Turkiye Klinikleri Journal of Nursing Sciences

.: ORIGINAL RESEARCH
Effects of the Telephone-Based Motivational Interviewing in Adults with Type 2 Diabetes: A Systematic Review of Randomized Controlled Trials
Tip 2 Diyabetli Erişkinlerde Telefona Dayalı Motivasyonel Görüşmenin Etkileri: Randomize Kontrollü Çalışmaların Sistematik Derlemesi
Eda KILINÇa, Asiye KARTALa
aDepartment of Nursing, Division of Public Health Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Türkiye
Turkiye Klinikleri J Nurs Sci. 2022;14(2):372-86
doi: 10.5336/nurses.2021-84110
Article Language: EN
Full Text
ABSTRACT
 Objective: The aim of this systematic review is to evaluate the effect of the telephone-based MI intervention in adults with Type 2 diabetes with randomized controlled trials. Material and Methods: This research was created in line with the recommendations of the PRISMA systematic review guide. Literature was searched using Web of Science, ScienceDirect, EBSCO CINAHL Complete, PubMed, Cochrane Central Register of Controlled Trials as databases. Keywords consisted of 'Diabetes mellitus' and 'Motivational interview' and 'telephone' and 'randomized controlled trial' from 2010 to 2020. Inclusion criteria in the systematic review were determined according to the PICOS components. Results: The electronic search yielded 907 studies and 7 articles were included in the systematic review. Blood pressure control in 2 of 4 studies, body mass index (BMI) in one of two studies, weight loss in one of three studies, waist circumference loss in two of three studies, high density lipoprotein (HDL) in one of three studies, and low density lipoprotein (LDL) in one of four studies reached clinical targets. Two of three studies were healthy eating/diet, and one of two studies exercise/physical activity reached behavioral goals. There was no difference in clinical outcomes (HbA1c, total cholesterol, triglyceride, fasting plasma glucose, hip circumference loss), and self-care behaviors (diabetes self-efficacy, medication adherence, blood glucose monitoring, foot care). Conclusion: As a result of telephone-based MI interventions, some studies have found improvements in the clinical (blood pressure, BMI, weight loss, HDL, LDL) and behavioral outcomes (healthy eating/diet, exercise/physical activity) of patients with T2DM.

Keywords: Diabetes mellitus; Type 2; motivational interviewing; telephone; systematic review
ÖZET
 Amaç: Bu sistematik derlemenin amacı, Tip 2 diyabetli erişkinlerde telefona dayalı MG müdahalesinin etkisini, randomize kontrollü çalışmalarla değerlendirmektir. Gereç ve Yöntemler: Bu araştırma, PRISMA sistematik inceleme kılavuzunun önerileri doğrultusunda oluşturulmuştur. Literatür, 'Web of Science', 'ScienceDirect', 'EBSCO CINAHL Complete', 'PubMed', 'Cochrane Central Register of Controlled Trials' veri tabanları kullanılarak taranmıştır. Anahtar kelimeler, 2010-2020 yıllarını kapsayacak şekilde 'Diabetes mellitus' ve 'Motivasyonel görüşme' ve 'telefon' ve 'randomize kontrollü çalışmalar'dır. Sistematik derlemeye dâhil edilme kriterleri PICOS bileşenlerine göre belirlenmiştir. Bulgular: Elektronik arama sonucunda ulaşılan 907 çalışmadan 7 makale sistematik derlemeye dâhil edilmiştir. Dört çalışmadan 2'sinde kan basıncı kontrolü, 2 çalışmadan 1'inde beden kitle indeksi (BKİ), 3 çalışmadan 1'inde kilo kaybı, 3 çalışmadan 2'sinde bel çevresinde azalma, 3 çalışmadan 1'inde yüksek yoğunluklu lipoprotein [high density lipoprotein (HDL)] ve 4 çalışmadan 1'inde düşük yoğunluklu lipoprotein [low density lipoprotein (LDL)] değerlerinde azalma klinik çıktıları bulunmuştur. Üç çalışmadan 2'si sağlıklı beslenme/diyet ve 2 çalışmadan 1'i egzersiz/ fiziksel aktivite davranışsal çıktılarına ulaşmıştır. HbA1c, açlık plazma glukozu, kalça çevresinde azalma, toplam kolesterol, trigliserid gibi klinik sonuçlarda ve ilaç uyumu, diyabet öz-etkililik, kan şekeri izleme, ayak bakımı gibi öz bakım davranışlarında fark bulunmamıştır. Sonuç: Telefona dayalı MG müdahaleleri sonucunda bazı araştırmalarda, T2DM'li hastaların klinik (kan basıncı, BKİ, kilo kaybı, HDL, LDL) ve davranışsal (sağlıklı beslenme/diyet, egzersiz/fiziksel aktivite) sonuçlarında iyileşmeler saptanmıştır.

Anahtar Kelimeler: Diabetes mellitus; Tip 2; motivasyonel görüşme; telefon; sistematik derleme
REFERENCES:
  1. International Diabetes Federation. IDF Diabetes Atlas. 9th ed. India: International Diabetes Federation; 2019. Cited: 18 Aug 2020. Available from: [Link] 
  2. Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, et al; 2017 Standards Revision Task Force. 2017 National Standards for Diabetes Self-Management Education and Support. Diabetes Educ. 2017; 43(5):449-64. Erratum in: Diabetes Educ. 2017;43(6):650. [Crossref]  [PubMed] 
  3. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25(7):1159-71. [Crossref]  [PubMed] 
  4. Cochran J, Conn VS. Meta-analysis of quality of life outcomes following diabetes self-management training. Diabetes Educ. 2008;34(5): 815-23. [Crossref]  [PubMed]  [PMC] 
  5. Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, et al. Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. J Acad Nutr Diet. 2015; 115(8):1323-34. [Crossref]  [PubMed] 
  6. Berhe KK, Gebru HB, Kahsay HB. Effect of motivational interviewing intervention on HgbA1C and depression in people with type 2 diabetes mellitus (systematic review and meta-analysis). PLoS One. 2020;15(10): e0240839. [Crossref]  [PubMed]  [PMC] 
  7. Ekong G, Kavookjian J. Motivational interviewing and outcomes in adults with type 2 diabetes: A systematic review. Patient Educ Couns. 2016;99(6):944-52. [Crossref]  [PubMed] 
  8. Song D, Xu TZ, Sun QH. Effect of motivational interviewing on self-management in patients with type 2 diabetes mellitus: A meta-analysis. Int J Nurs Sci. 2014;1(3):291-7. [Crossref] 
  9. Chen SM, Creedy D, Lin HS, Wollin J. Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: a randomized controlled trial. Int J Nurs Stud. 2012; 49(6): 637-44. [Crossref]  [PubMed] 
  10. Miller WR, Rollnick S. Ten things that motivational interviewing is not. Behav Cogn Psychother. 2009;37(2):129-40. [Crossref]  [PubMed] 
  11. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change 3rd ed. New York: Guilford Press; 2012.
  12. Fisher WA, Fisher JD, Harman J. The information-motivation-behavioraI skills model: A general social psychological approach to understanding and promoting health behavior. In: Suls J, Wallston KA, eds. Social Psychological Foundations of Health and Illness. 1st ed. Blackwell Series in Health Psychology and Behavioral Medicine. Malden: Blackwell Publishing; 2003. p.82-106. [Crossref]  [PubMed] 
  13. Winkley K, Upsher R, Stahl D, Pollard D, Kasera A, Brennan A, et al. Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review. Health Technol Assess. 2020;24(28):1-232. [Crossref]  [PubMed]  [PMC] 
  14. Lee JY, Chan CKY, Chua SS, Paraidathathu T, Lee KK, Tan CSS, et al. Using telemedicine to support care for people with type 2 diabetes mellitus: a qualitative analysis of patients' perspectives. BMJ Open. 2019;9(10):e026575. [Crossref]  [PubMed]  [PMC] 
  15. Shea S, Weinstock RS, Teresi JA, Palmas W, Starren J, Cimino JJ, et al; IDEATel Consortium. A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel study. J Am Med Inform Assoc. 2009;16(4):446-56. [Crossref]  [PubMed]  [PMC] 
  16. Nundy S, Dick JJ, Solomon MC, Peek ME. Developing a behavioral model for mobile phone-based diabetes interventions. Patient Educ Couns. 2013;90(1):125-32. [Crossref]  [PubMed]  [PMC] 
  17. Krishna S, Boren SA, Balas EA. Healthcare via cell phones: a systematic review. Telemed J E Health. 2009;15(3):231-40. [Crossref]  [PubMed] 
  18. Davis RM, Hitch AD, Salaam MM, Herman WH, Zimmer-Galler IE, Mayer-Davis EJ. TeleHealth improves diabetes self-management in an underserved community: diabetes TeleCare. Diabetes Care. 2010;33(8):1712-7. [Crossref]  [PubMed]  [PMC] 
  19. Swoboda CM, Miller CK, Wills CE. Impact of a goal setting and decision support telephone coaching intervention on diet, psychosocial, and decision outcomes among people with type 2 diabetes. Patient Educ Couns. 2017;100(7):1367-73. [Crossref]  [PubMed] 
  20. Özdemir H, Taşcı S. Motivasyonel görüşme tekniği ve hemşirelikte kullanımı [Motivational interviewing technique and use of nursing]. ERÜ Journal of Health Science Faculty. 2013;1(1):41-7. [Link] 
  21. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7): e1000097. [Crossref]  [PubMed]  [PMC] 
  22. Lauffenburger JC, Ghazinouri R, Jan S, Makanji S, Ferro CA, Lewey J, et al. Impact of a novel pharmacist-delivered behavioral intervention for patients with poorly-controlled diabetes: The ENhancing outcomes through Goal Assessment and Generating Engagement in Diabetes Mellitus (ENGAGE-DM) pragmatic randomized trial. PLoS One. 2019;14(4): e0214754. [Crossref]  [PubMed]  [PMC] 
  23. Egede LE, Williams JS, Voronca DC, Gebregziabher M, Lynch CP. Telephone-delivered behavioral skills intervention for African American adults with type 2 diabetes: a randomized controlled trial. J Gen Intern Med. 2017;32(7):775-82. [Crossref]  [PubMed]  [PMC] 
  24. Browning C, Chapman A, Yang H, Liu S, Zhang T, Enticott JC, et al. Management of type 2 diabetes in China: the Happy Life Club, a pragmatic cluster randomised controlled trial using health coaches. BMJ Open. 2016;6(3): e009319. [Crossref]  [PubMed]  [PMC] 
  25. Blackberry ID, Furler JS, Best JD, Chondros P, Vale M, Walker C, et al. Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the Patient Engagement and Coaching for Health (PEACH) pragmatic cluster randomised controlled trial. BMJ. 2013; 347:f5272. [Crossref]  [PubMed]  [PMC] 
  26. Fischer HH, Eisert SL, Everhart RM, Durfee MJ, Moore SL, Soria S, et al. Nurse-run, telephone-based outreach to improve lipids in people with diabetes. Am J Manag Care. 2012;18(2):77-84. [PubMed] 
  27. Eakin EG, Winkler EA, Dunstan DW, Healy GN, Owen N, Marshall AM, et al. Living well with diabetes: 24-month outcomes from a randomized trial of telephone-delivered weight loss and physical activity intervention to improve glycemic control. Diabetes Care. 2014; 37(8):2177-85. [Crossref]  [PubMed] 
  28. Higgins JP, Savović J, Page MJ, Elbers RG, Sterne JA. Chapter 8: Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al; eds. Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020). 2nd ed. Cochrane: 2020. Available from: [Link] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com