Journal of Education and Health Promotion

Abstract BACKGROUND: Eating disorders (EDs) can lead to life‑threatening nutritional deficiencies whereas 
self‑esteem influences interpersonal relationships and academic performance. Excessive concerns 
about body image resulting in body dissatisfaction not only affect psychological well‑being but also 
predisposes to disordered eating behaviors. The objective of this study is to assess the eating 
behavior and level of self‑esteem, their relationship with body image perception and also identify 
factors associated with them among undergraduate female college students.
MATERIALS AND METHODS: This cross‑sectional study was conducted among 180 female 
undergraduate students of University of Delhi. Sociodemographic characteristics and anthropometric 
measurements were recorded. Eating Attitude Test‑26, Rosenberg Self‑esteem Scale, Contour 
Drawing Rating Scale and Body Shape Questionnaire 34 were used to assess eating behavior, 
self‑esteem, body image dissatisfaction and body shape concerns, respectively. Both descriptive 
and inferential statistics were used and binary logistic regression was applied to identify the factors 
determining high risk eating behavior and low self‑esteem.
RESULTS: In this study, 27.8% of the study participants were overweight or obese, 30.6% had body 
shape concerns and 76.7% had body image dissatisfaction. Significant proportion (13.9%) of the 
participants was identified as high risk for the development of EDs and having low self‑esteem (12.8%). 
Body shape concern and family influences were significant predictors of high risk eating behavior 
whereas type of college and family influences significantly predicted low self‑esteem.
CONCLUSIONS: The study concluded that factors such as nutritional status, family influences, type 
of college and body shape concerns lead to high risk eating behavior and low self‑esteem. These 
findings will help in creating awareness on importance of concept of positive body image, healthy 
weight control behaviors and in developing future interventions.

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: Quality of relationship marital status affects all aspects of family functioning,
including sustainability of cohabit living, supporting children, and happiness of couples. This study
was conducted to examine the effect of group cognitive‑behavioral counseling on optimism and
self‑esteem of women during the 1st month of marriage that referring to marriage counseling center.
MATERIALS AND METHODS: A semi‑experimental study was designed by a test, posttest, and
follow‑up. Participants consisted of 30 women admitted to premarriage counseling center of Farsan
city in 2018 with using purposive sampling by random numbers’ table into experimental and control
groups. The experimental group participated in eight consecutive 2‑h group counseling sessions.
Data collection tools were demographic questionnaire, Rosenberg’s Self‑Esteem Scale, and optimism
designed by Mir Ahmadi (reliability and validity are calculated and was 0.96) and completed in three
rounds. Women’s self‑esteem retested was done after 1 month. Data were analyzed with independent
t‑test and repeated measures ANOVA (significance level <0.005). Quantitative variables were
analyzed using the Kolmogorov–Smirnov test.
RESULTS: There were no significant differences between optimism scores in the
experimental (M = 150.47, standard deviation [SD] = 22.07) and control groups (M = 149.2,
SD = 21.54) prior to intervention (P = 0.875). The mean optimism score was significantly different in
intervention (M = 169.33, SD = 17.01) and control (M = 147.2, SD = 22.22) groups immediately after
counseling (P = 0.005) and 1 month after counseling (P = 0.002, M = 171.08, SD = 17.98). The mean
self‑esteem scores were statistically significant in both groups immediately after counseling (P = 0.023,
I: M = 37.06, SD = 8.69, C: M = 31.4, SD = 4.83) and 1 month after counseling (P = 0.028, I: M =
34.73, SD = 4.93, C: M = 30.06, SD = 4.8).
CONCLUSION: Cognitive‑behavioral counseling enhances women’s optimism by emphasizing
the training of communication and conflict resolution skills, which leads to positive attitude and life
satisfaction. Therefore, using cognitive‑behavioral counseling in marriage counseling sessions can
improve couples’ relationships.

Abstract INTRODUCTION: Spiritual health is one of the four dimensions of health in humans, and the others
are physical, psychological, and social dimensions. This dimension is essential to increase the
adaptation to the disease. Therefore, this study was aimed to determine spiritual health in women
with multiple sclerosis (MS) and its association with self‑esteem.
METHODS: This is a descriptive cross‑sectional study, and 210 women with MS referring to Ayatollah
Kashani Hospital affiliated to Isfahan University of Medical Sciences were selected using convenience
sampling method. The data were collected by questionnaires of demographic characteristic
questionnaire (6 items), Rosenberg Self‑esteem Scale (10 items), and Ellison and Paloutzian Spiritual
Well‑being Questionnaire (20 items). Data were analyzed using descriptive statistics, Pearson’s
correlation coefficient, and multiple regression analysis at a significance level of 0.05.
RESULTS: The mean and standard deviation of spiritual health  (including religious health and
existential health) and self‑esteem in MS patients were 48.8 ± 6.80, 44.7 ± 6.70, and 3.21 ± 2.5,
respectively. The results showed that 95.2% of the research units had moderate‑to‑high
spiritual (religious and existential) health and 57.7% had high self‑esteem. Pearson’s correlation
coefficient also showed a significant positive correlation between religious health and existential
with self‑esteem (r = 0.22, P = 0.03 and r = 0.24, P = 0.01, respectively).
CONCLUSIONS: In this study, most of the women with MS had high levels of spiritual health and
self‑esteem. This can be used as a coping strategy and has a protective effect against stress‑induced
illness and even against complications of the treatment. In addition, in some cases, it is effective in
alleviating frustration in these patients.

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.

Abstract BACKGROUND: Birth of a child with cleft lip and palate, as a crisis, can affect family relationships and
interactions seriously and hence self‑esteem in family members. The present study was conducted
to investigate the effect of a happiness training program on self‑esteem in the mothers of children
with cleft lip and palate.
MATERIALS AND METHODS: In this quasi‑experimental study, 64 mothers of children with cleft lip
and palate referring to health‑care team in the Isfahan University Medical Sciences were enrolled
by convenience random sampling. Then, the program of happiness training was implemented within
10 sessions, and a questionnaire of demographic characteristics and Coopersmith Self‑Esteem
Inventory was filled out before and 2 months after the last session. The data were analyzed by
descriptive and analytical statistics (paired t‑test, independent t‑test, Chi‑square, and Mann–Whitney)
in SPSS 20 (SPSS Inc: Chicago),
RESULTS: The mean age of the mothers in intervention and control groups was 33.3 ± 6.3 and
33.5 ± 5.8 years, respectively. The mean age of the children in the intervention and control groups
was 6.34 ± 3.37 and 5.03 ± 3.36 years. Independent t‑test indicated a significant difference in
self‑esteem mean score after training in the intervention and control groups. Moreover, paired t‑test
indicated a significant difference in self‑esteem mean score between before and after training in the
intervention group.
CONCLUSION: In the light of the effect of happiness training on the promotion of self‑esteem
in children with cleft lip and palate, this program can be used as a care intervention to reduce
psychological and mental problems and to enhance adjustment in parents.

Abstract Introduction: Noncommunicable diseases are recognized as the major cause of old
people’s death. One of the models concerning the family health level is the family‑centered
empowerment model (FCEM) which has been designed with the aim of promoting the health
level and self‑esteem of the patients and their family members. Purpose: This study was
carried out to investigate about the effect of implementation of FCEM on the self‑esteem of old
people with high blood pressure. Settings and Design: This was a clinical trial study which
focused on 62 old adults with high blood pressure in 1392. After cluster sampling, samples
were divided randomly into test group and control group. Methods: FCEM was used for
the test group; whereas, for the control group, common health cares and one educational
session were performed. Study materials were checklist of demographic information, and
a researcher‑made questioner to evaluate the level of self‑esteem. Posttest was given
1‑weak after the intervention and was followed‑up 1½ months later. Statistical Tests: T‑test,
analysis of variance, and SPSS 20 were used to analyze the date. Finding: Before the
intervention, the mean scores of self‑esteem in both the test group and the control group
were the same (t = 0.55) (P > 0.05). However, 1‑week after the intervention (t = 6.38) and
1½ months later, meaningful differences were observed in the test group (P < 0.001).
Conclusion: Implementation of FCEM has a positive effect on the high self‑esteem of the
old people with high blood pressure.

Abstract Background: A student under optimal stress does bring out his or her best; however, extreme
stress can result in mental health problems and deteriorates their academic performance.
Students who esteem themselves low are most likely to engage in destructive and self‑destructive
behaviors. Moreover, excessive stress is harmful to academic performance and may lead to
dropping out in student. Can Yoga be of benefit in students for improving their attention and
self‑esteem (SE)? Objective: To assess attention and SE in girls undergoing Integrated Yoga
Module (IYM). Materials and Methods: Sixty low‑income high school girls with 15.17 + 0.64 years
of mean age participated in this single group pre‑post study. The data was collected before and
after 5 days of IYM. Statistical Analysis: Means, standard deviations, Kolmogorov‑Smirnov
test, and Wilcoxon signed rank test were used to analyze the data with the help of SPSS 16.
Results: The data analysis showed 9.04% increase (P = 0.001) in SE scores, whereas d2 test for
attention revealed 10.12% increase (P < 0.001) in total number of symbols processed scores and
44.73% decrease (P < 0.001) in total number of errors. Conclusion: The present study suggests
that of IYM can result in improvement of attention and SE among students and thereby enhancing
their mental health and can help them in improving their academic achievement. Efforts aimed
at reducing mental health problems among students may focus more on implementing effective
and culturally acceptable interventions, such as Yoga, counseling, and social support. Additional
well‑designed studies are needed before a strong recommendation can be made.