---

Background & Aim: Diabetes education does not assure adherence to diabetic regimen. The aim of this study was to investigate the effect of nurse-led telephone follow ups (Tele-Nursing) program on adherence to diabetic diet among type 2 diabetic patients.

Methods & Materials: This was a quasi experimental study. Sixty patients who were registered at Iranian Diabetes Society were selected using convenience sampling method. Data gathering instruments included a data sheet to record glycosylated hemoglobin and a questionnaire. Data were gathered at baseline and 12 weeks after the intervention. First, all participants attended in a three-day self-care education and dietary consultation program at Iranian Diabetes Society. Then, they were randomly assigned to the experiment and control groups. Telephone follow ups were applied in experiment group for 3 months, twice a week for the first month and then weekly for the second and third months. Data were analyzed using SPSS version 13.

Results: Results showed that there were significant statistical differences between control and experiment groups in adherence to diabetic diet (P=0.035). There were significant differences in glycosylated hemoglobin between control and experiment groups after the intervention (P<0.000).

Conclusion: According to the results of the study, it is concluded that the nurse-led telephone follow ups can improve HbA_1c and diet adherence in type 2 diabetic patients.

---

  Background & Aim: Medication usage is the bases of disease management in patients who undergo hemodialysis. Non-adherence to medication regimen increases the incidence of complications among the patients . The aim of this study was to investigate the effect of a cognitive-behavioral intervention on medication adherence in patients undergoing hemodialysis .

  Methods & Materials: In this clinical trial, 70 patients were selected from Imam Reza and Valiasr hospitals. Patients were assigned into two intervention (n=35) and control (n=35) groups. The intervention group received a cognitive-behavioral intervention including six steps: 1) Identifying the problem 2) Creating confidence and commitment 3) Increasing awareness of behavior 4) Developing and implementing the action plan 5) Evaluating the plan and 6) Maintaining the desired behavior. Adherence to medication regimen was assessed using a self-report questionnaire before and immediately after the intervention. Data were analyzed using the independent t-test . 

  Results: At baseline, there was no significant difference in adherence to medicine regimen between the intervention (20.77 ± 4.56) and control (22.34 ± 3.65) groups (P=0.1). After the intervention, significant difference was observed between the two groups in adherence to medication regimen (P<0.001) .

  Conclusion: Cognitive–behavioral intervention could improve medication adherence in patients undergoing hemodialysis. It is recommended for nurses to use this approach to improve medical care among the patients .

  

---

  Background & Aim: Medication adherence affects the outcome of treatment in patients with epilepsy. Non adherence to the antiepileptic drugs in patients may result in exacerbation of seizure frequencies, higher health-care system costs and higher risk of morbidity and mortality . This study aimed to assess the medication adherence and its related factors in patients with epilepsy .

  Methods & Materials: In this cross-sectional study, we recruited 120 patients with epilepsy from the Iran Epilepsy Association using purposive sampling method. Data were gathered using a demographic checklist and the Morisky’s modified medication adherence questionnaire. Data were analyzed in the SPSS-16 . 

  Results: A total of 87.5%, 10.8% and 1.7% of the patients showed high, medium and low adherences, respectively. Being seizure-free for a period of time was the most cited reason of non-adherence (8.3%). There was a statistically significant relationship between the number of drugs and seizures with the medication adherence (P<0.05). The older people had more adherences to their medications. The patients, who had higher adherences, had experienced fewer seizures in the previous three months .

  Conclusion: The results showed high rates of medication adherences among the patients. Planning and implementing educational programs on medication regimens, emphasizing on necessity of continues use of antiepileptic drugs despite absence of seizures, can be useful in increasing the medication adherence .

  

---

Background & Aim: Patients with heart failure experience some outcomes such as poor self-management, poor adherence to treatment and low quality of life. The aim of the current study was to evaluate the effect of self-management based discharge planning on treatment adherence in patients with heart failure.
Methods & Materials: In this quasi-experimental research, 80 patients with heart failure hospitalized in teaching hospitals in Zahedan in 2019-2020, were selected by convenience sampling and were randomly allocated into either intervention or control groups. The self-management-based discharge plan consisted of four educational sessions in hospital for the intervention group. In order to follow up, the first call was made 2-3 days after discharge. Then, the patients or their family caregivers were contacted weekly in the first month and twice a month in the second and third month. Data were collected by the treatment adherence questionnaire and were analyzed using independent sample t-test, Fisher exact test, Chi-square and repeated measures ANOVA by the SPSS software version 16.
Results: The two-way repeated measures analysis of variance showed a significant difference in the mean scores of treatment adherence over time (P<0.001) and in the intervention and control groups (P<0.001).
Conclusion: According to the findings, it is recommended that self-management-based discharge plan be employed in an integrated manner for patients with heart failure in medical wards.
 

---

Background & Aim: Epilepsy is the most common chronic neurological disease after headache. About half of the patients with epilepsy do not properly adhere to medication regimens, which leads to a lack of control over seizures, increased treatment costs, and even increased mortality rate in these patients. The aim of this study was to determine the effect of telephone education on medication adherence in patients with epilepsy.
Methods & Materials: In this quasi-experimental study, 60 patients referred to neurology clinic of Valiasr Hospital in Zanjan in 2019 were selected by the convenience sampling method, and were randomly divided into either control or experimental groups. The Morisky drug adherence Questionnaire was used for data collection. At the beginning of the study and after completing the questionnaires, a face-to-face training session was held for the study participants. Then, telephone education was performed for the experimental group for two months and no intervention for the control group. Two months after the intervention, all the patients completed the questionnaire again. Finally, the collected data were analyzed through the SPSS software version 25 using descriptive (mean and standard deviation) and inferential statistics (Chi-square, Fisher's exact test, independent t-test and paired t-test).
Results: Before the intervention, there was no statistically significant difference between the two groups in terms of individual characteristics and medication adherence scores (P<0.05); But two months after the intervention, a statistically significant difference was observed in the mean score of medication adherence between the two control and experimental groups so that the patients in the experimental group had higher scores of medication adherence (P<0.001).
Conclusion: The results of this study showed the usefulness of using the telephone education method in improving the medication adherence of patients with epilepsy. Therefore, it is recommended that this method be used in the training program for these patients. In addition, further studies are needed on the comparison of the effectiveness of telephone education with other methods of telemedicine such as cyberspace and online education.
 

---

Background & Aim: Compliance with health behaviors during pregnancy plays an important role in the health of mothers and their neonates. The aim of the study was to determine factors predicting adherence to COVID-19 health protocols among pregnant women in Zanjan province in 2020.
Methods & Materials: A cross-sectional, descriptive study was conducted on 2336 pregnant women referred to comprehensive health centers in Zanjan province in 2020. The samples were selected by the multi-stage sampling method. Data were collected by telephone using a researcher-designed questionnaire on health practices and overall perception of COVID-19 disease. To analyze the data, descriptive statistics and multiple linear regression model were used at the confidence level of 95% through the SPSS software version 16.
Results: Most women were in the second trimester of pregnancy and living in the urban areas. Considering the median score as a cutting point, the participants’ adherence level was 46.5% over the median score and at a desirable level. The handwashing adherence was 84.7% and mask use was 76.6%. Location, age, education, occupation, household income, and family history of COVID-19 disease were the most important predictors of compliance with COVID-19 health protocols (P<0.001).
Conclusion: Adherence to health protocols was at a relatively desirable level in almost half of the participants. It is suggested that education and support programs be designed and implemented for young and low-income groups living in rural areas.

 

---

Background & Aim: The main care need of patients with myocardial infarction (MI) is continuous care, presenting an important challenge in the field of nursing care. Therefore, This study aimed to evaluate the effect of nurse-led home-based cardiac rehabilitation on adherence to therapeutic regimens in patients with MI.
Methods & Materials: In this randomized clinical trial study, 80 eligible patients were selected through convenience sampling from selected hospitals affiliated with Tehran University of Medical Sciences in 2020-2021. Subsequently, they were randomly allocated to either the intervention or control groups. The control group received routine education upon hospital discharge, whereas the intervention group participated in a nurse-led cardiac rehabilitation program conducted both in-person at home and online, comprising four 90-minute sessions once a week, and were monitored for two months. Participants completed socio-demographic and treatment compliance questionnaires before and three months after the intervention. The collected data was analyzed using descriptive and inferential statistics with SPSS software version 20.
Results: Both groups were homogeneous in most demographic variables (P>0.05). The mean and standard deviation of treatment adherence scores before the intervention in the intervention and control groups were 70.82±7.91 and 67.94±11.20, respectively (P=0.015). After the intervention, these values changed to 75.10±6.13 and 68.77±10.12, respectively, with a statistically significant difference observed between the two groups (P<0.001).
Conclusion: The results revealed that nurse-led home-based cardiac rehabilitation was effective in enhancing treatment adherence. Therefore, it is suggested that cardiac rehabilitation care be consistently extended to the home setting.
Clinical trial registry: IRCT20201006048953N

 

---

Background & Aim: Stroke, as the primary and most critical cerebrovascular condition, is known as a leading cause of disability and mortality. Timely and appropriate care plays an important role in reducing death and associated complications. The purpose of this research is to assess the knowledge and adherence of emergency nurses to tissue plasminogen activator guidelines for patients with stroke.
Methods & Materials: In this descriptive study, a random quota sampling method was employed to select participants. A total of 170 emergency department nurses in Tabriz hospitals in 2023 self-administered knowledge and adherence scales. Data were analyzed using SPSS version 26, employing t-test, one-way ANOVA and Pearson’s correlation coefficient.
Results: The mean (SD) age of the nurses was 34.24±6.57 years, with a majority (101 nurses, 59.4%) having completed courses on the process and activation of Code-724. The mean scores for nurses' knowledge and adherence to tissue plasminogen activator guidelines were 52.67±10.37 (range score: 0-100) and 68.14±5.18 (range score: 15-75), respectively. A positive yet weak relationship was observed between nurses' knowledge and adherence to the guidelines (r=0.263, P=0.332). No significant association was found between nurses' socio-demographic characteristics and their knowledge and adherence scores (P>0.05).
Conclusion: The findings revealed suboptimal scores in nurses' knowledge and adherence to tissue plasminogen activator guidelines for stroke patients. Given the importance of adequate knowledge for adherence to guidelines, it is suggested to implement essential training and supervision measures for nurses.

 

---

Background & Aim: Medication non-adherence remains a significant problem in managing the global epidemic of hypertension. This study aimed to explore the factors affecting medication non-adherence from the perspectives of both patients with hypertension and healthcare providers in Mahan health centers, located in Kerman province.
Methods & Materials: This qualitative study utilized a conventional content analysis method within healthcare centers in Mahan city in 2022. A total of 29 participants were included in the study, selected through purposive sampling. Data were collected through in-depth semi-structured interviews, with all interviews being recorded, transcribed verbatim, and utilized as the primary data for analysis. The trustworthiness of data was evaluated in accordance with the criteria established by Guba and Lincoln criteria.
Results: Three categories of factors contributing to medication non-adherence among patients with hypertension were identified: ""nature of the disease and treatment," "individual and family factors," and "organizational factors." Factors related to the "nature of the disease and treatment" included the asymptomatic and chronic nature of hypertension as well as fatigue stemming from continuous drug use. "Individual and family factors" encompassed fear and internal doubts, a desire for non-pharmacological treatments, and inadequate family support. "Organizational factors" comprised high treatment costs and access to specialized services, insufficient support from treatment and care teams, and inadequate disease monitoring.
Conclusion: Various factors across a spectrum of influences contribute to medication non-adherence in patients with hypertension. It is crucial for healthcare providers to engage in consistent patient education regarding the nature of the condition and the importance of medication adherence to enhance compliance among patients.