Health education using the theory of planned behavior to modify ergonomic posture in hospital computer users: a randomized controlled trial.

OBJECTIVE: Work-related musculoskeletal disorders are prevalent in those who use computers, and education using ergonomic principles may be helpful to prevent such conditions. The present study sought to identify how an educational intervention based on the theory of planned behavior (TPB) may be effective for adopting healthy ergonomic postures. METHODS: A convenience sample of 162 computer users working in a hospital setting in Iran were randomly assigned to intervention or control groups. The intervention group (n = 81) received six weekly educational sessions based on TPB principles, whereas the control group received no intervention during the study period. Both groups were assessed at baseline and 3 months after the intervention using a TPB questionnaire, rapid office strain assessment (ROSA), and Nordic musculoskeletal questionnaire. Data were analyzed using the independent/paired Student's t test, chi-square, and analysis of covariance. RESULTS: All TPB constructs in the intervention group improved from baseline to follow-up, indicating considerable progress compared to the control group (p < 0.001). More than 60% of intervention and control groups were categorized as high risk at baseline in terms of ergonomic posture measured by ROSA. This percentage was reduced to 21% for intervention group and increased to 65% in the control group at follow-up. Symptom relief was obtained for wrist/hands, lower back, neck, shoulders and upper back in the intervention group (all p < 0.05). The number of affected areas also significantly decreased in the intervention group compared to the control group three months after the intervention. CONCLUSION: Educational programs based on TPB principles may be helpful in correcting ergonomic postures among computer users. Such interventions are recommended for worksite health promotion in that they may prevent the development of musculoskeletal disorders in staff.

An Intervention Program Using the Health Belief Model to Modify Lifestyle in Coronary Heart Disease: Randomized Controlled Trial.

BACKGROUND: Most effective interventions to control coronary heart disease (CHD) and prevent negative outcomes involve behavioral modification. This study examined how such modification based on the Health Belief Model (HBM) might improve lifestyle and clinical outcomes. METHODS: A total of 120 people with CHD seeking help at a general hospital in Iran were randomly assigned to either the intervention or control group. Information was collected using an HBM-specific questionnaire and the Health Promoting Lifestyle II (HPLP-II) scale. Clinical outcomes (blood pressure, body mass index, and fasting blood sugar) were also measured. The intervention group received a tailored education based on HBM principles plus routine care, while those in the control group received only routine care. Three months after the intervention, both groups were reassessed using Student's t test and analysis of covariance. RESULTS: All HBM subscale scores indicated significant improvements in the intervention group, in contrast to the control group, where scores worsened or stayed the same. Perceived severity and susceptibility were the dimensions that changed most. Total score on the HPLP-II improved significantly in the intervention group (p < 0.001, F = 747.5); however, subscale scores on spiritual growth and interpersonal relationships did not demonstrate significant between-group differences at follow-up. After adjustment for baseline scores, significant improvements in lifestyle subscales were also accompanied by significant improvements in clinical measures. CONCLUSIONS: This HBM-based behavior modification program improved both lifestyle and clinical measures in patients with CHD. Utilizing this program in patients with other cardiovascular diseases may in the future demonstrate similar results.

An educational intervention using the health belief model for improvement of oral health behavior in grade-schoolers: a randomized controlled trial.

BACKGROUND: Oral health problems especially dental caries are common in school children, and education programs may help to prevent these conditions. The aim of current study was to examine the effects of an educational program based on a Health Belief Model (HBM) to improve oral health behaviors of elementary school children. METHODS: A total of 112 children ages 6-12 years old accompanied by one of their parents were randomly assigned to intervention/test and control groups. In the intervention group, five consecutive weekly educational sessions based on the HBM were provided, while the control group received only routine education delivered by the dental clinic. The Decayed, Missing, and Filled Teeth (DMFT) score, papillary bleeding index, and responses to the HBM questionnaire were assessed in the intervention and control groups at baseline and three-month follow-up after the intervention was completed. Within-group and between-group differences were examined using the Student's t-test and analysis of covariance. RESULTS: All HBM domains were improved at follow-up in the intervention group compared to the control group (p < 0.001). The largest change was in perceived susceptibility, whereas the smallest changes were in perceived severity and perceived benefits. The papillary bleeding index demonstrated a significant change from baseline to follow-up in the intervention group (reduction of 0.7, 95% CI = - 0.9 to - 0.5). All components of the DMFT score except missing teeth also improved in the intervention group compared to controls. However, no significant difference was found in total DMFT score between intervention and control groups. CONCLUSION: An education program based on HBM may be more effective than current methods used to educate children and their parents on optimal oral health behaviors. Administration of interventions of this type along with other school-based programs to prevent dental caries may be helpful in grade-school children.

A spiritual intervention to reduce stress, anxiety and depression in pregnant women: Randomized controlled trial.

We assessed the efficacy of a spiritually-integrated cognitive-behavioral educational group intervention for reducing stress, anxiety, depression, and blood pressure during pregnancy and improving delivery outcomes. A randomized controlled trial was conducted in 84 pregnant women randomly assigned to either the intervention or a control group. Demographic information was collected at baseline, along with measures of religiosity, stress, anxiety, depression, and blood pressure. Our intervention consisted of four 90-minute group sessions over 8 weeks that utilized a spiritually-integrated cognitive-behavioral approach to help participants cope with the stress of pregnancy. Stress, anxiety and depression scores in the intervention group decreased significantly by 41%, 28%, and 41%, respectively, from baseline to 3-month follow-up. There were also significant differences in systolic and diastolic blood pressure between groups at the 3-month follow-up, favoring the intervention group. Between-group differences were also significant for these outcomes. Applying such spiritually-integrated intervention may help to improve the mental and physical health of young, healthy nulliparous pregnant women.

Psychometric Validation and Translation of Religious and Spiritual Measures.

Scale development, validation, and translation are complicated and often arduous procedures that involve considerable cost, time, personnel, and skills necessary to perform the complex statistical analyses required. The need to follow a standard procedure when developing new scales and translating old scales into new languages is essential in order to ensure that researchers accurately measure what they are claiming to measure. Well-designed scales form the foundation for much of the quantitative research conducted today in the psychological, social, behavioral and physical health sciences. This is also true for studies that examine the relationship between religiosity and/or spirituality (R/S) and health. The relationship between R/S and health is a complex one, requiring the development of measures that comprehensively, sensitively, reliably, and accurately measure R/S. As with many other emerging areas in the health sciences, quantitative measurement using psychometrically sound scales and the translation of existing scales into other languages is essential for advancement of the field of religion and health. In this article, a standard procedure for developing, validating, and translating multi-item scales is described.

Moral Injury: An Increasingly Recognized and Widespread Syndrome.

Moral injury (MI), originally discussed in relationship to transgressing moral beliefs and values during wartime among military personnel, has expanded beyond this context to include similar emotions experienced by healthcare professionals, first responders, and others experiencing moral emotions resulting from actions taken or observations made during traumatic events or circumstances. In this article, we review the history, definition, measurement, prevalence, distinctiveness, psychological consequences, manifestations (in and outside of military settings), and correlates of MI in different settings. We also review secular psychological treatments, spiritually integrated therapies, and pastoral care approaches (specific for clergy and chaplains) used to treat MI and the evidence documenting their efficacy. Finally, we examine directions for future research needed to fill the many gaps in our knowledge about MI, how it develops, and how to help those suffering from it.

Beliefs of cancer patients in Saudi Arabia.

Objectives: To examine oncology patients' beliefs about the transmissible nature of cancer or its treatments and to determine the correlates thereof.Design: Cross-sectional.Participants: Sixty-nine hospital outpatients completed the questionnaire.Methods: Beliefs about the spread of cancer, chemotherapy, and radiation therapy with physical contact, along with demographic, social, psychological, health-related characteristics were assessed by questionnaire. Bivariate and multivariate analyses identified correlations between these beliefs and patient characteristics.Findings: A percentage (5.8%) believed their cancer could spread like an infection or be transmitted through sexual or nonsexual contact and 15.9% were unsure. Even more (13.0%) believed that chemotherapy could spread through sexual or nonsexual contact and 18.8% were unsure. Likewise, many believed (10.1%) that radiation therapy could spread through sexual or nonsexual contact and 21.7% were unsure. Obsessions with contamination were most strongly associated with such beliefs (B = 0.73, SE = 0.09, p < .0001).Conclusions: Beliefs about the spread of cancer or its treatments are not uncommon in Saudi Arabia, where cultural beliefs and tradition strongly influence healthcare decisions.

Religiosity and Beliefs About the Transmission of Cancer, Chemotherapy, and Radiation Through Physical Contact in Saudi Arabia.

We examined relationships between religiosity and Saudi cancer patients' beliefs about the spread of cancer, chemotherapy, and radiation therapy through close physical contact. Surveyed were 64 patients seen in university oncology clinics. Assessed were beliefs about the spread of cancer and its treatments, along with religious, demographic, social, psychological, and cancer-related characteristics. Greater religiosity was related to older age, non-Saudi nationality, less anxiety, earlier cancer stage, and greater time since initial diagnosis. Non-significant trends suggested that religious practices were associated with less, but intrinsic religious beliefs with more concern about contagiousness, although the findings were limited by low statistical power.

The effectiveness of a model-based health education intervention to improve ergonomic posture in office computer workers: a randomized controlled trial.

PURPOSE: Lack of knowledge about computer ergonomics predisposes users to musculoskeletal and visual disorders. The present study examined the effect of a trans-theoretical model (TTM)-based educational program on work-related posture in office computer users. METHODS: This experimental study examined 102 hospital personnel whose primary job involved working at a computer. Participants were randomized to intervention and control groups. An educational intervention based on TTM was conducted over five sessions. A self-report questionnaire was used to collect data including stages of change, processes of change, pros and cons of change, and self-efficacy. A pen-paper-based observational method (i.e., Rapid Office Strain Assessment or ROSA) was used for assessing work posture. A visual analogue scale assessed pain intensity. Data were collected at baseline and 3-month follow-up. RESULTS: Significant differences were found on TTM's constructs and ROSA score between intervention and control groups at follow-up (p < 0.05). The mean ROSA score decreased from 5.65 (SD 1.03) to 3.95 (SD 0.83) in the intervention group, while no significant change was found in the control group. Pain intensity also decreased significantly among those in the intervention vs. control group (p < 0.001). CONCLUSION: An educational intervention based on TTM was effective in improving ergonomic posture in computer workers. Further research is needed to determine if these results can be generalized to computer workers in other settings.

Religiosity and Telomere Length in Colorectal Cancer Patients in Saudi Arabia.

Numerous studies have reported a significant relationship between psychological stress, depression, and telomere length (TL), an indicator of cellular lifespan. Religious involvement, which is associated with lower levels of stress and depression, has also recently been related to TL. To our knowledge, this relationship has not yet been examined in Muslims, colorectal cancer patients, cancer patients more generally, or any population outside the USA. A convenience sample of 50 colorectal patients was recruited from hospital-based oncology clinics in Jeddah, Saudi Arabia. Religious involvement was assessed with the 13-item Muslim Religiosity Scale. Social and psychological mediators were measured using established scales. TL was determined from whole-blood leukocytes using quantitative PCR technology. Bivariate analyses indicated a positive but nonsignificant relationship between religiosity and TL (r = 0.13, p = 0.35). Controlling for age, did not affect the relationship (B = 15.6, SE = 17.3, p = 0.37), nor did controlling for other demographic, social or psychological factors. Religious involvement was unrelated to TL in this small sample of colorectal patients. Future cross-sectional and prospective studies in different populations with larger samples are needed.

The Effect of Holy Qur'an Recitation on Depressive Symptoms in Hemodialysis Patients: A Randomized Clinical Trial.

Patients with advanced renal failure often face considerable sociopsychological stress as a result of lifestyle changes due to the disease and its treatment. The aim of the present study is to examine the effect of the Holy Qur'an recitation on depressive symptoms in hemodialysis patients. In this clinical trial, 54 hemodialysis patients were randomized to either an experimental (n = 27) or a control (n = 27) group. Patients completed the Beck Depression Inventory-II (BDI-II) at baseline and at 1 month after the intervention. Participants in the experimental group listened to recitation of the Holy Qur'an, while those in the control group received no intervention. The mean BDI-II score at baseline was 33.6 (±6.7) for the experimental group and 29.3 (±9.0) for the control group; at the end of treatment, BDI-II scores in the experimental and control groups were 14.5 (±4.8) and 31.6 (±9.2), respectively. Results from the repeated-measures general linear model controlling for baseline differences indicated a significant treatment effect (F = 9.30, p = 0.004, Cohen's d = 0.85). Holy Qur'an recitation has a significant effect on lowering depressive symptoms in hemodialysis patients. Holy Qur'an recitation is an easy-to-implement and cost-effective strategy that may be used to supplement the treatment of depression in this setting in Iran.

Religious beliefs, practices, and health in colorectal cancer patients in Saudi Arabia.

OBJECTIVE: Colorectal cancer (CRC) patients experience considerable psychological stress because of changes brought on by their illness. Religion may be a resource for such patients. We examined the prevalence of religious beliefs and practices in CRC patients and correlation with demographic, social, psychological, and physical health characteristics. METHODS: Seventy CRC patients (all Muslim) in Jeddah, Saudi Arabia, were surveyed using a 13-item Muslim religiosity scale. Standard measures were used to assess depressive symptoms, depressive disorder, and social support; demographic and social factors, psychiatric history, and disease factors were also measured. RESULTS: All 70 participants (100%) engaged in group worship and prayer (Fard) five times/day, and 75.7% never skipped or combined two or more obligatory prayers; 71.4% read or recited the Qur'an several times/week or daily; 80.0% gave money to the poor each year (Zakat); 71.4% fasted throughout the month of Ramadan (Sawm) and other times as well; 91.4% said they 'definitely' experienced the presence of Allah; and 74.3% said their entire approach to life was definitely based on their religious beliefs. Overall religiosity was inversely related to depressive symptoms (B = -0.58, SE = 0.30, p = 0.026) and suicidal ideation (B = -0.07, SE = 0.03, p = 0.025), after controlling for financial status and social factors. CONCLUSIONS: Religious involvement was widespread in this sample of CRC patients in Saudi Arabia and was related to fewer depressive symptoms and less suicidal ideation. No relationship was found with stage of disease or duration of treatment.

Depression in patients with colorectal cancer in Saudi Arabia.

OBJECTIVE: Persons with colon cancer experience considerable psychological stress due to physical and social changes brought on by illness, increasing their risk of depressive disorder (DD). We examine the prevalence of DD and depressive symptoms and determine baseline demographic, social, psychological, and physical health correlates. METHODS: A convenience sample of 70 cancer patients in Jeddah, Saudi Arabia, was screened for DD using an abbreviated version of the Structured Clinical Interview for Depression (SCID) and for depressive symptoms using the Hamilton Depression Rating Scale (HDRS). Demographic, psychosocial, psychiatric, and physical health characteristics were also assessed, along with past treatments for colon cancer. Bivariate and multivariate analyses identified predictors of DD and symptoms. RESULTS: The 1-month prevalence of DD was 30.0% (12.9% major depression, 5.7% minor depression, and 11.4% for dysthymia) and significant depressive symptoms were present in 57.1% (HDRS 8 or higher), including having persistent suicidal thoughts for 2 weeks or longer wthin the past month (14.3%) . Low social support and having a co-morbid psychiatric illness (particularly anxiety) independently predicted DD based on the SCID. Saudi nationality, poor financial situation, low social support, and co-morbid psychiatric illness independently predicted depressive symptoms on the HDRS. Surprisingly, stage of cancer, duration of cancer, and treatments for cancer were unrelated to DD or depressive symptoms. CONCLUSIONS: DD and significant depressive symptoms are common in patients with colon cancer in Saudi Arabia, and are predicted by a distinct set of demographic and psychosocial risk factors that may help with identification. Demographic and psychological risk factors were more likely to be associated with depression than cancer characteristics in this sample.

Psychometric evaluation of the Persian version of the Type 2 Diabetes and Health Promotion Scale (T2DHPS): a diabetes-specific measure of lifestyle.

BACKGROUND: A healthy lifestyle is important for maintaining health and preventing complications in patients with type 2 diabetes, and yet, few instruments are available to measure this. AIM: The aim of the present study was to examine the psychometrics of a recently developed tool that can be used to screen for a health-promoting lifestyle in patients with type 2 diabetes. METHODS: Data were collected from outpatients attending diabetes clinics. The Type 2 Diabetes and Health Promotion Scale (T2DHPS), EQ-5D, medical records and a demographic questionnaire were administered to 368 participants. Forward-backward translation of the original English version was used to develop a Persian version. Internal consistency of the scale was assessed by Cronbach's alpha and item-to-total correlation. Acceptability was measured by assessing floor and ceiling effects for each item and subscale. The item scaling test was used to examine the convergent and discriminant validity of the measure. Pearson correlation was used to determine the predictive validity of the scale. An explanatory factor analysis and known-group method were used to establish construct validity. RESULTS: Adjusted item-total correlations were higher than 0.20. Cronbach's alpha for the 28-item scale was 0.88 and for subscales ranged from 0.53 to 0.94. Correlations between the total score and subscale scores were significant (<0.01) and adequate (r's ≥ 0.53). There were significant relationships between the T2DHPS and both the EQ-5D and indicators of glycaemic control. Convergent and discriminant validity of the scale was established. Significant differences in lifestyle dimensions were present between different groups of patients, demonstrating known-group validity. A six-factor solution was obtained that explained 54.6% of the total variance. CONCLUSION: The T2DHPS is a valid and reliable tool for investigating lifestyle behaviours in patients with type 2 diabetes. Further studies to establish the psychometric properties of the scale in other languages and cultures are suggested.

Test-retest reliability of the Muslim Religiosity Scale: follow-up to "Religious involvement and health among dialysis patients in Saudi Arabia".

The intra-class correlation coefficient for the scale was 0.961, 95 % CI 0.912-0.983. We conclude that the MRS is a highly reliable measure of Muslim religiosity over time.

Religious involvement and health in dialysis patients in Saudi Arabia.

Patients on hemodialysis experience considerable psychological and physical stress due to the changes brought on by chronic kidney disease. Religion is often turned to in order to cope with illness and may buffer some of these stresses associated with illness. We describe here the religious activities of dialysis patients in Saudi Arabia and determined demographic, psychosocial, and physical health correlates. We administered an in-person questionnaire to 310 dialysis patients (99.4 % Muslim) in Jeddah, Saudi Arabia, that included the Muslim Religiosity Scale, Structured Clinical Interview for Depression, Hamilton Depression Rating Scale, Global Assessment of Functioning scale, and other established measures of psychosocial and physical health. Bivariate and multivariate analyses identified characteristics of patients who were more religiously involved. Religious practices and intrinsic religious beliefs were widespread. Religious involvement was more common among those who were older, better educated, had higher incomes, and were married. Overall psychological functioning was better and social support higher among those who were more religious. The religious also had better physical functioning, better cognitive functioning, and were less likely to smoke, despite having more severe overall illness and being on dialysis for longer than less religious patients. Religious involvement is correlated with better overall psychological functioning, greater social support, better physical and cognitive functioning, better health behavior, and longer duration of dialysis. Whether religion leads to or is a result of better mental and physical health will need to be determined by future longitudinal studies and clinical trials.

Religiosity/spirituality of German doctors in private practice and likelihood of addressing R/S issues with patients.

This study examined the self-assessed religiosity and spirituality (R/S) of a representative sample of German physicians in private practice (n = 414) and how this related to their addressing R/S issues with patients. The majority of physicians (49.3 %)reported a Protestant denomination, with the remainder indicating mainly either Catholic(12.5 %) or none (31.9 %). A significant proportion perceived themselves as either religious(42.8 %) or spiritual (29.0 %). Women were more likely to rate themselves R/S than did men. Women (compared to men) were also somewhat more likely to attend religious services (7.4 vs. 2.1 % at least once a week) and participate in private religious activities(14.9 vs. 13.7 % at least daily), although these differences were not statistically significant.The majority of physicians (67.2 %) never/seldom addressed R/S issues with a typical patient. Physicians with higher self-perceived R/S and more frequent public and private religious activity were much more likely to address R/S issues with patients. Implications for patient care and future research are discussed.

Body Dysmorphic Disorder Symptoms: Prevalence and Risk Factors in an Arab Middle Eastern Population.

Background: The present study examined the prevalence of and risk factors for symptoms of body dysmorphic disorder (BDD) in the general population of Jeddah, a large port city in Saudi Arabia. Methods: This cross-sectional study surveyed a convenience sample of 520 adults. We used a validated self-screening measure to assess BDD, the body dysmorphic disorder questionnaire (BDDQ). Results: The prevalence of significant BDD symptoms among the general Saudi population was 8.8% (ie, those scoring above the cut off for BDD on the BDDQ). Over half (52%) of all respondents reported concerns about the attractiveness of their body parts, and of those expressing such concerns, 66% were preoccupied with these thoughts. Only 3% of all respondents opted for cosmetic surgery because of these concerns, and most of those individuals (69%) had only one surgery. Nearly 9% of all respondents reported that these concerns affected their relationships with family and friends. Almost 15% of all participants spent an hour or more each day thinking about these concerns. Patients who reported a history of depression were 3.8 times more likely to have BDD. Other variables included in the model predicting high BDD scores (eg, age, job status, and marital status) did not achieve statistical significance. Conclusion: Significant symptoms of BDD (based on the BDDQ) are not uncommon among the general population of Jeddah, Saudi Arabia. Risk factors for this condition were female gender, younger age, being unmarried, and in bivariate and multivariate analyses, history of depression and female gender. These findings underscore the need for increased awareness by clinicians of this disorder, particularly when treating patients with depressive disorder, particularly among women.

Prevalence of and Risk Factors for Skin Picking Disorder Symptoms Among Adults in an Arab Middle Eastern Population: A Cross-Sectional Study.

Introduction: Skin Picking Disorder (SPD) is a skin-related disease, also recognized as psychogenic excoriation, dermatillomania, or excoriation disorder. SPD is defined as a habitual picking of skin, which in turn harms skin tissue. Given the paucity of information on SPD symptoms, their prevalence, and risk factors in Saudi Arabia, the present study seeks to fill this gap by investigating these factors in a community sample from Jeddah. Methods: This descriptive cross-sectional study was conducted in the city of Jeddah. The Skin Picking Scale-Revised (SPS-R) scale was administered to a convenience sample of 520 respondents. A partial least squares path model (PLS-PM) for "impairment" and "symptoms severity" subscales was assessed by evaluating the validity of measurement and structural models. Results: Skin picking behavior was reported by 28.8% (n=150). A significant level of skin picking disorder symptoms was present in 1.2% (n=6). Skin picking visual effect, depressive symptoms, and being unmarried were the only positive independent predictors of the total SPS-R score. Conclusion: SPD symptoms are relatively common among the adult population in Jeddah, but those with threshold symptoms indicative of SPD are relatively few. Such behavior is particularly common in vulnerable groups such as those with depressive symptoms and the unmarried. More attention to this condition by clinicians will improve the quality of life of those affected, and reduce the emotional and physical health consequences of this often unrecognized condition.

Trichotillomania Prevalence in an Arab Middle Eastern Population.

Aim: Trichotillomania (TTM) (hair-pulling disorder) is a relatively rare psychiatric condition. We are aware of no studies of this disorder in Arab Middle Eastern populations. We examine the prevalence and correlates of TTM in a community sample of individuals living in a large port city in western Saudi Arabia. Methods: An observational cross-sectional study of 511 adults aged 18 years or over living in Jeddah, Saudi Arabia, was conducted. After inquiring about demographic information and self-reported psychiatric disorders, the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS) was administered to assess symptoms of TMM. Results: A total of 9 of 511 participants (1.8%) scored above the cutoff for suspected TTM on the MGH-HPS, whereas 203 (39.7%) had a history of hair-pulling. Those with suspected TTM were more likely to be female (2.8% vs 0.4% in males, P = 0.047) and somewhat more likely to have a history of obsessive-compulsive disorder (OCD) (6.7% vs 1.5%, P = 0.093). Hair pulling was also more common in unmarried, not living with family, and unemployed. Among those with a history of hair-pulling, the most frequent locations were from the face (62.7%), head (55.7%), and legs (15.3%). Conclusions: While a history of hair-pulling is common in this community sample (40%), suspected TTM is much less prevalent (<2%), although not rare by any means. When present, the condition is more common in women and possibly in those with OCD.