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

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

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

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

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

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

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

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

Factors Predicting Self-Care Behaviors among Low Health Literacy Hypertensive Patients Based on Health Belief Model in Bushehr District, South of Iran.

The aim of this study was to determine the factors influencing adherence to self-care behaviors among low health literacy hypertensive patients based on health belief model. A cross-sectional study was conducted among 152 hypertensive patients with low health literacy. Patients with limited health literacy were identified by S-TOFHLA. The data were collected using H-scale for assessing self-care behaviors and, HK-LS for assessing knowledge of hypertension. A researcher-made questionnaire was applied for collecting data of health belief model constructs. Data were analyzed by SPSS version 22 with using multiple logistic regression analyses. Perceived self-efficacy was associated with all self-care behaviors except medication regimens. There was a significant association between perceived susceptibility and adherence to both low-salt diet (OR = 3.47) and nonsmoking behavior (OR = 1.10). Individuals who had more perceived severity (OR = 1.82) had significantly greater adherence to their medication regimens. Perceived benefits and barriers were not significantly associated with either type of hypertension self-care behaviors. It seems that designing and implementation of educational programs to increase self-efficacy of patients and promote their beliefs about perceived susceptibility and severity of complications may improve self-care behaviors among low health literacy hypertensive patients.

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

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

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

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

The effect of education on improvement of intake of fruits and vegetables aiming at preventing cardiovascular diseases.

BACKGROUND: Cardiovascular diseases refer to a group of diseases that affect the cardiovascular system; principally cardiac diseases, vascular diseases of the brain and kidney and peripheral arterial diseases which are caused by various factors. Considering the importance of nutrition education, especially the intake of fruits and vegetables, this study was performed to determine the effect of health education, Based on the Health Belief Model, on the improvement of intake of fruits and vegetables aiming at preventing cardiovascular diseases among high school girls in the city of Shahre- Kord, Iran. METHODS: This was a quasi-experimental intervention study, in which 120 female students of high schools in Isfahan were selected through convenient sampling and were divided into two groups of experimental (60) and control (60). The instruments for data collection were the Health Belief Model and FFQ questionnaires. The HBM questionnaire was completed three times (before, immediately and two months after the intervention) and the FFQ questionnaire was completed two times (before and two months after the intervention) by the students. After the pre-test, six educational sessions were provided for the experimental group. Finally, data were collected and analyzed by SPSS 16 (ttest, paired t-test and repeated measure ANOVA). RESULTS: There were no differences between the two groups in terms of demographic variables. Before the intervention, there were not any significant differences between the scores of different structures of this model between the two groups (p>0.05); however, after the intervention, significant differences were found between the experimental and control groups in the levels of knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived efficacy and performance (p<0.001). CONCLUSION: According to the results, the intervention had a positive impact on the improvement of intake of fruits and vegetables among the students.

Investigation of educational intervention based on Theory of Planned Behavior on breakfast consumption among middle school students of Qom City in 2012.

BACKGROUND: Eating breakfast is crucial for adolescents to be healthy. It also improves students' capacity of learning and doing school homework. Although healthy habits such as eating breakfast, weight control, and regular sleep increase the lifespan in adults, the effects of healthy habits on school-age children have not been studied much. The present study aimed at investigating the impact of an educational program based on Theory of Planned Behavior (TPB) on eating breakfast among middle school students. MATERIALS AND METHODS: This interventional study was conducted on sixth-grade students in Qom City during the academic year 2012-2013. First, 97 students were randomly assigned to the experimental group and 97 other students were assigned to the control group. Then, a questionnaire was developed on eating breakfast by the researchers according to the TPB. A pilot study was conducted to assess the reliability of the questionnaire. To assess the validity of the questionnaire, advice by a panel of experts was sought. To carry out a pre-test, both groups answered the questions. After analyzing the pre-test results, the required content was developed for the experimental group. Educational methods included delivering speech, discussion groups, pamphlets, and posters. The required educationalcontent was provided for students during five sessions and for parents in one session. To determine the effect of educational intervention, a post-test study was carried out 2 months after the intervention. Collected data were analyzed using independent t-test, χ,([2]) and repeated measures. RESULTS: In the experimental group, 36.7% of students were eating breakfast at least in a day of a week, before educational intervention. After implementation of the educational program, only 32.7% of them were continuing their past habit. There was a significant difference between themean scores of attitudes, perceived behavioral control, intention, and practice of eating breakfast in the experimental and control groups (P < 0.05), while there was no significant difference between the mean scores of subjective norms after implementing the educational program in both groups (P < 0.26). CONCLUSION: Using the TPB improved students' intentions and behavior of eating breakfast. Thus, it seems necessary to consider all effective environmental factors on the subjective norms in the education of healthy eating behaviors or improving breakfast-eating practice among students.

The effect of preventive educational program in cigarette smoking: Extended Parallel Process Model.

BACKGROUND: Cigarette smoking is one of the preventable causes of diseases and deaths. The most important preventive measure is technique to resist against peer pressure. Any educational program should design with an emphasis upon theories of behavioral change and based on effective educational program. To investigate the interventions through educational program in prevention of cigarette smoking, this paper has used the Extended Parallel Process Model (EPPM). MATERIALS AND METHODS: This study is a quasi-experimental study. Two middle schools were randomly selected from male students in Shiraz. Therefore, we randomly selected 120 students for the experimental group and 120 students for the control group. After diagnostic evaluation, educational interventions on the consequences of smoking and preventive skills were applied. RESULTS: Our results indicated that there was a significant difference between students in the control and experimental groups in the means of perceived susceptibility (P < 0.000, t = 6.84), perceived severity (P < 0.000, t = -11.46), perceived response efficacy (P < 0.000, t = -7.07), perceived self-efficacy (P < 0.000, t = -11.64), and preventive behavior (P < 0.000, t = -24.36). CONCLUSIONS: EPPM along with educating skills necessary to resist against peer pressure had significant level of efficiency in improving preventive behavior of cigarette smoking among adolescents. However, this study recommends further studies on ways of increasing perceived susceptibility in cigarette smoking among adolescents.

The relationship between functional health literacy and health promoting behaviors among older adults.

BACKGROUND: Health literacy is a measure of individual's ability to read, comprehend, and act on medical instructions. Older adults are one of the most important at risk groups affected by the impact of inadequate health literacy. Health promoting behaviors in older adults have potential impact on their health and quality of life and reduce the costs incurred to health care. Given the paucity of information health literacy and health promoting behavior, the purpose of this study was to examine health literacy level in older adults and the relationship between health literacy and health promoting behaviors. MATERIALS AND METHOD: A cross-sectional survey of 354 older adults was conducted in Isfahan. The method of sampling was clustering. Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA). Data were collected via home interviewing. Health promoting behaviors were measured based on self-reported smoking status, exercise, and consumption of fruit and vegetables. The collected data were analyzed using descriptive statistics and one-way ANOVA and χ2 tests under SPSS 18 software. RESULTS: The sample group averaged 67 ± 6.97 years in age. Approximately 79.6% of adults were found to have inadequate health literacy. They tended to be older, have fewer years of schooling, lower household income, and being female Individuals with inadequate health literacy were more likely to report limitations in activity and lower consumption of fruit and vegetables (P < 0.001). No significant association was found between health literacy and smoking status. CONCLUSION: Considering high prevalence of inadequate health literacy among older adults, and its inverse relationship with some health promoting behaviors. Simple educational materials and effective interventions for low health literacy people can improve health promotion in society and mitigate the adverse health effects of low health literacy.

Barriers related to fecal occult blood test for colorectal cancer screening in moderate risk individuals.

INTRODUCTION AND OBJECTIVE: Colorectal cancer is one of the most important and most common cancer and second leading cause of cancer deaths worldwide. Through secondary prevention of this cancer, effective proactive measures would be taken to treat and to prevent the incidence of the disease. The fecal occult blood test (FOBT) has priority over other methods and is recommended for adults above 50 years. This study was carried out to assess perceived barriers related to participating in colorectal cancer screening programs among average risk population, based on health belief model. MATERIALS AND METHODS: A cross-sectional survey of 196 individuals of more than 50 years was conducted in Isfahan. The target group consisted of people going to laboratories for doing FOBT test (n = 98), and those who refrained from going to laboratories (n = 98). The questionnaire was used based on barrier assessment question associated with performing fecal occult blood test. The data collected were analyzed using descriptive and inferential statistics methods. RESULTS: The mean score of perceived barriers in the first group was 40.9 and in other group was 56.54, with significant difference statistically (P < 0.001). Lack of information, fear of cancer diagnosis, lack of recommendation by doctors, and not setting the priority of time for doing the test were some of barriers reported by the nongoing group. DISCUSSION AND CONCLUSION: According to this study, it seems that there is an urgent need to more information to be provided for the public about colorectal cancer and its prevention through screening, as important step to increase the rate of early detection and curb the mortality rate, costs, and improve community health outcomes.

The effect of education on the improvement of fruits and vegetables consumption aiming to preventing colorectal cancer.

AIM: This study was performed to determine the effect of health education on the improvement of intake of fruits and vegetables aiming at preventing colorectal cancer among high school girls in the city of Shahr-e-kord. BACKGROUND: Colorectal cancer is one of the most important and most common cancers and the second leading cause of cancer death worldwide. Every year, nearly one million new cases of colorectal cancer are recognized around the world and nearly half of them lose their lives due to the disease. PATIENTS AND METHODS: 130 students were randomly divided to two groups, which experimental (65) and controls (65) were chosen from the city of Shahr-e-kord for this experimental study. The instruments for data collecting were self-made questionnaire health belief model based and food frequency questionnaire. The HBM FFQ questionnaires were completed before, immediately and two months after education by participants. After pre-test, 5 educational session classes in experimental group were performed. Finally, data collected and analyzed by SPSS16 computer software (T- test, T-Paired, repeated measure ANOVA). RESULTS: Findings of the study showed that before the intervention there was no significant differences between the scores of different structures of HBM model in two groups (P > 0.05), after the intervention there was significant differences between experimental and control groups in the levels of knowledge, structures of HBM model and performance for preventing colorectal cancer (p < 0.001). CONCLUSION: Performing educational programs based on health belief model increases the knowledge and improves the attitudes and practices of students regarding prevention of the colorectal cancer.

Factors affecting cigarette smoking based on health-belief model structures in pre-university students in Isfahan, Iran.

INTRODUCTION: The goal of this study was to determine the association between constructs of the Health Belief Model (HBM) (i.e., perceived susceptibility to health-related problems due to smoking, perceived barriers to non-smoking, perceived benefits of non-smoking, perceived self-efficacy to non-smoking, and cues to action of non-smoking) and cigarette smoking among male pre-college students. MATERIALS AND METHODS: A cross-sectional survey of 382 pre-college students was conducted in Isfahan, in 2010. The method of sampling was systematic randomized and students were selected from eight schools. The instrument was developed by the researchers based on the Health Belief Model. Statistical analyses were carried out using SPSS.V.18, Chi-square, and independent t-tests. RESULTS: The mean age of the students was 17.72 ± 0.62 years. Overall 7.2% of the subjects reported having smoked in the past 30 days and 32.7% % of the samples reported ever having smoked in their life time. Results of the t-test showed that there were significant differences in knowledge, perceived susceptibility (P =0.03), benefits (t (246) = -2.51, P =0.01), self-efficacy (P < 0.001), and cues to action (P = 0.007), between smokers and non-smokers. CONCLUSION: These results suggested that the constructs of HBM can be incorporated when examining the predictors of cigarette smoking and developing smoking prevention programs among pre-college students. Furthermore, with a better understanding of the factors affecting this complex behavior (cigarette smoking), it can be a useful step to reduce the rate of death, costs, and also improve the community health outcomes.

Knowledge, attitudes, and practice of breast self-examination among female health workers in Isfahan, Iran.

BACKGROUND: Breast cancer as a most common organ cancer in women is the first cause of death among women with 40-45 years old. The only way to control this disease is early detection, that it can be treated in about 90% of women with breast cancer. The best way for early detection of breast cancer is screening, and the best accessible way is breast self-examination (BSE). Considering this fact that female health workers are responsible for improvement of public health, in addition to self-care, they can encourage the clients and help to improve healthy goals. Therefore, this study investigates the knowledge, attitudes, and practice (KAP) of BS E among female health workers. MATERIALS AND METHODS: This descriptive cross-sectional study was done among 119 female health workers in Isfahan, working in healthcare centers. The method of sampling was clustering. KAP of theses participants were assessed with KAP questioner. The collected data were analyzed using descriptive and inferential statistics methods. FINDINGS: The mean age of participants was 38/3 ± 7/27. The knowledge about breast cancer and doing B SE was good (79/8%) in most participants and (72/45%) of them have positive attitudes, but only (39/5%) of the samples performed BSE regularly every month. A significant relationship was found between the attitudes and the university degree of the health workers and also between age, university degree, and the times of taking part in education classes with performing BSE in the best time for BSE (P < 0.005). A total of 12/6% of them did not have a good performance. CONCLUSION: Considering that health workers can play an important role in encouraging the clients to perform healthy and preventive behaviors, their weak behavior is not acceptable in these groups. This result also shows that additional studies are needed to identify the factors that make women using screening services and encourage them for using these methods.

Quality of life in peptic ulcer patients referring to Al-Zahra hospital of Isfahan, Iran.

AIM: The purpose of this study was to determine quality of life in peptic ulcer patients referring to Al-Zahra hospital of Isfahan. BACKGROUND: Peptic ulcer disease (PUD) is one of the most prevalent diseases. Its prevalence is 6-15% and about 10% of people experience its symptom in their life. PUD can have a considerable impact on patients' quality of life (QOL). PATIENTS AND METHODS: This descriptive- analytic survey was done on 93 randomly patients referred to Al-Zahra hospital of Isfahan city in Iran. Data gathering was done via questionnaire including five domains: physical, psychological, social, behavioral and economical. For data analysis, t-test, Pearson correlation and ANOVA test were used. RESULTS: 93 patients with mean age of 38.54 years, including 43 (46.2%) women and 54 (53.8%) men, were studied. There was a negative significant between quality of life and age and between disease duration and psychological, economical domains and between the mean of QOL scores in physical and social domains with the number of cigarette per day, also there was significant relation between social domain and gender, and physical, psychological and behavioral domains with marital status; Physical, social domains with smoking. Also there was a negative significant between physical, social and behavioral domains with years of smoking. CONCLUSION: Study results showed that quality of life is in a relatively good level among patients, thus some diseases such as peptic ulcer can effect on quality of life. So, treatment and prevention of these diseases may improve their quality of life.