@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2019;11(1):41-47

Background
Spinal cord injuries are one of the negative consequences of the war affecting a large number of soldiers [1]. ... [2]. Disability due to spinal cord injuries should be highly considered, because it can result in several complications in various systems of the body, and these complications are often extensively affect the quality of life of the injured individuals in different aspects [3].
Previous Studies
... [4-9]. For many veterans with spinal cord injuries, mobility, distance and time limitations are great concerns to visit the doctor. Accordingly, limited access or lack of access to health services is sometimes a worse fact that can affect the poor adherence of the therapeutic regimen [10]. Studies available indicate that patients have difficulty to adherence to their therapeutic regimens [11]. The statistics indicate that between 30-40% of patients with chronic diseases do not adhere to their therapeutic regimen [12]. ... [13-15]. self-efficacy has been suggested as one of the important factors in chronic diseases which is associated with is the improvement of quality of life, adherence to therapeutic regimen and health behaviors [16]. ... [17-21]. The beneficial and effective effects of self-efficacy on the rehabilitation of spinal cord injury patients in weight loss, empowerment following an stroke, and stuttering have been proven [22]. Craig et al. reported a significant relationship between low self-efficacy with depression, anxiety and poor outcome of rehabilitation in spinal cord injury patients [22]. It has been shown that people with high self-efficacy are more powerful in difficult situations facing with problems and self-efficacy is an important indicator in determining overall performance, health and life satisfaction [23]. In patients with spinal cord injury, high self-efficacy predicts functional independence, social support, forward movement behaviors, mental health, and the increased sense of well-being [24, 25]. ... [26, 18].
Aim(s)
This study aimed at determining the correlation between self-efficacy and adherence to therapeutic regimen in veterans with spinal cord injury in Khatam al-anbia Hospital, Tehran.
Research type
This research is a descriptive-correlational study.
Research society, place and time
This study was conducted on all veterans with paraplegic spinal cord injury referring to the Khatam al-anbia Hospital, Tehran in the second half of 2017 (October to the end of the February for 5 months).
Sampling method and number
Using Cochran's formula, 250 patients who referred to the spinal cord injury ward and neuropsychiatric clinics of the Khatam al-anbia Hospital who were willing to participate in the study were included.
Used devices&materials
Data was collected using demographic questionnaire, Adherence to Therapeutic Regimen questionnaire by Modanloo, and Moorong’s self-efficacy scale (MSES). The essential permission was obtained from the Deputy of the Shafa Neuroscience Research Center, Khatam al-anbia Hospital and the informed consent was received from patients and the questionnaires then were completed by the subjects. The ethical observations were considered; the informed consent was obtained from all patients and they were informed that they can avoid writing their names, they are free to enter the study and their participation has no effect on the treatment process. The researcher accompanied the participants while answering the questionnaires and responded to the possible questions. SPSS 19 software was used for data analysis. Descriptive statistics (frequency, frequency percentage, mean and standard deviation) were used to assess the scores of self-efficacy and adherence to therapeutic regimen variables. Inferential statistics were used for analyzing the results. The Kolmogorov-Smirnov test was used to determine the normal distribution of the data, and parametric tests were applied, since the distribution of the data was normal (p>0.05). Pearson correlation coefficient and multiple regression analysis were used to measure the correlation between two variables.
Findings by Text
The mean age of the patients was 51.28±7.83 years (46-60 years) and the mean age of the suffering from disease was 26.48±6.72 years. Most of the participants were male and married and had diploma education. They had more injury in chest area and they were generally retired (Table 1). There was a positive and significant correlation between the total mean scores of adherence to therapeutic regimen and self-efficacy (p=0.017; r=0.357; Table 2).In the presented model, self-efficacy explained 4.3% of the variance of the adherence to therapeutic regimen in veterans (β=0.666) (Tables 3 and 4).
Main comparison to the similar studies
Patients with spinal cord injuries from the Khatam al-anbia Hospital had a moderate level of adherence to therapeutic regimen, which is consistent with Iranian and international studies on patients with chronic diseases. Masror Roudsari et al. study showed that about 80% of patients had a relatively favorable adherence to therapeutic regimen. Gholamaliei et al. reported a moderate level of adherence to therapeutic regimen in type 2 diabetic patients. Shahinzadeh et al. reported a moderate level of adherence to therapeutic regimen in patients with tuberculosis in Ahvaz [6, 33, 34]. Al-Noumani et al. in a pilot study on patients with hypertension showed a moderate level of adherence to therapeutic regimen in patients [35]. ... [36, 37]. Patients with spinal cord injury had a low level of self-efficacy, which is consistent with some Iranian and international studies. Middleton et al. in a study entitled “Relationship between quality of life and self-efficacy in persons with spinal cord injuries” reported a low level of self-efficacy in these patients [21]. Heidari et al. in their study showed that the subjects had low self-efficacy [38]. Esmaeil et al., in a similar study, concluded that patients with higher self-efficacy had higher levels of adherence to therapeutic regimen [39]. Afkhami Ardakani et al. indicated that interventions to increase self-efficacy and modification in diabetic patients’ lifestyle can help in adherence to therapeutic regimen and better control of blood glucose levels in these patients [40]. ... [41, 42]. Martos-Méndez study in Spain showed that there is a significant relationship between self-efficacy and adherence to therapeutic regimen and those with low self-efficacy have low level of adherence to therapeutic regimen [43]. Huang et al., in a study on HIV-infected patients concluded that self-efficacy is predictive of adherence to therapeutic regimen and both factors can predict the quality of life in these patients [44]. ... [45].
Suggestions
A study on patients with quadriplegia is also suggested. It is also suggested to use a specific tool for an accurate study and generalization of data, as well.
Limitations
The type of spinal cord injury limited to the paraplegic spinal cord injury can be considered as one of the limitations that this study and the results can not be generalized to patients with quadriplegia. The used scale for adherence to therapeutic regimen is another limitation of this research that is commonly designed for all patients with chronic diseases.
Conclusions
The self-efficacy of patients with spinal cord injury is directly and significantly correlated with their adherence to therapeutic regimen. It means that by increasing self-efficacy in these patients, their adherence to the prescribed therapeutic regimen is higher.
Acknowledgments
This study is extracted from a research (ID: 596), which was approved in 2017-07-05 by the Shafa Neuroscience Research Center, Khatam al-anbia Hospital, Tehran and was done in the Khatam al-anbia Hospital. The authors are thankful to the research center and the sincere cooperation of the hospital director and the honorable director of nursing and patients that this research could not be done without their cooperation.
Conflict of interest
None declared.
Ethical Permissions
None declared.
Funding Sources
Half of the cost of this research was supported by the Shafa Neuroscience Research Center.

TABLES and CHARTS

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