Exploring the barriers to Pap smear test compliance: A qualitative study for improving cervical cancer screening in the primary health care.

Background: Cervical cancer in Iran ranks as the fourth most frequent cancer among women. Pap smear (PS) is the best standard for detecting cervical cancer, but many people, even healthcare providers (HCPs), do not maintain it. HCPs play a critical role in promoting PS uptake. The purpose of the study was to explore barriers to cervical cancer PS screening compliance from the HCPs' perspective. Methods: The present qualitative content analysis was conducted through semi-structured in-depth interviews. A total of 28 HCPs were interviewed between July and August 2020. A diverse sample of HCPs was selected using purposive sampling. Data analysis was based on the five steps proposed by Graneheim and Lundman. MAXQDA (2020) was used for data analyzing. Results: Ten key sub-categories were identified and organized into three categories: individual, environmental, and socio-cultural factors. The sub-categories included inadequate risk perception, inappropriate attitude, low commitment, emotional factors, low priority over health, requirements and consequences of the test, deficiencies of health centers, organizational factors, traditions and religious believes. Conclusion: HCPs face multiple barriers for PS. Exploring and decreasing barriers of PS in HCPs may increase compliance in them and their clients because they play an influential role in instructing and persuading women to take the PS. There is need to explore these barriers and identify possible interventions to change them. Insights from this study are useful for developing policies around national PS programs, too.

Body image perception and physical activity behavior among adult population: Application of trans-theoretical model of behavior change.

BACKGROUND: The human body changes during life, but research on how sociodemographic characteristics and physical activity (PA) related to all aspects of body image are still unclear and there is conflict in the relevant results. This study aims to examine gender-specific body image perception and physical activity in relation to BMI and sociodemographic characteristics among health employees who worked in health and medical care centers. METHODS: The study was a population-based cross-sectional survey of 170 health employees (55 men and 115 women) in Binaloud, Iran. Participants completed a self-administered questionnaire, which consisted of a self-administered Multidimensional Body-Self Image Questionnaire (MBSRQ) and stages of change scales. The full version of Marcus-TTM based on the stages of physical activity changes was used based on 5 items related to regular physical activity behavior and intentions. RESULTS: There were no significant differences between men and women in total body image score, body area satisfaction, and attitude. Disease orientation (p = 0.02) and health orientation (p = 0.05) were the only significant differences between men and women. The number of children, level of education, BMI, and PA had a stronger influence on body image concerns and body dissatisfaction. PA and 7 of the 10 subclasses of MBSRQ (appearance evaluation, fitness evaluation, fitness orientation, health evaluation, health orientation, and illness orientation) showed a significant difference (P<0.05) between participants in the five TTM stages. CONCLUSION: The ideal body image and body satisfaction may differ by the number of children, level of education, gender, BMI, and PA. Evidence from this study supports that participants' stages of change affect their physical activity and body image perception. This result suggests a need for conducting work/home place intervention to promote adults' body image perception and body area satisfaction based on the usage-specific stage under consideration.

Women's perception of barriers and facilitators of cervical cancer Pap smear screening: a qualitative study.

OBJECTIVE: Although Pap smear (PS) is considered the best standard in detecting cervical cancer, adherence to timely and regular PS is often lower than global standards in developing countries. Thus, the present study aimed to identify barriers and facilitators of adherence to cervical cancer screening in Mashhad, Iran. DESIGN: A qualitative content analysis was done from July to December 2022 using semistructured in-depth interviews. SETTING: The study was conducted in health centres in Mashhad, Iran. PARTICIPANTS: A sample of 36 married women aged 18-70 years was selected using a purposive sampling, with maximum diversity. RESULTS: The mean age of participants was 42.8±7.6 years. Among all, 66.7% had the PS test at least once; only 8.3% regularly had the test. The qualitative content analysis led to the extraction of four major themes: (1) individual challenges, (2) environmental limitations, (3) individual motivators, and (4) supportive and efficient environments. The most significant barriers were psychological stress, unhealthy attitudes, insufficient information, cultural issues and insufficient healthcare services. Facilitators included an active and efficient healthcare system, advice and support of important others, and positive emotions and individual beliefs. CONCLUSIONS: Participants' perceptions showed that the main factors influencing the PS testing were supportive environments, individual motivators, individual challenges and environmental limitations. To encourage women to take the PS and reduce barriers, it may be necessary to revise current health system policies, promote individual and public awareness, reduce psychological stress and correct negative beliefs and attitudes.

Exploring the conceptual framework of a health-promotion faculty from the perspective of members: a qualitative study.

OBJECTIVES: Understanding the concepts and structures of health promotion in the faculty from the perspective of its members. STUDY DESIGN: Qualitative study. SETTINGS: Faculties of Medical Sciences University. PARTICIPANTS: A sample of four main groups in the faculty (students, faculty members, staff and managers) were purposively sampled for demographic characteristics and their views on the concepts of health promotion. METHODS: A descriptive qualitative study using thematic analysis of content was conducted. Data were obtained using semistructured interviews and then analysed thematically. MAXQDA V.10 software was used to organise and code the imported interview transcripts. RESULTS: Three main categories of management policy, environmental structure and executive strategies were identified as health-promotion structures in the faculty based on the views of the interviewees. CONCLUSION: The inclusion of a health-promotion approach in university policies requires administrators' commitment to health promotion and the participation of all members and partners inside and outside the faculty to identify health needs and engagement in programmes.

Predicting preventive behaviors of cardiovascular disease among oil industry workers based on health belief model.

BACKGROUND: Working conditions play a significant role in the process that causes cardiovascular disease. In this regard, it is required to monitor the health conditions of workers to design proper interventions to encourage healthy behaviors. This investigation was performed to determine preventive behaviors against cardiovascular disease based on the health belief model (HBM). MATERIALS AND METHODS: This research was a cross-sectional and descriptive study with 228 subjects of oil industry workers under shift work schedules in the oil regions of Khuzestan, Iran. The HBM questionnaire provided the theoretical framework for this study. Participants completed the questionnaires in person at work. Data were analyzed using SPSS 24.0. Descriptive statistics including frequencies, percentages, and means, and linear regression analysis were calculated for variables. RESULTS: Findings of the study showed that most workers were of a weak level of knowledge (55.3%), self-efficacy (82.5%), perceived severity (83.8%), perceived susceptibility (75.4%), perceived benefit (57.5%), and behavior (82.5%). Furthermore, results showed that most of the workers considered smoking (3.51 out of 5) and proper diet for good heart function (2.54 out of 5). In this study, the item of exercise was the lowest among all the preventive behaviors (1.39 out of 5). Self-efficacy was the strongest predictor of health belief about cardiovascular disease. CONCLUSION: To decrease the increasing burden of cardiovascular disease in our population, and fight against this rank-one killer, multiple useful prevention strategies must be adopted. Educational theory-based interventions and applying designed programs to improve the adoption of preventive behaviors are a necessity.

Predictors of physical activity among women in Bojnourd, north east of Iran: Pender's health promotion model.

BACKGROUND: This study examined how socio-demographic characteristics constructs derived from the health promotion model (HPM) influence the level of physical activity (PA) women in Bojnourd, North East of Iran. METHOD: This cross-sectional study has been carried out through multi-stage sampling design on 356 women aged 18-60 years living in Iran. Data was collected through reliable and valid questionnaire survey women who were selected from their homes. RESULTS: Most of participants (53.40%) had a low level of physical activity behaviors with minimal physical activity (PA) scores. Using regression analysis showed that 23.22% of the total variance in PA behaviors was predicted by socio-demographic variables, whilst 40.81% of the variance in PA behaviors was predicted by constructs from the HPM. The results from Path modeling indicated that prior behavior, interpersonal influences, perceived self-efficacy, perceived barriers and commitment to PA, were significant predictors for PA behaviors with 86.93% of total effects on PA, whereas, activity-related affect and situational influences had no significant effect on the PA behaviors. CONCLUSIONS: We found that constructs derived from the HPM are determinants of PA among Iranian women and may be important in developing educational intervention programs to facilitate a physically active lifestyle in this population.

Effect of a theory-based educational intervention for enhancing nutrition and physical activity among Iranian women: a randomised control trial.

OBJECTIVE: The relative contribution of health promotion models (HPM) to improve health-related behaviours in intervention programmes is still limited. Here, we tested whether Pender's HPM operationalised in the educational intervention was effective to modify nutrition and physical activity (PA) behaviours among Iranian women. DESIGN: A randomised controlled field trial evaluating the efficacy of an educational intervention based on Pender's HPM to improve PA and nutrition behaviours from August 2016 to October 2016. R version 3.0.2 and SPSS version 16 were used to conduct multiple statistical analyses. SETTING: Ten public healthcare centres in Bojnourd, Iran were randomly divided into intervention and control groups. The experimental group received the full intervention programme, which included nine 4-h training sessions and consulting support via phone contact and social media group. The control group did not receive any intervention. PARTICIPANTS: Women aged 4-6 years (n 202) were randomised to intervention (n 102) and control conditions (n 100) and completed baseline and 3-month follow-up. RESULTS: In the experimental group, the intervention programme had a significant effect (P < 0·05) on all construct of Pender's HPM and behaviour outcome, and the estimates for prior behaviours, self-efficacy, interpersonal influences, feeling, perceived benefits and barriers, commitment and behaviour outcomes in the intervention group were 0·72 (95 % CI 0·31, 0·98), 0·54 (95 % CI 0·27, 0·71), 0·74 (95 % CI 0·27, 0·91), 0·52 (95 % CI 0·19, 0·75), 0·62 (95 % CI 0·22, 0·91), 0·63 (95 % CI 0·30, 0·86) and 0·56 (95 % CI 0·37, 0·85), respectively. CONCLUSIONS: Educational intervention based on Pender's HPM was feasible and highly acceptable to modify PA and nutrition behaviours in the women population.

Women's Attempts Related to Complementary and Alternative Medicine Use in Infertility Causes and Diagnosis: A Narrative Inquiry.

In most cultures of the world, infertility is seen as a disaster and is associated with a myriad of emotional and psychological problems for women. Using Complementary and alternative medicine (CAM) can help treat infertility. The present qualitative study aimed to explore women's attempts related to CAM use in infertility causes and diagnosis. This qualitative study has been carried out through a purposive sampling technique on 78 women living in Neyshabur, Iran. An individual interview and focus group discussions (FGDs) was used to collect data. Purposive sampling was used based on the objective of the study and the characteristics of a population. The data collection was discontinued when saturation occurred, and no new themes or information were explored in the data. Data analysis was performed by content analysis and Atlas T software. This study revealed medical diagnosis and traditional medicine, custom activity, medicine causes, and nutrition issues influence women's view pints and attempt towards infertility and CAM use. Results suggested that infertility should be understood not only in biomedical terms but in light of cultural beliefs and the contingent need for culturally-appropriate supportive CAM. The application of CAM along with medical medicine is an essential element in assisting couples in infertility causes.

Behavioral determinants of brucellosis incidence among stockbreeders and their family members in rural area based on PRECEDE model.

INTRODUCTION: Brucellosis is one of the common diseases between humans and animals. The purpose of this study was to investigate behavioral determinants of brucellosis incidence among stockbreeders and their family members in a rural area based on the PRECEDE model. MATERIALS AND METHODS: This cross-sectional study was carried out among 540 stockbreeders and their family members in Northeastern Iran in 2019. Sampling was done in two stages including stratified sampling and random sampling method. Data collection was conducted by a valid and reliable questionnaire developed based on the PRECEDE model. Data were analyzed using SPSS16 through Pearson correlation coefficient, independent t-test, and ANOVA. Furthermore IBM SPSS AMOS version 20 was used for the path analysis. RESULTS: The mean age of the participants was 39.02 ± 16.41 years, of whom 53.1% and 46.9% were men and women, respectively. About 23.9% of the participants had a history of brucellosis in their families. Enabling factors were the most important determinant of self-efficacy and self-efficacy was the most important determinants of behavior. Evaluation of the chi-square indicators, chi-square ratio to degree of freedom, root mean square error of approximation, adjusted goodness of fit index, parsimony comparative fit index, comparative fit index, incremental fit index, and parsimonious normed fit index indices indicated that the model was well fitted and there was a positive and significant relationship between the predisposing, enabling, and reinforcing factors on the one hand and behavior on the other. chi-square indicators, chi-square ratio to degree of freedom, root mean square error of approximation, adjusted goodness of fit index, parsimony comparative fit index, comparative fit index, incremental fit index, and parsimonious normed fit index. CONCLUSION: Designing and implementing health plans based on the PRECEDE model with more emphasis on self-efficacy as the most important behavioral determinants can bring about a positive effect on enhancing the brucellosis preventing behaviors.

Psychometric Properties of a Questionnaire on Brucellosis Prevention Behaviors Based on the PRECEDE Model Among Rural Farmers and Their Family Members.

INTRODUCTION: Brucellosis is one of the most prevalent diseases in Torbate Heidarieh, Iran; it is a common disease between human and animals. The present study aimed to review the psychometric properties of a questionnaire on brucellosis prevention behaviors based on the PRECEDE model among rural farmers and their family members (PRECEDE-QBPB). MATERIALS AND METHODS: The study was a combination of qualitative and quantitative stages. In the qualitative stage, an 86-item questionnaire including interviews with 30 farmers, their family members and other effective people, as well as literature review, was designed. In the quantitative stage, psychometric properties of the PRECEDE-QBPB including the face, content, and constructs validities, as well as reliability measurement of the questionnaire were evaluated. Item impact, content validity ratio (CVR) and content validity index (CVI) for all items were calculated. Besides, confirmatory factor analysis (CFA) was done to evaluate the construct's validity; AMOS 20 was used for this purpose. In this stage, a cross-sectional study was conducted on 500 rural farmers and their family members. To estimate the internal consistency of this questionnaire, Cronbach's alpha was used for each variable. Further, descriptive statistics and Kaiser-Meyer-Olkin and Bartlett's test of sphericity were used to describe the characteristics of the participants and collect samples, respectively. RESULTS: Based on the results of face validity and content validity (CVR, CVI and CFA 9), 19 and 22 items were removed, respectively, leaving the final questionnaire with 36 items and eight subscales including knowledge, attitude, self-efficacy, social support, enabling factors, environmental factors, behavioral factors, and reinforcing factors. The Cronbach's coefficient alpha was calculated for the total questionnaire (α= 0.92, 0.69-0.87 for subscales). The evaluation of model fit indices showed that all indices confirmed the suitability of the final model fit; therefore, the questionnaire has suitable construct validity. CONCLUSION: A questionnaire, as a valid tool, was designed in the present study. Healthcare providers, policymakers, planners, researchers may use this tool to find a comprehensive understanding of enabling, reinforcing, environmental and behavioral factors that affect brucellosis before implementing health education and health promotion programs.

Stages of Behavior Change for Physical Activity in Airport Staff: a quasi-experimental study.

OBJECTIVES: This work sought to determine the effect of an educational intervention based on the stages of change in promoting physical activity in employees in the Mashhad airport in Iran. METHODS: This was a quasi-experimental study conducted with the participation of 60 volunteers (30 in the intervention group and 30 in the control group) who were in the stages of contemplating or preparing for change in physical activity. The intervention consisted in educational activities provided during home visits, telephone calls, group training sessions, and delivery of printed material. To gather the information, the study used five questions on the stage in which they were for behavioral change in physical activity, according to the Theoretical Model by Marcus et al., (1. pre-contemplation, 2. contemplation, 3. preparation, 4. action, and 5. maintenance), and the International Questionnaire on Physical Activity. Changes in the stages were evaluated during three moments: upon entering the study, at the end of the intervention (8th month), and two months after the second evaluation (10th month). RESULTS: During the 10th month evaluation, it was noted that 26.7% of the subjects from the intervention group versus 3.3% from the control group improved their physical activity and were in the action stage (p < 0.01). CONCLUSIONS: The educational intervention based on stages of change is effective in promoting physical activity in the participants and may be used in educational programs that seek to improve physical activity in the employees studied.

Stages of Behavior Change for Physical Activity in Airport Staff: a quasi-experimental study

Objective. This work sought to determine the effect of an educational intervention based on the stages of change in promoting physical activity in employees in the Mashhad airport in Iran. Methods. This was a quasi-experimental study conducted with the participation of 60 volunteers (30 in the intervention group and 30 in the control group) who were in the stages of contemplating or preparing for change in physical activity. The intervention consisted in educational activities provided during home visits, telephone calls, group training sessions, and delivery of printed material. To gather the information, the study used five questions on the stage in which they were for behavioral change in physical activity, according to the Theoretical Model by Marcus et al., (1. pre-contemplation, 2. contemplation, 3. preparation, 4. action, and 5. maintenance), and the International Questionnaire on Physical Activity. Changes in the stages were evaluated during three moments: upon entering the study, at the end of the intervention (8th month), and two months after the second evaluation (10th month). Results. During the 10th month evaluation, it was noted that 26.7% of the subjects from the intervention group versus 3.3% from the control group improved their physical activity and were in the action stage (p<0.01). Conclusion. The educational intervention based on stages of change is effective in promoting physical activity in the participants and may be used in educational programs that seek to improve physical activity in the employees studied.

Objetivo. Determinar o efeito de uma intervenção educacional baseada nos estágios de mudança na promoção da atividade física nos funcionários do aeroporto de Mashhad, no Irã. Métodos Estudo quase experimental realizado com a participação de 60 voluntários (30 no grupo intervenção e 30 no grupo controle) que estavam nos estágios de contemplação ou preparação para a mudança na atividade física. A intervenção consistiu em atividades educativas realizadas durante visitas domiciliares, telefonemas, sessões de treinamento em grupo e entrega de material impresso. Para a coleta de informações, foram utilizadas 5 questões no estágio em que se destinava à mudança de comportamento na atividade física, conforme o Modelo Transteórico de Marcus et al. (1. pré-contemplação, 2. Contemplação, 3. Preparação, 4. Ação e 5. Manutenção) e o Questionário Internacional de Atividade Física. As alterações nas etapas foram avaliadas em três momentos: na admissão ao estudo, ao final da intervenção (mês 8) e dois meses após a segunda avaliação (mês 10). Resultados. Na avaliação de 10 meses, observou-se que 26.7% dos indivíduos no grupo intervenção versus 3.3% no grupo controle melhoraram a atividade física e estavam no estágio de ação (p<0.01). Conclusão A intervenção educacional baseada nos estágios de mudança é eficaz na promoção da atividade física dos participantes e pode ser usada em programas educacionais que visam melhorar a atividade física dos funcionários.

Objetivo. Determinar el efecto de una intervención educativa basada en las etapas de cambio en la promoción de la actividad física en los empleados del aeropuerto de Mashhad en Irán. Métodos. Estudio cuasiexperimental realizado con la participación de 60 voluntarios (30 en el grupo de intervención y 30 en el grupo control) quienes se encontraban en las etapas de contemplación o preparación para el cambio en la actividad física. La intervención consistió en actividades educativas proporcionadas durante visitas domiciliarias, llamadas telefónicas, sesiones de capacitación en grupo y entrega de material impreso. Para la recolección de información se utilizaron 5 preguntas sobre la etapa en la que se encontraba para el cambio de comportamiento en la actividad física, según el Modelo Transteórico de Marcus et al. (1. pre-contemplación, 2. contemplación, 3. preparación, 4. acción y 5. mantenimiento), y el Cuestionario Internacional de Actividad Física. Los cambios en las etapas se evaluaron en 3 momentos: al ingreso al estudio, al finalizar la intervención (mes 8) y dos meses después de la segunda evaluación (mes 10). Resultados. En la evaluación de los 10 meses se apreció que el 26.7% de los sujetos del grupo de intervención versus el 3.3% del grupo control mejoraron su actividad física y se encontraban en la etapa de acción (p<0.01). Conclusión. La intervención educativa basada en las etapas de cambio es efectiva en la promoción de la actividad física en los participantes por lo que puede ser empleada en programas educativos que tengan como objetivo mejorar la actividad física de los empleados

Family-centred empowerment program for health literacy and self-efficacy in family caregivers of patients with multiple sclerosis.

BACKGROUND: With the obtained advancement in solving health problems, family caregivers are replaced with the care institutions. The accompanying and supporting patients during the disease treatment is very effective in the Iranian culture. AIM: This study aims at determining the effect of health intervention based on family-centred empowerment model on health literacy and self-efficacy among caregivers of patients with multiple sclerosis. METHODS: In this quasi-experimental study, 70 family caregivers were randomly assigned to the two control and experimental groups, who were evaluated using demographic TOFHLA health literacy and self-efficacy questionnaires. Then, based on training needs in the experimental group, intervention was conducted based on the family-centred empowerment model during one month. The control group received no intervention, and immediately after training and three months after implementing the program, the health literacy and self-efficacy in both the experimental and control groups were re-evaluated. RESULTS: Before intervention, mean of health literacy in the experimental group was 57.2 ± 9.15 and 3 months after intervention, it reached 62.45 ± 9.39, (p < 0.001). The self-efficacy score in the experimental group was 17.2 ± 3.48 before intervention and it reached to 19.34 ± 11.3 after intervention, which was also significant(p < 0.001). CONCLUSION: interventions based on family-centred empowerment approach can improve the health literacy and self-efficacy of caregivers, assist them to provide specialised and efficient care and lead to improved quality of care in caregiving.

Self-care behaviors in patients with type 2 diabetes: Education intervention base on social cognitive theory.

AIM: This study aimed to determine the effect of education intervention, based on social cognitive theory, on self-care behaviors in patients with type 2 diabetes. METHODS: This study was conducted in descriptive and interventional stages. The effective factors and constructs of social cognitive theory were identified in a descriptive study (n = 320). After that, a quasi-experimental study was conducted to determine the effect of intervention on 120 diabetic patients whom were randomly assigned to experimental and control groups. The educational intervention was implemented in six 40 -minute sessions for the experimental group. The questionnaires were completed before, immediately after and three months after the intervention. RESULTS: The results of regression showed that emotional adaptation (P < 0.05), self-efficacy to overcome barriers (P < 0.05) and self-regulation (P < 0.05) could predict self-care. There was no significant difference between the experimental and control groups before the educational intervention, however, after the intervention, there was a significant difference in self-care (p < 0.001), knowledge (p < 0.001), outcome expectations (p < 0.001), outcome value (p < 0.001), self-efficacy (p < 0.001), self-efficacy to overcome barriers(P < 0.001) p), environment (p < 0.001), observational learning (P < 0.05), situational perception (p < 0.001), self-regulation (p < 0.001) and emotional adaptation (p < 0.001)) in the intervention group. CONCLUSION: The results of this study showed that intervention, based on social cognitive model, has a positive effect on diabetes self-care in the patients. Emotional adaptation, self-efficacy to overcome barriers and self-regulation have the biggest impact on diabetes self-care.

Applying a health action model to predict and improve healthy behaviors in coal miners.

INTRODUCTION: One of the most important ways to prevent work-related diseases in occupations such as mining is to promote healthy behaviors among miners. This study aimed to predict and promote healthy behaviors among coal miners by using a health action model (HAM). METHOD: The study was conducted on 200 coal miners in Iran in two steps. In the first step, a descriptive study was implemented to determine predictive constructs and effectiveness of HAM on behavioral intention. The second step involved a quasi-experimental study to determine the effect of an HAM-based education intervention. This intervention was implemented by the researcher and the head of the safety unit based on the predictive construct specified in the first step over 12 sessions of 60 min. The data was collected using an HAM questionnaire and a checklist of healthy behavior. RESULTS: The results of the first step of the study showed that attitude, belief, and normative constructs were meaningful predictors of behavioral intention. Also, the results of the second step revealed that the mean score of attitude and behavioral intention increased significantly after conducting the intervention in the experimental group, while the mean score of these constructs decreased significantly in the control group. CONCLUSION: The findings of this study showed that HAM-based educational intervention could improve the healthy behaviors of mine workers. Therefore, it is recommended to extend the application of this model to other working groups to improve healthy behaviors.

Digital Media-based Health Intervention on the promotion of Women's physical activity: a quasi-experimental study.

BACKGROUND: Technological advances have caused poor mobility and lower physical activity among humankind. This study was conducted to assess the impact of a digital media-based (multi-media, internet, and mobile phone) health intervention on promotion of women's physical activity. METHODS: In this quasi-experimental study, 360 women were divided into case and control groups. The digital media-based educational intervention was conducted in two months in the case group electronically, using mail and Internet and telephone platforms. Physical activity was measured using International Physical Activity Questionnaire (IPAQ) that estimated women's physical activity rate in the previous week. Data was analyzed using descriptive and analytical statistics (ANOVA, chi-square, paired and independent t-tests) using SPSS 20. RESULTS: The mean score of knowledge, attitude and level of physical activity in the control group were not significantly different before and after the intervention. While in the case group, this difference before and after the intervention was significant (p < 0.001), and mean scores of the above-mentioned factors increased after the intervention. CONCLUSIONS: Using innovative and digital media-based health education can be effective in improving health-based behavior such as physical activity. Therefore, it seems necessary to develop user-based strategies and strengthen the behavioral change theories and hypotheses based on digital media for effective influence on behavior. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT), IRCT20160619028529N5 . Registered December 24, 2017 [retrospectively registered].

Assessment of health literacy with the Newest Vital Sign and its correlation with body mass index in female adolescent students.

Background One of the significant outcomes of health education is health literacy (HL), which should be expanded to improve health promotion. Objective The aim of this study was to assess HL and its relationship with Body Mass Index (BMI) in female adolescent students. Subjects This study was conducted on 235 female students (aged 13-15 years) which were selected with cluster sampling. Methods For assessing HL, the Newest Vital Sign (NVS) was used and BMI Z-score was evaluated following the World Health Organization (WHO) guidelines. Data were analyzed using SPSS version 16. Results Based on this study's results, 11.5%, 37% and 51.5% of adolescents had adequate HL, limited HL and inadequate HL, respectively. There was a negative correlation between adolescents HL and BMI, rs = -0.233 (p < 0.001). Conclusion Most of adolescents had limited HL and students with higher BMI had a worse HL score. As a matter of fact, as adequate HL has a significant role for promoting health in the society policy makers must design educational programs for adolescents especially in non-medical settings such as schools where adolescents spend most of their time.

Comparing Motivational Interviewing-Based Treatment and its combination with Nicotine Replacement Therapy on smoking cessation in prisoners: a randomized controlled clinical trial.

BACKGROUND: The prevalence of smoking is much higher in prisoners than it is in the general population. Prisoners who smoke cause many health problems for themselves and other prisoners. Therefore, we should help them stop smoking. OBJECTIVE: To compare the effects of motivational interviewing-based (MI-based) treatment and its combination with nicotine replacement therapy (NRT) on smoking cessation in prisoners at Mashhad Central Prison. METHODS: The study was designed as a double-blind, randomized, controlled clinical trial, and it began in February 2013 and ended in February 2014. Two hundred and thirteen prisoners met the inclusion criteria and were enrolled in the study. They were divided randomly into three groups, i.e., MI-based treatment, MI with NRT, and the control group, which didn't receive any therapy. The outcome measures were reported after intervention and at a 90-day follow-up, and changes in the CO levels in expired air and nicotine dependency were measured. RESULTS: The average age of the subjects was 37.59 ± 8.76, and their mean duration of imprisonment was 3.3 ± 1.90 years. They smoked an average of 21.84 ± 8.72 cigarettes per day. Analysis of the concentration of CO in expired air in the pre-test, post-test, and at the follow-up for the three groups showed that the variations in the mean CO concentrations in the MI group and the MI with NRT group at the pre-test and at the post-test were statistically significant (p < 0.001), but no significant changes occurred between the post-test and the follow-up (p > 0.050). In addition, the results indicated that CO concentration in expired air in the MI with NRT group was statistically significant, with better efficacy of smoking cessation, compared with control group and the MI group after the follow-up (p = 0.02). CONCLUSIONS: Motivational interviewing combined with NRT for smoking cessation is more effective than MI alone, and it resulted in a significant decrease in the CO concentration in expired air at the 90-day follow-up.

Knowledge of Iranian medical interns regarding cardio-pulmonary resuscitation.

OBJECTIVES: Cardio-Pulmonary Resuscitation (CPR) is one of the most important procedures in emergency medicine. As new trends are evolving in medical education , we planned to evaluate the interests and knowledge of medical students regarding educational methods in CPR learning. MATERIALS AND METHODS: In a cross-sectional analytical descriptive study, a standardized questionnaire was distributed among 180 medical interns at the Mashhad University of Medical Sciences. The questionnaire had three parts: demographics, general questions, and CPR knowledge. If they had more than 10 correct answers (out of 15) in knowledge, they were placed in group A and if more than 5, in group B and correct answers less than 5 were categorized in group C. RESULTS: 159 interns filled the questionnaires. Mean age was 24.99 ± 0.96 and 56.5% were female; 52.7% were educated only theoretically and 47.3% had combined theoretical and clinical knowledge; male interns were significantly more educated (P = 0.041). Residents were the majority of trainers (56.8%) and only 14.3% were educated by the staffs. Only 7% mentioned that they felt they could do a complete CPR and 37.3% considered themselves as assistants; 93.7% believed that isolated emergency ward and teaching courses were needed for better education and 95% declared that continuous education is obligatory; 33.5% were in group A and 45.8% were in group B. CONCLUSIONS: CPR education is of interest to most interns. Due to lack of emergency medicine wards and, the interns' knowledge and their practical skills were insufficient to perform acceptable CPR.