Knowledge and Practice of Personal Hygiene and Sanitation: A Study in Selected Slums of Dhaka City

Background: : Slum dwellers are likely to be among the most deprived people in urban areas. Poor hygiene practices and inadequate sanitary conditions play major roles in the increased burden of communicable diseases within developing countries like ours.Objective: To assess the knowledge and practice about personal hygiene and environmental sanitation in selected slums of Dhaka city.Materials and method: This cross sectional study was conducted in purposively selected urban slum areas of Moghbazar slum, Bashabo slum and T&T slum of Dhaka city during February 2014 to April 2014. Convenient sampling technique was applied. Semi-structured pre-tested questionnaire was used and face to face interview was conducted. Total 475 subjects, irrespective of age and sex, were included in this study.Results: Out of 475 respondents, more than fifty percent slum dwellers resided in tin shaded room while 21.7% in kacha houses. Sixty six percent of the respondents used to drink water from tube-well and 24% used supplied water provided by the city corporation. The study revealed that near 59% of the respondents used sanitary latrine. About 67% slum dwellers regularly practiced hand washing before taking meal and 59.2% respondents used soap after defecation. About fifty percent respondents brushed their teeth regularly with tooth paste. Regarding personal cleanliness, 81% subjects took bath regularly while 78% washed clothes irregularly. A statistically significant relation was found between washing of hands before meal (p=0.001), washing of hands after defecation (p=0.02), tooth brushing (p=0.001), bathing (p=0.009), washing of cloths (p=0.001), use of footwear (p=0.63) with knowledge of personal hygiene of the slum dwellers.Conclusion: Continuous community hygiene education along with adequate access to water supply and sanitation improves hygiene behaviour and policy makers and health care providers should have definite strategy and implementation.Delta Med Col J. Jul 2015; 3(2): 68-73

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Nurses’ knowledge and practices related to pain assessment in critically ill patients in a selected private hospital in Bangladesh

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20183957 ◽

2018 ◽

Vol 5 (10) ◽

pp. 4219 ◽

Cited By ~ 1

Author(s):

Sipra Mondol ◽

Faisal Muhammad ◽

A. B. M. Alauddin Chowdhury

Keyword(s):

Critically Ill ◽

Health Care Providers ◽

Pain Assessment ◽

Subjective Experience ◽

Sampling Technique ◽

Care Providers ◽

Cross Sectional ◽

Management Interventions ◽

The Mean ◽

Nurses Knowledge

Background: Most of the time pain is difficult to assess and manage because of being inherently a subjective experience influenced by multiple factors. The perception and tolerance of pain may vary because of different psychological and social influences of the patient. Therefore it is important for health care providers to assess the pain so that individualized management interventions can be provided. This study was aimed to assess the nurses’ knowledge and practices related to pain assessment in critically ill patients.Methods: A descriptive cross-sectional study was carried out among 200 registered nurses working at different ICU in Square Hospital. The study was conducted within April to August 2017. A non-probability purposive sampling technique was used. The data was collected using pre-tested self-administered semi-structured questionnaire and it was analysed using SPSS 22.0 version.Results: About 81% of the respondents were in the age group 22-32 years and the mean age of the respondents was 27.74±12.06 years. About 79.0% of the respondents were female and 59.5% of the respondents had diploma in nursing. The mean monthly income of the respondents’ was 19450.5 taka. The majority (59.5%) of the respondents had less than 2 years’ service experience. About 85.5% of the respondents said it is important to assess the pain and need for analgesia before, during, and after wound care.Conclusions: Our findings reported that the nurses were reasonably knowledgeable about the principles of pain assessment. More than four-fifths of the respondents had adequate knowledge about pain assessment.

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Health Problems of Elderly Patients attending Combined Military Hospital, Dhaka

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v13i1.41008 ◽

2017 ◽

Vol 13 (1) ◽

pp. 8-12

Author(s):

SM Humayun Kabir ◽

Md Ziaul Islam ◽

Masuda Begum ◽

Masud Ahmed ◽

Mohammad Mohsin ◽

...

Keyword(s):

Elderly Patients ◽

Health Care Providers ◽

Family Income ◽

Sampling Technique ◽

Armed Forces ◽

The Elderly ◽

Health Problems ◽

Military Hospital ◽

Care Providers ◽

Cross Sectional

Introduction: Health problems of elderly are an emerging health burden throughout the world. Bangladesh is currently undergoing a demographic transition and the proportion of the population of 60 years and older is increasing rapidly. Health care providers and policymakers are highly concerned with this burning issue. Objective: To know the disease pattern among the elderly patients in Combined Military Hospital, Dhaka. Materials and Methods: This cross-sectional study was carried out from July 2015 to June 2016 among 152 elderly patients above 60 years of age admitted in Combined Military Hospital (CMH), Dhaka Cantonment. Data were collected by face-to-face interview with semi-structured questionnaire and checklist following purposive sampling technique. Analysis of data was done by Statistical Package for Social Science (SPSS, version 20.0). Results: Mean age of the elderly was 72.06±4.56 years with the range of 60-80 years and majority (90.8%) of the elderly was male. Out of total 152 elderly patients, by occupation majority (31.6%) were in the business group followed by 30.3% in the retired group and 9.2 % in the housewife group. Average monthly family income was BDT 17927.63±7360.75 with the range of BDT 6000-35000. With initial complaints elderly patients reported to doctors in private chamber (38.2%), private hospital (25.6%) and Govt hospital (5.9%). Among all of the elderly patients, majority (21.1%) had Diabetes Mellitus followed by Rheumatoid Arthritis (17.6%), Asthma (12.5%), Cataract (11.2%), ENT problem (6.6%), Malignancy (5.9%) and Benign Enlargement of Prostate 8(5.3%). Conclusion: The number of elderly people is expanding rapidly; it also presents multifaceted health problems and thus creates unique challenges for the national healthcareservices. Early identification of problem and ensuring the availability of health with economic and social support can have a control over the elderly health problems. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 8-12

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Knowledge on Post Exposure Prophylaxis of HIV among Nurses in a Hospital of Pokhara

Janapriya Journal of Interdisciplinary Studies ◽

10.3126/jjis.v7i1.23050 ◽

2018 ◽

Vol 7 (1) ◽

pp. 57-66

Author(s):

Manu Thapa ◽

Bishnu Gurung

Keyword(s):

Nursing Education ◽

Standard Deviation ◽

Health Care Providers ◽

Sampling Technique ◽

Education Programme ◽

Post Exposure Prophylaxis ◽

Care Providers ◽

Cross Sectional ◽

Post Exposure ◽

Exposure Prophylaxis

Health care providers are at risk of acquiring human immunodeficiency virus (HIV) infection from occupational exposure, with nurses being the most vulnerable. Post exposure prophylaxis (PEP) of HIV is the only way to reduce risk of HIV after potential exposure. A study was conducted on Nurses Knowledge on PEP of HIV at Gandaki Medical College (GMC), Pokhara to find out the knowledge on PEP of HIV among nurses. Descriptive cross sectional research design was used for the study. Probability stratified systematic random sampling technique was used for sampling and self administered questionnaires was used for data collection with sample size of 90 nurses working in GMC. The data was analyzed using Statistical Package for Social Science (SPSS) version 20 software programme and presented in terms of frequency distribution, percentage, mean and standard deviation. For inferential statistics, chi square test was used at 5% level of significance. The findings of the study revealed that mean age of the respondents was 24.57 with standard deviation 3.43. Out of 90 respondents majority (83.3%) of the respondents were PCL passed and 47.8% of the respondents had adequate knowledge regarding PEP of HIV. The study found no significant association between demographic variables and knowledge level. It can be concluded that the nurses need to improve their level of knowledge on PEP of HIV by participating in different training programs. Health institution should also conduct continue nursing education programme to improve and update knowledge among the employees.

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Socioeconomic factor and satisfaction of MCH client in urban slum of Meerut, Uttar Pradesh

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20174230 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3664

Author(s):

Nripendra Singh ◽

Seema Jain ◽

Harivansh Chopra ◽

Arun Kumar ◽

Ganesh Singh ◽

...

Keyword(s):

Health Care ◽

Socioeconomic Status ◽

Health Care Providers ◽

Client Satisfaction ◽

Urban Slum ◽

Family Education ◽

Socioeconomic Factor ◽

Care Providers ◽

Cross Sectional ◽

Socioeconomic Class

Background: The health of the mother and child constitutes one of the most serious health problems affecting the community, particularly in the developing countries like India. Promotion of maternal and child health has been one of the most important aspects. But any program, however, relevant its components were likely to fail unless it succeeds in improving the knowledge and achieving satisfaction of its respondent. Client satisfaction has traditionally been linked to the quality of services given and the extent to which specific needs were met. The objective of the study was to determine the level of satisfaction and correlated factor among mothers visiting primary health care institutions for maternal care services.Methods: A cross sectional study was carried out on 384 women attending 19 urban health post located in Meerut.Results: In present study 76.0% MCH respondent belong to lower socioeconomic class, 46.4% MCH respondent were 6-12th class pass, 33.1% MCH respondent belong to SC/ST category. Satisfaction with behavior of staff was significant associated with socioeconomic class, educational qualification and religion of respondent. Satisfaction with cleanliness is significantly associated with socioeconomic status, type of family, education and caste of client. Satisfaction with availability of drug is significantly associated with socioeconomic status, education, category and religion of respondent. Satisfaction with behavior of doctor is significantly associated with type of family, education and category of respondent.Conclusions: In present study, we observed that satisfaction of MCH respondents were closely related to the services provided at MCH center and with the behavior of health care providers.

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The magnitude and associated Factors of Postoperative Trichiasis among adults who underwent Trachomatous Trichiasis Surgery in Ambassel District, North-East Ethiopia

10.21203/rs.3.rs-61501/v1 ◽

2020 ◽

Author(s):

Abdu Tabor Yimam ◽

Gizachew Tadesse Wassie ◽

Getu Degu Alene

Keyword(s):

Health Care Providers ◽

Associated Factors ◽

Sampling Technique ◽

Fiscal Year ◽

High Recurrence Rate ◽

Care Providers ◽

Cross Sectional ◽

North East ◽

The Face ◽

Trachomatous Trichiasis

Abstract Background In Trachoma endemic countries, many people who underwent Trichiasis surgery faced a recurrence of the disease. Postoperative Trichiasis is a significant problem for patients and health care providers because it puts the eye at renewed risk of sight loss. Despite the low utilization of Trachomatous Trichiasis (TT) surgery and high recurrence rate, evidences that elucidate why TT recurs after surgery are limited. This study was aimed to assess the magnitude and associated factors of postoperative Trichiasis among 18 years and above individuals who underwent Trachomatous Trichiasis surgery between 2006 and 2011 Ethiopian Fiscal year in Ambassel District, North-East Ethiopia, 2020. Methods The community-based cross-sectional study design was conducted from March 10 to March 23/2020 in selected kebeles of Ambassel District. The required sample size was calculated using EPI-INFO Version 7. A multi-stage sampling technique was used to employ a total of 506 individuals. Data were collected through the interviewer-administered structured pre-tested questionnaire and entered into EpiData version 3.1 and then exported to SPSS version 23.0. Bi-variable and multivariable logistic regression models were fitted to identify associated factors of Trachomatous Trichiasis recurrence. Results Four hundred ninety two individuals participated in this study with response rate of 97.2%. In Ambassel district the prevalence of postoperative Trichiasis was 23.8% (95%CI = 19.9–27.8). Among associated factors of postoperative Trichiasis age 50–59 AOR = 3.34 (CI = 1.38–8.1), 60–69 AOR = 3.24(CI = 1.38–7.61), ≥ 70 years AOR = 6.04 (CI = 2.23–16.41), duration since surgery AOR = 1.7(CI = 1.35–2.14), complication AOR = 2.98(CI = 1.24–7.2), washing the face two times AOR = 0.25(CI = 0.13–0.47), washing the face three and more times AOR = 0.1(CI = 0.41 − 0.25), taking Azithromycin following surgery AOR = 0.19(CI = 0.09–0.41), pre-operative epilation history AOR = 2.11, (CI = 1.14, 3.9)and having a knowledge about TrachomaTtrichiasis AOR = 0.21(CI = 0.08–0.58) showed a statistical significant association. Conclusions The prevalence of postoperative Trichiasis in Ambassel District was higher than most Ethiopian studies. Age, frequency of face washing, medication following surgery, duration since the last surgery, knowledge about trachoma, pre-operative epilation history and complication after surgery were identified to be independent factors. To minimize postoperative Trichiasis stakeholders need to consider health education for patients, provision of Azithromycin after surgery and proper training for IECWs.

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Tuberculosis Case Finding Practice: The Intention of Cadres

Jurnal Keperawatan Indonesia ◽

10.7454/jki.v23i2.1050 ◽

2020 ◽

Vol 23 (2) ◽

pp. 128-135

Author(s):

Agnes Pude Lepuen ◽

Cicilia Nony Ayuningsih Bratajaya ◽

Sada Rasmada

Keyword(s):

Public Health ◽

Health Care Providers ◽

Public Awareness ◽

Sampling Technique ◽

Case Finding ◽

Public Health Care ◽

Care Providers ◽

Chi Square ◽

Tuberculosis Case ◽

Cross Sectional

Tuberculosis (TB) is a difficult health problem to overcome. Active case finding is an important step in managing this infectious disease. However, the prevalence of TB case finding among cadres at the community level is low because of the stigma attached to TB, difficulty in geographical coverage, low public awareness, and social economic barriers. In addition, the empowerment and intention of cadres to perform community-based TB case finding are not optimal yet. This cross-sectional study aimed to determine the intention of TB case finding among 162 public health cadres at one district. Convenient sampling technique was employed in this study. Relationship analyses were performed using Chi-Square test. Results suggested that three factors, namely, attitude, subjective norm, and perceived behavior control influenced the intention to practice TB case finding among cadres. Public health care providers must encourage cadres to practice active TB case finding and understand the benefits and burdens encountered by cadres during TB case finding. Abstrak Praktik Penemuan Kasus Tuberkulosis: Niat Kader. Tuberkulosis (TB) masih menjadi masalah kesehatan yang sulit diatasi. Penemuan kasus TB secara aktif merupakan langkah awal yang menjadi kunci keberhasilan dalam penanganan kasus TB, namun angka penemuan kasus TB masih rendah. Kader belum dapat melakukan pendeteksian dini kasus TB secara optimal. Selain itu sebagai penemu kasus TB di masyarakat, kader memiliki berbagai tantangan dalam upaya menemukan kasus TB, salah satunya adalah niat untuk menemukan kasus TB mengingat banyak stigma yang muncul terkait penyakit TB, keadaan geografi yang sulit dijangkau, rendahnya kesadaran masyarakat, dan kendala biaya. Tujuan dari penelitian ini adalah untuk mengetahui intensi atau niat kader dalam menemukan kasus TB. Penelitian ini menggunakan desain cross sectional dengan melibatkan 162 kader kesehatan di sebuah kecamatan. Metode pengambilan sampel menggunakan convenient sampling. Analisa hubungan menggunakan uji statistik Chi Square. Hasil penelitian menunjukkan ketiga faktor yaitu sikap, norma subjektif, dan kendali perilaku yang dirasakan memiliki hubungan dengan intensi dalam menemukan kasus TB. Maka dapat disimpulkan, dukungan tenaga kesehatan sangat penting dalam meningkatkan praktik penemuan kasus TB dan penting untuk memperhatikan manfaat dan tantangan yang ditemui oleh kader dalam menemukan kasus TB. Kata Kunci: kader kesehatan, kontrol kendali yang dirasakan, niat, norma subjektif, sikap, penemuan kasus Tuberkulosis

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Community Knowledge and Practice on Sanitation, Hygiene and Household Water Utilization in Afabet City, Northern Red Sea Zone of Eritrea: Cross Sectional Study

10.21203/rs.3.rs-566458/v1 ◽

2021 ◽

Author(s):

Berhe Tesfai ◽

Hagos Milkyas ◽

Fitsum Kibreab ◽

Meron Goitom ◽

Hermon Berhe ◽

...

Keyword(s):

Sampling Technique ◽

Water Source ◽

Cross Sectional Study ◽

Hand Washing ◽

Personal Hygiene ◽

Cluster Sampling ◽

Cross Sectional ◽

Water Utilization ◽

Comprehensive Knowledge ◽

Knowledge And Practice

Abstract Background: Water and sanitation entitles the human right to affordable access and sanitation. The objective of this study was to determine the knowledge and practice on sanitation, hygiene and water utilization and to estimate the prevalence of diarrhea in Afabet city.Methods: It was a community-based descriptive cross-sectional type of study with a multistage cluster sampling technique. First, 12 clusters were selected from the city and 30 households were nominated from each cluster. Then, a total of 360 individuals were sampled and every family head was interviewed. A structured interviewer administered questionnaire and field observation was used for data collection from December 05-20, 2020. Cross tabulation and association of variables using chi-square test was determined and results were weighted as cluster sampling was used. Results: A total of 360 respondents were enrolled in the study with females (75.3%) and Muslin (99.0%) predominance. About 66.2% and 66.9% respondents were satisfied with the amount and quality of water they received respectively. The prevalence of diarrhea in the community in the last six months of 2020 was 13.0%. The investigators practically approved that 90.7% of the communities revealed functional toilets and feces were observed in only 5.7% of the living area of the community. The community’s comprehensive good knowledge and practice was 99.4% and 93.0% respectively. Their comprehensive knowledge and practice showed significant association with age, sex, marital status, level of education, household size and distance to municipality water source (p<0.001). Furthermore, their comprehensive knowledge and practice, prevalence of diarrhea, presence of latrine, distance from their home to municipality water source and hand washing practice were significantly associated with the administrative area of the study participants (p<0.001).Conclusion: The community had good level of knowledge and practice but the prevalence of diarrhea was relatively high. Latrines were highly utilized but the usage of soap, personal and food hygiene was slightly low. The level of comprehensive practice, prevalence of diarrhea, distance to municipality water source and hand washing practice was associated to the administrative areas. Enhancing environmental sanitation, personal hygiene and provision of adequate and clean water are highly recommended.

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RELATIONSHIP BETWEEN SHARIA-BASED NURSING SERVICES AND PATIENT LOYALITY AT ISLAMIC HOSPITAL

Nurscope Jurnal Penelitian dan Pemikiran Ilmiah Keperawatan ◽

10.30659/nurscope.4.2.109-117 ◽

2018 ◽

Vol 4 (2) ◽

pp. 109

Author(s):

Dyah Wiji Puspita Sari ◽

Muhammad Abdurrouf ◽

Rismawati Rismawati

Keyword(s):

Health Services ◽

Health Care Providers ◽

Sampling Technique ◽

Good Health ◽

P Value ◽

Care Providers ◽

Cross Sectional ◽

Nursing Services ◽

Patient Loyalty

Introduction: Sharia labeled hospitals have more responsibility in providing health services to patients. This challenge requires health care providers to compete by improving the quality of services so that patient loyalty is formed. The purpose of this study was to identify the relationship between sharia-based nursing services and patient loyalty in Semarang Hospital. Methodology: This research is a quantitative type with a cross sectional approach. Data collection using a questionnaire with the number of respondents 105 patients with total sampling technique. Results: the characteristics of respondents mostly consisted of age 36-45 (24.8%), last education elementary school 69 people (65.7%), length of stay that is 4 days a number of 35 people (33.3%), there is a relationship between services sharia-based nursing with patient loyalty at RSISA Semarang with pvalue 0.002 (p-value <0.05) with an R value (0.305). Discussion: This study can be used as a reference in improving good health services by implementing services in accordance with sharia principles so that patient loyalty is achieved.

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Level of Utilization and Provider-Related Barriers to Hydroxyurea Use in the Treatment of Sickle Cell Disease in Jos, Nigeria

Blood ◽

10.1182/blood-2019-128185 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 1029-1029 ◽

Cited By ~ 1

Author(s):

Akinyemi Olugbenga David Ofakunrin ◽

Kehinde Adekola ◽

Edache Sylvanus Okpe ◽

Stephen Oguche ◽

Tolulope Afolaranmi ◽

...

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Health Care Providers ◽

Conflicts Of Interest ◽

Sampling Technique ◽

P Value ◽

Care Providers ◽

Cell Disease ◽

Cross Sectional ◽

Inadequate Knowledge

Background: Hydroxyurea is one of the currently approved medications capable of modifying the pathogenesis of sickle cell disease (SCD), and its use has transformed the management of this disease worldwide.However, available evidences suggest that hydroxyurea is underutilized by sickle cell health-care providers in Nigeria despite the huge burden of the disease. Objectives: This study assessed the level of utilization and provider-related barriers to the use of hydroxyurea in the treatment of SCD patients in Jos, Nigeria. Methods: A cross-sectional study conducted among 132 medical doctors providing care for SCD patients in four tertiary hospitals in Jos using a multistage sampling technique. In this setting, SCD patients are cared for by the Hematologists, Pediatricians, Family Physicians and General Practitioners. Data on socio-demographics of the respondents, knowledge, utilization and barriers to the utilization of hydroxyurea were obtained using an interviewer-administered questionnaire. The data were processed and analysed using SPSS version 23. Hydroxyurea was adjudged utilized if a provider has prescribed hydroxyurea to any SCD patient within the last 12 months. Chi square test was used to test the association between the demographic, provider-related barrier variables and the level of utilization of hydroxyurea. The barriers were fed cumulatively into logistic regression model as predictors of utilization of hydroxyurea. Adjusted odds ratio and 95% confidence interval were used as point and interval estimates respectively. A P-value of <0.05 was considered statistically significant. Results: Of the 132 respondents, 88 (67%) had been in medical practice for upward of six years while 80 (60.6%) of them affirmed that they have attended to more than 10 SCD patients in the last 6 months. Sixty-seven (50.8%) of the participants had inadequate knowledge of hydroxyurea use in SCD management while the level of utilization of hydroxyurea in SCD treatment was 24.2%. The odds of non-utilization of hydroxyurea was 5.1 times higher in providers with no expertise in its use (OR =5.1; 95% CI =2.65-9.05; P<0.0001). Other barriers that predicted its non-utilization included inadequate knowledge (OR =0.17; 95% CI =0.29-0.71; P=0.017), fear of side-effects (OR =0.50; 95% CI =0.22-0.68; P=0.019) and doubt about the effectiveness of the medication (OR =0.30; 95% CI =0.20-0.90; P=0.002). Conclusion: The level of utilization of hydroxyurea in the treatment of SCD among the sickle cell care-providers is sub-optimal with the lack of expertise in its use identified as the most prominent barrier. Therefore, training of Nigeria sickle cell care-providers to attain and maintain competence in the use of hydroxyurea for the treatment of SCD is required. Keywords: Sickle cell disease, hydroxyurea, utilization, barriers, Jos, Nigeria Disclosures No relevant conflicts of interest to declare.

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Hubungan Tingkat Pengetahuan dan Tingkat Kepatuhan Minum Obat dengan Tingkat Kekambuhan Lupus Eritematosus Sistemik

Jurnal Epidemiologi Kesehatan Komunitas ◽

10.14710/jekk.v6i2.9930 ◽

2021 ◽

Vol 6 (2) ◽

pp. 261-268

Author(s):

Dinda Sinta Rahayu ◽

Ari Udiyono ◽

Lintang Dian Saraswati

Keyword(s):

Systemic Lupus Erythematosus ◽

Health Care Providers ◽

Lupus Erythematosus ◽

Sampling Technique ◽

Integrated Approach ◽

Drug Adherence ◽

Care Providers ◽

Systemic Lupus ◽

Cross Sectional ◽

Her Family

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease with varied manifestations and characterized by recurring flares. Lack of disease knowledge and non-compliance with drug therapy are an important cause of not achieving treatment targets and worsening lupus symptoms.Methods: This research is a descriptive study with a cross-sectional approach. The research method is quantitative. The sample in this study were 136 patients who came to examine themselves at Central-General Hospital in Semarang City. The sampling technique used in this study was total sampling. This study used a questionnaire to determine the variables studied.Result: The results of this study indicate a significant correlation between the level of knowledge (r=-0,332; p < 0,05) and level of drug adherence (r=-0,644; p < 0,05) to the level of systemic lupus erythematosus flaresConclusion : Based on the results, there is a correlation between knowledge and drug adherence to the level of systemic lupus erythematosus flares. The recommendation given is an integrated approach between patients and health care providers to improve patients understanding of systemic lupus erythematosus flares. Beside of that, specific attention should be paid to integrate the service provision system into the collaborative approach of the patients and his/her family in order to promote the level of drug adherence.

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