Journal of Education and Health Promotion

Abstract

Abstract Background: Many researchers believe that adolescents’ problem behaviors are indicators of
a deficiency in social skills. This study was aimed to evaluate the effectiveness of a prevention
program on reducing problem behaviors in male adolescents. Materials and Methods: In a
preposttest design with randomized control group, 49 students received social skills training(SST).
Follow‑up assessment of outcomes took place 5 months post baseline. The SST program was
administered over the course of 10 weeks (10 sessions of 1 h). The main tools were multiple
problem behaviors index (MPBI) and Social Skills Rating System – student form (SSRS‑S).
The control group (57 students) did not receive any intervention. Intervention effects were
evaluated with t‑test, univariate ANCOVA, and repeated measures ANOVA. Results: Significant
difference between groups founded on SSRS at posttest (t = 2.5, P = 0.014) by univariate
ANCOVA. In addition, the findings indicated that variation trend of mean scores of SSRS
in the intervention group was significant (F = 225.3, P < 0.0001). The intervention group
reported Lower levels of MPBI at posttest and follow‑up compared to the control group.
Significant difference between the two groups did not achieved on MPBI scores in the posttest
 after adjusting for the pretest scores; however, this difference was significant at the follow
up (F = 5.3, P = 0.020). Conclusion: The results suggest that SST was effective in improving
social competence and preventing problem behaviors among male adolescent. Future
researches must be examined the role of peer and family.

Abstract Introduction and Objective: Perception is the most important predictor of behavior and
there is a strong relation and correlation between behavior and believes. Thus, to improve
self‑care behaviors of patients, it is required to fully understand their perceptions about
behavior. This paper aimed to assess the prediction power of health promotion model
of systolic blood pressure (SBP) as the result of self‑care behavior in rural hypertensive.
Methods: This cross‑sectional study has been carried out through random multistage
sampling on 671 rural patients under the coverage of health center of Ardebil city in
2013. Data were collected through reliable and valid questionnaire based on the health
promotion model in eight sectors. For data analysis, Pearson correlation statistical
tests, multivariate linear regression, ANOVA and independent t‑test were used and for
confirmatory factor analysis, SPSS 18 and AMOS 18 (SPSS Inc., Chicago, IL, USA) were
used. Results: The results showed significant negative correlation between self‑efficacy,
perceived benefits, situational influences, affects related to behavior and commitment to
action structures with SBP and showed a positive significant correlation between perceived
barriers and SBP. Furthermore, age and body mass had direct significant relation with SBP.
The age of patients showed inverse significant correlation with self‑efficacy, perceived
benefits, affects related to behavior, interpersonal influences and commitment and showed
a direct significant correlation with perceived barriers, means that by increase of age,
the perceived barriers also increased. The structures of health promotion model have
in overall the prediction power of 71.4% of SBP changes. Conclusion: The diet perceptions of patients, the same as health
promotion model, has good predictive power of SBP, especially the structures
of perceived benefits and self‑efficacy have inverse meaningful relation with
systole blood pressure and predicted a higher percentage of this variable.

Abstract Background: Sensitivity of teaching and learning processes in universities emphasizes
the necessity of assessment of the quality of education which improves the efficiency and
effectiveness of the country. This study was conducted with an aim to review and develop the
evaluation criteria of health information technology course at Master of Science level in Tehran,
Shahid Beheshti, Isfahan, Shiraz, and Kashan medical universities in 2012 by using CIPP model.
Materials and Methods: This was an applied and descriptive research with statistical population
of faculty members (23), students (97), directorates (5), and library staff (5), with a total of
130 people, and sampling was done as a census. In order to collect data, four questionnaires
were used based on Likert scale with scores ranging from 1 to 5. Questionnaires’ validity was
confirmed by consulting with health information technology and educational evaluation experts,
and questionnaires’ reliability of directorates, faculty, students, and library staff was tested using
the Cronbach’s alpha coefficient formula, which gave r = 0.74, r = 0.93, r = 0.98, and r = 0.80,
respectively. SPSS software for data analysis and both descriptive and inferential statistics
containing mean, frequency percentage, standard deviation, Pearson correlation, and Spearman
correlation were used. Results: With studies from various sources, commentary of experts, and
based on the CIPP evaluation model, 139 indicators were determined and then evaluated, which
were associated with this course based on the three factors of context, input, and process in the
areas of human resources professional, academic services, students, directors, faculty, curriculum,
budget, facilities, teaching–learning activities, and scientific research activities of students and
faculty, and the activities of the library staff. Conclusion: This study showed that in total, the
health information technology course at the Master of Science level is relatively good, but trying
to improve and correct it in some areas and continuing the evaluation process seems necessary.

Abstract Background: According to investigations, pregnant women hypothesized that anxiety is a
common factor that will improve spontaneously; they are not aware of its side effects on the fetus,
baby, and pregnancy outcome, as a whole. Other studies have also not tried to design a theoretical
framework based on Health Education Models (HBMs) to overcome this problem. The current
study aimed at exploring the effectiveness of education on the anxiety of nulliparous women based
on a HBM. Materials and Methods: An experimental study on 88 eligible nulliparous women
(n = 44 per group), from Doroud city, was performed in 2012. The data was collected using a
researcher made questionnaire. Education was conducted in three sessions tailored with HBM
constructs with the help of lectures, group discussions, inquiries, Power Point presentations,
and booklets. Evaluation performed using a posttest four and eight weeks after last session. The
collected data were analyzed using statistical tests, including Chi-square, independent t-test, and
repeated measure Analysis of Variance (ANOVA) by the significance level of 0.05. Results: The
mean score of knowledge, perceived sensitivity, perceived severity, perceived benefits and
barriers, cues to action, self efficacy, and behavior, four weeks after intervention (P < 0.001) and
eight weeks after intervention (P < 0.001) were significantly more in the case group Than the
control group. ANOVA with repeated measures showed a significant increase in the case group
in knowledge (from 32.1 to 89.1), perceived sensitivity (from 34.8 to 91.5), perceived severity
(from 31.82 to 88.48), perceived benefits (from 39.28 to 92.41), perceived barriers (from 26.93 to
88.61), cues to action (from24.65 to 92.03), self efficacy (from 29.71 to 88.75), and behavior (from
28.83 to 94.63). Changes were not significant in the control group. Conclusion: The effect of HBM
and education on increasing knowledge and changing people’s beliefs and behavior, in terms
of anxiety based pregnancy, should make health planners and authorities pay more attention to
these issues. Moreover, it will help in the betterment of the health of mothers and babies.

Abstract Introduction: Research self‑efficacy if the people’s judgment of their abilities in order to
organize and conduct meaningful research in different formats. The aim of this study is to
determinate the rate of research self‑efficacy among students of Isfahan University of Medical
Sciences based on Research Self‑efficacy Scale. Materials and Methods: The method of this
study is an applied survey method. Statistical population is all students of Isfahan University of
Medical Sciences and the sample size was calculated to be 361 samples based on Krejcie and
Morgan table. Random sampling method was used with equal number of samples from every
department. Data collection tool is Salehi et al. questionnaire (with 7 dimensions) with Likert
scale (5 grades). Its validity and reliability were confirmed by Psychology and Research Method
experts and Cronbach’s alpha (r = 0.84) respectively. Data gathering method was direct visit to
each department. The data was then analyzed using t‑test and one‑tailed ANOVA using SPSS 16
software. Results: The finding showed that among research self‑efficiency dimensions research
ethics dimension had the highest and quality research dimension had the lowest means.
Furthermore comparing the research self‑efficacy scores with demographic characteristics
suggests that there is no significant difference between total score of research self‑efficacy of
different departments, genders or educational degrees (P > 0.05). Conclusion: Since the score
of most of the research self‑efficacy dimensions were, lower than average, holding periodical
workshops, inclusion of necessary courses in the educational plan, forcing student to perform
research activity such as writing articles in lower educational levels and improvement of research
culture for students with the help of experienced professors are some of practical solutions,
which can lead to increasing the motivation of the students for conducting efficient research.

Abstract Background: In all areas of life including health, choices have widely increased and
concerns over getting hold of further choices have made trust a necessary element. This
study, taking into consideration the interconnection of three concepts of trust, risk, and
body, aims at describing and interpreting different types of trust experienced in a risky
medical operation (cosmetic surgery). Materials and Methods: To achieve the given
purpose, within interpretative paradigm and employing qualitative method, in‑depth
phenomenological interviews were conducted with 26 people who volunteered to have
a cosmetic surgery. Participants, who have been selected through purposive sampling
techniques, were fully aware of their participation in the study and were insured that the
data would be confidential and would be used only for the purpose of the study. Data
were gathered within a one‑year period of the study, from February 20, 2012 to February
20, 2013. Results of three‑phase interviews were validated against participatory feedback
and researchers’ triangulation and were further analyzed by means of seven‑stage
Colaizzi method. Findings: Consequently, five main themes, namely, vicarious trust, trust
within the reach, institutionalized trust, criterion trust, and wrapped trust were extracted.
Conclusion: Apart from existing differences among these five themes (e.g. degree of the
subjectivity and objectivity in the patient), they can be regarded comparable in terms of
being single‑sided (from the patient’s side).In other words, in all experiences, participants,
having considered “the necessity of gaining trust” as a presupposition, have made a
unilateral effort in creating the aforementioned phenomenon.

Abstract Background: This study aimed to find the influence of education level on the trends of changes
of these risk factors among a great sample of Iranian population. Materials and Methods: This
cross‑sectional study is a secondary analysis of Isfahan Healthy Heart Program (IHHP). Blood
samples were taken to determine the lipid levels including total cholesterol (TC), low‑density
lipoprotein cholesterol (LDL‑C), low levels of high‑density lipoprotein cholesterol (HDL‑C),
and triglycerides. Education categorized based on training system in Iran as 1‑5, 6‑12,
and more than 12 years training. Results: The prevalence of diabetes was higher among
illiterate participants in both areas. Hypertension was more prevalent in illiterate subjects
(2001; 44.0% and 2007; 46.3%) in intervention area (P < 0.001). Dyslipidemia was more
prevalent among illiterate people (P < 0.001). In the intervention, illiterates have higher BMI in
both 2001 and 2007 (P < 0.001). The prevalence of current smoking was the highest in education
level range 6 to 12 years and was steadily decreased in higher education levels (P < 0.001).
Subjects with 6‑12 years of education have more unhealthy nutritional habits in both areas.
In 2001, subjects with 12 years of education or more had more physical activity than other
groups (P < 0.001), whereas, in 2007, subjects with 6‑12 years of education were more
active (P < 0.001). Conclusion: Although the prevalence of diabetes, hypertension obesity, and
dyslipidemia are more in illiterate subjects and prevalence of diabetes and hyperlipidemia was
sharply decreased with education level, it seems that well educated participants have higher
daily physically activity compared with those who have lower education without considering
the place or residency.

Abstract Objective: This study was conducted to investigate the relationship between the intake of
different food groups by pregnant mothers and neonatal low birth weight and premature
births. Materials and Methods: In this cohort, the target population was 225 pregnant women,
randomly selected from different geographical areas of the city of Isfahan, Iran (from April to
September, 2012). The main variables in the study were weight and gestational age of the
neonates and the type and amount of different food groups used by the mothers. All nutritional
variables were compared according to different groups of infants (normal, premature, and low
birth weight). In the multivariate analysis, multiple linear and logistic regression models were
used to identify those different food frequency questionnaire (FFQ) variables independently
associated with the newborn’s weight and gestational age, adjusted by maternal consumption
of calcium supplementation, folic acid, and omega‑3, during pregnancy. Results: A total
of 214 (47.7% boys) infants with complete information were included. They had a mean
gestational age of 38.72 ± 1.2 weeks. The mean birth weight was 3.11 ± 0.384 kg. The
percentages of premature and low birth weight (LBW) infants were 7 and 5%, respectively. At
multiple logistic regression controlling for potentially confounding factors that were significantly
associated with prematurity and LBW at univariate analysis (maternal consumption of calcium
supplementation, folic acid, and omega‑3, during pregnancy), type of nutritional groups
containing dairy products, proteins, fish, and shrimp group, as well as fruits and vegetables,
had a significant positive association with increasing the gestational age (P < 0.05). The group
that consumed proteins, fish, and shrimp, as well as fruits and vegetables had a significant
positive association with the newborn’s weight (P < 0.05). Conclusion: This study indicated
the importance of proper nutrition on reducing the rates of LBW and premature births.
Comprehensive educational programs at
individual and public levels are warranted in
this regard.

Abstract Context: General practitioners should be competent to be accountable for patients’ needs,
but they do not acquire core competencies during education in medical schools. Aims: This
study was aimed at determine the most usual obstetric and gynecological as well as pediatric
diseases in rural and urban care centers in Isfahan province. Settings and Design: This is a
cross‑sectional descriptive study which was done in Isfahan province in 2011. Sixty‑four physicians
(general practitioners) in rural and urban health care centers in Isfahan province participated in
this study. Subjects and Methods: Participants completed valid and reliable questionnaires for
gynecological/obstetric and pediatric diseases. These questionnaires included some demographic
data and diseases of each category (according to general medicine curriculum). Scales 1‑5 for
each disease referral times was determined respectively as: Rare, sometimes, weekly to monthly,
daily to weekly and daily. Statistical Analysis Used: The data were descriptively analyzed by
SPSS 11.5(SPSS Inc. in Chicago). Results: Nearly 43.7% of participants were male. The mean
age of participants was 39.0 ± 7.0 and their mean working experience was 11.3 ± 5.9 years. The
highest referral times’ score in rural and urban care centers in gynecological and obstetric group
was vaginal discharge; in pediatrics, it was the common cold. Conclusions: In this study, the
extent to which general practitioners encountered different gynecological/obstetric and pediatric
diseases in rural and urban care centers in Isfahan province was determined. Although, these
data are useful for decision makers to establish medical core curriculum, other factors such as
seasonal load of diseases should also be observed to determine the differences between rural
and urban care centers in most usual diseases of women and children.

Abstract Background: Admission includes written and interview at universities belonging to the
ministry of the health and medical education of Iran at PhD level. In the present work, it
was tried to find out the likelihood of interview performance of different candidates with
their teaching experience in Iranian national medical PhD admission in the year 1386‑87.
Methods and Materials: In this study, applicants’ exam results were extracted from their score
workbooks for year 86‑87. PhD applicants’ categories were public (ordinary) and employed
lecturers. Invited numbers of candidates for interview were 556 from 29 different fields of study.
As the number of written subjects were not the same within different fields of study, at the
first, each group score distribution were normalized to one and then combined together for
final consideration. Results: Accept and reject percentage within public applicants were 45.1
and 54.9, respectively, while the accept percentage within lecturer applicants was 66 and the
reject was 34 respectively. Scores of all 29 groups were combined after normalization. The
overall performance including test plus interview for public and lecturers were 1.02 ± 0.12
and 0.95 ± 0.1, respectively. The average and standard deviation of test exam of public and
lecturer were 1.04 ± 0.16 and 0.91 ± 0.12, respectively. The average and standard deviation of
interview exam of public applicants and lecturers applicants were 0.98 ± 0.18 and 1.04 ± 0.17,
respectively. Conclusion: As results show, the interview performance of lecturers is better
than public applicants. Unbalanced acceptance rate amongst lecturers was increased due to
the hold of reservation toward interview and due to their higher results gain during interview.
If the test performance was a reliable measure for viability of applicant, this reservation would
change the acceptance rate close to balance.

Abstract Objective: To enquire about the level of awareness regarding various important aspects
of palliative medicine among doctors of various departments in four Medical Colleges in
Kolkata through a questionnaire. Materials and Methods: A questionnaire was developed
by few members of Indian Association of Palliative Care. It was distributed, to a convenience
sample of doctors who worked at various departments in all four teaching hospitals in
Kolkata. The distribution and collection of questionnaires was carried out within four months.
Results: The results suggested that 85% of the doctors felt that cancer was the commonest
reason for the palliative care teams to be involved. Seventy four percent of the doctors mentioned
that pain control was their prime job; 53% said that they are enjoying their encounter with
palliative care, so far; 77% of the doctors thought breaking bad news is necessary in further
decision making process; only 22% of the doctors reported the WHO ladder of pain control
sequentially, 35% of the doctors believed other forms of therapies are useful in relieving pain,
35% of the doctors thought that they gave enough importance and time for pain control; 77%
said that they had heard about a hospice, among them still 61% of the doctors thought that the
patients should spend last days of their life at home. Thinking of the future, 92% of the doctors
think that more and more people will need palliative care in the coming days. Conclusion:
Amongst the doctors of various departments, there is a lack of training and awareness in
palliative care. Almost all the doctors are interested and they are willing to have more training
in pain control, breaking bad news, communication skills and terminal care.

Abstract Background: There is general lack of knowledge concerning the sings, symptoms, and risk
factors of oral cancer in the general population, particularly among tobacco users. A challenging
measure for the health care professions is to improve patients’ knowledge about the causes
and signs of oral cancer and, more importantly, to modify their health behaviors. The most
frequent approach used to achieve this is production of leaflet. The aim of this study was to
outline and carry out the steps involved in the production of information leaflet for tobacco
users and its evaluation. Materials and Methods: The existing materials on tobacco and its ill
effects were reviewed. Leaflets were prepared based on the European Commission Guidelines
for patient information leaflet and information packages. Subject experts reviewed the content
of leaflet. Content validity was checked using Lawshe method. Reliability was checked using
Flesch formula. Results: Content Validity Ratio (CVR) value was 0.99, which was acceptable.
The reliability of the final wording of the leaflet was 80, which was classified as “fairly ease.”
Conclusion: The leaflet could be used as a health education aid to motivate tobacco users
to quit tobacco use.

Abstract Introduction: Heart transplantation is considered as a golden standard of treatment for
advanced heart failure. After ‑ transplantation health of patients is influenced by numerous
issues which many of them are unknown to the treatment team including nurses. This
research ‑ with the aim of describing the life experiences of heart transplant patients ‑ help us
to get close to the patients private life and gain comprehensive and a general understanding of
all aspects of their life. Methods: This study applied qualitative approach using phenomenology
method. The purposive sampling was conducted and continued with 9 participants until
information reached saturation point. The participants are the heart transplant recipients who
had surgery in Esfahan’s Heart Surgery Center of Shahid Chamran. Results: The extracted
interviews were analyzed through Colaizzi method: The eleven extracted main concepts were
included: Belief, tendencies of the recipient and family of donor, bewilderment, moment of
facing with transplantation, satisfaction, vital organ, support, temperament, physical effects of
transplantation, mental changes, paradox of life and death. Conclusion: In heart transplant
patients, being in touch with peers and family support have an important role in putting up with
the transplantation issue. Lack of social situation and social support were among the patients
distresses. Lack of the necessary information about transplantation made patients dissatisfied
with the heart transplantation. Regarding the research findings, training received by patients
would not be suffice and lack of information has been made them face with problems; therefore,
the nurse team of transplantation should play more an active role in training the patients.

Abstract Background: The health status of medical practitioners can potentially impact their ability
to counsel patients. The purpose of the study was to examine the prevalence of obesity and
behaviors associated with the development of metabolic disease among medical practitioners
in the country of Jordan. Materials and Methods: The participants were 748 (male n = 285,
32.3 years ± 7.3, female n = 463, 29.7 years ± 5.7) randomly selected pharmacists, nurses,
physicians, medical lab technicians, and radiation specialists from a variety of medical
institutions in Jordan. A short 25‑item validated instrument was chosen for this investigation.
After the survey was administered and data were tabulated, one‑way analysis of variance
and Pearson’s Chi‑square analysis were conducted to examine differences in reported risk
behaviors (low physical activity [PA], smoking) and obesity by gender, age and medical
specialty. Results: Descriptive analysis revealed that 20.9% of the participants self‑reported as
smokers of cigarettes, 47.9% were either overweight or obese, and 52.9% reported no days of
planned PA on average per week. The results suggested a difference in body mass index (BMI)
classification (F = 17.9, P ≤ 0.001) and smoking (F = 5.33, P = 0.021) by age. Mean age
associated with being underweight was 26.4 years for normal weight 29.3 years for overweight
31.6 years and finally for obese was 34.5 years. Chi‑square test resulted in differences by
gender(2 > 50, P ≤ 0.001)forBMI (males: 26.4 ± 3.7; females: 24.6 ± 3.7),PA (males no planned
PA 61.1%, females 47.9%) and smoking (males 43.1% smokers, females 7.1%). Researchers
discovered that medical specialty was related to differences in reported smoking (2 = 26.5,
P ≤ 0.001) and days of planned PA (2 = 24.2, P = 0.019). Conclusions: Within the population
of medical practitioners there is still a high incidence of obesity and risk behaviors associated
with metabolic diseases. It also appears that
these incidence rates are greater among
men, with increasing age, and among certain
medical specialties.

Abstract Background: One of the practical models for the assessment of stressful working conditions due
to job strain is job demand and control model, which explains how physical and psychological
adverse consequences, including cardiovascular risk factors can be established due to high
work demands (the amount of workload, in addition to time limitations to complete that work)
and low control of the worker on his/her work (lack of decision making) in the workplace. The
aim of this study was to investigate how certain cardiovascular risk factors (including body mass
index [BMI], heart rate, blood pressure, cholesterol and smoking) and the job demand and
job control are related to each other. Materials and Methods: This prospective cohort study
was conducted on 500 workers of the petrochemical industry in south of Iran, 2009. The study
population was selected using simple random statistical method. They completed job demand
and control questionnaire. The cardiovascular risk factors data was extracted from the workers
hygiene profiles. Chi‑square (2
) test and hypothesis test () were used to assess the possible
relationship between different quantified variables, individual demographic and cardiovascular
risk factors. Results: The results of this study revealed that a significant relationship can be
found between job demand control model and cardiovascular risk factors. Chi‑square test
result for the heart rate showed the highest (2 = 145.078) relationship, the corresponding
results for smoking and BMI were 2 = 85.652 and 2 = 30.941, respectively. Subsequently,
hypothesis testing results for cholesterol and hypertension was 0.469 and 0.684, respectively.
Discussion: Job strain is likely to be associated with an increased risk of cardiovascular risk
factors among male staff in a petrochemical company in Iran. The parameters illustrated in
the Job demands and control model can act as acceptable predictors for the probability of
job stress occurrence followed by showing a high trend of CVD risk factors.

Abstract Background: Considering globalization of health care and quality improvement trend to
respond to competition and customer orientation, attention to organizational structure
and its relationship with market orientation is essential. Therefore, this study reviews the
relationship between organizational structure and market orientation in selected hospitals
of Isfahan (Iran). Materials and Methods: This study was a descriptive survey. The study
population comprised nurse managers from selected hospitals (n = 80). Data collection tools
were two questionnaires (market orientation questionnaire and organizational structure) that
the validity and reliability were confirmed (r = 0.83 for market orientation questionnaire and
r = 0.87 for organizational structure). SPSS (Ver. 16) software was used for the analyses.
Results: The mean score of organizational structure was 65.4 (11.2) and total mean of
market orientation was 51.14 (17.6). All aspects of the organizational structure (Organization
Centralization, Formalization in Organization, and Organization Complication) and market
orientation (responding to competition, accountability, customer satisfaction, intelligent
organization)—except by responding to clients with Formalization in Organization—as well as
all aspects of the Systemic attitude (the system of internal coordination and communication
systems_ and market orientation (responding to competition, accountability, customer
satisfaction, intelligent organization), there was a meaningful relationship (P < 0.05).
Conclusion: Market orientation and its dimensions have a significant relationship with
organizational structure and can lead managers’ view to the analysis and recognizing elements
of success and achievement to goals. With increasing competition in markets, globalization
of health services, and presence in international markets and more attention to patients’
satisfaction, hospitals need to understand and use of market orientation in order to promote
quality and services in the health care system.

Abstract Duplicate publication is the republication of an article in which a lot of important parts overlap with
the published copy. This issue is nearly at the top of the list of subjects, which medical journal
editors discuss. this study was conducted with the purpose of investigating the publication
patterns and determining it’s root causes in research articles in the Isfahan University of Medical
Science and to find a solution to prevent it. In a cross sectional study , All the discovered cases
of duplicate publication, which were referred to the ethics committee of the Isfahan University
of Medical Science during 2005–2008 were selected to be investigated through a descriptive
method. After confirmation about the case of a duplicate publication, the requisite investigation
was conducted through interviews and review of the correspondence and documentaries, and
then, a radical line was charted. After investigating the cases and classifying the radical causes
and incidents, categorization and definition of duplicate publication are presented. Eight out
of nine republished articles belonged to the first category of Baily’s index (copy publication)
and one was in the third category (minimum publishable unit: Salami slicing). The results of
the present article indicate that, the scientific community of the country is not yet familiar with
the professional principles of scientific and research affairs. According to the results of this
investigation, it is recommended to take official action against duplicate publication cases,
violation of copyright, and also to have strict instructions against this unethical practice.

Abstract Type 2 diabetes is one of the most serious health concerns and policy agendas around the
world. Epidemiological evidence suggests that it will likely continue to increase globally.
Diabetes is strongly associated with the patients’ unhealthy lifestyle and behavioral patterns
and socio-economic changes. New model of thinking is required to recognize whether the
patients are in control of and responsible for the daily self-management of diabetes. Such a
new approach should be based on ‘empowerment and involvement’ to be more applicable
to daily activities in diabetic patients. Rapid changes toward patient empowerment and
increasing involvement of patients in their care plan indicate more emphasis on disease
prevention and health promotion and education than on mere disease and its treatment.
Such changes make a step toward pervasive sense of responsibility among patients
about their illness for their daily activities. Using the empowerment approach, healthcare
professionals would help patients make informed decisions in accordance with their particular
circumstances. Patient empowerment implies a patient-centered, collaborative approach
that helps patients determine and develop the inherent capacity to be responsible for their
own life. Empowerment is something more than certain health behaviors. Empowerment
is more than an intervention, technique or strategy. It is rather a vision that helps people
change their behavior and make decisions about their health care. It has the potential to
improve the overall health and well-being of individuals and communities, and to change
the socio-environmental factors that cause poor health conditions. The main concept of this
change is the tendency to change.

Abstract The purpose of this paper is to describe the multifaceted nature and benefits of worksite health
promotion programs (WHPPs), with emphasis on the college setting. An assessment of the
peer-reviewed literature was conducted of articles published since 2000. Several search engines
were accessed and selected key words were used. Most studies examining WHPPs have
focused on return on investment and productivity. Research that targets the softer side-benefits
of health promotion programs in the workplace is less available. Although the college setting
offers some advantages for implementing health promotion programs. They may also have
unique challenges due to their large and diverse employee population. There is little research
to show the effectiveness and unique challenges of college-based health promotion programs.