Health Education and Health Promotion

Abstract Aims: Regular engagement in physical activity is a prerequisite for physical and mental health and reduces the risk of several diseases and psychological disorders. This study aimed to investigate the status of physical activity among female students aged 13-17 years in Khoy County.
Instrument & Methods: This descriptive cross-sectional study was designed and conducted during the winter of 2021-2022. The Global School-based Student Health Survey (GSHS) was provided online to all female students aged 13-17 in Khoy County, with 2,225 students completing it. The data were entered into SPSS 22 software, and descriptive statistics (frequency tables) and the chi-square test were used for analysis.
Findings: Over 58% of the students had not participated in any sports teams in the past 12 months. More than 43% of the surveyed participants had not engaged in any sports to strengthen their muscles in the past week, despite more than 75% reporting that the benefits of physical activity had been discussed with them in at least one of their classes.
Conclusion: The level of physical activity among female students in Khoy is low.

Abstract Aims: Despite the advantages of physical activity, many people still don't exercise much. The study aimed to examine the impact of intervention mapping model-based training on the health-promoting behaviors of Ilam University of Medical Sciences employees.
Materials & Methods: In this semi-experimental study, 221 Ilam University of Medical Sciences staff were given Walker's health-promoting lifestyle questionnaire to determine their needs. Then, a training program was created to increase staff physical activity levels based on the efficient structures. Sixty Ilam University of Medical Sciences employees who scored lowest on the physical activity dimension participated in the educational intervention phase. Participants received the international physical activity questionnaire before and three months after the intervention. Data analysis was done using SPSS 22 software by independent t-test, paired t-test, Pearson correlation coefficient, one-way analysis of variance, and generalized linear regression.
Findings: Among the health-promoting lifestyle dimensions, the physical activity dimension was identified as the most important predictor of health-promoting behaviors. There were significant differences before and after the educational intervention in the housework and family care and the average physical activity (p<0.05). The average total physical activity increased significantly after the educational intervention compared to before the intervention (p<0.016).
Conclusion: The mapping model education improves physical activity levels in medical university staff.

Abstract Aims: A healthy lifestyle reduces the mortality from diseases such as cardiovascular diseases and diabetes mellitus. This study aimed to assess the effectiveness of an online health and well-being program in improving physical activity, nutrition, and sleep in college students.
Materials & Methods: The present study utilized a quantitative methodology, mainly a two-group pretest-posttest design on 178 college students. The experimental group received three months of a health and well-being program while the control resumed their daily activities. The participants answered an adapted online questionnaire divided into socio-demographic and physical activity, nutrition, and sleep data. Data were analyzed using SPSS 27 software.
Findings: In both experimental and control groups, the participants’ physical activity in a day was at an average level. Moreover, the frequency of eating nutritious foods in a week was at an average level for both groups. In terms of hours of sleep per night, the total pretest and posttest mean scores for the experimental and control groups indicated that the participants’ hours of sleep per night are at a below-average level. In terms of physical activity, nutrition, and hours of sleep per night, there was no statistically significant difference between the pretest and posttest for both groups (p>0.05).
Conclusion: There is no evidence of a significant difference between college students' physical activity, nutrition, and sleep after the online health well-being program.

Abstract Aims: This study aimed to investigate the motivational sphere of students to physical activity, as well as to analyze medical and sports-oriented approaches in physical education.
Instruments & Methods: The experimental base for the study was the National University of Ukraine on Physical Education and Sport. The main research methods for this problem were the methods of analysis and synthesis, deduction, comparison, and survey.
Findings: According to a survey, every three male students and every five female students experience psychological stress while studying at universities. Students have a low level of physical fitness, low motivation, lack of interest in physical education, and an unformed values-based attitude to independent physical education.
Conclusion: The low level of physical activity of school graduates does not allow to ensure a sufficient level of development of the general physical proficiency of students, which leads to a decrease in health indicators to a level that does not provide sufficient effectiveness for training and future professional activity.

Abstract Aims: Although physical activity has many health benefits during pregnancy, few women engage in regular physical activity. The purpose of this study was to test the validity and reliability of a physical activity scale in pregnant women based on social cognitive theory.
Instrument & Methods: A multi-phase scale development method was used to build the scale. To generate a pre-final version of the instrument, face and content validity were measured at the following step. The validation of the instrument was evaluated through a sample of 240 pregnant women. Then, the construct validity, internal consistency, test-retest reliability, and Cronbach’s alpha of the scale were calculated.
Findings: In the beginning, a 36-item scale was created by undertaking a qualitative phase. This number was lowered to 24 items after content validity. Seven factors emerged from the exploratory factor analysis (outcome expectations, outcome value, self-efficacy, social support, self-regulation, mutual determinant, and behavior) which accounted for 52% of the observed variance. The confirmatory factor analysis revealed a model with a suitable fitness for the data. For the subscales, Cronbach's alpha coefficients ranged from 0.83 to 0.94, and the Intraclass correlation coefficient ranged from 0.80 to 0.88, which is within acceptable limits.
Conclusion: The findings showed that the psychometric properties of the physical activity scale is valid and reliable scale that can help us better understand aspects associated to physical activity in pregnant women. As a result, it has the potential to be employed in the future research.

Abstract Aims: There is evidence that physical activity plays an essential role in preventing illnesses during pregnancy. This study aimed to determine facilitators, barriers, and structural factors of physical activity in nulliparous pregnant women: A qualitative study using Maxqda.
Participants & Methods: This qualitative study was conducted from January to June 2020 in nulliparous pregnant women. Forty participants selected randomly from the Pounak Health Center of Tehran City, Iran, answered open-ended questions about the obstacles that deprived them of physical activity during pregnancy. Data were analyzed by MAXQDA 12 software.
Findings: According to the results, 620 primary codes, 42 secondary codes, 11 sub-themes, and 6 themes were extracted. These themes were divided into the PEN-3 categories; facilitators, barriers, and structural factors. The nurture factors as facilitators had communication and support from others as sub-themes. Barriers consisted of socio-cultural (participate in pregnancy loss with a companion; social beliefs; culture of poverty), socioeconomic (financial problems), individual factors (physical, psycho-emotional, and spiritual dimensions), and structural factors consisting of environmental (equipment) and organizational (possibilities in health centers) factors.
Conclusion: It is essential to comprehend why pregnant women face obstacles to physical activity. Many issues are proposed: the need for enough information on the advantages of physical activity and the role of nurturing factors that need to be motivated to physical activity. Therefore, its a need to investigate structural problems in the community to provide facilities for pregnant women to have physical activity during pregnancy.

Abstract Aims: As a basic factor in a healthy lifestyle, physical activity is less than necessary in health system workers such as health workers. Explaining Physical activity by successful perceptual frameworks such as the developed theory of planned behavior identifies the factors influencing this complex behavior to design effective educational interventions. This study aimed to assess path analysis of the Physical activity of health workers based on the developed theory of planned behavior with planning.
Instrument & Methods: This analytical cross-sectional study was performed on 210 female health workers at Babol University of Medical Sciences in 2019. Data were collected by a valid and reliable theory of planned behavior-based questionnaire. Data were analyzed by SPSS 21 and Lisrel 8.8 software using the maximum likelihood method and correlation matrix at a significance level of less than 5%.
Findings: A total of 210 female health workers with a mean age of 39.35±8.64 participated. The developed theory of planned behavior model explained 62, 56, 37, and 58% of the variances of behavioral intention, action planning, coping planning, and Physical activity behavior, respectively. The intention was predicted by perceived behavioral control. Behavior was explained by intention, perceived behavioral control, and action planning, respectively. Fit indices showed that the developed model was fitted to the data (Relative Chi-square=1.58, RMSEA: 0.05, Comparative Fit Index: 1, Goodness of Fit Index: 0.98).
Conclusion: Intention, perceived behavioral control, and action planning, based on the developed theory of planned behavior, were the constructs influencing physical activity behavior. It is necessary to consider these structures and their relationships in designing educational interventions to promote physical activity in health workers as a key element in promoting community health.

Abstract Aims: Physical inactivity and a sedentary lifestyle increase the risk of all-cause mortality. This study aimed to assess the impact of a theory-based education on PA among female health volunteers in Iran by applying the Theory of Planned Behavior.
Materials & Methods: This randomized controlled trial was conducted on female health volunteers in Shushtar, Iran, from March to December 2016. One hundred ten participants were selected by purposive sampling, and they were randomized into intervention and control groups based on a 1:1 ratio in a single block. The intervention included three educational sessions and a walking program. A multi-section questionnaire containing items on TPB constructs, the international physical activity questionnaire, and the physiological cost index (PCI- an objective measure of PA) was used to collect the data at baseline and six-month follow-up assessments. Then the data were compared within and between groups using t-test and paired test using SPSS 19 software.
Findings: All 110 ‘Health Volunteers’ (55 in each group) were entered into the study. The mean±SD age of participants was 35.65±10.25 years. The results obtained from the analysis showed that the educational program improved attitude towards PA, perceived behavioral control, intention, behavior, and PCI among the intervention group (p<0.001). However, no significant changes occurred in the control group regarding the study variables (p>0.05).
Conclusion: The TPB-directed educational program improved physical activity and physiological cost index. The study framework might be used as a practical template for interventions aimed at improving physical activity among female health volunteers.

Abstract Aims: Osteoporosis is a major public health problem in the world, which can be prevented or its onset can be delayed through some lifestyle changes. The aim of this study was to assess the application of the precede-proceed model in promoting physical activity for prevention of osteoporosis among women.
Materials and Methods: The present quasi-experimental study examined the application of precede-proceed model on the physical activity of 120 women with the age range of 15 to 49 years old, who were selected by multistage random sampling in Kerman in 2014. The participants were divided to the control (n=60) and intervention (n=60) groups. Among the preventive behaviors of osteoporosis, physical activity was selected for the educational intervention. The educational intervention lasted for 2 months. An international standard questionnaire was used to measure physical activity, and a researcher-made questionnaire, according to the constructs of precede model was used to collect data before and after the intervention. The data were analyzed by SPSS 20, using Mann-Whitney, Wilcoxon, and Chi-square tests as well as descriptive statistics.
Findings: After educational interventions, the mean scores of predisposing, reinforcing and empowering factors, as well as osteoporosis preventive behaviors (physical activity) significantly increased only in the intervention group (p<0.001).
Conclusion: Health education and health promotion interventions based on precede-proceed model can lead to increased physical activity and eventually prevent osteoporosis in women.

Abstract Aim: Continuous physical activity is required after coronary artery bypass graft (CABG) surgery to prevent recurrence of the disease; however, its amount is not suitable in many patients. The present study aimed to investigate the stages of physical activity in patients after CABG using the Trans-Theoretical Model (TTM).
Methods: In this cross-sectional research, 120 cardiac patients participated; they had CABG surgery and referred to Ekbatan Hospital of Hamadan. Sampling was conducted using a purpose-based approach. Data were collected using a researcher-made questionnaire based on the TTM and analyzed using the SPSS18 software. Descriptive statistics and statistical processes of one-way ANOVA, Tukey's post-hoc, and Chi-square tests were also conducted at a significant level of p<0.05.
Findings: The mean age of the participants was 57.87±9.89 years. From the 120 patients under study, 4.2% were in the pre-contemplation phase, 14.2% in the contemplation stage, 58.3% in the preparation stage, 10.8% in the action stage, and 12.5% in the maintenance phase of the physical activity. The results of ANOVA test showed a significant difference between the stages of change in behavior with perceived advantages, perceived disadvantages, perceived self-efficacy, and processes of change (p <0.001).
Conclusion: The results showed that many patients did not have regular physical activity after surgery. This makes clear the need for educational interventions based on theoretical models by health educators.

Abstract Aim: Hypertension (HTN) is considered to be the most important modifiable risk factor for cardiovascular morbidity and mortality. Although lifestyle modifications such as increase in physical activity (PA) are effective for lowering blood pressure (BP), it can often be difficult for hypertensive (HTN) individuals to modify their lifestyle and maintain such modification. So this study aimed at assessing the effectiveness of trans-theoretical model (TTM)-based intervention on PA in HTN patients.
Methods: This randomized controlled trial was conducted on 78 hypertensive patients (39 in the experimental group (EG) and 39 in the control group (CG)) from January 2015 to September 2015 in the city of Shiraz in southern Iran. The EG received TTM-based intervention about PA for four weeks. The study outcomes included PA stages of change, processes of change, exercise self-efficacy (ESE), decisional balance and PA, which were measured at the onset and at one week post-intervention. The data were analyzed using SPSS 16 software.
Findings: At one week post-intervention, PA increased significantly in the EG (1218.35±917.95) compared to the CG (810.28±785.21) (p=0.04). A significantly larger percentage of the EG (80.6%, n= 25) progressed to the stage of action compared with the CG (16.1%, n=5). Also one week post-intervention, the EG demonstrated higher ESE (p=0.004), higher decisional balance (p<0.001), and greater process of change (p=0.001) compared with the CG.
Conclusion: The present study showed that the TTM-based intervention effectively increased PA. So the use of TTM-based interventions can be effective in increasing the commitment to PA in HTN patients.

Abstract Aim: Insufficient physical activity in women exposes them to problems such as overweight, diabetes, depression and cardiovascular diseases on top. In between, employees have minimum physical activity due to type of their job. The goal of this study was determining psychological factors effective on the physical activity of women working in University of Tehran based on the theory of planned behavior. Methods: The research population included female office workers from the University of Tehran, who were selected through a call at this university in 2014 for this descriptive analytical cross-sectional study. For data gathering, a questionnaire was used with acceptable validity and reliability including demographic information and constructs of the Theory of Planned Behavior (TPB) as well as International Physical Activity Questionnaire (IPAQ). Data were analyzed using SPSS21. The statistical bivariate correlation test and stepwise regression test were employed at the significance level of 0.05. Findings: In this study, behavioral intention had a positive and significant relation with perceived behavioral control (P=0.000) and attitude (P=0.042). Also behavioral intention had a positive and significant relation with physical activity (P=0.000). Stepwise regression analysis was used to evaluate important factors effective on prediction of behavior and intention; it determined 40% of intention variance (R2= 0.408). Conclusion: The results of the study showed that constructs such as attitude and perceived behavioral control can be effective on the behavioral intention and physical behavior of female employees; therefore, these factors must be seriously considered in educational planning for this group of the society.

Abstract Aim: Physical inactivity, as the leading risk factor for death, is more common among women than men. Despite the effective role of extended Theory of Planned Behavior (TPB) with planning to promote exercise behavior, there is no Iranian standard scale in this regard. This research evaluated psychometric characteristics of the expanded TPB-based questionnaire regarding to the physical activity of military staff’s spouses in Tehran. Methods: Content, face, construct validity and reliability (internal consistency and stability) of this scale was assessed. A cross-sectional survey was conducted among 200 women, who were living in organizational houses, in Tehran, Iran in 2014, in order to do exploratory factor analysis (EFA).The participants were chosen with multi-stage cluster random sampling. EFA was performed applying the principal component analysis and Varimax rotation. Data were analyzed using SPSS. v16. Findings: Content validity index, content validity ratio and impact score of the extended TPB scale were 0.8-0.97, 0.78-0.98 and 4.5-4.8, respectively. An eight-factor structure was extracted as a result of the EFA and accounted for 76.33% of the variance. The calculated KMO was 0.72 and the Bartlett’s test of sphericity was significant (P<0.001). Eight constructs consisted of behavior, affective attitude, subjective norms, perceived behavioral control, coping planning, instrumental attitude, intention and action planning. Cronbach’s alpha value (0.83-0.97) and the intraclass correlation coefficient (0.63-0.91) demonstrated satisfying reliability for the subscales. Conclusion: Validity and reliability of the first developed TPB-directed scale with planning about women's exercise perceptions and behavior in Iran was appraised and approved in this study. This instrument can be utilized by other health researchers.

Abstract Aim: Level of physical activity as key determinant of healthy lifestyle is less than what is required in individuals particularly women. Applying theories of behavioral change about complex behaviors such as physical activity leads to identify effective factors and their relations. The aim of this study was to determine predictors of exercise behavior based on developed Theory of Planned Behavior with planning constructs in military personnel’s wives. Methods: We performed this cross-sectional study on 150 military personnel’s spouses residing in organizational houses, in Tehran, Iran in 2013. The participants were randomly selected with multi-stage cluster sampling. The validity and reliability of developed scale were evaluated before conducting the path analysis. Data were analyzed using SPSS.16 and LISREL8.8. Finding: The developed model predicted 48, 11, 12 and 35 percent of the variance in intention, action planning, coping planning and behavior, respectively. Subjective norms (Beta=0.35, p<0.01) and perceived behavioral control (Beta=0.28, p<0.01) were the predictors of intention. Determinants of behavior included action planning (Beta=0.40, p<0.01), coping planning (Beta=0.39, p<0.01), intention (Beta=0.23, p<0.01) and subjective norms (Beta=0.08, p<0.01). Instrumental and affective attitude had no significant path coefficient to dependent variables. The path of perceived behavioral control to behavior was non-significant. The developed theory fitted to data better than the original theory. Conclusion: This research demonstrated relative weights and relationships of Theory of Planned Behavior constructs with action and coping planning in physical activity behavior of military staffs' spouses. It is essential to consider these effective factors in designing of health education programs.

Abstract Aims: Most of the world population who is at work and production age does not have appropriate and regular physical activity for various reasons. Accordingly, the researchers tried to evaluate the effect of physical activity predictors of employees through the path analysis based on the Pender's Health Promotion Model (HPM). Methods and Materials: We conducted this study on 359 employees of the milk and milk powder production factories in Mashhad. A questionnaire consisted of items related to the structure of the Pender's Health Promotion Model (Perceived Benefits, Perceived Barriers, Prior Related Behavior, Perceived Self-Efficacy, Activity Related Affect, Personal Factors, Interpersonal Influences and Situational Influences) and the IPAQ standard questionnaire related to the physical activity were designed and applied in interviews as data collection instruments. Findings: One fourth of the employees had proper physical activity. Generally, structures of the Pender's Health Promotion Model predicted 34.8 % of the physical activity behavior variance. Regression analysis has shown that the predictability of Prior Related Behavior, Perceived Self-Efficacy, Personal Factors, Activity Related Affect and Interpersonal Influences are significant and Situational Influences are nearly significant. Prior Related Behavior (β = 0.45, P < 0.000) and Self-Efficacy (β = 0.17, PConclusions: The findings of the study revealed that HPM is efficient in identifying and predicting the physical activity behavior. This pattern can be used as a framework for planning and implementing educational interventions in order to improve the physical activity of the adult employees.