Cohort profile: Bandar Kong prospective study of chronic non-communicable diseases

Oral health and smoking in Bandare-Kong cohort study: a cross-sectional population-based study (findings from PERSIAN cohort study)

Considering the harmful effects of smoking on oral and dental health, our aim was to investigate the oral and dental health status of people in the city of Bandare-Kong, Iran, and its relationship to smoking. This cross-sectional population-based study used baseline data from the Bandare-Kong Cohort Study. A total of 4063 participants aged 35-70 years were included in this study. Using Stata17 software, negative binomial regression was employed to identify factors related to the decayed, missing, and filled teeth (DMFT) index. The association between smoking status and DMFT was assessed by the adjusted incidence rate ratio (IRR). Of the 4063 participants, 987 (24.29%) used cigarettes, hookahs, or both. The mean ± standard error (SE) DMFT index in all subjects was 11.08 ± 0.15; it was 14.17 ± 0.53 for cigarette smokers and 12.39 ± 0.37 for hookah users (p < 0.001). After adjusting for other variables, the rate of DMFT for cigarette smokers was 0.33 (IRR: 1.33; 95% confidence interval [CI]: 1.22, 1.44), which was higher than for those who did not use cigarettes. The rate of DMFT for those who used cigarettes, hookahs, or both was 0.11 (IRR: 1.11; 95% CI: 1.05, 1.18), which was also higher than for those who did not smoke. Cigarette smoking is a risk factor for oral health complaints. Although the rate of DMFT was increased in hookah smokers, it was not a predictor of dental problems. However, we suggest that hookah use be included in educational policies to control oral and dental diseases.

Predictors of treatment adherence in patients with type 2 diabetes: a cross-sectional study in Southern Iran based on Pender's Health Promotion Model using structural equation modelling

OBJECTIVES

Treatment adherence in type 2 diabetes (T2D) is an important factor in optimal diabetes control and prevention of mortality. The present study aimed to determine the predictability of Pender's Health Promotion Model (HPM) constructs in T2D treatment adherence behaviour.

DESIGN

The present cross-sectional and analytical study was conducted from November 2022 to January 2023.

SETTING

The present study was conducted in Bandar Abbas, a city in Hormozgan Province, in the south of Iran.

PARTICIPANTS

The participants included 396 patients with T2D with medical records in the Hormoz Diabetes Clinic. Based on their record number, the participants were selected for inclusion in the study through a random systematic sampling.

PRIMARY AND SECONDARY OUTCOME MEASURES

The data collection instruments included a demographic questionnaire and a researcher-made questionnaire based on HPM constructs. The questionnaire was valid and reliable, achieving Cronbach's alpha coefficients ranging from 0.609 to 0.798 across various constructs. The questionnaires were completed face to face. Pearson's correlation test, path analysis and structural equation modelling were conducted using SPSS V.23, and STATA V.15.

STUDY STAGE

This study was conducted before intervention (pre-results).

RESULTS

As the path analysis showed, perceived self-efficacy (β=0.23, p<0.001), treatment adherence experiences (β=0.26, p<0.001), immediate competing demands and preferences (β=-0.15, p<0.001) and commitment to plan of action (β=0.24, p<0.001) could significantly predict the treatment adherence behaviour. The results of indirect path analysis showed that the total effect of perceived benefits (β=0.24, p<0.001), perceived barriers (β=-0.14, p=0.002), perceived self-efficacy (β=0.32, p<0.001) on commitment to plan of action was statistically significant. Through the mediation of commitment to plan of action, they could predict the treatment adherence behaviour.

CONCLUSIONS

In light of the present findings, it can be concluded that the proposed model of T2D treatment adherence behaviour has an acceptable fit. Commitment to plan of action, treatment adherence experiences, perceived self-efficacy and immediate competing demands and preferences are the main predictors of T2D treatment adherence behaviour. It is recommended that educational interventions focus on these constructs.

TRIAL REGISTRATION NUMBER

This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1).

Correction: Cohort profile: Bandar Kong prospective study of chronic non-communicable diseases

[This corrects the article DOI: 10.1371/journal.pone.0265388.].

The association between neutrophil and lymphocyte to high-density lipoprotein cholesterol ratio and metabolic syndrome among Iranian population, finding from Bandare Kong cohort study

BACKGROUND

Metabolic Syndrome (MetS) is characterized by the co-occurrence of various metabolic risk factors, significantly increasing the risk of cardiovascular diseases (CVD) and type 2 diabetes (T2DM). This study investigates the potential of hematological indices, specifically the neutrophil to high-density lipoprotein cholesterol ratio (NHR) and lymphocyte to high-density lipoprotein cholesterol ratio (LHR), as predictors of MetS in a population from southern Iran.

METHODS

Utilizing baseline data from the Bandare-Kong Non-Communicable Diseases (BKNCD) Cohort, part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN), A total of 2,684 participants aged 35-70 years were analyzed. Participants were evaluated using the Iranian National Cholesterol Education Program (NCEP) criteria to diagnose MetS. Receiver operating characteristic (ROC) analysis was conducted to assess the predictive validity of NHR and LHR across different demographic categories.

RESULTS

The mean LHR and NHR values were significantly higher in individuals diagnosed with MetS (P < 0.001). Specifically, the LHR was 0.85 ± 0.26 in MetS patients compared to 0.76 ± 0.23 in those without MetS, while the NHR was 1.33 ± 0.35 in MetS patients compared to 1.20 ± 0.32 in those without MetS. After adjusting for confounding factors, both LHR and NHR remained significantly associated with MetS, with odds ratios (OR) of 6.61 (95% CI: 4.43-9.83) for LHR and 4.76 (95% CI: 3.51-6.45) for NHR. Among MetS components, LHR was associated with low HDL cholesterol and elevated triglycerides, while NHR showed significant associations with central obesity, low HDL cholesterol, and elevated triglycerides. ROC analysis revealed moderate predictive capabilities for both indices, with areas under the curve of 0.60 for LHR and 0.61 for NHR.

CONCLUSION

The findings suggest that NHR and LHR are promising, easily obtainable hematological markers for predicting MetS. These indices could serve as valuable tools for early detection and ongoing monitoring in clinical settings, aiding in the prevention and management of MetS.

The predictive power of conventional and novel obesity indices in identifying metabolic syndrome among the southern Iranian populations: findings from PERSIAN cohort study

BACKGROUND

Metabolic syndrome (MetS) contributes to an increased risk of cardiovascular diseases. Traditional metrics like body mass index (BMI) have limitations in discerning fat distribution. The purpose of this study was to evaluate the diagnostic accuracy of traditional and novel anthropometric indices in metabolic syndrome and its components in the south coast of Iran.

METHODS

In this cross-sectional study, 2694 adults aged 35 to 70 were included. Comprehensive anthropometric and biochemical data were collected and analyzed. There were eight anthropometric indices evaluated in this study, including a body shape index (ABSI), body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), body roundness index (BRI), abdominal volume index (AVI), weight-adjusted waist index (WWI) and waist-height ratio (WHtR).

RESULTS

WHtR (AUC: 0.766 for males, 0.799 for females), BRI (AUC: 0.766 for males, 0.799 for females), and AVI (AUC: 0.769 for males, 0.793 for females) were the best predictors of MetS. ABSI had the weakest correlation with metabolic variables.

CONCLUSIONS

AVI, WHtR, BRI, and WHR were superior to other measures as anthropometric indexes for determining MetS and its components. The study contributes valuable insights into the utility of traditional and novel metrics in clinical practice, highlighting the need for standardized diagnostic approaches and further research in diverse populations.

Age Group-Wise Burden of Non-Communicable Diseases Among Shrimp Cultivators in India: A Retrospective Analysis of Disability-Adjusted Life Years Method

OBJECTIVE

Despite generating huge employment opportunities and profitable business, fishing is considered a dangerous occupation due to challenging weather conditions and exposure to unhealthy occupational factors and lifestyles, which contribute to various health issues. However, few studies have examined the health status of shrimp cultivators. Consequently, this study aims to estimate the age group-wise burden of non-communicable diseases (NCDs) among shrimp cultivators.

METHODS

Simple random sampling was employed for collecting data. The sample size was 357 shrimp cultivators. Disability-adjusted life years (DALY) and relative risk (RR) methods were used to measure the burden of NCDs among shrimp cultivators. This study reported the burden of NCDs per 100,000 shrimp cultivators.

RESULTS

The top five prevalence of NCDs per 100,000 shrimp cultivators were mental disorders (85,434), musculoskeletal diseases (26,325), digestive diseases (9,803), diabetes (5,882), and cardiovascular diseases (4,481). DALY per 100,000 shrimp cultivators was 33,407.59, while at the national level, it was 24,775.99 per 100,000 people across all age groups. The RR of NCDs among shrimp cultivators in terms of DALY was 1.35, indicating a 0.35 times higher burden of NCDs among shrimp cultivators than at the national level. The largest RR of NCDs was found among shrimp cultivators aged 15-49 years (1.85), followed by 50-69 years (1.09). The highest percentage changes in the burden of NCDs among shrimp cultivators, resulting from changes in the methods of estimating DALY, was observed in the age group of 70 years and above (-48.36%) followed by 15-49 years (-46.08%) and 50-69 years (-40.33%) when compared to the baseline method of estimating DALY without utilizing age weightage and discount rate.

CONCLUSIONS

Focus should be given to improving the lifestyle and occupational factors of shrimp cultivators to mitigate the burden of NCDs.

Prevalence of Chronic Kidney Disease and Associated Factors among the Diabetic and Prediabetic Population in the Bandare-Kong Cohort Study; A Population-Based Study

BACKGROUND

This investigation aims to examine the relationship between diabetes and prediabetes with chronic kidney disease (CKD) while taking into account key risk factors such as gender, age, lifestyle, smoking habits, and blood pressure.

METHODS

Between November 17, 2016, and November 22, 2018, 4063 subjects aged 35 to 70 years were enrolled in the first phase of the Bandare-Kong Non-Communicable Disease (BKNCD) Cohort Study, which is part of the PERSIAN (Prospective Epidemiological Research Studies in IrAN) cohort and was conducted in a coastal region of the Hormozgan province in southern Iran. CKD was calculated using the Modification of Diet in Renal Disease (MDRD) formula based on glomerular filtration rate (GFR)<60 mL/min per 1.73 m2 , or albumin/Cr>30 mg/g in random urine, self-reported kidney failure, or dialysis. Urine albumin and creatinine were determined by standard kits (Pars Azmoon, Tehran, Iran) and the BT1500 automatic chemistry analyzer (Biotecnica Instruments, Rome, Italy).

RESULTS

The prevalence of CKD was found to be 15.3%, with 29.6% identified in diabetic individuals and 16.5% in prediabetic patients. So, the prevalence of CKD in diabetics was higher than prediabetics and normal people. Increased age, dysglycemia (diabetes or prediabetes), hypertension, and use of angiotensin receptor blockers were markedly associated with an elevated risk of CKD in adults.

CONCLUSION

The study emphasizes the importance of early detection and management of CKD risk factors, particularly among high-risk individuals, to mitigate CKD progression and associated complications. By addressing modifiable risk factors, proactive screening, and enhanced awareness, significant strides can be made in reducing CKD burden and improving patient outcomes.

A health promotion model-based intervention to enhance treatment adherence in patients with type 2 diabetes

BACKGROUND

The present study aimed to determine the effect of an intervention based on Pender's health promotion model (HPM) on treatment adherence in patients with type 2 diabetes (T2D).

METHODS

The present quasi-experimental study with a 3-month follow-up was conducted in Bandar Abbas, a city in the south of Iran in 2023. The intervention group (IG) with a total number of 95 T2D patients was selected from Hormuz diabetes clinic and the control group (CG) with 95 T2D patients was selected from comprehensive health centers through a clustering sampling method. The educational intervention was implemented in 10 sessions to improve patients' treatment adherence. The teaching methods in training sessions were lectures, joint discussions, Q&A, role-play and peer training. The participants were evaluated using a researcher-made questionnaire including the constructs of Pender's HPM about T2D treatment adherence, hemoglobin A1C (HbA1C), and BMI. Independent-samples t-test, paired-samples t-test, covariance analysis and stepwise regression analysis were used. Data analysis was done in SPSS 26.

FINDINGS

Three months after the intervention, in comparison to the CG, the mean and standard deviation of treatment adherence benefits (p = 0.002), treatment adherence self-efficacy (p = 0.010), treatment adherence related affect (p = 0.001), interpersonal influences (p = 0.012), commitment to plan of action (p < 0.001), treatment adherence behavior (p = 0.022), treatment adherence experiences (p = 0.001) was higher in the IG. The mean and standard deviation of situational influences (p < 0.001), immediate competing demands and preferences (p = 0.018) were lower than the CG. The results obtained from the analysis of covariance proved the effectiveness of the intervention in the constructs of Pender's HPM and HbA1C in participants of the IG (p < 0.001). The regression analysis showed, after the intervention, for every 1 unit of change in commitment to behavior planning, action related affect and perceived self-efficacy, compared to before the intervention, there were 0.22 units, 0.16 units and 0.26 units of change in the behavior score in the IG.

CONCLUSION

The findings proved the effectiveness of the educational intervention in improving the constructs in Pender's HPM and the blood sugar level of T2D patients. As the results of the educational intervention showed, the use of a suitable educational approach as well as the development of appropriate educational content for the target population can significantly improve the treatment adherence behavior.

TRIAL REGISTRATION

This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741 ) and first release date of 17th March 2022.

Atherogenic index of plasma as a predictor of coronary artery disease: a cohort study in south of Iran

BACKGROUND

Coronary artery disease (CAD) is an atherosclerotic disease of an inflammatory nature. Previous studies examining the relationship between triglycerides and high-density lipoprotein cholesterol have highlighted the importance of plasma atherogenic index (AIP) as an important predictor of coronary heart disease. However, due to the lack of adequate information on this topic, this study aimed to investigate the relationship between AIP and coronary heart disease risk.

RESULTS

This study included 2,226 women and 1,690 men aged 35-70 years who participated in the Bandar Kong Cohort study and met the eligibility criteria. The data was collected using a checklist and questionnaires, which were designed by experienced individuals. After participants completed a registration form and gave informed consent, face-to-face interviews were conducted by trained experts. The validity and reliability of the questionnaire had been verified by the national cohort team prior to its use. The Ethics Committee of Hormozgan University of Medical Sciences (IR.HUMS.REC.1400.171) approved the study. Data from the initial cohort survey using SPSS software version 25, were analyzed to include several factors, including age, sex, smoking status, body mass index (BMI), physical activity level, socioeconomic status, AIP, systolic blood pressure, and diastolic blood pressure. The prevalence of coronary heart disease was found to be 7.5% higher in people with a BMI of 25 or higher. Also, Individuals with low physical activity had a higher prevalence. Individuals with CAD had significantly higher mean values for the AIP, age, systolic blood pressure, and diastolic blood pressure (0.46, 57.50, 128.43, and 81.10, respectively) compared to those without CAD. Furthermore, patients with CAD had lower years of education (2649.45 and 3.59) than individuals without CAD (P < 0.05). Importantly, our findings showed that AIP increased the odds ratio of coronary heart disease by 1.86 as an independent risk factor.

CONCLUSIONS

Based on our investigation, the AIP is a valuable and independent predictive risk factor for coronary artery disease. This index can be utilized effectively due to its accessibility and affordability, making it a promising tool for risk assessment in clinical settings.

The association between dietary patterns and metabolic syndrome among Iranian adults, a cross-sectional population-based study (findings from Bandare-Kong non-communicable disease cohort study)

BACKGROUND

Metabolic syndrome is a cluster of metabolic disorders increasing the risk of cardiovascular disease and diabetes. Dietary patterns are supposed to be important and controllable factors in developing metabolic syndrome. The purpose of this study was to investigate the association of dietary patterns with metabolic syndrome and its components.

SUBJECTS/METHODS

Cross-sectional data were extracted from the Bandare-Kong cohort study conducted on 4063 people aged 35 to 70. Dietary patterns were extracted using principal component analysis based on thirty-eight pre-defined food groups. Multivariable logistic regression was conducted to investigate the association between metabolic syndrome and its components with quintiles of dietary patterns in crude and adjusted models.

RESULTS

Three major dietary patterns were identified (healthy, western, and traditional) in the final analysis of 2823 eligible individuals. After adjusting for covariates, the odds of metabolic syndrome were significantly decreased by 46% in subjects with the highest adherence to the healthy dietary pattern compared to those with the lowest adherence quintile. Results from fully adjusted models on individual metabolic syndrome components showed an inverse association between higher adherence to the healthy dietary pattern and the odds of increased blood glucose, high waist circumference, and elevated blood pressure. However, in fully adjusted models, no significant association was observed between the western and traditional dietary patterns with odds of metabolic syndrome and its components.

CONCLUSIONS

Adherence to a healthy dietary pattern containing high amounts of fruits, vegetables, nuts, low-fat dairy products, and legumes, could be recommended to prevent and control metabolic syndrome.

Assessing the risk of metabolic syndrome and diabetes in relation to Hookah smoking: Evidence from a cohort study in Southern Iran

Background

Hookah smoking has pointedly increased worldwide and could have different harmful health effects. However, long term hookah smoking effects on chronic diseases has not been well studied. This study was aimed to investigate the relationship between hookah smoking with metabolic syndrome and diabetes.

Methods

In this prospective study, the baseline data from 3695 participant (35-70 years old) of Bandar-e-Kong cohort study in Hormozgan province, Iran were used. In this study, data were collected through the questionnaires designed in the Kong cohort study and 25 mm of blood sample. All analyses were performed using SPSS version 27.0 and the ggplot2 package in RStudio version 2023.06.1 + 524. p < 0.05 was considered a significant difference.

Results

The prevalence of hookah smoking was 17.3% in total. Also, the prevalence of metabolic syndrome, diabetes, hypertension, and dyslipidemia were 35.6, 15.2, 31.2, and 78.0%, respectively. Our results showed that there were statistically significant relationship between hookah smoking and metabolic syndrome, hypertension and diabetes (p < 0.05). In the case of dyslipidemia, hookah smoking was also associated with increase in dyslipidemia (p < 0.05).

Conclusions

More evidence is needed to understand the mechanism of hookah smoking and these health effects. As well as, health education and increasing public awareness about the health effects of hookah smoking and implementation of smoking prohibition policies are highly recommended.

Kharameh cohort study (KHCS) on non-communicable diseases and preliminary findings of 3-year follow-up

PURPOSE

The Kharameh cohort study (KHCS) is one branch of the 'Prospective Epidemiological Research Studies in Iran', located in the south of Iran. The enrolment phase of KHCS spanned from April 2015 to March 2017, during which urban and rural residents of Kharameh were enrolled in the study. KHCS aims to investigate the incidence of non-communicable diseases (NCDs) such as hypertension, diabetes mellitus, cardiovascular diseases and cancer, and its related risk factors in a 15-year follow-up.

PARTICIPANTS

KHCS was designed to recruit 10 000 individuals aged 40-70 years old from both urban and rural areas of Kharameh. Thus, a total of 10 800 individuals aged 40-70 years of age were invited and, finally, 10 663 subjects were accepted to participate, with a participation rate of 98.7%.

FINDINGS TO DATE

Of the 10 663 participants, 5944 (55.7%) were women, and 6801 (63.7%) were rural residents. The mean age of the participants was 51.9±8.2 years. 41.8% of the participants were aged 40-49, 35.2% were aged 50-59 and the remaining 23% were 60-70 years old. Until March 2020 (first 3 years of follow-up), the total number of patients diagnosed with NCDs was 1565. Hypertension, type 2 diabetes and acute ischaemic heart disease were the most common NCDs. Furthermore, the total number of deaths during the first 3 years of follow-up was 312, with cardiovascular diseases (38.7%) as the most common cause of death, followed by cerebrovascular diseases (11.8%) and cancer (16.2%).

FUTURE PLANS

The remaining 12 years of follow-up will inevitably shed light on the genetic, lifestyle/socioeconomic status, and environmental risk and protective factors of NCDs.

Contrasting socioeconomic inequality with noncommunicable diseases: Insights from a population-based survey using the concentration index in Kong cohort study

Background

Noncommunicable diseases (NCDs) are the major causes of mortality across the globe, which impose a substantial burden on health care systems, particularly in low- and middle-income countries. The present study aimed to determine socioeconomic inequality in the prevalence of NCDs using the concentration index (CI).

Methods

This cross-sectional study was conducted on the baseline data of the Bandar Kong cohort. The principal component analysis was used to determine people's socioeconomic status (SES). The CI and Lorenz Curve were used for the assessment of socioeconomic inequality. Multivariate logistic regression was used to assess the relationship between SES and the prevalence of NCDs. A p Value less than 0.05 is considered significant.

Results

Frequency and prevalence of diabetes was 653 (16.22%), hypertension 848 (21.06%), chronic lung diseases 161 (4%), epilepsy 70 (1.74%), mental disorders 191 (4.74%), stillbirth 299 (13.94%), thyroid disorders 391 (9.71%) and depression 146 (3.63%). CI for the prevalence of diabetes was [-0.107, %95 CI: -0.146 to -0.068], hypertension [-0.122, %95 CI: -0.155 to -0.088], chronic lung disease [-0.116, %95 CI: -0.202 to -0.03], psychiatric disorders [-0.230, %95 CI: -0.304 to -0.155], depression [-0.132, %95 CI: -0.220 to-0.043] and stillbirth [-0.162, %95 CI: -0.220 to -0.105]. The Gini index was negative for all these diseases, indicating that these are significantly concentrated in people of poor SES.

Conclusions

The findings suggest that selected NCDs were concentrated among the poor and the low-income. Particular attention may be necessary to address the problem of NCDs among these groups.

Smoking waterpipe, cigarette, and heart disease: a cross-sectional analysis of baseline data from the Kong Cohort Study in the South of Iran

Previous studies have shown the association between smoking and increased risk of cardiovascular diseases, but long-term effects of waterpipe use are unknown and more research is needed. The present study explored the relationship between cigarette and waterpipe smoking and heart disease in southern Iran. This cross-sectional study used the basic data of Bandar Kong Cohort Study (KCS) to test the relationship between waterpipe and cigarette smoking and heart disease in 4009 participants. A multivariate binary logistic regression was run to estimate adjusted odds ratios (ORs) in SPSS 16. The prevalence of tobacco use was 27.7%. The frequency of heart disease was 7.8% percent (n = 314). There was a statistically significant relationship between cigarette smoking and heart disease (OR = 2.11; 95% CI:1.41-3.16). In individuals who only smoked waterpipes, the odds of heart disease were higher than non-smokers. This relationship was not statistically significant (OR = 1.25, 95% CI:0.88-1.78). In those who smoked cigarettes and waterpipe at the same time, the odds of heart disease were higher than non-smokers (OR = 1.42; 95% C.I: 0.83-2.59). In general, cigarette smoking increases the risk of heart disease. As well as waterpipe smoking was associated with heart disease. However, this association was not statistically significant. More studies are required to validate the association between waterpipe smoking and heart disease. Also, waterpipe use was more common at younger ages, and on the other hand, heart diseases have a long latent period, so in this age group, high incidence of heart disease is likely in the future.

Factors predicting age at menopause among Iranian women in the Bandare-Kong cohort study (a cross-sectional survey of PERSIAN cohort study)

BACKGROUND

Menopause is a natural period in women's life and can be affected by several factors. The aim of this study was to identify the associated factors for age of natural menopause and among women with early and premature menopause based on a cohort study in Iran.

METHODS

This population-based study was conducted on 894 post menopause women between 35 and 70 years old who participated in the Bandare-Kong Non-Communicable Diseases (BKNCD) Cohort Study, a part of Prospective Epidemiological Research Studies in Iran (PERSIAN) from March 2016 to February 2019. All women completed a standard self-reported questionnaire. Data were analyzed using chi-square test, independent t test, and ANOVA as well as a multivariable linear regression model.

RESULTS

The mean age at natural menopause was 48.31 ± 6.34 years. After adjusting other variables, gravida, history of cardiac disease, socioeconomic status and residence status were predictive of age at menopause (P < 0.001). Among the premature menopause group, the mean age at menopause was significantly higher among women with diabetes compared to women without diabetes group (35.68 ± 2.92 vs. 33.82 ± 3.06; P = 0.043), while the mean age at menopause was significantly lower in women with infertility compared to women without infertility (29.13 ± 5.22 vs. 34.84 ± 2.826; P = 0.048).

CONCLUSIONS

This study suggests that the predictors of menopausal age differed in women with premature menopause compared to overall menopause age. Prospective studies are needed to evaluation the effects of these factors on menopausal age.

Application of Pender's health promotion model for type 2 diabetes treatment adherence: protocol for a mixed methods study in southern Iran

BACKGROUND

Type 2 diabetes (T2D) mellitus treatment as a chronic disease requires adequate adherence to treatment including controlling blood glucose levels and lifestyle management. The aim of this study is to investigate the factors affecting of adherence to T2D treatment from the perspective of patients and design an intervention program based on Pender's health promotion model (HPM) to increase T2D treatment adherence in Bandar Abbas, a city located in the south of Iran.

METHODS

This mixed method study will consist of qualitative stage, questionnaire design and a randomized, open-label, parallel-group interventional study based on HPM in southern Iran. Sampling for qualitative stage will continue until reaching the saturation. In the intervention stage, participants will be 166 T2D patients referring to the Bandar Abbas Diabetes Clinic will be randomized into intervention and control groups (allocation 1:1). After identifying the factors affecting adherence to treatment in T2D patients by qualitative study and literature review, a questionnaire based on HPM will be designed. In the next stage, 10 sessions of intervention for the intervention group will be designed. To evaluate the effect of the intervention, intervention and control groups will be tested for hemoglobin A1c (HbA1c) before and 3 months after the intervention.

DISCUSSION

This designed study is a program for improving treatment adherence in T2D based on the HPM model and contributes to a better understanding of effective factors in adherence to treatment in T2D patients. The results of this project can be used for macro-diabetic planning.

TRIAL REGISTRATION

This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741 ) and first release date of 17th March 2022.