mohsen Asadi Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.23

Background: Cancers impose an increasing burden on health of the populations and individuals, but little is known about cancer patient satisfaction with care. The aim of this study was to assess the psychometric properties of the Persian version of European Organisation for Research and Treatment of Cancer (EORTC) In-Patsat32, as a recently developed questionnaire to assess cancer patient satisfaction with care and information provided during hospital admission. Materials and Methods: Complying with EORTC protocols, the Persian version of Inpatsat32 was translated and piloted in a small group of patients, then applied to 380 cancer patients admitted to different oncology wards in Tehran. Validity (convergent, discriminant, and divergent) and reliability of the tool was assessed through using multitrait analysis, factor analysis, intraclass correlations, Chronbach's alpha and test-retest (on a sample of 70 patients). Results: Good acceptance and high sensitivity of the questionnaire with low floor and ceiling effects were recognized, indicating power of the instrument to detect differences between groups with heterogeneous levels of satisfaction. Multitrait scaling analyses supported the convergent validity of the majority of scales (correlation coefficient >0.4) and favorable discriminant validity (item own scale correlation >0.8). There was no correlation between In-patsat32 scales and the EORTC-C30, which measures different concepts, confirming divergent validity of the tool. Internal consistency for all domains was high (${\alpha}$ >0.70) except for the hospital access score and the test-retest reliability was excellent (r=0.86-0.96). There was a weak responsiveness to change except for nurses technical skills. Principle component analysis confirmed five domains with much improved internal consistency (${\alpha}$ >0.9). Conclusions: The Persian version of the EORTC-in-patsat32 module is a reliable and valid instrument to measure cancer patient satisfaction with care received during their hospitalization period and can be utilized in clinical cancer research.

Religious Coping and Quality of Life in Women with Breast Cancer

Zamanian, Hadi,Eftekhar-Ardebili, Hasan,Eftekhar-Ardebili, Mehrdad,Shojaeizadeh, Davood,Nedjat, Saharnaz,Taheri-Kharameh, Zahra,Daryaafzoon, Mona Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.17

Background: The aim of this study was to assess the predictive role of religious coping in quality of life of breast cancer patients. Materials and Methods: This multi-center cross-sectional study was conducted in Tehran, Iran, from October 2014 to May 2015. A total of 224 women with breast cancer completed measures of socio-demographic information, religious coping (brief RCOPE), and quality of life (FACT-B). Data were analyzed using descriptive statistics and the t-test, ANOVA, and linear regression analysis. Results: The mean age was 47.1 (SD=9.07) years and the majority were married (81.3%). The mean score for positive religious coping was 22.98 (SD=4.09) while it was 10.13 (SD=3.90) for negative religious coping. Multiple linear regression showed positive and negative religious coping as predictor variables explained a significant amount of variance in overall QOL score ($R^2=.22$, P=.001) after controlling for socio-demographic, and clinical variables. Positive religious coping was associated with improved QOL (${\beta}=0.29$; p=0.001). In contrast, negative religious coping was significantly associated with worse QOL (${\beta}=-0.26$; p=0.005). Conclusions: The results indicated the used types of religious coping strategies are related to better or poorer QOL and highlight the importance of religious support in breast cancer care.

Perception of Breast Cancer Screening among Iranian Women without Experience of Mammography: A Qualitative Study

Khazaee-pool, Maryam,Majlessi, Fereshteh,Foroushani, Abbass Rahimi,Montazeri, Ali,Nedjat, Saharnaz,Shojaeizadeh, Davoud,Tol, Azare,Salimzadeh, Hamideh Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.9

Background: In Iran, there are high rates of breast cancer. It is among the five most common cancers, the first among cancers diagnosed, and is the leading cause of cancer deaths among Iranian women. Objectives: The purpose of this qualitative study was to explore perception of breast cancer screening among Iranian women who have never had a mammograph. Materials and Methods: The current study was part of a qualitative research conducted by means of content analysis method and purposive sampling of 16 women over the age of 30 years who had not undergone mammography using individual semi-structured interviews. Interviews were recorded and transcribed verbatim. The data were under continuous consideration and comparative analysis in order to achieve data saturation. Results: After codification of data, three concept categories were achieved including: i) low awareness, ii) worries, and iii) lack of motivation. Conclusions: Although there is a tendency among Iranian women to participate in breast cancer screening, there is a powerful cultural belief that breasts are sexual organs that should not be discussed publicly. Due to the incidence of breast cancer in Iranian women, it is critical that breast awareness education be performed by health care experts to explore the concepts of breast cancer and breast cancer screening.

Development of an Instrument based on the Protection Motivation Theory to Measure Factors Influencing Women's Intention to First Pap Test Practice

Hassani, Laleh,Dehdari, Tahereh,Hajizadeh, Ebrahim,Shojaeizadeh, Davoud,Abedini, Mehrandokht,Nedjat, Saharnaz Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.3

Background: Given that there are many Iranian women who have never had a Pap smear, this study was designed to develop and validate a measurement tool based on the Protection Motivation Theory to assess factors influencing the Iranian women's intention to perform first Pap testing. Materials and Methods: In this psychometric research, to determine the Content Validity Index (CVI) and the Content Validity Ratio (CVR), a panel of experts (n=10) reviewed scale items. Reliability was estimated through the Intraclass Correlation Coefficient (n=30) and internal consistency (n=240). Also, factor analysis (exploratory and conformity) was performed on the data of the sample women who had never had a Pap smear test (n=240). Results: A 26-item questionnaire was developed. The CVI and CVR scores of the scale were 0.89 and 0.90, respectively. Exploratory factor analysis loaded a 26-item with seven factors questionnaire (perceived vulnerability and severity, fear, response costs, response efficacy, self-efficacy, and protection motivation (or intention)) that jointly accounted for 72.76% of the observed variance. Confirmatory factor analysis indicated a good fit for the data. Internal consistency (range 0.70-0.93) and test-retest reliability (range 0.72-0.96) of sub-scales were acceptable. Conclusions: This study showed that the designed instrument was a valid and reliable tool for measuring the factors influencing the women's intention to perform their first Pap testing.

Effects of an Educational Intervention Based on the Protection Motivation Theory and Implementation Intentions on First and Second Pap Test Practice in Iran

Dehdari, Tahereh,Hassani, Laleh,Hajizadeh, Ebrahim,Shojaeizadeh, Davoud,Nedjat, Saharnaz,Abedini, Mehrandokht Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.17

Background: Few Iranian women take the Papanicolaou test despite its important role in preventing cervical cancer. This study aimed to determine the effectiveness of an educational intervention based on the protection motivation theory (PMT) variables and implementation intentions in the first and second Pap test practice among Iranian women. Materials and Methods: In this quasi-randomized controlled trial, 200 women who were referred to 30 primary health care clinics in Tehran were randomly selected. PMT variables and Pap test practice were measured at baseline and again after 3 and 15 months. The 4-week educational intervention program was conducted for the intervention group. Results: Following the intervention, the mean scores of self-efficacy, perceived vulnerability, and behavior intention variables were significantly higher in the intervention group when compared to the control group (p<0.05). No significant differences were found in the perceived severity, response efficacy, response cost, and fear between the two groups following the intervention. Higher percent of women in the intervention group had obtained first and second Pap test compared to the controls. Conclusions: The PMT and implementation intentions provide a suitable theory-based framework for developing educational interventions regarding Pap test practice in Iran.