Modifying attitude and intention toward regular physical activity using protection motivation theory: a randomized controlled trial.

We were guided by the Protection Motivation Theory to test the motivational interviewing effects on attitude and intention of obese and overweight women to do regular physical activity. In a randomized controlled trial, we selected using convenience sampling 60 overweight and obese women attending health centres. The women were allocated to 2 groups of 30 receiving a standard weight-control programme or motivational interviewing. All constructs of the theory (perceived susceptibility, severity, self-efficacy and response efficacy) and all anthropometric characteristics (except body mass index) were significantly different between the groups at 3 study times. The strongest predictors of intention to do regular physical exercise were perceived response efficacy and attitude at 2- and 6-months follow-up. We showed that targeting motivational interviewing with an emphasis on Protection Motivation Theory constructs appeared to be beneficial for designing and developing appropriate intervention to improve physical activity status among women with overweight and obesity.

Expediency and coincidence in re-engineering a health system: an interpretive approach to formation of family medicine in Iran.

BACKGROUND: Analysing the evidence generated over decades, the World Health Report 2008 recommended the expansion of primary health care (PHC) to achieve better population health, higher equity and lower costs. Over the last two decades, the Iranian model of PHC has resulted in population health indices that match the best in the region. Despite the extensive PHC networks in rural areas, there was an expansion of private outpatient care and hospital-based services. This model has been inadequate to meet the evolving health needs of the population and increasingly difficult to afford. In response, a family medicine (FM) programme has been implemented since August 2005, funded through Behbar, a model of social insurance. In this paper, we aim to identify facilitators of and barriers to implementation of FM in Iran. METHODS: Data were collected between November 2006 and May 2007 through semi-structured interviews at national (19 interviews), provincial (9) and local (43) levels, and through a purposive document analysis. The framework approach was used for analysing interviews. Document analysis followed a narrative contextual framework. We interpreted data using an interpretive framework consisting of multiple streams and network theories. RESULTS: The introduction of Behbar provided FM advocates with the opportunity to place FM on the policy agenda. They skillfully coupled the two policies and defined FM as the only solution to fulfill Behbar. However, the manner in which policy was formed was the main obstacle to desired FM implementation. CONCLUSION: The interpretive framework links the concept of outreach to the poor and enhancing equity to rationing health services at a particularly opportune moment in Iran. However, using windows of opportunity to implement a major policy change, if it results in sacrifices in planning and preparedness, may harm the policy and the future success in achieving its objectives.