Health Education and Health Promotion

Abstract Aims: Primary health care requires personnel with strong psychological resources to maintain optimal performance. Grounded in the Job Demands-Resources model, this study examines the mediating role of work engagement in the relationship between personal resources—self-efficacy, resilience, and optimism—and healthcare professionals’ performance.
Instrument & Methods: This study employed an explanatory cross-sectional design. Data were collected from 292 primary healthcare professionals using a Likert-scale questionnaire and proportional stratified random sampling. Structural relationships and mediation effects were analysed using Structural Equation Modeling-Partial Least Squares (SEM-PLS) with SmartPLS 4, assessing both measurement and structural models.
Findings: Personal resources significantly influenced work engagement, with optimism (β=0.430), self-efficacy (β=0.318), and resilience (β=0.161) showing positive effects. Work engagement had a strong and significant effect on performance (β=0.699). Direct effects of optimism and resilience on performance were not significant. However, mediation analysis revealed significant indirect effects of optimism (β=0.301), self-efficacy (β=0.222), and resilience (β=0.113) on performance through work engagement.
Conclusion: The findings indicate that personal resources primarily enhance performance through work engagement. Strengthening psychological resources and fostering supportive work environments are essential strategies for improving performance in primary health care settings.

Abstract Aims: Occupational hazards in healthcare settings threaten the safety of medical students, whose protective behaviors during clinical training are vital for their well-being and patient care. This study applied Protection Motivation Theory (PMT) to identify key determinants of protective behaviors among medical students.
Methods: A descriptive–analytical (cross-sectional) study was conducted in 2025 among 420 medical students at Shahid Beheshti University of Medical Sciences, Tehran, Iran, selected through multistage cluster sampling. Data were collected using demographic and PMT-based questionnaires. Pearson correlation and linear regression analyses were performed in SPSS version 18, with a significance level of p < 0.05.
Findings: Participants had a mean age of 22.45 ± 3.9 years; 61% of the participants were female. Regression analysis showed that perceived susceptibility (p = 0.003), intention (p < 0.001), and behavior (p = 0.002) significantly predicted protection motivation. Self-efficacy (p = 0.001), intention (p = 0.001), and protection motivation (p = 0.002) significantly predicted protective behaviors.
Conclusion: Self-efficacy, intention, and protection motivation were the strongest determinants of students’ safety behaviors. PMT-based educational interventions may improve protective practices and reduce occupational risks in clinical environments.

Abstract Aims: This study aimed to examine the relationship between perceived social support and the university-to-work transition among graduates of the School of Health.
Instrument & Methods: This descriptive-analytical cross-sectional study was conducted on 227 graduates of the School of Public Health, Qazvin University of Medical Sciences, in the fields of public health, environmental health engineering, occupational health engineering, and health services management over three consecutive years (2023-2025). Data were collected via an online questionnaire developed using the Porsline platform, including demographic and educational parameters, the Multi-Dimensional Scale of Perceived Social Support, and University-To-Work Transition Scale. Analyses were performed using independent t-tests, Pearson correlation coefficients, ANOVA, and multivariate regression in SPSS version 25.
Findings: The mean age of the students was 22.89±1.04 years; 75.4% were female, 24.6% were male, and 45.6% were relatively satisfied with their field of study. Pearson correlation analysis revealed significant positive associations between university-to-work transition and the four transition competencies—concern (r=0.77, p=0.0001), curiosity (r=0.80, p=0.0001), confidence (r=0.74, p=0.0001), and control (r=0.75, p=0.0001)—as well as perceived social support from significant others (r=0.13, p=0.037). Multiple regression indicated that field of study, satisfaction with the field, family financial status, and perceived support from significant others accounted for 15% of the variance in university-to-work transition.
Conclusion: Strengthening transition competencies and social support, along with field alignment and finances, can improve graduates’ readiness for the university-to-work transition and their employment outcomes.

Abstract Aims: This study aimed to investigate the relationship between demographic factors and self-care behaviors and their predictors based on protection motivation theory in hypertensive patients.
Instrument & Methods: This cross-sectional study was conducted on 397 patients with hypertension in Omidieh, Khuzestan Province, southern Iran, in 2022. Data were collected using a demographic information form and a protection motivation theory-based researcher-made questionnaire and analyzed using SPSS 27. Independent t-tests and ANOVA were employed to compare parameters.
Findings: Self-care behavior was statistically significant among individuals with excellent economic status, while no statistically significant differences were observed across other demographic parameters, such as gender, marital status, occupation, and education level. A higher level of education was associated with higher mean scores in self-care and self-efficacy (p<0.05). Men exhibited a higher perceived threat (p=0.015) and perceived rewards (p<0.001) than women. Marital status had no significant impact on the examined parameters. Additionally, part-time employees reported significantly higher perceived rewards compared to other occupational groups (p=0.006). Economic status also significantly influenced self-care and self-efficacy, with individuals in better financial conditions having higher mean scores in these parameters (p<0.05).
Conclusion: Educational level, sex, economic status, and job status influence self-care behaviors in patients with hypertension.

Abstract Aims: Toddlers aged 0-3 require proper parenting; however, self-efficacy and caregiving methods remain deficient. The WHO’s Nurturing Care Framework includes health, nutrition, stimulation, responsive care, and safety. Videos can enhance self-efficacy and parenting skills. This study aimed to determine the effect of video nurturing care education on mothers’ self-efficacy and practices in toddler parenting.
Materials & Methods: This non-equivalent quasi-experimental study employed a pre-test and post-test control group design, utilizing a straightforward approach and consecutive sampling for selecting participants. Data gathering occurred in Kapanewon, Depok, between May and August 2022. The intervention group consisted of 39 participants who utilized videos, while the control group included 49 participants who received informational leaflets. Data collection commenced with a pre-test and, after two weeks, a post-test. The evaluation tools included the Maternal Care Practice Questionnaire and the Maternal Self-Efficacy Questionnaire. Data analysis was conducted using paired t-tests, Wilcoxon tests, independent sample t-tests, and Mann-Whitney tests to compare the two groups.
Findings: Most participants showed a moderate level of self-efficacy, whereas a noticeable difference in parenting practices was observed between the intervention and control groups. In the intervention group, significant differences were found in maternal self-efficacy (p=0.034) and maternal care practices (p=0.0001), while in the control group, no distinctions were observed before and after the intervention.
Conclusion: The utilization of educational videos positively impacts both self-efficacy and parenting skills.

Abstract Aims: Given that the skin is the body’s largest organ, it is not surprising that skin cancer is considered the most prevalent type of cancer among humans. This study aimed to investigate the behavior of students at Khomein University of Medical Sciences regarding the use of sunscreen to prevent skin cancer based on the health belief model.
Instrument & Methods: This cross-sectional study was conducted with students of Khomein University of Medical Sciences in Markazi Province in central Iran from February to January 2024. Given the small student population, a census sampling method was used, resulting in the participation of 353 students. The research tool comprised a demographic information questionnaire, along with a researcher-made questionnaire on the use of sunscreen in skin cancer prevention based on the health belief model. Data analysis was performed using STATA 17 software, employing descriptive statistics and simple and multiple linear regression analyses, with a significance level set at α=0.05.
Findings: A one-unit increase in the scores of perceived benefits, perceived barriers, cues to action, and perceived self-efficacy led to increases of 0.13 (95% CI=0.05, 0.26; p=0.041), 0.10 (95% CI=0.02, 0.17; p=0.007), 0.14 (95% CI=0.07, 0.22; p≤0.001), and 0.18 (95% CI=0.07, 0.29; p=0.001) in the mean behavioral score.
Conclusion: Gender, socioeconomic status, parental occupation, and level of education are associated with the adoption of sunscreen use behavior and perceived benefits, cues to action, and self-efficacy are strong predictors of sunscreen use.

Abstract Aims: Self-efficacy in making professional decisions refers to people's confidence in their abilities to complete tasks and display particular behaviors, which enables them to successfully connect these activities to their career goals. This study aimed to examine and determine the level of self-efficacy of high school students in choosing a career during the Covid-19 pandemic.
Instruments & Methods: This cross-sectional pilot study survey was conducted on 469 high school students in Boyolali Regency and Surakarta City, Indonesia, who were selected using the cluster proportionate stratified random sampling technique. The Career Decision Making Self-Efficacy Scale-short Form was used to gather the data. Data were analyzed using SPSS 23 software.
Findings: The self-efficacy of high school students in making career decisions during the Covid-19 pandemic was rated as moderate. There was no significant difference in the level of self-efficacy in career decision-making between the male and female students (p>0.05). However, there was a significant difference between junior and senior high school students in Career Decision-Making Self-Efficacy (p<0.05) and problem-solving (p<0.01).
Conclusion: Problem-solving indicators can be used to create guidance and counseling programs in schools and have implications for future career planning.

Abstract Aims: Diabetes foot is a complication of diabetes mellitus that can be avoided by practicing proper foot care. This behavior is influenced by factors such as self-efficacy and family support. The presence of communication and language barriers between healthcare providers and patients with diabetes mellitus leads to difficulties in understanding diabetes education, which ultimately hinders self-care. This study aimed to evaluate the impact of a community health worker intervention program on the self-efficacy and family support of patients with diabetes regarding foot care.
Materials & Methods: This quasi-experimental study with pre-test and post-test design with a control group was conducted on 72 diabetes mellitus patients who were in the working area of the Lempake Primary Health Care Center, Samarinda City. The respondents were selected by purposive sampling method and divided into two groups, including the intervention group (n=36) and the control group (n=36). Data were collected using Foot Care Confident Scale and Family Support Questionnaire and were analyzed by Statistical tests.
Findings: There was a significant difference in the mean score of family support in the intervention group compared to the control group (p=0.01). Meanwhile, for self-efficacy, there was no significant difference between the two groups (p=0.48). However, significant differences were observed in self-efficacy and family support before and after the intervention (p<0.05). Whereas in the control group, there was no significant difference in self-efficacy and family support (p>0.05).
Conclusion: Community health worker intervention programs can increase family support and self-efficacy of diabetes mellitus patients in foot care.

Abstract Aims: We aimed to investigate the association between health beliefs and exercise behavior in infertile women at risk of developing osteoporosis.
Instrument & Methods: This cross-sectional study was conducted in Sanandaj city, west of Iran, in 2018. Four hundred and eighty-three infertile women were included in the study through convenience sampling from 35 comprehensive healthcare centers. Standardized face-to-face interviews were conducted using established and reliable instruments to assess exercise behavior and health beliefs. Data were analyzed by SPSS 22 using Logistic regression models, Chi-square, independent t-test, and Pearson correlations.
Findings: Employed women compared to homemakers had substantially higher odds of adopting exercise behaviors (OR=3.19; 95% CI=1.53-6.66; p<0.01). Moreover, the odds of exercise behavior adoption increased with self-efficacy (OR=1.35; 95% CI=1.2-1.52; p<0.01), and decreased with perceived barriers (OR=0.9; 95% CI=0.84-0.97; p<0.01).
Conclusion: It is essential to increase perceived self-efficacy and reduce perceived barriers to promote exercise behaviors in infertile women. Consequently, health professionals should develop or adopt appropriate strategies to decrease barriers and increase self-efficacy to enhance exercise behaviors in this group of women.

Abstract Aims: Psychological well-being is a key concept in preventing health problems and increasing life expectancy. Psychological well-being is associated with some positive psychological structures. The purpose of this study was to investigate the mediating role of resilience and self-efficacy in the relationship between cognitive emotion regulation and the psychological well-being of Iranian students.
Materials & Methods: In this cross-sectional descriptive study, 285 students (142 men and 143 women) were selected by multistage sampling method from Zanjan University, Zanjan, Iran in the academic year of 2017-2018. Data were collected using psychological well-being, resilience, self-efficacy, and cognitive-emotional regulation questionnaires. Data were analyzed by LISREL 8.8 and SPSS-20 software using Pearson correlation coefficient and structural equation modeling (SEM).
Findings: Psychological well-being had a direct relation with resilience, self-efficacy, and catastrophizing strategy. Cognitive emotion regulation strategies showed a direct relationship with resilience and self-efficacy and finally, resilience, and self-efficacy in the relationship between cognitive emotional regulation and psychological well-being strategies had a complete mediating role and incomplete mediating role, respectively.
Conclusion: Resilience and self-efficacy play a mediating role in the relationship between psychological well-being and cognitive emotion regulation strategies in Iranian students.

Abstract Aims: Considering the evolution of schools and the growth of smart schools, the aim of the present study was to compare the self-efficacy and academic performance of students in conventional and smart schools.
Instruments and Methods: This cross-sectional descriptive-analytic study was conducted in Kerman, Iran, in 2015. 300 students of 8th grade studying in Kerman (145 smart school student and 155 conventional school students) were selected by multi-stage sampling method. Data were collected by a standardized academic self-efficacy questionnaire of Jinks-Morgan and analyzed using independent t-test, linear regression, Pearson correlation test and SPSS 20 software.
Findings: Academic achievement in conventional and smart schools was statistically different. So that students of smart schools had better academic achievement than ordinary schools (p=0.0001). While the self-efficacy of the two groups did not differ significantly. There was a significant direct correlation between students' academic achievement and their self-efficacy score (r=0.159, p=0.006). Also, there was a significant statistical difference, according to the type of school, occupation, and education level of parents (p<0.0001).
Conclusion: The academic self-efficacy of students in the two groups do not differ, students of smart schools have the higher academic achievement. School smartness and high self-efficacy will improve students' academic achievement.

Abstract Aims: Health literacy becomes increasingly important in understanding the prenatal perception of risk by pregnant women. Maternal understanding of and perception of risk may have an impact on mothers’ willingness to follow antenatal recommendations. This study aimed at investigating correlation between maternal health literacy and dietary self-efficacy in pregnant mothers.
Instruments & Methods: In this cross-sectional descriptive-analytical study, 120 pregnant mothers were selected from health centers in Mashhad city, Iran in 2016. The subjects were selected through multi-stage cluster random sampling method. Data were collected using Maternal Health Literacy and Pregnancy outcomes Questionnaire and Perceived Dietary Self-efficacy Questionnaire. The obtained data were analyzed by SPSS 15 software and using descriptive statistics (mean, standard deviation, and frequency) and analytical statistical tests (independent t-test, ANOVA, Turkey’s Post hoc test and Pearson correlation test).
Findings: There was a positive and significant correlation between maternal health literacy and dietary self-efficacy (r=0.29; p=0.001). Significant relationships were found between maternal health literacy and educational level, incomes, and living place (p<0.05). But dietary self-efficacy had only a significant relationship with incomes (p<0.05).
Conclusion: There are the significant correlation between maternal health literacy and self-efficacy in pregnant mothers.

Abstract Aims: Hemodialysis patients experience numerous problems in the fields of self-care in adherence to dietary and fluids-intake restriction. For increasing their self-care, they require controlling these problems. This can be done with the education based on a behavior change theory, this study attempted to determine the effect of the educational intervention based on SET (Self-efficacy Theory) on adherence to diet and fluid-intake restriction in patients with hemodialysis.
Materials & Methods: The present study is a randomized clinical trial that was conducted on 70 hemodialysis patients of Qom City in 2016 (35 in the trial group, 35 in the control group). The data were collected by demographic questionnaire, self-efficacy (SUPPH) and researcher-made validated and relied questionnaire of adherence to dietary and fluids-intake restriction (8 and 6 questions, respectively) in two steps (before and three months after education). The educational program was performed for the trial group in two half-hour sessions. The data were analyzed by SPSS 16, using paired-test, Independent t-test, Chi-square and Mann-Whitney test.
Findings: Before the test, there was no significant difference in adherence to dietary (p=0.49) and fluids-intake restriction (p=1.00). After training, significant differences were observed between the two groups in adherence to dietary (p<0.001) and fluids-intake restriction (p<0.001). There was significant difference between pre-test and post-test in the control group (p<0.05).
Conclusion: The educational intervention based on Self-efficacy Theory has the effect on adherence to diet and fluid-intake restriction in patients with hemodialysis.

Abstract Aim: Many patients with chronic renal failure are prone to depression and anxiety. A self-efficacy promotion-training program can be effective in these mental disorders. Thus, the aim of this study was to investigate the effect of education based on self-efficacy theory on improvement of mental health in hemodialysis patients.
Methods: This interventional study that conducted in 2016 on 70 hemodialysis patients (35 in experimental group, 35 in control group). The data collection instruments consisted of demographic questionnaire, self-efficacy (SUPPH) and researcher-made validated and relied questionnaire of mental health (6 questions). The data were collected in two steps: before and three months after the training intervention. The educational program was performed for the experimental group in two half-hour sessions. The obtained data were analyzed by SPSS 16, Paired-test, Independent t-test, Chi-square and Mann-Whitney’s test at the significance level of α=0.05.
Findings: The groups did not differ significantly regarding the mean of mental health before the study (p=0.56). However, three months after the intervention, the mean of self-care in the field of mental health in the experimental group was significantly higher than in the control group (p<0.001).
Conclusion: The research results showed that employing the educational program based on self-efficacy theory was positively effective as for promotion of self-care in the field of mental health in hemodialysis patients.

Abstract Aims: Diabetes as the most common diseases caused by metabolic disorders is an important global challenge. This is a disease that requires lifelong self-care; because the self-care and improvement of the life quality is cost effective .The aim of this study is to determine the effects of the self-Efficacy education program on reducing blood sugar levels among the type 2 diabetic patients. It was conducted in Zahedan. Methods and Materials: 138 diabetic type 2 patients were selected in Zahedan Diabetic Center and divided randomly into control groups (n=69) and test group (n=69); and special checklist and health belief model questionnaire were applied as data collection instruments. Reliability and validity of the questionnaire was evaluated and confirmed. The data collected before intervention was analyzed, then educational design method executed 3 and 6 months after intervention and the collected data was analyzed using SPSS software. Findings: According to the results, there is a significant statistical difference in average number of models before and after educational intervention (pConclusions: Self-efficacy training in striation improves knowledge, attitude and self-care behaviours performance of the subjects and the related average of HbA1c and FB. The training seems to increase the learners' active participation in caring themselves, because they have experienced the results of the training program and they are motivated to enhance their better self-care behaviours.