Journal of Education and Health Promotion

Abstract BACKGROUND: Cardiovascular disease (CVD) is the number one cause of death in India.
Atherosclerosis begins in the second decade of life; thus, preventive efforts beginning in adolescence
are crucial. Yet, there are no national or regional school‑based educational programs in India for
the prevention of CVD. We aimed to assess the impact of a simple educational intervention on the
awareness regarding CVD among school‑going adolescents in a rural area of Bengaluru.
MATERIALS AND METHODS: This study was conducted using a convenience sample of school‑going
adolescents of classes 8, 9, and 10 in three schools in a rural area of Anekal subdistrict, Bengaluru,
with a sample size of 170. A standardized, validated questionnaire testing CVD awareness was
administered, followed by a simple lecture with audio‑visual aids on key aspects of CVD. Three weeks
later, the same questionnaire was administered to the same students. The results were then analyzed
using appropriate descriptive (mean, percentage) and inferential analyses (Chi‑square, paired t‑test).
RESULTS: The mean (SD) age was 14.5 (1.0) years, and 54% (n = 100) were boys. 75% (139)
belonged to privately funded schools. 23% (43) belonged to class 8, 37% (69) to class 9, and 40% (74)
to class 10. The mean (SD) total score on baseline assessment was 27.4 (9.3) out of 100, with girls
and students of private schools scoring higher. The mean (SD) post‑test total score was 48.5 (15.7),
with significant increases in all domains of awareness, and in all categories of students.
DISCUSSION: Awareness regarding CVD among adolescents from rural Bengaluru was poor,
highlighting the need for educational interventions to aid preventive efforts. A simple educational
intervention resulted in significant improvements in CVD awareness, even after 3 weeks.

Abstract BACKGROUND: Skill Training Intervention Based on the Healthy Lifestyle Counselling Module (5As
model) in the Ira PEN Program.
MATERIALS AND METHODS: This study was a randomized controlled trial in Iran. Participants
were 184 health workers and 184 clients (92 in each study group). The training program entailed
an online training course, educational video, and clip. The behavior related to a healthy lifestyle in
clients was also followed‑up 2 months later. Data were analyzed using SPSS 22 software.
RESULTS: Based on the observations, significant improvement in lifestyle counseling skills
among health workers in the intervention group compared to the control group in terms of healthy
nutrition (P < 0.001), physical activity (P < 0.001), smoking cessation (P = 0.03), and withdrawal of
alcohol consumption (P < 0.001) was observed. Also, lifestyle‑related behaviors among clients in
terms of healthy nutrition (P < 0.001), physical activity (P < 0.001), and withdrawal smoking (P < 0.001)
increased significantly. Furthermore, waist circumference (P < 0.024) and BMI (P < 0.001) among
clients were significantly reduced.
CONCLUSION: The training program for health personnel in healthy lifestyle has a more effective
role in changing people’s behavior and prevention of noncommunicable risk factors. Healthy life
style counselling in primary health cares may lead to control risk factors for Noncommunicable
disease.

Abstract BACKGROUND: Nursing students have a role in the awareness of risk factors in the development
of healthy lifestyle behaviors. Nursing students’ awareness of disease risk factors plays a role in
developing healthy lifestyle behaviors. Therefore, it was aimed to determine the relationship between
the effect of nursing students’ healthy lifestyle behaviors and cardiovascular disease risk factors’
knowledge levels and obsessive–compulsive symptoms.
MATERIALS AND METHODS: This was a descriptive cross‑sectional study. Two hundred and
twenty‑four students studying in the nursing departments of two foundation universities participated
in the study between April and October 2020. Sociodemographic information form, Health Promoting
Lifestyle Profile II (HPLP‑II), Cardiovascular Disease Risk Factors Knowledge Level (CARRF‑KL),
and Maudsley Obsessive–Compulsive Inventory (MOCI) were applied to the students.
RESULTS: It was found that the nursing students’ healthy lifestyle behaviors (123.53 ± 25.78) and
cardiovascular risk factors’ knowledge level (21.08 ±± 2.70) were high. Obsessive–compulsive
symptoms (16.12 ± 6.22) were moderate. In the correlation of sociodemographic characteristics, it
was found that age correlated with the nutrition subdimension of CARRF‑KL and HPLP‑II, income
level correlated with HPLP‑II, place of residence correlated with HPLP‑II, CARRF‑KL, and MOCI, and
having a health problem correlated with health responsibility. Income status, place of residence, and
presence of health problems were found to be correlated with HPLP‑II in all subdimensions in the
regression analysis. In the regression analysis of HPLP‑II with CARRF‑KL and MOCI scales, it was
found that it was significantly related to interpersonal relations, spiritual growth, stress management,
and total score dimensions.
CONCLUSION: Healthy lifestyle behaviors of nursing students are related to cardiovascular risk
factors’ knowledge level and obsession symptoms. In addition, some demographic characteristics
affect healthy lifestyle behaviors.

Abstract BACKGROUND: The Iran Package for Essential Noncommunicable Disease (Ira‑PEN) program 
has been established since 2018 with the aim of controlling and caring of noncommunicable 
diseases (NCDs) as well as their underlying causes in Iran. In this study protocol, a healthy lifestyle 
module will be used for the first time in Iran, which was recommended in 2018 by the World Health 
Organization to train health workers. This module relies on the 5As model, a training intervention 
design, then, implement, evaluate, and present the results to the managers and decision makers 
of the Ira‑PEN program.
MATERIALS AND METHODS: This study will be performed in 2 stages, including 2 steps per stage. 
The first stage involves designing the 2 steps and validation of the healthy lifestyle counseling skills 
tool. The tool will encompass a health counseling evaluation checklist and a counseling assessment 
questionnaire according to the counseling recipients. The second stage also entails 2 steps; 
designing a training program for health workers in the field of healthy lifestyle counseling based on 
the Oles‑Cement model followed by implementation and evaluation.
CONCLUSIONS: The training program and the results obtained in this study will be presented to 
the managers and decision makers of both the Ira‑PEN program and NCDs control in Iran, and it is 
suggested to enhance the training program, network, and educational curriculum of health workers 
in providing healthy lifestyle counseling to play a more effective role in changing the public behavior 
toward a healthy lifestyle and preventing the risk factors of NCDs.

Abstract BACKGROUND: Coronary artery bypass graft (CABG) plays an important role in reducing coronary 
heart disease mortality, but patients are still at risk after surgery. Consequences can be avoided if 
threatening behaviors are soon detected and lifestyles are promoted. Therefore, the present study 
aimed to evaluate, follow‑up, and promote a healthy lifestyle in the patients.
MATERIALS AND METHODS: The present research was a quasi‑experimental pre‑ and 
postintervention single‑group study on 35 patients under the CABG at two hospitals affiliated to the 
Baqiyatallah University of Medical Sciences in Tehran from August 2020 to April 2021. The samples 
were selected using the purposive sampling method and the educational content was determined 
by creating an expert panel. We utilized the Health‑promoting Lifestyle Profile II to collect data, and 
SPSS 22 to analyze them.
RESULTS: There was a significant difference between mean total scores of health‑promoting lifestyle 
before and after the intervention and they reached from 138.7 ± 20 to 157.2 ± 18 (P < 0.0001). There 
was also a statistically significant difference between mean scores of nutrition (P < 0.003), physical 
activity (P < 0.0001), health responsibility (P < 0.0001), and stress management (P < 0.0001) before 
and after the intervention, but there was no statistically significant difference between mean scores 
of interpersonal relationships, and spiritual growth before and after the intervention.
CONCLUSIONS: The program had a positive effect on the health‑promoting lifestyle scores of 
patients after CABG. It is possible to increase scores of healthy lifestyles in the patients by combining 
face‑to‑face and virtual training methods as well as involving family members and relatives of patients 
in training and follow‑up programs.

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: 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: Students must be made aware about the essentiality of optimum level of physical
activity and the fact that it is the key to good health and an important technique to prevent and control
a lot of noncommunicable diseases including depression and other related mental ill‑health.
MATERIALS AND METHODS: It was an institution‑based intervention study among 187 Madrasah
students of classes VII and VIII, conducted in five‑phase assessment of the training needs of
Madrasah students on different aspects of healthy lifestyle, development of a need‑based module
to be used by teachers to impart training of students through classroom setting, training of teachers
to use the module to train students, training of students by the trained teachers in classroom setting,
and evaluation of effectiveness of the training module.
RESULTS: The mean pretest knowledge score in study Madrasah was 2.64 ± 1.35 (Mean ± SD)
and post test score was 4.13 ± 0.88 (Mean ± SD). In paired t‑test, t‑value was 13.54 and P < 0.05
with effect size of 1.370 (Cohen’s d). Practice related to the mean score in pretest was 2.38 ± 1.08
and posttest score was 2.73 ± 1.03. In paired test, t‑value was 6.25 and P < 0.05 with effect size of
0.458 (Cohen’s d).
CONCLUSIONS: The study revealed the effectiveness of training by teachers using the module
developed by the researcher to address significant changes in lifestyle‑related issues.

Abstract BACKGROUND: The health-promoting lifestyle by empowering individuals will increase control over
their health, improve quality of life, and prevent diseases. The purpose of the present study was to
determine the effect of the educational intervention based on the intervention mapping approach on
health-promoting lifestyle in Iranian college students.
METHODS: This study is a quasi-experimental control study that was conducted in two groups of
65 students of Iran University of Medical Sciences in 2018–2019. The data were collected using the
Health-Promoting Lifestyle Standard Profile II questionnaire and a researcher-made questionnaire
based on the mapping approach, whose validity and reliability were confirmed. The educational
intervention was designed according to the pretest results, including five training sessions and
performed for the intervention group. The two groups were evaluated with the same questionnaires
1 month and 3 months later, and the data were analyzed using independent t-test, Spearman,
ANCOVA, ANOVA test, and covariance.
Results: Before the intervention, no significant difference was observed between the mean scores of
health-promoting behaviors in the two groups, but after the intervention, the mean scores of attitude,
subjective norms, enabling factors, and perceived self-efficacy and mean scores of health-promoting
lifestyle and its dimensions increased significantly in the intervention group (P < 0.001) compared
to the control group.
Conclusion: The educational intervention is effective in improving behaviors related to healthpromoting lifestyle and its dimensions. Therefore, performing educational interventions are suggested
to adopt and adhere to behaviors related to health-promoting lifestyle by utilizing and reinforcing
perceived self-efficacy, subjective norms, enabling factors, and attitudinal change.

Abstract BACKGROUND AND AIM: Little information is available on the use of text messages through
mobile phones to address overweight/obesity in children. This study aims to evaluate the impact
of a text message‑based intervention for weight control and health‑promoting lifestyle behaviors of
overweight/obese children.
MATERIALS AND METHODS: This quasi‑experimental study was conducted among
overweight/obese school students. Data on sociodemographic, dietary intake, sleep, sedentary
behavior, physical activity (PA), and anthropometry were collected before and after the intervention.
Weight and height were examined according to the standard protocols. The intervention was consisted
of tailored messages for weight control and healthy lifestyle, including diet, PA, sedentary behavior,
and sleep. Child attitude and his practice were asked before and after the intervention. The paired
t‑test was performed to compare means of continuous variables before and after the intervention for
normal distribution data. The Wilcoxon test was also used for nonnormal data.
RESULTS: A total of 71 boy students were included in the study (62% obese). The mean age was
10.07 years. The means of attitude score for PA, nutrition, and sleep after intervention were greater
than before it, but it was significant only for PA. The mean of nighttime sleep duration of students after
the intervention was significantly less. Furthermore, unhealthy score decreases after the intervention.
CONCLUSION: Three‑month lifestyle intervention as text messages had positive effects on the
nutritional intake of obese children and their attitudes toward PA, but no effect on child body mass
index.

Abstract OBJECTIVE: The aim was to explore the relationship between mental health problems (MHPs) and
health‑promoting lifestyle (HPL) in the medical students.
METHODS: This cross‑sectional study was carried out on medical students in 2017 at Semnan
University of Medical Sciences applying a stratified random sampling. The Symptom Checklist‑25
and the HPL profile scales were used. Logistic regression models were used to analysis.
RESULTS: Of the participants, 84 were male and 148 were female. The mean age was
22.69 years (±2.42). Most students (95.3%) were single and 40.1% were in the preclinical stage.
The mean MHP score was 44.14 (±13.99), and 3% were in the severe category. The mean HPL
score was 104.88  (±16.84); 95.7% and 4.3% of them had average and satisfactory lifestyles,
respectively. The MHP score of the female (P < 0.001), younger (P < 0.001), single (P = 0.045),
preclinical (P < 0.001), and who were away from home (P  =  0.009) were significantly higher.
The HPL score of female (P < 0.001), older (P = 0.041), and married students (P = 0.028) were
significantly higher. The female gender (odds ratio [OR] = 4.45, P < 0.001) and studying in the clinical
level (OR = 0.30, P < 0.001) were the most important associated factors with MHP. Adjusting for
them, there was a significant relationship between an increase in the HPL score and a decrease in
the likelihood of MHP (OR = 0.96, P < 0.001).
CONCLUSIONS: The mental health of medical students was shown to be in association with lifestyle
independent of other important determinants, including gender and academic level. It seems that
modifying the lifestyle to a healthier way can improve students’ mental health.

Abstract Background: Medical and health advances have led to relative increases in human longevity
and elderly population. Common diseases in elders can be prevented using healthy lifestyle.
Identifying current status of the elderly is necessary to design educational intervention programs
to improve their health and quality of life. Therefore, this study aimed at assessing the lifestyle of
the elderly in Islamshar (suburban of Tehran). Materials and Methods: A descriptive – analytical
study conducted among 480 elderly people over 60 years old referred to Islamshahr Health
Center of Tehran University of Medical Sciences for a period of 12 months in 2012–2013. Data
were collected through at two‑part questionnaire including sociodemographic and health‑related
characteristics and healthy lifestyle instrument. Healthy lifestyle of the elderly was assessed
using a 46 items self‑report standard instrument with five subscales reflecting domains including
exercise, nutrition, prevention, stress management, and social relationship. Finally, the data
obtained were analyzed using the SPSS 18 software using an independent t‑test, analysis of
variance and ordinal logistic regression test at a significant level of P < 0.05. Results: Mean
score of total healthy lifestyle was 148.56 ± 11.5. Men and women scored 151.95 ± 11.15 and
145 ± 10.32, respectively (P < 0.001). 76.2% of participants had moderately healthy lifestyle,
and 23.8% had desirable healthy lifestyle. Marital status and gender were important factors
in elderly healthy lifestyle. Discussion: The status of a healthy lifestyle among the elderly in
Islamshar was relatively moderate. However, more studies are needed for further information to
confirm study results. Study results were posed the necessity of tailoring specific interventional
programs to achieve desirable healthy lifestyle.

Abstract Background: Lifestyle choices and individuals’ behaviors have the potential to influence
health and improve the quality of life. Objectives: The purpose of this study was to develop
and psychometrically test an instrument for measuring healthy lifestyle in Iranian adolescents.
Materials and Methods: A comprehensive literature review related to health‑promoting lifestyles
was used to identify potential scale items. Data were collected from 797 school students. Construct
validity was analyzed using exploratory factor analysis. Confirmatory factor analysis (CFA) was
used to cross‑validate. Results: Nine factors emerged that explained 59.8% of the variance in
the 43 items. Cronbach’s a coefficient Healthy Lifestyle Questionnaire was r=0.82. After the
model was modified, the fit indices indicated that the data were an adequate‑to‑good fit to the
proposed models. Conclusions: The current study provides some support to the internal and
external validity of the healthy lifestyles questionnaire for Iranian adolescents.