Journal of Education and Health Promotion

Abstract BACKGROUND: Dried Urmia Lake in the northwest of Iran is a major regional source of sodium
and toxic metal aerosols which may cause numerous health problems. The aim of this study was to
evaluate iron‑deficiency anemia (IDA) and some related risk factors among women of reproductive
age in the suburb of dried Urmia Lake to provide the information about the problem to the health‑care
providers.
METHODS: This cross‑sectional study was conducted on 278 healthy nonpregnant, nonlactating
women aged 18–45 years, living in the rural area of the Salmas city, closest to the Urmia Lake between
February and June 2017. The study participants were selected using a stratified random sampling
method with proportional allocation from seven villages. A general questionnaire was completed for
each participant to collect sociodemographic information and a 3‑day dietary recall questionnaire
to obtain daily dietary intakes. IDA was defined as a hemoglobin (Hb) level of <12 g/dl and ferritin
concentration of <15 μg/l. Spearman’s correlation coefficient and Fisher’s exact test were applied to
determine sociodemographic factors associated with the serum Hb and ferritin levels.
RESULTS: The prevalence of overall anemia (Hb <12 g/dl) was 7.9%. IDA was determined in 4.3%
and iron deficiency (ID) in 19.1% (serum ferritin <15 μg/l) of the participants. There was a significant
positive correlation between serum Hb concentrations and the mean daily intakes of protein and
iron (P < 0.001). Similarly, a significant positive correlation was observed between serum ferritin
levels and body mass index (P < 0.001). Significant inverse associations were found between Hb
concentrations and the number of pregnancies and children (P < 0.001), as well as the number of
family members (P < 0.05).
CONCLUSIONS: Results indicated a mild prevalence of IDA and a relatively high rate of ID among
studied participants. Educational programs are needed to improve nutritional habits as well as the
use of contraceptives to promote women’s health.

Abstract BACKGROUND: Empowerment is an essential issue in women’s lives. Powerful women can act
successfully in health‑related issues more than others. This study aimed to determine the effectiveness
of an educational intervention designed based on theory of planned behavior (TPB) on health care
empowerment among married women in reproductive age.
METHODS: This randomized controlled trial was carried out among 488 reproductive‑age women
between 2018 and 2019 in Tehran, Iran. Participants were recruited using randomized cluster
sampling and divided into intervention (n = 243) and control (n = 245) groups by random allocation.
Data were collected using a self‑administered researcher‑made questionnaire based on TPB and
Health Care Empowerment Questionnaire. Validity (content validity index = 0.87; content validity
ratio  =  0.89) and reliability of the questionnaires were confirmed  ( = 0.96). Intervention was
implemented within four sessions (lasting 60 min) using eight health related scenarios based on
TPB constructs. Baseline and post intervention data (6 months after the intervention) were analyzed
by SPSS25 (Inc., Chicago, IL, USA) using independent t‑test, Chi‑squared test, Fisher’s Exact test,
Mann–Whitney, path analysis, and regression of generalized estimating equation model. P < 0.05
was considered statistically significant.
RESULTS: Results showed the mean ± standard deviation age of the participants was 33.6 ± 7.1.
Six months after the intervention, a significant difference was highlighted in health care empowerment
domains as well as behavioral intention, attitude toward behavior, subjective norms, and perceived
behavioral control (P < 0.001) between intervention and control groups.
CONCLUSION: TPB‑based educational intervention can significantly improve women’s perception
about health care empowerment. Tailoring and implementation of TPB‑based intervention by health
policy makers and health care providers is suggested to achieve better perception of empowerment
toward receiving health care among women.