Papers by Fazlollah Ghofranipour
PubMed, May 1, 2009
Background & objective: Evidences suggest that relaxation therapy may improve psychological outco... more Background & objective: Evidences suggest that relaxation therapy may improve psychological outcomes in heart patients. We evaluated the effect of progressive muscular relaxation (PMR) training in decreasing anxiety and improving quality of life among anxious patients after coronary artery bypass graft surgery (CABG). Methods: This study was an open uncontrolled trial. The sample included 110 anxious patients referred to the cardiac rehabilitation clinic of Tehran Heart Center, Tehran, Iran, during six weeks after coronary artery bypass graft (CABG). Patients were allocated to receive both exercise training and lifestyle education plus relaxation therapy (relaxation group; n=55) or only exercise training beside lifestyle education (control group or the recipient of usual care group; n=55). Duration of the relaxation therapy was 6 wk and in the case of usual care was 8 wk. Both the groups were followed up one month after completion of intervention. Anxiety and quality of life in the two treatment groups were compared. Results: There were no significant differences in overall QOL, state anxiety and trait anxiety scores between the two groups before intervention. Significant reductions in state anxiety (P<0.01) and trait anxiety (P<0.01) levels were observed in relaxation group after intervention compared to control group. Women had high state anxiety and a low quality of life than men in the two groups before intervention. After intervention, there was no difference between men and women in the relaxation group. Interpretation & conclusion: Our findings show that progressive muscular relaxation training may be an effective therapy for improving psychological health and quality of life in anxious heart patients.
DOAJ (DOAJ: Directory of Open Access Journals), Sep 1, 2007
Background: Patients with psychological problems after coronary artery bypass graft surgery (CABG... more Background: Patients with psychological problems after coronary artery bypass graft surgery (CABG) show poorer outcomes; nevertheless, there is a paucity of research into the effects of cardiac rehabilitation programs on such patients. The purpose of this study was to determine the effect of phase III cardiac rehabilitation programs on the anxiety and quality of life of anxious patients who had undergone CABG in Iran. Methods: Six weeks after CABG, 83 anxious patients participated in an 8-week cardiac rehabilitation program that consisted of formal supervised exercise training and educational sessions. The state/trait anxiety inventory and SF-36 questionnaire were two instruments for collecting data in the present study. Of the total of 83, 66 participants saw out the eight-week period. Results: With the exception of the mental health aspect, significant improvements were noted in the following components of the quality of life measures after the cardiac rehabilitation program: physical functioning (P<0.001), role-physical (P<0.001), bodily pain (P<0.001), social functioning, (P=0.003), general health (P=0.020), vitality (P=0.006), and role-emotional (P=0.003). Additionally, significant reductions were observed in state anxiety (P=0.010) and trait anxiety (P=0.010). Conclusion: These findings suggest that phase III cardiac rehabilitation may be an effective therapy for improving psychological outcomes of patients with psychological problems after CABG.
Health promotion perspectives, Jul 7, 2015
Iranian Journal of Endocrinology and Metabolism, Jul 15, 2010
Introduction: There is convincing evidence that family environment plays an important role in inf... more Introduction: There is convincing evidence that family environment plays an important role in influencing the obesity related-behaviors in adolescents. Considering the necessity of understanding the familial correlates of obesity in adolescents, and the lack of related studies in Iran, this study aimed to explore mothers' perceptions and experiences regarding these associated factors of overweight and obesity related behaviors in adolescents. Materials and Methods: A grounded theory approach was used for analyzing the participants' experiences, and their perceptions. To collect data, 6 semi-structured focus group discussions were conducted with 25 mothers who had at least one overweight or obese child. Based on open sampling, with the aim of maximal variation of the participants' experiences, two demographically diverse areas from the north and south of Tehran were selected and then followed with theoretical sampling. All the focus group discussions were audio recorded and transcribed verbatim. Data collection and analysis were done simultaneously using the Strauss and Corbin analysis method. Results: Five main familial correlates of overweight and obesity in adolescents emerged from data: 1) Parents with inadequate knowledge, 2) Parents' modeling of unhealthy behaviors, 3) Dissimilarity of members, 4) Maternal employment and 5) Children's studies being the top priority for parents. Conclusion: Findings demonstrate familial correlates of overweight and obesity in adolescents as perceived by mothers, correlates that must be addressed by effective interventions for tackling overweight and obesity in adolescents
DOAJ (DOAJ: Directory of Open Access Journals), Dec 1, 2008
Background: Coronary artery bypass grafting surgery (CABG) and precutaneous transluminal coronary... more Background: Coronary artery bypass grafting surgery (CABG) and precutaneous transluminal coronary intervention (PCI) are safe and effective in the treatment of coronary artery disease. The aim of this study was to determine and compare anxiety, self efficacy expectation and perceived social support between CABG patients and PCI patients referral to receiving cardiac rehabilitation programs. Methods: In this descriptive-analytical study 150 patients with CABG and PCI were selected. The Spilberger state trait anxiety inventory, general self efficacy scale and perceived social support scale three instruments for collecting data in the present study. Results: PCI patients as compared to CABG patients experience higher anxiety (P= 0.02) and lower perceived social support (P= 0.02). Self efficacy score in the PCI patients was higher than CABG patients (P= 0.01). Conclusion: It is necessary to be more considerate to psychological problems in the PCI patients.
Journal of Business and Industrial Development.
Introduction: Unwanted pregnancy remains a major public health concern. In Iran, 8.7% of women of... more Introduction: Unwanted pregnancy remains a major public health concern. In Iran, 8.7% of women of reproductive age (15-49) have an unwanted pregnancy during use of a reversible method of contraception, and 5.6% of these pregnancies occur among Oral Contraceptive (OC) users. OC use is the most popular and widely used method among Iranian women. The recent Iran Demographic and Health Survey (IDHS) reported that only half (51.5%) of OC users take it correctly. The aim of this study was to investigate the influence of the women's self-efficacy on their oral contraceptive performance. Materials & Methods: This study was a cross-sectional survey on oral contraceptives that investigated contraceptive behavior based on steps to behavior change (SBC) model and self efficacy theory of OC users in Iran. The survey was conducted from July 2005 to May 2006 in family planning clinics of Mashad Health Centers. Three hundred and fifty two OC users were interviewed. The collected data were analyzed by SPSS software. Statistical methods such as descriptive analysis, spearman correlation and multiple regressions were employed. Results: Family planning self-efficacy was significantly related to knowledge, approval, intention, practice and advocacy, among which, intention and advocacy had the highest correlation and predictability power. Standard multiple regression analysis revealed that this model had worked extremely well. Indeed, the independent variables accounted for 54.5% of the variance in intention. Conclusion: This study confirms that the hypothesis of improving family planning self-efficacy can be effective in consistent and correct use of oral contraceptive pills and it can produce positive outcomes. It is suggested that the findings of present study be used as a basis for interventions designed to enhance better performance in the concerned area.
BMC Public Health
Background The prevalence of overweight and obesity among children has raised public health conce... more Background The prevalence of overweight and obesity among children has raised public health concerns. This study aimed to design and evaluate a behaviour change intervention program to promote weight management among Tehranian preschoolers. Methods The PRECEDE-PROCEED model is one of the most popular models in health education used to develop and evaluate most educational interventions. In this one-group pre and post-pilot study, 13 mothers of preschoolers were recruited from preschools in Tehran (the capital of Iran), in August 2020. Mothers received a six-week educational intervention, including text messages and educational videos via WhatsApp, to increase their self-efficacy to overcome barriers changing their children’s lifestyle. Mothers reported preschoolers’ height and weight to assess Body Mass Index and filled out the Food Frequency Questionnaire, the Persian version of the children's health-related quality of life questionnaire, and demographic features. The “Children...
PLOS ONE
The current study aimed to understand the perceptions and experiences of Iranian parents and prin... more The current study aimed to understand the perceptions and experiences of Iranian parents and principals of preschool children on weight management based on the PRECEDE-PROCEED Model (PPM), a comprehensive structure for assessing health needs for designing, implementing, and evaluating health promotion, and other public health programs. PRECEDE provides a structure for planning a targeted and focused public health program, and PROCEED provides a structure for implementing and evaluating the program. Data were gathered from 17 preschoolers’ parents and two principals using semi-structured interviews in the preschool setting in Tehran, the capital of Iran, in 2019. Data were analyzed manually through directed content analysis based on constructs in phases two and three of the PPM, simultaneously with data collection. This study identified genetic, behavioral (e.g., food preferences, physical activity, sedentary behaviors, the effect of parents’, peers’, principals’ and teachers’ behavi...
Introduction: Measuring tools in each study must be evaluated themselves. The goal of present stu... more Introduction: Measuring tools in each study must be evaluated themselves. The goal of present study was designing, validating, and determining the reliability of some scales, which are used for measuring concepts of behavior change theory/models. Materials & Methods: This study was a descriptive one in which, at first literature review and need assessment were done. Then designed tools were validated by face and content method. For reliability of scales 3 methods were done: 1) test-retest method for knowledge questionnaire, 2) internal consistency method for attitudinal scales, and 3) a greement method for checklists . Results: Validity of tools was confirmed by 15 experts, and reliability coefficients (r, alpha, and kappa) for all scales of this study were high and acceptable. Conclusion: In most studies, designing, validating and determining the reliability of data gathering tools are time consuming and costly and if there are valid and reliable tools in different topics, we could...
Journal of Basic Research in Medical Sciences, 2016
Introduction: Breakfast is repeatedly called to as the most important meal of the day and has pos... more Introduction: Breakfast is repeatedly called to as the most important meal of the day and has positive effects on nutritional profile, cognitive activities and disease prevention in schoolchildren. The aim of this study was to assess the eating breakfast status in a sample of primary students of Ilam city. Materials and methods: Participants of this cross-sectional study were 298 schoolchildren grade 4th, 5th and 6th from 8 primary schools of Ilam city. Data were collected by researcher-made self-report brief questionnaire and were analyzed using IBM SPSS statistics data editor. Results: The subjects included 148 boys (49.7%) and 150 girls (50.3%) from eight primary schools. The majority of sample (35.9%) educating in 4th grade and 54.0% of sample were living in the inner city areas. The results showed that 32.2% of study schoolchildren skipped breakfast. There was a significant difference between boys and girls breakfast habit, (P<0.018). Also, the results revealed that boys (47...
JMIR Public Health and Surveillance, 2021
Background Unsafe worker behavior is often identified as a major cause of dangerous incidents in ... more Background Unsafe worker behavior is often identified as a major cause of dangerous incidents in the petrochemical industry. Behavioral safety models provide frameworks that may help to prevent such incidents by identifying factors promoting safe or unsafe behavior. We recently conducted a qualitative study to identify factors affecting workers' unsafe behaviors in an Iranian petrochemical company. Objective The aims of this study were to (1) conduct a review of the relevant research literature between the years 2000 and 2019 to identify theoretical models proposed to explain and predict safe behavior in the workplace and (2) to select the model that best reflects our qualitative findings and other evidence about the factors influencing safe behaviors among petrochemical workers. Methods This research used mixed methods. Initially, we conducted a qualitative study of factors that Iranian petrochemical workers believed affected their safety behavior. Four themes emerged from the ...
Open Access Macedonian Journal of Medical Sciences, 2020
BACKGROUND: Dyslipidemia is one of the main risk factors of cardiovascular disease in people with... more BACKGROUND: Dyslipidemia is one of the main risk factors of cardiovascular disease in people with diabetes. The principle of diabetes prevention and control is based on patient self-care and education. The Islamic self-care nutrition method is a common and successful way to modify behavior in Islamic ethics and mysticism. AIM: The study aimed to determine the effect of the Islamic self-care nutrition method on the lipid profile of patients with type 2 diabetes. MATERIALS AND METHODS: The present clinical trial was conducted in 2014 on 98 middle-aged patients with type 2 diabetes referred to the Diabetes Center of the Mazandaran University of Medical Sciences, Sari, Iran, who were randomly allocated into two groups of experimental and control. Lipid indices were measured before intervention, and the same education about diabetic healthy diet was provided in both groups. In addition, in the experimental group, Islamic teachings and the Islamic self-care method of nutrition were taught...
BMC Public Health, 2020
Background Mechanical life made us witness the growing increase of chronic diseases despite the p... more Background Mechanical life made us witness the growing increase of chronic diseases despite the prominent scientific developments in the field of health, treatment and control. The aim of this study was to evaluate the impact of educational intervention based on Health Belief Model (HBM) using mobile applications (Telegram messenger) on doing exercise among the health care workers of Ilam university of medical sciences in 2017. Methods In this interventional study, 114 people working in Ilam University of medical sciences participated in two groups of intervention and control (employed at two different cities) after providing the informed consent form. HBM-ISCS questionnaire was used to collect the required data and its reliability was approved using Cronbach’s alpha. Descriptive statistics, chi square, t test, repeated measures ANOVA (RMANOVA) and structural equation model (SEM) were used. Results Half of the participants were men, 58.77% of them were undergraduate. The mean and SD...
BMC Pregnancy and Childbirth, 2020
Background Maternal mental health including postpartum mental health is essential to women’s heal... more Background Maternal mental health including postpartum mental health is essential to women’s health. This study aimed to develop a specific measure for assessing postpartum depression literacy and consequently evaluate its psychometric properties among a sample of perinatal women. Methods This investigation was composed of two studies: developing the measure, and evaluating of psychometric properties of the developed questionnaire. In development stage an item pool was created. Then, based on definition of mental health literacy and preliminary screening, an initial questionnaire was developed. The content and face validity of the questionnaire were then assessed. In the second study psychometric properties of the questionnaire were examined. Overall 692 perinatal women with the mean age of 27.63 years (ranging from 17 to 43) participated in the study. Results In all an item pool of 86 items was generated. Of these, 31 items were removed and the remaining 55 items subjected to conte...
Journal of Research and Health, 2019
The obesity is increasing as one of the risk factors of CVD among high classes in developing coun... more The obesity is increasing as one of the risk factors of CVD among high classes in developing countries. This study aimed to identify the determinants of daily exercises among overweight or obese employees using the Health Belief Model (HBM) in 2017. For the purpose of the study, 101 employees working in healthcare facilities affiliated with Ilam University of Medical Sciences were included after presenting a written consent form. The tool to collect data was a self-made questionnaire, which was applied after reviewing and approving its validity and reliability. The results showed that the mean of daily exercises among participants was 8.22±1.19 min. Statistical tests showed that there was a significant relationship between gender and the amount of daily exercises so that the mean exercises of men was higher than that of women. Accordingly, self-efficacy was determined as the strongest predictor of daily exercises based on multiple linear regression tests. At the end of the study, the researchers concluded that amount of daily exercises among the participants of this study was low while overweight and obesity would increase the risk of cardiovascular diseases; therefore, applying appropriate interventions, based on HBM in particular, can be effective in reducing the risk of obesity.
Journal of Education and Community Health, 2018
Background & Objective: Inactivity is one of the 10 leading causes of death in the world, doublin... more Background & Objective: Inactivity is one of the 10 leading causes of death in the world, doubling the risk of cardiovascular disease. Health belief model (HBM) is an effective model in predict the regular physical activity behavior. This study aimed at identifying determinants of the regular physical activity in order to prevent cardiovascular diseases, using HBM. Instruments & Methods: This descriptive-analytical cross sectional study was conducted on employees working in a healthcare network affiliated to Ilam University of Medical Sciences in 2017. 163 subjects were selected by simple random sampling method. The instruments to collect the data were standard inventory of HBM-ISCS and self-made questionnaire that were applied after reviewing and approving their validity and reliability. Eventually, the data were analyzed, by SPSS 16, using Pearson correlation coefficient, multiple regression analysis, and ETA test. Results: The perceived severity and self-efficacy were significant predictors of daily and weekly regular physical activity. Meanwhile, multiple regression analysis predicted 23.3% of the behavior. Also, gender had the strongest relationship with the barriers of physical activity and marital status and occupation had the strongest relationship with selfefficacy. Education had no significant statistical relationship with model constructs and age had a significant statistical relationship with perceived severity and the benefits of physical activity. Conclusion: The perceived severity and self-efficacy from health belief model are the strongest determinants for daily and weekly physical activity.
Iranian Red Crescent Medical Journal, 2018
Background: Inactivity is one of the factors to increase the risk of having cardiovascular diseas... more Background: Inactivity is one of the factors to increase the risk of having cardiovascular diseases. Objectives: This methodological design study was conducted on the staff of Ilam Medical Science University (Ilam, Iran) in 2016 in order to assess the psychometric properties of the Iranian version of Impact of Sport on the Cardiovascular Diseases Scale based on the Health Belief Model (HBM-ISCS). Methods: In this study, first, targeted questions were selected based on the scientific literature review (N = 54) and then, the basic version of the questionnaire, including 14 questions in terms of HBM (Health Belief Model) constructs, went on the validation phase using the opinions of experts. At this stage, content and construct validity and reliability were reviewed and approved. Results: Over all, 433 individuals with a mean age of about 38 years participated in the study. Based on the results, content validity rate (CVR) higher than 0.05 (number of specialists = 20) and content validity index (CVI) higher than the acceptable level of 0.79 were calculated. The primary Exploratory Factor Analysis (in a random spitted sample, N = 187) extracted five factors that jointly accounted for 59.804% of the variance observed. The results of Confirmatory Factor Analysis (in a random spitted sample, N = 246) showed that the questionnaire has desirable construct validity: (X 2 = 146.81, df = 67, P < 0.001, CFI = 0.93, IFI = 0.93, RMSEA = 0.074 and SRMR = 0.067). Similarly, the Cronbach's alpha coefficient was calculated between 0.715 and 0.816, and the Intraclass Correlation Coefficient (ICC) was obtained between 0.455 and 0.623 for the subscales. Conclusions: The results indicated that HBM-ISCS is a valid and reliable tool for measuring the health beliefs about the impact of sport on CVDs prevention.
Journal of Advances in Medicine and Medical Research, 2019
Introduction: Breakfast consumption has a lot of beneficial effects on nutritional status and cog... more Introduction: Breakfast consumption has a lot of beneficial effects on nutritional status and cognitive activities of school-aged children's. This study aimed to examine the efficacy of social cognitive theory–based education on schoolchildren breakfast eating behaviors. Methods: Two schools with similar socio-demographic characteristics were selected from 20 public primary schools of Ilam city (west of Iran) and randomly assigned as intervention or control school. Fifty school children from 3rd, 4th and 5th grades of each school participated in this study. Educational intervention was performed during 6-weeks and was focused on enhancing the self-efficacy, social support and self-regulation mediators to promote the school children’s breakfast consumption. Data were collected at baseline and 8-weeks after intervention using a 57-item questionnaire and a breakfast food diary and analyzed using Nutritionist IV food processor software and IBM SPSS statistics data editor. Results: T...
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Papers by Fazlollah Ghofranipour
deficiencies and it is the most preventable cause of brain damages in the world.
Current studies reveal reduced urine iodine median and the iodine content of
households salt in Tehran. Pregnant women are more at a risk for iodine deficiency
than other age groups because of their increased need for iodine during pregnancy.
Therefore this study aimed to design and evaluate an educational package on the
status of women’s knowledge, attitude and practice (KAP) regarding iodine and
iodized salt intake and its association with iodine nutrition levels. Materials and
methods: For this purpose a randomized controlled trial study was designed and 100
pregnant women were randomly selectedin from five health care centers in 19th area
in Tehran (50 each). Knowledge, attitude and practice scores, urinary iodine
concentrations and content of salt iodine were assessed at baseline and four months
after the intervention in two groups. Results: The findings showed knowledge,
attitude and practice scores increased after educational intervention in two groups
significantly; although it increased in intervention group more than in control group
significantly, but no affect pregnant women iodine status.Urine iodine concentration
significantly associated with practice score as well as with content of salt iodine.
Conclusion: Designed educational package increased knowledge, attitude and
practice status in pregnant women effectively but it needs on-going monitoring of
universal salt iodization program and supplement consumption during pregnancy to
improve maternal iodine status.
Keywords: pregnant women, educational package, Iodine status, Tehran
Introduction: Cancer is the cause of 13% of deaths around world and is the third cause of mortality
in Iran. Meanwhile, more than one third of these cases are preventable and one third curable with
early detection. So educating people about symptoms and signs of cancer in order to early detection is
essential. Recent studies on different behaviors including cancer screening and early detection
apparently show the effectiveness of mass media especially TV in this area. As determining factors or
strategies of media interventions which causes a special \behavior change is difficult, these
interventions should be based on an adequate theory. Protection Motivation Theory (PMT) is a whole
theory in health communication and is a useful framework for predicting and intervention on
behaviors related to cancer prevention and early detection. So this study carried out with the aim of
designing, implementation and evaluation of a theory based media program in order to cancer early
detection (CED).
Methods: The study was performed in three stages. In the first stage in order to designing required
media program, a cross-sectional study was carried out on 260 above 20 years old people in Yazd
city. In this stage, CED behaviors and PMT constructs were determined by a PMT based
questionnaire. The validity and reliability of the scale were determined by face validity, content
validity, Internal Consistency and Intraclass Correlation Coefficient. Based on findings from data
analysis, media program was created. In the next stage, media program was showed in three parts
from Yazd Broadcasting. In final stage for media program evaluation, a mixed method study with
embedded design was performed including a quasi-experimental (case-control) study on two 60
persons groups and a qualitative content analysis study by 16 participants. Final results provided by
combination of quantitative and qualitative findings. Data were analyzed using descriptive and
inferential statistics in every stage.
Results: The total score of the respondents for protection motivation, passive behaviors and active
behaviors constructs were 64.47%, 30.97% and 45.64%, respectively. Perceived reward and response
efficacy were the powerful predictors of protection motivation. Knowledge and response cost were
the powerful predictors of passive behaviors. Also self efficacy was the powerful predictor of active
behaviors. Media program increased all of the main variables of the study including passive and
active behaviors so that in comparing the passive behavior and active behavior after intervention, it
was 55% and 18% higher in case group than control group, respectively. During qualitative data
analysis, six main categories were developed: “knowledge reinforcing”, “motivating and empowering
beliefs”, “fear reduction and hope increasing”, “program attraction”, “maintenance of program
positive effect” and “conductor timing effect” that supported the quantitative finding of study.
Conclusion: Considering the low level of CED behaviors among the respondents and the applicability
of PMT in predicting those behaviors, interventional programs aimed at accelerating early detection
and secondary prevention with an emphasis on reinforcement of knowledge, response efficacy and
self efficacy as well as reducing rewards and response costs may be effective on cancer control. In
this regard designing theory based media intervention with coordination of education and media
principals and techniques will be even more useful and beneficial.
Key words: Media, Protection Motivation Theory, Cancer early detection
Introduction: According to some research, patients’ dissatisfaction with the quality and
quantity of the doctor-patient relationship is at the top of the patients' complaints list
and improving physicians' communication skills results in many valuable and positive
health outcomes.
Methods: This study, with both cross-sectional and quasi-experimental parts, was conducted in
order to design and evaluate the effect of an intervention applying PRECEDE PROCEED
model on interns’ doctor-patient communication skills and their patients’ satisfaction in
2014. Applying PRECEDE model, assessments were done based on directed content analysis of
interviews with participants. The impact and the outcome of the education were evaluated by
the mean score from both interns' self-assessments and researcher's observation checklist and by
the mean rank of the patients' satisfaction with intern's doctor-patient communication skills,
respectively. The data was analyzed using SPSS.21 and LISREL 8.80.
Results: Social, environmental and behavioral indicators of effective doctor-patient relationship
were identified. Interns' knowledge and self-efficacy were the most important predictors of their
communication behavior with patients. Interns' performance in the intervention group was
significantly better than those in the control group; however, the increase in patient satisfaction
with interns' communication skills was not statistically significant.
Conclusion: Instructional designers would better consider increasing interns'
motivation to build effective relationship with patients, supervising and providing them
with continual constructive feedback as well as training patients about their rights, in
order to acquiring continuous effects of theory-based interventions.
Keywords: Doctor-patient relationship; Intern; Patient satisfaction; PRECEDE
PROCEED model; Self-efficacy
The present study is a pseudo-empirical research and a pre-test and post-test in type,
and has control group. It has been conducted in two phases in order to consider the
effect of feeding behavior on reducing symptoms of the premenstrual syndrome. The
under study population consisted of female high school students of Chabahar-Iran. In
this study, we have firstly selected two high schools, using the simple random
sampling method. In the selected schools, we specified the students with the syndrome
among the volunteers (using PAS questionnaire). At the second phase, sampling was
conducted among the syndrome-infected students through simple sampling method
(n= 180). Ultimately, the samples were classified in test group (n=90) and control
group (90). The intervention program was implemented and two months later the
retest was conducted using PAS questionnaire. According to the findings of the study,
the PMS frequency was 98% in test group and the most prevalent physical symptoms
were as follows, respectively: abdominal and back pain (85.1%), energy reduction
(83.9%), pain in muscles and joints (71.1%); and the most prevalent behavioral
symptoms were as: fatigue (86.6%), agitation, anxiety (82.5%), decreased interest in
usual activities (82.9%). Following the educational intervention, frequency of the
physical symptoms (P= 0.001), behavioral symptoms (P= 0.001) and the severity of
the symptoms decreased significantly among the test group. There was no significant
difference between the test and control groups, concerning the mean score of physical
and behavioral symptoms before intervention (P> 0.05); but it was a meaningful
difference after the intervention (P< 0.05). The results indicated the frequency of
premenstrual syndrome among the students and efficiency of the feeding behaviorbased
education in reducing the frequency and severity of the premenstrual syndrome.
Keywords: premenstrual syndrome, nutrition, health education, teenager, Chabahar
Nutrition is a pillar of healthy lifestyle, and suitable educational methods are required
to improve nutritional awareness, attitude, and behavior among people, especially
children. This research aims to compare the effects of two educational methods,namely,
multimedia-based vs. opportunistic (face-to-face) training, on improving the level of
nutritional awareness, attitude, and behavior in primary-school students.
This is a quasi-experimental research conducted on two groups of 84 students, selected
randomly from two primary schools in Jajrood County, Tehran, Iran. Educational
intervention was made in the first group using opportunistic method by the teacher, and
in the second group using multimedia educational package.The nutritional awareness,
attitude, and behavior were measured at three stages:(Before, immediately after, and
three months after trainings using a researcher-made questionnaire). The data were
analyzed using suitable statistical tests including Repeated Measures, T-test, and Chisquare.
The findings show an average awareness score of 77.3% before intervention in both
groups, while it increased to 94.6% and 89.3% respectively for the two groups 3 months
after training. The average attitude scores before and after intervention in the two
groups, changed from 81.2% and 80% to 90% and 83% respectively. Also, the average
behavior scores before and after intervention in the two groups, improved from 50.4%
and 51% to 79% and 65.7% respectively, showing meaningful differences in the two
method-groups, with P<0.001. Overall, the research findings demonstrate higher effect
on students’ nutritional attitudes and behaviors in opportunistic training than
multimedia-based training method.
Based on the results of this research, considering teachers’ special role and effect on
students’ training, as well as their opportunity of being in direct contact with the
students, it is advisable to make more opportunistic use of teacher-student contact times
to improve the students’ knowledge, awareness and behavior in health-related subjects
such as nutrition.
Keywords: Opportunistic Training, Multimedia Training, Nutritional Awareness,
Nutritional Attitude, Nutritional Behavior, Students.
factors into account in safety management, particularly in the Petrochemical industry were
human operations dominated. Based on the reported studies, near to 90 percent of workplace
accident is due to unsafe behaviors and human errors, even though, in a safe work conditions. So that, the most important strategy in reducing the rate of these accident is training workers
regarding the safe behaviors. The current study is going to determine the effects of a safety
education program on promoting healthy and safe behaviors among workers using the
PRECEDEPROCEED model integrated with both social cognitive and adult learning
theories. Materials & Methods: This study is the report of a randomized clinical trial study done on
182 workers working in Factories related to the Razi Petrochemical Company in the city of
Mahshar. The study population was the divided in two groups (91 in case group and 91 in
control group). Data was collected using a researcher made questionnaire and the behavior
observation form (Checklist). Validity and reliability of statistical instruments to assess
knowledge, attitude and practices of safe an unsafe behaviors by the study population were
tested by face and content validity, and testretest method and alpha chronbach respectively. Following data collection step, and based on the results, and educational intervention applied
using various methods including group discussion, adult education theory, modeling
education in workplaces, plus an indirect program through inviting the family members of
workers. Three months later, the data recollected and was analyzed using statistical software
spss13. Based on distribution of variables, we used parametric (ttest, paired ttest) or
nonparametric (Mann Whitney, Wilcoxon) tests.
Results: Following educational intervention, the score mean of safe behaviors has been
significantly increased in exprimental group. However, this changes was not significant in
control group. The results indicate a 60% increase in safe behaviors and a 59% reduction in
unsafe behaviors in exprimental group. Six months following the intervention , the safe
behaviors of exprimental group has been continued. The difference between exprimental
group using the integrated PRECEDEPROCEED model and control group was not
statisticaly significant.
Discussion & Conclusion: The results show that application of mentioned integrated models
has an acceptable and positive influence on promoting safe behaviors of workers working in
Mahshar Company. It is, therefore, recommended that some educational programs would be
useful for other and similar industries
Keywords: PRECEDEPROCEED model, Social cognitive theory, Adult learning theory, Safety education, Safe behavior, Unsafe behavior, Petrochemical workers.
management the stressors can lead to psychosomatic disorders in adulthood and their
outbreak as abnormal behaviors, aggression, and depression. The aim of this research
was evaluation a model based stress reduction intervention among a sample of male
adolescents.
Materials & methods: this is an interventional randomized control trial. Among
male high schools that were located in southern area of Tehran, 242 students were
selected by multistage sampling method and allocated to two intervention groups (n=78
& n=81) and a control group (n=83). In first intervention group, emotion focused coping
techniques such as: relaxation, exercise, and in second intervention group problem
focused coping techniques such as problem solving skills and time management were
educated. The intervention was included 4 face to face educational sessions. Data were
collected by adolescent stress and coping processes inventory, perceived stress scale,
Rosenberg self esteem scale, general self efficacy scale, center for epidemiological
studies depression scale and demographic questionnaire at 3 times (before, 1 month and
3 months after intervention).
Results: after intervention there was significant difference between intervention and
controls group in term of stress, depression, self-esteem and self-efficacy (P<0.01).the
results showed that both emotion focused and problem focused educations were
effective in stress reduction among adolescents but the emotion focused method
revealed more impact in comparison to problem focused in stress reduction (P< 0.05).
Also after 3 months follow up the results showed significance difference among the
groups. In general, among intervention groups the mean score of perceived stress was
reduced from 17.99 (SD=6.02) at before intervention to 14.72 (SD=5.63) at 3 months
after intervention.
Discussion: the results revealed that using both problem focused and emotion
focused coping educations can have significant impact on stress reduction among
adolescents but stress management training in the format of emotion focused techniques
seems to be more effective on stress reduction among adolescents.
Key words: stress, emotion focused coping, problem focused coping, adolescents
Intruduction: Diabetes is a serious problem and epidemic in the wourldwide. One of the
most effective nonpharmacological treatment strategies for control diabetes, is physical activity.
Diabetic patients especially women have low participant in physical activity. Theory based
intervention is necessary for stoping the sedentary lifestyle in diabetic women. The aim of this
study was evaluation of educational program based on health promotion model (HPM) and
stages of change construct in promoting physical activity.
Material and method: This study performed in two stages. In the first stage, 348 diabetic
women participated in descriptive study for fitting model. Then, intervention performed for two
groups of women in precontemplation and contemplation stages. In this clinical trial study, 40
women in each groups in the first, 3 and 6 months after education, evaluated for stages of
change, physical activity, Hb A1c, BMI and waist hip ratio. In educational program, each
patients educated in 1 session of group education, and 3 sessions of individual counseling with
5 A’s method. Data were analyzed with using of LISREL 8.8 and SPSS 13 with repeated
measurement ANOVA and fridman test.
Results: The results of first stage showed that the patients with different stages of change
need to different constructs for promoting physical activity. Perceived benefits and barriers,
perceived self-efficacy and perceived social support were effective factors. The patients with
more duration diabetes history and unsuitable perception of health status were more susceptible
for sedentary lifestyle. The results of second stage showed that time- group interaction effects
after education were significant for Hb A1c (P= 0.003) and physical activity (P= 0.000), but
BMI (p= 0.192) and waist hip ratio (P= 0.486) weren’t significant. Also case (P= 0.000) and
control (P= 0.001) grops had progress in stages of change.
Conclusion: HPM based intervention with using stges of change was effected to decrese of
Hb A1c, to increase of physical activity and to improve stages of change in diabetic women of
precontemplation and contemplation stages.
Key word: health promotion model, stages of change, physical activity, and diabetic women.
This study was a pre-post experimental design that describes the outcomes from the
application of a health promotion model in combination with health locus of control (HLC)
to the development, implementation and evaluation of a participant-educational program
designed to improve mental health literacy and early help seeking among university
student from 2004 to 2007. 144 students in Gonabad and Birjand universities of medical
sciences were recruited into the study. The participants were pair-matched and randomly
assigned to intervention (71) and control groups (73). The data were collected by standard
and researcher–made questionnaires according to precede–proceed model in combination
with HLC. Afterwards the program was used based on HLC and the life skills framework
as a focus group discussion method in the sub-group of 10-12 participants. Then planned
and implemented program was evaluated including impact and outcome (after 3 months)
evaluation in two groups. Moreover, this is the first study that has examined the validity
and reliability of multidimensional HLC scale in Iranian subjects. The data analyses were
conducted through related soft ware and were performed by statistical methods e.g. factor
analysis, Pearson and Spearman-Brown correlations, ANOVA, regression, chi square, ttest.
The results showed that the reliability and validity of Persian Forms A and B were
acceptable and respectable. The path analysis revealed that model showed a good fit with
the data and there was a statistically significant difference in predictors and determinants
pre-post intervention in the groups (P<0.05). In impact evaluation, the External
components of HLC showed a significant decrease and the Internal HLC, knowledge, selfesteem,
and health-related behavior revealed a significant increase (P= 0.000). In outcome
evaluation students mental health showed a significant increase (P= 0.000). The findings
emphasized that the participant-educational program as a new project can empower and
improve HLC beliefs and finally continuous efficiency of the predictive behaviors that
cause mental health promotion of the students need to be followed and coordinated in inter
and intra sections.
Key words: Precede-Proceed, Health Locus of Control, Mental Health Promotion,
Student.
Background: Level of knowledge about diabetes is an important factor for prevention of many
complications in diabetics. There are many models for changing the behavior of patients toward
better results for controlling chronic diseases. In this research to build a new model for changing
behavior of diabetic patients; Health Belief Model, Fear Model and Fear Drive Model were used. This new model is insisting on discrimination between “fear” and “threat”. This model is called
as “Developed Health Belief Model” (DHBM). Methodology: methodology is based on clinical experimental intervention. 91 of diabetics from a
province diabetic’s clinic “Hormozgan, Iran” were chose for the study. They should be
diagnosed at least one year ago as diabetic (type2), as inclusion criteria. They divided into two
groups based on follow up times. Since the follow up times was every other week, group 1 was
patients who followed in odd weeks and group two with even weeks. The progress for
controlling of the disease was checked by level of hemoglobin A1C (HbA1c), once at the
baseline, then after 3 and 6 months. Health personnel also filled out a questionnaire during an
interview with patients after sampling blood for HbA1c. The questionnaire was aimed to
evaluate the quality of life, and the patients’ level of knowledge about the diabetes and its
complications, and also prevention of complications. The questionnaire was designed based on
World Health Organization Quality of Life (WHOQOLBREF 26) and Iranian Diabetics Quality
of Life questionnaire (IRDQOL). The questionnaire was validated by a pilot study. Health
personnel did interventions by the new model, through a facetoface education. Results: the mean value of HbA1c showed a significant difference between two groups. The
level of reduction of HbA1c after 6 months in intervention group was significant while it was not
significant in group 2. Discussion: DHBM is a good model to increase the awareness and concerns in diabetic patients
to change their behavior for a better control on blood sugar and decreasing the complications in
this regard. The DHB model has many potentials and it can be developed by more researches in
other populations. Keywords: diabetes , HbA1c, Fear, Health Belief Model
Breast cancer is the most common and the second leading cause of cancer related
deaths among women. Recent advances in breast cancer detection and treatments have
increased women’s chances of surviving. Increases in survival rate hase made researchers
more interested in studying the quality of life among breast carcinoma survivals, which is
really an important aspect of their health. This study uses a triangulation approach that
consists of both qualitative and quantitative methods, and aims to improve the quality of
life of breast cancer patients. Data collection and analysis were done simultaneously
according to the grounded theory.
In the first phase of research, we used purposeful sampling; 39 Iranian women
participated in this part. All of them were diagnosed to have cancer at various stages for at
least a year. Then we continued with theoretical sampling according to the codes and
categories as they emerged. Therefore, in this stage, 4 patient spouses, 5 daughters, 1 sister,
1 neighbor and 2 members of health care system were interviewed. 267 open codes, 16
initial codes, and 5 main themes emerged from the data. From the participants' points of
view, “perceived physical and functional disabilities”, “role conflicts”, “perceived
inadequate socio-economic supports”, and “perceived spirituality” were considered as
buffers and “social believes about cancer” was considered as a barrier. Then the conceptual
model was developed on this basis
In the second phase of research, for evaluating this model, an educational intervention
was designed based on gain frame approach and a quasi-experimental study. 63 patients (at
least one year after diagnosis) were randomly assigned into experimental and control
groups. For evaluating perceived quality of life, perceived self efficacy, and perceived
social support, a comparison between case and control group was done first before the
intervention and then one month after the intervention. The results showed that educational
intervention based on supportive model improved quality of life in Iranian breast cancer
survivors which participated in this intervention.
Key words: Breast Cancer, Grounded Theory, Supportive Model, Improving Quality of Life
Introduction: Reasearch Findings indicate that Problem behaviors are growing among
Iranian students. Prevention Programs aren’t effective approaches on prevention of problem
behaviors without identification its structure. An educational program without understanding of
problem behavior structure isn't an effective approach. The main goal of the current study was
development and evaluation of protection-risk model-based training for prevention of problem
behaviors among male high school students.
Materials & Methods: At first, the research team conducted a multi-staged preliminary
study. The aim of the first study was to assess the psychometric properties of Persian version of
tools and a new model to explain problem behaviors using calibration and validation samples of
adolescents. For evaluation new model, a pretest-posttest study with randomized control group
was designed and implemented. Follow-up assessments of outcomes took place after 5 months
post of intervention. The intervention group (49 students) received prevention education
program. Intervention variables (basic social skills, identifing risk factors, avoidance problem
behavior, problem-solving…) include the predictors of problem behaviors in individual level
that were identified by the new model. The intervention comprised of approximately 10 weekly
hour-long sessions. The main tools were multiple problem behavior indexes (MPBI) and Social
Skills Rating System – student form (SSRS-S). The control group (57 students) did not receive
any intervention. This study applied exploratory and confirmatory factor analysis procedures to
development of model, and to analyze intervention effects, the analysis of variance and t-test
procedures were used.
Results: The final result of preliminary study was to develop of a new model to explain
adolescents’ problem behaviors and introduce problem behavior syndrome. Fit statistics
indicated that model provided an adequate model fit (CFA=.98, NNFI= .98, RMSEA=.068).
The findings of educational intervention indicated that variation trend of mean scores of SSRS
in the expremental group was significant (P < 0.001). In addition, significant difference between
groups founded on SSRS at posttest (p = 0.026). Compared to the control group, the
intervention group reported Lower levels of MPBI and its subscales at posttest and follow-up.
Significant differences in delinquency (p = 0.003), cigarette use (p= 0.048) and hashish use (p =
0.036) were found between groups at follow-up. However, these differences were nonsignificant
at post-intervention. Also, Intervention had no significant effect on the use of hookah
and opium.
Conclusion: The results suggest that new established model for problem behaviors can be
usefully applied for studies among Iranian high school students. Educational intervention based
on Social competence enhancement can be effective in promoting social competence and
prevention of these problem behaviors among male students. Future researches should be
examined the role of the peer and more long- term services or interventions.
Key words: Problem behavior, protection and risk factors, new explanation model for problem
behaviors, social competence, high school students
Introduction: Current data shows that most interventions in the field of obesity prevention among
adolescents have not achieved their goals. Understanding the obesity process, and designing
context-based interventions, is essential. Comprehending the lack of related studies from Iran, this
study was conducted to explain the obesity process in Iranian adolescents and to test a model
designed for obesity prevention.
Material and methods: This triangulation study (a combination of qualitative and quantitative
research methods) was conducted in two consecutive phases, the first of which included two stages.
In the first phase, using the grounded theory approach, the obesity process in adolescents was
explained; a total of 72 adolescents, mothers and related experts participated in deep interviews and
focus group discussions. Data analysis was then conducted, in three steps, manually using constant
comparative methods, the open, axial and selective coding and to determine data trustworthiness,
we assessed credibility, dependability, confirmability and transferability; in the second stage of this
phase, based on the initial theoretical concepts, the preventional model of obesity-related behavior
in adolescents was determined. During the first stage of the second phase, to assess predicting
factors of adolescents’ obesity, a questionnaire was developed and its face, content and construct
validity were evaluated, with reliability being assessed based on stability and internal consistency.
In the last step of current phase, the relation between model constructs was assessed using the
structural equation model.
Findings: Based on constant comparative analysis of data, the “Theory of Obesity-Related
Behaviors in Adolescents” emerged, of which the core concept was “Motivation Loss”. The main
constructs of motivational-based model for Prevention of Obesity-Related Behaviors in Adolescents
are “modification of obesity-related behaviors”, “resolution and revision of priorities”, “realitybased
self evaluation”, “self control and goal-oriented expectations”, “cognition and perception of
threat” and “environmental and social support”. Qualitative and quantitative face validity of the
questionnaire were confirmed. Qualitative content validity was confirmed by a panel of experts. The
content validity ratio and content validity index scores being above 0.6 and 0.7 respectively for all
items thereby confirming the quantitative content validity of the questionnaire. Our findings
regarding exploratory and confirmatory factor analysis confirmed the presented model. Total
variance explained was 49.9. The results of structural equation model show that the optimum model
was matched to the presented grounded theory and reasonably confirmed by related indices.
Conclusion: Motivating adolescents to healthy behaviors and weight control is the main concern of
prevention of obesity-related behaviors in this group. The motivational-based model which
presented by current study could be considered as an effective conceptual framework to design and
implement interventions aimed at preventing obesity in adolescents.
Key words: Adolescents, Obesity-related behaviors, Grounded theory, Prevention, Motivation,
Qualitative study
Introduction: Despite the many benefits of Universal (standard) precautions and implementation of different educational intervention, so this precautions compliance is low and is one of health problem among nurses that high risks for them and their patients. Therefore, the purpose of this study was to investigate the effect of educational intervention for promotion and maintenance of preventive behaviors from HIV, HBV and HCV infections in health care workers with using constructs of health belief modle In precede – proceed model
Material and Methods: This study is semi-experimental research. Data collection instruments after validity and reliability was gave samples. One group of 91 nurses received educational intervention based on health belief modle and precede – precede model constructs. Post and 6 months after intervention evaluation was conducted by Data collection instruments and results was analyized.
Results: The study findings with statistical analyizis showed significant differences in before, post and 6 months after educational intervention about health belief modle and precede – precede model constructs and preventive behaviors(p=0.0001).
Conclusion: Educational intervention based on precede – proceed model with using health belief modle constructs for promotion and maintenance of preventive behaviors from HIV, HBV and HCV infections in health care workers in rafsanjan university of medical sciences
Key Words: precede – precede Model, Health Belief Modle, preventive Behavior, HIV, HBV and HCV Infections, Health Care Worker
Introduction: High prevalence of dental caries in Iranian adolescents emphasizes on exploring dental
caries process of viewpoints of them and it will be crucial base for designing preventive and effective
interventions. The first aim of this study was designing an educational model for adolescent's dental caries
prevention and second aim was evaluating of an educational model based on quasi-experiment study in
preventing of dental caries.
Materials and Methods: This Mixed Method study (a combination of qualitative and quantitative
research methods) was conducted in three phases in Iranian adolescents in guidance schools in Tehran city
in years 2012 to 2014. In the first phase, a grounded theory approach, developed by Strauss and Corbin,
was used to collect and analyze data. Data collection was conducted through in- depth interview, journal
writing and focus group. Participants were who experienced the phenomenon of dental caries and agreed
to participate in the study. In the second phase, theory was developed then to prevent of dental caries in
adolescent a model was created by Walker and Avant's method. After analyzing the data and creating the
theory, questionnaire of predicting factors for dental caries in adolescents was developed and its validity
and reliability was evaluated and the most efficient model was obtained for preventing tooth decay. In the
third phase, educational intervention was done based on educational needs and data were collected using
the same tools after tow month again. Finally, data were analyzed using appropriate statistical tests.
Results: During data analysis in the first step, five main themes developed: “threat to dental health”,
“maintaining dental health”, “uncertainty in decision-making” and “supportive factors” and “perceived
inability”. The main concern of adolescents was confidence and continuous pursuit for maintaining tooth.
In the second, steps of dental caries prevention model were “internalizing control”, “understanding the
importance of mouth and teeth”, “effective factors in decision-making”, “social and environmental
supports”, “confidence” and “behavior modification”. During exploratory factor analysis, eight factors
developed: “behavioral factors”, “phobia”, “social support”, “motivational beliefs”, “role of school”,
“instructive elements”, “socio–economic status”, and “value of teeth”. Results of confirmatory factor
analysis showed that the eight-factor model for preventing of dental caries fit in Iranian adolescents and
the four-factor model is the strongest predictor of oral health behavior and foresee 76% of behaviors relate
to oral and dental health. In the third step, Dental plaque in adolescents decreased before and after the
intervention significantly (P=0.001).
Conclusion: The results of this study showed that designed educational model based on adolescent’s
experiments is effective in decreasing dental plaque and promoting oral health in them. Also the findings
emphasize on role of individual, family, dentist and community in preventing dental caries. Further
research is needed in different groups to confirm the results of this study.
Key words: Grounded Theory, Dental Caries, Adolescents, Educational Intervention, and Questionnaire.
Introduction: Sedentary is among the women health problem in postpartum women.
Regular physical activities in this period reduce the risk of various diseases, and provide women
with many other advantages. On the other hand, postpartum is an opportunity for women to
replace the unhealthy life style with the healthy one. Therefore, the research team decided to
plan and implement a model-centered theoretical training program, and evaluate its effects on
the reduction of sedentary life style among this population.
Material and Methods: The study was conducted in two stages. In descriptive study, we
have studied the transtheoretical model's constructs (stage of change, process of change,
benefits, barriers and self-efficacy), social support and the past related behavior) among 300
mothers in 3-5 months after delivery; aiming at processing the predictive model of physical
activity behavior. Based on the model, the self-education multimedia was designed to promote
mothers' physical activity in 8 training sessions (8 weeks). In clinical evaluation conducted after
the basic evaluation, we compared the intervention of the two-month multimedia training
among 60 postpartum mothers with 60 mothers in control group. The follow up evaluations
were conducted 3 and 9 months later.
Results: In sectional study, the fitting model explained 42% of the physical activity
behavior variance; the self-efficacy and processes of change were the two top predictors of
stage of change, respectively; and barriers (inverse relation) and the benefits were the most
effective items in direct prediction of physical activity behavior. The results of the intervention
study revealed that 74.6% of mothers in experimental group had promoted, concerning the
action and maintenance stages 9 months after intervention; the rate was just 3.6% among the
control group. Therefore, the time-group interaction effect was significant, concerning the
amount of physical activity and the effective constructs. The body mass index reduced in both
groups in a significant; although it was more salient among the intervention group.
Conclusion: The physical activity promoting self-training multimedia designed based on
the fitting model has been effective in promotion and sustaining the postpartum mothers'
physical activity behavior.
Keywords: Postpartum mothers, Transtheoretical model, Physical activity behavior, Selftraining
multimedia.
Background and aim: Although, being active is an essential determinant of healthy lifestyle, but
the amount of physical activity in individuals particularly women less than is required. According scientific evidence, Health education interventions based on the extended Theory of Planned Behavior with action and coping planning are effective in promoting and maintaining physical activity in people. The aim of the present study was to design and evaluate the theory-based educational intervention in order to change of physical activity in AJA (Army of Islamic Republic of Iran) personnel’s wives.
Method: Firstly, a cross-sectional study was performed to examine predictors of physical activity behavior based on developed theory with planning constructs in 150 AJA staffs’ spouses residing in organizational houses in Tehran. In the second stage, a Randomized Controlled Trial carried out to assess the impact of educational multimedia in 130 women. Participants were randomly chosen with multi-stage cluster sampling. Developed theory constructs, physical activity and physical fitness indices were analyzed to applying SPSS16 and LISREL8.8 in baseline, 3 and 6 months post-intervention.
Results: The results of path analysis indicated the developed model fitted to data better than the original theory and explained respectively 48% and 35% of variance in intention and behavior. Utilizing educational multimedia led to improve and maintain of developed theory structures, physical activity and physical fitness indices in 3 and 6 months post-intervention in the experimental group (p<0.001). However, no significant changes occurred in the control group (p>0.05).
Conclusion: The findings of this study showed using the educational multimedia based on the developed Theory of Planned Behavior resulted in improving and sustaining of physical activity behavior and physical fitness indices in women.
Keywords: Physical activity, Theory of Planned Behavior, Action planning, Coping planning, Physical fitness indices, Military personnel’s wives