An Intervention Program Using the Health Belief Model to Modify Lifestyle in Coronary Heart Disease: Randomized Controlled Trial.

BACKGROUND: Most effective interventions to control coronary heart disease (CHD) and prevent negative outcomes involve behavioral modification. This study examined how such modification based on the Health Belief Model (HBM) might improve lifestyle and clinical outcomes. METHODS: A total of 120 people with CHD seeking help at a general hospital in Iran were randomly assigned to either the intervention or control group. Information was collected using an HBM-specific questionnaire and the Health Promoting Lifestyle II (HPLP-II) scale. Clinical outcomes (blood pressure, body mass index, and fasting blood sugar) were also measured. The intervention group received a tailored education based on HBM principles plus routine care, while those in the control group received only routine care. Three months after the intervention, both groups were reassessed using Student's t test and analysis of covariance. RESULTS: All HBM subscale scores indicated significant improvements in the intervention group, in contrast to the control group, where scores worsened or stayed the same. Perceived severity and susceptibility were the dimensions that changed most. Total score on the HPLP-II improved significantly in the intervention group (p < 0.001, F = 747.5); however, subscale scores on spiritual growth and interpersonal relationships did not demonstrate significant between-group differences at follow-up. After adjustment for baseline scores, significant improvements in lifestyle subscales were also accompanied by significant improvements in clinical measures. CONCLUSIONS: This HBM-based behavior modification program improved both lifestyle and clinical measures in patients with CHD. Utilizing this program in patients with other cardiovascular diseases may in the future demonstrate similar results.

An educational intervention using the health belief model for improvement of oral health behavior in grade-schoolers: a randomized controlled trial.

BACKGROUND: Oral health problems especially dental caries are common in school children, and education programs may help to prevent these conditions. The aim of current study was to examine the effects of an educational program based on a Health Belief Model (HBM) to improve oral health behaviors of elementary school children. METHODS: A total of 112 children ages 6-12 years old accompanied by one of their parents were randomly assigned to intervention/test and control groups. In the intervention group, five consecutive weekly educational sessions based on the HBM were provided, while the control group received only routine education delivered by the dental clinic. The Decayed, Missing, and Filled Teeth (DMFT) score, papillary bleeding index, and responses to the HBM questionnaire were assessed in the intervention and control groups at baseline and three-month follow-up after the intervention was completed. Within-group and between-group differences were examined using the Student's t-test and analysis of covariance. RESULTS: All HBM domains were improved at follow-up in the intervention group compared to the control group (p < 0.001). The largest change was in perceived susceptibility, whereas the smallest changes were in perceived severity and perceived benefits. The papillary bleeding index demonstrated a significant change from baseline to follow-up in the intervention group (reduction of 0.7, 95% CI = - 0.9 to - 0.5). All components of the DMFT score except missing teeth also improved in the intervention group compared to controls. However, no significant difference was found in total DMFT score between intervention and control groups. CONCLUSION: An education program based on HBM may be more effective than current methods used to educate children and their parents on optimal oral health behaviors. Administration of interventions of this type along with other school-based programs to prevent dental caries may be helpful in grade-school children.

Evaluating the Consistency Between Conceptual Frameworks and Factors Influencing the Safe Behavior of Iranian Workers in the Petrochemical Industry: Mixed Methods Study.

BACKGROUND: Unsafe worker behavior is often identified as a major cause of dangerous incidents in the petrochemical industry. Behavioral safety models provide frameworks that may help to prevent such incidents by identifying factors promoting safe or unsafe behavior. We recently conducted a qualitative study to identify factors affecting workers' unsafe behaviors in an Iranian petrochemical company. OBJECTIVE: The aims of this study were to (1) conduct a review of the relevant research literature between the years 2000 and 2019 to identify theoretical models proposed to explain and predict safe behavior in the workplace and (2) to select the model that best reflects our qualitative findings and other evidence about the factors influencing safe behaviors among petrochemical workers. METHODS: This research used mixed methods. Initially, we conducted a qualitative study of factors that Iranian petrochemical workers believed affected their safety behavior. Four themes emerged from the semistructured interviews: (1) poor direct safety management and supervision; (2) unsafe workplace conditions; (3) workers' perceptions, skills, and training; and (4) broader organizational factors. Electronic databases, including PubMed, Embase, Scopus, Google Scholar, EBSCOhost, and Science Direct, were then searched for eligible studies on models to explain and predict safe behaviors, which were published between the years 2000 and 2019. Medical subject headings were used as the primary analytical element. Medical subject headings and subheadings were then extracted from the literature. One researcher conducted the search and 3 researchers performed screening and data extraction. Then, constructs described in each study were assessed to determine which were the most consistent with themes derived from our qualitative analysis. RESULTS: A total of 2032 publications were found using the search strategy. Of these, 142 studies were assessed and 28 studies met the inclusion criteria and were included in the review. The themes identified in the qualitative study most closely matched 3 scales included in Wu et al's model that measured safety behavior and performance, safety leadership, and safety climate in petrochemical industries. Poor direct safety management and supervision matched with safety leadership and its subscales; unsafe workplace conditions matched with safety climate and its subscales; workers' perceptions, skills, and training matched with safety performance and its subscales; and broader organizational factors matched with some subscales of the model. CONCLUSIONS: This is the first literature review to identify models intended to explain and predict safe behavior and select the model most consistent with themes elicited from a qualitative study. Our results showed that effective safety leadership and management and safety climate and culture systems are the most frequently identified factors affecting safe behaviors in the petrochemical industry. These results can further help safety researchers and professionals design effective behavior-based safety interventions, which can have a more sustainable and persistent impact on workers' safety behaviors. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20170515033981N2; https://www.irct.ir/trial/26107. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-019-7126-1.

A mediating role for mental health in associations between COVID-19-related self-stigma, PTSD, quality of life, and insomnia among patients recovered from COVID-19.

INTRODUCTION: Patients with COVID-19 often suffer from psychological problems such as post-traumatic stress disorder (PTSD) and self-stigmatization that may negatively impact their quality of life and sleep. This study examined mental health as a potential mediating factor linking self-stigmatization and PTSD to quality of life and sleep. METHODS: Using a cross-sectional design, 844 people who had recovered from COVID-19 were called and interviewed. Data were collected using structured scales. Structural equation modeling was applied to assess fitness of a mediation model including self-stigma and PTSD as independent factors and quality of life and insomnia as dependent variables. RESULTS: Mental health, COVID-19-related self-stigma, and mental quality of life were associated. Insomnia, PTSD, and COVID-19-related self-stigma displayed significant direct associations (r = .334 to 0.454; p < .01). A mediation model indicated satisfactory goodness of fit (CFI = 0.968, TLI = 0.950, SRMR = 0.071, RMSEA = 0.068). Mental health as a mediator had negative relationships with COVID-19-related self-stigma, PTSD, and insomnia and positive associations with quality of life. CONCLUSION: Mental health may mediate effects of COVID-19-related self-stigma and PTSD on quality of life and insomnia. Designing programs to improve mental health among patients with COVID-19 may include efforts to reduce negative effects of PTSD and COVID-19-related self-stigma on quality of life and insomnia.

Effects of a health education program to promote healthy lifestyle and glycemic control in patients with type 2 diabetes: A randomized controlled trial.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a common chronic disease with an increase in prevalence within developing countries. The aim of this study was to determine the efficacy of a structured educational program for improving lifestyle and health-related measures in Iranians with T2DM. METHODS: A randomized controlled trial was conducted in 80 participants with T2DM who were randomly assigned to either the intervention or a control group. A demographic questionnaire along with the Health Promoting Lifestyle Profile-II and related laboratory tests were used to assess the efficacy of the program. The intervention consisted of six educational sessions held over 45 days. The control group received routine diabetic care at the clinic. Three months after the intervention, participants completed the measures again. Within-group and between-group comparisons were then made. RESULTS: All subscales of lifestyle measure improved in the intervention group, whereas only the nutrition domain improved in the control group. After adjusting for baseline differences, physical activity and nutrition domains showed the greatest improvement in the intervention group compared to controls. All clinical measures were also significantly improved within intervention group from baseline to follow-up (p < 0.001), whereas HbA1c, fasting blood glucose, HDL, triglyceride, cholesterol, and weight also changed significantly in the control group. The frequency of HbA1c < 7% was increased from 27.5% at baseline to 37.5% at follow-up (10%) in the intervention group compared to only a 5% increase in the control group. CONCLUSION: This educational health program significantly improved lifestyle changes and health-related clinical characteristics in persons with T2DM, compared to routine diabetic care in Iran. Further research is needed to better understand the usefulness of such programs in diabetics and other medical conditions among those in different cultural settings.

A spiritual intervention to reduce stress, anxiety and depression in pregnant women: Randomized controlled trial.

We assessed the efficacy of a spiritually-integrated cognitive-behavioral educational group intervention for reducing stress, anxiety, depression, and blood pressure during pregnancy and improving delivery outcomes. A randomized controlled trial was conducted in 84 pregnant women randomly assigned to either the intervention or a control group. Demographic information was collected at baseline, along with measures of religiosity, stress, anxiety, depression, and blood pressure. Our intervention consisted of four 90-minute group sessions over 8 weeks that utilized a spiritually-integrated cognitive-behavioral approach to help participants cope with the stress of pregnancy. Stress, anxiety and depression scores in the intervention group decreased significantly by 41%, 28%, and 41%, respectively, from baseline to 3-month follow-up. There were also significant differences in systolic and diastolic blood pressure between groups at the 3-month follow-up, favoring the intervention group. Between-group differences were also significant for these outcomes. Applying such spiritually-integrated intervention may help to improve the mental and physical health of young, healthy nulliparous pregnant women.

Educational Intervention Based on the Health Belief Model to Modify Risk Factors of Cardiovascular Disease in Police Officers in Iran: A Quasi-experimental Study.

OBJECTIVES: Police officers may be at a greater risk for cardiovascular disease (CVD) than the general population due to their highstress occupation. This study evaluated how an educational program based on the health belief model (HBM) may protect police officers from developing CVD. METHODS: In this single-group experimental study, 58 police officers in Iran participated in a 5-week intervention based on HBM principles. Outcomes included changes in scores on an HBM scale, time spent on moderate to vigorous physical activity (International Physical Activity Questionnaire), body mass index (BMI), blood lipid profile, blood glucose, and blood pressure. The intervention consisted of 5 HBM-based educational sessions. Follow-up was conducted at 3 months post-intervention. The paired t-test was used to examine differences between baseline and follow-up scores. RESULTS: All aspects of the HBM scale improved between baseline and follow-up (p<0.05), except the cues to action subscale. Self-efficacy and preventive behaviors improved the most. BMI decreased from 26.7±2.9 kg/m2 at baseline to 25.8±2.4 kg/m2 at follow-up. All components of the lipid profile, including triglycerides, cholesterol, high-density lipoprotein, and low-density lipoprotein, showed significant improvements post-intervention. Blood glucose and blood pressure also decreased, but not significantly. Nearly 25% of participants who were not physically active at baseline increased their physical activity above or beyond the healthy threshold. CONCLUSIONS: A relatively brief educational intervention based on HBM principles led to a significant improvement in CVD risk factors among police officers. Further research is needed to corroborate the effectiveness of this intervention.

Factors associated with unsafe work behaviours in an Iranian petrochemical company: perspectives of workers, supervisors, and safety managers.

BACKGROUND: The petrochemical industry is hazardous, in part because of the inherently dangerous nature of the work conducted, and incidents frequently result in significant financial and social losses. The most common immediate cause of incidents and injuries in this industry is unsafe worker behaviour. Identifying the factors encouraging unsafe work behaviours is the first step in taking action to discourage them. The aim of this study was to (a) explore workers', supervisors' and safety managers' attitudes and perceptions of safety in a petrochemical company in Iran, and (b) identify the factors that discourage safe work behaviours. METHODS: A qualitative study was conducted by applying the steps described by Graneheim and Lundman (2004). Twenty participants were recruited from an Iranian petrochemical company using a multi-stage approach, with initial purposive sampling followed by snowball sampling to enhance recruitment. Individual face-to-face and semi-structured interviews were conducted to gain an in-depth understanding of factors acting as barriers to safe behaviour. The interviews were recorded and transcribed in Persian and then translated into English. Conventional content analysis was performed. RESULTS: The main themes emerging from the interviews were: (i) poor direct safety management and supervision; (ii) unsafe workplace conditions; (iii) workers' perceptions, skills and training; and (iv) broader organisational factors. CONCLUSIONS: The findings give insights into practical organisational measures that can be implemented by management to promote workers' commitment to safety and engage in safe behaviours in their workplace. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20170515033981N2 . Retrospectively registered 19 June 2018.

Effect of a health-education program using motivational interviewing on oral health behavior and self-efficacy in pregnant women: a randomized controlled trial.

Oral health problems are common among pregnant women. The objective of this study was to examine the effectiveness of motivational interviewing (MI) as a behavior-change technique to enhance self-efficacy and oral health among pregnant women. A randomized controlled trial was conducted with 112 pregnant Iranian women. Women in the intervention group received an education program on oral health using MI during two face-to-face sessions, along with routine health education (two 1-h lectures on oral health changes and needs during pregnancy presented as a lecture by an oral health technician over a 2-wk period). Those in the control group received two 1-h lectures on oral health changes and needs during pregnancy. Oral health behaviors, oral health self-efficacy, and general self-efficacy, were assessed, along with gingival and dental health from baseline to the 3-month follow-up. Analysis of covariance was used to determine differences between intervention and control groups. Scores for both general and specific self-efficacy and for healthy behaviors increased in the intervention group, whereas there was no significant change within controls from baseline to follow-up. Between-group analyses also indicated a significant difference in the scores for self-efficacy and behavior favoring the intervention group. Scores on the gingival inflammation index decreased, as did the number of decayed teeth in the intervention group relative to the control group. The number of filled teeth increased significantly in the intervention group. Health education interventions using MI techniques may help to improve oral health-related self-efficacy and behaviors among pregnant women.

A Theory of Planned Behavior-Based Program to Increase Physical Activity in Overweight/Obese Military Personnel: A Randomised Controlled Trial.

BACKGROUND: Designing a health promotion program to increase physical activity may contribute to weight management. The purpose of this study was to investigate a theory of planned behavior (TPB) program to address this problem in military people. METHODS: Eighty-four obese/overweight military personnel were randomised into the intervention or control group. A questionnaire assessed demographics, aspects of the TPB program, and physical activity levels. Also assessed were blood glucose and lipid levels. The intervention consisted of seven educational sessions based on TPB. Data were collected at baseline and 3 months after the intervention. RESULTS: All constructs of the TPB improved between baseline and follow-up in the intervention group (p < .001), while there were no significant changes in the control group (within-group comparisons). Between-group comparisons on TPB measures revealed differences in all domains when results were controlled for baseline covariates. Greater light and moderate physical activity was observed in the intervention group. Body mass index decreased significantly within the intervention group (p < .001). Changes in triglyceride and high-density lipoprotein also favored the intervention over the control group. CONCLUSION: An intervention based on the TPB may be effective in promoting physical activity and decreasing weight in military personnel who are obese or overweight.

A randomised controlled trial of an educational intervention to promote safe behaviours in petrochemical workers: a study protocol.

BACKGROUND: The worldwide concern about safety has created a need for new and effective strategies to improve safety in the workplace. Based on reported studies, approximately 90% of workplace accidents are due to unsafe behaviour and human error. Therefore, the most important strategy in reducing the rate of these accidents is training workers regarding safe behaviour and avoiding human error. There is limited research on understanding the barriers to promoting safe behaviour amongst petrochemical workers. This paper presents a protocol for an intervention study, using training sessions in combination with an educational software (application). The intervention aims to both promote workers' safe behaviour and reduce the rate of occupational accidents. METHODS: One hundred seventy-six workers will be recruited to this study from an Iranian petrochemical industry. The study is Mixed Methods Research (MMR) which will be carried out in two phases. In the first phase, using a qualitative approach, in-depth interviews will identify the causes of unsafe behaviour in the petrochemical industry. In the second phase, models of safe behaviour used in workplaces and the petrochemical industry will be investigated. The findings of the first phase will be matched with the constructs of these models to produce a well-suited conceptual model. Questionnaires and an educational intervention will be designed based on the results of the two phases. The workers will receive training interventions using direct methods, involving training sessions and workshops, and in an indirect method for which educational software will be designed. A randomised controlled trial (RCT) will assess comparability between the intervention group and the control group at baseline, after the intervention, and at a three-month follow up. DISCUSSION: This research will provide a practical approach for promoting safe behaviours and reducing occupational hazards amongst industrial workers. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20170515033981N2 . Registered 19 June 2018.

An Education-Based Text Messaging Program to Improve Nurses' Knowledge, Attitude, and Practice Related to Nosocomial Infections in Intensive Care Settings.

BACKGROUND: Nosocomial infection (NI) is common in health care settings. Educational strategies such as mobile teaching methods for health care providers may help to resolve this problem. This pilot study assessed the influence of a text messaging program to improve intensive care unit nurses' knowledge, attitude, and practice related to NI prevention. METHOD: In this single-group experimental study, 32 nurses received an educational intervention via short text messages on their cell phones. Information on knowledge, attitude, and practice regarding NI prevention was collected using a standard scale. Preventive messages about NI were prepared and sent to participants during a 2-month trial. Results were assessed 2 weeks after the intervention, and data were analyzed by paired t test. RESULTS: Knowledge, attitude, and practice of participants increased by 17%, 3%, and 9%, respectively, from baseline to follow up. The average score on the knowledge dimension was lower than for other components. Knowledge components such as hand hygiene, work safety, and protective equipment increased to a lesser degree from pre- to posttest, compared with other aspects (p < .05 versus p < .001). CONCLUSION: An education-based program operating through short text messages may be a useful in-service training strategy for intensive care unit nurses. [J Contin Educ Nurs. 2019;50(5):211-217.].

Strategies for disaster risk reduction education: A systematic review.

INTRODUCTION: For many years, numerous researches and risk reduction activists have emphasized the importance of public awareness and education for disaster risk reduction (DRR). These needs, due to human natural manipulation, have increased. The present study was aimed to assess and determine the evidence on the strategies for education of DRR. MATERIALS AND METHODS: This study was a systematic review of publications and gray literatures regarding to strategies for education of DRR conducted in December 2016. Fifteen articles and dissertations published during January 1, 2000 to December 31, 2016 were extracted through PubMed, Scopus, ProQuest, Web of Science, ScienceDirect, Ovid, Google Scholar, Scientific Information Database, Magiran, and Irandoc with the inclusion criteria of English and Persian language. Thematic analysis technique was used to analyze the articles. RESULTS: The thematic analyses revealed eight major categories of DRR educational strategies such as raising knowledge, educational needs assessment, educational planning, educational approaches, educational content, educational tools, involved organizations, and educational learning barriers and challenges. CONCLUSIONS: Most countries have launched DRR education activities, but these actions are not enough, and there are some gaps between what is it and what should be. More effective and efficient teaching and learning strategies are needed to increase the effectiveness of preparedness and DRR activities at all levels of community.

The effectiveness of a model-based health education intervention to improve ergonomic posture in office computer workers: a randomized controlled trial.

PURPOSE: Lack of knowledge about computer ergonomics predisposes users to musculoskeletal and visual disorders. The present study examined the effect of a trans-theoretical model (TTM)-based educational program on work-related posture in office computer users. METHODS: This experimental study examined 102 hospital personnel whose primary job involved working at a computer. Participants were randomized to intervention and control groups. An educational intervention based on TTM was conducted over five sessions. A self-report questionnaire was used to collect data including stages of change, processes of change, pros and cons of change, and self-efficacy. A pen-paper-based observational method (i.e., Rapid Office Strain Assessment or ROSA) was used for assessing work posture. A visual analogue scale assessed pain intensity. Data were collected at baseline and 3-month follow-up. RESULTS: Significant differences were found on TTM's constructs and ROSA score between intervention and control groups at follow-up (p < 0.05). The mean ROSA score decreased from 5.65 (SD 1.03) to 3.95 (SD 0.83) in the intervention group, while no significant change was found in the control group. Pain intensity also decreased significantly among those in the intervention vs. control group (p < 0.001). CONCLUSION: An educational intervention based on TTM was effective in improving ergonomic posture in computer workers. Further research is needed to determine if these results can be generalized to computer workers in other settings.

A theory of planned behavior-based intervention to improve quality of life in patients with knee/hip osteoarthritis: a randomized controlled trial.

Osteoarthritis (OA) is a common chronic disorder among elderly people that affects joints such as the knee and hip in particular. The objective of the current study was to examine the efficacy of an intervention based on a theory of planned behavior (TPB) in improving health-related quality of life in middle-age and older adults with this condition. One hundred twenty patients diagnosed with knee/hip OA were recruited from a general hospital. Measures administered at baseline were the SF-12, EuroQol (EQ-5D), Osteoarthritis Knee and Hip Quality of Life (OAKHQoL), and TPB questionnaire. Also assessed were body mass index (BMI), Kellgren-Lawrence Scale, six-minute walk test (SMWT), muscle strength, range of motion (ROM), and joint tenderness and swelling. Participants were randomly assigned to either the intervention (n = 60) or the control group (n = 60). The intervention group received an educational program based on TPB that was administered over 1 month. The control group did not receive this treatment. Three months after the intervention, both groups were reevaluated and comparisons made. Compared to the no-treatment control group, those in the intervention group scored higher on HRQoL, both general and specific, at 3-month follow-up (p < 0.01). The only exception was the vitality domain. Significant differences were also found on the TPB questionnaire, the SMWT, and muscle strength in the expected direction (p < 0.05). While those in the intervention group improved significantly on all clinical measures from pre-test to post-test, those in the control group showed improvement only on BMI and joint tenderness. This TPB-based intervention was found to be efficacious in improving HRQoL and several clinical parameters in patients with knee/hip OA. Studies are needed to examine the effectiveness of this intervention in patients with other chronic medical conditions.

Impact of Game-Based Health Promotion Programs on Body Mass Index in Overweight/Obese Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Sedentary lifestyle is growing among children and adolescents that may contribute to problems such as overweight and obesity. Consequently, interventions to improve weight loss in this population are necessary. The aim of this current review was to evaluate the effectiveness of game-based interventions to reduce body mass index (BMI) among children who were overweight or obese. METHODS: All randomized controlled trials with a game-based approach for lowering weight in obese/overweight youths aged 5-18 years old were identified from January 2005 to June 2017 across PubMed, Web of Science, Embase, Scopus, and ScienceDirect. Two independent reviewers completed data extraction sheets on information such as sample size, country of origin, age of participants, type of interventions, and BMI change from pre- to posttest. A consensus on collected data was obtained, and a final list of studies meeting inclusion and exclusion criteria was arrived at. Data were analyzed using Comprehensive Meta-analysis software, and effect size was measured by standardized mean difference (SMD) and Hedges' g measure. Heterogeneity and publication bias were also examined using I2 index and funnel plot. RESULTS: A total of 388 articles were identified from electronic and manuals' searches. After deletion of duplicated articles, 138 articles remained that were then screened in terms of relevance. Of those, 41 articles were examined to determine eligibility. Finally, 10 articles met inclusion/exclusion criteria and were entered into the quantitative meta-analysis. Results indicated a small but significant effect size in terms of BMI reduction [SMD, -0.234; standard error (SE), 0.069] among included studies. The average BMI z-score reduction was -0.181 (SE, 0.071). Trials which used other types of interventions along with active game-based approaches achieved greater effect sizes than single game-based interventions. There was a significant difference between studies based on their country of origin, BMI value, and intervention type. Those conducted in United States, those including participants with BMI ≥30, and studies with multicomponent intervention reported a higher reduction of BMI than others. However, no significant difference in BMI was found in terms of variables such as age, sample size, type of participant (overweight/obese), intervention duration, or participant gender. No publication bias was identified, and studies were homogenous (I2 = 22.5%). CONCLUSIONS: Interventions that involve active gaming may produce small effects in terms of improving BMI among children who are overweight/obese. Therefore, we recommend that supplemental interventions be used to enhance the effectiveness of game-based interventions.

Effect of a transactional model education program on coping effectiveness in women with multiple sclerosis.

OBJECTIVES: Multiple sclerosis (MS) is a chronic and progressive disease that causes stress due to its unpredictability and lack of definitive treatments. This study examined the effects of an educational program using a transactional model to help women with MS cope with their disease. MATERIALS AND METHODS: In a randomized clinical trial, 80 female patients from the MS Society of Iran were randomized to the intervention (n = 40) or a control group (n = 40). Outcomes were assessed using Cohen's Perceived Stress Scale (PSS) and the Jalowiec Coping Scale (JCS), which were completed by both groups at baseline, 1 month, and 3 months after the intervention. The intervention consisted of six educational sessions administered over 2 months based on a transactional model. The data were analyzed using repeated measures ANOVA. RESULTS: Average PSS scores decreased significantly over time in the intervention group, while increasing in the control group. Between-group differences were significant at both 1-month and 3-month follow-up (p < .001). Both problem-focused and emotion-focused coping styles improved over time in use and effectiveness in the intervention group, whereas little or no change occurred in these coping behaviors in the control group. CONCLUSION: The transactional model-based education program tested here was successful in reducing stress levels and increasing healthy coping styles in women with MS. If these findings are replicated in future studies, widespread adoption of this program may help women with MS cope more successfully with their disease.

Cultural Adaptation, Validity, and Factor Structure of the Jalowiec Coping Scale in Iranian Women with Multiple Sclerosis: Which Coping Strategies Are Most Common and Effective?

BACKGROUND: The aims of this study were to evaluate the Jalowiec Coping Scale (JCS) psychometrically in Iranian women with multiple sclerosis (MS) and to identify the most frequent and efficacious coping strategies. METHODS: A total of 306 women with MS participated in a cross-sectional study. A demographics questionnaire, the JCS, and the Perceived Stress Scale were administered. Forward-backward translation was used to achieve a Persian version of the scale. Cronbach α and test-retest were assessed for reliability. Convergent and discriminant validity were tested using an item-scaling procedure. The association of the JCS with perceived stress was examined using multiple regression. The factor structure was also explored using rotated exploratory factor analysis. RESULTS: Participants had a mean (SD) age of 32.0 (6.6) years, and nearly half reported visual impairment as the first symptom of disease. Cronbach α for the scale was 0.898 and for the subscales ranged from 0.254 to 0.778. Relatively good convergent and discriminant validity were achieved (success rate ≥69%). Subscales assessing optimistic, fatalistic, and emotive coping predicted stress levels. A four-factor solution explained 30% of the total variance. Optimistic and supportive coping styles were the most common and effective styles, respectively, reported. CONCLUSIONS: The JCS may be useful in assessing coping strategies in Iranian women with MS. Further studies are needed to better understand how coping styles used in practice are similar to their theoretical constructs.

The Social Determinants of Health in Military Forces of Iran: A Qualitative Study.

Providing effective health interventions and achieving equity in health need to apply the community-based approaches such as social determinants of health. In the military organizations, these determinants have received less attention from the military health researchers and policymakers. Therefore, this study aimed to identify and explain the social determinants affecting the health of military forces in Iran. This was a qualitative study which was conducted in 2014. The required data were collected through semistructured interviews and analyzed through Conventional Content Analysis. The studied sample consisted of 22 military health experts, policymakers, and senior managers selected using purposeful sampling method with maximum variation sampling. MAXQDA.2007 was used to analyze the collected data. After analyzing the collected data, two main contents, that is, "general social determinants of health" and "military social determinants of health," with 22 themes and 90 subthemes were identified as the social determinants of military forces' health. Main themes were religious rule, spirituality promotion policies, international military factors, military command, and so forth. Given the role and importance of social factors determining the military forces' health, it can be recommended that the military organizations should pay more attention to these determinants in making policies and creating social, economic, and cultural structures for their forces.

The Social Determinants of Health (SDH) in Iran: A Systematic Review Article.

BACKGROUND: Many studies have been conducted in Iran in order to investigate the status of social determinants of health (SDH) and their associations with health indicators. This study aimed to review the Iranian studies conducted on SDH. METHODS: A systematic review of all Iranian Persian and English languages articles published between 2005 and 2014 on the SDH was conducted using the search of SID, Iran Medex, Iran Doc, Medline, Embase, Scopus, and Google Scholar databases. The eligibility criteria were studies describing SDH status, designed based on the WHO conceptual framework of SDH, published in Persian or English languages, and full text articles. The structured narrative approach was used to synthesize the data. RESULTS: The entire review process led to the selection of 21 papers. Most of studies had been conducted on the intermediary (38%) and structural (33%) components and determinants in Iran, 4 studies (19%) on the study of all components affecting the health and health inequality and, finally, the minimum number of studies (10%) on the context components and determinants. The focus of 43% of selected studies was on the WHO conceptual framework of SDH and had evaluated this model as an appropriate conceptual framework. CONCLUSION: In order to fill the gap in the scientific evidence of SDH and make appropriate policies and plans in Iran, it is needed to conduct studies on all SDH according to the WHO conceptual framework.