Factors influencing breast cancer screening practices among women worldwide: a systematic review of observational and qualitative studies

BACKGROUND

The variation in breast cancer incidence rates across different regions may reflect disparities in breast cancer screening (BCS) practices. Understanding the factors associated with these screening behaviors is crucial for identifying modifiable elements amenable to intervention. This systematic review aims to identify common factors influencing BCS behaviors among women globally.

METHODS

Relevant papers were sourced from PubMed, Scopus, Embase, and Google Scholar. The included studies were published in English in peer-reviewed journals from January 2000 to March 2023 and investigated factors associated with BCS behaviors.

RESULTS

From an initial pool of 625 articles, 34 studies (comprising 29 observational and 5 qualitative studies) with 36,043 participants were included. Factors influencing BCS behaviors were categorized into nine groups: socio-demographic factors, health status history, knowledge, perceptions, cultural factors, cues to action, motivation, self-efficacy, and social support. The quality appraisal scores of the studies ranged from average to high.

CONCLUSIONS

This systematic review highlights factors pivotal for policy-making at various levels of breast cancer prevention and assists health promotion professionals in designing more effective interventions to enhance BCS practices among women.

Impact of virtual education based on health belief model on cervical cancer screening behavior in middle-aged women: A quasi-experimental study

BACKGROUND

Cervical cancer is one of the most common cancers in women worldwide and a cause of high mortality among people. Pap smear screening is an appropriate method to prevent cervical cancer and reduce its mortality.

AIM

This study aimed to determine the effect of web-based education based on the Health Belief Model (HBM) on cervical cancer screening behavior in middle-aged women.

METHODS AND RESULTS

This study is a quasi-experimental interventional research that was conducted on 240 middle-aged women aged 40-59 years in Isfahan, Iran, in 2022. An online educational intervention based on the constructs of the Health Belief Model was conducted for the intervention group using the Triple-B platform. The information on the intervention and control groups was collected before, immediately after the intervention, and 2 months later using a valid questionnaire. The gathered Data was analyzed using ANOVA and LSD post-hoc, independent samples t test, chi-square, and MANCOVA statistical tests in SPSS 26 software. After the intervention, the mean scores of knowledge, perceived susceptibility, perceived severity, perceived benefits, self-efficacy, and internal cues to action in the intervention group increased and the mean score of perceived barriers decreased (p < .001). The mean score of the external cues to action did not show a significant difference between the intervention and control groups before, immediately, and 2 months after the intervention. Two months after the intervention, 32 women (26.2%) in the intervention group and two women (1.7%) in the control group performed the Pap smear test.

CONCLUSION

Web-based educational intervention based on HBM using different strategies such as question and answer, presentation of infographics, lectures, brainstorming, showing videos and numerous educational images can be an effective way for increasing knowledge and cognitive variables of women and doing Pap smear test.

The effect of a health belief model-based education on nutritional behavior and biochemical factors of patients with myocardial infarction: A line follow-up experimental study

Background and Aim

Myocardial infarction is a common cause of hospitalization, and nutritional behaviors are risk factors in such patients. The present study aimed to determine the effect of education based on the health belief model on nutritional behavior and indices in patients with myocardial infarction.

Methods

The present experimental study examined patients with myocardial infarction in 2021. Seventy-two patients with myocardial infarction were randomly divided into intervention and control groups. The intervention group received educational interventions based on the health belief model in four 60-min sessions for 3 months. The constructs of the health belief model, nutritional behavior, and indices were measured using a valid questionnaire before, 1, and 3 months after the intervention. At the end, the study data was analyzed using SPSS version 22 software.

Results

There was a significant difference between the two groups in the mean scores of knowledge, perceived susceptibility, perceived severity, perceived benefits, self-efficacy, nutritional behaviors, and body mass index after the intervention (p < 0.05); however, no significant difference was found in the field of perceived barriers (p > 0.05). Biochemical factors also had a significant difference after the intervention (p < 0.05).

Conclusion

Educational intervention based on the health belief model is effective for myocardial infarction patients and has a significant impact on the constructs of perceived sensitivity, perceived intensity, perceived benefits, and self-efficacy as well as biochemical factors, so it can be used to improve the nutritional status of patients suffered from a myocardial infarction.

The effect of educational intervention based on the PEN-3 model on breast cancer screening behaviors

Background

Breast cancer is the most important malignancy and the main cause of cancer deaths among women worldwide. Breast cancer screening is an effective way to reduce breast cancer deaths.

Objectives

The present study aimed to provide breast cancer screening behavior training for female teachers in Isfahan, Iran.

Materials and methods

This randomized controlled trial included 120 teachers who have randomly divided into two groups (60 in the control group and 60 in the intervention group). The data collection tool was a PEN-3 model-based questionnaire. Four 90 min training sessions were held for the intervention group to modify perception and enablers. Breast self-examination (BSE), Clinical breast exam (CBE), and mammography (MMG) were investigated in both groups before and after 6 months after the last training using SPSS20 and appropriate statistical tests.

Results

The frequency of BSE (p = 0.02), CBE (p = 0.04), and MMG (p = 0.01) in the intervention group was significantly higher than in the control group 6 months after training. The mean scores of perception and enablers were significantly higher in the intervention group than in the control group 3 and 6 months after training (p < 0.001). The logistic regression analysis indicated that perception factors were the strongest predictors of breast cancer screening behavior in teachers.

Conclusion

Results of the present study indicated that using the PEN-3 model in the educational intervention was effective in improving breast cancer screening behavior.

Application of Theory of Planned Behavior in Pregnant Women Training Regarding Urinary Tract Infection Prevention Behaviors: A Randomized Controlled Trial

OBJECTIVE

This study aimed to determine the effect of the theory of planned behavior-based education program on promoting the urinary tract infection prevention behaviors in pregnant women.

METHODS

The present study was a randomized controlled trial in which 100 pregnant women, who visited the healthcare centers of Zarinshahr City, were randomly divided into two groups, intervention and control. Five education sessions based on the theory of planned behavior were held for the intervention group.

RESULTS

After implementing the educational intervention, the mean scores of knowledge and constructs of the theory of planned behavior significantly increased in the intervention group over time (P < 0.001). After the educational intervention, the incidence of urinary tract infections (UTI) was 4.3% in the intervention group and 21.3% in the control group.

CONCLUSION

In this study, the use of methods such as group discussion and role playing promoted attitudes, perceived behavioral control and subjective norms of pregnant women, and as a result, UTI in women in the intervention group was reduced.

Application of the Protection Motivation Theory (PMT) in Teaching Skin Cancer Prevention Behaviors in Male Students

Adolescents are at high risk of skin cancer. Since protecting the skin from the sun's ultraviolet rays is an important way to prevent this disease, the present study aimed to evaluate the effectiveness of teaching skin cancer prevention behaviors using the Protection Motivation Theory (PMT) in male students in Isfahan. An intervention study examined change in attitudes and behaviors among 104, 13-year-old male students from two schools in Isfahan, Iran. The schools were randomized to either receive or not receive a 5-session skin cancer prevention curriculum based in PMT theory. Data were collected using a validated questionnaire that included demographic, PMT, and behavior construct variables. Questionnaires were completed by both groups before and 2 months after the intervention. Data were analyzed using SPSS 20, chi-square test, Mann-Whitney test, paired t-test, and McNemar's test. The results indicated that the mean scores of all constructs of PMT increased in the intervention group compared to the baseline assessment, except for the response cost (P < 0.001). The mean score of students' skin cancer preventive behaviors was 39.6 (21.4) in the intervention group, and it increased to 74.7 (23.5) after educational intervention, while the control group did not exhibit any significant behavior change. The intervention certainly shows the potential for being effective over the short-term. Therefore, it is recommended that PMT-based educational interventions be designed to teach and promote social health, particularly at an early age.

Psychometrics of the Persian version of the COVID-19-related health literacy in the Iranian population

Background

Since the occurrence of the COVID-19 pandemic, information dissemination has increased rapidly. Promoting health literacy is currently crucial to prepare people to respond quickly to situations, such as the COVID-19 pandemic. Due to the importance of health literacy in this critical situation, we are looking for a questionnaire to measure COVID-19 health literacy. The COVID-19 Germany Health Literacy Questionnaire (HLS-COVID-Q22) is an excellent tool, so the study aimed to create a cultural validity of this questionnaire for the Iranian population.

Methods

In this validation study, 880 samples were enrolled using a convenient sampling method. The questionnaire was translated through a backward forwarding procedure. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were employed for Persian version validity. McDonald's omega (Ω), Cronbach's alpha, and average inter-item correlation (AIC) coefficients were assessed for reliability.

Results

Using EFA on the random half sample (n = 440), the EFA indicated that the scale had four factors: accessing, understanding, appraising, and applying health-related information in the COVID-19 pandemic context, which explained 59.3% of the total variance. CFA was used for the sample's second part (n = 440) to evaluate the goodness of fit of the four-factor solution. CFA showed the model fit. All indices RMSEA = 0.067, CFI = 0.934, IFI = 0.934, PCFI = 0.772, PNFI = 0.747, and CMIN/DF = 2.972 confirmed the model fit. The convergent validity of the HLS-COVID-Q22 was confirmed. McDonald's omega and Cronbach's alpha were very good (α and Ω >0.80).

Conclusion

The Persian version of the HLS-COVID-Q22 had acceptable psychometric properties and is applicable to measure COVID-19 health literacy.

Design and evaluation of two educational media in the form of animation and games to promote the cutaneous leishmaniasis prevention behaviors in adolescent female

BACKGROUND

Cutaneous leishmaniasis (CL) has social and psychological effects on different groups, especially adolescents and young girls in 98 countries of the world, in addition to the economic burden. Therefore, it is necessary to apply effective methods for CL prevention. In this study, educational messages were designed based on Extended Parallel Process Model in both forms of animation and game, whose effect on the cutaneous leishmaniasis prevention behaviors was evaluated in adolescent female students.  METHODS: This experimental study was carried out from January to September 2021 on 275 adolescent female students in Isfahan province, Iran. Cluster sampling method was used, and then the students were randomly divided into three groups, namely animation education, game education, and control groups. The educational intervention was performed with two new media in the form of animation and games. The data collected before and two months after the education through a valid and reliable researcher-made questionnaire were analyzed in SPSS24 software using statistical tests of ANOVA, Chi-square, paired t and analysis of covariance (ANCOVA).

RESULTS

The mean age of the participants was 14.07 ± 0.94. The mean scores of behavior in the animation group (60.60 ± 23.00), the game group (61.70 ± 22.05), and the control group (66.13 ± 24.62) were not significantly different prior to the education. However, after the education, there was a significant difference between the animation (80.66 ± 17.62) and game groups (82.58 ± 19.07) and the control group (69.79 ± 23.29) (P < 0.001). The mean scores of model constructs following the intervention (susceptibility, severity, response efficacy, and perceived self-efficacy) significantly increased in the animation and game groups compared to that in the control group (P < 0.05).

CONCLUSION

The results showed that if educational programs contain a combination of threat and efficiency messages, CL-preventive behaviors in adolescents increase. Providing similar educational content with both game and animation methods indicated that both methods had an almost same effect. Although animation production is more costly, it has the advantage of being used in periods and for other adolescents.

Development and psychometric assessment of cutaneous leishmaniasis prevention behaviors questionnaire in adolescent female students: Application of integration of cultural model and extended parallel process model

Background

Cutaneous Leishmaniasis (CL) is an important public health issue in at least 83 countries, including Iran. Individuals’ behavior modification is believed to be one of the best ways for CL prevention. However, no comprehensive questionnaires have been psychoanalyzed for identification of CL prevention behaviors and its numerous associated factors, as well as the impact of educational messages. Thus, the present study was conducted to develop and psychometrically assess CL prevention behaviors questionnaire in female students.

Methods

The present study was performed from October 2020 to May 2021 by developing a preliminary questionnaire based on integration of Cultural Model and Extended Parallel Process Model. The questionnaire was completed online by 460 adolescent female students living in endemic areas of Isfahan, Iran. Exploratory factor analysis was performed using SPSS 24 to ensure the construct validity. Internal reliability was assessed via Cronbach’s alpha and external reliability was determined using the test-retest method based on the intraclass correlation coefficient (ICC) index.

Results

The first version of the questionnaire contains 110 items, out of which 82 remained according to content validity ratio (CVR) and content validity index (CVI) criteria. Afterwards, 11 items were removed due to low factor load in the construct validity process using the factor analysis technique. Ultimately, a 71-items questionnaire was developed and 12 factors were extracted from it. According to Cronbach’s alpha index, the internal reliability for the questionnaire was 0.877 and the ICC index calculated the external reliability as 0.833.

Conclusions

Integration of a Cultural Model with individual model was used for the first time to measure the factors related to CL prevention behaviors in this questionnaire; owing to the strength of the factor structure and appropriate psychometric properties, the questionnaire is applicable in the evaluation process of educational interventions concerning CL prevention, especially in female students.

Evaluation of medication adherence and its relevant factors among hypertensive patients: A cross-sectional study in Shahrekord health-care system

BACKGROUND

Medication adherence means compliance with patient adherence to medication orders, including timely and correct consumption of medication prescribed by a physician. The present study aimed to determine the extent of adherence to hypertension drug medication in patients covered by comprehensive health service centers of Shahrekord, Iran.

MATERIALS AND METHODS

A cross-sectional study examined 401 hypertensive patients registered in the Integrated Health Record System (SIB). SIB is a Persian term related to Health Record System. To collect data, Morisky Medication Adherence Scale was used. The questionnaire was completed by the patients and analyzed using SPSS (SPSS Inc., Chicago, Illinois, USA, version 26), Chi-square test, independent t-test, and analysis of variance.

RESULTS

The results indicated that adherence to antihypertensive medication was low in 5.7% of patients, while 63.3% of patients had sufficient compliance. Forgetting to take medications (52.9%) was the most common reason for nonadherence to medication in hypertensive patients.

CONCLUSION

Given that forgetting to take medications was the main reason for nonadherence to medication in hypertensive patients, designing and implementing necessary trainings by comprehensive health centers to realize the importance of daily use of medication by hypertensive patients and their families are recommended.

Application of BASNEF model in students training regarding cutaneous leishmaniasis prevention behaviors: a school-based quasi experimental study

BACKGROUND

Cutaneous leishmaniasis (CL) is endemic in 98 countries, and 350 million people are at risk of the disease worldwide. In endemic areas, conducting educational interventions is necessary to change preventive behaviors of CL. This study aimed to investigate the effect of an educational intervention based on the BASNEF model on CL preventive behavior in students.

METHODS

The present quasi-experimental study examined 80 students living in endemic areas of leishmaniasis in Isfahan province, Iran based on the BASNEF model. The required data were collected twice before and two months after the educational intervention based on a questionnaire whose validity and reliability had been already proven in other studies. The intervention was performed in three educational sessions for the students in the intervention group and 1 educational session for teachers and parents. Data were analyzed by SPSS (VER26) using the chi-square test, independent t-test, analysis of covariance (ANCOVA), and Paired t-test.

RESULTS

After intervention, the mean scores of Knowledge (P < 0.001), attitude (P = 0.02), subjective norms (P = 0.04), behavioral intention (P < 0.001), and behavior (P = 0.02) indicated significant differences between the intervention and control groups, but an increase in mean scores of enabling factors was not significant (P = 0. 93).

CONCLUSIONS

Providing students with the educational intervention based on the BASNEF model improve their ability to the extent that they transmit these educations to their family members, which would be effective in preventing and controlling CL in leishmaniasis-prone areas.

TRIAL REGISTRATION

Name: Iranian Registry of Clinical Trials. Registration number: IRCT20201024049131N1. Registration date: 2020-11-20. Registration timing: prospective.

Behaviors and Perceptions Related to Cutaneous Leishmaniasis in Endemic Areas of the World: A Review

The investigation of perceptions and behaviors associated with cutaneous leishmaniasis (CL) in different societies has indicated that mere attention to biological and medical aspects is not enough to prevent and control diseases and it is necessary to know the disease-associated behaviors and beliefs. The present study aimed to answer a question: what are the behaviors and perceptions associated with cutaneous leishmaniasis in endemic regions of the world?. This study is a review of the articles published on CL from January 2010 to January 2021, on the International databases Science Direct, Scopus and PubMed. We utilized the terms cutaneous leishmaniasis, in combination with some keywords, including belief, perceptions, knowledge, attitude, practices, prevention, and behavior. Non-original studies, including editorials, reviews, prefaces, brief communications, and letters to the editor, CL epidemiological articles, pre-published articles that has not been peer reviewed, and articles that not provide complete findings on CL-related perceptions and behaviors were excluded from the present paper. After screening, 25 articles from 17 regions of the world were included in the study. The results depicted a novel classification of behaviors and perceptions related to CL prevention and control. Two positive and negative categories of perceptions and behaviors were discovered. Positive perceptions and behaviors were classified into five categories, including: 1- good awareness, 2- perceived susceptibility, 3- perceived severity, 4- perceived response efficiency, and 5- appropriate behaviors. Furthermore, negative perceptions and behaviors were classified into four categories: 1- poor awareness 2- misconceptions (A. About the disease vector B.about the cause of the disease, C. about the consequences of the disease and the treatment process), 3- perceived barriers (A. in prevention, B. in medical treatment), and 4- misbehaviors (A. negligence, B. local and traditional behavioral patterns). In most endemic parts of the world, misconceptions are probably the leading cause of several misbehaviors in dealing with CL. It seems that providing educational programs to strengthen positive beliefs and correct negative beliefs are rooted in the studies in different countries and could be useful for improving the relevant behaviors and ultimately, taking a step towards the prevention and control of CL.

A quasi-experimental study to improve health service quality: implementing communication and self-efficacy skills training to primary healthcare workers in two counties in Iran

BACKGROUND

Service satisfaction ratings from clients are a good indicator of service quality. The present study aimed to investigate the impact of communication skills and self-efficacy training for healthcare workers on clients' satisfaction.

METHODS

A quasi-experimental study was conducted in health centers of Saveh University of Medical Science in Iran. Primary Healthcare (PHC; N = 105) workers and service recipients (N = 364) were randomly assigned to intervention and control groups. The intervention group received four 90-min training sessions consisting of lecture, film screening, role-playing, and discussion group. Before and 3 months after the intervention, a multi-part questionnaire (including demographics, self-efficacy and communication skills in PHC workers; and satisfaction questionnaire in service recipients) was completed by participants in both intervention and control groups.

RESULTS

PHC worker mean scores of self-efficacy and communication skills after the educational program were increased in the intervention group compared to the control group (p < 0.05). Also, mean satisfaction scores for service recipients of the intervention group (PHC workers) generally significantly increased compared to the control group (p < 0.001).

CONCLUSIONS

The educational program improved the self-efficacy, and communication skills in health workers and improved client satisfaction overall. Our results support the application of self-efficacy and communication skills training for other medical groups who wish to improve clients satisfaction as an important health services outcome.

Predictability of constructs of theory of planned behavior in adopting urinary tract infection prevention behaviors among pregnant women

BACKGROUND

Urinary tract infection is a common infection in women during pregnancy, leading to many complications for both mother and fetus if untreated. The present study aimed to investigate the predictability of constructs of the theory of planned behavior (TPB) in adopting urinary tract infection prevention behaviors in pregnant women.

MATERIALS AND METHODS

In the present cross-sectional study, we selected 100 pregnant women who visited the comprehensive health service centers of Zarrinshahr using convenience sampling from July to September 2019. We collected data by a questionnaire designed based on the constructs of the TPB and analyzed data using SPSS 20 and linear regression test and Pearson correlation coefficient. A significant level was considered as α < 0.05.

RESULTS

In the study, the Pearson correlation coefficient showed direct relationships between the score of behavior and the scores of knowledge (P = 0.005), attitude (P = 0.02), perceived behavioral control (P < 0.001), and behavioral intention (P = 0.001). Linear regression analysis indicated that among the above variables, the perceived behavioral control, knowledge, and behavioral intention were significant predictors of scores of urinary tract infection prevention behaviors, respectively, in terms of their importance.

CONCLUSION

In this study, perceived behavioral control is detected as the main predictor of doing urinary tract infection prevention behaviors in pregnant women and should be considered in designing educational interventions.

Designing and evaluation of E-health educational intervention on students' physical activity: an application of Pender's health promotion model

BACKGROUND

The present study was conducted to design and evaluate the software and web-based curriculum based on Pender Model in order to promote students' physical activity.

METHODS

This is a quasi-experimental study conducted on 225 eligible students who were randomly divided into two groups of web and software-based intervention and control. The sample size of the study was selected using stratified sampling method. The evaluation was done with pre-test and post-test and follow-up, which were performed immediately two and six months following the intervention. The data were analyzed employing statistical software SPSS using descriptive statistics, chi-square, one way ANOVA, and repeated measures ANOVA.

RESULTS

The obtained results revealed that the level of physical activity after the intervention in the web and software groups significantly increased compared to the control group (p < 0.001). Moreover, the mean score of Pender model constructs, immediately two and six months after the intervention, was significantly different in the web and software groups (p < 0.001).

CONCLUSION

Our results indicated that, providing tailored message based on health promotion model's constructs has a positive effect on promoting physical activity of students.

TRIAL REGISTRATION

Name: Iranian Registry of Clinical Trials. Registration number: IRCT20181009041298N1 . Registration date: 2018-12-02 [retrospectively registered].

Assessing preventive health behaviors from COVID-19: a cross sectional study with health belief model in Golestan Province, Northern of Iran

Background

Coronavirus disease 2019 (COVID-19) is a new viral disease that has caused a pandemic in the world. Due to the lack of vaccines and definitive treatment, preventive behaviors are the only way to overcome the disease. Therefore, the present study aimed to determine the preventive behaviors from the disease based on constructs of the health belief model.

Methods

In the present cross-sectional study during March 11–16, 2020, 750 individuals in Golestan Province of Iran were included in the study using the convenience sampling and they completed the questionnaires through cyberspace. Factor scores were calculated using the confirmatory factor analysis. The effects of different factors were separately investigated using the univariate analyses, including students sample t-test, ANOVA, and simple linear regression. Finally, the effective factors were examined by the multiple regression analysis at a significant level of 0.05 and through Mplus 7 and SPSS 16.

Results

The participants’ mean age was 33.9 ± 9.45 years; and 57.1% of them had associate and bachelor's degrees. Multiple regression indicated that the mean score of preventive behavior from COVID-19 was higher in females than males, and greater in urban dwellers than rural dwellers. Furthermore, one unit increase in the standard deviation of factor scores of self-efficacy and perceived benefits increased the scores of preventive behavior from COVID-19 by 0.22 and 0.17 units respectively. On the contrary, one unit increase in the standard deviation of factor score of perceived barriers and fatalistic beliefs decreased the scores of the preventive behavior from COVID-19 by 0.36 and 0.19 units respectively.

Conclusions

Results of the present study indicated that female gender, perceived barriers, perceived self-efficacy, fatalistic beliefs, perceived interests, and living in city had the greatest preventive behaviors from COVID-19 respectively. Preventive interventions were necessary among males and villagers.

Physical activity determinants among students based on Pender’s health promotion model constructs: a cross-sectional study using path analysis

Background:

Over recent years, new lifestyles have raised ongoing concerns about the quality of life of students, especially inactivity. The purpose of this study was to determine the factors associated with regular physical activity among students using Pender’s health promotion model.

Methods:

The present cross-sectional correlational study was conducted on 650 students of Isfahan University of Medical Sciences, Iran, who were selected by stratified sampling with probability proportional to size. Data were collected using a three-part questionnaire, including demographic profile, Pender’s health promotion model constructs and the international physical activity questionnaire. The strongest determinants of physical activity were identified using structural equation modeling by Amos software. Data were analysed by SPSS software (16) using chi-square, one-way analysis of variance and Spearman correlation.

Results:

The results showed walking activity in 69.1%, moderate activity in 3.8% and vigorous activity in 27.1%. According to path analysis, perceived barriers were the most efficient predictor of physical activity among students, and Pender’s health promotion model constructs explained 84.9% of physical activity changes.

Conclusion:

The satisfactory predictive value of Pender’s health promotion model constructs for physical activity behaviour focused on effective structures, such as perceived barriers, supports the application of this model to design educational interventions better.

Effect of web-based and software-based educational intervention on stages of behavior change of students' physical activity

INTRODUCTION

The present study aims at designing and evaluating the effect of new educational media-based educational intervention on students' stages of behavior change of physical activity.

SUBJECTS AND METHODS

In the present interventional study, 225 students of medical sciences university were assigned into two experimental and one control groups using proportional stratified random sampling, where web-based and software-based educational interventions were used. Data were collected using International Physical Activity Questionnaire, Marcus's stages of change scales, and a self-made questionnaire including constructs of barriers, benefits, and self-efficacy. Evaluation was conducted through pretest and posttest and immediate and 2 and 6 months of follow-ups after the intervention. Data were analyzed by SPSS software using descriptive statistics and Chi-square, Friedman, one-way ANOVA, and ANOVA with repeated measure.

RESULTS

Based on the results, there was no significant difference between the experimental and control groups before the intervention (P = 0.37); however, immediately and 2 and 6 months after the intervention, there was a significant difference between the experimental and control groups in terms of stages of change (P < 0.001). Furthermore, in the experimental group, the educational intervention led to improvement of individuals in the stages of change of physical activity. At 6-month follow-up, 75.4% of the software group and 60.6% of the web group achieved the maintenance stage.

CONCLUSION

The results suggest that designing intervention based on people's level of preparation for changing behavior and using new educational methods such as web and software were effective on individuals' progress in different stages of change of physical activity behavior and physical activity rate.

The Effect of Continuous Care Model Implementation on the Quality of Life of Patients with Heart Failure: A Randomized Controlled Trial

BACKGROUND

Heart failure is an important chronic and progressive disease worldwide. Patients are faced with several stressors that decrease their quality of life (QoL). The present study aimed to determine the effectiveness of implementing a continuous care model on improving the QoL of patients with heart failure.

METHODS

In the present randomized controlled trial, 72 patients with heart failure admitted to Shahid Chamran Hospital of Isfahan (in Central Iran) were randomly divided into 36-individual two groups: the experimental (continuous care model) and control (normal care) groups. In the experimental group, the continuous care model was implemented for 3 months. Data were collected using the standard Minnesota Living with Heart Failure Questionnaire for patients with heart failure. Subsequently, the collected data were entered into the IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA) and analyzed using the Mann-Whitney U-test, chi-square test, and independent and paired t-test at a significance level of α≤0.05.

RESULTS

The results indicated that the mean scores of QoL before the implementation of continuous care model were 43.3±6.1 in the experimental group and 42.7±5.1 in the control group, indicating no statistically significant difference between the two groups. After the implementation of continuous care model, the mean score of QoL of the experimental group was significantly higher than that of the control group.

CONCLUSION

Considering the results obtained in the present study, model implementation could improve the overall scores of QoL in patients with chronic heart failure.

The Effect of Home Base Physical Activity Program based on the BASNEF Model on Motor Recovery in Patients with Stroke

The present study aimed to determine the effect of education based on the BASNEF model on the physical activity and improvement of motor activity in patients with stroke. This randomized control trial study was conducted on 40 patients with acute ischemic stroke admitted to a teaching hospital in Isfahan, Iran from August 2017 to September 2018. The patients were randomly divided into intervention and control groups. The intervention included personal education and a manual CD of physical activity for the intervention group. After education, the mean scores of the BASNEF model's constructs in the intervention group were significantly higher than those of the control group (P < .001). Furthermore, the motor ability of the intervention group in upper and lower extremities was significantly higher than that of the control group (p < .001). Interventions based on educational models can increase the motivation of patients with stroke in performing recommended physical activity.

Implementation of home-based health promotion program to improve flow-mediated dilation among patients with subacute stroke

INTRODUCTION

Stroke causes physiologic functional changes such as vascular resistance and arterial remodeling. This study aimed to explore the effects of 3-month regular home-based exercise rehabilitation on brachial flow-mediated dilation (FMD), daily physical activity, and upper and lower extremity sensorimotor of the acute ischemic stroke patients.

MATERIALS AND METHODS

This randomized control trial was done from August 2017 to September 2018. Patients with unilateral ischemic stroke were recruited from inpatient wards at an educational hospital. Patients were randomly assigned to the home-based rehabilitation program (intervention group) or usual care (control group). Fugl-Meyer upper and lower extremity sensorimotor score and Barthel score were evaluated in both the groups before and 3 months after baseline assessment. Furthermore, brachial artery vasomotor reactivity (FMD) hemiparetic arm assessed vascular health. The intervention group received home-based rehabilitation exercise program for 3 months. The control group did not receive home-based rehabilitation program and incentive telephone call. All data were collected and analyzed by SPSS software (version 20) and appropriate statistical tests.

RESULTS

Forty ischemic stroke patients (twenty in the intervention group and twenty in the control group) were examined. Results showed that Barthel score and Fugl-Meyer upper and lower extremity score and FMD in the intervention group were significantly higher than the control group after 3-month home-based exercise rehabilitation (P < 0/001).

CONCLUSION

Twelve-week regular home-based exercise training was well tolerated by the intervention group. After this period, improvements were reported in brachial FMD as well as daily physical activity and upper and lower extremity functional capacity.

The Impact of Home-Based Exercise Rehabilitation on Functional Capacity in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial

One of the major consequences of stroke impairments is hemiparesis, which affects activities of daily living and contributes sedentary lifestyle. The purpose of this study was evaluation of the effectiveness of home-based exercise rehabilitation incentive on daily living activities and functional capacity among acute ischemic patients. This randomized controlled trial was done from August 2017 to September 2018. Iranian subjects with unilateral ischemic stroke were recruited from inpatient wards at educational hospital. Patients were randomly assigned to the home-based rehabilitation program (intervention group) or usual care (control group). National Institute of Health Stroke Scale (NIHSS), Barthel Index Score (BI), Modified Rankin Scale (MRS), and Fugl-Meyer Upper and Lower Extremity Sensorimotor Score were evaluated in both groups at baseline and 3 months later. Intervention group received home-based rehabilitation exercise program for 3 months. Control group did not receive home-based rehabilitation program and incentive telephone call. All data were collected and analyzed by SPSS software (Version 20.0; SPSS Inc., Chicago, Illinois) using chi-square test to compare demographic variables, and independent and paired t-tests to between- and within-group assessment, respectively. Forty ischemic stroke patients (20 intervention group and 20 control group) were examined. Results showed BI, Fugl-Meyer Upper and Lower Extremity Score, and MRS score in the interventional group were significantly higher than the control group after 3-month home-based exercise rehabilitation ( p < .001). Providing a home rehabilitation program in this study resulted in a motor recovery on ischemic stroke survivors in the acute phase of recovery. This was assumed to be cost-effective intervention in low-income countries

The effect of educational intervention based on BASNEF model for reducing internet addiction among female students: a quasi-experimental study

Background

Adolescents and students are encountered with a challenge so-called “internet Addiction”. This issue affects both their physical and mental health, as well as their academic, social, and family performance. The aim of the current research is to determine the impact of educational intervention. To achieve this aim, BASNEF is utilized to reduce the excessive use of the internet by students.

Methods

This quasi-experimental study was implemented on 120 high school female students in Shahrekord (west of Iran), which were addicted to the internet. Paticipants was randomly divided into two groups of control and intervention. For data collection before and after the intervention, the standard Yang internet Addiction Questionnaire and BASNEF researcher-developed Questionnaire were used. Educational intervention for mothers was conducted in one session (as the most important subjective norm) and for students in two sessions. This method was based on BASNEF construct. Then, data were analyzed using SPSS-20 and chi-square test, Mann-Whitney test, independent t-test, and paired t-test.

Results

After the education intervention, the mean scores of knowledge, attitude, subjective norms, perceived behavioral control and enabling factors in the intervention group were significantly different from the control group (p < 0.001). In Post-test assessment, the intervention group revealed a significant decrease, in terms of using the internet (based on the time). (p < 0.001).

Conclusions

The results of this study revealed that BASNEF and its related constructs was a suitable framework to design the educational interventions in order to reduce the extreme use of internet in students. Applying of this model can be a cognitive and intellectual framework that affects students’ internet use behavior.

The Effect of Nutritional Education Based on Health Belief Model on Nutritional Knowledge, Health Belief Model Constructs, and Dietary Intake in Hemodialysis Patients

Background:

Based on the results of many studies on the relationship between nutritional status and clinical implications in dialysis patients, malnutrition is one of the most important factors associated with mortality in these patients. The current study examined the effect of nutritional education based on Health Belief Model (HBM) on nutritional knowledge, HBM constructs, and dietary intake in Hemodialysis (HD) patients.

Materials and Methods:

One-hundred chronic HD patients entered to this randomized clinical trial in 2017 in Iran; 41 in control group and 45 in intervention group completed the study. Demographic data and four 24-h recalls were collected. To evaluate the nutritional knowledge and HBM constructs, a researcher-made questionnaire was used. Patients were evaluated before, immediately after, and 3 months after intervention. Eight 1-h education sessions in 4 weeks were considered for intervention group. Independent samples t-test, Chi-square test, and repeated measures ANOVA were used to analyze the data.

Results:

Repeated measures ANOVA test showed significant increases in scores of the nutritional knowledge test, perceived susceptibility, perceived severity, perceived barriers (p = < 0.001), perceived benefits (p = 0.010), and self-efficacy (p = 0.019) after the study in the intervention group. There were no significant differences between two groups in energy, protein, High Biologic Value (HBV) protein, carbohydrate, fat, cholesterol, fiber, vitamin B2, B3, B6, B12, E, calcium, phosphorus, and potassium intake.

Conclusions:

It seems that education based on HBM can improve nutritional knowledge but in order to influence on dietary intake, longer interventions that are more comprehensive are needed.

Predictive Power of PEN-3 Model Constructs in Breast Cancer Screening Behaviors among Teachers: A Cross- Sectional Study in Central Iran

Objective

Identifying the factors influencing screening is necessary to promote early detection of breast cancer. This study aims to determine the predictive power of PEN-3 model structures in breast cancer screening behaviors among teachers of Isfahan city in Iran.

Materials and Methods

This cross-sectional study was conducted on 192 female teachers in Isfahan selected by the multi-stage random sampling method. A questionnaire based on PEN-3 model was used for data collection. Statistical analysis was conducted using SPSS version 20 (multiple linear regression analysis, independent t-test, Pearson correlation coefficient), and p<0.05 was considered statistically significant.

Results

The mean score of behavior, perceptual, enabling and nurturer factors in early detection of breast cancer was 36.5±30.5, 74.6±8.9, 65.5±19.9 and 68.1±20.7, respectively. The mean score of behavior in early detection of breast cancer in women with individual and familial history of breast disease was significantly higher than that of those who did not have such history. Perceptual and nurturer factors as the best predictors of screening behaviors were associated with screening behaviors.

Conclusion

The study results indicate that nurturer and perceptual factors were the best predictors of breast cancer screening behaviors among teachers. Therefore, attention to these constructs in developing educational interventions is highly recommended.

Designing an educational intervention to prevent excessive gestational weight gain: a protocol for a randomized controlled trial

BACKGROUND

Pregnancy as one of the critical stages of life carries a high risk to the health of pregnant women. The amount of weight gained during pregnancy can affect the woman and her infant health immediately or in the future. The present study is conducted to design and explore the effectiveness of an educational intervention based on health belief model (HBM) to preventing excessive gestational weight gain (GWG).

METHODS

This research-based planning is designed in three phases and will be conducted on pregnant women in first trimester. In the first phase of this randomized controlled trial study, body mass index (BMI), the level of knowledge and the level of the HBM constructs will be measured using a questionnaire. The HBM questionnaire is designed based on a literature review and experts opinions. In the next phase the educational program content will be designed based on the results of the first phase of the study on the level of women's knowledge, and HBM constructs as well as a literature review and experts opinions. The intervention will be designed in four training sessions about the importance of behaviors, especially physical activity and nutrition, in the prevention of excessive weight gain during pregnancy. The tired phase includes the implementation of educational intervention with two intervention and control groups. The efficacy of the program will be evaluated by measuring the level of the knowledge, HBM constructs and women's weight gain during pregnancy in the second and third trimesters. Appreciate weight gain will be considered according to the BMI in first trimester.

DISCUSSION

The present study will provide strong information regarding the effetiness of the HBM and appropriate framework to develop educational interventions together with enhancing pregnant women's knowledge and belief toward weight management behaviors.

TRIAL REGISTRATION

Registration of this randomized control trial has been completed with the Iranian Registry of Clinical Trials, IRCT20180703040325N1 . Date of registration: 2018-08-20.

Improving Student's Self-Efficacy and Perceived Susceptibility Toward Oral and Dental Health: A Randomized Controlled Trial

Objectives

We sought to assess the impact of educational intervention on female junior high school students' perceived susceptibility and self-efficacy regarding oral and dental health.

Methods

We recruited 100 female junior high school students (50 in intervention and 50 in control group) from Falavarjan city using multistage random sampling. A self-administered questionnaire was used to gather data about study variables. Students in the intervention group attended five 90-minute sessions designed to teach the students about dental hygiene.

Results

We found no significant difference between the two groups with respect to the preintervention mean scores of knowledge, perceived susceptibility, and self-efficacy (p > 0.050). The postintervention mean scores in the intervention group were significantly higher than those in the control group (p < 0.050).

Conclusions

Training plans with particular behavioral goals and good instructional strategies can be useful in empowering students toward dental health.

Health Journalism: Health Reporting Status and Challenges

Background:

Media play crucial role in disseminating health information. Due to the importance of accurate health news reports, and the national need to professionalism in health journalism, this study aimed to investigate the characteristics of health journalists, and health reporting status and the challenges involved.

Materials and Methods:

Using consensus sampling, this descriptive cross-sectional study was conducted on all health news reporters in Isfahan (34 journalists) in 2015–2016. Data collection was done via a researcher-made questionnaire. Content validity of the questionnaire was determined by qualitative method and based on the opinions of six experts. The test–retest reliability coefficient was 98.0. Data analysis was done by Statistical Package for the Social Sciences, version 16 and descriptive statistics and content analysis were used for analyzing the responses to two open questions.

Results:

Among 34 journalists, 56% were women and 44% men; the majority of journalists (65%) had no specialized training on health reporting, 35% of journalists were not able to understand the health issues, and the knowledge of medical terminology in 59% of them was moderate to low. The most important required skill for reporters was the ability to interpret medical research reports (88%), 97% were eager to participate in specialized health education.

Conclusions:

Our study showed that health journalists lacked knowledge and specialized training for dissemination of health news. This has brought about serious challenges. Thus, development and implementation of training courses in close collaboration with educational department of the Ministry of Health and news programs professionals at Islamic Republic of Iran Broadcasting is highly recommended.

Effects of Tailored Health Education Program on Overweight Elementary School Students' Obesity-Related Lifestyle: A School-Based Interventional Study

OBJECTIVES

Overweight and obesity are regarded as one of the most serious health and nutrition issues worldwide. This is immediately recognizable in both children and adolescents. In this study, we aimed to determine the effects of tailored education on lifestyle modification in elementary school students in Isfahan.

METHODS

In a quasi-experimental study, two elementary schools in Isfahan District 3, Iran, were randomly selected to determine the intervention and comparison groups. Subsequently, 32 students from each school, 64 in total, were chosen arbitrarily and included in the study. They filled out the standardized questionnaire of physical activity and dietary behaviors before the intervention. Following one and four months' educational intervention, they were asked to complete the questionnaires once more.

RESULTS

The average general lifestyle score, one and four months after education, was significantly different between the groups (p < 0.001). However, this difference was not significant before the intervention 
(p = 0.660). Furthermore, the average lifestyle scores related to nutrition and physical activity one and four months after education showed a significant difference between the groups (p < 0.001).

CONCLUSIONS

Providing overweight elementary school students with education about a healthy lifestyle improves their general lifestyle and reduces weight. Therefore, it is recommended that such interventions are applied to prevent complications associated with being overweight in children.

Determinants of the self-efficacy of physical activity for maintaining weight during pregnancy: The application of the health belief model

INTRODUCTION

Pregnancy is one of the high-risk periods for women's health that the lack of attention to healthy behaviors such as weight control behaviors can lead to adverse consequences on the health of women and also the fetus. Therefore, the aim of this paper was to explore the determinants of weight control self-efficacy among pregnant women using Health Belief Model (HBM).

MATERIALS AND METHODS

In this cross-sectional study were enrolled 202 pregnant women referring to Health Care Center in Isfahan city, Iran. Sampling method was multistage random. A researcher-made instrument based on HBM structures was used after confirming the valid and reliable. Data were analyzed by software SPSS 21 and descriptive statistics were represented with (frequency, mean and standard deviation) and analytical (Pearson correlation, independent t and liner regression) at the significant level of <0.05.

RESULTS

The average age of participants was 27.80 ± 5.08. HBM structures were able explained 31% of variance of weight control self-efficacy. Also, of the studied structures, perceived benefits, perceived barriers were statistically significant predictors of weight control self-efficacy, within which perceived barriers (β = 0.391) was the most significant predictor.

CONCLUSION

The findings of current study showed that the HBM model could be as a suitable framework to identify effective factors for designing educational intervention to improve weight control behaviors among pregnant women.

THE EFFECT OF EDUCATIONAL INTERVENTION ON KNOWLEDGE AND SELF-EFFICACY FOR PAIN CONTROL IN PATIENTS WITH MULTIPLE SCLEROSIS

INTRODUCTION

Multiple Sclerosis (MS) is one of the most common autoimmune diseases affecting the central nervous system. The prevalence of it is increasing in our country too. The pain from disorders can affect quality of life. Several studies have pointed to the improvement of patients through educational intervention. This study attempted to evaluate the effectiveness of an educational intervention based on raising the awareness and self-efficacy for pain control among patients with multiple sclerosis during 2015 under the coverage of Isfahan MS Society (IMSS).

MATERIALS AND METHODS

This was a quasi-experimental study involving pre-test, post-test and randomized control group conducted on 100 patients with MS referred to the Isfahan MS Society (IMSS). The educational intervention group learned the pain management self-care lesson during 4 weekly sessions. The data were collected through a self-structured questionnaire with adequate validity and reliability, containing demographic data, awareness and self-efficacy of pain control. The data were assessed through descriptive and analytical tests assisted by SPSS 17. The significant level was considered as P<0.05.

RESULTS

Concerning the questionnaire, 96% of the items were responded. Most participants were women. The frequency distribution of demographic variables was not significantly different between the two pre-test groups. After the intervention, the mean score of knowledge and efficacy among patients in the intervention group was significantly higher than the control group (P<0.001).

CONCLUSIONS

Educational interventions can improve awareness and self-efficacy for pain control among patients with MS. Therefore, such interventions can be designed to reduce physical and psychological complications following multiple sclerosis.

Effect of Educational Intervention on Perceived Susceptibility Self-Efficacy and DMFT of Pregnant Women

Background

The World Health Organization identifies oral health as a necessity for public health through the entirety of life. This issue has been considerably addressed due to susceptibility to tooth decay during pregnancy and maternal and fetal health.

Objectives

Investigate the effect of educational intervention on perceived susceptibility, self-efficacy, and DMFT of pregnant women.

Patients and Methods

A quasi-experimental survey (pretest, posttest, and control group) was implemented in 88 primiparous women in the first trimester of pregnancy who attended private clinics in Delfan city, Iran. It was conducted using random sampling and then assigned to intervention and control groups. Data were collected using a questionnaire that included demographic characteristics, a DMFT checklist, and some health belief model (HBM) constructs. After collecting baseline information, an educational intervention consisting of 4 training sessions for the intervention group was scheduled. In the sessions, lecture, focus-group discussion, video, and role-playing were used as the main educational strategies. Four months after the intervention, a post-test questionnaire and DMFT checklist were conducted. Data were analyzed using SPSS (ver20) software and Chi-square, independent t-test, and repeated measure ANOVA at the significant level of α < 0.05.

Results

According to the independent t-test, the mean score of knowledge, perceived susceptibility, self-efficacy, and DMFT was not different between the two groups before the education (P > 0.05), during the intervention, or after intervention. Repeated measure ANOVA explained that the aforementioned score was different in the three cases (pretest, 2 months after intervention, and 4 months after intervention) after intervention (P < 0.05). Paired t-test also showed that the DMFT mean increased 4 months after intervention in the control group (P < 0.001). It was not, however, augmented in the intervention group (P = 0.92).

Conclusions

Results showed that education on some of the HBM constructs resulted in increased knowledge of oral health, perceived susceptibility, and self-efficacy of pregnant women. It is also possible to prevent increased DMFT during pregnancy.

Can the BASNEF Model Help to Develop Self-Administered Healthy Behavior in Iranian Youth?

Background:

The stage of youth is critical for human development in several ways. On the one hand, it can lead people towards the adoption of a healthy lifestyle during adulthood based on these earlier practices. On the other hand, it can comprise the development of healthy living practices later on in live, an outcome which is often caused by the youth adopting a risky lifestyle early on.

Objectives:

The primary objective of this study was to determine the effectiveness of implementing an educational intervention program based on the BASNEF Model (a simplified approach to understanding behavior), designed to cultivate self-administered lifestyle control skills in youths.

Materials and Methods:

This was a quasi-experimental intervention study, implemented during 2010 - 2011. A total of 288 randomly selected high-school students between the ages of 15 and 17 participated in this study. These students were later divided into experimental and control groups. Subjects completed a BASNEF questionnaire at the baseline (pre-test), one month later (post-test) and three months after the educational intervention (follow-up). Four educational sessions were held, each of a 120 - 150 minute duration. After the data had been collected, the ANOVA test was used to compare trends in changes. The Pearson correlation coefficient was then used to analyze the correlation between components of the BASNEF model. Finally, regression analysis was used to determine the predictive power of the study.

Results:

Results from the intervention study reveal that the beliefs and attitudes about nutrition of the intervention group, calculated in terms of scores, improved significantly for both male and female subjects (P < 0.001) as compared to the control group. The mean BASNEF scores for improvements in beliefs among girls and boys were 79.2% and 70.1%, respectively and for attitudes, 61.2% and 59.4%. The increase was significantly higher in the intervention group (P < 0.001). Furthermore, participation in physical activity was more frequent among members of the intervention group than among those in the control group (P < 0.001).

Conclusions:

The BASNEF model could be effective in encouraging the adoption of nutritious eating habits and more active lifestyles at an early age in order to foster long-term health and well-being.

The effect of educational intervention on health promoting lifestyle: Focusing on middle-aged women

BACKGROUND

Lifestyle affects people's health and life length, however, no sufficient studies have been done on the effect of lifestyle on middle-ageing, as the transitional period from adulthood to old-ageing, this study has been conducted to study the effect of educational intervention on health promoting lifestyle of middle-aged women in Lenjan city of Isfahan Province, Iran.

METHODS

This quasi-experimental study was conducted on 88 middle-aged women were selected through randomized sampling from two health centers in Lenjan, and then were categorized into experimental and control groups. To collect data, a researcher-made demographic and life style questionnaire was used. The educational intervention was performed in five sessions. Data were collected from both groups in two stages: Before the intervention and 3 months after the education. Data were analyzed with using SPSS-20 and P < 0.05 were considered statistically significant.

RESULTS

The results showed that educational program had a positive significant effect on increasing the mean scores in the intervention group, considering the physical activity, mental health, and interpersonal relationship, P < 0.001. However, regarding the nutrition, the mean increase was not significant (P = 0.113).

CONCLUSION

According to the findings, it is evident that educational intervention is beneficial for various aspects of middle-aged women's lifestyle. Therefore, applying a healthy lifestyle seems essential for having a healthy aging period, and educational intervention can be effective.

The impact of education intervention on the Health Belief Model constructs regarding anxiety of nulliparous pregnant women

BACKGROUND

According to investigations, pregnant women hypothesized that anxiety is a common factor that will improve spontaneously; they are not aware of its side effects on the fetus, baby, and pregnancy outcome, as a whole. Other studies have also not tried to design a theoretical framework based on Health Education Models (HBMs) to overcome this problem. The current study aimed at exploring the effectiveness of education on the anxiety of nulliparous women based on a HBM.

MATERIALS AND METHODS

An experimental study on 88 eligible nulliparous women (n = 44 per group), from Doroud city, was performed in 2012. The data was collected using a researcher made questionnaire. Education was conducted in three sessions tailored with HBM constructs with the help of lectures, group discussions, inquiries, Power Point presentations, and booklets. Evaluation performed using a posttest four and eight weeks after last session. The collected data were analyzed using statistical tests, including Chi-square, independent t-test, and repeated measure Analysis of Variance (ANOVA) by the significance level of 0.05.

RESULTS

The mean score of knowledge, perceived sensitivity, perceived severity, perceived benefits and barriers, cues to action, self efficacy, and behavior, four weeks after intervention (P < 0.001) and eight weeks after intervention (P < 0.001) were significantly more in the case group Than the control group. ANOVA with repeated measures showed a significant increase in the case group in knowledge (from 32.1 to 89.1), perceived sensitivity (from 34.8 to 91.5), perceived severity (from 31.82 to 88.48), perceived benefits (from 39.28 to 92.41), perceived barriers (from 26.93 to 88.61), cues to action (from24.65 to 92.03), self efficacy (from 29.71 to 88.75), and behavior (from 28.83 to 94.63). Changes were not significant in the control group.

CONCLUSION

The effect of HBM and education on increasing knowledge and changing people's beliefs and behavior, in terms of anxiety based pregnancy, should make health planners and authorities pay more attention to these issues. Moreover, it will help in the betterment of the health of mothers and babies.

Job satisfaction survey among health centers staff

BACKGROUND

Due to the importance of health care organizations with significant responsibility for prevention and care, assessment of job satisfaction among health care staff is essential. Quality of health services will be decreased provided they are not satisfied.

MATERIALS AND METHODS

This study was a cross-sectional analysis of health care staff in Khomeinishahr (centers, buildings, and networks) If they had at least 6 months work experience, they could enter the study. Data included a two-part questionnaire with a standardized questionnaire, demographic variables, and Smith job descriptive index, which is a questionnaire with six domains. Reliability was obtained for each domain and its validity was reported 0.93.

FINDINGS

The results showed an overall satisfaction score averages 43.55 ± 12.8 (from 100). Job satisfaction score was not significantly different between the sexes. However, within the current attitude toward job satisfaction, men scores was better than women (P = 0.001). Highest score in job satisfaction was related to relationships with colleagues and lowest score was related to the income, benefits, and job promotion. The more the years of work, the less the job satisfaction was. The attitude toward the current job had a direct relationship with income (P = 0.01). There was a significant inverse relationship between educational level and job satisfaction in domains promotion, income, and benefits (P = 0.01). The staff with higher education levels was less satisfied with income and job promotion qualification.

CONCLUSION

Managers should focus on job qualification to increase job satisfaction and improve the quality of work.

Factors affecting cigarette smoking based on health-belief model structures in pre-university students in Isfahan, Iran

INTRODUCTION

The goal of this study was to determine the association between constructs of the Health Belief Model (HBM) (i.e., perceived susceptibility to health-related problems due to smoking, perceived barriers to non-smoking, perceived benefits of non-smoking, perceived self-efficacy to non-smoking, and cues to action of non-smoking) and cigarette smoking among male pre-college students.

MATERIALS AND METHODS

A cross-sectional survey of 382 pre-college students was conducted in Isfahan, in 2010. The method of sampling was systematic randomized and students were selected from eight schools. The instrument was developed by the researchers based on the Health Belief Model. Statistical analyses were carried out using SPSS.V.18, Chi-square, and independent t-tests.

RESULTS

The mean age of the students was 17.72 ± 0.62 years. Overall 7.2% of the subjects reported having smoked in the past 30 days and 32.7% % of the samples reported ever having smoked in their life time. Results of the t-test showed that there were significant differences in knowledge, perceived susceptibility (P =0.03), benefits (t (246) = -2.51, P =0.01), self-efficacy (P < 0.001), and cues to action (P = 0.007), between smokers and non-smokers.

CONCLUSION

These results suggested that the constructs of HBM can be incorporated when examining the predictors of cigarette smoking and developing smoking prevention programs among pre-college students. Furthermore, with a better understanding of the factors affecting this complex behavior (cigarette smoking), it can be a useful step to reduce the rate of death, costs, and also improve the community health outcomes.

Evaluating puberty health program effect on knowledge increase among female intermediate and high school students in Birjand, Iran

BACKGROUND

Puberty is one of the most critical periods in a female adolescents' life. This intervening study aimed to evaluate the effect of educational program for puberty health on improving intermediate and high school female students' knowledge in Birjand, Iran.

MATERIALS AND METHODS

In this quasi-experimental study, 325 female intermediate and high school students were selected through randomized cluster sampling during several stages. Then, researcher-made questionnaire including 20 questions, each having one point regarding puberty health, was distributed. After completion of the questionnaires were gathered. Following this, under a systemic educational plan all intermediate and high school selected students were given the same instruction by trained instructors. Instruction time for each meeting was estimated 1.5 hours. One month after the educational program and handing out the pamphlets in schools, the previous questionnaires were again distributed among the students to fill out. At the end, 302 students who had filled out the questionnaires before and after intervention were studied.

RESULTS

Out of 302 students, 151 were intermediate and 151 high school students. Knowledge level among intermediate students was 5.03 ± 3.7 before intervention and was 10.8 ± 4.8 after intervention. Among high school students, the scores were 4.1 ± 2.3 and 8.7 ± 3.8, respectively. There was a significant difference between pre and post intervention stages in both groups (P < 0.001). Furthermore, mean knowledge grade in all the students increased from 4.6 ± 3.1 before intervention to 9.7 ± 4.4 after intervention (P < 0.001).

CONCLUSION

Performing educational programs during puberty has a crucial role in young girls' knowledge increase. Since young girls often do not share their problems with their parents and their peers during the period, instructional classes in schools provide a good opportunity for them to present their problems and finding solutions.

Adherence to recommended breast cancer screening in Iranian turkmen women: the role of knowledge and beliefs

The aim of the current study was to investigate breast cancer screening performance among Iranian Turkmen women along with their knowledge and beliefs. A cross-sectional study was carried out in June to December 2011. Through clustered sampling method, 1080 Iranian Turkmen women completed the questionnaire including breast cancer screening adherence, knowledge, fatalism beliefs, and perceived threat using Champions Health Belief Model Scale (CHBMS).The mean age of the participants was 43.04 (SD = 11.80) years. Compliance rate in a regular basis based on national guidelines was 13.1%, 2.5%, and 0.9% for SBE, CBE, and mammography, respectively. A mere 4% have been provided adequately with information about breast cancer. Having knowledge was the best predictor of breast cancer screening adherence along with high educated husbands for SBE performing. Susceptibility and fatalism were low and were influenced by participants' educational level and age. In conclusion, Iranian Turkmen women had insufficient knowledge, low perceived susceptibility, high fatalistic belief, and very poor adherence to breast cancer screening. There is a need for providing breast cancer education programs among the Iranian Turkmen women to increase their adherence rate.

The effectiveness of nutrition education program based on health belief model compared with traditional training

INTRODUCTION

This study was aimed to compare the effect of nutrition educational program based on HBM with traditional education recommended weight gain among pregnant women in Gonabad. Target population was pregnant women who were resided in Gonabad and went to urban health care centers for prenatal cares.

MATERIALS AND METHODS

110 pregnant women (case group: 54, control group: 56) were selected who had come to this centers in the first stage of prenatal care (6th -10th week of pregnancy) in 1388 and were consequently classified in case and control group. There is no significant difference for age, education, number of parity, history of abortion and job between case and control groups.

RESULTS

There was no significant differences in nutritional behavior mean score before intervention in case (74.42 ± 12.78) and control (77.14 ± 15.35) groups (P value = 0.82, independent t- test); but after education, intervention was significant in nutritional behavior between two groups (P value = 0.01, independent t-test);

DISCUSSION

after intervention, there also was significant difference in HBM structures mean score in case group compare with control group and the highest rise in score was related to perceived benefits (15.13 increment).

Epidemiology of animal bite in Aq Qala city, northen of Iran

BACKGROUND

Animal bite is one of the problems of public health which has the potential risk of rabies disease. This study was conducted to determine the epidemiology of animal bite in Aq Qala city from 2000 to 2009.

MATERIALS AND METHODS

In this descriptive cross-sectional study, 13142 cases of animal bites which were recorded in Rabies Treatment Center of Aq Qala City were entered into the study by census method. The data were collected from the registered office profile of people who had referred to this center. The obtained data were analyzed using descriptive statistics (frequency distribution, percentage, mean, and standard deviation) and Chi-square test.

FINDINGS

Of 13142 registered cases, 72.1% were men and 27.9% were women. The mean age of the victims was 25.0 ± 17.8 years, most of whom (84%) lived in villages. Also, most cases of animal bite were done by dogs, (97.8%) occurred in legs (69.6%). Most of the victims were students (28.9%). The highest frequency of bites happened in spring (28.8%). The incidence rate of animal bite was 1222/100,000 people. The highest and lowest incidence rates were 1608/100 000 in 2004 and 1117/100,000 in 2009, respectively. There was a significant relationship between season and the number of bites (P < 0.05).

CONCLUSION

The incidence of animal bite in Aq Qala city was higher than that in other studies in different parts of the country. Considering the high cost of antirabies serum and vaccination, it is essential to take necessary measures reduce the incidence of this problem.

Breastfeeding status during the first two years of infants' life and its risk factors based on BASNEF model structures in Isfahan

BACKGROUND

Breastfeeding depends on social and cultural conditions of societies. Behavior,Attitude, Subjective Norms, Enabling Factors (BASNEF) model is one of the comprehensive models of behavior study, especially in developing countries. This study was performed to investigate the status of breastfeeding during the first two years of infants' life and its risk factors through BASNEF model structures.

MATERIALS AND METHODS

In this cross-sectional descriptive-analytical study, 406 mothers with 6-24-month-old babies were selected by multistage cluster sampling method. The data were collected using a questionnaire with five sections based on the BASNEF model structures. Demographic characteristics of the studied population were also recorded and analyzed using Chi-square tests and analysis of variance in SPSS18 statistical software.

RESULTS

The prevalence of breastfeeding was 86.4% (351 mothers). Three hundred and thirty three mothers (82%) had good knowledge and there was a significant relationship between knowledge and breastfeeding behavior of mothers (P < 0.05). Two hundred and eighty five mothers (70.2%) had good and very good attitude in this regard. There was no significant relationship between attitude and breastfeeding behavior of mothers (P > 0.05). There was a significant relationship between breastfeeding behavior of mothers and subjective norms of husbands, mother and mother-in-law (P < 0.05); however, no significant relationship was found with regard to enabling factors (P > 0.05). Moreover, no significant relationship was observed between type of children nutrition and variables of delivery mode, maternal age and number of children (P > 0.05).

CONCLUSION

In addition to knowledge of nursing mothers, supports and encouragement of husbands, mothers and mother-in-laws, as subjective norms of behavior, have a positive impact on the breastfeeding behavior of mothers. Thus, breastfeeding programs should pay more attention to the role of these mentioned factors.

Smoking behavior, nicotine dependency, and motivation to cessation among smokers in the preparation stage of change

OBJECTIVE

To investigate selected constructs of the transtheoretical model (TTM) of behavior change regarding smoking behavior among people in the preparation stage, as well as motivation for cessation and nicotine dependency.

METHODS

A convenience sample of 123 smokers, during between June to and September 2011, completed the Persian version of the short form of a smoking questionnaire based on TTM, the Fagerstrom nicotine dependence test, and the motivational test.

RESULTS

Motivation for cessation was great (16.35 ± 2.45). The negative affects of self-efficacy were higher than those to other situations (4.02 ± 0.84). The pros and cons of smoking were 2.69 ± 1.00 and 3.78 ± 0.78, respectively. Temptation was influenced by nicotine dependency (P < 0.05). Early initiation of smoking was significantly associated with severe nicotine dependency (P < 0.05).

CONCLUSION

The results confirm the role of temptation, increase in the cons, decrease in the pros, and nicotine dependency.

The effect of individual counseling, line follow-up, and free nicotine replacement therapy on smoking cessation in the samples of Iranian smokers: Examination of transtheoretical model

BACKGROUND

According to transtheoretical model (TTM), Stage matched interventions are more effective in quitting. The objective of current study was to investigate the effect of individual counseling, line follow-up, and free nicotine replacement therapy (NRT) on smoking cessation in smokers who are in preparation stage of smoking.

MATERIALS AND METHODS

In a randomized clinical trial design, through sending the short message system, potential participants in preparation stage of smoking were recruited and divided into control (n = 60)and treatment (n = 50) groups. The treatment group received an in-person counseling, line follow-up, and free NRT. TTM variables trend; pros and cons of smoking, behavioral and experiential processes, temptation, were assessed at baseline, 3 and 6 months follow-up along with point prevalence and continuous abstinence.

RESULTS

Continuous abstinence at 6-month follow-up were 3.3% (n = 2) in control group and 46% (n = 23) in the treatment group (x (2) = 34.041, P < 0.001). Time Χ group analyses indicated that except cons of smoking (P > 0.05), all TTM constructs had significantly changed; temptation (F = 36.864, P < 0.001), pros (F = 12.172, P < 0.001), experiential processes (F = 3.377, P < 0.001), and behavioral processes (F = 11.131, P < 0.001).

CONCLUSION

Interventions based on TTM variables increased the quite rate in prepared and motivated people. Our findings suggest that interventions through individual counseling along with free NRT and line follow-up in people who prepare for quitting are beneficial for our country.

Exploring self care in Tehran, Iran: A population based study

BACKGROUND

self care empowers individuals to self manage their minor ailments, chronic conditions, and to exert more control over their lives. Self care includes activities such as influencing prevention, health maintenance, and treatment of illness by individuals, this study was conducted to assess views about self care among the general population living in south of Tehran.

MATERIALS AND METHODS

This survey was cross-sectional study by using of two-stage random cluster sampling, 1200 individuals aged 17 years and over was surveyed regarding self care. A structured closed validated questionnaire was used to collect data. Data were finally analyzed by Kruskal-Wallis, Pearson Chi-square, Fisher exact test and linear by linear association. Questionnaire has totally five parts including knowledge, attitude, performance toward self care, views regarding general health and demographic characteristics as well. Furthermore; project number is 4276-62-02-85.

RESULTS

The mean age of subjects was 27.9 years (SD = 5.2); 50.2% (n = 603) were female; 54% (n = 643) were married (deleted), (55%, n = 658) reported that they were not knowledgeable about self care and (82%, n = 986) were interested in self care. Only 4% (n = 53) of subjects indicated they drank ≥ 7 glasses of water daily; fewer reported they consumed at least five portions of fruits/vegetables daily (3%, n = 31; and (4%, n = 51) engaged in physical activity more than 3 h weekly. There were statistically significant relationships between knowledge and interest (P < 0.01), knowledge and practice (P < 0.001), and interest and practice regarding self care (P < 0.001).

CONCLUSION

The vast majority of subjects approximately two third felt satisfied with their health, most of subjects reported "feeling healthy" despite engaging in unhealthy life styles, it is revealed that more educated people, and likely those with more income, were interested in and knowledgeable regarding self care and were actually active in healthy life styles. In brief; this study suggests that physicians could support self care through their consultations with patients.

Smoking behaviors in Iranian male students: An application of transtheoretical model

OBJECTIVE

To investigate selected constructs of the transtheoretical model (TTM) of behavior change regarding smoking behavior among Iranian male students.

MATERIALS AND METHODS

A convenience sample of 578 smokers and ex-smokers from six universities during December 2009 to June 2010 completed three Persian versions of the short form smoking questionnaire based on TTM, developed by Prochaska, Velicer, and Diclemente. Data were analyzed using SPSS 15. Frequency analysis was conducted to demographic variables. Stages' differences were assessed with analysis of variance (ANOVA) followed by post-hoc multiple comparisons with Tukey's honestly significant difference (HSD) test. Alpha levels were set at P<0.05.

RESULTS

More than half of the subjects were in contemplation stage. The pros of smoking among subjects in the precontemplation stage were significantly higher than those of subjects in the preparation and maintenance stages. Meanwhile; the pros of smoking ratings were significantly higher for the contemplation and preparation stages than for the maintenance stage. Significant mean differences in cons of smoking behavior emerged across the stages of change. However, pros and cons of smoking in the action stage were not significantly different than other stages of change. In line with self-efficacy/temptation construct, the result showed that positive social efficacy, negative affect efficacy, and habit strength were significantly different between the stages of change.

CONCLUSION

The results provide support to the advantages of increased self-efficacy and the role of decisional balance for the intervention program development for smoking cessation.