The Impact of Educational Intervention Based on Pender's Health Promotion Model on Healthy Lifestyle in Women of Reproductive Age in Iran.

Background: Lifestyle is one of the most important factors affecting women's health. Women's quality of life and health depends on their health-promoting behaviors and lifestyles. The aim of this study was to determine the impact of an educational intervention based on Pender model on healthy lifestyle in women of reproductive age in Iran. Methods: This randomized controlled trial study was carried out in women of reproductive age in Iran, from August to December 2019. The samples were divided into experimental (n = 120) and control (n = 120) groups. 6 training sessions were provided for the experimental group. The questionnaire consisted of several items including socio-demographic characteristics, health-promoting lifestyle profile-II (HPLP-II), self-efficacy, social support and constructs of Pender's health promotion model. SPSS-18 software has been applied for statistical analysis. Results: The mean age of the experimental group was 31.88±7.624 years and for the control group was 30.33±6.89 years. There was no statistically significant relationship between demographic variables such as marital status, education, employment status, age and body mass index with lifestyle in women. Lifestyle in women had a statistically significant relationship with the structure prior health-related behavior (p < 0.001). The score of women in structures of prior health-related behavior, perceived benefits, commitment to action, and social support increased after educational intervention (p < 0.001). Conclusion: Findings showed that educational intervention based on Pender health promotion model has increased the score of healthy lifestyle in women. Therefore, planning and performing educational interventions to improve health promotion behaviors based on this model is essential.

What do parents of children with autism spectrum disorder think about their quality of life? A qualitative study.

BACKGROUND: Living with children with autism spectrum disorder (ASD) can affect different aspects of parents' physical and mental health and quality of life. This study aimed to identify parents' perceptions of their quality of life and factors influencing such perceptions and investigate how they cope with difficulties in their daily lives. MATERIALS AND METHODS: This study was conducted using a qualitative research design to gain insight into how children with ASD may influence their parents' quality of life. A total of 31 parents and school counselors were selected by the snowball sampling method in autism schools in Tehran in the academic year 2018-2019. Semi-structured interviews were used to collect the data. Each interview was held based on a preprepared guideline by the researchers. In-depth questions were also asked as needed. Finally, the data were analyzed using the content analysis approach. RESULTS: The participants reported a variety of difficulties and crises to cope with in their daily lives. The factors reported to decrease the quality of life were categorized into six main themes and 20 subthemes. The main themes included "family interactions," "parenting," "daily living," "health," "financial issues," and "community-related." CONCLUSIONS: Due to the diversity and multilevel factors affecting the quality of life of parents having children with ASD, it is essential to adopt a comprehensive approach with the participation of all stakeholders in the development, design, and implementation of future interventions.

The effect of educational intervention on nutritional behavior in pregnant women based on social cognitive theory.

BACKGROUND: One of the key issues for women's health is pregnancy. Healthy nutrition during pregnancy is a reliable guarantee for proper pregnancy and childbirth. This study sought to determine the impact of an educational intervention based on social cognitive theory on the nutritional behavior of pregnant women in Iran. METHODS: This randomized controlled trial study was carried out in women of reproductive age in Iran, from February to April 2020. The samples were divided into experimental (n = 150) and control (n = 150) groups. The questionnaire included demographic questions, questions related to the structures of social cognitive theory and nutritional behavior questionnaire. The data were analyzed through the SPSS20 and AMOS23 software. RESULTS: The mean age of the women was 28.11 ± 6.54 and 28.83 ± 6.62 years in the intervention and control groups, respectively. The results of the Structural Equation Model showed that direct effect of self-efficacy, self-regulation, and mutual determinants on behavior were significant. After the educational intervention, nutritional behavior in the experimental group was increased significantly. Also, there was a significant difference between two groups in structures such as outcome expectations, outcome value, self-efficacy and knowledge. But there was no significant increase in the self-regulation and social support after educational intervention. CONCLUSION: Social cognitive theory as a theoretical framework is able to predict healthy eating behavior during pregnancy. Also educational intervention based on the structures of social cognitive theory, improved the behavior of pregnant mothers. Educational intervention based on social cognitive theory and providing simple and understandable training packages for pregnant women is recommended.

The effectiveness of an intervention designed based on health action process approach on diet and medication adherence among patients with type 2 diabetes: a randomized controlled trial.

BACKGROUND: Diabetes is a major cause of worldwide morbidity and mortality. Diet and medication non-adherence are common among individuals with diabetes, making glycemic control difficult to attain. This study aimed to evaluate an intervention designed based on Health Action Process Approach (HAPA) to improve adherence to diet and medication among patients with type 2 diabetes in Tehran, Iran. METHODS: The study was a randomized controlled trial. A total of 248 patients with type 2 diabetes who had low diet and medication adherence were randomly allocated into two intervention (n = 124) and control (n = 124) groups. Intervention group received educational intervention during three months. HAPA constructs, diet and medication adherence, and Hemoglobin A1c (HbA1c) levels were assessed at baseline, one month and six months after the intervention. Mixed Model Analysis was used to compare between and within group changes in the outcomes. RESULTS: There was a statistically significant improvement in HbA1c levels after six months (7.77 ± 1.36% vs. 8.07 ± 1.52%, 95% CI, p < 0.001). Diet and medication adherence, intention, task self-efficacy, coping self-efficacy, recovery self-efficacy, action and coping planning, barriers, benefits and perceived social support were significantly improved one month and six months after the intervention (p < 0.001). CONCLUSION: Our intervention designed based on health action process approach led to improvements in diet and medication adherence, and HbA1c among the patients within one and six months. TRIAL REGISTRATION: IRCT, IRCT20151208025431N4. Registered 10 March 2018, https://fa.irct.ir.

The effect of educational intervention based on the health belief model on knowledge, attitude, and function of women about Pap smear test at Iranian health centers: A randomized controlled clinical trial.

BACKGROUND AND OBJECTIVE: This study aimed to examine the effect of educational intervention using the health belief model on knowledge, attitude, and function of women about Pap test at health centers. METHODOLOGY: This randomized controlled clinical trial was conducted on 120 women who were allocated into two groups (intervention = 60 and control = 60). The sampling method was a multistage cluster. The training was provided in two sessions for 90 min. Data gathering tool was a 4-part researcher-made questionnaire including demographic characteristics, knowledge, health belief model structures, and function. Women were evaluated and completed the questionnaire in two stages (before and 2 months after training). Data were analyzed by Kolmogorov-Smirnov, Wilcoxon, linear regression, Mann-Whitney U-test, Fisher, Chi-square, and marginal homogeneity tests. RESULTS: At baseline, there was no significant difference between the groups regarding the mean of knowledge and the structures of health belief model scores. The average scores of participants in terms of health belief model structures were increased significantly after the training sessions. Furthermore, the comparison of the performance of Pap smear before training showed that in the intervention group (23.3%) and in the control group (31.7%), there was no significant difference in terms of the history of performing the Pap smear test (P = 0.414). However, a significant difference (P = 0.001) was observed after training in the intervention group (31.7%) and in the control group (3.3%). CONCLUSION: Educational intervention using the health belief model is effective in increasing knowledge, attitude, and function of women in terms of providing useful and required education.

Using health action process approach to determine diet adherence among patients with Type 2 diabetes.

INTRODUCTION: Diet adherence may cause diabetes complications to be diminished. OBJECTIVES: This study aimed at identifying determinants of diet adherence among patients with Type 2 diabetes based on the health action process approach (HAPA). METHODS: In this cross-sectional study, 734 patients with Type 2 diabetes, attending to South Tehran health centers, were recruited during June-December 2018. The dietary regimen scale (nine items) and a researcher-designed questionnaire consisting of HAPA constructs were used to gather the data. Data were analyzed using the Mann-Whitney test, Pearson Chi-squared test, Fisher's exact test, and linear regression test. All statistical tests were assessed using SPSS (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY, USA: IBM Corp.). RESULTS: The level of nonadherence to diet was 91.1%. Diet adherence was significantly associated with family income (P = 0.005), level of education (P < 0.001), and age (P = 0.009). The linear regression showed that 55% of the variance of diet adherence was determined by HAPA variables. Diet adherence was associated with intention (P < 0.001), action planning (P = 0.005), and barriers (P = 0.003). CONCLUSION: Most of the patients did not adhere to their diet. Appropriate programs should be designed to promote diet adherence among the patients, especially those with low literacy and patients living in poor communities.

Determinants of medication adherence among Iranian patients with type 2 diabetes: An application of health action process approach.

To identify determinants of medication adherence among patients with type 2 diabetes based on the health action process approach. This cross-sectional study was conducted among 734 patients with type 2 diabetes attending to south Tehran health centers during June to December 2018. Data were gathered using the Morisky Medication Adherence Scale (MMAS-8-Item) and the health action process approach questionnaire. We used Mann-Whitney, Pearson Chi-Squared, Fisher's Exact and Independent Samples Tests for comparison of adherence medication by demographic characteristics; and linear regression analysis to predict factors related to medication adherence based on HAPA. P-value less than 0.05 considered statistically significant. A total of 232 men and 502 women participated in the study, Mean age was 61.61 ± 9.74. Most participants (82.3%) reported low medication adherence (females: 68.4%). Medication adherence was significantly associated with gender (p = 0.03). Medication adherence was significantly predicted by intention (ß = 0.172, p = 0.0001), task self-efficacy (ß = 0.172, p = 0.01), copping planning (ß = 0.6, p = 0.0001) and copping self-efficacy (ß = -0.244, p = 0.001). The level of adherence to medications among type 2 diabetes patients was low. The behavior intention, task self-efficacy, copping planning and copping self-efficacy were significant determinants contributed to the medication adherence. HAPA inventory includes various factors, especially types of self-efficacy. Thus, utilization of this comprehensive model in interventional studies is suggested. These determinants should be considered in developing interventional programs to improve adherence.

Factors Influencing Health Promoting Behaviours in Women of Reproductive Age in Iran: Based on Pender's Health Promotion Model.

INTRODUCTION: Health promotion behaviours are considered as preventives of non-communicable diseases and key determinants of maintaining and improving the health status. AIM: This study aimed to investigate and identify effective factors on health-promoting behaviours based on Pender model in women of reproductive age from February to April 2017, in Savojbolagh, Iran. METHODS: This cross-sectional study is conducted on 240 women aged between 15 to 49 years in Savojbolagh, Iran, in 2017. The questionnaire consisted of several items, including socio-demographic characteristics, health-promoting lifestyle profile-II (HPLP-II), self-efficacy, social support and constructs of Pender's health promotion model. SPSS-18 software has been applied for statistical analysis. RESULTS: The mean age of the women was 31.10 ± 7.29 years. Total HPLP-II score was 106.64 ± 11.93. The highest and the lowest mean in the subscales were belonged to nutrition and physical activity, respectively. According to the bivariate analysis, the total HPLP-II score is significantly related to prior health-related behaviour (p = 0.000). There was a statistically significant relationship between stress management and the variables including perceived benefits, perceived barriers, prior health-related behaviour, situational influences, commitment to a plan of action (p < 0.05). Also, health responsibility had a statistically significant relationship with self-efficacy (p < 0.05). CONCLUSION: According to our results, it can be inferred that there is a problem with the HPBs of women. Considering that health-promoting behaviours like physical activity had a low score, it is a necessity to plan and perform interventions for improving health promotion behaviours.

Socioeconomic determinants of excess weight and central obesity among Iranian women: Application of information, motivation, and behavioral skills model.

INTRODUCTION: In developing countries, there is an increased risk of incidence of noncommunicable diseases due to general and abdominal obesity. Therefore, this study aimed to assess socioeconomic determinants of excess weight and central obesity among women in Tehran city based on information motivation behavioral skills model (IMB). MATERIALS AND METHODS: A cross-sectional study was conducted among 260 women aged between 20 and 49 years old using cluster sampling. A skilled interviewer completed socioeconomic status (SES), food insecurity, and IMB questionnaires. Analysis of variance, Chi-square tests, and regression model were used for statistical analysis. The multiple logistic regression analysis was used to identify independent predictors of the excess weight and central obesity using SPSS 21. RESULTS: The mean and standard deviation of participants' age was 34.7 (±7.59) years old. The prevalence of overweight and obesity in adult women was estimated 35% and 21.2%, respectively. The prevalence of abdominal obesity was 34.6%. Independent predictors of overweight/obesity in women were age (odds ratio [OR] =1.09, 95% confidence interval [CI] =1.03-1.14), educational level (OR = 2.35, 95% CI = 1.05-5.27), and total expenditure (OR = 3.14, 95% CI = 1.06-9.37). Whereas, independent predictors for increased the likelihood of central obesity were age (OR = 1.12, 95% CI = 1.06-1.18), marital status (OR = 6.44, 95% CI = 1.94-21.40), low education (OR = 0.38, 95% CI = 0.16-0.91), number of rooms (OR = 1.19, 95% CI 1.03-3.45), and self-regulation score (OR = 0.94, 95% CI = 0.88-1.00). CONCLUSIONS: The socioeconomic determinants, especially age, level of education, and expenditure, as well as self-regulation, play an important role in excess weight and central obesity among women. Therefore, further research is needed to reach women in different SES groups with a variety of interventions through concurrent triangulation of longitudinal studies and qualitative research.

Effect of BASNEF-based nutrition education on nutritional behaviors among elderly people and Mini Nutritional Assessment on nutritional status in elderly with diabetes with type 2 diabetes (A clinical trial intervention).

INTRODUCTION: The number of elderly people is growing in different communities like Iran, increasingly. Malnutrition prevalence is unknown among elderly patients with diabetes. Malnutrition is a common risk factor in elderly people with diabetes that may affect their health. SUBJECTS AND METHODS: This study is a random clinical trial. There are 200 samples in this study chosen randomly and divided into two intervention and control groups (100 each). Data of both groups were collected in the same way, before and 3 months after the intervention. Educational intervention was based on pretest, baseline BASNEF model, and Mini Nutritional Assessment questionnaire in four sessions. STATISTICAL ANALYSIS USED: Descriptive indices were used to analyze the data while Chi-square, t-test, one-way ANOVA, and correlation tests were used to examine the relationship between variables. RESULTS: The results were significantly different after intervention (P < 0.05), but they were not significantly different in control group after 3 months (P > 0.05). It was clear that 22% of samples had normal nutrition (score >24), 29% of participants were exposed to malnutrition, and 51% of samples were suffering from malnutrition. These numbers were 20% for normal nutrition, 30% for exposing to malnutrition, and 50% for suffering from malnutrition in the control group, respectively. Fifty percent of elderly people with diabetes suffered from malnutrition and almost half of them had normal nutrition that was 20%. CONCLUSIONS: BASNEF-based nutrition education intervention improves nutritional behaviors in addition to knowledge and attitude of elderly people with type 2 diabetes. It led to improve indices of glucose control during 3-month intervention. AIMS: The aim of this study was to investigate the nutritional status of elderly people with diabetes and the effect of educational intervention based on the BASNEF model on promoting nutritional behaviors in the elderly with type 2 diabetes in Babol city, Iran.

Developmental and Psychometric Properties of a Belief-based Reproductive Health Behavior Questionnaire for Female Adolescents.

BACKGROUND: The aim of this study was to develop and evaluate the psychometric properties of a questionnaire for the measurement of reproductive health among female adolescents in Iran. METHODS: This cross-sectional study was conducted among 289 female students aged 12-15 yr in Tehran, Iran from 2015-2016. The participants were selected using multi-stage random cluster sampling. In addition, the Belief-Based Reproductive Health Questionnaire (BBRHQ) was designed using the properties of the Theory of Planned Behavior (TPB). RESULTS: Exploratory factor analysis of 104 items identified a six-factor solution. These factors jointly accounted for 67% of the observed variance of outcome variable. The confirmatory factor analysis indicated a good fit to the data. In addition, the Cronbach's alpha coefficient showed an excellent internal consistency (alpha=0.92). CONCLUSION: Belief-Based Reproductive Health Questionnaire (BBRHQ) is a valid and reliable instrument for measurement of reproductive health behaviors of adolescents.

Influence of lifestyle factors on Body Mass Index in preschoolers in Behbahan city, southwest Iran, 2016.

BACKGROUND AND AIM: The body mass index (BMI) of Iranian preschoolers is noticeably increasing. Thus, studying the factors influencing BMI in preschool children is crucial. The purpose of this study was to identify the effects of lifestyle factors on BMI of preschool children, residing in Behbahan city, southwest Iran, in 2016. METHODS: A total of 120 preschool children, aged 4 to 6 years, participated in this cross-sectional study. Multi-stage random sampling was done. Using researcher-developed questionnaires whose validity and reliability was confirmed, demographic and lifestyle data were obtained, as the questionnaires were completed by the subject's mothers. Lifestyle factors included physical activity, fruit and vegetable consumption, sugar-free beverage intake, and screen time. Multiple logistic regression was conducted to analyze the influence of lifestyle-related behaviors on BMI. Data were analyzed by means of the SPSS 22 software and p<0.05 was resulted as the meaningful level of statistics. RESULTS: The average BMI values for children was 15.13±1.90 kg/m2. A total of 88.3% of children did not receive 5 cups of fruits and vegetables each day. Also, 12.5% consumed more than one serving of sweetened beverages per day. Only 2.5% engaged in 60 minutes of structured physical activity every day and 40% did not limit screen-time viewing to 2 hours per day or less. The findings indicated that the physical activity and screen time affected the BMI (p<0.05), and the duration of physical activity had inverse relationship with obesity, and screen time was directly related to obesity. CONCLUSION: Understanding the factors affecting the BMI of preschool children can inform the development of interventions to impact children's weight-related behavior and it can be used as the basis for future healthy body weight policies. Efforts to lower the obesity rate of preschoolers should be focused on the lifestyle behaviors, especially on the physical activity and screen time.

Depression, Anxiety, and Perceived Social Support among Adults with Beta-Thalassemia Major: Cross-Sectional Study.

BACKGROUND: Considering the high prevalence of depression and anxiety among thalassemia patients and the role of social support in preventing mental disorders, this study aimed to determine prevalence of depression, anxiety, and perceived social support (PSS) among adults with beta-thalassemia major. METHODS: This cross-sectional study was performed with 389 adults with beta-thalassemia major. Data were collected via a questionnaire consisting of three parts: demographic and medical information, the Persian version of the hospital anxiety and depression scale, and the Persian version of the Multidimensional Scale of Perceived Social Support. Data were analyzed using IBM SPSS ver. 23.0 (IBM Corp., Armonk, NY, USA) through analytical statistics (independent-samples t-test, one-way analysis of variance, Pearson correlation coefficient, and multilevel linear regression), and the results less than 0.05 were considered to be significant. RESULTS: The mean scores of depression, anxiety, and PSS of patients were 7.42±3.17, 7.47±4.35, and 41.8±8.64, respectively. Of 389 patients, 19.8% had depression and 23.7% had an anxiety disorder. Relationships of depression and anxiety with age, the level of education, job, and family income were statistically significant, as were those of PSS with age, thalassemia center, family income, job, and the level of education. PSS from family, friends, and significant others were the significant predictive factors of depression and anxiety among adult patients with beta-thalassemia major. CONCLUSION: Considering the PSS as a factor influencing the reduction in depression and anxiety in thalassemia patients, social support from the social networks (spouse, family members, friends, and healthcare workers) should be integrated with interventions that are designed to improve the mental and physical health of thalassemia patients.

The Effect of Psychosocial Factors and Patients' Perception of Tuberculosis Treatment Non-Adherence in Addis Ababa, Ethiopia.

BACKGROUND: Although there are several studies reported on factors affecting tuberculosis (TB) treatment non-adherence, there is information gap on psychosocial and patients' perceptions aspects. Therefore, this study was aimed to investigate the effect of psychosocial factors and patients' perceptions on TB treatment non-adherence in Ethiopia. METHODS: A cross sectional study was conducted in Addis Ababa from May to December, 2014. Thirty one health facilities were randomly selected and 698 TB patients, who had been on treatment, were enrolled consecutively using patient registration number. Structured questionnaire was used to collect data on demographics, knowledge, psychological distress, alcohol use, tobacco smoking and six HBM domains. Treatment adherence level was the main outcome variable, and it measured using visual analog scale. Statistical Package for Social Sciences version 20 was used for data analysis. RESULTS: Non-adherence level within last one month prior to the study was 19.5%. After controlling for all potential confounding variables, Antiretroviral Therapy (ART) status (Adjusted Odds Ratio (AOR) = 1.79, 95% Confidence interval (CI) (1.09 -2.95)), alcohol use (AOR = 2.11, 95% CI (1.33-3.37)), economic status (AOR = 0.53, 95% CI (0.33-0.82)), perceived barriers (AOR = 1.21, 95% CI (1.10-1.47)) and psychological distress (AOR = 1.83, 95% CI (1.47-2.29)) were independently associated with TB treatment non-adherence. CONCLUSION: ART status, economic status, alcohol use, perceived barrier and psychological distress are the major areas that need to be targeted with health promotion intervention to enhance TB treatment adherence.

The Effect of a Theory of Planned Behavior-based Educational Intervention on Sexual and Reproductive Health in Iranian Adolescent Girls: A Randomized Controlled Trial.

BACKGROUND: We aimed to assess the effect of a theory of planned behavior (TPB)-based educational intervention on attitude, norms, parental control, behavioral control, and intention in high school girls in Tehran, Iran. STUDY DESIGN: Randomized controlled trial. METHODS: This study was conducted among 578 high school girls, 12 to 16 yr, in Tehran, Iran in 2016. The subjects were randomly assigned to the experimental (n=289) and control (n=289) groups using multistage random cluster sampling. TPB is the basis for both education and evaluation; therefore, the TPB-based questionnaire was used before and after the intervention. The intervention included three months education and six months follow up. The obtained data were analyzed using SPSS version 16 through statistical tests and analysis of covariance. RESULTS: Significant improvement in attitude (difference=16.8; 95% CI: 15.3, 18.3), subjective norms (16.4; 95% CI=14.83 to 18.11), perceived behavioral control (18.0; 95% CI: 16.6, 19.4), perceived parental control (17%; 95% CI: 15.1, 18.9), behavioral intention (18.4%; 95 CI: 14.8, 18.3), and behavior (18.5; 95% CI:16.8, 20.2) was observed in experimental group compared to control group (P<0.001). CONCLUSIONS: Theory-based educational intervention in sexual and reproductive health can effectively reduce the high-risk behaviors related to sexual and reproductive health in adolescent girls. Health and education policy-makers are advised to review the current education programs and replace them with new influential education programs related to sexual and reproductive health in the school system.

Psychological empowerment of NGO women in Iran: Designing a tool.

BACKGROUND: As the core of health promotion, proper assessment of empowerment is a base for planning for a process that increases people's control on their decisions, lifestyle, and effective activities for their health. OBJECTIVE: To design and develop a special tool to assess the empowerment of NGO women in Iran. METHODS: This successive exploratory study of combinational type was conducted in 2015 in two steps. In the first step, using comments of participants and the help of authentic texts related to this field, dimensions of psychological empowerment were developed. In the second step, psychometric properties of the scale or tool were determined using formal content, and structural validity and reliability were determined using internal consistency and stability via SPSS version 21. RESULTS: In the first step, the initial tool including 58 items was developed in the form of eight domains. In the second step, based on exploratory factor analysis (EFA), the number of items was reduced to 37. Considering the eigenvalues of higher than one, items were classified into eight factors. KMO index was 0.896 in this study. Reliability of the tool was 0.81 using Cronbach's alpha. This tool is able to predict 66.1% of total changes in psychological empowerment. CONCLUSION: A questionnaire with relevant reliability and validity, including eight domains of participation, motivation, cognitive thinking, critical thinking, self-efficacy, intention, perceived control and social support was developed to measure psychological empowerment of NGO women in Iran.

Effects of a theory-driven educational package and social support on durability of cigarette smoking cessation behavior: A community-based program.

BACKGROUND: According to a World Health Organization (WHO) report, the prevalence of smoking in Iranian individuals aged 15-64 is up to 12%. OBJECTIVE: The aim of the current study was to determine the durability of smoking cessation behavior based on a trans-theoretical model. METHODS: This educational experimental study was conducted on smokers in Khomein City, Iran, in 2015. Sampling was done through a public announcement and then a random allocation of participants into two study group (50 persons) and control group (60 persons). Tools to gather data were as follows: an individual characteristics form and DiClemente's stages of change, Velicer's self-efficacy, Prochaska's processes of change, Velicer's decisional balance, and Fagerstrom's nicotine dependency questionnaires. The study group received five sessions of 45-minute individual counseling each and were followed-up three and six months later. Data were analyzed by SPSS version 16, using paired-samples t-test, independent-samples t-test, and chi-square. RESULTS: Within six months of follow-up, 20 persons (40%) of the intervention group reached the maintenance stage of smoking cessation, while no one from controls managed to do that. Except for the perceived barriers and benefits of smoking cessation, all other constructs of the trans-theoretical model (cognitive and behavioral processes and smoking temptation) showed significant changes among the intervention group during six months' follow-up (p<0.05). There was no significant relationship between variables of having smoker friends, occupation, marital status, education status, and success or failure in cigarette smoking cessation (p>0.05). CONCLUSION: According to our study, selection of cigarette smokers who are willing to quit, delivery of individual counseling according to specific personal characteristics, and also provision of free nicotine replacement therapies should be taken into account in cigarette smoking cessation programs.

Barriers to Pap Smear Test for the Second Time in Women Referring to Health Care Centers in the South of Tehran: A Qualitative Approach.

BACKGROUND: Cervical cancer is a preventable disease with a regular screening program. Many studies have reported a large number of barriers that women had for the first time, but this study decided to find other barriers for the second time pap smear. METHODS: In this qualitative research, data were gathered through in-depth interviews and expressed through conventional content analysis in the form of constant comparison. The participants were 15 women with family profile at 30 health care centers who lived in the south of Tehran and had done Pap smear for one time but didn't do it for the second time. RESULTS: Three main themes emerged from the analysis of the interviews: negative experiences of the first Pap test were as follows: results of the first time test, readiness for performing the test, getting the test itself, and the site of the first Pap test. Personal barriers to getting the second Pap test were: inattention to time, physical barriers to the second Pap test, and inhibitory beliefs. Perceived social barriers to getting the second Pap test with two sub-themes included social supports and abstract norms. CONCLUSION: This study provided other barriers about Pap smear including lack of the spouse's support, the role of health care providers and physicians in screening program for early diagnosis in women.

Teenage girls' experience of the determinants of physical activity promotion: A theory-based qualitative content analysis.

BACKGROUND: The progress of technology in developed countries has changed lifestyles to sedentary and has increased non-communicable diseases. Identifying factors affecting patterns of physical activity among adolescents is valuable and it is important to change these pattern. OBJECTIVE: This study aimed to explore teenage girls' experiences regarding the determinants of physical activity promotion based on Pender's Health Promotion Model. METHODS: This qualitative study is a content analysis research on the girls of three high schools in Minoodasht city for six months from September 2015 until the end of February 2016. The data were obtained by focused group discussions and semi-structured in-depth interviews from 48 girls ranging from 15 to 18 years old and six teachers. Data analysis was done using theory-driven qualitative content analysis. RESULTS: Data analysis resulted in a total number of 53 primary codes which were classified in the six predetermined classifications of Pender's Health Promotion Model (Perceived benefits, perceived barriers, perceived self-efficacy of physical activity behavior, feelings related to physical activity behavior, interpersonal and situational influencers). The results showed that two classifications (perceived barriers, and situational influencers) were considered more important than other classifications in reducing levels of physical activity in adolescent girls and also high self-efficacy for promoting physical activity in adolescents. CONCLUSION: The results obtained from this study specified the determinants affecting the promotion of physical activity among adolescent girls and can help the planners to choose the most appropriate methods and strategies in order to promote physical activity among adolescent girls and to prevent chronic non-communicable diseases in this age group and gender.