The effect of web-based education on self-care behaviors in cardiovascular patients: application of the pender's health promotion model.

BACKGROUND: Coronary artery disease is the most common cardiovascular disease, the mortality rate of which is increasing significantly. The most important way to prevent a second attack in patients undergoing angioplasty is self-care, which can be influenced by several factors such as the patient's beliefs. Thus, the present study aimed to determine the effect of a web-based intervention based on the Pender's health promotion model in patients with cardiovascular disease. METHODS: The present clinical trial study was conducted with 99 patients undergoing angioplasty treatment referring to Bushehr Heart Specialist Center. Random sampling was done and the participants were divided into two groups (50 subjects in intervention group and 49 subjects in control group). The data collection tool was a three-part questionnaire (including demographic information, a researcher-made questionnaire based on the health promotion model constructs, and self-care behaviors), which was completed in three stages (before, two weeks, and three months after the intervention). In addition to routine hospital services, the intervention group received multimedia training based on the constructs of the Pender's health promotion model from the website. The control group received usual hospital services. Data were analyzed with chi-square, independent T-test and repeated measure ANOVA using SPSS-22 software. RESULTS: The results showed that 2 weeks and 3 months after the intervention, the mean scores of perceived benefits, perceived self-efficacy and perceived social support had a significant increase in the intervention group compared to the control group, but the mean score of perceived barriers had a significant decrease in the intervention group (p < 0.001). Regarding self-care behaviors, after the intervention, the mean scores of self-care behaviors, physical activity, healthy diet, medication adherence and stress management had a significant increase in the intervention group compared to the control group (p < 0.001), but no significant was observed between the two groups in terms of changes in the non-smoking (p = 0.38). CONCLUSION: The results of the study showed that the web-based educational intervention based on the health promotion model is useful in improving the self-care behaviors of cardiac patients undergoing angioplasty. Nursing education and care have a great role in improving the self-care behaviors of cardiovascular patients. TRIAL REGISTRATION: Registration number: IRCT2017080635429N2. Registration date: 09/03/2017 ( https://en.irct.ir/trial/26775 ).

Effectiveness of a web-based program on self-care behaviors and glycated hemoglobin in patients with type 2 diabetes: Study protocol of a randomized controlled trial.

BACKGROUND: Type 2 diabetes (T2DM) decreases the life expectancy and quality of life of diabetics and causes economic and societal problems. For this purpose, diabetes self-management education and support (DSMES) has been designed for many years, which is recently provided through technology-assisted education. Therefore, we developed a web-based program in accordance with DSMES to assess its effect on self-care behaviors and glycated hemoglobin (HbA1c) for patients with T2DM during the coronavirus disease (COVID-19) pandemic, which is described in detail in this paper. MATERIALS AND METHODS: This randomized controlled trial (RCT) was performed on 70 diabetic patients in Al-Zahra Hospital for three months. After random allocation, web-based educational content (including videos, lectures, educational motion graphics, text files, educational posters, and podcasts) according to DSMES was provided for the intervention group to improve self-care behaviors and HbA1c levels. The control group received routine educational pamphlets. A diabetes self-management questionnaire (21 questions) with a Likert scale was completed to assess self-care behaviors scores before and after intervention and three months later. Also, HbA1c was determined before and after the intervention. Analysis of variance with repeated measurements will be applied to compare mean scores of self-care behaviors components three times, and an independent t-test analyzed mean differences of HbA1c values. CONCLUSION: The obtained results of this study might be useful for promoting self-care behaviors and assessing HbA1c in diabetic patients.

Predictive Factors of Stages of Change in Hookah Smoking Cessation Among Iranian Adults Based on the Transtheoretical Model.

Background: Hookah, as a traditional method of smoking, is widely used in Iran, especially in Bushehr province. It is essential to identify the most important determinants of modifying hookah smoking behavior. This study aimed to investigate the predictors of the stages of change in quitting hookah smoking in 15-60-year-old individuals in Bushehr province, southern Iran, based on the transtheoretical model (TTM). Methods: This descriptive-analytical study was conducted on 1173 Hookah smokers in Bushehr province. The samples were selected by two-stage random sampling from 10 cities. Data were collected using a valid and reliable questionnaire consisting of 5 sections (demographic characteristics, stages of change, processes of change, decisional balance, and self-efficacy). Data were analyzed by R version.3.3.1 using analysis of variance and ordinal logistic regression at a significant level of 0.05. Findings: The data revealed 82% of the participants were in the preparatory phase (55.3% in pre-contemplation and 26.7% in contemplation stages). Marital status, family members smoking hookah, cigarette smoking, level of education, number of family members, number of quitting attempts, self-efficacy, self-reevaluation, counter-conditioning, reinforcement management, and stimulus control were predictors of quitting hookah smoking. Conclusion: Given that most study participants were in the inactive stages of quitting hookah smoking, it seems necessary to design and implement behavioral interventions based on the predictive TTM constructs in this population.

Is Web-Based Program Effective on Self-Care Behaviors and Glycated Hemoglobin in Patients with Type 2 Diabetes: A Randomized Controlled Trial.

Background: Diabetes Self-Management Education and Support (DSMES) as a framework focuses on seven self-care behaviors. Moreover, technology-assisted self-care education is increasingly suggested for patients with Type 2 Diabetes Mellitus (T2DM). Therefore, we examined the effect of a web-based program on self-care behaviors and glycated hemoglobin values in patients with diabetes mellitus. Materials and Methods: This randomized controlled clinical trial was conducted at Alzahra Hospital in Isfahan, Iran, between April and November 2020 and included 70 patients with T2DM. Data were collected using a questionnaire that included a demographic information section and a diabetes self-management section with 21 questions on a Likert scale. Fasting blood samples (2.50 ml) were collected before and after the interventions to measure HbA1c levels. The study intervention involved a web-based program that included multimedia educational content (such as videos, lectures, educational motion graphics, text files, posters, and podcasts) presented in seven sections based on DSMES over a 21-day period with monitoring by an instructor. Results: The mean scores for healthy eating (F = 3.48, p = 0.034) and medication adherence (F = 6.70, p < 0.001) significantly increased in the interventional group, while the mean scores for being active, monitoring, reducing risks, problem-solving, and healthy coping did not significantly change. Additionally, the mean differences in HbA1c values significantly improved in the interventional group compared to the control (F = 5,1, p = 0.026). Conclusions: A web-based program in accordance with DSMES improved HbA1c levels and increased scores for healthy eating and medication adherence in patients with T2DM. However, further research with larger sample sizes and qualitative interviews is needed.

Utilizing a health-promotion model to predict self-care adherence in patients undergoing coronary angioplasty in Bushehr, Iran.

BACKGROUND: Self-care refers to the conscious actions and behaviors that patients engage in to maintain and promote their own health and to the decisions that they make about managing signs or symptoms. Despite the importance of self-care in improving the health status of patients with cardiovascular disease, such as those undergoing angioplasty, these patients do not implement self-care optimally. This study aimed to identify factors affecting self-care behaviors in cardiac patients undergoing angioplasty based on a health-promotion model. METHODS: A cross-sectional study was conducted among 200 cardiovascular patients undergoing angioplasty referred to the Bushehr Health Center. Health-promotion-model constructs and self-care behaviors were assessed by a researcher-made questionnaire. Data were analyzed by SPSS version 22 using multiple linear regression analyses. RESULTS: Stepwise regression revealed that three variables - perceived barriers, perceived self-efficacy, and social support - were significant predictors of self-care behaviors among patients undergoing angioplasty. These factors accounted for 43.1% (R 2=0.431) of variance in self-care. Among the health-promotion-model constructs, self-efficacy (ß =0.237, P<0.001) was the strongest predictor of self-care behaviors, followed by perceived barriers (ß =-0.195, P<0.001) and perceived social support (ß =0.13, P<0.001). Perceived benefits did not significantly predict self-care behaviors. CONCLUSION: According to the results of this study, it is suggested that designing and implementing training programs to improve self-efficacy and perceived social support of cardiovascular patients and also decreasing barriers to self-care may improve self-care behaviors among patients undergoing angioplasty.

A Theory-Based Self-Care Intervention with the Application of Health Literacy Strategies in Patients with High Blood Pressure and Limited Health Literacy: A Protocol Study.

The purpose of this study is to assess the effectiveness of a theory-based self-care intervention with the application of health literacy strategies in patients with high blood pressure and limited health literacy. This is a randomized controlled trial, with measurements at baseline and 1 and 3 months follow-up. 100 patients with high blood pressure and limited health literacy will be randomly allocated to either an intervention group or a usual care control group. We will mainly establish the intervention model based on the principal health belief model components. Patients randomized to the intervention group will receive four educational sessions during four weeks. Considering the limited health literacy level of the patients of the study, health literacy strategies will be used in educational material design for enhancing the quality of the intervention. In order to cover these strategies, we will design four standard animated comics and fact sheets with illustrations and photos consistent with the health belief model constructs and educational sessions' topics. Data will be collected using some questionnaires and will be analyzed using the SPSS software. The findings of this study may assist with the development of a theoretical model for self-care intervention in patients with high blood pressure and limited health literacy.

Impact of Health Literacy, Self-efficacy, and Outcome Expectations on Adherence to Self-care Behaviors in Iranians with Type 2 Diabetes.

OBJECTIVES: Diabetic patients with higher health literacy (HL) may feel more confident in their ability to perform self-care behaviors and may have strong beliefs that diabetes-related behaviors will lead to specific outcomes. Our study aimed to document the relationships between HL, self-efficacy, outcome expectations, and diabetes self-care of patients with type 2 diabetes mellitus (T2DM) in Iran. METHODS: We conducted a cross-sectional observational study of 187 patients with T2DM. Participants completed the Functional Communicative and Critical Health Literacy scale, the Summary of Diabetes Self-Care Activities, the Diabetes Management Self-Efficacy Scale, Outcome Expectations Questionnaire, and a demographic questionnaire. RESULTS: Participants who received diabetes education (t = 5.79, p<0.001) and were married (F = 3.04, p<0.050) had better diabetes self-care behavior. There was a significant positive correlation between self-care behaviors and communicative HL (r = 0.455, p<0.010), critical HL (r = 0.297, p<0.010), self-efficacy (r = 0.512, p<0.010) and outcome expectations (r = 0.387, p<0.010). Diabetes education and marital status accounted for 16.9% of the variance in diabetes self-care. Self-efficacy, outcome expectations, communicative, and critical HL explained 28.0%, 1.5%, 3.7%, and 1.4% of the variance, respectively. CONCLUSIONS: This study revealed that the potential impact of self-efficacy, outcome expectations, communicative, and critical HL should be considered in the education program for patients with diabetes. We found self-efficacy to be the most important predictor of diabetes self-care. Therefore, the use of self-efficacy theory when designing patient education interventions could enhance diabetes self-care. It is essential that health care providers assess patient's HL levels to tailor health-related information specific to a domain of HL. This would fully inform patients and promote empowerment rather than simple compliance.

The Effect of nutrition education on knowledge, attitude, and performance about junk food consumption among students of female primary schools.

BACKGROUND: Undoubtedly, proper nutrition has important role in safeguarding the individual from many diseases, especially chronic ones, and increasing ones physical and intellectual efficiency. Considering the importance of nutrition education to school-age kids, this research was done with the purpose of determining the effect of nutrition education on the knowledge, attitude, and performance of female students at primary school about junk food consumption. MATERIALS AND METHODS: This is an experimental intervention study in Shahr-e-kord city about the reduction of junk foods consumption in 2011. Seventy-two primary girl students were randomly divided into 2 groups, experimental (36) and controls (36). Before of the educational program, self-administrative questionnaire and FFQ (Food Frequency Questionnaire) questionnaire were filled out for both the groups. The self-administrative questionnaire was completed 3 times (before, immediately, and 2 months after education), and FFQ questionnaire was completed 2 times (before and 2 months after education) by students. After pre-test, 4 educational session classes in experimental group were performed. Finally, data were collected and analyzed by SPSS 16 computer software. RESULTS: Demographic variables of the studied population in 2 groups were similar. Before intervention, there were no significant differences regarding the knowledge, attitude, and performance in 2 groups (P > 0/05). After intervention, there were significant differences in the levels of knowledge, attitude, and performance between experimental and control groups (P < 0.001). CONCLUSION: According to the results, intervention has positive impact on pattern of nutrition, and it can be concluded that intervention is effective on increasing or improving the knowledge, attitude, and performance of the students.

Predictors of nurses' intention and behavior in using health literacy strategies in patient education based on the theory of planned behavior.

BACKGROUND: Health literacy is one of the most important priorities for improving health care quality through enhancing patient-provider communication. Implementing health literacy strategies enable nurses to provide information and instructions for patients in a manner that is more commensurate and understandable. The purpose of this study was to investigate the factors affecting nurses' intention to implement health literacy strategies in patient education based on theory of planned behavior. METHODS: A cross-sectional study was done on 148 nurse practitioners of AL-Zahra educational hospital in Isfahan, Iran, using a descriptive-analytic method. Data collected via a standardized questionnaire based on theory of planned behavior constructed and analyzed by SPSS v.17 using ANOVA, Independent T-test, Pearson correlation and linear regression. RESULTS: There was statistically significant correlation between using health literacy strategies and marriage status, attending in retraining courses, employment type, job history, and job status. Perceived behavioral control was the most powerful predictor of intention (ß=0.417) and use health literacy strategies in patient education and behavior of nurses (ß=0.33). CONCLUSION: According to the findings of this study, perceived behavioral control is a powerful determinant of nurses' intention and behavior of using health literacy strategies in patient education. Hence we recommend nurse educators to pay special attention to the constructs of this theory mainly perceived behavioral control in retrain courses about patient education and health literacy strategies.