Introduction:The purpose of this study was to assess the status of diabetes management among elderly people living in Isfahan nursing homes using the Donabedian framework in three parts: structure, process, and outcome.
Methods:In 2018, the current descriptive-cross-sectional approach was used in 13 nursing homes in Isfahan. Data was collected using a dependable and valid research-created checklist that evaluated diabetes management through three components: organizational structure (8 dimensions and 33 items), processes (3 dimensions and 23 items), and outcomes (2 dimensions and 7 items). Data was collected by observing the equipment and human resources, interviewing key informants and nurses, reviewing documents, and collecting blood and urine samples under standard conditions.Results: Structure, process, and outcome mean scores were 34.5±2.6, 38.5±5.9, and 65.6±13.9, respectively. The highest and lowest structure scores were associated with "referral system" and "trained personnel," respectively; process scores were associated with "counseling and risk factor reduction" and "immunization," and outcome scores with "physical examination and history taking" and "documentation of laboratory results." The mean score of structure was found to have a direct relationship with process and outcome (p < 0.05). There was also a direct relationship (p <0.05) between the mean process and outcome scores. Linear regression analysis revealed that structure was a significant predictor of outcome (p = 0.01).
Conclusions:The findings revealed some issues with the structure, process, and outcome of providing appropriate diabetes management care in nursing homes. To achieve positive results in this area, it is necessary to focus on the human resources, facilities, and equipment required to manage diabetes in nursing homes.
Background: Despite the notorious effects of inadequate physical activity (PA), adopting appropriate interventions to increase PA is still problematic. This study identifies and prioritizes evidence-based strategies to increase PA in Iranian women. Methods: This is a mixed-method study. A systematic review of clinical interventions was used to stimulate academic and focus group discussions (FGDs), where the participants identified the most salient strategies to promote PA in Iranian women. Then a nominal group technique (NGT) was used to reach a consensus on the prioritization of the strategies. This mixed methods study (systematic review and FGD) was conducted in 2014. The participants (n=13) included Iranian women, the research team, health sciences experts, managers, and policymakers. They rated the strategies’ importance and applicability (from 3 to 13); higher scores indicated higher prioritization. The prioritized plans were then categorized under a socioecological model of intrapersonal, interpersonal, organizational, and community factors. Results: Overall, 26 strategies were identified and coded as items. The challenging of inaccurate beliefs about PA, along with the increasing self-confidence and self-prioritization, creation of sports groups, the use of sports coaches, and increase of awareness via text messaging and informative multimedia placed in local mosques and schools got the highest scores both in terms of importance and applicability in this model. Conclusion: In promoting PA, collaboration with key stakeholders is paramount. The strategies identified and prioritized in this study could be used to design future PA programs for increasing PA in Iranian women.
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