Sample and procedure
This research is a quasi-experimental study in two groups. Participants in the study were a total of 60 patients and caregivers with COVID-19, with a positive PCR test sample discharged from hospitals affiliated with Shahrekord University of Medical Sciences (SKUMS). The inclusion criteria were as following: having the consent to enroll the study, healthy caregivers, and being responsible for daily care of the patient. Patients were included in the study using the available method and were randomly assigned to two groups by quadratic block classification. Patients were divided into intervention and control groups based on this process. In the intervention group, patients and their caregivers were provided with empowerment trainings in addition to the usual trainings, and the control group received only the usual trainings by the medical centers after discharge. After obtaining the consent and cooperation of patients and caregivers to participate in the research, in the intervention group, in addition to the usual follow-up, a family-centered empowerment program for caregivers and patients was implemented as described in Table 1, which has four axes in total. Before training, demographic, quality of life, self-efficacy questionnaires as well as Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) questionnaires were filled out immediately after the patient was discharged from the hospital with the cooperation of patient caregivers. Three months after the training, the quality of life, self-efficacy, ADL and IADL questionnaires were filled out again.
Measures
WHO Quality of Life Questionnaire
The WHO Quality of Life Questionnaire consists of 26 criteria and each criterion has five parts (never, rarely, relatively, most often, always) which has a total of 104 points and the questionnaire has four areas: social, physical, psychological and living environment. After performing the necessary calculations in each domain, a score of 4 to 20 for each domain was obtained, in which the score of 4 signs represents the worst and 20 signs represents the best status of the domain. The WHO quality of life questionnaire was evaluated for the first time in Iran by Nejat et al. in 2006. The reliability of the questionnaire was measured using Cronbach's alpha and the correlation within the clusters obtained from the retest. Intra-cluster and Cronbach's alpha values are above 0.7 in all domains with an acceptable reliability [9].
Scherer Self-Efficacy Questionnaire
The Scherer Self-Efficacy Questionnaire has 17 questions, each of which, on a Likert scale, ranges from strongly disagree to strongly agree. In scale scoring, each item is awarded from 1 to 5 points. The maximum score a person can get from this scale is 85 and the minimum score is 17. To assess the validity of the constructs of the General Self-Efficacy Scale, Bakhtiari Barati (1996) correlated the scores obtained from this scale with the dimensions of several personality traits including the Rutter Internal and External Control Scale, the Personal Control subscale, the Marlowe-Kran Social Degree Scale, and the Rosenberg Interpersonal Competency Scale. The predicted correlation between self-efficacy scale and moderate personality traits was obtained as 0.61 and significant at the level of 0.05 which was in order to confirm the desired structure. Also, the reliability coefficient of the scale using the Cronbach's alpha coefficient was calculated as 0.79 [10].
ADL Questionnaire
ADL and IADL criteria were used to assess daily activity. In the seven-item ADL questionnaire, each item has three points: depended, zero point; needing help, one point and two points as independent. The validity and reliability of the ADL index have been examined by Taheri and Azadbakht sensitivity and specificity for ADL and IADL were reported as 0.75 and 0.96 as compared to 0.71 and 0.77, respectively [11].
Table 1. Stages of family-centered empowerment of patients with COVID-19
Statistical analysis
The data obtained were analyzed by the software SPSS v. 21. The normal distribution for the variables was investigated by Kolmogorov-Smirnov test. To examine the differences between the groups, Fisher's exact test or chi-square test as well as parametric analysis of variance (ANOVA) were used for qualitative variables. To examine the difference before and after the variables, paired t-test was used for quantitative normal variables and Wilcoxon symptomatic rank non-parametric test was used for quantitatively abnormal variables.
Ethics statement
We confirm that all procedures were performed in accordance with the ethical standards laiddown in the Declaration of Helsinki and its later amendments or comparable ethical standards. The present study was approved by Ethical Committee Shahrekord University of Medical Sciences (ethics code: IR.SKUMS.REC.1399.163). Also, after selecting the eligible participant, the researcher was introduced to them and the objectives of the study were elaborated for the participants. The informed consent was obtained from the subjects and they were assured that their information will remain confidential.