Journal of Education and Health Promotion

Abstract BACKGROUND: Psychological well‑being is an important part that undergraduate students and
universities cannot neglect as it helps students lead a better study life at the university. Various
studies revealed that social support can affect students’ psychological well‑being. However, the causal
relationship between social support and psychological well‑being has received little attention in North
China. Therefore, the aim of the current study was to analyze the causal relationship between social
support and psychological well‑being among undergraduate students in North China.
MATERIALS AND METHODS: The survey approach was adopted and conducted with a total of 689
undergraduate students in North China. Data were collected using a reliable questionnaire. Data
analysis was performed with descriptive statistics, Pearson’s correlation, and structural equation
modeling at P < 0.01 significance level using Statistical Package for Social Sciences (SPSS) and
Linear Structural Relations (LISREL).
RESULTS: The overall levels of social support and psychological well‑being among undergraduate
students in North China were high. All observed variables in this study were significantly correlated.
The findings also confirmed that the causal relationship between social support and undergraduate
students’ psychological well‑being in North China fitted to the empirical data well (χ2 [22, N = 689]
= 27.69, χ2
/degree of freedom [df] = 1.26, P = 0.19, goodness of fit index [GFI] = 0.99, adjusted
goodness of fit index [AGFI] = 0.98, comparative fit index [CFI] = 1.00, standardized root mean square
residual [SRMR] = 0.02, root mean square error of approximation [RMSEA] = 0.02).
CONCLUSIONS: Undergraduate students’ psychological well‑being had been significantly affected
by social support in North China. The findings from the current study will be useful for university
administrators to develop strategies for the enhancement of undergraduate students’ psychological
well‑being.

Abstract BACKGROUND: Substance use disorders (SUDs) are one of the most stigmatized health conditions
that impact drug user’s treatment engagement. However, to date, little is known about perceived
stigma and its correlates with psychological factors among high‑risk groups such as people with
SUDs in the criminal justice system. This study aimed to determine the association of psychological
factors and perceived stigma of addiction among women with SUDs.
MATERIALS AND METHODS: This cross‑sectional design was conducted on 652 women with SUDs
who were treated in all 7 compulsory drug detention centers in Thailand with consecutive sampling
technique. The data were collected by standardized interviewers with interviewing questionnaire.
Multiple logistic regression was applied to examine the effect of psychological factors and perceived
stigma.
RESULTS: More than half of SUD patients (57.2%) were methamphetamine abuse or dependence,
approximately 69.9% reported high level of perceived stigma, 56.7% had mild depression, 34.8% had
low level of perceived social support, and the average perceived stress score was 19.2 (standard
deviation, 7.5). The perceived stigma was positively related to depressive symptom and perceived
stress while was inversely related to perceived social support.
CONCLUSION: The psychological factors were strongly associated with perceived stigma of addiction.
Thus, the detection of psychological problems among SUD patients may be benefit clinicians for
identifying which patients are most at risk of perceived stigma and are the potential targets of
intervention to reduce stigma in clinical practice.

Abstract BACKGROUND: Social resources help to adapt to stress and might positively affect the well‑being
of individuals with severe conditions like human immunodeficiency virus/acquired immunodeficiency
syndrome (HIV/AIDS). The present study investigates the effect of social support, social capital, and
coping in a positive state of mind of Iranian older people with HIV/AIDS.
MATERIALS AND METHODS: This cross‑sectional study was conducted on 160 older people with
HIV referred to AIDS clinics in Tehran in 2019. Samples were randomly selected from patients aged
50 years and older. Data were collected using a questionnaire, a positive state of mind, social capital,
coping, social support, and a checklist of demographical variables. Data analysis was performed
using SPSS software version 21.
RESULTS: A significant positive correlation was found between social support, social capital, coping,
education, and a positive state of mind. A significant negative correlation was also found between
age, several chronic diseases of the patient, and a positive state of mind. The linear regression results
showed that social support, social capital, coping, and education improved the positive state of mind.
CONCLUSIONS: Based on our findings, we believe that social and psychological interventions
effectively enhance patients’ positive state of mind with HIV and ultimately, improve their quality of life.

Abstract INTRODUCTION: Health promotion is one of the most important aspects in pregnancy, and
health‑promoting behaviors are one of the major determinants of health under the influence of various
factors. This study aimed to determine the association between social support and psychological
factors with health‑promoting behaviors in pregnant women.
MATERIALS AND METHODS: This cross‑sectional was performed on 375 pregnant women when
they had 24–28 weeks in Ilam, October 2018 to May 2019. Two‑stage cluster sampling was performed
after checking the inclusion criteria. Data collection tools consisted of four questionnaires that were
completed in self‑report form. The collected data were analyzed by the descriptive and inferential
tests with the SPSS software version 19.
RESULTS: The mean score of health‑promoting behaviors was 139.87 (21.26) and self‑healing and
physical activity had the highest and the lowest mean 27.67 (4.84) and 16.29 (4.84), respectively.
Linear regression analysis showed a significant difference between different level of stress, anxiety,
depression, and social support with health‑promoting behaviors (P < 0.001). The results showed
that one‑point increase in the score of stress, anxiety, and depression led to the 2.2%, 6.1%, and
24.1% reduction of health‑promoting behaviors, respectively, and one‑point score increase in social
support resulted in 40% increase in health‑promoting behaviors (P < 0.001).
CONCLUSION: A negative association was found between psychological factors and a positive
relationship with health‑promoting behaviors. Although perceived moderate health promotion
behaviors and perceived social support were moderate, they did not have a good status in terms of
psychological factors. Given awareness of the issues under study in each region is essential and
planning to improve stress, anxiety, and depression, as well as promoting and correcting inappropriate
behaviors through planned interventions are required.

Abstract INTRODUCTION: Getting pregnant care is different due to the psychological problems of pregnant
mothers. Self‑compassion and social support are the important components of mental health.
Women with higher self‑compassion and social support can take full care of their pregnancies. The
aim of this study was to determine the relationship between social support and self‑compassion with
adequate prenatal care.
METHODS: The present study is a cross‑sectional descriptive study that was performed in
2018 using the available sampling method on 500 pregnant mothers referred to Isfahan health
centers. Individuals entered the study if they had entry criteria and no exit criteria, and completed
social support, self‑compassion, and adequacy of pregnancy care questionnaires. The data were
coded and analyzed by SPSS software version 22 and Pearson’s correlation statistical test.
RESULTS: The results of data analysis with Pearson’s correlation test showed a positive and
statistically significant relationship with pregnancy care between the overall score of social support
(P < 0.001) and the dimensions of social support such as family support (P < 0.002), support of
friends (P < 0.004), and the support of other people (P < 0.001). The results also showed a positive
and statistically significant relationship between self‑compassion and prenatal care (P < 0.001). There
was a significant positive relationship between the subscales of the self‑empathy questionnaire,
including kindness to oneself, human commonalities, mindfulness and increasing replication, and
pregnancy care, but there was a significant negative relationship between subscales of isolation and
self‑judgment with pregnancy care.
CONCLUSION: According to the results of the present study, social support and self‑compassion
as two components of mental health can affect the quality of services during pregnancy. For this
reason, it is recommended that health‑care providers pay attention to these two issues in order to
increase the level of care during pregnancy and thus ensure maternal health during pregnancy and
childbirth and the health of the fetus and baby.

Abstract BACKGROUND: Dynamic aging depends on providing opportunities to improve the quality of life
of the elderly. The objective of this study was to investigate the relationship between social support
and quality of life in the elderly in Guilan.
MATERIALS AND METHODS: This descriptive‑correlational study was conducted in the elderly
who visited urban public places in the East of Guilan (mosques, parks, weekly markets, and clubs).
A total of 168 elderly who met the inclusion criteria were selected through two‑stage, cluster, and
convenience sampling. Data were collected using Phillips Standard 23‑item social support scale
and 12‑item quality of life scale‑short form. Data were analyzed through descriptive and inferential
statistics (Pearson correlation coefficient).
RESULTS: The mean score of social support in the elderly in Guilan was 73.25 ± 9.18 and the mean
quality of life was obtained at 24.67 ± 7.06. Data analysis showed that there was a significant and
positive correlation between social support and quality of life (r = 0.29, P < 0.0001).
CONCLUSIONS: Increased social support leads to a higher quality of life in the elderly. Thus, it is
necessary to timely identify the needs and promote comprehensive social support to improve the
quality of life in the elderly.

Abstract BACKGROUND: Social support is one of the most effective factors on the diabetic self‑care. This
study aimed to assess social support and its relationship to self‑care in type 2 diabetic patients in
Qom, Iran.
STUDY DESIGN: A cross‑sectional study was conducted on 325 diabetics attending the Diabetes
Mellitus Association.
METHODS: Patients who meet inclusion and exclusion criteria were selected using random sampling
method. Data were collected by the Summary of Diabetes Self‑Care Activities and Multidimensional
Scale of Perceived Social Support, with hemoglobin A1
C test. Data were analyzed using descriptive
statistics and independent t‑test, analysis of variance, Pearson correlation, and linear regression
test, using 0.05 as the critical significance level, provided by SPSS software.
RESULTS: The mean and standard deviation of self‑care and social support scores were
4.31 ± 2.7 and 50.32 ± 11.09, respectively. The mean level of glycosylated hemoglobin (HbA1
C) of
patients was 7.54. There was a significant difference between mean score of self‑care behaviors
and social support according to gender and marital status (P < 0.05). The regression analysis
showed that disease duration was the only variable which had a significant effect on the level
of HbA1
C (P < 0.001). Pearson correlation coefficient indicated that self‑care and social support
significantly correlated (r = 0.489, P > 0.001) and also predictive power of social support was 0.28.
Self‑care was significantly better in diabetics with HbA1
C ≤7%. Patients who had higher HbA1
C felt
less, but not significant, social support.
CONCLUSIONS: This study indicated the relationship between social support and self‑care behaviors
in type 2 diabetic patients. Interventions that focus on improving the social support and self‑care of
diabetic control may be more effective in improving glycemic control.

Abstract Background and Objectives: Congestive heart failure is one of the most common
cardiovascular diseases that have a progressive and chronic trend and influences individuals’
and their families’ various dimensions. Social support is one of the psychosocial factors that
can have a positive effect on individuals’ physical, mental and social status. Despite the
existence of evidences, revealing the importance of family’s support on patients’ condition,
family centered supportive interventions with goal of clinical outcomes improvement have
been less conducted among these patients. Therefore, the present study aimed to investigate
the effect of family supportive intervention on the level of the support, received among heart
failure patients. Materials and Methods: This is a two‑group two‑stage clinical trial, conducted
on 64 patients with cardiac failure, referring to selected educational centers and meeting the
inclusion criteria, who were selected through convenient sampling. They were assigned to
study (n = 32) and control (n = 32) groups through random allocation. Data were collected
by questioning through a two‑section medical records questionnaire and were analyzed by
SPSS. Results: Results of the study showed that mean scores of received support score were
13.7 (3.8) in the study and 0.8 (2.4) in the control group. Independent t‑test showed a significant
difference in mean changes of perceived support scores after the intervention between study
and control groups (P < 0.001). Conclusions: Based on familial dimension in social support
have a positive effect on patients’ perceived support. Nurses, as professional members of
health care team, and with an important role in education and care of cardiac failure patients,
can support, educate and guide these patients through designing appropriate care plans and
educating their family members.

Abstract Background: Although psychological factors are now recognized as playing a significant
and independent role in the development of coronary heart disease (CHD) and its
complications, many of these factors are correlated with each other. The present study is
aimed at examining the association between alexithymia and anxiety depression, stress,
quality of life, and social support in CHD patients. Materials and Methods: In this research
398 patients with coronary heart disease (166 females and 232 males) from the city of
Isfahan were selected using random sampling. The tools used included depression, anxiety,
and stress scale (DASS-21), Health-related to Quality Of Life (HRQOL-26), Multiple Scale
Perceived Social Support (MSPSS-12), and the Toronto Alexithymia Scale (TAS-20). The data
were analyzed using structural equation modeling by using the Statistical Package for Social
Science (SPSS21) (IBM Corp: Armonk, New York.U.S.) and Asset Management Operating
System (AMOS21) SPSS, an IBM Company: Chicago, U.S. Software. Results: Results of
the structural equation model showed an acceptable goodness of fit, for the explanation
alexithymia that was significantly associated with lower HRQOL and social support and
increasing anxiety, depression, and stress. Conclusions: Alexithymia may increase anxiety,
depression, and stress and can be a predisposing factor to poorer HRQOL and social
support.

Abstract Introduction: The present study aims to provide a model for explaining the mental health of
war veterans based on the variables of spiritual well-being, social support, and self-efficacy,
with the mediating role of life satisfaction. Materials and Methods: The research method was
descriptive a correlational. The study samples included 210 veterans, who had records in the
Veterans Foundation in Tehran’s number one district, Sarallah and Imam Khomeini shelters
and Essaar Sports Center in Tehran. They were selected randomly and were asked to respond
to questionnaires on mental health, spiritual well-being, life satisfaction, social support, and
self-efficacy. The data was analyzed by LISREL software version 8.5, using the path analysis.
Results: The results showed that the designed model fitted the data (AGFI = 1.00, RMSEA = 0.00
and NFI = 1.00). In the fitted model, life satisfaction and spiritual well-being directly, and social
support indirectly, had a significant relationship with the mediator variable of life satisfaction
of the war veterans’ mental health. Conclusions: Veterans with better social support, life
satisfaction, and spiritual well-being have better mental health.

Abstract Background and Objectives: Diabetes is one of the major concerns in the third millennium,
affecting more people every day. The prevalence of this disease in Iran is reported to be
high (about 7.7%). The most important method to control this disease and prevent its
complications is self‑care. According to various studies, this method has not found its
proper place among patients with diabetes due to several reasons. The present study was
aimed at determining the relationship between social support, especially family support, and
self‑care behavior of diabetes patients. Materials and Methods: This study was a narrative
review in which the relevant papers of cross‑sectional, cohort, clinical trial, and systematic
review designs were selected using databases and scientific search engines such as
PubMed, ProQuest, SCOPUS, and Elsevier, with the keywords diabetes, social support,
and self‑care. Moreover, Persian papers were selected from MEDLAB and IRANMEDEX
databases and through searching the websites of original research papers published in
Iran. All the papers published from 1990 to 2011 were reviewed. Results: The results of
the study indicated that the status of self‑care and social support in patients with diabetes
was not favorable. All the studied papers showed that there was a positive relationship
between social support and self‑care behavior. Also, some studies pointed to the positive
effect of social support, especially family support and more specifically support from the
spouse, on controlling blood sugar level and HbA1c. Conclusion: As social support can
predict the health promoting behavior, this concept is also capable of predicting self‑care
behavior of patients with diabetes. Therefore, getting the family members, especially the
spouse, involved in self‑care behavior can be of significant importance in providing health
care to patients with diabetes.