In-depth analysis to develop a social marketing model to promote women's participation in waste segregation behaviour: A qualitative study.

Waste separation is one of the key factors in managing solid waste and creating a healthy environment. Waste separation at source has always been associated with challenges. Therefore, this study was conducted to determine the perceptions of housewives and related parties regarding the factors that influence waste separation behaviour and to identify approaches to improve behaviour based on the social marketing framework. This study was conducted as a qualitative content analysis in Amol City in 2022. The data was collected through semi-structured individual interviews. A total of 25 housewives were selected as main participants and 5 stakeholders through purposive selection. The results of the study included lack of awareness of recyclable materials (product), personal, family and environmental barriers (price), lack of doorstep collection of dry waste (place), and lack of use of appropriate technology (promotion). The lack of financial resources, inappropriate political measures and the coronavirus pandemic were also the causes of this challenge. Most participants cited environmental and educational deficits as the main reason for not separating waste. It is possible to improve waste sorting behaviour at source through appropriate behavioural interventions at the individual, social and environmental levels. Researchers can use the results of this study to design, implement and evaluate waste segregation intervention programmes for housewives.

The effect of intervention programs on road traffic injury prevention among adolescents and young people: a systematic review.

Road traffic injuries (RTIs) are a significant cause of death and disability among young people worldwide. Programs that use injury prevention strategies have been shown to effectively reduce the number of injuries. This systematic review aims to present the available evidence on the effectiveness of intervention programs in preventing RTIs among adolescents and young adults. Articles were identified and retrieved from databases including PubMed, Embase, Web of Science, Scopus, Science Direct, Magiran, SID, and Iran Medex. Two reviewers independently screened the articles. Articles published from the first year of publication until January 2018 that met the eligibility criteria were included in the review. These articles covered randomized controlled trials, pretest/post-test interventions, and controlled pretest/post-test interventions aimed at reducing RTIs among adolescents and young people aged 12-26 years. The framework, provided by Murphy and Haddon, were used to categorize the interventions. According to this framework, the interventions were categorized into five groups including education/behavior change, incentive, engineering/technology, legislation/enforcement, and multifaceted programs. The methodological quality of the studies was assessed using the Effective Public Health Practice Project. Of the initial 3165 findings, 13 studies met the inclusion criteria. Eleven of these studies used educational/behavioral approaches, while two employed multifaceted programs. In the educational/behavioral approach, participants' behaviors were considered as outcome variables. Only one of these studies was not successful. Multifaceted interventions were successful in changing behaviors. No studies were found on the effectiveness of other interventions. Eight studies were assessed as having moderate quality. The systematic review shows that educational/behavioral strategies and multifaceted programs are effective in reducing RTIs among young adults and adolescents. However, there is a lack of studies on other potential interventions. The quality of the included studies was moderate, suggesting a need for more rigorous research.

Factors related to medication adherence in patients with hypertension in Iran: a systematic review study.

OBJECTIVES: This study aimed to review the available studies of the factors in Iranian hypertensive patients' adherence to drug treatment. METHODS: Four Persian databases and seven English databases were searched. The articles, which were published from 2000 to 2022 in Persian and English and examined the adherence to drug treatment in the Iranian population of adults with high blood pressure, were reviewed. Based on the primary examination, 31 of the initial 1062 articles met the inclusion criteria and were included in the analysis. The evidence, which was provided by the examined articles, was summarized and discussed using the 5-dimensional framework of adherence to long-term treatments, which was developed by WHO. RESULTS: The factors that significantly correlated with adherence to drug treatment in the examined studies were: (1) factors that were related to the health team or the health system: patients' satisfaction with their doctor-patient relationship; (2) factors that were related to the conditions: the number of concomitant diseases, high quality of life and the implementation of effective interventions; (3) factors which were related to the treatment: long duration of illness, short intervals between the visits, duration of treatment, lower numbers of drugs, and the patient's blood pressure control; and (4) factors that were related to the patient: self-efficacy, health literacy, social support, locus of control, illness perception, beliefs, attitude, knowledge, and cues to action. CONCLUSION: It is possible to draw definite conclusions about the factors which affect adherence to drug treatment in patients with high blood pressure because most of the relevant studies have been cross-sectional. Therefore, in the future, valuable results can be obtained by conducting more studies that preferably use objective instruments for assessing adherence to drug treatment.

Development and Psychometric Properties of an Extended Theory of Planned Behavior Questionnaire for Childbearing Intentions and Behaviors in Iran.

BACKGROUND: Childbearing is the most important determinant of population fluctuations, and its study is more important than other population phenomena. Owing to the lack of a valid questionnaire based on the extended theory of planned behavior, this mixed-method study was conducted to determine the validity and reliability of a questionnaire designed to examine related belief-based factors on the intention to bear children in Iranian society. METHODS: This study was conducted in two phases in Hamadan city, western Iran, in 2021. Phase 1 consisted of an extensive literature review and a qualitative study using a directed content analysis approach to generate an item pool. Psychometrics were measured in phase 2, including content, face, and construct validity. Reliability was assessed based on internal consistency and stability. The collected data were analyzed using IBM SPSS and AMOS ver. 24.0. RESULTS: Mean content validity ratio and content validity index were 0.7 and 0.85, respectively. Exploratory factor analysis of the 32 items identified an eight-factor solution. These factors jointly accounted for 79.1% of the observed variance in the outcome variables. Confirmatory factor analysis indicated a good fit for the data. The internal consistency based on Cronbach's α was 0.85 (0.71-0.93). In addition, stability was confirmed using the test-retest method and intraclass correlation coefficient (0.74-0.94). CONCLUSION: The designed questionnaire is a valid and reliable instrument for evaluating related belief-based factors on the intention and behavior of childbearing among married men and women in Iran.

Understanding the rationales behind childbearing: A qualitative study based on extended theory of planned behavior.

BACKGROUND: Childbearing is the most important determinant of population fluctuations and its studies are more important than other population phenomena. Many factors are associated with childbearing, but individual factors associated with it have been less studied in a specific framework. The present study aimed to explore and identify the factors related to childbearing based on extended theory of planned behavior (ETPB). MATERIALS AND METHODS: This qualitative study was conducted among married women <35 years of age and married men whose spouses were under 35 years of age and lived in the City of Hamadan, Iran, in 2019. The data were collected by semistructured and face-to-face in-depth interviews and continued until the data saturation was reached. Overall, 15 interviews were conducted with 17 people. The data were analyzed, using a directed content analysis approach. RESULTS: The data analysis resulted in the extraction of 28 main codes, 9 subcategories, and 4 themes, which were correspond to constructs of the theory, consisting of attitudes, subjective norms, perceived behavioral control, and social support in the field of childbearing. The main predictors were attitude toward childbearing and perceived control. CONCLUSION: The findings of this study showed that ETPB has a potential to explain the intention and behavior of childbearing. The ETPB makes it possible to understand many of the factors associated with childbearing. The results of this study could be the basis for designing appropriate data collection instrument in quantitative studies and vast surveys.

The relationship between readiness for treatment of substance use and self-efficacy based on life skills.

Substance use is a social harm. Promoting substance users readiness for treatment of substance use with a non-medical approach is important besides the medical approach. The current study aimed to determine the relationship between readiness for treatment of substance use and self-efficacy based on life skills. In this descriptive-analytical study, a number of 118 substance users in Hamadan city (Iran) were participated. The data collection tools were Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) and Drug Avoidance Self-Efficacy Scale (DASES). Analytical and descriptive tests were used for data analysis, at 95% significant level, using Statistical Package for the Social Sciences 16. The results of this study showed that the readiness for treatment of substance use had a significant relationship with the self-efficacy includes assertiveness and communication (Df:1; Pvalue<0.05). Self-efficacy based on life skills can be used to promote substance users readiness for treatment of substance use in educational interventions.

The Impact of Preventive Interventions on Intimate Partner Violence among Pregnant Women Resident in Hamadan City Slum Areas Using the PEN-3 Model: Control Randomized Trial Study.

BACKGROUND: Intimate partner violence is a severe life-threatening criminal and public health problem affecting the well-being of individuals, families, and society. Planning interventions to reduce the burden of this persistent and criminal violence should be relevant culturally and socially. METHODS: In this randomized control trial, 150 pregnant women residing in slum areas of Hamadan were randomly assigned to two groups (intervention group: n=50 and control group: n=100). Interventional strategies included educating the victims based on local cultural norms, culturally sensitive individual and group counseling, and educating health care providers. Data were collected via face-to-face interviews at baseline and again at 3 months after the intervention. We used a paired t-test to evaluate the effect of the intervention by comparing changes in the outcomes measured. RESULTS: There were no statistically significant differences between the two groups at baseline in terms of sociodemographic characteristics. Post-test scores of knowledge (7.50±2.65 vs. 5.14±3.51, P=0.001), communication skills (18.38±4.25 vs. 16.2±3.83, P=0.04), and family support and social expectation of obedience (15.79±4.45 vs. 13.40±4.57, P=0.005) of the victims were statistically significantly higher in the experimental group compared to the control group. Moreover, physical (0.74±2.28 vs. 1.20±2.60, P=0.06), psychological (2.80±4.10 vs. 4.52±5.43, P=0.06), and sexual (0.11±0.58 vs. 0.61±1.22, P=0.04) violence reduced in the experimental group compared to the control group. CONCLUSION: Culturally relevant interventions can reduce intimate partner violence.

Improving phenylalanine and micronutrients status of children with phenylketonuria: a pilot randomized study.

BACKGROUND: Children with Phenylketonuria (PKU) need a special diet to avoid a variety of physical and psychological complications. The aim of this study was to compare and assess the effects of two interventions on and levels of phenylalanine and micronutrients in children with PKU. METHODS: Forty-six children with PKU (ages 1-12 years) and their caregivers were randomly assigned to one of two 10-week interventions: a caregiver educational intervention based on the Integrative Model of Behvioral Prediction (IMBP) and supplementary low-protein-modified foods. Outcomes consisted of Children's plasma phenylalanine and micronutrients (i.e., vitamin B12, vitamin D3, and zinc) and hemoglobin levels. To assess the sustainability of outcomes, we also compared the children's phenylalanine level at five-time points including baseline and 10-week, 6 months, 12 months, and 24 months follow-ups. In addition, caregivers of both groups were asked to complete a questionnaire to assess how well the interventions were implemented as well as satisfaction with interventions. RESULTS: While a large percentage of children had phenylalanine levels out of range indicating non-adherence (69.6% and 81% in the educational and food items group, respectively), micronutrient deficiencies were not prevalent in the patient cohort. The levels of phenylalanine in both groups decreased significantly over time. However, conducting a repeated-measures ANOVA to evaluating the change in groups across five-time points, revealed a significant difference between groups (F = 4.68, p = 0.03). That is, the educational intervention was more effective in lowering the children's phenylalanine level. At 24-month follow-up, the percentage of children with a normal range of phenylalanine level in the educational and food items groups increased to 73.9 and 57.1 percent, respectively, from 26 and 38 percent at baseline. There were no significant changes in children's micronutrients level following the interventions, except in the hemoglobin. In this way, at 10-week follow-up, the mean hemoglobin of children in the educational group reduced significantly (P = 0.041). However, there was no significant difference between the two groups. In general, all caregivers completed the process evaluation checklist, the feedback was largely positive. CONCLUSIONS: The results of this study demonstrated that both educational and providing food item interventions resulted in a significant reduction in phenylalanine levels. Empowering caregivers of patients, creating and fortifying social networks, providing favorable social supports, and providing access to special food items may be effective in controlling PKU. CLINICAL TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT20180506039548N1). Registered 6th Jun 2018, https://www.irct.ir/trial/30977 .

Prevalence of Intimate Partner Violence Among Pregnant Women in the Poor Neighborhoods of Hamadan, Iran.

Intimate partner violence (IPV) occurs in all settings, especially in poor neighborhoods. It is considered to be a serious public health concern with serious consequences in the short and long term for abused women because of distinct barriers in obtaining support sources. Therefore this cross-sectional study focuses on the prevalence and the determinants of IPV among pregnant women residents in poor neighborhoods. Overall, 63.8% experienced at least one type of IPV. Also, educational status, family's monthly income, husband's employment status, and having a smoker husband were found to be important predictors of IPV against pregnant women. A better understanding of social determinants of violence can help decision-makers in developing effective policies. It is crucial to prioritize the poor neighborhoods for future interventions to reduce IPV imposed during pregnancy.

Factors affecting substance use relapse among Iranian addicts.

BACKGROUND: Substance use relapse after treatment is one of the most important aspects of addiction. The present study aimed to investigate the factors affecting the substance use relapse among Iranian addicts. MATERIALS AND METHODS: This cross-sectional study was conducted in 2019 on 396 addicts referring to the addiction treatment centers in Hamadan, who were selected using a cluster random sampling method. The data were collected by a two-section questionnaire (demographic variables and risk factors for substance abuse recurrence). The collected data were analyzed using descriptive statistics and logistic regression analysis. RESULTS: The participants' mean (standard deviation) age was 36.56 (8.8) years, and 84.6% of the participants had a history of relapse. The logistic regression analysis revealed that marital status (odds ratio [OR] = 2.594; 95% confidence interval [CI]: 1.472-4.570), personal willingness (OR = 8.186; 95% CI: 1.875-35.738), pleasure (OR = 2.738; 95% CI: 1.122-6.679), drug availability (OR = 3.392; 95% CI: 1.023-11.247), family disputes (OR = 4.583; 95% CI: 1.345-15.609), an addicted friend (OR = 2.693; 95% CI: 1.014-7.157), and close addicted relatives (OR = 3.513;95% CI: 1.193-10.348) were the main predictors of addiction relapse (P < 0.05). CONCLUSION: The present study confirmed the effect of several factors (namely demographic, individual, interpersonal, environmental, and behavioral) on the substance use relapse. Accordingly, designing and implementing some interventions based on the findings of the present study may contribute to preventing substance use relapse.

Overcoming the problems caused by collinearity in mixed-effects logistic model: determining the contribution of various types of violence on depression in pregnant women.

BACKGROUND: Collinearity is a common and problematic phenomenon in studies on public health. It leads to inflation in variance of estimator and reduces test power. This phenomenon can occur in any model. In this study, a new ridge mixed-effects logistic model (RMELM) is proposed to overcome consequences of collinearity in correlated binary responses. METHODS: Parameters were estimated through penalized log-likelihood with combining expectation maximization (EM) algorithm, gradient ascent, and Fisher-scoring methods. A simulation study was performed to compare new model with mixed-effects logistic model(MELM). Mean square error, relative bias, empirical power, and variance of random effects were used to evaluate RMELM. Also, contribution of various types of violence, and intervention on depression among pregnant women experiencing intimate partner violence(IPV) were analyzed by new and previous models. RESULTS: Simulation study showed that mean square errors of fixed effects were decreased for RMELM than MELM and empirical power were increased. Inflation in variance of estimators due to collinearity was clearly shown in the MELM in data on IPV and RMELM adjusted the variances. CONCLUSIONS: According to simulation results and analyzing IPV data, this new estimator is appropriate to deal with collinearity problems in the modelling of correlated binary responses.

COVID-19 Prevention Behaviors among Health Staff: Data from a Large Survey in the West of Iran.

BACKGROUND: Hospital staffs are at high risk of Novel Coronavirus (2019-nCoV preventive behaviors play a peculiar role in the reduction of the incidence and mortality of this infection. Therefore, the present study aimed to assess the prevention behaviors of COVID-19 among health staff based on the Extended Parallel Model (EPPM) in western Iran. STUDY DESIGN: It was a cross-sectional study. . METHODS: The present study was performed in the west of Iran in April 2020. In total, 1,664 cases were enrolled in this study via multi-stage sampling. The data were collected using a questionnaire, including the demographic characteristics of participants and EPPM constructs. All analyses were conducted in Stata software (version 14) at a 5% significant level. RESULTS: As evidenced by the obtained results,  1,523 (91.53%), 1,226 (73.68%), 1,526 (91.71%), 893 (53.67%), and 862 (51.86%) of health staff wear gloves, use masks, avoid contact with others, maintain a good distance from other people, and wash their hands frequently with water and soap, respectively. In terms of using gloves and avoiding contacts with others, participants with high perceived threat had higher odds of observing health behaviors (OR= 3.14, 95% CI: 2.08, 4.73; P<0.001) and (OR= 3.1, 95% CI: 2.04, 4.69; P<0.001), respectively. In all categories of EPPM, the participants with high efficacy had higher odds of exhibiting health behaviors, compared to those with low efficacy (P<0.001). CONCLUSION: The results of the present study demonstrated that  health workers are expected to be at the highest level of threat and efficiency. Moreover, the findings emphasized the effectiveness of the recommended strategies in the prevention of COVID-19 disease.

Effect of interventions based on regular physical activity on weight management in adolescents: a systematic review and a meta-analysis.

BACKGROUND: Physical inactivity is one of the major risk factors for non-communicable diseases. This systematic review and meta-analysis aimed to assess the effects of educational interventions on promoting regular physical activity in adolescent weight management programs. METHODS: The relevant studies indexed in Embase, Web of Science, Scopus, and ProQuest databases were searched using keywords namely "Physical Activity, Adolescent, Weight Management, Body Mass Index (BMI), Randomized Controlled Trials, and Clinical Trial." Up to the end of March 2020, two authors independently screened the papers, extracted data, and assessed the methodological quality of the studies using Effective Public Health Practice Project (EPHPP) tool. RESULTS: Out of 12,944 initial studies, 14 met the inclusion criteria after screening the titles, abstracts, and full texts of the papers. The participants in these studies were aged between 6 and 18 years, and 13 studies included participants from both sexes. Moreover, eight of them were performed as a controlled clinical trial. The overall estimate of the difference showed that the interventions improved weight loss which is a statistically significant finding. The participants in the intervention group had a weight loss of 1.02 kg compared to the control group at a 95% confidence interval (- 4.794-0.222). CONCLUSION: Published longitudinal data indicated that physical activity declines over the transition from adolescence to adulthood. Using the results of the study, policy-makers can design educational interventions using educational models and patterns. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD42020173869.

Prediction of Seat Belt Use Behavior among Adolescents Based on the Theory of Planned Behavior.

BACKGROUND: Road Traffic Injuries (RTIs) are the important causes of unintentional injuries and deaths. In this respect, seat belt wearing is an influential factor in reducing the mortality and severity of road traffic injuries. The rate of seat belt use among is lower adolescents, compared to adults. The present study aimed to investigate the influential factors on seat belt-weraing behavior among adolescent students as car occupants based on the Theory of Planned Behavior (TPB). STUDY DESIGN:   A cross-sectional design. METHODS: This study was conducted among 952 adolescent students studying in grades 7, 8, and 9 in the schools of Tabriz, Iran, in the 2019-20 academic year. A researcher-made questionnaire was designed based on TPB for data collection, the validity and reliability of which have been confirmed. RESULTS: The results indicated that the rate of seat belt use in the front seat inside the city was lower than that outside the city. Regarding TPB constructs, perceived behavioral control (ß=0.137; 95% CI: 0.006-0.013; P<0.001), subjective norm (ß=0.313; 95% CI: 0.021-0.032; P<0.001), and attitude (ß=0.322; 95% CI: 0.034-0.053; P<0.001) had a significant and positive relationship with the intention of seat belt-wearing behavior. Moreover, the behavioral intention (ß=0.571; 95% CI: 0.62-0.64; P<0.001) had a significantly positive relationship with seat belt-wearing behavior. CONCLUSION: The Theory of Planned Behavior is appropriate to determine predictor factors of seat belt-weraing behavior among adolescent students as car occupants. In addition, the results of the present study may provide a theoretical basis for policy-making to improve adolescent students' seat belt use.

How Is the Relationship of Spiritual Health and Body Image with the Desire for Aesthetic Surgery among Students?

BACKGROUND: The desire for aesthetic surgery in Iran has increased. The relationship between spirituality and body image has not been studied simultaneously with the desire for aesthetic surgery. The present study aimed to examine this relationship among students of Hamadan University of Medical Sciences, Hamadan, Iran. METHODS: In this analytical cross-sectional study in 2019, 397 students were enrolled by stratified random sampling. The data were collected using the Paloutzian and Ellison's spiritual health questionnaire and Appearance Schemas Inventory. Data were analyzed using Pearson correlation, independent t-test and logistic regression. RESULTS: The mean age of the subjects was 22.26±4.24 years, while 26.7% of the subjects had desire for aesthetic surgery. There was a significant negative correlation between body image and spiritual health (p<0.001). The mean score of spiritual health and its dimensions in female students were higher than males. Based on logistic regression model, age (p=0.018, 95% CI: 0.341-0.904) and body image (p<0.001, 95% CI: 1.05-1.112) had significant correlation with the desire for aesthetic surgery. CONCLUSION: According to the results; it is necessary to make plans for the promotion of spirituality and the strengthening of a positive body image among students residing in student homes, male students and those who desire to engage aesthetic surgery.

Determinants of medication adherence among hypertensive patients using the Pender's health promotion model.

BACKGROUND: Poor adherence in treatment and medication is a global issue in curing the chronic diseases such as hypertension. The present study was conducted to identify the factors related with medication adherence among hypertensive patients referred to the health centers of Borujerd based on the Pender's Health Promotion Model (HPM). MATERIALS AND METHODS: This cross-sectional study was conducted on 463 patients who were referred to the comprehensive health centers of Borujerd city by cluster sampling method in 2019. The data were collected using a questionnaire including demographic variables and Pender's HPM constructs. Data were analyzed by SPSS 18 software using Pearson correlation coefficient and linear regression. RESULTS: The mean and standard deviation of the participants' age was 63.29 ± 11.2 years. The results showed that hypertensive patients had a relatively desirable level of medication adherence behavior. Perceived barriers (ß = -0.169), perceived self-efficacy (ß = 0.196), activity related affect (ß = 0.232), and following medication regimen (ß = 0.225) were the best predictors of performing the medication adherence behavior. In total, different structures of the HPM explained 42.2% of the variation of medication adherence behavior changes. CONCLUSIONS: According to the findings, the design of educational programs using HPM is recommended to increase the medication adherence among hypertensive patients.

The effectiveness of an educational intervention to enhance happiness in Iranian older people: Applying social support theory.

OBJECTIVE: The aim of this study was to explore the effectiveness of an educational program based on social support theory (SST) to enhance happiness in older adults (60-75 years) in Hamadan (Iran) in 2017. METHODS: This study was a quasi-experimental intervention with a control group, consisting of 60 participants and an intervention group of 40 participants. The research instruments included the Oxford Argyle Happiness Inventory and a questionnaire derived from SST. RESULTS: The findings showed that there was a significant difference between the scores of happiness, social support and their components in the intervention group compared to the control group three months after the intervention. CONCLUSION: The study results indicate that an educational intervention to promote happiness using social support can play a pivotal role in the mental health, life satisfaction and happiness of older adults.

Randomized controlled trial protocol to evaluate the effect of an educational intervention using information, motivation and behavioral skills model on sexual satisfaction of new couples in Iran.

BACKGROUND: Sexual satisfaction is considered as one of the key factors in assessing a person's quality of life and the quality and continuity of marital relationships. According to the results of reports in Iran, many couples are dissatisfied with their sexual lives. Sexuality education is one of the important strategies to prevent early sexual problems and improve sexual satisfaction. The aim of this randomized controlled trial is to compare the efficacy of sexual and marital enrichment package using information, motivation and behavioral skills model on sexual satisfaction of new couples in Iran to routine sexual care program that provided at governmental health centers. METHODS: This is a randomized, controlled, superiority trial with two parallel groups. One hundred new couples (n = 200) will be recruited and randomized with simple randomization method and a 1:1 allocation. Recruitment will be from governmental health centers and calling on social networks. Couples will be randomized to intervention which will receive Sexual and Marital Enrichment package and control group (routine care at health centers). Couples will be followed up for 4 months. Then primary outcomes (mean score of couples' sexual information, motivation and behavior skills) and secondary outcome (mean score of couples' sexual satisfaction) of study will be measured through the online questionnaire. DISCUSSION: This trial will be examined the impact of the sexual and marital skills training package tailored to the values and norms governing the sexual life of Iranian couples on their sexual satisfaction. If the trial is effective, its results will be presented to policy makers for implementation at national level. TRIAL REGISTRATION: (Iranian Registry of Clinical Trials (IRCT) number): IRCT20181211041926N1. Date of registration: March 2, 2019.

Examining the Effectiveness of a Web-Based Intervention for Depressive Symptoms in Female Adolescents: Applying Social Cognitive Theory.

BACKGROUND: Depression is a serious mental health illness among adolescents especially girls. Web-based treatment can possibly become a solution for reducing mental health problems in adolescents. This study is one of the first trials aimed to evaluate the efficiency of web-based depression improvement program among female adolescents based on the Social Cognitive Theory (SCT). STUDY DESIGN: Randomized Controlled Trial. METHODS: A six-month randomized controlled trial based on the SCT was implemented in female schools in Hamadan City, west of Iran in 2018 on 128 female students with mild to moderate depressive symptoms (CES-D =10-45). They were randomly assigned to either intervention or control group (n= 64 in each group). Depression improvement program was implemented through the website via short videos, animations and Power-Point slides. Depression was evaluated using Center for Epidemiologic Depression Scale. A researcher-made questionnaire based on the sheerer and Perceived-Social-Support-Scale-Revised (PSSS-R) questionnaires were used to evaluate the SCT constructs. The data were analyzed using SPSS software. RESULTS: The intervention program resulted in the improvement of depression in 12 wk based on Intent-to-treat analyses. Nevertheless, these achievements seem to have decreased by 24 wk in intervention group. The intervention increased the mean scores of the constructs of social support and self-regulation from baseline to 12 wk in the intervention group (P<0.05). The intervention had no effect on outcome expectations and self-efficacy. There were no statistically significant associated between theory constructs changes and changes in depression (P>0.05). CONCLUSION: The web-based intervention improved depression in female students. Future training using strategies for the sustainable improvement of depression in female students are needed.

An Exploratory Mixed Method Study for Developing and Psychometric Properties of the Sexual Information, Motivation and Behavioral Skills Scale (SIMBS) in Iranian Couples.

BACKGROUND: This study was designed to construct and assay the psychometric properties of a scale in order to recognize sexual information, motivation and behavioral skills of Iranian couples. STUDY DESIGN: a mixed method study. METHODS: This was an exploratory mixed method investigation conducted in two stages from Sep 2017 to Jun 2018 in Isfahan, Iran. First, qualitative methods (individual interviews with 22 couples) were applied to generate items and develop the questionnaire. Second, psychometric properties of the questionnaire were assessed. Reliability was evaluated by composite reliability, Interclass Correlation Coefficient (ICC) and internal consistency. Moreover, Exploratory Factor Analyses (EFA) and Confirmatory Factor Analyses (CFA) were carried out to examine construct validity. To evaluate content validity were performed CVI and CVR. RESULTS: An item pool comprising 107 statements related to couple 'sexual information, motivation and behavioral skills were generated in the first stage. In the second stage, item reduction was exerted and the final issue of the questionnaire including 51 items was expanded. The evaluation of the psychometric properties of the final version displayed that the scale had good reliability and structure. The results from exploratory factory analysis demonstrated a 9-factor solution for the scale that jointly reported for the 39.5% of the observed variance. The mean scores of the CVI and CVR were 0.92 and 0.90, respectively. Additional analyses indicated acceptable results for composite reliability for the subscale of instrument ranging from 0.78 to 0.95. CONCLUSION: The sexual information, motivation and behavioral skills scale is a reliable and valid instrument that can be used in future studies on Iranian couples.