| 1. |
- Alijanzadeh, Mehran, et al.
(författare)
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Measurement Invariance and Differential Item Functioning of the Health Literacy Instrument for Adults (HELIA) : A Large-Scale Cross-Sectional Study in Iran
- 2022
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Ingår i: Healthcare. - : MDPI. - 2227-9032. ; 10:10
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Tidskriftsartikel (refereegranskat)abstract
- Health literacy is important for health behavior engagement. Therefore, it is important to have a good instrument assessing health literacy with a theoretical framework. The present study aimed to examine the measurement invariance and differential item functioning (DIF) of a newly developed health literacy instrument; that is, the Health Literacy Instrument for Adults (HELIA). Confirmatory factor analysis (CFA) and Rasch models were used to examine the data collected from a large Iranian sample (N = 9678; 67.3% females; mean age = 36.44 years). All the participants completed the HELIA. CFA was used to examine if the HELIA had a five-factor structure (including reading, access to information, understanding, appraisal, and decision making/behavioral intention factors) and multigroup CFA to examine if the five-factor structure of HELIA was invariant across gender, educational level, accommodation, and age subgroups. Rasch models were used to examine whether each factor of HELIA was unidimensional and DIF contrast in Rasch to examine if the HELIA items were interpreted similarly across the aforementioned subgroups. The CFA results supported the five-factor structure of HELIA, and the Rasch models verified that each HELIA factor is unidimensional. Additionally, multigroup CFA supported the measurement invariance of HELIA across the following subgroups: male vs. female; highly educated vs. poorly educated; city residents vs. suburban residents; and younger age vs. older age. The DIF contrasts in the Rasch models additionally showed that there are no substantial DIF items in the HELIA across aforementioned subgroups. Therefore, the HELIA is a feasible and comprehensive instrument assessing health literacy across different populations in Iran.
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| 2. |
- Alijanzadeh, Mehran, et al.
(författare)
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Sleep hygiene behaviours mediate the association between health/e-health literacy and mental wellbeing
- 2023
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Ingår i: Health Expectations. - : John Wiley & Sons. - 1369-6513 .- 1369-7625. ; 26:6, s. 2349-2360
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundHealth literacy and e-health literacy are important factors helping people shape awareness of health behaviours in different aspects, including sleep hygiene behaviours. Good sleep hygiene behaviours promote sleep quality and are beneficial to overall mental wellbeing.ObjectiveWe aimed to examine if sleep hygiene behaviours may mediate the association between health literacy/e-health literacy and mental wellbeing.MethodsAdult Iranian subjects (n = 9775; mean [SD] age = 36.44 [11.97] years; 67.3% females) completed the Health Literacy Instrument for Adults, eHealth Literacy Scale, three items on sleep hygiene behaviour that have been used in prior research and the Short Warwick Edinburgh Mental Wellbeing Scale. Data were then subjected to structural equation modelling (SEM) including 500 bootstrapping resampling to examine whether sleep hygiene is a mediator in the relationship between health literacy/e-health literacy and mental wellbeing.FindingsBoth health literacy and e-health literacy were significantly associated with mental wellbeing (r = .63 for health literacy and .39 for e-health literacy; p < .001) and sleep hygiene behaviours (r = .58 for health literacy and .36 for e-health literacy; p < .001). Sleep hygiene behaviours were significantly associated with mental wellbeing (r = .42; p < .001). Moreover, SEM that incorporated bootstrapping approaches indicated that sleep hygiene behaviours were significant mediators in the association between health literacy/e-health literacy and mental wellbeing.ConclusionsWe conclude that health literacy and e-health literacy are associated with mental health wellbeing in the Iranian population. Additionally, the association could be mediated via sleep hygiene behaviours.Patient or Public ContributionThe study was co-designed with healthcare providers from the vice-Chancellor's Office for Health Affairs of Qazvin University of Medical Sciences as equal partners. Moreover, the women's health volunteers were involved in the design of the study.
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| 3. |
- Pakpour, Amir H., et al.
(författare)
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Large-scale dataset on health literacy, sleep hygiene behaviors, and mental well-being in the general population of Qazvin, Iran
- 2023
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Ingår i: Data in Brief. - : Elsevier. - 2352-3409. ; 48
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Tidskriftsartikel (refereegranskat)abstract
- The collected data included socio-demographic information and measurements of health literacy, e-health literacy, men-tal well-being, and sleep hygiene behaviors. The study aimed to provide insights regarding health literacy status and re-lated factors in the general population residing in Qazvin province, Iran. The findings of the study will assist health au-thorities and policy makers in developing and implementing effective interventions, which in turn, improving health lit-eracy in the community. Additionally, the findings can also aid health sector workers, including non-communicable dis-ease researchers, public health experts, health education spe-cialists, epidemiologists, and sociologists, in their work to improve health literacy and overall health outcomes among general population. Therefore, the present study used paper-pencil method with multi-stage cluster sampling to collect data. Trained research associates (n = 25) collected data from9775 people living in Qazvin province between January and April 2022. All the participants completed the study ques-tionnaires using self-reported paper-pencil mode.
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| 4. |
- Feigin, Valery L., et al.
(författare)
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Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016
- 2019
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Ingår i: Lancet Neurology. - : Elsevier. - 1474-4422 .- 1474-4465. ; 18:5, s. 459-480
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Tidskriftsartikel (refereegranskat)abstract
- Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders.Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach.Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable).Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies.Funding: Bill & Melinda Gates Foundation.
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| 5. |
- Lozano, Rafael, et al.
(författare)
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Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 392:10159, s. 2091-2138
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Tidskriftsartikel (refereegranskat)abstract
- Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.
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| 6. |
- Stanaway, Jeffrey D., et al.
(författare)
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Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017
- 2018
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Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1923-1994
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Tidskriftsartikel (refereegranskat)abstract
- Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk- outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.
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| 7. |
- Yahaghi, Rafat, et al.
(författare)
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Fear of covid-19 and perceived covid-19 infectability supplement theory of planned behavior to explain iranians’ intention to get covid-19 vaccinated
- 2021
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Ingår i: Vaccines. - : MDPI. - 2076-393X. ; 9:7
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Tidskriftsartikel (refereegranskat)abstract
- One of the most efficient methods to control the high infection rate of the coronavirus disease 2019 (COVID-19) is to have a high coverage of COVID-19 vaccination worldwide. Therefore, it is important to understand individuals’ intention to get COVID-19 vaccinated. The present study applied the Theory of Planned Behavior (TPB) to explain the intention to get COVID-19 vaccinated among a representative sample in Qazvin, Iran. The TPB uses psychological constructs of attitude, subjective norm, and perceived behavioral control to explain an individual’s intention to perform a behavior. Fear and perceived infectability were additionally incorporated into the TPB to explain the intention to get COVID-19 vaccinated. Utilizing multistage stratified cluster sampling, 10,843 participants (4092 males; 37.7%) with a mean age of 35.54 years (SD = 12.00) completed a survey. The survey assessed TPB constructs (including attitude, subjective norm, perceived behavioral control, and intention related to COVID-19 vaccination) together with fear of COVID-19 and perceived COVID-19 infectability. Structural equation modeling (SEM) was performed to examine whether fear of COVID-19, perceived infectability, and the TPB constructs explained individuals’ intention to get COVID-19 vaccinated. The SEM demonstrated satisfactory fit (comparative fit index = 0.970; Tucker-Lewis index = 0.962; root mean square error of approximation = 0.040; standardized root mean square residual = 0.050). Moreover, perceived behavioral control, subjective norm, attitude, and perceived COVID-19 infectability significantly explained individuals’ intention to get COVID-19 vaccinated. Perceived COVID-19 infectability and TPB constructs were all significant mediators in the relationship between fear of COVID-19 and intention to get COVID-19 vaccinated. Incorporating fear of COVID-19 and perceived COVID-19 infectability effectively into the TPB explained Iranians’ intention to get COVID-19 vaccinated. Therefore, Iranians who have a strong belief in Muslim religion may improve their intention to get COVID-19 vaccinated via these constructs.
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