Research Article
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The Effects of Sleep Hygiene and Deep Breathing - Cough Exercise Training on The Quality of Sleep and Life in COPD Diagnosed Patients

Year 2024, Volume: 9 Issue: 2, 258 - 270, 31.08.2024
https://doi.org/10.25279/sak.1113406

Abstract

Introduction: Chronic diseases are one of the leading factors that negatively affect quality of life and therefore interventions should be planned to alleviate the symptoms of chronic diseases and improve the quality of life of patients. Aim: The purpose of this study was to determine the effects of sleep hygiene and deep breathing-coughing exercise training on the post-discharge quality of sleep and life in COPD diagnosed patients. Material and Method: The study was conducted with patients diagnosed with COPD between 25 February and 30 April 2018. A Patient Information Form, the Pittsburgh Sleep Quality Scale (PSQI) and the Quality of Life (SF-36) Scale were administered before deep breathing-coughing exercise and sleep hygiene training were given to patients. In assessing the data, percentages, arithmetic means, chi-square and t-test were used. Results: The mean pre-training and post-training total PDQI scores of the patients in the intervention group were 14.20±1.45 and 12.57±0.97, respectively, and 15.00±1.89 and 14.80±1.13 in the control group. The mean scores of the Quality of Life Scale before and after the intervention group were 43.98±12.72 and 117.12±15.09, respectively; the mean scores of the patients in the control group were 36.93±5.77 and 38.13±5.67, respectively. There was a statistically significant difference between pretest and posttest total PDQI (z:-4.178, p<0.001) and quality of life (z:-4.782, p<0.001) mean scores in the intervention group, whereas there was no statistically significant difference in the control group. Conclusion: Sleep hygiene and deep breathing-coughing exercises training were found to be effective on sleep and quality of life.

References

  • Ağargün, M.Y., Kara, H., & Anlar, Ö. (1996). Pittsburgh Uyku Kalitesi İndeksi‟nin Geçerlilik ve Güvenilirliği, Türk Psikiyatri Dergisi, 7(2), 107- 115.
  • Akıncı, A.Ç. KOAH’lı Hastalara Uygulanan Pulmoner Rehabilitasyonun Fiziksel ve Psikolojik Parametrelere Etkisi. MÜ, Doktora Tezi, 2008, İstanbul (Danışman: Prof. Dr. Nermin Olgun).
  • Baker, E., & Fatoye, F. (2017). Clinical and Cost Effectiveness of Nurse-led Self-Management Interventions for Patients with COPD in Primary Care: A Systematic Review. International Journal of Nursing Studies, 71, 125-138.
  • Budhiraja, R., Parthasarathy, S., Budhiraja, P., Habib, M.P., Wendel, C., & Quan, S.F. (2012). Insomnia in Patients with COPD. Sleep, 35, 369-375.
  • Buysse, D.J., Reynolds, C.F., Berman, S.R., & Kupfer, D.J. (1989). The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Psychiatry Research, 28(2), 193-213.
  • Bülbül, Y. (2013). Kronik Obstrüktif Akciğer Hastalığında Uyku Sorunları. Güncel Göğüs Hastalıkları Serisi, 1 (1), 80-85.
  • Büyüköztürk, Ş. (2011). Sosyal Bilimler için Veri Analizi El Kitabı. Pegem Akademi, Ankara.
  • Caia, J., Scott, TJ, Halson, S.L., & Kelly, V.G. (2018). The influence of sleep hygiene education on sleep in professional rugby league athletes. Sleep Health, 4(4), 364-368.
  • Cho, H.L., Tung, H.H., Lin, MS, Hsu, W.C., & Lee, C.P. (2017). Self Determined Motivation and Exercise Behavior in COPD Patients. International Journal of Nursing Practice, 23 (3), 1-9.
  • Demiralp, M., Oflaz, F., & Komurcu, S. (2010). Effects of relaxation training on sleep quality and fatigue in patients with breast cancer undergoing adjuvant chemotherapy, Journal of Clinical Nursing, 19, 1073–1083.
  • Doğan, U. KOAH Tanılı Hastalara Verilen Sağlık Eğitiminin Günlük Oksijen Konsantratörü Kullanım Sürelerine Etkisi. Gaziantep Üniversitesi Sağlık Bilimleri Enstitüsü Yüksek Lisans Tezi, Gaziantep, 2016 (Danışman: Prof. Dr. Nimet Ovayolu).
  • Duman, M., & Taşhan, S.T. (2018). The effect of sleep hygiene education and relaxation exercises on insomnia among postmenopausal women: A randomized clinical trial, Int J Nurs Practice, 24 (4), e12650.
  • Esen, H. KOAH Hastalarında Uyku Kalitesi ve Yaşam Kalitesi Arasındaki İlişkinin Değerlendirilmesi. Afyon Kocatepe Üniversitesi Sağlık Bilimleri Enstitüsü, Yüksek Lisans Tezi, 2008, Afyonkarahisar (Danışman: Doç. Dr. Serap Demir).
  • Erdinç, E., Polatlı, M., & Kocabaş, A. et al. (2010). Türk Toraks Derneği Kronik Obstrüktif Akciğer Hastalığı Tanı ve Tedavi Uzlaşı Raporu, Turkish Thoracic Journal, 11(1), 1-64.
  • Folch-Ayoraa, A., Orts-Cortés, M.I., Macia-Soler, L., Andreu-Guillamon M.V., & Moncho, J. (2019). Patient education during hospital admission due to exacerbation of chronic obstructive pulmonary disease: Effects on quality of life- Controlled and randomized experimental study, Patient Education and Counseling, 102 (3), 511-519.
  • Gellis, L.A., & Lichstein, K.L. (2009). Sleep hygiene practices of good and poor sleepers in the United States: An ınternet-based study. Behaviour Threapy, 40 (1), 1-9.
  • Global Initiative for Chronic Obstructive Lung Disease (2017). Pocket Guide to COPD Diagnosis, Management, and Prevention A Guide for Health Care Professionals, 1-33.
  • Hermiz, O., Comino, E., Marks, G., Daffurn, K., Wilson, S., & Harris, M. (2002). Randomized controlled trial of home based care of patients with chronic obstructive pulmonary disease. British Medical Journal, 325 (7370), 938-940.
  • Jen, R., Li, Y., Owens, R.L., & Malhotra, A. (2016). Sleep in Chronic Obstructive Pulmonary Disease: Evidence Gaps and Challenges. Canadian Respiratory Journal, 8,1-5.
  • Koçyiğit, H., Aydemir, Ö., Ölmez, N., & Memiş, A. (1999). Kısa form-36 (KF36)’nın Türkçe Versiyonunun Güvenirliliği ve Geçerliliği. İlaç ve Tedavi Dergisi, 12(2), 102-106.
  • Köktürk, N., Gürgün, A., Şen, E., Kocabaş, A., Polatlı, M., & Naycı, S.A. (2017). Türk Toraks Derneği’nin GOLD 2017 Kronik Obstrüktif Akciğer Hastalığı (KOAH) Raporuna Bakışı, 1-42.
  • Luk, E. K., Hutchinson, A. F., Tacey, M., Irving, L., & Khan, F. (2017). COPD: Health Care Utilisation Patterns with Different Disease Management Interventions. Lung, 195 (4), 455-461.
  • McCurry, M.S., Gibbons, L.E., Logsdon, R.G., Vitiello, M.V., & Teri, L. (2005). Nighttime Insomnia Treatment and Education for Alzheimer's Disease: A Randomized, Controlled Trial. Journal of the American Geriatrics Society, 53 (5), 793- 798.
  • McKay, A., Mahesh, P. A., Fordham, J. Z., & Majeed, A. (2012). Prevalence of COPD in India: A Systematic Review. Primary Care Respiratory Journal, 21 (3), 313-321.
  • McDonnell, L.M., Hogg, L., McDonnell, L., & White, P. (2014). Pulmonary Rehabilitation and Sleep Quality: A Before and After Controlled Study of Patients With Chronic Obstructive Pulmonary Disease, Primary Care Respiratory Medicine (2014) 24, 14028.
  • Özgen Alpaydın, A., Baha, A., Çöplü, L., et al. (2021). Tanım ve Epidemiyoloji, Hastalık Gelişimi ve İlerlemesine Etkili Faktörler, Patoloji, Patogenez, Fizyopatoloji, Türk Toraks Derneği’nin GOLD 2021 Kronik Obstrüktif Akciğer Hastalığı (KOAH) Raporuna Bakışı, Ed: Şen, E., 1-7.
  • Özmen, İ., Yıldırım, E., & Öztürk, M., et al. (2018). Pulmonary Rehabilitation Reduces Emergency Admission and Hospitalization Rates of Patients with Chronic Respiratory Diseases. Turk Thorac J., 19 (4), 170-175.
  • Öztürk, Ö. (2011). Chronic Obstructive Pulmonary Disease and Sleep. Euras J Pulm., 13(2), 67-77. Padilha, J. M., Sousa, P.A.F, & Pereira, F.M.S. (2018). Nursing Clinical Practice Changes to Improve Self Management in Chronic Obstructive Pulmonary Disease. International Nursing Review, 65 (1), 122-130.
  • Reardon, J. Z. (2007). COPD and Exercise: What’s Really İmportant? A Nursing Perspective. Journal of Chronic Obstructive Pulmonary Disease, 4 (3), 283-287.
  • Scharf, S. M., Maimon, N., Simon-Tuval, T., Bernhard-Scharf, B.J., Reuveni, H., & Tarasiuk, A. (2011). Sleep Quality Predicts Quality of Life in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis., 22 (6), 1-12.
  • Sevilla Berrios, R.A., & Gay, P.C. (2016). Advances and New Approaches to Managing Sleep-Disordered Breathing Related to Chronic Pulmonary Disease. Sleep Medicine Clinics, 11 (2), 257-264.
  • Soler, X, Diaz-Piedra, C, & Ries, A.L. (2013). Pulmonary Rehabilitation Improves Sleep Quality in Chronic Lung Disease. COPD, 10, 156 –163.
  • Sullivan, M., Karlsson, J., & Ware, J. E. (1995). The Swedish SF-36 Health Survey I. Evaluation of Data Quality, Scaling Assumptions, Reliability and Construct Validity Across General Populations in Sweden. Social Science & Medicine, 41(10), 1349-1358.
  • Türk Toraks Derneği (8.11.2017). KOAH Tanı ve Tedavi Uzlaşı Raporu 2010. Retrieved from www.toraks.org.tr.
  • Vicdan, A.K. (2018). Kronik Obstrüktif Akciğer Hastalarının Uyku Kalitesinin Değerlendirilmesi, Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 11 (1), 14-18.
  • Ware, J.E., & Sherbourne, C. D. (1992). The MOS 36-Item Short-Form Healty Survey. Conceptual Framework and Item Selection. Med Care, 30 (6), 473-483.
  • Yıldırım, N. (2006). KOAH ve Reversibilite. Dispne, 2 (7), 49-54.
  • Yıldız, F. T., & Tel, H. (2013). Uyku hijyeni eğitiminin koroner yoğun bakım ve sonrası hastaların uyku kalitesine etkisi, Yoğun Bakım Hemşireliği Dergisi, 17 (1), 1-7.
  • Zohal, M. A, Yazdi, Z., Kazemifar, A. M., Mahjoob, P., & Ziaeeha, M. (2014). Sleep Quality and Quality of Life in COPD Patients with and without Suspected Obstructive Sleep Apnea, Sleep Disorders, 2014, 508372.

KOAH Tanısı Almış Hastalara Verilen Uyku Hijyeni ve Derin Solunum-Öksürük Egzersizleri Eğitiminin Uyku ve Yaşam Kalitesine Etkisi

Year 2024, Volume: 9 Issue: 2, 258 - 270, 31.08.2024
https://doi.org/10.25279/sak.1113406

Abstract

Giriş: Kronik hastalıklar, yaşam kalitesini olumsuz etkileyen faktörlerin başında gelmektedir ve bu nedenle kronik hastalık semptomlarının hafifletilmesi ile hastaların yaşam kalitesinin artırılmasına yönelik girişimlerin planlanması gerekmektedir. Amaç: Bu çalışmanın amacı, KOAH tanısı ile yatmakta olan hastalara verilen uyku hijyeni ve derin solunum-öksürük egzersizi eğitiminin hastaların taburculuk sonrasında uyku ve yaşam kalitesine etkisinin belirlenmesidir. Gereç ve Yöntem: Bu çalışma, KOAH tanısı almış hastalarla 25 Şubat-30 Nisan 2018 tarihleri arasında yürütülmüştür. Eğitim verilmeden önce hastalara “Hasta Tanıtım Formu”, ”Uykuyu Etkileyen Faktörler Formu”, “Pittsburgh Uyku Kalitesi Ölçeği (PUKİ)” ile “Yaşam Kalitesi Ölçeği (SF-36)” uygulanmıştır. Verilerin değerlendirilmesinde yüzdelik, aritmetik ortalama, ki-kare ve t-testi kullanıldı. Bulgular: Girişim grubundaki hastaların eğitim öncesi ve eğitim sonrası toplam PUKİ puan ortalaması sırasıyla 14.20±1.45 ve 12.57±0.97; kontrol grubundaki hastaların 15.00±1.89 ve 14.80±1.13 idi. Girişim grubundaki hastaların eğitim öncesi ve eğitim sonrası Yaşam Kalitesi Ölçeği puan ortalaması sırasıyla 43.98±12.72 ve 117.12±15.09; kontrol grubundaki hastaların ise 36.93±5.77 ve 38.13±5.67 idi. Girişim grubunda ön test ve son test toplam PUKİ (z:-4.178, p<0.001) ve yaşam kalitesi (z:-4.782, p<0.001) puan ortalamaları arasında istatistiksel olarak anlamlı farklılık saptanırken, kontrol grubunda istatistiksel olarak anlamlı farklılık saptanmamıştır. Sonuç: Uyku hijyeni ve derin solunum öksürük egzersizi eğitiminin uyku ve yaşam kalitesi üzerinde etkili olduğu saptandı

References

  • Ağargün, M.Y., Kara, H., & Anlar, Ö. (1996). Pittsburgh Uyku Kalitesi İndeksi‟nin Geçerlilik ve Güvenilirliği, Türk Psikiyatri Dergisi, 7(2), 107- 115.
  • Akıncı, A.Ç. KOAH’lı Hastalara Uygulanan Pulmoner Rehabilitasyonun Fiziksel ve Psikolojik Parametrelere Etkisi. MÜ, Doktora Tezi, 2008, İstanbul (Danışman: Prof. Dr. Nermin Olgun).
  • Baker, E., & Fatoye, F. (2017). Clinical and Cost Effectiveness of Nurse-led Self-Management Interventions for Patients with COPD in Primary Care: A Systematic Review. International Journal of Nursing Studies, 71, 125-138.
  • Budhiraja, R., Parthasarathy, S., Budhiraja, P., Habib, M.P., Wendel, C., & Quan, S.F. (2012). Insomnia in Patients with COPD. Sleep, 35, 369-375.
  • Buysse, D.J., Reynolds, C.F., Berman, S.R., & Kupfer, D.J. (1989). The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Psychiatry Research, 28(2), 193-213.
  • Bülbül, Y. (2013). Kronik Obstrüktif Akciğer Hastalığında Uyku Sorunları. Güncel Göğüs Hastalıkları Serisi, 1 (1), 80-85.
  • Büyüköztürk, Ş. (2011). Sosyal Bilimler için Veri Analizi El Kitabı. Pegem Akademi, Ankara.
  • Caia, J., Scott, TJ, Halson, S.L., & Kelly, V.G. (2018). The influence of sleep hygiene education on sleep in professional rugby league athletes. Sleep Health, 4(4), 364-368.
  • Cho, H.L., Tung, H.H., Lin, MS, Hsu, W.C., & Lee, C.P. (2017). Self Determined Motivation and Exercise Behavior in COPD Patients. International Journal of Nursing Practice, 23 (3), 1-9.
  • Demiralp, M., Oflaz, F., & Komurcu, S. (2010). Effects of relaxation training on sleep quality and fatigue in patients with breast cancer undergoing adjuvant chemotherapy, Journal of Clinical Nursing, 19, 1073–1083.
  • Doğan, U. KOAH Tanılı Hastalara Verilen Sağlık Eğitiminin Günlük Oksijen Konsantratörü Kullanım Sürelerine Etkisi. Gaziantep Üniversitesi Sağlık Bilimleri Enstitüsü Yüksek Lisans Tezi, Gaziantep, 2016 (Danışman: Prof. Dr. Nimet Ovayolu).
  • Duman, M., & Taşhan, S.T. (2018). The effect of sleep hygiene education and relaxation exercises on insomnia among postmenopausal women: A randomized clinical trial, Int J Nurs Practice, 24 (4), e12650.
  • Esen, H. KOAH Hastalarında Uyku Kalitesi ve Yaşam Kalitesi Arasındaki İlişkinin Değerlendirilmesi. Afyon Kocatepe Üniversitesi Sağlık Bilimleri Enstitüsü, Yüksek Lisans Tezi, 2008, Afyonkarahisar (Danışman: Doç. Dr. Serap Demir).
  • Erdinç, E., Polatlı, M., & Kocabaş, A. et al. (2010). Türk Toraks Derneği Kronik Obstrüktif Akciğer Hastalığı Tanı ve Tedavi Uzlaşı Raporu, Turkish Thoracic Journal, 11(1), 1-64.
  • Folch-Ayoraa, A., Orts-Cortés, M.I., Macia-Soler, L., Andreu-Guillamon M.V., & Moncho, J. (2019). Patient education during hospital admission due to exacerbation of chronic obstructive pulmonary disease: Effects on quality of life- Controlled and randomized experimental study, Patient Education and Counseling, 102 (3), 511-519.
  • Gellis, L.A., & Lichstein, K.L. (2009). Sleep hygiene practices of good and poor sleepers in the United States: An ınternet-based study. Behaviour Threapy, 40 (1), 1-9.
  • Global Initiative for Chronic Obstructive Lung Disease (2017). Pocket Guide to COPD Diagnosis, Management, and Prevention A Guide for Health Care Professionals, 1-33.
  • Hermiz, O., Comino, E., Marks, G., Daffurn, K., Wilson, S., & Harris, M. (2002). Randomized controlled trial of home based care of patients with chronic obstructive pulmonary disease. British Medical Journal, 325 (7370), 938-940.
  • Jen, R., Li, Y., Owens, R.L., & Malhotra, A. (2016). Sleep in Chronic Obstructive Pulmonary Disease: Evidence Gaps and Challenges. Canadian Respiratory Journal, 8,1-5.
  • Koçyiğit, H., Aydemir, Ö., Ölmez, N., & Memiş, A. (1999). Kısa form-36 (KF36)’nın Türkçe Versiyonunun Güvenirliliği ve Geçerliliği. İlaç ve Tedavi Dergisi, 12(2), 102-106.
  • Köktürk, N., Gürgün, A., Şen, E., Kocabaş, A., Polatlı, M., & Naycı, S.A. (2017). Türk Toraks Derneği’nin GOLD 2017 Kronik Obstrüktif Akciğer Hastalığı (KOAH) Raporuna Bakışı, 1-42.
  • Luk, E. K., Hutchinson, A. F., Tacey, M., Irving, L., & Khan, F. (2017). COPD: Health Care Utilisation Patterns with Different Disease Management Interventions. Lung, 195 (4), 455-461.
  • McCurry, M.S., Gibbons, L.E., Logsdon, R.G., Vitiello, M.V., & Teri, L. (2005). Nighttime Insomnia Treatment and Education for Alzheimer's Disease: A Randomized, Controlled Trial. Journal of the American Geriatrics Society, 53 (5), 793- 798.
  • McKay, A., Mahesh, P. A., Fordham, J. Z., & Majeed, A. (2012). Prevalence of COPD in India: A Systematic Review. Primary Care Respiratory Journal, 21 (3), 313-321.
  • McDonnell, L.M., Hogg, L., McDonnell, L., & White, P. (2014). Pulmonary Rehabilitation and Sleep Quality: A Before and After Controlled Study of Patients With Chronic Obstructive Pulmonary Disease, Primary Care Respiratory Medicine (2014) 24, 14028.
  • Özgen Alpaydın, A., Baha, A., Çöplü, L., et al. (2021). Tanım ve Epidemiyoloji, Hastalık Gelişimi ve İlerlemesine Etkili Faktörler, Patoloji, Patogenez, Fizyopatoloji, Türk Toraks Derneği’nin GOLD 2021 Kronik Obstrüktif Akciğer Hastalığı (KOAH) Raporuna Bakışı, Ed: Şen, E., 1-7.
  • Özmen, İ., Yıldırım, E., & Öztürk, M., et al. (2018). Pulmonary Rehabilitation Reduces Emergency Admission and Hospitalization Rates of Patients with Chronic Respiratory Diseases. Turk Thorac J., 19 (4), 170-175.
  • Öztürk, Ö. (2011). Chronic Obstructive Pulmonary Disease and Sleep. Euras J Pulm., 13(2), 67-77. Padilha, J. M., Sousa, P.A.F, & Pereira, F.M.S. (2018). Nursing Clinical Practice Changes to Improve Self Management in Chronic Obstructive Pulmonary Disease. International Nursing Review, 65 (1), 122-130.
  • Reardon, J. Z. (2007). COPD and Exercise: What’s Really İmportant? A Nursing Perspective. Journal of Chronic Obstructive Pulmonary Disease, 4 (3), 283-287.
  • Scharf, S. M., Maimon, N., Simon-Tuval, T., Bernhard-Scharf, B.J., Reuveni, H., & Tarasiuk, A. (2011). Sleep Quality Predicts Quality of Life in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis., 22 (6), 1-12.
  • Sevilla Berrios, R.A., & Gay, P.C. (2016). Advances and New Approaches to Managing Sleep-Disordered Breathing Related to Chronic Pulmonary Disease. Sleep Medicine Clinics, 11 (2), 257-264.
  • Soler, X, Diaz-Piedra, C, & Ries, A.L. (2013). Pulmonary Rehabilitation Improves Sleep Quality in Chronic Lung Disease. COPD, 10, 156 –163.
  • Sullivan, M., Karlsson, J., & Ware, J. E. (1995). The Swedish SF-36 Health Survey I. Evaluation of Data Quality, Scaling Assumptions, Reliability and Construct Validity Across General Populations in Sweden. Social Science & Medicine, 41(10), 1349-1358.
  • Türk Toraks Derneği (8.11.2017). KOAH Tanı ve Tedavi Uzlaşı Raporu 2010. Retrieved from www.toraks.org.tr.
  • Vicdan, A.K. (2018). Kronik Obstrüktif Akciğer Hastalarının Uyku Kalitesinin Değerlendirilmesi, Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 11 (1), 14-18.
  • Ware, J.E., & Sherbourne, C. D. (1992). The MOS 36-Item Short-Form Healty Survey. Conceptual Framework and Item Selection. Med Care, 30 (6), 473-483.
  • Yıldırım, N. (2006). KOAH ve Reversibilite. Dispne, 2 (7), 49-54.
  • Yıldız, F. T., & Tel, H. (2013). Uyku hijyeni eğitiminin koroner yoğun bakım ve sonrası hastaların uyku kalitesine etkisi, Yoğun Bakım Hemşireliği Dergisi, 17 (1), 1-7.
  • Zohal, M. A, Yazdi, Z., Kazemifar, A. M., Mahjoob, P., & Ziaeeha, M. (2014). Sleep Quality and Quality of Life in COPD Patients with and without Suspected Obstructive Sleep Apnea, Sleep Disorders, 2014, 508372.
There are 39 citations in total.

Details

Primary Language English
Subjects Nursing
Journal Section Original research articles
Authors

Başak Menekşe 0000-0002-4784-1187

Kıvan Çevik 0000-0002-0556-8012

Publication Date August 31, 2024
Submission Date May 6, 2022
Acceptance Date March 23, 2024
Published in Issue Year 2024 Volume: 9 Issue: 2

Cite

APA Menekşe, B., & Çevik, K. (2024). The Effects of Sleep Hygiene and Deep Breathing - Cough Exercise Training on The Quality of Sleep and Life in COPD Diagnosed Patients. Sağlık Akademisi Kastamonu, 9(2), 258-270. https://doi.org/10.25279/sak.1113406

Health Academy Kastamonu is included in the class of 1-b journals (journals scanned in international indexes other than SCI, SSCI, SCI-expanded, ESCI) according to UAK associate professorship criteria. HEALTH ACADEMY KASTAMONU Journal cover is registered by the Turkish Patent Institute.