Journal of Education and Health Promotion

Abstract BACKGROUND: Hypertension is a worldwide health issue. Increasing aging has given rise to the
prevalence of this problem. Disease management using educational intervention based on theoretical
frameworks is effective for influencing self‑care behavior. The goal of this study is to investigate the
effects of educational intervention on self‑care behaviors that influence hypertension control among
the elderly population during 2020 based on the health belief model.
MATERIALS AND METHODS: A quasi-experimental study was conducted on rural older people in
Ardestan, Iran. Assessments were done before and after three educational intervention sessions
with a control group. The random sampling has done on 99 hypertensive elderly people in two rural
centers of Ardestan from 2019 to 2020. Awareness variables, components of the health belief model,
and blood pressure were assessed before and three months after the intervention. Data analysis
was done using descriptive and analytical statistics.
RESULTS: The study groups did not differ significantly in terms of the variables studied at the
beginning of the study. After three months, the variables of awareness, self‑care, and perceived
sensitivity constructs, perceived severity, perceived benefits, and guide to action showed a significant
rise in the experimental group compared to the control group. In addition, the effectiveness of
educational intervention significantly increased self‑care behavior in the experimental group.
CONCLUSIONS: Educational intervention based on the health belief model can be effective to
reduce the barriers of self‑care behaviors. In order to have a lasting change in behavior, the use
of behavioral change patterns that ecologically take into account interpersonal, organizational, and
social factors is suggested too.

Abstract BACKGROUND: Medication adherence means compliance with patient adherence to medication 
orders, including timely and correct consumption of medication prescribed by a physician. The present 
study aimed to determine the extent of adherence to hypertension drug medication in patients covered 
by comprehensive health service centers of Shahrekord, Iran.
MATERIALS AND METHODS: A cross‑sectional study examined 401 hypertensive patients 
registered in the Integrated Health Record System (SIB). SIB is a Persian term related to Health 
Record System. To collect data, Morisky Medication Adherence Scale was used. The questionnaire 
was completed by the patients and analyzed using SPSS (SPSS Inc., Chicago, Illinois, USA, 
version 26), Chi‑square test, independent t‑test, and analysis of variance.
RESULTS: The results indicated that adherence to antihypertensive medication was low in 5.7% of 
patients, while 63.3% of patients had sufficient compliance. Forgetting to take medications (52.9%) 
was the most common reason for nonadherence to medication in hypertensive patients.
CONCLUSION: Given that forgetting to take medications was the main reason for nonadherence 
to medication in hypertensive patients, designing and implementing necessary trainings by 
comprehensive health centers to realize the importance of daily use of medication by hypertensive 
patients and their families are recommended.

Abstract BACKGROUND: Health‑promoting behaviors can affect the psychological and physical consequences 
of hypertension. For the prevention and control of hypertension, lifestyle modification has been 
recommended. This study aimed to investigate the health‑promoting behaviors of patients with 
hypertensive heart disease in Iran and compare them with those of healthy people.
MATERIALS AND METHODS: This was a descriptive comparative study with cross‑sectional 
design. Participants were 141 patients with hypertensive heart disease (mean age = 39 ± 10.2 years) 
referred to the cardiac clinic of Madani Hospital in Khorramabad, Iran, and 141 healthy people 
selected from those referred to the hospital. The Persian version of the revised Health‑Promoting 
Lifestyle Profile‑II (HPLP‑II) was used to evaluate the health‑promoting behaviors of participants. 
After collecting data, they were analyzed in SPSS v. 22 software using descriptive statistics and 
statistical tests including independent t‑test and one‑way ANOVA.
RESULTS: The overall HPLP‑II score was 142.34 ± 30.48 in patients and 150.52 ± 37.07 in 
controls. The highest and lowest HPLP‑II dimension scores in both groups were related to health 
responsibility and stress management dimensions. There was a significant difference between 
groups only in dimensions of nutrition (P = 0.017) and physical activity (P = 0.016), and in the overall 
score (P = 0.044), whose scores were lower in patients compared to controls. The difference in 
HPLP‑II score of patients with different demographic characteristics (marital status, place of residence, 
gender, age, educational level, and occupation) was not statistically significant.
CONCLUSION: Patients with heart disease caused by high blood pressure in Iran have poorer diet 
and physical activity compared to healthy people. Educational interventions with a focus on the 
importance of dietary regime and exercise are recommended for them.

Abstract BACKGROUND: Healthy dietary adherence might be one of the effective and modifiable factors
for hypertension (HTN) control; therefor, empowering patients for self‑care management including
healthy food patterns play a key role in guiding their care, in partnership with health care providers.
This study aimed to identify the factors predicting nutritional knowledge, illness perceptions, and
adherence to a diet based on transtheoretical model (TTM) among hypertensive middle‑aged women.
MATERIALS AND METHODS: A cross‑sectional survey was conducted on 164 patients with
HTN attending west health centers of Tehran, Iran, in 2020. Simple random sampling was used.
Sociodemographic characteristics of the respondents were collected, a valid and reliable measure
on nutritional knowledge, illness perceptions, and adherence to diet, and a researcher‑made
measure based on TTM constructs through in‑person interview was applied. Descriptive statistics
and general linear model were utilized for data analysis using SPSS version 25. The significance
level was considered less than 0.05.
RESULTS: Mean and standard deviation of participants was 50.82 ± 8.77 years. Multivariate
regression analysis indicated that family income (P < 0.001) and body mass index (P < 0.001) predicted
nutritional knowledge and adherence to diet, respectively. Decisional balance and self‑efficacy
constructs predicted nutrition knowledge and illness perceptions (P < 0.001). In adherence to diet,
overcoming the temptation construct was indicated as the only predictor (P < 0.001).
CONCLUSION: Study findings highlighted the necessity of tailoring and implementing interventions
based on TTM using appropriate strategies to promote quality of HTN management approach in
nutritional knowledge, illness perceptions, and dietary adherence.

Abstract INTRODUCTION: We know that risk communication is equally important as risk identification, which
is usually not communicated properly to the patients and resulting in poor outcomes, especially in
hypertensive patients.
OBJECTIVE: Our study objective was to evolve and test a colour coded client segmentation based
public health approach to educate the community to deal with problem of hypertension.
METHODOLOGY: This cross‑sectional pilot study was done in March 2020 among purposively approached
in a primary health centre to 100 people aged above 18 years, among them 41 gave written consent for the
study and their demographic information was noted. They were given colour coded cards as per the current
blood pressure level and previous history of hypertension. On each colour coded card, specific advice
was written for that category. For all the participants, blood pressure and treatment seeking behaviour was
noted. For hypertensive patients, adherence to medication and non‑pharmacological measures was noted.
RESULTS: Mean age of the participants was 46.5 ± 13.06 years. Mean systolic blood pressure (SBP)
and diastolic blood pressure (DBP) of the participants were 135 ± 16.85 mm Hg and 86 ± 11.42
mm Hg, respectively. Among the participants, 10 (24.39%) had a known history of hypertension.
Among them, as per the blood pressure levels measured on the day of the study 50% (5) had their
blood pressure levels under control. Interestingly 16 (39%) participants were found hypertensive
incidentally.
DISCUSSION: It is evident from the studies that colour coded approach is used in multiple ways, in
multiple settings, for multiple diseases. To our knowledge, little focus has been given for hypertensive
disorders in the community level. We merely bother about making their risk profiling, even in the
digital age. Sometimes physicians in emergency become puzzled whenever patients collapsed in front
of them and we missed the “Golden Hour” for the treatment by searching patients’ medical details.
CONCLUSION AND RECOMMENDATIONS: The above problem can be solved by risk profiling of
chronic patients by colour coded OPD/Health cards.

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: Hypertension (HTN) has become a major public health problem which can cause
serious complications when it is not well-controlled. Prevention and effective care of HTN require
a population-based registry. Thus, establishing this registry can be used to collect comprehensive,
timely, and reliable data on epidemiology cases. The aim is to create a registry for the collection of
highly required prospective data that will present an in-depth analysis of the characteristics of all
individuals with HTN and track them over a particular chronological interval.
MATERIALS AND METHODS: The study was divided into three phases: At first, a comprehensive
literature review was conducted to determine the proposed data classes and data fields. Then, the
final minimum data set was designed by a two-round Delphi consensus approach of 20 experts of
cardiologists, nephrologists, nutritionist, and health information management. Finally, a web-based
registry system was developed by a Structured Query Language environment.
RESULTS: A total of two clinical and nonclinical data categories with nine data classes and 68 data
fields were selected for their inclusion in the registry following the consensus phase. A web-based
registry was designed with a modular and layered architecture.
CONCLUSIONS: This study provides an appropriate information infrastructure for active tracing and
monitoring of individuals with HTN. It has provided a practical information system allowing quality
improvement, aggregate reporting for planning, and research purposes.

Abstract INTRODUCTION: Hypertension is one of the major health threats in the world today. The purpose
of this study was to find the relationship between hypertension with irrational health belief and health
locus of controls.
MATERIALS AND METHODS: The current work is a descriptive (case–control) study. One hundred
patients with hypertension and 100 healthy individuals were included in the study through available
sampling method. The Irrational Health Belief Scale and Multidimensional Health Locus of Control
questionnaire were used. Data were analyzed using independent t‑test and logistic regression.
RESULTS: The findings showed a significant relationship between the variables of irrational health
beliefs and the external health locus of control in hypertension. For a unit increase in an irrational
health belief score, the chance of having high blood pressure increases by 6%, and for a unit increase
in the score of external health locus of control, there is a 17% higher chance of having hypertension.
The independent t‑test of irrational health belief also showed a statistically significant difference
between the two groups (P < 0.01). There was also a statistically significant difference regarding
the health locus of control in the two groups of hypertension and healthy individuals in the subscale
of chance control (P < 0.01) and external locus of control (P < 0.01).
CONCLUSION: The results of this study make it necessary to identify irrational health beliefs as
well as the health locus of control in individuals. Modification of these structures can be useful in the
prevention and management of this chronic disease.

Abstract BACKGROUND: Poor adherence in treatment and medication is a global issue in curing the chronic
diseases such as hypertension. The present study was conducted to identify the factors related with
medication adherence among hypertensive patients referred to the health centers of Borujerd based
on the Pender’s Health Promotion Model (HPM).
MATERIALS AND METHODS: This cross‑sectional study was conducted on 463 patients who were
referred to the comprehensive health centers of Borujerd city by cluster sampling method in 2019.
The data were collected using a questionnaire including demographic variables and Pender’s HPM
constructs. Data were analyzed by SPSS 18 software using Pearson correlation coefficient and
linear regression.
RESULTS: The mean and standard deviation of the participants’ age was 63.29 ± 11.2 years. The
results showed that hypertensive patients had a relatively desirable level of medication adherence
behavior. Perceived barriers (β = −0.169), perceived self‑efficacy (β = 0.196), activity related affect
(β = 0.232), and following medication regimen (β = 0.225) were the best predictors of performing
the medication adherence behavior. In total, different structures of the HPM explained 42.2% of the
variation of medication adherence behavior changes.
CONCLUSIONS: According to the findings, the design of educational programs using HPM is
recommended to increase the medication adherence among hypertensive patients.

Abstract INTRODUCTION: Hypertension has a direct relationship with the circulation, respiration, and function
of vital organs. Similarly, complementary therapy such as alternate nostril breathing exercise has a
direct effect on mental and physical health.
MATERIALS AND METHODS: This is a quantitative experimental research with randomized
controlled trial design. A total of 170 and 85 individuals were allotted to each group. Patients in the
study group were instructed alternate nostril breathing exercise two times a day (10 min duration
of exercise each time) for 5 days along with routine treatment, and patients in the control group
underwent routine treatment.
RESULTS: There was a marked reduction in systolic blood pressure (BP), diastolic BP, heart rate,
and rate pressure product after the continuous 5‑day alternate nostril breathing exercise in the study
group. P < 0.0001 demonstrated a statistically significant difference in systolic BP, diastolic BP,
heart rate, and rate pressure product that existed pre‑ and post‑assessment on 1st day and 5th day.
CONCLUSION: It can be concluded that regular simple alternate nostril breathing exercise effectively
reduces hypertension.

Abstract BACKGROUND: Sympathetic overactivity mediates abnormal cardiovascular outcome that is affected
by stress, lack of physical activity (PA), and familial hypertension (HTN). It can be assessed by blood
pressure‑based sympathetic function tests.
OBJECTIVE: We studied sympathetic function tests in young nonathletic males in relation to measures
of obesity, PA, and familial HTN.
METHODOLOGY: We recruited 100 males (mean age: 19 years) and measured body mass
index (BMI) and body composition parameters by tetrapolar bioelectrical impedance such as total body
fat, visceral fat, subcutaneous fat, and skeletal muscle mass. Using instrument cardiac autonomic
neuropathy system of Recorders and Medicare System Company, India, blood pressures (supine,
standing, and post hand grip) were recorded and studied quantitatively and qualitatively.
RESULTS: Physically active and inactive individuals (n = 50 each) had comparable age, BMI,
measures of obesity, and sympathetic function tests. However, individuals with familial HTN (n = 37)
showed significantly higher obesity measures and blood pressures (supine: systolic blood
pressure [SBP] – 133 vs. 115 and diastolic blood pressure [DBP] – 79 vs. 76; standing: SBP – 136 vs.
122 and DBP – 80 vs. 76; post hand grip: SBP – 136 vs. 125 and DBP – 86 vs. 81). Qualitatively,
postural hypotension was seen in only two individuals, while worst grading was in post hand grip
test significantly and more so in physically inactive group (30%, 28%, and 42% vs. 16%, 20%, and
64%) and individuals with positive familial HTN (32%, 38%, and 30% vs. 17%, 13%, and 70%).
CONCLUSION: Familial HTN, but not physical inactivity, affects sympathetic functioning in nonathletic
young male medical personnel. It asks for other lifestyle modifications for better cardiovascular health
as primary prevention.

Abstract BACKGROUND: Aerobic exercise is helpful in reducing elevated blood pressure (BP). It was also
found that yoga is useful in reducing raised BP. Thus, they both can be used in prevention and
treatment of hypertension. Hence, the study aimed to observe both awareness and practice of aerobic
exercise and yoga among hypertensive patients in Anand city.
MATERIALS AND METHODS: A cross‑sectional descriptive study was conducted. A questionnaire
was prepared containing 24 questions about awareness and practice of aerobic exercise and yoga
among hypertensive patients. The questions were explained to all the patients, and 200 patients
were recruited from Anand city through convenience sampling.
RESULTS: Two‑hundred patients were included in this study, of which 100% were aware of
hypertension. 67.68% were aware of the role of aerobic exercise in hypertension, of which 58.29%
practiced them. The awareness of the role of yoga in hypertension was noted in 33.67% of patients,
of which only 13.07% practiced pranayama and 9.50% practiced asanas.
CONCLUSION: There was a complete awareness of hypertension among hypertensive patients.
A large number of patients were aware of the role of aerobic exercise in hypertension, but only few of
the patients practiced them. However, there was less awareness of the role of yoga in hypertension
and even lesser number practiced them.

Abstract BACKGROUND: Hypertension is an important treatable public health problem both globally and in
India with an increasing prevalence significantly in both urban and rural population. It is one of the
leading causes of adult mortality and morbidity, but poorly controlled hypertension remains a major
health problem.
OBJECTIVE: The objective of this study was to find out awareness, treatment, and control
of hypertension among study population and association of hypertension awareness with
sociodemographic factors, if any.
MATERIALS AND METHODS: This study was conducted from May 2013 to April 2014 in the rural
community of Singur block, West Bengal. Data were collected with respect to sociodemographic
characteristics as well as records related to hypertension such as awareness, treatment, and control
of hypertension. Blood pressure (BP) measurement of individuals aged 20 years and above of both
sexes was done. Pearson’s Chi‑square test was performed to find out the association between the
categorical variables. SPSS 19.00 software was used for analysis.
RESULTS: Nearly 48.2% of the participants were aware of their elevated BP; 47.1% of the participants
were taking pharmacological treatment, mostly allopathic and only 8.8% had their BP under control.
A  statistically significant association was found between age, education, and socioeconomic
status (per capita income) with awareness of hypertension.
CONCLUSION: Lack of awareness of the disease and very low rate of control of hypertension
among those who were treated became the major issues. These findings emphasize the need for
dissemination of knowledge about the disease and counseling of the patients during treatment
continuation.

Abstract BACKGROUND AND OBJECTIVE: There is remarkable alteration in hypertension prevalence
and awareness, and their correlates among various geographic locations and ethnic groups. The
aim of this study was to report hypertension prevalence, awareness, and its correlates as well as
hypertension treatment, and control among Azari people aged 35 years and older.
MATERIALS AND METHODS: The pilot phase of the Azar Cohort Study; a state level of a nationwide
PERSIAN cohort study was conducted in Khameneh city between October 2014 and January 2015.
All people 35 years of age and above were invited to take part in this study. A comprehensive range of
different biomarkers, lifestyle, socioeconomic factors, and health‑related factors was collected. Blood
pressure was measured by a trained nurse/midwife. Descriptive statistical methods were used to present
general characteristics of the study population as frequency tables. Separate multiple logistic regression
models were built to assess the predictors of hypertension prevalence.
RESULTS: A total of 1038 people were included in this study. The overall prevalence of hypertension
was 22.9%. Awareness of hypertension was 60.5% and in those with known hypertension, 84% were
using the antihypertensive medications, of those 68.5% had controlled hypertension. After adjustment;
age (odds ratios [OR] adj = 1.12 95% confidence interval [CI]: 1.09–1.15), gender (ORadj = 1.65 95% CI:
1.08–2.51), obesity ORadj = 2.51 (1.40–4.88), waist‑to‑hip ratio (WHR) (ORadj = 1.70 (1.05–2.75), and
comorbidities (ORadj = 2.51 (1.72–3.66) were independent predictors of hypertension.
CONCLUSION: Age, sex, body mass index, WHR, and comorbidities were known as predictors
of hypertension in this study, health promotion strategies including lifestyle modification to reduce
overweight/obesity and secondary prevention programs for early detection of hypertension in high‑risk
groups according to age, gender, and disease profile are recommended.

Abstract INTRODUCTION: Barriers to medication adherence in patients with hypertension can have significant
differences that made researchers confute to conclude that medication adherence is required to
be more explored, and then, beneficial interventions develop to decrease these barriers. Thus, the
current study was aimed to identify barriers to adherence in Iranian society.
MATERIALS AND METHODS: A qualitative content analysis was carried out. Participants were as
follow: Patients with hypertension who had clinic records in the health centers of Isfahan University of
Medical Science. Purposive sampling method was conducted and continued until data saturation, as
well. Semi‑structured interview was selected as the best‑qualified technique to select data. Data were
analyzed using qualitative content, constant comparative analysis, and MAXQDA (Ver 10) software.
RESULTS: After study and separation of basic concepts, 1620 basic codes were extracted from
interviews. Classes were made based on codes and after multiple reviews, summarizing as well
as similarity. Primary themes were identified using more explorations and comparison of classes.
Based on the nature, the conceptual themes were named. These themes include (1) environmental
challenges of life, (2) incompatibility of patients; (3) forget to take medicine, and (4) inefficient
recommendations of family.
CONCLUSION: Findings revealed that barriers to patient adherence to the treatment had four
dimensions that may be likely useful for managers and planners in the health field to plan and intervene
regarding medication adherence as the most critical preventing factor for patients with hypertension.

Abstract BACKGROUND: This study was aimed at developing and studying the scale of self‑efficacy in
adherence to treatment in Iranian patients with hypertension.
METHODS: A mix‑method study was conducted on the two stages: in the first phase, a qualitative
study was done using content analysis through deep and semi‑structured interviews. After data
analysis, the draft of tool was prepared. Items in the draft were selected based on the extracted
concepts. In the second phase, validity and reliability of the instrument were implemented using a
quantitative study. The prepared instrument in the first phase was studied among 612 participants. To
test the construct validity and internal consistency, exploratory factor analysis and Cronbach’s alpha
were used, respectively. To study the validity of the final scale, the average score of self‑efficacy in
patients with controlled hypertension were compared with patients with uncontrolled hypertension.
RESULTS: In overall, 16 patients were interviewed. Twenty‑six items were developed to assess
different concepts of self‑efficacy. Concept‑related items were extracted from interviews to study
the face validity of the tool from patient’s point of view. Four items were deleted because scored
0.79 in content validity. The mean of questionnaire content validity was 0.85. Items were collected
in two factors with an eigenvalue >1. Four items were deleted with load factor <0.4. Reliability was
0.84 for the entire instrument.
CONCLUSION: Self‑efficacy scale in patients with hypertension is a valid and reliable instrument that
can effectively evaluate the self‑efficacy in medication adherence in the management of hypertension.

Abstract BACKGROUND: Prevalence of hypertension in patients with type 2 diabetes is two to three times
more than nondiabetic patients. This study aimed at assessing the impacts of an educational program
based on BASNEF Model on blood pressure modification among diabetic patients with hypertension.
MATERIALS AND METHODS: Two hundred patients with type 2 diabetes were recruited in an
educational intervention study among two groups. The intervention group attended a 3‑month
self‑care educational program regarding hypertension control in addition to the regular care presented
for both the groups. Another group received no extra program except regular treatment. To collect
information about demographic characteristics, type 2 diabetes‑related variables, and BASNEF Model
construct items, a self‑designed questionnaire was utilized. Data analyzed by SPSS version 16 using
Chi‑square, independent t‑test, and paired t‑test.
RESULTS: Knowledge, behavioral beliefs, attitude to action, enabling factors, subjective norms, and
practice were significantly higher in intervention group as compared to the controls (P< 0.001). In addition,
blood pressure revealed significant differences in intervention group before and after program using paired
t‑test (P= 0.001) while in the control group, there was no significant difference in blood pressure (P= 0.54).
DISCUSSION: The study results revealed a significant change in blood pressure and model constructs
in intervention group compared to control. This research suggested intervention program based on
BASNEF Model has essentially effectiveness in blood pressure modification among diabetic patients.
CONCLUSION: BASNEF Model has effectiveness to high blood modification among diabetic patients
with hypertension.

Abstract Context: Successful aging is a pattern of aging that has gained much attention during recent
years. One factor that has a negative impact on successful aging variables is hypertension. The
phenomenon of aging when accompanied with hypertension promotes spiritual needs. The aim
of this study was to examine the effect of the Islamic spiritual program on successful aging in
elderly patients with hypertension who were referred to health centers of Isfahan, Iran, in 2014.
Settings and Design: This study was a randomized clinical trial. Materials and Methods: The
participants (52 elderly patients with hypertension) were randomly divided into experimental
and control groups. While the control group received training related to health promotion, the
Islamic spiritual program was implemented in the experimental group for eight sessions in two
health centers of Isfahan. The data collection tools consisted of the 12‑item General Health
Questionnaire developed by Goldberg and the satisfaction with life scale developed by Diener.
The questionnaires were completed in three steps; pretest, posttest, and follow‑up (1‑month).
Statistical Analysis Used: Data were analyzed using SPSS statistical software version 20
and Chi‑square, independent t‑test, and repeated measures ANOVA. Results: Statistical tests
showed that the mean score of general health and life satisfaction of the experiment group had
a meaningful difference from that of the control group in the posttest stage (P < 0.001). This
difference was also meaningful in the follow‑up stage (P < 0.001). Conclusion: The results of the
study indicated the effectiveness of an Islamic spiritual program on successful aging variables.

Abstract Background: Noncommunicable diseases such as Hypertension are among the
important factors of mortality and morbidity of the elderly people. The family‑centered
empowerment model (FCEM) has not been performed for elderly people with hypertension.
Settings and Design: This clinical trial study was carried out on 62 elderly people with
hypertension under the coverage of the Lenjan Health Network in 2013. After performing the
sampling by using the cluster‑randomized method, the samples were divided randomly into
the experimental and control groups. Methods: For the experimental group, the (FCEM) was
implemented based on the four steps. For the control group, it was only implemented the
usual care and one training session. Research tools included questionnaires of demographic
data, empowerment assessment and a blood pressure‑measuring device. The post‑test was
performed 1 week later. The blood pressure was recorded, and it was followed 1.5 month later
again. Statistical Tests: Statistical tests for data analysis included χ2
‑test, independent t‑test,
Mann–Whitney, analysis of variance, and SPSS 20. Results: 1 week later and 1.5 month after
the intervention, the mean blood pressure was significant in both groups (P < 0.001). also, the
difference in the mean score of empowerment dimensions was significant in the experimental
group 1 week later and 1.5 month after the intervention (P < 0.001). Conclusion: Implementation
of the FCEM for elderly people with hypertension has been possible from a practical point of
view, and it has been associated with controlling and improving the blood pressure.

Abstract Introduction: Measurement tools designed to ensure the achievements of studies’ objectives
must be evaluated. Based on the health promotion model (HPM), the present study was
conducted to assess the validity and reliability of the designed questionnaire of hypertensive
patients’ nutritional perceptions. Methodology: In a cross‑sectional study, the mentioned
questionnaire was assessed based on opinions of 11 experienced faculty members and
671 hypertensive patients in rural areas in the year 2013. To evaluate the reliability, internal
consistency (Cronbach’s alpha) was calculated. Concerning the validity of the questionnaire,
its content and construct validity were examined. Data analysis was performed using
Statistical Package for the Social Sciences version 18 (SPSS Inc., Chicago, IL, USA).
Results: Spearman‑Brown and Cronbach’s alpha coefficients results were acceptable in all
constructs indicating a satisfactory reliability of the questionnaire. Questionnaire’s questions
were highly correlated with the total score signifying the internal consistency of the questions;
therefore, all questions had a similar effect on the total score and the removal of each did no
increase the alpha significantly (all questions had acceptable reliability). Factor analyses showed
that all questions had acceptable factor loading and suitable validity. Moreover, the entire
constructs of the questionnaire were approved by experts with high validity coefficient of 0.9.
Conclusion: The designed questionnaire for assessment of the HPM constructs regarding
hypertensive patients’ nutritional issues had appropriate psychometric characteristics. Reliability
and validity of the questionnaire were also satisfactory and its overall structure was approved.

Abstract Introduction: Workers in different jobs are exposed to noise, which can affect hearing loss and
sleep disturbance in the long term. Excessive noise exposure may lead to increased blood
pressure, reduced efficiency, and increased absenteeism. Materials and Methods: In this
case‑control study, 80 workers were studied in terms of noise exposure and blood pressure.
Noise exposure was measured by SEL 440 sound level meters according to ISO 1996 standard.
Blood pressure of the case and control groups was measured in workplace, under standard
circumstances, using ALPK2 mercury sphygmomanometer during physical examination. Data
were analyzed by t‑test and Pearson’s correlation coefficient. Results: Mean level of noise was
95.21 ± 2.56 db, which was significantly higher than permitted limit of 85 db (ACGIH 2009) (P <
0.01). Diastolic blood pressure was normal in 28.8% and high in 50.1%, and between these in
21.1% of workers. Mean difference of systolic blood pressure in two studied groups (P < 0.01)
was meaningful. However, mean difference of diastolic blood pressure was not significant in two
studied groups (P > 0.05). There was a positive and weak relationship between noise and systolic
blood pressure (r = 0.28, P < 0.006). Conclusion: Prolonged exposure to industrial noise is related
with high blood pressure as a risk factor of cardiovascular diseases. Therefore, it is recommended
that training programs be held for workers, preventive measures for noise exposure at workplace
be taken, blood pressure of workers be attended to and special care be given to workers with a
history of hypertension.