towhid babazadeh

 Current evidence suggests that health literacy (HL) impacts self-care behaviors and quality of life (QOL) in patients with type 2 diabetes mellitus (T2DM). This study aimed to evaluate the impact of a short-time health literacy promotion program (HeLPP) on self-care behaviors and QOL in rural patients with type 2 diabetes.

 Conducted from 2018 to 2019 in Chaldoran county, Iran, this randomized controlled trial followed the Solomon four-group design. Participants included 160 rural individuals with T2DM, who were divided into two intervention (A and C) and two control (B and D) groups. Pre-tests were conducted for intervention group A and control group B, with post-tests administered to all groups at three and six months. Interventions, consisting of five training sessions lasting 45 to 55 minutes, were planned and executed based on pre-test analyses. Primary outcomes were QOL and self-care behaviors, and secondary outcomes were glycated hemoglobin (HbA1c), HL and patients’ awareness of the disease.

 Prior to the intervention, there was no significant difference in awareness, HL, self-care behaviors, HbA1c, and QOL between intervention group A and control group B (P>0.05). However, at three and six months after the educational program, intervention group A exhibited significantly increased average scores in awareness, HL, self-care behaviors, and QOL, along with reduced HbA1c levels (P<0.05) compared to control group B. No interaction was detected between the pre-test and the primary and secondary outcome scores after intervention.

 Implementing intervention programs like HeLPP focusing on enhancing practical HL and empowering T2DM patients seems to be promising in improving patients’ self-care behaviors and QOL, while reducing their HbA1c levels.

We developed a protocol for a health literacy promotion program (HeLPP) to promote self-care behaviors and quality of life (QOL) among T2DM patients in Chaldoran County, Iran. To develop the educational program, we primarily conducted a behavioral and educational assessment on the pre-test data collected from the participants. In this paper, we report a summary of the protocol and the primary results of the pre-test findings.  The HeLPP protocol is naturally developed for a randomized controlled trial with Solomon four-group design. Developing the HeLPP, we will conduct it for both test groups. To plan the HeLPP and to find the main predictors of self-care behaviors and QOL, we firstly conducted a cross-sectional study (as a needs assessment phase). So, applying simple random sampling, data on 160 patients were collected and analyzed. The validated scales (Health Literacy Questionnaire (HLQ), Self-care activities scale, and Diabetes QOL Brief Clinical Inventory) were used to collect data. The mean age of participants was 61.08 ± 11.35. The most significant determinants of self-care behaviors were understanding (β: 0.26), reading skills (β: 0.23), and knowledge (β: -0.19). Self-care behaviors (β: 0.29) and decision-making (β: 0.28) were significant predictors of QOL.  Considering the predicting role of understanding, reading skills, and decision-making for self-care behaviors and QOL of the rural T2DM patients, the focus of HeLPP should be on clear communication, goal-setting, and teach back strategies. The developed protocol seems to be helpful in promoting the outcome variables of the study.

The aim of the present study was identifying factors associated with h delayed initiation of post-exposure prophylaxis (PEP) among animal bite victims.

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 recognizing by a decision tree model.

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 delay more than 48 h in females was higher than the males (12.9% compared to 8.5%) (p-value= 0.004). Relative frequency of delay 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.

Based on the study findings on various variables that affect the delayed initiation of PEP, particularly being female, and rural residents 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 indicate that provider training and patient education are required to ensure the completion of appropriate treatment.

Brucellosis is one of the most common diseases between humans and animals (zoonosis); one of its transmission routs is through the consumption of infected cattle dairy products. Since Sarab city has a large cattle population, and traditional dairy production and processing practices are still prevalent in this region and are known as tourist attractions and souvenirs of the region, this study aimed to investigate the prevalence of infection in employees of traditional dairy products workshops in Sarab in 2018.

This descriptive cross-sectional study was conducted on 196 employees of traditional dairy production and packaging workshops. Blood samples were obtained from all subjects in order to determine the serological status of the patients. After sera isolation, Rose Bengal, seroagglutination in tube (Wright), 2-mercaptoethanol (2ME), and ELISA tests were used to evaluate them.

In this study, the disease prevalence in the subjects with the mean age of 33±4.2 years was determined as 2, 1, 1, and 1% using Rose Bengal, Wright, 2-mercaptoethanol, and ELISA tests, respectively. The mean knowledge score of the employees in dairy products workshops was 31±5.7, and by increasing age and duration of work, knowledge about brucellosis was also increased

In this study, the mean knowledge score showed the average knowledge of the subjects about brucellosis. The disease prevalence in this occupational group was lower than that reported in other studies conducted on other at-risk occupational groups in other parts of Iran and the world. Therefore, health personnel should take the necessary measures against brucellosis.

In order to increase the acceptance level of the cervical cancer screening behavior among women, understanding the associated factors of the behavior is necessary. The aim of this study was to evaluate the cognitive determinants of Pap smear screening (PSS) behaviors among rural women in Tabriz, Iran. In this cross sectional study, multistage random sampling was employed to recruit 220 rural women in Tabriz, Iran. A valid and reliable health behavior model (HBM)-based instrument was completed by all the respondents. The odds ratio of perceived benefits in multivariable was 1.18 (1.08 - 1.27) i.e. with one unit increase in perceived benefits, odds cervical cancer screening behavior 18% increases, and age = 0.94 (0.91 - 0.98) i.e. with one unit increase in age, odds cervical cancer screening behavior 6% decreases were statistically significant. The HBM was promising in determining the cognitive predictors of PSS behavior. Healthcare providers may specifically focus on perceived benefits and perceived barriers for designing PSS promotion interventions.

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).

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.

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.

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.

Ageing is a stage of human life that can affect the quality of life (QOL) of people by being exposed to the resultant problems of old age. Therefore, this study aims to examine QOL and identify the influential factors to adopt accurate and comprehensive policies concerning the senior citizens aged 60 and older in health centers of Khoy city, Iran.
This cross-sectional study was conducted on 297 elderly. Sampling was performed using multi-stage random sampling method among the healthcare centers. To collect data, Lipad 31-statement QOL questionnaire was used. To analyze the data, SPSS software, descriptive statistical tests, Student's independent t-test, one-way analysis of variance and Pearson correlation were used at the significance level of P The overall score of life quality of the participants was 49.70. Accordingly, 83.8% of the elderly had a medium-quality life. The results of this study showed that there was no difference between the life quality of men and women. In addition, there was a significant correlation between QOL and its dimensions and education, marital status and life partners. Also there was significant negative correlation between QOL and age (r = -0.600, P = 0.001).
According to findings of the study, most of the elderly lead a medium-quality life. Education, living with spouse and marital status are influential factors on QOL. Identifying these factors and enhancing them among the elderly can considerably empower the elderly and optimize planning the related issues.

Considering increasing sexual risk behaviors such as lack of using condoms and having several sexual partners, identifying factors affecting on it can be useful in the design of preventive interventions for health educators. The aim of this study was to investigate cognitive-emotional determinants of high-risk behaviors among young people using Prototype/Willingness (P/W) Model.
In this cross-sectional study, non-random sampling was employed to enroll 400 aged 18 to 28 referring to public places. A valid and reliable instrument based on P/W structures wad applied to measure cognitive factors.
The results showed that sexual risk behaviors at males (62.7%) are more than females (37.3%). Between sexual risk behaviors and self-control (p0.05) were significant and direct predictors of sexual risk behavior in females. None of P/W structures was not significant predictors of sexual risk behaviors in males (p>0.05). In male, the previous experiences of sexual risk behaviors was significant at formation of the prototype (p=0.039) and prototype, also, in creating positive willingness toward risky sexual behaviors (p=0.004). In addition, at males, attitude toward behavior was significantly associated with behavioral intention (p According to the findings, subjective norms and intention are the most important influential factors on sexual risk behaviors in females. In males, as well as, previous experiences play an important role in the formation of prototype and their willingness toward sexual risk behaviors

Spiritual well-being is one of the fundamental concepts in chronic diseases and is considered an important approach to improve public health among individuals. Given the importance of spiritual well-being and its role in the promotion of mental health, the present study was conducted with the aim of evaluating spiritual well-being and mental health in patients with breast cancer who visited a center for cancer control at the University of Medical Sciences.
This cross-sectional study was conducted on 122 patients with breast cancer in 2015. The data were collected through self-administered 20-item Paloutzian & Ellison’s Spiritual Well-Being Scale and a 28-item questionnaire of mental health after determining their validity and reliability. The collected data were then analyzed using ANOVA and Pearson correlation and linear regression.
The results show that most patients had moderate spiritual health (37.8%), and most of them suffered mild mental health problems. (50 percent). Furthermore, there was a significant relationship between mental health and demographic characteristics (Marital status, education, income, physical activity). There was also a significant relationship between mental health and spiritual health.
According to the findings, to prevent mental suffering among patients with breast cancer, promoting spiritual health of patients should be regarded as one of the priorities of health care professionals.

Cervical cancer is the fourth most common cancer in women worldwide that causes more mortality each year. Given that lack of regular screening for cervical cancer is associated with an increased risk of 2 to 6 times and that the Health Belief Model (HBM) has been introduced as a suitable model to improve screening behaviors, this study was conducted aimed to survey the effect of blended educational program on cervical cancer screening behavior based on HBM among housekeeper women.
In this quasi-experimental study, 120 individuals of housekeeper women referring to health centre in West Eslamabad city were randomly selected. Using standardized questionnaire knowledge, HBM items and Pap test performance were measured before and after 3 months of educational intervention. The educational intervention consisted of four sessions of 45-minute-long of four weeks. Data were analyzed by software spss 21 and descriptive statistics (frequency, mean and standard deviation) and analytical (paired t, independent t and Chi-square tests) at the significant level of less than 0.05.
Findings: After the educational intervention, the mean scores of knowledge and HBM items except the perceived severity, were significantly higher in the intervention group compared to control group (pDiscussion & The results of current study showed that the combined program consisting of BEP and HBM provide a suitable framework for developing educational interventions regarding Pap test practice.

Diabetes is the most common metabolic disorder which if not controlled; it can cause a decrease in patient’s quality of life. Therefore, this study was carried out to evaluate the effect of educational intervention of self-care behaviors on quality of life in patients with type 2 diabetes.
This clinical trial study was conducted in 2015 on 90 patients with Type II diabetes in the city Chalderan. Patients were stratified randomization to intervention and control groups. Data was collected using standardized questionnaires in two phases before and 3 month after the educational. To analyze the data was used descriptive statistics and paired t and independent t tests in level of p Mean and standard deviation age of the patients was 46.3 ± 9.5. The results showed that the mean (SD) score of knowledge, attitudes and self-care behaviors significantly has increased in intervention group, but changes was not significant in the control group. Also, the educational intervention had a significant effect in improving the quality of life in all its dimensions compared to the control group had (p The findings of current study showed that educational intervention has been improved self-care behaviors in patients with type II diabetes. Also the results showed that by training self-care behaviors can be improved quality of life.

The importance of consuming fruits and vegetables (F&V) in prevention of chronic diseases is known. Childhood play an important role in formation of healthy eating habits. The purpose of this study was to examine the effect of education, with application of the theory of planned behavior, on improvement of F&V consumption.
In this quasi-experimental study, 184 fourth, fifth, and sixth-grade students participated were enrolled from Jan 2013 to Jun 2014. The samples were selected from 6 schools in Chalderan County, West Azerbaijan, Iran through cluster random sampling method. Two out of 6 schools were randomly selected and each was employed in either experimental or control group. The data collection instruments included a researcher-made questionnaire and a 24-h F&V recall. Data were collected after verification of the reliability and validity of the questionnaire.
Before the intervention, no significant difference was observed between the intervention and control group regarding attitude, subjective norms, perceived behavioral control, behavioral intention and fruits and vegetables consumption (P>0.05). However, after the educational intervention, the mean scores of attitude, subjective norms, perceived behavioral control, behavioral intention variables and fruits and vegetables were significantly higher in the intervention group when compared to the control group(P Increased behavioral intention, attitude, subjective norms, and perceived behavioral control can promote F&V consumption among the students.

Health promoting schools (HPS) project is currently being used in Iran but many challenges still lie ahead. The present study aimed, to test feasibility of implementing a comprehensive advocacy program (CAP) to overcome the obstacles and problems associated with the consummation of school health programs based on the HPS framework.
This quasi-experimental study was performed through recruiting all schools that were enrolled in the national HPS program and located in Jolfa as the intervention group and all of the schools situated in the East Azerbaijan province as control. In order to collect data, Iranian Ministry of Health’s checklists and external audit guidelines for HPS were utilized. In addition, to plan a CAP required data for coordinating fund raising activities including current rules and regulations regarding implementation of local health promotion interventions were collected.
Findings of the study revealed that the implemented CAP had improved all HPS dimensions’ mean score in the intervention group. The observed change in the pre- and post-test score in the intervention group was significant (P Commencing changes in the recruited schools’ structure through coordinated multi-level activities is feasible and this must be considered as a priority where contextual determinants exist to motivate progress towards providing healthier educational settings for school aged children in Iran.

Identifying the effective factors on oral health behaviors could have an important role in promotion of oral health in diabetic patients. Therefore, the aim of the present study was the assessment of cognitive-behavioral determinants of oral health in students using Pender's Health Promotion Model.
In this cross-sectional study, 251 subjects were selected from Azad University, Payame Noor University and Sarab Faculty of Medical Sciences by multistage random sampling in 2016. To collect data, a standard instrument was applied based on Health Promotion Model (HPM) structures. This questionnaire consisted of three parts: demographic variables, Pender’s HPM constructs items based on oral and dental health promotion, and health behavior.
The mean age (standard deviation) was (21.9 ± 1.67). Oral health behaviors had statistically significant correlations with all of the HPM structures except for situational influences (r = 0.048). The HPM structures were able to predict 43.6% of oral heath behaviors and 24.6% of commitment to action. Self-efficacy (β = 0.342) was the strongest predictor to behavior and perceived barriers of commitment to action (β = -0.217).
According to the results, self-efficacy was the strongest predictor of oral health behaviors and perceived barriers was the strongest predictors of commitment to action plan. Generally, based on the present study findings, HPM may be used as an appropriate framework for identifying factors and developing educational interventions, aiming at improving oral health behaviors among students.

Psychiatric disorders such as depression, stress, and anxiety are factors that affect the quality of life, suicide and many physical problems, and socioeconomic in elders. Considering the importance of the issue and increasing the number of elderly people in this County, researchers decided to investigate the levels of stress, anxiety, and depression in the elderly health centers of Khoy, Iran.
This cross-sectional study was done on 383 elderly people referred to health centers in Khoy County. A random cluster sampling was used in this study where each health care is considered as a cluster. The Depression, Anxiety, Stress Scale 21 (DASS-21) standard questionnaire was used for data collection. The SPSS software was used for all computations. Data were analyzed using descriptive statistic, t-test, and one-way ANOVA. P The results of this study showed that 1.3% of the elderly people suffer from very severe stress, 1.3% from severe depression, and 3.1% from severe anxiety. Likewise, the comparison between anxiety, stress, and depression disorders with demographic variables showed that there is a significant association between these disorders and sex, education, marital status, medical condition, as well as their housing conditions (P The results of this study indicated anxiety disorders, depression, and stress prevail among the elderly. In addition, some factors such as education, housing, medical condition, and marital status had significant effects on anxiety disorders, depression, and stress. Therefore, more attention is deserved in these aspects. Moreover, appropriate measures need to be taken to improve the mental health of elderly people.

Today, chronic diseases such as high blood pressure are increasing; this disease is closely associated with lifestyle. Therefore, the current study was conducted to assess the effect of lifestyle modifying educational intervention on blood pressure control in patients with hypertension.
This Quasi-experimental study was conducted on 210 patients with hypertension, referring to health centers of Shabestar County, Iran in 2016. Patients were assigned into two groups of intervention (n = 105) and control (n = 105) using random multi-stage sampling method. The data was collected using standard life style questionnaire (LSQ) in four dimensions of exercise, weight control, nutrition, and mental and spiritual health, before and two months after the educational intervention. Data were analyzed in SPSS-21 using descriptive and inferential statistics, such as chi-squared, paired t-test and independent t-test.
The results showed that the mean scores of exercise, weight control, nutrition and mental health in the intervention group increased significantly after the intervention (P 0.05). Also, the educational intervention had a significant effect on reducing blood pressure in the intervention group compared with the control group (P According to the findings of the study, educational intervention is effective in promoting physical activity, improving weight management, nutrition and mental health in patients with hypertension. In addition, the results indicated that controlled blood pressure can be achieved by improving the lifestyle.

Inadequate consumption of fruits in students is as a risk factor for some diseases such as cancers and cardiovascular in adulthood. The purpose of this study was to survey associated with the fruit daily consumption in elementary student based on the theory of planned behavior (TPB) in Chalderan.
In this study were selected randomly 184 students from elementary school boys and completed questionnaires related to demographic data, structures the theory of planned behavior and daily consumption of the fruits of the data gathering were analyzed with SPSS version 20 and statistical analysis of correlation and Linear Regression.
Findings: The results showed that mean 1.32 of the students 1 time, 2.58 of 2 time, 2.9 percent 3 times and only 0.5 percent 4 times daily consumption of fruits. The results showed that 32.1 percent of the students 1 time, 58.2 percent 2 times, 9.2 percent 3 times and only 0.5 percent, consumed 4 times in day fruits. According to Linear Regression analysis, attitude and subjective norms were greater predictive power for intention of fruit consumption (=0.19, F=36, P Fruit consumption in students is less than the amount recommended by the World Health Organization. According to the findings of this study should be attention in design educational interventions for elementary student on subjective norms and behavioral intention variables.

Skin cancer is one of the most common types of cancer in the world and in Iran as well. The incidence of this disease continues to climb. The present study was therefore aimed to investigate the copping with skin cancer among farmers in Chaldoran County in 2015.
Materials and Totally, 238 farmers from the rural areas of Chaldoran County participated in this analytical-descriptive study. They were selected through a multi-stage random sampling process. A reliable and valid questionnaire used by Tazval et.al was exploited for data collection. The gathered data were analyzed by the use of descriptive and analytic statistics in SPSS software (v. 21). A statistically significance level of p≤ 0.05 was considered. Ethical issues such as confidentiality of studied community were all considered.
A statistically significant relationship was observed between the education level of participants (p=0. 001) and their income status (p=0. 025). About 12.2% of respondents showed high perceived self-efficacy towards skin cancer protective behaviors. It was further found that response self-efficacy was low among 45.5% of community. The most of the farmers (61.8%) had moderate response cost towards skin cancer protective behaviors. The assessment of farmers copping status with skin cancer revealed that 182 (76.5%), 8 (3.4%) and 48 20.1%) respondents have an unacceptable, borderline, and acceptable copping appraisal, respectively.
The results of this study indicate that the farmers’ coping appraisal status towards skin cancer was low. Thus, it is necessary to design and implement appropriate interventions in this field.

Skin cancer is a serious public health problem in the world. Its prevalence in many countries has been increased in recent years. This study aimed to assess the effects of a theory-based educational intervention to promote skin cancer preventive behaviors (SCPBs) among rural farmers in Chalderan County, Iran.
This was a quasi-randomized controlled field trial study conducted on 238 rural farmers. The data were collected by a questionnaire containing the constructs of the Protection Motivation Theory (PMT) as well as the items of SCPBs. The differences between the groups before and 3 months after the intervention were determined by independent t-test, paired t-test, and chi-square applying SPSS software.
Before the intervention, no significant difference was found in the scores of the PMT constructs between the two groups (p>0.05). However, significant differences were found between the scores of all the variables, as well as SCPBs, in the two groups after the intervention (p The PMT was found to be an appropriate framework for designing educational interventions aiming at promoting SCPBs among rural farmers. It was concluded that designing an educational program with a focus on promoting perceived susceptibility increased the level of performing SCPBs among the rural farmers.

Inadequate consumption of fruits in students is a risk factor for some diseases such as cancers and cardiovascular disorders in adulthood. The purpose of this study was to predict the fruit consumption in elementary student based on the theory of planned behavior (TPB) in Chalderan. In this study, 184 students were selected through clustered randomization from male elementary schools. The data collection instruments included a researcher-made questionnaire and a 24-hour F&V recall. The reliability of the questionnaire with α=0.82 was confirmed. Data were collected after verification of the reliability and validity of the questionnaire. The data gathered were analyzed using SPSS version 20 and statistical analysis of correlation, regression and descriptive data. The results showed that mean (SD) of fruit and vegetable consumption is 1.47 unit in day. According to regression analysis, subjective norms, amount of pocket money, and behavioral intention, 39% of the predicted changes of fruit and vegetable consumption (R2 =0/39, F=10/72, p<0.001). As well as based on this model, attitude predicts 20% changes of intention the consumption of fruit and vegetables (R2=0/20, F=6/68, p=0.01). Fruit consumption in students is less than the amount recommended by the World Health Organization. According to the findings of this study, there should be attention in design of educational interventions for elementary student on subjective norms and behavioral intention variables. Also, economic status can be an effective factor in the consumption of fruit and vegetables.