Application of the path analysis model to evaluate the role of distress, mental health literacy and burnout in predicting self-care behaviors among patients with type 2 diabetes.

INTRODUCTION: Mental complications of diabetes are one of the main obstacles to the implementation of self -care behaviors that have been less studied. Therefore, this study was conducted to survey the effective factors in predicting burnout and self-care behaviors among patients with type 2 diabetes. METHODS: In this Path analysis, 1280 patients with type 2 diabetes were selected from Mashhad (Iran) in 2023 to 2024. Four scales, the mental health literacy (MHL) scale, diabetes burnout scale, diabetes distress scale, and self-care behavior scale were used for data gathering. AMOS software checked the direct and indirect paths between the variables. RESULTS: In the path analysis, variables of MHL and diabetes distress predicted 25% variance of diabetes burnout (R2 = 0.25), and diabetes distress (total effect = 0.491) had the greatest impact on predicting diabetes burnout. Variables of MHL, diabetes distress, and diabetes burnout predicted 12% variance of Self-care behaviors (R2 = 0.12) and MHL (total effect = -0.256), age of onset of diabetes (total effect = 0.199), and diabetes burnout (total effect = - 0.167) had the greatest impact on prediction of self-care behaviors. CONCLUSION: MHL could reduce diabetes distress and burnout and eventually promote self-care behaviors among patients with type 2 diabetes. Therefore, screening and identifying psychological problems (such as distress and burnout) and designing interventions to increase MHL can ultimately increase the health of patients with diabetes.

Validity and reliability of anxiety literacy (A-Lit) and its relationship with demographic variables in the Iranian general population.

Introduction: Anxiety disorder is one of the most common mental disorders. This cross-sectional research aimed to determine anxiety literacy (A-Lit) psychometric properties among the Iranian population in 2022. Methods: This research was conducted on 690 people in Iran in 2022. In this study, people were selected by proportional stratified sampling, and the validity and reliability of the A-Lit designed by Griffiths were assessed. Validity of A-Lit was assessed by face validity, content validity, and confirmatory factor analysis. Reliability of A-Lit was evaluated by the McDonald's omega coefficient, Cronbach's alpha coefficient, and test- retest. In analytical sections, the tests of One-way ANOVA, Chi-squared test, and independent samples t-test were used. Results: The rates of S-CVI/Ave and CVR for A-Lit were 0.922 and 0.774, respectively. In confirmatory factor analysis, three items were deleted because the factor loading was less than 0.4, and goodness-of-fit indexes (Some of goodness-of-fit indexes: χ2/df = 4.175, GFI: 0.909, RMSEA = 0.068, PCFI = 0.745, AGFI = 0.883) were confirmed as the final model with 19 items. For all items, the Cronbach's alpha coefficient was 0.832, the McDonald's omega coefficient was 0.835, and the intraclass correlation coefficient was 0.874. According to the results of this study, 1.3% (n = 9) did not answer any questions correctly and 8.4% (n = 58) were able to answer 1-6 questions correctly. Approximately 72% (n = 495) were able to answer 7-12 questions, and eventually only 18.6% (n = 128) were able to answer 13 questions and more. There was a significant relationship between sex, age group, occupation status, marital status, and get information related to mental illness with A-Lit level (p < 0.05). Conclusion: The Persian version of A-Lit was confirmed with 19 items, and this scale is a reliable tool for measuring A-Lit in the general population. The results also showed that a few people have a higher level of anxiety literacy and that educational and intervention programs need to be designed and implemented for the public population.

A modified persian version of the self-stigma of depression scale among the Iranian population: a methodological study in 2023.

INTRODUCTION: This cross -sectional research evaluated the psychometric properties of the Self-Stigma of Depression Scale (SSDS) among Iranian people. METHODS: This methodological study was conducted among 881 people in 2023, Iran. The method of proportional stratified sampling was used to select participants. To evaluate the validity, face, content, construct, convergent, and discriminant were evaluated. The reliability of SSDS was assessed with the McDonald's omega coefficient, Cronbach α coefficient, and test- retest (Intraclass Correlation Coefficient). RESULTS: In confirmatory factor analysis, the factor loading of all items of SSDS was more than 0.5, and two items had low factor loading. After deleted these items, goodness of fit indexes (such as GFI = 0.945, RMSEA = 0.067, AGFI = 0.917, CFI = 0.941, RFI = 0.905) confirmed the final model with 14 items and four factors of social inadequacy (3 items), help-seeking inhibition (4 questions), self-blame (3 questions), and shame (4 questions). In the reliability phase, for all items of SSDS, Cronbach α coefficient was 0.850, the McDonald omega coefficient was 0.853, and the intraclass correlation coefficient was 0.903. CONCLUSION: The Persian form of SSDS was approved with 14 items and four factors: social inadequacy, help-seeking inhibition, self-blame, and shame. This tool can be used to check the status of self-stigmatization of depression in different groups.

Role of diabetes health literacy, psychological status, self-care behaviors, and life satisfaction in predicting quality of life in type 2 diabetes.

One of the factors that can affect the quality of life is the psychological status of people. Also, the psychological status of individuals can be affected by other variables. Therefore, this study was aimed to determine the role of diabetes health literacy, psychological status, self-care behaviors, and life satisfaction in predicting the quality of life in Iranian patients with type 2 diabetes. This cross-sectional study was conducted in Iran in 2021 among 300 patients with type 2 diabetes. The method of selecting the participants in this study was the proportional stratified sampling method. Data collection instruments included six questionnaires of demographic questionnaire and diabetes status, DASS-21 questionnaire (depression, anxiety, and stress), diabetes health literacy scale, self-care behavior questionnaire, satisfaction with life scale (SWLS), and quality of life questionnaire. Statistical methods such as independent sample t test, one-way analysis of variance, linear regression test, and Pearson correlation were used to analyze the data. Based on the results of Pearson correlation test, there was a positive and significant correlation between diabetes health literacy (r = 0.438, p < 0.001), depression (r = - 0.380, p < 0.001), anxiety (r = - 0.355, p < 0.001), stress (r = - 0.423, p < 0.001), and SWLS (r = 0.265, p < 0.001) with quality of life. Based on the results of linear regression, variables of diabetes health literacy, life satisfaction, self -care behaviors, depression, stress, anxiety, age of onset of diabetes and diabetes duration were able to predict 31% of the quality of life (p < 0.001). The results of this study indicated that diabetes health literacy, life satisfaction, stress and the duration of diabetes are able to predict the quality of life of patients with diabetes. Therefore, it is necessary to pay more attention to these effective variables training programs, especially health literacy, the effect of which is very obvious in this study.

Evaluation the validity and reliability of persian short form of the literacy of suicide scale (LOSS): a methodological study in 2022.

INTRODUCTION: This research was conducted with the aim of evaluating the validity and reliability of Persian short version of the Literacy of Suicide Scale (LOSS) among the general population. METHODS: This methodological study was conducted to evaluate the validity and reliability of Persian short form of LOSS among the general population, using a sample of 1175 participants in Iran, 2022. Participants were entered to study using method of proportional stratified sampling. The validity of Persian short form of LOSS was checked by four measures of validity: qualitative face validity, qualitative content validity, EFA (exploratory of factor analysis), and CFA (confirmatory factor analysis). The measure of reliability of Persian short form of LOSS was checked by three reliability of McDonald omega coefficient, ICC (Intraclass Correlation Coefficient), and Cronbach's alpha coefficient. RESULTS: Based on the findings of EFA, 4 components with eigenvalues > 1 were extracted and these 4 factors were able to explain 57.96% of variance. In EFA section, only 1 question was deleted due to entry into the non -relevant sub -scale. Based on the results of CFA, all items had the factor loading greater than 0.4 and none of the items were removed at this stage. In CFA, based the results of goodness-of-fit indexes for example: χ2/df = 2.077, NFI: 0.957, IFI = 0.977, RMSEA = 0.030, GFI: 0.988, and PGFI = 0.569, the final mode was approved with 11 items and 4 factors. In this study for all items, Cronbach's alpha coefficient was 0.739, McDonald omega coefficient was 0.753, and ICC was 0.860. Finally, the Persian short form of LOSS was approved with 11 items and four dimensions of signs/ symptoms with 3 questions, the risk factors with 2 questions, treatment/ prevention with 2 questions, and causes/ triggers with 4 questions. CONCLUSION: The Persian short form of LOSS with 11 items and four subscales is a valid and reliable scale to survey the suicide literacy status in the general population.

The effect of prenatal education in two ways, face-to-face and virtual, on the fear of natural childbirth in pregnant women.

Aims: This study was designed and implemented to compare the effect of prenatal education on the fear of natural birth in pregnant women. Subject and method: This research was a semi-experimental study with a control group conducted on 96 pregnant women in Mashhad. People were randomly allocated to face-to-face and virtual groups. The Wijma childbirth experience/expectation questionnaire version A and the midwifery personal information form were used as pre-test and post-test tools. Results: In the face-to-face and virtual groups, the average scores before and after the intervention were different, which indicated a decrease in fear of Natural childbirth in pregnant women, which was statistically significant. The changes in fear of natural childbirth score were significantly different between the three groups, and these changes were higher in the face-to-face group than in the other two groups. Conclusion: Attendance in natural childbirth preparation classes in face-to-face and virtual training methods positively affects the fear of natural childbirth. Therefore, encouraging and supporting women to participate in training courses increase the women's desire for natural childbirth.

Psychometric properties of multidimensional health locus of control scale, form C among Iranian type 2 diabetes.

Objective: This study aimed at examining the psychometric properties of Persian version of Multidimensional Health Locus of Control scale, form C (MHLC-C) among Iranian type 2 diabetes. Method: This cross sectional study was conducted on 557 type 2 diabetes in eastern city of Iran in 2022. Participants were selected by proportional stratified sampling. The validity of MHLC-C was tested by face validity, content validity, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).Reliability of MHLC-C was assessed by McDonald omega coefficient, Cronbach's alpha coefficient, and Intraclass Correlation Coefficient. Results: Based on the results of EFA, 4 factors with eigenvalues greater than 1 were extracted, which explained 61.66% of the variance. In EFA, a question was removed. In CFA, the factor loading of all questions was more than 0.4 and the indexes of the goodness-of-fit were acceptable (for example: X2/df = 4.457, RMSEA: 0.079, CFI = 0.904, and PGFI = 0.663). McDonald omega coefficient and Cronbach's alpha coefficient of MHLC-C were 0.869 and 0.866. The Intraclass Correlation Coefficient of MHLC-C was 0.817. Finally, the MHLC-C with 17 questions and 4 factors of chance (6 items), internal (5 items), other powerful people (3 items), and doctors (3 items) was approved. Conclusions: The Persian version of the MHLC-C questionnaire, with 17 questions and four factors, is a valid and reliable scale for Iranian type 2 diabetes to assess their health locus of control status.

Chronic heart failure health-related quality of life questionnaire (CHFQOLQ-20): development and psychometric properties.

BACKGROUND: Health-related quality of life (HRQoL) is an important outcome indicator for chronic diseases. This study aimed to develop a new instrument for assessment of HRQoL in chronic heart failure (CHF) and evaluate its psychometric properties. METHODS: This study included two steps of conceptualization and item generation, and assessment of the psychometric properties of an instrument for measuring HRQoL in patients with CHF. A sample of 495 patients with confirmed diagnosis of heart failure participated in the study. In addition to content validity, exploratory and confirmatory factor analyses, concurrent validity, convergent validity, known groups comparison were performed to assess construct validity. Internal consistency, and stability were estimated by the Cronbach's alpha, the MacDonal's Omega, and intraclass correlation coefficients. RESULTS: The content validity of the developed chronic heart failure quality of life questionnaire was assessed by 10 experts. The exploratory factor analysis indicated a four-factor solution for the instrument containing 21 items that jointly accounted for 65.65% of variance observed. The confirmatory factor analysis confirmed the four factor solution with the following fit indexes (χ2/df = 2.214, CFI = 0.947, NFI = 0.91, TLI = 0.937, IFI = 0.947, GFI = 0.899, AGFI = 0.869, RMSEA = 0.063). However, at this stage one item was removed. The concurrent and convergent validity of the CHFQOLQ-20 were established using the Short Form Health Survey (SF-36), and the MacNew Heart Disease Quality of Life Questionnaire, respectively. The known-groups validity as assessed by using the New York Heart Association (NYHA) functional classification showed that the questionnaire discriminated well between patients who differed in functional classification. The internal consistency and test-retest reliability of the CHFQOLQ-20 were satisfactory, with a Cronbach's alpha and intraclass correlation coefficient (ICC) values of 0.93 and 0.84, respectively. CONCLUSION: The results confirmed that CHFQOLQ-20 is a valid and reliable instrument for measuring quality of life (QoL) in patients with CHF. It is a short and easy-to-use instrument that is also capable of assessing the cognitive functioning, which has been overlooked in previous questionnaires.

Title page: psychometric properties of literacy of suicide scale (LOSS) in iranian population: long form.

INTRODUCTION: Suicide and suicide attempts are among the most important indicators of mental health in the world. In this research, the validity and reliability of Literacy of Suicide Scale (LOSS) was examined in general people over the age of 18. METHODS: This cross-sectional psychometric study was conducted in 2022 among 952 general population in Iran. Participants were selected by two methods of proportional stratified sampling and simple random sampling. The internal consistency of the tools was assessed using Cronbach's alpha coefficient, and McDonald omega coefficient. Also, test-retest reliability was checked by Intraclass Correlation Coefficient (ICC). RESULTS: In the confirmatory factor analysis section, the factor loading of all questions were above 0.4 and one questions were deleted and final model with four factors and 25 questions was confirmed (Some of goodness-of-fit indexes: AGFI = 0.910, RMSEA = 0.050, IFI = 0.901, and χ2/df = 3.333). For all questions, the Cronbach's alpha coefficient was 0.859, McDonald omega coefficient was 0.866, and ICC was 0.895. Finally, the Persian long version of LOSS was approved with 25 items and four subscales: causes/triggers (9 items), risk factors (7 items), signs and symptoms (5 items) and treatment/prevention (4 items). CONCLUSION: The Persian long version of LOSS with four subscales and 25 items is an appropriate tool to investigate the state of suicide literacy in the public population.

The status of depression literacy and its relationship with quality of life among Iranian public population: a cross sectional study.

BACKGROUND: This study was designed and conducted to determine the status of depression literacy (D-Lit) and its relationship with the quality of life across the Iranian population. METHODS: This cross-sectional study was conducted in 2020 among 1382 participating from the general population in Gonabad, Iran. Participants were selected and recruited using a multistage sampling method. Data were collected using three sets of questionnaires (demographic section, D-Lit scale, and quality of life questionnaire). Data were analyzed by SPSS software version 24 and using independent samples t- test, Chi-square test, One-way ANOVA, and Pearson correlation. RESULTS: Based on the results, the mean (± standard deviation) of D-Lit and quality of life were 44.14 (± 4.69) and 35.81 (± 5.17), respectively. Based on the results of Pearson correlation coefficient, there was a significant positive correlation between D-Lit and quality of life (r = 0.104, p < 0.001). D-Lit was significantly higher in those who reported having consulted with a psychiatrist compared with those who did not (p < 0.001). Participants with a family history of mental illness and those whose family members were referred to a psychologist for psychological issues had significantly higher levels of D-Lit than others (p < 0.001). CONCLUSION: Based on the results of this study, some D-Lit projects should be improved. Also, the results revealed that D-Lit is a potential factor that can affect people's mental health status and enhance their quality of life. Therefore, it is necessary to develop appropriate educational programs to enhance D-Lit in the community and ultimately improve the quality of life in the community by reducing mental illness.

Psychometric properties of Persian version of diabetes health literacy scale (DHLS) in patients with type 2 diabetes.

BACKGROUND: The purpose of this study was to investigate the psychometric properties of the Persian version of Diabetes Health Literacy Scale in type 2 diabetic patients. METHOD: This cross-sectional study was conducted in 2021 in 1040 patients with type 2 diabetes in eastern Iran. Participants was selected by proportional stratified sampling method. The validity of DHLS was investigated through qualitative face validity, qualitative content validity, and structural validity (exploratory factor analysis and confirmatory factor analysis). The reliability of DHLS was checked by Cronbach's alpha coefficient, McDonald omega coefficient, and test-retest. RESULTS: In exploratory factor analysis, 3 factors with eigenvalues greater than 1 were extracted, explaining 68.57% of the variance. These factors entered the confirmatory factor analysis, none of the questions were removed, and all questions had factor loading above 0.4. Cronbach's alpha coefficient and McDonald omega coefficient of DHLS were 0.919 and 0.922. Also, the Intraclass correlation coefficient of DHLS was 0.957. Finally, the DHLS was approved with 14 questions and the three subscales of Informational Health Literacy (6 items), Numerate Health Literacy (5 items), and Communicative Health Literacy (3 items). CONCLUSIONS: DHLS with 14 questions and the three subscales is a valid and reliable tool for examining diabetes health literacy in people with type 2 diabetes.

Psychometric properties of Persian version of depression literacy (D-Lit) questionnaire among general population.

BACKGROUND: The prevalence of depression in society is increasing and there is a need for a suitable tool to assess the health literacy of people in this field. This study was conducted to evaluate the psychometric of the Iranian version of the depression literacy (D-Lit) questionnaire. METHODS: This cross-sectional study was conducted on 845 participants with a proportional stratified sampling method. First, the translation and cultural adaptation of questionnaire was performed. Then, the validity of D-Lit was assessed by face validity, content validity, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). The reliability of D-Lit was assessed by the Cronbach's alpha coefficient and McDonald omega coefficient. RESULTS: Based on the results of EFA, 5 factors emerged with eigenvalues of greater than 1, which accounted for 56.30% of the variance. Based on the results of CFA, one question was deleted and the results of goodness fit indexes confirmed the model. Cronbach's alpha coefficient and McDonald omega coefficient for D-Lit questionnaire were 0.890 and 0.891, respectively. Finally, D-Lit questionnaire with 21 questions and 5 subscales of Knowledge of the psychological symptoms (5 items), Knowledge about the effectiveness of available treatment methods (4 items), Knowledge about cognitive-behavioral symptoms (6 items), Knowledge about taking medications and their side effects (4 items), and Knowledge of the severity of the disease (2 items) were confirmed. CONCLUSION: The results of this psychometric evaluation confirmed the Persian version of D-Lit questionnaire with 21 questions and 5 subscales is an appropriate tool for measuring people's literacy about depression.

Comparing the effect of education based on PRECEDE - PROCEED model in person-centered and supportive group methods on women's psychological well-being in the menopausal period.

BACKGROUND: Positive psychology introduce mental health as a positive psychological functioning and represent it as well-being psychology. From this point of view, psychological health is more supposed to be known as having positive characteristics such as self-esteem, positive social relationships, and satisfaction. This study was conducted to compare the effect of education in two methods of person-centered and supportive group based on the PRECEDE-PROCEED model on women's psychological well-being during menopause. MATERIALS AND METHODS: The present study was a clinical trial. One hundred and ten menopausal women have been placed in two groups (tests and control). The training program was designed according to the PRECEDE-PROCEED model. The educational intervention was implemented for two groups (person-centered and the supportive group) and the control group did not receive any training. Data analysis was used by descriptive statistics and in the case of normal distribution of alternative tests such as Kruskal-Wallis test, Man-Whitney test, Wilcoxon, spearman correlation, Spearman correlation was used. RESULTS: Results of variance analysis showed that awareness, attitude, self-efficacy, enabling factors, reinforcement, support, behavioral environment, six psychological well-being factors were significantly different from the individual group and control group. Furthermore, the overall score of the psychological well-being was significantly higher than the control group. CONCLUSIONS: As a result of the design and deployment of health care monitoring system, building and reform of community beliefs toward women's status in decision making and their role in menopause, the design and development of support group meetings in women's health care system and enhancing women's access to specialist and heterogeneous health services tailored to the needs of the menopause.

Effect of educational- counseling program based on precede-proceed model during Pregnancy on postpartum depression.

AIM: To explore the effects of an educational- counselling programme based on the precede-proceed model during pregnancy on preventing post-partum depression. DESIGN: A randomized clinical trial (RCT) study. METHOD: 130 pregnant women were selected and randomly assigned to intervention and control groups. Data collection was carried out using questionnaires of predisposing, reinforcing and enabling factors, GHQ and Edinburgh Postnatal Depression Scale (EPDS). The Education programme was designed and performed in each group in a given weekday through four 60-minute sessions. The whole intervention lasted for one month in all groups. The participants in the control group were given routine pregnancy care. Data were gathered before and after the intervention in both groups. RESULTS: Independent t test showed a significant difference between the two groups in terms of the mean score of predisposing, reinforcing, enabling factors and post-partum depression (p < .05). Regression tests indicated predisposing, reinforcing, enabling factors and general health as the most important factors associated with post-partum depression (p < .05). The results supported the effectiveness of the educational intervention on reducing post-partum depression and showed that implementing these training during pregnancy leads to a reduced level of post-partum depression.

Validation of the Persian version of family health climate scale (FHC-Scale) in Iranian families.

BACKGROUND: Family health is an important issue which has attracted researchers from different fields. The present study aimed to validate the Persian version of the Family Health Climate Scale (FHC-Scale). METHODS: In this methodological research, a total of 620 individuals presenting to Comprehensive Healthcare centers affiliated with Mashhad University of Medical Sciences and Gonabad University of Medical Sciences were selected through random multistage sampling. Validation of the FHC-Scale was performed. First, the original scale was translated and back-translated. Then its content validity and construct validity were assessed using exploratory and confirmatory factor analysis. Reliability was assessed using internal consistency and stability. Data were analyzed using SPSS version 20 (IBM Corp., Armonk, NY, USA) and LISREL version 8.5 (SSI Inc., Skokie, IL, USA). RESULTS: Results of exploratory factor analysis showed that "physical activity" of family health climate scale (FHC-PA) has three dimensions: value, cohesion and information explaining 61.99% of the variance. "Nutrition" of family health climate scale (FHC-NU) had four dimensions of value, communication, cohesion and consensus explaining 66.19% of the variance. Internal consistency of the dimensions of (FHC-PA) ranged 0.82-0.85 and that for FHC-NU ranged 0.82-0.84. Confirmatory factor analysis revealed goodness of fit and confirmed family health climate scale (Nutrition and physical activity). CONCLUSION: Results of the study revealed that the FHC-Scale has appropriate reliability and validity for Iranian families. Therefore, the Persian version of the scale can be used for assessing health-related aspects of family.

Developing Pedestrians' Red-light Violation Behavior Questionnaire (PRVBQ); Assessment of Content Validity and Reliability.

OBJECTIVE: To develop a self-completion pedestrians' red-light violation behavior questionnaire (PRVBQ) based on the theory of planned behavior (TPB) and assess the content validity and reliability. METHODS: This study was conducted in three phases of (i) PRVBQ development study; (ii) Content validity study including face validity; and (iii) Reliability assessment. The directed content analysis method was used for the analysis of the qualitative interviews. The item impact score was used for face validity. Content validity index (CVI) in the item level and average scale level, and content validity ratio (CVR) were determined. Intra-class Correlation Coefficient (ICC), and Cronbach's alpha was assessed for test-retest reliability and internal consistency respectively. RESULTS: Draft questionnaire including 86 items was constructed. Sixteen items were eliminated due to low face and content validity, remaining 70 items in total. The PRVBQ was rated as having good content validity (individual items CVI ranged from .80 to 1, and overall PRVBQ CVI-Average=0.95, p=0.05). The direct measures (reflective indicators) showed excellent internal consistency with Cronbach's alpha=0.9. All items showed excellent agreement. CONCLUSION: This study using a comprehensive process of development and assessment of content validity and reliability developed a content valid and reliable questionnaire predicting pedestrians' red light violation behavior.

Perceived benefits of the disease: A qualitative study of patients' experiences of heart failure.

Heart failure may bring about positive outcomes, which have not been adequately addressed in the literature. Therefore, this qualitative study sought to scrutinize the experiences of patients and the perceived positive effects of heart failure. The opinions of 19 patients with heart failure in Mashhad city (Iran) were collected via semistructured interviews from December 2017 to November 2018. After analyzing the data, six themes were identified by framework analysis: healthy lifestyle, effective interactions, appreciation of life, spirituality, reappraisal of life and priorities, and endurance. Such positive effects may lead to empowerment and better coping of patients with the disease. Therefore, nurses should consider the patients' perception of illness in addition to the disease manifestations and offer training focusing on the possibilities instead of limitations.

Health literacy and quality of life among Iranian pregnant women: The mediating role of health locus of control.

Background: Main health challenge of the 21st century is improving quality of life (QoL). This study aimed to investigate the mediating role of health locus of control (HLC) between health literacy and QoL among Iranian pregnant women. Methods: In this cross sectional survey, 400 pregnant women referred to the community health centers of Gonabad, Iran, and completed the demographic, health literacy, QoL, and multidimensional HLC questionnaires during 2015-2016. Descriptive statistics and structural equation modeling were conducted using SPSS 22.0 version and AMOS 24.0 software. Results: The findings showed that health literacy has a significant positive effect on the physical (ß= 0.54, p< 0.001) and mental (ß= 0.57, p< 0.001) health. Also, it has a significant positive effect on internal subscale (ß= 0.42, p< 0.001) and a significant negative effect on the chance (ß= -0.51, p< 0.001) and powerful others (ß= -0.33, p< 0.001) subscale of HLC. From HLC subscales, internal HLC had a significant positive effect on physical (ß= 0.26, p< 0.001) and mental (ß= 0.12, p= 0.010) health, while the effects of chance and powerful others on QoL dimensions were not significant. The findings indicated that internal HLC is a partial mediator between health literacy and physical dimension of QoL. Conclusion: The results indicate that health literacy can be considered as an effective factor in HLC orientations and can improve QoL. This reflects the need for more attention on health literacy and the recognition of the type of HLC beliefs, especially the internal belief in health promotion programs for pregnant women.

Predictors of sun protection behavior in high school students of Ahvaz: a cross-sectional study.

OBJECTIVE: The aim of this study was to predict sun protection behavior by using the protection-motivation theory (PMT). INTRODUCTION: Sun exposure during childhood and adolescence has a very important role in the development of skin cancer in the future. CASE: This was a cross-sectional study. Applying multi-stage random assignment, 380 students from Ahvaz were entered into the study in 2014. Data were collected using a valid and reliable questionnaire based on the PMT. An independent t-test, the Mann-Whitney test, Spearman's correlation and a regression test were used to analyze data by SPSS 15. RESULT: Among 380 students, 48.2% were male and 51.8% were female. Constructs of the PMT accounted for (adjusted R2) 39% observed variance of protection-motivation or intention to do behaviors and 15% observed variance for sun-protection behaviors through protection motivation, self-efficacy and perceived susceptibility, respectively. DISCUSSION: The PMT may be used as a framework to design intervention programs in an attempt to improve intention to perform sun protection behaviors of students. However, the model did not show optimal predictive power for adherence to sun-protection self-care behavior. The findings from this study have important implications in skin cancer prevention.