Effectiveness of Multidisciplinary Group-Based Intervention versus Individual Physiotherapy for Improving Chronic Low Back Pain in Nursing Staff: A Clinical Trial with 3- and 6-Month Follow-Up Visits from Tehran, Iran

STUDY DESIGN: Clinical trial. PURPOSE: To evaluate the effectiveness of a multidisciplinary group-based intervention on improving pain and disability among Iranian nurses with chronic low back pain in Tehran, Iran. OVERVIEW OF LITERATURE: Although low back pain (LBP) is one of the most important health problems, the challenge remains on how to find an effective intervention to reduce pain and related disabilities. METHODS: Overall, 136 eligible nurses with chronic mechanical LBP were classified into two groups. The intervention group (n=66 participants) participated in a physiotherapy educational program (for 120 minutes) plus a health educational program based on predictive constructs of the social cognitive theory (for 120 minutes). These interventions were delivered by a physiotherapist and a health education specialist. The control group (n=70 participants) participated in a physiotherapy educational program (for 120 minutes). Disability rate, pain severity, and back pain prevention behavior were measured initially and at 3- and 6-month follow-up visits using the visual analogue scale, Roland-Morris Disability, and Nursing Low Back Pain Preventive Behaviors Questionnaire. Data were analyzed by SPSS ver. 16. RESULTS: There were statistically significant differences between the two groups in the main outcome measures immediately after the educational program and at 3- and 6-month follow-up visits. Preventive behaviors of participants in the intervention group were improved at 3- and 6- month follow-up visits (p<0.001). The mean scores of predictive constructs regarding LBP preventive behaviors in the intervention group were improved after 3 and 6 months (p<0.001). Finally, in the intervention group, pain severity and disability were decreased significantly. CONCLUSIONS: This study showed that a multidisciplinary educational program intervention can be an effective approach for reducing LBP and related disabilities among nurses.

A Multidisciplinary Workplace Intervention for Chronic Low Back Pain among Nursing Assistants in Iran

STUDY DESIGN: Interventional research with a 6-month follow-up period. PURPOSE: We aimed to establish the effectiveness of a multidisciplinary workplace intervention on reduction of work-related low back pain (WRLBP), using ergonomic posture training coupled with an educational program based on social cognitive theory. OVERVIEW OF LITERATURE: WRLBP is a major occupational problem among healthcare workers, who are often required to lift heavy loads. Patient handling is a particular requirement of nurse aides, and has been reported as the main cause of chronic WRLBP. METHODS: We included 125 nursing assistants from two hospitals affiliated to Qom University of Medical Sciences from May to December 2015. There was an intervention hospital with a number of 63 nursing assistants who received four multidisciplinary educational sessions for 2 hours each plus ergonomic posture training over two days and a control hospital with a number of 62 nursing assistants who didn't receive educational intervention about low back pain. The outcomes of interest were reductions in WRLBP intensity and disability from baseline to the follow up at 6 months, which were measured using a visual analog scale and the Quebec Disability Scale. Descriptive and analytical statistics were used to analyze the data. RESULTS: The comparison tests showed significant change from baseline in reduction of WRLBP intensity following the multidisciplinary program, with scores of 5.01±1.97 to 3.42±2.53 after 6 months on the visual analog scale in the intervention group (p<0.001) and no significant change in control groups. There was no significant difference in the disability scores between the two groups (p=0.07). CONCLUSIONS: We showed that our multidisciplinary intervention could reduce the intensity of WRLBP among nurse aides, making them suitable for implementation in programs to improve WRLBP among nursing assistants working in hospitals.

Work-Related Low Back Pain Treatment: A Randomized Controlled Trial from Tehran, Iran, Comparing Multidisciplinary Educational Program versus Physiotherapy Education

STUDY DESIGN: Clinical trial. PURPOSE: To compare the multidisciplinary educational program versus physiotherapy education among Iranian nurses. OVERVIEW OF LITERATURE: Low back pain (LBP) can accompany significant occupational injuries in the nursing profession. There is no agreement on the most effective educational practice. METHODS: This study was conducted from August 17, 2014 to September 22, 2014 in Tehran, Iran. Eligible nurses with chronic mechanical LBP (n=136) were classified into an intervention group (n=66) or the control group (n=70). The intervention group received physiotherapy education for 120-minutes followed by a 120-minute health education session based on predictive constructs of social cognitive theory (SCT). The control group received the 120-minute physiotherapy education. Disability rate, pain severity and back pain prevention behavior were measured at initially and 3 months after intervention using visual analogue scale, Roland-Morris disability questionnaire and nursing low back pain preventive behaviors questionnaire. RESULTS: The two groups were the same in terms of all studied variables at the initiation of the study. At the 3-month follow up, predictive constructs of LBP preventive behaviors of participants in the intervention were improved (p<0.001). Significant decreases were evident at 3 months in pain severity (p=0.03) and disability (p=0.003). CONCLUSIONS: The designed multidisciplinary educational intervention could decrease chronic mechanical LBP in nurses.

Development and Psychometric Evaluation of Nursing Low Back Pain Predictor Questionnaire Focusing on Nurses Suffering from Chronic Low Back Pain in Iran

STUDY DESIGN: Development and psychometric evaluation. PURPOSE: Design and psychometric assessment of the Nursing Low Back Pain Predictor Questionnaire addressing nurses suffering from chronic low back pain in Iran. OVERVIEW OF LITERATURE: Low back pain is the most prevalent behavior-related health problem among nurses, and it needs to be assessed through a validated multi-factorial questionnaire, using the premises of the social cognitive theory. METHODS: This was a cross-sectional study carried out in Tehran, Iran from April 17, 2014 to July 16, 2014. A 50-item questionnaire based on the social cognitive theory was generated. The questionnaire was distributed among 500 nurses working in hospitals located in different geographically areas in Tehran. Exploratory factor analysis was used to determine the factors and their related items. Cronbach's alpha was calculated to assess reliability. RESULTS: The exploratory factor analysis loaded six factors, named observational learning, outcome expectations, self-efficacy, self-regulation, and self-efficacy in overcoming impediments in the working environment and emotional coping. All factors were jointly accounted for 67.12% of behavior change variance. The Cronbach's alpha coefficient showed excellent internal consistency (alpha=0.91). Test and retest analysis with 2-week intervals indicated an appropriate stability for the questionnaire (intraclass correlation coefficient=0.94). CONCLUSIONS: According the results, the developed questionnaire is a reliable and validated theory-based instrument, which can be used to predict the work, related factors for low back pain among nurses.

Opinions of the midwives about enabling factors of skin-to-skin contact immediately after birth: a descriptive study

Despite the benefits of mother-newborn skin-to-skin contact [SSC] immediately after birth, the process has not been universally implemented as routine care for healthy term neonates. The purpose of this study was to determine opinions of the midwives about enabling factors of SSC immediately after birth in Tehran hospitals in 2012- 2013. This study has been conducted in a descriptive method based on PRCEDE-PROCEED model. The samples were 292 midwives from 18 hospitals. We used stratified and then simple random sampling. In this study midwives were working at delivery room; deliveries were conducted by midwives or they were in charge of the newborn immediately after birth. Data collection instrument was a self developed questionnaire concerning the enabling factors in the SSC. We applied face and content validity ratio [CVR], content validity index [CVI] and item impact method for the instrument's validity and Cronbach's Alpha for reliability. Finally, data were analyzed and interpreted using spss-18 through descriptive statistics. The results show that 90.4% of the midwives believed in necessity of a plan, 96.2% believed that good services should be provided to mothers, and 97.9%, 85.3% and 93.8% of them believed there is a need for private space, essential facilities and essential equipment for skin contact process; with Cronbach's Alpha of 0.731, 0.551, 0.501, and 0.600 respectively. Most of the midwives believed that enabling factors concerning the successful SSC are effective. We suggest further studies on other enabling factors effective in SSC from the view point of midwives, gynaecologists and caregivers

Cognitive factors related to regular physical activity in college students

Despite the well evidenced health benefits of regular physical activity, many Iranian college students do not engage in physical activity sufficiently. The aim of this study was to assess cognitive factors related to regular physical activity in college students in Hormozgan University of Medical Sciences, Bandar Abbass, Iran. A total of 314 students from three schools of the Hormozgan University of Medical Sciences were selected randomly. Of the total number of students, 249 students filled out the questionnaires completely [response rate = 79.3%]. Exercise Benefits/Barriers scale, Selfefficacy scale, Exercise norms scale, and Planning for exercise scale were used to assess cognitive factors regarding physical activity; the Cronbach's alpha of these scales were 0.87, 0.83, 0.73, and 0.82, respectively. The mean age of participants was 21.7 +/- 2.7. Of all the participants, 46.2% were male. Only 26.5% [n = 66] were engaged in regular physical activity. Perceived barriers to exercise, selfefficacy to exercise, planning for exercise, and exercise norms had a significant relationship with physical activity [P < 0.05]. However, there was no significant relationship between perceived benefits to exercise and physical activity. For increasing physical activity in college students, self-efficacy and social support improvement is suggested

survey on midwives' opinions about skin to skin contact between mother and newborn, immediately after birth; a cross- sectional study

Successful breast feeding, especially using breast crawl in the first 5 minutes after birth, is one of the important factors for newborn's health. Breast crawl is the way that can reduce newborns death rate; however it is not widely used in Iran. In this Analytic cross-sectional study, stratified sampling was applied to recruit 150 midwives from 16 hospitals who are responsible for delivery or newborns immediately after birth. Data collection was conducted using nineteen focus group discussion consisted of 6-12 participants. Discussions were held in hospitals' calm environment for about 1:45' - 2 hours. Also, a questionnaire was used as an instrument for collecting demographic information. Instructional leaflets, composed of five questions were distributed among the participants. The instruments' validity was assessed through CVI and CVR methods. Content analysis, descriptive statistics and Chi-Square test were conducted in SPSS-18 to analyze the data. The findings of the research reveal that 98% of the midwives have used skin-to-skin contact from at least two to four minutes. Moreover, 58.9% and 57.4% of the obstetricians have considered the contact as breast crawl in educational and non-educational hospitals, respectively; 58.9% and 53.2% of them have used skin-to-skin contact whenever possible; 28.6% and 23.4% have placed the newborns on their mother's abdomen to perform breast crawl; 44.6% and 33.3% applied such contact immediately afterbirth; and 67.9% and 85.1% are satisfied with their workplace environment, respectively. The results show that midwives are familiar with skin to skin contact and its benefits for both mother and newborn. However, they do not employ this method immediately after birth. There is an urgent need for more qualitative and quantitative studies to investigate the inhibitory factors

Health education program and tuberculosis preventive behaviors

This study aimed to investigate the effect of the educational program on knowledge attitude and preventive behaviors towards tuberculosis in the Ramin village of Iran. In this study 90 eligible participants were randomly divided into two groups of intervention group who took port in educational workshop [N=45] and control group [N=45] who received no education. Data were collected at baseline and 3-month follow up. Data was analyzed within statistical SPSS program. Initially, two groups were the same in terms of demographic data [p>0.05]. However, the intervention group improved significantly in terms of knowledge¸ attitude and behavior scores compared to control group [p<0.0001]. The educational program could improve preventive behaviors among individuals who living in the Ramin village of Iran.

[Relationship between perceived benefits/barriers and decisional balance with stages of change for physical activity among high school students in Bandar Abbas]

This study aimed to assess relationship between perceived benefits/barriers and decisional balance with stages of change for physical activity among high school students in Bandar Abbas, Iran. This cross-sectional study was conducted in high schools of Bandar Abbas, in the south of Iran. A total of 422 high school students were selected. Twenty two participants did not fill out questionnaires completely. A total of 400 questionnaires were analyzed [response rate=94.8%]. The perceived benefits/ barriers to exercise and decisional balance were assessed using the Exercise Benefits/Barriers Scale; and stages of change were assessed using the Physical Activity staging. Data were analyzed in the SPSS v.16. The mean age of the participants was 15.9 [SD=1.1] ranging from 14 to 18 years. More than half of the participants [51.8%] were male and 48.2% were female. About half of the participants [49.2%] were engaged in regular physical activities. Fifteen per cent of the participants in the precontemplation stage, 15.8% in the contemplation stage, 20% in preparation stage, 15.8% in action stage, and 33.4% in maintenance stage for physical activity. From precontemplation stage to maintenance stage, the perceived benefits and decisional balance were increased and the perceived barriers was decreased. The results of this study are in line with the Transtheoretical model. This model can be used as a framework to design interventions for improving physical activity in population

qualitative evaluation o men living with HIV: views on codom use

Unprotected sexual activity is an important reason for the currently growing incidence of HIV infection in Iran. Recognizing barriers to safe sexual practice and affordance of behavioral changes can improve planning for condom promotion. The main objective of our study is to evaluate the opinions of HIV-positive men on condom use. Our study was performed at three behavioral disease consultation clinics [HIV care clinics] in Tehran, Iran. Participants were initially selected among HIV-positive male patients by convenience sampling and narrowed-down by maximum diversity sampling in order to obtain the number of patients that would express various viewpoints regarding barriers and benefits to condom use. Data were collected using in-depth semi-structured individual interviews. All interviews were recorded and transcribed, and the codes were extracted after reviewing them several times. In this study, 22 HIV-positive men with a mean age of 37.5 +/- 7.3 years were interviewed. Participants mentioned the prevention of HIV and sexually transmitted diseases as a benefit of condom use. However, most named decreased sexual satisfaction as the most important reason for not using condom. Because of decreased sexual satisfaction and unpleasantness, 9% of participants had not used condom during sexual intercourse. The most important reason for not using condom was decreased sexual satisfaction. This study was indicated a need for consultations with HIV-positive and at risk populations to change their attitudes towards condom use and demonstrate the advantages of condom. To achieve this, government programs and media should be utilized

Fish consumption in a sample of people in Bandar Abbas, Iran: application of the theory of planned behavior

This study aimed to apply the conceptual framework of the theory of planned behavior [TPB] to explain fish consumption in a sample of people who lived in Bandar Abbass, Iran. We investigated the role of three traditional constructs of TPB that included attitude, social norms, and perceived behavioral control in an effort to characterize the intention to consume fish as well as the behavioral trends that characterize fish consumption. Data were derived from a cross-sectional sample of 321 subjects. Alpha coefficient correlation and linear regression analysis were applied to test the relationships between constructs. The predictors of fish consumption frequency were also evaluated. Multiple regression analysis revealed that attitude, subjective norms, and perceived behavioral control significantly predicted intention to eat fish [R[2] = 0.54, F = 128.4, P < 0.001]. Multiple regression analysis for the intention to eat fish and perceived behavioral control revealed that both factors significantly predicted fish consumption frequency [R[2] = 0.58, F = 223. 1, P < 0.001]. The results indicated that the models fit well with the data. Attitude, subjective norms, and perceived behavioral control all had significant positive impacts on behavioral intention. Moreover, both intention and perceived behavioral control could be used to predict the frequency of fish consumption

[Individual factors predisposing HIV/AIDS high risk behaviors: a qualitative study]

To investigate the individual factors which lead to the occurrence of high risk behaviors among HIV/AIDS patients and vulnerable people. This was a qualitative study approach carried out in 10 month in two public counseling clinic in Tehran. Data were obtained from 102 in depth and semi-structured interviews. A convenience sample of HIV/AIDS patients, clients and specialist took part in the study. Interviews were transcripted and then open coding and axial coding were performed. In all 69 HIV/AIDS patients and 19 high risk clients, 6 family members and 8 experts were interviewed. The majority of participants were male and single. Sexual high risk behaviors and drug use were the commonest ways of HIV/AIDS transition. Individual factors predisposing HIV/AIDS high risk behaviors included: 1. Predisposing perceptions. 2.Personal factors. 3. Decision and will. The results indicated that the beliefs, decision and individual factors might be the most underlying contributing to high risk behaviors

Knowledge of Iranian nurses about HIV/AIDS: a cross sectional study from Bandar Abbas

Surveying knowledge of nurses about HIV/AIDS can provide an evidence for designing appropriate educational program. This study aimed to investigate the knowledge of a sample of Iranian nurses about patients living with HIV/AIDS in Bandar Abbas, Iran. In this cross sectional study, 150 nurses completed two questionnaires, one dealing with demographic data and the other inquiring knowledge of nurses about HIV/AIDS based on existing instruments developed by Eckstein in 1987. The mean age of studied sample was 31.9 +/- 8.2 years. At the time of the study, 63.3% of the respondents had previously cared HIV-infected subjects. Most of the participants [99.3%] knew that drug abusers were at higher risk for HIV acquisition. Most of the participants [97.3%] also answered correctly that person with HIV could be asymptomatic but still infected. Finally, 29.3% thought that recapping used needles is a good way to prevent HIV infection. Those who had participated in educational program had higher overall scores of knowledge than non-participants [10.09 +/- 2.18 vs. 9.66 +/- 2.32, p=0.002]

Distribution of smokers by stages of change of smoking: a population based study from BndarAbbass, Iran

Transtheoretical Model is a behavior change model that incorporates the stages of change for the process of quitting smoking. The aim of this study was to determine these stages in smokers living in Bandar Abbass, Iran. This was a cross sectional study. Using cluster random sampling, 1810 subjects aged 15 years and over, were studied from April to May 2007 in Bandar Abbass, Iran. Economy Model Questionnaire was used to collect data regarding three stages of change including precontemplation, contemplation and preparation within current smokers to describe different levels of readiness to quit smoking. In all, 1810 individuals were studied. Two hundred and twelve participants [11.7%] were smokers, among them 204 [96.2] were men. There were statistically significant differences between smokers and non-smokers in terms of gender, age and education [P < 0.001]. The stage of change distribution across precontemplation, contemplation and preparation was 50.9%, 46.2%, and 2.8% respectively. There were no statistical differences between stages of change in terms of gender, age and education. This study revealed the majority of smokers were distributed in precontemplation and contemplation stages. These findings should be considered in future studies

[Exercise self- efficacy, exercise perceived benefits and barriers among students in hormozgan university of medical sciences]

The objective of this study was to determine self efficacy, perceived benefit/ barriers to exercise of students in Hormozagan University of Medical sciences [HUMS]. This was a cross-sectional study. Using stratified sampling, 350 current students of HUMS were studied from November to December 2007 in Bandar Abbass, Iran. Data regarding self efficacy, perceived benefits/barriers to exercise among participants were assessed through Exercise self efficacy scale and Exercise Benefits/Barriers Scale. Data were analyzed by SPPS version 1 3. In all, the data of 249 participants with mean age of 21.7 +/- 2.7 were analyzed. Among them 65 participants [26.5%] including 36 girls and 30 boys were doing physical activity. Mean scores of self efficacy, perceived benefits, perceived barriers were 23 + 7.1, 96 +/- 12.5 and 31.9 +/- 6.1, respectively. There were statistically significant relationship between self efficacy and perceived barriers with physical activity [P<0.05]. This study revealed perceived barriers such as insufficient time, money and also tiredness due of exercise could decrease physical activity. However perceived self-efficacy and encouraging by friends and family members have a key role of doing regular physical activities