Document Type : Original Article

Authors

1 Social Deputy Department of Zanjan University of Medical Sciences,

2 Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences

3 Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR

4 Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran

Abstract

INTRODUCTION: In recent decades, the focuses of health studies were mostly in middle‑aged
women, and few studies have investigated the lifestyle of women after delivery. The aim of this
study was to determine the effects of both self‑efficacy and perceived barriers on Iranian women
health‑promoting lifestyle (HPL) in the first 1 year after childbirth.
MATERIALS AND METHODS: Using a cross‑sectional design, 310 women at first‑year postpartum
were surveyed in Zanjan (Iran) in 2016. The proportionate stratified random sampling method was
carried out to select a participant. HPL has assessed with HPL profile II questionnaire. Self‑efficacy
was assessed using self‑rated abilities for health practices scale. Perceived barriers were assessed
by Barriers to Health‑promoting Activities for Disabled Person scale. A meditational model was used
to examine whether perceived barriers mediates between perceived self‑efficacy and HPL.
RESULTS: The participants mean age was 29.82 (5.1) years, 53.9% were primiparous, and most
of them were homemakers (82.9%). The mean total score of HPL was 2.50 (0.29). The relationship
between HPL and self‑efficacy was mediated by perceived barriers partially.
DISCUSSION: Self‑efficacy, not only promotes women’s HPL but also indirectly affect the women’s
lifestyle by reducing perceived barriers.

Keywords

1. Stahl ST, Patrick JH. Perceived functional limitation and health
promotion during mid‑to‑late life: The mediating role of affect.
New Sch Psychol Bull 2011;8:26‑33.
2. Pender N. Health Promotion in Nursing Practice. Stamford,
CT: Appleton & Lange; 1996. p. 3.
3. Baheiraei A, Mirghafourvand M, Charandabi SM, Mohammadi E.
Facilitators and inhibitors of health‑promoting behaviors: The
experience of Iranian women of reproductive age. Int J Prev Med
2013;4:929‑39.
4. Nicholson W, Baptiste‑Roberts K. Obesity During Pregnancy in
Clinical Practice. London: Springer; 2014.
5. Rooney BL, Schauberger CW, Mathiason MA. Impact of perinatal
weight change on long‑term obesity and obesity‑related illnesses.
Obstet Gynecol 2005;106:1349‑56.
6. Krummel DA. Postpartum weight control: A vicious cycle. J Am
Diet Assoc 2007;107:37‑40.
7. World Health Organization. Global Status Report on
Non‑communicable Diseases 2014. Switzerland: World Health
Organization; 2014.
8. Endres LK, Straub H, McKinney C, Plunkett B, Minkovitz CS,
Schetter CD, et al. Postpartum weight retention risk factors
and relationship to obesity at 1 year. Obstet Gynecol
2015;125:144‑52.
9. Ko SH, Chen CH. Comparison of health‑promoting lifestyles
between postnatal Han Taiwanese and indigenous women. J Nurs
Res 2010;18:191‑8.
10. Monteiro SM, Jancey J, Howat P, Burns S, Jones C, Dhaliwal SS,
et al. The protocol of a randomized controlled trial for playgroup
mothers: Reminder on food, relaxation, exercise, and support for
health (REFRESH) program. BMC Public Health 2011;11:648.
11. Carter‑Edwards L, Østbye T, Bastian LA, Yarnall KS, Krause KM,
Simmons TJ, et al. Barriers to adopting a healthy lifestyle: Insight
from postpartum women. BMC Res Notes 2009;2:161.
12. Cheng CY, Pickler RH. Effects of stress and social support on
postpartum health of Chinese mothers in the United States. Res
Nurs Health 2009;32:582‑91.13. Fowles ER, Cheng HR, Mills S. Postpartum health promotion
interventions: A systematic review. Nurs Res 2012;61:269‑82.
14. Ashford S, Edmunds J, French DP. What is the best way to change
self‑efficacy to promote lifestyle and recreational physical activity?
A systematic review with meta‑analysis. Br J Health Psychol
2010;15:265‑88.
15. Glasofer DR, Haaga DA, Hannallah L, Field SE, Kozlosky M,
Reynolds J, et al. Self‑efficacy beliefs and eating behavior in
adolescent girls at‑risk for excess weight gain and binge eating
disorder. Int J Eat Disord 2013;46:663‑8.
16. Smith BJ, Cheung NW, Bauman AE, Zehle K, McLean M.
Postpartum physical activity and related psychosocial factors
among women with recent gestational diabetes mellitus. Diabetes
Care 2005;28:2650‑4.
17. Koh D, Miller YD, Marshall AL, Brown WJ, McIntyre D.
Health‑enhancing physical activity behaviour and related factors
in postpartum women with recent gestational diabetes mellitus.
J Sci Med Sport 2010;13:42‑5.
18. Bandura A. Health promotion by social cognitive means. Health
Educ Behav 2004;31:143‑64.
19. Chen CM, Kuo SF, Chou YH, Chen HC. Postpartum Taiwanese
women: Their postpartum depression, social support and
health‑promoting lifestyle profiles. J Clin Nurs 2007;16:1550‑60.
20. Becker H, Stuifbergen A, Oh HS, Hall S. Self‑rated abilities for
health practices: A health self‑efficacy measure. Health Values J
Health Behav Educ Promot 1993;17:42‑50.
21. Becker H, Stuifbergen A. What makes it so hard? Barriers to
health promotion experienced by people with multiple sclerosis
and polio. Fam Community Health 2004;27:75‑85.
22. Zeidi I, Hajiagha A, Zeidi B. Reliability and validity of Persian
version of the health‑promoting lifestyle profile. J Mazandaran
Univ Med Sci 2012;22:S103.
23. MacKinnon DP, Fairchild AJ, Fritz MS. Mediation analysis. Annu
Rev Psychol 2007;58:593‑614.
24. Baron RM, Kenny DA. The moderator‑mediator variable
distinction in social psychological research: Conceptual, strategic,
and statistical considerations. J Pers Soc Psychol 1986;51:1173‑82.
25. Plotnikoff RC, Lippke S, Trinh L, Courneya KS, Birkett N, Sigal RJ,
et al. Protection motivation theory and the prediction of physical
activity among adults with Type 1 or Type 2 diabetes in a large
population sample. Br J Health Psychol 2010;15:643‑61.
26. Verloigne M, Cardon G, De Craemer M, D’Haese S,
De BourdeaudhuijI. Mediating effects of self‑efficacy, benefits and
barriers on the association between peer and parental factors and
physical activity among adolescent girls with a lower educational
level. PLoS One 2016;11:e0157216.
27. Zabinski MF, Daly T, Norman GJ, Rupp JW, Calfas KJ, Sallis JF,
et al. Psychosocial correlates of fruit, vegetable, and dietary
fat intake among adolescent boys and girls. J Am Diet Assoc
2006;106:814‑21.
28. GallawayMS, JagoR, BaranowskiT, BaranowskiJC, DiamondPM.
Psychosocial and demographic predictors of fruit, juice and
vegetable consumption among 11‑14‑year‑old boy scouts. Public
Health Nutr 2007;10:1508‑14.
29. Souza LA, Torres AR, Barbosa GA, Lima TJ, Souza LE. Self‑efficacy
as a mediator of the relationship between subjective well‑being
and general health of military cadets. Cad Saude Publica
2014;30:2309‑19.
30. Bruening M, Kubik MY, Kenyon D, Davey C, Story M. Perceived
barriers mediate the association between self‑efficacy and fruit
and vegetable consumption among students attending alternative
high schools. J Am Diet Assoc 2010;110:1542‑6.
31. Dijkstra SC, Neter JE, van Stralen MM, Knol DL, Brouwer IA,
Huisman M, et al. The role of perceived barriers in explaining
socio‑economic status differences in adherence to the fruit,
vegetable and fish guidelines in older adults: A mediation study.
Public Health Nutr 2015;18:797‑808.
32. Kanotra S, D’Angelo D, Phares TM, Morrow B, Barfield WD,
Lansky A, et al. Challenges faced by new mothers in the early
postpartum period: An analysis of comment data from the 2000
pregnancy risk assessment monitoring system (PRAMS) survey.
Matern Child Health J 2007;11:549‑58.
33. Banti S, Mauri M, Oppo A, Borri C, Rambelli C, Ramacciotti D,
et al. From the third month of pregnancy to 1 year postpartum.
Prevalence, incidence, recurrence, and new onset of depression.
Results from the perinatal depression‑research and screening unit
study. Compr Psychiatry 2011;52:343‑51.
34. Lucan SC, Barg FK, Long JA. Promoters and barriers to fruit,
vegetable, and fast‑food consumption among urban, low‑income
African Americans – A qualitative approach. Am J Public Health
2010;100:631‑5.
35. Glasgow RE, Christiansen SM, Kurz D, King DK, Woolley T,
Faber AJ, et al. Engagement in a diabetes self‑management
website: Usage patterns and generalizability of program use.
J Med Internet Res 2011;13:e9.
36. Hinton PS, Olson CM. Postpartum exercise and food intake: The
importance of behavior‑specific self‑efficacy. J Am Diet Assoc
2001;101:1430‑7.
37. Ristovski‑Slijepcevic S, Bell K, Chapman GE, Beagan BL. Being
‘thick’indicates you are eating, you are healthy and you have an
attractive body shape: Perspectives on fatness and food choice
amongst black and white men and women in Canada. Health
Sociol Rev 2010;19:317‑29.