مجله آموزش و سلامت جامعه
سال نهم شماره 1 (Mar 2022)

Lifestyle changes, advertising, and access to high-calorie, low-value foods have led to an increase in the prevalence of obesity and overweight, and women are at greater risk in this regard. The aim of the present study was to identify the determinants of weight loss and obesity control behaviors based on Pender’s health promotion model (HPM) among women referring to the healthcare centers of Shahrekord, Iran.

This descriptive-analytical study was performed on 500 women aged 18-49 years with a body mass index (BMI)≥25 in 2019. The cluster sampling method was performed on the healthcare centers, and women were selected using simple random sampling. The data collection instrument included a researcher-made questionnaire, the reliability and validity of which were approved, and finally, data were analyzed using analytical tests in SPSS 22 and Stata14.

The mean (±standard deviation) of the women’s age was 34.33±8.2 years. A total of 57.8% of women had no history of weight loss and obesity control behaviors. Variables such as age, education level, and marital status were statistically significantly related to weight loss and obesity control behaviors (P≤0.05). Moreover, the constructs of prior related behaviors, interpersonal influences, and commitment to a plan of action were among the predictors of weight loss and obesity control behaviors and predicted 6.6% of behavioral changes (R2 : 6.6, P<0.05).

Overall, prior related behaviors, interpersonal influences, and commitment to a plan of action are predictors of weight loss and obesity control behaviors, and thus it is suggested to place more on these constructs while designing relevant health-promotion interventions.

Inadequate dietary intake and malnutrition are commonly found in older adults. They tend to have early satiety that limits intake from main meals. Some reports indicated that small frequent meals may promote higher intake. From that point of view, snacks may be useful. Therefore, this study aimed to determine the effects of frequent snacks on energy intakes and nutritional status in older adults at risk of malnutrition.

A randomized controlled study was conducted among older adults at risk of malnutrition in a suburban community from November 2020 to March 2021 in Chiang Mai, Thailand. Two villages were randomly assigned to either a control group (n=17) or an intervention group (n=17), and they were matched pairs by age and gender. An intervention snack consisted of 2 desserts and a box of milk (total 548 kcal) was used. For the first 3 weeks, an intervention snack was provided every day although it was too heavy for some participants. Therefore, after that, the intervention snack was provided every other day for 4 weeks. A nutrition survey by the 24-hour recall method for 3 days, body weight, mid-arm circumference (MAC), triceps skinfold (TSF), and grip strength were assessed at weeks 3 and 7 as baseline.

Thirty-one participants completed the study (91%). The average age was 71.8±4.8 years, and body mass index (BMI) was 19.0±2.1 kg/m2 . In the intervention snack group, there was an increased daily energy intake by 316 kcal and 214 kcal at weeks 3 and 7, respectively, (P<0.001, effect size: 0.884), with a body weight of 0.8 kg (P<0.001, effect size: 0.314), BMI of 2% (P=0.009, effect size: 0.314), and MAC of 4% (P<0.001, effect size: 0.265) compared with baseline, but such energy intake was not observed in the control group.

Providing frequent snacks was an effective way to improve energy intake and nutritional status in community-dwelling older adults at risk of malnutrition.

Women of reproductive age have important responsibilities such as pregnancy, breastfeeding, and children raising. This study aimed at surveying the effect of educational interventions, based on the health belief model (HBM), in the prevention of self-medication (SM) in women of reproductive age.

This quasi-experimental study was performed on women of reproductive age in Jahrom in 2019 (January-September). Simple multi-stage random sampling was used to select the participants, and the sample size was determined 60 people for both intervention and control groups. Data collection tool was a questionnaire including demographic information and HBM construct questions. The questionnaire was completed in person by both groups before and three months after the educational intervention. The educational intervention was performed based on the HBM in the intervention group, including holding 4 educational sessions each lasting 60 minutes. The data were analyzed by SPSS 21 software using the chi-square test, paired t test, and independent t-test.

The results showed a significant difference between intervention and control groups in terms of knowledge, perceived severity, benefits, and barriers, as well as cues to action on the correct use of drugs after the intervention (P<0.05). Three months after the intervention, the practice mean of women in the intervention group was significantly decreased compared with the control group (P<0.001).

Overall, educational intervention based on HBM was effective in preventing SM, but the extent of this effect varied for different HBM constructs. Nonetheless, measuring the effectiveness of the intervention based on the HBM in preventing SM behaviors requires studies with a long follow-up period.

Patient health engagement (PHE) is a dynamic and evolutionary process that involves improving health; however, little information is available on the PHE model. This study aimed to investigate health engagement and its relationship with social support, self-efficacy, and the quality of life in women with breast cancer.

This cross-sectional study was conducted on 129 breast cancer patients who were referred to a specialized medical clinic and met the inclusion criteria. Data were collected using the EORTC QLQ-br23 questionnaire, Communication and Attitudinal Self-efficacy Scale for Cancer (19-item), Perceived Social Support Scale, NCCN Distress Thermometer, and PHE Scale. The statistical methods used in this study were linear regression, ANOVA, CATREG (Categorical regression with optimal scaling using alternating least squares), and descriptive statistics.

The most commonly reported problem was tingling in hands and/or feet (43.3%). The median PHE score was 2. Additionally, 29.45% and 16.27% of the patients reported moderate and severe distress, respectively. The results of regression analysis showed that the PHE scale could predict social support, self-efficacy, quality of life and all of its dimensions (P<0.001). However, it is the strongest predictor of understanding and participating in care (P<0.001, r=0.485).

Given that the model can predict factors effective in improving cancer and interventions based on this model have not been performed in Iran, it is recommended that health interventions based on this model should be designed and implemented.

Health literacy (HL) is one of the factors influencing the use of health-related information by patients with diabetes. As a social support resource, peers can help improve diabetes knowledge in these patients. The aim of this study was to determine the effect of peer support on HL in patients with type 2 diabetes (T2D) with low support resources.

This randomized controlled trial was conducted on 80 patients with T2D referring to a diabetes clinic in Aligoudarz. Patients meeting the inclusion criteria were selected by the random sampling method and randomly assigned to two groups of intervention and control each containing 40 cases. The data were collected using the Test of Functional Health literacy in Adults (TOFHLA) at the beginning of the study and after 3 months of educational peer support intervention. Eventually, data were analyzed by the statistical tests of chi-square, Fisher’s exact test, t test, and paired t test.

The results showed that there was no significant difference in the mean (±SD) HL between the two groups before the intervention (53.12±13.86 vs. 56.62±10.34, P=0.204). However, the mean HL in the intervention group represented a significant improvement after 3 months of peer intervention compared to the control group (70.27±9.78 vs. 56.87±10.07, P<0.001).

Overall, peer support was found to be effective in improving the HL of diabetic patients with limited access to support resources. Therefore, it is recommended to use the capacity of peers as a social support resource in diabetes care programs.

Healthy nutrition is necessary for normal growth and development. Although breakfast is considered the most important meal of the day, it is ignored by many adolescents. The purpose of this study was to apply the health promotion model (HPM) to predict breakfast consumption among adolescent girls using the structural equation modeling (SEM) approach.

A descriptive-analytical study was performed on 450 Iranian female high school students in 2019. Sampling was performed through a multi-stage method. The data collection instrument was a two-part questionnaire. The first part was about demographic information and the behavior of breakfast consumption. The second part was a questionnaire based on the HPM. Data were analyzed by SPSS (version 21) and AMOS (version 21) using the Chi-square test and the regression model.

Based on SEM, the constructs of Pender’s HPM explained approximately 0.47 of the variation in the breakfast consumption behavior. The highest total effects on breakfasting behaviors belonged to behavioral perceptions (0.833), prior related behaviors (0.800), perceived self-efficacy (0.677), activity-related affects (0.659), perceived barriers (-0.598), and commitment to planning (0.361).

HPM is a suitable theory for predicting commitment to the planning and behavior of breakfast consumption among Iranian adolescent girls. Accordingly, the impact of emotions and behavioral perceptions on a commitment to planning for breakfast consumption should be considered in designing nutritional interventions for female adolescents. Moreover, in planning educational interventions, pleasant experiences should be created to positively influence individual perceptions and effects related to the target behavior in order to enhance commitment to the breakfast consumption behavior.

Back pain is one of the most important public health problems that is on the rise among the schoolchildren’s population. The aim of this study was to determine cognitive factors related to back care-related behavior based on the social cognitive theory (SCT) among female schoolchildren.

A cross-sectional study was directed among 5th-grade female students through a convenience method. Structured questionnaire data were collected from 610 students attending public elementary schools in Tehran, Iran from October 2018 to March 2019. The initial model was formulated based on the SCT. Based on these data, the hypothesized model was confirmed via a structural equation modeling analysis using SPSS (version 24.0) and LISREL (version 8.80).

The skills (r=0.73, t-value=13.42), self-efficacy (r=0.87, t-value=15.51), and expectation beliefs (r=0.61, t-value=6.68) were verified as key cognitive factors that cause a back behavior. Finally, various indicators such as comparative fit index, normed fit index, and root mean squared error of approximation demonstrated the fitness of the models (P<0.0001).

The results showed that those schoolchildren having more self-efficacy, skills, and expectation beliefs are more likely to do proper back behavior. In this regard, school-based back pain prevention interventions should further focus on predefine key cognitive factors that consider the potential change strategies.

Divorce is the most important factor in family disintegration. This study aimed to assess the perspectives of Tehran residents aged over 20 years on women’s social exclusion after divorce and its related factors.

This descriptive cross-sectional study was carried out on the population over 20 years old in Tehran in September 2019. Due to the coronavirus disease 2019 epidemic conditions, the Social Exclusion Questionnaire for Iranian Divorced Women was provided to the subjects online. Convenience sampling was applied until 400 questionnaires were completely received. Independent t test, one-way analysis of variance, multiple linear regressions, and Pearson correlation coefficient were used to investigate the relationship between social exclusion and demographic variables via SPSS (version 16) at the significance level of 0.05.

The mean±standard deviation of the age of participants was 37.82±9.1 years. There was a significant relationship between social exclusion and employment status (P<0.001), education level (P<0.001), economic status (P<0.001), and marital status (P<0.001). Further, there was a significant correlation between social exclusion and age (P<0.001). The total average of economic dependence and discrimination based on marital status, terrifying, depriving, and damaging marital status were 4.19±0.70, 4.0±02.75, 3.80±1.06, 3.75±0.85, and 3.67±0.94, respectively.

The economic dependence based on marital status had the highest impact on the social exclusion of divorced women based on the opinion of Tehran residents aged over 20.

Breastfeeding affects long-term child health and improves the quality of their lives. This study sought to compare educational interventions based on the theory of planned behavior (TPB) in pregnant women and individuals influential to their exclusive breastfeeding (EBF) in the first six months of an infant’s life.

This quasi-experimental study was performed from 2020 to 2021 on pregnant women, who were at their>30 weeks of pregnancy, and relatives influential in their life in Jahrom, southern Iran. Sampling was conducted by the stratified random method, and the sample size was determined as 90 (30 cases in each group). The study consisted of two intervention groups and a control group. Data collection tools included the demographic questionnaire and the standard TPB questionnaire for EBF. In the first stage, the questionnaires were completed by all three groups. The second stage involved an educational intervention. The training lasted five weeks. In the third stage, the questionnaire was completed again six months later. The collected data were analyzed by SPSS 21 using one-way ANOVA, chi-square, Mann-Whitney, Wilcoxon, and Kruskal-Wallis tests.

Based on the results, a significant difference was observed in intervention group 1 in terms of the attitude construct (P=0.009) before [Median (IQR)=34.5 (6)] and after [Median (IQR)=36 (5.25)] the educational intervention. Similarly, a significant difference was found in intervention group 2 regarding the subjective norm construct (P<0.001) before [Median (IQR)=25 (4.25)] and after [Median (IQR)=30 (4)] the educational intervention.

Overall, in addition to pregnant women, their subjective norms should be considered in health education and promotion programs to improve EBF.