Journal of Education and Health Promotion

Abstract BACKGROUND: Gestational diabetes is the most common medical complication and a common
metabolic disorder during pregnancy. Increasing people’s self‑efficacy is one of the best ways to
control this disease. As there is a lag of intervention in this regard, the purpose of this study was to
determine the effect of couple supportive counseling on self‑efficacy in women with insulin‑treated
gestational diabetes.
MATERIALS AND METHODS: In this randomized clinical trial, 64 women with gestational diabetes
who referred to diabetes clinic of Mashhad Ommolbanin Hospital were divided into intervention and
control groups through block randomization during 2019. Their gestational age was in 26–30 weeks.
For the couples in the intervention group, three couple supportive counseling session was held. Each
session lasted 1 h and was held one time per week. The instruments were diabetes self‑efficacy
questionnaire, fasting and 2‑h postprandial checklist and Cassidy social support, which were assessed
before and 4 weeks after intervention in both groups. Data was analyzed by SPSS software version 25
through Mann–Whitney and Wilcoxon test. P values of < 0.05 were reported to be significant.
RESULTS: In the preintervention, the diabetes self‑efficacy score had no significant difference
in the intervention (30/6 ± 38/50) and control groups (09/8 ± 56/51) (P = 515/0). However, in
the postintervention, the diabetes self‑efficacy score was significantly higher in the intervention
group (58/6 ± 41/71) compared to the control group (15/7 ± 31/51) (P < 001/0). Also, before the
intervention, there was no significant difference between the intervention (30/2 ± 72/10) and control
group (87/1 ± 63/11) (P = 137/0) regarding social support. However, after the intervention, there was
a significant difference between the intervention and control groups (879/0 ± 53/13, 03/2 ± 41/11,
P < 0/001 respectively). Also, data analysis showed a significant correlation between self‑efficacy
and social support (r = 0.451, P < 0.001), self‑efficacy and fasting blood sugar (P < 0.001, r = ‑0.577),
and 2 h post prandial (r = ‑0.778, P < 0.001).
CONCLUSION: Couple supportive counseling leads to increased self‑efficacy and social support
in pregnant women with gestational diabetes. Therefore, it is recommended to use this counseling
as an effective method in the management of diabetic pregnant women during their prenatal care
to have a healthier pregnancy.

Abstract BACKGROUND: The COVID‑19 pandemic has become a major problem for education systems. This
study was conducted to investigate the effect of educational intervention based on the self‑efficacy
theory of high‑school students in adopting preventive behaviors of COVID‑19.
MATERIAL AND METHODS: This quasi‑experimental study was performed on Hazrat Zahra and
Shahed high‑school students in Jahrom (southern Iran) in 2021. In total, 160 students (80 each in
the intervention group and the control group) were selected by multistage random sampling. Data
collection tools included a demographic information questionnaire and self‑efficacy in adopting
preventive behaviors from COVID‑19 researcher‑made questionnaire. Questionnaires were completed
by all participants before and 3 months after the educational intervention. The educational intervention
was performed for 6 weeks by using an educational program based on Bandura self‑efficacy theory.
The intervention was performed during 12 sessions of face‑to‑face training in the classroom (two 1‑h
sessions per week), distributing educational packages and sending educational videos through
cyberspace. Data were analyzed using Chi‑square test, independent t test, paired t test, and linear
regression.
RESULTS: After the educational intervention, a significant difference was observed in the intervention
group before and after the educational intervention (P = 0.018) and between the intervention and the
control groups (P = 0.001) in the self‑efficacy in adopting preventive behaviors from COVID‑19 score.
Also, the average self‑efficacy score of students increased with an increase in parental education
level and a history of COVID‑19 in family members.
CONCLUSION: Educational intervention based on self‑efficacy theory was shown as an effective
method to improve students’ self‑efficacy in adopting preventive behaviors from COVID‑19.

Abstract BACKGROUND: Preconception reduces unplanned pregnancies and plays an important role in 
reducing maternal and infant mortality. Considering the importance of these care services, this study 
was conducted to determine the status of preconception care (PCC) model with Structural Equation 
Modeling (SEM).
MATERIALS AND METHODS: This cross-sectional descriptive study was conducted on 394 pregnant 
women referring to Gorgan’s health centers. Samples were selected by multi‑stage stratified sampling 
method. The instrument used in this research was a researcher-made questionnaire by Bayrami. Data 
were analyzed using R software version 4.1.4. Structural equation modeling (SEM) with weighted 
least square mean and variance method was used to fit the conceptual model and the significance 
level of the tests was considered 0.05.
RESULTS: The results showed that PCC model was deemed appropriate as optimum conditions 
indicators of goodness of fit; knowledge with a coefficient of 0.182 leads to self‑efficacy (SE), and 
SE affects the accessibility of facilities with a coefficient of 0.465 and the expected outcome with a 
coefficient of 0.500. After facility structure with a coefficient of 0.500, SE construct with a coefficient 
of 0.215 had the most effect on performing PCC behavior.
CONCLUSIONS: Facilities and SE as a key element of empowerment have an important role in 
promoting PCC. Identifying the factors associated with this care appears to help health policymakers 
to planning for these caregivers more precise and sensitive.

Abstract BACKGROUND: Vaginal childbirth is the most stressful physical and mental event for most women, 
which necessitates the use of coping styles. Furthermore, childbirth self‑efficacy will be one of the 
effective factors to cope with this stressful situation and doing compatible behaviors with childbirth 
pain. Therefore, the aim of this study was to determine the relationship between childbirth self‑efficacy 
and coping styles of problem based and emotive based in nulliparous pregnant women.
MATERIALS AND METHODS: This study is a descriptive‑correlational study that is done over 323 
nulliparous pregnant women attending the health centers in the city of Zahedan in 2020–2021. Data 
were collected by participants’ demographic questionnaire, childbirth self‑efficacy questionnaire 
of Lowe, and coping styles questionnaire of Folkman and Lazarus. The data were analyzed using 
Spearman’s correlation coefficient test, linear regressions model, and multiple regression in SPSS 
software version 22. P < 0.05 was considered statistically significant.
RESULTS: Results of Spearman’s correlation coefficient test showed a significant direct correlation 
between problem‑based coping style and childbirth self‑efficacy (P = 0/017, r = 0.13); but, there was 
no significant direct correlation with emotive‑based coping style (P = 0/782, r = 0.01). According 
to the linear regressions model, just the problem‑based coping style is predicted childbirth 
self‑efficacy (P = 0/006).
CONCLUSIONS: According to the findings, nulliparous pregnant women should be responsible, 
have a positive reassessment of vaginal childbirth, plan to solve their problems, and look for social 
support (all of these are part of a problem‑based coping style) to increase and improve their childbirth 
self‑efficacy. Furthermore, designing appropriate educational interventions based on problem‑based 
coping style is necessary.

Abstract BACKGROUND: Online learning self‑efficacy is considered a major contributor to academic success. 
The present study was conducted to assess the psychometric properties of the Persian version of 
the Online Learning Self‑Efficacy Scale.
MATERIALS AND METHODS: A cross‑sectional study was conducted on 211 medical students at 
Kerman University of Medical Sciences in 2021 who were selected through the convenience method. 
Data were collected using a two‑part self‑administered online questionnaire containing demographic 
information and the Persian version of the Online Learning Self‑Efficacy Scale (OLSES). Forward and 
back‑translation methods were used to provide the Persian version of OLSES. Internal consistency 
of the Persian version was determined by the Cronbach alpha coefficient in a pilot study. Exploratory 
and confirmatory factor analyses were conducted using SPSS version 20.0 and LISREL version 8.80.
RESULTS: The mean of the participants’ age was 21.40 ± 2.52 years, and most of them (56.4%) 
were female. The Cronbach alpha coefficient was determined as 0.74, 0.90, 0.75, and 0.89 for 
learning, time management, technology use subscales, and the whole scale, respectively. Exploratory 
factors analysis revealed the justifiability of factor analysis. In confirmatory factor analysis, most of 
the goodness of fit indices had an acceptable level.
CONCLUSIONS: Our study found that the Persian version of OLSES had good psychometric 
properties and can be used as a simple, valid, and reliable tool to assess students’ self‑efficacy 
related to the e‑learning environment.

Abstract BACKGROUND: To control blood sugar and prevent complications related to diabetes, eating fruits 
and vegetables in standard amounts is recommended. The aim of this study was to investigate the 
factors affecting the consumption of fruits and vegetables in diabetic patients based on the Pender 
health promotion model.
MATERIALS AND METHODS: This cross‑sectional study was conducted on 260 diabetic patients in 
Sirjan; one of the cities of Kerman in Iran in 2020. To collect data, a researcher‑made questionnaire 
of Pender’s Health Promotion Model and a standard Behavioral Risk Factor Surveillance System 
questionnaire were used to measure fruit and vegetable consumption. Data were analyzed using 
SPSS24 software. Data were analyzed using t‑test, Pearson correlation coefficient, linear regression, 
and path analysis. Significance level <0.05 was considered.
RESULTS: The study showed that 71.5% of patients consumed fruits three or more times and 52.3% 
consumed vegetables per week. Employment, income, education, and gender were significantly 
associated with fruit and vegetable consumption (P < 0.05). Perceived barriers (P < 0.0001, β =0.23), 
self‑efficacy (P < 0.0001, β =0.32), and commitment to action plan (P = 0.002, β =0.20) were the 
main predictors of fruit and vegetable consumption.
CONCLUSION: In this study, self‑efficacy was the strongest predictor of fruit and vegetable 
consumption in diabetic patients. Therefore, it is necessary to consider health education as well as 
health promotion interventions based on these variables is considered to increase the consumption 
of fruits and vegetables for diabetic patients.

Abstract BACKGROUND: Pregnancy anxiety is associated with a diverse birth outcomes. Mothers’ education
could have a critical role in increasing their self‑efficacy to defeat their anxiety and improve pregnancy
and child birth outcomes. The study was conducted to examine the effect of intervention based on
self‑efficacy theory on pregnancy anxiety and child birth outcomes.
MATERIALS AND METHODS: The study was conducted as a quasi‑experimental design on
60primiparous women (26–28 weeks) in Birjand (East Iranian province) from May to September 2017,
who were randomly divided into intervention and control groups. The intervention group received
8 sessions of 90‑min educational intervention based on self‑efficacy theory strategies besides the
routine prenatal care. Vanden Bergh’s pregnancy anxiety questionnaire and checklist of pregnancy
and delivery outcomes were used for data collection.
RESULTS: The level of pregnancy anxiety was similar in both groups before the intervention, but
immediately and 1 month after the intervention, the mean score of pregnancy anxiety significantly
reduced in the intervention group and significantly increased in the control group (P < 0.001). There
was a significant difference in mean neonatal weight (P < 0.001) between the two groups. Emergency
and elective cesarean section were significantly lower in the intervention group compared to the
control group (P < 0.001), but there were no significant differences in the frequency of preterm
delivery between two groups (P < 0.05).
CONCLUSION: The results provide support for the effectiveness of intervention based on self‑efficacy
theory in reducing pregnancy anxiety and enhancing positive pregnancy outcomes. Hence,
theory‑based educational interventions may serve as a cost‑effective and noninvasive approach to
reduce pregnancy anxiety in Iran.

Abstract BACKGROUND: Low self‑esteem and inefficiency are major problems in multiple sclerosis (MS)
patients. A progressive muscle relaxation technique is one of the complementary therapies. The
objective of this study was to investigate the effect of progressive muscle relaxation techniques on
self‑esteem and self‑efficacy in MS patients.
MATERIALS AND METHODS: This clinical trial was conducted on 100 MS patients were randomly
divided into two groups of experimental (n = 50) and control (n = 50). The experimental group received
progressive muscle relaxation techniques in eight 60‑min sessions twice a week for 4weeks. Rosenberg’s
Self‑Esteem Scale and Self‑Efficacy Scales of MS patients were completed before, immediately, and
4 weeks after the intervention. Data were analyzed using the SPSS software version 16.
RESULTS: The mean score of self‑esteem was not significantly different between the
control (26.02 ± 5.83) and experimental (26.40 ± 6.06) groups before intervention (P = 0.247).
The mean score of self‑esteem in the control group (27.16 ± 7.45) and the experimental
group (29.06 ± 6.61) immediately after the intervention (P = 0.083) was not significantly different.
4 weeks after the intervention, the mean scores of self‑esteem in the control (26.96 ± 8.33)
and the experimental (29.98 ± 7.02) groups were significantly different (P = 0.012). The
mean score of self‑efficacy was significantly different between the control (41.62 ± 4.46) and
experimental (39.32 ± 4.31) groups before intervention (P = 0.010). The mean scores of self‑efficacy
in the control group (38.38 ± 5.07) and the experimental group (44 ± 4.46) immediately after the
intervention (P < 0.001) and 4 weeks after intervention showed a significant difference between the
control group (38.04 ± 5.46) and the experimental (46.40 ± 5.04) groups (P < 0.001).
CONCLUSION: Due to the effect of progressive muscle relaxation on self‑esteem and self‑efficacy
of MS patients, its safety and simplicity, this technique can be used as a complementary therapy to
enhance the level of self‑esteem and self‑efficacy of MS patients.

Abstract BACKGROUND: This study aimed to investigate the effect of educational intervention based on the
Pender’s health promotion model (HPM) on lifestyle and self‑efficacy of the patients with diabetic
foot ulcer.
MATERIALS AND METHODS: In this clinical trial conducted in 2019, 74 patients based on
inclusion criteria were selected through convenience sampling and allocated to two groups of
intervention (n = 37) and control (n = 37) using the randomized permuted block method. In this
study, Demographic characteristics and localized Diabetes Foot Care Self‑Efficacy Scale and
Health‑Promoting Lifestyle Profile Questionnaire for diabetic foot care were completed by two groups.
The obtained data were analyzed using SPSS 16 and through descriptive and comparative statistics,
independent t‑test, paired t‑test, and ANCOVA.
RESULTS: After the intervention, the mean score of the intervention group significantly increased
in all lifestyle dimensions (P < 0.001). Furthermore, the mean score of self‑effcacy increased in the
intervention group after the intervention (P < 0.001). Comparing the change in the mean scores of
lifestyle and self‑efficacy in both the groups 50 days after the intervention, an increase was observed
in the mean scores of self‑efficacy (P < 0.001) as well as those of lifestyle and its dimensions in the
intervention group compared to those in the control group (P < 0.001).
CONCLUSION: Educational intervention based on the Pender’s HPM can promote the self‑efficacy,
lifestyle, and its dimensions in the patients with diabetic foot ulcers. The results of this study can be
used in educational interventions aiming at patients with diabetic foot ulcers to change their lifestyle
and improve their self‑efficacy.

Abstract BACKGROUND: Osteoporosis is a common disease in women over age 45 years.
Calcium intake is among the factors that help prevent osteoporosis. Identifying the social‑cognitive
determinants of calcium intake can have a major role in the development of osteoporosis prevention
programs.
MATERIALS AND METHODS: This cross‑sectional study was conducted on 400 women
aged <50 years from 10 health centers by cluster sampling in Isfahan in 2016. A hypothetical
social‑cognitive model was assessed using path analysis, and the fit indices and explanatory power
of the model were assessed. The constructs, including self‑efficacy, outcome expectations, social
support, and self‑regulation, were taken as the explanatory variables and calcium intake as the
criterion variable.
RESULTS: The mean age of the participating women was 34.07 years (standard deviation = 7.99)
(range = 19–50), and their mean calcium intake was reported as 909.94 (12. 6) mg/day. The
conceptual model was able to explain 73% of the variance in calcium intake and had good fit indices.
Self‑regulation was identified as the strongest predictor of calcium intake, and outcome expectation
was eliminated from the model since it was the weakest explanatory factor of calcium intake.
CONCLUSIONS: The theoretical model of this study is recommended as a suitable framework for
the development of targeted osteoporosis prevention interventions.

Abstract BACKGROUND: Adolescents experience many physical and psychological changes during
adolescence. Not paying attention to the issue of girls’ puberty may have a negative impact on their
mental health and self‑efficacy in future. The aim of this study was to compare the two methods of
motivational interviews and peers on puberty health of female high school students.
MATERIALS AND METHODS: This study was performed semi‑experimental intervention on 334
high school students in 2019 through multi‑stage randomization. Data using two demographic
questionnaires and Scherrer self‑efficacy questionnaire in three stages (pre‑test, immediately after
the test and one month after the test). It was collected that in the motivational interview group, 5
training sessions were presented, and in the peer group, only one training session was taught to the
peers and the control group was not trained in any intervention.
RESULTS: Immediately after, and 1 month after the intervention, the two intervention groups had
significantly better scores in self‑efficacy compared to the control group (P = 0.001). The mean score
of self‑efficacy in the control group in the three time periods before, immediately, and one month
after the intervention, respectively (50.75 ± 5.322, 50.45 ± 5.34, 50.45 ± 5.37), in the motivational
interview group (50.56 ± 5.95, 53.63 ± 5.83, 56.03 ± 6.49) and in the peer group (50.10 ± 5.62,
54.40 ± 4.28, 59.19 ± 4.43) was. Moreover, there were significant differences in self‑efficacy scores
within and between the groups by time (P < 0.001) in intervention groups.
CONCLUSION: This study showed that puberty health education increases students’ self‑efficacy,
that correct information should be conveyed by peers and motivational interview, and motivational
interview is more effective.

Abstract BACKGROUND: There is growing acknowledgment that medical education can be a stressful
experience for students and may have a devastating effect on their psychological well‑being. The
present article, therefore, aimed at investigating students’ academic resilience as a mediating variable
in self‑efficacy‑test anxiety relation.
MATERIALS AND METHODS: In this cross‑sectional correlational study, a convenience sample
of 243 medical students was selected and participated, three prevalidated questionnaires were
applied, that is, general self‑efficacy questionnaire, academic resilience questionnaire, and test
anxiety questionnaire. To analyze the data, Pearson’s correlation coefficient as well as structural
equation modeling (SEM) were used.
RESULTS: According to Pearson’s coefficients, self‑efficacy was found to be positively correlated
with academic resilience (r = 0.437, P ≤ 0.01) and negatively with test anxiety (r = −0.475, P ≤ 0.01).
SEM results also indicated that self‑efficacy positively impacts on academic resilience (β = 0.43,
P < 0.001) and negatively on test anxiety (β = −0.37, P < 0.001). In addition, results demonstrated the
mediating role of academic resilience in self‑efficacy‑test anxiety relationship (β = −0.108, P < 0.001).
CONCLUSION: This study showed that academic resilience could play a mediating role in students’
self‑efficacy‑test anxiety relationship.

Abstract BACKGROUND: Postpartum depression and anxiety is one of the most common complications
that women face and cause many problems for mother, baby, and family. Considering the effect of
self‑efficacy on women’s adaptation to pregnancy and delivery conditions and their mental health
during this period, the present study was designed to investigate the effect of pregnancy training
classes based on Bandura self‑efficacy theory on postpartum depression and anxiety and type of
delivery.
MATERIALS AND METHODS: In this clinical trial study, 64 pregnant women were randomly divided
into intervention and control groups. Mothers in the intervention group received pregnancy training
in eight sessions (each session was 2‑hour) from the 20th week of pregnancy. The classes were run
by a trained midwife and the content of the training was based on Bandura self‑efficacy components.
The mothers in the control group received routine care. The demographic‑reproductive information
form, Beck Depression and Spielberger Anxiety Questionnaire were completed by pregnant women
of both groups at several times, before the program, 1 week and 1 month after delivery.
RESULTS: The results showed that the training program significantly decreased the depression
score in 1 week and 1 month after delivery in the intervention group compared to the control group.
In addition, this training program decreased the mean score of apparent and hidden anxiety in the
intervention group 1 month after delivery, although this decrease was not statistically significant.
Furthermore, 80.55% of the intervention group and 58.33% of the control group had vaginal delivery,
which were significantly different between the two groups in terms of the type of delivery.
CONCLUSION: The findings showed that pregnancy training classes based on Bandura self‑efficacy
theory decrease depression and anxiety and increases vaginal delivery rate.

Abstract BACKGROUND: With the increase in the elderly population in the world and the consequent increase
in diseases and their physical and mental problems, improving self‑care behaviors by increasing
self‑efficacy in the elderly plays an important role in promoting their health and can increase their
life satisfaction. This study aimed to investigate the effect of self‑care self‑efficacy program on life
satisfaction of the elderly referred to selected health centers in Isfahan, Iran, in 2014.
MATERIALS AND METHODS: This study was a quasi‑experimental study with two experimental
and control groups and was performed on 64 elderly people referred to selected health centers in
Isfahan. The samples were randomly divided into experimental and control groups, and a self‑care
self‑efficacy program was performed on the experimental group. Data collection tools included
demographic information questionnaire and life satisfaction indexes A questionnaire. Data were
analyzed using the statistical tests such as Chi‑square, independent t‑test, Mann–Whitney, repeated
measures analysis of variance, and Least Significant Difference (LSD) post hoc test.
RESULTS: There was no significant difference between the two groups in terms of demographic
characteristics. Before the intervention, the mean score of life satisfaction was not statistically
significantly different between the two groups (P = 0.88). However, immediately and 1 month after
the intervention, the mean score of life satisfaction in the experimental group increased, and this
score was significantly different between the two groups (P < 0.001).
CONCLUSIONS: The results of this study showed that the self‑care self‑efficacy program has been
effective in increasing the life satisfaction of the elderly. Therefore, using this self‑care self‑efficacy
program is recommended to promote life satisfaction in the elderly.

Abstract BACKGROUND: Undergraduate dental students have to do multiple tasks as part of their extensive
curriculum in order to achieve the proficiencies expected of them. During the course of their study, a
tendency to procrastinate and question their self‑efficacy is detrimental for the students. The aim of
this study was to evaluate the level of procrastination and self‑efficacy and its related factors among
dental undergraduate students.
SUBJECTS AND METHODS: This cross‑sectional study was conducted among all (n = 361)
consented dental undergraduate students of our dental school. A twenty‑item Lay’s Procrastination
Scale for student population and a ten‑item General Self‑Efficacy Scale were used for the study after
getting institutional ethical approval. The quantitative data were explained using descriptive statistics.
Independent sample t‑test and ANOVA were used to determine the association between self‑efficacy,
academic procrastination, and genders and academic years. Pearson correlation coefficient was used
to determine the association between self‑efficacy and procrastination. Multiple linear regression
analysis was performed to determine the related factors to academic procrastination.
RESULTS: High procrastination (score ≥62) was seen among 28.5% of students. The mean
self‑efficacy score was 29.5. There was no significant difference between genders for procrastination
scores (P = 0.835) and between academic years (P = 0.226). Males showed significantly more
self‑efficacy (P < 0.001), and self‑efficacy did not show any significant difference (P = 0.204) between
academic years though a tendency for year 5 students to have lower self‑efficacy scores was observed.
Academic procrastination was negatively correlated with self‑efficacy (r = −0.238 and P < 0.001).
CONCLUSIONS: For dental undergraduates who have cognitive load as well as work associated
with patients, procrastination and self‑efficacy are negatively correlated.

Abstract INTRODUCTION: Families, especially parents, play an important role in identifying their children’s
talents and directing their educational journey. The role of parents in their children career applies
both to collectivist and to noncollectivist culture.
AIM: To examine the correlation between parental influences on medical students’ self‑efficacy and
career exploration in collectivist culture.
METHODS: This research was a quantitative study. The study involved 1017 medical students of
medical faculties in four faculties of medicine in Indonesia. All data were collected online in August
2018. The study was conducted using an online survey questionnaire and analyzed to finally form a
model that displays the determinants of career exploration behavior. The data were analyzed using
the maximum likelihood estimation in IBM AMOS 24.
RESULTS: The results found a model that has various routes toward career exploration in collectivist
culture. Path analysis revealed both direct and direct effect toward the variable studied. Parents’
expectations had influence on self‑efficacy.
CONCLUSION: The findings show the important role between the influence of parents expectations
for self‑efficacy and career exploration in children.

Abstract BACKGROUND: Osteoporosis is one of the major problems associated with aging and is more
common among women than men. This study was designed to modify osteoporosis‑related behaviors
in female students based on the transtheoretical model (TTM).
MATERIALS AND METHODS: This quasi‑experimental study was conducted on female
secondary school students. The sample size was determined 100 by using Altman’s nomogram,
including 50 cases and 50 controls. Participants were completed the Demographic Information and
Osteoporosis‑Related Behavior Questionnaire based on TTM. Evaluation of the data showed that
each participant was at what stage of change in physical activity and preventive dietary behavior
of osteoporosis. The content of the training package was designed, and for the intervention group,
2‑h training sessions were held weekly by the instructor in accordance with the stage of change
for 2 months, and the booklet was provided with the appropriate contents of the stage of change.
Three months after the completion of training, the questionnaires were completed by intervention
and control groups. Statistical analysis was performed using SPSS 23 software.
RESULTS: Concerning the stages of change in physical activity and nutrition, a significant difference
was before and after the intervention in the intervention group (P < 0.001), while no significant
difference was observed in the control group. After the intervention, there was a significant difference
in the self‑efficacy and some subconstruct of processes of change, but there wasnot a significant
difference in the decisional balance.
CONCLUSION: Educational intervention based on TTM has been successful in achieving the goal of
modifying osteoporosis‑related behaviors in female students. The results of this study can be used
by health planners to plan and implement health promotion interventions that will undoubtedly help
reduce the burden of disease.

Abstract INTRODUCTION: Emotional intelligence (EI) and self‑efficacy are important factors that lead to
success in work, life, and education. Various studies assessed the relationship between EI and
well‑being, performance, and self‑efficacy in educational levels, but this topic has been rarely
assessed in the occupational and administrative environments. The present study aimed to examine
the relationship between EI and self‑efficacy among administrative staffs of Kerman University of
Medical Sciences.
METHODS: The study employed a descriptive‑correlational design and was conducted in six deputies
supervised by the Kerman University of Medical Sciences in 2019, and 275 participants were selected
using a census method. The research data were collected using the Goleman’s EI framework with a
reliability coefficient of α = 0.87 and Sherer General Self‑Efficacy Scale with a reliability coefficient of
α = 0.78. Data analysis was performed through Kolmogorov–Smirnov, analysis of variance, Tukey,
and Pearson’s correlation coefficient techniques at P < 0.05 significance level.
RESULTS: The mean score of EI was 98.8 ± 11.1 and the mean score of self‑efficacy was 60 ± 7.17.
There was a significant positive relationship between the scores of EI and self‑efficacy. In addition,
the findings indicated a positive significant correlation between self‑efficacy with self‑awareness,
self‑regulation, and social skills.
CONCLUSION: The findings of the current study confirm that EI has positive relationships with
administrative personnel’s self‑efficacy. Therefore, implications of the findings can help in the selection,
training, counseling, and retention of administrative personnel to the improvement of medical sciences
universities’ occupational performance.

Abstract INTRODUCTION: Teacher empowerment is thought to improve student learning by fostering teaching
quality. Therefore, the purpose of this study is investigating the relationship between empowerment
and self‑efficacy of Iranian English as Foreign Language teachers.
MATERIALS AND METHODS: The present study is an experimental study; the population of the
study includes all the English language teachers of the universities of Ilam, Iran. Among whom by
random sampling, the sample which was consisted of 60 teachers were selected. Participants in
this study answered the School Participant Empowerment Scale questionnaire (Short and Rinehart,
1992) as the instrument of the study. The Pearson product‑moment correlation was computed to
determine the relationship between teacher empowerment and teacher self‑efficacy.
RESULTS: The results showed that there was a positive correlation between teacher empowerment
and their self‑efficacy (r = 0.55, P <  0.01) and differences among teachers’ self‑efficacy is not
significant according to age (r = −0.14, P = 0.23).
CONCLUSIONS: Based on the results of the study, empowerment and self‑efficacy have interactive
relationships; i.e. self‑efficacy in teachers leads to empowerment and empowerment in teachers
leads to self‑efficacy.

Abstract BACKGROUND: Metacognition and academic self‑efficacy are two emerging resources in the process
of learning. Basic levels of metacognition and academic self‑efficacy may differ and be influenced by
demographic and academic factors. This study investigated impacts of demographic and academic
factors on metacognition, metacognitive skills, and academic self‑efficacy in health sciences students.
MATERIALS AND METHODS: A cross‑sectional study was conducted among 404 participating
students attending various fields of study in health sciences at Shahrekord University of Medical
Sciences. Demographic and academic data were collected. Global metacognition, metacognitive
skills, and academic self‑efficacy scores were assessed using published or online questionnaires.
Means were compared using Student’s t‑test, whereas intra‑ and intergroups’ scores were compared
using one‑way ANOVA test.
RESULTS: Global metacognition and academic self‑efficacy were not impacted by demographic
students’ status. The gender and age impacted both knowledge and control of process‑ planning (favoring
male gender), as well knowledge and control‑of‑self (disfavoring 20–30 age class) of metacognitive
skills, (P < 0.05).  Academic status did not influence academic self‑efficacy. The school type influenced
the metacognitive skill component to knowledge and control of process‑regulation (disfavoring nursing
school) (P < 0.05). The academic discipline impacted the global metacognition (P < 0.05) and its
knowledge and control of self‑component (P < 0.01).
CONCLUSIONS: Demographic and academic status does impact metacognitive skills and global
metacognition scores. Given the heterogeneous level to innate metacognitive skills, this study sheds
lights on usefulness to screen learners’ subgroups that require supplementary educational instructions
to uniformly optimize metacognitive skills.

Abstract BACKGROUND AND AIM: The inability of women to demand from their husbands, for not smoking,
has been reported as a factor in exposure to cigarette smoke. This study aimed to investigate the
perceived barriers and self‑efficacy of pregnant women regarding second‑hand smoke (SHS) at home.
MATERIALS AND METHODS: This was a cross‑sectional study, and the sample size was 255
pregnant women who visited the health‑care centers in Isfahan, Iran, from July 2018 to September
2018, and were selected randomly and voluntarily. A questionnaire was designed to collect the
data about the exposure to smoke, perceived barriers, and self‑efficacy. The data were analyzed
using descriptive statistics (mean score and standard deviation), inferential statistics (nonparametric
Mann–Whitney and Kendall test), and Spearman’s correlation and regression.
RESULTS: The mean score of self‑efficacy in the exposure group was lower than that the other
group (P = 0.000). The mean score of perceived barrier was not a significant difference (P = 0.449).
Personal perceived barriers are the most important predictor of self‑efficacy of pregnant women
in exposure to SHS (95% confidence interval: 0.013–0.262) (P = 0.030). Kendall test comparing
items within the group and Mann–Whitney test comparing the two groups showed that personal
factors such as “Unaware of the dangers of SHS and protective measures” for notexposed women
and environmental factor “the lack of ban smoking law at home” for exposed women are considered
the most important barriers (P = 0.000). “Not being together a husband” (P = 0.293) and “going to
another place when smoking a husband” (P = 0.000) are the highest self‑efficacy items.
CONCLUSIONS: It is necessary to develop training programs to increase self‑efficacy to avoid
exposure to SHS and for both pregnant women and their husbands. It is also necessary to educate
and inform about SHS and protective measures against it and to set up “smoking ban law” at home
in our country to protect pregnant women.

Abstract OBJECTIVE: Self‑efficacy is an individual’s self‑perception of one’s ability to perform competently
and to achieve a task or goal effectively. In the nursing field, self-efficacy can be useful in predicting
performance, job satisfaction, or well-being. Therefore, due to the importance of this issue, this study
aimed to determine the effect of educational workshop on nurses’ self‑efficacy along with follow‑up
in patient training.
METHODS: The study employed a single group quasi‑experimental study with a pretest/posttest
design and was conducted in one educational hospital supervised by the Kerman University of Medical
Sciences in 2016. Nurses’ self‑efficacy was analyzed through a researcher‑made questionnaire
prior and after the workshop and along with the follow‑up period (n = 20). Data were analyzed using
descriptive statistics including mean and standard deviation and analytic statistics such as Pearson
correlation coefficient, independent t‑test, paired t‑test, and ANOVA with P ≤ 0.05.
RESULTS: This study showed that 1 month after educational workshop, the score of self‑efficacy
dimensions increased (P < 0.05). Furthermore, results showed that after a 3‑month follow‑up period,
self‑efficacy score increased in comparison to preintervention self‑efficacy score. Results showed that
the total score means of self‑efficacy before the workshop was 59.01 ± 14.91 while postworkshop,
self‑efficacy score means was 79.83 ± 11.90.
CONCLUSION: The present research results presented that educational workshop may enhance
self‑efficacy among nurses. According to the obtained results, it is recommended that the Ministry
of Health, Treatment and Medical Training, in cooperation with nursing institutions responsible for
nursing and medical in‑service education adopt necessary measures to enhance self‑efficacy among
employees in addition to improving patient training condition at medical processes through similar
workshops or conducting related studies.

Abstract BACKGROUND: Hemodialysis patients experience many issues in self‑care behavior. Patients
require to control of manage the issue to improve the self‑care. Educational intervention to behavior
change can be effective on self‑care behavior. This study was conducted to investigate the effect of
an educational intervention, based on the self‑Efficacy theory on promoting self‑care in hemodialysis
patients.
MATERIALS AND METHODS: Seventy hemodialysis patients recruited in this study and divided
randomly into intervention group (n = 35) and control group (n = 35) with convenience sampling in
2016 from Qom city, Iran. Data were collected before and 3 months after education using demographic
questionnaire, self‑efficacy, a valid researcher‑made questionnaire regarding to awareness and
self‑care. The educational intervention was performed for the intervention group in 4 1‑h sessions
over 2 months. The data were analyzed through Paired t‑test, Independent t‑test, Chi‑square, and
Mann–Whitney at the significant level of 0.05.
RESULTS: While variables in two groups did not show significant difference before education (P > 0.05),
a significant increase was observed in variables of self‑efficacy (P < 0.001), awareness (P < 0.001),
and self‑care dimensions (P < 0.05) between two groups after 3 months education.
CONCLUSION: The results of this research suggested that employing educational programs based
on the self‑efficacy theory can lead to the improvement of the self‑care behaviors in hemodialysis
patients.

Abstract INTRODUCTION: The present study aimed to investigate the effectiveness of cognitive behavioral
therapies (CBTs) for anxiety, hardiness, and self‑efficacy in female students of Birjand University
of Medical Sciences.
MATERIALS AND METHODS: This was an interventional study. A sample of 30 participants were
selected through the available sampling method and randomly assigned into experimental (CBT)
and control groups (each group, 15 female student). The data collection instrument was the Beck
Depression Inventory questionnaire. The questionnaires of Beck Anxiety Inventory, Ahvaz Hardiness
Inventory, and Schwartz’s General Self‑Efficacy Scale were completed by all participants in two
stages (pretest and posttest). A 6‑session protocol of cognitive behavioral group therapy was
performed only on the experimental group. The data were analyzed using Kolmogorov–Smirnov,
Levene’s F, Mbox, analysis of variance, and multivariate analysis of variance tests.
RESULTS: The intervention group showed that the mean of anxiety decreased, whereas (P< 0.001) the
means of hardiness and self‑efficacy increased in the posttest for the experimental group (P < 0.001).
CONCLUSION: Based on the obtained results, it can be concluded that CBT is an effective treatment
for anxiety, hardiness, and self‑efficacy. Therefore, through managing anxiety, the levels of hardiness
and self‑efficacy can be increased in students of university to be able to cope with the different
challenges in their life.

Abstract INTRODUCTION: Life satisfaction and its determinants in married women are essential for the
development of proper preventive programs. The aim of this study was to examine the relationship
between the communication skills, self‑efficacy, and self‑esteem with life satisfaction in married women.
SUBJECTS AND METHODS: This cross‑sectional, descriptive study was conducted on married
women who were selected by multistage random sampling, in Naien city health centers. Data
were collected using the Satisfaction With Life Scale (SWLS), General Self‑Efficacy Scale (GSE),
Rosenberg Self‑esteem Scale (RSE), and revised version of communication skills test. The data
were analyzed using the SPSS version 20 by descriptive statistics. Pearson correlations and multiple
regression analyses were used.
STATISTICAL ANALYSIS USED: Pearson correlations and multiple regression analyses and
ANOVA were used.
RESULTS: According to the regression analysis test, 35.8% of the total variance in life satisfaction
was accounted for by self‑efficacy, communication skills, and self‑esteem. Pearson correlations
demonstrated that all correlations between the variables were statistically significant. In
particular, self‑efficacy, communication skills, and self‑esteem had positively correlated with life
satisfaction (P < 0.05).
CONCLUSIONS: General self‑efficacy highly correlated with life satisfaction in married women.
Therefore, in order to increase life satisfaction in married women, it is necessary to focus more on
self‑efficacy promotion strategies.