Document Type : Original Article
Authors
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.
Keywords
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25155549.:1.
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Effects of a lifestyle‑related risk factor modification intervention
on lifestyle changes among patients with coronary artery
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China: A pilot study. BMC Public Health 2018;18:296.
25. de Deus Mendonça R, de Toled MT, Lopes AC. Incentive for
practicing counseling on healthy lifestyles in Primary Healthcare.
Escola Anna Nery Rev Enfermagem 2015;19:140‑6.
26. 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.
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and community health centers for providing noncommunicable
diseases‑related services in Bengaluru, South India. Int J
Noncommun Dis 2019;4:73‑9.
28. 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.
29. Malan Z, Mash B, Everett‑Murphy K. Development of a training
programme for primary care providers to counsel patients with
risky lifestyle behaviours in South Africa. Afr J Prim Health Care
Fam Med 2015;7:1‑8.
30. Moradi M, Nasiri M, Jahanshahi M, Hajiahmadi M. The effects
of a self‑management program based on the 5 A’s model on
self‑efficacy among older men with hypertension. Nurs Midwifery
Stud 2019;8:21-7. page1. Available From; http://nmsjournal.
kaums.ac.ir/article_129017_a697f0d4c549b0ce626d1b0a99f09009.
pdf.
31. Mortazavi H, Pakniyat A, Ganji R, Armat M, Tabatabaeichehr M,
Saadati H. The effect of self‑management education program on
disability of elderly patients with knee osteoarthritis referring to
elderly care clinic of Imam Reza (AS) treatment center in Shiraz,
2015‑2106. JNKUMS 2017;8:461‑70.
32. Ghaderpanah N, Mohaddesi H, Vahabzadeh D, Khalkhali H.
The effect of 5A model on behavior change of physical activity
in overweight pregnant women. Iran J Obstet Gynecol Infertil
2017;20:101‑14.
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 clinical trial.
J HAYAT 2014;20:89‑99.
34. Vallis M, Piccinini‑Vallis H, Sharma AM, Freedhoff Y. Clinical
review: Modified 5 As: Minimal intervention for obesity
counseling in primary care. Can Fam Physician 2013;59:27‑31.
35. Martínez 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.
36. 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.
37. Sherson EA, Jimenez EY, Katalanos N. A review of the use of
the 5 A’s model for weight loss counseling: Differences between
physician practice and patient demand. Fam Pract 2014;31:389‑98.
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; June 2018. Available from: https://www.who.int/en/
news‑room/fact‑sheets/detail/noncommunicable‑diseases.[Last
accessed 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. [Last accessed on 2019 Jun 27].
5. World Health Organization (WHO). Policy - National Document
for Prevention and Control of Non Communicable Diseases and
the Related Risk Factors in the Islamic Republic of Iran,2015-2025.
Available from: https://extranet.who.int/nutrition/gina/en/
node/40358
6. 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 2019 Jun 30].
7. 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
2019 Jun 30].
8. 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: Available from: http://iris.wpro.who.int/
bitstream/handle/10665.1/13561/9789290617983‑hyp‑mod2‑e
ng.pdf. [Last accessed on 2019 Jun 27].
9. World Health Organization (WHO). Expanding Access
to Health Services with Self‑Care Interventions; June 24,
2019. Available from: https://www.who.int/news‑room/
feature‑stories/detail/expanding‑access‑to‑health‑services-withself-care‑interventions. [Last accessed on 2019 Jun 30].
10. World Health Organization (WHO). Global Atlas on
Cardiovascular Disease Prevention and Control. Available from:
https://file:///C:/Users/3270/Downloads/9789241564373_
eng.pdf. [Last accessed on 2019 Jun 29].
11. World Health Organization (WHO). Implementation Tools:
Package of Essential Non‑Communicable (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
2019 Jun 27].
12. 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.
13. World Health Organization (WHO). Self‑Care in the Context of
Primary Health Care Report of the Regional Consultation Bangkok.
Thailand: World Health Organization(WHO); 2009. Available from:
https://apps.who.int/iris/bitstream/handle/10665/206352/
B4301.pdf?sequence=1&isAllowed=y. [Last accessed on
2019 Jun 29].
14. Uthman OA, Hartley L, Rees K, Taylor F, Ebrahim S, Clarke A.
Multiple Risk Factor Interventions for Primary Prevention of CVD
in LMIC: A Cochrane Review. Glob Heart. 2017 Sep;12(3):199-208.
e8. doi: 10.1016/j.gheart.2016.03.639. Epub 2016 Jul 21. PMID:
27452771.
15. Package of Essential Noncommunicable (PEN) Disease
Interventions for Primary Health Care in Iran. Educational
Content for Health Worker. Ministry of Health, Treatment and
Medical Education; 2017. Available from: https://arakmu.ac.ir/
file/download/regulation/1556431374-fixmohtava-behvarz.pdf.
16. World Health Organization (WHO). Cardiovascular
Disease. HEARTS Technical Package. Healthy‑Lifestyle
Counseling. Available from: https://apps.who.int/iris/
bitstream/handle/10665/260422/WHO‑NMH‑NVI‑18.1‑eng.
pdf?sequence=1. [Last accessed on 2019 Jun 30].
17. 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 2019 Jun 27].
18. Carletta J. Assessing agreement on classification tasks: The kappa
statistic. Computat Linguist 1996;22:249‑54.
19. Saffari M, Shojaeizadeh D. Health Promotion and Education.
1st ed. Iran: Samat Publisher; 2009.
20. Ebrahim S, Taylor F, Ward K, Beswick A, BurkeM, Davey Smith G.
Multiple risk factor interventions for primary prevention
of coronary heart disease. Cochrane Database Syst Rev.
2011 Jan 19;(1):CD001561. doi: 10.1002/14651858.CD001561.pub3.
PMID: 21249647.
21. Lin JS, 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 Oct 21;161(8):568‑78. doi: 10.7326/M14‑0130. PMID:
25155549.:1.
22. Olukokun TA, Ayodapo AO, Monsudi KF. Effect of nutritional
counseling on body mass index of adult hypertensive attending
general outpatient clinic, federal medical center, Ido‑Ekiti
South‑Western Nigeria. Int J Noncommun Dis 2019;4:15‑20.
23. Gaudel P, Neupane S, Koivisto AM, Kaunonen M, Rantanen A.
Effects of a lifestyle‑related risk factor modification intervention
on lifestyle changes among patients with coronary artery
disease in Nepal. Patient Educ Couns 2020;1. [doi: 10.1016/j.pec.
2020.11.030].
24. 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.
25. de Deus Mendonça R, de Toled MT, Lopes AC. Incentive for
practicing counseling on healthy lifestyles in Primary Healthcare.
Escola Anna Nery Rev Enfermagem 2015;19:140‑6.
26. 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.
27. Parameswaran K, Agrawal T. Readiness of primary health centers
and community health centers for providing noncommunicable
diseases‑related services in Bengaluru, South India. Int J
Noncommun Dis 2019;4:73‑9.
28. 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.
29. Malan Z, Mash B, Everett‑Murphy K. Development of a training
programme for primary care providers to counsel patients with
risky lifestyle behaviours in South Africa. Afr J Prim Health Care
Fam Med 2015;7:1‑8.
30. Moradi M, Nasiri M, Jahanshahi M, Hajiahmadi M. The effects
of a self‑management program based on the 5 A’s model on
self‑efficacy among older men with hypertension. Nurs Midwifery
Stud 2019;8:21-7. page1. Available From; http://nmsjournal.
kaums.ac.ir/article_129017_a697f0d4c549b0ce626d1b0a99f09009.
pdf.
31. Mortazavi H, Pakniyat A, Ganji R, Armat M, Tabatabaeichehr M,
Saadati H. The effect of self‑management education program on
disability of elderly patients with knee osteoarthritis referring to
elderly care clinic of Imam Reza (AS) treatment center in Shiraz,
2015‑2106. JNKUMS 2017;8:461‑70.
32. Ghaderpanah N, Mohaddesi H, Vahabzadeh D, Khalkhali H.
The effect of 5A model on behavior change of physical activity
in overweight pregnant women. Iran J Obstet Gynecol Infertil
2017;20:101‑14.
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 clinical trial.
J HAYAT 2014;20:89‑99.
34. Vallis M, Piccinini‑Vallis H, Sharma AM, Freedhoff Y. Clinical
review: Modified 5 As: Minimal intervention for obesity
counseling in primary care. Can Fam Physician 2013;59:27‑31.
35. Martínez 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.
36. 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.
37. Sherson EA, Jimenez EY, Katalanos N. A review of the use of
the 5 A’s model for weight loss counseling: Differences between
physician practice and patient demand. Fam Pract 2014;31:389‑98.
)