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 Table of Contents  
Year : 2023  |  Volume : 14  |  Issue : 1  |  Page : 12

Comparison of the effect of the person-centered and family-centered training via telenursing on the quality of life in COVID-19 patients

1 Student Research Committee, Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences; Department of Research, School of Nursing, Bank Melli Iran, Tehran, Iran
2 Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Nursing, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
5 Department of Mathematics and Computer Science, Faculty of Statistics, Amirkabir University of Technology, Tehran, Iran

Date of Submission16-Dec-2021
Date of Acceptance15-Jun-2022
Date of Web Publication25-Jan-2023

Correspondence Address:
Meimanat Hosseini
Vali Asr Ave., Niayesh Cross Road, Niayesh Complex, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpvm.ijpvm_522_21

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Background: Education of the patients with Coronavirus Disease 2019 (COVID-19) and their families is necessary to improve the quality of life. This study investigated the effect of person and family-centered training via telenursing on the quality of life in patients with COVID-19. Methods: This interventional study was performed on 88 patients with COVID-19 18--65 years and 44 family members referred to the Bank Melli Hospital, Tehran, Iran. The samples were randomly assigned into two groups person-centered and family centered. A cyberspace group including patients and their families was created. Four educational sessions planned (15--30-min-every day) and three sessions planned for completing the questionnaires via phone. The data were collected using demographic characteristics form and the 12-item Short-Form Health Survey version 2 before and 6 weeks after the intervention and were analyzed in SPSS 22 using Chi-square test, paired t-test, and independent t-test. Results: The mean scores of quality-of-life increased significantly in the person-centered group from 26.81 ± 5.15 to 34.4 ± 4.39 before and six weeks after intervention, respectively (p < 0.001). The means scores of quality-of-life increased significantly in the family-centered group from 28.11 ± 4.79 to 35.86 ± 3.85 before and 6 weeks after the intervention, respectively. (p < 0.001). Conclusions: The person and family centered methods increase the mean scores of quality-of-life of patients with COVID-19. The family centered method can be more effective to improve the quality of life of these patients.

Keywords: COVID-19, family nursing, quality of life, telehealth

How to cite this article:
Heidari M, Hosseini M, Vasli P, Nasiri M, Hejazi S, Fasihi M. Comparison of the effect of the person-centered and family-centered training via telenursing on the quality of life in COVID-19 patients. Int J Prev Med 2023;14:12

How to cite this URL:
Heidari M, Hosseini M, Vasli P, Nasiri M, Hejazi S, Fasihi M. Comparison of the effect of the person-centered and family-centered training via telenursing on the quality of life in COVID-19 patients. Int J Prev Med [serial online] 2023 [cited 2023 Sep 21];14:12. Available from: https://www.ijpvmjournal.net/text.asp?2023/14/1/12/368550

  Introduction Top

Coronavirus is one of the main pathogens that primarily targets the human respiratory system.[1] Since the outbreak of this infectious disease in Asia (Wuhan, China) late 2019, the disease has occurred on every continent except for Antarctica.[2],[3] Given that until March 1, 2020, no vaccine has been available and successfully developed to prevent and reduce coronavirus 2019- (COVID-19) related injuries, the prevention, and control of infection, observance of hygienic principles by the general public, and restriction of travel are among the priorities. Educating people to observe all the principles of health and inducing and maintaining peace are also of significant importance to deal with this disease.[4],[5] The best way to deal with the COVID-19 epidemic is to control the sources of infection, early detection, reporting, isolation, and quarantine, as well as supportive and protective measures, including personal hygiene.[6] Quarantining people is effective in reducing the rate of disease transmission and preventing the peak outbreak of COVID-19. In general, telecommunications should also be aimed at establishing personal and professional communication in the community through virtual tools and technology, including devices, such as mobile phones.[7] Staying in quarantine and keeping a large population at home will not be without psychological, social, and economic effects. In addition, misinformation about the pandemic, travel bans, and quarantine orders affect people's mental health and quality of life.[8],[9] Clinical trials have shown that the quality of life can be considered a sign of the quality of health care and part of the disease treatment plan; moreover, its measurement in diseases can provide more information about the state of health and disease. It can also be a helpful guide to improve the quality of care.[9]

The outbreak of COVID-19 has now become a clinical threat to the general population and healthcare professionals worldwide. However, knowledge about this new virus is limited, and given that definitive treatment for the disease has not yet been discovered, and since quarantine is one of the most important treatment measures, the patient's role is very important in self-care.[7],[10] On the other hand, in some cases, the family is responsible for caring for the patient, and due to the weakness of traditional education in terms of the main role and participation of patients and families in the treatment and care process, and the lack of studies in this field, this study was conducted to compare the effect of person-centered and family-centered training through telenursing on the quality of life of patients with COVID-19. The results of the present study help choose an effective educational method for patients and families at the community level.

  Methods Top

Study design and setting

This study was conducted based on a quasi-experimental research method. The research setting was the Emergency Department of Bank Melli, a general public Hospital in Tehran, Iran.

Study population and sampling method

All patients and their main family members referred to Bank Melli Hospital's emergency department, Tehran, Iran, were the study population. The inclusion criteria were: (1) willingness to participate in the study, (2) positive Polymerase Chain Reaction (PCR) test results, (3) a need for home quarantine due to clinical symptoms, (4) age between 18 to 65 years, (5) being aware of the time and place (be alert and awake), and (6) be able to answer the questionnaire questions and use a mobile phone as well as WhatsApp. The inclusion criteria for the main family member are similar to those listed above except for a positive. On the other hand, the patients and family members who did not answer the phone calls (no answer after three phone calls), along with inaccessible patients or main members of the family (due to displacement, death, or any other reasons), and patients whose condition worsened in quarantine and needed to be hospitalized were excluded from the study. The samples size was calculated according to this formula, based on the data from Maghsoudi's study[11]:

Finally, considering 20% of sample attrition, 44 samples were considered for each group. The sampling was done according to the convenience sampling method. The selected patients were then randomly divided into two groups of person-centered and family-centered each containing 44 cases by block randomization method. Totally, 88 patients in both groups and 44 main family members of the patients in the family-centered training group were investigated in this study.

Data collection and interventions

After sample selection, they were contacted by phone, and two questionnaires were sent to them via WhatsApp, including the “Demographic-Clinical Profile Questionnaire” and version 2 of the short form of the health-related quality of life questionnaire (SF-12V2).

Demographic-Clinical Profile Questionnaire included 15 items seeking general and clinical information (e.g., age, gender, educational and occupational status, family income, comorbidities, and history of COVID-19) of the patients and family members participating in the study.

The SF-12V2 consists of 12 questions that measure eight health domains [physical functioning (2 items), role limitations due to physical problems (2 items), bodily pain (1 item), general health perceptions (1 item), vitality (1 item), social functioning (1 item), role limitations due to emotional problems (2 items) and mental health (2 items)]. Although the SF-12 version 2 provides estimates of all eight domains, there is a greater interest in focusing on two distinct general concepts of physical and mental health known as the Physical Component Summary (PCS) and the Mental Component Summary (MCS).[12] The scores are calculated using the transformed scores (range: 0-100).[12],[13] Montazeri et al.[12] have translated this tool and evaluated its psychometric properties in the Iranian population. In this study, the reliability of this questionnaire was assessed by calculating the Cronbach Alpha for Physical Component Summary (0.77) and Mental Component Summary (0.71). So, the outcome variable of this study was quality of life.

The data were collected by telephone call, and the researcher filled out the questionnaires. For this purpose, a group in which the patient and the main family member (in the family-centered group) were present was created in cyberspace with a number of prototypes (15 cases per group) to upload the educational contents, videos, and slides, make more interactions among members, and ask questions by members to be answered by the researcher. It should be noted that the samples which were daily included in the study were added to the WhatsApp group to reach the size of the research sample (44 cases per group). This course lasted up to a week. The same content was sent individually to both groups, and four training sessions were provided for 15-30 min based on the protocol of the Ministry of Health through telenursing. Educational content included: definition of the disease, its signs and symptoms, isolation, how to use drugs, side effects of drugs, time of use and recovery process, methods of bud lip and diaphragm breathing, nutrition, and how to manage psychological issues during quarantine. After 6 weeks, SF-12V2 was completed by the samples. The data were then analyzed. In addition, to keep the medical information confidential, both groups were asked to put the first letter of their first and last names on the WhatsApp profile. The sampling took 2 months.

Data analysis

Statistical analysis was performed using SPSS software (version 22). Statistical tests, such as Shapiro-Wilkes's test (to check the normality of data), Chi-square test and independent t-test and analysis of covariance (to compare the two groups), and paired t-test (to compare changes in each group before and after training) were also employed in this study. A P value less than 0.05 was considered statistically significant.

Ethical consideration

This study was approved by Ethics Committee of school of Nursing and Midwifery,… University of Medical Sciences, Tehran, Iran (….REC.1399.272). Written informed consent was obtained from all participants.

  Results Top


In total, 44 cases were included in each group in this study without any drop-out. Shapiro-Wilkes's test showed that the data have a normal distribution. According to the results, the majority of the participants in the person-centered and family-centered groups were females (56.8%; n = 25) and males (63.6%; n = 28), respectively. In addition, the majority of the family members were female (81.8%; n = 36). The Median age of participants in the person-centered and family-centered groups were 42.5 and 42 years, respectively. Other demographic variable results are shown in [Table 1].
Table 1: Demographic-clinical characteristics of patients and family members (Original)

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Effect of person-centered and family-centered training on quality of life

Before the intervention, the quality-of-life scores (SD) were 41.20 (14.27) and 44.72 (12.89) in the person-centered and family-centered groups, respectively. There was no significant difference between the two groups regarding the preintervention quality of life score (p = 0.235). However, after six weeks following the intervention, the person-centered and family-centered groups obtained scores (SD) of 62.11 (10.31) and 65.46 (10.76) in the quality of life, respectively (p = 0.005). The paired t-test showed that the mean score of quality of life in both groups increased significantly after intervention, and this increase was greater in the family-centered group (p < 0.001). In addition, both groups were on average in terms of quality of life before and after training [Table 2].
Table 2: Comparison of quality of life in the person-centered and family-centered groups before and 6 weeks after intervention (Original)

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The results of the paired t-test indicated that the mean score of the physical health dimension of quality of life increased significantly in both groups after intervention (p < 0.001). Therefore, the analysis of covariance showed that this increase was higher in the family-centered group (p < 0.039) [Table 3]. The paired t-test also indicated that both groups' mean score of psychological health dimension of quality of life increased significantly after intervention (p < 0.001). The results of the analysis of covariance revealed that the family-centered group had a higher mean score, compared to the person-centered group (p < 0.041) [Table 3].
Table 3: Comparison of physical and psychological health dimension of quality of life in the person-centered and family-centered groups before and 6 weeks after intervention (Original)

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  Discussion Top

COVID-19 can be a limiting condition with many adverse effects on the patient's quality of life in terms of physical and psychological aspects. Therefore, improving the quality of life of such patients as part of the disease control programs is a goal, and it requires measuring the quality of life-related to the health of patients with COVID-19.[14],[15] For this reason, this study was conducted to compare the effect of person-centered and family-centered training on patients' quality of life with COVID-19. This study is the first to examine the quality of life in patients with acute illness. Results showed that the mean quality of life score in the patient (person)-centered group increased by 7.59 points at the end of the study. Since no specific study has been conducted on the effects of quality-of-life scores in patients with COVID-19, there is a shortage of information.

Dealing with the spread of the coronavirus requires preventive and self-care measures by individuals. On the other hand, studies have shown the effectiveness of person-centered education in improving patients' quality of life. In line with these results, a study was conducted by Bairami et al.[16] in 2017. Their findings showed a positive and significant correlation between self-care behaviors and three dimensions of quality of life, including physical function, mental function, and feeling of pain and discomfort. It is worth mentioning that a positive and significant correlation was observed between the general scores of quality-of-life and self-care behaviors.

The present study results also showed that the quality of life of patients with COVID-19 was increased in both patient-centered and family-centered groups after the intervention; however, this increase was significantly higher in the family-centered group. In this regard, a study was performed on children with hemophilia using a family-based training program. However, a significant difference was observed after the empowerment program regarding the total quality of life score.[15] Another study conducted in the family-centered method by Ghavidel et al. (2015)[17] also examined the effects of family-centered training on the quality of life of patients who underwent heart surgery. The results showed that in the postintervention stage, the mean score of quality-of-life dimensions increased significantly, compared to that in the control group. These findings indicate an improvement in the patients' quality of life after the family-centered intervention.

Since in the present study, family-centered training had a positive effect on increasing the total mean score of quality of life and the two dimensions of physical health and mental health quality of life, the results were consistent with the above study's findings. These findings suggest that involving family members in caring for and empowering them through education is a low-cost option that can improve the patient's health and ultimately improve their quality of life. The results of Katebi et al.[18] study showed a significant difference among the patients before and after the intervention regarding general health, physical function, social function, mental problem, energy and fatigue, physical problem, and the total quality of life score. Family-centered training as person-centered training could effectively improve the quality of life of diabetic patients. Furthermore, in the present study, the family-centered training method increased the total mean score of the quality of life.

In the same line, Zand et al.[19] study showed that family-centered education was more effective in reducing heart irregularities than patient-centered education. In this regard, the health care team and family members of these patients can work together to resolve the problematic aspects of Covid-19 and, if patients experience multiple problems, prioritize and address them.

The strength of this study was the novelty of the interventions on the patients with COVID-19. Another strength of this study was training via “telenursing” compared to previous research delivered conventionally before the COVID-19 pandemic, but we have limitations. One of the limitations of this study was the low sample size; another limitation of this study is a one-time follow-up postintervention.

  Conclusion Top

This study provides helpful information about the effect of person-centered and family-centered training. Health care providers should consider individual and family support to improve the quality of life; moreover, opportunities can be provided for patients to make them able to deal with the disease.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Shahid Beheshti University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3]


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