Effect of a Web-Based Educational Intervention on Quality of Life in Older Adults with Chronic Diseases: An Application of Orem’s Self-Care Theory

Effect of a Web-Based Educational Intervention on Quality of Life in Older Adults with Chronic Diseases: An Application of Orem’s Self-Care Theory | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of a Web-Based Educational Intervention on Quality of Life in Older Adults with Chronic Diseases: An Application of Orem’s Self-Care Theory Zahra Khalilzadeh-Farsangi, Fatihe Kerman-Saravi, samanh fallah-karimi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7365413/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Introduction: Elderly individuals with chronic diseases face numerous challenges in maintaining their quality of life. Self-care is considered an effective strategy for disease management and improving quality of life. Orem's Self-Care Theory can provide an effective framework for empowering older adults in this regard. Therefore, this study was conducted to examine the effect of a web-based educational program based on Orem's self-care theory on the quality of life of older adults with chronic diseases. Methods: This quasi-experimental study with a pretest-posttest design was conducted in 2024 on 140 elderly individuals with chronic illnesses who referred to teaching hospitals in Zahedan. Participants were randomly assigned to intervention and control groups. The intervention group used a researcher-developed software for two months. This software was based on Orem’s theory with a disease-centered approach and included three specific modules (diabetes, hypertension, and kidney disease) as well as shared content rooted in Orem's model. Both groups completed the World Health Organization Quality of Life (WHOQOL) questionnaire at baseline and two months after the intervention. Data were analyzed using Chi-square, paired t-test, and independent t-test. Results: The findings showed that the majority of elderly participants in both the intervention group (65.71%) and the control group (57.4%) were women. The mean general quality of life score before the intervention was 58.51 ± 5.28 in the intervention group and 57.56 ± 4.91 in the control group. After the intervention, the mean score increased to 64.97 ± 4.99 in the intervention group, while it was 57.08 ± 5.50 in the control group. Self-care education based on Orem’s model significantly improved quality of life in all domains within the intervention group (p < 0.001). Conclusion: Self-care education based on Orem’s theory significantly improves the quality of life in elderly individuals with chronic diseases and can be utilized as an effective intervention in care programs. Orem self-care Theory quality of life older adults chronic disease Introduction With advancements in medical technology and improvements in public health indicators, the average human lifespan has increased globally ( 1 ). This demographic shift has led to a significant growth in the elderly population. According to the World Health Organization (WHO, 2021), the number of individuals aged 60 years and older is projected to exceed 2 billion by 2050( 2 ). This change has brought about substantial transformations in social structures and healthcare systems, necessitating responses to challenges related to the health and well-being of older adults( 3 ). Elderly individuals, particularly those suffering from chronic diseases, face numerous risks and limitations that can severely affect their quality of life( 4 ). Chronic conditions such as diabetes, cardiovascular diseases, chronic respiratory illnesses, and arthritis not only reduce physical capacity and increase the need for medical care but also adversely impact mental health and social interactions among older adults( 5 ). These factors underscore the critical importance of providing comprehensive care services for this vulnerable population( 6 ). In Iran, the 2016 census showed that the elderly population exceeded 7 million people (approximately 9%), and it is projected that this percentage will rise to over 10% by 2050( 7 ). The high prevalence of chronic diseases among Iranian older adults, coupled with a shortage of specialized care programs, emphasizes the urgent need for effective interventions aimed at improving their quality of life( 8 ). Furthermore, Iran’s unique cultural, economic, and social contexts demand locally tailored programs to ensure the real effectiveness of such interventions( 9 ). One of the most effective approaches for managing chronic diseases and enhancing the quality of life in the elderly is empowering them through self-care education( 10 ). Self-care involves a set of purposeful activities performed by individuals to maintain health, prevent disease progression, and improve daily functioning. Extensive research has demonstrated that self-care education programs increase patients’ knowledge, skills, and motivation, thereby reducing disease complications, hospital admissions, and improving psychological and social well-being( 11 ). To design effective educational programs, it is essential to employ valid nursing theories and models. Orem’s Self-Care Deficit Nursing Theory, a foundational framework in nursing science, provides a precise conceptual structure for understanding individuals’ self-care needs and the role of caregivers( 12 ). The theory posits that while individuals naturally strive to meet their self-care needs, they may require support, education, and guidance during illness or disability. Educational interventions based on this theory aim to increase the independence of older adults in self-care and enhance their ability to manage chronic diseases effectively( 13 ). Globally, numerous studies have confirmed the efficacy of Orem-based self-care education in improving quality of life among patients with chronic diseases. For example, research conducted in various countries has shown that such education reduces disease symptoms, improves treatment adherence, enhances mental health, and promotes better daily functioning( 14 ). However, in countries like Iran, where cultural, economic, and healthcare access disparities exist, there is a relative paucity of research tailored to local contexts, highlighting the need for indigenous studies( 15 ). In Zahedan city—regions with lower socioeconomic status and limited healthcare access—older adults face greater vulnerabilities due to factors such as insufficient health education and economic hardships. Chronic diseases are prevalent in this area, and there is a noticeable lack of targeted interventions to empower the elderly. Hence, evaluating the effectiveness of Orem-based self-care education in this setting can provide valuable data for health policymakers and professionals, guiding the development of sustainable and effective care programs. Considering these factors, the present study aims to assess the impact of self-care education based on Orem’s theory on the quality of life of elderly patients with chronic diseases attending teaching hospitals in Zahedan. Methods Setting and Study Design: This quasi-experimental study with a pretest-posttest design was conducted on two groups. Seventy elderly individuals with chronic illnesses (diabetes, cardiovascular, or kidney disease) who referred to teaching hospitals in Zahedan were selected based on the sample size formula and similar studies( 16 ), and were randomly assigned to intervention and control groups (35 participants each). The focus on elderly individuals with chronic diseases was grounded in compelling scientific, epidemiological, and theoretical reasons. The higher prevalence of chronic conditions and polypharmacy in this age group, along with the progressive decline in functional and cognitive capacities associated with aging, puts them at greater risk of inadequate self-care and, consequently, reduced quality of life. Population, Inclusion, and Exclusion Criteria: Inclusion criteria were: age over 65 years, basic literacy (reading and writing), owning and being able to use a smartphone, having at least one of the mentioned chronic diseases for a minimum of six months, and willingness to participate in the study. Exclusion criteria included not using the software for more than one week, death, or sudden deterioration in physical condition. Data Collection Tool: Data collection tools consisted of two parts: a demographic information form and the World Health Organization Quality of Life (WHOQOL) questionnaire, which includes four subscales—physical health, psychological health, social relationships, and environmental health—along with a general quality of life score. Raw scores for each subscale were converted into standardized scores (0 to 100) using a specific formula, with higher scores indicating better quality of life. The validity and reliability of this questionnaire have been confirmed in Iran by Nasiri et al., reporting a Cronbach’s alpha coefficient of 0.84 ( 17 , 18 ). Study Procedure: To conduct the study, the researcher was present at the study site, introduced themselves, and provided a complete explanation of the study. Informed written consent was obtained from eligible participants. Participants were assured that their information would remain confidential and that they could withdraw from the study at any time. Initially, the educational needs of elderly participants in the intervention group were assessed using a needs assessment worksheet based on Orem’s self-care model, adapted from the book Concepts and Theories in Nursing by Amirkhanyan( 19 ).The study was implemented by sending the intervention group a link to the educational software developed by the researchers. The software was designed and implemented by a technology company located in the Science and Technology Park of Zahedan University of Medical Sciences. This company has a proven track record in developing digital health solutions and holds valid certifications in medical software development. The software was based on Orem’s theory with a disease-centered approach, containing three dedicated modules (diabetes, hypertension, and kidney disease) alongside shared content grounded in Orem’s model. Upon logging in with a unique code, each user was directed only to the module corresponding to their specific condition, with no access to the other modules. The educational content of each module is presented ( Table 1 ) . The Orem-based core, serving as the theoretical foundation across all modules, operationalized the three major components of Orem’s theory through practical tools. For universal self-care needs, training was provided in areas such as nutrition, sleep management, and fall prevention. For developmental needs, content included strategies for reducing anxiety and maintaining cognitive function. For health deviation needs, topics included polypharmacy management and monitoring of warning signs. The intervention group used the software for two months. Concurrently, the researcher conducted structured follow-up phone calls twice a week (a total of 16 calls, each lasting 15–20 minutes per participant). These calls were made by the corresponding author and aimed to resolve technical issues with the software, respond to content-related questions about self-care, and gather user feedback for system improvement. This interactive approach was integrated with the software’s automatic monitoring features (tracking usage time and educational progress) to ensure the intervention was delivered optimally and with maximum effectiveness. Two months after the intervention, both the intervention and control groups completed the quality of life questionnaire again. Table 1 Educational Content by Disease Module Educational Content Disease Module Visual instruction on using a glucometer Smart logging of results with weekly trend charts Automatic alerts for high/low blood sugar levels Foot examination training Step-by-step visual guide for daily foot washing and inspection Food image bank categorized by glycemic index (green, yellow, red) Carbohydrate calculator via product barcode scanning Audio guide for managing hypoglycemic episodes Visual checklist of diabetic ketoacidosis symptoms Diabetes Module Instruction on calibrating home blood pressure monitors Guided breathing exercises with audio support Digital diary for recording stress triggers Short games to reduce anxiety Barcode scanning of food items to display sodium content Weekly low-sodium meal plans with quick recipes Warning signs of stroke Hypertension Module Smart fluid intake calculator Image gallery of high-potassium/phosphorus foods with warning labels Visual checklist for detecting edema Instruction on daily weight monitoring Medication alerts to avoid NSAIDs Kidney Disease Module Statistical Analysis : After data collection, normality was assessed using the Shapiro-Wilk test. Subsequently, the data were analyzed using descriptive and inferential statistics. Paired t-tests were used for within-group comparisons, independent t-tests for between-group comparisons of variables, and Chi-square and Fisher’s exact tests for categorical data. All analyses were conducted using SPSS version 27, and a significance level of 0.05 was considered. Results The findings of the study indicated that the majority of participants in both the intervention group (51.42%) and the control group (57.14%) were aged between 65 and 75 years. Most elderly individuals in the intervention group (65.71%) and the control group (57.4%) were female. Chi-square analysis revealed no significant differences between the intervention and control groups in terms of age, gender, type of chronic disease, marital status, education level, economic status, and ethnicity ( Table 2 ). The assumption of normal distribution for quality of life and its subdomains was confirmed (p > 0.05). Comparison of quality of life between the two groups before the intervention showed no statistically significant differences in the mean scores of overall quality of life and its domains based on independent t-test results, indicating the two groups were homogeneous at baseline (p > 0.05). One month after the intervention, the comparison between the two groups showed a statistically significant difference in the mean (± SD) general quality of life scores: 64.97 ± 4.99 in the intervention group versus 57.08 ± 5.50 in the control group (p < 0.001), as demonstrated by the independent t-test. Self-care education based on Orem’s model significantly improved the quality of life among elderly individuals in the intervention group. This improvement was evident in the comparison of mean quality of life scores before and one month after the intervention within the intervention group (p 0.05) ( Table 3 ). Furthermore, statistically significant differences were found between the two groups across all domains of quality of life—including environmental health, physical health, psychological health, social relationships, and overall quality of life—with the intervention group, which received Orem-based self-care training, achieving notably higher scores (Table 3 ). Table 2 Frequency of demographic variables of elderly people with chronic diseases Variable Intervention group Control group p-value age 65–75 years 36(51/4%) 40 (57/1%) P = 0/34 75–85 years 24 (34/2%) 14(20%) 85 years and above 10 (14/2%) 16(22/8%) gender the man 24(34/2%) 30(42/8%) P = 0/46 woman 46(65/7%) 40(57/1%) Type of chronic disease diabetes 40 (57/1%) 34(48/5%) P = 0/74 high blood pressure 18 (25/7%) 20(28/5%) kidney 12 (17/1%) 16(22/8%) Level of education under diploma 24(34/2%) 16(22/8%) P = 0/26 diploma 20(28/5%) 36(51/4%) Higher than diploma 26(37/1%) 18(25/7%) marital status single 2(2/8%) 6(8/5%) P = 0/38 married 58(82/8%) 46(65/7%) deceased wife 8(11/4%) 16(22/8%) divorced 2(2/8%) 2(2/8%) Economic situation weak 18(25/7%) 14(20%) P = 0/67 average 32(45/7%) 28(40%) good 10(14/2%) 18(25/7%) great 10(14/2%) 10(14/2%) ethnicity Fars 22(31/4%) 30(42/8%) P = 0/59 other 48(68/5) 40(57/1%) Table 3 Comparison of the mean score of quality of life dimensions before and after intervention in the two control and intervention groups in elderly people with chronic diseases Dimensions of quality of life Intervention group Mean ± standard deviation Control group Mean ± standard deviation p-value environmental health Before intervention 44/77 ± 9/08 47/25 ± 9/38 P = 0/26 After the intervention 53/57 ± 8/53 47/02 ± 9/35 P = 0/003 The result of the paired t test P < 0/001 P = 0/57 physical health Before intervention 49/91 ± 8/36 51/22 ± 7/90 P = 0/50 After the intervention 55/20 ± 9/06 51/02 ± 7/99 P = 0/04 The result of the paired t test P < 0/001 P = 0/90 mental health Before intervention 49/77 ± 10/12 49/31 ± 7/71 P = 0/83 After the intervention 56/28 ± 9/68 49/37 ± 7/67 P = 0/001 The result of the paired t test P < 0/001 P = 0/13 Social relations Before intervention 60/91 ± 6/80 61/54 ± 5/46 P = 0/67 After the intervention 67/74 ± 5/61 62/20 ± 5/57 P < 0/001 The result of the paired t test P < 0/001 P = 0/12 General quality of life Before intervention 58/51 ± 5/28 56/57 ± 4/91 P = 0/11 After the intervention 64/97 ± 4/99 57/08 ± 5/50 P < 0/001 The result of the paired t test P < 0/001 P = 0/19 Discussion The present study aimed to evaluate the effect of Orem-based self-care education on the quality of life of elderly individuals with chronic diseases. The results showed a significant increase in the mean quality of life scores in the intervention group two months after the educational intervention, while no notable change was observed in the control group (p < 0.001). These findings support the effectiveness of theory-driven self-care education in improving the quality of life of older adults managing chronic health conditions over time. These outcomes are corroborated by several previous investigations. In a quasiexperimental trial conducted in Iran among patients with hypertension, Khademian et al. (2020) reported significant improvements in quality of life eight weeks after Orem-based self-care education in the intervention group compared to the control group, whereas no significant differences were observed immediately post-intervention ( 20 ). Similarly, Hashemlu et al. (2015) implemented a structured Orembased educational program in Iranian nursing home residents and found significant enhancements in both physical and psychological domains of quality of life one month postintervention, with posttest improvement significantly different from the control group ( 21 ). Moreover, Xu et al. (2020) performed a randomized clinical trial with elderly hip fracture patients and demonstrated that Orembased selfcare education significantly reduced complications, enhanced functional independence, and improved overall quality of life during hospitalization and recovery ( 22 ). Additionally, Nasiri et al. (2023) conducted a systematic review and metaanalysis of Oremguided selfcare interventions across various chronic illnesses, confirming consistent improvements in quality of life, selfefficacy, and emotional wellbeing among diverse patient populations( 23 ). Lastly, in cancer care, Rakhshani et al. (2022) documented that cancer patients undergoing chemotherapy who received Orembased selfcare education showed significantly higher selfcare ability two months post-intervention, highlighting the model’s applicability in complex chronic disease settings ( 14 ). Together, these studies reinforce the present findings, demonstrating that educational interventions framed by Orem’s SelfCare Deficit Nursing Theory reliably enhance quality of life and functional outcomes in elderly individuals with chronic conditions. The consistency observed across different diseases, populations, and settings supports the adaptability and robustness of Orem’s model as a foundational framework for designing effective care strategies. However, some investigations have reported limited or non-significant improvements in quality-of-life outcomes following Orem-based interventions. For instance, a randomized controlled trial among patients with advanced heart failure in the Netherlands demonstrated that, although selfcare behaviors improved in the intervention group, qualityoflife measures did not differ significantly between the intervention and control groups during follow-up; any observed improvements were similar across both groups over time, suggesting greater intervention intensity may be required to achieve QoL gains( 24 ). Similarly, a study on type II diabetes patients in Ilam, Iran, found no significant difference in overall quality-of-life scores between experimental and control groups immediately following Orem-based education, indicating that baseline equivalence did not necessarily guarantee post-intervention effectiveness in every context ( 25 ). These mixed outcomes may reflect variations in disease context, duration and intensity of educational exposure, cultural relevance, and healthcare infrastructure across settings. While many studies—especially those involving hypertension, cancer, coronary artery bypass and rehabilitation—demonstrate clear benefits in self-care and life quality, these divergent findings emphasize the importance of tailoring Orem-based programs rigorously to patient needs and local conditions. Such nuance is essential for designing interventions that are both feasible and impactful across different chronic disease populations and healthcare environments. The limitations of the present study are as follows: The sample size was relatively small, which may limit the generalizability of the results to the broader population of elderly individuals with chronic diseases. The follow-up period was only two months, which might be insufficient to assess the long-term sustainability of changes in self-care behaviors and quality of life. The use of self-reported questionnaires increases the risk of biases such as social desirability and recall inaccuracies. Additionally, the consistency in the delivery and adherence to the educational program may have varied, potentially affecting the uniformity of the intervention’s impact. The specific cultural, social, and economic factors of Iranian elderly may limit the applicability of the intervention in other contexts. Furthermore, differences in access to and literacy of technology among the elderly could influence participation rates and the overall effectiveness of the program. Conclusion The findings of this study clearly indicate that self-care education based on Orem’s theory can serve as an effective intervention to improve the quality of life among elderly individuals with chronic diseases. This type of education enhances personal skills and capabilities in managing chronic conditions, playing a crucial role in increasing functional independence and improving physical, psychological, and social aspects of quality of life. Given the growing elderly population and the high prevalence of chronic diseases in this group, implementing educational programs grounded in Orem’s theory can be considered an efficient strategy in health policy and care planning aimed at promoting the health and well-being of older adults. These results provide a foundation for developing targeted interventions across various levels of healthcare and nursing practice. Declarations Ethics approval and consent to participate. All methods were carried out in accordance with relevant guidelines and regulations. The study protocol was approved by the Ethics Committee of Zahedan University of Medical Sciences (Approval code: IR.Zaums.REC.1403.260). Informed consent was obtained from all participants before they took part in the study. The project ID was 11424. Clinical Trial Number: Not applicable; this study does not require a clinical trial. Ethical approval and consent to participate: All methods were carried out in accordance with relevant guidelines and regulations. The study protocol was approved by the Ethics Committee of Zahedan University of Medical Sciences (Approval code: IR.Zaums.REC.1403.260). Informed consent was obtained from all participants before they took part in the study. Research participants were informed of the confidentiality and voluntary nature of the information. All methods of participation in the study were conducted in accordance with relevant guidelines and regulations, consistent with the Declaration of Helsinki. Clinical Trial Number: Not applicable; this study does not require a clinical trial. Competing interests: The authors report no conflict of interest in the undertaking of research. Funding: This study was funded by the research project number 11424 at Zahedan University of Medical Sciences. Consent for publication: Not applicable. References Mahara G, Tian C, Xu X, Wang W. 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18:54:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":641212,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7365413/v1/2310b724-0a2f-46cc-ae80-6e014dd3c33a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of a Web-Based Educational Intervention on Quality of Life in Older Adults with Chronic Diseases: An Application of Orem’s Self-Care Theory","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith advancements in medical technology and improvements in public health indicators, the average human lifespan has increased globally (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This demographic shift has led to a significant growth in the elderly population. According to the World Health Organization (WHO, 2021), the number of individuals aged 60 years and older is projected to exceed 2\u0026nbsp;billion by 2050(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This change has brought about substantial transformations in social structures and healthcare systems, necessitating responses to challenges related to the health and well-being of older adults(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eElderly individuals, particularly those suffering from chronic diseases, face numerous risks and limitations that can severely affect their quality of life(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Chronic conditions such as diabetes, cardiovascular diseases, chronic respiratory illnesses, and arthritis not only reduce physical capacity and increase the need for medical care but also adversely impact mental health and social interactions among older adults(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). These factors underscore the critical importance of providing comprehensive care services for this vulnerable population(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In Iran, the 2016 census showed that the elderly population exceeded 7\u0026nbsp;million people (approximately 9%), and it is projected that this percentage will rise to over 10% by 2050(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The high prevalence of chronic diseases among Iranian older adults, coupled with a shortage of specialized care programs, emphasizes the urgent need for effective interventions aimed at improving their quality of life(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Furthermore, Iran\u0026rsquo;s unique cultural, economic, and social contexts demand locally tailored programs to ensure the real effectiveness of such interventions(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOne of the most effective approaches for managing chronic diseases and enhancing the quality of life in the elderly is empowering them through self-care education(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Self-care involves a set of purposeful activities performed by individuals to maintain health, prevent disease progression, and improve daily functioning. Extensive research has demonstrated that self-care education programs increase patients\u0026rsquo; knowledge, skills, and motivation, thereby reducing disease complications, hospital admissions, and improving psychological and social well-being(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo design effective educational programs, it is essential to employ valid nursing theories and models. Orem\u0026rsquo;s Self-Care Deficit Nursing Theory, a foundational framework in nursing science, provides a precise conceptual structure for understanding individuals\u0026rsquo; self-care needs and the role of caregivers(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The theory posits that while individuals naturally strive to meet their self-care needs, they may require support, education, and guidance during illness or disability. Educational interventions based on this theory aim to increase the independence of older adults in self-care and enhance their ability to manage chronic diseases effectively(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGlobally, numerous studies have confirmed the efficacy of Orem-based self-care education in improving quality of life among patients with chronic diseases. For example, research conducted in various countries has shown that such education reduces disease symptoms, improves treatment adherence, enhances mental health, and promotes better daily functioning(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, in countries like Iran, where cultural, economic, and healthcare access disparities exist, there is a relative paucity of research tailored to local contexts, highlighting the need for indigenous studies(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In Zahedan city\u0026mdash;regions with lower socioeconomic status and limited healthcare access\u0026mdash;older adults face greater vulnerabilities due to factors such as insufficient health education and economic hardships. Chronic diseases are prevalent in this area, and there is a noticeable lack of targeted interventions to empower the elderly. Hence, evaluating the effectiveness of Orem-based self-care education in this setting can provide valuable data for health policymakers and professionals, guiding the development of sustainable and effective care programs. Considering these factors, the present study aims to assess the impact of self-care education based on Orem\u0026rsquo;s theory on the quality of life of elderly patients with chronic diseases attending teaching hospitals in Zahedan.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSetting and Study Design:\u003c/h2\u003e\u003cp\u003eThis quasi-experimental study with a pretest-posttest design was conducted on two groups. Seventy elderly individuals with chronic illnesses (diabetes, cardiovascular, or kidney disease) who referred to teaching hospitals in Zahedan were selected based on the sample size formula and similar studies(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and were randomly assigned to intervention and control groups (35 participants each).\u003c/p\u003e\u003cp\u003eThe focus on elderly individuals with chronic diseases was grounded in compelling scientific, epidemiological, and theoretical reasons. The higher prevalence of chronic conditions and polypharmacy in this age group, along with the progressive decline in functional and cognitive capacities associated with aging, puts them at greater risk of inadequate self-care and, consequently, reduced quality of life.\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003ch3\u003ePopulation, Inclusion, and Exclusion Criteria:\u003c/h3\u003e\n\u003cp\u003eInclusion criteria were: age over 65 years, basic literacy (reading and writing), owning and being able to use a smartphone, having at least one of the mentioned chronic diseases for a minimum of six months, and willingness to participate in the study. Exclusion criteria included not using the software for more than one week, death, or sudden deterioration in physical condition.\u003c/p\u003e\n\u003ch3\u003eData Collection Tool:\u003c/h3\u003e\n\u003cp\u003eData collection tools consisted of two parts: a demographic information form and the World Health Organization Quality of Life (WHOQOL) questionnaire, which includes four subscales\u0026mdash;physical health, psychological health, social relationships, and environmental health\u0026mdash;along with a general quality of life score. Raw scores for each subscale were converted into standardized scores (0 to 100) using a specific formula, with higher scores indicating better quality of life. The validity and reliability of this questionnaire have been confirmed in Iran by Nasiri et al., reporting a Cronbach\u0026rsquo;s alpha coefficient of 0.84 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eStudy Procedure:\u003c/h3\u003e\n\u003cp\u003eTo conduct the study, the researcher was present at the study site, introduced themselves, and provided a complete explanation of the study. Informed written consent was obtained from eligible participants. Participants were assured that their information would remain confidential and that they could withdraw from the study at any time.\u003c/p\u003e\u003cp\u003eInitially, the educational needs of elderly participants in the intervention group were assessed using a needs assessment worksheet based on Orem\u0026rsquo;s self-care model, adapted from the book \u003cem\u003eConcepts and Theories in Nursing\u003c/em\u003e by Amirkhanyan(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).The study was implemented by sending the intervention group a link to the educational software developed by the researchers. The software was designed and implemented by a technology company located in the Science and Technology Park of Zahedan University of Medical Sciences. This company has a proven track record in developing digital health solutions and holds valid certifications in medical software development.\u003c/p\u003e\u003cp\u003eThe software was based on Orem\u0026rsquo;s theory with a disease-centered approach, containing three dedicated modules (diabetes, hypertension, and kidney disease) alongside shared content grounded in Orem\u0026rsquo;s model. Upon logging in with a unique code, each user was directed only to the module corresponding to their specific condition, with no access to the other modules.\u003c/p\u003e\u003cp\u003eThe educational content of each module is presented \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. The Orem-based core, serving as the theoretical foundation across all modules, operationalized the three major components of Orem\u0026rsquo;s theory through practical tools. For universal self-care needs, training was provided in areas such as nutrition, sleep management, and fall prevention. For developmental needs, content included strategies for reducing anxiety and maintaining cognitive function. For health deviation needs, topics included polypharmacy management and monitoring of warning signs.\u003c/p\u003e\u003cp\u003eThe intervention group used the software for two months. Concurrently, the researcher conducted structured follow-up phone calls twice a week (a total of 16 calls, each lasting 15\u0026ndash;20 minutes per participant). These calls were made by the corresponding author and aimed to resolve technical issues with the software, respond to content-related questions about self-care, and gather user feedback for system improvement. This interactive approach was integrated with the software\u0026rsquo;s automatic monitoring features (tracking usage time and educational progress) to ensure the intervention was delivered optimally and with maximum effectiveness.\u003c/p\u003e\u003cp\u003eTwo months after the intervention, both the intervention and control groups completed the quality of life questionnaire again.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEducational Content by Disease Module\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational Content\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisease Module\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisual instruction on using a glucometer\u003c/p\u003e\u003cp\u003eSmart logging of results with weekly trend charts\u003c/p\u003e\u003cp\u003eAutomatic alerts for high/low blood sugar levels\u003c/p\u003e\u003cp\u003eFoot examination training\u003c/p\u003e\u003cp\u003eStep-by-step visual guide for daily foot washing and inspection\u003c/p\u003e\u003cp\u003eFood image bank categorized by glycemic index (green, yellow, red)\u003c/p\u003e\u003cp\u003eCarbohydrate calculator via product barcode scanning\u003c/p\u003e\u003cp\u003eAudio guide for managing hypoglycemic episodes\u003c/p\u003e\u003cp\u003eVisual checklist of diabetic ketoacidosis symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiabetes Module\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInstruction on calibrating home blood pressure monitors\u003c/p\u003e\u003cp\u003eGuided breathing exercises with audio support\u003c/p\u003e\u003cp\u003eDigital diary for recording stress triggers\u003c/p\u003e\u003cp\u003eShort games to reduce anxiety\u003c/p\u003e\u003cp\u003eBarcode scanning of food items to display sodium content\u003c/p\u003e\u003cp\u003eWeekly low-sodium meal plans with quick recipes\u003c/p\u003e\u003cp\u003eWarning signs of stroke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHypertension Module\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmart fluid intake calculator\u003c/p\u003e\u003cp\u003eImage gallery of high-potassium/phosphorus foods with warning labels\u003c/p\u003e\u003cp\u003eVisual checklist for detecting edema\u003c/p\u003e\u003cp\u003eInstruction on daily weight monitoring\u003c/p\u003e\u003cp\u003eMedication alerts to avoid NSAIDs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKidney Disease Module\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e\u003cb\u003eStatistical Analysis\u003c/b\u003e:\u003c/h2\u003e\u003cp\u003eAfter data collection, normality was assessed using the Shapiro-Wilk test. Subsequently, the data were analyzed using descriptive and inferential statistics. Paired t-tests were used for within-group comparisons, independent t-tests for between-group comparisons of variables, and Chi-square and Fisher\u0026rsquo;s exact tests for categorical data. All analyses were conducted using SPSS version 27, and a significance level of 0.05 was considered.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe findings of the study indicated that the majority of participants in both the intervention group (51.42%) and the control group (57.14%) were aged between 65 and 75 years. Most elderly individuals in the intervention group (65.71%) and the control group (57.4%) were female. Chi-square analysis revealed no significant differences between the intervention and control groups in terms of age, gender, type of chronic disease, marital status, education level, economic status, and ethnicity \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe assumption of normal distribution for quality of life and its subdomains was confirmed (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Comparison of quality of life between the two groups before the intervention showed no statistically significant differences in the mean scores of overall quality of life and its domains based on independent t-test results, indicating the two groups were homogeneous at baseline (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eOne month after the intervention, the comparison between the two groups showed a statistically significant difference in the mean (\u0026plusmn;\u0026thinsp;SD) general quality of life scores: 64.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99 in the intervention group versus 57.08\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50 in the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as demonstrated by the independent t-test.\u003c/p\u003e\u003cp\u003eSelf-care education based on Orem\u0026rsquo;s model significantly improved the quality of life among elderly individuals in the intervention group. This improvement was evident in the comparison of mean quality of life scores before and one month after the intervention within the intervention group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, no significant change was observed in the control group during the same period (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFurthermore, statistically significant differences were found between the two groups across all domains of quality of life\u0026mdash;including environmental health, physical health, psychological health, social relationships, and overall quality of life\u0026mdash;with the intervention group, which received Orem-based self-care training, achieving notably higher scores (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency of demographic variables of elderly people with chronic diseases\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65\u0026ndash;75 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36(51/4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40 (57/1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75\u0026ndash;85 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (34/2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14(20%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85 years and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (14/2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(22/8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003egender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ethe man\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(34/2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30(42/8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ewoman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46(65/7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40(57/1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eType of chronic disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ediabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40 (57/1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34(48/5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ehigh blood pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (25/7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20(28/5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ekidney\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (17/1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(22/8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eLevel of education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eunder diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(34/2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(22/8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ediploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(28/5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36(51/4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigher than diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26(37/1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18(25/7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003emarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003esingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(2/8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(8/5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003emarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58(82/8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46(65/7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003edeceased wife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(11/4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(22/8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003edivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(2/8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(2/8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eEconomic situation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eweak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(25/7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14(20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eaverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32(45/7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28(40%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(14/2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18(25/7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egreat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(14/2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(14/2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eethnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFars\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22(31/4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30(42/8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48(68/5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40(57/1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of the mean score of quality of life dimensions before and after intervention in the two control and intervention groups in elderly people with chronic diseases\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eDimensions of quality of life\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention group\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eenvironmental health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBefore intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44/77\u0026thinsp;\u0026plusmn;\u0026thinsp;9/08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47/25\u0026thinsp;\u0026plusmn;\u0026thinsp;9/38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfter the intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53/57\u0026thinsp;\u0026plusmn;\u0026thinsp;8/53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47/02\u0026thinsp;\u0026plusmn;\u0026thinsp;9/35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe result of the paired t test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0/001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ephysical health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBefore intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49/91\u0026thinsp;\u0026plusmn;\u0026thinsp;8/36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51/22\u0026thinsp;\u0026plusmn;\u0026thinsp;7/90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfter the intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55/20\u0026thinsp;\u0026plusmn;\u0026thinsp;9/06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51/02\u0026thinsp;\u0026plusmn;\u0026thinsp;7/99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe result of the paired t test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0/001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003emental health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBefore intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49/77\u0026thinsp;\u0026plusmn;\u0026thinsp;10/12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49/31\u0026thinsp;\u0026plusmn;\u0026thinsp;7/71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfter the intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56/28\u0026thinsp;\u0026plusmn;\u0026thinsp;9/68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49/37\u0026thinsp;\u0026plusmn;\u0026thinsp;7/67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe result of the paired t test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0/001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSocial relations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBefore intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60/91\u0026thinsp;\u0026plusmn;\u0026thinsp;6/80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61/54\u0026thinsp;\u0026plusmn;\u0026thinsp;5/46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfter the intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67/74\u0026thinsp;\u0026plusmn;\u0026thinsp;5/61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62/20\u0026thinsp;\u0026plusmn;\u0026thinsp;5/57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0/001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe result of the paired t test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0/001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGeneral quality of life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBefore intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58/51\u0026thinsp;\u0026plusmn;\u0026thinsp;5/28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56/57\u0026thinsp;\u0026plusmn;\u0026thinsp;4/91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfter the intervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64/97\u0026thinsp;\u0026plusmn;\u0026thinsp;4/99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57/08\u0026thinsp;\u0026plusmn;\u0026thinsp;5/50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0/001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe result of the paired t test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0/001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0/19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to evaluate the effect of Orem-based self-care education on the quality of life of elderly individuals with chronic diseases. The results showed a significant increase in the mean quality of life scores in the intervention group two months after the educational intervention, while no notable change was observed in the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings support the effectiveness of theory-driven self-care education in improving the quality of life of older adults managing chronic health conditions over time.\u003c/p\u003e\u003cp\u003eThese outcomes are corroborated by several previous investigations. In a quasiexperimental trial conducted in Iran among patients with hypertension, Khademian et al. (2020) reported significant improvements in quality of life eight weeks after Orem-based self-care education in the intervention group compared to the control group, whereas no significant differences were observed immediately post-intervention (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Similarly, Hashemlu et al. (2015) implemented a structured Orembased educational program in Iranian nursing home residents and found significant enhancements in both physical and psychological domains of quality of life one month postintervention, with posttest improvement significantly different from the control group (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Moreover, Xu et al. (2020) performed a randomized clinical trial with elderly hip fracture patients and demonstrated that Orembased selfcare education significantly reduced complications, enhanced functional independence, and improved overall quality of life during hospitalization and recovery (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Additionally, Nasiri et al. (2023) conducted a systematic review and metaanalysis of Oremguided selfcare interventions across various chronic illnesses, confirming consistent improvements in quality of life, selfefficacy, and emotional wellbeing among diverse patient populations(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLastly, in cancer care, Rakhshani et al. (2022) documented that cancer patients undergoing chemotherapy who received Orembased selfcare education showed significantly higher selfcare ability two months post-intervention, highlighting the model\u0026rsquo;s applicability in complex chronic disease settings (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTogether, these studies reinforce the present findings, demonstrating that educational interventions framed by Orem\u0026rsquo;s SelfCare Deficit Nursing Theory reliably enhance quality of life and functional outcomes in elderly individuals with chronic conditions. The consistency observed across different diseases, populations, and settings supports the adaptability and robustness of Orem\u0026rsquo;s model as a foundational framework for designing effective care strategies.\u003c/p\u003e\u003cp\u003eHowever, some investigations have reported limited or non-significant improvements in quality-of-life outcomes following Orem-based interventions. For instance, a randomized controlled trial among patients with advanced heart failure in the Netherlands demonstrated that, although selfcare behaviors improved in the intervention group, qualityoflife measures did not differ significantly between the intervention and control groups during follow-up; any observed improvements were similar across both groups over time, suggesting greater intervention intensity may be required to achieve QoL gains(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Similarly, a study on type II diabetes patients in Ilam, Iran, found no significant difference in overall quality-of-life scores between experimental and control groups immediately following Orem-based education, indicating that baseline equivalence did not necessarily guarantee post-intervention effectiveness in every context (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese mixed outcomes may reflect variations in disease context, duration and intensity of educational exposure, cultural relevance, and healthcare infrastructure across settings. While many studies\u0026mdash;especially those involving hypertension, cancer, coronary artery bypass and rehabilitation\u0026mdash;demonstrate clear benefits in self-care and life quality, these divergent findings emphasize the importance of tailoring Orem-based programs rigorously to patient needs and local conditions. Such nuance is essential for designing interventions that are both feasible and impactful across different chronic disease populations and healthcare environments.\u003c/p\u003e\u003cp\u003eThe limitations of the present study are as follows: The sample size was relatively small, which may limit the generalizability of the results to the broader population of elderly individuals with chronic diseases. The follow-up period was only two months, which might be insufficient to assess the long-term sustainability of changes in self-care behaviors and quality of life. The use of self-reported questionnaires increases the risk of biases such as social desirability and recall inaccuracies. Additionally, the consistency in the delivery and adherence to the educational program may have varied, potentially affecting the uniformity of the intervention\u0026rsquo;s impact. The specific cultural, social, and economic factors of Iranian elderly may limit the applicability of the intervention in other contexts. Furthermore, differences in access to and literacy of technology among the elderly could influence participation rates and the overall effectiveness of the program.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study clearly indicate that self-care education based on Orem\u0026rsquo;s theory can serve as an effective intervention to improve the quality of life among elderly individuals with chronic diseases. This type of education enhances personal skills and capabilities in managing chronic conditions, playing a crucial role in increasing functional independence and improving physical, psychological, and social aspects of quality of life. Given the growing elderly population and the high prevalence of chronic diseases in this group, implementing educational programs grounded in Orem\u0026rsquo;s theory can be considered an efficient strategy in health policy and care planning aimed at promoting the health and well-being of older adults. These results provide a foundation for developing targeted interventions across various levels of healthcare and nursing practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate. All methods were carried out in accordance with relevant guidelines and regulations. The study protocol was approved by the Ethics Committee of Zahedan University of Medical Sciences (Approval code: IR.Zaums.REC.1403.260). Informed consent was obtained from all participants before they took part in the study. The project ID was 11424. Clinical Trial Number: Not applicable; this study does not require a clinical trial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll methods were carried out in accordance with relevant guidelines and regulations. The study protocol was approved by the Ethics Committee of Zahedan University of Medical Sciences (Approval code: IR.Zaums.REC.1403.260). Informed consent was obtained from all participants before they took part in the study. \u0026nbsp;Research participants were informed of the confidentiality and voluntary nature of the information. All methods of participation in the study were conducted in accordance with relevant guidelines and regulations, consistent with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable; this study does not require a clinical trial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no conflict of interest in the undertaking of research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the research project number 11424 at Zahedan University of Medical\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMahara G, Tian C, Xu X, Wang W. Revolutionising health care: Exploring the latest advances in medical sciences. J Glob Health. 2023;13:03042.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Ageing and health: World Health Organization; 2021 [Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health.\u003c/li\u003e\n\u003cli\u003eXi JY, Zhao JG, Li XQ, Yan B, Bai JJ, Xiang YN, et al. Quantifying the loss of healthy life expectancy due to population ageing: health benefit estimation from a global perspective. BMJ Glob Health. 2025;10(5).\u003c/li\u003e\n\u003cli\u003ePrince MJ, Wu F, Guo Y, Robledo LMG, O\u0026apos;Donnell M, Sullivan R, et al. The burden of disease in older people and implications for health policy and practice. The lancet. 2015;385(9967):549-62.\u003c/li\u003e\n\u003cli\u003eShaver LN, Beavers DP, Kiel J, Kritchevsky SB, Beavers KM. Effect of intentional weight loss on mortality biomarkers in older adults with obesity. The Journals of Gerontology: Series A. 2019;74(8):1303-9.\u003c/li\u003e\n\u003cli\u003eJunaid SB, Imam AA, Balogun AO, De Silva LC, Surakat YA, Kumar G, et al. Recent Advancements in Emerging Technologies for Healthcare Management Systems: A Survey. Healthcare (Basel). 2022;10(10).\u003c/li\u003e\n\u003cli\u003eFallahi F, Adib-hajbaghery M, Safa A. Status of age-friendly city indicators in Iran cities: a systematic review. BMC Geriatrics. 2024;24(1):412.\u003c/li\u003e\n\u003cli\u003eGoharinezhad S, Maleki M, Baradaran HR, Ravaghi H. A qualitative study of the current situation of elderly care in Iran: what can we do for the future? Glob Health Action. 2016;9:32156.\u003c/li\u003e\n\u003cli\u003eMobasseri K, Ghasemyani S, Khodayari-Zarnaq R, Kousha A. Developing a comprehensive model of home-based long-term care for older people in Iran: a multi-method study. BMC Health Services Research. 2025;25(1):298.\u003c/li\u003e\n\u003cli\u003eCong Z, Huo M, Jiang X, Yu H. Factors associated with the level of self-management in elderly patients with chronic diseases: a pathway analysis. BMC Geriatrics. 2024;24(1):377.\u003c/li\u003e\n\u003cli\u003eLorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1-7.\u003c/li\u003e\n\u003cli\u003eTanaka M, editor Orem\u0026apos;s nursing self‐care deficit theory: A theoretical analysis focusing on its philosophical and sociological foundation. Nursing forum; 2022: Wiley Online Library.\u003c/li\u003e\n\u003cli\u003eRasheed SP, Younas A, Mehdi F. Challenges, extent of involvement, and the impact of nurses\u0026rsquo; involvement in politics and policy making in in last two decades: an integrative review. Journal of Nursing Scholarship. 2020;52(4):446-55.\u003c/li\u003e\n\u003cli\u003eRakhshani T, Najafi S, Javady F, Taghian dasht bozorg A, Mohammadkhah F, Khani Jeihooni A. The effect of Orem-based self-care education on improving self-care ability of patients undergoing chemotherapy: a randomized clinical trial. BMC Cancer. 2022;22(1):770.\u003c/li\u003e\n\u003cli\u003eBordbar S, Shojaei P, Asadollahi A, Ravangard R, Shirazi F, Askarian M, et al. Identifying and evaluating the challenges of geriatric healthcare service provision in Iran: evidence from a mixed-methods study. Scientific Reports. 2025;15(1):28002.\u003c/li\u003e\n\u003cli\u003eAbdallah Moursi H, Said Sabry S, Abdelrazek Mahmoud A. Effect of Orem\u0026apos;s Self-Care Behavior Model on Quality of Life of Elderly Patients with Chronic Obstructive Pulmonary Disease. Egyptian Journal of Health Care. 2021;12(2):1126-51.\u003c/li\u003e\n\u003cli\u003eJenaabadi H, Valirooh S. The Effectiveness of World Health Organization-Based Life Skills Training on Resilience and Social Health among Sixth-Grade Male Elementary School Students. Preventive Counseling. 2021;2(2):41-50.\u003c/li\u003e\n\u003cli\u003eNejat S, Montazeri A, Holakouie Naieni K, Mohammad K, Majdzadeh S. The World Health Organization quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. Journal of school of public health and institute of public health research. 2006;4(4):1-12.\u003c/li\u003e\n\u003cli\u003eToygar İ, Han\u0026ccedil;erlioğlu S, Utku T, Şimşir IY, \u0026Ccedil;etinkalp Ş. Effect of an educational intervention based on Bandura\u0026rsquo;s theory on foot care self-efficacy in diabetes: a prospective quasi-experimental study. The International Journal of Lower Extremity Wounds. 2022;21(4):414-9.\u003c/li\u003e\n\u003cli\u003eKhademian Z, Kazemi Ara F, Gholamzadeh S. The Effect of Self Care Education Based on Orem\u0026apos;s Nursing Theory on Quality of Life and Self-Efficacy in Patients with Hypertension: A Quasi-Experimental Study. Int J Community Based Nurs Midwifery. 2020;8(2):140-9.\u003c/li\u003e\n\u003cli\u003eHashemlu L, Maslakpak MH, Bagherie F. The effects of a self-care educational program based on Orem\u0026rsquo;s theory on the quality of life of elderly people residing in nursing homes. Modern Care Journal. 2015;12(4):1-6.\u003c/li\u003e\n\u003cli\u003eXu X, Han J, Li Y, Sun X, Lin P, Chen Y, et al. Effects of Orem\u0026apos;s Self-Care Model on the Life Quality of Elderly Patients with Hip Fractures. Pain Res Manag. 2020;2020:5602683.\u003c/li\u003e\n\u003cli\u003eNasiri M, Jafari Z, Rakhshan M, Yarahmadi F, Zonoori S, Akbari F, et al. Application of Orem\u0026apos;s theory‐based caring programs among chronically ill adults: A systematic review and dose\u0026ndash;response meta‐analysis. International nursing review. 2023;70(1):59-77.\u003c/li\u003e\n\u003cli\u003eJaarsma T, Halfens R, Tan F, Abu-Saad HH, Dracup K, Diederiks J. Self-care and quality of life in patients with advanced heart failure: the effect of a supportive educational intervention. Heart Lung. 2000;29(5):319-30.\u003c/li\u003e\n\u003cli\u003eBorji M, Otaghi M, Kazembeigi S. The impact of Orem\u0026rsquo;s self-care model on the quality of life in patients with type II diabetes. Biomedical and Pharmacology Journal. 2017;10(1):213-20.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"ageing-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"agin","sideBox":"Learn more about [Ageing International](http://link.springer.com/journal/12126)","snPcode":"12126","submissionUrl":"https://submission.springernature.com/new-submission/12126/3","title":"Ageing International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Orem self-care Theory, quality of life, older adults, chronic disease","lastPublishedDoi":"10.21203/rs.3.rs-7365413/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7365413/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eElderly individuals with chronic diseases face numerous challenges in maintaining their quality of life. Self-care is considered an effective strategy for disease management and improving quality of life. Orem's Self-Care Theory can provide an effective framework for empowering older adults in this regard. Therefore, this study was conducted to examine the effect of a web-based educational program based on Orem's self-care theory on the quality of life of older adults with chronic diseases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003cbr\u003e\n \u003c/strong\u003eThis quasi-experimental study with a pretest-posttest design was conducted in 2024 on 140 elderly individuals with chronic illnesses who referred to teaching hospitals in Zahedan. Participants were randomly assigned to intervention and control groups. The intervention group used a researcher-developed software for two months. This software was based on Orem’s theory with a disease-centered approach and included three specific modules (diabetes, hypertension, and kidney disease) as well as shared content rooted in Orem's model. Both groups completed the World Health Organization Quality of Life (WHOQOL) questionnaire at baseline and two months after the intervention. Data were analyzed using Chi-square, paired t-test, and independent t-test.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nThe findings showed that the majority of elderly participants in both the intervention group (65.71%) and the control group (57.4%) were women. The mean general quality of life score before the intervention was 58.51 ± 5.28 in the intervention group and 57.56 ± 4.91 in the control group. After the intervention, the mean score increased to 64.97 ± 4.99 in the intervention group, while it was 57.08 ± 5.50 in the control group. Self-care education based on Orem’s model significantly improved quality of life in all domains within the intervention group (p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Self-care education based on Orem’s theory significantly improves the quality of life in elderly individuals with chronic diseases and can be utilized as an effective intervention in care programs.\u003c/p\u003e","manuscriptTitle":"Effect of a Web-Based Educational Intervention on Quality of Life in Older Adults with Chronic Diseases: An Application of Orem’s Self-Care Theory","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-28 17:36:55","doi":"10.21203/rs.3.rs-7365413/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-11T18:13:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-01T10:51:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288763288029562020176035124233186001967","date":"2025-11-27T14:05:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232621574293821947915418866167819390049","date":"2025-10-25T22:10:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-16T11:10:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49026674973465484454626401408937939462","date":"2025-10-16T10:59:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-14T17:12:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-18T07:25:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-18T07:25:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"Ageing International","date":"2025-08-13T13:17:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"ageing-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"agin","sideBox":"Learn more about [Ageing International](http://link.springer.com/journal/12126)","snPcode":"12126","submissionUrl":"https://submission.springernature.com/new-submission/12126/3","title":"Ageing International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"8f5685e4-0e78-4c0c-bd55-34204347afa8","owner":[],"postedDate":"October 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-28T17:36:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-28 17:36:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7365413","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7365413","identity":"rs-7365413","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}