Journal of Education and Health Promotion

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: Congenital heart disease (CHD) is one of the underlying medical conditions that
put children at increased risk for coronavirus. This study aimed to predict preventive behaviors of
COVID‑19 among children with CHD based on the protection motivation theory (PMT).
MATERIALS AND METHODS: This cross‑sectional study was conducted from March 2021 to April
2021, on 240 children 3–7 years with CHD whose data had been registered in Persian Registry of
Cardiovascular Disease/CHD (PROVE/CHD) System in Isfahan, Iran. The research variables were
measured using an online researcher‑made questionnaire that was based on PMT constructs. The
collected data were analyzed using statistical tests (e.g., Pearson correlation coefficient and linear
regression analysis).
RESULTS: From a total of 240 participants (mean age of 4.81 ± 1.50) in the present study, 122 (50.8%)
were girls. The most common types of CHD among children participating in this study were related
to atrial septal defect (ASD) (29.2%, n = 70) and ventricular septal defect (VSD) (26.7%, n = 64),
respectively. Protective behaviors showed a significant correlation with all constructs of PMT. The
PMT constructs explained 41.0% of the variances in protective behavior, in which the perceived
reward (β = 0.325) and perceived self‑efficacy (β = 0.192) was the most important, respectively.
CONCLUSION: The results of this study showed well the effectiveness of PMT on the preventive
behaviors of COVID‑19 in children with CHD. This theory can be used to teach preventive behaviors
of COVID‑19 to children with CHD in education programs.

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: Some pharmaceutical company sales representatives are using bribes to encourage
increasing medication prescriptions. In 2012, GlaxoSmithKline paid $3 billion on a felony charge
related to bribing doctors to prescribe the company’s medications. Using Hunt and Vitell’s general
theory of marketing ethics, the purpose of this qualitative multiple case study was to explore strategies
some sales managers in the pharmaceutical industry used to improve marketing training to reduce
unethical sales representative behavior.
MATERIALS AND METHODS: Data were collected from company reports and documents provided
by sales managers and semistructured interviews with five sales managers of different pharmaceutical
companies in the northeast region of the United States. Data were analyzed using thematic analysis
and Yin’s 5‑step process of compiling, disassembling, reassembling, interpreting, and concluding
thematic data analysis.
RESULTS: Three themes emerged from data analysis: developing ethical standards, developing
organizational policy, and implementing training and development programs. A key recommendation is
that pharmaceutical sales managers identify ethical standards to inculcate in their business practices
to achieve ethical marketing training that can result in sales representatives’ ethical behavior. The
implications for positive social change include the potential for sales managers to develop strategies
to reduce unethical behavior in the pharmaceutical industry.
CONCLUSION: Reducing unethical behavior may lead to more trust between patients and physicians,
improving patient satisfaction and promoting prosperity for the community through enhancing the
quality of health care.

Abstract BACKGROUND: Many measures have been taken so far to minimize the outbreak of COVID‑19, but 
it is still unclear to what extent people have understood the risk. Public participation plays a vital role 
in better and effective control of the coronavirus, and the importance of risk perception is effective 
in their preventive behavior. The aim of this study was to investigate the pandemic risk perception 
of coronavirus disease after began of pandemic in Iranian society.
MATERIALS AND METHODS: This cross‑sectional study was conducted in Iran in spring 2020. The 
data collection tool was a researcher‑made questionnaire. The questions were extracted through 
interviews with experts and summarizing the opinions of public interviews, etc., The questionnaire 
was made available to the public through social media. The information was collected within 
3 months. Quantitative data were reported as mean ± standard deviation and the qualitative data 
were reported as number and percent. Multiple linear regression and cross were also used to examine 
the demographic factors associated with risk perception. Data Analysis was performed using the 
SPSS version 21 statistical software.
RESULTS: In this study, 402 individuals from 28 provinces (Azarbaijan Gharbi, Azarbaijan Sharghi, 
Alborz, Ardabil, Bushehr, Chaharmahal and Bakhtiari, Esfahan, Fars, Ghazvin, Gilan, Golestan, 
Hamedan, Hormozgan, Ilam, Kerman, Kermanshah, Khorasan Razavi, Khorasan Shomali, Khuzestan, 
Kohgiluyeh and Boyerahmad, Kurdistan, Lorestan, Mazandaran, Semnan, Sistan and Baluchestan, 
Tehran, Yazd, and Zanjan) of Iran participated. The risk perception score obtained from the sum 
of the scores of the questions was classified into quartiles. Accordingly, the risk perception score 
of (22.9) 92 people was very low, (26.6) 107 people low, (26.9) 108 people moderate, and (23.6) 95 
people high. The results of multiple linear regression showed that the variables of gender (P = 0.008) 
and occupation (P = 0.013) had a significant relationship with risk perception. There was no 
significant relationship between risk perception and variables of age, marital status, and level of 
education (P > 0.05).
CONCLUSION: The study showed that the risk perception of the people is more in categories 
of moderate to high. Assessing the risk perception of a pandemic can be helpful for preventive 
measurements and planning, and also, according to the results of the research, can be done 
appropriate educational interventions. Given that 47.5% of respondents were employees, of course, 
it should be noted that in sending a questionnaire virtually, there is usually a lot of loss and this is 
a limitation of the research. The results of this study can be useful in making prevention decisions 
and maintaining safety and health in the workplace.

Abstract BACKGROUND: Noncommunicable diseases (NCDs) may be influenced by lifestyle behavior,
acquired during transition in student life at university. Health is a major concern globally. The
developing counties are facing a double burden of disease, both communicable and NCD. This
study is aimed to assess the lifestyle and its associated factors that can affect the health status of
medical and nursing students.
MATERIALS AND METHODS: A community‑based cross‑sectional study was conducted among
medical and nursing students of Sasaram, Bihar, by universal sampling. The study population
consisted of 303 medical and 233 nursing students. The 536 students in the study, included 195
from rural areas and 341 from urban areas. Simple Lifestyle Indicator Questionnaire was used and
Chi‑square statistics was computed to determine the association of demographic variables with
lifestyle behavior using Epi InfoTM 7 analysis software.
RESULTS: Mean age and body mass index were 21 ± 2.59 years and 22.12 ± 3.77, respectively.
After statistical analysis utilizing the Chi‑square test, it was shown that the difference was found to
be nonsignificant (P > 0.05) in all the following variables, such as gender, age, marital status except
in designation, and alcohol and tobacco intake which showed the difference to be highly significant.
CONCLUSIONS: The maximum number of students in the study population showed intermediate
healthy lifestyle (57.1%), despite being the upcoming health‑care providers of future. Fruits were
rarely present in diet in 82%, no physical activity in 21.2%, and tobacco and alcohol were consumed
by 11.7% and 13%, respectively. Targeted intervention for healthy diet, physical activity, stress,
tobacco, and alcohol reduction can lead to healthy lifestyle. Independence and autonomy gained in
the transition phase in student life needs guided supervision to raise responsible adults. It may help
to assist or to plan accordingly in future to improve lifestyle of the students.

Abstract BACKGROUND: Todays, human lifestyle has faced significant changes, and this lifestyle has
caused health problems. The increase of smoking, among young people, is one of the risk factors
and incorrect lifestyle factors. The present study will design an educational campaign intervention
based on the protection motivation theory (PMT) on smoking preventive behaviors in students.
MATERIALS AND METHODS: In designing this study, five phases are considered. (1) needs
assessment and determination of the current situation are considered. In this phase, the required
communication is established to form a planning team with key and influential people and experts, (2)
tool design, (3) educational intervention (educational campaign) is designed. Some individuals will
be selected and trained as facilitators to start entering the target population, have a better access
to the target group, and implement the interventions in the target group. (4) the implementation of
the educational plan, in which the designed educational intervention (educational campaign) will
be implemented on the students of the studied universities. (5) the educational evaluation, which
will be conducted 2 months after the intervention of the educational campaign. The posttest will be
based on before and after the implementation of the educational campaign. In the prevention of the
second type in smoking students, the salivary cotinine levels of smoking students will be measured
and comparisons will be made before and after educational using appropriate statistical tests.
RESULTS: The present study addresses the needs and strategies for smoking prevention using a
training campaign based on the PMT and web .
CONCLUSION: Designing a campaign which will lead to smoking preventive behaviors causes
lifestyle changes, prevent health problems such as cancer, cardiovascular diseases, and other
chronic diseases, reduce treatment costs, and increase life expectancy.

Abstract BACKGROUND: Increasing community awareness about the transmission and treatment of
COVID‑19 will stop the spread of the virus. Pharmacy students are the potential facilitator to give
community education about COVID‑19 treatment. The objective of this study is to evaluate the
pharmacy students’ knowledge of COVID‑19 treatment, behavior, and attitude of providing the
information about COVID‑19 treatment.
MATERIALS AND METHODS: We conducted cross‑sectional study, recruiting 429 pharmacy
students from three schools of pharmacy in Indonesia. The questionnaire about the knowledge of
COVID‑19 treatment, behavior, and attitude of providing the information on COVID‑19 treatment met
the validity and reliability criteria. We defined the proportion of knowledge, behavior, and attitude of
the students using SPSS® version 22.
RESULTS: Most of the students are in the earlier years (46.63%), female (84.15%), find the information
about COVID‑19 from many sources of media (85.08%) including scientific articles and know
information about COVID‑19 transmission around their life area (76.46%). The students’ knowledge
about antiviral and plasma convalescent is good (>70%), the positive behaviors are related to the
COVID‑19 treatment information regarding to the antiviral and the provision of Vitamin C (>50%), and
the positive attitude are related to giving information about the use of avigan®, plasma convalescent,
chloroquine, hydroxychloroquine, and immunomodulator (>50%).
CONCLUSIONS: As a future pharmacist, the knowledge of pharmacy students about COVID‑19
treatment needs to be improved since earlier years. Furthermore, using the good knowledge about
COVID‑19 treatment, the positive behavior and attitude of providing information of the students, the
community behavior and attitude will be improved. The high year students have a tendency for the
good knowledge and positive behavior and attitude of providing the information.

Abstract BACKGROUND: Urinary tract infection is a common infection in women during pregnancy, leading to
many complications for both mother and fetus if untreated. The present study aimed to investigate the
predictability of constructs of the theory of planned behavior (TPB) in adopting urinary tract infection
prevention behaviors in pregnant women.
MATERIALS AND METHODS: In the present cross‑sectional study, we selected 100 pregnant
women who visited the comprehensive health service centers of Zarrinshahr using convenience
sampling from July to September 2019. We collected data by a questionnaire designed based on
the constructs of the TPB and analyzed data using SPSS 20 and linear regression test and Pearson
correlation coefficient. A significant level was considered as α < 0.05.
RESULTS: In the study, the Pearson correlation coefficient showed direct relationships between the
score of behavior and the scores of knowledge (P = 0.005), attitude (P = 0.02), perceived behavioral
control (P < 0.001), and behavioral intention (P = 0.001). Linear regression analysis indicated that
among the above variables, the perceived behavioral control, knowledge, and behavioral intention
were significant predictors of scores of urinary tract infection prevention behaviors, respectively, in
terms of their importance.
CONCLUSION: In this study, perceived behavioral control is detected as the main predictor of
doing urinary tract infection prevention behaviors in pregnant women and should be considered in
designing educational interventions.

Abstract BACKGROUND: COVID‑19 is a serious and costly problem for communities. Observing health
issues and performing preventive behaviors is influenced by their knowledge and skills of people
toward COVID‑19. Hence, this study investigated the knowledge, skill, and practice of the public of
Shahrekord toward COVID‑19.
MATERIALS AND METHOD: The present study was performed as a cross sectional. Data were
collected using an online questionnaire from 540 Shahrekord residents who were selected via
convenience sampling in 2020. Knowledge, skill, and practice toward COVID‑19 were assessed
using a prevalidated questionnaire. Collected data were analyzed by SPSS‑21 software (one‑way
analysis of variance, Pearson test, and regression test).
RESULTS: In this study, 39.1% were male, and 60.9% were female and 46.3% were 20–25 years.
The mean score of knowledge, skill, and preventive behaviors was 75.69 ± 17.85, 53.87 ± 27.40,
and 59.97 ± 23.79, respectively. There was a significant direct relationship between knowledge
and skill (P = 0.05 and r = 081) so that public with more knowledge had a better skill as well.
There was a significant association between age (P = 0.036), education level (P = 0.019) , and
job (P = 0.014) with knowledge. In addition, a significant association between job (P = 0.027) and
marital status (P = 0.014) with skill was observed. Knowledge, skill, and demographic variables
predict 37.6% preventive behavior.
CONCLUSION: The majority of the participants had good knowledge, moderate skill, and relatively
enough practice. Government and policymakers must consider these knowledge levels, skill, and
practices to implement productive interventions for preventing the COVID‑19.

Abstract BACKGROUND: The novel coronavirus (COVID‑19) has infected nearly 9.5 million people in 216
countries, areas, or territories in the world. The fight against the COVID‑19 has become a very serious
international challenge. The aim of this study was to determine the predictors of COVID‑19‑preventive
behaviors using the health belief model (HBM).
MATERIALS AND METHODS: This cross‑sectional study was conducted with the participation of
558 samples from the adult population of Iran. The online convenience sampling was conducted
in this research. The online 68‑item questionnaire link was published all over Iran through social
networks including Telegram and WhatsApp, which are common in Iran. The data were analyzed
using SPSS software version 19. Descriptive statistics, bivariate Pearson’s correlation test, and
multiple linear regression were used to analyze the data.
RESULTS: The mean age of the subjects was 33.3 ± 10.01 years. The participants were often
female (61.3%), married (57.9%), and resident of the city (81.0%) with university educational
level (78.8%). The results showed that the HBM structures predicted 29.3% of the preventive
behaviors of COVID‑19 in the subjects. The perceived benefits, perceived barriers, and self‑efficacy
significantly predicted the preventive behaviors, but the perceived susceptibility and perceived
severity were not significant in the regression model. The internet and virtual social networks (49.8%),
broadcast (33.5%), and healthcare providers (15.8%) were the most important sources of information
related with COVID‑19. In response to COVID‑19‑related internal cues to action, 36.6% did not
pay attention and 34.7% tried to self‑medicate. Only 28.5% of the subjects referred to the hospital,
healthcare center, or physician.
CONCLUSION: Self‑efficacy, perceived barriers, and perceived benefits were the key determinants
of COVID‑19‑preventive behaviors in the subjects. It can be concluded that the HBM is a good tool
to predict COVID‑19‑preventive behaviors in Iranian population.

Abstract BACKGROUND: In chronic diseases such as osteoporosis, understanding the factors that improve
prevention, such as health literacy (HL), is essential in reducing the incidence of these diseases.
This study aimed to determine the association between HL and adoption of osteoporosis‑preventive
behaviors among students in Qazvin.
SUBJECTS AND METHODS: This is a cross-sectional study in which 375 female students
(aged 15–18 years) at high schools (grades 10th, 11th, and 12th) in Qazvin city were selected, in
2019. Sampling method was multistage. To collect data, the standardized questionnaire for measuring
HL in adolescents (health literacy measure in adolescents), in addition to another questionnaire for
assessing osteoporosis‑preventive behaviors, was used. Data were analyzed using SPSS 22 by
descriptive statistics and logistic regression. The association considered significant when P < 0.05.
RESULTS: The mean scores of adoption of osteoporosis‑preventive behaviors and HL were
22.43 ± 5.60 and 70.84 ± 12.58, respectively. Logistic regression showed that there was a significant
association between the adoption of osteoporosis‑preventive behaviors and HL (P = 0.001). In
addition, the association between the adoption of osteoporosis‑preventive behaviors and age was
also significant (P = 0.048 and odds ratio = 3.35).
CONCLUSIONS: Young students and those of low HL showed less adoption of osteoporosis‑preventive
behaviors. Therefore, it is necessary to pay more attention to design educational programs that may
raise the knowledge and awareness of those students about such these diseases, mainly prevention.

Abstract INTRODUCTION: Brucellosis is one of the common diseases between humans and animals. The
purpose of this study was to investigate behavioral determinants of brucellosis incidence among
stockbreeders and their family members in a rural area based on the PRECEDE model.
MATERIALS AND METHODS: This cross-sectional study was carried out among 540 stockbreeders
and their family members in Northeastern Iran in 2019. Sampling was done in two stages including
stratified sampling and random sampling method. Data collection was conducted by a valid and
reliable questionnaire developed based on the PRECEDE model. Data were analyzed using SPSS16
through Pearson correlation coefficient, independent t-test, and ANOVA. Furthermore IBM SPSS
AMOS version 20 was used for the path analysis.
RESULTS: The mean age of the participants was 39.02 ± 16.41 years, of whom 53.1% and 46.9%
were men and women, respectively. About 23.9% of the participants had a history of brucellosis in
their families. Enabling factors were the most important determinant of self-efficacy and self-efficacy
was the most important determinants of behavior. Evaluation of the chi-square indicators, chi-square
ratio to degree of freedom, root mean square error of approximation, adjusted goodness of fit index,
parsimony comparative fit index, comparative fit index, incremental fit index, and parsimonious normed
fit index indices indicated that the model was well fitted and there was a positive and significant
relationship between the predisposing, enabling, and reinforcing factors on the one hand and behavior
on the other. chi-square indicators, chi-square ratio to degree of freedom, root mean square error
of approximation, adjusted goodness of fit index, parsimony comparative fit index, comparative fit
index, incremental fit index, and parsimonious normed fit index
CONCLUSION: Designing and implementing health plans based on the PRECEDE model with more
emphasis on self-efficacy as the most important behavioral determinants can bring about a positive
effect on enhancing the brucellosis preventing behaviors.

Abstract BACKGROUND: Human immunodeficiency virus (HIV) is a kind of behavioral disease in that
adopting behavioral changes is the only way to control and stop the epidemic. The aim of this study
is to investigate the effect of education base on the health belief model (HBM) on health‑seeking
behavior among HIV‑positive women.
MATERIALS AND METHODS: This study is a paralleled, randomized controlled clinical trial done
with control group among HIV‑positive women who were registered at the voluntary and counseling
testing center of Imam Khomeini hospital in Tehran. Data were gathered by using information obtained
from the Motivation‑Skill‑Behavior questionnaire and demographic data. The women were divided by
permuted block and were randomized into two groups. Interventional group participated in six HBM
educational classes and used routine counseling guidelines, but the control group used only routine
counseling protocol. Data were collected before, immediately after, and 3 weeks after interference
among all participants. Data were analyzed by using SPSS software version 16.
RESULTS: According to the results and statistical test, before intervention, the mean score of
knowledge was not significantly different in the two groups, but after intervention in the interventional
group, test result and follow‑up increased statistically significantly (P = 0.000). Both groups had
increased mean score of knowledge, and there is significant trend in level of knowledge(interventional
group 20.79 ± 1.88, control group: 17.36 ±2.44) and there was a significant increase in mean attitude
follow‑up score (P < 0.001).
CONCLUSION: According to the result of the present study, counseling base on HBM by trained
educator can increase information‑motivation‑skill‑behavior among women living with HIV.

Abstract Introduction: Regular physical activity has positive effects on physical, mental and social
aspects of individual and community health. Considering the prevalence of noncommunicable
diseases such as primary hypertension, osteoporosis and cardiovascular diseases for which
sedentary lifestyle is a responsible factor, health policy makers have planned to encourage
people to do more physical activities. Development of beneficial health habits during childhood
and early adolescence are very important because the behaviors, which start at adolescence
tend to continue into adulthood, too. This study aimed to determine the effect of educational
intervention on physical activity-related knowledge, attitude and behavior of the first grade
students in male high schools of Bavanat in 2010. Materials and Methods: In this prospective
experimental study, after selecting two qualified schools from five high schools, all students of
one school (two classes including 42 individuals) were randomly assigned to the experimental
group and all the students of another high school (two classes including 43 individuals) were
randomly assigned to the control group. The data gathering tool was a 4-section questionnaire
which included demographic questions, knowledge- and attitude-related questions and the
questionnaire of physical activity performance. The first three sections of the questionnaire
were the researcher-designed and validated by face and content validity. Test-retest and internal
consistency (Cronbach’s Alpha) methods were used to determine the reliability of knowledge
questionnaire and attitude questionnaire, respectively. For the measurement of physical activity
behavior, a self-reporting questionnaire (valid and reliable Garcia scale) was used in this study.
After conducting the pretest, the educational intervention was done for the experimental group.
Post-tests were conducted immediately and 1 month after intervention. The collected data were
analyzed using SPSS18 statistical software (independent t-test, paired t-test, chi-square, MannWhitney test and repeated measures ANOVA). The participants voluntarily and consciously
participated in this study. Results: The findings indicated no significant differences between the
groups in terms of mean scores of knowledge
(P = 0.934), attitude (P = 0.155) and behavior
(P = 0.387) before the intervention. There
was a significant difference between mean
scores of knowledge in the immediate
follow-up (P< 0.001) and 1 month after
intervention follow-up (P < 0.001), and also
between mean scores of attitude immediately
(P < 0.001) and 1 month after intervention
(P = 0.01) follow-ups in the experimental
group compared with the control one. Mean
scores of physical activity 1 month after the
intervention in both experimental and control groups significantly increased (P < 0.001, P = 0.01, respectively), but the mean scores of
physical activity between two groups were not significantly different (P = 0.390). Discussion and
Conclusion: The results indicated the effectiveness of educational intervention, consequently
increased knowledge and improved attitude of students, in the experimental group compared
with the control one in terms of physical activities; thus, physical activity behavior of intervention
group increased. Although the mean scores of physical activity in the control group significantly
increased, other studies should be done which can control and consider confounding variables.