Document Type : Original Article
Authors
- . Najmolmolook Amini
- . Sakineh Rakhshanderou
- . Ali Ramezankhani
- . Alireza Delavari
- . Mohtasham Ghaffari
Department of Internal Medicine, School of Medicine, Digestive Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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.
Keywords
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patients. Healthy lifestyles for patients with hypertension.
Western Pacific Region, World Health Organisation 2017.
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0665.1/13561/9789290617983‑hyp‑mod2‑eng.pdf. [Last accessed
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bitstream/handle/10665/260422/WHO‑NMH‑NVI‑18.1‑eng.
pdf?sequence=1. [Last accessed on 2022 May 14].
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Tobacco Use and Dependence: 2008 Update. Rockville, MD: US
Department of Health and Human Services; 2008.
21. Prochaska JO, DiClemente CC. Stages and processes of self‑change
in smoking: Toward an integrative model of change. J Consult
Clin Psychol 1983;51:390‑5.
22. Saffari M, Shojaeizadeh D. Health Promotion and Education. 1st ed. Iran: Samat Publisher; 2009.
23. Carletta J. Assessing agreement on classification tasks: The kappa
statistic. Comput Linguist 1996;22:249‑54.
24. de Deus Mendonça R, de Toled MTT, Lopes ACS. Incentive for
practicing counseling on healthy lifestyles in primary healthcare.
Escola Anna Nery Revista de Enfermagem2015;19:140‑6.
25. Malan Z, Mash B, Everett‑Murphy K. Development of a training
programme for primary care providers to counsel patients with
risky lifestyle behaviors in South Africa. Afr J Prim Health Care
Fam Med 2015;7:1‑8. doi: 10.4102/phcfm.v7i1.819.
26. Stonerock GL, Blumenthal JA. Role of counseling to promote
adherence in healthy lifestyle medicine: Strategies to improve
exercise adherence and enhance physical activity. Prog
Cardiovasc Dis 2017;59:455‑62.
27. Kardakis T, Jerdén L, Nyström ME, Weinehall L, Johansson H.
Implementation of clinical practice guidelines on lifestyle
interventions in Swedish primary healthcare–a two‑year follow
up. BMC Health Serv Res 2018;18:227.
28. Vallis M, Helena Piccinini‑Vallis H, Sharma A M, Freedhoff Y.
Modified 5 As minimal intervention for obesity counseling in
primary care. Can Fam Physician 2013;59:27‑31.
29. Martinez C, Castellano Y, Andrés A, Fu M, Antón L, Ballbè M,
et al. Factors associated with implementation of the 5A’s smoking
cessation model. Tob Induc Dis 2017;15:41. doi: 10.1186/
s12971‑017‑0146‑7.
30. Chai W, Zou G, Shi J, Chen W, Gong X, Wei X, et al. Evaluation
of the effectiveness of a WHO‑5A model based comprehensive
tobacco control program among migrant workers in Guangdong,
China: A pilot study. BMC Public Health 2018;18:296. doi:
10.1186/s12889‑018‑5182‑6.
31. Moradi M, Nasiri M, Haji Ahmadi M, Gahanshahi M. The
effect of self‑management program based on 5A model on
coping strategies in the elderly men patients with hypertension.
J Geriatr Nurs 2017;4. Available from: http://jgn.medilam.ac.ir/
article‑1‑238‑fa.html.
32. Ebrahim S, Taylor F, Ward K, BeswickA, BurkeM, Davey Smith G.
Multiple risk factor interventions for primary prevention
of coronary heart disease. Cochrane Database Syst Rev
2011;CD001561. doi: 10.1002/14651858.CD001561.pub3.
33. Heidari M, Fayazi S, Borsi H, Moradbeigi Kh, Akbari Nassaji N.
Effect of a self‑management program based on 5A model on
dyspnea and fatigue severity among patients with chronic
obstructive pulmonary disease: A randomized clinicaltrial. Hayat
J Sch Nurs Midwifery Tehran Univ Med Sci 2014;20:89‑99.
34. Ghaderpanah N, Mohaddesi H, Vahabzadeh D, Khalkhali H.
The effect of 5A model on behavior change of physical activity
in overweight pregnantwomen. Iran J Obstet Gynecol Infertil
2017;20:101‑14.
35. Sherson EA, Jimenez EY, Katalanos N. A review of the use of the
5 A’s model for weight loss counselling: Differences between
physician practice and patient demand. Fam Pract 2014;31:389‑98.
36. Cingil D, Göger S. Effect of education and counseling on
anthropometric measures and healthy lifestyle behavior
among overweight and obese women. Transl Behav Med
2020;10:1450‑7.
37. Lin JA, O’Connor E, Evans CV, Senger CA, Rowland MG,
Groom HC. Behavioral counseling to promote a healthy lifestyle
in persons with cardiovascular risk factors: A systematic review
for the U.S. preventive services task force. Ann Intern Med
2014;161:568‑78.
Goals. Available from: https://www.who.int/gho/publications/
world_health_statistics/2018/EN_WHS2018_SDGhighlights.
pdf?ua=1. [Last accessed on 2019 Jun 27].
2. World Health Organization (WHO). Noncommunicable Diseases.
2018. Available from: https://www.who.int/en/news‑room/
fact‑sheets/detail/noncommunicable‑diseases. [Lastaccessed on
2019 Jun 30].
3. World Health Organization (WHO). Cardiovascular Disease/Fact
Sheets. Available from: https://www.who.int/en/news‑room/
fact‑sheets/detail/cardiovascular‑diseases‑(cvds). [Last accessed
on 2019 Jun 27].
4. World Health Organization (WHO). Hearts: Technical package
for cardiovascular disease management in primary health care.
Available from: https://www.who.int/cardiovascular_diseases/
hearts/Hearts_package.pdf.
5. World Health Organization (WHO). Prevention of Cardiovascular
Disease Guidelines for assessment and management of
cardiovascular risk. Available from: https://apps.who.int/
iris/bitstream/handle/10665/43685/9789241547178_eng.
pdf?sequence=1.
6. National Prevention and Control of Noncommunicable diseases
Document and related risk factors in the Islamic Republic of Iran
between 2015 and 2025. National Committee for the Prevention
and Control of Noncommunicable Diseases. July 2015. Ministry
of Health, Treatment and MedicalEducation. [Last accessed on
2022 May 14].
7. World Health Organization (WHO). Islamic Republic of Iran.
Health profile 2015. Available from: http://applications.emro.
who.int/dsaf/EMROPUB_2016_EN_19265.pdf?ua=1. [Last
accessed on 2022 May 14].
8. World Health Organization (WHO). Noncommunicable diseases
and their risk factors. Atlas of Non‑Communicable Diseases Risk
Factors Surveillance in the Islamic Republic of Iran. STEPs 2016.
Available from: https://www.who.int/ncds/surveillance/
steps/STEPS_2016_Atlas_EN.pdf?ua=1. [Last accessed on
2022 May 14].
9. Khazaei H, Komasi S, Komasi A, Rezaei M, Hatamian P,
Jashnpoor M, et al. Design and standardization of tools for
assessing the perceived heart risk and heart health literacy in
Iran. Ann Card Anaesth 2018;2146‑52.
10. World Health Organization (WHO). Noncommunicable disease
education manual for primary health care professionals and
patients. Healthy lifestyles for patients with hypertension.
Western Pacific Region, World Health Organisation 2017.
Available from: http://iris.wpro.who.int/bitstream/hand le/1
0665.1/13561/9789290617983‑hyp‑mod2‑eng.pdf. [Last accessed
on 2022 May 14].
11. World Health Organization (WHO). Self‑care in the Context
of Primary Health Care Report of the Regional Consultation
Bangkok, Thailand, 7–9 January 2009. Available from: https://
apps.who.int/iris/bitstream/handle/10665/206352/B4301.
pdf?sequence=1&isAllowed=y. [Last accessed on 2022 May 14].
12. World Health Organization(WHO). Global Atlas on cardiovascular
disease prevention and control. Available from: file:///C:/
Users/3270/Downloads/9789241564373_eng.pdf. [Last accessed
on 2022 May 14].
13. World Health Organization(WHO). Capacity Building for Tobacco
Control Training Package 4: Strengthening Health Systems for
Treating Tobacco Dependence in Primary Care. Geneva: World
Health Organization; 2013. Available from: https://apps.who.
int/iris/bitstream/handle/10665/84388/9789241505413_eng_
Part‑I_policy_makers.pdf; jsessionid=3A041E9877EE4CB101EE
4264B05F9CD8?sequence=1. [Last accessed on 2022 May 14].
14. World Health Organization (WHO). Implementation tools:
Package of essential noncommunicable (PEN) disease
interventions for primary health care in low‑resource settings.
Geneva: World Health Organization; 2013. Available from:
http://www.who.int/cardiovascular_diseases/publications/
implementation_tools_WHO_PEN/en/. [Last accessed on
2022 May 14].
15. Allen JK, Dennison Himmelfarb CR, Szanton SL, Frick KD.
Cost‑effectiveness of nurse practitioner/community health
worker care to reduce cardiovascular health disparities.
J Cardiovasc Nurs 2014;29:308‑14.
16. World Health Organization (WHO). Expanding access to health
services with self‑care interventions. 24 June 2019. Available
from: https://www.who.int/news‑room/feature‑stories/detail/
expanding‑access-to-health‑services‑with‑self‑care‑interventio
ns. [Last accessed on 2022 May 14].
17. Uthman OA, Hartley L, Rees K, Taylor F, Ebrahim S, Clarke A.
Multiple risk factor interventions for primary prevention of
cardiovascular disease in low‑ and middle‑income countries.
Cochrane Database of Syst Rev 2015;2015: CD011163. doi:
10.1002/14651858.CD011163.pub2.
18. Package of Essential Noncommunicable (PEN) Disease
Interventions for Primary Health Care in Iran. Educational
Content for Health Worker. 2017. Ministry of Health, Treatment
and MedicalEducation. [Last accessed on 2022 May 14].
19. World Health Organization (WHO). Cardiovascular
disease. HEARTS Technical Package. Healthy‑lifestyle
counselling. Available from: https://apps.who.int/iris/
bitstream/handle/10665/260422/WHO‑NMH‑NVI‑18.1‑eng.
pdf?sequence=1. [Last accessed on 2022 May 14].
20. Tobacco Use and Dependence Guideline Panel. Treating
Tobacco Use and Dependence: 2008 Update. Rockville, MD: US
Department of Health and Human Services; 2008.
21. Prochaska JO, DiClemente CC. Stages and processes of self‑change
in smoking: Toward an integrative model of change. J Consult
Clin Psychol 1983;51:390‑5.
22. Saffari M, Shojaeizadeh D. Health Promotion and Education. 1st ed. Iran: Samat Publisher; 2009.
23. Carletta J. Assessing agreement on classification tasks: The kappa
statistic. Comput Linguist 1996;22:249‑54.
24. de Deus Mendonça R, de Toled MTT, Lopes ACS. Incentive for
practicing counseling on healthy lifestyles in primary healthcare.
Escola Anna Nery Revista de Enfermagem2015;19:140‑6.
25. Malan Z, Mash B, Everett‑Murphy K. Development of a training
programme for primary care providers to counsel patients with
risky lifestyle behaviors in South Africa. Afr J Prim Health Care
Fam Med 2015;7:1‑8. doi: 10.4102/phcfm.v7i1.819.
26. Stonerock GL, Blumenthal JA. Role of counseling to promote
adherence in healthy lifestyle medicine: Strategies to improve
exercise adherence and enhance physical activity. Prog
Cardiovasc Dis 2017;59:455‑62.
27. Kardakis T, Jerdén L, Nyström ME, Weinehall L, Johansson H.
Implementation of clinical practice guidelines on lifestyle
interventions in Swedish primary healthcare–a two‑year follow
up. BMC Health Serv Res 2018;18:227.
28. Vallis M, Helena Piccinini‑Vallis H, Sharma A M, Freedhoff Y.
Modified 5 As minimal intervention for obesity counseling in
primary care. Can Fam Physician 2013;59:27‑31.
29. Martinez C, Castellano Y, Andrés A, Fu M, Antón L, Ballbè M,
et al. Factors associated with implementation of the 5A’s smoking
cessation model. Tob Induc Dis 2017;15:41. doi: 10.1186/
s12971‑017‑0146‑7.
30. Chai W, Zou G, Shi J, Chen W, Gong X, Wei X, et al. Evaluation
of the effectiveness of a WHO‑5A model based comprehensive
tobacco control program among migrant workers in Guangdong,
China: A pilot study. BMC Public Health 2018;18:296. doi:
10.1186/s12889‑018‑5182‑6.
31. Moradi M, Nasiri M, Haji Ahmadi M, Gahanshahi M. The
effect of self‑management program based on 5A model on
coping strategies in the elderly men patients with hypertension.
J Geriatr Nurs 2017;4. Available from: http://jgn.medilam.ac.ir/
article‑1‑238‑fa.html.
32. Ebrahim S, Taylor F, Ward K, BeswickA, BurkeM, Davey Smith G.
Multiple risk factor interventions for primary prevention
of coronary heart disease. Cochrane Database Syst Rev
2011;CD001561. doi: 10.1002/14651858.CD001561.pub3.
33. Heidari M, Fayazi S, Borsi H, Moradbeigi Kh, Akbari Nassaji N.
Effect of a self‑management program based on 5A model on
dyspnea and fatigue severity among patients with chronic
obstructive pulmonary disease: A randomized clinicaltrial. Hayat
J Sch Nurs Midwifery Tehran Univ Med Sci 2014;20:89‑99.
34. Ghaderpanah N, Mohaddesi H, Vahabzadeh D, Khalkhali H.
The effect of 5A model on behavior change of physical activity
in overweight pregnantwomen. Iran J Obstet Gynecol Infertil
2017;20:101‑14.
35. Sherson EA, Jimenez EY, Katalanos N. A review of the use of the
5 A’s model for weight loss counselling: Differences between
physician practice and patient demand. Fam Pract 2014;31:389‑98.
36. Cingil D, Göger S. Effect of education and counseling on
anthropometric measures and healthy lifestyle behavior
among overweight and obese women. Transl Behav Med
2020;10:1450‑7.
37. Lin JA, O’Connor E, Evans CV, Senger CA, Rowland MG,
Groom HC. Behavioral counseling to promote a healthy lifestyle
in persons with cardiovascular risk factors: A systematic review
for the U.S. preventive services task force. Ann Intern Med
2014;161:568‑78.
)