Journal of Education and Health Promotion

Abstract Background: Lifestyle choices and individuals’ behaviors have the potential to influence
health and improve the quality of life. Objectives: The purpose of this study was to develop
and psychometrically test an instrument for measuring healthy lifestyle in Iranian adolescents.
Materials and Methods: A comprehensive literature review related to health‑promoting lifestyles
was used to identify potential scale items. Data were collected from 797 school students. Construct
validity was analyzed using exploratory factor analysis. Confirmatory factor analysis (CFA) was
used to cross‑validate. Results: Nine factors emerged that explained 59.8% of the variance in
the 43 items. Cronbach’s a coefficient Healthy Lifestyle Questionnaire was r=0.82. After the
model was modified, the fit indices indicated that the data were an adequate‑to‑good fit to the
proposed models. Conclusions: The current study provides some support to the internal and
external validity of the healthy lifestyles questionnaire for Iranian adolescents.

Abstract Background: The purpose of this study was to assess self‑care practices and their relative
components among type 2 diabetic patients. We hypothesized that some sociodemographic
and health‑related factors, high diabetes distress, and low self‑efficacy would be associated
with poorer self‑care practices. Materials and Methods: A cross‑sectional study was conducted
for a period of 6 months in 2011. Study population was type 2 diabetic patients referring to
Omolbanin center, an outpatient diabetic center in Isfahan. One hundred forty diabetic patients
met the inclusion criteria and were all included in the study. Patients’ self‑care practices were
measured by Summary of Diabetes Self‑care Activities (SDSCA) self‑report scale that includes
items on the following aspects of the diabetes regimen: General diet, specific diet, exercise,
blood glucose testing, foot care, medications, and smoking. Diabetes distress measured
by Diabetes Distress Scale (DDS) scale and Stanford diabetes self‑efficacy scale was used
for scoring this issue. Collected data were analyzed by using SPSS software version 11.5.
Results: Participants were between the ages of 37 and 75 years, with a mean of 53.23 years
(SD=7.82). Fifty‑four percent (n=76) were females; 97.1% were married (n=136), and 53.6%
had education lower than diploma (n=75). Mean of duration of diabetes was 7.1 (SD=5.63)
years. “Medications” subscale was considered as the most important one in measuring
diabetes self‑care practices (5.24 ± 2.38 days/week). Study findings revealed that general diet
had significant relation with comorbidity, type of treatment, body mass index (BMI), fasting
blood sugar (FBS), (Blood Sugar) (BS), waist circumference, diabetes distress, and self‑efficacy.
Specific diet had significant relation with comorbidity, education, triglyceride (TG), diastolic
blood pressure (DBP), and low density lipoprotein (LDL). Exercise showed significant relation
with history of diabetes, education, type of treatment, disease duration, TG, BMI, and BS. Also,
blood glucose testing showed significant relation with disease duration, self‑efficacy, TG, DBP,
BS, LDL, and high density lipoprotein (HDL). On the other hand, foot care was related to age,
diabetes distress, TG, BMI, HDL, and diabetes complications. Medications subscale as the
most important subscale of self‑care practices was relevant with age, disease duration, diabetescomplications, type of treatment, FBS, HDL, and self‑efficacy. The last subscale, smoking, had
significant relation with sex, diabetes complications, diabetes distress, self‑efficacy, TG, total
cholesterol, BS, and HDL. Conclusion: This information should be used in clinical practice
when targeting and designing educational and care plan for patients with type 2 diabetes.

Abstract Background: Colorectal cancer is one of the most important and most common cancers and the
second leading cause of cancer deaths worldwide.Every year, nearly 1million new cases of colorectal
cancer are recognized around the world and nearly half of them lose their lives due to the disease.The
statistics reveal shocking incidence and mortality from colorectal cancer, therefore secondary
prevention of this cancer is important and research has shown that by early diagnosis 90% of patients
can be treated.Among the colorectal cancer screening tests, fecal occult blood test(FOBT)takes the
priority because of its convenience and also low cost. But due to various reasons, the participation of
people in this screening test is low. The goal of this study is to assess the factors that affect participation
of population at average risk in colorectal cancer screening programs, based on health belief model
structures. Materials and Methods: A cross‑sectional survey of 196 individuals, more than 50 years
old, was conducted in Isfahan. Ninety‑eight people of the target group were selected from laboratories
while they came there for doing FOBT test; the method of sampling in this group was random sampling.
The method of data collection in the other 98 individuals was by home interview and they were selected
by cluster sampling. The questionnaire used was based on health belief model to assess the factors
associated with performing FOBT. The data collected were analyzed using descriptive and inferential
statistical methods. Results: The mean score of knowledge in the first group was 48/5 ± 11/7 and in
the second group was 36/5 ± 19/3. Individuals in the first group were more likely to be married, had
more years of schooling, and better financial status. There were significant relationships between
knowledge (P<0.001), perceived susceptibility (P<0.001), perceived severity (P<0.001), perceived
barriers (P<0.001), and self‑efficacy (P<0.001) in the two groups. There was no significant association
between the perceived benefits in the two groups. Those people who have had FOBT test in last
year in each group reported better score of Health Belief Model model structures. Conclusion:
According to this study, it seems that there is an urgent need to pay more attention to this disease
and its prevention through screening. With a better understanding of factors affecting the test, it can
be a useful step to reduce the rate of death and costs, and improve the community health outcomes.

Abstract Background: Normal vaginal delivery (NVD) is the best method of delivery, but its rate is
decreasing. Results of many studies have shown that the risk of cesarean section (CS) for both
mother and child is more than that of NVD. The World Health Organization’s (WHO) goal was to
achieve a CS rate of 15% in 2010, but this rate in most of the developing countries is over than 50%.
In this study, we try to determine the related factors influencing the method of delivery selection by
mothers in Yazd city, Iran, based on Health Belief Model (HBM). Materials and Methods: This was
a cross‑sectional study done on 130 pregnant women who presented in four clinics of Yazd. The
mothers were in 32–37 weeks of gestational age. Samples were selected by simple randomized
method. Data were collected by questionnaire by interviewing and then analyzed by analysis of
variance (ANOVA) and t‑test. Results: Mean age of samples was 42.23 ± 4.52 years. Eighty‑four
(64%) women were primigravids and 49 (37.7%) mothers were multigravids. Of them, the method
of delivery in previous pregnancy was NVD in 29 (22.3%) and CS in 20 (14.3%). In their present
pregnancy, the method of delivery was NVD in 88 (67.7%) and CS in 42 (32.3%). The Pearson
test showed a significant correlation between perceived barriers and behavior (P=0.012). Also,
there was significant relationship between perceived susceptibility and behavior (P=0.03). There
was no significant relation between other variables (perceived benefits and perceived severity).
Conclusion: Based on the results of this study, perceived susceptibility and perceived barriers
were related to behavior significantly, so we must educate mothers using HBM to influence their
behavior toward selecting NVD as their delivery method.

Abstract Background: Studies have shown that the growth status of the children with working mothers
is about 2 standard deviations lower than that of the children of housewife mothers. It seems
that absence of mothers in the second stage of nutritional evolution (attachment), which is
a very sensitive stage, has an important role in initiating and continuation of an appropriate
supplemental feeding. Materials and Methods: In this cross-sectional study, 50 children
of working mothers and 50 children of housewife mothers were selected by non-probable
consecutive sampling method. Growth charts of the children in the two studied groups were
assessed within seven age groups. Knowledge and attitude of the mothers regarding nutritional
evolution stages in the two studied groups were assessed Obtained data were analyzed using
Software SPSS18 and statistical tests such as chi-square, t-test, and Mann–Whitney test.
Results: Growth monitoring charts of the infants with housewife mothers were better than those of
infants with working mothers in three out of seven age groups (12–18, 18–24, and 24–30 months)
(P=0.02). Mean of knowledge and performance of the mothers about nutritional evolution stages
was not significant in the two studied groups (P>0.05). Conclusion: This study showed that
growth status of children with housewife mothers in their second year of life was better than that
of children with working mothers. Awareness and knowledge of the mothers about nutritional
evolution stages and education of mothers about appropriate behaviors in each stage helped
them to recognize the children’s needs and did their best for their children.

Abstract Background: Effective cancer pain management requires accurate knowledge, attitudes,
and assessment skills. The purpose of this study was to obtain information about the
knowledge and attitudes of nurses concerning cancer pain management with the use Health
Belief Model (HBM) as conceptual framework. Materials and Methods: The study was a
descriptive survey and included 98 randomly selected nurses from Alzahra hospital, Isfahan,
Iran. A self‑administered questionnaire which was designed on the basis of HBM was used
to collect the data. Knowledge, attitudes, and HBM constructs regarding cancer pain were
the main research variables. The obtained data were analyzed by SPSS (version11.5) using
descriptive statistics, independent t–test, and Pearson correlation at the significant level of
α=0.05. Results: Ninety‑eight nurses aged 38.7 ± 7.04 years were studied in this survey. From
the 10 pain knowledge questions assessed, the mean number of correctly answered question
was 61.2 (SD=16.5), with a range of 30–100. There was a direct correlation between knowledge
and attitude of nurses with HBM constructs except for perceived barriers and perceived threat.
Among the HBM constructs, the highest score was related to self‑efficacy with mean score of
87.2 (SD=16.4). Conclusions: The findings support the concern of inadequate knowledge
and attitudes in relation to cancer pain management. We believe that basic and continuing
education programs may improve the knowledge level of nursing about pain management.

Abstract Background: Osteoporosis is a systemic skeletal disorder characterized by reduction of
one mass, deterioration of bone structure, increasing bone fragility, and increasing fracture
risk. Prevention of osteoporosis during childhood and adolescence is one of the most
important issues in World Health Organization. The purpose of this study was to determine
the effect of Health Belief Model based intervention on promoting nutritional behaviors
about preventive osteoporosis among the second grade middle school girl students.
Materials and Methods: This was an experimental intervention study, the research population
being 130 students who were randomly divided into groups, experimental (66) and control (64).
Before the educational program, Health Belief Model based standard questionnaire and Food
Frequency Questionnaire (FFQ) questionnaire were filled up by both the groups. The standard
questionnaire was completed three times (before, immediately, and 2 months after education)
and FFQ questionnaire was completed two times (before and 2 months after education) by
the students. After pre‑test, four educational session classes in the experimental group were
performed. Finally, data collected were analyzed by SPSS 18 computer software. Results: The
result of this study showed a significant increase in the mean score of knowledge, perceived
susceptibility, seriousness, benefits, barriers, as well as taking health action among girl
students in the experimental group. Conclusion: The findings of the present study confirmed
the practicability and effectiveness of the Health Belief Model based educational program in
promoting nutritional behaviors about prevention of osteoporosis.

Abstract Objective: Despite evidence that screening for breast cancer is effective, adherence with
screening recommendations in Iranian women is low. The purposes of this study were to
(1) identify the associations between individual characteristics, related health beliefs, and stages
of mammography behavior and (2) examine the socio‑demographic factors and the health
beliefs that predicate stages of mammography behavior. Design: All health care centers were
considered as clusters and 30 women were randomly selected from each of them. A sample of
689 Iranian women completed a questionnaire. Materials and Methods: The questionnaire
used was based on Champion’s revised Health Belief Model Scale (CHBMS). One‑way analysis
of covariance (ANCOVA) was used to assess differences in the outcome variables (perceived
severity, susceptibility, benefits, and barriers) across the stages. Multinomial logistic regression
was conducted to test multivariate relationships. Results: The percentage of participants in
each stage was: 40.1% in pre‑contemplation, 34.7 in contemplation, 7.5% in relapse, 12%
in action, and 5.7% in maintenance stage of mammography adoption. Older women were
most likely to be in the pre‑contemplation stage and action stage, and the youngest women
were most likely to be in the relapse stage. Differences across stages of change were found
for related beliefs for all participants except those in the relapse stage. Conclusion: Iranian
women are less likely to be in maintenance and action stages than ot er Asian women and
this study identifies constructs that may be targeted in interventions.

Abstract Background: To achieve stable social development, the cooperation of all members of a
community is basically required. Providing and improving the health standard is one of
the most fundamental dimensions of human social evolution. This is more essential than
the other aspects of development (public cooperation demands) and health volunteers
are the forerunners of this cooperation, who have voluntarily set about having the public
participate in providing and elevating the level of community health. The present study
aimed to determine the effect of implementing “the health communication plan” by health
volunteers in suburban villages regarding the health knowledge and attitude of rural
women. Materials and Methods: In this quasi‑experimental study, knowledge and attitude
of 121 females (age 15–49 years), who were under the supervision of health centers in
four suburban villages (the case group), before and after performing the health volunteer
plan, were compared to those of 94 females (age 15–49 years) in another group of four
suburban villages (the control group) lacking health volunteers under the care service of
two rural health centers. Data gathering instrument was questionnaires and interviews. The
obtained data were analyzed by SPSS (ver. 11.5) using statistical paired t‑test and Sign
test. P≤0.05 was considered to be statistically significant. Results: The study showed that
the mean of rural women’s health knowledge and attitude had increased and there was a
significant difference between before intervention and after intervention values in the two
groups (P<0.001). Comparing the averages of the two groups also revealed a significant
difference (P<0.001). Conclusions: According to the findings and the positive effects of
performing suburban health volunteer plan on the health knowledge and attitude of rural
women, it would therefore be important to suggest that suburban health volunteers are
very helpful and effective in improving the knowledge and attitude level of rural women.
In brief; as a direct result of their health performance, performing the plan all over rural
health centers is recommended.

Abstract Background: Breastfeeding is the most natural and essential way for feeding newborn babies. This
is an ideal approach for physical and emotional development of babies, as well as for the recovery
of mothers. This study was aimed to determine the effect of breastfeeding education based on the
health belief model (HBM) toward primiparous women. Materials and Methods: In a case–control
group, quasi‑experimental study, 88 subjects were allocated in control and experimental groups.
Subjects who were assigned to the experimental group were provided a program consisting of
group education based on HBM during their prenatal period. Instrument for data gathering was
made by the researchers and standard questionnaire from Dennis and Faux for Breastfeeding
Self‑efficacy Scale (BSES). Baseline interviews were conducted before delivery and follow‑up
visits were conducted after 30 days and at the fourth month after delivery. Data were analyzed
using SPSS (version 16) with c2
, independent sample t‑tests, and paired t‑test. Results: Mean
age of pregnant women who participated in the study was 22 ± 3.29 years. After the program,
the experimental group had significantly better scores in terms of self‑efficacy, knowledge, and
attitude scores statistically. In the fourth month, the mean of child weight in the experimental group
was significantly higher than that of the control group (P=0.001) and exclusive breastfeeding
was significantly higher than in the control group (P=0.007). Conclusion: Prenatal education
in this study based on HBM was successful, and knowledge, attitude, self‑efficacy, and related
indicators improved. The necessity of producing standard education package and education
of pregnant mothers, especially in their first pregnancy, by health professionals is perceived.