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Background and aims: Studies have indicated a considerable change in the trend of families’ adaptation to the hearing impairment of their children following the application of hearing screening programs in the past few years. This study was conducted in line with increased rehabilitation service quality and family-based intervention. It was performed to identify factors affecting the adaptation of mothers to hearing-impaired (HI) children with cochlear implants. Methods: This qualitative-descriptive research was performed with a phenomenological approach and involved 16 mothers of two to seven-year-old HI children with cochlear implants. The research setting was the centers for speech therapy of HI children in Shiraz, Iran. Data were collected through in-depth interviews with the subjects, and data analysis was performed in MAXQDA (2018) using Colaizzi’s seven-step method. Results: The mean age of the subjects was 34 years, and the children of these parents were two to seven years old. The mean age of the earliest known diagnosis was 12 months. Moreover, the mean age at cochlear implantation was 2.5 years. Based on the subjects’ experiences, the researchers extracted factors affecting mothers’ adaptation, leading to four main themes. These factors facilitated mothers’ adaptation and included the quality of medical services, condition normalization, individual capabilities of mothers, and effective use of the environment. Conclusion: Improving the quality of medical services, condition normalization, individual capabilities of mothers, and effective use of the environment led to an improvement in mothers’ adaptation to HI children with cochlear implants.

Background: Due to the low consumption of fruits and vegetables in adults, most of them are employed in workplaces; this condition is a good opportunity to implement an intervention to influence the behavior of this group. This study aims to determine the effects of social marketing techniques in an intervention on fruit and vegetable (F&V) intake among office staff. Methods: This descriptive study was a formative research. This study was conducted on 70 administrative staff in a government office in Ghaemshahr City, Mazandaran Province, Iran in two stages, formative research and developing intervention strategies according to social marketing techniques. Formative research consists of two distinct phases, qualitative and quantitative. The categories were extracted using the direct content analysis method by MAX QDA at the qualitative stage, and the questionnaire data were analyzed by SPSS software, version 22 using descriptive statistics and stepwise multiple linear regression. Results: In the qualitative section, factors affecting F&V consumption were extracted into five main categories, including product, place, price, promotion, and organizational support. In the quantitative stage, the mean age of participants was 42.14±6.84 years, and the lowest percentage of mean scores related to the commitment to the action plan (29.16%) was related to the construct of Pender’s health promotion model (HPM). Previous related behaviors, behavioral outcomes, preferences, and immediate demand predicted 43% of F&V consumption behavior. The mean intake of F&V per day was 1.57±1.32 and 0.45±0.75 units, respectively. Conclusion: Although social marketing is a planning process, using theory can lead to the development of effective and accurate marketing strategies by covering all aspects of behavior to take more effective action to improve it.

Abstract Background Endometriosis is a chronic disease affecting 6–10% of women worldwide. Sexual dysfunction has been reported in a significant percentage of these patients. Thus, the present study will be conducted to design, implement, and determine the effectiveness of an interventional program to improve the sexual function of women with endometriosis. Materials and methods This mixed-methods study will be carried out in three phases with a sequential exploratory approach. In the first phase (qualitative study) participants will be selected by purposive sampling in Isfahan, Iran. The data will be collected through in-depth interviews and field notes and analyzed using conventional content analysis. The interventional program will be designed in the second phase based on the results of the qualitative study and literature review and using the Delphi method and panel of experts. The interventional program will be implemented at the individual level in the third phase to investigate its effect on improving women’s sexual function. This phase includes quasi-experimental research, in which the pre- and post-intervention data will be collected from the intervention and control groups using the FSFI questionnaire and analyzed by descriptive and inferential statistical methods. Ultimately, a suitable interventional program will be presented by combining the data obtained in the qualitative and quantitative phases of the research. Conclusion Conducting the present study, along with the design and implementation of an appropriate, native, and culturally sensitive interventional program, can contribute to improving the sexual function of women with endometriosis and enhancing the quality of sexual relations between couples.

Abstract Background Pregnancy, and childbirth can encounter many challenges for the teen mother, family, and health system. The simultaneity of two transition periods, i.e. transition to adulthood and post-partum period may disrupt the acceptance of new roles. Lack of knowledge, information and life skills in managing this situation may threaten the physical and mental health of the mother, and child, as well as reduce the level of role adaptation. One way to increase women's empowerment in postpartum care is self-efficacy promotion training program. The current mixed methods study will be conducted to provide an interventional program sensitive to the culture of the Iranian society for adolescent mothers to improve their self-efficacy. Method This study will be conducted as an exploratory sequential mixed methods study (Qual-quan) based on a pragmatism paradigm in four phases. In the first phase, a qualitative study will be performed using a directed content analysis method to explore the needs and strategies related to promote postpartum self-efficacy from the viewpoint of teen mothers, their family, healthcare providers, and policymakers. In the second phase, using a scoping review, self-efficacy promotion strategies, and postpartum care service packages, programs, guidelines, and protocols in other countries will be identified. In the third phase, with integrating the results of qualitative phase and scoping review, the first draft of program will be developed, and validated by an expert panel based on the Delphi approach in three rounds. In the last step, the effectiveness of the interventional program will be evaluated on postpartum self-efficacy of teen mother. Discussion Developing an interventional program that includes teen mother’s experiences, evidence based practice principles, and health staff opinions in a distinct cultural and social context can supply new direction to lead manager, policymakers, and other health care provider to improve the maternal self-efficacy in infant, family, and self-care with considering their age characteristics.

BACKGROUND: World Health Organization suggests that different societies should investigate the causes of abuse in their culture. AIMS: This study was conducted to investigate the risk factors of elder abuse in Iran using an ecological approach. MATERIALS AND METHODS: This is a qualitative study, and the participants were older adults and caregivers. The data were collected using 66 interviews. Analysis of data was simultaneously performed with data collection, using MAXQDA 10, and results were reported based on Elo’s recommendation. RESULTS: Five main categories of data analysis were obtained based on Bronfenbrenner’s model: exo-system: conflict of care with caregivers’ jobs, meso-system: failure to meet expectations of support systems, macro-system: social culture, socioeconomic structure, status of enactment, and implementation of legal and financial laws. CONCLUSIONS: This study showed risk factors of elder abuse in the sociocultural context of Iran, and its results can be used for health promotion interventions.

BACKGROUND: Menopause is a natural event in women’s life that leads to physical, psychological, and social consequences. A fundamental health concern in postmenopausal women is problems with their sexual function. This study aims to design an interventional program to promote sexual function in postmenopausal women. MATERIALS AND METHODS: This sequential exploratory mixed methods study will be conducted in three phases. The first phase will be a qualitative study with a content analysis approach. The participants will be selected using a purposive sampling in Isfahan, Iran. The data will be collected through in-depth interviews and field notes and analyzed using conventional content analysis. In the second phase, the intervention will be designed and finalized to promote sexual function in postmenopausal women using the results of qualitative study and literature review, asking experts’ opinions, and holding specialized panels. In the third phase, the intervention will be implemented (in the form of a quasi-experimental study) and the effect of the intervention will be determined. In this phase, the data will be collected using the female sexual function index. Finally, an appropriate interventional program will be presented. CONCLUSION: It is hoped to promote sexual function in postmenopausal women by conducting this study and implementing an appropriate interventional program that is culturally sensitive. If it is proved that the intervention is effective, a basis for health policy–making to promote sexual health in postmenopausal women can be provided by presenting evidence and increasing the knowledge in this field of health.

BACKGROUND: The higher prevalence of hookah tobacco smoking (HTS) has become worrisome in women. Thus, it is essential to identify and measure the perceptions associated with this unhealthy behavior as well as the type of response to risk messages to design the effective programs. This study aimed to psychometric evaluation of a new instrument, named the Extended Parallel Process Model-Hookah Tobacco Smoking Questionnaire (EPPM-HTSQ), for female university students. MATERIAL AND METHODS: This methodological study was conducted in 2019–2020 in central and western Iran. The first version of the instrument was developed with 97 items. Face, Content, and construct validity methods were used to assess the EPPM-HTSQ validity. The data viability for factorability was guided through Kaiser-Meyer-Olkin (KMO) measure of sample adequacy (Values >0.7) and Bartlett’s test of Sphericity (P < 0.05). The Exploratory Factor Analysis (EFA) method with varimax rotation and SPSS software was performed to identify the main factors of the questionnaire and interpretable factors. The internal consistency and external reliability were determined. The test–retest was used for evaluating the stability of tools. RESULTS: During the assessment of the face and content validity 71 items remained in the questionnaire. EFA led to the extraction of nine dimensions: “Focusing on superior rewards,” “Response Efficacy,” “Perceived physical threat,” “Perceived social threat,” “Self-efficacy,” “Fear control,” “Attitude,” “Fear,” and “Intention” Kaiser-Meyer-Olkin (KMO) test (0.957) and Bartlett’s test (P < 0.001). Cronbach’s alpha (0.871–0.951) and ICC (0.985–0.998) were approved for scale dimensions. CONCLUSION: Important findings of the present study were the development and validation of the EPPM-HTSQ for measuring EPPM variables in relation to HTS; introducing a new variable “focusing on superior rewards”; as well as, the new classification of the concept of “perceived threat.” The final version of the EPPM-HTSQ is a valid and reliable tool, but it is suggested to be re-evaluated in other studies with different populations and sample sizes.

Background & Aims: Family-centered care demands family to be accepted as the primary core of all cares neglected in practice. The purpose of the study was to plan and put into effect a family-centered interventional training program for the empowerment of mothers while examining its effectiveness on the expressive language skill of children with hearing impairment. Materials & Methods: The sampling method in this process was a randomized controlled trial of the available type. The samples were selected from the people who referred to the centers providing speech therapy services to hearing impaired children in Shiraz (Iran). By selecting random blocks, 35 people were placed in each intervention and control groups. Family-centered intervention was scheduled into 6 sessions, each session lasting 80 minutes. Meantime, we used a researcher-made questionnaire and Newsha developmental scale to assess mothers' empowerment and children's speech development, respectively. Results: Data gathered from 35 intervention and 33 control group members were carefully examined. Repeated measurement test used for the assessment of primary and interactional effects of “time” and “group” showed the effect of time (i.e. pretest, posttest, and follow-up) on the variables of “awareness”, which was significantly large. As for the "self-efficacy" variable, the triple time stages have also proved effective. Time and interaction both manifested a meaningful effect on "child's expressive language skills" (P0.001). Conclusion: The study wraps up by affirming the role of family-centered intervention programs in expanding the ability of mothers with hearing-impaired children and, consequently, upgrading the expressive language skill of the child.

Background and aims: Given the importance of reducing barriers hindering the empowerment of mothers from contributing to the rehabilitation of hearing-impaired children with cochlear implants, the present study points to the direction of designing, adopting, and assessing a program that would lessen such barriers. Methods: In this randomized controlled trial (RCT), participants were consecutively selected from individuals referring to speech-therapy centers serving hearing-impaired children in the Town of Shiraz (Iran). Intervention and control groups were established using randomized block selection (35 individuals per group). The parent-based intervention was adopted in 6 training sessions, each session lasting 80 minutes. A researcher-made questionnaire was employed to investigate empowerment barriers, while children’s speech skill was assessed using the Newsha scale. Results: Data collected from 35 intervention and 33 control group members were examined. Evaluation of primary and interactional effects of "time" and "group" shows time to have a meaningful effect on "parental discord" and "empowerment barrier" variables (P

Abstract Background Vulnerable adolescents are exposed to sexual and reproductive health harms. Ignoring the sexual and reproductive health of this group can have irreparable consequences. The present qualitative study aimed to explore the barriers to the access of vulnerable adolescent girls to sexual and reproductive health. Methods In this study, sixteen 14-19-year-old adolescent girls and twenty-two key informants were selected using purposive sampling method. Through in-depth semi-structured interviews, they expressed their experiences of barriers to sexual and reproductive health in vulnerable adolescent girls. The data were encoded using the conventional qualitative content analysis. Results Based on the results of the study, neglecting the reproductive and sexual health of vulnerable adolescent girls at different levels leads to serious challenges and obstacles in providing and maintaining it. Lack of a responsible family, the repulsive behaviors of the family and following risky behaviors of peers led to ignoring the sexual and reproductive health of adolescent girls. Unanswered sexual questions, defective life skills, unwanted pregnancy during adolescence, lack of awareness of unsafe sex, violating cultural norms and wounded psyche in vulnerable adolescent girls threaten their sexual and reproductive health. Ineffectiveness of key organizations in providing sexual and reproductive health services alongside lack of legal, political and social support in this area indicate that the sexual and reproductive health of these girls is not a priority for the society. Conclusion Numerous personal, family, social, legal and political barriers challenge the sexual and reproductive health of vulnerable adolescent girls. Developing a comprehensive and practical program beside legal and political support for this issue can provide the basis for the sexual and reproductive health of this group of adolescents in societies.

Abstract Background Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women. Given the prevalence of this disease in adolescent girls as well as its serious physical, psychological, and social consequences, the present study aimed to explore the health system-related needs for healthy nutritional behaviors in adolescent girls with PCOS. Methods This qualitative content analysis was conducted in Shiraz, Iran between November 2016 and October 2017. Eighteen Adolescent girls with PCOS and 15 healthcare providers (midwives, gynecologists, nutritionists, and endocrinologists) were selected through purposeful sampling with maximum variation strategy. Data were collected through individual in-depth and semi-structured interviews, focus group discussions, and field note, and simultaneously analyzed using the conventional qualitative content analysis method. Results Three main categories that appeared included: 1) education and counseling on healthy nutrition and support for adolescent girls with PCOS with sub-categories of “empowering adolescent girls with PCOS to adopt healthy nutritional behaviors”, “providing services and education about healthy nutritional behaviors as a team”, and “the health team attention to the concerns of adolescent girls with PCOS and closely following the disease status, 2) solving communication problems with sub-categories of “proper interactions and building trust between health team members and adolescent girls” and “proper interactions between members of the health team”, and 3) developing the optimal structure for providing health services with sub-categories of “solving problems related to human resources, “promoting the position of health issues related to adolescent girls in the health system”, and “promoting policy-making in the field of nutritional health of adolescent girls”. Conclusions Based on the results of the present study, necessary measures should be taken to educate and advise on healthy nutrition, and to support adolescent girls with PCOS. The desired structure should also be developed to provide health services to these girls. By solving communication problems and building trust between the members of the health team and these girls, one can guide them to adopt healthy nutritional behaviors.

Introduction: Polycystic ovary syndrome is the most common endocrine disorder in women of childbearing age. Prevalence of this syndrome in adolescent girls has increased in recent years and unhealthy nutritional behaviors play an important role in the progression and complications of this syndrome. The present study was conducted aimed to explore individual components of nutritional behaviors in adolescent girls with this syndrome. Methods: This qualitative study was conducted with a content analysis approach in 2016-2017. Thirty-nine participants were selected through purposeful sampling method in gynecological clinics as well as offices of gynecologists and midwives in Shiraz. Data were gathered using individual in-depth interviews, focus group discussions and field notes. Data were analyzed using conventional qualitative content analysis. Results: In this study, 22 sub-categories and 8 main categories were obtained including: “having self-efficacy”, “impact of changes resulting from puberty and adolescence”, “prioritize academic success and promotion”, “experiences related to diet”, “awareness and attitude about the disease and related nutritional behaviors”, “have the knowledge to adopt healthy nutritional behaviors”, “emotional cravings for food”, and “amount of time available”. Conclusion: Different individual components affect the nutritional behaviors of adolescent girls with polycystic ovary syndrome. By identifying these components, policy makers and planners in the field of adolescent health can design various interventions in order to adopt healthy nutritional behaviors in these girls.

Abstract Background Polycystic ovary syndrome is the most common endocrine disorder among adolescents and adults. Given the importance of healthy nutritional behaviors in management of this disease, the present study was conducted to determine the impact of an educational intervention program based on the theory of planned behavior on the nutritional behaviors of adolescents and young adults with polycystic ovary syndrome. Methods In this field trial study, 72 participants aged between 15 and 21 years old from four gynecology clinics in Shiraz, Iran, were assigned into the intervention and control groups. Educational intervention program was implemented based on the theory of planned behavior over 4 sessions during two weeks. The data collection tools were researcher-made questionnaires of demographic information, knowledge assessment, and assessment of theory of planned behavior constructs, as well as a questionnaire for assessing consumption of food groups, fast food, and snacks. The data were collected at two stages (once at baseline and once three months after the intervention), and then the changes in knowledge, attitude, subjective norms, the perceived behavioral control, behavioral intention, and nutritional behavior were analyzed using descriptive and inferential statistical methods (t-test, Chi-square, Mann- Whitney U, and Wilcoxon tests; as well as one- way ANOVA, repeated measures ANOVA, and ANCOVA, respectively). Results Statistically significant increases were observed in the mean scores of knowledge, attitude, subjective norms, the perceived behavioral control, behavioral intention, and nutritional behavior in the intervention group by passing three months from the intervention compared to the scores before the intervention (P 0.05). Moreover, the mean scores of knowledge, attitude, subjective norms, perceived behavioral control, behavioral intention, and nutritional behavior had no statistically significant difference before the intervention between the two groups; however, this was statistically significant by passing three months from the intervention (P

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

Abstract Background The present study was conducted to design and evaluate the software and web-based curriculum based on Pender Model in order to promote students’ physical activity. Methods This is a quasi-experimental study conducted on 225 eligible students who were randomly divided into two groups of web and software-based intervention and control. The sample size of the study was selected using stratified sampling method. The evaluation was done with pre-test and post-test and follow-up, which were performed immediately two and six months following the intervention. The data were analyzed employing statistical software SPSS using descriptive statistics, chi-square, one way ANOVA, and repeated measures ANOVA. Results The obtained results revealed that the level of physical activity after the intervention in the web and software groups significantly increased compared to the control group (p

Abstract Background The adherence of diabetic patients to their medication regimen is associated with many psychosocial factors that are still unknown. Therefore, the present study aims to identify the psychosocial barriers to medication adherence of patients with type2 diabetes (T2D). Methodology This descriptive qualitative study was done in Isfahan, Iran by conducting in-depth unstructured interviews with 23 purposively selected patients with T2D and 10 healthcare providers (HCPs). The participants were interviewed face-to-face between November 2017 and June 2018 at the patient’s home, a Health Care Center, or at the diabetes clinic. Data analysis was performed using MAXQDA-10 software and the conventional content analysis. Results The analysis of the data led to six categories of perceived psychosocial barriers: 1) fear, concern and distress, 2) exhaustion and burnout, 3) the children’s issues being the priority, 4) poor financial support, 5) communication challenges, and 6) poor work conditions. Conclusions This study identified some of the psychosocial barriers to medication adherence of patients with T2D, which will be of great help to researchers and HCPs in designing and implementing effective interventions to overcome these barriers and change patient self-care behaviors and increase their medication adherence.

Background: Meeting the reproductive and sexual health needs of vulnerable adolescent girls is a priority of every community. Lack of attention to this dimension of health can be associated with issues such as unwanted pregnancy, unsafe abortion, sexually transmitted infections. Thus, the identification of these needs is a necessary step for purposive planning, operational intervention, and resource and facility allocation. The present study was conducted to explain the needs and facilitators of reproductive and sexual health in vulnerable adolescent girls. Methods: The present qualitative study was a part of an extensive study conducted using a mixed method to develop a reproductive and sexual program for vulnerable adolescent girls. Purposive sampling as utilized in the present study to select 16 adolescent girls of 12-19 years of age and 22 well-informed key experts. The experts participated in semi-structured interviews to provide the article with their experiences about the needs and facilitating factors of vulnerable adolescent girls’ sexual and reproductive health. The data were coded and classified following content analysis using MAXQDA software. Results: After scrutinizing and analyzing the data, the category of the needs were obtained under the title of the vulnerable adolescents’ reproductive and pregnancy health needs. The category of facilities was also obtained under the title of targeted prevention of adolescents’ vulnerability. Conclusion: Risky sexual behaviors in adolescent girls are associated with negative physical and psychological consequences for reproductive health. Family and the Welfare Organization play a significant role in supporting vulnerable adolescent girls and meeting their reproductive and sexual health needs.

Abstract Aims Type 2 diabetes is a major global health concern, and its prevalence is rapidly increasing throughout the world. The present study was conducted to explore the experiences of patients and healthcare providers to identify the social barriers to patients' adherence to their recommended diet and thus help the design of future interventions. Design This study was conducted as a qualitative study with content analysis approach. Methods The present qualitative study was conducted from November 2016–July 2017. Data were collected through 38 unstructured in‐depth interviews with 33 T2D patients and their treatment supervisors and field notes. The interview transcripts were coded using the MAXQDA 10 software. To extract categories and themes, the thematic analysis approach was used. We followed the COREQ Checklist to ensure rigour in our study. Results The analysis of the study revealed the emergence of five categories of perceived barriers including social priorities and rivalries, family's food habits, poor social support, social impasses and dominant food patterns.

Background and Objective: The World Health Organization encourages hospitals to implement the health promoting hospital plan to improve health service quality. The aim of this study was to self-assessment status of health promotion in hospitals and identify existing strengths and gaps. Materials and Methods: This study is a descriptive cross-sectional survey in which 9 educational hospitals were selected through census sampling. Health promotion self-assessment tools were used for the data collection. Data were analyzed using SPSS software and descriptive statistics. Results: In most hospitals, the status were good regarding the health promoting policy in the hospitalchr('39')s mission, the availability of information to other patient organizations, providing information on high-risk diseases, recording patient information and follow-up training to patients and families in outpatient counseling, referral or during discharge. But the status were poor in terms of policies for participating in Health Promoting Hospitals Network, allocating specific funding for these services, revising guidelines for evaluating health promotion needs of patients, training new staff on hospital health promotion policies, implementing staff smoking cessation programs, Staff awareness on the organizationchr('39')s health promotion policy, a written plan to work with partners, and a specific process for exchanging patient information between organizations to continue patient care. Other standards evaluated average in most hospitals. Conclusion: The average evaluation of most elements of standards indicates the unorganized implementation of some health promotion activities in hospitals. It is essential to organize and reinforce existing on-going activities, regular self-assessment of health promotion activities, and design interventions based on self-assessment results.

Increasing fruit and vegetable (F&V) intake has a protective role against chronic conditions such as cardiovascular disease, cancer and diabetes. The present study aimed to validate an instrument for measuring the perception of effective factors on consumption behaviour of F&V based on Pender's health promotion model (HPM).This cross-sectional validation survey has consisted of five steps: literature review in order to plan and develop an instrument, face validity assessment, content validity assessment, reliability assessment and construct validity assessment with the cooperation of experts in health education, nutritionists and the target group (government employees). In the present study, reliability and validity of constructs were determined through Cronbach's alpha and exploratory factor analysis, respectively, in SPSS 22. The mean impact score was acceptable for 96·42 % of items in face validity. The mean scores of content validity ratio (CVR), content validity index (CVI) and reliability were 0·92, 0·97 and 0·96, respectively. According to the principal component analysis with varimax rotation, 104 items were identified in 15 factors contributing to 61·17 % of the model cumulative variance. Given the favourable scores of the research instrument in face validity, content validity and reliability as well as its ability to predict the extracted factors from the model, it can be used as a suitable instrument in future studies.

Background: Schools of health sciences play an important role in public health by training the workforce and the development of scientific work. However, several factors can threaten the position and status of these centers and disrupt their interactions with executive-industrial environments. Since no comprehensive study has been conducted on the barriers facing the schools of health sciences, this study is conducted with the objective to identify the concerns of the schools of health sciences for interaction with executive-industrial environments. Methods: In this study, the conversation flow of 20 specialists and heads of the schools of health sciences of Iranian type 1 universities was filmed at Isfahan University of Medical Sciences, Isfahan, Iran in summer 2018; the conversations were handwritten and then typed word for word; they were then analyzed by content analysis method. Findings: As a result of data analysis, the related factors were classified into two main categories: 1) challenges and needs of interaction with health deputies, 2) challenges and needs of interaction with industry, which the latter itself included four categories. Conclusion: For the first time, the present study achieved some important results on the categorization of a set of challenges and needs related to the interactions with the health deputy office, as well as the interactions with the office of industrial relationships as the barriers to the operations of the universities and the operational environments. Therefore, the above results can be used as a guideline for designing comprehensive programs to remove barriers to communication and interaction at the schools of health sciences with their offices of health deputy and industrial relationships.

Abstract Background Polycystic ovary syndrome (PCOS) is a hormonal disorder in women of reproductive age. It seems that over the recent years, PCOS has augmented in adolescent girls due to unhealthy food habits and obesity. So, the present study was conducted to explore the food habits in overweight and obese adolescent girls with PCOS. Methods In the present qualitative study, 33 participants were selected using a purposive sampling method. Data were collected through individual in-depth interviews, focus group discussions (FGDs), and field notes. These data were analyzed through the use of conventional qualitative content analysis. Results Three main categories were extracted: First, the high consumption of unhealthy food had three sub-categories: “high consumption of fatty and salty foods”, “high consumption of unhealthy snacks”, and “high consumption of sugar-rich foods”. Second, low consumption of healthy food had three sub-categories: “low consumption of dairy products”, “low consumption of fiber-rich foods”, and “low consumption of meat, beans, fish and seafood” Third, inappropriate behavioral habits had three sub-categories: “lack of concentration and consumption of large meals”, “inappropriate dietary and physical activity patterns”, and “skipping the meals and going on arbitrary diets”. Conclusion This research through presenting an image of food habits in overweight and obese adolescent girls with PCOS is able to help for designing the necessary interventions to change the food habits, control the symptoms and complications of PCOS, and finally, improve the reproductive health of these girls.

Abstract Background and aim: The lack continuous and correct use of this equipment causes many respiratory problems. Hence, providing safety educations by using the models identifying and strengthening the effective factors is an essential. Thus, this study was conducted to evaluate the effect of educational intervention based on the theory of planned behavior on the use of masks in the Isfahan Atlas Flour Factory workers. Nowadays, respiratory diseases caused by work can be prevented to a large extent. Excessive exposure to respiratory dust is one of the most common environmental hazards in the workshops, which can have a harmful impact on the health of workers. Excessive exposure to this group of contaminants causes irritation and discomfort of the respiratory system, and in some cases, it causes disabling and malignant diseases such as lung cancer. There is no accurate estimate of the burden of lung disease caused in workplace in the world. Limited estimates reported on the burden of work-related diseases suggest that the respiratory disease is among the most common job diseases with a contribution of 14.1%. Accordingly, timely identification of respiratory symptoms in workplace and their proper management can play major role in reducing worker-related diseases and death of workers. Studies suggest that most of chronic respiratory diseases, which occur often due to the negligence and ignorance, lack of knowledge, and unsafe behaviors of workers, can be prevented by simple measures such as using mask during work. Flour dust is one of the factors involved in chronic respiratory diseases in the workplace. A large number of workers in various jobs such as flour industries, silo workers, bakers and workers of confectionery industry, are exposed to flour dust and this dust can cause respiratory asthma in airways and other lung illnesses. The results of some studies have indicated that exposure to flour dust increases the susceptibility of people to these diseases and causes allergy in the eyes, nose, and airways of the respiratory system. Respiratory equipment is considered as the last solution for respiratory protection against workplace contaminations. However, studies suggest that most workers do not use this equipment properly and continuously. It should be noted that the use of personal respiratory protection equipment is not adequate, but they should be also used properly. Thus, it is necessary to explain the factors affecting the use of respiratory masks, especially in flour industry workers, using appropriate models and theories. One of these comprehensive models used to explain and change the health-promoting behaviors is the theory of planned behavior. Based on this theory, behavior related to human health is based on their intention to perform it. Behavioral intention is affected by attitudes, normative beliefsand perceived behavioral control. Attitude is a negative or positive personal evaluation on performing a behavior. The normative beliefs are based on the fact that individuals are influenced by different people in society. Perceived behavioral control shows that to what extent a person feels that his behavior is under his voluntary control. Despite its predictive value, this theory has been used very limitedly in explaining and even changing the preventive behaviors in terms of safety and safe behaviors related to workplace among workers. In general, limited number of studies has evaluated the impact of educational interventions on changing flout industry workerschr('39') behaviors on increasing the use of respiratory protective equipment. As effectiveness of the theory-based educational interventions in the job health and safety area has been proven, the objective of this study was to evaluate the effect of educational intervention based on the theory of planned behavior on the use of respiratory protection equipment. Methods This quasi-experimental study was conducted on all workers of Isfahan Flour Atlas Factory in 2017. Using census method, 50 workers were assigned into two work shifts (each contained 25 workers). One shift was randomly selected as the intervention group and the other shift was selected as control group. A researcher-developed questionnaire was used to collect the data. The questionnaire was developed based on a previous studieschr('39') questionnaire. The tools for assessing the questionnaire information included 7 demographic questions (age, employment history, marital status, educational level, monthly income level and two questions about respiratory problems and educations received before on respiratory diseases). The questions of the theory of planning behavior structure include the indirect assessment of attitude structures (9 questions of behavioral beliefs and 9 questions of evaluation of the outcomes), normative beliefs (8 questions of normative beliefs and 8 questions of adherence motivation), perceived behavioral control (13 questions of control beliefs, 13 questions on the effect of control beliefs), and behavioral intention (2 questions: One question on previous behavior of the use of a protective mask and one question of the behavior of use in next month). Validity of the questionnaire was analyzed by a panel of experts, included a set of health experts, health education expert and psychologist. After calculating the content validity ratio (CVR) at an acceptable range of 0.75-1, content validity index (CVI) was calculated 0.81. To determine the reliability of the questionnaire before the study, 20 staff members randomly completed the questionnaire. The Cronbachchr('39')s alpha coefficient was calculated 0.873 for the entire structures. For each section, it was calculated as follows: behavioral beliefs 0.810, evaluation of outcomes 0.918, normative beliefs 0.735, adherence motivation 0.842, control 0.774, and the effect of control beliefs 0.924. At the beginning of the study, participants were invited to participate in the research project in different parts of the factory. After informing about the goals and obtaining their consent, they entered the project. The first stage of the questionnaires was completed by the two groups. After obtaining information from pre-test questionnaires, educational sessions were designed and educational interventions were provided for 2 months, 4 sessions per hour (15 days each) for the participants of the intervention group. The aim of these sessions was to provide knowledge for workers with respiratory diseases caused by lack of using of masks, behavior of continuous use of masks, as well as increased behavioral beliefs, normative beliefs, adherence motivation, and reduced control beliefs. For this purpose, various teaching methods such as lectures, group discussions, brainstorming, practical presentation, role play, and the invitation of relevant professionals as well as teaching aids (boards, slideshows, booklets, pamphlets, posters and educational laminates) were used. The educational sessions was provided in this way: in the first session, s definition was provided on heath and onechr('39')s mission in maintaining the heath and protective strategies against the most common respiratory diseases in flour companies with the aim of increasing the behavioral beliefs to maintain personal health and self-care against respiratory problems. The second session was provided with the aim of stabilizing the positive attitude and increase the behavioral beliefs of using masks and reducing control beliefs about not using the mask by inviting the physician and lecturing on the respiratory diseases and the complications of not using respiratory mask and the emergence of job-related respiratory diseases, and symptoms of these diseases. The third session was provided with a focus on subjective norms and with the aim of identifying the role of key people in maintaining health and creating a healthy environment at work. In this session, the role of a professional health experts and safety officer as an important contributor to the health and safety of people was explained. In this session, all participants were involved in the subject by holding a group discussion. In this session, the use of various respiratory masks used by the personnel of various units was trained using slideshows for the workers. In addition, the way of using it was displayed for them. In the fourth session, all the contents of the 3 previous sessions were reviewed. In this session, questions and answers were given to the group to discuss on all the questions in group. After completing the questionnaires, the data were entered into the software and analyzed using independent t-test, Fisher, Mann-Whitney, ANOVA and Chi-square tests. Results: The results also showed that there was no significant difference between the two groups in the mean of the scores of TPB constructs . there was a significant difference in all the TPB variables between the two groups (after intervention, P < 0.001). of statistical observation and recording of observational behaviors showed that there was a significant increase in the use of mask in the intervention group immediately (P = 0.02) and 3 months after the intervention (P = 0.04). Also, all the structures of the planning behavior theory ()In the intervention group, it increased in two periods. (P >0/05) Conclusion: The results of this study showed that educational intervention based on the theory of planned behavior was effective in improving the behavior of using masks. Therefore, using this model is recommended for creating safe behaviors. The results of this study revealed that providing educational intervention based on the model of planned behavior caused change in behavioral beliefs structures and evaluation of outcomes, normative beliefs, adherence motivation, control beliefs and its impact on the behavior of using masks in the intervention group. Based on the results of this study, it can be concluded that intervention in the form of planned behavior is effective in behavior of using the mask. Given the high density of flour particles in air of some parts, clinical examinations of workers are recommended to identify and treat patients with respiratory tract infections as soon as possible. In order to provide appropriate health conditions in workplace to protect the health of workers, flour factory owners are recommended to use proper ventilation systems, to oblige workers to use respiratory masks and periodic measurements of inhaled particles by plant officials. These measures can play major role in reducing respiratory diseases. Keywords: worker, mask, educational intervention, planned behavior model

Abstract Background Reproductive health of vulnerable adolescent girls is a top priority in global programs. Alcohol consumption, drug abuse, high risk sexual behaviors, sexually transmitted diseases, sexual assault, escape from home, unrestrained sex in the family, history of robbery, imprisonment and living in drug hangouts expose adolescents to different sorts of damage and injury. These adolescent girls are at risk of AIDS and other STDs, unwanted pregnancies, illegal and unsafe abortions, unplanned pregnancy and childbirth, and unsafe motherhood. Therefore, assessing these girls’ reproductive health needs and designing programs to improve their sexual and reproductive health seem to be essential. This study will be conducted to design a comprehensive program for improving the reproductive health of vulnerable adolescent girls. Methods The present study is an exploratory sequential mixed methods study (Qual-Quan) designed in three phases. In the first phase, a qualitative study will be used to describe the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, and explain the strategies of reproductive health programs for these girls. Participants will be selected in this phase using purposive sampling method, and the data will be collected through semi-structured interviews. The obtained data will be analyzed using conventional qualitative content analysis. In the second phase, through a quantitative study, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners to prioritize and select the best strategies. In the third phase, the initial draft of the program will be formulated based on prioritized strategies and will be proposed in a panel comprised of specialists in the areas of reproductive and sexual health, health promotion, social injuries and a psychiatrist. Finally, the final program will be developed and presented after obtaining the agreement and approval of the panel members. Discussion Designing a program based on a qualitative study, review of the existing evidence and programs, and using the opinions of experts in different areas can lead to different aspects of reproductive and sexual health of vulnerable adolescent girls. On the other hand, taking into account all cultural sensitivities and taboos as well as political, economic and social barriers, the development of such a program can provide the appropriate possibility of presenting comprehensive reproductive and sexual health services to vulnerable adolescent girls and achieve the goals agreed universally.

Background: Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in the women of reproductive age. In addition to multiple physical problems, this syndrome has many psychological manifestations. Thus, the present research was conducted aimed at investigating the psychological experiences of the adolescent girls with PCOS. Materials and Methods: This research was conducted using the qualitative content analysis method. A total of 18 adolescent girls with PCOS and 15 healthcare providers were selected by the purposive sampling method. The data were collected through in-depth interviews, focus group discussions, and field notes, which were analyzed using the conventional content analysis method. Results: After analyzing, three main categories and seven subcategories were extracted. First, the psychological experiences related to the disease symptoms had three subcategories: “psychological experiences related to hirsutism, alopecia, and acne,” “psychological experiences related to obesity,” and “psychological experiences related to menstrual disorders.” Second, the psychological experiences related to disease complications had two subcategories: “psychological experiences related to infertility” and “psychological experiences related to disease progression.” Third, the psychological experiences related to treatment of the disease had two subcategories: “psychological experiences related to prolongation of the treatment and uncertain fate of the disease” and “psychological experiences related to the complications of the medical treatment.” Conclusions: Results of the study showed that adolescent girls with PCOS were exposed to multiple concerns endangering their psychological health. Therefore, it is recommended to provide adequate and appropriate information about the disease and its consequences, as well as psychosocial supports and regular assessment of psychological state by the team of healthcare providers in the adolescent girls with PCOS.

Background and Objective: Adherence to self-care behaviors among hypertensive patients is a major factor in hypertension management. Hence, this study aimed to determine the self-care behaviors among patients with hypertension in Isfahan. Materials and Methods: A cross-sectional study, with 210 hypertensive patients having referred to health centers in Isfahan 2016 Multistage random sampling was applied. The H-SCALE questionnaire including data on adherence to medication, low salt diet, smoking, physical activity and weight management was completed by interview. The data were analyzed using the SPSS software, version 20. Descriptive and analytical statistics as well as the independent t-test and Chi-Square were applied. The significance level was set at 0.05. Results: The mean age of the subjects was 57.3±8.9. More than 90% of male and more than 80% of female reported being adherent to hypertension medication. Low-salt diet adherence in male was more than female 15.4% and 6% respectively. But female were following physical activity (22.8%) more than male (11.5%). The results showed that there was a significant difference between men and women in adherence to medication (p=0.034), no smoking (p=0.001) and and physical activity (p=0.004) . Discussion: Although more than 90% of our participants adhered medication description or weight managements for self- care, but the rate of low salt diet adherence and physical activity still needs improvement. It seems that health educators should be prepared specific protocol to improve the self- care behaviors.

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

Background: Over recent years, new lifestyles have raised ongoing concerns about the quality of life of students, especially inactivity. The purpose of this study was to determine the factors associated with regular physical activity among students using Pender’s health promotion model. Methods: The present cross-sectional correlational study was conducted on 650 students of Isfahan University of Medical Sciences, Iran, who were selected by stratified sampling with probability proportional to size. Data were collected using a three-part questionnaire, including demographic profile, Pender’s health promotion model constructs and the international physical activity questionnaire. The strongest determinants of physical activity were identified using structural equation modeling by Amos software. Data were analysed by SPSS software (16) using chi-square, one-way analysis of variance and Spearman correlation. Results: The results showed walking activity in 69.1%, moderate activity in 3.8% and vigorous activity in 27.1%. According to path analysis, perceived barriers were the most efficient predictor of physical activity among students, and Pender’s health promotion model constructs explained 84.9% of physical activity changes. Conclusion: The satisfactory predictive value of Pender’s health promotion model constructs for physical activity behaviour focused on effective structures, such as perceived barriers, supports the application of this model to design educational interventions better.

Aims: Elderly people with low levels of health literacy, as one of the most at-risk groups, have some problems regarding the perception of information related to their health. This study was conducted with the aim of determining health literacy status in elderly population of Dorood, Iran. Materials and Methods: This cross sectional descriptive-analytical study was conducted on 220 elderly people referring to health centers in Dorood in 2017. The sampling method was first stratified random sampling. To collect information, the Test of Functional Health Literacy in Adults (TOFHLA) was used as self-report. Data were analyzed by SPSS 20 software, using Pearson correlation coefficient, Spearman correlation, independent t-test, and one-way ANOVA. Findings: The mean age of participants in this study was 66.29 ± 7.57 years. The results of this study showed that the mean of health literacy score in the subjects was56.45± 19.9 from 100 and the health literacy of 57.2% of the elderly was insufficient. This study showed that there is a significant relationship between health literacy with age, education level and income (p

Abstract Background Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women. Inappropriate eating behaviors are some of the most important risk factors for obesity in all age groups. Therefore, performing comprehensive culturally sensitive interventions for modification of eating behaviors as a useful affordable strategy seems necessary. So, this study aims to present a comprehensive interventional program for promoting eating behaviors in adolescent girls with PCOS. Methods This study has a sequential exploratory mixed methods design including three sequential phases. The researcher represents eating behaviors among adolescent girls with PCOS using a qualitative approach. In the onset of the second phase, a comprehensive interventional program for promoting eating behaviors is designed for adolescent girls with PCOS. In this regard, in addition to qualitative studies, some related papers and texts are used. The suggested program of expert panel is approved based on prioritization guidelines. Then, in the third phase and after different stages of finalization of the program, its affectability is evaluated regarding improvement of eating behaviors in adolescent girls with PCOS. Discussion Results of the present mixed methods study, by presenting an interventional culturally sensitive program for promoting eating behaviors in adolescent girls with PCOS, lead to the improvements of the health of young girls. If this program works, it can become one of the leading education guidelines for eating behaviors in adolescent girls with PCOS. Trial registration IRCT20160224026756N6. Registered 18 Aug 2018.

Background and Objectiv: The elderly are at risk of the negative effects of stress, anxiety and depression and all these factors must be identified; then the current survey was aimed to investigate the effect of theory-based education (Theory of Planned Behavior) on subscales of mental health of elders. Methods: In an experimental study, one hundred elders (50 allocated randomly to the intervention group and 50 to the control group) aged over 60 were chosen. Data were collected using two instruments including a DASS-21 standard questionnaire and a researcher- made questionnaire. Education was provided in ten sessions (70 minutes) based on Theory of Planned Behavior. Data were assessed in pre-intervention and 8 weeks follow-up and finally analyzed using SPSS20 and Chi-square, Mann-Whitney, Independent t-test, and Paired t-test. Results: The mean score of knowledge, attitude, subjective norms and perceived behavioral control of the intervention group was significantly higher 8 weeks after educational program and the mean score of DASS (stress, anxiety and depression) was lower than the control group (P

Purpose: Waterpipe tobacco smoking (WTS) is currently a serious and growing public health threat in the world, especially in adolescents and young women. The aim of the study was to explore sociocultural factors contributing to WTS among adolescents and young adult women in Iran. Methods: This qualitative study was conducted from August 2017 to January 2019 in Isfahan and Hamadan cities, Iran; it included 13–30-year-old females with experience of WTS. For data collection, in-depth semi-structured personal interviews were conducted at participants’ preferred time and place. Concurrent with data collection, data were analysed through conventional content analysis. Results: The study participants described the various sociocultural factors contributing to WTS. These factors were categorized into four following main categories: waterpipe glamorization by its producers and sellers, media advertisement or silence, common sociocultural traditions, and governmental policies and regulations. Conclusion: A wide range of sociocultural factors affects WTS among Iranian adolescents and young adult women. Therefore, interdisciplinary multidimensional strategies are needed for WTS management and prevention among these at-risk groups. Public education, strict supervision of tobacco import, export, and selling, ample employment opportunities for young people and effective leisure time management are essential to reduce WTS.Abbreviation WTS: Waterpipe Tobacco Smoking; MPOWER: Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, Raise taxes on tobacco

BACKGROUND: Daily consumption of fruit and vegetable (F and V) can effectively reduce the risk factors of cardiovascular diseases; therefore it is necessary to identify the factors affecting this behavior. This study aimed to determine the Predictive Power of Pender's Health promotion model (HPM) constructs in F and V consumption behavior and the effects of some background variables on this behavior. MATERIALS AND METHODS: A descriptive-correlation study was conducted on 418 employees working in different offices of Qaemshahr, Mazandaran Province from April 8, 2019, to July 23, 2019. The participants filled out a questionnaire about perceived F and V Consumption behavior based on Pender's HPM Constructs. The data were statistically analyzed by descriptive statistics and parametric tests, including the Pearson correlation, Independent– Sample t-test, One-Way analysis of variance test, and multiple linear regression, in SPSS-22. RESULTS: The mean age of participants was 40.25 ± 7.56 years. The results showed that F and V consumption behavior was positively correlated with some constructs of Pender's HPM including, behavioral outcome (r = 0.51, P < 0.001), previous related behavior (r = 0.48, P < 0.001), commitment to action (r = 0.47, P < 0.001), perceived self-efficacy and behavior-related emotions (r = 0.39, P < 0.001). Behavioral outcome alone explained 26% of the dependent variable changes (F and V consumption behavior). The results also indicated that there was a significant relationship between gender and F and V consumption behavior (P = 0.01). CONCLUSION: The study findings demonstrated that some of Pender's HPM Constructs could predict F and V consumption behavior. Behavioral outcome alone was a strong predictor of this behavior. Therefore, in addition to background variables, these constructs should be taken into account in the development of training interventions and courses.

Objective: Acceptance and commitment therapy (ACT) interventions increase psychological flexibility and improve mental health and quality of life in patients with myocardial infarction. Study design: A controlled clinical trial study was conducted to evaluate the efficacy of an ACT intervention in improving the quality of life in patients with MI in Isfahan, Iran. Method: The present controlled clinical trial with a pre and post-test design was conducted on a statistical population consisting of patients with MI admitted to hospitals in Isfahan (n = 60) who were selected through sequential sampling based on the study inclusion criteria and were randomly divided into an intervention and a control group (n1 = n2 = 30). The case group received 8 weekly 90-minute sessions of ACT and the control group received no interventions. The pretest-posttest design was administered in both groups using a demographic questionnaire and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) designed to assess the health status of patients with heart failure in terms of quality of life. The data obtained were analyzed in SPSS-20 using descriptive statistics and the ANCOVA. Results: In this study, 2 general areas of quality of life, including physical and mental health, were examined in the patients. There was a significant increase in the quality of life and subscales of mental and physical health in the experimental group (p < 0.001). Conclusion: Considering the effectiveness of ACT in improving quality of life in these patients, this method of intervention can be used as a complementary therapy in health care centers to reduce the side-effects experienced by these patients.

Abstract Background Managing type 2 diabetes (T2D) is assumed to be heavily dependent on patients’ active participation in their own self-care behaviors including prescribed diets. Objectives The purpose of the present study was to investigate the effectiveness of educational intervention based on psychological factors on nutritional behaviors as well as levels of fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) in patients with T2D referring to diabetes clinics and healthcare centers in the city of Izeh, Iran. Methods A total number of 145 patients were recruited in this clinical trial and then randomly assigned to two groups of intervention (n = 73 individuals) and control (n = 72 individuals). After that, a researcher-made multi-part questionnaire including a demographic characteristics information form, a nutritional perceptions and beliefs questionnaire; a scale measuring fears, concerns, and discomforts associated with diabetic diet, as well as the valid and reliable Perceived Dietary Adherence Questionnaire were used to collect the required data before and 3 months after the completion of the educational intervention. To this end, the patients in the intervention group attended an educational program for eight sessions but the individuals in the control group only received routine services. Data analysis was also conducted using the SPSS Statistics (Version 18) and via descriptive and inferential statistics. Results The findings revealed that the mean scores of the sub-groups of nutritional perceptions and beliefs (but not exaggerated ones) in the patients assigned to the intervention group were significantly higher than those in the control group after 3 months (p = 0.001). As well, the mean scores of the sub-groups of fears, concerns, and discomforts in patients as well as exaggerated beliefs witnessed a significant decrease in the intervention group compared to those in the control group (p = 0.001) 3 months after the educational intervention. Furthermore, the mean scores of adherence to a healthy diet in the intervention group had significantly increased compared to those in the control group. There was correspondingly a significant descending trend in the average levels of fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) in the intervention group compared to those obtained in the control group (p = 0.001). Conclusion The results of this study shed light on the importance of the effectiveness of psychological factors on achieving health outcomes in patients with type 2 diabetes (T2D). Moreover, a new combination of diet-related psychological factors in patients with diabetes was introduced in the present study. Trial registration IRCT. IRCT20180308039008N1. Registered 15 April 2018, http://www.irct.ir

Background: Hypertension is usually symptomless, and is not seriously attended until it causes some chronic complications. Individuals’ skills in understanding and applying information about health subjects may have a substantial impact on patients’ behavior and health. Objective: to determine the relationship between health literacy and knowledge among patients with hypertension in Isfahan province, Iran. Methods: This cross-sectional study was conducted on 700 patients with hypertension selected according to multistage random and quota types in Isfahan province (Iran). Data collection tools included Health Literacy for Iranian Adults (HELIA) and Hypertension Knowledge Level Scale (HK-LS), which were completed by patients. Data were analyzed by SPSS version 23 using Pearson’s correlation, one way ANOVA, and Independent-samples t-test. The significance level was set at 0.05. Results: The mean (SD) of participants’ age was 60.58±11.14 years. Results showed that the relationship between age and health literacy (r=-0.354, p

Background: In recent years, the Internet has become one of the most popular sources of health information for users, and pregnant women are no exception. This study aimed to investigate Internet usage among pregnant women for achieving health information on the finding of related studies. Materials and Methods: This review study was conducted by searching databases such as IranMedex, Magiran, Scientific Information Database, Irandoc, PubMed, Science Direct, Cochrane, Google Scholar, and Scopus in December 2016. Restrictions were placed on publication to within 16 years and language of publication was restricted to English and Persian. Keywords used in the search included information-seeking behavior, information-seeking, information needs, access to information, pregnancy, and pregnant women. Results: This search resulted in 106 related publications and among them sixteen articles met inclusion criteria. This review showed that the use of the Internet by pregnant women was driven by information needs, ease, and speed of access and finding people with the same situation. Fetal development, symptoms, and complications of pregnancy, prenatal tests and nutrition, activities during pregnancy, and stages of delivery were the most often mentioned topics of interest. The benefits of internet use include reduced anxiety, personal support, creating an emotional connection and an increased confidence. Conclusions: Health providers must have sufficient ability for interpreting the achieved information from the Internet and should allocate efficient amount of time for discussing information-seeking manners with pregnant women. Furthermore, they must try to respond to the doubts of pregnant women and provide valid and reliable online educational resources.

AIDS is a problem threatening public health throughout the world, especially developing countries. Injecting drug users are most at risk of HIV infection and account for 68.15% of all suffering cases in Iran. This study investigated the effect of health intervention on the AIDS preventive behaviors among addicts based on HBM. This was a quasi-experimental research with pretest-posttest design. The study sample comprised 88 randomly selected male addicts being kept at rehabilitation centers in Khorramabad, Iran. The participants were randomly assigned to intervention and control groups. Data were collected through questionnaire designed to assess health belief model structures as well as knowledge, and behavior domains. The educational content was designed, edited, and executed after the analysis of pretest results. The intervention group received 3 sessions each of 90 minutes. Two months after the intervention, the posttest was performed using the same questionnaire. The results showed that mean scores of perceived benefits, self-efficacy, susceptibility, severity, knowledge, and preventive behaviors significantly increased in the intervention group after the intervention while the mean score of perceived barriers significantly decreased. Based on the results of this study, of this survey, it can be concluded that an increase in the score of health belief model structures including perceived susceptibility, perceived severity, and perceived benefits could result in adopting preventive behaviors against AIDS. Therefore, this survey confirms the efficacy of health belief model in adopting AIDS preventive practices among addicts.

Background: The use of cochlear implants has been a remarkable success in reducing disabilities in those with impaired hearing, which have made a significant change in the patients’ quality of life. Only by relying on cochlear implants, disabilities cannot be eliminated in the hearing impaired, and, alongside this intervention, rehabilitation practices such as through family and community support are necessary. Aim: To explain the needs of parents of children with cochlear implants to increase the quality of rehabilitation services and family-based interventions. Methods: A descriptive phenomenology study was performed with the participation of 16 people, including eight mothers, three fathers, and five experts involved with the rehabilitation of children aged 2-7 years with cochlear implants. The research setting was centers with speech therapy service providers for hearing-impaired children in the city of Shiraz (Iran) in 2015. Information was gathered through in-depth interviews with participants and analyzed by using Colaizzi’s nine-step analysis method and MAXQDA (Ver10) applications. Results: The mean age of participants was 34 years, and the average age of diagnosis of hearing problems in children was 12 months. The obtained data from the analysis of interviews about the needs of parents of children with cochlear implants were categorized into 19 sub-contents and five contents, as follows: the need for access to health care services; psychological needs; mood-related needs of a child; educational needs and financial requirements. Conclusion: Parents of children with cochlear implants have numerous needs, and they encounter problems based on their situation and experiences. The results indicate the necessity of close cooperation among different professionals such as an audiologist, pediatrician, psychologist, and speech therapist for the program’s success.

Background: Although compliance with all self-care behaviors is necessary for successful management of diabetes, patients with diabetes often refuse favorable self-care. This article is aimed to test the effects of a theory-related intervention to conduce self-aid adherence and metabolic curb in patients having type-2 diabetes. Methods: In this randomized controlled trial, 80 patients suffering from type-2 diabetes were arbitrarily allotted to intervention and control group. The intervention group attended six sessions in a batch and one-on-one consultation and received an education on self-efficacy and outcome expectations on improving the strategies. Self-efficacy, outcome expectations, self-care behaviors and HbA1c were measured and compared in two groups in the starting, after three and six-months of the interventions. “Intention to treat” analysis was used. Data were analyzed using t test and ANOVA for repeated measures. Results: Mean score of self-efficacy, outcome expectations and self-care behaviors revealed significant differences between two groups in the results of three and six months after the intervention (P < 0.01). A major fall in HbA1c was noted in the intervention group. The mean scores of the HbA1c showed a significant difference between two groups, six months after the intervention (P < 0.05). After the intervention diet, physical activity and foot care improved significantly in the intervention group (P < 0.001). No significant improvement occurred in self-monitoring of blood glucose and medication adherence between two groups after the intervention Conclusion: It is concluded that implementing educational interventions based on the self-efficacy model and related strategies can be effective for patients with type-2 diabetes and is recommended to be used for patient education in the field of metabolic control.

BACKGROUND: The improper control of self-care in hypertension imposes a lot of financial burden on the health-care system. On the other hand, the importance of participatory care and high effectiveness of self-management programs have been confirmed. This study was aimed to examine the effect of an educational intervention on self-efficacy, self-care behaviors and blood pressure (BP) of hypertensive obese or overweight women in the primary health-care setting in Isfahan, Iran. METHODS: This randomized controlled trial was an educational intervention program. It was performed among 146 hypertensive women of 30-65 age range who referred to 6 health care centers of Isfahan that randomly assigned to a control and intervention groups. The interventional group participated in the 6 weekly sessions including exercises, weight control, medication adherence, and home self-monitoring based on goal setting, and promotion of self-efficacy. The control group received routine care from health-care center and any special intervention has been done for the control group. Output variables were analyzed after intervention, and 6-month follow-up. RESULTS: There are no significant differences between age, weight, body mass index and BP and biochemical variables except lipids as well as behavioral factors at the baseline. After 6 months intervention self-efficacy (< 0.001) and physical activity (< 0.001) improvement of in the intervention group was significantly different in comparison with the control group. After 6 months, there was a significant reduction in systolic (P < 0.001) and diastolic BP (P = 0.010) in the intervention group. CONCLUSION: Participatory method of education could help us to convince patients to have better self-care to control disease. Furthermore, since adherence to the treatment of hypertensive patients in our society is low, organizing such courses can teach essential knowledge and skills to lifestyle change and prevention of complications. Performing these courses is recommended for other chronic disease patients in health-care centers to assess self-management programs on self-care behavior.

Background Iranian single women are deprived of reproductive healthcare services, though the provision of such services to the public has increased. This study aimed to explore the experiences of Iranian single women on their access to reproductive health services. Methods A qualitative design using a conventional content analysis method was used. Semi-structured interviews were held with 17 single women and nine health providers chosen using the purposive sampling method. Results Data analysis resulted in the development of three categories: ‘family’s attitudes and performance about single women’s reproductive healthcare,’ ‘socio-cultural factors influencing reproductive healthcare,’ and ‘cultural factors influencing being a single woman.’ Conclusion Cultural and contextual factors affect being a single woman in every society. Therefore, healthcare providers need to identify such factors during the designing of strategies for improving the facilitation of access to reproductive healthcare services.

Background: The low level of physical activity is a risk factor behind several chronic diseases. Evidence shows the level of physical activity is decreasing, especially in women. This study aimed to apply the transtheoretical model to identify physical activity behavior in women who referred to health centers of Isfahan. Materials and Methods: This cross-sectional study was carried out among 400 women in Isfahan's health centers. Data were collected using a questionnaire including demographic factors, the standard of exercise behavior, stages-of-change questionnaire, processes of change, self-efficacy, and decisional balance. Data were analyzed with the Statistical Package for the Social Sciences (SPSS) (version 16). Descriptive statistics, the Mann–Whitney test, one-way analysis of variance (ANOVA), and Pearson correlation were used. Results: The mean (SD) of age was 31.46 (8.92); 81.5% of women were housewives and the others employees. The mean score of physical activity per day for women was 10.66 min. Ninety-six persons (24%) were classified in the pr-contemplation stage, 100 (33.3%) in the contemplation stage, 102 (25.5%) in the preparation stage, 29 (7.2%) in the action stage, and 40 (10%) in the maintenance stage. The results showed the stages of change significantly correlated with the decisional balance (P = 0.04), processes of change, and self-efficacy (P < 0.01). Conclusions: With regard to the low level of physical activity in women and the role of the stages-of-change model in determining effective factors behind behavior, there should be an attempt to develop continuous and organized educational programs to promote physical activity in women by using the transtheoretical model.

Introduction: Self-efficacy is an essential factor for effective self-management in chronic-disease patients. Therefore, the measurement of self-efficacy with a valid and reliable instrument is required. In this study, cultural adaptation and psychometric properties of the Persian version of “Self-Efficacy for Managing Chronic Disease” (SES6G) are illustrated in a sample of Iranian chronic-disease patients. Materials and Methods: This was a cross-sectional study in which translation and backward translation was performed by bilingual translators. The final version of the Persian scale was assessed to determine the content validity index (CVI) and the content validity ratio (CVR). A panel of experts reviewed items of the scale. Factor analysis was performed for the final version of the Persian scale to assess internal consistency and construct validity among chronic-disease patients attending government health care centers from March 2015 to June 2015 in Isfahan, Iran (n = 483). Results: CVI and CVR scores were 0.87 and 0.89, respectively. There were no eliminated items in the cross-cultural adaptation process. Internal consistency met the criterion for a reliable measure (Cronbach's alpha = 0.89). An initial factor analysis produced a one-dimensional scale (6 items) with Eigenvalues more than 1 that explained 69.49% of the extracted variance. Conclusions: The SES6G is a reliable and valid instrument to assess patients' self-efficacy for managing chronic diseases in Persian language. Because the self-efficacy score determines the educational strategies to have effective educational programs, the use of this simple and brief scale could be considered among Persian patients.

Background: Today, one of the most serious causes of mortality and disability among youth is the traffic accidents. Regarding its importance, this paper aimed to investigate the community-based program to promote the safe traffic behaviors among youth. Methods: This was a quasi-experimental conducted on 5000 youth in five Iranian cities named Lanjan, Gomishan, Fasa, Tehran, and Zahedan in 2015–2016. The questionnaire was based on the constructs of the theory of planned behavior as well as a questionnaire of pedestrian behavior and driving behavior, which was completed before and after the intervention. The educational intervention was carried out based on the theory of planned behavior. Finally, the obtained data were analyzed using STATA software. Results: Six months after the intervention, the mean score of the theory of planned behavior and safe driving behavior in different cities was significantly increased. Here, regarding the safe crossing of the street, the most behavioral changes were observed in Gomishan (P = 0.000), Fasa (P = 0.001), and Tehran (P < 0.0001). The mean score of driving behaviors in Gomishan (P < 0.000), Fasa (P = 0.016), Lanjan (P = 0.047), and Tehran (P < 0.0001) scores was significantly higher. conclusions: In most of the studied cities, it can be concluded that education based on the theory of planned behavior can improve the safe driving behaviors among youth. Therefore, it is recommended to be implemented this program in other cities using the theory of planned behavior.

Background: The current situation of health promotion (HP) services in hospitals of Iran is unclear. The aim of this study was to assess the status of HP in hospitals in Isfahan, Iran. Methods: This study is a cross-sectional survey in which 9 educational hospitals selected through census sampling. HP self-assessment was used for the data collection. The assessment teams formed, and evidence examined in line with the tools. Results: The results identified five categories of HP activities in the hospitals consisted: patients,staff, environmental, community, and organizational. The mean of total score of HP was 48.8(9.8). In terms of the HP standards scores, 5 hospitals (55.5%) were at the intermediate level;3 hospitals (33.3%) were at the weak level, and 1 hospital (11.1%) was at the good level.About the standards, the highest score was "information and patient interventions" standard 79.8 (13.5), and the lowest was "continuity and cooperation" standard 36.2 (10.8). Conclusion: It seems that some of the health promoting hospitals (HPS) duties carried out by hospitals. So, to improve the quality of health services, it seems useful to encourage policymakers and health service managers to create coherent policies and guidelines in HPS.

Objectives: Diabetic patients with higher health literacy (HL) may feel more confident in their ability to perform self-care behaviors and may have strong beliefs that diabetes-related behaviors will lead to specific outcomes. Our study aimed to document the relationships between HL, self-efficacy, outcome expectations, and diabetes self-care of patients with type 2 diabetes mellitus (T2DM) in Iran. Methods: We conducted a cross-sectional observational study of 187 patients with T2DM. Participants completed the Functional Communicative and Critical Health Literacy scale, the Summary of Diabetes Self-Care Activities, the Diabetes Management Self-Efficacy Scale, Outcome Expectations Questionnaire, and a demographic questionnaire. Results: Participants who received diabetes education (t = 5.79, p

BACKGROUND: Mobile app education is one of the new educational models. Hence, the purpose of this study was to determine the effectiveness of mobile app intervention on knowledge, attitude, and practice of youth for a healthy marriage. MATERIALS AND METHODS: This quasi-experimental study was conducted in 2019 on 88 young people who were selected by simple random sampling in premarital counseling center of Falavarjan city (Isfahan). Then, participants were randomly allocated to an intervention and a control group. Mobile application intervention was installed on the intervention group's mobiles. Data were collected by questionnaire in two times. Data were analyzed using paired t-test and independent t-test. RESULTS: The mean (Standard deviation) of couples' age was 21.11 (5.06) years. The results showed that after the installation of educational consulting app in the intervention group, the mean score of knowledge (P = 0.001), attitude (P = 0.001), and practice (P = 0.001) after intervention were significantly higher than before the intervention. CONCLUSION: Mobile-based educational and counseling app increases couples' knowledge, attitude, and practice in premarital education. Therefore, it is recommended that this type of education (mobile app) be used to promote premarriage education classes.

INTRODUCTION: The present study aims at designing and evaluating the effect of new educational media-based educational intervention on students' stages of behavior change of physical activity. SUBJECTS AND METHODS: In the present interventional study, 225 students of medical sciences university were assigned into two experimental and one control groups using proportional stratified random sampling, where web-based and software-based educational interventions were used. Data were collected using International Physical Activity Questionnaire, Marcus's stages of change scales, and a self-made questionnaire including constructs of barriers, benefits, and self-efficacy. Evaluation was conducted through pretest and posttest and immediate and 2 and 6 months of follow-ups after the intervention. Data were analyzed by SPSS software using descriptive statistics and Chi-square, Friedman, one-way ANOVA, and ANOVA with repeated measure. RESULTS: Based on the results, there was no significant difference between the experimental and control groups before the intervention (P = 0.37); however, immediately and 2 and 6 months after the intervention, there was a significant difference between the experimental and control groups in terms of stages of change (P < 0.001). Furthermore, in the experimental group, the educational intervention led to improvement of individuals in the stages of change of physical activity. At 6-month follow-up, 75.4% of the software group and 60.6% of the web group achieved the maintenance stage. CONCLUSION: The results suggest that designing intervention based on people's level of preparation for changing behavior and using new educational methods such as web and software were effective on individuals' progress in different stages of change of physical activity behavior and physical activity rate.

BACKGROUND: Despite exercise is recommended as an adjunct to medication therapy in patients with heart failure (HF), non-adherence to exercise is a major problem. While improving self-efficacy is an effective way to increase physical activity, the evidence concerning the relationship between strategies to enhance self-efficacy and exercise among HF has not been systematically reviewed. The objective of this systematic review is to assess the effect of interventions to change the self-efficacy on exercise in patients with HF. METHODS: A systematic database search was conducted for articles reporting exercise self-efficacy interventions. Databases such as PubMed, ProQuest, CINAHL, Scopus, and PsycINFO, and the Cochrane Library were searched with restrictions to the years 2000-June 2014. A search of relevant databases identified 10 studies. Published randomized controlled intervention studies focusing strategies to change self-efficacy to exercise adherence in HF were eligible for inclusion. In addition, studies that have applied self-efficacy-based interventions to improve exercise are discussed. RESULTS: Limited published data exist evaluating the self-efficacy strategies to improve exercise in HF. Dominant strategies to improve patients’ self-efficacy were performance accomplishments, vicarious experience, verbal persuasion, emotional arousal. CONCLUSION: Evidence from some trials supports the view that incorporating the theory of self-efficacy into the design of an exercise intervention is beneficial. Moreover, exercise interventions aimed at integrating the four strategies of exercise self-efficacy can have positive effects on confidence and the ability to initiate exercise and recover HF symptoms. Findings of this study suggest that a positive relationship exists between self-efficacy and initiating and maintaining exercise in HF, especially in the short-term period.