تاثیر آموزش همتا بر اضطراب بیماران مبتلا به تالاسمی ماژور: یک مطالعه نیمه تجربی

زمینه و هدف: تالاسمی ماژور یکی از شایع‌ترین بیماری‌های ژنتیکی و مزمن در عصر حاضر است. مبتلایان به بیماری‌های مزمن نظیر تالاسمی ناگزیرند در تمام طول زندگی خود تحت درمان مداوم پزشکی قرار داشته باشند و ادامه زندگی آنها به این درمان‌ها وابسته است. این پروتکل درمانی باعث تاثیر بر جنبه‌های مختلف زندگی این بیماران می‌گردد و می‌تواند باعث بروز اضطراب در این بیماران شود. بر این اساس، هدف تحقیق حاضر، تعیین تاثیر آموزش همتا بر اضطراب بیماران مبتلا به تالاسمی ماژور بوده است.روش بررسی: پژوهش حاضر یک مطالعه نیمه تجربی و تک گروهی است که در نیمه اول سال 1399در بیمارستان امام خمینی زابل انجام گرفت. مشارکت کنندگان به تعداد50 نفر و به روش نمونه‌گیری مستمر از بین افراد مبتلا به تالاسمی ماژور انتخاب شدند. اطلاعات از طریق فرم اطلاعات جمعیت شناختی و مقیاس سنجش اضطراب بک (bai: beck anxiety inventory) جمع آوری گردید. مطالعه در ابتدا با انتخاب دو نفر از همتایان واجد شرایط آغاز گردید. پس از انتخاب و آموزش همتایان، ابتدا پیش آزمون از شرکت کنندگان گرفته شد. و سپس برنامه آموزش کنترل اضطراب به شرکت کنندگان ارائه شد. این برنامه آموزشی با تاکید بر تجربه همتایان طی دو جلسه 60 دقیقه‌ای به فاصله یک ساعت در یک روز انجام شد. یک ماه پس از اتمام مداخله، از شرکت کنندگان در مطالعه، پس آزمون گرفته شد. تحلیل داده‌ها نیز با بهره‌گیری از نرم افزار spss نسخه 16 و با استفاده از آمار توصیفی (میانگین و انحراف معیار) و استنباطی (آزمون تی زوجی) انجام یافت.یافته‌ها: میانگین سنی افراد شرکت کننده در این مطالعه24/4 ± 5/24 سال بود. در مرحله پیش آزمون، میانگین نمره اضطراب افراد، 63/11 ± 73/17بود. در مرحله پس آزمون، این میانگین نمره به کاهش 32/11 ± 07/17 یافت. آزمون تی زوجی نشان داد که نمره اضطراب افراد مبتلا به تالاسمی ماژور در مراحل پیش آزمون و پس آزمون با هم اختلاف آماری معنی‌داری نداشته است (434/0 p=و 788/0t=).نتیجه‌گیری کلی: بر اساس نتایج حاصل اجرای برنامه آموزش همتا نتواسته تاثیر مثبتی بر اضطراب بیماران مبتلا به تالاسمی ماژور بگذارد. پیشنهاد می‌شود در مطالعات آتی تاثیر سایر مداخلات کاهنده اضطراب مانند آرام سازی عضلانی و موسیقی درمانی در کنار آموزش مورد بررسی قرار گیرد و در مطالعات آتی سایر ابزار های سنجش مورد استفاده قرار گرفته و گروه کنترل جهت تعیین تاثیر مداخلات بر اضطراب در این گروه بیماران لحاظ شود.

The Effect of Peer Education on the Anxiety of Patients with Thalassemia Major: A Quasi-experimental Study

Background Aims: Thalassemia major (TM) is one of the most common chronic genetic disorders in today rsquo;s world. The number of patients with thalassemia in the world is estimated at 240 million and is reported in 60 countries. Iran is located in the thalassemia belt and has about 26,000 patients with thalassemia major. Patients with chronic diseases such as thalassemia have to undergo continuous medical treatment throughout their lives and their survival depends on these treatments. The treatment protocol affects different aspects of these patients #39; lives and can make them anxious. Therefore, any measures taken to reduce the anxiety of these patients are very important. Educational intervention can be a method for improving the quality of life in patients with chronic diseases. Nowadays, the educational methods that engage learners in their learning process have acquired attention. One of the methods to educate patients is peer education which has been effective in promoting their health status. In this educational approach, patients share their experiences about their common disease. Having worked in the thalassemia ward, the researcher realized the importance of peer education as a scientific and codified method for efficient education of these patients. Moreover, considering the clinical observation of psychological problems in patients with thalassemia major and also the lack of continuous and reliable research in this field, the present study aimed to evaluate the effect of peer education on the anxiety experienced by patients with thalassemia major.Materials Methods: This onegroup, quasiexperimental study was conducted at Imam Khomeini Hospital in Zabol between March and July 2020 on 50 participants, who were selected via continuous sampling from the patients with the thalassemia major based on the inclusion and exclusion criteria of the study. Data were collected using a demographic questionnaire exploring participants #39; age, sex, residency, occupation, level of education, economic status, parents rsquo; familial relationship, the frequency of blood transfusions per month, another family member with the same disease, the type of ironchelating agent, regular drug consumption, and history of other diseases. In addition, the valid and reliable Beck Anxiety Inventory (BAI) was used to measure anxiety. The study began with the selection of eligible peers educators based on inclusion criteria. Finally, 2 patients with thalassemia major (a man and a woman) who obtained higher scores were selected as peer educators, who were then trained by the researcher in 3 sixtyminute educational sessions within one week. The educational content included explanations about research objectives, the importance and benefits of peer education, educational concepts, communication skills including attention to verbal and nonverbal behaviors, active listening skills, and anxiety control concepts. The educational content was taught through an interactive lecture using audiovisual aids, and question and answer. Based on the training given by the researcher and the experiences expressed by the peer educators, their final evaluation was conducted through a roleplay. After training the peer educators, the pretest was conducted. Afterwards, an anxiety management training program was presented to the participants with thalassemia major which included the definition of anxiety, its symptoms and its role in exacerbating the disease, strategies to reduce and control anxiety, revision of beliefs, and negative and anxious attitudes. The training program, with emphasis on the peer educators rsquo; experiences, was conducted over two 60minute sessions in two consecutive hours. Participants were placed in groups of 6 to 7 patients. Each group was trained separately by a peer in a training class in the thalassemia ward. After the training sessions, the educational booklet was given to all participants of the study. One month after the intervention, the participants took the posttest. The present research was approved by the Ethics Committee of Iran University of Medical Sciences. The researcher adhered to the ethical policies such as obtaining informed consent from the participants and their voluntary participation. Data analysis was performed in SPSS version 16 using descriptive statistics (mean and standard deviation) and inferential statistics (pairedsample ttest).Results: The mean age of the participants was 24.5 ± 4.24 years. In this study, most participants were women, had a diploma, and were unemployed. Moreover, the parents of most of the patients had familial relationships. The mean score of anxiety was 17.73 ± 11.63 in the pretest, which reduced to 17.07 ± 11.32 in the posttest. The results of paired ttest indicated no significant differences in the pretest and posttest scores of anxiety in the patients with the thalassemia major (t=0.788; P=0.434).Conclusion: According to the results, the peer education program did not have any positive effects on the anxiety level of the patients with thalassemia major. Considering the nature of educational interventions, these patients may benefit from concurrent anxietyreducing interventions such as relaxation exercises and music therapy. The findings also suggest that future researches use other assessment tools, broader educational content, and a control group to assess anxiety in patients with thalassemia major. Furthermore, it is recommended that researchers compare the effects of peer training with other anxiety management training methods used for these patients.