Using the health beliefs model to implement mobile puberty health education in Iranian adolescent boys: a randomized controlled trial.

Introduction: Given boys' low health knowledge and their unhealthy behavior during puberty, which can cause many physical, mental, and psychological problems, it is important to prevent these complications. This study was therefore aimed to determine the efficacy of a mobile health educational intervention based on the Health Beliefs Model (HBM) on Iranian adolescent boys. Materials and methods: This randomized controlled trial involved junior high school boys (n = 148) in Iran studying during the 2020-2021 school year. Educational content concerning healthy behaviors during puberty (e.g., the importance of bathing) was developed based on HBM and sent to the intervention group via mobile phone. HBM addresses multiple factors (e.g., perceived disease risk) that explain health behaviors. The intervention was delivered in five sessions over four weeks using real-time Internet communication and texting. The control group did not receive any intervention. One school was randomly selected from each of the four districts of the study site. The schools were then randomized into intervention and control groups. The boys were then randomly selected from each school to participate in the study. Data collected at baseline and 2-month follow-up assessments included demographic information, health knowledge (e.g., physical changes during puberty), health behaviors (e.g., bathing), and HBM constructs (e.g., self-efficacy to perform healthy behaviors). Data analysis was done using the chi-square, independent and paired t-tests, and analysis of covariance (ANCOVA). Results: The two groups did not differ in terms of demographic characteristics. Before the intervention, the two groups were slightly different in terms of knowledge, health behavior, and HBM constructs. Following the intervention, the scores of the intervention group improved significantly (p < 0.05). After adjusting for pre-intervention knowledge, HBM, and health behavior scores, the intervention group remained superior to the control group in terms of improvement of knowledge, HBM constructs, and healthy behaviors (p < 0.05). Effect sizes ranged from medium to large (0.25-0.86). Conclusion: Mobile phone education based on the HBM is efficacious in encouraging healthy behavior in boys during puberty. Organizations interested in encouraging healthy behaviors in boys should consider the use of such a program.

A quasi-experimental study to improve health service quality: implementing communication and self-efficacy skills training to primary healthcare workers in two counties in Iran.

BACKGROUND: Service satisfaction ratings from clients are a good indicator of service quality. The present study aimed to investigate the impact of communication skills and self-efficacy training for healthcare workers on clients' satisfaction. METHODS: A quasi-experimental study was conducted in health centers of Saveh University of Medical Science in Iran. Primary Healthcare (PHC; N = 105) workers and service recipients (N = 364) were randomly assigned to intervention and control groups. The intervention group received four 90-min training sessions consisting of lecture, film screening, role-playing, and discussion group. Before and 3 months after the intervention, a multi-part questionnaire (including demographics, self-efficacy and communication skills in PHC workers; and satisfaction questionnaire in service recipients) was completed by participants in both intervention and control groups. RESULTS: PHC worker mean scores of self-efficacy and communication skills after the educational program were increased in the intervention group compared to the control group (p < 0.05). Also, mean satisfaction scores for service recipients of the intervention group (PHC workers) generally significantly increased compared to the control group (p < 0.001). CONCLUSIONS: The educational program improved the self-efficacy, and communication skills in health workers and improved client satisfaction overall. Our results support the application of self-efficacy and communication skills training for other medical groups who wish to improve clients satisfaction as an important health services outcome.

Program development using intervention mapping in primary healthcare settings to address elder abuse: A randomized controlled pilot study.

BACKGROUND: Abuse of elderly women is of great concern and yet relatively little is known about interventions. OBJECTIVES: The aim of this study was to develop and test a culturally informed treatment, based on Intervention Mapping (IM), for primary healthcare settings. The intervention targets family members of elderly women and seeks to reduce elder abuse. METHODS: N = 80 family members of elderly women were randomized to intervention or control. Elderly women completed assessment prior to randomization. Elder abuse was measured by self-reported frequency of neglect, physical, psychological, and financial abuse in the last 2 months across 16 items. Intervention included 4 sessions, each under 1 hr. At 2-month follow-up, elderly women completed an assessment. Linear mixed modeling was used for analyses. RESULTS: Significant reduction in frequency of psychological abuse and neglect was found in comparison to control, with trend effects for financial abuse (F = 127.12, p < .005; F = 95.4; p < .005; and F = 16.53, p < .07, respectively). Physical abuse was infrequent. CONCLUSION: This culturally tailored intervention reduced elder abuse. Given its basis in IM, it is well-positioned for roll-out and testing in a larger randomized trial to study adoption, implementation, and sustainability in practice settings.

Motivational interviewing with computer assistance as an intervention to empower women to make contraceptive choices while incarcerated: study protocol for randomized controlled trial.

BACKGROUND: Unplanned pregnancies and sexually transmitted infections (STIs) are important and costly public health problems in the United States resulting from unprotected sexual intercourse. Risk factors for unplanned pregnancies and STIs (poverty, low educational attainment, homelessness, substance abuse, lack of health insurance, history of an abusive environment, and practice of commercial sex work) are especially high among women with a history of incarceration. Project CARE (Contraceptive Awareness and Reproductive Education) is designed to evaluate an innovative intervention, motivational interviewing with computer assistance (MICA), aimed at enhancing contraceptive initiation and maintenance among incarcerated women who do not want a pregnancy within the next year and who are anticipated to be released back to the community. This study aims to: (1) increase the initiation of highly effective contraceptives while incarcerated; (2) increase the continuation of highly effective contraceptive use at 3, 6, 9, and 12 months after release; and (3) decrease unsafe sexual activity. METHODS/DESIGN: This randomized controlled trial will recruit 400 women from the Rhode Island Department of Corrections (RI DOC) women's jail at risk for an unplanned pregnancy (that is, sexually active with men and not planning/wanting to become pregnant in the next year). They will be randomized to two interventions: a control group who receive two educational videos (on contraception, STIs, and pre-conception counseling) or a treatment group who receive two sessions of personalized MICA. MICA is based on the principles of the Transtheoretical Model (TTM) and on Motivational Interviewing (MI), an empirically supported counseling technique designed to enhance readiness to change targeted behaviors. Women will be followed at 3, 6, 9, and 12 months post release and assessed for STIs, pregnancy, and reported condom use. DISCUSSION: Results from this study are expected to enhance our understanding of the efficacy of MICA to enhance contraceptive initiation and maintenance and reduce sexual risk-taking behaviors among incarcerated women who have re-entered the community. TRIAL REGISTRATION: NCT01132950.

Working Inside for Smoking Elimination (Project W.I.S.E.) study design and rationale to prevent return to smoking after release from a smoke free prison.

BACKGROUND: Incarcerated individuals suffer disproportionately from the health effects of tobacco smoking due to the high smoking prevalence in this population. In addition there is an over-representation of ethnic and racial minorities, impoverished individuals, and those with mental health and drug addictions in prisons. Increasingly, prisons across the U.S. are becoming smoke free. However, relapse to smoking is common upon release from prison, approaching 90% within a few weeks. No evidence based treatments currently exist to assist individuals to remain abstinent after a period of prolonged, forced abstinence. METHODS/DESIGN: This paper describes the design and rationale of a randomized clinical trial to enhance smoking abstinence rates among individuals following release from a tobacco free prison. The intervention is six weekly sessions of motivational interviewing and cognitive behavioral therapy initiated approximately six weeks prior to release from prison. The control group views six time matched videos weekly starting about six weeks prior to release. Assessments take place in-person 3 weeks after release and then for non-smokers every 3 months up to 12 months. Smoking status is confirmed by urine cotinine. DISCUSSION: Effective interventions are greatly needed to assist these individuals to remain smoke free and reduce health disparities among this socially and economically challenged group. TRIAL REGISTRATION: NCT01122589.