Publications by authors named "Tahereh Dehdari"

27 Publications

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Can adopting skin cancer preventive behaviors among seafarers be increased via a theory-based mobile phone-based text message intervention? A randomized clinical trial.

BMC Public Health 2021 Jan 14;21(1):134. Epub 2021 Jan 14.

Department of Health Education and Health Promotion, Faculty of Public Health, Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran, Iran.

Background: One of the main occupational hazards for seafarers is the long exposure to sunlight. This study aimed to determine the efficacy of a mobile phone-based text message intervention in adopting skin cancer preventive behaviors among a sample of seafarers in Genaveh port located in Bushehr province, Iran.

Methods: In this randomized controlled trial, 136 seafarers were randomly selected and assigned to the intervention (n = 68) or a control groups (n = 68). As a theoretical basis, we followed the Protection Motivation Theory (PMT) variables to develop the text messages. The data related to PMT variables and skin cancer preventive behaviors were collected through a questionnaire. Forty-five text messages were designed, pre-tested and sent to the seafarers' phones in the intervention group in 45 days. Both groups were followed up 1 month after the intervention. Data collected in the two stages were analyzed using paired-samples t-test, ANCOVA, and Chi-square tests.

Results: Following the intervention, the mean scores of adopting skin cancer preventive behaviors (p = 0.001), perceived self-efficacy (p = 0.01), protection motivation (p = 0.02), and fear (p = 0.001) were significantly higher in the intervention group than the control group. There was significant reduction in the response costs (p = 0.05) and perceived rewards (p = 0.01) scores in the intervention group compared with the control group after the intervention. However, there were no significant differences in the perceived vulnerability (p = 0.14), perceived severity (p = 0.09), and response efficacy (p = 0.64) between the two groups after the intervention.

Conclusions: The results of the study indicated the effectiveness of mobile phone-based text message intervention for increasing skin cancer preventive behaviors in Iranian seafarers.

Trial Registration: Iranian Registry for Clinical Trial (the link to trial: https://www.irct.ir/trial/7572 ). Registered 16 July, 2016. Prospectively registered.
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http://dx.doi.org/10.1186/s12889-020-09893-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807693PMC
January 2021

Using health action process approach to determine diet adherence among patients with Type 2 diabetes.

J Educ Health Promot 2020 28;9:170. Epub 2020 Jul 28.

Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Diet adherence may cause diabetes complications to be diminished.

Objectives: This study aimed at identifying determinants of diet adherence among patients with Type 2 diabetes based on the health action process approach (HAPA).

Methods: In this cross-sectional study, 734 patients with Type 2 diabetes, attending to South Tehran health centers, were recruited during June-December 2018. The dietary regimen scale (nine items) and a researcher-designed questionnaire consisting of HAPA constructs were used to gather the data. Data were analyzed using the Mann-Whitney test, Pearson Chi-squared test, Fisher's exact test, and linear regression test. All statistical tests were assessed using SPSS (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY, USA: IBM Corp.).

Results: The level of nonadherence to diet was 91.1%. Diet adherence was significantly associated with family income ( = 0.005), level of education ( < 0.001), and age ( = 0.009). The linear regression showed that 55% of the variance of diet adherence was determined by HAPA variables. Diet adherence was associated with intention ( < 0.001), action planning ( = 0.005), and barriers ( = 0.003).

Conclusion: Most of the patients did not adhere to their diet. Appropriate programs should be designed to promote diet adherence among the patients, especially those with low literacy and patients living in poor communities.
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http://dx.doi.org/10.4103/jehp.jehp_175_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482647PMC
July 2020

Determinants of medication adherence among Iranian patients with type 2 diabetes: An application of health action process approach.

Heliyon 2020 Jul 14;6(7):e04442. Epub 2020 Jul 14.

Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

To identify determinants of medication adherence among patients with type 2 diabetes based on the health action process approach. This cross-sectional study was conducted among 734 patients with type 2 diabetes attending to south Tehran health centers during June to December 2018. Data were gathered using the Morisky Medication Adherence Scale (MMAS-8-Item) and the health action process approach questionnaire. We used Mann-Whitney, Pearson Chi-Squared, Fisher's Exact and Independent Samples Tests for comparison of adherence medication by demographic characteristics; and linear regression analysis to predict factors related to medication adherence based on HAPA. P-value less than 0.05 considered statistically significant. A total of 232 men and 502 women participated in the study, Mean age was 61.61 ± 9.74. Most participants (82.3%) reported low medication adherence (females: 68.4%). Medication adherence was significantly associated with gender (p = 0.03). Medication adherence was significantly predicted by intention (β = 0.172, p = 0.0001), task self-efficacy (β = 0.172, p = 0.01), copping planning (β = 0.6, p = 0.0001) and copping self-efficacy (β = -0.244, p = 0.001). The level of adherence to medications among type 2 diabetes patients was low. The behavior intention, task self-efficacy, copping planning and copping self-efficacy were significant determinants contributed to the medication adherence. HAPA inventory includes various factors, especially types of self-efficacy. Thus, utilization of this comprehensive model in interventional studies is suggested. These determinants should be considered in developing interventional programs to improve adherence.
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http://dx.doi.org/10.1016/j.heliyon.2020.e04442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364035PMC
July 2020

A qualitative exploration of Iranian smokers' experiences in terms of cigarette butt littering behaviour.

Authors:
Tahereh Dehdari

Int J Environ Health Res 2020 May 21:1-9. Epub 2020 May 21.

Department of Health Education and Health Promotion, School of Public Health, Iran University of Medical Sciences , Tehran, Iran.

Although literature shows that Cigarette Butt (CB) is not just litter but a toxic waste which has harmful effects on the environment, a large number of smokers litter their CBs onto the ground. This study explored the experiences of smokers in terms of CB littering behaviour. A qualitative content analysis study was conducted in Tehran, Iran in 2019. Twenty-seven semi-structured in-depth interviews were done with smokers who discarded CB on the ground in outdoor public areas. Participants were asked about their experiences of littering CB. After the first interview, continuous data analysis began and continued up to saturation level. Three main categories including personal, social and structural factors emerged as the participants' experiences about discarding CB. These variables may suggest areas of focus for developing interventions to meet butt littering issue in Iran.
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http://dx.doi.org/10.1080/09603123.2020.1769040DOI Listing
May 2020

Development of an instrument based on the theory of planned behavior variables to measure factors influencing Iranian adults' intention to quit waterpipe tobacco smoking.

Psychol Res Behav Manag 2019 24;12:901-912. Epub 2019 Sep 24.

Department of Biostatistics, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Theory of planned behavior (TPB) is one of the most widely used theoretical frameworks to explain addictive behaviors, such as tobacco smoking. The aim of this study is to develop and validate an instrument based on TPB variables to measure factors influencing Iranian rural adults' intention to quit waterpipe tobacco smoking.

Methods: This study was performed on a sample of rural adult waterpipe consumers living in two villages in Shiraz, Southern Iran. In the beginning, the initial items of instrument were extracted from the literature review and interviews with 20 waterpipe consumers. After that, face validity and qualitative content validity of the items were appraised. To measure quantitative content validity index (CVI) and the content validity ratio (CVR), a panel of experts reviewed the items. In addition, the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied to characterize the construct validity of the instrument. Finally, Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were computed.

Results: CVI and CVR of items were within the ranges of 0.89-0.95 and 0.85-0.96, respectively. EFA indicated the Kaiser-Meyer-Olkin (=0.71) and Bartlett's test of sphericity was significant (=912.36, df=105, <0.0001). Principal component analysis revealed that 15 items could be grouped into four subscales that accounted for 64.97% of the variance. Based on CFA, two items were deleted. CFA results showed that the remained data were fit to the model. The Cronbach's alpha and ICC of subscales were, respectively, in the ranges of 0.72-0.87 and 0.64-0.82. Finally, a 13-item instrument with four subscales was confirmed.

Conclusions: The findings reveal that the developed TPB instrument is a reliable and valid scale to identify the determinants of the intention to quit waterpipe smoking among Iranian rural adults.
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http://dx.doi.org/10.2147/PRBM.S196417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767482PMC
September 2019

Obesity consequences from the people's perspective living in Kurdish regions of Iran: A qualitative content analysis.

J Educ Health Promot 2019 30;8:159. Epub 2019 Aug 30.

Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

Background: Overweight and obesity are one of the most public health problems in the world. Considering obesity prevalence and its widespread health, economic, psychological, and social consequences, this study aimed to explain the consequences of obesity among women and men in the Kurdish region of Mukryan.

Subjects And Methods: The present qualitative study was conducted in the Mukryan Kurdish region in West Azerbaijan province in Iran from June 2017 to November 2017. Data were collected by deep interview, focus group and dialogue with 111 obese and thin men and women and various fields experts who were selected by purposive sampling, and analyzed by qualitative content analysis technique of conventional type and Graneheim and Lundman steps.

Results: Data analysis results were classified into two categories and 12 subcategories: Favorable consequences of normal obesity (social acceptance, internalization of obesity, and reproduction of the family institution), unfavorable consequences of extreme obesity (decreasing agency, physical-psychological dysfunctionalities, family fragility, prevalence of passive leisure, clothing obligation, social objectivity, exogenous and endogenous social exclusion, imposing economic costs, and devaluation of life).

Conclusion: With due attention to unfavorable consequences of extreme obesity on health, illness, social issues and costs, simultaneously with the adoption of preventive approaches to obesity through targeted policies in education, health literacy, promotion of sport culture, development of sports context especially for women, improving recreational facilities, etc., appropriate planning and interventions should be designed and applied for changing the behavior, culture, and community beliefs in dealing with obesity phenomenon.
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http://dx.doi.org/10.4103/jehp.jehp_13_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745888PMC
August 2019

The determinants of anti-diabetic medication adherence based on the experiences of patients with type 2 diabetes.

Arch Public Health 2019 16;77:21. Epub 2019 May 16.

2Department of Health Education and Health Promotion, School of Public Health, Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran, Iran.

Background: The purpose of this study is to explain the experiences of patients with type 2 diabetes (T2DM) about medication adherence.

Method: A qualitative content analysis study was conducted at the Institute of Endocrinology and Metabolism Research and Training Center of Firoozgar Academic Hospital, affiliated to Iran University of Medical Sciences in Tehran, Iran during April-June 2017. Twenty-six semi-structured in-depth interviews were conducted with diabetic patients and their families. The participants were asked about their experiences of medication adherence. After the first round of the interviews, content analysis of data started and continued up to the data saturation.

Results: Four main themes including perceived barriers (with 6 subthemes including inadequate knowledge, situational influences, inadequate perceived threat about diabetes, treatment characteristics, personality traits and medication cost), perceived social support (with 3 subthemes including family, doctor and community supports), medication beliefs (with 3 subthemes including belief in the effectiveness of treatment, belief in the more effectiveness of complementary therapies than medication use and prioritizing the use of the pills instead of the insulin injection) and cues to action (with 2 subthemes including internal and external cues to action) emerged as the experiences of the participants in terms of anti-diabetic medications adherence which should be considered in developing medication adherence interventions for the patients with T2DM.

Conclusion: The patients with T2DM had more barriers for regular drugs consumption. They had incorrect beliefs about anti-diabetic drugs. In addition, they were in need of abroad support community, surroundings and also health professionals. Health systems should consider medication adherence training to be added to the treatment protocols of the diabetic patients.
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http://dx.doi.org/10.1186/s13690-019-0347-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521335PMC
May 2019

Psychometric Properties of the Iranian Brief Version of the Transtheoretical Model Instrument in Terms of Hookah Tobacco Smoking Cessation.

Addict Health 2018 Apr;10(2):102-111

Professor, Department of Biostatistics, School of Medicine AND Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Transtheoretical model (TTM) has been recognized as a common theoretical model in researches in terms of addictive behaviors. The aim of this study was to examine the psychometric properties of the Persian brief version of the TTM for hookah tobacco smoking cessation in a sample of Iranian rural adults who were in the preparation stage for hookah cessation.

Methods: This was a validation study on Iranian rural adult hookah smokers by the TTM instrument. First, to translate the questionnaire items from English to Persian, backward-forward procedure was used. Face and content validity of the instrument items were assessed. Confirmatory factor analysis (CFA) was performed to determine the construct validity of the instrument. For this aim, 300 participants completed the instrument. Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were calculated to examine the internal consistency and reliability of the subscales of the instrument.

Findings: The content validity index (CVI) and content validity ratio (CVR) of the items were ≥ 0.80 and ≥ 0.60, respectively. Based on CFA, the data fitted the TTM model. root mean square error of approximation (RMSEA), the goodness of fit index (GFI), adjusted GFI, and comparative fit index (CFI) were 0.037, 0.960, 0.910, and 0.950, respectively. At this stage, 6 items were deleted. The ICC and Cronbach's alpha of the subscales ranged between 0.60-0.74 and 0.71-0.86, respectively. The final instrument with 29 items was confirmed.

Conclusion: The findings suggest that translating Persian brief version of the TTM instrument was a reliable and valid tool to identify the determinants of hookah smoking cessation among Iranian rural adults.
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http://dx.doi.org/10.22122/ahj.v10i2.563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494985PMC
April 2018

Nutrition knowledge, attitudes, and practice towards breast cancer prevention among the female population of Iran University of medical science students.

Nutr Cancer 2019 6;71(8):1355-1364. Epub 2019 May 6.

Department of Nutrition, School of Public Health, Iran University of Medical Sciences , Tehran , Iran.

Diet plays a measurable role in breast cancer (BC) prevention. The aims of this study were to assess nutrition-related BC prevention Knowledge, attitudes and practice (KAP) of female university students and to examine the relationship between demographic characteristics of students and their KAP. We conducted a cross-sectional study among 500 female students from Iran University of Medical Science (IUMS). A pretested self-administered questionnaires were used to assess the participants' nutrition-related BC prevention KAP. A total of 500 students completed the survey. Students' knowledge with the mean score of 16.97, significantly varied by age (P= 0.03), the field of study (P= 0.001) and family history of BC (P= 0.01). The mean score of attitudes and practice toward nutrition-related BC prevention factors were 24.86 and 39.39, respectively. A significant relationship was observed between nutrition knowledge and attitude (r = 0.27, P < 0.001). Also, Nutrition-related attitudes were positively correlated with the BC prevention dietary practices (r = 0.23, P < 0.001). Nutrition KAP about BC prevention factors was found to be influenced by individual factors such as age, field of study, familial history of BC, job and residency status. Together, our findings confirm that increasing nutrition knowledge is not sufficient for dietary behavior change, but is necessary.
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http://dx.doi.org/10.1080/01635581.2019.1607410DOI Listing
July 2020

Iranian experiences in terms of consumption of disposable single- use plastics: Introduction to theoretical variables for developing environmental health promotion efforts.

Environ Toxicol Pharmacol 2019 Jan 14;65:18-22. Epub 2018 Nov 14.

Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.

In recent years, the consumption of disposable plastic items such as single-use plastic bags, plates, cutlery and so on has rapidly increased in Iran. Present study explored the Iranians' experiences in terms of the consumption of disposable single-use plastics. A qualitative content analysis study was conducted in Delfan, Lorestan, Iran in 2017. Thirty semi-structured in-depth interviews were done with citizens who resided in Delfan. Participants were asked about their experiences of single-use plastics consumption. After the first interview, continuous analysis of data began and continued up to data saturation. Three main themes including perceived barriers for less consumption of disposable single-use plastics, decisional balance and structural factors emerged as the Iranians' experiences in terms of the consumption of disposable single-use plastics. Health promotion practitioners should increase public awareness about the harmful outcomes of high consumption of disposable single-use plastic items through mass media. In addition, they should convince policymakers to enact laws for increasing the production of recyclable single-use items.
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http://dx.doi.org/10.1016/j.etap.2018.11.004DOI Listing
January 2019

Barriers to Pap Smear Test for the Second Time in Women Referring to Health Care Centers in the South of Tehran: A Qualitative Approach.

Int J Community Based Nurs Midwifery 2017 Oct;5(4):376-385

Department of Epidemiology and Biostatistics, School of Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Cervical cancer is a preventable disease with a regular screening program. Many studies have reported a large number of barriers that women had for the first time, but this study decided to find other barriers for the second time pap smear.

Methods: In this qualitative research, data were gathered through in-depth interviews and expressed through conventional content analysis in the form of constant comparison. The participants were 15 women with family profile at 30 health care centers who lived in the south of Tehran and had done Pap smear for one time but didn't do it for the second time.

Results: Three main themes emerged from the analysis of the interviews: negative experiences of the first Pap test were as follows: results of the first time test, readiness for performing the test, getting the test itself, and the site of the first Pap test. Personal barriers to getting the second Pap test were: inattention to time, physical barriers to the second Pap test, and inhibitory beliefs. Perceived social barriers to getting the second Pap test with two sub-themes included social supports and abstract norms.

Conclusion: This study provided other barriers about Pap smear including lack of the spouse's support, the role of health care providers and physicians in screening program for early diagnosis in women.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635557PMC
October 2017

Diet-Related Stomach Cancer Behavior Among Iranian College Students: A Text Messaging Intervention

Asian Pac J Cancer Prev 2016 12 1;17(12):5165-5172. Epub 2016 Dec 1.

Iran University of Medical Sciences, Tehran, Iran. Email:

Background: Stomach cancer is one of the five most common cancers in Iran. This study examined the effectiveness of a mobile telephone short-message service (SMS) based-education intervention using Health Belief Model (HBM) variables in improving dietary behavior in terms of stomach cancer prevention among a sample of Iranian female college students. Materials and Methods: In this quasi-experimental study, 124 female college students in the dormitories of Yazd University, Yazd, Iran were randomly selected and assigned to either the intervention (n=62) or the control group (n=62). Information (data) regarding HBM variables and dietary behavior related to stomach cancer prevention was collected by a self-administrated questionnaire. Forty eight messages were designed and sent to the participants’ phones in the intervention group during the 48-day intervention period. Two groups were followed-up one month after the intervention delivered via SMS. Results: There were significant differences in HBM variables (except for the perceived severity) and the preventive dietary behaviors for stomach cancer in the intervention group compared to the comparison group following the education intervention delivered via SMS. Conclusions: SMS-delivered nutrition education intervention can be a practical strategy to improve dietary behavior related to stomach cancer prevention.
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http://dx.doi.org/10.22034/APJCP.2016.17.12.5165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454653PMC
December 2016

Oral health education program among pre-school children: an application of health-promoting schools approach.

Health Promot Perspect 2016 10;6(3):164-70. Epub 2016 Aug 10.

Department of Biostatistics, Iran University of Medical Sciences, Tehran, Iran.

Background: Preschool children have a limit ability to take care of their teeth. The aim of this study was to determine the effect of an intervention based on Albanian's Health Promoting Schools Model (Albanian's HPSM) on the oral health behaviors among a group of Iranian female preschool (5-6 years old) children.

Methods: In this quasi-experimental study, 120 children in seventh district of Tehran, Iran were randomly recruited and assigned to either the intervention or the control groups. A scale was designed and validated to assess the oral health behaviors among the children and knowledge,attitude, self-efficacy beliefs, perceived barriers and oral health behaviors among the parents and the schoolteachers. An expert panel approved the content validity of the scale (CVR = 0.89,CVI = 0.90). The reliability was also approved applying intraclass correlation coefficient (range,0.83-0.92) and Cronbach alpha (range, 0.83-0.96). Based on the preliminary data, a 6-week intervention was designed and conducted to the intervention group. One month following the intervention, both groups were followed-up. The data were analyzed using covariance and paired t tests.

Results: Following the intervention, significant differences were found in the oral health behaviors of the children in the intervention group (P < 0.05) and knowledge, attitude, oral health behaviors, self-efficacy, and perceived barriers of their parents and the schoolteachers (P < 0.05).

Conclusion: Using Albanian's health-promoting schools (HPSs) approach was useful in improving the oral hygiene behaviors among the preschool children.
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http://dx.doi.org/10.15171/hpp.2016.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002884PMC
August 2016

Dairy Foods Intake among Female Iranian Students: A Nutrition Education Intervention Using a Health Promotion Model.

Glob J Health Sci 2016 10 1;8(10):54893. Epub 2016 Oct 1.

School of Health, Iran University of Medical Sciences, Tehran, Iran.

Introduction: This aim of this study was to increase dairy consumption in students following an education intervention based on Pender's Health Promotion Model (Pender's HPM) variables.

Methods: The study was done during September 2014-April 2015 in Savojbolagh, Alborz, Iran. The study sample included 142 middle-school female students who were allocated to either the intervention (n=71) or the comparison group (n=71). Pender's HPM variables and the daily servings of dairy foods consumed were measured in both groups by a self-administered questionnaire and a 3 d record before the intervention and 4 weeks later. The 4-week intervention was conducted for the intervention group. The data was analyzed through analysis of covariance and paired t tests.

Results: Compared to the comparison group, there were significant differences in Pender's HPM variables (except for the negative feelings, perceived barriers and competing demands), the daily servings of dairy foods consumed, and intakes of Calcium, riboflavin, and vitamin A in the intervention participants following the conducted intervention program.

Conclusion: Developing theory-driven nutrition education programs may increase student's dairy foods intake.
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http://dx.doi.org/10.5539/gjhs.v8n10p192DOI Listing
October 2016

Prevention of Esophageal Cancer: Experience of an Educational Campaign for Reducing Hot Tea Consumption in Iran.

Asian Pac J Cancer Prev 2016 ;17(1):305-10

Department of Health Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran E-mail :

Background: Given the association between drinking hot tea and the risk of esophageal squamous cell carcinoma, this study was designed to determine the effectiveness of an educational campaign based on the Theory of Planned Behavior (TPB) in reducing hot tea consumption among a sample of Iranian female students.

Materials And Methods: In this quasi-experimental study, 130 primary-school female students in Salas Babajani, Kermanshah, Iran were randomly selected. A two-month campaign based on TPB constructs was developed and conducted for the intervention group. Combined mass media approaches (such as posters, pamphlet, and brochure) with small group and individual activities were used to transfer the campaign messages. Also, five 40-minute instructional sessions for the students and one session for their parents and teachers were held. The hot tea consumption, attitude, subjective norms, perceived behavioral control and no intention to drink hot tea were variables which were measured at baseline and again after 4 weeks.

Results: There was a significant improvement in the perceived behavioral control and intention to drink no hot tea variables in the intervention group as compared to the control group following the campaign. In addition, significant reductions were found for the hot tea consumption and favorable attitude toward drinking hot tea in the intervention group as compared to the control group.

Conclusions: Conducting educational campaigns based on TPB variables may reduce hot tea consumption among Iranian students.
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http://dx.doi.org/10.7314/apjcp.2016.17.1.305DOI Listing
November 2016

Predictors of Sun-Protective Practices among Iranian Female College Students: Application of Protection Motivation Theory.

Asian Pac J Cancer Prev 2015 ;16(15):6477-80

Department of Health Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran E-mail :

Purpose: Given the importance of sun protection in the prevention of skin cancer, this study was designed to determine predictors of sun-protective practices among a sample of Iranian female college students based on protection motivation theory (PMT) variables.

Materials And Methods: In this cross-sectional study, a total of 201 female college students in Iran University of Medical Sciences were selected. Demographic and PMT variables were assessed with a 67-item questionnaire. Multiple linear regression was used to identify demographic and PMT variables that were associated with sun-protective practices and intention.

Results: one percent of participants always wore a hat with a brim, 3.5% gloves and 15.9% sunglasses while outdoors. Only 10.9% regularly had their skin checked by a doctor. Perceived rewards, response efficacy, fear, self-efficacy and marital status were the five variables which could predict 39% variance of participants intention to perform sun-protective practices. Also, intention and response cost explained 31% of the variance of sun-protective practices.

Conclusions: These predictive variables may be used to develop theory-based education interventions interventions to prevent skin cancer among college students.
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http://dx.doi.org/10.7314/apjcp.2015.16.15.6477DOI Listing
July 2016

Psychological Aspects of Cosmetic Surgery Among Females: A Media Literacy Training Intervention.

Glob J Health Sci 2015 Jun 1;8(2):35-45. Epub 2015 Jun 1.

Department of Biostatistics, School of Health, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: The present study examined the favorable attitude of a sample of female university students regarding elective cosmetic surgery, body dysmorphic disorder, self-esteem and body dissatisfaction following a media literacy training intervention.

Methods: This study was a quasi-experimental type. The study sample included 140 female university students who were allocated to either the intervention (n=70) or the control group (n=70). Attitude toward cosmetic surgery, body dysmorphic disorder, self-esteem and, body satisfaction was measured in both groups before the intervention and 4 weeks later. Four media literacy training sessions were conducted over 4 weeks for the intervention group. The data was analyzed through analysis of covariance, student's paired-samples t test, and Pearson correlation.

Results: Our findings showed that favorable attitude, body dysmorphic disorder and body dissatisfaction scores were significantly lower (p<0.05) in the intervention group than the control group. Furthermore, self-esteem score increased significantly in the intervention group.

Conclusions: Our results underscores the importance of media literacy intervention in decreasing female's favorable attitude towards elective cosmetic surgery, body dysmorphic disorder and body dissatisfaction as well as increasing self-esteem.
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http://dx.doi.org/10.5539/gjhs.v8n2p35DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803990PMC
June 2015

Poor Sleep Quality in Patients after Coronary Artery Bypass Graft Surgery: An Intervention Study Using the PRECEDE-PROCEED Model.

J Tehran Heart Cent 2015 8;10(1):1-8. Epub 2015 Jan 8.

Department of Biostatistics, School of Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Poor sleep quality (SQ) is common among patients after coronary artery bypass graft surgery (CABG). This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG.

Methods: This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifestyle training plus designed intervention based on the PRECEDE-PROCEED model) or to the control group (recipient of exercise and lifestyle training). Eight training sessions over 8 weeks were conducted for the intervention group. Predisposing, enabling, and reinforcing factors as well as social support and SQ were measured in the intervention group before and one month after the intervention and compared to those in the control group at the same time points.

Results: The mean age of the patients in the intervention (24% women) and control (24% women) groups was 59.3 ± 7.3 and 59.5 ± 9.3 years, respectively. The results showed that the mean scores of SQ (p value < 0.001), knowledge (p value < 0.001), beliefs (p value < 0.001), sleep self-efficacy (p value < 0.001), enabling factors (p value < 0.001), reinforcing factors (p value < 0.001), and social support (p value < 0.001) were significantly different between the intervention and control groups after the intervention.

Conclusion: Adding an intervention based on the PRECEDE-PROCEED model to the cardiac rehabilitation program may further improve the SQ of patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494514PMC
July 2015

Psychometric Properties of the Coping Self-Efficacy Scale Among HIV-Infected Iranian Patients.

Iran Red Crescent Med J 2015 Feb 10;17(2):e25074. Epub 2015 Feb 10.

Department of Clinical Psychology, Islamic Azad University, Saveh Branch, Saveh, IR Iran.

Background: Self-efficacy is an important predicator of coping with stress.

Objectives: This study aimed to determine the psychometric characteristics of the coping self-efficacy (CSE) scale among HIV-infected Iranian patients.

Patients And Methods: Psychometric properties of the CSE scale were examined by using a cross-sectional study design. One hundred and twenty HIV-infected Iranian patients that had been referred to the Counseling of Behavioral Diseases Center at Imam Khomeini Hospital in Tehran, Iran in 2014 were selected through simple random sampling method. To determine the Content Validity Index (CVI) and the content validity ratio (CVR), a panel of experts (n = 20) reviewed items of CSE scale. Reliability was estimated through the internal consistency (n = 30) and the conformity factor analysis was performed.

Results: Iranian version of the CSE scale contained 16 items, including 7 items on the "use of problem-focused coping" method, 5 items on "stopping unpleasant emotions and thoughts", and 4 items on "getting support from friends and family". CVI and CVR scores were 0.79, 0.42 and more, respectively. Internal consistencies (range, 0.64 to 0.84) of 3 subscales were acceptable. Confirmatory factor analysis showed that comparative indices of the model, including CFI, IFI, GFI, RMSEA, and Chi-square (χ2/df) were 0.96, 0.95, 0.84, 0.83, and 1.82, respectively, which indicated a good fit for the data.

Conclusions: The Iranian version of the CSE scale is a valid instrument to measure the coping self-efficacy among people living with HIV in research and community settings in Iran.
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http://dx.doi.org/10.5812/ircmj.25074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353189PMC
February 2015

Coping With Stress Strategies in HIV-infected Iranian Patients.

J Assoc Nurses AIDS Care 2015 Jul-Aug;26(4):464-71. Epub 2015 Jan 13.

Stress has significant adverse impacts on health outcomes of HIV-infected patients. Our study explored coping with stress strategies by HIV-infected Iranian patients. A qualitative content analysis study was conducted at the Consultation Clinic of HIV at the Imam Khomeini Hospital in Tehran, Iran in 2012. Twenty-six semi-structured in-depth interviews were done. Participants were asked about coping strategies for stress. After the first interview, continuous analysis of data was started and continued up to data saturation. Results showed that participants used two categories of strategies (emotion-based coping and problem-based coping) to cope with stress. Emotion-based coping had two sub-themes: adaptive and maladaptive. The problem-based coping category had three sub-themes: participation in education sessions, adherence to medication, and efforts to maintain a healthy lifestyle. Explanations of different strategies available to HIV-infected patients to cope with stress may help develop tailored interventions to improve the psychological conditions of people living with HIV.
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http://dx.doi.org/10.1016/j.jana.2015.01.001DOI Listing
March 2016

Establishing a framework of influential factors on empowering primary school students in peer mediation.

Iran Red Crescent Med J 2014 Oct 5;16(10):e14194. Epub 2014 Oct 5.

Department of Health Promotion and Education, Tehran University of Medical Sciences, Tehran, IR Iran.

Background: Empowerment of children and adolescents in terms of social skills is critical for promoting their social health.

Objectives: This study attempts to explore a framework of influential factors on empowering primary school students by means of peer mediation from the stakeholders' point of view, as a qualitative content analysis design.

Patients And Methods: This study was a qualitative content analysis (conventional method). Seven focused group discussions and six in-depth interviews were conducted with schoolchildren, parents and education authorities. Following each interview, recordings were entered to an open code software and analyzed. Data collection was continued up to data saturation.

Results: Within the provided framework, the participants' views and comments were classified into two major categories "educational empowerment" and "social empowerment", and into two themes; "program" and "advocacy". The "program" theme included factors such as design and implementation, development, maintenance and improvement, and individual and social impact. The "advocacy" theme included factors such as social, emotional and physical support.

Conclusions: The explained framework components regarding peer mediation are useful to design peace education programs and to empower school-age children in peer mediation.
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http://dx.doi.org/10.5812/ircmj.14194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329752PMC
October 2014

Effects of an educational intervention based on the protection motivation theory and implementation intentions on first and second pap test practice in Iran.

Asian Pac J Cancer Prev 2014 ;15(17):7257-61

Department of Health Education and Health Promotion, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran E-mail :

Background: Few Iranian women take the Papanicolaou test despite its important role in preventing cervical cancer. This study aimed to determine the effectiveness of an educational intervention based on the protection motivation theory (PMT) variables and implementation intentions in the first and second Pap test practice among Iranian women.

Materials And Methods: In this quasi-randomized controlled trial, 200 women who were referred to 30 primary health care clinics in Tehran were randomly selected. PMT variables and Pap test practice were measured at baseline and again after 3 and 15 months. The 4-week educational intervention program was conducted for the intervention group.

Results: Following the intervention, the mean scores of self-efficacy, perceived vulnerability, and behavior intention variables were significantly higher in the intervention group when compared to the control group (p<0.05). No significant differences were found in the perceived severity, response efficacy, response cost, and fear between the two groups following the intervention. Higher percent of women in the intervention group had obtained first and second Pap test compared to the controls.

Conclusions: The PMT and implementation intentions provide a suitable theory-based framework for developing educational interventions regarding Pap test practice in Iran.
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http://dx.doi.org/10.7314/apjcp.2014.15.17.7257DOI Listing
June 2015

Developing and testing a measurement tool for assessing predictors of breakfast consumption based on a health promotion model.

J Nutr Educ Behav 2014 Jul-Aug;46(4):250-258. Epub 2014 Mar 15.

Department of Nutrition, School of Health, Alborz University of Medical Sciences, Karaj, Iran.

Objective: To develop an instrument for measuring Health Promotion Model constructs in terms of breakfast consumption, and to identify the constructs that were predictors of breakfast consumption among Iranian female students.

Design: A questionnaire on Health Promotion Model variables was developed and potential predictors of breakfast consumption were assessed using this tool.

Participants: One hundred female students, mean age 13 years (SD ± 1.2 years).

Settings: Two middle schools from moderate-income areas in Qom, Iran.

Variables Measured: Health Promotion Model variables were assessed using a 58-item questionnaire. Breakfast consumption was also measured.

Analysis: Internal consistency (Cronbach alpha), content validity index, content validity ratio, multiple linear regression using stepwise method, and Pearson correlation.

Results: Content validity index and content validity ratio scores of the developed scale items were 0.89 and 0.93, respectively. Internal consistencies (range, .74-.91) of subscales were acceptable. Prior related behaviors, perceived barriers, self-efficacy, and competing demand and preferences were 4 constructs that could predict 63% variance of breakfast frequency per week among subjects.

Conclusions And Implications: The instrument developed in this study may be a useful tool for researchers to explore factors affecting breakfast consumption among students. Students with a high level of self-efficacy, more prior related behavior, fewer perceived barriers, and fewer competing demands were most likely to regularly consume breakfast.
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http://dx.doi.org/10.1016/j.jneb.2013.12.007DOI Listing
April 2015

Development of an instrument based on the protection motivation theory to measure factors influencing women's intention to first pap test practice.

Asian Pac J Cancer Prev 2014 ;15(3):1227-32

Department of Health Education and Health Promotion, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran E-mail :

Background: Given that there are many Iranian women who have never had a Pap smear, this study was designed to develop and validate a measurement tool based on the Protection Motivation Theory to assess factors influencing the Iranian women's intention to perform first Pap testing.

Materials And Methods: In this psychometric research, to determine the Content Validity Index (CVI) and the Content Validity Ratio (CVR), a panel of experts (n=10) reviewed scale items. Reliability was estimated through the Intraclass Correlation Coefficient (n=30) and internal consistency (n=240). Also, factor analysis (exploratory and conformity) was performed on the data of the sample women who had never had a Pap smear test (n=240).

Results: A 26-item questionnaire was developed. The CVI and CVR scores of the scale were 0.89 and 0.90, respectively. Exploratory factor analysis loaded a 26-item with seven factors questionnaire (perceived vulnerability and severity, fear, response costs, response efficacy, self-efficacy, and protection motivation (or intention)) that jointly accounted for 72.76% of the observed variance. Confirmatory factor analysis indicated a good fit for the data. Internal consistency (range 0.70-0.93) and test-retest reliability (range 0.72-0.96) of sub-scales were acceptable.

Conclusions: This study showed that the designed instrument was a valid and reliable tool for measuring the factors influencing the women's intention to perform their first Pap testing.
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http://dx.doi.org/10.7314/apjcp.2014.15.3.1227DOI Listing
November 2014

Prediction of milk consumption among Iranian pregnant women: application of the theory of planned behavior.

Iran Red Crescent Med J 2013 May 5;15(5):440-1. Epub 2013 May 5.

Department of Biostatistics, Faculty of Medical Science, Tarbiat Modares University, Tehran, IR Iran.

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http://dx.doi.org/10.5812/ircmj.1912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838658PMC
May 2013

Effect of nutrition education intervention based on Pender's Health Promotion Model in improving the frequency and nutrient intake of breakfast consumption among female Iranian students.

Public Health Nutr 2014 Mar 30;17(3):657-66. Epub 2013 Jan 30.

3 Department of Mathematics & Statistics, Hospital Management Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

Objective: To determine the effectiveness of nutrition education intervention based on Pender's Health Promotion Model in improving the frequency and nutrient intake of breakfast consumption among female Iranian students.

Design: The quasi-experimental study based on Pender's Health Promotion Model was conducted during April-June 2011. Information (data) was collected by self-administered questionnaire. In addition, a 3 d breakfast record was analysed. P < 0·05 was considered significant.

Setting: Two middle schools in average-income areas of Qom, Iran.

Subjects: One hundred female middle-school students.

Results: There was a significant reduction in immediate competing demands and preferences, perceived barriers and negative activity-related affect constructs in the experimental group after education compared with the control group. In addition, perceived benefit, perceived self-efficacy, positive activity-related affect, interpersonal influences, situational influences, commitment to a plan of action, frequency and intakes of macronutrients and most micronutrients of breakfast consumption were also significantly higher in the experimental group compared with the control group after the nutrition education intervention.

Conclusions: Constructs of Pender's Health Promotion Model provide a suitable source for designing strategies and content of a nutrition education intervention for improving the frequency and nutrient intake of breakfast consumption among female students.
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http://dx.doi.org/10.1017/S1368980013000049DOI Listing
March 2014

Effects of progressive muscular relaxation training on quality of life in anxious patients after coronary artery bypass graft surgery.

Indian J Med Res 2009 May;129(5):603-8

Department of Health Education, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran.

Background & Objective: Evidences suggest that relaxation therapy may improve psychological outcomes in heart patients. We evaluated the effect of progressive muscular relaxation (PMR) training in decreasing anxiety and improving quality of life among anxious patients after coronary artery bypass graft surgery (CABG).

Methods: This study was an open uncontrolled trial. The sample included 110 anxious patients referred to the cardiac rehabilitation clinic of Tehran Heart Center, Tehran, Iran, during six weeks after coronary artery bypass graft (CABG). Patients were allocated to receive both exercise training and lifestyle education plus relaxation therapy (relaxation group; n=55) or only exercise training beside lifestyle education (control group or the recipient of usual care group; n=55). Duration of the relaxation therapy was 6 wk and in the case of usual care was 8 wk. Both the groups were followed up one month after completion of intervention. Anxiety and quality of life in the two treatment groups were compared.

Results: There were no significant differences in overall QOL, state anxiety and trait anxiety scores between the two groups before intervention. Significant reductions in state anxiety (P<0.01) and trait anxiety (P<0.01) levels were observed in relaxation group after intervention compared to control group. Women had high state anxiety and a low quality of life than men in the two groups before intervention. After intervention, there was no difference between men and women in the relaxation group.

Interpretation & Conclusion: Our findings show that progressive muscular relaxation training may be an effective therapy for improving psychological health and quality of life in anxious heart patients.
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May 2009