Document Type : Original Article

Authors

1 Department of Public Health, Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran

2 Department of Health Education and promotion, Faculty of Health, International Campus of Tehran University of Medical Sciences, Tehran, Iran

3 Department of Biostatistics, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Introduction: The elderly are vulnerable to negative effects of stress factors; so, the present
study was conducted to determine the effect of educational intervention based on the PRECEDE
model on stress level of the elderly and to control stress factors. Materials and Methods: In
this quasi-experimental study, 94 elderly people from the clubs for the elderly in Tehran were
randomly divided into case and control groups in 2008–2009. Planning for the educational
program was done according to the PRECEDE model. Before implementing the program,
valid and reliable depression, anxiety, and stress questionnaires (DASS 21) were completed
for both groups. The experimental group received the educational intervention based on the
PRECEDE model (eight sessions, one session per week), and both groups were followed up
two months after the intervention (the previous questionnaires were filled again). DASS 21
Scoring and Interpretation Generator was used for calculating scores of the questionnaires.
Finally, the data obtained were analyzed by the SPSS 15 software using t-test, paired t-test, and
Mann-Whitney test at a significant level of P≤0.05. Results: The findings showed significant
differences between the experimental group and control group in terms of predisposing
factors of knowledge (P≤0.001) and attitude (P≤0.001), enabling factors (P≤0.001), reinforcing
factors (P≤0.001), and functioning especially in deep breathing and relaxation techniques
(P≤0.001). Mean scores and severity of stress were significant after the intervention (P≤0.001).
Conclusion: The findings of the present study confirmed the effectiveness of the PRECEDE
model-based educational program on preventing or reducing stress level in the elderly.

Keywords

1. Tajvar M, Farzian Pour F. Seniors’ health and review various aspects
of their lives. 1st ed. Tehran: Nasle Farda Publication; 2003. p. 21-8.
2. Statistical Center of Iran [Online]. 2007. Available from: http://www.
sci.org.ir/content/user files/-sci/sci/sel/f02/2.4.html/. [Last cited on
2009 Feb 5].
3. Afshar H, Salehi M. Geriatric psychiatry. 1st ed. Isfahan: Oruoj
Publication; 2004. p. 246-54.
4. Harsini S. Stress, causes, signs, symptoms and solutions. 1st ed.
Tehran: Iran University of Medical Sciences and Health Services
Publication; 2007. p. 1-2.
5. Kushan M, Vaghei S. Psychiatric Nursing. 1st ed. Tehran: Andishe
Rafia Publication; 2012. p. 170.
6. Razm Azma H. What is stress? 1st ed. Tehran: Sepanj Publication;
2008. p. 9-11.
7. Galvin JA, Benson H, Deckro GR, Fricchione GL, Dusek JA. The
relaxation response: Reducing stress and improving cognition in
healthy aging adults. Complement Ther Clin Pract 2006;12:186-91.
8. Ghaffari S, Ahmadi F, Nabavi M, Memarian R. The effect of progressive
muscle relaxation technique on depression, anxiety and stress in
patients with multiple sclerosis. J Res Med Sci 2008;32:45-53.
9. Hamidi Zadeh S, Ahmadi F, Asgari M. The effects of relaxation
techniques on anxiety and stress in elderly patients with
hypertension. J Shahrekord Univ Med Sci 2006;8:45-51.
10. Modeste N, Tamayose T. Dictionary of public health promotion
and education: Terms and concepts. Trans. In: Shams M, Karimi A,
editors. 1st ed. Tehran: Tandis Publications; 2008. p. 122.
11. Hazavehei SM, Sabzmakan L, Hassan Zadeh A, Rabie K. The effect
of PRECEDE Model-based educational program on depression level
in patients with coronary artery bypass grafting. J Qazvin Univ Med
Sci Health Serv 2008;12:32-40.
12. Lesan SH, Ghofrani Pour F, Byrshk B, Faghihzadeh S. Application
of PRECEDE in reducing Tehranian firemen anxiety. Iran Psychiatry
Clin Psychol 2003;9:77-84.
13. Mirzaei E. Health education. In: Hatami H, Razavi SM, editors. Textbook
of public health. 2nd ed. Tehran: Arjomand Publication; 2008. p. 206.
14. Green LW, Kreuter MW. Health program planning: An educational and
ecological approach. 4th ed. New York: McGraw-Hill; 2005. p. 7-23.
15. Butler JT. Principles of health education and health promotion. 3rd
ed. Belmont: Wadsworth; 2000. p. 234-5,269-74.
16. National Institutes of Health. Theory at a Glance: A guide for health
promotion practice. 2nd ed. Washington (DC): National Institutes of
Health Publication; 2005. p. 39-43.
17. Sahebi A, Asghari M, Salari R. Validation of anxiety, depression
and stress scale (DASS21) for the Iranian population. Dev Pscychol
2005;1:299-312.
18. Samani V, Jokar R. Reliability and validity of the short form ofdepression, anxiety and stress scale. J Soc Sci Humanit, Shiraz
Univ 2007;26:65-77.
19. Aghebati N. The effect of therapeutic touch on pain and psychological
symptoms of anxiety, depression and stress in hospitalized cancer
patients [MSc Thesis]. School of Medical Sciences, Tarbiat Modarres
University, Tehran; 2006.
20. Moshki M, Ghofrani Pour F, Azad Fallah P, Haji Zadeh E. Implementation
of participatory-educational program based on PRECEDE model for
self-esteem and psychological well-being enhancement of university
students. Hormozgan Med J 2010;14:22-31.
21. Yates P, Edwards H, Nash R, Aranda S, Purdie D, Najman J, et al.
A randomized controlled trial of a nurseadministered educational
intervention for improving cancer pain management in ambulatory
settings. Patient Educ Couns 2004;53:227-37.
22. Sanaenasab H, Kazemnejad A, Khavanin A, Tavakoli R, Ghofrani
Pour F. The effect of composed precede-proceed model, social
cognitive and adult learning theories to promote safety behaviors
in employees. Behbood 2008;12:11-25.
23. Saffari M, Shojaei Zadeh D, Ghofrani Pour F, Pak Pour A. Health
education and promotion (Theories, Models & Methods). 1st ed.
Tehran: Sobhan Publications; 2009. p. 155-7.
24. Nikbakht Nasrabadi A, Taghavi Larijani T, Mahmoudi M, Taghlili F.
Comparison of two methods of Benson Relaxation and repeat the
recommended requirements on state anxiety in patients before
abdominal surgery. Hayat 2004;10:29-37.
25. Dehdari T, Heidar Nia A, Ramezan Khani A, Sadeghian S,
Ghofranipour F, Etemadi S. Planning and evaluation of an
educational intervention programm to improve life quality in patients
after coronary artery bypass graftsurgery according to PRECEDEPROCEED model. J Birjand Univ Med Sci 2008;15:45-53.