Journal of Research and Health
2423-5717
2423-5717
3
2
2013
6
1
Equity in health: From concept to application in healthcare system
333
334
FA
Malihe
Pishvaei
noorallah.moradi@gmail.com
N
0000-0001-7148-0919
Nooralah
Moradi
pismaster70@yahoo.com
Y
Vajihe
Armanmehr
varmanmehr@gmail.com
N
Pezhman
Baghery
bpegman@yahoo.com
N
Equity is the prime virtue of social institutions, and its role is as truth is for human thought system [1]. Equity has been studied in various areas such as economics, politics, and judicial system. One of the areas of social equity that has recently been considered by experts is health. Health is defined as complete physical, mental, and social well-being. Health refers not only to the physical well-being, but also focuses on social, emotional, spiritual, and cultural well-being of the whole society [2]. Equity in health could be defined as absence ofunfair disparities in health. Since social equity and fairness can be interpreted differently by different people, its definition requires measurable functional criteria. For the purpose of functionality and measurement, equity in health can be defined as absence of disparities or systematic prejudices (or in the most important social determinants of health) among social groups with varying levels of social entitlementor deprivation in the social hierarchy. Health inequities systematically expose socially deprived groups to problems associated to their future health. Social entitlement or deprivation, based upon wealth, power, and prestige, determines how people are grouped in the social hierarchy. Deprivation may also be understood as being deprived that can be absolute or relative [3]. Not all health inequities are unjust, only those specific health inequalities systematically created between more and less entitled social groups are unjust. For instance, we expect young people to be healthier than older people. It is expected that baby boys weigh more than girls at birth. Men have prostate cancer problem and women do not. It is hard to judge all these inequalities unfair. Even though differences in nutrition or immunization between boys and girls, or differences in ethnicity or race could be a major concern to equitable approach in likelihood of receiving proper treatment for heart attack [3]. On the other hand, it could be argued that not all equalities are just, either. A clear example of this is a deprived group with severe health needs receiving similar level of services as an entitled and rich group [4]. The World Health Organization has considered three fundamental goals for health systems, which include health promotion of the population under cover, response to people’s non-medical needs,and equitable participation in provision of funds. It seems equity is an important factor in achieving these goals [5]. Health promotion is the first and undoubtedly the most important goal of health systems. However, the global health report of 2000 emphasizes that health promotion alone is not enough, and reducing health inequalities among groups must also be considered. Accordingly, there are two aspects to the goal of a desirable health the best attainable average level (being good), and the least difference between people and groups (being fair). The second goal of health system is responsivenessto people’s lawful expectations. Of course, responsiveness explicitly ignores expectations for improving population health, since these expectations are already reflected in the first goal (of health). Responsiveness has two components of respect for the individual and customer-orientation. The distinction between general level of health and its distribution among population also has an application in responsiveness. Being good, in health system responsiveness terms means that the health system can on average respond well to what people expect of it. Being fair in responsiveness means that the systems response to every person is equally good, and there is no distinction or prejudice in treating people. Fairness in responsiveness, just like distribution of health is important [6]. The third goal of health systems is fairness of financial contributions. The important issue is how fairly health systems can share their financial burden. To be fair in funding health systems, two main indicators must be considered first, households must not be impoverished or pay great portions of their income for providing healthcare. In other words, fairness in financial contribution requires application of advanced payment systems such as insurance systems based on people’s ability to pay and significant degree of risk accumulation. A healthcare system in which some individuals or households are forced further into poverty through having to purchase their needed healthcare, or else do not receive it, since they cannot afford the costs, is an unjust system. Second, payment for healthcare services rendered must not be such that less well-off people pay comparatively more than affluent people. The first problem can be solved by minimizing direct contribution from the pocket to the system, such that, predictable advanced payments that are unrelated to disease or provision of services, are as much as possible relied upon. The second problem can be solved by ensuring that, any form of payment has a rising trend, or at least is neutral in relation to income, and it is linked to capacity to pay rather than to health risk [5]. What was briefly described here was an examination of equity in health within the health system boundaries with especial attention to its main goals. Nevertheless, it must be admitted that the strongest determinants of equity in health are structural factors such as national wealth, income inequality, and access to education and employment. These are often referred to as social determinants of health [7]. These factors can accentuate the role of national governments and states in reducing health inequities. Successful governments can reduce health inequities in at least three ways. First, they can ensure that basic services are fairly distributed, and improve and protect human rights (including issues like healthcare and education), provide proper living standards, and ensure fair distribution of resources. Second, they can provide legal regulatory frameworks that could influence and monitor their own actions as well as other sectors’. Third, they can monitor health status of different groups of population, health consequences of social inequalities, and progress of actions to reduce in equities, and use this information to enforce sustainable interventions [8].
not
http://jrh.gmu.ac.ir/article-1-204-en.html
http://jrh.gmu.ac.ir/article-1-204-en.pdf
Journal of Research and Health
2423-5717
2423-5717
3
2
2013
6
1
Development and psychometric properties of perceived barriers scale (PBS) for self-care in middle-aged patients with diabetes mellitus type 2
335
344
FA
Shohreh
Naderimagham
Tarbiat modares university
naderimagham@modares.ac.ir
N
Shamsoddin
Niknami
Tarbiat modares university
niknamis@modares.ac.ir
Y
Farid
Abolhassani
Tehran Uuniversity of Medical Sciences
abolhassanif@tums.ac.ir
N
Ebrahim
Hajizadeh
Tarbiat modares university
hajizadeh@modares.ac.ir
N
Ali
Montazeri
Iranian Institute for Health Sciences Research
montazeri@acecr.ac.ir
N
Appropriate self-care has an important role in improving the life level of diabetics and it has been proven that perceived barriers is one of the most contributory factors on the success self-carein diabetes. Thus, this study aimed to develop a scale for evaluating perceived barriers for self-care in middle-aged patients with diabetes mellitus type 2. The qualitative part of this mixed study was conducted in order to develop a preliminary item pool. In quantitative part, content and face validity, reliability (internal consistency and test-retest analysis), construct validity and factor analysis (exploratory and confirmatory) were performed for assessing psychometric properties of the scale. The 33-item questionnaire was developed through the qualitative phase. Exploratory factor analysis loaded a 23-item with a seven factor solution that jointly accounted for 64.75% of observed variance. The confirmatory factor analysis indicated a good fit to the data. Cronbach’s alpha coefficient showed excellent internal consistency (α=0.80), and test-retest of the scale with a 2-week interval indicated an appropriate stability for the scale (ICC=0.89). The findings showed that the designed questionnaire was a valid and reliable instrument for measuring perceived barriers for self-care in middle-aged patients with diabetes mellitus type 2. It is a short and easy to use questionnaire and contains the most significant diabetes related self-care behaviors.
Diabetes mellitus type 2, Middle-aged, Reliability, Self-care, Validity
http://jrh.gmu.ac.ir/article-1-93-en.html
http://jrh.gmu.ac.ir/article-1-93-en.pdf
Journal of Research and Health
2423-5717
2423-5717
3
2
2013
6
1
Using of social cognitive theory: predictors of physical activity among women with diabetestype 2
345
354
FA
Nooshin
Peyman
peymann@mums.ac.ir
N
Mehrsadat
Mahdizadeh
mahdizadehm1@mums.ac.ir
Y
Ali
Taghipour
taghipoura@mums.ac.ir
N
Habibollah
Esmaily
esmaeilyh@mums.ac.ir
N
Physical activity is a complex behavior and its determinants are different in various groups. Due to the chronic nature of type 2 diabetes, treatment Adherence requires lifestyle changes that are difficult for many people to adopt and maintain it. This study aimed to determine predictive structure of social cognitive theory on physical active among women with type 2 diabetes. Thisstudy was cross sectional -correlative that were randomly selected 300 people with type 2 diabetes by multi-stage cluster sampling method. Tools for data collection, a questionnaire was consistent with social cognitive theory constructs and IPAQ that had been used in the scientific sources and texts. Reliability and validity was determined for use in this study in a pilot study. Data were analyzed by using analysis of variance and regression testes. The results showed the structure of social cognitive theory, Self-regulation (P=0.001), Social Support (P=0.001), and self-efficacy (P=0.005), had the significant effecton the Physical activity among theresearch sample. According to the results, the self-regulation, self-efficacy and social support were important influences on the physical activity and they must be considerate in designing and implementing of educational interventions.
Diabetes mellitus, Physical activity, Social Cognitive Theory,Woman
http://jrh.gmu.ac.ir/article-1-206-en.html
http://jrh.gmu.ac.ir/article-1-206-en.pdf
Journal of Research and Health
2423-5717
2423-5717
3
2
2013
6
1
Predictions of post-traumatic growth according to spirituality, social support and positive affection in deferent age groups with breast cancer
355
362
FA
Zahra
Nikmanesh
Faculty of education and psychology,University of Sistan and Baluchestan, Iran
zahranikmanesh@yahoo.com
Y
Mohammadali
Emamhadi
Forensic Medicine and Toxicology Department, Shahid Beheshti University of Medical Sciences, Iran
emamhadi@yahoo.com
N
Nasrin
Mirabdollahi
Faculty of education and psychology,University of Sistan and Baluchestan, Iran
Nasrin_mirabdollahi@yahoo.com
N
Cancer causes a great suffering situation which leads the psychosocial outcomes and quality of life such as anxiety and depression. The purpose of this research is prediction of PTG by spirituality, social support and positive affection in women with breast cancer. The results were presented according to different ages. Participants were 106 females with breast cancer who were hospitalized at 3 hospitals in Tehran, Iran, in a four-month period. They were selected by census then, they answered the Post-traumatic Growth Inventory, Spirituality Questionnaire, Medical Outcomes Survey social support scale, and Positive and Negative Affect Schedule. The data were analyzed by Pearson correlation and stepwise regression. The results, with study of age roles, showed that in the group of 25 to 35 years old, spirituality, social support and positive affection predicted PostTraumatic Growth. But in the group of 36 to 45 years old, positive affection, social support and spirituality, and in the group of 46 to 60 years old, only positive affection predicted Post Traumatic growth. Accordingly, it is inferred that through increasing of positive affection, spirituality and social support could improve the PTG. The importance of each of these variables is dependent on the patients' age.
Age, Breast Cancer, Positive affect, Post Traumatic Growth,Spirituality
http://jrh.gmu.ac.ir/article-1-203-en.html
http://jrh.gmu.ac.ir/article-1-203-en.pdf
Journal of Research and Health
2423-5717
2423-5717
3
2
2013
6
1
Relationship between self-efficacy with physical activity stages of change in housewives
363
369
FA
Seyede zahra
Hashemi
medecine univercity zahedan
hashemizahra44@yahoo.com
Y
Fateme
Rakhshani
health research & promotion center
rakhshanif@gmail.com
N
Razieh
Kykhaei
medecine univercity zahedan
kykhaeiraz@yahoo.com
N
Afsoon
Tizvir
karaj university
afsoon@yahoo.com
N
Eraj
Zareban
medecine univercity zahedan
zareban@yahoo.com
N
Despite the benefits of physical activity, women are less physically active than men in most areas. The transtheoretical model is known as a comprehensive model in the field of sport. The purpose of this study was to determine the relationship between self-efficacy with physical activity stages of change among housewives. In the cross-sectional study, 220 housewives aged 19 to 52 were studied. Sampling of the first block was done through simple random method then sampling continued in other blocks according to sampling number by referring to the doors of the houses and those who wished, entered into the study until the sampling was completed. Data collection was performed by a researcher-made questionnaire whose academic value was determined by content validity, and its reliability was determined by Cronbach's alpha. Data analysis was carried out by SPSS - 18. The results of this study showed that self-efficacy could predict physical activity stages of change. 5.5% of the participants were at pre-contemplation level, 44.1% at contemplation level, 38.6% at preparation level, 4.1% at action level, and 7.7% were at maintenance level. Significant differences were observed between self-efficacy and stages of change (P<0/001) and self-efficacy and education level (P<0.05) but no significant difference was observed between self-efficacy and age. According to the results of the study, self-efficacy had a significant impact on physical activity engagements therefore, practical actions should be taken to enhance self-efficacy by relevant institutions.
Physical Activity, Self Efficacy, Woman
http://jrh.gmu.ac.ir/article-1-56-en.html
http://jrh.gmu.ac.ir/article-1-56-en.pdf
Journal of Research and Health
2423-5717
2423-5717
3
2
2013
6
1
The effect of education based on health belief model on reduction of HbA1c level in diabetestype 2
370
378
FA
Iraj
Zareban
zareban@modares.ac.ir
N
Shamsadin
Niknami
niknamis@modares.ac.ir
Y
Ali Reza
Hiedarnia
N
Fatemeh
Rakhshani
N
Mahnaz
Sharakipour
N
Mahdi
Moshki
دانشگاه علوم پزشکی گناباد، مرکز تحقیقات توسعه اجتماعی و ا رتقای سلامت
N
Diabetes, as the most common disease caused by metabolic disorders, is an important global challenge. This disease needs a lifelong self-care throughout one's life, so this study aimed to determine the effect of health belief model based on educational program on reduction of HbA1c levels in type 2 diabetic females. This study is a quasi-experimental. The samples were 138 diabetic female into two case (n=69)and control groups (n=69).Data was collected via a questionnaire whose validity and reliability had been confirmed. The checklist was according to their reports and tests (HbA1c). Before the educational intervention, the checklist was completed by the two case and control groups. Then, the case samples received required educations in 5 sessions for one month. The educational program consisted of lecture, question and answer, group discussion and film screening. After 3 months, both groups completed the questionnaire and the checklist. The collected data was analyzed by SPSS software and appropriate tests. This study results showed that the mean scores of HBM structures in groups, before and after the educational intervention, have a statistically significant difference. Reduction of HbA1c levels in two studied groups was significant (from 9.63 mg/l before the intervention to 8.30mg/l at 3 months after training). Health belief model based on educational program reduces the HbA1c in diabetic patients. Therefore, training in the framework of this model should be further considered by nurses and health care centers.
Diabetes type 2, HbA1c, Health Education, Self-care
http://jrh.gmu.ac.ir/article-1-92-en.html
http://jrh.gmu.ac.ir/article-1-92-en.pdf
Journal of Research and Health
2423-5717
2423-5717
3
2
2013
6
1
Social anxiety prediction pattern with regard to cognitive behavioral factors
379
387
FA
Mahdi
Hassanvand Amouzadeh
Shahed university of Tehran
m.amouzade@gmail.com
Y
Mohamad Reza
Shairi
Shahed university of Tehran
N
Mohamad Ali
Asghari Moghadam
Shahed university of Tehra
N
Social anxiety is one of the most debilitating anxiety disorders that can negatively affect all aspects of a person's life. Yet, despite the fact that its prevalence rates are relatively high, factors associated it are still poorly understood. The study aimed at determining the prediction model of social anxiety through investigating variables like: depression, shame, behavioral Inhibition, shyness,and anger aspredictors of social anxiety. The study applied a correlative method and a Sample of 581 participants (235 males and 346 females) selected through Cluster Sampling from among Shahed University students. Data were collected through Social Fobia Inventory, Revised Check and Buss Shyness Scale, The third Scale of Adult Self-Conscious Affection, Carver and White Behavioral Activation/Inhibition System Scale, Depression Anxiety Stress Scale-21 and the State-Trait Anger Expression Inventory-2. Data were then analyzed using Pearson correlation coefficient and Simultaneous Multiple Regression Analysis in SPSS-16 software. All variables were significantly correlated with social anxiety. Simultaneous multiple regression analysis suggested that with the exception of anger which cannot predict social anxiety, other studied variables (depression, shame, behavioral inhibition, and shyness) can predict social anxiety. Although part of the obtained results are in line with other research findings, the rest should be encountered carefully and more cross-cultural and inter-cultural research can help scrutinize the findings.
Anger, Anxiety, Behavioral, Depress Shame, Shyness
http://jrh.gmu.ac.ir/article-1-157-en.html
http://jrh.gmu.ac.ir/article-1-157-en.pdf
Journal of Research and Health
2423-5717
2423-5717
3
2
2013
6
1
A study of public schools students\' consumption of school buffet snacks
388
394
FA
Simin
Foroughzadeh
foroughzadeh.simin@gmail.com
Y
This study investigates the quality and quantity of school foodstuff available to the students. The survey was conducted utilizing questionnaire for collecting data. The samples were 490 students at the last grade of daily elementary school, junior high school, and high school in cities of Bojnord, Esfarayen and Shirvan selected randomly. The findings indicate that about half of the students (54%) purchase foodstuff once a day and around 20% never buy from the buffet. The majority of the people buying foodstuffs from the buffet (56.8%) have an average rate of purchasing. The number of students who buy rarely and limited stuff from the buffet (31.5%) was three times more than those who purchase frequently and various stuff (11.7%).In regard with the food being purchased most of the students (75.3%) prefer cakes. The students who buy juice and biscuits stand on the second and third rank (with 33.3 and 22.2% of the sample respectively). Another finding is that no significant correlation exists between students inclination for purchasing from school buffets and the independent variables including the city where the students study, gender, parents' jobs, and the pocket money. It was also found that the students' evaluation of the school buffet, their grade, important others (parents, teachers and friends) expectations and approval contribute to the students tendency for buying from school buffets.
School, Snack, Student
http://jrh.gmu.ac.ir/article-1-53-en.html
http://jrh.gmu.ac.ir/article-1-53-en.pdf