Background & Aim: Several studies have indicated that hospitalizing infants causes disruption on mother-infant attachment. The aim of this study was to assess the effect of infant massage by mothers on maternal attachment behavior in infants hospitalized in the neonatal care units .

  Methods & Materials: In this clinical trial, 42 mothers and their neonates were recruited and randomly allocated to the intervention and control groups. Mothers in the intervention group received training by means of educational movies about practical exercises on how to massage the infants. The trained mothers used massage techniques on their infants for five days. The process lasted 15 minutes. The attachment of the mothers on their infants was assessed before and on the day 5 after the massage. Data were collected using the scale of mother-to-infant attachment. Data were analyzed using the Chi-squared test, Fisher’s exact test and the t-test in the SPSS-19 . 

  Results: There were no differences between the two groups in terms of demographic variables and the mean of maternal attachment at baseline (P>0.05). Five days after the massage, there were statistically significant differences between the two groups in the mean maternal attachment (P<0.001) .

  Conclusion: According to the role of massage in attachment behavior, this traditional care is recommended to be used in neonatal units .

  Background & Aim: The aim of present study was to assess psychometric properties of premenstrual symptoms screening tool (PSST) to provide a fast and appropriate screening tool for women who suffer from severe PMS/PMDD and their clinicians .

  Methods & Materials: It was a cross-sectional study. The study included 404 female students studying at Semnan University who were randomly selected using stratified method. In order to assess psychometric properties, we used the exploratory factor analysis, convergent validity (evaluated by symptom checklist-90-Revised), criterion-related validity (calculated by comparing psychiatrist diagnosis and PSST). Sensitivity and specificity coefficients of optimal cutoff points were calculated by the ROC Curve and construct validity was evaluated by the PSST ability to separate PMS and PMDD groups from healthy group. Reliability was evaluated using the cronbach’s alpha and test-retest method . 

  Results: The p rinciple component analysis revealed that the PSST consists of four factors: interest reduction, interference in functions, physical and neurotic symptoms, and eating and sleep patterns. As an evidence of convergent validity, PSST scores showed significant correlations with the SCL-90-R’s dimensions. Agreement coefficient between psychiatrists and the PSST diagnosis was 0.314 for the PMS and 0.80 for the PMDD. This tool separated the PMS and PMDD groups from healthy group well. Optimal Cutoff point for separating females suffering from PMDD was 2.22. The sensitivity and specificity coefficients were 0.9 and 0.77, respectively. The cronbach’s alpha was 0.91 and the test-retest reliability was 0.56 for the total tool .

  Conclusion: The translated version of the premenstrual symptoms screening tool can be used as a valid tool for Iranian females. This instrument can be useful for rapid screening and identifying women who suffer from severe PMS/PMDD, especially in clinical settings .

  Background & Aim: Implantable Cardioverter Defibrillator is the most effective treatment for cardiac dysrhythmias. Having such life-saving device is the unique experience with important changes in the patient’ life. Understanding of these experiences can lead to success in treatment and follow- up.This study aimed to understand the experiences of patients with Implantable Cardioverter Defibrillator .

  Methods & Materials: A qualitative study using interpretative phenomenological approach was used. Thirteen participants were selected purposefully from heart clinics of Imam Khomeini hospital (Tehran). Each semi-structured interview was conducted in the period 30 to 45 minutes. Data analysis was performed using the six steps of van Manen . 

  Results: The main theme of ‘Start Living Again’ was extracted from patients with implantable defibrillator.This theme consist of ‘a sense of security’, ‘living with angel’, ‘attachment to the device’ and ‘attempt to maintain power’ .

  Conclusion: The participants with an Implantable Cardioverter Defibrillator have a life again with a sense of security and peace of mind. They try to keep this life-saving device.Therefore, health care providers, especially nurses can help this patients and their families by providing appropriate self care education .

  Background & Aim: H ospital emergency departments in Iran are prone to crisis for different reasons. Understanding nurses’ perspectives about these crises help in crisis management. The purpose of this study was to explain the nature, causes and consequences of crisis in emergency departments from nurses’ points of views .

  Methods & Materials: This was a qualitative study with content analysis approach. Data were collected using semi-structured interviews with 12 nurses working in emergency departments of general and trauma hospital. Participants were selected through purposive sampling method. Interviews lasted between 45 minutes to an hour. The data were recorded and transcribed. The accuracy and consistency of data were confirmed. Interviews were conducted until no new data were emerged. Data were analyzed using qualitative content analysis with conventional approach . 

  Results: Five themes were emerged through data analysis including: 1) unexpected imbalance 2) events 3) defect in service provider factors 4) positive consequences and 5) negative consequences .

  Conclusion: The results of this study revealed that every factor that can affect balance and daily tasks can make a crisis in emergency departments. Causes of the crisis can be divided into internal or external factors. Several measures should be planned to decrease the crisis in emergency departments from high rank decision making in the ministry of health and medical education to planning appropriate programs in hospitals .

  Background & Aim: Premenopausal syndrome affects daily activities of many women. This study aimed to compare the effects of Vitexagnus and Flaxseed on premenstrual symptoms in women referred to health centers of Tabriz from October 2013 to September 2014 .

  Methods & Materials: This randomized controlled trial was conducted among 159 women suffered from premenstrual syndrome (PMS). The PMS was measured using the premenstrual assessment form (PAF) . The participants were allocated into three groups (n=53 per group) using block randomization. The group I received 25 grams/d Flaxseed powder and placebo of the Vitexagnus group II received 3.2-4.8 mg/d Vitexagnus tablets and placebo of the Flaxseed and the control group received both placeboes. The PAF was completed at baseline and 1 and 2 month after the intervention. Data were analyzed using the general linear model . 

  Results: The PMS improved significantly in both intervention groups during the first and the second month after the intervention. In the Vitexagnus and Flaxseed groups, the mean total PMS score were significantly lower than that in the control group at the first months after the intervention (adjusted mean difference: -3.3 (95% CI: -4.0 to -2.1) -4.3 (-5.5 to -3.0), respectively). In the second month after the intervention, the mean total PMS score was -5.8 (-7.0 to -4.7) in the Vitexagnus group and -6.6 (-8.1 to -5.7) in the Flaxseed group. There was no significant difference between the Vitexagnus and Flaxseed groups in terms of the PMS score .

  Conclusion: According to the results of this study, Flaxseed and Vitexagnus are effective in improving PMS .

  Background & Aim: Psychological and social factors such as attachment styles may influence chronic diseases through self-care behaviors. This study was conducted to determine the relationship between attachment styles and self-care behaviors in patients with heart failure .

  Methods & Materials: In this correlational study, 180 patients with heart failure hospitalized in CCUs and Post CCUs of educational hospitals in Zahedan in 2014 were selected through convenience sampling. Data collection tools included the Experiences in Close Relationships-Revised (ECR-R) questionnaire and Self-Care of Heart Failure Index (SCHFIV6.2). Data were analyzed in the SPSS-20 using the descriptive statistics, independent T-Test, Pearson's correlation and regression analysis . 

  Results: The mean and standard deviation of self-care behaviors score of the group with secure attachment style (62.89 ± 12.66) was significantly higher than the group with insecure attachment style (40.43 ± 16.11) (P<0.05). Also, the regression model showed that the score of anxiety, attachment avoidance and age were as predictors of the self care scores in patients .

  Conclusion: Regarding the relationship between attachment styles and self-care behaviors and the low level of self-care in patients with insecure attachment style, psychological interventions should be considered through long-term treatment of chronic heart failure .

Background & Aim: In the view of the importance of evidence-based clinical practice in recent years, clinical disciplines such as nursing and midwifery have found a special need to systematic review and meta-analysis. However, systematic reviews and meta-analysises like any other studies may be poorly designed and implemented. Therefore, certain guidelines have been considered for reporting of such studies. The PRISMA statement is one of the most recent developments to improve the reporting quality of systematic reviews. The present study aimed to assess the reporting quality of systematic reviews and meta-analysises in the Iranian journals of Nursing and Midwifery, based on the PRISMA statement.

Methods & Materials: In this study, we conducted a comprehensive search on the Iranian journals of Nursing and Midwifery (Persian and English), indexed by the SID, Magiran, Irandoc, Iranmedex and Google Scholar databases during 2010 to 2015 years. The search was implemented using the key words such as systematic review and meta-analysis. Of the 44 articles found, after considering the inclusion criteria, 16 articles remained that were investigated using the PRISMA statement. Data were analyzed through the descriptive statistics and chi-square test using SPSS software version 16.

Results: The compliance rate of studies on the basis of PRISMA statement was estimated to be about 63%. The most common deficiency in the reporting quality was related to methodology estimated to be about 57%. The most visible deficiencies in the reporting of systematic reviews and meta-analysises were related to bias in the primary studies and bias in combining the results of these studies and lack of reporting these biases.

Conclusion: In this study, the reporting quality of systematic reviews and meta-analysises in the Iranian journals of nursing and midwifery was in the moderate level. The most probable reason for this may be the lack of enough attention of researchers to the PRISMA statement or not using this statement in reviewing articles. Therefore, it is recommended that an appropriate share of the educational programs on research methodology be allocated to systematic reviews and familiarizing with valid criteria such as PRISMA statement.

Background & Aim: One of the assisted reproductive technologies is the use of donated oocyte. Although, the data about medical aspects of this process is available, knowledge of the psychological aspect related to this therapy is limited. Each individual's psychological aspects can be assessed by the self-concept and the self-discrepancy. Therefore, the present study aimed to assess the self-concept and self-discrepancy among women receiving and donating oocyte.

Methods & Materials: In this descriptive-analytical investigation, carried out in 2015, given the limited research population, 53 women referred to Royan infertility institute, were investigated in each of the donor and recipient groups using the available sampling method. The data were collected by three questionnaires including demographic questions, Rogers’s self-concept scale and self discrepancy scale (ideal-self discrepancy and ought-self discrepancy). The data were analyzed through the descriptive statistics, Chi-square and t-test using SPSS v.16.

Results: Results showed that the self-concept and self-discrepancy scores were poor in both the donor group and the recipient group. Scores of the recipient women (the questionnaire was reverse scored) were more than scores of the donor women. There was no significant difference between the two groups in the mean scores of self-concept (P=0.53). There was a significant difference between the two groups in the ought-self discrepancy score (P=0.02) but no significant difference was found between the two groups in the ideal-self discrepancy score (P=0.15).

Conclusion: According to the results, it should be noted that in the process of oocyte donation, only physical assessment is not enough but individuals’ psychological needs are necessary to be taken into account. So, the authorities should consider measures to assess the psychological aspects of women receiving and donating oocyte.

Background & Aim: Given the importance of mothers’ health and considering that developmental delay in children affects their mothers’ mental health this study aimed to compare stress and perceived social support in mothers of 6-18 month old children with and without developmental delay.

Methods & Materials: This cross-sectional, analytical study was performed on 610 mothers and their 6-18 month-old infants in health centers affiliated to Shahid Beheshti University of Medical Sciences. The participants were selected through the multi-stage random sampling. To collect data, the following questionnaires were used: obstetric and demographic characteristics, socio-economic status, infants’ characteristics, the Cohen perceived stress scale, perceived social support, and Ages and Stages questionnaire to determine the children’s development status. The data were analyzed by SPSS v.19 software and using descriptive statistics, Pearson correlation, chi-square, independent t-test and Man-Whitney statistical tests.

Results: The mean age of infants were 10.68±4.5 months. Independent t-test revealed a significant difference between mothers’ perceived stress (P=0.004) and social support (P=0.01) in the two groups. In addition, a relationship was observed between the mother’s social support and stress (P<0.04).

Conclusion: The results showed that mothers of children with developmental delays have more stress and lower perceived social support than mothers of normal children. Therefore, it is recommended to perform developmental screening for further examination and the reduction of mothers’ stress, as well as to provide appropriate social support.

Background & Aim: Maternal request for caesarean section due to fear of normal vaginal delivery (NVD) is one of the main reasons for the high rate of caesarean section. This study aimed to compare the fear of NVD and type of delivery between two groups of pregnant women attended childbirth preparation classes (CPC) and women received routine prenatal care (RPC).

Methods & Materials: In this prospective cohort study, 202 Primigravid women attended healthcare centers for prenatal care services in the East of Guilan were selected using convenient sampling in 2013-2014. Fear of NVD was assessed using a childbirth attitude questionnaire at two stages (before attending CPC or receiving RPC, then at the third trimester of pregnancy). Both groups were followed up to the delivery time. Data were analyzed using inferential and descriptive statistics (Chi square, paired t-test, ANOVA, t-test) through SPSS v.16. P<0.05 was considered as significant.

Results: There was no significant difference (P=0.23) in the mean score of fear of NVD between two groups before attending CPC (35.59±8.78) and receiving RPC (37.08±9.08). The comparison of the mean score of fear of NVD between two groups at the third trimester of pregnancy showed a significant reduction (P<0.001) in the first group (32.30±8.31) than in the second group (37.29±9.55). A significant difference was also observed between two groups in the rate of NVD (P=0.002).

Conclusion: Results confirm the importance of CPC in decreasing fear of NVD and increasing the rate of NVD in primigravid women attended these classes. Therefore, women’s attendance at CPC is recommended to be encouraged.

Background & Aim: Pap smear test is an effective screening method for early detection of cervical cancer. This study aimed to determine the effect of education based on the health belief model on women’s belief and practice regarding Pap smear test.

Methods & Materials: In this quasi experimental study, 100 married women under coverage of Bushehr health centers participated in the study in 2014-2015. The data collection instrument was a questionnaire consisted of demographic information, the questions concerning knowledge and the HBM constructs regarding Pap smear. The training program was performed in two group sessions. Three months after the intervention, women’s practice about Pap smear test was evaluated in both groups. After data collection, data were analyzed by descriptive statistics, repeated measure analysis of variance, independent t-test and Chi square on SPSS software v.20.

Results: Before the study, both groups had not any significant differences in all variables and constructs. After the intervention, the mean scores of knowledge (P<0.001), perceived seriousness (P=0.015) and perceived barriers (P<0.001) were significantly different between two groups. Three months after the intervention, 42 (85.7%) in the intervention group and 4 (8.2%) in the control group had performed Pap smear test (P<0.001).

Conclusion: Designing and implementing educational program based on health belief model can promote women’s awareness and reduce their perceived barriers and as well as enhance their practice regarding Pap smear test.

Background & Aim: Patient falling is one of the most important indicator of patient safety. Nurses have an important role in the prevention of patient falls and the improvement of patient safety standards. The current study aimed to determine the relationship between the incidence of patient falls and nurses’ professional commitment.

Methods & Materials: In this cross-sectional study,300 nurses employed in hospitals affiliated to Tehran University of Medical Sciences, were selected through a proportional stratified sampling method. Data were collected by a three-part questionnaire consisted of the demographic data, the Nurses’ Professional Commitment Scale and the reports on the number of patient falls in the past three months. Data were analyzed on SPSS software using statistical tests including Pearson's correlation coefficient, Kruskal-wallis and independent-t test.

Results: The mean score of patient falls in the past 3 months was 6±1.61(moderate) for each nurse and the mean score of nurses' professional commitment was 86±8.61 (committed).A significant and reverse relationship was observed between the incidence of patient falls and nurses’ professional commitment (R= -0.51; p<0.018).There is no relationship between nurses’ demographic characteristics and patient falls.

Conclusion: Despite the lower incidence of falls in the patient under the supervision of the committed nurses, its prevention entails taking into account all factors that influence this phenomenon besides improving professional commitment.

Background & Aim: Lack of orgasm during intercourse and loss of libido in menopause is very common and can reduce women's quality of life. The aim of the present study was to determine the effect of Aphrodite on orgasm and sexual desire in postmenopausal women.

Methods & Materials: The study design was a randomized clinical trial with a control group. Participants were comprised of 80 postmenopausal women 50-60 years old. The instruments consisted of the demographic characteristics form and the Sabbatsbergsexual function scale that a part of itevaluates orgasm and sexual desire. Descriptive statistics, paired t-test and independent t-test were used to analyze data through SPSS software v.16.

Results: The mean score of orgasm before intervention in the Aphrodite group was 30.25±20.6 and in the placebo group was 29±21.9. One month after intervention, this score increased to 41.12±10.08 in the Aphrodite groupand was 29.12±29.66 in the placebo group, that the difference between the two groups was statistically significant (P=0.02). As well, for the sexual desire score, there was a significant difference between the two groups of Aphrodite and control after intervention (P=0.008).

Conclusion: The use of Aphrodite can improve sexual desire and orgasm in menopausal women. So, it is essential that healthcare providers be familiar with this herbal supplement.

Background & Aim: Male andropause begins with hormonal, physiological and chemical changes, and usually occurs in men between the ages of 40 to 55 years. These changes affect their quality of life. Hence, the current study investigated the quality of life of men with andropause and its related factors.

Methods & Materials: This preliminary cross-sectional study was conducted through the census method on 80 males aged 40 to 60 years, employed at the schools of Tehran University of Medical Sciences. Data were collected in 2014 using a demographic questionnaire, the Short-Form 36 (QOL) questionnaire, and the Persian version of the Aging Males' Symptoms (AMS) questionnaire. Data were analyzed by SPSS software v.22 through descriptive and inferential statistics (Independent t-test, one-way ANOVA, Pearson’s Correlation Coefficient and Stepwise multivariate Regression). The level of significance was set at 0.05.

Results: The mean age of the andropausal men was 47.6±4.79 years and the majority (38.8%) of the samples were in the 45-49 age group. The mean quality of life score was 61.75±13.52. Stepwise regression showed a significant relationship between age and the scores of overall quality of life, physical and psychological health dimensions. Moreover, significant associations were observed between the overall quality of life score and the andropause severity, and between physical health dimension and sleep hours per day.

Conclusion: This study indicates that andropause lowers the quality of life, and age, andropause severity and sleep hours affect the quality of life in the andropausal men.

Background & Aim: Reducing water-pipe use is among the most effective ways to reduce chronic disease and some cancers. The aim of this study was to determine effect of education based on Health Belief Model (HBM) by health volunteers on water-pipe use among women.

Methods & Materials: This Quasi-experimental study performed on 127 women who used water-pipe (63 in the intervention group and 64 in the control group) in Bushehr in 2014. The data collection tool included demographic characteristics, the HBM constructs about water-pipe use, knowledge about water-pipe complications, and behavior (frequency of water-pipe use in last week and nicotine dependence scale). Intervention group received two sessions of education based on HBM by health volunteers. Data were analyzed using descriptive statistics, Chi-square test, Mann-whitney test, independent t-test, repeated measures ANOVA, and Friedman test on SPSS software version 18.

Results: Before education, both groups were similar in terms of demographic variables, the mean score of knowledge and all the HBM constructs (P>0.05). After education, the mean scores of HBM constructs and knowledge significantly increased and nicotine dependence decreased in the intervention group compared to the control group (P<0.001). After 3 months, the frequency of water-pipe smoking significantly reduced in the intervention group (P=0.007). But in the same period, there was no significant difference in term of the frequency of water-pipe smoking in the control group.

Conclusion: The results show that education based on the behavior change patterns by health volunteers can be effective in changing beliefs and reducing water-pipe use among women.

Background & Aim: The physiological and psychological changes in pregnancy, can affect the lives of couples. The present study aimed to determine the effect of sex education on the marital relationship quality of pregnant women.

Methods & Materials: This study is a quasi-experimental. In this study, 100 pregnant women referred to health centers in Zahedan in 2015, were selected and assigned into two groups of intervention and control (50 in each group). Data collection tool was the perceived marital relationship quality components questionnaire. Questionnaires were completed by the both groups before and six weeks after the sex education sessions. Data were analyzed using descriptive and inferential statistics through SPSS software version 20.

Results: There was no statistically significant difference between the two groups (P<0.05) in terms of age, the duration of marriage, gestational age and gravidity. In post-test measurement, the mean of the total score of marital relationship quality and components such as satisfaction, sexual excitement, love, commitment, intimacy, and trust, were significantly higher in the intervention group than in the control group. Analysis of covariance also showed that the total score mean for the marital relationship and its components had significant difference in the pregnant women in two groups, after sex education (P<0.001).

Conclusion: Given the effectiveness of sex education in the improvement of marital relationship quality in pregnant women, this educational intervention is recommended to be integrated into the education program and prenatal care of pregnant women in order to improve the couple’s relationship quality in pregnancy.

Background & Aim: Females’ quality of sexual life is one of the key issues of sexual and reproductive health. This is a subjective concept and defined as individual’s perception of sexual aspect of life. The aim of this study was to explore the factors affecting Iranian women’s quality of sexual life.

Methods & Materials: This qualitative study was conducted by conventional content analysis. Data were collected by 17 in-depth, unstructured interviews and 14 sexual life narratives through purposeful sampling among married and reproductive aged women from five university-affiliated health centers in Tehran and Shiraz. Constant comparative method was used to analyze data.

Results: According to the participants’ experiences, 3 themes emerged as direct factors affecting the quality of sexual life including ‘preparation before sexual relationship’, ‘couple’s interaction and harmony in sexual relationship’ and ‘previous sexual relationship outcomes’. ‘Marital life status’ and ‘passive sexual socialization’ were explored as the factors which can conceptualize the context of females’ quality of sexual life.

Conclusion: In this study, factors affecting females’ quality of sexual life were identified. Attention to these factors is suggested to design appropriate interventions by health care system in Iran.

Background & Aim: Job satisfaction is of the most fundamental components of mental health in every profession and one of the most important factors in career success. Therefore, identifying factors affecting job satisfaction is necessary. One of these factors is employee empowerment. This study aimed to determine the relationship between structural and psychological empowerment and job satisfaction among nurses.

Methods & Materials: In this cross-sectional correlational study, the study population was all nurses working in public hospitals in Mashhad (N=4300) in 2015. The samples consisted of 340 nurses, were selected by multistage cluster sampling method. Participants were assessed by the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II), Psychological Empowerment Questionnaire and Job Description Index (JDI). In order to analyze the data, Pearson’s correlation coefficient and regression analysis were used through SPSS software v.19, and for validation stage, the confirmatory factor analysis were applied using AMOS software v.21.

Results: Results showed that there is a significant multiple correlation between structural empowerment, psychological empowerment and job satisfaction (P<0.001, R²=0.286). Of the eight variables entered into the regression analysis using stepwise technique, three variables including meaningfulness (β=0.30, P<0.001), impact (β=0.25, P<0.001) and access to support (β=0.13, P<0.001) altogether predict 28.6% of the variance in job satisfaction.

Conclusion: The results show the importance of psychological empowerment, the sense of meaningfulness, impact, and access to support as strong predictors of job satisfaction. So, providing the conditions needed for the empowerment of nurses is recommended to increase their job satisfaction and subsequently their efficiency and life satisfaction.

Background & Aim: Cesarean rate has had a rising trend in Iran during the last two decades. Natural childbirth promotion plan has been implemented in the form of health sector evolution plan (HSEP) in order to increase natural childbirth. Present study aimed to evaluate the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers hospitalized in Kurdistan province.

Methods & Materials: This descriptive study was conducted as longitudinal and retrospective study. Cesarean rate in all hospitals of Kurdistan province was assessed in 2013 and one year after the implementation of HSEP. Furthermore, data related to the percentage of out of pocket expenditures by pregnant mothers in one of the hospitals of Kurdistan University of Medical Sciences, which was randomly selected, was also studied. Data were analyzed using SPSS v.20.

Results: There was a 14.02% reduction in the rate of cesarean in Kurdistan province one year after the implementation of HSEP compared to its basal rate in 2013 (P<0.001). The average out of pocket expenditures was 16.05% before the implementation of HSEP. This rate was reduced to 4.30% and 2.5% respectively after the implementation of first and third phases of HSEP.

Conclusion: Natural childbirth promotion plan has reached its predetermined goal, which was a 10% decrease in cesarean rate one year after the implementation of HSEP compared to its rate in 2013. In addition, there was a significant reduction in the percentage of out of pocket expenditures.

Background & Aim: Cesarean rate has had a rising trend in Iran during the last two decades. Natural childbirth promotion plan has been implemented in the form of health sector evolution plan (HSEP) in order to increase natural childbirth. Present study aimed to evaluate the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers hospitalized in Kurdistan province.

Methods & Materials: This descriptive study was conducted as longitudinal and retrospective study. Cesarean rate in all hospitals of Kurdistan province was assessed in 2013 and one year after the implementation of HSEP. Furthermore, data related to the percentage of out of pocket expenditures by pregnant mothers in one of the hospitals of Kurdistan University of Medical Sciences, which was randomly selected, was also studied. Data were analyzed using SPSS v.20.

Results: There was a 14.02% reduction in the rate of cesarean in Kurdistan province one year after the implementation of HSEP compared to its basal rate in 2013 (P<0.001). The average out of pocket expenditures was 16.05% before the implementation of HSEP. This rate was reduced to 4.30% and 2.5% respectively after the implementation of first and third phases of HSEP.

Conclusion: Natural childbirth promotion plan has reached its predetermined goal, which was a 10% decrease in cesarean rate one year after the implementation of HSEP compared to its rate in 2013. In addition, there was a significant reduction in the percentage of out of pocket expenditures by mothers.

Background & Aim: The challenges that patients face after intestinal ostomy surgery can lead to impaired adjustment and self-efficacy. There is evidence suggesting these variables have reciprocal effects on each other. Therefore, the present study aimed to determine the correlation between adjustment and self-efficacy in patients with intestinal ostomy.

Methods & Materials: This descriptive correlational study was conducted on 76 patients with intestinal ostomy hospitalized in hospitals affiliated to Mashhad University of Medical Sciences using convenience sampling method in 2015. Research instruments were comprised of the demographic and disease information questionnaire, the Stoma Self-efficacy Scale, and the Ostomy Adjustment Inventory. The SPSS software v.19 using descriptive and inferential statistics was used to analyze the data.

Results: The results of Pearson correlation test showed a significant and positive linear correlation between the mean score of self-efficacy and the dimensions of adjustment: acceptance (P<0.001, r=0.518), anxious preoccupation (P<0.001, r=0.438), social engagement (p<0.001, r=0.488), and anger (P<0.001, r=0.384). Moreover, multiple regression analysis indicated that the dimensions of social engagement and acceptance have a significant and positive linear correlation with self-efficacy in patients with intestinal ostomy.

Conclusion: The results revealed that the dimensions of social engagement and acceptance of ostomy were the most important factors in relation to self-efficacy. Therefore, in order to care for patients with intestinal ostomy especially in the early months after surgery, it was recommended to help patients adjust themselves to the physical appearance of ostomy and maintain their social engagement, by designing and implementing appropriate educational and supportive interventions.