Development and validation of assessment tool of knowledge, attitude, and practice of outdoor workers regarding heat stress.

BACKGROUND: Improving the level of knowledge, attitude and practices of workers exposed to heat stress using a suitable tool can be a cheap and effective method. This requires the consideration of personal, environmental and social factors, which, the PRECEDE model is highly applicable for. Thus, the aim of the present study is the development of a tool assessment for measuring the knowledge, attitude and practices of workers in outdoor occupations regarding heat stress exposure using the PRECEDE model. METHODS: In the present study, a tool was designed and constructed using the PRECEDE model by analyzing the relevant literature and expert opinion. The face validity of the tool was determined based on the opinion of ten experts with experience in the field of occupational weather conditions. The content validity of the tool was determined using the Content Validity Ratio (CVR) and the Content Validity Index (CVI). Cronbach's alpha reliability coefficient was used to determine the reliability of the tool's internal consistency. SPSS version 23 was used for statistical analysis. RESULTS: A PRECEDE based questionnaire was designed with a total of 55 questions consisting of predisposing factors (28 questions for knowledge and 14 questions for attitude), enabling factors (5 questions), reinforcing factors (3 questions) and preventive behaviors (5 questions). The Content Validity Index (CVI) of all questions was above 0.79. The Content Validity Ratio (CVR) of all questions was above 0.62 (Lawshe method). The Cronbach's alpha reliability coefficient of all PRECEDE domains were above the 0.7 acceptable value. Based on the results obtained, all 55 questions were approved and thus the content validity and reliability of this tool was deemed acceptable. CONCLUSION: Considering the reliability and validity of this tool, its application is recommended in all health and safety inspections within various industries for measuring the heat stress knowledge, attitude and practices of workers engaged in outdoor occupations and also for presenting suitable solutions or preventive measures.

Effect combined learning on oral health self-efficacy and self-care behaviors of students: a randomized controlled trial.

BACKGROUND: In order to prevent oral diseases, the use of appropriate oral health education at childhood is one of the most important strategies for improving oral health knowledge and by extension positive oral health habits. Therefore, the present study aimed to evaluate the effect of animations and games as a strategy for improving oral health self-efficacy and self-care behaviors among 6-12-aged students. METHODS: In this interventional study, 82 students were selected based on cluster random sampling including 38 for the case and 44 for the control group. The case group received four sessions of combined learning per week including animations and games while the control group received routine school education. The data were collected in six domains including demographics, self-care, knowledge, attitude, behavior and self-efficacy before and 5 months after the intervention using a questionnaire. SPSS version 20 was used for data analysis. RESULTS: Five months after the intervention, the mean score of self-care, self-efficacy, behavior increased from 3.8 to 4.8, 36.8 to 48.9, and 17.07 to 18.29, respectively indicating a significant change (p < 0.05). However, no significant change was reported in these variables in the control group (p  > 0.05). CONCLUSION: The use of animation combined with other strategies for oral health self-care education can positively influence the students' performance and self-efficacy. IRCT registration number This trial was registered at IRCT. IRCT2017042133565N1 Registration date: 2017-05-17 https://en.irct.ir/trial/25851.

The effect of educational program based on theory of planned behavior on promoting retinopathy preventive behaviors in patients with type 2 diabetes: RCT.

BACKGROUND: Diabetic retinopathy is the most common microvascular complication of diabetes and it is a leading cause of visual impairment and blindness among patients with diabetes. This study aimed to investigate the effect of educational program based on Theory of Planned Behavior (TPB) on promoting retinopathy preventive behaviors in patients with type 2 diabetes. METHODS: The present study is an educational randomized controlled trial research that was conducted on 94 patients with type 2 diabetes who had gone to diabetes clinic. The samples were randomly assigned to the intervention (N = 47) and control groups (N = 47). Data collection instrument was a researcher-made questionnaire based on TPB and FBS and HbA1C tests. Then, educational program was performed for the intervention group through four educational sessions. After 3 months, data collection was repeated for the two groups and FBS, HbA1C testes were done again and data were analyzed. RESULTS: The performance of the intervention group on preventive behaviors of retinopathy increased from 2.48 ± 1.42 to 4.48 45 1.45 after the education (p < 0.001). The mean of FBS and HbA1c in the intervention group also decreased after the intervention (P < 0.05). CONCLUSION: Applying the TPB model proved is very effective in developing an educational program for patients with diabetes, to control their blood sugar and enhance preventive behaviors of retinopathy. Besides such programs, follow-up education for controlling and monitoring are highly recommended. This theory serves as a helpful theoretical framework for health-related behaviors and can be an appropriate pattern to plan for educational interventions. TRIAL REGISTRATION: This trial has been registered at Iranian Registry of Clinical Trials, IRCT20180819040834N1 . Prospectively registered 8 Apr 2019, https://en.irct.ir/trial/38401.

Path analysis of skin cancer preventive behavior among the rural women based on protection motivation theory.

BACKGROUND: Determining the effective factors on the adoption of preventive behaviors capable of reducing the risk of skin cancer is an important step in designing interventions to promote these behaviors. Based on the protection motivation theory, the present study is aimed to conduct a path analysis of skin cancer preventive behaviors in rural women to explore these factors. METHODS: In this cross-sectional study, 243 rural women were randomly selected from the west of Iran to receive a valid and reliable questionnaire assessing constructs from the protection motivation theory, as well as demographic information. Fully completed questionnaires were returned by 230 women and the data were analyzed by SPSS 22 and LISREL8.8. RESULTS: Concerning skin cancer preventive behaviors, 27.8% of women wore sun-blocking clothing when working under the sun, 21.7% used sunscreen cream, 5.7% wore a cap, and 4.8% used gloves and sunglasses. Protection motivation theory and per capita income explained 51% of motivation variance and 25% of the variance of skin cancer preventive behaviors. The response efficacy construct was the strongest predictor of the motivation of protection (ß = - 0.44, p < 0/001). Per-capita income (ß = - 0.34, p < 0/001) and motivation (ß = - 0.33, p < 0/001) were the strongest predictors of these behaviors. CONCLUSIONS: This study showed that protection motivation theory is efficient in predicting skin cancer preventive behaviors and the interventions can be designed and implemented by this theory. Proper planning is also necessary for promoting these behaviors among people with low per-capita income.

Investigation of the effect of education based on the health belief model on the adoption of hypertension-controlling behaviors in the elderly.

PURPOSE: Hypertension is one of the risk factors for cardiovascular diseases and stroke, and has a direct relationship with aging. The aim of this study was to investigate the effect of education based on the health belief model (HBM) on the adoption of hypertension-controlling behaviors in the elderly. METHODS: The present quasiexperimental study was conducted on 100 hypertensive elderly persons from Qom, Iran. The questionnaire was completed by the participants before, immediately after, and 3 months after the intervention. RESULTS: The results of repeated measure analysis of variance showed a significant difference in the scores of the constructs in the intervention and nonintervention groups before, immediately after, and 3 months after the intervention (P<0.001). CONCLUSION: Education based on the HBM increases the performance and enhances the health beliefs regarding hypertension in the elderly population with hypertension. Therefore, it is recommended to consider the HBM to enhance self-care behaviors in the elderly.

The Effect of an Educational Intervention Program on the Adoption of Low Back Pain Preventive Behaviors in Nurses: An Application of the Health Belief Model.

Study Design Randomized controlled trial. Objective The purpose of this study was to identify the effect of a theory-based educational intervention program on the level of knowledge and Health Belief Model (HBM) constructs among nurses in terms of the adoption of preventive behaviors. Methods This pretest/posttest quasi-experimental study was conducted on 100 nurses who were recruited through the multistage sampling method. The nurses were randomly assigned to intervention and control groups. The participants were evaluated before and 3 months after the educational intervention. A multidimensional questionnaire was prepared based on the theoretical structures of the HBM to collect the data. Data analysis was performed using descriptive and inferential statistics. Results There was no significant difference in the mean values of HBM constructs prior to the intervention between the intervention and control groups. However, after the administration of the educational program, the mean scores of knowledge and HBM constructs significantly increased in the intervention group when compared with the control group (p < 0.0001). Conclusion The results of the current study revealed that the educational intervention based on the HBM was effective in improving the nurses' scores of knowledge and HBM constructs; therefore, theory-based health educational strategies are suggested as an effective alternative to traditional educational interventions.

Prevalence of preterm labor in Iran: A systematic review and meta-analysis.

BACKGROUND: Preterm labor, which defines as live-birth delivery before 37 weeks of gestation is a main determinant of neonatal morbidity and mortality around the world. OBJECTIVE: The aim of this study was to determine the prevalence of preterm labor in Iran by a meta-analysis study, to be as a final measure for policy makers in this field. MATERIALS AND METHODS: In this meta-analysis, the databases of Thomson database (Web of Knowledge), PubMed/Medline, Science Direct, Scopus, Google Scholar, Iranmedex, Scientific Information Database (SID), Magiran, and Medlib were searched for articles in English and Persian language published between 1995 and 2014. Among the studies with regard to the inclusion and exclusion criteria, 14 studies (out of 1370 publications) were selected. Data were analyzed by using Stata software version 11. The heterogeneity of reported prevalence among studies was evaluated by the Chi-square based Q test and I2 statistics. RESULTS: The results of Chi-square based on Q test and I2 statistics revealed severe heterogeneity (Q=2505.12, p-value < 0.001 and I2= 99.5%) and consequently, the random effect model was used for the meta-analysis. Based on the random effect model, the overall estimated prevalence of preterm in Iran was 9.2% (95% CI: 7.6 - 10.7). CONCLUSION: Present study summarized the results of previous studies and provided a comprehensive view about the preterm delivery in Iran. In order to achieve a more desirable level and its reduction in the coming years, identifying affecting factor and interventional and preventive actions seem necessary.

Iranian version of childbirth self-efficacy inventory.

AIM: The primary purpose of this study was to translate the Lowe's Childbirth Self-Efficacy Inventory to Persian and to examine the psychometric properties of its Iranian version. BACKGROUND: Self-efficacy for childbirth has been found to be a factor in a woman's decision about her choice of delivery and an essential key in coping with labour pain. Creating a valid and reliable questionnaire is necessary to gain a better understanding of the emotional preparation of pregnant women. It is also essential for the development of educational interventions and improving the sense of self-efficacy during pregnancy. DESIGN: Questionnaire translation. METHODS: The standard 'forward-backward' procedure was applied to translate the questionnaire from English into Persian (Iranian language) and then was reviewed by a panel of experts. We used exploratory factor analysis to examine the construct validity of the instrument. To test the reliability, Cronbach's coefficient alpha was employed. A random sample of 176 pregnant women, attending public prenatal clinics in Tehran, was recruited for participation in the study. RESULTS: The results indicated that each subscales of Childbirth Self-Efficacy Inventory is essentially a unidimensional scale. The results revealed that Iranian pregnant women were able to distinguish between self-efficacy expectancy and outcome expectancy, but they did not differentiate the active phase of labour from second stage. Religious or spiritual beliefs were found to have an important role in the Iranian version of the Childbirth Self-Efficacy Inventory. CONCLUSION: This preliminary study of the Iranian version of the Childbirth Self-Efficacy Inventory showed that it is an acceptable, reliable and valid measure of women's belief and their confidence in coping with labour pain. RELEVANCE TO CLINICAL PRACTICE: A culturally sensitive, reliable and valid instrument is crucial to better understand the self-efficacy of childbirth as a basis for developing effective interventions to increase normal childbirth among Iranian pregnant women.