Design and Validation of a Health Literacy Assessment Tool for COVID-19 Among Iranian Workers.

BACKGROUND: The workforce is an organization's most important asset, and ensuring their health and safety is crucial for achieving the organization's mission and goals. OBJECTIVE: The objective of this study was to design and validate a health literacy tool for COVID-19 among Iranian workers. METHODS: This cross-sectional study involved a total of 201 participants. A personal information questionnaire was administered, and The Health Literacy Assessment (HLA) Tool was used to collect data specifically related to COVID-19. The HLA for COVID-19 was designed and developed, and the validity of the tool was evaluated through face, content, convergent, and construct validity analyses. To examine convergent validity, the Perceived Stress Scale was used. The reliability of the questionnaire was assessed using internal consistency measures, such as Cronbach's alpha coefficient. KEY RESULTS: The mean content validity index was 0.93, indicating high content validity. Confirmatory factor analysis results supported the five-dimensional structure of the tool. Significant correlations were found between the HLA for COVID-19 and perceived stress levels. The Cronbach's alpha coefficient for all items was 0.84, indicating high internal consistency. CONCLUSION: The HLA for COVID-19 is a concise, reliable tool for measuring health literacy related to COVID-19 among Iranian workers. Assessing COVID-19 health literacy in this population can be useful in evaluating the effectiveness of government officials, the media, and the medical and scientific community in providing necessary information. [HLRP: Health Literacy Research and Practice. 2024;8(2):e62-e68.].

PLAIN LANGUAGE SUMMARY: The workforce is an organization's most important asset, and ensuring their health and safety is crucial for achieving the organization's mission and goals. The objective of this study was to design and validate a health literacy tool for COVID-19 among Iranian workers.The HLA for COVID-19 is a concise, reliable tool for measuring health literacy related to COVID-19 among Iranian workers. Assessing COVID-19 health literacy in this population can be useful in evaluating the effectiveness of government officials, the media, and the medical and scientific community in providing necessary information. Health literacy plays a crucial role in disease prevention, including the control of epidemics. It can be particularly valuable in empowering societies affected by crises like the COVID-19 pandemic, which has had a profound impact on all aspects of human life. In international studies focused on assessing health literacy during the pandemic, researchers utilized public health literacy scales. However, only one study developed a specific scale to evaluate people's health literacy concerning COVID-19.

Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial.

Introduction: The highest incidence of overweight among adults is found among women, predominantly middle-aged women. While it has been demonstrated that being overweight increases mortality by compromising physical and mental health, it also imposes substantial costs on the healthcare system. Lack of physical activity is a primary contributing factor to becoming overweight. The majority of inactive adults are women, particularly middle-aged women. Consequently, this study investigated the training program for overweight women based on the health belief model (HBM) and social support approach. Methods: A randomized, controlled trial involving 73 overweight middle-aged women (control group: 37, intervention group: 36) was conducted using simple random sampling. The intervention group participated in six 120-min sessions per week for 6 weeks of a training program based on HBM and social support through physical activity, group discussion, role play, and media. Data were collected using the Physical Activity Questionnaire (IPAQ), Bandura's Exercise Self-Efficacy Scale (Bandura's ESE), and a researcher-made questionnaire before and 4 weeks after the training. The collected data were analyzed using descriptive and inferential statistics via SPSS 27 software. p-values <0.05 were considered statistically significant. Results: A training program based on HBM and social support led to improved perceived benefits (p < 0.001), cues to action (p = 0.03), and self-efficacy (p < 0.001) of physical activity; decreased perceived barriers (p = 0.001); increased social support (p = 0.001); and increased physical activity (p < 0.001). In addition, the BMI of the intervention group decreased after the training program (p = 0.01). Conclusion: The findings of the study demonstrate the efficacy of the training program based on HBM and the social support approach in improving social support and physical activity of women. In addition, the study evaluates the long-term outcome in populations with varying social, economic, and cultural standings. Clinical Trials Registration: https://clinicaltrials.gov/, (IRCT201706236261N17).

Predictors of musculoskeletal disorders and job satisfaction among office workers of an oil company: A cross-sectional study in Iran.

BACKGROUND: Musculoskeletal disorders are among the significant causes of disabilities and occupational injuries all over the world and can reduce the quality of life and job satisfaction. These disorders prevail among the office workers of the Iranian Oil Company, though research on the involved factors is limited. OBJECTIVE: The present study investigated the incidence and risk factors of musculoskeletal disorders and their association with job satisfaction among the office workers of the Iranian Oil Company. METHODS: The present research was a cross-sectional descriptive-analytical study on 210 male office workers of the Iranian Oil Company. The prevalence of musculoskeletal disorders and the rate of job satisfaction were measured by Nordic Musculoskeletal and Minnesota job Satisfaction Questionnaires, respectively. The relationship between the variables was analyzed by the SPSS 28 software. RESULTS: The most prevalent musculoskeletal disorders among office workers in the past 12 months were associated with the neck, waist, and knee organs, with 45.70, 41, and 38.10 percentages. Smoking, second jobs, and physical injury histories were identified as three risk factors connected to musculoskeletal disorders (p < 0.05). Forty-one percent of the participants were moderately satisfied with their jobs, and this number was significantly related to musculoskeletal disorders in the shoulders, elbows, back, waist, and knees (p < 0.05). CONCLUSION: The results of this study indicate that second jobs, smoking, and physical injury histories are three risk factors for musculoskeletal disorders among office workers of the Iranian Oil Company. Thus, it is imperative to identify at-risk office workers and train and encourage them to take preventive actions and employ ergonomic job equipment.

Environment Intensifies Imbalance and Fear of Falling: Comparing Urban and Rural Aging Communities.

BACKGROUND: The relationship between environmental diversity and the health status of older adults has been less considered in studies. This study seeks to investigate the causal relationship among the environment, falling, fear of falling, and the imbalance of older adults in southern Iran in 2021. OBJECTIVE: The investigation into the relationship between environmental pollution to the imbalance and fear of falling, especially in comparing urban and rural aging societies is the aim of current study. METHODS: In a cross-sectional study, 489 older samples from rural and urban areas were chosen randomly and their experience of falling, fear of falling, imbalance, and IADL were examined. The ordinal and nominal logistic regression and ANOVA were performed using IBM-SPSS. RESULTS: With a mean age of 71.8 (SD = 8.3), older participants have long time chronic disease (69.6%) and falling experience twice a year (42.7%). The values of effect size indicated the high effectiveness of settlement in explaining IADL, health situation, experience and fear of falling, and imbalance (Eta squared > 30). The odds ratio for being in the urban settlement was 5.51, indicating the imbalance score increased by approximately 5.52 times. CONCLUSION: Imbalance in older people leads to the fear and experience of falling. This imbalance is strongly influenced by the environment. Urban pollution can contribute to this problem. Future studies on aging need to focus on environmental pollution and diversity in the experience of falling and imbalance.

Psychometric Validation and Setting Cutoff Point for Persian Version of World Health Organization Quality of Life-Old Questionnaire.

Health professionals assume the quality of life (QOL) as a main outcome of health care activities, especially in the elderly. Thus, they need valid tools for evaluating the effectiveness of their interventions. This study aimed to investigate the psychometric properties of the Persian version of the World Health Organization quality of life-old questionnaire (WHOQOL-OLD). The questionnaire was translated into Persian by standard translate/back-translate procedure. The Cronbach's alpha and intra-class correlation (ICC) coefficients were estimated to assess the internal validity and reliability. Confirmatory factor analyses (CFA) in a sample of 300 Persian-speaking elderly in Shiraz, Iran, were used for construct validity assessment. ROC curve analysis was used to determine the cutoff point for poor or good QOL. All the analyses were conducted using SPSS 24 and IBM AMOS 24. The internal consistency and reliability indices of the Persian version of WHOQOL-OLD were acceptable (Cronbach's alpha: 0.66-0.95; ICC: 0.71-0.91). CFA confirmed the WHOQOL-OLD six-domain structure (CMIN/df = 3.12, p < .001; CFI = 0.93; NFI = 0.89; RMSEA = 0.08). The ROC curve indicated 71.5 as the best cutoff point, with a sensitivity of 82.3% and specificity of 61.8%. The Persian version of the WHOQOL-OLD is valid and can be used for investigating the QOL in Persian-speaking elderly.

The effect of a social cognitive theory-based educational intervention on nonsuicidal self-injury prevention in high school students: A randomized educational intervention trial.

INTRODUCTION: Nonsuicidal self-injury (NSSI) in adolescents is a growing public health concern, demanding preventive measures, particularly among high school students. Based on social cognitive theory (SCT), self-efficacy coupled with outcome expectations, social support, self-regulation, and behavioral intention, determine the likelihood of engaging in such a behavior. Thus, the present study was to investigate the effect of a SCT-based educational intervention on NSSI prevention in female high school students. METHODS: This randomized educational intervention trial was conducted on 191 female high school students, aged 15-17 years (15.95 ± 0.59) (viz. 99 individuals in intervention group and 92 controls). Intervention group attended five SCT-based educational intervention sessions concerning NSSI prevention. Data were then collected by three self-administered questionnaires. The first questionnaire was to measure demographic variables and the second one, intermediate outcome measure, was implemented to evaluate SCT constructs. The third questionnaire also measured NSSI (final outcome measure). Data were analyzed using SPSS software v.24. RESULTS: After controlling the pretest scores, the repeated-measure multivariate analysis of covariance revealed a significant time and group interaction in multivariate (F = 154.8, p < .001) and univariate analysis, which is in favor of the effectiveness of educational intervention on changing the mean scores of NSSI and all SCT constructs. SCT constructs explained 41% of the variance in conforming intention for NSSI prevention (p < .001). CONCLUSION: The study findings were in favor of effectiveness of an SCT-based educational intervention in intention of preventing NSSI.

The impact of family social support on postpartum quality of life among Iranian women: structural equation modelling.

OBJECTIVE: To assess the impact of family social support (FSS) on postpartum quality of life (PQOL). METHODS: This analytical cross-sectional study enrolled postpartum women and asked them to complete the PQOL and FSS questionnaire (FSSQ) between October 2021 and February 2022 in three urban health centres in Shiraz, Iran. Pearson correlation coefficient analysis and multiple regression were used to determine the relationship between the FSS and PQOL variables. Structural equation modelling was used to determine the relationship pathways of the impact of FSS on PQOL. RESULTS: A total of 240 women were enrolled in the study. The mean ± SD scores of PQOL and FSSQ were 61.63 ± 9.59 and 69.80 ± 11.19, respectively. Family support seeking (7.95) and emotional support seeking (-6.80) were two factors affecting PQOL. CONCLUSION: Women should be empowered to seek support through education and actions from health workers, especially nurses and midwives, during routine regular prenatal care.

Effectiveness of Educational Intervention Based on Transtheoretical Model on Physical Activity and Menopausal Symptoms.

Introduction: Menopause is an inevitable part of women's lives. Physical activity as nonhormonal therapy can decrease the symptoms of menopause. This study is aimed at investigating the effect of educational intervention based on the transtheoretical model (TTM) on physical activity and menopausal symptoms of female clients of the health center in Pasargad City, Iran. Methods: This quasi-experimental study was performed on 140 females admitted to health center of Pasargad City, Fars Province, Iran (intervention = 70 and control = 70). The data collection tool consisted of demographic data, menopause rating scale, international physical activities questionnaire, and TTM questionnaire (stages of change, processes of change, decision-making balance, and self-efficacy) that were completed before and two months after intervention. For intervention group, the educational program was implemented during 5 sessions of 50-55 min. Data were analyzed by SPSS 25 and by using Chi-square test, independent t-test, and paired t-test. Results: After intervention, the mean scores of physical symptoms are sleep problems, muscle problems and discomfort, psychological symptoms, depression, irritability, and anxiety of intervention group decreased significantly post intervention (p < 0.001). Analysis showed that psychological symptoms, mental fatigue, somatic, and urogenital symptoms, and vaginal dryness increased 2 months after the intervention. Also, the mean score of cons, pros, decision balance, self-efficacy, consciousness raising, dramatic relief, environmental reevaluation, and self-reevaluation have significant changed in intervention group (p < 0.05). In addition, the top percent of progress can be seen in contemplation (31. 5%). Conclusion: This study showed the effectiveness of educational intervention based on TTM to reduce menopausal symptoms and promote physical activity in postmenopausal women.

Adolescent Mental Health Literacy Questionnaire: Investigating Psychometric Properties in Iranian Female Students.

Objectives: Mental Health Literacy (MHL) is an important factor in promoting mental health. Assessing this structure is required for early recognition and intervention in mental health problems. To date, there was no tool to assess it among Iranian adolescents, so this study was aimed at examining the psychometric properties of the Persian version of the Adolescent Mental Health Literacy Questionnaire (AMHLQ) among Iranian female students. Method: The study instrument was a Persian version of the AMHLQ prepared through a translation and back-translation process. In this cross-sectional study, 275 female students completed the AMHLQ, and the Adolescent Strengths, and Difficulties Questionnaire (SDQ). Results: Findings of content, construct validity tests, Cronbach's alpha, and split-half coefficient demonstrated that the AMHLQ had satisfactory validity and suitable reliability. The exploratory factor analysis showed four dimensions of the AMHLQ: (1) knowledge of mental health problems (α = 0.89); (2) erroneous beliefs/stereotypes (α = 0.89); (3) help-seeking and first aid skills (α = 0.86); and (4) self-help strategies (α = 0.74). Conclusion: The findings showed that the tool was confirmed by questions and subscales, and this questionnaire was a valid and reliable tool in assessing level differences of MHL and in determining the impact of programs designed to improve MHL in Iranian female adolescents.

The Effect of an Educational Intervention on Oral Health Literacy, Knowledge, and Behavior in Iranian Adolescents: A Theory-Based Randomized Controlled Trial.

Introduction: Oral health is one of the most important issues in public health. Most educational interventions, as the primary prevention strategy, are focused on increasing information and knowledge and are not usually effective. Therefore, the present study is aimed at determining the effect of theory-based education on oral health behavior and its psychological determinants including dental health literacy. Method: This randomized controlled educational trial was conducted in two girls' high schools that were selected by multistage cluster sampling and were divided into an intervention and a control group. Literacy, knowledge, oral health behavior, dental plaque index, and constructs of the protection motivation theory were evaluated before and one month after four training sessions. Finally, the data were entered into the SPSS 19 software and were analyzed using the chi-square test, independent t-test, and Mann-Whitney test at the significant level of 0.05. Result: Before the intervention, there was no significant difference between the intervention and control groups regarding the mean scores of knowledge, behavior, and oral health literacy; plaque index; and protection motivation theory constructs. After the educational intervention, however, the means of these variables were significantly improved in the intervention group compared to the controls (p < 0.05). Conclusion: The study findings were in favor of the effectiveness of the theory-based educational intervention in improving the knowledge, literacy, and behavior related to oral health. Yet, further research is suggested to determine the effectiveness of such an intervention in male students as well as in populations with different socioeconomic and cultural statuses.

Cross-cultural translation and psychometric properties of the Persian version Manchester respiratory activities of daily living questionnaire (MRADLQ-P).

PURPOSE: The present study was an attempt to investigate cross-cultural adaptability and evaluate the psychometric properties of the Persian version of the Manchester respiratory activities of daily living questionnaire ((MRADLQ-P). PATIENTS AND METHODS: In a cross-sectional study, we selected 260 patients with severe respiratory diseases who needed to be admitted to the respiratory wards of this city hospital. The process of cultural localization of the questionnaire was performed based on a standard and valid process. Psychometric properties of the instrument were confirmed based on face and content validity assessments, convergent validity, discriminative validity and internal consistency. Data collected by demographic questionnaire, MRADL questionnaire and work ability index. Data were analyzed by SPSS 22 using descriptive statistics (mean and standard deviation), Spearman correlation coefficient, Cronbach's alpha coefficient, and Mann-Whitney test. RESULTS: The mean age of participants was 48.8 ± 20.1 years. 176 (71.5%) were male. face content validity including content validity index (CVI) was 0.82 and content validity ratio and it was good. The questionnaire was measured at the same time as the work ability index, which Mann-Whitney test showed that the questionnaire has good differential power. Cronbach's alpha coefficient of 0.9 indicates a very good reliability of the questionnaire. CONCLUSION: The results show that intercultural psychometrics of MRADL questionnaire has good validity, reliability, and differential power that can be a good tool for use in future studies. Also, the translation of this checklist included translation into the target language, backward translation of the Persian versions into the original language, and comparisons and ambiguities to obtain a final and acceptable version.

Alleviating work-family conflict for female employees in Iran: The effect of a multimedia educational intervention.

Work-family conflict can lead to irreparable losses to individuals, families and organizations. This matter is especially important for married working women who cannot eschew home responsibilities. To consider an appropriate intervention for this issue, we investigated the effect of a one-month intervention on support from the workplace and the family, individual characteristics and work-family conflict. This quasi-experimental longitudinal study includes an intervention group and a control group, and uses a pre-test, post-test and 6-months follow up design. Participants were 120 married women working in healthcare services, recruited from two cities in South Iran. The web-based multimedia educational program comprised four modules: one for each of the women participants, their spouses, their co-workers, and their workplace supervisors. Data collection tools included a demographic information form, and co-worker support, supervisor social support, spouse support, core self-evaluation and work-family conflict questionnaires. The effect of the intervention was examined at two post-intervention time points. A comparison of changes in mean scores between the intervention and control groups indicated that scores of supervisor support, spouse support, core self-evaluation and work-family conflict in the intervention group one month and six months after the intervention were all significantly improved compared to before the intervention. There was no benefit of the intervention in terms of a change in co-worker support. There was no significant difference across the three time points in the control group. These results confirm that online educational methods can enable health promotion professionals to reduce work-family conflict to the benefit of both employees and organizations.

Epidemiological and clinical features of cutaneous leishmaniasis and its time trend model in a high-endemic focus of disease in the southwest of Iran from 2014 to 2019.

BACKGROUND: Cutaneous leishmaniasis (CL) is a tropical infection with a relatively high incidence rate in Iran. The present study aimed to explore the time trend and associated factors of CL in Dezful, in southwest Iran. METHODS: This case series study was conducted on all CL patients registered from 2014 to 2019. The descriptive analysis of the data was done using SPSS 20 software and the time series model on the number of cases was run through Interactive Time Series Modeling software. RESULTS: A total of 5349 leishmaniasis cases were identified in the study area during 2014-2019. The highest incidence rate was 35 840 per 100 000 in 2014. The fitted time series model revealed a decreasing trend with an annual periodic pattern. The mean age of infection was 19.82 y (standard deviation 21.87). The infection was most frequent in the 1-10 y age group (41.7%). Also, females were more prone to leishmaniasis (54.7%). Most lesions were located on the hand (23.1%), face (19.7%), and forearm (17.75%) and 48.5% of patients had only one lesion. CONCLUSIONS: The results revealed a decreasing trend of leishmaniasis in Dezful. It has been predicted that this infection will reach a minimum rate (300 per 100 000) in the winter of 2021.

Quality of Life and Metabolic Indicators of Patients with Type 2 Diabetes: A Cross-Sectional Study in Iran.

Background: The World Health Organization (WHO) has considered type 2 diabetes mellitus (T2DM) a major global health challenge because of its high prevalence worldwide. T2DM can affect patients' personal, social, and economic statuses. On the other hand, due to the increasing prevalence of T2DM, Quality of Life (QOL) has received more attention in recent years. Objective: The present study was conducted to investigate the relationships between QOL and physical activity level, body mass index, fasting blood sugar, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, total cholesterol, HbA1c, and systolic and diastolic blood pressure among Iranian patients with uncomplicated T2DM. Methods: This cross-sectional study was conducted on 135 participants selected through consecutive sampling. The study data were collected using International Physical Activity Questionnaire and Short-Form Health Survey Questionnaire. Then, the data were entered into the SPSS ver. 28 software, and Pearson's correlation was used to measure the correlation between the variables. Linear regression was also employed. The significance level was set at 0.05. Results: The significant association was observed between gender (p = 0.007), HDL level (p = 0.02), and gender-adjusted physical activity (p = 0.002) with QOL. Conclusions: Due to the association between physical activity and HDL level with QOL in patients with uncomplicated T2DM, they should be given the necessary training to improve their physical activity and regulate HDL level. Also, empowering them in this matter improves their QOL.

Investigating the predictors of breast cancer screening behaviors (breast self-examination, clinical examination or examination by physician/midwife and mammography) based on protection motivation theory (PMT) in women.

BACKGROUND: Breast cancer is one of the most common health problems worldwide. The mortality rate of this disease is due to the lack of knowledge about screening methods and late diagnosis of cancer. OBJECTIVE: The purpose of this study is to determine the predictors of breast cancer screening behaviors using protection motivation theory. METHODS AND MATERIALS: The conduction of study was cross-sectional and on 400 women aged 30-59 in Kashan. The data collection instrument was a researcher-made questionnaire based on protection motivation theory. Sampling was performed from all community health service centers in Kashan and the proportional to size sampling method was used as available sampling. The statistical tests were Pearson correlation and linear regression. The software used was version 22 SPSS and the significance level was 0.05. RESULTS: The results showed that the average age of women was 39.7 ± 7.9 years. There is a direct and statistically significant relationship between perceived breast cancer screening behaviors and perceived self-efficacy (P < 0.05) and there is an inverse statistically significant relationship between breast cancer screening behaviors and perceived cost (P < 0.05). There is also a direct and significant statistical relationship between motivation of protection and perceived sensitivity, intensity, self-efficacy, cost, and perceived response efficiency (P < 0.05). Perceived self-efficacy, cost, and response efficiency are the predictors of breast cancer screening behaviors. The perceived cost is the negative predictor. CONCLUSION: Overall, health care providers can view PMT as a framework for developing educational interventions aimed at improving behaviors related to breast cancer screening of women.

Lifestyle in Female Teachers: Educational Intervention Based on Self-Efficacy Theory in the South of Fars Province, Iran.

INTRODUCTION: Today, improving lifestyles and promoting health are basic needs for human society. The main goal in promoting health is to achieve healthy lifestyle behaviors, and self-efficacy is one of the factors influencing people's lifestyle. Therefore, the impact of educational intervention based on self-efficacy theory on improving lifestyles of the female teachers in Galledar was investigated. METHOD: This study was a semiexperimental study with educational intervention with a control group that was performed on 120 teachers in Galledar. Data collection tools included demographic information questionnaires, health-promoting lifestyle questionnaires, and Sherry's self-efficacy questionnaire. Data were analyzed using SPSS 25 software. RESULT: The mean age and standard deviation of teachers in the control and intervention groups were 33.40 ± 5.68 and 32.83 ± 6.46 years, respectively. Health-promoting lifestyle variables are significant correlation with self-efficacy and overall lifestyle index. Six dimensions which consisted of spiritual growth and self-actualization, health responsibility, interpersonal relationships, stress management, exercise and physical activity, and nutrition showed significant statistical differences before and after educational intervention (P = 0.001). CONCLUSION: Due to the sensitive role of teachers as an effective human force in the development and evolution of society and their students' role modeling, the authorities should formulate policies, regulate educational interventions, and design strategies for promoting self-efficacy beliefs and promoting a healthy lifestyle for all teachers. We suggest that other methods and theories of behavior change be used in future studies to promote a healthy lifestyle.

Care burden dimensions of informal caregivers having patients with bipolar disorder (challenges and alternatives) (qualitative study).

BACKGROUND: Taking care of patients with bipolar disorder (BD) makes critical challenges for their informal caregivers (ICGs) and forces them to tolerate considerable burden. This qualitative study explored the dimensions of ICGs' care burden (CB) based on their own experiences and the patients' therapists. MATERIALS AND METHODS: This is a qualitative study which was conducted based on conventional content analysis through semistructured and in-depth interviews. Purposive sampling was used to select the participants including 13 ICGs and 14 therapists (2 psychiatrists, 10 psychiatric nurses, and 2 clinical psychologists). Interviews were audiotaped, transcribed verbatim, and analyzed using Graneheim's 2004 principles. RESULTS: Qualitative analyses yielded three major themes: "challenges associated with the nature of BD," "challenges related to the ICGs," and "challenges related to interventions." The categories of the first theme entailed "individual-oriented characteristics of BD" and "social-oriented characteristics of BD." The categories of the second theme consisted of "social stigma," "psychiatric problems and helplessness of ICGs," "financial costs related to providing cares," and "insufficient self-efficacy of ICGs in cares provision." The categories of the last theme included "educational interventions" and "organizational interventions." CONCLUSIONS: This study showed that the burden of ICGs have individual, social, and organizational aspects. Every one of them impacts the severity of their burden remarkably. The depth of the therapists' experiences has a significant role in designing the interventions to reduce this burden. The present investigation emphasized the constitution of a comprehensive framework related to all factors affecting burden in a developing country.

Developing strategies to improve the community readiness level to prevent drug abuse in adolescents: Based on the community readiness model, Eghlid City, Iran, 2019.

The aim of this study was to investigate the level of readiness of Eghlid city community for adolescents' substance abuse prevention programs, and to develop strategies to improve community readiness levels based on the community readiness model (CRM). In this two-stage qualitative study, a 36-item semi-structured CRM questionnaire, was used to interview 11 key informants in Eghlid city, Iran, 2019. The interviews were analyzed and scored by two independent researchers. Strategies for increasing the level of readiness were developed and prioritized by participants using the nominal group method. The readiness levels to prevent substance abuse in community efforts and leadership dimensions were at stabilization and preparation stage. In terms of community awareness of efforts, community space, and public awareness of the issue, the readiness level was at the pre-planning stage, and in the resources for prevention efforts dimension, it was at the vague awareness level. In the strategy development section, the key participants focused on using traditional methods such as holding face-to-face training programs and festivals, using IRIB platform, local media, and lectures. The general level of readiness is at a moderate level. It seems necessary to focus on resources and areas related to public information.

Mobile-Based and Cloud-Based System for Self-management of People With Type 2 Diabetes: Development and Usability Evaluation.

BACKGROUND: As the use of smartphones and mobile apps is increasing, mobile health (mHealth) can be used as a cost-effective option to provide behavioral interventions aimed at educating and promoting self-management for chronic diseases such as diabetes. Although many mobile software apps have been developed for this purpose, they usually lack a theoretical foundation and do not follow the guidelines suggested for evidence-based practice. Therefore, this study aimed to develop a theory-based self-management app for people with type 2 diabetes and provide an app based on a needs assessment analysis. OBJECTIVE: This paper describes the development and usability evaluation of a cloud-based and mobile-based diabetes self-management app designed to help people with diabetes change their health behavior and also enable remote monitoring by health care providers. METHODS: The development of this mHealth solution comprises 3 phases. Phase I: feature extraction of the Android apps that had a user rating of 4 stars or more and review of papers related to mHealth for diabetes self-management were performed followed by seeking expert opinions about the extracted features to determine the essential features of the app. Phase II: design and implementation included selecting which behavioral change and structural theories were to be applied the app and design of the website. Phase III: evaluation of the usability and user experience of the mobile app by people with diabetes and the portal by health care providers using the User Experience Questionnaire. RESULTS: The developed mobile app includes modules that support several features. A person's data were entered or collected and viewed in the form of graphs and tables. The theoretical foundation of behavioral intervention is the transtheoretical model. Users were able to receive customized messages based on the behavioral change preparation stage using the Kreuter algorithm. The clinician's portal was used by health care providers to monitor the patients. The results of the usability evaluation revealed overall user satisfaction with the app. CONCLUSIONS: Mobile- and cloud-based systems may be an effective tool for facilitating the modification of self-management of chronic care. The results of this study showed that the usability of mobile- and cloud-based systems can be satisfactory and promising. Given that the study used a behavioral model, assessment of the effectiveness of behavior change over time requires further research with long-term follow-up.

Development and validation of the tool for the evaluation of the behavioral factors affecting the prevalence of musculoskeletal disorders in Iranian students.

BACKGROUND: This study was conducted with the aim of developing a standard and valid questionnaire to evaluate the behavioral factors affecting musculoskeletal disorders among adolescent students based on the educational and ecological diagnosis phase of the PRECEDE model. METHODS: Based on the PRECEDE model and by using available resources and a panel of experts, a reservoir of items was proposed. The content validity of the questions was measured using content validity ratio (CVR) and content validity index (CVI). 400 Iranian first-year female high school students completed the questionnaire. The construct validity was assessed using confirmatory factor analysis (CFA). The reliability of the questionnaire was evaluated using Cronbach's alpha coefficient. RESULTS: The age range of study students was 13.69 ± 0.86 years. The final developed questionnaire included 25 items in three dimensions: knowledge (9 items), attitude (10 items) and enabling factors (6 items). The mean scores of CVI and CVR were 0.97 and 0.92, respectively. The results of CFA confirmed the three-factor structure of the questionnaire. The Cronbach's alpha coefficients of the dimensions of knowledge, attitude and enabling factors were 0.65, 0.80 and 0.71, respectively. CONCLUSIONS: The present questionnaire had appropriate psychometric properties and could be used as a valid tool in evaluating the factors affecting the development of musculoskeletal disorders among adolescent students.