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Abstract Background Patients with end stage renal disease (ESRD) are increasing worldwide. This is especially paramount in low and middle income countries in which ESRD patients are struggling to access specialist services e.g. hemodialysis (HD). Benchmarking analysis of the offered healthcare packages in several countries and comparison of the utilized alternative healthcare models for ESRD patients may be auspicious for institutional capacity-building in the existing healthcare facilities. Main aim of this study was to perform a benchmarking and evidence-informed gap analysis of the ESRD care provision in Iran and recognize the gaps that cause diversification in care quality for ESRD patients that hinder efforts for care quality improvement in the Iranian National Healthcare System. Methods Dimensions of the Australian Anglicare Southern Queensland Clinical and Care Governance Framework (ASQCGF) were utilized as corner stones of a comprehensive clinical care plan that is essential in responding to HD patients’ needs in Iran. An extensive literature search was performed at the next stage to recognize the gold standard core elements. The ascertained components were assigned to the five separate dimensions of the ASQCGF and a preliminary draft (comprehensive package of care for HD patients) was prepared. A checklist was developed at a later stage which was sent to a panel of expert consisting professional healthcare providers in nephrology and hemodialysis wards for their opinions. A gap analysis was conducted to evaluate current care processes of the Iranian HD patients align with the elements of the gold standard framework. Results The identified deficits were classified in five areas in accord with the elements of ASQCGF as follow: A) supply of resources, medical devices and equipment support B) recruitment and endorsement of clinics and general work force C) infection prevention and controlling procedures D) care effectiveness monitoring and quality improvement E) provision of safe environment for both HD patients and hospitals’ staff. Conclusions The study findings revealed considerable gaps in providing quality HD services to the Iranian HD patients that herald their therapeutic unmet needs and the shift that is needed to narrow down the widening organizational failure which fuels the current disenchantment among the both healthcare providers and HD patients.

Abstract Background Polypharmacy and low literacy increase medication self-administration errors (MSEs) among older adults, adversely affecting both patients and healthcare systems through increased costs and reduced treatment efficacy. Objectives This study explored the reasons for MSEs among illiterate and low-literate older adults with polypharmacy from the perspective of older adults, informal family caregivers, physicians, and pharmacists. Method The qualitative study used a conventional content analysis approach from September 2022 to April 2023. Purposeful sampling was used to recruit participants for interviews. Results The study included fifteen older adults, five caregivers, four physicians, and seven pharmacists. Seven main categories were extracted: 1) Age-related physical and cognitive changes, 2) Medication Mismanagement, 3) Inhibitor beliefs of proper medication use, 4) Caregiving challenges, 5) Deficiency in effective communication and education, 6) Health systems inefficiencies, 7) The challenges of producing, dispensing and obtaining medications. Conclusion The origins of MSEs encompass a broad spectrum of factors, ranging from individual to systemic levels. Successful interventions for reducing errors will be those that take into account all aspects of error occurrence and strive to minimize them through a holistic approach. The findings highlight the importance of improving organizational health literacy strategies for older adults with limited literacy. Tailoring health information to the specific needs of older patients is crucial for addressing MSEs.

Background: As physical inactivity is presently a global concern, encouraging people to engage in physical activity (PA) is a public health policy priority. This study was conducted to analyze the process of change in the adoption of policies which aim at promoting PA in setting the policy agenda.Methods: This qualitative study was conducted using document reviews and semi-structured interviews. A total of 23 key informants from different sections of the policymaking process for PA promotion programs in Iran participated in the study. Purposeful sampling with a maximum variation was used to identify the key informants. Analysis of documents and interviews was conducted on the basis of Kingdon’s multiple streams Framework (MSF): problems, policies, and political streams. The MAXQDA-10 software was used to manage the data analysis process.Results: The problem stream was found to be “the high prevalence of physical inactivity, perceived subjective barriers, and contextual factors for PA” throughout the country. The policy stream focused on integrating PA services into primary health care, scheduling national and global calendar campaigns and events, and using the existing legal structures to promote PA in communities. At the political stream, support for policy documents and various legislative and governing authorities, as well as international support, particularly the World Health Organization 2018–2030 agenda, provided a favorable environment for this issue.Conclusion: Despite the opening of a policy window for developing policies to promote PA, several challenges may hinder the policy implementation process, including a lack of health promotion approach in the health system, lack of inter-sectoral cooperation, COVID-19 pandemic-associated restrictions, and management and structural issues. As the policy window is not being used appropriately, the policymakers must review the policies, with particular attention to the feasibility of policies, the organizational culture of the different ministries, and the mediating and advocating roles of the health sector in operationalizing the policies.

Abstract Road traffic crashes (RTCs) disproportionately impact low and middle-income countries (LMICs). Current interventions in LMICs primarily target road user behavior, neglecting systemic issues and casting drivers as mere contributors. Given Iran’s unique cultural, financial, and social intricacies, this study aims to explore the latent causes of RTCs, prioritizing drivers’ experiences and encompassing insights from various traffic system components. Applying a qualitative approach, data were collected through 46 semi-structured interviews with 38 participants, including drivers and experts from traffic-related organizations. Content analysis identified ten themes as contributing to driving errors. Direct factors included fatigue influenced by economic and occupational conditions, distraction from internal and external sources, reckless behaviors influenced by traffic culture and environment, and Inadequate driving skills due to training. Macro-scale challenges in road infrastructure, vehicle quality, education, and accident investigations were highlighted. The lack of a centralized traffic safety authority and a predominant focus on penalizing drivers overshadowed systemic issues. The study offers valuable insights into the complex interplay of factors contributing to driving errors in LMICs, advocating for a paradigm shift towards holistic, systemic interventions beyond individual driver behavior and challenging the conventional blame-centric view associated with driving errors.

Background: Current evidence suggests that health literacy (HL) impacts self-care behaviors and quality of life (QOL) in patients with type 2 diabetes mellitus (T2DM). This study aimed to evaluate the impact of a short-time health literacy promotion program (HeLPP) on self-care behaviors and QOL in rural patients with type 2 diabetes. Methods: Conducted from 2018 to 2019 in Chaldoran county, Iran, this randomized controlled trial followed the Solomon four-group design. Participants included 160 rural individuals with T2DM, who were divided into two intervention (A and C) and two control (B and D) groups. Pre-tests were conducted for intervention group A and control group B, with post-tests administered to all groups at three and six months. Interventions, consisting of five training sessions lasting 45 to 55 minutes, were planned and executed based on pre-test analyses. Primary outcomes were QOL and self-care behaviors, and secondary outcomes were glycated hemoglobin (HbA1c), HL and patients’ awareness of the disease. Results: Prior to the intervention, there was no significant difference in awareness, HL, self-care behaviors, HbA1c, and QOL between intervention group A and control group B (P>0.05). However, at three and six months after the educational program, intervention group A exhibited significantly increased average scores in awareness, HL, self-care behaviors, and QOL, along with reduced HbA1c levels (P

Background. In recent decades, epidemics of various infectious diseases have occurred. Despite the health authorities' educational efforts to provide people with adequate information, there is not enough evidence regarding the evaluation and effectiveness of educational methods. Therefore, the present study aimed to evaluate the effectiveness of educational methods provided for the public during epidemics of infectious diseases from people's perspective. Methods. This cross-sectional study was conducted in Iran in 2023. The participants included individuals who were older than 15 years and were living in Iran during the recent epidemics. We used a tailored questionnaire consisting of 14 questions to gather information. The validity of the questionnaire was ensured by calculating the content validity index and ratio. Furthermore, its reliability was confirmed through a pilot study. The participants were selected using convenience sampling. In order to collect data, the questionnaire was distributed to the target group both electronically and in person. The collected data were analyzed using SPSS software (version 24) with normality tests conducted, and any P-value below 0.05 was considered significant. Results. A total of 278 individuals participated in the study, with the majority being women (61.9%). The average age of the participants was 33.9 years old. Most of the participants had a bachelor's degree (43.2%). According to the results of the study, social networks were identified as the most commonly used source for receiving educational materials during infectious disease epidemics (76.8%), and they were also considered to be the most effective source (87.6%). Additionally, based on the participants' opinions, social networks outperformed other information sources (78%). Face-to-face education provided by healthcare workers was identified as the most trusted educational source (81.6%), and the participants recommended this method to others more than any other method (82.4%). Interviews with healthcare experts and in-person education provided by healthcare workers were perceived as the most effective educational methods by the people surveyed (60.4%). Furthermore, the results indicated that as individuals age, their reliance on sources of information like the Internet, social networks, and newspapers tends to decrease. Conclusion. The results of the current study can provide valuable information for policymakers on educating the public during epidemics of communicable diseases, as well as help them make quick, effective, and evidence-based decisions.

Background and aims: Usually non-daily smokers do not consider themselves smokers, and they are at a higher level of health risks due to smoking compared to non-smokers. This study aimed to identify the prevalence of non-daily smoking (NDS) and its associated factors among university students. Methods: This cross-sectional web-based study was performed in Tabriz, Iran. A proportional random sample of 3666 students from all universities of Tabriz were recruited from July to August, 2019, and an online questionnaire was used to collect data. Predictors of NDS were investigated using a multiple logistic regression model. Results: A total of 15.7% and 7.8% of the students were daily and NDSs, respectively. Compared to the non-smokers, the NDSs were more likely to exhibit high-risk behaviors such as substance abuse (odd ratio [OR]=2.96; 95% CI: 2.12-4.13), alcohol drinking (OR=2.54; 95% CI: 1.78-3.62), hookah smoking experience (OR=9.30; 95% CI: 6.06-14.25), and regular hookah use (OR=24.22; 95% CI: 14.86-39.46). Compared to daily smokers, NDSs were more likely to be female gender (OR=0.16; 95% CI: 0.10-0.24), denial of being a smoker (OR=11.69; 95% CI: 6.86-19.91), not addicted to nicotine (OR=10.02; 95% CI: 4.21-23.85), and less likely to have an intention for quitting in recent months (OR=2.27; 95% CI: 1.28-4.04). Conclusion: Non-daily smokers do not consider themselves smokers and have no intention to quit smoking. They are more prone to present high-risk health behaviors. Health policymakers should pay more attention to NDSs while planning smoking cessation programs.

BackgroundOlder adults with polypharmacy are more prone to medication errors. People with low educational attainment have more difficulties in taking their medications.ObjectivesThis study aimed to identify the extent of medication self-administration errors (MSEs) and the contributing factors among illiterate and low-literate community-dwelling older adults with polypharmacy.MethodThe present cross-sectional study was conducted among people aged 60 and above. The data were collected using the sociodemographic, clinical, and Belief about Medicines Questionnaires (BMQ). To determine the extent of MSE, a medication error checklist was used. The negative binomial hierarchical regression model in the five blocks was performed.ResultsThe final sample size was 276 people. The frequency of MSEs in the last 6 months was 69.2%. Sixteen percent of participants had made four or more mistakes. The most common MSEs were forgetting, improper taking of medications with food, improper timing, incorrect dosage (lower dose), and forgetting the doctor's instructions. Near 18% of participants reported adverse events following their mistakes. The significant predictors of MSEs were being completely illiterate (p = 0.021), the higher number of doctor visits per year (p = 0.014), irregularly seeing doctors (p < .001), the higher number of medications (p < .001), and having poor medication beliefs (p < .001).ConclusionDespite the high prevalence of MSEs among older patients, practical strategies to deal with them at their homes have not been established among health systems. MSE as a multifactorial event can be caused by a collection of internal and external factors. Further studies to identify the role of patients, clinicians, procedures, and systems in developing MSEs as interconnected components are needed.

Objectives: Social isolation of older adults is one of the major global concerns associated with widespread negative outcomes. The present study aims to investigate the psychometric properties of the Persian version of the social disconnectedness and perceived isolation scales in Iranian older adults. Methods & Materials: The translation/back-translation process was performed based on the standard protocol of world health organization. Face and content validities were assessed based on the opinions of a panel of experts. The content validity of the scales was evaluated by calculating the content validity ratio (CVR) and content validity index (CVI). Internal consistency, reliability, and construct validity were evaluated using Cronbach’s alpha, test-retest method, and factor analyses, respectively. Factorial structure of the scales was tested using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling in a sample of 390 community-dwelling older adults aged ≥ 60 years residing in Tabriz, Iran. Data analysis was performed in SPSS software, version 26 and AMOS version 24. Results: For the social disconnectedness scale, CVR‌=‌0.98 and CVI‌=‌0.91; for the perceived isolation scale, CVR‌=‌0.91 and CVI‌=‌0.96. The EFA with the varimax rotation identified new factors in both scales. Cronbach’s alpha of 0.64 for the social disconnectedness scale and 0.76 for the perceived isolation scale showed that their internal consistency was acceptable. The number of factors in the social disconnectedness scale changed from two to three factors, and the number of factors in the perceived isolation scale changed from two to four factors in the Persian versions. The CFA and SEM confirmed the three-factor solution of the Persian version of the social disconnectedness scale (RMSEA=0.050, GFI=0.951, CFI=0.950, and TLI=0.955) and the four-factor solution of the Persian version of perceived isolation scale (RMSEA=0.045, GFI=0.955, CFI=0.955, and TLI=0.950). Conclusion: Although the structures are different from those of the main versions, the Persian versions of the social disconnectedness and perceived isolation scales have acceptable reliability and validity to be used in Iranian older adults.

Background: In this study, we aimed to assess the cognitive determinants of weight control behaviors by dietary patterns among postmenopausal women with osteoporosis. Methods: This cross-sectional study, based on the theory of planned behavior (TPB) was conducted from July to December 2017 among 240 postmenopausal women with osteoporosis in Tabriz, Iran. A validated and reliable TPB-based instrument, namely Weight-CuRB, and the food frequency questionnaire (FFQ) were used. Results: The results of exploratory factor analysis (EFA) indicated three dietary patterns (total variance explained=24.44%); healthy (n=71), mixed (n=78), and western (n=91). In addition, food items consumed by participants were classified into twenty-two food groups for dietary pattern analysis. In the healthy and western dietary patterns, attitude (β: 0.140, P

Background: Despite the intention to perform physical activity (PA), a number of individuals cannot manage to have PA program on a regular basis. In this study we explored the barriers of regular PA behavior among healthy adults in Tabriz, Iran. Methods: This qualitative study with a conventional content analysis approach, was carried out from June to September 2020. Nineteen 30-59 years old individuals, were purposefully (purposive sampling) selected to participate in the study. The participants were formerly registered as "physically inactive" in the health records of Tabriz Health System. Individual semi-structured interviews were conducted until data saturation. Data were managed using MAXQDA-10 software. Results: The barriers of regular PA that emerged from our data were being listless and lethargic, non-supportive environment, disintegration in PA education chain, and restrictive social norms. Conclusion: Our findings uncover several PA barriers that are less discussed in the literature. Poor level of regular PA among adults in Iran, as a developing context, is rooted in perceptions with social and economic origins, which should be taken into account by public health policy makers while planning PA promotion programs in such communities. To promote regular PA among healthy adults in developing countries, regular PA programs should be tailored to bridge the gap between their recognition of PA barriers and subsequent behavior change through creating group dynamics highlighting the measures to diminish the behavior.

BackgroundType 2 diabetes mellitus (T2DM) is one of the most important risk factors for cardiovascular diseases, with a high economic burden on health care systems. Since gender and residency can affect people's lifestyle and health behaviors, this study was conducted to investigate the prevalence of T2DM and its determinants by gender and residency.MethodsA secondary analysis study was conducted on the survey data of the IraPEN (Iran's Package of Essential Non-Communicable Disease) pilot program conducted in 2017 in Naghadeh County, Iran. Data of 3,691 participants aged 30-70 years from rural and urban areas of the County were included into data analysis process. Sociodemographic factors, anthropometric measurements, and cardiovascular risk factors related to T2DM were assessed.ResultsThe overall prevalence of T2DM within the population was 13.8%, which was significantly higher among women (15.5%) than men (11.8%), and non-significantly higher in urban (14.5%) areas than rural (12.3%) areas. In both genders, age (male: OR 1.01, 95% CI: 1.00-1.03; P = 0.012; female: OR 1.03, 95% CI: 1.02-1.04; PConclusionGiven the higher prevalence of T2DM among females, risk reduction strategies at the community level should be more targeted at women. The higher prevalence of T2DM risk factors among the urban population is a wake-up call for policymakers to pay more attention to the consequences of unhealthy and sedentary lifestyles within urban communities. Future actions should be focused on appropriate timely action plans for the prevention and control of T2DM from early years of life.

Abstract Purpose Our objective was to estimate the change in community-based education interventions throughout the world that may effectuate in risk parameters of type II diabetes (T2D), including the diabetes incidence rate, fasting blood glucose, hemoglobin A1C, body mass index, waist circumference, and systolic and diastolic blood pressure. Methods A comprehensive search for globally eligible studies was conducted on PubMed, Embase, ProQuest, CINAHL nursing & allied health source, Cochrane Library, Google Scholar, conference proceedings, and reference lists. Data were extracted using JBI standardized data extraction tool. The primary outcome variables were diabetes incidence rate, fasting blood sugar (FBS), hemoglobin A1c (HbAlc), body mass index (BMI), waist circumference (WC), systolic/diastolic blood pressure (s/d BP). Random-effects meta-analysis and sub-group analyses were conducted. Results Nineteen interventional studies were included in the review, and ten studies were pooled in the meta-analysis (n = 16,106, mean age = 41.5 years). The incidence rate of T2D was reported in three trials, within which the risk of developing T2D was reduced by 54.0% in favor of community-based educational interventions, (RR = 0.54, 95% CI = 0.38–0.75; p < 0.001). In eleven (n = 11,587) and six (n = 6416) studies, the pooled mean differences were − 0.33 (95% CI: − 0.45 to − 0.20, p < 0.0001) and − 0.15 (95% CI: − 0.28 to − 0.03, p < 0.0001) for FBS and HbA1c levels, respectively. Positive significant effects were observed on reducing BMI [pooled mean difference = − 0.47 (95% CI: − 0.66 to − 0.28), I 2 = 95.7%, p < 0.0001] and WC [pooled mean difference = − 0.66 (95% CI: − 0.89 to − 0.43), I 2 = 97.3%, p < 0.0001]. The use of theoretical frameworks was found to provide a 48.0% change in fasting blood sugar. Conclusions Based on a comprehensive data collection of about 16,106 participants and reasonable analyses, we conclude that educational interventions may reduce diabetes incidence by 54.0%, particularly through reductions in fasting blood glucose, body mass index, and waist circumference. The diabetes risk parameters may favorably improve irrespective of the duration of intervention, at as low as 6 months. The application of theoretical frameworks while designing educational interventions is also encouraged. Systematic review registration PROSPERO CRD42018115877

Abstract Background Health literacy is essential to self-care, which is an important precedence to improve the quality of healthcare services and a key factor in health. It also plays a pivotal role in decision-making in various health fields. Therefore, policymakers consider health literacy to be a primary tool to promote community health and enhance the proper use of healthcare services. The present study aimed to assess the health literacy status of the Kurdish population in Kurdistan province, Iran based on the nine constructs of the Iranian health literacy questionnaire (IHLQ) individually and collectively and determine the significant effects of demographic variables on health literacy. Methods This cross-sectional study was conducted on the Iranian adult Kurdish population living in the urban and rural areas of Kurdistan province, willing to participate during April 2017–September 2018. Data were collected using the IHLQ. The sample size was determined to be 980 people, with 490 in the rural areas and 490 in the urban areas. The researchers visited potential participants at their doorstep, asking them to complete the questionnaire. The willing participants were assisted in completing the IHLQ in case they were illiterate; the questions and answers were read by the researchers to the participants, and the responses were recorded. Results About 50.4% (n = 494) of the Kurdish population had poor health literacy, while 34.0% (n = 333) had average health literacy, and 15.6% (n = 153) had good health literacy. Meanwhile, 60.2% of the participants obtained poor scores in the construct of health information access, and 74.1% (n = 726) obtained poor scores in the individual empowerment construct. In addition, the analysis of the adjusted model indicated that education level (lowest β = 7.42; P = 0.001) and in male participants (β = − 1.10; P = 0.001) were significantly associated with higher health literacy. Conclusion According to the results, the investigated Kurdish population mostly had average or low health literacy. Therefore, proper strategies should be adopted to enhance the health literacy of this population and increase their access to health information. Furthermore, effective training should be provided to these individuals (especially vulnerable social groups) to improve their individual capabilities to compensate for poor health literacy.

Abstract Background The present study aimed to investigate the effects of a multi-level intervention on hookah smoking frequency and duration among Iranian adolescents and adults. Methods In this study, two comparable cities in Iran were selected to participate in an intervention program based on a social-ecological model (SEM). In each city, 133 hookah smokers in coffee houses were selected. Environmental changes in coffee houses such as serving light foods and games were conducted. A virtual group named “no hookah” was established on the Telegram application to train participants in the intervention group. Messages, pictures, and short videos were sent to the participants through that virtual network. The frequency and duration of hookah consumption were assessed in both groups at baseline and after the intervention. Results The frequency of hookah consumption decreased in 72.6% of participants in the intervention group (vs. 6.3% in the control group), and the duration of hookah consumption per session decreased in 39.5% of participants in the intervention group (vs. 5.5% in the control group). Conclusions Using multi-level interventions through a social-ecological model can reduce hookah consumption in adults.

Abstract Background High-risk behaviors are among the most serious threats for the physical and mental health of adolescents and young adults. Our aims in this study were to investigate the subgroups of students based on risky behaviors and to identify the prevalence rate of these subgroups. Methods This cross-sectional web-based survey was conducted from July to August 2019 in Tabriz, Iran. We performed proportional sampling in all nine universities of the city, according to the number of students in each university. Applying an online survey questionnaire, the data were collected from 3649 students and analyzed using Latent Class Analysis. Results For total sample, standardized prevalence rates of cigarette smoking, hookah use, alcohol consumption, substance abuse and unsafe sex were 18.5 (Confidence Interval (CI) 95%: 17.3–19.8), 9.1 (CI 95%: 8.2–10.1), 9.2 (CI 95%: 8.3–10.2), 8.3 (CI 95%: 7.4–9.3) and 14.5 (CI 95%: 13.3–15.7), respectively. Three latent classes of risky behaviors were determined among students: a) low risk b) smoking and c) high risk. About 18% of boys and 1.5% of girls were in the high risk class. Cigarette smoking (18.5%, CI 95%: 17.3–19.8) and substance abuse (8.3%, CI 95%: 7.4–9.3) were the most and the least common risky behaviors among the students. Conclusion In this we-based survey, a considerable number of students, particularly boys (18%), was at high-risk class, stressing the need for preventive interventions for this group of youth. Our findings are beneficial for planning and development of risky-behavior preventive strategies to prevent high-risk behaviors among college students.

Abstract Background Poor mental health is common among adolescents. Given the increasing burden of poor mental health among adolescents in developing countries, it seems necessary to identify the effective interventions. The main purpose of this study was to investigate the effects of a school-based mental health promotion program (SMHPP) on mental health parameters among female adolescents in Tabriz, Iran. Method In this experimental study, a random sample of female high-school students of grade nine was recruited. The subjects were then randomly allocated to intervention (n = 145) and control (n = 139) groups. The three-stage SMHPP was designed based on the shortages and unmet needs of the students as reported in the pretest stage. All subjects in the intervention group were provided with a stress management skill training program of six sessions using McNamara Model. Coincided with making environmental changes, a joyful intervention program was carried out. After 2 months, post-test data were collected. Results A total of 284 students completed their participation in the study. The groups did not differ in none of socio-demographic characteristics and mental health parameters, at baseline. The number of subjects reporting medium-level of happiness was increased by 32.6% among intervention group. Moreover, upon sign test and pre-post comparison, the group-wise distribution changed between the intervention and control groups for the parameters of life satisfaction (p ≤ 0.001) and psychological well-being (p ≤ 0.01). Conclusion The implementation of SMHPP as a low-cost, needs-based and multifaceted program, showed promise in promoting adolescents’ mental health, particularly in the parameters of happiness, life satisfaction and psychological well-being. This was an important evidence for the development and implementation of interventions and policies in the field of mental health promotion among adolescents. Our work provided means for reducing burden of poor mental health among adolescents in a non-western cultural context. Further larger studies are required to evaluate the effectiveness of such school-based mental health promotion interventions in students.

Abstract Background Tobacco smoking is the second leading cause of death and is closely linked to fatal diseases. Hookah Smoking (HS) is a traditional way to smoke tobacco, especially in the Eastern Mediterranean region that is constantly rising around the world. This study aimed to evaluate the different levels of personal, interpersonal and social HS in Iranian urban men and determine the most important predictors of the levels through applying the socio-ecological approach (SEA). Methods This study was conducted in the coffee houses of Hashtrud and Qarah Aghaj counties in East Azerbaijan, Iran. Data collection was conducted from the entire coffee house (n = 18) from April to June 2017. Systematic sampling was employed to recruit 266 men in the coffee house. A valid and reliable instrument was used to investigate the frequency of HS and its determinants based on SEA. The SEA consists of three levels: personal (age, education, employment, income, and perceived severity and sensitivity), interpersonal (perceived reward), and social level (social support) intended to assess HS determinants. Hierarchical regression was used to determine the predictive value of SEA levels and frequency of HS. Results The mean age of daily hookah smokers (once per day and more than once per day) were (26.8) significantly lower than those (30.4) smokes weekly (once a week or more than once a week). The hierarchical logistic regression model showed that in the first step individual variables significantly predict 25.1% HS. In the second and third level interpersonal and social levels of SEA explained HS 30.1 and 30.8%, respectively. Conclusion This study found that age, income, education, and perceived reward were all important factors influencing HS among men youth. Application of SEA to determine the factors associated with HS could contribute in the development of a holistic prevention program.

Background: The worldwide trend of hookah use among adolescents is increasing, and literature shows arelationship between obscenity and adolescents’ tendency toward hookah smoking. As there is a lack ofappropriate instruments to measure the obscenity of hookah smoking, in the present study, we aimed todevelop an instrument to measure hookah smoking obscenity among adolescents.Methods: In this methodological study, a sequential exploratory design was used to conduct the study fromFebruary 2017 to July 2018 on adolescents in Tabriz, Iran. In the qualitative phase, we conducted semistructured individual interviews (with 18 students) and a focus group discussion (FGD) (with 13 students) toexplain the concept of obscenity and develop the items of hookah smoking obscenity scale (HSOS). We thenexamined the psychometric properties of the HSOS based on face, content, construct and predictive validitiesas well as internal consistency and repeatability.Findings: The HSOS was developed with 21 items based on the results of qualitative data analysis. Applyingconfirmatory factor analysis (CFA), the χ2/degree of freedom (df) ratio was found to be 3.792 for the fourfactor structure of the questionnaire and the fit indices of this structural model were satisfactory. The valuesof Cronbach’s alpha and the intraclass correlation coefficient (ICC) for the constructs in the HSOS ranged0.81-0.93 and 0.79-0.92, respectively.Conclusion: We found the HSOS with a good level of fit indices, validity, and reliability. The HSOS may beapplied by school healthcare providers and health practitioners to find valid and reliable data on theobscenity of hookah smoking when developing hookah smoking prevention/cessation interventions amongadolescents.

Background: Considering the increasing prevalence rate of smoking among Iranian adolescents,and recent evidence on the relationship between obscenity of smoking and tendency of adolescents towards the behavior, there is a need for an appropriate measurement tool to measure the level of obscenity on cigarette smoking among adolescents. This study was conducted to develop a valid and reliable questionnaire for measuring the obscenity of cigarette smoking in adolescents. Methods: This study was conducted in Tabriz, Iran, using an exploratory sequential mixed methods design. To explain the concept of obscenity and develop the questionnaire’s items, 18 students attended semi-structured individual interviews and 13 others took part in focus group discussions (FGDs) in three groups of 4-5. Extracting and summarizing the codes derived from the interviews, an item pool was developed, from which the initial draft of the scale was provided.Next, the psychometric properties of the scale were assessed using face, content, construct, and predictive validity, as well as internal consistency, and reliability in a sample of 1013 high school students. Results: The 22-item Cigarette Smoking Obscenity Scale (CSOS) was developed based on thecodes derived from qualitative data. Explanatory factor analysis revealed five-factor structure(Negative Attitude; Negative Consequence; Negative Valuation; Inappropriate Relationship; Agateway to addiction). In confirmatory factor analysis, the χ2/df ratio was 3.911 for the CSOS five-factor structure. Suitable values were obtained for the goodness of fit indices (GFI = 0.88,AGFI = 0.85, NFI = 0.87, IFI = 0.90, CFI = 0.90, RFI = 0.85, and RMSEA = 0.072). The Cronbach’s alpha and intraclass correlation (ICC) coefficients for the constructs ranged between 0.77 to 0.90 and 0.80 to 0.91, respectively. Conclusion: The validity and reliability of the CSOS was appropriate; therefore, it can be used infuture studies as a suitable tool for measuring the obscenity of cigarette smoking in adolescents.

BackgroundProviding lonely older adults with informal home care services is important to improving their health and quality of life. The study aims to evaluate the feasibility of design, implementation and evaluation of an informal home care support intervention program (HoSIP) for community-dwelling lonely older adults in Gorgan, Iran.Method/designThis feasibility study is a mixed-method with a concurrent nested design. Lonely older adults will be enrolled as the HoSIP intervention group and will receive 12-weeks of informal home care service by peer supporters. The purpose of this feasibility study is to determine the recruitment capability and resulting sample characteristics, data collection procedure and outcome measures, the acceptability and suitability of the intervention and study procedures, the resource and ability to manage the study and intervention, and preliminary evaluation of participant response to intervention. Primary outcomes including participant feelings of loneliness, quality of life, general health, social network, social support, and self-care ability, will be assessed at baseline and post-intervention for the intervention and control groups. Semi-structured interviews will be conducted immediately after the intervention using content qualitative approach to describe participants' experiences with HoSIP.DiscussionThrough this study we will examine the feasibility of delivering informal home care services to community-dwelling lonely older adults in a developing country through employing a concurrent nested mixed-method design.Trial registrationIRCT20190503043455N.

Background: Optimism is known to be associated with many health behaviors. However, the associations between optimism, tobacco smoking and substance abuse in adolescents are not well documented. This study aimed to address this research gap in a large school-based population. Methods: Participants (N = 1104) were selected based on multi-stage cluster sampling method. Cigarette and hookah smoking behaviors, illicit drug use, optimism, and relevant covariates were measured using a validated questionnaire. Data were analyzed using ordinal logistic regression. Results: After adjustment, higher optimism score was a protective factor against being situated in advanced stages of cigarette smoking (odds ratio [OR] = 0.88, 95% CI: 0.84-0.91), hookah smoking (OR = 0.91, 95% CI: 0.88-0.94), and illicit drugs usage (OR = 0.90, 95% CI: 0.85-0.95). Moreover, the results showed that negative-stability and negative-globality domains of optimism were significantly higher among advanced-stage smokers and illicit drug users. Conclusion: Optimism was found to be a protective factor against tobacco smoking and substance abuse; whereas pessimism (negative-stability and negative-globality) was found to be a determinant factor. Further research is needed to investigate the effects of optimism on the transition in cigarette and hookah smoking stages.

Abstract Background A huge number of people living with HIV/AIDS lives in developing countries. Thus, strengthening health systems in these countries is a prerequisite for improving disease prevention and care. After three decades of HIV/AIDS policy-making in Iran, conducting a comprehensive analysis on the policy process seems to be essential. In the present study, we aimed to analyse the HIV/AIDS policy-making process in Iran from 1986 to 2016. Methods This was a theory-based, multi-method and retrospective study. Interviewing of key informants and review of policy documents were concurrently conducted to identify and include further key informants (39 participants) and documents in the study. Framework analysis was used to analyse data. Results The mean age of participants working in HIV/AIDS policy-making was of 48 years and participants had a mean of 14 years of working experience. Findings were categorized as contextual factors, content of HIV/AIDS policies, actors involved in the policy process, and evidence use in the policy process. Contextual effective factors on the HIV/AIDS policy-making process were categorized into five major themes, namely situational factors, structural-managerial factors, socioeconomic factors, political and legal factors, and international factors. The HIV/AIDS phenomenon in Iran was identified to be deeply rooted in the culture and traditions of society. The HIV/AIDS policy content has, recently, been crystallized in the national strategic plans and harm reduction policies of the country. The policy process has been conducted with a solely governmental top-down approach and is now suffering from poor evidence and lack of sufficient consideration of contextual factors. Conclusions There is a great need for change in the approach of government towards the issue and to increase the participation of non-governmental sectors and civil society in the policy process.

Abstract Background The role of self-care behaviors in promoting physical function, pain management, health status and quality of life among patients with Rheumatoid Arthritis (RA) is well documented. However, there is no valid and reliable instrument in the literature to assess such behaviors among the patients. In the present study, we aimed to develop and assess the psychometric properties of a Self-care Behaviors Scale (SCBS) among patients with RA. Methods In 2017, applying a cross-sectional design, we recruited a convenient sample of 436 RA patients in Hamadan, Iran, to participate in the study. We developed the initial scale, including 30 items, after literature review, and having recommendations from an expert panel. Face, content, construct and convergent validity, as well as reliability of the scale were investigated. Results In Exploratory Factor Analysis, the optimal solution comprising 25 items and 7 factors was emerged, which explained 62.5% of all variances between the items. In Confirmatory Factor Analysis, the measurement model fit the data well, and all subscales were significant within an acceptable range (χ2 [233] = 428.654, p

Background: Some treatment reported for cutaneous leishmaniasis. The studies examined the impact of the paromomycin has different characteristics and results. The aim of the present study was to conduct a systematic review and meta-analysis of all randomized clinical trials evaluating the effectiveness of paromomycin in the treatment of cutaneous leishmaniasis in Iran.Methods: Literature search was conducted using MEDLINE, Web of Science, Scopus, Scientific Information Database, IranMedex, Magiran, Iranian Registry of Clinical Trials (from February 2000 to May 2016), and references cited in the text of selected studies. Search terms used were “paromomycin”, “cutaneous leishmaniasis”, “randomized”,” aminosidine”, “controlled trial”, and “clinical trial”. Random effects models were used to calculate the measure of association, with 95% confidence intervals, to analyze the efficacy of paromomycin in the treatment of cutaneous leishmaniasis.Results: Initial search yielded 76 citations. Of these original results, 9 met our specific selection criteria. Four of the randomized controlled trials compared the efficacy of paromomycin in the treatment of cutaneous leishmaniasis with that of a placebo; they were included in the meta-analysis. The success rate of treatment with paromomycin was higher than that with the placebo (pooled RR=4.50, 95% CI: 2.54 to 8.02; P=0.001 and I2=26.7%), whereas the difference with the non-placebo treatments was nonsignificant (pooled RR=0.79, 95% CI: 0.58 to 1.073; P=0.131 and I2=83.3%).Conclusion: No significant difference was observed between paromomycin and the other treatments in their effectiveness in the treatment of cutaneous leishmaniasis. Because no single drug is effective against all the forms of leishmaniasis, we suggest multidrug therapy.

Background: Excessive use of plastic bags has become a major problem in the worldwide causing irreparable damages to the environment and humans. The purpose of this study was to identify the individual and environmental factors associated with the use of plastic bags among the vendors of Hadishahr city, Iran. Materials and Methods: This is a cross-sectional study conducted on 400 vendors working in Hadishahr city. The data were gathered using a researcher-made questionnaire, which measured knowledge and attitudes of vendors regarding the use of plastic bags at the individual level. At the environmental level, access to alternatives plastic bags and social support to use of alternative was measured. Plastic bags in kilograms per week was measured as the consumer behavior Data were analyzed using SPSS software via Chi-square, t-test and hierarchical regression tests. Results: The average usage of plastic bags by the vendors was 4.5 kg per week. 97.8% of vendors gave plastic bags for the customers to carry away their purchased items. The individual-level factors (knowledge and attitude), along with social support for the use of alternatives taken from environmental factors were the most important predictors for the use of plastic bags; they were able to predict consumption behavior (15%) along with other variables. Conclusion: In order to reduce the plastic bags consumption while training, it is necessary to provide social support for the usage of alternatives and environmental access to these alternatives.

Abstract Background Drug misuse is a major problem that has an extreme negative effect on people’s health. Methamphetamine (MA) is frequently used by young adults, despite its harmful consequences. The Transtheoretical Model (TTM) has been known to be very effective in explaining both the achievement and cessation of several health-related behaviors. Therefore, in this study, the TTM was used toward the domain of immoderate MA use among young adults. This study aimed to test the validity and reliability of a decisional balance scale for MA use in young adults. Methods A multi-phase scale development approach was used to develop the scale. First, 41 university students enrolled in a qualitative study that generated content for a primary set of a 40-item instrument. In order to produce a pre-final version of the instrument, face and content validity were calculated in the next step. The instrument validation was assessed with a sample of 250 university students. Then, the construct validity (exploratory and confirmatory), convergent validity, discriminate validity, internal consistency applying test-retest reliability, and Cronbach’s alpha of the scale were measured. Results Forty items were initially generated from the qualitative data. After content validity, this amount was reduced to 25 items. The exploratory factor analysis revealed four factors (self and other cons, coping and social pros) containing 21 items that jointly accounted for 55.24% of the observed variance. The confirmatory factor analysis indicated a model with appropriate fitness for the data. Cronbach’s alpha coefficient for the dimensions ranged from .74 to .87, and the Intraclass Correlation Coefficient (ICC) ranged from .83 to .91, which is within acceptable ranges. Conclusion The findings showed that the Methamphetamine Decisional Balance Scale is a valid and reliable scale that increases our ability to study motivational factors related to MA use among young adult. Consequently, the instrument could be applied in both practice and future studies.

Background: Heart failure (HF) is a common clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of ventricles to fill with or eject blood.Our aim in this study was to examine the possible direct/indirect effects of health belief model(HBM) constructs on self-care behaviors among HF patients.Methods: A secondary analysis was conducted on an HBM-based data set collected from 180 patients with HF who were recruited from a heart hospital in Tehran, Iran, during a prospective experimental study in 2008. A regression-based path analysis was conducted to examine the relationships between HBM constructs (as independent variables) and self-care behaviors (as dependent variable).Results: A conceptual path model was identified for the cognitive determinants of self-care behaviors among HF patients. Knowledge (β = 0.399), perceived barriers (β = 0.315) and susceptibility (β = 0.165) had direct effects on self-care (R2 = 0.512, P < 0.001). Perceived benefits, self-efficacy, severity and threat, locus of control and cues to action had indirect effects on self-care through the first three variables.Conclusion: HBM was found to be helpful in understanding direct and indirect associations between the cognitive determinants and self-care behaviors among HF patients. Based on this challenging path analysis, HF patients’ knowledge and perceived barriers and susceptibility are suggested as the most core categories while designing HF educational programs. Better understanding on such associations may lead nurses and health practitioners in designing properly informed stage-specific educational interventions aiming to foster self-care behaviors among HF patients.

Background and Objective: Traffic and transport, as a political and social phenomenon, play an important role in the quality and socioeconomic structure of a society. This phenomenon constitutes one of the foundations of modern urban life and social needs of populations. Regarding this, the present study was performed to investigate the impacts of urban traffic and transport on the social determinants of health (SDH) based on the viewpoints of urban residents and key informants in Sanandaj, Iran. Materials and Methods: This qualitative study was conducted on 22 urban residents and 8 key informants selected through purposive sampling technique. The data were analyzed through conventional content analysis approach. Data collection was conducted using four focus group discussions (FGDs) (including 22 residents) and eight in-depth interviews. MAXQDA10 was applied for the purpose of data management. Results: The SDHs that were negatively affected by Sanandaj urban traffic and transport included socio-cultural (e.g., recreation and free times, daily work trends, safety of within-city commuting, tobacco use, and education) and environmental factors (e.g., vegetation, antiquities, noise pollution, urban aesthetic status, and environment, and soil, food, and water status). Conclusion: Urban traffic/transport stakeholders, health policy makers, and health professionals in Iran should pay much more attention to the impacts of urban traffic/transport plans on health and its determinants. It seems necessary to comprehensively assess urban traffic/transport on health status and its determinants in Iran.

Background: Mental health problems, as one of the most neglected issues among adolescents,are common during adolescence and emerging adulthood. The aim of present study was to investigate the determinants of psychological well being among female adolescents in Tabriz,Iran.Methods: In this cross-sectional study, multi-stage cluster sampling was employed to recruit 289 female high school students to participate in the study during 2013–2014. A 3-section questionnaire was applied to collect data. Hierarchical linear regression analysis was applied to illustrate the variations in psychological wellbeing score on the basis of socio-demographic and psychological variables.Results: Self-efficacy, hopefulness, happiness and life satisfaction were positively correlated (r> 0.400) and perceived stress was negatively associated with psychological well-being (r =-0.689). In the first model, satisfaction with family lifestyle (β = 0.168, P < 0.001) and perceived stress (β = -0.470, P < 0.001) were the most significant positive and negative predictors for psychological wellbeing, respectively (R2 = 0.595, P < 0.001). In the second model (step 6),physical activity (β = -0.109, P < 0.019), have/had boyfriend (β = 0.237, P < 0.001), hopefulness(β = -0.130, P < 0.05) and happiness (-β = 0.387, P < 0.001) were significant predictors for perceived stress (R2 = 0.453, P < 0.001).Conclusion: Considering the various behavioral, mental and social predictors of psychological wellbeing, it seems that perceived stress has overshadowed the influence of a majority of the other factors. Such influence may be due to the specific cultural and context-based rules enforced for female adolescents in the Iranian community.

Background: General physicians play a significant role in the health management of crises. In order to enhance the knowledge and skills of medical students on how to address health-related issues in crises and to promote their ability to manage and deal with such crises after graduation, appropriate training is necessary. Methods: Applying the Delphi method, 103 experts with field experience in health management and crises were invited to participate in the study. The Delphi study provided aggregation of the opinions and extracted the topics. Conventional content analysis was used to make sense of qualitative data gathered during the study. Results: Among the feedback (n = 66) obtained in the first round, a primary list was extracted including 27 topics and 97 single items. Nineteen major topics, encompassing 97 items, were finally determined in the subsequent rounds. The participants agreed to teach this course at the beginning the internship period via different methods of instruction. Conclusion: This study indicated that health management in crises is important and must be taught in medicine. This study provided a blueprint and an educational rationale as well as contents and structure of a course on health management in crisis to be delivered in undergraduate medical education.

Background and Objective: Considering the role of women in the family and society, development of societies is strongly influenced by the health especially the women’s mental health. The aim of this study was to investigate the relationships between social capital and perceived social support with mental health among women in Sanandaj-Iran. Methods: In this cross-sectional study, 392 women aged 18 years and over were selected by multi-stage random sampling in Sanandaj (1394) General Health Questionnaire-12 (GHQ-12), Social Capital Questionnaire (SCQ) and Social Support Questionnaire (SSQ) were delivered and completed by the respondents. Data were analyzed applying SPSS-v.16 for Windows. Results: The majority of the women had a bachelors’degree (48.7%), married (53.3%) and a housewife (26.3%), Pearson Correlation Coefficient test showed a significant and positive association between the three variables (r > 0.350, p < 0.01). Linear Regression analysis indicated that both, social capital and perceived social support significantly predicted 30% of mental health changes that thesocial capital was the stronger predictor. Conclusion: The women surveyed in Sanandaj had a moderate level of mental health and perceived social support and the level of social capital was weak. Interventional efforts to promote their mental health, emphasizing social capital, should be priorities of the authorities. Also, family members training is suggested as the main strategy for decision-makers and policy makers in the field of women's health.

Background and Objective: Traffic jams and transportation are an important part of the spectrum socioeconomic and environmental factors outside the health system with impacts on health. The aim of this study was to explain the residents’ viewpoints about the impacts of urban traffic on their physical health in Sanandaj. Materials and methods: The study was carried out qualitatively with content analysis method in 2014. Twenty-two residents of the city were selected as participants who were interviewed in a Focus Group Discussions (FGDs) (4 sessions) and in-depth individual interviews (8 sessions), respectively. A purpose-based sampling method was used in this study. The MAXQDA10 software was applied to facilitate the coding and categorizing the data. Results: Based on the viewpoints of the participants, urban traffic jams has two direct and indirect negative impacts on physical health. The direct effects cause premature aging, excessive fatigue, and mental illness and make some problems in the musculoskeletal system, digestive system, nervous system, respiratory system, cardiovascular system. The indirect influences include pure reliance on the car, accidents, traffic congestion and air pollution. Conclusion: Healthcare researchers and urban traffic policymakers should design comprehensive studies to assess the impacts of urban traffic jams and transportation on community health. Therefore, they would be able to investigate the impacts on the health of individuals after the enactment of each law and planning and to implement community-based health promoting strategies in the society.

Background and Objectives: The prevalence of skin cancer has been rising in Iran in the recent years. This disease is the most common cancer in Kurdistan province, Iran. Regarding this, the present study aimed to investigate the determinants of skin cancer preventive behaviors (SCPBs) among the high school students of Sanandaj, Iran, using the PRECEDE model. Materials and Methods: This descriptive cross-sectional study was conducted on 225 second- and third-grade high school students (age range: 15-17 years) in Sanandaj during the academic year of 2013-2015. The study population was selected through multistage sampling method. The students filled out some questionnaires covering such data as knowledge, attitude, self-efficacy, social support (as reinforcing factors), enabling factors, and SCPBs. The data were analyzed using one-way ANOVA, independent t-test, Pearson correlation coefficient, and linear regression in SPSS software, version 21. Results: According to the results, SCPBs showed a direct correlation with attitude (r=0.175), self-efficacy (r=0.509), social support (r=0.332), and enabling factors (r=0.347). The mean SCPBs among the students was lower than moderate. The results of linear regression analysis revealed that the independent variables predicted 29.9% of SCPBs within which self-efficacy was the only significant variable (P

Background: Considering the renewed emphasis on women’s health, attention to the new aspects of their health, such as equity, among different groups is warranted. The aim of this study was to investigate the economic inequalities among women with osteoporosis-related bone fractures (ORBFs) in Sanandaj, Iran. Methods: In this cross-sectional study, convenient sampling was employed to recruit 220 women with osteoporosis referring to the only rheumatology clinic in Sanandaj (the center of Kurdistan province in Iran) from January to April 2013. Main outcome was the history of fractures due to osteoporosis. Concentration index decomposition (CID) and logistic regression were used for data analysis. Results: In multivariate logistic analysis, the fourth and fifth quintiles of family economic status were found to be significantly associated with ORBFs. Risk difference and confidence interval (CI) for the relation between the history of bone fracture and family economic status was -0.115 (95% CI: -0.209, -0.021; P = 0.016), which reflected the higher prevalence of bone fractures among women with the lower economic levels. About 25% out of all ORBFs were happened among 20% of the women with low economic status. Conclusion: It was concluded that economic status plays an important role in happening ORBFs among underprivileged women. A reorientation on women’s health care services in Iran with a focus on underprivileged postmenopausal women seems to be necessary. There is a need for inter-sectoral coalition between the policymakers of the health system and those of other organizations to reduce the economic inequalities among osteoporotic women.

Background: To investigate the determinants of smoking behavior among Iranian adolescents applying the Prototype/Willingness (P/W) Model. Methods: In this cross-sectional study, a self-administered P/W model-based questionnaire was completed between 760 randomly selected adolescents (high school students and dropouts) in Hamadan, Iran, in 2015. Generalized structural equation modeling (GSEM) was applied to analyze data. Results: Significant associations were found between subjective norms and positive attitudes toward smoking (P

Background: There are no studies on the trend of gastric cancer (GC) incidence in Kurdistan, a province in the west of Iran. We aimed to estimate the trend, age-standardized incidence rate (ASR), and annual percentage change (APC) of GC in this province during 2001–2014. Materials and Methods: The data of newly diagnosed GC patients were obtained from the regional Cancer Registering Database. The ASRs were calculated per 100,000 population during 2001–2014. Direct standardization and 95% confidence intervals (CI) were calculated by an efficient method. The temporary changes in ASRs were determined based on the APC by the joinpoint regression model. Results: Overall, 2225 newly diagnosed GC patients were identified. The ASRs ranged from 13.5 (95% CI: 10.4–17.3) to 29.0 (95% CI: 24.5–34.0). The highest ASRs were related to the men and women lived in Divandareh as 32.26 and 13.66, respectively. The respective APC value of GC incidence in women demonstrated a nonsignificant increase during 2001–2008 and a nonsignificant decrease during 2008–2014 (P = 0.1). Accordingly, the incidence of GC in men increased during 2001–2004 (P = 0.1) and decreased during 2004–2014 (P = 0.001). Conclusion: The incidence of GC showed nonsignificant and significant decreasing trends in women and men in Kurdistan province, respectively. Despite such decreasing trends, the Kurdistan province is still considered as one of the regions with high incidence of GC in Iran. Therefore, it is necessary to implement screening programs in the province to early diagnose GC.

As a basic psychological need, the level of perceived competence could expedite the achievement of diabetes self-management goals. Because of a lack of a specific data collection tool to measure the level of self-competence among Persian-speaking patients with diabetes, this study was conducted for (1) cross-cultural adaptation and (2) psychometric assessment of the Persian version of the Perceived Competence Scale for Diabetes (PCSD-P). Standard translation/back-translation procedure was carried out to prepare a preliminary draft of the PCSD-P. Content and face validities of the early draft were checked by an expert panel including 15 scholars in the field of health education and promotion as well as nursing education with experience of working and research on diabetes. The final drafted questionnaire was completed by 177 randomly selected patients with type 2 diabetes. On the basis of the collected data, the structural validity of the contrived version was appraised using exploratory and confirmatory factor analysis (EFA, CFA). Cronbach’s alpha and intraclass correlation (ICC) coefficients were used to check the scale’s reliability and internal consistency. The estimated measures of content validity index (CVI = 0.95) and content validity ratio (CVR = 0.8) were within the acceptable recommended range. The EFA analysis results demonstrated a single factor solution according to the items’ loadings for the corresponding component. The model fit indices, that is, root mean square error approximation (RMSEA = 0.000), comparative fit index (CFI = 1), Tucker−Lewis index (TLI = 1), incremental fit index (IFI = 1), normed fit index (NFI = 0.999), and relative fit index (RFI = 0.995), confirmed the consistency of the hypothesized one-factor solution. The values of the internal consistency and reliability coefficients were also in the vicinity of an acceptable range (α = 0.892, ICC = 0.886, P = 0.001). The study findings revealed good internal validity and applicability of the PCSD-P to measure the degree of self-competence among Persian-speaking type 2 diabetes patients to manage the chronic disease. Owing to unrepresentativeness of the study sample, future cross-cultural tests of PCSD-P are recommended on diverse and broader Persian-speaking populations.

Abstract Background: The aim of this study was to investigate the ability of Iranian medical and dental students in thinking critically and to assess their ability in using definite components of critical thinking (CT). Methods: Multistage cluster sampling was utilized to recruit 125 preclinical (1st, 2nd and 3rd year of study) students in Yazd Shaheed Sadoughi University of Medical Sciences in Yazd, Iran. The Watson-Glaser Critical Thinking Appraisal (WGCTA) was applied to collect data. The statistical analysis of the data included One-way analysis of variance (ANOVA), t-test and bivariate correlations. Results: The mean total score for this sample was 45.33±5.4. Significant differences were found in total critical thinking score by gender (p= 0.022), residency (p= 0.026) and the year of education (p= 0.01). A significant correlation was found between the total CT score and the student’s number of passed credits (r= 0.297, p= 0.003). Also, a significant difference was found in the students’ scores on the WGCTA evaluation subtest by passing any research method courses (p= 0.04). Conclusion: The CT ability in medical and dental students in the present study was weak overall. Medical educators and clinical instructors should try to develop the ability of CT by teaching methods and techniques like purposeful planning and problem-based teaching to promote the components of CT in their students. The improving of CT in medical students has implications for medical education and promotion of medical profession.

Introduction: Society needs are constantly changing. As a result, it seems to be necessary to make changes in education as well. The viewpoints of faculty members as the educators and the most authentic group involved in medical education system are of significant influence. This study was conducted to investigate the determinants of effective teaching from non-clinical teachers' viewpoint in Kurdistan University of Medical Sciences in year 2009. Methods: In this descriptive cross-sectional study, the entire 72 non-clinical teachers in academic year 2009 were selected for investigation. Data collection tool was a questionnaire made by researcher which was validated and reliable. Faculties’ viewpoints toward educational status of the university were collected via this questionnaire. After completion of the questionnaire by these non-clinical teachers, data was collected and codified. Then the SPSS software v.11.5 was used to analyze the data using descriptive statistical tests (frequency and percent). Results: Nonclinical teachers believed that: having scientific capability (97.2%), oratory competency (97.2%), having communication skills (95.9%), the capability to develop critical thinking in the students (91.6%), the role of professional degree (88.8%), and the ability to motivate students for problem solving (84.7%) are respectively the most important factors determining effective teaching. Meanwhile, 68.1% of the respondents believed that the teacher’s research activity is considered significant in his educational success. Conclusion: The results of the study revealed that several factors may influence the effective teaching of non-clinical teachers. Considering these factors at the time of developing educational plans and retraining workshops for teachers may help these workshops to be more effective and successful. Our results may also be an emphasis on the necessity of including courses like the basics and teaching methods in the curriculums of master degree and PhD.

Background: In order to help rheumatoid arthritis (RA) patients in carrying out and attaining relevant self-care behaviors and adaptation to the physical limitations of this disease and, conse-quently, promoting their level of health status, an education program based on the PRECEDE component of the PRECEDE–PROCEED model targeting patients with RA was developed. This paper describes the planning of a RA Patient Education Program (RAPEP) designed to promote their quality of life.Methods: The development of the program began with a comprehensive review of the literature. This included a review of the signs and symptoms of RA, accompanying functional disabilities, previous educational programs and the effect of the disease on the patient’s quality of life. Be-sides, in order to help inform RAPEP program development, and organize the survey according to the factors identified in the PRECEDE model a cross-sectional survey was applied on a non-prob-ability sample of 181 outpatients in Yazd, center of Iran.Results: The quality of life (QOL) problem identified was the considerable low role functioning, health perception and physical functioning due to chronic pain. One of the most significant modi-fiable behavioral factors impacting pain and functional limitations was self-care behaviors in RA patients. Higher level of knowledge, attitude, self-efficacy, enabling factors and social support is associated with better self-care behavior.Conclusions: The PRECEDE component of the PRECEDE–PROCEED model provided a com-prehensive conceptual framework for the development of RAPEP aiming at RA patients in Yazd. Further research to evaluate this educational program is suggested.

Background: Disposal and release of plastic bags in the environment can cause environmental, economic, and social problems. The aim of this study was to explore the determinants of the behavior of plastic bag use (BPBU) among residents using socioecological approach (SEA). Methods: In this cross-sectional study, multistage random sampling was employed to enroll 400 residents in Hadishahr County, North West of Iran. A valid and reliable instrument based on SEA variables was used. Results: Hierarchical multiple linear regressions were performed with SEA and BPBU as outcome variables. Predictors of outcome variables were classified into four different blocks. Demographic characteristics and SEA constructs explained 50% of the observed variance in BPBU. In the first block, age (P = 0.03) and purchase frequency (P = 0.902) were significant predictors of BPBU (R2 = 0.34), and in the third block, access to alternatives in environment (P = 0.01) was significant predictor for BPBU (R2 = 0.49). The majority of residents (47%) were taking home 6 to 10 plastic bags and more than 10 freezer bags after their shopping per week. Conclusions: Health-care providers may consider purchase frequency and SEA as a framework for developing educational, environmental, and social interventions aiming at reducing the consumption of plastic bags.

There are many problems with the waste management systems (WMSs) in developing countries. In order to provide applicable strategies for improving the WMSs in these countries, there is a need to identify the barriers and challenges at the community level. Our aim in the present study was to explain the challenges and barriers in front of the citizen’s participation in the Source Separation of Waste (SSW) program in Tabriz, Iran. In this qualitative research, 13 citizens were invited to participate and were then interviewed. Data were analyzed with the content analysis approach. MAXQDA10 was applied to facilitate the organization of data. Four core categories of the barriers to sourcing the separation of household waste were identified: (a) problems in the collecting system of waste; (b) a lack of responsibility among citizens; (c) insufficient awareness among citizens, and (d) the expectation of receiving incentives. The findings of the study indicated the potential infrastructure barriers that may hinder in-process household solid waste separation attempts. Recycling investors, environmental health policymakers, and stakeholders should take into account these barriers while designing, implementing, and/or reorienting the Source Separation of Waste (SSW) programs.

Objective: The aim of this study was to estimate the prevalence of sexual intimate partner violence (SIPV) and to investigate its associated factors among women attending public obstetrics, genecology, and family planning health services of the city of Marivan, Iran. Materials and methods: This multistage cluster sampling study recruited 770 women attending the public obstetrics, gynecology and family planning health services of the city of Marivan from May to November, 2009. Results: Our findings confirmed that about one-third of the women experienced SIPV (32.9%). Statistically significant differences were found (p < .001) in SIPV by almost all demographic and characteristic variables. Woman's circumcision, forced marriage, spouse's infidelity, level of sexual desire, woman's pleasure from intercourse, and spouse's inattention to woman's sexual satisfaction during intercourse were statistically significant predictors of SIPV, and also, were accounted for 61.8% of the participants. Conclusion: Public health centers and health-care providers should focus on both women and their spouses in order to participate in both national and community level of educational and promotional intervention programs. Without their participation, the likelihood of success in decreasing SIPV against women would be low.

Background: Healthy lifestyle is a major strategy to promote current and subsequent health status. The aim of this study was to assess the status of health-promoting the lifestyle and its determinants among students. Methods: A stratified random sample of 500 students in a university in the city of Sabzevar, Iran participated in this cross-sectional study. Health-promoting lifestyle was measured using Walker′s health-promoting lifestyle profile II. Results: There was a significant correlation between all domains of health-promoting the lifestyle. The highest score among the domains was for an interpersonal relationship (70.8%), and the lowest score was for nutrition (53.6%), and physical activity (53.4%). Significant differences were found in physical activity by gender (P ≤ 0.05). There were significant differences in health responsibility, spiritual growth and body mass index by marital status (P < 0.01). Conclusions: Since one out of five students in this study were overweight/obese, health program planning to promote lifestyle, especially physical activity and nutrition among students is recommended. Our findings may be helpful for faculty administrators, curriculum planners, and health educators in designing guidelines to structuralize a healthier campus and to develop health promotion programs supporting healthy choices among students.