Journal of Education and Health Promotion

Abstract INTRODUCTION: Reviewing articles are one of the most important methods for maintaining and
improving the scientific quality of research outputs, especially in the field of health and medicine,
and are often accompanied with various challenges.
AIM: The current study was carried out to Health Promotion in the Review Process of the Health
Scientific Journals according to Explanation of Experts.
MATERIALS AND METHODS: This study has a qualitative approach and was carried out using
the content analysis method. Data were gathered through semi‑structured interviews with experts
with direct and related experiences with health scientific journals including editors in chief, internal
managers, editorial boards, authors’ council and members of national journal commission with at
least 2 years of continuous related work experience in journals and review of at least 10 articles.
Sampling was carried out using purposeful snowball sampling, and data were analyzed using content
analysis method. Lincoln and Guba tests were used to determine the validity and reliability of the
analysis based on the following four criteria – credibility, transferability, certainty, and verifiability.
RESULTS: Experts’ opinions were categorized based on criteria for reviewer selection with three
dimensions of technical expertise, ethical behavior, and orientation and order; reviewer selection
methods including emphasis on others and emphasis on self; and review problems in the Iranian
Health Science and Research Journals including incentive system, reviewer characteristics, and
structural problems.
CONCLUSION: Findings of the current study are usable for all Iranian Health Scientific Journals,
editors, editors in chief, and internal managers as well as lawmakers in the area of scientific research.

Abstract BACKGROUND: Health promotion is the process of enabling people to increase control over their
own health. Community involvement in social and environmental interventions tends to improve
people’s health and quality of life. Self‑help groups (SHGs) primarily focus on microfinancing, thereby
acting as a catalyst in bringing backward society to the mainstream. They possess huge potential
to influence the health of the community.
OBJECTIVE: The objective of the study is to assess the willingness among SHGs for the involvement
in health promotion activities and to assess their health information needs.
MATERIALS AND METHODS: A community‑based, cross‑sectional study was conducted during
September 2017 in rural Puducherry. All 86 SHGs in four selected villages were covered, and their
leaders were interviewed using a structured questionnaire on functioning of SHGs and their health
information needs. Willingness for health promotion activities was rated on an interest scale (1–100).
RESULTS: Among the 86 heads of SHGs interviewed, 81 SHGs (94.1%) were registered. They were
mainly involved in microfinancing. Health information needs expressed were cancer detection (45%),
diabetes (60%), hypertension (56%) and vector‑borne diseases (63%). When asked to rate
their willingness on an interest scale for health promotion activities, nearly 64% showed a great
interest (i.e., score > 60). Majority were willing to work for noncommunicable disease‑related activities
such as provision of drugs (86%) and for screening of various cancers (84%).
CONCLUSION: This study has shown that majority of SHG members have expressed willingness
for the involvement in health‑related activities, thereby can be utilized as an important resource for
health promotion in rural areas.

Abstract AIMS: Although chronic diseases are the most common and expensive health problems, they are
preventable too. Nurses play a key role in the care of these patients. One of the important roles
of nurses is consultation role. Due to the high impact of nurse consultant role on health promotion
and also the fact that this role is not fully understood in Iran, this study aims at clarifying the role of
nurse consultant.
MATERIALS AND METHODS: This is a qualitative study with content analysis approach conducted
through semi‑structured interviews in Isfahan University of Medical Sciences from April to December
2017. A total of 35 participants (11 patients, 9 nurses, 6 faculty members, 4 postgraduate students,
and 5 nursing managers) were included in the study. Sampling was done based on purposive sampling
method, and participants were asked to express their opinions about nurse consultant.
RESULTS: In this article, we discussed the following three categories and seven subcategories: (1)
nursing consultation as a treatment facilitator (nursing consultation as a way to reduce the treatment
course, nursing consultation as a way to reduce complications, and nursing consultation as a way
to reduce costs); (2) professional performance in nursing consultation (nursing consultation based
on problem‑solving and evidence‑based practice and management and teamwork in nursing
consultation); and (3) prerequisites for the nursing consultation role (supporting nurses and introducing
the role in decision‑making units and creating demand).
CONCLUSION: Nursing consultation has an essential role in patient health promotion. Therefore, it
is better that nurses and other health‑care team should be familiar with this vital role.

Abstract BACKGROUND: Although the World Health Organization has emphasized the need for reorientation
of hospitals toward health promotion (HP), HP in hospitals of Iran is a new concept. This study
investigated the concept of HP among health‑care professionals working in educational hospitals
of Isfahan, Iran, 2015.
METHODS: A descriptive exploratory qualitative approach was employed in this study, with
semi‑structured interviews to investigate HP concept. The study settings included four selected
educational hospitals affiliated to the Isfahan University of Medical Sciences. A purposive sample
consisted of 15 health‑care professionals who were participated in the study.
RESULTS: Most of the participants perceived HP as a concept synonymous to health education and
disease prevention. Other meaning attributes to HP were improved quality of life and well‑being,
clinical practice, individual and group approach to increase health, and holistic view to health. Some
empowerment strategies were described by participants, but most of the participants rarely went
beyond traditional health education strategy aimed at an individual target. A sizeable number of
participants used interchangeably the terms “health promotion” with “prevention,” “health education,”
and “hygiene”.
CONCLUSIONS: It seems that participants of this study had limited knowledge about HP. Health‑care
staff have a decisive role for reorienting hospitals toward HP; thus, there is a need for ongoing
in‑service training for health‑care professionals of hospitals to focus on HP.

Abstract BACKGROUND: The dust and sand storms (DSS) in Iran increased in recent years, which have
caused adverse health effects. Regarding the effects of DSS on the health indicators, the health
system plays a key role based on the mission and the services which it provides. The present study
was conducted, in Iran, to fill the existing knowledge gap and to understand the preparedness
challenges of the health system in response to the DSS.
MATERIALS AND METHODS: Twenty‑one semi‑structured interviews, in 2016–2017, were
undertaken. This study carried out using purposeful sampling with key informants in the Khuzestan
Province, national policymakers in Tehran, as well as people affected by this phenomenon.
A qualitative approach, using the conventional content analysis, was employed to analyze the
collected data.
RESULTS: Four main categories that appear to explain the preparedness challenges of the health
system for DSS include the risk assessment, knowledge management, organizational elements, as
well as monitoring and evaluation.
CONCLUSIONS: It is imperative that policymakers of the country pay special attention to the hazard
risk understanding and managing the various aspects of the beliefs and attitudes associated with
DSS. The development of early warning system, regular drills and exercises, as well as public and
specialized health promotion training related to this phenomenon are suggested.

Abstract CONTEXT: Lifestyle modifications play a major role in controlling blood glucose levels among
diabetes mellitus for the prevention of its complications. Mobile phones can be used as an efficient
tool for improving the healthy lifestyle through health education.
AIMS: The aim of the study is to measure the efficacy of behavior change communication using
mobile calls in controlling blood sugar levels, increasing medication adherence, healthy diet, and
physical activity among diabetic patients.
SETTINGS AND DESIGN: A randomized controlled trial was conducted in an urban area of
Pondicherry between 50 (25 per arm) type 2 diabetes patients.
SUBJECTS AND METHODS: All participants were interviewed using a structured questionnaire.
Fasting blood glucose (FBG) was measured. Single‑time health education was given to both
groups. The intervention group received a mobile phone calls reminders thrice weekly for 2 months.
Changes in FBG, diet, physical activities, and adherence to medications were assessed after
2 months.
STATISTICAL ANALYSIS USED: Means and proportions were calculated. Chi‑square test and
paired t‑test were used to calculate the P value.
RESULTS: FBG increased significantly in the control group by 25.6 mg/dl (P = 0.03), whereas it
was only 6.5 mg/dl in the intervention group (P = 0.56). Adherence to medications was increased
significantly in both interventions (+21%) and control (+19%) groups. Number of fruits intake days
per week (+1, P = 0.01) and fruits serving per day (+0.5, P = 0.00) have increased significantly in
the intervention group. Recreational physical activity was increased in the intervention group but
not statistically significant.
CONCLUSION: Our study findings suggest that mobile phone calls might help to improve
glycemic control. It also suggests that it could improve the adherence to medications and
intake of fruits. In the future, studies with large sample size and longer intervention need to be
conducted.

Abstract BACKGROUND: Childhood obesity remains a major health issue. The understanding of the
multifactorial nature of childhood obesity remains the cornerstone to eliminate the rising trends. This
study aimed to examine the association between parental and childhood weight status, in relation
to various socioeconomic (SE) factors.
METHODS: A cross‑sectional survey was conducted including 1190 children aged 10–12 years and
their parents, during school years 2014–2016. Primary schools from five Greek counties (including
Athens metropolitan area) were randomly selected. Parental and child data were collected through
self‑administered, anonymous questionnaires. Children’s weight status was based on gender‑ and
age‑specific tables derived from the International Obesity Task Force body mass index (BMI) cut offs.
General Linear Model (GLM), Univariate and multivariate analyses were applied. Multiple logistic
regressions was used to determine the association between children and parents’ weight status.
RESULTS: Childhood prevalence of overweight and obesity was 25.9% (21.8% overweight and 4.1%
obese), with prevalence being significantly higher in males (31.7% compared to 21.3%; P for gender
differences < 0.001). The percent of overweight and obese male (34.4% and 43.1%) and female
children (20.3% and 31.8%) significantly increased with paternal overweight and obesity status,
respectively. The same relationship was observed between male children and maternal overweight and
obesity status (43.4% and 65.7%). This was not evident among females (27% and 23.2%). Regression
analysis showed a significant positive association with parental BMI, a negative association with
both parental educational levels (low to high), living space, and parental age (P < 0.05, for all).
Children’s likelihood of being overweight or obese increased significantly with increasing parental
weight status (P < 0.001).
CONCLUSIONS: Parental weight status remained the most significant predictive factor for early
adolescence obesity among various SE factors. Health promotion strategies should consider parental
education as an effective childhood obesity preventive measure.

Abstract Now, lifestyle diseases are quite common globally. The risk factors of lifestyle diseases such
as sedentary habits, lack of physical exercise, and lack of fiber result in the development of
noncommunicable diseases. However, when the point of discussion slightly shifted toward toilet
habits, it is always seems to be a secret affair. In fact, the discussion of defecation‑related matter
openly is considered a taboo. This is not uncommon even in medical fraternity. In fact, during the early
1980s, some researches on the association between the diarrhea prevalence, open‑air defecation,
and latrine use rate were documented. However, nobody acknowledges it socially desirable, now,
to discuss defecation‑related issues. The public health experts completely ignored the discussion
of ill‑effects of the use of pedestal latrine on human health. It is evident from scientific studies over
a period, that many of the abdominal disorders of the human due change in his toilet habits from a
squatting‑to‑sitting posture using a pedestal latrine. That disease correlation was ignored at that time.
The increase in disease burden is due to nonmaintaining the ergonomic design during the construction
of this kind of toilets. Squatting posture for the defecation is the most appropriate way, as in this case,
abdominal muscles work actively and complete evacuation takes place. To conclude, the time has
come to reacquaint people with their natural habits and put this unfortunate experiment to an end.

Abstract PURPOSE: Noncommunicable disease (NCD) prevention is emerging as a public health priority in
developing countries. For better health outcome in these countries, it is necessary to understand the
different community‑based interventions developed and implemented across the world.
OBJECTIVE: The objective of the current review is to identify the best strategies used in
community‑based health intervention (CBHI) programs across the world.
MATERIALS AND METHODS: For review, we searched in PubMed and Google Scholar with the
keywords “community based,” “health interventions,” “health promotions,” “primary prevention,” chronic
diseases,” “lifestyle‑related diseases,” and “NCD.” Data were extracted using predesigned data
extraction form. CBHI studies detailing their intervention strategies only were included in the review.
RESULTS: Out of 35 articles reviewed, 14 (40%) were randomized control trials, while 18 (51.4%)
were quasi‑experimental design. Individual level (n = 14), group level (n = 5), community level (n = 6),
and policy level (n = 4) intervention strategies were identified. Twenty‑three (64%) studies were based
on interventions for 1 year and above. Twenty‑eight (80%) studies were intervened among specific
populations such as Latinos and so on.
CONCLUSION: Successful programs advocate for a package or a chain of interventions than a single
intervention. The type of interventions at different levels, namely individual, group, community, and
policy levels vary across studies, but individual, and group level interventions are more frequently used.

Abstract CONTEXT: The World Health Organization (WHO) has emphasized the need for reorientation of
hospitals toward health promotion (HP).
AIMS: This study explores health‑care professionals’ perception of barriers and strategies to
implementing HP in educational hospitals of Isfahan Province in Iran.
SETTINGS AND DESIGN: The study settings included four selective educational hospitals and the
Treatment Administration affiliation to the Isfahan University of Medical Sciences.
SUBJECTS AND METHODS: A qualitative content analysis approach was employed in this study,
with semi‑structured in‑depth interviews. Eighteen participants from hospital and accreditation
managers, nurses, community medicine specialist, and directors of health‑care quality improvement
and accreditation participated in the study by purposeful sampling method. The data were analyzed
using content analysis method.
RESULTS: The barriers can be categorized into the following areas: (1) barriers associated with
patient and community, (2) barriers associated with health‑care professionals, (3) barriers associated
with the organization, and (4) external environment barriers. The results were summarized into four
categories as strategies, including: (1) marketing the plan, (2) identifying key people and training, (3)
phasing activities and development of feasible goals, and (4) development of strategic goals of health
promoting hospitals and supportive policies.
CONCLUSIONS: The interactions of individual, organizational, and external environmental factors
were identified as barriers to implementation of HP in hospitals. To hospital reorientation toward HP,
prioritizing the barriers, and using the proposed strategies may be helpful.

Abstract INTRODUCTION: Providing health promotion and communication learning opportunities for medical
students practising their theoretical information into action, addressing the health problems, and
trying to find suitable and feasible interventions is very much neededto learn and experience directly
about healthrelated behavior in the community. Health promotion practice of PRECEDE‑PROCEED
model, is used as the foundation of this Family Outreach and Empowerment Program (FOEP). This
study aims to implement and evaluate FOEP as an effective health promotion learning model for
undergraduate medical students.
METHODS: Two hundred and forty‑four medical students joined the program for the whole weeks.
The reports were evaluated to assess their activities throughout the process. Evaluation was done
using the assessment checklists based on PRECEDE‑PROCEED framework. Data collected from
the assessment will be processed and analyzed using the IBM SPSS Statistics 22 program.
RESULTS: Two hundred and forty‑four report’s has been evaluated, the report’s scores in the
category very good is 136, good 64, enough 26, bad 12 and very bad 6. The main problem in FOEP
is behavior (37,6%) and the most alternate intervention choosen is education (232).
DISCUSSION: The most intervention used by students for FOEP was education because it has been
proven that can demonstrate feasibility, effectivity, increase knowledge control, and self‑efficacy
among disease.
CONCLUSION: Student’s reports was already satisfied.

Abstract INTRODUCTION: In recent decades, the focuses of health studies were mostly in middle‑aged
women, and few studies have investigated the lifestyle of women after delivery. The aim of this
study was to determine the effects of both self‑efficacy and perceived barriers on Iranian women
health‑promoting lifestyle (HPL) in the first 1 year after childbirth.
MATERIALS AND METHODS: Using a cross‑sectional design, 310 women at first‑year postpartum
were surveyed in Zanjan (Iran) in 2016. The proportionate stratified random sampling method was
carried out to select a participant. HPL has assessed with HPL profile II questionnaire. Self‑efficacy
was assessed using self‑rated abilities for health practices scale. Perceived barriers were assessed
by Barriers to Health‑promoting Activities for Disabled Person scale. A meditational model was used
to examine whether perceived barriers mediates between perceived self‑efficacy and HPL.
RESULTS: The participants mean age was 29.82 (5.1) years, 53.9% were primiparous, and most
of them were homemakers (82.9%). The mean total score of HPL was 2.50 (0.29). The relationship
between HPL and self‑efficacy was mediated by perceived barriers partially.
DISCUSSION: Self‑efficacy, not only promotes women’s HPL but also indirectly affect the women’s
lifestyle by reducing perceived barriers.

Abstract Introduction: Mass‑media campaigns such as, “Change4Life’ in the UK and “get
active America” in the US, promote physical activity (PA) recommendations of at least
150 min/week of moderate‑to‑vigorous PA (MVPA). We investigated whether different
messages used in MVPA campaigns were associated with intention to engage in more
MVPA. Materials and Methods: Theory of planned behavior (TPB) constructs; subjective
norms, affective attitudes, instrumental attitudes and perceived behavioral control (PBC)
were applied to explain the associations between campaign messages and intentions to
engage in more MVPA. Results: A total of 1412 UK adults completed an online survey on
MVPA and TPB. The sample was 70% female and 93% white with 23% reporting meeting PA
guidelines. Participants received one of three messages: A walking message either with or
without the 150 min/week threshold (WalkT; WalkNT); a physiological description of MVPA
with the 150 min/week threshold (PhysT). ANCOVA examined group differences in intention.
Path analysis evaluated mediation by TPB variables. ANCOVA identified lower intentions to
increase MVPA in group PhysT relative to WalkT and WalkNT (P < 0.001). PBC mediated
this relationship in WalkT (β = 0.014, 95% confidence interval [CI] = 0.004–0.028) whereas
affective attitudes mediated this relationship in WalkNT (β = 0.059, 95% CI = 0.006–0.113).
Conclusions: Campaigns promoting MVPA guidelines need to choose their messages carefully.
Messages which exemplified MVPA through walking were associated with higher intentions to
increase MVPA than messages using a physiological description. Further, PBC was enhanced
when the 150 min/week threshold was promoted alongside the walking exemplar. Future
exemplars should be investigated to inform adults how to meet MVPA guidelines.

Abstract Objective: This study was conducted to investigate the relationship between the intake of
different food groups by pregnant mothers and neonatal low birth weight and premature
births. Materials and Methods: In this cohort, the target population was 225 pregnant women,
randomly selected from different geographical areas of the city of Isfahan, Iran (from April to
September, 2012). The main variables in the study were weight and gestational age of the
neonates and the type and amount of different food groups used by the mothers. All nutritional
variables were compared according to different groups of infants (normal, premature, and low
birth weight). In the multivariate analysis, multiple linear and logistic regression models were
used to identify those different food frequency questionnaire (FFQ) variables independently
associated with the newborn’s weight and gestational age, adjusted by maternal consumption
of calcium supplementation, folic acid, and omega‑3, during pregnancy. Results: A total
of 214 (47.7% boys) infants with complete information were included. They had a mean
gestational age of 38.72 ± 1.2 weeks. The mean birth weight was 3.11 ± 0.384 kg. The
percentages of premature and low birth weight (LBW) infants were 7 and 5%, respectively. At
multiple logistic regression controlling for potentially confounding factors that were significantly
associated with prematurity and LBW at univariate analysis (maternal consumption of calcium
supplementation, folic acid, and omega‑3, during pregnancy), type of nutritional groups
containing dairy products, proteins, fish, and shrimp group, as well as fruits and vegetables,
had a significant positive association with increasing the gestational age (P < 0.05). The group
that consumed proteins, fish, and shrimp, as well as fruits and vegetables had a significant
positive association with the newborn’s weight (P < 0.05). Conclusion: This study indicated
the importance of proper nutrition on reducing the rates of LBW and premature births.
Comprehensive educational programs at
individual and public levels are warranted in
this regard.

Abstract The purpose of this paper is to describe the multifaceted nature and benefits of worksite health
promotion programs (WHPPs), with emphasis on the college setting. An assessment of the
peer-reviewed literature was conducted of articles published since 2000. Several search engines
were accessed and selected key words were used. Most studies examining WHPPs have
focused on return on investment and productivity. Research that targets the softer side-benefits
of health promotion programs in the workplace is less available. Although the college setting
offers some advantages for implementing health promotion programs. They may also have
unique challenges due to their large and diverse employee population. There is little research
to show the effectiveness and unique challenges of college-based health promotion programs.

Abstract Background: The advent of internet has triggered a growth in provision of more interactive
health promotion messages, which are likely to enhance the potential for behavior change
especially among children. We intended to find out the determinants and prevalence of use
of internet among school students of Puducherry. Materials and Methods: An exploratory
study was carried out among all the students belonging to the standards VI to IX (n = 421) in
three schools from urban areas and two schools from rural areas of Puducherry. A pretested,
self-administered questionnaire which sought information on sociodemographic details (age,
gender, standard of education, occupation of father, and type of school), use of internet, and
place of accessing internet, hours of use, and reasons for use was utilized. The statistical
significance between the categorical variables was done using chi-square test. All significance
tests were two-tailed and statistical significance was defined as a value of P < 0.05. Results:
Majority (72.2%) were boys. Less than one-third (23.8%) of the students used internet. The
use of internet was found to be significantly higher in mid-adolescents (Adjusted OR: 2.205);
among boys (Adjusted OR: 3.835) and students from urban areas (Adjusted OR: 4.694).
Conclusion: There is a geographical and gender divide observed among the school children
in the use of internet. Taking the steps to bridging the digital divide will help utilize internet as
a media for health promotion.

Abstract Background: Asthma is the most prevalent disease during childhood, known as the most important
reason for children’s disability adolescences truancies, thanks to their hospitalization and as a result
intensification of disease symptom. Material and methods: The present study is quasi-experimental
kind, implemented with two groups. Sampling method was straightforward. 80 student’s secondgrade high school students constitute participants. Both groups were homogenized considering
age, gender, education, and parent’s vocation. First of all, a letter agreement was received from
students. Then, the knowledge and accomplishment of students were measured by means of
relevant questionnaire and checklist in advance of educational intervention. In the next step, during
4 sessions, educational content specified beforehand was presented to students via interview,
lecture, group discussion, and display methods. The knowledge and accomplishment of both
groups’ students was measured through questionnaire and checklist. Finally, the data was analyzed
by SPSS 16 and statistical test of t-paired, independent-t, man-Whitney, and ANOVA. Results: The
finding demonstrated that group’s student accomplishment registered 91.8 ± 1.3 while being
2.2 ± 0.6 before holding session. In addition, their knowledge increased significantly, registering
99.6 ± 1.2 while it had measured as 1.3 ± 0.3 before sessions. The results of paired t-test indicated
that the average of difference between knowledge and accomplishment grades of two groups
was significant (P<0.05). Conclusions: Regarding the finding of the present study and the fact
that asthma is on the rise resulting in an increase in truancies as well as stressing the efficacy of
training peers suffering from the disease, the implementation of the curriculum could be necessary.