https://dspace.aua.am/xmlui/handle/123456789/123 2026-04-18T20:26:36Z https://dspace.aua.am/xmlui/handle/123456789/2132 Knowledge, attitudes, and practices regarding skin cancer among dermatologists and primary healthcare providers of Yerevan, Armenia: a cross-sectional survey Simonyan, Zarine The study aims to assess the current knowledge related to skin cancer and its screening, to reveal attitudes toward skin cancer screening and counselling as well as current practices and barriers to skin cancer screening among dermatologists and primary healthcare providers of Yerevan, Armenia. The primary objective of this study is to document and compare the knowledge, attitudes, and practices of skin cancer prevention and diagnosis of dermatologists and primary healthcare providers in Yerevan, Armenia and to identify gaps between these groups. The secondary objectives are to: - explore the associations of the socio-demographic characteristics such as age, gender, years of clinical practice, and trainings in dermatology of dermatologists and primary healthcare providers with their knowledge, attitudes, and screening and counselling practices on skin cancer. - identify barriers to skin cancer screening practices among dermatologists and primary healthcare providers of Yerevan, Armenia. - investigate the association between barriers to skin cancer screening and current practices of dermatologists and primary healthcare providers. - compare the knowledge, attitudes, and practices of skin cancer prevention and diagnosis between dermatologists working in polyclinics and the Medical-Scientific Center of Dermatology and Sexually Transmitted Infections (STI). - compare the knowledge, attitudes, and practices of skin cancer prevention and diagnosis between primary healthcare providers working in polyclinics and general practitioners/family physicians working in specialized medical centers. Thesis 2021-01-01T00:00:00Z https://dspace.aua.am/xmlui/handle/123456789/2131 Survey of experiences of stroke patients during and after the Artsakh War and COVID-19 Pandemic in Yerevan, Armenia Avetisyan, Lilit The year of 2020 was already challenging because of worldwide COVID-19 pandemic. In Armenia, the Artsakh Second War started on September 27, 2020, resulted in a humanitarian crisis, and had a significant negative impact on provision of healthcare services. Objectives: This study aimed to understand how both war and pandemic situation affected experiences of care and well-being of stroke patients in Armenia. Methods: The study used an independent sample pre-post design in which the pre- period included the period of war in Armenia and the post- period included the post war period. Study was conducted in a single, tertiary care center in Yerevan, Armenia, enrolling adult stroke patients who received care during the defined periods. Data sources included phone surveys and medical records review for collecting information on sociodemographic and clinical characteristics, patient reported experiences, access to care and COVID-19 worry. Descriptive and inferential statistics as well as regression analysis were used to answer study questions. Results: We completed 66 interviews for each period. The mean age of patients was 64.3 (standard deviation (SD) = 10.2) years, the majority were men (5%), half were from Yerevan (51.4%), 93.8% had comorbidities, and one third (34.1%) received reperfusion therapy (RT) (p>0.05 for comparisons by time period). The overall hospital rating was high (mean = 8.6, SD=2.2), and was similar during War and post-War periods (p>0.05). Access to urgent and emergent care was not different by study period either (p>0.05) The overall rating of COVID-19 worry, and the perceived risk was low among stroke patients in both periods. In multivariable regression analyses, RT (OR = 3.52, 95% CI: 1.31 to 9.48) and diabetes (OR = 0.35, 95% CI: 0.16 to 0.94) were predictors of hospital rating. Conclusions: We found no differences in patent experiences between War and post-War periods. Considering that RT was identified as an independent predictor of positive overall hospital rating, a better capacity and infrastructure for timely access, early diagnosis and management of stroke is recommended. Thesis 2021-01-01T00:00:00Z https://dspace.aua.am/xmlui/handle/123456789/2130 Experiences of displaced persons during and in the aftermath of the War in Nagorno-Karabakh: a qualitative research study Gharibyan, Natella Armed conflicts have resulted in the forcible displacement of almost 80 million population of the world by the end of 2019 recording the highest such number in history. Forcible displacement is defined as leaving homes due to a sudden crisis, including an armed conflict. Armed conflicts and forcible displacement are shown to be associated with multiple mental and physical health disorders among affected population. Also, overall social functioning of displaced people is disturbed. In 2020, a war broke out in Nagorno-Karabakh (NK), an area of conflict between Armenia and Azerbaijan, resulting in around 60,000 people forcibly leaving their homes. During this time, the Republic of Armenia (RA), as the host country was experiencing the second wave of coronavirus disease of 2019 (COVID-19) pandemic, which further restrained the country’s capacity to accommodate the displaced persons. Given this backdrop, this study aimed to explore the experiences of displaced persons during and in the aftermath of the war. Specifically, the study aimed to understand (1) how the displacement happened, (2) how displaced persons were currently living, (3) what were the experiences with psychosocial support are, and (4) what were the perceived needs for psychosocial support. Methods: This qualitative research was guided by the principles of phenomenology. The target population was adult individuals who were forcibly displaced due to the war of NK in 2020. The data were collected in March 2021 through 12 semi-structured in-depth interviews, either face- to-face or online. The participants were purposefully selected through convenience, snowball, and maximum variation sampling. The interview guide inquired about the participants’ demographics, displacement process, current living circumstances, psychosocial well-being, and experiences with psychosocial services. The data were analyzed through inductive and deductive thematic analysis, using the pre-defined themes of the Adaptation and Development after Persecution and Trauma (ADAPT) model for part of the data. Results: Seven participants were women and 5 were men, and the mean age of the sample was around 40 years. Most of the participants came from Shushi and the region of Hadrut, and half were currently residing in Yerevan. Three themes were identified: (1) displacement as an overlooked stage of war; (2) psychological support: projecting needs, rejecting services; and (3) adapting to the post-war situation. It was revealed that the participants were left alone as decision makers during the displacement finding themselves in extremely unsafe situations. However, the expectations were low for a system-based support during the process. When speaking about their needs for psychological support, all were skeptical towards the effectiveness of psychological services, as these services concerned themselves. In contrast, they thought that psychological services were useful in meeting the needs of others. Also, low propensity to seek or accept psychological support was identified. Finally, all the psychosocial domains of the ADAPT model were found to be disturbed. The ‘four walls’, a self-owned living place, regained social interaction, restoration of social roles and re-evaluation of existential meanings were reported to be important in the post-conflict adaptation. Conclusions: Displacement is an important war stage which requires proper coordination and communication by the government to ensure residents’ safety. Mental health care professionals and advocates should tailor the provided care integrating the revealed important patterns of perception of psychosocial support to diminish the resistance towards psychological services among the displaced persons. Also, further research on and advocacy for mental health care are recommended to thoroughly understand the reasons behind the skepticism and the resistance to psychological services and to enhance the overall mental health literacy in the population. Finally, a re-establishment of safe, predictable and comfortable environment, eliminating social stigma towards the displaced persons and promoting social engagement and integration, are needed as urgent measures to support recovery and adaptation. Thesis 2021-01-01T00:00:00Z https://dspace.aua.am/xmlui/handle/123456789/2129 Thyroid cancer survivors’ experience in Armenia: a qualitative study Sargsyan, Kristina This study aimed to explore TC survivors’ experience from the patients’ and healthcare providers’ perspectives in Yerevan, Armenia. Methods: A qualitative approach was used with in-depth interviews with patients, endocrinologists, and endocrine surgeons recruited by convenience sampling method. Because of the COVID-19 pandemic during the study period, we collected the data via online interviews. The semi-structured interview guides with open-ended questions, prompts, and probes, were developed separately for TC survivors and health care providers. The guides were based on Warwick’s framework and contained open-ended thematic questions exploring the domains of the framework. A mixed approach including deductive and inductive methods was used to create data driven codes and group them into categories and themes. Both code and meaning saturation was reached. Results: Ten patients and six health care providers participated in this study. Four major categories (continuity of care, communication and information, the patient as an active participant, and responsiveness.) were generated based on the theoretical framework. The study found the referral flow in the diagnosis and treatment processes was not always well directed towards efficient care. The inadequacy of interdisciplinary collaboration resulted in fragmented care. Patients were unaware of their rights and had a vague understanding of their roles in TC treatment. Lack of trust in health care providers lead to failed patient-provider communication by approaching more than one specialist. Conclusion: This study was successful in looking into TC survivors' experiences and associated challenges in Armenia from the patients' and healthcare providers' perspectives. The findings illustrated distinct patterns of TC diagnosis and treatment pathways and revealed valuable insights into the barriers. This project could serve as a roadmap for health care providers to better understand and meet patients' needs. Thesis 2021-01-01T00:00:00Z