Sebahat Gözüm

Complementary alternative treatments used by patients with cancer in eastern Turkey

Interest in complementary-alternative medicine therapies is growing rapidly in Turkey. Therefore, the purpose of this research was to determine the types and prevalence of alternative therapies used by the patients with a diagnosis of cancer, and to determine factors influencing the choices of their therapies in Erzurum, Turkey. Approximately 10-minute face-to-face interviews were conducted with each subject in the radiation oncology department. The factors associated with the use of alternative therapies after a diagnosis of cancer were assessed by chi-square analysis. The findings indicated that complementary-alternative medicine therapies were used by 41.1% of the subjects after their diagnosis, and that all of the alternatives they used were herbs. The most commonly used herb was stinging nettle leaf (urtica dioica) or seed of nettle. Almost all (93.2%) of the herbs used were nettle. In general, especially the women and the younger patients of both genders were more likely to be using alternative therapies. There was no difference in demographic and cancer characteristics between users of alternative therapy and nonusers. More than the half of the patients using alternative therapies (54.5%) reportedly did not discuss the use of herbs with their healthcare professionals. Most of the patients using stinging nettle and other herbs therapies reported that they had heard about the use of herbs from friends or relatives (52.3%), or from the other patients in this clinic (43.2%). This study found that there is a high prevalence of alternative therapies used by patients with cancer in eastern Turkey. The use of these alternative therapies requires that nursing professionals rethink staff competency, patient assessment, and patient-focused care. Communication between patients and healthcare professionals should initiate dialogues on this topic for a better understanding of patient choices with regard to treatment options.

Complementary and Alternative Medicine Use in Pediatric Oncology Patients in Eastern Turkey

The use of complementary and alternative medicines (CAM) among children with cancer is becoming increasingly popular. Therefore, it is important to gain insight into the prevalence and factors related to the use of CAM. This study presents findings from a study of parents of 88 children with cancer who were receiving or had received conventional therapy for treatment of childhood cancer at a pediatric oncology unit in eastern Turkey. The findings indicated that 48.9% of the respondents reported the use of 1 or more CAM therapies. The most commonly used modality was herbal products such as herbal tea and herbal meal, mostly stinging nettle (Urtica dioica). The findings of this study indicate that CAM users were children who were an average of 3 years older than nonuser children and that CAM use was more prevalent among the children who had been diagnosed with cancer for a longer time than nonusers. There were no significant difference between users and nonusers regarding sociodemographic characteristics (such as age education level, economic status), hopelessness score of parents, gender of child, and treatment status. Healthcare providers should remain informed about the benefits and adverse effects of complementary and alternative therapies to discuss treatment options with patients and their families and to monitor treatment efficacy.

The effect of patient education and home monitoring on medication compliance, hypertension management, healthy lifestyle behaviours and BMI in a primary health care setting

AIM The aim of this study was to determine the effect of anti-hypertensive patient-oriented education and in-home monitoring for medication adherence and management of hypertension in a primary care setting, by providing education on healthy lifestyle behaviours and medication adherence. BACKGROUND Hypertension is the third most common cause of death worldwide. Prevalence of hypertension in Turkey is approximately 30% in the general population and 45-50% in population over 50. DESIGN Randomised controlled study. METHODS This study conducted in Turkey used a study group comprised of 120 subjects (40 Group A, 40 Group B, 40 controls), all previously diagnosed with hypertension and who started medication therapy at least one year prior to start of study. The study was conducted between February-November 2006 at public primary health care facilities and homes of the study participants. Participants in Group A and B received a total of six monthly education sessions, four times during clinic visits and two home visits. Medication adherence education for Groups A and B and education about healthy lifestyle behaviours for Group B were administered in a structured and individualised format. The control group was routinely monitored in health care facilities. RESULTS Healthy lifestyle behaviours and perception of self-efficacy regarding medication adherence showed improvement after education sessions in Groups A and B. Systolic and diastolic blood pressures of subjects in Group A and B showed a significant decrease compared with those of the control group; the blood pressure decrease in Group B was greater than in Group A. CONCLUSION Nurses play an important role in uncontrolled hypertension detection and can improve medication adherence and healthy lifestyle behaviours. RELEVANCE TO CLINICAL PRACTICE Patient education medication adherence alone and in combination with healthy lifestyle behaviour teaching is an effective tool for blood pressure reduction in the hypertensive population in primary health care settings.

Effectiveness of peer education for breast cancer screening and health beliefs in eastern Turkey.

Background: The primary site of cancer in Turkish women is breast cancer. The incidence of breast cancer is increasing in Turkey. Objective: The aim of the research was to educate women 40 years and older to increase their awareness on early detection and diagnosis, to facilitate the use of the early diagnosis methods, to improve the womens beliefs in relation breast cancer, and to increase the use of Cancer Early Diagnosis and Screening Centers available in the city. Methods: The target population of the research was 5000 women. Forty selected women were educated as peer educators. Twenty-five of them were selected as principal peer educator. Each peer educator was expected to educate 200 women. Peer trainers educated their peer and also arranged for the mammography appointment of the women who decided to have theirs taken. Data were obtained before and after the training by Champions Health Belief Model Scale, questionnaire forms, and Cancer Early Diagnosis and Screening Centers data for mammography practice. Results: Breast cancer was detected in 8 women. Statistical analyses showed positive changes in womens health beliefs and breast self-examination knowledge. There were 20.4% of women (n = 1040) who did get mammograms, and 8% (n = 8) of women were found to have cancer in all of those screened. Conclusion: Peer education was found to be effective for increasing the knowledge, beliefs, and practice of women related to breast cancer. Implications for Practice: Peers can reinforce learning through ongoing contact. Peer education can be used to improve early diagnosis of breast cancer and breast cancer awareness in asymptomatic women.

Comparison of two different educational methods on teachers’ knowledge, beliefs and behaviors regarding breast cancer screening

AIM This research has been carried out to compare the effects of different educational initiatives on the beliefs and behaviors related to the practice of early diagnosis of breast cancer. Ninety-three female primary school teachers who were working in Ordu during the time of the research agreed to join the research; 51 of them comprised the model group and 42 the video group. METHODS The teachers both in video and model groups were equaled from the point of view of their age, having had previous breast problems, a history of breast cancer in the family, or knowing how to do breast self examination (BSE). Questionnaires were used to collect data. These included the Champions Health Belief Model Scales of Breast Cancer Screening and the control list regarding how to do BSE. The collected data were evaluated by computer using the following tests: descriptive statistics, chi-square test, Mann-Whitney U, Independent Samples t-test, Paired t-test, and McNemar test. RESULTS Following the education given to the video group, susceptibility, perceived self-efficacy of BSE, and perceived benefits of mammography increased relative to prior to education. In addition the teachers in the video group also improved in their knowledge of BSE. Regarding the education given to the model group, susceptibility, perceived self-efficacy of BSE, and perceived benefits of mammography increased relative to before the education. The teachers in the model group also improved in their knowledge and ability to perform BSE. As a result, it was determined that there is no difference between the beliefs of both groups. CONCLUSION This study showed that both video and model methods of education were effective in changing health beliefs regarding breast cancer screening and on the same level increasing knowledge and practice of BSE.

Response to the needs of Turkish chemotherapy patients and their families.

The purpose of this study was to determine the quality of life, depressive symptoms, and informational needs of cancer patients receiving chemotherapy and of their family caregivers. This article presents findings from a study of 111 patients with cancer and 34 of their primary family caregivers from an outpatient chemotherapy unit in eastern Turkey. The results indicated that the patients perceived a poorer quality of life than their family caregivers. The patients also were more clinically depressed. Furthermore, both the patients and caregivers received little information regarding the illness and the side effects of chemotherapy from their health professionals. Nearly half of the patients and over half of the caregivers reported that information given by health professionals was verbal. Most of the patients and caregivers reported they felt that they needed to be visited by health professionals at their home when they ask for such services and/or once a week. Patients reported the need for assistance with one or more personal, instrumental, or administrative activities. The need for administrative activities of patients and caregivers were found to be similar. In conclusion, nurses must continue to work hard to focus not only on the disease and its symptoms, but also on the impact on the day-to-day living of the patient with cancer and his or her family. Home visits may empower patients and caregivers by giving them information and professional support.

Reliability and Validity of the Turkish Adaptation of Medication Adherence Self-Efficacy Scale in Hypertensive Patients

Abstract: Background: Despite a lot of study related to medication adherence in hypertension, a major problem in research is the measurement of adherence. Aim: To evaluate the reliability and validity of the Turkish version of the Medication Adherence Self-Efficacy Scale (MASES) among hypertensive patients in an outpatient setting in Turkey. Methods: One hundred-forty adult patients, who are receiving medication for hypertension in the last one year, were included to study sample. MASES was translated using a back-translation technique, which includes the use of a panel of experts and interpreters to translate the items from the source language to the target language and then back-translate them to the source language. Psychometric evaluations of MASES-Turkish form were used construct validity; item analysis, principal component analysis and known group validity and internal consistency reliability (Chronbachs alpha) Results: Reliability coefficient of the Turkish adaptation of MASES was found 0.92, and item–total correlations ranged between 0.26 and 0.72. It was found that factor structure of the MASES-Turkish consisted with original instrument. Patients with uncontrolled hypertension had lower self-efficacy scores compared to those with normal blood pressure.

Reliability and validity of the Turkish form of the eight-item Morisky medication adherence scale in hypertensive patients

OBJECTIVE The aim of this study is to evaluate the reliability and validity of the Turkish version of the 8-item Morisky medication adherence scale. METHODS The study was conducted as a methodological design. The study included 196 patients with hypertension who applied to the Family Health Centers in three different regions of Turkey. Data were collected from February-June 2012. Methods used in the analysis included factor analysis, assessment of Cronbachs α test and item-total correlation in order to perform psychometric measurements. Variables influencing scores of medication adherence were determined using logistic regression analysis. RESULTS Factor loadings of all items in the scale were above 0.40, and the variation explained was determined to be 42.4. The Turkish form consisted of a single domain. The Cronbachs α coefficient of the items in the scale was 0.79. Item-total correlations of items in the scale were between 0. 30 and 0. 62. Scores of medication adherence were observed to be affected by low economic condition and city where said individuals reside. CONCLUSION It was determined that levels of reliability and validity of Turkish version of 8-item Morisky medication adherence scale is acceptable.

Effects of Interventions Based on Health Behavior Models on Breast Cancer Screening Behaviors of Migrant Women in Turkey.

Background: Antalya is a city receiving internal and external migration in Turkey, including migrant women in need of developing breast cancer screening behaviors. Objective: The aim of this study was to develop breast cancer screening behaviors of migrant women through nursing interventions based on the Health Belief Model and the Health Promotion Model. Methods: This quasi-experimental study was conducted with 200 women (100 women in the intervention group, 100 women in the control group) in Antalya. The intervention group received training, consultancy service, and reminders and was followed up at 3 and 6 months after interventions. Results: The rates of breast self-examination, clinical breast examination and mammography were higher at months 3 and 6 in women in the intervention group compared with the women in the control group. In the intervention group, perceptions of susceptibility and barriers decreased after the interventions, and benefit, health motivation, and self-efficacy perceptions increased. According to month 6 data, in the intervention group, the decrease of each unit in perception of barriers increased the rate of breast self-examination 0.8 times and the rate of mammography 0.7 times. An increase of each unit in health motivation increased the rate of clinical breast examination 1.3 times and the rate of mammography 1.5 times. Conclusion: Interventions based on health behavior models positively affected breast cancer screening behaviors of migrant women. Health motivations and perceptions of barriers are determinants in performing the screening behaviors. Implications for Practice: Migrant women should be supported more by healthcare professionals regarding recognition of breast health and disease and in transportation to screening centers in their new location.

Validity of the Turkish version of the medication adherence self-efficacy scale-short form in hypertensive patients

OBJECTIVE Study purpose was to examine the validity of a 13-item short form of the Medication Adherence Self-Efficacy Scale-Short Form (MASES-SF) in an independent sample of 150 hypertensive Turkish patients. METHODS This is a methodological study and 150 adult patients, who are receiving medication for hypertension in the last one year, were included as the study sample. The sample of the study was chosen with the method of simple random sampling. The study was conducted between October 25, 2010 and December 31, 2010 at Family Health Center (FHC). In this study, exploratory and confirmatory factor analyses were used for psychometric evaluation. Cronbachs alpha coefficient was used to evaluate the reliability of the scale. RESULTS Confirmatory factor analysis showed that all goodness indexes were at acceptable quality: χ(2)=61.72, df=65, p>0.05, GFI=0.99, CFI=1.00, RMSA=0.00. Reliability coefficient of the Turkish adaptation of MASES-SF was found as 0.94 and item-total correlations ranged between 0.63 - 0.80. [corrected]. Patients with uncontrolled hypertension had lower self-efficacy scores compared to those with normal blood pressure. CONCLUSION This result indicated that the preliminary criterion validity is adequate. Psychometric testing demonstrated satisfactory internal consistency and validity of the instrument for patients in the study group. It can be used confidently in determining and testing interventions to improve medication adherence self-efficacy perceptions and behaviors in hypertensive Turkish patients. The MASES-SF is brief, quick to administer, and capture useful data on medication adherence self-efficacy in hypertensive patients.