Effects of the COVID-19 pandemic on lifestyle among Iranian population: A multicenter cross-sectional study.

Background: Quarantine, an unpleasant experience, was implemented in many countries to limit the spread of Coronavirus disease 2019 (COVID-19), which it could associated whit lifestyle changes. The present study aimed to determine the changes in Iranian's lifestyle during COVID-19 pandemic. Materials and Methods: In the present cross-sectional study, 2710 Iranian people completed an online researcher-made questionnaire asking lifestyle regarding COVID-19, which includes five sections about physical activity, stress and anxiety, nutrition habit, sleep disorders, and interpersonal relationship in addition to demographic data from January to February 2021, using the multistage cluster sampling method. Results: The participants' mean age was 33.78 ± 11.50 years and 68.3% of them were female. Traveling, sightseeing, and family visits have been eliminated from 91%, 83.5%, and 77.5% of participants' lives, respectively. There were increase in stress level (P < 0.001), weight of the participants (P < 0.001), sleep problems (P < 0.001), and healthier foods (P < 0.001) but decrease in interpersonal communication (P < 0.001) and the amount of physical activity (P < 0.001). Conclusion: In summary, this study indicates some changes in lifestyle of Iranian people, including changes in some eating practices, physical activity, social communication, and sleeping habits during the pandemic. However, as the COVID-19 pandemic is ongoing, a comprehensive understanding of these behaviors and habits can help develop interventions to mitigate the negative lifestyle behaviors during COVID-19 pandemic.

The postpartum depression literacy scale (PoDLiS): development and psychometric properties.

BACKGROUND: Maternal mental health including postpartum mental health is essential to women's health. This study aimed to develop a specific measure for assessing postpartum depression literacy and consequently evaluate its psychometric properties among a sample of perinatal women. METHODS: This investigation was composed of two studies: developing the measure, and evaluating of psychometric properties of the developed questionnaire. In development stage an item pool was created. Then, based on definition of mental health literacy and preliminary screening, an initial questionnaire was developed. The content and face validity of the questionnaire were then assessed. In the second study psychometric properties of the questionnaire were examined. Overall 692 perinatal women with the mean age of 27.63 years (ranging from 17 to 43) participated in the study. RESULTS: In all an item pool of 86 items was generated. Of these, 31 items were removed and the remaining 55 items subjected to content and face validity and further 16 items removed. In the second stage a 39-item questionnaire namely the Postpartum Depression Literacy Scale (PoDLis) was evaluated. In principal component factor analysis, 31 items were loaded indicating a 7-factor solution for the questionnaire. The factors designated the following constructs: ability to recognize postpartum depression, knowledge of risk factors and causes, knowledge and belief of self-care activities, knowledge about professional help available, beliefs about professional help available, attitudes which facilitate recognition of postpartum depression and appropriate help-seeking, and knowledge of how to seek information related to postpartum depression. Finally performing the confirmatory factor analysis, the Postpartum Depression Literacy Scale with 31 items was supported for the structures suggested by theoretical model and findings from the exploratory factor analysis. The Cronbach's alpha coefficient for the scale was .78 and it ranged from .70 to .83 for each factor lending support to the internal consistency of the questionnaire. CONCLUSION: The findings suggest that the Postpartum Depression Literacy Scale (PoDLiS) is a reliable and valid instrument for measuring the postpartum depression literacy and now can be used in studies of mental health literacy in women.

Impact of Short Message Service (SMS) Education Based on a Health Promotion Model on the Physical Activity of Patients with Type II Diabetes.

INTRODUCTION: Physical activity is the most important self-management behaviour in diabetes. The aim of this study was to evaluate the impact of a short message service (SMS) based on a health promotion model (HPM) on the physical activity of diabetic patients. METHODS: This quasi-experimental study consisted of 37 type II diabetes patients in an SMS group and 36 type II diabetes patients in a control group. The patients in both groups completed written consent forms and questionnaires at the beginning of the study. The patients in the SMS group received training messages within two weeks (two or three messages daily) in the field of physical activity based on HPM constructs. Both groups completed questionnaires in three stages (at the beginning of the study, four weeks after the first visit, and three months later) comprising demographic factors, questions regarding the constructs, and 7-day physical activity recall. After data collection, statistical analysis was conducted using an independent t-test, a Chi-square test, and a repeated measures analysis of variance (ANOVA). RESULTS: As compared with the control group, changes in mean scores of perceived self-efficacy (P = 0.001) and family support (P = 0.046) of physical activity in the training group were significantly greater and perceived barriers (P < 0.001) were significantly lower over time. The physical activity performance of the SMS group was better three months after training as compared with that of the control group (P < 0.001). CONCLUSION: The results demonstrated the efficacy of training messages in changing the beliefs and physical activity behaviours of diabetic patients.

Effect of Multimedia Education on Nutritional Behaviour for Colorectal Cancer Prevention: An Application of Health Belief Model.

BACKGROUND: Colorectal cancer is a major public health problem. A way to decrease this cancer is through dietary behavioural changes. The aim of this study was to determine the effects of education on dietary behaviour based on the health belief model (HBM) using multimedia. METHODS: In this clinical trial study, 98 participants were randomly allocated to an HBM group (n = 48) and a control group (n = 50). The HBM group received an audiovisual compact disc (CD) that contained information about nutritional behaviour of colorectal cancer (CRC) prevention based on HBM that lasted 45 min. Both groups completed questionnaires regarding demographic factors, knowledge and HBM constructs, and a three-day dietary recall at the beginning of the study, 1 week after, and 3 months after the education. The outcome of this study was measured by the amount of food servings consumed and dietary micronutrient intake. RESULTS: At the baseline, there were no significant differences between groups regarding demographic factors. Findings showed that self-efficacy (P < 0.001), severity (P < 0.001), and benefits (P < 0.001) were perceived to be higher, and knowledge (P < 0.001) was increased in the HBM group compared to control group 3 months after education. There was a significant increase in fruit and vegetable (P < 0.001) and dairy (P = 0.001) intake and a significant decrease in red meat servings (P = 0.016) in the HBM group compared to the control group. Also, intake of vitamin D (P < 0.001), folate (P < 0.001), calcium (P = 0.008), and dietary fibre (P < 0.001) was increased in the HBM group compared to the control group 3 months after education. CONCLUSION: Education plans based on HBM and implemented through multimedia can change nutritional beliefs and behaviours for the prevention of colorectal cancer.

Determinants of breast self-examination performance among Iranian women: an application of the health belief model.

Breast cancer is one of the most common cancers among women. Screening behavior rates are low in the world. Therefore, the purpose of the current study was to investigate breast self-examination (BSE) rate and the relationships of Health Belief Model (HBM) constructs for predicting BSE. Path analysis was used to examine both one-way direct and indirect effects of HBM factors on BSE in this population (N = 382). Data were collected by a part of Champion's HBM Scale (CHBMS) and a self-administered questionnaire. The results showed that 7.6% of the participants reported performing BSE regularly. The final model provided a good fit to the data, with 13 variables explaining 62% of the variance in BSE. Perceived self-efficacy was intermediate construct between modifying factors and HBM constructs. Also, perceived self-efficacy and perceived benefits were the most highly related to BSE. The results suggest that HBM is a useful framework for identifying factors influencing the use of BSE in Iranian women.

Effect of electronic education based on health promotion model on physical activity in diabetic patients.

BACKGROUND: By high prevalence of inactivity, particularly in diabetic patients, the need to effective interventions to promote physical activity is essential. The aim of this study was to determine the effects of education based on health promotion model (HPM) through multimedia on the physical activity in diabetic patients. METHOD: In this quasi-experimental study, 76 patients with type II diabetes were evaluated (40 patents in intervention group and 36 patients in control group). The intervention group members and a friend or a family member, that could be supportive in physical activity, received teaching CD based on health promotion model. Both group members at the beginning of the study, two weeks and three months after the training, completed questionnaires. After data collection, statistical analysis was conducted using independent T-test, chi-square test, and repeated measurement of ANOVA. RESULTS: Finding showed that self-efficacy (P<0.001), health status (p=0.032), benefits (P<0.001) and friends support in physical activity (P<0.001) were perceived to be higher, and barrier of physical activity (P<0.001) was perceived to be lower in multimedia group compared to control group 3 months after training. There was a significant difference in average of metabolic equivalent of task (MET) between two groups after the intervention (P<0.001). CONCLUSION: Planning of education based on the HPM and implementation through multimedia can change belief about physical activity and increase participation in physical activity.

The Effect of Health Belief Model-Based Education through Telegram Instant Messaging Services on Pap smear performance

Background: Pap smear is an effective screening method for early detection of cervical cancer. This study aimed to investigate the effect of education based on Health Belief Model (HBM) through Telegram instant messaging services on the Pap smear test. Material and methods: This research was a quasi-experimental study which was performed on 106 eligible women (48 participants in the intervention group and 47 participants in the control group). The patients in both groups completed the written consent form and questionnaires at the beginning of the study. In intervention group, the educational content based on HBM was regularly sent via Telegram during one month. After education and three months later, both groups completed questionnaires. Then, the data was analyzed with using SPSS version 22. Results: The findings showed that the two groups at first were similar in demographic characteristics. In the intervention group, the mean difference of the scores before and immediate post training on the knowledge and all of the constructs were significant (P<0.001). Also, the mean difference of the scores before and three months after training on knowledge and all of the constructs (except for perceived barriers) has increased and about the perceived barriers this difference has decreased significantly compared to the score before the training. In the control group, changes in knowledge and other constructs were not significant in during the study. Within the three months after the training, 23 participants (47.9%) in the intervention group, and 4 participants (5.8%) in the control group performed Pap smear which indicates a statistically significant difference (P<0.001). Conclusion: With regard to the individuals' access to mobile phone, content posted by Telegram on the HBM-based education affects the women's belief and behavior regarding Pap smear test.

Is Health Locus of Control a Modifying Factor in the Health Belief Model for Prediction of Breast Self-Examination?

BACKGROUND: Breast cancer is one of the most common cancers among women in the world. Early detection is necessary to improve outcomes and decrease related costs. The aim of this study was to assess the predictive power of health locus of control as a modifying factor in the Health Belief Model (HBM) for prediction of breast self-examination. MATERIALS AND METHODS: In this cross- sectional study, 400 women selected through the convenience sampling from health centers. Data were collected using part of the Champion's HBM scale (CHBMS), the Health Locus of Control Scale and a self administered questionnaire. For data analysis by SPSS the independent T test, Chi square test, logistic and linear regression modes were appliedl. RESULTS: The results showed that 10.9% of the participants reported performing BSE regularly. Health locus of control did not act as a predictor of BSE as a modifying factor. In this study, perceived self-efficacy was the strongest predictor of BSE performance (Exp (B) =1.863) with direct effect, while awareness had direct and indirect influence. CONCLUSIONS: For increasing BSE, improvement of self-efficacy especially in young women and increasing knowledge about cancer is necessary.

Psychometric Evaluation of the Colorectal Cancer Screening Belief Scale Based on Health Belief Model's Constructs for the Fecal Occult Blood Test.

BACKGROUND: It is important to validate scales related to cancer screening beliefs in order to better understand perceptions. The aim of this study was to test the psychometric properties of the colorectal cancer screening belief scale based on Health Belief Model (HBM) constructs. MATERIALS AND METHODS: Data were collected from 600 persons referred to outpatient laboratory units in Iran through a convenience sampling procedure. In this cross-sectional study, exploratory and confirmatory factor analyses were used to examine construct validity of scale. RESULTS: Through exploratory factor analysis, 52 items of the scale converged to five constructs of HBM with 4 items omission. Construct validity was determined by confirmatory factor analysis through which correlated model was supported. Cronbach's alpha coefficient for the whole scale was obtained as 0.78, which indicates reliability of the scale. CONCLUSIONS: The study findings showed that this scale is a valid and reliable instrument that can be used for measuring HBM constructs about colorectal cancer screening with the fecal occult blood test.

Factors Predicting Fecal Occult Blood Testing among Residents of Bushehr, Iran, Based on the Health Belief Model.

Colorectal cancer is a major cause of mortality worldwide. Fecal occult blood testing has proven a very effective screening tool for early detection and mortality reduction. The aim of this study was to determine predictors factors related to fecal occult blood testing using the Health Belief Model method among residents of Bushehr, Iran. A cross sectional study was performed on a sample of 600 men and women more than 50 years of age. The sample was selected by a convenience method from patients referred to public and private laboratories throughout the city. Each subject filled out a questionnaire which was designed and developed based on Health Belief Model constructs. Statistical analysis was conducted using ANOVA, T-test, chi-square test, and logistic regression. Fecal occult blood tests were performed on 179 (29.8%) out of 600 subjects, of which 95 patients (58.1%) did a periodic examination test and 84 patients (46.9%) had a doctor's advice for testing. According to the logistic regression model, the perceived barriers (P=0.0, Exp(B)= 0.3), perceived benefits (P <0.01, Exp(B)= 1.9) and self-efficacy (P<0.01, Exp(B)= 1.6) were predictive factors related to occult blood testing among subjects.The results showed that reducing people's perception of barriers to testing, increasing perceived benefits of screening, and reinforcing self efficacy can have major effect in increasing the rate of fecal occult blood screening for colorectal cancer prevention.

Effective Factors on Health-Promoting Lifestyle Among Iranian Chemical Veterans in 2014 Based on Health Promotion Model: A Path Analysis.

BACKGROUND: Health-promoting behaviors can enhance physical and mental health among individuals with disability, particularly veterans. OBJECTIVES: The current study aimed to examine both one-way direct and indirect effects of the factors of the Health Promotion Model (HPM) on health-promoting behaviors in chemical veterans from Ilam province in Iran. MATERIALS AND METHODS: This cross-sectional study was conducted in 2014. In this study, 239 moderate-to-severe chemical veterans from Illam province supported by the veterans' affairs department of Ilam were evaluated via census sampling. Data including health-promoting behaviors, perceived self-efficacy, perceived barriers and benefits, perceived social support, and perceived health status were collected using standard questionnaires. RESULTS: The results show that the HPM is a poor predictor of the health-promoting lifestyles of chemical veterans (R2 = 15%). Social support (factor loading = 0.38) is the strongest predictor of health-promoting behaviors and it influences such behaviors directly, while perceived barriers (factor loading = -0.11) and perceived self-efficacy (factor loading = 0.02) indirectly predict behavior through social support. CONCLUSIONS: Perceived social support is the most important factor that influences health-promoting behaviors. Increasing social support by enhancing self-efficacy and decreasing perceived barriers can improve health-promoting behaviors among veterans.

Comparison of Two Different Educational Methods for Teachers' Mammography Based on the Health Belief Model.

BACKGROUND: Breast cancer is the most common cancer in women. One way to decrease the burden of this cancer is early detection through mammography. This study compared the effectiveness of two different educational methods for teachers' uptake of mammography based on the Health Belief Model. MATERIALS AND METHODS: The current study was a randomised trial of 120 teachers over 40 years old in two groups receiving multimedia or group education, both based on the Health Belief Model. Participants completed questionnaires before, immediately and three months after educational intervention. Mammography was evaluated before and after educational intervention. RESULTS: The participants in the two groups were demographically similar. Comparison showed no difference noted in the scores of knowledge, perceived barriers, susceptibility, and severity constructs between two groups (p > 0.05). Health motivation and benefit were perceived to be higher in the group education compared to the multimedia group. There was a significant difference in mammography between two groups after the intervention (p= 0.003). CONCLUSIONS: Planning and implementation of educational program based on the Health Belief Model can raise knowledge and increase participation in mammography especially with group education.

Determinants of self-management among diabetic patients: a path analysis.

Diabetes self-management (DSM) is a complex behavior and various factors influence it. Despite continual recommendations to DSM, implementation of this behavior still remains a major health problem for diabetic patients. Identifying effective factors in DSM is useful to promote health in diabetic patients. The purpose of this study was to test the effects of individual and environmental factors on DSM. Path analysis was used to examine both one-way direct and indirect effects of 7 constructs and 3 demographic factors on DSM in this population (N = 396). Data were collected from a convenience sample of 104 (26.3%) males and 292 (73.7%) females with a median age 53 years. The final model provided a good fit to the data explaining 25% of the variance in DSM. Illness perception and provider-patient communication were the most effective factors in DSM. Knowledge and self-efficacy affected DSM indirectly via illness perception. The results of this study showed that effective DSM interventions should be designed to change illness perception and patient-provider communication, especially in patients with low duration of diabetes and low level of education.

Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system).

PURPOSE: The main objective of the Bushehr Elderly Health Programme, in its first phase, is to investigate the prevalence of cardiovascular risk factors and their association with major adverse cardiovascular events. PARTICIPANTS: Between March 2013 and October 2014, a total of 3000 men and women aged ≥ 60 years, residing in Bushehr, Iran, participated in this prospective cohort study (participation rate=90.2%). FINDINGS TO DATE: Baseline data on risk factors, including demographic and socioeconomic status, smoking and medical history, were collected through a modified WHO MONICA questionnaire. Vital signs and anthropometric measures, including systolic and diastolic blood pressure, weight, height, and waist and hip circumference, were also measured. 12-lead electrocardiography and echocardiography were conducted on all participants, and total of 10 cc venous blood was taken, and sera was separated and stored at -80 °C for possible future use. Preliminary data analyses showed a noticeably higher prevalence of risk factors among older women compared to that in men. FUTURE PLANS: Risk factor assessments will be repeated every 5 years, and the participants will be followed during the study to measure the occurrence of major adverse cardiac events. Moreover, the second phase, which includes investigation of bone health and cognition in the elderly, was started in September 2015. Data are available at the Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran, for any collaboration.

Factors influencing breast cancer screening behavior among Iranian women.

BACKGROUND: Early detection of breast cancer is of great importance to improve women's health and to decrease the cost related to cancer death. Therefore, recognition of variables related to breast cancer screening behaviors is necessary. Objectives of this study were to identify the rates of breast self-examination (BSE) performance and mammography use in Iranian women, and to characterize the demographic and cognitive factors associated with their breast cancer screening behavior. METHOD: Data were collected from a convenience sample of 388 females, using an adapted version of Champion's revised Health Belief Model Scale. RESULTS: The results showed that 7.5% of the participants performed BSE on a regular monthly basis, and among the women aged 40 and older, 14.3% reported having had at least one mammography in their lifetime. Perceived self-efficacy and perceived barriers to BSE were significant predictors for BSE performance. For having mammography, health motivation was the main predictor. CONCLUSION: Eliminating barriers and increasing perceived self-efficacy with an emphasis to make the women acquainted with BSE performance; as well as increasing health motivation of women and persuading of physicians for clinical breast examination (CBE) performance with low cost and free access to m ammography, are important to promote BSE and mammography.

Validity and reliability of the social support scale for exercise behavior in diabetic women.

OBJECTIVE: The present study aimed at examining the reliability and validity of the Persian version of Sallis's Social Support Scale for Exercise Behavior. It also aimed at measuring the predictive power of this scale among diabetic women. METHOD: confirmatory factor analysis was used to identify potential differences between English and Persian versions and construct validity of the scale. Cronbach's α coefficients were determined to estimate internal consistency of the scale. RESULTS: A total of 348 women who referred to a diabetes institute in Iran filled in the questionnaire. Confirmatory factor analysis supported the friend factor of the scale completely. However, it modified the family factor and reduced the English items. That is, it changed the items into 13 and generated 3 subfactors with a different structure. Cronbach's α coefficients for the family and friend support were .89 and .86, respectively. Therefore, this scale consisting of 18 items can be used to assess the social support (friend and family) in exercise behavior. In diabetic patients, emotional support subfactor was found to be the most predictive subfactor for physical activity in family social support scale. CONCLUSION: This 18-item scale was valid and reliable and can be used for diabetic women to evaluate their exercise social support. The results showed that consideration of emotional support is the most important point in promotion of exercise among diabetic women in Iran.