Psychometric evaluation of a new instrument to hookah tobacco smoking-related factors in the Iranian female university students based on the Extended Parallel Process Model.

BACKGROUND: The higher prevalence of hookah tobacco smoking (HTS) has become worrisome in women. Thus, it is essential to identify and measure the perceptions associated with this unhealthy behavior as well as the type of response to risk messages to design the effective programs. This study aimed to psychometric evaluation of a new instrument, named the Extended Parallel Process Model-Hookah Tobacco Smoking Questionnaire (EPPM-HTSQ), for female university students. MATERIAL AND METHODS: This methodological study was conducted in 2019-2020 in central and western Iran. The first version of the instrument was developed with 97 items. Face, Content, and construct validity methods were used to assess the EPPM-HTSQ validity. The data viability for factorability was guided through Kaiser-Meyer-Olkin (KMO) measure of sample adequacy (Values >0.7) and Bartlett's test of Sphericity (P < 0.05). The Exploratory Factor Analysis (EFA) method with varimax rotation and SPSS software was performed to identify the main factors of the questionnaire and interpretable factors. The internal consistency and external reliability were determined. The test-retest was used for evaluating the stability of tools. RESULTS: During the assessment of the face and content validity 71 items remained in the questionnaire. EFA led to the extraction of nine dimensions: "Focusing on superior rewards," "Response Efficacy," "Perceived physical threat," "Perceived social threat," "Self-efficacy," "Fear control," "Attitude," "Fear," and "Intention" Kaiser-Meyer-Olkin (KMO) test (0.957) and Bartlett's test (P < 0.001). Cronbach's alpha (0.871-0.951) and ICC (0.985-0.998) were approved for scale dimensions. CONCLUSION: Important findings of the present study were the development and validation of the EPPM-HTSQ for measuring EPPM variables in relation to HTS; introducing a new variable "focusing on superior rewards"; as well as, the new classification of the concept of "perceived threat." The final version of the EPPM-HTSQ is a valid and reliable tool, but it is suggested to be re-evaluated in other studies with different populations and sample sizes.

A comprehensive interventional program to improve the sexual function of women with endometriosis: a mixed-methods protocol study.

BACKGROUND: Endometriosis is a chronic disease affecting 6-10% of women worldwide. Sexual dysfunction has been reported in a significant percentage of these patients. Thus, the present study will be conducted to design, implement, and determine the effectiveness of an interventional program to improve the sexual function of women with endometriosis. MATERIALS AND METHODS: This mixed-methods study will be carried out in three phases with a sequential exploratory approach. In the first phase (qualitative study) participants will be selected by purposive sampling in Isfahan, Iran. The data will be collected through in-depth interviews and field notes and analyzed using conventional content analysis. The interventional program will be designed in the second phase based on the results of the qualitative study and literature review and using the Delphi method and panel of experts. The interventional program will be implemented at the individual level in the third phase to investigate its effect on improving women's sexual function. This phase includes quasi-experimental research, in which the pre- and post-intervention data will be collected from the intervention and control groups using the FSFI questionnaire and analyzed by descriptive and inferential statistical methods. Ultimately, a suitable interventional program will be presented by combining the data obtained in the qualitative and quantitative phases of the research. CONCLUSION: Conducting the present study, along with the design and implementation of an appropriate, native, and culturally sensitive interventional program, can contribute to improving the sexual function of women with endometriosis and enhancing the quality of sexual relations between couples.

Endometriosis is a chronic disease in women of reproductive age. The negative impact of endometriosis on intimate relationships and sexual function has been reported in a significant number of women with this disease. The results of this study offer a rich source of information for the required interventions to promote the sexual and reproductive health of women with endometriosis. This study is a sequential exploratory (qualitative­quantitative) mixed methods design that consists of three consecutive phases. In this study, following a qualitative approach, the researchers will explain the experiences of women with endometriosis of sexual function and the appropriate strategies to improve the sexual function of these women. In the second phase, the researcher will design an appropriate interventional program for to improving the sexual function of women with endometriosis by using the results of the qualitative phase and literature reviews. The purposed interventional program is designed using the Delphi method and panel of experts and will be finalized for execution. In the third stage, the effectiveness of interventional program on the sexual function of women with endometriosis will be investigated in a quasi-experimental study. Therefore, it is expected that conducting a mixed method study by presenting an interventional culturally sensitive program can contribute to improving the sexual function of women with endometriosis and enhancing the quality of sexual relations between couples.

Promoting adolescent mother self-efficacy for parenting roles, and self-care after childbirth: protocol for a mixed methods study.

BACKGROUND: Pregnancy, and childbirth can encounter many challenges for the teen mother, family, and health system. The simultaneity of two transition periods, i.e. transition to adulthood and post-partum period may disrupt the acceptance of new roles. Lack of knowledge, information and life skills in managing this situation may threaten the physical and mental health of the mother, and child, as well as reduce the level of role adaptation. One way to increase women's empowerment in postpartum care is self-efficacy promotion training program. The current mixed methods study will be conducted to provide an interventional program sensitive to the culture of the Iranian society for adolescent mothers to improve their self-efficacy. METHOD: This study will be conducted as an exploratory sequential mixed methods study (Qual-quan) based on a pragmatism paradigm in four phases. In the first phase, a qualitative study will be performed using a directed content analysis method to explore the needs and strategies related to promote postpartum self-efficacy from the viewpoint of teen mothers, their family, healthcare providers, and policymakers. In the second phase, using a scoping review, self-efficacy promotion strategies, and postpartum care service packages, programs, guidelines, and protocols in other countries will be identified. In the third phase, with integrating the results of qualitative phase and scoping review, the first draft of program will be developed, and validated by an expert panel based on the Delphi approach in three rounds. In the last step, the effectiveness of the interventional program will be evaluated on postpartum self-efficacy of teen mother. DISCUSSION: Developing an interventional program that includes teen mother's experiences, evidence based practice principles, and health staff opinions in a distinct cultural and social context can supply new direction to lead manager, policymakers, and other health care provider to improve the maternal self-efficacy in infant, family, and self-care with considering their age characteristics.

Barriers to vulnerable adolescent girls' access to sexual and reproductive health.

BACKGROUND: Vulnerable adolescents are exposed to sexual and reproductive health harms. Ignoring the sexual and reproductive health of this group can have irreparable consequences. The present qualitative study aimed to explore the barriers to the access of vulnerable adolescent girls to sexual and reproductive health. METHODS: In this study, sixteen 14-19-year-old adolescent girls and twenty-two key informants were selected using purposive sampling method. Through in-depth semi-structured interviews, they expressed their experiences of barriers to sexual and reproductive health in vulnerable adolescent girls. The data were encoded using the conventional qualitative content analysis. RESULTS: Based on the results of the study, neglecting the reproductive and sexual health of vulnerable adolescent girls at different levels leads to serious challenges and obstacles in providing and maintaining it. Lack of a responsible family, the repulsive behaviors of the family and following risky behaviors of peers led to ignoring the sexual and reproductive health of adolescent girls. Unanswered sexual questions, defective life skills, unwanted pregnancy during adolescence, lack of awareness of unsafe sex, violating cultural norms and wounded psyche in vulnerable adolescent girls threaten their sexual and reproductive health. Ineffectiveness of key organizations in providing sexual and reproductive health services alongside lack of legal, political and social support in this area indicate that the sexual and reproductive health of these girls is not a priority for the society. CONCLUSION: Numerous personal, family, social, legal and political barriers challenge the sexual and reproductive health of vulnerable adolescent girls. Developing a comprehensive and practical program beside legal and political support for this issue can provide the basis for the sexual and reproductive health of this group of adolescents in societies.

Health system-related needs for healthy nutritional behaviors in adolescent girls with polycystic ovary syndrome (PCOS): a qualitative study in Iran.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women. Given the prevalence of this disease in adolescent girls as well as its serious physical, psychological, and social consequences, the present study aimed to explore the health system-related needs for healthy nutritional behaviors in adolescent girls with PCOS. METHODS: This qualitative content analysis was conducted in Shiraz, Iran between November 2016 and October 2017. Eighteen Adolescent girls with PCOS and 15 healthcare providers (midwives, gynecologists, nutritionists, and endocrinologists) were selected through purposeful sampling with maximum variation strategy. Data were collected through individual in-depth and semi-structured interviews, focus group discussions, and field note, and simultaneously analyzed using the conventional qualitative content analysis method. RESULTS: Three main categories that appeared included: 1) education and counseling on healthy nutrition and support for adolescent girls with PCOS with sub-categories of "empowering adolescent girls with PCOS to adopt healthy nutritional behaviors", "providing services and education about healthy nutritional behaviors as a team", and "the health team attention to the concerns of adolescent girls with PCOS and closely following the disease status, 2) solving communication problems with sub-categories of "proper interactions and building trust between health team members and adolescent girls" and "proper interactions between members of the health team", and 3) developing the optimal structure for providing health services with sub-categories of "solving problems related to human resources, "promoting the position of health issues related to adolescent girls in the health system", and "promoting policy-making in the field of nutritional health of adolescent girls". CONCLUSIONS: Based on the results of the present study, necessary measures should be taken to educate and advise on healthy nutrition, and to support adolescent girls with PCOS. The desired structure should also be developed to provide health services to these girls. By solving communication problems and building trust between the members of the health team and these girls, one can guide them to adopt healthy nutritional behaviors.

Investigating the predictive power of constructs of extended Pender's health promotion model and some background factors in fruit and vegetable consumption behavior among government employees.

BACKGROUND: Daily consumption of fruit and vegetable (F and V) can effectively reduce the risk factors of cardiovascular diseases; therefore it is necessary to identify the factors affecting this behavior. This study aimed to determine the Predictive Power of Pender's Health promotion model (HPM) constructs in F and V consumption behavior and the effects of some background variables on this behavior. MATERIALS AND METHODS: A descriptive-correlation study was conducted on 418 employees working in different offices of Qaemshahr, Mazandaran Province from April 8, 2019, to July 23, 2019. The participants filled out a questionnaire about perceived F and V Consumption behavior based on Pender's HPM Constructs. The data were statistically analyzed by descriptive statistics and parametric tests, including the Pearson correlation, Independent- Sample t-test, One-Way analysis of variance test, and multiple linear regression, in SPSS-22. RESULTS: The mean age of participants was 40.25 ± 7.56 years. The results showed that F and V consumption behavior was positively correlated with some constructs of Pender's HPM including, behavioral outcome (r = 0.51, P < 0.001), previous related behavior (r = 0.48, P < 0.001), commitment to action (r = 0.47, P < 0.001), perceived self-efficacy and behavior-related emotions (r = 0.39, P < 0.001). Behavioral outcome alone explained 26% of the dependent variable changes (F and V consumption behavior). The results also indicated that there was a significant relationship between gender and F and V consumption behavior (P = 0.01). CONCLUSION: The study findings demonstrated that some of Pender's HPM Constructs could predict F and V consumption behavior. Behavioral outcome alone was a strong predictor of this behavior. Therefore, in addition to background variables, these constructs should be taken into account in the development of training interventions and courses.

Validation of an instrument for perceived factors affecting fruit and vegetable intake based on Pender's health promotion model.

Increasing fruit and vegetable (F&V) intake has a protective role against chronic conditions such as cardiovascular disease, cancer and diabetes. The present study aimed to validate an instrument for measuring the perception of effective factors on consumption behaviour of F&V based on Pender's health promotion model (HPM).This cross-sectional validation survey has consisted of five steps: literature review in order to plan and develop an instrument, face validity assessment, content validity assessment, reliability assessment and construct validity assessment with the cooperation of experts in health education, nutritionists and the target group (government employees). In the present study, reliability and validity of constructs were determined through Cronbach's alpha and exploratory factor analysis, respectively, in SPSS 22. The mean impact score was acceptable for 96·42 % of items in face validity. The mean scores of content validity ratio (CVR), content validity index (CVI) and reliability were 0·92, 0·97 and 0·96, respectively. According to the principal component analysis with varimax rotation, 104 items were identified in 15 factors contributing to 61·17 % of the model cumulative variance. Given the favourable scores of the research instrument in face validity, content validity and reliability as well as its ability to predict the extracted factors from the model, it can be used as a suitable instrument in future studies.

Assessing the impact of an educational intervention program based on the theory of planned behavior on the nutritional behaviors of adolescents and young adults with PCOS in Iran: a field trial study.

BACKGROUND: Polycystic ovary syndrome is the most common endocrine disorder among adolescents and adults. Given the importance of healthy nutritional behaviors in management of this disease, the present study was conducted to determine the impact of an educational intervention program based on the theory of planned behavior on the nutritional behaviors of adolescents and young adults with polycystic ovary syndrome. METHODS: In this field trial study, 72 participants aged between 15 and 21 years old from four gynecology clinics in Shiraz, Iran, were assigned into the intervention and control groups. Educational intervention program was implemented based on the theory of planned behavior over 4 sessions during two weeks. The data collection tools were researcher-made questionnaires of demographic information, knowledge assessment, and assessment of theory of planned behavior constructs, as well as a questionnaire for assessing consumption of food groups, fast food, and snacks. The data were collected at two stages (once at baseline and once three months after the intervention), and then the changes in knowledge, attitude, subjective norms, the perceived behavioral control, behavioral intention, and nutritional behavior were analyzed using descriptive and inferential statistical methods (t-test, Chi-square, Mann- Whitney U, and Wilcoxon tests; as well as one- way ANOVA, repeated measures ANOVA, and ANCOVA, respectively). RESULTS: Statistically significant increases were observed in the mean scores of knowledge, attitude, subjective norms, the perceived behavioral control, behavioral intention, and nutritional behavior in the intervention group by passing three months from the intervention compared to the scores before the intervention (P < 0.001). However, these differences were not statistically significant in the control group (P > 0.05). Moreover, the mean scores of knowledge, attitude, subjective norms, perceived behavioral control, behavioral intention, and nutritional behavior had no statistically significant difference before the intervention between the two groups; however, this was statistically significant by passing three months from the intervention (P < 0.001). CONCLUSION: Considering the effect of an educational intervention program based on the theory of planned behavior on creating healthy nutritional behaviors in adolescents and young adults with polycystic ovary syndrome, it is recommended to use it in order to improve the nutritional health of them. TRIAL REGISTRATION: IRCT, IRCT20160224026756N6. Registered 18 Aug 2018, https://en.irct.ir/user/trial/32693/view.

Evaluating Community-Based Programs in Promoting Traffic Behaviors and Safe Road Crossing Behaviors in Youth: An Application on Theory of Planned Behavior.

BACKGROUND: Today, one of the most serious causes of mortality and disability among youth is the traffic accidents. Regarding its importance, this paper aimed to investigate the community-based program to promote the safe traffic behaviors among youth. METHODS: This was a quasi-experimental conducted on 5000 youth in five Iranian cities named Lanjan, Gomishan, Fasa, Tehran, and Zahedan in 2015-2016. The questionnaire was based on the constructs of the theory of planned behavior as well as a questionnaire of pedestrian behavior and driving behavior, which was completed before and after the intervention. The educational intervention was carried out based on the theory of planned behavior. Finally, the obtained data were analyzed using STATA software. RESULTS: Six months after the intervention, the mean score of the theory of planned behavior and safe driving behavior in different cities was significantly increased. Here, regarding the safe crossing of the street, the most behavioral changes were observed in Gomishan (P = 0.000), Fasa (P = 0.001), and Tehran (P < 0.0001). The mean score of driving behaviors in Gomishan (P < 0.000), Fasa (P = 0.016), Lanjan (P = 0.047), and Tehran (P < 0.0001) scores was significantly higher. CONCLUSIONS: In most of the studied cities, it can be concluded that education based on the theory of planned behavior can improve the safe driving behaviors among youth. Therefore, it is recommended to be implemented this program in other cities using the theory of planned behavior.

The promotion of healthy breakfast and snacks based on the social marketing model: a mixed-methods study.

BACKGROUND: Skipping breakfast and replacing it with non-nutritious snacks are progressively increasing among adolescents. This study aimed to develop an educational intervention based on the Social Marketing Model and evaluate its effects on healthy breakfast and snack consumption among female adolescent students. METHODS: This mixed-methods study was conducted in 2016-2019 in two phases. In the first phase, a qualitative study was conducted through directed content analysis in guidance schools in Khorramabad, Isfahan, and Tehran, Iran, to explore factors affecting breakfast consumption. The results of this phase were set in the benchmarks of the Social Marketing Model. In the second phase, a randomized controlled trial was conducted based on the benchmarks of the Social Marketing Model on 94 students randomly recruited from guidance schools in Khorramabad, Iran. RESULTS: The findings of the qualitative phase were categorized into the benchmarks of the Social Marketing Model, namely the social marketing mix, the intended behavior, internal and external competing factors for behavior modification, theoretical concepts related to the behavior, and the role of supporters. In the quantitative phase, the univariate analysis showed significant between-group differences concerning the product, price, promotion, and behavior (p < 0.05). CONCLUSION: Healthy breakfast and snack consumption can be promoted through making acceptable the tastes, costs, preparations, and consumption places of breakfast and snack. TRIAL REGISTRATION: The trial was registered in the Iranian Registry of Clinical Trials (code: IRCT20170201032347N1 ). The trial was registered in 11/07/2018 and is accessible on the Iranian Clinical Trial Registration website.

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].

Sociocultural factors contributing to waterpipe tobacco smoking among adolescents and young adult women: a qualitative study in Iran.

Purpose: Waterpipe tobacco smoking (WTS) is currently a serious and growing public health threat in the world, especially in adolescents and young women. The aim of the study was to explore sociocultural factors contributing to WTS among adolescents and young adult women in Iran. Methods: This qualitative study was conducted from August 2017 to January 2019 in Isfahan and Hamadan cities, Iran; it included 13-30-year-old females with experience of WTS. For data collection, in-depth semi-structured personal interviews were conducted at participants' preferred time and place. Concurrent with data collection, data were analysed through conventional content analysis. Results: The study participants described the various sociocultural factors contributing to WTS. These factors were categorized into four following main categories: waterpipe glamorization by its producers and sellers, media advertisement or silence, common sociocultural traditions, and governmental policies and regulations. Conclusion: A wide range of sociocultural factors affects WTS among Iranian adolescents and young adult women. Therefore, interdisciplinary multidimensional strategies are needed for WTS management and prevention among these at-risk groups. Public education, strict supervision of tobacco import, export, and selling, ample employment opportunities for young people and effective leisure time management are essential to reduce WTS.Abbreviation WTS: Waterpipe Tobacco Smoking; MPOWER: Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, Raise taxes on tobacco.

The psychosocial barriers to medication adherence of patients with type 2 diabetes: a qualitative study.

BACKGROUND: The adherence of diabetic patients to their medication regimen is associated with many psychosocial factors that are still unknown. Therefore, the present study aims to identify the psychosocial barriers to medication adherence of patients with type2 diabetes (T2D). METHODOLOGY: This descriptive qualitative study was done in Isfahan, Iran by conducting in-depth unstructured interviews with 23 purposively selected patients with T2D and 10 healthcare providers (HCPs). The participants were interviewed face-to-face between November 2017 and June 2018 at the patient's home, a Health Care Center, or at the diabetes clinic. Data analysis was performed using MAXQDA-10 software and the conventional content analysis. RESULTS: The analysis of the data led to six categories of perceived psychosocial barriers: 1) fear, concern and distress, 2) exhaustion and burnout, 3) the children's issues being the priority, 4) poor financial support, 5) communication challenges, and 6) poor work conditions. CONCLUSIONS: This study identified some of the psychosocial barriers to medication adherence of patients with T2D, which will be of great help to researchers and HCPs in designing and implementing effective interventions to overcome these barriers and change patient self-care behaviors and increase their medication adherence.

Explaining the dimensions of social support for breakfast and healthy snacks in students: a qualitative study.

BACKGROUND: breakfast elimination as well as consumption of low-value snacks is ever increasing among adolescents. This study sought to explain the dimensions of social support for breakfast and healthy snacks among students. METHODS: A qualitative research was conducted in Isfahan, Tehran, and Khorramabad, Iran high schools in 2017-18. Data were obtained from five focus group discussions and 35 in-depth interviews as well as semi-structured interviews with students of both sex, parents and school authorities. The data simultaneously analyzed using conventional content analysis in three stages including preparation, organization, and reporting. Prolonged engagement, maximum variation of sampling and member check were the enrichment factors of the research. RESULTS: Three main categories emerged. First, family supports with sub- categories of family in the school programs as well as mother-sponsored support and family life patterns. Second, school supports with sub- categories of instrumental and informational support. And third, support of other community organizations with sub- categories of intra-department coordination and mass media. CONCLUSION: The concepts emerging in the present study develop multilevel ecological strategies to promote nutritional health including family, school, and community organizations such as school renovations, municipalities, police, education, and mass media to promote healthy breakfast and snack behavior are applicable for students.

Psychological Experiences of Adolescent Girls with Polycystic Ovary Syndrome: A Qualitative Study.

BACKGROUND: Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in the women of reproductive age. In addition to multiple physical problems, this syndrome has many psychological manifestations. Thus, the present research was conducted aimed at investigating the psychological experiences of the adolescent girls with PCOS. MATERIALS AND METHODS: This research was conducted using the qualitative content analysis method. A total of 18 adolescent girls with PCOS and 15 healthcare providers were selected by the purposive sampling method. The data were collected through in-depth interviews, focus group discussions, and field notes, which were analyzed using the conventional content analysis method. RESULTS: After analyzing, three main categories and seven subcategories were extracted. First, the psychological experiences related to the disease symptoms had three subcategories: "psychological experiences related to hirsutism, alopecia, and acne," "psychological experiences related to obesity," and "psychological experiences related to menstrual disorders." Second, the psychological experiences related to disease complications had two subcategories: "psychological experiences related to infertility" and "psychological experiences related to disease progression." Third, the psychological experiences related to treatment of the disease had two subcategories: "psychological experiences related to prolongation of the treatment and uncertain fate of the disease" and "psychological experiences related to the complications of the medical treatment." CONCLUSIONS: Results of the study showed that adolescent girls with PCOS were exposed to multiple concerns endangering their psychological health. Therefore, it is recommended to provide adequate and appropriate information about the disease and its consequences, as well as psychosocial supports and regular assessment of psychological state by the team of healthcare providers in the adolescent girls with PCOS.

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.

Food habits in overweight and obese adolescent girls with Polycystic ovary syndrome (PCOS): a qualitative study in Iran.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a hormonal disorder in women of reproductive age. It seems that over the recent years, PCOS has augmented in adolescent girls due to unhealthy food habits and obesity. So, the present study was conducted to explore the food habits in overweight and obese adolescent girls with PCOS. METHODS: In the present qualitative study, 33 participants were selected using a purposive sampling method. Data were collected through individual in-depth interviews, focus group discussions (FGDs), and field notes. These data were analyzed through the use of conventional qualitative content analysis. RESULTS: Three main categories were extracted: First, the high consumption of unhealthy food had three sub-categories: "high consumption of fatty and salty foods", "high consumption of unhealthy snacks", and "high consumption of sugar-rich foods". Second, low consumption of healthy food had three sub-categories: "low consumption of dairy products", "low consumption of fiber-rich foods", and "low consumption of meat, beans, fish and seafood" Third, inappropriate behavioral habits had three sub-categories: "lack of concentration and consumption of large meals", "inappropriate dietary and physical activity patterns", and "skipping the meals and going on arbitrary diets". CONCLUSION: This research through presenting an image of food habits in overweight and obese adolescent girls with PCOS is able to help for designing the necessary interventions to change the food habits, control the symptoms and complications of PCOS, and finally, improve the reproductive health of these girls.

A comprehensive reproductive health program for vulnerable adolescent girls.

BACKGROUND: Reproductive health of vulnerable adolescent girls is a top priority in global programs. Alcohol consumption, drug abuse, high risk sexual behaviors, sexually transmitted diseases, sexual assault, escape from home, unrestrained sex in the family, history of robbery, imprisonment and living in drug hangouts expose adolescents to different sorts of damage and injury. These adolescent girls are at risk of AIDS and other STDs, unwanted pregnancies, illegal and unsafe abortions, unplanned pregnancy and childbirth, and unsafe motherhood. Therefore, assessing these girls' reproductive health needs and designing programs to improve their sexual and reproductive health seem to be essential. This study will be conducted to design a comprehensive program for improving the reproductive health of vulnerable adolescent girls. METHODS: The present study is an exploratory sequential mixed methods study (Qual-Quan) designed in three phases. In the first phase, a qualitative study will be used to describe the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, and explain the strategies of reproductive health programs for these girls. Participants will be selected in this phase using purposive sampling method, and the data will be collected through semi-structured interviews. The obtained data will be analyzed using conventional qualitative content analysis. In the second phase, through a quantitative study, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners to prioritize and select the best strategies. In the third phase, the initial draft of the program will be formulated based on prioritized strategies and will be proposed in a panel comprised of specialists in the areas of reproductive and sexual health, health promotion, social injuries and a psychiatrist. Finally, the final program will be developed and presented after obtaining the agreement and approval of the panel members. DISCUSSION: Designing a program based on a qualitative study, review of the existing evidence and programs, and using the opinions of experts in different areas can lead to different aspects of reproductive and sexual health of vulnerable adolescent girls. On the other hand, taking into account all cultural sensitivities and taboos as well as political, economic and social barriers, the development of such a program can provide the appropriate possibility of presenting comprehensive reproductive and sexual health services to vulnerable adolescent girls and achieve the goals agreed universally.

Effect of a mobile application intervention on knowledge, attitude and practice related to healthy marriage among youth in Iran.

BACKGROUND: Mobile app education is one of the new educational models. Hence, the purpose of this study was to determine the effectiveness of mobile app intervention on knowledge, attitude, and practice of youth for a healthy marriage. MATERIALS AND METHODS: This quasi-experimental study was conducted in 2019 on 88 young people who were selected by simple random sampling in premarital counseling center of Falavarjan city (Isfahan). Then, participants were randomly allocated to an intervention and a control group. Mobile application intervention was installed on the intervention group's mobiles. Data were collected by questionnaire in two times. Data were analyzed using paired t-test and independent t-test. RESULTS: The mean (Standard deviation) of couples' age was 21.11 (5.06) years. The results showed that after the installation of educational consulting app in the intervention group, the mean score of knowledge (P = 0.001), attitude (P = 0.001), and practice (P = 0.001) after intervention were significantly higher than before the intervention. CONCLUSION: Mobile-based educational and counseling app increases couples' knowledge, attitude, and practice in premarital education. Therefore, it is recommended that this type of education (mobile app) be used to promote premarriage education classes.

The development and psychometric evaluation of a new instrument to market healthy breakfast and snacks among adolescents.

BACKGROUND: The consumption of non-nutritious snacks instead of a proper breakfast is becoming more widespread among adolescents. It is expected that using the 4P (product, price, place, promotion) strategies of the social marketing (SM) model can help to better identify factors affecting healthy breakfast and snack consumption. The objective of this study was to develop and evaluate the psychometric properties of the Healthy Breakfast and Snack Consumption Scale (HBSCS) using the SM model. METHODS: This was a cross-sectional descriptive study that was conducted in 2017. First, a scale was developed using the results of a qualitative research based on the SM model. Then, its face, content and construct validities as well as its reliability were assessed. Construct validity was evaluated via exploratory factor analysis conducted on a random sample of 300 high school pupils selected from five girls' schools located in Isfahan, Iran, using the multistage cluster sampling method. Exploratory factor analysis was performed using the methods of principle components extraction and varimax rotation with eigenvalues greater than 1. RESULTS: A four-factor structure that explained 61.73% of the total variance of the HBSCS included healthy breakfast and snack preferences, readiness to pay the price, place preferences and communication channel preferences. Items with an impact score of less than 1.5 were removed. Additionally, items with content validity ratio values of less than 0.62 and content validity index values of less than 0.79 were deleted. The Kaiser-Meyer-Olkin measure value was 0.74 [chi-squared (χ2) = 2353.622; p-value < 0.001]. The Cronbach's α values of the scale and its four dimensions were 0.71 and 0.56-0.72, respectively. CONCLUSION: This scale has acceptable validity and reliability. School authorities and health professionals can use this scale to screen adolescents at risk of consuming unhealthy foods and snacks. Besides, the scale might be used as a framework for assessing, implementing and promoting healthy eating behaviors among pupils.