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Deek H, Türkoğlu N, Massouh AR, Kavuran E. Psychometric evaluation of the Arabic version of the heart failure-specific health literacy scale in a socio-politically challenged setting. J Adv Nurs 2024. [PMID: 39180745 DOI: 10.1111/jan.16386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/01/2024] [Accepted: 07/31/2024] [Indexed: 08/26/2024]
Abstract
INTRODUCTION Low levels of formal education among Lebanese people with HF were reported. Additionally, limited discharge education is provided to this population. Therefore, it was necessary to evaluate the health literacy levels among this population following the translation of the heart failure-specific health literacy scale into Arabic and to evaluate its psychometric properties in the Lebanese setting. METHODS A cross-sectional design conducted on participants from the community with confirmed cases of heart failure. A research team was trained for data collection. Following securing participants' consents, baseline sociodemographic characteristics and the Arabic version of the heart failure-specific health literacy scale were administered. Data collection took place between June and December 2022. A pilot sample analysis was done to confirm homogeneity between the English and the Arabic versions. Exploratory and confirmatory factor analysis were performed to evaluate content and construct validity of the scale. Cronbach alpha was done to evaluate reliability. RESULTS The pilot analysis confirmed homogeneity of the items of the Arabic and English versions of the scale. The final sample of 343 participants was randomly divided to two parts for each of the exploratory factor analysis and confirmatory factor analysis. The mean age was 64 years with the majority being male participants. In terms of exploratory factor analysis, the three subscales of the literacy scale explained 60% of the variance. The best acceptable fit was found on 11 items of the scale after dropping the 10th item from the analysis. The Cronbach alpha of the scale was 0.68. CONCLUSION The Arabic version of the heart failure-specific health literacy scale was evaluated to be a valid and reliable tool. Further analysis should be done on the dropped item, and correlations should be done with significant variables such as self-care. REPORTING METHOD STROBE checklist. PATIENT/PUBLIC CONTRIBUTION No patient/public contribution. CONTRIBUTION TO THE WIDER GLOBAL COMMUNITY Participants with heart failure were shown to have low levels of literacy in Lebanon. Additionally, low literacy levels are also common among Lebanese older adults living in high income, Western Countries. Therefore, this valid and reliable scale can be used to evaluate health literacy among people with heart failure in Lebanon and among Lebanese and other Arabic-speaking older adults globally.
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Affiliation(s)
- Hiba Deek
- Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Nihan Türkoğlu
- Department of Public Health Nursing, Nursing Faculty, Ataturk University, Erzurum, Turkey
| | - Angela R Massouh
- Adult and Critical Care Nursing, Undergraduate Division, Research, Education, and Innovation, Cardiology and Heart Failure, Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Esin Kavuran
- Department of Nursing Fundamentals, Nursing Faculty, Ataturk University, Erzurum, Turkey
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Ramadan A, Aboeldahab H, Bashir MN, Belal MM, Wageeh A, Atia A, Elbanna M, Alhejazi TJ, Abouzid M, Atef H, Khalid E, Elaziz OAA, Eldeeb MI, Kamel Omar DO, Refaey N, Setouhi A, Ak M. Evaluating knowledge, attitude, and physical activity levels related to cardiovascular disease in Egyptian adults with and without cardiovascular disease: a community-based cross-sectional study. BMC Public Health 2024; 24:1107. [PMID: 38649883 PMCID: PMC11036560 DOI: 10.1186/s12889-024-18553-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) represents a significant health challenge in Egypt, yet there exists limited understanding regarding the knowledge, attitudes, and physical activity levels associated with CVD. These factors play a pivotal role in developing effective prevention and management strategies. Hence, this cross-sectional study aimed to evaluate Egyptian adults' knowledge, attitudes, and physical activity (KAP) levels. METHODS Data were collected using a previously validated questionnaire encompassing demographic characteristics, CVD knowledge (including risk factors and symptoms), attitudes toward CVD, and self-reported physical activity levels. The survey was distributed among social media channels, and trained researchers administered the questionnaire via face-to-face interviews with adult patients with and without CVD admitted to Cairo University Hospital clinics. RESULTS The study involved 591 participants, of whom 21.7% had CVD. Overall, participants exhibited poor knowledge regarding CVD, with a mean score of 21 ± 7 out of 40, equivalent to 52.5%. Attitudes toward CVD were moderate, with a mean score of 66.38 ± 8.7 out of 85, approximately 78%. Physical activity levels per week were also moderate, averaging 1188 MET-min with a range of 1121-18,761. Subgroup analysis revealed that individuals with CVD had lower average knowledge, attitude, and physical activity levels than those without CVD. Working in the healthcare field was a predictor of higher knowledge score (standard error (SE) 5.89, 95% confidence interval (CI) 4.61 to 7.17, P < 0.001), while those with CVD and smokers were predictors of lower attitude score (SE -4.08, 95% CI -6.43 to -1.73, P < 0.001) and (SE -2.54, 95% CI -4.69 to -0.40, P = 0.02), respectively. CONCLUSION The study findings highlight a significant disparity in knowledge, attitudes, and physical activity levels related to CVD in Egypt. Targeted interventions aimed at improving awareness, fostering positive attitudes, and promoting physical activity among individuals at risk for CVD are crucial for effective prevention and management.
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Affiliation(s)
- Alaa Ramadan
- Faculty of Medicine, South Valley University, Qena, Egypt
| | - Heba Aboeldahab
- Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | | | | | - Ahmed Wageeh
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Atia
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, Poznan, Poland
| | - Hady Atef
- School of Allied Health Professions, Keele University, Staffordshire, UK
- Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Esraa Khalid
- Faculty of Medicine, Misr University of Sciences and Technology, Cairo, Egypt
| | | | | | - Doha Omar Kamel Omar
- Faculty of Medicine, Cairo University, Cairo, Egypt
- Cornwall Partnership NHS Foundation Trust, Bodmin, UK
| | - Neveen Refaey
- Department of Women's Health, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Amr Setouhi
- Cardiovascular Medicine, Minia University, Minya, Egypt
| | - Mohammed Ak
- Internal Medicine, Faculty of Medicine, Qena University Hospital, Qena, Egypt
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Gebara N, Abdel-Massih T, Sahakian JP, Sleilaty G, Bazzi M, Ashoush R, Jebara V, Habib J. Unconventional Cardiovascular Risk Factors and Systematic Coronary Risk Estimation (SCORE) in the Lebanese Rural Population: The Forgotten Factors. Vasc Health Risk Manag 2023; 19:507-517. [PMID: 37575670 PMCID: PMC10416781 DOI: 10.2147/vhrm.s411864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose To evaluate the correlation between unconventional risk factors and the Systematic Coronary Risk Estimation (SCORE), and estimate the prevalence of conventional and unconventional cardiovascular (CV) risk factors in the rural Lebanese population in order to assess their CV risk. Methods This is a retrospective descriptive study conducted between November 2017 and June 2019 among the Lebanese rural population. The risk factors were analyzed from the files of the patients who presented for the CV disease screening days organized by a non governmental organization. The CV risk estimation tool is the SCORE. The classification of socio-economic level ranges from zero (low level) to 3 (high level). Results A total of 433 patients were included. The prevalence of hypertension, diabetes, dyslipidemia, smoking, and metabolic syndrome was 45.1%, 31.2%, 39.2%, 50% and 42.9% respectively. Only 13.6% of hypertensive patients and 6.7% of diabetics were controlled. A total of 0 or 1 point for the classification of socio-economic status was found in 62.6% of cases. A family history of CV diseases was present in 87.3% of participants. The SCORE was correlated with diabetes and metabolic syndrome (p = 0.000), without being correlated to socio-economic status (HR = -0.104; p = 0.059) or to family history (p = 0.834). Conclusion The socio-economic status and the family history of CV disease must be evaluated in addition to the classical risk calculation of the SCORE to better pinpoint the actual risk of the targeted population. The risk factors are prevalent but poorly controlled, hence the need for a national effort to ensure better care for the rural Lebanese population.
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Affiliation(s)
- Nicole Gebara
- Department of Family Medicine, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Tony Abdel-Massih
- Department of Cardiology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jean-Paul Sahakian
- Department of Cardiology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ghassan Sleilaty
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Mariam Bazzi
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ramzi Ashoush
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Victor Jebara
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jad Habib
- Department of Family Medicine, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Farah R, Groot W, Pavlova M. Knowledge, attitudes and practices survey of cardiac rehabilitation among cardiologists and cardiac surgeons in Lebanon. Egypt Heart J 2021; 73:87. [PMID: 34648092 PMCID: PMC8517050 DOI: 10.1186/s43044-021-00212-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background Cardiovascular diseases (CVDs) are among the leading causes of morbidity and mortality worldwide. Over three quarters of the cardiovascular deaths take place in low and middle-income countries. Despite the benefits, Cardiac Rehabilitation (CR) is still not routinely and not universally available. Numerous studies have found that barriers to access to CR are correlated with providers, patients and environment characteristics. This first national survey on CR in Lebanon assesses the knowledge, attitudes and practices among physicians. In addition, the study identifies what the main barriers to access to CR are and provides suggestions for the implementation of CR in the country. Results The response rate was 41.5% (n = 83). Results show that the cardiologists have medium level of knowledge about CR and its multidisciplinary content. Physicians support the implementation of a comprehensive CR program in the country. 50% of the physicians recommended first to solve the financial issues before implementing a CR program. Supplementary learning about the benefits of CR is highly recommended to enroll more patients with CVD into CR. In addition, the lack of specialists in the field, lack of motivation for patients to enroll to CR and inconvenient location of the rehabilitation centers were identified as major barriers by the respondents. Conclusions The role of physicians in promoting patient enrolment should be optimized and exploited in the country. The access barriers identified can help to develop CR programs and to improve CR referral and enrolment rates. Funds from private parties and a budget from the government are needed to launch new CR programs in the country. Further research is needed to provide evidence on the CR benefits in Lebanon and to motivate policy-makers to place priority on the establishment of a comprehensive CR program in the country. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-021-00212-2.
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Affiliation(s)
- Rebecca Farah
- Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center; Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. .,Department of Rehabilitation and Physical Therapy (Group A); Delta-Chirec Hospitals Group, Brussels, Belgium.
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center; Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center; Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Alhadrami HA, Syed RUR, Zahid AA, Ahmed R, Hasan S, Hasan A. Structure and Rheological Properties of Bovine Aortic Heart Valve and Pericardium Tissue: Implications in Bioprosthetic and Tissue-Engineered Heart Valves. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:3290370. [PMID: 31976052 PMCID: PMC6949733 DOI: 10.1155/2019/3290370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/09/2019] [Accepted: 11/29/2019] [Indexed: 11/18/2022]
Abstract
Heart valve (HV) diseases are among the leading causes of cardiac failure and deaths. Of the various HV diseases, damaged HV leaflets are among the primary culprits. In many cases, impaired HV restoration is not always possible, and the replacement of valves becomes necessary. Bioprosthetic HVs have been used for the replacement of the diseased valves, which is obtained from the sources of bovine and porcine origin, while tissue-engineered heart valves (TEHV) have emerged as a promising future solution. The bioprosthetic valves are prone to become calcified, and thus they last for only ten to fifteen years. The adequate understanding of the correlations between the biomechanics and rheological properties of native HV tissues can enable us to improve the durability of the bioprosthetic HV as well as help in the development of tissue-engineered heart valves (TEHV). In this study, the structural and rheological properties of native bovine aortic HV and pericardium tissues were investigated. The microstructures of the tissues were investigated using scanning electron microscopy, while the rheological properties were studied using oscillatory shear measurement and creep test. The reported results provide significant insights into the correlations between the microstructure and viscoelastic properties of the bovine aortic HV and pericardium tissues.
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Affiliation(s)
- Hani A. Alhadrami
- Faculty of Applied Medical Sciences, Department of Medical Laboratory Technology, King Abdulaziz University, P.O. Box 80402, Jeddah 21589, Saudi Arabia
- King Fahd Medical Research Centre, King Abdulaziz University, P.O. Box 80402, Jeddah 21589, Saudi Arabia
| | - Raza ur Rehman Syed
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
| | - Alap Ali Zahid
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
| | - Rashid Ahmed
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
| | - Shajia Hasan
- College of Medicine, Qatar University, 2713 Doha, Qatar
| | - Anwarul Hasan
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
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Abdel Rida N, Mohamed Ibrahim MI, Babar ZUD. Relationship between pharmaceutical pricing strategies with price, availability, and affordability of cardiovascular disease medicines: surveys in Qatar and Lebanon. BMC Health Serv Res 2019; 19:973. [PMID: 31852546 PMCID: PMC6921405 DOI: 10.1186/s12913-019-4828-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 12/10/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death in Lebanon and Qatar. When lifestyle modifications prove insufficient, medication becomes a cornerstone in controlling such diseases and saving lives. Price, availability, and affordability hinder the equitable access to medicines. The study aimed to assess prices, availability, and affordability of essential cardiovascular disease medicines in relation to pricing strategies in Qatar and Lebanon. METHODS A cross-sectional survey using a variant of the World Health Organization and Health Action International (WHO/HAI) methodology as outlined in "Measuring medicine prices, availability, affordability and price components" (2008), second edition, was adopted. Prices and availability of 27 cardiovascular medicines were collected from public and private dispensing outlets. For international comparison, prices were adjusted to purchasing power parity. Data was analyzed across multiple sectors, within and across countries. RESULTS A total of 15 public and private outlets were surveyed in each country. Prices were more uniform in Qatar than in Lebanon. In the public sector, medicines were free-of-charge in Lebanon and priced lower than the international reference prices in Qatar. The ratio of medicine unit price to international reference price in the private sectors surveyed are significantly higher than the acceptable threshold of 4. This ratio of originator brands and lowest priced generics in Qatar were up to two and five times those in Lebanon, respectively, even after adjusting for purchasing power parity. However, prices of lowest priced generics in the private sector were at least 35% cheaper in Qatar and 65% cheaper in Lebanon than their comparative originator brands. Medicines were more available in the private sector in Lebanon than in Qatar, but only the originator brand availability in the public sector in Qatar exceeded the WHO target of more than 80%. While affordable in the public sector in Qatar, four out of thirteen medicines exceeded the threshold in all private sectors covered. Hence, only the public sector in Qatar had a satisfying level of availability and affordability. CONCLUSIONS Except for the Qatari public sector, medicine prices, availability, and affordability are falling short from targets. Key policy decisions should be implemented to improve access to medicines.
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Affiliation(s)
- N. Abdel Rida
- College of Pharmacy, Qatar University, PO BOX 2713, Doha, Qatar
| | | | - Z. U. D. Babar
- Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH UK
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An evaluation of involving family caregivers in the self-care of heart failure patients on hospital readmission: Randomised controlled trial (the FAMILY study). Int J Nurs Stud 2017; 75:101-111. [PMID: 28772186 DOI: 10.1016/j.ijnurstu.2017.07.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The prevalence of heart failure is increasing in Lebanon but to date there is no systematic evaluation of a disease management intervention. OBJECTIVE The aim of this study was to evaluate the effect of involving family caregivers in the self-care of patients with heart failure on the risk of hospital readmission. DESIGN A multi-site, block randomised controlled trial. SETTINGS The study was conducted over a 13-month period in three tertiary medical centres in Beirut and Mount Lebanon, Lebanon. PARTICIPANTS Adult patients presenting for an exacerbation of heart failure to one of the study centres were included. Patients with limited life expectancy or physical functionality, planned cardiac bypass or valve replacement surgery, living alone or in nursing homes, or aged less than 18 years were excluded. METHODS Patients allocated to the intervention group and their family caregivers were provided with a comprehensive, culturally appropriate, educational session on self-care maintenance and symptom management along with self-care resources. The usual care group received the self-care resources only. Follow-up phone calls were conducted 30days following discharge by a research assistant blinded to treatment assignment. The primary outcome was hospital readmission and the secondary outcomes were self-care, quality of life, major vascular events and healthcare utilization. RESULTS The final sample included 256 patients hospitalized for heart failure randomised into control (130 patients) and intervention (126 patients) groups. The mean age was 67 (SD=8)years, and the majority (55%) were male. Readmission at 30days was significantly lower in the intervention group compared to the control group (n=10, 9% vs. n=20, 19% respectively, OR=0.40, 95% CI=0.02, 0.10, p=0.02). Self-care scores improved in both groups at 30days, with a significantly larger improvement in the intervention group than the control group in the maintenance and confidence sub-scales, but not in the self-care management sub-scale. No differences were seen in quality of life scores or emergency department presentations between the groups. More patients in the control group than in the intervention group visited health care facilities (n=24, 23% vs. n=12, 11% respectively, OR=0.39, 95% CI=0.18, 0.83, p=0.01). CONCLUSION The trial results confirmed the potential of the family-centred self-care educational intervention under evaluation to reduce the risk of readmission in Lebanese patients suffering from exacerbated heart failure. Further research is needed to validate these findings with longer periods of follow-up and to identify the intervention components and intensity required to induce sustained benefits on patients' self-care management and quality of life.
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Zhang J, Huang H, Ju R, Chen K, Li S, Wang W, Yan Y. In vivo biocompatibility and hemocompatibility of a polytetrafluoroethylene small diameter vascular graft modified with sulfonated silk fibroin. Am J Surg 2017; 213:87-93. [DOI: 10.1016/j.amjsurg.2016.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 03/30/2016] [Accepted: 04/04/2016] [Indexed: 10/20/2022]
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Deek H, Noureddine S, Newton PJ, Inglis SC, MacDonald PS, Davidson PM. A family-focused intervention for heart failure self-care: conceptual underpinnings of a culturally appropriate intervention. J Adv Nurs 2015; 72:434-50. [PMID: 26365459 DOI: 10.1111/jan.12768] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 12/22/2022]
Abstract
AIM A discussion of the conceptual elements of an intervention tailored to the needs of Lebanese families. BACKGROUND The role of informal caregiving is strongly recommended for individuals with chronic conditions including heart failure. Although this importance is recognized, conceptual and theoretical underpinnings are not well elucidated nor are methods of intervention implementation. DESIGN Discussion paper on the conceptual underpinning of the FAMILY model. METHODS AND DATA SOURCES This intervention was undertaken using linked methods: (1) Appraisal of theoretical model; (2) review of systematic reviews on educational interventions promoting self-management in chronic conditions in four databases with no year limit; (3) socio-cultural context identification from selected papers; (4) expert consultation using consensus methods; and (5) model development. RESULTS Theories on self-care and behavioural change, eighteen systematic reviews on educational interventions and selected papers identifying sociocultural elements along with expert opinion were used to guide the development of The FAMILY Intervention Heart Failure Model. Theory and practice driven concepts identified include: behavioural change, linkage, partnership and self-regulation. IMPLICATIONS FOR NURSING Heart failure is a common condition often requiring in-hospital and home-based care. Educational interventions targeting the socio-cultural influences of the patients and their family caregivers through a structured and well-designed program can improve outcomes. CONCLUSION As the burden of chronic diseases increases globally, particularly in emerging economies, developing models of intervention that are appropriate to both the individual and the socio-cultural context are necessary.
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Affiliation(s)
- Hiba Deek
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Australia
| | - Samar Noureddine
- Rafic Hariri School of Nursing, American University of Beirut, Lebanon
| | - Phillip J Newton
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Australia
| | - Sally C Inglis
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Australia
| | - Peter S MacDonald
- Transplantation Research Laboratory at the Victor Chang Institute, St Vincent Hospital, Darlinghurst, Australia
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