Using the health beliefs model to implement mobile puberty health education in Iranian adolescent boys: a randomized controlled trial.

Introduction: Given boys' low health knowledge and their unhealthy behavior during puberty, which can cause many physical, mental, and psychological problems, it is important to prevent these complications. This study was therefore aimed to determine the efficacy of a mobile health educational intervention based on the Health Beliefs Model (HBM) on Iranian adolescent boys. Materials and methods: This randomized controlled trial involved junior high school boys (n = 148) in Iran studying during the 2020-2021 school year. Educational content concerning healthy behaviors during puberty (e.g., the importance of bathing) was developed based on HBM and sent to the intervention group via mobile phone. HBM addresses multiple factors (e.g., perceived disease risk) that explain health behaviors. The intervention was delivered in five sessions over four weeks using real-time Internet communication and texting. The control group did not receive any intervention. One school was randomly selected from each of the four districts of the study site. The schools were then randomized into intervention and control groups. The boys were then randomly selected from each school to participate in the study. Data collected at baseline and 2-month follow-up assessments included demographic information, health knowledge (e.g., physical changes during puberty), health behaviors (e.g., bathing), and HBM constructs (e.g., self-efficacy to perform healthy behaviors). Data analysis was done using the chi-square, independent and paired t-tests, and analysis of covariance (ANCOVA). Results: The two groups did not differ in terms of demographic characteristics. Before the intervention, the two groups were slightly different in terms of knowledge, health behavior, and HBM constructs. Following the intervention, the scores of the intervention group improved significantly (p < 0.05). After adjusting for pre-intervention knowledge, HBM, and health behavior scores, the intervention group remained superior to the control group in terms of improvement of knowledge, HBM constructs, and healthy behaviors (p < 0.05). Effect sizes ranged from medium to large (0.25-0.86). Conclusion: Mobile phone education based on the HBM is efficacious in encouraging healthy behavior in boys during puberty. Organizations interested in encouraging healthy behaviors in boys should consider the use of such a program.

Socioeconomic correlates of face mask use among pedestrians during the COVID-19 pandemic: An ecological study.

Background: Many countries have recommended using face masks for the general population in public places to reduce the risk of COVID-19 transmission. This study aimed to assess the effects of socioeconomic status on face mask use among pedestrians during the COVID-19 pandemic. Methods: This cross-sectional study was conducted in Ahvaz, southwest Iran in August 2020. A total of 10,440 pedestrians have been studied from 92 neighborhoods of the city. Three socioeconomic indicators including Land price, Literacy rate, and the Employment rate for each neighborhood were used in this study. Analysis of Covariance and partial correlation coefficients were applied to assess the relationship between prevalence rates of mask usage and SES indicators. Results: The mean ± SD age of the pedestrians was 32.2 ± 15.1 years. Of 10,440 observed participants, 67.9% were male. The overall prevalence of face mask usage was 45.6%. The prevalence of mask usage in older people and women was significantly higher than the others. The three assessed socioeconomic indicators were directly correlated to the prevalence of mask usage at individual and neighborhood levels. Conclusion: We found that literacy had the strongest correlation with the prevalence of mask usage compared to the land price and employment rate among the three assessed SES indicators. Hence, it can be concluded that the social component of socioeconomic status has a greater effect on mask usage by people than the economic component of socioeconomic status.

Explaining the experiences of health care providers regarding organizational factors affecting health education: a qualitative study.

BACKGROUND: Health education is considered the most important component of primary health care. Paying attention to organizational factors can help to improve the quality of health education. Therefore, the present study was conducted to explain organizational factors affecting health education among health care providers. METHOD: This is a qualitative, descriptive, and phenomenological study that was conducted between 2020 -2022 on 50 health care workers who had been selected by purposeful sampling method in different settings including hospitals, GP office, behavioral disease counseling center, universities, and comprehensive health centers in the south and the center region of Iran. Data were collected by in-depth, semi-structured, and individual interviews, as well as focus group discussion, and continued until data saturation. Data were analyzed by MAXQDA software using qualitative content analysis in three stages: preparation, organization, and reporting. To evaluate the scientific accuracy of the findings in this study, 4 criteria of Lincoln & Guba were used. RESULTS: The results revealed that every practice and policy in a health care organization from assessing needs, setting goals, planning activities, implementations and measurement outcome could affect health education practice and subsequently the health of population; nevertheless, the crucial role of health education practice is being neglected in health organizations. Organizational factors affecting health education were classified into three categories of planning, organizing, and also monitoring and evaluating. The category of planning had three subcategories of infrastructure planning, manpower planning, and design and planning for implementation of health education programs. The categories of organizing had two subcategories of coordination between different units of the Minister of Health and coordination between the health sector and other sectors of society. The categories of monitoring and evaluation had three subcategories of proper feedback, bureaucracy system, reward or reinforcement, failure to define health education as part of the job description, and the impact of electronic health records on the quality of evaluation. CONCLUSION: The results offer expertise and preliminary tools to help with evidence-based health education program planning and evaluation. The Support of managers, like providing manpower in accordance with the target population and infrastructure, can improve health education in the health system. In addition, intra- and inter-sectoral coordination at different levels of the health system to implement tailored programs according to the needs of clients by health education professionals, and the use of health education theories seem necessary. It is also recommended to review the monitoring system with appropriate feedback, define health education as a healthy activity, and develop appropriate criteria for better implementation of health education.

Effectiveness of a mobile-based educational intervention on self-care activities and glycemic control among the elderly with type 2 diabetes in southwest of Iran in 2020.

BACKGROUND: The elderly constitute a large fraction of patients with type 2 diabetes worldwide. It has been well documented that the elderly's adherence to disease control is not adequate. The present study aimed to evaluate the impact of a mobile-based educational intervention on self-care behaviors and glycemic control among elderly with type 2 diabetes. METHODS: The present study was conducted on 118 older people (59 in the intervention group and 59 in the control group) with type 2 diabetes who referred to Golestan Hospital in Ahvaz, southwest of Iran in 2020. Participants were randomly divided into experimental and control groups. Data were collected at baseline and after a 3-month follow-up. At baseline, the participants completed a valid and reliable multi-section questionnaire including items on attitude, the multidimensional scale of perceived social support (MSPSS), the Coping Self-Efficacy Scale (CSES), self-care constructs, and HBA1C. After analyzing the pre-test data, we designed a training program which was offered to the intervention group online via mobile phone in three online sessions. The control group, however, received no intervention except diabetes routine care. Data were analyzed using SPSS-15 at a significance level of 0.05. RESULTS: Before the intervention, the mean scores of CSES, attitudes towards self-care, MSPSS, and self-care were not statistically significant between study groups (P > 0.05), but after intervention, the study found significant differences between the groups in terms of CSES, attitude, MSPSS, and self-care (P = 0.001). Furthermore, after implementation of the intervention, the mean value of HbA1C in the intervention group was significantly less than that of the control group (7.00 vs. 7.32%) (P = 0.001). CONCLUSION: The present results indicated that implementing an educational intervention via mobile phone can improve self-care practice and reduce HbA1C in the elderly with type 2 diabetes. The study also showed a moderate to large effect on the outcome variables. However, further studies with longer follow-up periods are recommended to confirm the results.

Non-Adherence to Preventive Behaviors and the Risk of COVID-19: A Comparative Study.

Background: Transmission routes of COVID-19 have been well identified and documented. Considering the high prevalence of the Covid-19 and its impacts on the population, this study aimed to assess the status of preventive behaviors against coronavirus infection and estimate the odds of its transmission routes among people. Methods: A comparative study was conducted from March to April 2021. A total of 1256 participants were randomly selected, including 262 COVID-19 patients and 994 healthy people from 10 counties in Khuzestan, southwest Iran. A two-part questionnaire was used for data collection that included items on demographic and adherence to preventive behaviors. Statistical analysis was performed using the statistical software SPSS 18.0.0 applying logistic regression. Results: The mean age of participants was 37.60±11.48 years (female: 36.49±11.15 years; male: 38.86±11.74 years). The results showed that having contact with infected patient at home (OR = 4.90, 95%CI = 3.32-7.25), going to the hospital for not-necessary medical reasons (OR = 4.47, 95%CI = 3.05-6.55), leaving home for essential daily services (OR = 2.49, 95% CI = 1.63-3.81), and going to doctors' office (OR = 1.78, 95% CI = 1.20-2.63) could increase the odds of infection. Conclusion: The findings suggest that different factors are responsible for the increased spread of the Covid-19. Indeed, since the intervention for every single factor will have a small contribution to reducing the prevalence of the disease, it seems essential to design comprehensive interventions while emphasizing isolation and contacts tracing. The study provides evidence for multi-level and multi-faceted policy and interventions for promoting adherence to COVID-19 preventive behaviors.

Predictors of Adherence to Treatment in Hemodialysis Patients: A Structural Equation Modeling.

Background: Non-compliance to the treatment is a major problem in hemodialysis patients. This study aimed to determine factors predicting adherence to treatment in hemodialysis patients in selected cities of Khuzestan province, Iran. Methods: This cross-sectional study was conducted on 500 patients undergoing hemodialysis in Ahvaz, Shush, Shushtar, and Dezful cities. The data collection tools were ESRD-AQ, perceived health, perceived social support, Beck Depression, self-efficacy, and demographic and clinical factors questionnaires. Data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson's correlation coefficient. Structural equation modeling (SEM) was employed to analyze the relationship between various exogenous and endogenous or mediating variables. Results: The results showed that all predicting variables of perceived social support, depression, self-efficacy, and perceived health had been associated with the variable of adherence to treatment. Accordingly, there was a reverse correlation between social support and depression (p< 0.001, r= -0.94), as well as depression and self-efficacy (p< 0.001, r= -0.87). There was a direct correlation between self-efficacy and perceived health (p< 0.001, r= 0.79), perceived health and adherence to treatment (p< 0.001, r= 0.72). Fitness indices also indicate the adequacy of the proposed model (X2/df= 4.94, CD=0.937, SRMR=0.076, TLI= 0.870, CFI= 0.873, RMSEA= 0.071). Conclusion: The results showed that high social support, low level of depression, high perceived self-efficacy, and high perceived health predicted better compliance with the treatment in hemodialysis patients. The proposed model can be used as a framework to improve adherence to treatment regimens in hemodialysis patients.

Addressing the COVID-19 Pandemic in an Iranian Sample: Health Beliefs and Respondent Characteristics Associated with Preventive Behaviors.

Background: The COVID-19 pandemic has become a grave threat to public health. Along with vaccination, preventive behaviors are still an important part in controlling in controlling the COVID-19 pandemic. The present study aimed to investigate health beliefs and sample characteristics associated with COVID-19 preventive health behaviors among an Iranian sample. Preventive behaviors are still an important part in controlling in controlling the COVID-19 pandemic. Methods: This is a cross-sectional study, using a multi-stage randomized sampling method. Participants (N = 250 males and 236 females) were recruited from health centers in Saveh, Iran. Self-administered questionnaires included sociodemographic information, health behaviors, and constructs associated with the Health Beliefs Model (HBM). Data were analyzed using independent t-tests, analysis of variance, and multiple regression with significance level set at α ≤ 0.05. Results: Perceived disease susceptibility (ß = 0.44, P< 0.001), self-efficacy to enact preventative behaviors (ß = 0.24, P < 0.01), education (ß = 0.20, P < 0.001), non-smoking status (ß = 0.14, P < 0.01), marital status (ß = 0.10, P < 0.03), and perceived barriers to disease preventative behaviors (ß = -0.10, P < 0.04) were important predictors of prevention practices for COVID-19, and accounted for 61.4% (adjusted R2) of the variance associated with preventive behavior for COVID-19. Conclusion: As there is accepted therapy for COVID-19, it is especially important to control COVID-19 through behavior change. Results indicate that two behavioral constructs that have the most impact on prevention are perceived disease susceptibility and self-efficacy. Therefore, public health initiatives are needed to enhance perceived susceptibility to the disease and improve self-efficacy to perform preventative behaviors in spite of perceived barriers.

Epidemiological and clinical characteristics of patients with COVID-19 in Islamic Republic of Iran.

Background: Coronavirus disease 2019 (COVID-19) is a worldwide public health emergency. Aims: This study aimed to investigate the epidemiological and clinical characteristics of patients with COVID-19 in Saveh city, Islamic Republic of Iran in 2020. Methods: In this descriptive analytical research, 3181 patients suspected of having COVID-19 who visited Saveh medical centres were investigated. Patients were confirmed with COVID-19 using polymerase chain reaction testing. Data on sociodemographic, epidemiological and clinical characteristics of the patients were collected using a validated form through interviews and medical records. The chi-squared, t and Fisher exact tests were used to assess differences in sociodemographic, epidemiological and clinical characteristics between patients with positive and negative polymerase chain reaction results. Logistic regression analysis was used to examine the association between independent variables and death from COVID-19. Results: About half the patients (48.3%) had a history of chronic disease. Diabetes (16.2%), high blood pressure (14.8%) and cardiovascular disease (12.4%) were the most prevalent chronic diseases among patients who were confirmed positive for COVID-19. Risk factors for death among confirmed COVID-19 patients were: intubation (odds ratio (OR) = 8.97; 95% confidence interval (CI): 5.15-15.63), age ≥ 80 years (OR = 5.81; 95% CI: 1.91-17.60), oxygen saturation < 93% (OR = 2.48; 95% CI: 1.51-4.08), diabetes (OR = 1.88; 95% CI: 1.00-3.54) and shortness of breath (OR = 1.70; 95% CI: 1.02-2.82). Conclusion: Given the greater risks of contracting and dying from COVID-19 in certain groups of patients, health education programmes targeting these groups are recommended.

High blood pressure self-care among hypertensive patients in Iran: a theory-driven study.

High blood pressure is becoming a universal epidemic for both developed and developing countries; it is one of the main public health problems all over the world. This research was conducted to assess blood pressure self-care among hypertensive patients in Iran. This cross-sectional analytic study was conducted on 527 patients with hypertension recruited from Zarandieh, Iran in 2018. Data were gathered using questionnaires assessing socio-demographic information, social support, health belief model (HBM) constructs (perceived benefits to healthy behavior, barriers to healthy behavior, perceived disease threat, self-efficacy to engage in healthy behavior, and cues to action), and self-care activities to address blood pressure. A stepwise multiple linear regression analysis was used to determine factors associated with self-care behaviors. Overall, 512 patients (215 men and 297 women) participated in this study. Participants who were married, and more educated engaged in more self-care behaviors. At least one-half of the patients (47.6%) demonstrated a moderate level of self-care behaviors with a mean score of self-care equal to 9.32 ± 3.6 (out of 18). All the elements of HBM and social support were significant predictors of self-care behaviors and self-efficacy was the strongest predictor, followed (in descending order) by perceived barriers, social support, perceived disease threat, and perceived benefits. Health education based on HBM, enhanced with attention to social support, may help patient enact healthier behaviors to reduce blood pressure.

Explanation of Socio-economic Inequality in Medicine Use: A Cross-sectional Analysis from Iran.

Background: Despite the favorable progress in the production of medicines, there is no significant access to these important health inputs among different socio-economic groups. Objectives: This study aimed to measure and explain socio-economic inequality in prescribed and non-prescribed medicine use in Iran. Methods: Data were obtained from a recent household survey on health services in Iran conducted in 2016. The Erreygers concentration index (ECI) was used to measure socio-economic inequality in the use of prescribed and non-prescribed medicines. In addition, Decomposition analysis was conducted to explain socio-economic inequality. Results: The ECI revealed pro-rich socio-economic inequality in prescribed medicine use (ECI = 0.067, SE = 0.010), indicating that prescribed medicine use was concentrated on the better-offs. On the other hand, this index showed pro-poor inequality in non-prescribed medicine use (ECI = -0.064, SE = 0.009). Decomposition analysis showed that economic status and place of residence were the main determinants of socio-economic inequality in prescribing medicines. These factors and the number of health care needs explained the majority of socio-economic inequality in non-prescribed medicine use. Conclusions: Despite previous positive beliefs, we found remarkable socio-economic inequality in the use of medicines in Iran. Facilitating access to pharmaceutical services for disadvantaged households and rural residents and promoting of national essential medicines list could be recommended against socio-economic inequality in the pharmaceutical market of Iran.

The effect of mobile health educational intervention on body image and fatigue in breast cancer survivors: a randomized controlled trial.

BACKGROUND: Cancer-related fatigue, physical changes, and pain are among the most troublesome symptoms caused by breast cancer treatment and influence the patients' quality of life. The aim of the present study was to examine the effect of mobile health educational intervention on body image and fatigue in breast cancer survivors. METHODS: The present clinical trial study conducted on 38 women with breast cancer referred to Golestan and Shahid Baghaei 2 hospitals, Ahvaz, south west Iran in 2018-2019. Patients were randomly assigned into two intervention group, and control groups on 1:1 basis. Data collection tool included three parts: cancer fatigue scale, body image concern inventory, and demographic information. Text messages sent to intervention group via WhatsApp messenger for 7 weeks on a daily schedule. The control group did not receive any messages. Data were analyzed using SPSS Version 23.0. RESULTS: The mean age of participants was 46.34 ± 9.96. The mean score of cancer fatigue scale after the intervention in the intervention group was decreased significantly (p = 0.005), but no statistically significant difference was observed in the control group. There was a significant difference in the mean score of body image concern inventory in the intervention group (p = 0.002) after the intervention compared with the control group. CONCLUSION: Mobile health educational intervention improved cancer-related fatigue and body image among women breast cancer survivors. The integration of education for the management of fatigue and body image disturbance as part of routine care among breast cancer survivors is recommended.

The meaning of losing a child in older adults: a qualitative study.

BACKGROUND: After losing their child, elderly parents look for a meaning in this phenomenon. This meaning comes out from their experiences, and their responses to and actions in life are shaped based on this meaning. Therefore, this study was conducted with the aim of "understanding the meaning of losing a child in older adults." METHODS: This qualitative study was conducted using conventional content analysis method. Using semi-structured face-to-face interviews, data were collected from 15 older adults who had experienced of losing their adult child. Data analysis was performed according to the steps proposed by Graneheim and Lundman, 2004. To prove the trustworthiness of the data, credibility, dependability, confirmability and transferability were used. RESULTS: The age range of participants was between 61 and 83 years and 73.3% of them were female. The two main categories of "tasting the bitter flavor of life" and "searching for a positive meaning in losing a child" together with the theme of "finding hope in the heart of darkness" were extracted from the participants' experiences. CONCLUSIONS: Despite the grief of losing a child, which had cast a dark shadow over the parents' lives, the child's liberation from worldly sufferings, his/her presence in a better world, and being hopeful about the grace of God had caused the elderly parents to find hope in the heart of darkness. After identifying the parents with a deceased child, they should be helped through psychological counseling and care of the healthcare team so that they can adapt to this situation by finding a positive meaning in losing their child.

Factors related to preventive COVID-19 behaviors using health belief model among general population: a cross-sectional study in Iran.

BACKGROUND: Coronavirus disease (COVID-19) pandemic has become one of the biggest challenges to global health and economy. The present study aimed to explore the factors related to preventive health behaviors during the COVID-19 pandemic in Khuzestan Province, South of Iran, using the Health Belief Model (HBM). METHODS: The present cross-sectional study was conducted in the period between July 2020 and September 2020. A total of 1090 people from Khuzestan province participated in the study. The data collection method included a multistage cluster sampling method with a random selection of provincial of health centers. The questionnaire collected socio-demographic information and HBM constructs (e.g., perceived susceptibility, perceived severity, perceived benefits and barriers, cues to action, and COVID-19 preventive behaviors). Data were analyzed using ANOVA, t-test, hierarchical multiple linear regression, and SPSS version 22. RESULTS: The mean age of the participants was 35.53 ± 11.53, more than half of them were female (61.6%) and married (65.3). The results showed that 27% of the variance in the COVID-19 preventive behaviors was explained by HBM constructs. The regression analysis indicated that female gender (ß = 0.11), perceived benefits (ß = 0.10), perceived barriers (ß = - 0.18), external cues to action (ß = 0.25), and internal cues to action (ß = 0.12) were significantly associated with COVID-19 preventive behaviors (p < 0.05). CONCLUSION: Designing an educational intervention on the basis of HBM might be considered as a framework for the correction of beliefs and adherence to COVID-19 behavior. Health information campaigns need to (1) emphasize the benefits of preventive behaviors including avoiding the likelihood of getting a chronic disease and complications of the disease, (2) highlight the tips and advice to overcome the barriers (3) provide cues to action by means of showing various reminders in social media (4) focusing on adoption of COVID-19-related preventive behaviors, especially among men.

Oral self-care behavior and its influencing factors in a sample of school children from Central Iran.

BACKGROUND: Oral health is an important part of public health and crucial to health promotion and enhancing the quality of life. This research examined childhood oral self-care behavior and their related factors using extended Theory of Planned Behavior (TPB). METHOD: This cross-sectional study was conducted on 368 sixth-grade elementary school students in Saveh city, Iran, in 2019. The students were selected using a random multi-stage sampling method. The instrument included the socio-demographic questions, TPB constructs, and action and coping plan items. Data were analyzed by SPSS software (Version 21) at alpha level p ≤ 0.05. RESULT: Overall, 24 (6.6%) students have never used toothbrushes, 222 (62.7%) have never used dental floss, and 298 (82.7%) students have never used mouthwash. The stepwise multiple linear regression analysis results indicated that the TPB with action and coping planning constructs had better predictive power than the original model. In the final model, coping planning (ß = .28), intention (ß = .24), action planning (ß = .23), and perceived behavior control (ß = .15) were the most important predictors of oral self-care behavior. CONCLUSION: The results indicated that the oral self-care behavior status in Iranian elementary students was not favorable, and the extended model of the TPB with action and coping plan constructs were significant predictors of self-care behavior. Therefore, these findings emphasize the need for expanding educational interventions based on the extended model of the TPB to improve the oral self-care behavior of students.

Factors affecting Pakistani young adults' intentions to uptake COVID-19 vaccination: An extension of the theory of planned behavior.

INTRODUCTION: Aside from personal beliefs, young adults' intention to uptake the COVID-19 vaccine can be influenced by their fear of COVID-19 and perceived infectability of COVID-19. The present study incorporated fear of COVID-19 and perceived infectability with the theory of planned behavior (TPB) to form an expanded TPB to analyze factors affecting Pakistani young adults' intentions to uptake the COVID-vaccine in Pakistan. METHODS: A cross-sectional study was conducted and recruited participants from Pakistani social media users. The proposed extended TPB model was examined by using structural equation modeling. RESULTS: A total of 1034 individuals replied to the survey. The three factors of the original theory of planned behavior and the fear of COVID-19 were positively related to their intention to uptake COVID-19 vaccination (r = 0.25-0.66). Moreover, the perceived infectability positively influenced the three theories of planned behavioral factors and the fear of COVID-19 (r = 0.27-0.60), also affecting the participants' intentions to uptake COVID-19 vaccination. CONCLUSIONS: Perceived infectability was positively related to the participants' intentions to uptake COVID-19 vaccination, and perceived behavioral control was the strongest mediator. More evidence-based information concerning treatments and COVID-19 vaccination are needed to encourage individuals to uptake the vaccine.

Predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior in Kashan, Iran.

BACKGROUND: The incidence of application of medicinal herbs during pregnancy has increased significantly among women over the past years; however, the safety and efficacy of medicinal herbs during pregnancy are still unclear. The aim of the present study was to categorize the predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior (TPB). METHODS: The present descriptive-analytical study was conducted on 300 pregnant women referred to Kashan health center to receive prenatal care services in 2020. The study participants were randomly selected using stratified random sampling with proportional allocation. The data collection tool was a two-part researcher made questionnaire. The first part of the questionnaire included demographic information, midwifery information, and questions related to women's awareness about herbal medicine. The second part of the questionnaire was designed based on the theory of planned behavior including attitudes, perceived behavioral control, subjective norms, intention, and behavior performance. Data were analyzed using descriptive statistics, regression analysis, and SPSS version 18.0. RESULTS: The mean age of participants was 28. 7±5.4 years (range, 15-45 years), the majority were housewives (88.3%) and had secondary education (39.3%). A total of 164 women (57. 1%) used medicinal herbs during pregnancy. The individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with behavioral intention (P < 0.05). Similarly, subjective norms were the most predictor of using herbal medicine among pregnant women (P < 0.05). CONCLUSION: The findings revealed that more than 50 % of pregnant women used medicinal herbs during pregnancy. The present study showed that the individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with intention of herbal medicine use among pregnant women. Likewise, subjective norms were the most predictor of herbal medicine use among pregnant women. The TPB should be addressed in planning health education programs and modifying health behaviors, including self-medication, especially during pregnancy.

A quasi-experimental study to improve health service quality: implementing communication and self-efficacy skills training to primary healthcare workers in two counties in Iran.

BACKGROUND: Service satisfaction ratings from clients are a good indicator of service quality. The present study aimed to investigate the impact of communication skills and self-efficacy training for healthcare workers on clients' satisfaction. METHODS: A quasi-experimental study was conducted in health centers of Saveh University of Medical Science in Iran. Primary Healthcare (PHC; N = 105) workers and service recipients (N = 364) were randomly assigned to intervention and control groups. The intervention group received four 90-min training sessions consisting of lecture, film screening, role-playing, and discussion group. Before and 3 months after the intervention, a multi-part questionnaire (including demographics, self-efficacy and communication skills in PHC workers; and satisfaction questionnaire in service recipients) was completed by participants in both intervention and control groups. RESULTS: PHC worker mean scores of self-efficacy and communication skills after the educational program were increased in the intervention group compared to the control group (p < 0.05). Also, mean satisfaction scores for service recipients of the intervention group (PHC workers) generally significantly increased compared to the control group (p < 0.001). CONCLUSIONS: The educational program improved the self-efficacy, and communication skills in health workers and improved client satisfaction overall. Our results support the application of self-efficacy and communication skills training for other medical groups who wish to improve clients satisfaction as an important health services outcome.

Effectiveness of message-framing to improve oral health behaviors and dental plaque among pregnant women.

BACKGROUND: Oral health is considered a prominent factor that contributes to quality of life. Hormonal changes during pregnancy can influence oral health. Message framing can play an important role in oral health. The aim of the present study was to investigate the effect of message framing on oral health and dental plaque among pregnant women. METHODS: The study was conducted in 2017 on 108 pregnant women in Izeh county, Iran. Participants were randomly assigned to gain-framed, loss-framed, and control groups. The research instrument included a two part questionnaire containing demographic information and oral health knowledge, attitude, behavioral intention, self-efficacy, practice, and dental plaque index. Gain-and loss-framed messages were sent to the intervention groups via cell phone texts, but the control group did not receive any messages. Participant dental plaque was clinically assessed. Analysis of covariance with follow-up tests were performed using SPSS version, 23.0 with p-value set at 0.01 for significance. RESULTS: Intervention groups had better oral health (knowledge, atttitude, intention, efficacy, practices and plaque) scores compared to the control group (p < 0.001), but intervention (gain- vs loss-framed) groups did not differ on outcomes. CONCLUSION: Text message intervention improved knowledge, attitude, behavioral intention, self-efficacy, practice, and dental plaque among pregnant women. While differences between control and both intervention groups indicated text messaging had an impact on oral health outcomes, message framing (i.e., gain vs loss) had no discernable impact on oral health outcomes.

Mask use among pedestrians during the Covid-19 pandemic in Southwest Iran: an observational study on 10,440 people.

BACKGROUND: Many countries have recommended the use of face masks for general population in public places to reduce the risk of COVID-19 transmission. This study aims to estimate the prevalence of face mask usage and investigate about different types of face mask and their distribution among pedestrians in southwest Iran during the Covid-19 pandemic. METHODS: This cross-sectional study was conducted in August 2020 in Ahvaz, southwest Iran. Using a multistage sampling method, a total of 10,440 pedestrians selected from 8 urban districts and 92 neighborhoods of the city. The data gathered by observation method. Percentage, mean and standard deviation were used to describe the variables. Chi-square test, fisher exact test and Chi-square for trend used to assess relationship between two categorical variables. We used unconditional logistic regression model to control confounders. RESULTS: The most common age group was 10 to 39 years and 67.9% of the participants were male. The overall prevalence of face mask usage was 45.6% (95% CI, 44.6-46.5). In general, as the age increased, the prevalence of face mask use significantly increased (p for trend < 0.001). Women used face masks significantly higher than men (60.2% vs. 38.7%, p < 0.001). Among the pedestrians who used the mask, 75.6% wore facemask correctly. The most common type of facemask used by the pedestrians were surgical (medical) masks (63.8%). In total, the prevalence of facemask usage was significantly higher during a.m. (49.4%) compared to p.m. (43.9%), (p < 0.001). Besides, in our study, 1.7 and 0.3% of Pedestrians had worn gloves and shielded respectively. Women used shields and gloves significantly higher than men (3.6% vs. 0.7%, p < 0.001). Also, women used shields more than men (0.5% vs. 0.3%, p = 0.036). CONCLUSION: We concluded that the prevalence rate of face mask use in Ahvaz was fairly low especially in men and younger people. Hence, the observed rates probably cannot protect the community against COVID-19 spread. Therefore, it is important to implement educational programs as well as to establish laws and regulations governing the use of face masks in public places.