Impact of health literacy and illness perception on medication adherence among older adults with hypertension in Iran: a cross-sectional study.

Background: Adherence to medication is an essential factor in controlling and reducing the side effects of non-communicable diseases, particularly hypertension. Medication adherence varies in older adults due to the effects of various factors. The research aimed to examine the determinants of medication adherence among older adults with hypertension. Methods: This cross-sectional study was performed among 300 people aged 60 years or older referring to health centers in Sarab, Iran, between February and May 2023. To collect data, valid and reliable tools were applied. Results: There was a significant association between age groups, level of education, and monthly income status with adherence to medication (p-value <0.05). According to the results of hierarchical regression, demographic variables collectively explained 3.2% of the variance in adherence to therapeutic regimens (p-value = 0.143). The inclusion of illness perception at step 2, along with demographic variables, led to a further significant increase in 9.6% of the variance (p-value <0.001). In the final step, health literacy dimensions were added, which explained an additional 8.7% of the variance (p-value <0.001). In total, demographic variables, illness perception, and HL dimensions explained 21.5% of the variance in adherence to therapeutic regimens. Conclusion: According to the results, demographic variables, illness perception, and HL dimensions were the main determinants of medication adherence among older adults. Health educators should focus on creating interventions that improve medication adherence by addressing illness perception and health literacy dimensions in this particular population.

Psychological well-being and factors affecting it after the COVID-19 pandemic.

Introduction: The COVID-19 pandemic has enormously impacted human activity worldwide, partly due to many governments issuing stay-at-home orders and limiting the types of social interactions citizens can engage in. Hence, this study investigated psychological well-being and factors affecting it after the COVID-19 pandemic. Methods: A total of 345 participants were recruited in the study. This research was conducted between February and May 2023 in Sarab, East Azerbaijan, Iran. To measure the data, valid and reliable instruments of Goldberg's General Health Questionnaire (GHQ-28), Multidimensional Health Locus of Control (MHLC), interpersonal support evaluation list (ISEL-SF), and health-protective behaviors checklist instrument were used. Results: According to the results, health locus of control (r = 0.227; p < 0.001), social support (r = 0.339; p < 0.001), and COVID-19 preventive behaviors (r = 0.376; p < 0.001) were positively correlated with psychological well-being. The strongest correlation was observed between psychological well-being and protective behaviors (r = 0.376; p < 0.001). In the hierarchical regression model, total, demographic characteristics along with health locus of control, social support, covid-19 preventive behaviors, and history of COVID-19 infection were able to explain 57.4% of the variation in psychological well-being. Discussion: Public healthcare providers' and policymakers' preventive and supportive actions are highly advised for promoting health locus of control and social support in adults after the COVID-19 pandemic. In addition, it is better to include a community's social and environmental changes.

Barriers to COVID-19 vaccine uptake: classification and the role of Health Literacy and Media Literacy.

Background: Vaccination is one of the most influential and cost-effective health interventions for preventing and reducing COVID-19 diseases. Unfortunately, the majority of the world's population is deprived of vaccination. Health Literacy (HL) and Media Literacy (ML) are essential to the COVID-19 vaccination. The present study investigates the barriers to COVID-19 vaccine uptake, focusing on classification and the roles of HL and ML. Methods: A cross-sectional study was conducted among people 18-65 years old in Sarab City, located in East Azerbaijan, Iran, between September to October 2020. Multistage cluster sampling was employed to recruit 298 people from Health Care Services Centers (HCCs). Results: The results of this research demonstrated that about 32.6% of participants reported that they have fully injected COVID-19 vaccines. Also, HL was positively associated with ML (r = 0.214, p < 0.05). Barriers of COVID-19 vaccine uptake were classified into personal, interpersonal, group and organizational, society and decision-making factors. Besides, barriers to the COVID-19 vaccine were significantly correlated with HL (r = -0.298, p < 0.05) and ML (r = 0.266, p < 0.05). Additionally, in the hierarchical regression model, demographic characteristics accounted for 8.2% of the variation in barriers to the COVID-19 vaccine (F = 4.34; p = 0.001), that monthly income (ß = -0.237; p < 0.05) and marriage statues (ß = 0.131; p < 0.05) were statistically associated with low barriers. HL as predictor variables explained an additional 14.4% of variation in barriers of COVID-19 vaccine (F = 53.84; p < 0.001) and ML explained an extra 9.2% of the variation (F = 38.83; p < 0.001). In total, demographic characteristics, HL dimensions and ML were able to explain 31.8% of the variation in barriers to COVID-19 vaccine. Conclusions: According to the findings, various strategies are needed to increase the COVID-19 vaccination uptake. This is due to the fact that barriers to COVID-19 vaccination uptake are multifactorial. These facts can help health policymakers and healthcare providers design media-based interventions to reduce barriers to COVID-19 vaccination uptake among adults. Enhancing vaccine HL and ML for adults and improving vaccine confidence are of high priority.

Head lice infestation and the role of some cognitive-behavioral factors in its spread and prevention among adolescent girls: A cross-sectional study in Northwest Iran.

Background and Aims: Head lice is a public health problem of worldwide distribution, particularly among school children and girls. Head lice infestation (HLI) can lead to negative social and psychological outcomes such as distress and anxiety in children and their families. Hence, the present study aimed to investigate the role of cognitive-behavioral factors in its spread and prevention among adolescent girls. Methods: The cross-sectional study was conducted among 276 school-aged adolescent girls from September 2022 to January 2023 in Herris, a city located in Northwest Iran. A multistage cluster random sample was used to recruit adolescent girls in secondary schools. Two schools were randomly selected from five secondary schools. Then, students in each school were randomly selected from a school list. Data were collected using a valid and reliable questionnaire. Results: The high protective behaviors were significantly associated with the number of family members (ß = 0.158; p value = 0.012). An additional 21.8% of the variation in preventive behaviors was explained by cognitive factors as predictor variables (p value > 0.05). Perceived collective family efficacy, perceived barriers, perceived self-efficacy, and response efficacy were predictors of head lice preventive behaviors, respectively. Among all variables, perceived collective family efficacy was the strongest predictor. Conclusions: The findings of current research support the determinants of the cognitive-behavioral factors in the spread and prevention of HLI. It is better to involve these factors in school-based educational programs by policymakers and healthcare providers.

The Role of Perceived Social Support on Quality of Life in People with Cardiovascular Diseases.

Background: Cardiovascular Diseases (CVDs) are one of the major causes of hospitalization and mortality worldwide. Strengthening perceived social support and quality of life can reduce these problems. This study aimed to describe the role of perceived social support on cardiovascular patients' quality of life. Methods: This cross-sectional study was conducted from September 2020 to February 2021. We selected 150 cardiovascular patients through convenience sampling. The questionnaires included: the Persian version of the WHOQOL-BREF, Perceived Social Support, and demographic variables. Hierarchical linear regression was used to explore the association between perceived social support and quality of life. Data were analyzed by SPSS version 21.0 software. A P-value less than 0.05 is considered statistically significant. Results: The demographic variables could predict 12.2% of the variance of quality of life in the first step. In the second step, after adjusting control variables and dimensions of social support, the predictability increased to 29% of the variance with the addition of variables. All dimensions of social support, excluding tangible assets support, were significant predictors of quality of life and monthly income status. Self-esteem support (ß= 0.387) was the strongest predictor of quality of life in cardiovascular patients. Conclusions: Patients with higher perceived social support have a better quality of life than the other patients. Perceived social support is one of the strategies that can be utilized to improve quality of life and overcome disease in cardiovascular patients.

Assessment of Health Literacy and Health Promoting Behaviors among the Urban Adult Population.

Background: The main criteria of health determinants are Health Promoting Behaviors (HPBs) and Health Literacy (HL). This study aimed to assess HL and HPBs among the urban population of adults. Methods: This study was conducted as a cross-sectional study with 379 adults in Iran. The inclusion criteria was that participants were randomly selected from health centers using health records. Data were collected by demographic information questionnaire, Health Literacy for Iranian Adults (HELIA) and Health Promoting Lifestyle Profile II (HPLP-II). Descriptive statistics, independent samples t-test, and Pearson's r correlation coefficient were used to analyze the data. Also, the hierarchical regression analysis was used to adjust for confounders. Results: There was a significant association between HL and demographic factors, including age, gender and education level. HL dimensions were significantly correlated with HPBs of adults (p <0.05). Decision-making was the strongest HL dimension to predictive HPBs (ß=0.606). In this study, 49.7% of the variation in HPBs is predicted by the HL, and the demographic characteristics. Conclusions: It can be advantageous to design programs to promote HL and HPBs in adults, focusing on the aging group, gender, and education level.

The role of e-health literacy and some cognitive factors in adopting protective behaviors of COVID-19 in Khalkhal residents.

Background: Several vaccines have recently been generated and are being utilized to prevent COVID-19 mortality. Although the disease is causing many fatalities worldwide, preventative practices should be prioritized, even if vaccines are available. Therefore, this study aimed to identify the role of e-health literacy and some cognitive factors in adopting protective behaviors against COVID-19 in Khalkhal residents. Methods: In the present cross-sectional study we recruited 380 people aged 18-65 according to cluster sampling from September 2021 to December 2021 in Khalkhal County, Iran. Reliable and validated tools were applied to data collection, including the eHealth Literacy Scale (eHEALS) in Persian and the Cognitive factors assessment questionnaire based on the Health Belief Model (HBM). Data were analyzed using Chi-square, one-way ANOVA, independent samples t-test, and bivariate correlation. The predictors were also determined using hierarchical linear regression analysis. Results: The average age of the participants was 35.26 ± 11.51 years. The regression analysis implied that gender (p-value = 0.032), education level (p-value = 0.001), occupational status (p-value = 0.002), income (p-value = 0.001), and marriage (p-value = 0.001) had statistically significant associations with e-HL. Additionally, education level (p-value = 0.001), occupational status (p-value = 0.001), income (p-value = 0.001), and marriage (p-value = 0.002) revealed statistically significant associations with COVID-19 preventive behaviors. Approximately 16.5% of the variation in the COVID-19 protective behaviors is explained by the cognitive factors and the demographic variables. Overall, demographic, cognitive, and e-HL variables were able to explain roughly 35.5% of the variation in COVID-19 protective behaviors. Furthermore, self-efficacy was the strongest predictor of protective behaviors (ß = 0.214). Conclusions: HBM constructs successfully predicted the role of e-health literacy and some cognitive factors in adopting COVID-19 protective behaviors. People with high socioeconomic levels were better at e-health literacy and COVID-19 protective behaviors during the pandemic. Moreover, applying approaches to adopting COVID-19 protective behaviors is essential, especially in low socioeconomic status (SES) groups.

Predictors of self-care behaviors and glycemic control among patients with type 2 diabetes mellitus.

Aims: This study used the Extended Theory of Reasoned Action (ETRA) to predict self-care behaviors and HbA1c among patients with type 2 diabetes in Iran. Materials and methods: A cross-sectional study was performed using a multistage random sample. A total of 240 patients with type 2 diabetes, who were referred to the diabetes healthcare centers in Chaldoran, participated in the research. Instruments consisting of standardized questionnaires were used based on the Extended Theory of Reasoned Action (ETRA) constructs and the summary scale of diabetes self-care behaviors measure. Findings: The results of this study demonstrated that demographic variables explained ~ 7% (p-value = 0.23) and ETRA constructs 18% of the variance (p-value = 0.02) in behavioral intention, respectively. According to the hierarchical multiple linear regressions on self-care behaviors, demographic factors (p-value 0.001) dictated 45.7% of the variation of the self-care behavior, while knowledge, attitude, self-efficacy, and behavioral intention (p-value 0.001) accounted for 63.4% of the variance. The ETRA constructs, self-care practices, and demographic factors together account for almost 57% of the variation in the HbA1c. Self-care practices were the best indicator of HbA1c (ß = -0.593). Conclusion: ETRA constructs and self-care behavior can be the best determinants of HbA1c level in type 2 diabetes. This model is suggested to be applied in designing intervention programs to improve HbA1c in these groups of patients.

Impact of health literacy and self-care behaviors on health-related quality of life in Iranians with type 2 diabetes: a cross-sectional study.

BACKGROUND: Regarding the importance of health literacy as a key factor in self-care, appropriate understanding of health information by patients with type 2 diabetes mellitus (T2DM) is fundamental for better management of risk factors, which can also benefit their quality of life. This study aimed to describe the relationship between health literacy (HL), and self-care behaviors with health-related quality of life (HRQL) in patients with T2DM. METHODS: A cross-sectional survey was done in Iran in 2019. Patients were recruited randomly from health centers by medical records (n = 192, 55.2% male, mean age 58.12 years). The data collection included demographic form, health literacy questionnaire, diabetes self-care behavior questionnaire, and world health organization's Quality of Life-BREF (WHOQOL-BREF). Analyses were adjusted for confounders using hierarchical regression analysis. RESULTS: HL as predictor variables explained 47.5% of variance in overall HRQL (p value < 0.001), reading health information was the strongest HL dimension (ß = 0.478). Self-care behaviors explained an additional 13.6% of the HRQL variance. In total, 65.5% of the variation in the HRQL is explained by the HL, self-care behavior, and the demographic variables. CONCLUSION: We found that more almost two-third of the HRQL explained by the HL and self-care behaviors. Given the importance of health literacy and self-care behaviors in the quality of life in patients with T2DM, adoption of health-promoting behaviors and increasing health literacy can be beneficial for promoting quality of life among these patients.

The Association of Health Literacy Level with Self-Care Behaviors and Glycemic Control in a Low Education Population with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Iran.

INTRODUCTION: Promoting Health Literacy (HL) can be a priority in strategic healthcare planning of the countries. Low HL is prevalent in some societies which make barriers to successful self-care of diseases. The aim of this study was to examine the association of HL with self-care behaviors and glycemic control in a low education population with type 2 diabetes mellitus. METHODS: This cross-sectional study was conducted in Sarab city, Iran. The 192 participants were patients diagnosed as type 2 diabetes and with low level of education. Convenient sampling method was applied and the participants were chosen by their medical records in health-care centers. To collect data a valid and reliable tool was used based on HL dimensions and self-care behaviors. Using hierarchical logistic regression, the possible association of variables with self-care behaviors and glycemic control was assessed. RESULTS: The mean age of study participants was 58.12 (±11.83) years. A 28.8% of the variation in the self-care behaviors is explained by the HL and the demographic variables (R= 0.288%; p-value<0.05). Furthermore, decision-making was the strongest predictor of self-care behaviors (ß= 0.451). Approximately 80% of the variation in the HbA1c is explained by the HL, self-care behaviors, and the demographic variables (R= 0.804%; p-value<0.05). CONCLUSION: This study revealed that the HL dimensions predicted approximately one-fourth of self-care behaviors and the self-care behaviors and HL dimensions about eight-tenths of HbA1c in this population. These findings call for the need for interventional programs on HL to improve the self-care behaviors and HbA1c control.

Assessing the link between head lice infestation and selected cognitive-behavioral factors in a sample of Iranian female adolescents.

BACKGROUND: Head lice infestation is a serious health issue among adolescents in Iran. The primary purpose of the study was to determine the association of head lice infestation with cognitive-behavioral factors in female adolescents. METHODS: The study was cross-sectional, took place between September and October of 2017 in Sarab, East Azerbaijan province, Iran. Using a multi-stage sampling to recruit the study's 226 female adolescents, five of the Sarab's 13 schools were selected through simple random sampling. In the second step, the students were randomly selected using the systematic random sampling method. A survey questionnaire was used to collect the data. FINDINGS: The prevalence rate of head lice was calculated 20.4%, and the subjects with head lice infestation had lower levels of severity, benefits, self-efficacy, and preventive behaviors. Those without head lice infestation reported adhering to preventive behaviors. The perceived severity and self-efficacy were the statistically significant predictors of head lice infestation and use of preventive behaviors. CONCLUSION: Public health authorities, with feedback from the community, must design and implement prevention programs, focusing on mothers and their school-aged children, school principals, and managers of public places as potential change agents. In addition to, perceived severity and self-efficacy should be considered as the key categories when developing these prevention programs.

Adherence to a Health Literacy and Healthy Lifestyle with Improved Blood Pressure Control in Iran.

INTRODUCTION AND AIM: High blood pressure is the leading and most important modifiable risk factor for cardiovascular disease. Health literacy and lifestyle are two paramount key factors behind better control of hypertension. This study was conducted to examine the current situation of health literacy and health-promoting lifestyle and its association with blood pressure control among people affected by hypertension in the population over age 30 of Northwest Iran. PATIENTS AND METHODS: This was a cross-sectional study conducted in October and December 2018 on the over 30-year-old population among subjects suffering from hypertension (n= 210). A self-reported questionnaire was used for assessing health literacy dimensions and lifestyle. RESULTS: In hierarchical linear analysis, the HL explained 33.9% of the variance in healthy lifestyle. Among HL dimensions, the ability to access health information and decision-making were significantly associated with healthy lifestyle. The health literacy dimensions contributed to an additional significant increase in 4.7% of the variance explained in hypertension, furthermore, the health-promoting lifestyle items were explained an additional 14.8% of the hypertension variance. In total, lifestyle and health literacy dimensions were able to explain 21.7% of the variance in hypertension. CONCLUSION: Our study encourages efforts to monitor health literacy in people with hypertension and investigate associations with involvement with health-promoting lifestyle.

Cognitive Factors Associated to Pediculosis Preventive Behaviors Among Mothers of School-Age Children in Chaldoran County, Iran.

BACKGROUND: Despite the improvement of living standards and public health as well as conducting the specific programs based on pediculosis control guidelines, Head Lice Infestation (HLI) is still a worldwide health concern. The purpose of this study was to investigate the cognitive factors associated to school-age children's HLI among mothers in an urban community. SUBJECTS AND METHODS: In this cross-sectional study, a multi-stage cluster random sample of 619 mothers of students in elementary schools of Chaldoran County, located in North-West of Iran, was recruited to participate in the study. Data were collected applying a set of questionnaires including socio-demographic and cognitive-behavioral factors, including Pediculosis Preventive Behaviors (PPBs), HLI knowledge, threat appraisal, as well as HLI prevention perceived self-efficacy, response efficacy, and perceived collective family efficacy. RESULTS: Statistically significant differences were found in the children's HLI by their mother's age and performance in PPBs (p-value=0.001). Hierarchical multiple linear regressions were performed with PPBs as outcome variable. According to their natures, the predictors for this outcome variable were classified in two different blocks. Demographic characteristics (p > 0.05), and cognitive constructs (p< 0.001) explained 9% and 21.1% of the observed variance in PPBs, respectively. Pediculosis was found as an epidemic among the students, particularly female students, of Chaldoran County, which call for action by health stakeholders and policymakers. CONCLUSION: The healthcare providers are recommended to develop HLI prevention programs, within which the mothers and their school-age children as well as school mangers and public places' employers are considered as the core target groups for interventions. Besides PPBs, response efficacy and perceived collective family efficacy to perform the behaviors should be considered as the core categories while designing such prevention programs.

Factors related to delay in initiating post-exposure prophylaxis for rabies prevention among animal bite victims: a cross-sectional study in Northwest of Iran.

OBJECTIVES: The aim of the present study was to identify factors associated with h delayed initiation of post-exposure prophylaxis (PEP) among animal bite victims. METHODS: This cross-sectional study assessed biting patterns among 3032 cases that were referred to Tabriz Rabies Center. The delay was described as the initiation of PEP more than 48 hours (h) after possible exposure to the rabies virus. Determinants of delay in initiating PEP were recognized by a decision tree model. RESULTS: Totally, 8.5% of the victims who were bitten by an animal had a delay of more than 48 h in the initiation of PEP. The relative frequency of a delay more than 48 h in females was higher than in males (12.9% compared to 8.5%) (p-value= 0.004). Relative frequency of a delay of more of 48 h from carnivorous (dog, jackal, fox) was significantly less than others (p-value< 0.001). Of the decision tree, the overall classification accuracy was 89.5%, with 44.1% sensitivity and 92.3% specificity. The identified variables included gender, biting place (rural, urban), and type of animal. CONCLUSION: according to the results of the present study, among the various variables that affect the delayed initiation of PEP, rural residents and being female, in particular, were the major factors associated with a delay in the initiation of PEP for rabies prevention. We found relatively low rates of vaccine completion. Our findings indicat that providing training and patient education are required to ensure the completion of appropriate treatment.

Cognitive factors associated with brucellosis preventive behaviours among diagnosed patients: an application of Empowerment Model.

BACKGROUND: Brucellosis is an endemic disease in many countries, especially in the Mediterranean region, as well as countries such as the Islamic Republic of Iran. Despite the preventive measures against brucellosis adopted in different countries throughout the world, the disease is still a public health concern. AIMS: Our aim in the present study was to examine the cognitive factors associated with Brucellosis Preventive Behaviours (BPBs) among diagnosed patients utilizing Empowerment Model. METHODS: In 2013, applying a cross-sectional study, all 238 patients with brucellosis in Chaldoran County, Islamic Republic of Iran, were recruited to answer a researcher-made EM-based questionnaire and BPBs Scale through interview. RESULTS: Hierarchical multiple linear regressions were performed with BPBs as the outcome variable. Predictors for this variable, according to their natures, were classified in two different blocks. In the first block, significant effect was found on BPBs by demographic variables (ΔR2 = 0.301). In the second block, the level of education, knowledge, and self-efficacy were significant predictors (P < 0.001) of BPBs (ΔR2 = 0.808). CONCLUSIONS: The Empowerment Model was found as a helpful framework in predicting the risk factors of BPBs. Health care providers in low- and middle-income countries should consider the patients' knowledge on the disease and their level of self-efficacy to perform BPBs as the core categories of empowerment while designing brucellosis prevention programmes.

Cognitive predictors of physical activity behaviors among rural patients with type 2 diabetes: applicability of the Extended Theory of Reasoned Action (ETRA).

Background: This study aims to examine the cognitive-behavioral determinants of physical activity behaviors (PABs) of patients diagnosed with type 2 diabetes. Subjects and methods: In this cross-sectional study, census sampling was employed to enroll 120 rural patients with type 2 diabetes in the Chalderan County in 2015. To collect data, a valid and reliable instrument, based on the Extended Theory of Reasoned Action (ETRA) constructs, was used. Data were analyzed by SPSS 21 software using descriptive and inferential statistical methods. Results: Using the one-way ANOVA test, it was found that PABs had statistically significant correlation with all ETRA constructs except subjective norms (P=0.574). Knowledge (P=0.015), self-efficacy (P<0.001) and behavioral intention (P<0.001) had a significant association with PABs, respectively. Also, ETRA structures were able to reflect 41.0% of the behavioral changes. Among structures, knowledge (P=0.014), self-efficacy (P<0.001), and behavioral intention (P=0.020) were significant predictors of PABs (R2=0.414). Conclusions: Health care providers may consider the ETRA an appropriate framework to design educational interventions aimed at improving PABs among rural patients with type 2 diabetes.

Factors associated with therapeutic target achievement in the control of complications in consequence of diabetes: A hospital-based study in west of Iran.

BACKGROUND AND AIM: The goal of diabetes management is to enhance the performance of the surveillance system to perpetuate optimal blood sugar, blood pressure and cholesterol levels in the normal values. This paper aimed to identify factors associated with therapeutic target achievement in the control of complications in consequence of diabetes. METHODS: In this cross-sectional study, a secondary analysis was performed on data obtained in the surveillance center of patients referred to in Makoo city, West Azerbaijan Province. The main interested variables included Fasting Blood Sugar (FBS), HbA1c, triglycerides, cholesterol, Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL) diastolic and systolic blood pressure, duration of diabetes, family history of diabetes, early and late complications of diabetes, treatment received, history of smoking. RESULTS: Average age of the patients with diabetes mellitus, insulin-dependent was 35.43 (SD = 17.25) and in patients of diabetes mellitus 53.37 (SD = 10.89), which was significantly different (p-value = 0.001). Frequency amount of fasting blood sugar in diabetes mellitus, insulin-dependent and diabetes mellitus, type II was 64.30% and 66.0%, respectively. Only 19.0% of patients with diabetes mellitus, insulin-dependent and 13.90% of diabetes mellitus, type II breached to the optimum level of blood glucose control. CONCLUSIONS: This study found that a considerable proportion of subjects with diabetes mellitus, insulin-dependent and diabetes mellitus, type II did not achieve the goals of care guidelines of Iran on secondary prevention of complications related to diabetes, especially vascular complication.

The Role of a Community-Based Intervention in Promoting Helmet Use in a Non-probability Sample of Rural Motorcyclists in Iran.

Although the use of helmets is known to prevent the majority of mortalities by head injuries, it is ignored by a large number of motorcyclists. The present study was conducted to promote helmet use in an attempt to reduce injuries among motorcyclists in a rural area by adopting a community-based participation approach. The one-group pretest-posttest pre-experimental design was conducted in northwest Iran. The study was conducted in three phases: (1) baseline measurement, (2) implementation of the intervention, and (3) assessment of the outcomes. The intervention included the distribution of learning tools, education of various community groups, tightening of driving laws for offending motorcyclists, promotional programs at community level, and utilizing all opportunities to discuss the benefits of helmets. Due to the non-experimental nature of the study, no causal inferences were drawn. After the intervention, the percentage of the awareness of the benefits of helmet use was increased by 28%, positive attitudes towards benefits of helmet use was increased by 32.6%, and supporting helmet use was increased by 58.6%. Moreover, helmet sale and use increased by 147.0% and 32.0%, respectively. Additionally, motorcycle accidents, head injuries, and mortalities were decreased by 71.8, 55.5, and 60.0%, respectively. Community-based participation approach may positively influence health promoting behaviors and motorcyclists' decisions to wear helmet in rural areas.

Mental Health-Ill Health Differences in Disease Severity and Its Sociodemographic Biobehavioral Predictors Among Patients With Knee Osteoarthritis.

Our aim in this cross-sectional study was to investigate mental health-ill health differences in disease severity and its sociodemographic biobehavioral predictors among patients with knee osteoarthritis (OA). Applying convenient sampling, 180 patients with knee OA in Tabriz, Iran, were recruited to participate in completing a three-section questionnaire (SF-12, Lequesne Algofunctional Index and Self-Management Behaviors Scale). Separate hierarchical multiple linear regressions were performed with OA severity as dependent variable: one for OA patients with positive mental health and other for OA patients with mental disorders symptoms. Among the patients with positive mental health, but not those with symptoms of mental disorder, pain management, duration of OA, physical activity management, living alone, and level of education were significant predictors of disease severity. Health care providers with a better understanding on the determinants of disease severity by mental health status may identify vulnerable patients and develop targeted interventions to foster disease management behaviors among OA patients.

Primary development and validation of a quantitative health policy impact assessment tool (HEPIAT): The case of Iranian targeted subsidy plan.

Background: As a primary phase of a Health Impact Assessment (HIA) on the Iranian Targeted Subsidy Plan (TSP), this study was conducted to assess the psychometric properties of a newly developed quantitative Health Policy Impact Assessment Tool (HEPIAT). Methods: In 2014, multistage cluster sampling was employed to recruit 509 key informants in Sanandaj, Iran, to participate in this cross-sectional study. A comprehensive literature review was conducted to develop the initial draft of HEPIAT. Content validity was determined by a consensus panel of experts, and construct validity and factor structure of the HEPIAT were assessed using Exploratory Factor Analysis (EFA). Reliability was assessed utilizing the Cronbach's alpha coefficient and the test- retest reliability coefficient. Results: Applying EFA, the optimal solution including 35 items and 6 factors was emerged, which accounted for 64.94% of the total variance. The mean items' relevancy, clarity, simplicity, and their total mean±SD score were 88.3±0.2, 90.1±0.5, 86.1±0.7, and 89.6±0.4, respectively. The scores of intra-class correlation coefficients (ICC) and internal consistency reliability for all the factors were ranged from 0.67 to 0.89. HEPIAT demonstrated an appropriate validity, reliability, functionality, and simplicity. Conclusion: Although further works in different settings are warranted, HEPIAT may be a practical and useful quantitative instrument in socioeconomic-related HIAs aimed to inform policymakers and stakeholders on the health impacts of their decisions and plans.