Effectiveness of Applying Green Heart, a Smartphone-Based Self-management Intervention to Control Smoking: A Randomized Clinical Trial.

BACKGROUND: Cardiovascular diseases (CVDs) pose a significant global health concern and are the most common cause of death and disability, necessitating preventive interventions targeting modifiable risk factors. Recently, mobile-health technology has been developed to improve the delivery of cardiovascular prevention by risk factor modification. The "Green Heart" mobile application (app) was designed to aid in risk factor control among coronary artery disease (CAD) patients. METHODS: This parallel-group, single-blinded randomized controlled trial enrolled 1590 CAD patients, including 668 current smokers, randomly assigned to control (paper-based education) and intervention (application-based) groups. The app encompassed three modules targeting smoking cessation, dyslipidemia control, and blood pressure management. This study evaluated the impact of the smoking cessation module on behavioral change among current smokers. Green Heart assesses nicotine dependence, offering personalized quit plans, educational content, motivational messages, and automated progress tracking. The odds of smoking behavior changes during the 24-week follow-up underwent assessment. RESULTS: The intention-to-treat analysis highlighted significantly elevated rates of smoking cessation and reductions in the intervention group versus the control group. Adherence to the app (per-treatment analysis) also demonstrated significantly more favorable smoking behavior changes among the application users. Logistic regression emphasized higher odds of quitting and reduction in smoking in the application group, showing an odds ratio of 2.14 (95% CI: 1.16-3.97) compared to those not using the app (P=0.015). CONCLUSION: Our results confirmed that complete adherence to the app for at least 24 weeks was linked to alterations in cigarette smoking behavior among CAD patients. Trial Registration Number: IRCT20221016056204N1.

The effectiveness of green heart application to manage modifiable risk factors of coronary artery disease in Tehran Heart Center: Study protocol for a randomized controlled trial.

The burden of cardiovascular disease (CVD) is diminishing in developed countries. However, in middle- and low-income countries the CVD death rates are growing. CVD is the most common cause of death and disability in Iran and accounts for nearly half of all mortalities in Iranians. Therefore, preventive strategies by risk factor modification are a top priority in the country. Recently, Mobile-Health (mHealth) technology has been the focus of increasing interest in improving the delivery of cardiovascular prevention, targeting a combination of modifiable risk factors. This parallel-group single-blinded randomized controlled trial study has been designed to evaluate the impact of using a mHealth application on risk factors control. Individuals aged between 25 and 75 years who have documented CVD by coronary angiography in Tehran Heart Center and have at least one uncontrolled risk factor from the three including hypertension, dyslipidemia, and current cigarette smoking will be included. We are going to randomize 1544 patients into two study arms as follows: 1- Intervention: usual care + mHealth 2- Control: usual care + paper-based recommendations and educational materials. After 3 and 6 months of follow-up, the status of risk factors will be determined through outpatient visits and face-to-face interviews for both arms. Outcome: Successful risk factor control will be measured after 3 and 6 months. Nowadays, mHealth is becoming increasingly popular, providing a good opportunity for constant monitoring of risk factors and changing health behavior in a target population. Meanwhile, providing evidence for the effectiveness of health intervention delivery using mobile technologies could help health providers encourage their at-risk population to stop smoking, control blood pressure and blood cholesterol, and participate in regular physical activity. While the burden of CVD is growing in developing countries, this type of intervention can be a cost-effective way to reduce it in these countries.

Comparison of the Effect of 2 Virtual Education Methods: Family-based Versus Peer-Support on Perceived Stress and Stress Coping in Women with Breast Cancer: A Randomized Controlled Trial.

Background: Stress is an overwhelming feeling in patients with breast cancer (BC). However, The effect of virtual education has not been fully regulated. Hence, this study intends to compare the impact of 2 virtual education methods on perceived stress and stress coping in women with BC. Methods: A 3-armed randomized clinical trial was conducted among 315 women with BC who were referred to the Cancer Institute in Tehran. They were randomly assigned to 3 groups: (a) Family-based, receiving family-based training package; (b) peer-support, receiving peer-support educational package; and (c) control, receiving routine hospital care. Data were collected through demographic and disease characteristics, the Perceived Stress Scale (PSS-14), and Coping Inventory for Stressful Situations (CISS-21) questionnaires before and 3 months after the intervention. Results: The effect of the group factor after controlling the before-intervention scores in perceived stress, problem-oriented, emotion-oriented, and avoidance-oriented strategies were P < 0.0001, P = 0.015, P < 0.0001, and P = 0.111, respectively. Also, the effect of the confounding factor of BC disease stage in the dependent variables was P = 0.527, P = 0.275, P = 0.358, and P = 0.609, respectively. The effect size test showed that before the intervention, the mean scores of perceived stress, problem-oriented, emotion-oriented, and avoidance-oriented strategies were 32.00 ± 7.03, 19.36 ± 4.68, 25.10 ± 5.90, and 17.65 ± 6.64 respectively, but after the intervention showed a decrease in mean scores of perceived stress, emotion-oriented, and avoidance strategies. Conclusion: What is vibrant in virtual family-based education is far more effective than peer support when problem-oriented coping increases. Conversely, reducing perceived stress in women with BC receiving enough information and family support should be considered.

Challenges for implementation of inter-sectoral efforts to improve outbreak response using consolidated framework for implementation research; Iran's COVID-19 experience.

BACKGROUND: The recurrence of emerging infectious diseases reminds us that rapid response to related outbreaks require coordinated inter-sectoral/ organizational and trans-disciplinary approaches. This study examined the challenges for implementation of inter-sectoral efforts to improve COVID-19 pandemic response in Iran using the consolidated framework for implementation research (CFIR). METHODS: We conducted a qualitative content analysis of in-depth interviews between March 2020 and February 2021 in Tehran, Iran. Participants included health professionals and experts involved in the prevention, treatment and control of COVID-19 pandemic from different levels of the health system (macro: Ministry of Health and Iranian National Institute of Health Research; meso: universities of medical sciences and health services; and micro: hospitals), selected using purposive sampling. Recorded interviews were transcribed verbatim and coded using a deductive approach (CFIR constructs). RESULTS: In total, 12 interviews with the participants were conducted; and eight themes emerged as the most important challenges for implementation of inter-sectoral efforts to improve outbreak response in COVID-19. These challenges include lack of proper intervention sources, complexity, poor networking with external organizations, cultural issues, inadequate availability of resources, inadequate access to knowledge and information about inter-sectoral collaboration implementation, and planning issues for it. CONCLUSIONS: Implementing inter-sectoral efforts to improve outbreak response require addressing several implementation challenges. There should be effective leadership and command system, prioritizing the problem, having proper intra-sector collaboration, adequate supervisory, strong social capital, managers and officials' positive beliefs and organizational culture towards inter-sectoral collaboration, sufficient knowledge and information about the implementation, and providing proper programs to implement inter-sectoral collaboration. These findings recall the need to develop and in particular, implement a specific infra-structure through a well-designed program at the government level to strengthen this approach.

Effect of "Mehrpishegan" web-based support group on depression, anxiety, and stress among elderly informal caregivers: a protocol for a randomized-controlled trial.

BACKGROUND: Elderly population in low- and middle-income countries is rapidly growing, which indicates an increase in the number of dependent people needing long-term care. Caring for the elderly is difficult and stressful and threatens physical and mental health of informal caregivers. We aim to design a web-based support group and assess its effectiveness on depression, anxiety, and stress among elderly informal caregivers. METHODS: This is a protocol for a two-arm randomized controlled trial. A total of 160 informal elderly caregivers will be recruited from the southern area of Tehran. Eligible participants will be randomly allocated to two intervention and control groups. The inclusion criteria include not receiving salary for caring, having primary responsibility for care, having smartphone/tablet/computer, being able to use the contents and web applications, having at least one month of experience in caring for the elderly, and having access to the Internet at least once weekly. The intervention will be implemented by giving an account access to the designed website. Depression, anxiety, and stress will be assessed using the DASS21 questionnaire at baseline, and at the end of third and sixth months. DISCUSSION: Our findings can pave the way for improving the mental health of informal caregivers of the elderly through provision of web-based supportive services. This study stands as an opportunity to address the needs of caregivers and help them support each other in a novel way. TRIAL REGISTRATION: Iran Randomized Clinical Trial Center IRCT20201012048999N1 . Registered on 25 December 2020 (current status: ongoing). The World Health Organization Trial Registration Data Set is in Additional file 1 PROTOCOL VERSION: Second version 2021-05-27.

Barriers to home care for older adults from perspectives of Iranian informal caregivers: a qualitative study.

OBJECTIVE: A longer life expectancy increases the number of older adults who require long-term care. The presence of a caregiver at home prevents the placement of older adults in care facilities. Identifying the caregivers' viewpoints around the care clarifies key factors in providing quality care.This study aimed to assess barriers to home care from the perspective of Iranian informal caregivers of older adults. DESIGN: This was a qualitative study with content analysis. Semistructured interviews were conducted via telephone in Persian with informal caregivers of older adults using open-ended questions. SETTING: Social and health organisations in southern Tehran, Iran. PARTICIPANTS: Seventeen informal caregivers were selected on purpose. Participants were eligible to participate in the study if they were 18 years or older, and had at least 1 month of care experience for a minimum of 6 hours per week. RESULTS: Barriers to home care for older adults from informal caregivers' points of view were categorised into three domains: (1) Individual barriers include the physical, mental and social burden of care as well as personal characteristics of the caregiver; (2) interpersonal barriers include psychobehavioural characteristics of the older adult and misbehaviour of people around the caregiver and (3) care system barriers include inefficient institutional/organisational infrastructure, moral issues and inefficiency in public policy. CONCLUSIONS: Our study showed multiple individual, interpersonal and care system barriers to home care for older adults. Specific contextual challenges among Iranian caregivers, such as their attitudes and beliefs, as well as a lack of social and healthcare support for families, hindered the quality of care. TRIAL REGISTRATION NUMBER: IRCT20201012048999N1.

Developing an Educational Parenting Skills Package to Parents Undergoing Substance Abuse Treatment for Preventing Addiction among Adolescents: A Study Protocol Based on Social Marketing Approach.

BACKGROUND: Developing an educational parenting skills package for parents with substance abuse may be effective in preventing the same problem in their adolescents. Social marketing is one of the approaches facilitating the preparation of educational content for this purpose. Social marketing is a regular and planned process focusing on customers and their needs for encouraging a target group to exhibit a particular behavior or adopt a specific idea. This study protocol aims to use the social marketing approach to prepare an educational parenting skills package for the parents undergoing substance abuse treatment to prevent addiction in their adolescents. METHODS: An educational parenting skills package will be designed and validated by a combination of qualitative research (descriptive phenomenology), scoping review, and Delphi study based on social marketing approach (4 Ps = product, price, place, promotion). The package will be prepared in four phases including educational need assessment, ranking the identified educational needs, determining the suitable health education constructs, and modeling and developing the educational content based on the identified constructs. The designed educational package will be validated from the perspective of the target group (parents undergoing substance abuse treatment) and experts. CONCLUSION: Developing educational packages based on a scientific health education approach and mainly the Social Marketing Assessment and Response Tool (SMART) model with an emphasis on market analysis or marketing mix (4 Ps = product, price, place, promotion) can prove effective in attracting the audience and promoting the target activities.

The effect of the mobile "blood pressure management application" on hypertension self-management enhancement: a randomized controlled trial.

BACKGROUND: Self-management of hypertension is of great significance given its increasing incidence and its associated disabilities. In view of the increased use of mobile health in medicine, the present study evaluated the effect of a self-management application on patient adherence to hypertension treatment. METHODS: This clinical trial was performed on 120 hypertensive patients who were provided with a mobile intervention for 8 weeks and followed up until the 24th week. Data on the primary outcome (adherence to treatment) and secondary outcomes (adherence to the DASH diet, regular monitoring of blood pressure, and physical activity) were collected using a questionnaire and a mobile application, respectively. The inter-group change difference over time was analyzed using repeated measures ANOVA (general linear model). RESULTS: The treatment adherence score increased by an average of 5.9 (95% CI 5.0-6.7) in the intervention group compared to the control group. The scores of "adherence to the low-fat and low-salt diet plans" were 1.7 (95% CI 1.3-2.1) and 1.5 (95% CI 1.2-1.9), respectively. Moreover, moderate physical activity increased to 100.0 min (95% CI 61.7-138.3) per week in the intervention group. CONCLUSION: The treatment and control of blood pressure require a multifaceted approach given its complexity and multifactorial nature. Considering the widespread use of smartphones, mHealth interventions can be effective in self-management and better patient adherence to treatments. Our results showed that this application can be used as a successful tool for hypertension self-management in patients attending public hospitals in developing countries. TRIAL REGISTRATION: Iran Randomized Clinical Trial Center IRCT2015111712211N2 . Registered on 1 January 2016.

Can we improve the quality of medical news merely by increasing journalists' health knowledge?

Background: The aim of this study was to determine the effectiveness of an educational intervention on the quality of health research-based news, given the sensitivity of disseminating incorrect information. Methods: An uncontrolled before-after study was conducted among health news producers in Tehran from November 2011 to March 2012. The intervention that included educational content in the form of a workshop was evaluated in advance. The outcome of measuring the scientific quality of news extracted from medical and health research results was considered for authenticity and accuracy. The health research-based news quality assessment tool was used. In this study, 32 individuals voluntarily entered the program, and their produced news was collected in 4 stages. To determine the effectiveness of the educational intervention, paired t-tests were used. SPSS version 17 was used for statistical analysis and p<0.05 was considered significant. Results: The mean score (±SD) of the participants' produced news was 0.40 (±0.089) before and 0.61 (±0.086) after the intervention, which increased by 0.21±0.09 (p<0.001). Of the news collected from the participants as baseline data, 544 (65%) articles aimed at increasing public knowledge and awareness. Almost all the news had been gathered from interviews, and only 41 (4.8%) news articles were based on health research results. Conclusion: The educational intervention proved effective in promoting the quality of health research news. Only a few health journalists participated in this study, and thus the need to educate health news producers is felt. Since interviews with health researchers and experts were the largest source of news, interventions need to target other groups who affect the quality and accuracy of the news.

The meaning of "socialization of health" to Iranian policymakers and how it can be implemented.

Complex nature of health and disease, the impact of various socioeconomic factors on the health system arrangements and health of the society, and also the impact of health on the social and economic conditions of the society require a social approach to health. This necessity has led to the creation of new policies and programs, under the name of socialization of health, to strengthen the social approach to health in the health system of Iran. However, there must be more convergence between various stakeholders about the definition, conceptual framework, and different dimensions of this term (socialization of health). Using the experts' opinions and scientific evidence, we clarified the concepts and different dimensions of socialization of health to be used by healthcare policymakers and managers.

Understanding Non-Adherence to Treatment in Hypertension: A Qualitative Study.

BACKGROUND: Hypertension is a major public health issue. With regard to the current trend, it has been estimated that one out of three people will be suffering from hypertension by 2025. This study was designed to provide a better insight into the adherence to treatment and its underlying reasons. METHODS: A directed qualitative content analysis approach was conducted in collaboration with 35 hypertensive patients and 3 cardiologists in the form of in-depth interviews and focused group discussions from October 2015 to February 2016. Sampling was carried out from patients with hypertension using purposeful and heterogeneous method. Some of the PRECEDE model structures were applied as the conceptual framework. RESULTS: The reasons affecting adherence to hypertension treatment were analyzed in three general categories of predisposing, enabling and reinforcing factors based on the model structures. Factors such as "knowledge", "belief and attitude", "mental-personality traits", "culture and lifestyle" were classified as the predisposing factors category. "Access to health service" and "access to facilities in the workplace, home and society" were fit in the enabling factor category. The reinforcing factors category addresses "individuals' internal incentives" and "family and health service providers' support". CONCLUSION: Several reasons account for non-adherence to treatment in hypertensive patients. Diversity of these reasons is an indication that design and implementation of different kinds of interventions are required in order to increase the patients' awareness, empower them and encourage self-efficacy.

Promoting the Quality of Health Research-based News: Introduction of a Tool.

INTRODUCTION: While disseminating health research findings to the public, it is very important to present appropriate and accurate information to give the target audience a correct understanding of the subject matter. The objective of this study was to design and psychometrically evaluate a checklist for health journalists to help them prepare news of appropriate accuracy and authenticity. METHODS: The study consisted of two phases, checklist design and psychometrics. Literature review and expert opinion were used to extract the items of the checklist in the first phase. In the second phase, to assess content and face validity, the judgment of 38 persons (epidemiologists with a tool production history, editors-in-chief, and health journalists) was used to check the items' understandability, nonambiguity, relevancy, and clarity. Reliability was assessed by the test-retest method using intra-cluster correlation (ICC) indices in the two phases. Cronbach's alpha was used to assess internal validity of the checklist. RESULTS: Based on the participants' opinions, the items were reduced from 20 to 14 in number. The items were categorized into the following three domains: (a) items assessing the source of news and its validity, (b) items addressing the presentation of complete and accurate information on research findings, and (c) items which if adhered to lead to the target audiences' better understanding. The checklist was approved for content and face validity. The reliability of the checklist was assessed in the last stage; the ICC was 1 for 12 items and above 0.8 for the other two. Internal consistency (Cronbach's alpha) was 0.98. DISCUSSION AND CONCLUSIONS: The resultant indices of the study indicate that the checklist has appropriate validity and reliability. Hence, it can be used by health journalists to develop health research-based news.

Comparing the effectiveness of the BPMAP (Blood Pressure Management Application) and usual care in self-management of primary hypertension and adherence to treatment in patients aged 30-60 years: study protocol for a randomized controlled trial.

BACKGROUND: Hypertension is one of the most important and well-known risk factors for cardiovascular diseases. Unfortunately, in spite of effective treatments, adherence to the regular use of drugs and other nondrug treatments, such as lifestyle improvement, is often poor. This study evaluates the effectiveness of an educational, supportive intervention - in the form of a Blood Pressure Management Application (BPMAP) - on self-management in patients with primary hypertension on controlling the determinant factors of hypertension, and on adherence to treatment. METHODS/DESIGN: A two-arm, parallel-design randomized controlled clinical trial will be conducted on 30 to 60 year-old patients with primary hypertension who are attending the Tehran Heart Center. One hundred and thirty-two (132) patients will be randomly assigned to the intervention and control (usual method) groups. The most important inclusion criteria are, having primary hypertension and being pharmacologically treated for it, and not having developed the complications of hypertension, such as myocardial infarction, cerebral stroke and cardiac insufficiency. The participants should be able to read Persian and be able to use the application. The most important outcomes of the study include adherence to treatment, weight control, and regular monitoring of blood pressure which are assessed in the primary assessment (baseline data questionnaire) and again at the 8th and 24th weeks. The intervention is a mobile application that has capabilities such as reminders and scientific and supportive information. DISCUSSION: This application has been programmed to reduce many of the nonadherence factors of hypertension treatment. Therefore, the findings may contribute to a rise in adherence to treatment. If proven to have an appropriate impact, it may be extended for use in the national hypertension control plan. TRIAL REGISTRATION: This study was registered in the Iran Randomized Clinical Trial Center under the number IRCT2015111712211N2 on 1 January 2016.

Barriers of health news producers' empowerment: a qualitative study in iran.

BACKGROUND: Studies show that raising news producers' knowledge and skills are influential and necessary for promoting the quality of health news. This study aimed to investigate the barriers to implementing empowerment programs for news producers and to identify their respective solutions. METHODS: In this qualitative content analysis the opinion of 14 journalists, one translator, 10 editors or editors-in-chief of health news agencies were gathered through 12 in-depth interviews and 4 focus group discussions. Purposive sampling was done and interviews continued up to the point of saturation. Data were analyzed with Open Code software. RESULTS: The barriers to the implementation of empowerment programs were identified as: a) individual factors, b) deficiency of certain facilitators, and c) organizational and macro policymakings. Various solutions were suggested for the barriers respectively. CONCLUSION: The implementation of empowerment programs for news producers requires a system approach toward its determinant factors. This will be more likely if measures at other concerned levels are also taken. Creating incentives on behalf of the news-producing organizations can also contribute to this end and create a suitable context for news producers. Training and empowerment alone will not be sufficient.

Establishing a framework of influential factors on empowering primary school students in peer mediation.

BACKGROUND: Empowerment of children and adolescents in terms of social skills is critical for promoting their social health. OBJECTIVES: This study attempts to explore a framework of influential factors on empowering primary school students by means of peer mediation from the stakeholders' point of view, as a qualitative content analysis design. PATIENTS AND METHODS: This study was a qualitative content analysis (conventional method). Seven focused group discussions and six in-depth interviews were conducted with schoolchildren, parents and education authorities. Following each interview, recordings were entered to an open code software and analyzed. Data collection was continued up to data saturation. RESULTS: Within the provided framework, the participants' views and comments were classified into two major categories "educational empowerment" and "social empowerment", and into two themes; "program" and "advocacy". The "program" theme included factors such as design and implementation, development, maintenance and improvement, and individual and social impact. The "advocacy" theme included factors such as social, emotional and physical support. CONCLUSIONS: The explained framework components regarding peer mediation are useful to design peace education programs and to empower school-age children in peer mediation.

Health Emergency Mass Notification: Lessons Learnt from the H1N1 Pandemic in Tehran.

BACKGROUND: Timely notification is of great importance in health emergencies. So identifying the most important sources of information used by people in emergencies seems necessary. The objective of this study was to assess peoples' level of awareness concerning the symptoms, routes of transmission, prevention, and treatment of H1N1 at the time of the pandemic and also to identify their most important source of information. METHODS: Two telephone surveys were performed at the beginning of levels five and six of the pandemic at a four-month interval on two populations. Using a questionnaire, random phone numbers were called and 662 and 701 individuals from Tehran were surveyed at the two phases, respectively. RESULTS: Peoples' level of awareness concerning the disease, symptoms, its routes of transmission, prevention, and treatment of H1N1 had increased in the second phase of the study. At the same time, people were less afraid of the disease in the second phase. The most important sources of information used were TV, newspapers, and radio, respectively. CONCLUSIONS: Mass media including TV and newspapers were recognized as the most important sources of information used by the people in emergencies. It seems that designing educational programs and synchronizing the media's policies with health authorities can help fight future health emergencies and prevent delays in notifying people.

Methodologies and messages in Iranian articles on maternal care, diabetes mellitus, and tuberculosis, published in 2001 - 2006.

INTRODUCTION: An article with a clear message can transfer research knowledge better. However, this is the case when the message suits the type of study methodology (research design) and its results. The objective of this study was to assess the presence of message articles and the type of study methodologies. METHODS: Articles published between 2001 and 2006, on maternal care, diabetes, and tuberculosis, which were based on studies performed on the Iranian population were investigated. A systematic search was performed in foreign databases 'Pubmed, Medline, and Embase', and national databases 'Iranmedex, SID (Scientific Information Database), and Iranpsych'. Seven hundred and ninety-five articles were examined for the type of study methodology and presence of an actionable message (one that specifies what and how an action should be carried out). RESULTS: Among the 795 articles accessed, cross-sectional studies were the most frequent (50.9%) and systematic reviews were the least frequent (0.4%). Cohort cases were observed in 6.9% of the cases. Actionable messages were observed in 22.1% of all the cases and 24.7% of the cross-sectional studies. CONCLUSIONS: Cohort studies increased from 5% in 2001 to 6.9% in 2006, but the shortage of systematic reviews represented a major weakness in the country's knowledge production process. Studies with a higher level of evidence such as systematic reviews, and cohort and interventional studies should be among the priorities of knowledge production in the country.

Lessons Learned from H1N1 Epidemic: The Role of Mass Media in Informing Physicians.

OBJECTIVES: Preparedness and response at the time of pandemic range from writing programs to conducting procedures as well as informing the target population. The present study was conducted to evaluate the awareness of general practitioners in Tehran, at the time of H1N1 pandemic. It also aimed to identify the main sources used for gathering information at each alert level. METHODS: Two telephone surveys were conducted with a 4 month interval, at the beginning of H1N1 pandemic alert level 5 and 6, on 90 and 100 general practitioners, respectively. The knowledge of these physicians on the symptoms of H1N1 flu, the transmission methods, the preventative measures, and existing treatments along with the sources used for gathering information were assessed. RESULTS: While mass media was the main source of gathering information in the H1N1 pandemic alert level 5, more professional sources were used at the H1N1 pandemic alert level 6. Despite the acceptable improvement noted in the knowledge of the physicians during the two phases of the study, their understanding of the disease was believed to be less than the expected level based on H1N1 pandemic alert level. CONCLUSIONS: The routine use of mass media as one of the main sources of information gathering at the two stages of the study points out its importance in providing physicians with the required information at the time of H1N1 pandemic. Using adequate, up-to-date, but non-specialized media can fill the gap in information gathering, required for fighting pandemic.