ARTICLE INFO

Article Type

Original Research

Authors

Zende Talab   H.R. (* )
Norouzi   H.M. (1 )






(* ) Health & Psyche Department, Nursing & Midwifery Faculty, Mashhad University of Medical Sciences, Mashhad, Iran
(1 ) Health & Psyche Department , Nursing & Midwifery Faculty, Mashhad University of Medical Sciences, Mashhad, Iran

Correspondence

Address: Psychological Health Department, Nursing & Midwifery Faculty, Mashhad University of medical Sciences, Doktori Junction, mashhad, Iran
Phone: +985118591511
Fax: +985118597313
zendehtalabhr@mums.ac.ir

Article History

Received:  September  16, 2013
Accepted:  May 15, 2014
ePublished:  July 1, 2014

BRIEF TEXT


… [2, 5, 6] Mental health, especially self-esteem, is hugely affected by changes caused by the diseases [7]. In chronic diseases, such as Multiple Sclerosis (MS), poor self-esteem badly affects emotions, thought, and interpersonal relationships of the patients, and only a few patients with MS have high self-esteem [1, 3].

Studies on patients with MS, which have been conducted in Iran, are mostly about the patients’ quality of life [1, 4, 8], and no study on effects of educational interventions on self-esteem of the patients was found.

The aim of this study was to investigate the effect of educational interventions on patients’ self-esteem with MS.

This is a quasi-experimental study with control group.

Patients with MS from Mashhad, Iran, were studied in 2012-13.

75 patients referred to MS Society of Mashhad were selected, using continuous sampling method. They were divided into experiment (37 persons) and control (38 persons) groups. Regarding confidence level 95% and according to sample size determining formula based on the mean values comparison [1], 35-person volume size was estimated for each group. The inclusion criteria were as the followings: Willingness to participate in the study; aged between 15 and 60years old; lettered; no disease acute phase; already non-hospitalized; no body disease corrupting the study (such as heart and brain strokes); no depression; no drug use.

Data were collected, using demographic information questionnaire, Rosenberg’s self-esteem questionnaire, and self-report checklist. The demographic information questionnaire included age, sex, educational level, occupation, marital status, the disease duration, frequency of hospitalization, family history, and another simultaneous disease. Validity of the questionnaire was evaluated as proper by 10 university teachers and experts. Rosenberg’s self-esteem scale includes 10 phrases (5 positives and 5 negatives), graded by 4-point Likert scale (from fully agree to completely disagree) ranging from zero to 30. The obtained numbers were divided into three groups, as follows [3]: Weak self-esteem (less than 17 scores); mean self-esteem (17 to 21 scores); good self-esteem (more than 21 scores) Both its internal reliability (out of Iran) and its test-retest correlation coefficient with 2 weeks interval were computed 0.84. Its reliability (in Iran) via Cronbach’s Alpha, test-retest correlation coefficient, and split-halves method was computed 0.69, 0.78, and 0.68, respectively [8]. To determine its reliability, 10 patients, no participated in the study, completed it with a 2-week interval; and the correlation coefficient was computed 0.81. Based on various aspects of self-esteem, the self-report checklist was designed, so that the participants could sign the issues which they could successfully perform during 4 weeks after training interventions. The scores from the checklist were not statistically analyzed. The results obtained from the tool showed every self-esteem issue successfully performed by the research units, compared to the issues less successfully performed by the units. Its validity was confirmed by 10 experts. To determine its reliability, 10 patients, no participated in the study, completed it with a 2-week interval; and the correlation coefficient was computed 0.84. All participants completed demographic information and Rosenberg’s self-esteem questionnaires. The designed training plan was presented to experiment group as 3 sessions of 45 minutes. The training interventions were done as lectures, group discussions, questions and answers, and slideshow. At the end of every session, the participants were provided by the presented issues as an educational booklet. The issues, presented at every session, were as the followings: Mental health importance; role of self-esteem and self-worth feeling in improving the quality of life in patients with MS; different aspects of self-esteem; the role of high self-esteem in daily life; ways to self-esteem enhancement; signs of low self-esteem; problems due to low self-esteem; needs for changes in lifestyle; the relatives’ roles in rehabilitation and the patients’ efficiency enhancement; role of self-care; the importance of following proper exercises; training the exercises reinforcing the pelvic floor muscles; time-regulation training for liquid consumption and excretion; learning how to use assistive devices; need for periodic examinations After training sessions and at performing stage, the subjects were asked to practice the presented issues for 4 weeks, signing every item, which they could successfully do, on the checklist. During these four weeks, the researches continued to contacted them, in order to follow performance of the plan and to advise about solving the problems. Finally, Rosenberg’s self-esteem questionnaire was completed by members of both groups. Data were analyzed, using SPSS 11.5 software, Paired-T test (for comparison between self-esteem values before and after intervention in each group), Independent-T test (for comparison between self-esteem values before and after intervention between two groups), and Chi Square test (to evaluate difference significance of demographic characteristics between two groups).

The subjects were 15 to 60 years old with 34.2±3.7years mean age. 47 subjects were female. 64% of the subjects were married. 70.7% of the subjects had diploma. Among 58.7% of the subjects, the disease history was less than 5 years. There was no significant difference in any demographic characteristics between experiment and control groups. There was significant difference between self-esteem and age, sex, educational level, occupation, marital status, the disease duration, frequency of hospitalization, and number of disease relapses. There was no significant difference between self-esteem numbers of control group (17.1±3.4) and experiment group (17.2±3.5) before intervention. Nevertheless, after intervention, there was significant increase in numbers of control group (16.8±2.9) and experiment group(25.4±3.1). There was no significant difference in self-esteem numbers of control group before and after intervention. However, in experiment group, this difference was significant.

The results show more self-esteem with higher educational level, while no relation between these items has been reported in another study [1]. The results of the present study show more self-esteem among unmarried persons than others do. However, the result is inconsistent with results of other studies [1]. … [9, 10] Only 12% of the subjects have been reported job loss due to MS, which is consistent with results of other studies [12, 13], except a study conducted in Spain and reporting job loss for 66% participants due to MS [11]. In general, studies, which have investigated the effects of a health promotion program [14] and a one-week program for self-esteem enhancement [15] on patients with MS, are consistent with the present study.

Training the methods for self-esteem enhancement ought to be included in self-care and rehabilitation programs for patients with MS, or perform as short-term programs.

Lack of MS intensity investigation (due to time constraints), increase in the subjects’ orientation probability (due to the used self-assessment tool), and restricted generalization power of the study findings (due to non-random selection of the samples) were of the limitations for the study.

There is relation between self-esteem and age, sex, educational level, occupation, marital status, the disease duration, frequency of hospitalization, and number of disease relapses. The training interventions are effective on self-esteem of patients with MS.

The researchers feel grateful to all the patients who participated in the study, personnel of Mashhad MS Society, and personnel of Shahid Mottahari Health Center.

Non-declared

All procedures were done, regarding all ethical codes for researches on human samples.

No organization funded the study.


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