Predictors of fear of COVID-19 in a low-income country: health literacy is important.

Introduction: Excessive fear of a threatening condition or situation can result in individuals engaging in unhealthy behaviors, especially during the COVID-19 pandemic. Identifying the influential factors of fear can be effective in designing and implementing health-center interventions to control and reduce the COVID-19 pandemic. Methods: This study was a cross-sectional design implemented in Iran in 2022. Participants were adults 18-65 years of age recruited randomly from primary Health Care Services Centers (HCSCs) by medical records (n = 380, 64.7% female, mean (SD) age 32.14 ± 10.98 years) in urban and rural areas of the county. The data collection included a demographic form, Fear of COVID-19 questionnaire, Perceived Barriers of COVID-19 preventive behaviors, Self-efficacy, and Health Literacy for Iranian Adults (HELIA) questionnaire. Results: It was determined that the fear of COVID-19 showed statistically significant differences according to gender (p-value = 0.013), education level (p-value = 0.001), and job status (p-value = 0.001). According to the hierarchical linear regression, educational level (p-value = 0.001; ß = 0.665), job (ß = 0.126; p-value = 0.018), self-efficacy (p-value = 0.015; ß = 0.103), and Health Literacy (HL) (p-value = 0.001; ß = 0.446) were significant predictors of fear of COVID-19. Also, among variables, educational level (p-value = 0.001; ß = 0.665) and HL (p-value = 0.001; ß = 0.446) were the most important predictors for fear of COVID-19. Discussion: This research shows that HL has a potential and determinative role in controlling fear of COVID-19. The findings can help healthy policymakers and healthcare providers design HL-based programs in similar epidemics and pandemic situations.

Impact of health literacy and illness perception on medication adherence among older adults with hypertension in Iran: a cross-sectional study.

Background: Adherence to medication is an essential factor in controlling and reducing the side effects of non-communicable diseases, particularly hypertension. Medication adherence varies in older adults due to the effects of various factors. The research aimed to examine the determinants of medication adherence among older adults with hypertension. Methods: This cross-sectional study was performed among 300 people aged 60 years or older referring to health centers in Sarab, Iran, between February and May 2023. To collect data, valid and reliable tools were applied. Results: There was a significant association between age groups, level of education, and monthly income status with adherence to medication (p-value <0.05). According to the results of hierarchical regression, demographic variables collectively explained 3.2% of the variance in adherence to therapeutic regimens (p-value = 0.143). The inclusion of illness perception at step 2, along with demographic variables, led to a further significant increase in 9.6% of the variance (p-value <0.001). In the final step, health literacy dimensions were added, which explained an additional 8.7% of the variance (p-value <0.001). In total, demographic variables, illness perception, and HL dimensions explained 21.5% of the variance in adherence to therapeutic regimens. Conclusion: According to the results, demographic variables, illness perception, and HL dimensions were the main determinants of medication adherence among older adults. Health educators should focus on creating interventions that improve medication adherence by addressing illness perception and health literacy dimensions in this particular population.

Psychological well-being and factors affecting it after the COVID-19 pandemic.

Introduction: The COVID-19 pandemic has enormously impacted human activity worldwide, partly due to many governments issuing stay-at-home orders and limiting the types of social interactions citizens can engage in. Hence, this study investigated psychological well-being and factors affecting it after the COVID-19 pandemic. Methods: A total of 345 participants were recruited in the study. This research was conducted between February and May 2023 in Sarab, East Azerbaijan, Iran. To measure the data, valid and reliable instruments of Goldberg's General Health Questionnaire (GHQ-28), Multidimensional Health Locus of Control (MHLC), interpersonal support evaluation list (ISEL-SF), and health-protective behaviors checklist instrument were used. Results: According to the results, health locus of control (r = 0.227; p < 0.001), social support (r = 0.339; p < 0.001), and COVID-19 preventive behaviors (r = 0.376; p < 0.001) were positively correlated with psychological well-being. The strongest correlation was observed between psychological well-being and protective behaviors (r = 0.376; p < 0.001). In the hierarchical regression model, total, demographic characteristics along with health locus of control, social support, covid-19 preventive behaviors, and history of COVID-19 infection were able to explain 57.4% of the variation in psychological well-being. Discussion: Public healthcare providers' and policymakers' preventive and supportive actions are highly advised for promoting health locus of control and social support in adults after the COVID-19 pandemic. In addition, it is better to include a community's social and environmental changes.

Barriers to COVID-19 vaccine uptake: classification and the role of Health Literacy and Media Literacy.

Background: Vaccination is one of the most influential and cost-effective health interventions for preventing and reducing COVID-19 diseases. Unfortunately, the majority of the world's population is deprived of vaccination. Health Literacy (HL) and Media Literacy (ML) are essential to the COVID-19 vaccination. The present study investigates the barriers to COVID-19 vaccine uptake, focusing on classification and the roles of HL and ML. Methods: A cross-sectional study was conducted among people 18-65 years old in Sarab City, located in East Azerbaijan, Iran, between September to October 2020. Multistage cluster sampling was employed to recruit 298 people from Health Care Services Centers (HCCs). Results: The results of this research demonstrated that about 32.6% of participants reported that they have fully injected COVID-19 vaccines. Also, HL was positively associated with ML (r = 0.214, p < 0.05). Barriers of COVID-19 vaccine uptake were classified into personal, interpersonal, group and organizational, society and decision-making factors. Besides, barriers to the COVID-19 vaccine were significantly correlated with HL (r = -0.298, p < 0.05) and ML (r = 0.266, p < 0.05). Additionally, in the hierarchical regression model, demographic characteristics accounted for 8.2% of the variation in barriers to the COVID-19 vaccine (F = 4.34; p = 0.001), that monthly income (ß = -0.237; p < 0.05) and marriage statues (ß = 0.131; p < 0.05) were statistically associated with low barriers. HL as predictor variables explained an additional 14.4% of variation in barriers of COVID-19 vaccine (F = 53.84; p < 0.001) and ML explained an extra 9.2% of the variation (F = 38.83; p < 0.001). In total, demographic characteristics, HL dimensions and ML were able to explain 31.8% of the variation in barriers to COVID-19 vaccine. Conclusions: According to the findings, various strategies are needed to increase the COVID-19 vaccination uptake. This is due to the fact that barriers to COVID-19 vaccination uptake are multifactorial. These facts can help health policymakers and healthcare providers design media-based interventions to reduce barriers to COVID-19 vaccination uptake among adults. Enhancing vaccine HL and ML for adults and improving vaccine confidence are of high priority.

Head lice infestation and the role of some cognitive-behavioral factors in its spread and prevention among adolescent girls: A cross-sectional study in Northwest Iran.

Background and Aims: Head lice is a public health problem of worldwide distribution, particularly among school children and girls. Head lice infestation (HLI) can lead to negative social and psychological outcomes such as distress and anxiety in children and their families. Hence, the present study aimed to investigate the role of cognitive-behavioral factors in its spread and prevention among adolescent girls. Methods: The cross-sectional study was conducted among 276 school-aged adolescent girls from September 2022 to January 2023 in Herris, a city located in Northwest Iran. A multistage cluster random sample was used to recruit adolescent girls in secondary schools. Two schools were randomly selected from five secondary schools. Then, students in each school were randomly selected from a school list. Data were collected using a valid and reliable questionnaire. Results: The high protective behaviors were significantly associated with the number of family members (ß = 0.158; p value = 0.012). An additional 21.8% of the variation in preventive behaviors was explained by cognitive factors as predictor variables (p value > 0.05). Perceived collective family efficacy, perceived barriers, perceived self-efficacy, and response efficacy were predictors of head lice preventive behaviors, respectively. Among all variables, perceived collective family efficacy was the strongest predictor. Conclusions: The findings of current research support the determinants of the cognitive-behavioral factors in the spread and prevention of HLI. It is better to involve these factors in school-based educational programs by policymakers and healthcare providers.

Effects of Educational Interventions on Dietary Adherence among Type 2 Diabetics in Zahedan: Using the Health Action Process Approach.

Background: Type 2 diabetes is the most common type of diabetes, and dietary adherence is a self-care practice. This research aims to improve dietary adherence among type 2 diabetics in Zahedan using the HAPA model. Methods: In this cross-sectional study, a total of 210 type 2 diabetics admitted to hospital clinics in Zahedan during summer 2022 were selected. The intervention group (n = 105) and the control group (n = 105) were from hospitals in Zahedan. Samples were selected by the simple random sampling method among the diabetics. After data collection using the demographic characteristics questionnaire and the Dietary Adherence Questionnaire and the HAPA model constructs questionnaire, the pre-test analysis was performed. One and three months after the educational intervention, the questionnaires on HAPA model constructs and self-care behavior were filled out by the patients. Next, data were analyzed using independent t-test, chi-square test, and the Shapiro-Wilk test in SPSS 23. Results: The results showed that all of the HAPA model constructs had significant differences, one and three months after the educational intervention (P = 0.001), indicating the effectiveness of education in the intervention group. However, there was no significant difference in the control group (P = 0.009). Conclusion: After the intervention using the HAPA model, the model's constructs had a significant impact on the patients' self-care of dietary adherence following the training.

The Role of Perceived Social Support on Quality of Life in People with Cardiovascular Diseases.

Background: Cardiovascular Diseases (CVDs) are one of the major causes of hospitalization and mortality worldwide. Strengthening perceived social support and quality of life can reduce these problems. This study aimed to describe the role of perceived social support on cardiovascular patients' quality of life. Methods: This cross-sectional study was conducted from September 2020 to February 2021. We selected 150 cardiovascular patients through convenience sampling. The questionnaires included: the Persian version of the WHOQOL-BREF, Perceived Social Support, and demographic variables. Hierarchical linear regression was used to explore the association between perceived social support and quality of life. Data were analyzed by SPSS version 21.0 software. A P-value less than 0.05 is considered statistically significant. Results: The demographic variables could predict 12.2% of the variance of quality of life in the first step. In the second step, after adjusting control variables and dimensions of social support, the predictability increased to 29% of the variance with the addition of variables. All dimensions of social support, excluding tangible assets support, were significant predictors of quality of life and monthly income status. Self-esteem support (ß= 0.387) was the strongest predictor of quality of life in cardiovascular patients. Conclusions: Patients with higher perceived social support have a better quality of life than the other patients. Perceived social support is one of the strategies that can be utilized to improve quality of life and overcome disease in cardiovascular patients.

Assessment of Health Literacy and Health Promoting Behaviors among the Urban Adult Population.

Background: The main criteria of health determinants are Health Promoting Behaviors (HPBs) and Health Literacy (HL). This study aimed to assess HL and HPBs among the urban population of adults. Methods: This study was conducted as a cross-sectional study with 379 adults in Iran. The inclusion criteria was that participants were randomly selected from health centers using health records. Data were collected by demographic information questionnaire, Health Literacy for Iranian Adults (HELIA) and Health Promoting Lifestyle Profile II (HPLP-II). Descriptive statistics, independent samples t-test, and Pearson's r correlation coefficient were used to analyze the data. Also, the hierarchical regression analysis was used to adjust for confounders. Results: There was a significant association between HL and demographic factors, including age, gender and education level. HL dimensions were significantly correlated with HPBs of adults (p <0.05). Decision-making was the strongest HL dimension to predictive HPBs (ß=0.606). In this study, 49.7% of the variation in HPBs is predicted by the HL, and the demographic characteristics. Conclusions: It can be advantageous to design programs to promote HL and HPBs in adults, focusing on the aging group, gender, and education level.

The role of e-health literacy and some cognitive factors in adopting protective behaviors of COVID-19 in Khalkhal residents.

Background: Several vaccines have recently been generated and are being utilized to prevent COVID-19 mortality. Although the disease is causing many fatalities worldwide, preventative practices should be prioritized, even if vaccines are available. Therefore, this study aimed to identify the role of e-health literacy and some cognitive factors in adopting protective behaviors against COVID-19 in Khalkhal residents. Methods: In the present cross-sectional study we recruited 380 people aged 18-65 according to cluster sampling from September 2021 to December 2021 in Khalkhal County, Iran. Reliable and validated tools were applied to data collection, including the eHealth Literacy Scale (eHEALS) in Persian and the Cognitive factors assessment questionnaire based on the Health Belief Model (HBM). Data were analyzed using Chi-square, one-way ANOVA, independent samples t-test, and bivariate correlation. The predictors were also determined using hierarchical linear regression analysis. Results: The average age of the participants was 35.26 ± 11.51 years. The regression analysis implied that gender (p-value = 0.032), education level (p-value = 0.001), occupational status (p-value = 0.002), income (p-value = 0.001), and marriage (p-value = 0.001) had statistically significant associations with e-HL. Additionally, education level (p-value = 0.001), occupational status (p-value = 0.001), income (p-value = 0.001), and marriage (p-value = 0.002) revealed statistically significant associations with COVID-19 preventive behaviors. Approximately 16.5% of the variation in the COVID-19 protective behaviors is explained by the cognitive factors and the demographic variables. Overall, demographic, cognitive, and e-HL variables were able to explain roughly 35.5% of the variation in COVID-19 protective behaviors. Furthermore, self-efficacy was the strongest predictor of protective behaviors (ß = 0.214). Conclusions: HBM constructs successfully predicted the role of e-health literacy and some cognitive factors in adopting COVID-19 protective behaviors. People with high socioeconomic levels were better at e-health literacy and COVID-19 protective behaviors during the pandemic. Moreover, applying approaches to adopting COVID-19 protective behaviors is essential, especially in low socioeconomic status (SES) groups.

The effectiveness of an intervention designed based on health action process approach on diet and medication adherence among patients with type 2 diabetes: a randomized controlled trial.

BACKGROUND: Diabetes is a major cause of worldwide morbidity and mortality. Diet and medication non-adherence are common among individuals with diabetes, making glycemic control difficult to attain. This study aimed to evaluate an intervention designed based on Health Action Process Approach (HAPA) to improve adherence to diet and medication among patients with type 2 diabetes in Tehran, Iran. METHODS: The study was a randomized controlled trial. A total of 248 patients with type 2 diabetes who had low diet and medication adherence were randomly allocated into two intervention (n = 124) and control (n = 124) groups. Intervention group received educational intervention during three months. HAPA constructs, diet and medication adherence, and Hemoglobin A1c (HbA1c) levels were assessed at baseline, one month and six months after the intervention. Mixed Model Analysis was used to compare between and within group changes in the outcomes. RESULTS: There was a statistically significant improvement in HbA1c levels after six months (7.77 ± 1.36% vs. 8.07 ± 1.52%, 95% CI, p < 0.001). Diet and medication adherence, intention, task self-efficacy, coping self-efficacy, recovery self-efficacy, action and coping planning, barriers, benefits and perceived social support were significantly improved one month and six months after the intervention (p < 0.001). CONCLUSION: Our intervention designed based on health action process approach led to improvements in diet and medication adherence, and HbA1c among the patients within one and six months. TRIAL REGISTRATION: IRCT, IRCT20151208025431N4. Registered 10 March 2018, https://fa.irct.ir.

Predictors of self-care behaviors and glycemic control among patients with type 2 diabetes mellitus.

Aims: This study used the Extended Theory of Reasoned Action (ETRA) to predict self-care behaviors and HbA1c among patients with type 2 diabetes in Iran. Materials and methods: A cross-sectional study was performed using a multistage random sample. A total of 240 patients with type 2 diabetes, who were referred to the diabetes healthcare centers in Chaldoran, participated in the research. Instruments consisting of standardized questionnaires were used based on the Extended Theory of Reasoned Action (ETRA) constructs and the summary scale of diabetes self-care behaviors measure. Findings: The results of this study demonstrated that demographic variables explained ~ 7% (p-value = 0.23) and ETRA constructs 18% of the variance (p-value = 0.02) in behavioral intention, respectively. According to the hierarchical multiple linear regressions on self-care behaviors, demographic factors (p-value 0.001) dictated 45.7% of the variation of the self-care behavior, while knowledge, attitude, self-efficacy, and behavioral intention (p-value 0.001) accounted for 63.4% of the variance. The ETRA constructs, self-care practices, and demographic factors together account for almost 57% of the variation in the HbA1c. Self-care practices were the best indicator of HbA1c (ß = -0.593). Conclusion: ETRA constructs and self-care behavior can be the best determinants of HbA1c level in type 2 diabetes. This model is suggested to be applied in designing intervention programs to improve HbA1c in these groups of patients.

Using health action process approach to determine diet adherence among patients with Type 2 diabetes.

INTRODUCTION: Diet adherence may cause diabetes complications to be diminished. OBJECTIVES: This study aimed at identifying determinants of diet adherence among patients with Type 2 diabetes based on the health action process approach (HAPA). METHODS: In this cross-sectional study, 734 patients with Type 2 diabetes, attending to South Tehran health centers, were recruited during June-December 2018. The dietary regimen scale (nine items) and a researcher-designed questionnaire consisting of HAPA constructs were used to gather the data. Data were analyzed using the Mann-Whitney test, Pearson Chi-squared test, Fisher's exact test, and linear regression test. All statistical tests were assessed using SPSS (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY, USA: IBM Corp.). RESULTS: The level of nonadherence to diet was 91.1%. Diet adherence was significantly associated with family income (P = 0.005), level of education (P < 0.001), and age (P = 0.009). The linear regression showed that 55% of the variance of diet adherence was determined by HAPA variables. Diet adherence was associated with intention (P < 0.001), action planning (P = 0.005), and barriers (P = 0.003). CONCLUSION: Most of the patients did not adhere to their diet. Appropriate programs should be designed to promote diet adherence among the patients, especially those with low literacy and patients living in poor communities.

Determinants of medication adherence among Iranian patients with type 2 diabetes: An application of health action process approach.

To identify determinants of medication adherence among patients with type 2 diabetes based on the health action process approach. This cross-sectional study was conducted among 734 patients with type 2 diabetes attending to south Tehran health centers during June to December 2018. Data were gathered using the Morisky Medication Adherence Scale (MMAS-8-Item) and the health action process approach questionnaire. We used Mann-Whitney, Pearson Chi-Squared, Fisher's Exact and Independent Samples Tests for comparison of adherence medication by demographic characteristics; and linear regression analysis to predict factors related to medication adherence based on HAPA. P-value less than 0.05 considered statistically significant. A total of 232 men and 502 women participated in the study, Mean age was 61.61 ± 9.74. Most participants (82.3%) reported low medication adherence (females: 68.4%). Medication adherence was significantly associated with gender (p = 0.03). Medication adherence was significantly predicted by intention (ß = 0.172, p = 0.0001), task self-efficacy (ß = 0.172, p = 0.01), copping planning (ß = 0.6, p = 0.0001) and copping self-efficacy (ß = -0.244, p = 0.001). The level of adherence to medications among type 2 diabetes patients was low. The behavior intention, task self-efficacy, copping planning and copping self-efficacy were significant determinants contributed to the medication adherence. HAPA inventory includes various factors, especially types of self-efficacy. Thus, utilization of this comprehensive model in interventional studies is suggested. These determinants should be considered in developing interventional programs to improve adherence.

Cognitive factors associated with brucellosis preventive behaviours among diagnosed patients: an application of Empowerment Model.

BACKGROUND: Brucellosis is an endemic disease in many countries, especially in the Mediterranean region, as well as countries such as the Islamic Republic of Iran. Despite the preventive measures against brucellosis adopted in different countries throughout the world, the disease is still a public health concern. AIMS: Our aim in the present study was to examine the cognitive factors associated with Brucellosis Preventive Behaviours (BPBs) among diagnosed patients utilizing Empowerment Model. METHODS: In 2013, applying a cross-sectional study, all 238 patients with brucellosis in Chaldoran County, Islamic Republic of Iran, were recruited to answer a researcher-made EM-based questionnaire and BPBs Scale through interview. RESULTS: Hierarchical multiple linear regressions were performed with BPBs as the outcome variable. Predictors for this variable, according to their natures, were classified in two different blocks. In the first block, significant effect was found on BPBs by demographic variables (ΔR2 = 0.301). In the second block, the level of education, knowledge, and self-efficacy were significant predictors (P < 0.001) of BPBs (ΔR2 = 0.808). CONCLUSIONS: The Empowerment Model was found as a helpful framework in predicting the risk factors of BPBs. Health care providers in low- and middle-income countries should consider the patients' knowledge on the disease and their level of self-efficacy to perform BPBs as the core categories of empowerment while designing brucellosis prevention programmes.

Poor Sleep Quality in Patients after Coronary Artery Bypass Graft Surgery: An Intervention Study Using the PRECEDE-PROCEED Model.

BACKGROUND: Poor sleep quality (SQ) is common among patients after coronary artery bypass graft surgery (CABG). This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG. METHODS: This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifestyle training plus designed intervention based on the PRECEDE-PROCEED model) or to the control group (recipient of exercise and lifestyle training). Eight training sessions over 8 weeks were conducted for the intervention group. Predisposing, enabling, and reinforcing factors as well as social support and SQ were measured in the intervention group before and one month after the intervention and compared to those in the control group at the same time points. RESULTS: The mean age of the patients in the intervention (24% women) and control (24% women) groups was 59.3 ± 7.3 and 59.5 ± 9.3 years, respectively. The results showed that the mean scores of SQ (p value < 0.001), knowledge (p value < 0.001), beliefs (p value < 0.001), sleep self-efficacy (p value < 0.001), enabling factors (p value < 0.001), reinforcing factors (p value < 0.001), and social support (p value < 0.001) were significantly different between the intervention and control groups after the intervention. CONCLUSION: Adding an intervention based on the PRECEDE-PROCEED model to the cardiac rehabilitation program may further improve the SQ of patients.