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COVID-19 Pandemi Sürecinde Demanslı Bireylere Bakım Veren Aile Üyelerinin Sağlık Okuryazarlık Düzeyleri ve İlişkili Faktörler

Year 2023, Volume: 6 Issue: 1, 55 - 64, 17.04.2023
https://doi.org/10.38108/ouhcd.1097620

Abstract

Amaç: Bu araştırma COVID-19 pandemi sürecinde demanslı bireylere bakım veren aile üyelerinin sağlık okuryazarlık düzeyleri ve ilişkili faktörlerini incelemek amacıyla yapılmıştır.
Yöntem: Tanımlayıcı tipteki araştırma Ekim-Kasım 2021 tarihleri arasında demanslı bireylere bakım veren 114 aile üyesiyle yürütülmüştür. Araştırmada amaçlı örneklem yöntemi kullanılmıştır. Veriler; tanımlayıcı özellikler formu, Avrupa Sağlık Okuryazarlığı Ölçeği (ASOY-TR) ve COVID-19 Korkusu Ölçeği kullanılarak toplanmıştır. Verilerin değerlendirilmesi araştırmacılar tarafından SPSS 24.0 programı kullanılarak yapılmıştır. Değerlendirmede sayı, yüzde, ortalama, One-way ANOVA testi ve ki-kare testi kullanılmıştır.
Bulgular: Araştırmaya katılan demanslı bireylere bakım verenlerin yaş ortalaması 55.90±10.72 yıl (min-maks:20-79), %82.5’i kadın, %66.7’sinin geliri giderine eşit, %55.4’ü lisans mezunudur. Bakım verenlerin %34.2’sinin yeterli ve mükemmel düzeyde sağlık okuryazarlığına sahip olduğu bulunmuştur. Bakım veren bireylerin genel sağlık okuryazarlığı puan ortalamalarının, çalışma ve eğitim durumlarının sağlık okuryazarlık düzeyleri üzerinde istatistiksel açıdan anlamlı bir fark oluşturduğu (p<0.05) bulunmuştur. Yaş ortalamalarının, cinsiyetlerinin, COVID-19 korkusu, sosyal medyada sağlıkla ilgili bilgileri okuma durumlarının ise fark oluşturmadığı (p>0.05) görülmüştür.
Sonuç: Çalışma COVID-19 pandemi sürecinde demanslı bireylere bakım veren aile üyelerinin sağlık okuryazarlık düzeylerine ve ilişkili faktörlere ışık tutmaktadır. Bu sonuçlar doğrultusunda özellikle çalışmayan ve düşük eğitim seviyesi olan bakım verenlerin sağlık okuryazarlık düzeylerinin geliştirilmesi önerilmektedir. Ayrıca bakım verenlerin üçte ikisinin yetersiz ve sorunlu-sınırlı düzeyde sağlık okuryazarlığına sahip olduğu ortaya konmuştur. Sağlık profesyonellerinin demanslı bireye bakım veren aile üyelerinin sağlık bilgilerine etkin bir şekilde erişmesine, anlamasına, değerlendirmesine ve uygulamasına yardımcı olmaları önerilmektedir.

References

  • Abacigil F, Harlak H, Okyay P, Kiraz DE, Gursoy Turan S, Saruhan G, et al. (2019). Validity and reliability of the Turkish version of the European Health Literacy Survey Questionnaire. Health Promotion International, 34 (4), 658-667.
  • Abel T, McQueen D. (2020). Critical health literacy and the COVID-19 crisis. Health Promotion International, 35 (6), 1612-1613.
  • Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. (2020). The fear of COVID-19 scale: Development and initial validation. International Journal of Mental Health and Addiction, 1-9.
  • Aközer M, Nuhrat C, Say Ş. (2011). Türkiye'de yaşlılık dönemine ilişkin beklentiler araştırması. Sosyal Politika Çalışmaları Dergisi, 7 (27), 103-128.
  • Alzheimer’s Association (AA). (2021). Alzheimer’s Disease Facts and Figures. Erişim Tarihi: 30.03.2022. https://www.alz.org/media/documents/alzheimers-facts-and-figures.pdf
  • Artan T, Meydan S, Irmak HS. (2021). Turkish version of the fear of COVID-19 scale: Validity and reliability study. Archives of Health Science and Research, 8 (2), 117-123.
  • Ashida S, Goodman M, Pandya C, Koehly LM, Lachance C, Stafford J, et al. (2011). Age differences in genetic knowledge, health literacy and causal beliefs for health conditions. Public Health Genomics, 14 (4-5), 307-316.
  • Ayaz-Alkaya S, Dülger H. (2022). Fear of coronavirus and health literacy levels of older adults during the COVID-19 pandemic. Geriatric Nursing, 43, 45-50.
  • Berens EM, Vogt D, Messer M, Hurrelmann K, Schaeffer D. (2016). Health literacy among different age groups in Germany: Results of a cross-sectional survey. BMC Public Health, 16, 1151.
  • Bliss D, Rolnick C, Jackson J, Arntson C, Mullins J, Hepburn K. (2013). Health literacy needs related to incontinence and skin damage among family and friend caregivers of individuals with dementia. Journal of Wound, Ostomy, and Continence Nursing, 40 (5), 515-523.
  • Dassel KB, Carr DC, Vitaliano P. (2017). Does caring for a spouse with dementia accelerate cognitive decline? Findings from the Health and Retirement Study. The Gerontologist, 57 (2), 319-328.
  • Diviani N, van den Putte B, Giani S, van Weert JC. (2015). Low health literacy and evaluation of online health information: A systematic review of the literature. Journal of Medical Internet Research, 17 (5), e4018.
  • Efthymiou A, Middleton N, Charalambous A, Papastavrou E. (2017). The association of health literacy and electronic health literacy with self-efficacy, coping, and caregiving perceptions among carers of people with dementia: research protocol for a descriptive correlational study. JMIR research protocols, 6 (11), e8080.
  • Feast A, Moniz-Cook E, Stoner C, Charlesworth G, Orrell MA. (2016). Systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being. International Psychogeriatrics, 28 (11),1761-1774.
  • Garcia CH, Espinoza SE, Lichtenstein M, Hazuda HP. (2013). Health literacy associations between Hispanic elderly patients and their caregivers. Journal of Health Communication, 18 (sup1), 256-272.
  • Goren A, Montgomery W, Kahle-Wrobleski K, Nakamura T, Ueda K. (2016). Impact of caring for persons with Alzheimer’s disease or dementia on caregivers’ health outcomes: Findings from a community based survey in Japan. BMC Geriatrics,16:122.
  • Häikiö K, Cloutier D, Rugkåsa J. (2020). Is health literacy of family carers associated with carer burden, quality of life, and time spent on informal care for older persons living with dementia? PloS one, 15 (11), e0241982.
  • Hattink B, Meiland F, van der Roest H, Kevern P, Abiuso F, Bengtsson J, et al. (2015). Web-based STAR E-learning course increases empathy and understanding in dementia caregivers: Results from a randomized controlled trial in the Netherlands and the United Kingdom. Journal of Medical Internet Research, 17 (10), e241.
  • Heerman WJ, Perrin EM, Yin HS, Sanders LM, Eden SK, Shintani A, et al. (2014). Health literacy and injury prevention behaviors among caregivers of infants. American Journal of Preventive Medicine, 46 (5), 449-456.
  • Huh J, McDonald DW, Hartzler A, Pratt W. (2013). Patient moderator interaction in online health communities. AMIA Annual Symposium Proceedings, 627-636.
  • Kimzey M, Howe C J, Martin C, McLarty J, Baucham R. (2022). Development of health literacy in persons and caregivers living with dementia: A qualitative directed content analysis. Dementia, 21(2), 540-555.
  • Kjallman Alm A, Hellzen O, Norbergh KG. (2014). Experiences of long term ongoing structured support in early stage of dementia–a case study. International Journal of Older People Nursing, 9 (4), 289-297.
  • Küçükgüçlü Ö, Akpınar Söylemez B, Yener G, Demir Barutcu C, Akyol MA. (2017). Examining factors affecting caregiver burden: A comparison of frontotemporal dementia and Alzheimer’s disease. American Journal of Alzheimer's Disease & Other Dementias®, 32 (4), 200-206.
  • Lee SYD, Arozullah AM, Cho YI. (2004). Health literacy, social support, and health: A research agenda. Social Science & Medicine, 58 (7), 1309-1321.
  • Li Y, Hu L, Shen Y, Xue H, Hou P, Liu Y. (2020). Health literacy, social support, and care ability for caregivers of dementia patients: Structural equation modeling. Geriatric Nursing, 41 (5), 600-607.
  • Ma M, Dorstyn D, Ward L, Prentice S. (2018). Alzheimers’ disease and caregiving: A meta-analytic review comparing the mental health of primary carers to controls. Aging & Mental Health, 22 (11), 1395-1405.
  • Onat Kaya H, Çelik, Y. (2018). Hasta bakım yükü: Alzheimer hastalarına bakım verenler arasında bir çalışma. Hacettepe Sağlık İdaresi Dergisi, 21 (4), 625-640.
  • Ornstein K, Gaugler JE. (2012). The problem with “problem behaviors”: A systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad. International Psychogeriatrics, 24 (10),1536-1552.
  • Perez SL, Paterniti DA, Wilson M, Bell RA, Chan MS, Villareal CC, et al. (2015). Characterizing the processes for navigating Internet health information using real-time observations: A mixed-methods approach. Journal of Medical Internet Research, 17 (7), e3945.
  • Pleasant A, Cabe J, Patel K, Cosenza J, Carmona R. (2015). Health literacy research and practice: A needed paradigm shift. Health Communication, 30 (12), 1176-1180.
  • Polenick CA, Min L, Kales HC. (2020). Medical comorbidities of dementia: Links to caregivers' emotional difficulties and gains. Journal of American Geriatrics Society, 68 (3), 609-613.
  • Queiroz JPC, Machado ALG, Vieira NFC. (2020). Health literacy for caregivers of elders with Alzheimer’s disease. Revista Brasileira de Enfermagem, 73 (Supp 3), e20190608.
  • Quinn C, Gamble LD, Parker S, Martyr A, Collins R, Victor C, et al. (2022). Impact of COVID‐19 on carers of people with dementia in the community: Findings from the British IDEAL cohort. International Journal of Geriatric Psychiatry, 37(5).
  • Shaukat R, Asghar A, Naveed MA. (2021). Impact of health literacy on fear of covid-19, protective behavior, and conspiracy beliefs: University students’ perspective. Library Philosophy and Practice, 1-13.
  • Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, et al. (2015). Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU). European Journal of Public Health, 25 (6), 1053-1058.
  • Vaingankar JA, Chong SA, Abdin E, Picco L, Shafie S, Seow E, et al. (2016). Psychiatric morbidity and its correlates among informal caregivers of older adults. Comprehensive Psychiatry, 68, 178-185.
  • van den Kieboom R, Snaphaan L, Mark R, Bongers I. (2020). The trajectory of caregiver burden and risk factors in dementia progression: A systematic review. Journal of Alzheimers Disease, 77 (3), 1107-1115.
  • van der Heide I, Rademakers J, Schipper M, Droomers M, Sørensen K, Uiters E. (2013). Health literacy of Dutch adults: A cross sectional survey. BMC Public Health, 13, 1-11.
  • Vitaliano PP, Ustundag O, Borson S. (2017). Objective and subjective cognitive problems among caregivers and matched non- caregivers. The Gerontologist, 57 (4), 637-647.
  • Wasilewski MB, Stinson JN, Cameron JI. (2017). Web-based health interventions for family caregivers of elderly individuals: A scoping review. International Journal of Medical Informatics, 103, 109-138.
  • World Health Organization (WHO). (2021). Erişim Tarihi: 30.03.2022. https://www.who.int/news-room/fact-sheets/detail/dementia
  • Yamashita T, Kunkel SR. (2015). An international comparison of the association among literacy, education, and health across the United States, Canada, Switzerland, Italy, Norway, and Bermuda: Implications for health disparities. Journal of Health Communication, 20 (4), 406-415.
  • Yılmaz M, Tiraki Z. (2016). Sağlık okuryazarlığı nedir? Nasıl ölçülür? Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 9 (4), 142-147.

Health Literacy Levels of Family Caregivers of People with Dementia during the COVID-19 Pandemic and Related Factors

Year 2023, Volume: 6 Issue: 1, 55 - 64, 17.04.2023
https://doi.org/10.38108/ouhcd.1097620

Abstract

Objective: This study was conducted to determine health literacy levels and related factors of family caregivers of people with dementia (PwD) during the COVID-19 pandemic.
Methods: The descriptive and cross-sectional study was conducted with 114 family caregivers of PwD between October-November 2021. Purposeful sampling method was used in the study. The data were collected using socio-demographic form, European Health Literacy Survey Questionnaire (HLS-EU) and fear of COVID-19 scale. The assessment of the data was carried out by researchers using the SPSS 24.0 program. Number, percentage, mean, One-way ANOVA test and chi-square test were used in the analysis of the data.
Results: The mean age of the caregivers of PwD who participated in the study was 55.90±10.72 years (min-max: 20-79), 82.5% of them were women, 66.7% of them had an income equal to expenses, and 55.4% of them had a bachelor's degree. The 34.2% of the caregivers had sufficient and excellent health literacy level. Statistically significant relationship was found between the health literacy levels of the caregivers and mean scores of general health literacy, working and educational status (p<0.05). There is no statistically significant relationship between the health literacy levels of the caregivers and their mean of age, sex, level of fear of COVID-19, status of reading health information on the internet (p>0.05).
Conclusion: This study sheds light on the health literacy levels and related factors of family caregivers of PwD during the COVID-19 pandemic. In line with these results, it is recommended to improve the health literacy levels of caregivers, especially to those who are unemployed and undereducated. In addition, it has been revealed that two-thirds of caregivers have insufficient and problematic-limited level of health literacy. It is recommended that health professionals help family caregivers of PwD to effectively access, understand, appraise, and apply to/of health information.

References

  • Abacigil F, Harlak H, Okyay P, Kiraz DE, Gursoy Turan S, Saruhan G, et al. (2019). Validity and reliability of the Turkish version of the European Health Literacy Survey Questionnaire. Health Promotion International, 34 (4), 658-667.
  • Abel T, McQueen D. (2020). Critical health literacy and the COVID-19 crisis. Health Promotion International, 35 (6), 1612-1613.
  • Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. (2020). The fear of COVID-19 scale: Development and initial validation. International Journal of Mental Health and Addiction, 1-9.
  • Aközer M, Nuhrat C, Say Ş. (2011). Türkiye'de yaşlılık dönemine ilişkin beklentiler araştırması. Sosyal Politika Çalışmaları Dergisi, 7 (27), 103-128.
  • Alzheimer’s Association (AA). (2021). Alzheimer’s Disease Facts and Figures. Erişim Tarihi: 30.03.2022. https://www.alz.org/media/documents/alzheimers-facts-and-figures.pdf
  • Artan T, Meydan S, Irmak HS. (2021). Turkish version of the fear of COVID-19 scale: Validity and reliability study. Archives of Health Science and Research, 8 (2), 117-123.
  • Ashida S, Goodman M, Pandya C, Koehly LM, Lachance C, Stafford J, et al. (2011). Age differences in genetic knowledge, health literacy and causal beliefs for health conditions. Public Health Genomics, 14 (4-5), 307-316.
  • Ayaz-Alkaya S, Dülger H. (2022). Fear of coronavirus and health literacy levels of older adults during the COVID-19 pandemic. Geriatric Nursing, 43, 45-50.
  • Berens EM, Vogt D, Messer M, Hurrelmann K, Schaeffer D. (2016). Health literacy among different age groups in Germany: Results of a cross-sectional survey. BMC Public Health, 16, 1151.
  • Bliss D, Rolnick C, Jackson J, Arntson C, Mullins J, Hepburn K. (2013). Health literacy needs related to incontinence and skin damage among family and friend caregivers of individuals with dementia. Journal of Wound, Ostomy, and Continence Nursing, 40 (5), 515-523.
  • Dassel KB, Carr DC, Vitaliano P. (2017). Does caring for a spouse with dementia accelerate cognitive decline? Findings from the Health and Retirement Study. The Gerontologist, 57 (2), 319-328.
  • Diviani N, van den Putte B, Giani S, van Weert JC. (2015). Low health literacy and evaluation of online health information: A systematic review of the literature. Journal of Medical Internet Research, 17 (5), e4018.
  • Efthymiou A, Middleton N, Charalambous A, Papastavrou E. (2017). The association of health literacy and electronic health literacy with self-efficacy, coping, and caregiving perceptions among carers of people with dementia: research protocol for a descriptive correlational study. JMIR research protocols, 6 (11), e8080.
  • Feast A, Moniz-Cook E, Stoner C, Charlesworth G, Orrell MA. (2016). Systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being. International Psychogeriatrics, 28 (11),1761-1774.
  • Garcia CH, Espinoza SE, Lichtenstein M, Hazuda HP. (2013). Health literacy associations between Hispanic elderly patients and their caregivers. Journal of Health Communication, 18 (sup1), 256-272.
  • Goren A, Montgomery W, Kahle-Wrobleski K, Nakamura T, Ueda K. (2016). Impact of caring for persons with Alzheimer’s disease or dementia on caregivers’ health outcomes: Findings from a community based survey in Japan. BMC Geriatrics,16:122.
  • Häikiö K, Cloutier D, Rugkåsa J. (2020). Is health literacy of family carers associated with carer burden, quality of life, and time spent on informal care for older persons living with dementia? PloS one, 15 (11), e0241982.
  • Hattink B, Meiland F, van der Roest H, Kevern P, Abiuso F, Bengtsson J, et al. (2015). Web-based STAR E-learning course increases empathy and understanding in dementia caregivers: Results from a randomized controlled trial in the Netherlands and the United Kingdom. Journal of Medical Internet Research, 17 (10), e241.
  • Heerman WJ, Perrin EM, Yin HS, Sanders LM, Eden SK, Shintani A, et al. (2014). Health literacy and injury prevention behaviors among caregivers of infants. American Journal of Preventive Medicine, 46 (5), 449-456.
  • Huh J, McDonald DW, Hartzler A, Pratt W. (2013). Patient moderator interaction in online health communities. AMIA Annual Symposium Proceedings, 627-636.
  • Kimzey M, Howe C J, Martin C, McLarty J, Baucham R. (2022). Development of health literacy in persons and caregivers living with dementia: A qualitative directed content analysis. Dementia, 21(2), 540-555.
  • Kjallman Alm A, Hellzen O, Norbergh KG. (2014). Experiences of long term ongoing structured support in early stage of dementia–a case study. International Journal of Older People Nursing, 9 (4), 289-297.
  • Küçükgüçlü Ö, Akpınar Söylemez B, Yener G, Demir Barutcu C, Akyol MA. (2017). Examining factors affecting caregiver burden: A comparison of frontotemporal dementia and Alzheimer’s disease. American Journal of Alzheimer's Disease & Other Dementias®, 32 (4), 200-206.
  • Lee SYD, Arozullah AM, Cho YI. (2004). Health literacy, social support, and health: A research agenda. Social Science & Medicine, 58 (7), 1309-1321.
  • Li Y, Hu L, Shen Y, Xue H, Hou P, Liu Y. (2020). Health literacy, social support, and care ability for caregivers of dementia patients: Structural equation modeling. Geriatric Nursing, 41 (5), 600-607.
  • Ma M, Dorstyn D, Ward L, Prentice S. (2018). Alzheimers’ disease and caregiving: A meta-analytic review comparing the mental health of primary carers to controls. Aging & Mental Health, 22 (11), 1395-1405.
  • Onat Kaya H, Çelik, Y. (2018). Hasta bakım yükü: Alzheimer hastalarına bakım verenler arasında bir çalışma. Hacettepe Sağlık İdaresi Dergisi, 21 (4), 625-640.
  • Ornstein K, Gaugler JE. (2012). The problem with “problem behaviors”: A systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad. International Psychogeriatrics, 24 (10),1536-1552.
  • Perez SL, Paterniti DA, Wilson M, Bell RA, Chan MS, Villareal CC, et al. (2015). Characterizing the processes for navigating Internet health information using real-time observations: A mixed-methods approach. Journal of Medical Internet Research, 17 (7), e3945.
  • Pleasant A, Cabe J, Patel K, Cosenza J, Carmona R. (2015). Health literacy research and practice: A needed paradigm shift. Health Communication, 30 (12), 1176-1180.
  • Polenick CA, Min L, Kales HC. (2020). Medical comorbidities of dementia: Links to caregivers' emotional difficulties and gains. Journal of American Geriatrics Society, 68 (3), 609-613.
  • Queiroz JPC, Machado ALG, Vieira NFC. (2020). Health literacy for caregivers of elders with Alzheimer’s disease. Revista Brasileira de Enfermagem, 73 (Supp 3), e20190608.
  • Quinn C, Gamble LD, Parker S, Martyr A, Collins R, Victor C, et al. (2022). Impact of COVID‐19 on carers of people with dementia in the community: Findings from the British IDEAL cohort. International Journal of Geriatric Psychiatry, 37(5).
  • Shaukat R, Asghar A, Naveed MA. (2021). Impact of health literacy on fear of covid-19, protective behavior, and conspiracy beliefs: University students’ perspective. Library Philosophy and Practice, 1-13.
  • Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, et al. (2015). Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU). European Journal of Public Health, 25 (6), 1053-1058.
  • Vaingankar JA, Chong SA, Abdin E, Picco L, Shafie S, Seow E, et al. (2016). Psychiatric morbidity and its correlates among informal caregivers of older adults. Comprehensive Psychiatry, 68, 178-185.
  • van den Kieboom R, Snaphaan L, Mark R, Bongers I. (2020). The trajectory of caregiver burden and risk factors in dementia progression: A systematic review. Journal of Alzheimers Disease, 77 (3), 1107-1115.
  • van der Heide I, Rademakers J, Schipper M, Droomers M, Sørensen K, Uiters E. (2013). Health literacy of Dutch adults: A cross sectional survey. BMC Public Health, 13, 1-11.
  • Vitaliano PP, Ustundag O, Borson S. (2017). Objective and subjective cognitive problems among caregivers and matched non- caregivers. The Gerontologist, 57 (4), 637-647.
  • Wasilewski MB, Stinson JN, Cameron JI. (2017). Web-based health interventions for family caregivers of elderly individuals: A scoping review. International Journal of Medical Informatics, 103, 109-138.
  • World Health Organization (WHO). (2021). Erişim Tarihi: 30.03.2022. https://www.who.int/news-room/fact-sheets/detail/dementia
  • Yamashita T, Kunkel SR. (2015). An international comparison of the association among literacy, education, and health across the United States, Canada, Switzerland, Italy, Norway, and Bermuda: Implications for health disparities. Journal of Health Communication, 20 (4), 406-415.
  • Yılmaz M, Tiraki Z. (2016). Sağlık okuryazarlığı nedir? Nasıl ölçülür? Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi, 9 (4), 142-147.
There are 43 citations in total.

Details

Primary Language Turkish
Subjects Nursing
Journal Section Araştırma
Authors

Merve Aliye Akyol 0000-0001-5107-266X

Burcu Akpınar Söylemez 0000-0002-9643-0325

Ecem Özgül 0000-0002-1294-9446

Early Pub Date April 17, 2023
Publication Date April 17, 2023
Submission Date April 2, 2022
Published in Issue Year 2023 Volume: 6 Issue: 1

Cite

APA Akyol, M. A., Akpınar Söylemez, B., & Özgül, E. (2023). COVID-19 Pandemi Sürecinde Demanslı Bireylere Bakım Veren Aile Üyelerinin Sağlık Okuryazarlık Düzeyleri ve İlişkili Faktörler. Ordu Üniversitesi Hemşirelik Çalışmaları Dergisi, 6(1), 55-64. https://doi.org/10.38108/ouhcd.1097620