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Zamanifar H, Alijani Renani H, Komeili Sani H, Maraghi E, Komeili Sani H. The Effect of Ten Life Skills on Quality of Life in Adolescents with Thalassemia. Avicenna J Nurs Midwifery Care. 2020; 28 (2) :144-153
URL: http://nmj.umsha.ac.ir/article-1-2055-en.html
1- Master of Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran
2- Department of Pediatric Nursing, Nursing Care Research Center for Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran , hadiszamanifar69@gmail.com
3- Department of Mental Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran
4- Department of Statistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
5- Assistant Professor, Department of Pediatrics, Department of Blood and Cancer, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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✅ Teaching ten life skills can have a significant impact on improving the quality of life of adolescents with thalassemia and can be used as an effective measure in this regard.
Extended Abstract:   (153 Views)

Thalassemia major is a common form of an inherited anemia in the world that occurs due to a defect in the synthesis of one of the globin chains, hemoglobin, and causes severe anemia in the individual [1]. In this disease, one's life necessarily requires regular blood transfusions and medical care [2]. The disease has severe effects on a person's life; these include chronic anemia, enlarged liver and spleen, ascites, heart failure, delayed or immature puberty, and noticeable changes in the facial bones in later years. Approximately 240 million people worldwide carry the disease gene, and about 200,000 babies with thalassemia are born each year.
Many adolescents and young people with chronic diseases, including thalassemia, have a low quality of life [5]. Thalassemia causes emotions such as anger, depression, premature death, and stress for the adolescent. Marriage is a way of dealing with important life events, employment, economic pressures, emotional worries, and problems with medical care during adolescence. [6] Therefore, considering the effect of this disease on the psychological, economic and social dimensions of their lives, it is necessary to pay attention to these patients [7].
The primary goal of treatment, especially in chronic disease, is to enhance the quality of life by reducing its effects. Quality of life is one of the objective needs of human beings in relation to personal and group understanding of people's sense of well-being and is considered as an important indicator and the effectiveness of many health and medical interventions [8]. Among the programs designed and implemented so far, the Life Skills Training Program is been the most effective and efficient [9].
The psychosocial problems of thalassemia patients are more severe than those of healthy people; therefore, in order to improve the quality of life in these patients, medical treatment should be combined with social emotional and psychological support to prevent irreversible complications [12].
The quality of life of patients with chronic disease is of great importance. Patients with thalassemia major have a low quality of life. They receive no training other than routine training on diet and nutrition, the effects of the disease, and the symptoms of the disease [18]. Given the need to improve the quality of life of thalassemia patients and the population of adolescents with thalassemia, the present study was conducted to determine the impact of using life skills on the quality of life of adolescents with thalassemia major.


Materials and Methods

The present study was a semi-experimental study of two groups of previous and subsequent types that was designed to determine the effect of using life skills on the quality of life of adolescents with thalassemia major referred to Baqaei Hospital 2 in Ahvaz, Iran.
Target-based sampling was performed on individuals with thalassemia based on entry and exit criteria. The entry criteria were that the adolescent was willing to attend training sessions, had not previously participated in life skills training courses, and was 13 to 18 years old, but the exclusion criteria was not attending a class session. The method of assigning intervention to individuals was random and by the method of alternative permuted block randomization with the size of block 4 (using a table related to random replacements). Then, the samples were divided into two intervention groups (42 people) and control group (42 people). Being in either group was randomly based on the draw. Both groups then completed pre-test questionnaires. After this, for the experimental group, the educational intervention was performed by the researcher in the form of face-to-face sessions during 6 2-hour sessions [19].
Adolescents were randomly divided into intervention and control groups. Both groups completed the demographic information questionnaire and the Kid Screening Questionnaire for Quality of Life of the Teenager 52. Then the experimental group received the educational content (holding a class, Q&A and booklet) for 6 sessions of 2-hour. The control group did not receive any training.
At the end of the data, using SPSS software version 22 (SPSS Inc., Chicago, IL., USA) and quantitative variables as mean, standard deviation, minimum and maximum and qualitative variables as number (percentage) were reported. The normality of quantitative variables was assessed using the Shapiro-Wilk test. To investigate the relationship between qualitative variables, Fisher's exact test and to compare quantitative variables between the two groups, independent t-test or its non-parametric equivalent (Mann-Whitney test) were used. The significance level of the above tests was less than 0.05.



The results showed that the difference between the mean of quality of life in the two groups of control and intervention was not significant (P<0.05) in pre-test. Also, post-hoc test (assuming non-homogeneity of variances) also showed a significant difference in mean of quality of life in post-test in both intervention and control groups (P<0.05).

Table 1. Distribution of relative frequency and percentage of research units based on parent demographic characteristics in two groups of intervention and control

P-value Intervention Group Control Group Class Index
Statistical variable
  % N % N
0.99< 52.4 22 50 21 Female Gender
47.6 20 50 21 Male
0.207 4.76 2 0 0 illiterate Education
11.90 5 19.4 8 Elementary
40.47 17 38.9 16 Pre-highschool
28.57 12 26.19 11 High school
14.28 6 16.66 7 University
0.799 21.4 9 16.7 7 Weak The economic situation
54.76 23 57.1 24 medium
23.80 10 26.2 11 Good
0.706 28.57 12 19.04 8 4 people Family members
71.42 30 80.95 34 More than 4 people

Table 2. Comparison of the average age of the studied units in the two groups of control and intervention
Variable SD ±Mean SD ±Mean P-value
Age 15.66±66 /1 15.40±80 /1 0.490

Table 3. Comparison of mean and standard deviation in the two groups of intervention and control, before the intervention

P-value Control Intervention Variable
From intervention
0.565 3.98 15.40 2.58 14.88 Physical
0.074 3.76 14.80 3.25 18.33 Psychological
0.576 4.41 14.76 3.29 14.16 Behavior
0.052 3.56 15.35 2.82 13.92 Perception
0.032 3.63 14.52 3.13 13.69 Autonomy
0.482 3.97 15.23 2.66 14.52 Communication with parents
0.034 3.63 15.47 2.88 15.47 Social acceptance and harassment
0.936 2.75 14.40 2.69 13.09 Social support and friends
0.037 3.12 15.00 2.98 13.57 School
0.006 3.66 15.00 2.45 13.09 Financial resources


Table 4. Comparison of mean and standard deviation in the two groups of intervention and control, after the intervention

P-value Control Intervention Variable
From intervention
0.001> 3.76 14.80 3.25 18.33 Physical
0.001> 3.02 16.54 3.77 21.66 Psychological
0.001> 3.16 15.95 3.95 19.52 Behavior
0.001> 4.06 15.71 3.31 15 Perception
0.001> 2.91 14.76 3.79 19.52 Autonomy
0.004 3.34 15.59 3.67 17.97 Communication with parents
0.008 2.93 16.30 3.70 18.57 Social acceptance and harassment
0.020 2.93 16.30 3.70 18.57 Social support and friends
0.001> 3.31 15.00 2.95 17.85 School
0.002 3.58 13.92 3.17 16.42 Financial resources




The aim of this study was to determine the effect of using life skills on the quality of life of adolescents with thalassemia major. Life skills training can be helpful in achieving this goal. These trainings have a positive effect on the level of emotion, mindset and behavior of people in the community. Life skills are related to practice and behavior, and if learned in practice, can improve society by changing the behavior of individuals in society.
The results showed that after the intervention, the mean score of quality of life in all dimensions and the mean score of total quality of life increased. This study is consistent with the results of a study by Khani et al. that showed that life skills training can play an important role in improving the quality of life and psychological characteristics of patients with diabetes [22]. The results of the present study showed that life skills training has increased the mental health and physical health of the intervention group.
Life skills training can enable people to use effective and compromised strategies to deal with everyday problems; in other words, life skills are important coping strategies that increase a person's ability to develop personally and socially and reduce their mental and physical problems [28].
Life skills training is almost a complete therapeutic package that teaches people the set of necessary and essential life skills and helps people to know and evaluate their emotions and feelings well. They can also understand the logical and irrational thoughts associated with them and ultimately conclude that they are guided by efficient and inefficient thoughts and their positive and negative emotions. When subjects are aware that it is themselves and their perceptions that are greatly influenced by positive and negative emotions, they can control them with the life skills they have learned; as a result, teaching life skills with the principles and skills increases public health and quality of life [33].



Teaching ten life skills can have a significant impact on improving the quality of life of adolescents with thalassemia and can be used as an effective measure in this regard.



This article is taken from the dissertation of Master of Nursing with the code of ethics (IRCT20181202041825N1) which has been done with the financial support of Ahvaz Jundishapur University of Medical Sciences. We would like to express our sincere gratitude to the Vice Chancellor for Research and Technology of this university, as well as to the esteemed patients, without whose cooperation it would have been impossible to conduct this research.


Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Type of Study: Original Research | Subject: Nursing
Received: 2019/06/19 | Accepted: 2020/03/2 | Published: 2020/03/25

1. Babar M, Shan M. Significance of combo chelation therapy over mono chelation therapy in patient with thalassemia. Journal of Pharmaceutical Sciences and Research. 2010; 2(12): 837-43.
2. Awadallah SM, Atoum MF, Nimer NA, Saleh SA. Ischemia modified albumin: An oxidative stress marker in β-thalassemia major. Clinica Chimica Acta. 2012 May 18;413(9-10):907-10. [DOI:10.1016/j.cca.2012.01.037] [PMID]
3. Yalçn SS, Durmusoglu-Sendogdu M, Gümrük F, Ünal S, Karg E, Tugrul B. Evaluation of the children with β-thalassemia in terms of their self-concept, behavioral, and parental attitudes. Journal of pediatric hematology/oncology. 2007 Aug 1;29(8):523-8. [DOI:10.1097/MPH.0b013e3180f61b56] [PMID]
4. Azami M, Parizad N, Sayehmiri K. Prevalence of hypothyroidism, hypoparathyroidism and thefrequency of regular chelation therapy in patients with thalassemia major in Iran: a systematic review and meta-analysis study. Iranian Journal of Pediatric Hematology and Oncology. 2016 Nov 10;6(4):261-76.
5. Madmoli Y, Beiranvand R, Korkini N, Mashalchi H, Karimi H, Madmoli M. Comparison of health-related quality of life in beta thalassemia major and healthy people in Dezful in 2015. Iranian Journal of Nursing Research. 2016 Apr 10;11(1):9-16.
6. Mohammadi S, Tajvidi M, Ghazizadeh S. The relationship between spiritual well-being with quality of life and mental health of young adults with beta-thalassemia major. Scientific Journal of Iranian Blood Transfusion Organization. 2014 Jun 1;11(2).
7. Knowledge & Research in Applied Psychology Vol 15. No. 3 (Continuous No. 57)- Autumn 2014 PP: 81-91.
8. Greenberg MT, Weissberg RP, O'Brien MU, Zins JE, Fredericks L, Resnik H, et al. Enhancing school-basedprevention and youth development through oordinated social, emotional, and academic learning. American. 9. Amirian K. P-834-Effect of life skills education on academic achievement of first year high school male students. European Psychiatry. 2012 Jan 1;27:1. [DOI:10.1016/S0924-9338(12)75001-0]
9. Sepahamansour M. [Tasireamozeshemaharatheyezendegi bar angizeyepishraft, khodehteramivasazgareiejtemaee]. AndishevaRaftar. 2008;2(6):85-93. ( ersian)
10. Steptoe A, Wardle J. Life skills, wealth, health, and wellbeing in later life. Proceedings of the National Academy of Sciences. 2017;114(17):4354-9.
11. Shasati S, Mir Hehjo S, Masouleh S, Sigarodi A,Roshan Z. Study of life skills of children with thalassemia11-19Y who referred to educational and therapeutic centers of Rasht from the viewpoint of their mothers in the year,Two Quarterly Nursing and Midwifery Schools of Guilan Province, 2010.Year 20, No. 63, P16-21
12. TabursiB. Comparison of the Problems of Thalassemia Major Patients withIrregular Follow-up of Principles of Therapy in Patients with Thalassemia Treatment Center in Tehran, Tehran, Iran.2010, Vol. 4, No. 1, p. 33
13. KhalediS;Moridi G; valiee S; Comparison The Quality Of life Of Healthy And Thalasemic Children Iranian jornal Of Nursing Research.2013;8(2):87-94. (Persion).
14. Torcharus K, Pankaew T. Health-related Quality of Life in Thalassemia Treated with Iron Chelation. Southeast Asian J Trop Med Public Health. 2011;42(4):951-9.
15. Hadi N. Karami d, Montazeri A.]Health-related quality of life in patients with thalassemia major (Persian)]. Payesh. 2009;8(4):387-93.
16. 17 Rashidi Nejad M, Miri S, Bahramnejad A. The effect of life skills education on emotional, think, behavior in situational and different times of Bam nursing school students. Journal of Qualitative Research in Health Sciences. 2011 Jun 21;10(2):47-53.
17. Fatemeyan Rad F, Mostanbt N, Zoladl M. The effect of training on coping with stress, anxiety and depression among patients with special diseases. Armaghane danesh. 2013 Dec 15;18(9):777-86.
18. Ebrahimi, A. A Study of the Group Effectiveness of Life Skills Training on Parent-Adolescent Conflicts2012. Master thesis. Faculty of Education and Psychology, Islamic Azad University, Arak Branch
19. Nick Azin A, NainianM, ShaeeriM. Reliability and Reliability of Kids-Scan-52 Health-Related Quality of Life Questionnaire (KIDSCREEN-52) in Iranian students. Journal of Health Research.2014, 3 (3): 210-224
20. Farmahinifarahani, M. Sobhaninejad, M. & Pidad, F. (2010). ComparativeStudy of the Life Skills of Students in Philosophical and Non-Philosophical Sciencesof the Schools of Humanities in Tehran State Universities. Higher EducationCurriculum Studies, 142-158. (Persian).
21. Khani F, Samsam Shariat MR, Mehdad A, Taki F, Kourang Beheshti M, Hekmatravan R. The effecti of life skills training on improving SCL-90 psychological indicators and quality of life in patients with diabetes. JSR. 2015 Jan 15;15(57):81-91.
22. Yazdi Moghadam H, Estaji Z, Heydari A. Study of the quality of life of nurses in Sabzevar hospitals in 2005-2006. J Sabzevar Univ Med Sci. 2009;16(1):50-6.
23. Raiisee R. Impact of counseling sessions on life skills training on mental health of children of Journal of Shahrekord University of Medical Sciences / Volume 14, Issue 4, Oct. and Nov. 2012 / 30-37
24. Khalatbari J, Haghighi FA. The effect of lifeskills and coping strategies with stress training on mental health of girl students. Knowledge Res App Psycho. 2011 Jan 1;12(2):29-37.
25. Javadi M, Sepahvand MJ, Mahmudi H. The effect of life skills training on quality of life in nurses of Khorramabad Hospitals. Scientific Journal of Hamadan nursing & midwifery faculty. 2013 May 15;21(1):32-42.
26. Zahrakar,K.Effectiveness of problem solving skills training on self-efficacy of female student students in Tehran2010.13 - 150: (3) 5
27. Akbari, M.P. Shaghaghi, f. Behrouzian, M. The Impact of Problem Solving Skills Training on Students' Test Anxiety. Transformational Psychology Quarterly: Iranian Psychologists,67-74,29(8)
28. Salimi BH, Abedi F. The effectiveness of life skills training on anxiety, depression and happiness of secondary school students mothers in Karaj city. JCP. 2013;11(3):29-48.
29. Botvin GJ, Eng A, Williams CL. Preventing the onset of cigarette smoking through life skills training. Preventive medicine. 1980 Jan 1;9(1):135-43. [DOI:10.1016/0091-7435(80)90064-X]
30. Rasooli Ali Abadi B, Kalantari M. Based on acceptance and commitment therapy on depression, self-esteem and body image concerns, after the first birth, women in Kashan city. Avicenna J Nurs Midwifery care. 2018; 26 (2) :103-112 [DOI:10.30699/sjhnmf.26.2.103]
31. Fallahchai R. Effectiveness of academic and life skills instruction on the freshmen academic achievement. Journal of Life science and biomedicine. 2012;2(4):137-41.
32. Shirkavand N, GHOLAMI HS, ARAB SZ, Ashoori J. The impact of life skills training on happiness and hopefulness among patients with type ii diabetes.

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