Exploring the barriers of adherence to dietary recommendations among patients with type 2 diabetes: A qualitative study in Iran.

Aims: Type 2 diabetes is a major global health concern, and its prevalence is rapidly increasing throughout the world. The present study was conducted to explore the experiences of patients and healthcare providers to identify the social barriers to patients' adherence to their recommended diet and thus help the design of future interventions. Design: This study was conducted as a qualitative study with content analysis approach. Methods: The present qualitative study was conducted from November 2016-July 2017. Data were collected through 38 unstructured in-depth interviews with 33 T2D patients and their treatment supervisors and field notes. The interview transcripts were coded using the MAXQDA 10 software. To extract categories and themes, the thematic analysis approach was used. We followed the COREQ Checklist to ensure rigour in our study. Results: The analysis of the study revealed the emergence of five categories of perceived barriers including social priorities and rivalries, family's food habits, poor social support, social impasses and dominant food patterns.

The Effectiveness of Acceptance and Commitment Therapy on Quality of Life in a Patient with Myocardial Infarction: A Randomized Control Trial.

Objective: Acceptance and commitment therapy (ACT) interventions increase psychological flexibility and improve mental health and quality of life in patients with myocardial infarction. Study design: A controlled clinical trial study was conducted to evaluate the efficacy of an ACT intervention in improving the quality of life in patients with MI in Isfahan, Iran. Method : The present controlled clinical trial with a pre and post-test design was conducted on a statistical population consisting of patients with MI admitted to hospitals in Isfahan (n = 60) who were selected through sequential sampling based on the study inclusion criteria and were randomly divided into an intervention and a control group (n1 = n2 = 30). The case group received 8 weekly 90-minute sessions of ACT and the control group received no interventions. The pretest-posttest design was administered in both groups using a demographic questionnaire and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) designed to assess the health status of patients with heart failure in terms of quality of life. The data obtained were analyzed in SPSS-20 using descriptive statistics and the ANCOVA. Results: In this study, 2 general areas of quality of life, including physical and mental health, were examined in the patients. There was a significant increase in the quality of life and subscales of mental and physical health in the experimental group (p < 0.001). Conclusion: Considering the effectiveness of ACT in improving quality of life in these patients, this method of intervention can be used as a complementary therapy in health care centers to reduce the side-effects experienced by these patients.

Assessment of the Efficacy of Physical Activity Level and Lifestyle Behavior Interventions Applying Social Cognitive Theory for Overweight and Obese Girl Adolescents.

BACKGROUND: Childhood obesity has become a global epidemic and physical inactivity and considered as one of the most important contributing factors. We aimed to evaluate a school-based physical activity intervention using social cognitive theory (SCT) to increase physical activity behavior in order to prevent obesity among overweight and obese adolescent girls. STUDY DESIGN: Randomized controlled trial study. METHODS: A seven-month randomized controlled trial based on SCT was implemented with 172 overweight and obese girl students (87 in intervention and 85 in control group), with the presence of their parents and teachers. Activities of the trial included: Sports workshops, physical-activity consulting private sessions, free practical and competitive sports sessions, family exercise sessions, text messages, and newsletters. Body Mass Index (BMI) and Waist Circumference (WC) were measured and questionnaires about duration of physical activity, duration of screen time (watching television and playing computer games) and psychological variables regarding the SCT constructs were obtained. RESULTS: Duration of physical activity (in minutes) and most of psychological variables (self-efficacy, social support, and intention) significantly increased at post-intervention, while hours of watching television and playing computer were significantly decreased (P<0.001). The subjects' mean BMI and WC reduced in the intervention group from 29.47 (4.05) kg/m2 to 28.5 (4.35) kg/m2 and 89.65 (8.15) cm to 86.54 (9.76) cm, although they were not statistically significant compared with the control group (P=0.127 and P=0.504, respectively). CONCLUSIONS: School-based intervention using SCT led to an increase in the duration of physical activity and reduction in the duration of screen time in overweight and obese adolescent girls.

Obesity intervention programs among adolescents using social cognitive theory: a systematic literature review.

Social cognitive theory (SCT) is a well-known theory for designing nutrition education and physical activity programs for adolescents. This systematic review aimed to evaluate the efficacy of intervention studies based on SCT in reducing or preventing overweight and obesity in adolescents. An electronic literature search in PubMed-Medline, Web of Science and Scopus was performed to identify intervention studies based on SCT aiming at preventing or reducing obesity in adolescents. All the articles published up to July 2016 were included. Only studies reporting body mass index (BMI) or its variant as one of the outcome measures were included. From 240 initially identified studies, 12 met the eligibility criteria. Seven had moderate or strong study quality. Two of the eight randomized controlled trials (RCT) and two of the four quasi-experimental studies showed significant reduction in BMI among intervened participants compared to control. Impacts on diet and physical activity were mixed, but were mostly not significant. The current systematic review found only weak evidence for the efficacy of SCT-based interventions in treating and preventing obesity in adolescents. Further studies systematically using effective behavior change strategies or techniques, larger population sizes, better measurement tools and more robust designs are warranted for a conclusive judgment.

The impact of educational intervention on self-care behaviors in overweight hypertensive women: A randomized control trial.

BACKGROUND: The improper control of self-care in hypertension imposes a lot of financial burden on the health-care system. On the other hand, the importance of participatory care and high effectiveness of self-management programs have been confirmed. This study was aimed to examine the effect of an educational intervention on self-efficacy, self-care behaviors and blood pressure (BP) of hypertensive obese or overweight women in the primary health-care setting in Isfahan, Iran. METHODS: This randomized controlled trial was an educational intervention program. It was performed among 146 hypertensive women of 30-65 age range who referred to 6 health care centers of Isfahan that randomly assigned to a control and intervention groups. The interventional group participated in the 6 weekly sessions including exercises, weight control, medication adherence, and home self-monitoring based on goal setting, and promotion of self-efficacy. The control group received routine care from health-care center and any special intervention has been done for the control group. Output variables were analyzed after intervention, and 6-month follow-up. RESULTS: There are no significant differences between age, weight, body mass index and BP and biochemical variables except lipids as well as behavioral factors at the baseline. After 6 months intervention self-efficacy (< 0.001) and physical activity (< 0.001) improvement of in the intervention group was significantly different in comparison with the control group. After 6 months, there was a significant reduction in systolic (P < 0.001) and diastolic BP (P = 0.010) in the intervention group. CONCLUSION: Participatory method of education could help us to convince patients to have better self-care to control disease. Furthermore, since adherence to the treatment of hypertensive patients in our society is low, organizing such courses can teach essential knowledge and skills to lifestyle change and prevention of complications. Performing these courses is recommended for other chronic disease patients in health-care centers to assess self-management programs on self-care behavior.

Cultural Adaptation and Psychometric Properties of the Persian Version of Self-Efficacy in Chronic Disease Patients.

INTRODUCTION: Self-efficacy is an essential factor for effective self-management in chronic-disease patients. Therefore, the measurement of self-efficacy with a valid and reliable instrument is required. In this study, cultural adaptation and psychometric properties of the Persian version of "Self-Efficacy for Managing Chronic Disease" (SES6G) are illustrated in a sample of Iranian chronic-disease patients. MATERIALS AND METHODS: This was a cross-sectional study in which translation and backward translation was performed by bilingual translators. The final version of the Persian scale was assessed to determine the content validity index (CVI) and the content validity ratio (CVR). A panel of experts reviewed items of the scale. Factor analysis was performed for the final version of the Persian scale to assess internal consistency and construct validity among chronic-disease patients attending government health care centers from March 2015 to June 2015 in Isfahan, Iran (n = 483). RESULTS: CVI and CVR scores were 0.87 and 0.89, respectively. There were no eliminated items in the cross-cultural adaptation process. Internal consistency met the criterion for a reliable measure (Cronbach's alpha = 0.89). An initial factor analysis produced a one-dimensional scale (6 items) with Eigenvalues more than 1 that explained 69.49% of the extracted variance. CONCLUSIONS: The SES6G is a reliable and valid instrument to assess patients' self-efficacy for managing chronic diseases in Persian language. Because the self-efficacy score determines the educational strategies to have effective educational programs, the use of this simple and brief scale could be considered among Persian patients.

School-Based Nutrition Education Intervention Using Social Cognitive Theory for Overweight and Obese Iranian Adolescent Girls: A Cluster Randomized Controlled Trial.

Background Nowadays childhood obesity has become one the most challenging issue which is considered as a principle public health problem all around the world. This study was conducted with the aim of evaluating the impact of a 7-month school-based nutrition education intervention using social cognitive theory (SCT) to prevent obesity among overweight and obese adolescent girls. Method In this cluster randomized community trial after choosing schools, a total of 172 overweight and obese girl students participated in the study (87 in the intervention and 85 in the control group). A 7-month intervention based on SCT for students, their parents, and teachers was conducted. At baseline and end of the study, body mass index (BMI), waist circumstances (WCs), dietary intake, and psychological questionnaires regarding the SCT constructs were obtained. Results After 7 months, the mean of BMI and WCs reduced in the intervention group from 29.47 (4.05) to 28.5 (4.35) and from 89.65 (8.15) to 86.54 (9.76), respectively, but in comparison to the control group, they were not statistically significant ( p values .127 and .504, respectively). In the intervention group, nutritional behaviors and most of the psychological variables (self-efficacy, social support, intention, and situation) were improved in favor of the study and they were significant in comparison to the control group ( p < .05). Conclusion Although school-based nutrition education intervention using SCT did not change significantly BMI and WCs among the targeted population in this study, dietary habits as well as psychological factors improved significantly in the intervention group. This trial was registered in Iranian Registry of Clinical Trials, www.irct.ir (IRCT2013103115211N1).

Relationship of body satisfaction, with nutrition and weight control behaviors in women.

BACKGROUND: Considering the importance and prevalence of obesity and the desire to lose weight, especially among women, this study intended to investigate the relationship between Body Mass Index, body satisfaction, and weight control behavior among women employees in Isfahan. METHODS: An analytical cross-sectional study was conducted among 408 women who were selected by stratified random sampling method among employees at Isfahan University and Isfahan University of Medical Sciences during 2012. The data collection tool was a multidimensional questionnaire which comprised two sections: Demographic Tool and Body Satisfaction Tool (7 items), Weight Control Behavior Scale (18 items). RESULTS: Age, marital status, educational level, and multiparity were significantly correlated with body size satisfaction. Seventy-five participants were dissatisfied with their weight and 60.5% reported a desire to lose weight; 92.15% of women studied had participated in a healthy dieting behavior and 10.8% of them had participated in an unhealthy one during the past six months. There was an inverse correlation between body satisfaction and Body Mass Index (BMI) (r = -0.64, P = 0.001). Ninety percent of participants had at least one of the dieting behaviors. There was an inverse significant relationship between body satisfaction and dieting behaviors (r = -0.19, P = 0.001). CONCLUSIONS: Due to the importance of the prevention of obesity and the necessity of having a normal BMI in order to prevent subsequent complications, precise self-evaluation of body size can be used to focus on designing and conducting public health programs, especially for women.