Examining the educational experiences of Behvarzes from the insufficient participation of some people in preventive measures against the COVID-19 pandemic: a lesson for the future.

BACKGROUND: This study aims to explore the experiences of Behvarzes regarding the reasons behind the insufficient participation of some individuals with the preventive protocols established during the COVID-19 pandemic. METHODS: A qualitative study was conducted from July 2021 to December 2022 using the conventional content analysis method. Purposive sampling was employed to select 14 Behvarzes working in villages covered by Kashan University of Medical Sciences. Data were collected through semi-structured in-depth individual interviews and analyzed using conventional content analysis. RESULTS: The study identified seven subcategories which were grouped into two main categories of reasons for inadequate compliance with health protocols by some individuals. These include: (1) Intentional non-compliance with preventive protocols, with the following subcategories: perceived obligation and adherence to social customs, denial of risk, belief in external health locus of control, and fear and distrust of prevention and treatment methods. (2) Unintentional non-compliance with preventive protocols, with the following subcategories: insufficient or contradictory information, negligence, and inevitability. CONCLUSION: The findings suggest that ensuring compliance with health guidelines is not a one-size-fits-all approach. providing empowerment and obstacle removal solutions to those forced to violate preventive protocols for various reasons are all critical components of successful interventions. Also, cultural familiarity can aid in the design of appropriate interventions to address these challenges.

Development and psychometric analysis of a new tool to assess food literacy in diabetic patients.

BACKGROUND: One of the factors affecting self-care in diabetic patients is food literacy, which helps said patients in following a healthy diet. Thus, it is crucial to analyze food literacy in diabetic patients through suitable and reliable instruments.  OBJECTIVE: The current study aimed to design a questionnaire for food literacy assessment in diabetic patients and analyze its psychometric features. METHOD: The present study was a cross-sectional descriptive analysis carried out in 2021. Firstly, the concepts of food literacy in diabetic patients were identified and the questionnaire was deigned based on them. Secondly, its face and content validities and its reliability were analyzed. Finally, the construct validity was analyzed by exploratory factor analysis. The study was carried out on 300 diabetic participants chosen at random via stratified cluster sampling from Health service centers. The exploratory factor analysis was carried out by extracting the main factors and using varimax rotation with eigenvalue values more than 1. RESULTS: A five-pronged structure accounted for 52.745% of food literacy variance. This included the ability to read food facts, practical ability to group foods, the ability to identify the caloric content of different foods, the ability to understand the effect of food on health, and the ability to prepare a healthy meal. Items with an impact score below 1.5 were discarded. Additionally, items with CVR scores below 0.62 and CVI scores below 0.79 were deleted too. The Kaiser-Meyer-Okin measurement was 0.836 (p < 0.001). Alpha Cronbach Scale dimension was 0.610-0.951. CONCLUSION: The results of this study showed that the exploratory dimensions of the current study were consistent with health literacy measurements, such as functional, interactive, and critical food literacy. This scale has acceptable reliability and validity. Health professionals can use this scale to analyze and improve food literacy in diabetic patients. This is a new instrument and thus far no questionnaire has been made to evaluate food literacy in diabetic patients.

Explaining the experiences of health care providers regarding organizational factors affecting health education: a qualitative study.

BACKGROUND: Health education is considered the most important component of primary health care. Paying attention to organizational factors can help to improve the quality of health education. Therefore, the present study was conducted to explain organizational factors affecting health education among health care providers. METHOD: This is a qualitative, descriptive, and phenomenological study that was conducted between 2020 -2022 on 50 health care workers who had been selected by purposeful sampling method in different settings including hospitals, GP office, behavioral disease counseling center, universities, and comprehensive health centers in the south and the center region of Iran. Data were collected by in-depth, semi-structured, and individual interviews, as well as focus group discussion, and continued until data saturation. Data were analyzed by MAXQDA software using qualitative content analysis in three stages: preparation, organization, and reporting. To evaluate the scientific accuracy of the findings in this study, 4 criteria of Lincoln & Guba were used. RESULTS: The results revealed that every practice and policy in a health care organization from assessing needs, setting goals, planning activities, implementations and measurement outcome could affect health education practice and subsequently the health of population; nevertheless, the crucial role of health education practice is being neglected in health organizations. Organizational factors affecting health education were classified into three categories of planning, organizing, and also monitoring and evaluating. The category of planning had three subcategories of infrastructure planning, manpower planning, and design and planning for implementation of health education programs. The categories of organizing had two subcategories of coordination between different units of the Minister of Health and coordination between the health sector and other sectors of society. The categories of monitoring and evaluation had three subcategories of proper feedback, bureaucracy system, reward or reinforcement, failure to define health education as part of the job description, and the impact of electronic health records on the quality of evaluation. CONCLUSION: The results offer expertise and preliminary tools to help with evidence-based health education program planning and evaluation. The Support of managers, like providing manpower in accordance with the target population and infrastructure, can improve health education in the health system. In addition, intra- and inter-sectoral coordination at different levels of the health system to implement tailored programs according to the needs of clients by health education professionals, and the use of health education theories seem necessary. It is also recommended to review the monitoring system with appropriate feedback, define health education as a healthy activity, and develop appropriate criteria for better implementation of health education.

Predicting preventive behaviors against COVID-19: A structural equation modeling approach from Iran.

Background: The purpose of this study was to use the health belief model (HBM) to predict the adoption of preventive behaviors against COVID-19 using the structural equation modeling approach. Methods: As a descriptive-analytical study, this research was conducted on 831 men and women who were under the coverage of comprehensive health service centers in the Lorestan province of Iran in 2021. A questionnaire based on HBM was used to collect data. Data were analyzed by the SPSS software version 22 and AMOS version 21. Results: The mean age of participants was 33.0 ± 8.5, with a range of 15-68 years. The constructs of the HBM explained about 31.7% of the variance in COVID-19-related preventive behaviors. The greatest total effect on preventive behaviors against the COVID-19 disease belonged to the constructs of perceived self-efficacy (0.370), perceived barriers (-0.294), and perceived benefits (0.270), in descending order of impact. Conclusion: Educational interventions can be useful in promoting COVID-19 preventive behaviors by bringing about a correct understanding of self-efficacy, barriers, and benefits.

Factors related to preventive COVID-19 behaviors using health belief model among general population: a cross-sectional study in Iran.

BACKGROUND: Coronavirus disease (COVID-19) pandemic has become one of the biggest challenges to global health and economy. The present study aimed to explore the factors related to preventive health behaviors during the COVID-19 pandemic in Khuzestan Province, South of Iran, using the Health Belief Model (HBM). METHODS: The present cross-sectional study was conducted in the period between July 2020 and September 2020. A total of 1090 people from Khuzestan province participated in the study. The data collection method included a multistage cluster sampling method with a random selection of provincial of health centers. The questionnaire collected socio-demographic information and HBM constructs (e.g., perceived susceptibility, perceived severity, perceived benefits and barriers, cues to action, and COVID-19 preventive behaviors). Data were analyzed using ANOVA, t-test, hierarchical multiple linear regression, and SPSS version 22. RESULTS: The mean age of the participants was 35.53 ± 11.53, more than half of them were female (61.6%) and married (65.3). The results showed that 27% of the variance in the COVID-19 preventive behaviors was explained by HBM constructs. The regression analysis indicated that female gender (ß = 0.11), perceived benefits (ß = 0.10), perceived barriers (ß = - 0.18), external cues to action (ß = 0.25), and internal cues to action (ß = 0.12) were significantly associated with COVID-19 preventive behaviors (p < 0.05). CONCLUSION: Designing an educational intervention on the basis of HBM might be considered as a framework for the correction of beliefs and adherence to COVID-19 behavior. Health information campaigns need to (1) emphasize the benefits of preventive behaviors including avoiding the likelihood of getting a chronic disease and complications of the disease, (2) highlight the tips and advice to overcome the barriers (3) provide cues to action by means of showing various reminders in social media (4) focusing on adoption of COVID-19-related preventive behaviors, especially among men.

The promotion of healthy breakfast and snacks based on the social marketing model: a mixed-methods study.

BACKGROUND: Skipping breakfast and replacing it with non-nutritious snacks are progressively increasing among adolescents. This study aimed to develop an educational intervention based on the Social Marketing Model and evaluate its effects on healthy breakfast and snack consumption among female adolescent students. METHODS: This mixed-methods study was conducted in 2016-2019 in two phases. In the first phase, a qualitative study was conducted through directed content analysis in guidance schools in Khorramabad, Isfahan, and Tehran, Iran, to explore factors affecting breakfast consumption. The results of this phase were set in the benchmarks of the Social Marketing Model. In the second phase, a randomized controlled trial was conducted based on the benchmarks of the Social Marketing Model on 94 students randomly recruited from guidance schools in Khorramabad, Iran. RESULTS: The findings of the qualitative phase were categorized into the benchmarks of the Social Marketing Model, namely the social marketing mix, the intended behavior, internal and external competing factors for behavior modification, theoretical concepts related to the behavior, and the role of supporters. In the quantitative phase, the univariate analysis showed significant between-group differences concerning the product, price, promotion, and behavior (p < 0.05). CONCLUSION: Healthy breakfast and snack consumption can be promoted through making acceptable the tastes, costs, preparations, and consumption places of breakfast and snack. TRIAL REGISTRATION: The trial was registered in the Iranian Registry of Clinical Trials (code: IRCT20170201032347N1 ). The trial was registered in 11/07/2018 and is accessible on the Iranian Clinical Trial Registration website.

Explaining the dimensions of social support for breakfast and healthy snacks in students: a qualitative study.

BACKGROUND: breakfast elimination as well as consumption of low-value snacks is ever increasing among adolescents. This study sought to explain the dimensions of social support for breakfast and healthy snacks among students. METHODS: A qualitative research was conducted in Isfahan, Tehran, and Khorramabad, Iran high schools in 2017-18. Data were obtained from five focus group discussions and 35 in-depth interviews as well as semi-structured interviews with students of both sex, parents and school authorities. The data simultaneously analyzed using conventional content analysis in three stages including preparation, organization, and reporting. Prolonged engagement, maximum variation of sampling and member check were the enrichment factors of the research. RESULTS: Three main categories emerged. First, family supports with sub- categories of family in the school programs as well as mother-sponsored support and family life patterns. Second, school supports with sub- categories of instrumental and informational support. And third, support of other community organizations with sub- categories of intra-department coordination and mass media. CONCLUSION: The concepts emerging in the present study develop multilevel ecological strategies to promote nutritional health including family, school, and community organizations such as school renovations, municipalities, police, education, and mass media to promote healthy breakfast and snack behavior are applicable for students.

Application of Freire's adult education model in modifying the psychological constructs of health belief model in self-medication behaviors of older adults: a randomized controlled trial.

BACKGROUND: Self-medication by older adults has been always a public health concern. The present study aimed to modify the psychological constructs of Health Belief Model (HBM) in relation to self-medication behaviors using Freire's Adult Education Model (FAEM) among older adults in Khorramabad, Iran, from 2017 to 2018. METHODS: The mean age of the older adults was 66.28 ± 7.18 years. This was a randomized controlled trial study conducted on 132 individuals older than 60 who were referred from different health care centers. The participants were selected using multistage sampling method and randomly divided into two groups of intervention and control. The data collection instruments included a questionnaire which was designed based on both HBM and self-medication behaviors questionnaire. The phase of adult education model (AEM) was used to modify the psychological constructs of HBM and self-medication behaviors. Data were analyzed using SPSS software version 20 with a significant level of 0.05. Descriptive statistical tests, chi-squared test, paired t-test, independent t-test, and univariate modeling were employed for the purpose of analyzing data. RESULTS: There was no significant difference between groups in terms of self-medication. Unawareness of the effects of medicine were the most important reason for self-medication (p = 0.50). The two groups were not significantly different in terms of knowledge, HBM constructs, and self-medication behaviors (p > 0.05). However, they came up to be considerably different for the above variables after the intervention was implemented (p <  0.05). When the findings were adjusted for the effects of confounding variables, there were significant differences between the two groups in almost all constructs of HBM and their behaviors (p <  0.05). However, the perceived barrier modality of HBM did not reach to a significant level of difference between two groups. CONCLUSION: The educational intervention, which was based on Freire's AEM, had positive effects on the constructs of HBM and consequently on self-medication behaviors. The psychological constructs of HBM were affected at the phases of listening to problems. Self-medication was tempered at the action-reflection phase with shared creation and evaluation of the action plan geared toward the achievement of the behavioral objectives. The results might be of importance to healthcare professionals involved in care of older patients. TRIAL REGISTRATION: Current Controlled Trials IRCT2013091814512N2. Registered on January 2 - prospectively registered, the trial was registered in the Iranian Clinical Trials Registry http://www.irct.ir .

The development and psychometric evaluation of a new instrument to market healthy breakfast and snacks among adolescents.

BACKGROUND: The consumption of non-nutritious snacks instead of a proper breakfast is becoming more widespread among adolescents. It is expected that using the 4P (product, price, place, promotion) strategies of the social marketing (SM) model can help to better identify factors affecting healthy breakfast and snack consumption. The objective of this study was to develop and evaluate the psychometric properties of the Healthy Breakfast and Snack Consumption Scale (HBSCS) using the SM model. METHODS: This was a cross-sectional descriptive study that was conducted in 2017. First, a scale was developed using the results of a qualitative research based on the SM model. Then, its face, content and construct validities as well as its reliability were assessed. Construct validity was evaluated via exploratory factor analysis conducted on a random sample of 300 high school pupils selected from five girls' schools located in Isfahan, Iran, using the multistage cluster sampling method. Exploratory factor analysis was performed using the methods of principle components extraction and varimax rotation with eigenvalues greater than 1. RESULTS: A four-factor structure that explained 61.73% of the total variance of the HBSCS included healthy breakfast and snack preferences, readiness to pay the price, place preferences and communication channel preferences. Items with an impact score of less than 1.5 were removed. Additionally, items with content validity ratio values of less than 0.62 and content validity index values of less than 0.79 were deleted. The Kaiser-Meyer-Olkin measure value was 0.74 [chi-squared (χ2) = 2353.622; p-value < 0.001]. The Cronbach's α values of the scale and its four dimensions were 0.71 and 0.56-0.72, respectively. CONCLUSION: This scale has acceptable validity and reliability. School authorities and health professionals can use this scale to screen adolescents at risk of consuming unhealthy foods and snacks. Besides, the scale might be used as a framework for assessing, implementing and promoting healthy eating behaviors among pupils.

Factors behind healthy snack consumption at school among high-school students: a qualitative study.

BACKGROUND: The prevalence of consuming fast foods and non-nutritious snacks is progressively increasing among adolescents. This study aimed to explore factors behind snack consumption at school among Iranian high-school students. METHODS: This descriptive qualitative study was conducted in 2017 in four boys' and four girls' high-schools located in Isfahan, Khorramabad, and Tehran, Iran. Data were collected through 42 in-depth semi-structured interviews and four focus groups with male and female students, their parents, and their school teachers and administrators. The conventional content analysis approach was used for data analysis. Trustworthiness was applied to the study through prolonged engagement, maximum variation sampling, and member checking techniques. RESULTS: Factors behind students' snack consumption came into two main groups, namely influential behaviors, and influential emotions and perceptions. Influential behaviors included the behaviors of students, their family members, peers, school administrators, and snack sellers. Moreover, influential emotions and perceptions included positive and negative feelings towards healthy snacks, fear over the consequences of unhealthy snacks, and perceived positive outcomes of healthy snacks. CONCLUSIONS: Students' snack consumption at school is affected not only by their own behaviors, emotions, and perceptions, but also by significant others' behaviors and environmental factors. School administrators need to make environmental modifications to turn school environment into a pleasant place for healthy snack consumption and make healthy snack consumption a pleasurable experience for students.

An investigation of the effects of infertility on Women's quality of life: a case-control study.

BACKGROUND: Human instinctively desire to have offspring. Infertility can cause painful emotional experiences throughout the life mainly known as quality of life impairment. This study aimed to investigate the impact of infertility on a woman's quality of life. METHODS: A number of 180 infertile and 540 fertile women participated in this matched case-control study. The cases were selected through a combination of multistage stratified and cluster sampling methods. For each infertile woman three fertile women were randomly selected. The data gathering instrument consisted of demographic variables and the WHOQOL-BREF questionnaire. Data collection was conducted through interview with participants. The multivariate marginal model and SPSS software 21 were used for data analyses with a significance level of 0.05. RESULTS: The results of the multivariate modeling show infertility can potentially affect various aspects of women's quality of life such as physical health (p <  0.001), mental health (p <  0.001), social health (p <  0.001) and the total score of quality of life (p <  0.001) significantly. CONCLUSION: An infertile woman practice a relatively lower scores in QOL sub-scales of mental, physical and environmental health; while they experience a higher social health score than a fertile woman.

Sources of Health care providers' Self-efficacy to deliver Health Education: a qualitative study.

BACKGROUND: The self-efficacy of educators plays a crucial role in their professional competence and subsequent provision of care. The present study aims to explain the main sources contributing to the development of self-efficacy beliefs among healthcare providers in delivering health education. METHODS: This qualitative study was conducted from 2015 to 2016 in various settings of Isfahan such as hospitals, doctor's offices, and healthcare centers. Twenty three health educators with an average of 10-year work experience in healthcare participated in the study. Data were collected using semi-structured in-depth individual interviews and were analyzed through conventional content analysis. Prolonged engagement with the participants, maximum variation in the participants' characteristics, sampling, and member check were among the factors enriching the research. RESULTS: The six main categories extracted during data analysis included: 1) Quantity and quality of their experience; 2) Encountering unexpected events; 3) Client trust; 4) Self-concept; 5) Professional knowledge and skill; 6) Vicarious experiences. CONCLUSIONS: The study results show two new findings, including "encountering unexpected events" and "client trust", affecting professional self-efficacy beliefs among healthcare providers in the delivery of health education. The other main findings were extremely similar to Bandura's theory. These results can be used as a basis in planning and implementing health development educational models for human resources.

Factors associated with mental health of high-school students in the Islamic Republic of Iran.

BACKGROUND: Mental disorders of adulthood can be traced to childhood and adolescent disorders so attention to the mental health of young people is important. OBJECTIVES: We aimed to determine the mental health status of high-school students in Khorramabad and the factors that may affect it. METHODS: This cross-sectional study included 1 202 high-school students in Khorramabad in the 2015-2016 academic year. Students were selected using stratified and multistage cluster random sampling. Data were collected on sociodemographic characteristics of the students, and the General Health Questionnaire (GHQ-28) was used to assess symptoms of mental disorders. Logistic regression analysis was used to evaluate the relationship between the presence of symptoms of mental disorder and sociodemographic characteristics. RESULTS: The mean age of the students was 16.1 (SD 0.9) years and 52.7% were girls. Overall, 481 (40%) students (34% of males, 46% of females) had symptoms of mental disorders. Most had mild symptoms; 5% had severe symptoms. Symptoms of anxiety, depression and social impairment were seen in 40%, 33% and 32% of the students respectively; significantly more girls had these symptoms (P < 0.05). Female students, those in higher school grades, and those whose fathers were unemployed and mothers were housewives were significantly more likely to have symptoms of mental disorders (P < 0.05). CONCLUSIONS: This study found a high prevalence of symptoms associated with mental disorders in the adolescents in Khorramabad. Counselling centres in schools are needed to offer psychiatric counselling services to students and to implement regular mental health training programmes.

The effect of training interventions on the psychological factors of oral health in pregnant women.

BACKGROUND AND AIM: Oral health is crucial for high-risk pregnant women in order to preserve their health and the health of their infants. Therefore, this study aimed to determine the impact of training programs on the behavior of pregnant mothers concerning oral health in Khorramabad, Iran. METHODS: This is an educational experimental study carried out in 2015 on 164 pregnant women referring to health centers in the city of Khorramabad who were randomly divided into two groups (each n=82). The instruments for data collection included a questionnaire based on the Health Belief Model regarding oral health and two checklists of oral health indexes (OHIS and DMFT). Data were analyzed using SPSS 20 via paired-samples t-test, independent-samples t-test and Chi-square. RESULTS: The mean score of knowledge and performance, and the variables of the components of the Health Belief Model including the perceived susceptibility, severity, benefits, barriers and self-efficacy regarding the oral health care, significantly increased in the intervention group following the training intervention (p<0.001). However, the DMFT index did not show any changes after the intervention in the intervention and control groups (p=0.381). On the other hand, the OHIS index significantly decreased in the intervention group as compared with the pre-intervention scores (p=0.002). CONCLUSION: The results of this study showed that training based on the Health Belief Model leads to the enhancement of performance regarding oral health in pregnant women and thus prevents any increase in OHIS and DMFT levels during pregnancy.

Effect of educational intervention on knowledge, perceived benefits, barriers and self-efficacy regarding AIDS preventive behaviors among drug addicts.

BACKGROUND AND OBJECTIVES: Addicts account for approximately 68.15% of AIDS cases in Iran and injection drug users are considered as a major factor in the spread of AIDS in Iran. The purpose of this study was to determine the effect of an educational intervention on the perceived self-efficacy, benefits, and barriers concerning AIDS preventive behaviors among drug addicts in Khorramabad, Iran. METHODS: This is a quasi-experimental study carried out in 2013 on 88 addicts kept in rehabilitations center in Khorramabad. The data collection instruments included a questionnaire on self-efficacy, perceived benefits, perceived barriers, knowledge and preventive behaviors regarding HIV. Data were analyzed by paired t-test, independent t-test, Chi-square and analysis of covariance. RESULTS: Paired t-test showed that the mean scores for perceived benefits and barriers, knowledge and preventive behaviors significantly increased in the intervention group after the intervention than before the intervention. But the increase in self-efficacy score was not statistically significant. CONCLUSIONS: The results of this study showed that training and education based on the health belief model led to an increase in knowledge, self-efficacy, perceived benefits, performance and reduction in perceived barriers in addicts. It is recommended that future studies should include strategies for enhancing self-efficacy and perceived benefits as well as strategies for reducing barriers to the adoption of preventive behaviors.