Journal of Education and Health Promotion

Abstract BACKGROUND: Health literacy (HL) is the ability of a person to acquire the process, understand the
necessary health information, and make the health services needed for conscious health decisions.
Besides, diabetes is the most common metabolic disorder that affects patients’ quantity and quality
of life. This study focused on determining the factors that affect the HL status of patients with type 2
diabetes (T2D) through the role of the demographic variables.
MATERIALS AND METHODS: This descriptive‑analytical research survey recruited a sample
based on 280 patients with T2D at the Diabetes Research Center of Ayatollah Taleghani Hospital
in Kermanshah in 2020. This study selected patients with T2D using a simple random sampling
technique. The study applied the demographic information questionnaire and the Functional,
Communicative, and Critical HL Scale to collect data from patients with T2D. This study used the
SPSS version 23 on the received data sets to perform statistical analysis, including t‑test, analysis
of the variance, and multiple regression, to predict the factors affecting HL among diabetes patients.
RESULTS: The study results showed that the mean age of the participating patients with T2D was
55.80 ± 13.04. The results indicated the mean score and standard deviation of total HL score in patients
with T2D 2.70 ± 0.44. The findings specified a statistically significant relationship between HL, gender,
education, occupation, income, and place of residence. Results indicated that β‑coefficients of the
multiple regression analysis and the income variable (β = 0.170), age (β = 0.176), and employment
variable (β = 0.157). These are the most predictive of the HL of patients with T2D.
CONCLUSION: The results of this study specified that the HL rate of individuals with diabetes type 2
is average. The potential communicative and critical HL influence is essential for communication and
education for diabetes patients in the primary health‑care system settings. The findings indicate that
communicative and critical HL related to patients’ management and functional HL looks passable
in this study.

Abstract BACKGROUND: The long‑term outcomes are important concepts for cost‑effectiveness analysis
in patients with premature coronary artery disease after revascularization (coronary artery bypass
grafting [CABG] and percutaneous coronary intervention [PCI]) and medical therapy (MT). The
finding of this study will be used to calculate the events probabilities for cost‑effectiveness study.
METHODS AND ANALYSIS: This systematic review will use studies in which patients age must be
18–60 years in eligible studies that obtained from PubMed, Web of Science, Scopus, and Embase.
We will assess the long‑term outcomes after CABG, PCI, and MT by random‑effects meta‑analysis
and effects will be shown by risk ratio. We will ascertain the probabilities of adverse events during
certain periods and then outcomes will compare separately based on specific characteristics.
CONCLUSION: This study will provide information related to outcomes of CABG, PCI, and MT
in patients with premature coronary artery disease. Doing this systematic review is valuable from
clinically and economically aspects such as cost‑effectiveness and cost‑utility analysis.

Abstract BACKGROUND: This research is one of the very few studies, which seeks a focalized examination
to observe the effects of the backpack on the teenager students. Adolescents prefer rucksacks as
one of their favorite school bags during their school studies. This study inspects how knapsacks
gradually bring changes as injuries in the bodies of school‑going adolescents. There are ample
studies in the past literature, which evidence the injuries of backpack among adolescents, such as
backache, neck pain, and shoulder pain. The principal objective of this study is to determine the
effects of backpacks on musculoskeletal injuries among school‑going adolescents based on previous
studies support in this research field.
MATERIALS AND METHODS: This review study selected observational studies from the past
literature indexed in the databases of Scopus, PubMed, ScienceDirect, and CINAHL during 1999–
2020. This review focused on the keywords of “Backpack,” “Musculoskeletal Injuries,” and “Adolescent”
from MESH and selected 14 out of 210 articles based on the research objective. According to the
Crombie Checklist, inclusion and exclusion criteria, and investigating the quality of the report, this
review focused on literature evidence to the field under investigation.
RESULTS: Based on the chosen 14 articles, the findings of the present review indicated two
outcomes by considering the impact of the backpack on musculoskeletal injuries and pains among
adolescents. The results of the review studies specified that there was a statistically significant
positive relationship between the prevalence of musculoskeletal injuries and pain using a backpack
among most of the male and female adolescents. The findings also stipulate that injuries and pain
intensity among female adolescents were higher than the male students.
CONCLUSION: The results of this review study specified that improper use of the backpack,
which exceeded the standard weight, caused chorionic pain and injuries between both genders of
adolescents. The generalizability of the results is suitable for this review study.

Abstract BACKGROUND: Breast cancer is the most common type of cancer among women. Mammography
is the most sensitive and important method for screening and early diagnosis of breast cancer.
Considering the importance of using mammography in breast cancer screening, this study was
performed to evaluate mammographic determinants.
MATERIALS AND METHODS: In the cross‑sectional study, we surveyed 985 women over 40 years in
Tehran concerning demographic characteristics: age, socioeconomic status, a problem in the breast,
alcohol use, drug use, and health belief model. Logistic regression was used to identify determinant
factors associated with mammography performance.
RESULTS: The results of this study showed that 42.1% (95% confidence interval [CI]: 38, 45)
participant performed mammography at least once during their lifetime. Age (odds ratio [OR] = 4.252;
95% CI = 2.041–8.857); housing situation (OR = 1.706; 95% CI = 1.178–2.469); having breast
problems (OR = 5.224; 95% CI = 3.501–7.795); socioeconomic status (OR = 1.855; 95%
CI = 1.035–3.325); family income level (OR = 1.998; 95% CI = 1.028–3.884); alcohol
consumption (OR = 2.676; 95% CI = 1.344–5.328); smoking (OR = 2.824; 95% CI = 1.418–5.623);
self‑efficacy (OR = 1.935; 95% CI = 1.242–3.015); perceived barriers (OR = 2.017; 95%
CI = 1.348–3.019); self‑care (OR = 4.901; 95% CI = 3.152–7.620); perceived susceptibility (OR = 1.971;
95% CI = 1.271–3.057) and perceived severity (OR = 1.830; 95% CI = 1.170–2.860) were
mammography behaviors determinants.
CONCLUSION: The findings indicated that the rate of mammography screening among Tehranian
women is low and highlights the need for developing a comprehensive national breast cancer control
program, which should be considered as the priority for health‑care providers. Furthermore, the
identification of these factors can help to design an appropriate educational intervention that focuses
on the benefits of mammography screening.

Abstract INTRODUCTION: One of the most thought‑provoking problems in the world is child marriage that is
affected by various factors. Therefore, the purpose of this study is to identify the social determinants
of child marriage in Kurdish regions of Iran.
MATERIALS AND METHODS: This qualitative study was conducted using conventional content
analysis approach. The participants of the study were 30 Iranian‑Kurdish women married under the
age of 18 who were selected through purposeful and snowballing sampling. Data collection was
conducted through semi‑structured interviews and face‑to‑face interviews and continued until the
saturation of concepts was achieved. Graneheim and Lundman method was used to analyze the
data, and Guba and Lincoln criteria were used to strengthen the research.
RESULTS: In general, findings include 5 categories and 17 subcategories: 1 – economic
factors  (financial problems and economic benefits); 2  –  sociocultural factors  (social customs,
cultural beliefs, community encouragement, social learning, gaining prestige, and social support);
3 – individual factors (physical characteristics, personality traits, lack of awareness of the damaging
consequences of early marriage, and fear of the future); 4 – family factors  (dysfunctional family,
weak awareness of parents, and harm prevention); and 5 – structural factors (high demand, limited
access to educational services, and the lack of supportive social and legal structures).
CONCLUSION: By raising the level of awareness and attitude of girls and their families about
the consequences of early marriage, creating the culture of correcting cultural beliefs and social
misconceptions, passing appropriate laws, and the use of local and national media to prevent child
marriage, this social harm can be reduced.

Abstract BACKGROUND: The health-promoting lifestyle by empowering individuals will increase control over
their health, improve quality of life, and prevent diseases. The purpose of the present study was to
determine the effect of the educational intervention based on the intervention mapping approach on
health-promoting lifestyle in Iranian college students.
METHODS: This study is a quasi-experimental control study that was conducted in two groups of
65 students of Iran University of Medical Sciences in 2018–2019. The data were collected using the
Health-Promoting Lifestyle Standard Profile II questionnaire and a researcher-made questionnaire
based on the mapping approach, whose validity and reliability were confirmed. The educational
intervention was designed according to the pretest results, including five training sessions and
performed for the intervention group. The two groups were evaluated with the same questionnaires
1 month and 3 months later, and the data were analyzed using independent t-test, Spearman,
ANCOVA, ANOVA test, and covariance.
Results: Before the intervention, no significant difference was observed between the mean scores of
health-promoting behaviors in the two groups, but after the intervention, the mean scores of attitude,
subjective norms, enabling factors, and perceived self-efficacy and mean scores of health-promoting
lifestyle and its dimensions increased significantly in the intervention group (P < 0.001) compared
to the control group.
Conclusion: The educational intervention is effective in improving behaviors related to healthpromoting lifestyle and its dimensions. Therefore, performing educational interventions are suggested
to adopt and adhere to behaviors related to health-promoting lifestyle by utilizing and reinforcing
perceived self-efficacy, subjective norms, enabling factors, and attitudinal change.

Abstract INTRODUCTION: Hypertension is one of the most critical factors for chronic diseases such as
cardiovascular disease, stroke, arrhythmias, heart failure, and renal disease. The aim of this study
was to evaluate the quality of life and its related factors in hypertensive patients.
MATERIALS AND METHODS: This study was descriptive research. The sampling method was
simple random, i.e., 137 were selected among the ten health centers of the list of the existing patients
by simple random sampling. Data were collected using a questionnaire World Health Organization
Quality of Life-BREF (Short Form-26). After collecting the questionnaires, the data analysis was
carried out using SPSS software and using statistical methods (e.g., number, percentage, mean,
standard deviation, and MANOVA tests).
RESULTS: The results showed that the mean score for the physical domain (52.82), the psychological
domain (50.26), the social domain (48.33), the environmental domain (46.1), and the total quality of life
(49.60). Among the demographic variables, the education level variable (P =0.000), job (P = 0.013),
and the duration of hypertension (P = 0.039) were significantly correlated with the quality of life of
patients. The “levels of education” variables are significantly correlated with the physical domain
(P = 0.000), psychological domain (P = 0.000), social domain (P = 0.000), and environmental domain
(P = 0.000) of the quality of life. The “job status” variable is only significantly correlated with the social
domain of the quality of life (P = 0.005). The “duration of hypertension” variable is only significantly
associated with the physical domain of the quality of life (P = 0.011).
CONCLUSION: The findings of the present study show that demographic variables such as
educational level, occupation, and duration of hypertension have a significant relationship with the
quality of life domains of hypertensive patients. It is recommended that the principled education of
patients is a step toward the improvement of the quality of life of patients.

Abstract BACKGROUND: Today, one of the biggest concerns of parents is protecting their children and
properly educating them about sex. The aim of this study was to determine the effect of educational
intervention on parental skills in sex education on their children in elementary schools in the northwest
of Tehran‑Iran in 2019 based on literature.
MATERIALS AND METHODS: This quasi‑experimental study was conducted on 125 parents of
elementary schoolchildren in the northwestern of Tehran. The data were collected by valid and
reliable questionnaire. Before the intervention, two intervention and control groups filled up the pretest
questionnaire; the data were collected by valid and reliable questionnaire. Before the intervention,
two intervention and control groups filled the pretest questionnaire, and then the parents participated
in the educational program based on dramatic literature. Two months later, the same questionnaire
was completed by the control and intervention groups. Finally, the data were analyzed by regression
and one‑way ANOVA test.
RESULTS: The results showed that there was a statistically significant difference between the mean
scores of knowledge in the experimental and control groups in the posttest (P < 0.01). There was
also a statistically significant difference between the mean scores of attitude in the experimental and
control groups at the posttest stage (P < 0.01). There was also a statistically significant difference
between the mean scores of performance based on group membership (experimental group and
control group) in the posttest phase (P < 0.01).
CONCLUSIONS: The findings of the study showed that educational intervention on parental skills
in sex education based on the dramatic literature to their children has significant effect on parental
knowledge, attitude, and performance.

Abstract INTRODUCTION: Hospitals are the main axis of health‑care reforms or national health plans;
therefore, accurate recognition of hospital costs based on operational indexes to these plans is
necessary. The impact of implementing national health plans on the performance of health systems
is ambiguous and misleading; therefore, the aim of this study was to assess the impact of Healthcare
Reform Plan (HRP) on the micro level (e.g., educational or university hospitals).
METHODS: This study was a descriptive retrospective study that research variables are checked
in 1 year before and mean of 3 years after implementation of HRP by self‑administrated checklist in
selected public‑educational hospitals covered by the medical universities in Tehran. The final analysis
of the data was performed using cost–performance ratio and independent t‑test for comparing the
variables’ changes before and after HRP.
RESULTS: Unlike adjusted hospitalization costs, most operational indexes were not significant.
The per capita cost adjusted of hospitalization in first and mean of 3 years after HRP increased
49.49% and 16.31%, respectively (P < 0.001), the adjusted cost per day was increased by 24.48%
and 21.46% (P < 0.001), and adjusted cost per bed was increased 47.06% and 20.07% compared
to before HRP (P < 0.001).
CONCLUSION: Given the lack of alignment in adjusted cost changes in exchange for functional
indicators, certainly, it cannot be argued that HRP had a favorable or undesirable effect on the
hospitals.

Abstract BACKGROUND: Through self‑care, people can solve their health‑related problems through increasing
their awareness and correcting their lifestyles.
OBJECTIVES: To determine the association of self‑care status with some relevant factors in
Kashanian middle‑aged women in their early menopausal stage.
METHODS: This is a cross‑sectional study on 351 women in the age range of 45–60 years. Women
were selected based on cluster sampling method from the individuals at health‑care centers in
Kashan, Iran. Researcher‑constructed questionnaire on self‑care was used. The validity and the
reliability of the questionnaire were calculated. The information gathering method was questionnaire
completion by the study participants or interview with them. Collected data were analyzed with SPSS
16 software. T‑test, ANOVA, Spearman correlation, and linear regression analysis were applied.
RESULTS: The mean (±standard deviation) of the self‑care score was 108.14 ± 20.43. Self‑care
scores were weak in 13.92%, intermediate in 71.02%, and good in 15.06%. Regression analysis
showed that the mean of self‑care was significantly higher in those with higher educational level of
women’s (P = 0.045) and their spouses (P = 0.001). Women who were covered by insurance also
showed higher self‑care; in addition, there was no significant relationship between self‑care and
participants’ job, spouses’ jobs, marital status, marital satisfaction, economic satisfaction, number
of children, number of households, and type of accommodation (P > 0.05).
CONCLUSION: The results indicate that self‑care is inadequate and that the level of education of
couples and insurance coverage has a positive effect on the level of self‑care in postmenopausal
women. To promote self‑care in old age, education and empowerment can be considered.