Health Education and Health Promotion

Abstract Background: Adolescents in coastal areas face heightened risks of early marriage and unwanted pregnancy due to limited access to reproductive health services and enduring socio-cultural norms. In South Konawe Regency, Southeast Sulawesi, Youth Posyandu functions as a community-based adolescent health platform, yet its effectiveness in preventing early marriage and unwanted pregnancy in coastal communities remains underexamined.
Methods: This quantitative cross-sectional study involved 210 adolescents selected through proportional random sampling. Partial Least Squares–Structural Equation Modeling (PLS-SEM) was employed to examine direct effects as well as mediating and moderating relationships among knowledge, attitudes, program-supporting and inhibiting factors, Youth Posyandu empowerment, early marriage, and unwanted pregnancy.
Results: Program-supporting and inhibiting factors significantly influenced unwanted pregnancy (t = 2.881; p = 0.004). Knowledge showed a significant positive effect on unwanted pregnancy (t = 6.644; p < 0.001) and Youth Posyandu empowerment (t = 6.168; p < 0.001). Attitudes significantly affected unwanted pregnancy (t = 6.090; p < 0.001) but had no significant effect on empowerment (t = 0.479; p > 0.05). Youth Posyandu empowerment significantly reduced unwanted pregnancy (t = 2.566; p = 0.010). Mediation analysis revealed that empowerment partially mediated the effect of knowledge on early marriage and unwanted pregnancy (coefficient = −0.061; t = 2.112; p = 0.035), while attitudes showed no mediating effect. Program factors did not moderate the relationship between empowerment and unwanted pregnancy.
Conclusion: Enhancing adolescent knowledge and strengthening Youth Posyandu empowerment are key strategies for preventing early marriage and unwanted pregnancy in coastal communities.

Abstract Aims: This study aimed to develop the American national institutes for social advancement education model to support anemia prevention through a digital approach.
Materials & Methods: This quantitative research employed a research and development design that included model development, expert validation, one-on-one testing, small-group testing, and effectiveness testing using a pre-post-test design. Participants included pregnant women in Merangin District, Jambi Province selected using purposive sampling. Validated and reliable questionnaires measured knowledge and attitudes. Data were analyzed using the Wilcoxon and Mann-Whitney U tests.
Findings: The American national institutes for social advancement model was considered feasible based on assessments of navigation, language clarity, content completeness, visual appeal, and technical performance. Effectiveness testing showed a significant improvement in mothers’ knowledge after the intervention (p<0.001) and a significant improvement in attitudes (p<0.001). Between-group comparisons indicated that the intervention group had significantly higher post-test knowledge than the control group (p<0.001), although the differences in attitudes were not statistically significant (p=0.252).
Conclusion: The American national institutes for social advancement model is effective in improving knowledge and enhancing attitudes related to anemia prevention among pregnant women.

Abstract Aims: The implementation of a social capital model-based prevention approach significantly influences the enhancement of sustainability awareness in social communities. This study aimed to analyze sustainability awareness in dengue prevention as a result of developing the social capital model.
Materials & Methods: This observational study was conducted on a sample size of 140 respondents selected from five community health centers in East Java province using area or cluster sampling technique. Statistical analysis was conducted using structural equation modeling with Smart Partial Least Squares to assess the relationships between research parameters and to test hypotheses, assisted by the proposed software.
Findings: All independent parameters, including value (X1), belief system (X2), cooperation (X3), participation (X4), perception (X5), and satisfaction (X6), had a significant positive influence (p<0.05) on sustainability awareness.
Conclusion: The social capital model-based prevention approach significantly enhances awareness among both patients and the community simultaneously.

Abstract Aims: Nurses are more susceptible to low back pain rather than other Healthcare workers. The present study aimed to assess nurses' knowledge and practice toward the prevention of low back pain related to work and to find out the association between nurses' knowledge and practice with their demographic characteristics.
Instruments & Methods: This descriptive analysis study was conducted on nurses at Al-Diwaniya Teaching Hospital, Diwaniyah City, Iraq, from 1 March 2022 until 30 October 2022. Fifty nurses were selected by a purposive sampling (non-probability) method. Data were collected using a self-administered questionnaire regarding nurses' knowledge of prevention low back pain related to work and an observational checklist to assess nurses’ practice. Data were analyzed using a Chi-square test by SPSS 23 software.
Findings: The majority of nurses (60.0%) had a fair level of knowledge, and the mean score of nurses' knowledge was 0.48±0.21. Also, 50.0% of nurses had a low level of practice, and the mean score of nurses' practice was 1.75±0.45. There was a significant relationship between nurses' knowledge and education level (p=0.003). However, there was a significant relationship between nurses' practice and gender, education level, years of experience in nursing, and the workplace in hospital (p<0.05).
Conclusion: Most of the nurses in Al-Diwaniya Teaching Hospital, have a fair level of knowledge and a low level of practice in the prevention of low back pain related to work.

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: This study aimed to design and psychometric a tool for measuring the knowledge, beliefs, and behavior of teachers regarding COVID-19 preventive behaviors.
Instrument & Methods: The goal was to create a tool that may be used to create an educational intervention that promotes preventive behaviors. A 60-item scale regarding COVID-19 preventive behaviors was developed upon literature review. Then, face and content validity were evaluated using quantitative and qualitative methods, through the involvement of the participants and expert panel. The internal consistency and reliability were assessed and approved using Cronbach's alpha index and test-retest.
Findings: The face and content validity of the primarily developed scale was confirmed by item impacts of 1.5, 0.49 CVR, and 0.79 CVI, and the number of items dropped to 60. The reliability of the instrument was approved by Cronbach's alpha of 0.67 to 0.95 and a correlation coefficient of 0.65 to 0.93.
Conclusion: Based on the results, the scale that was developed using the constructs of the HBM for COVID-19 preventive behaviors among teachers had appropriate validity and reliability.

Abstract Aims: Eating disorders are making a point of challenge for health-related researches. Using big data for this type of researches can effectively help researchers use a beneficial resource of information worldwide in real-time. This study aimed to introduce a more accurate index for analyzing food-related data and making relations between people's opinions and the prevention treatments for eating disorders.
Instrument & Methods: In this data mining study, more than 2 million eating-related tweets were collected from Twitter in 2017 and analyzed by novel methods for big data research. Three main indicators (Basic-sentiment-rate, Health-rate, and Relation-rate) were used to predict if every user is more likely to have a healthy or unhealthy diet. Finally, these parameters were normalized, clustered, and combined to obtain an overall sentiment rate.
Findings: Location and gender were estimated as effective indicators making the relationship between peoples' opinion and prevention treatments for eating disorders. Some combinations of factors were also considered influencing indicators when applied together, such as gender+age and gender+location.
Conclusion: Punishment/reward combination criteria that are predicted with both gender and location data by FSR index is the most effective factor in making the relationship between peoples' opinion and prevention treatments for eating disorders.

Abstract Introduction: Early Childhood Caries (ECC) is a worldwide disease increasing in many developing countries. The purpose of this study was to investigate the preventive behaviors of early childhood caries among mothers referring to comprehensive health service centers in Ahvaz.
Instruments & Methods: This descriptive-analytical and cross-sectional study was performed among 318 mothers with infants from 6 months to one-year-old in 2020. The method of data collection was a researcher-made questionnaire whose reliability and validity were confirmed. It included demographic information and questions about measuring awareness, attitude, self-efficacy, and performance in early childhood caries' preventive behaviors among mothers referring to comprehensive health service centers in Ahvaz. The data were analyzed by statistical tests such as ANOVA, t-test, and Pearson correlation coefficient using SPSS statistical software.
Findings: The results showed that the mean scores of mothers' awareness were 6.23±1.86, the attitude was 38.48±4.85, self-efficacy was 20.91±3.14, and performance was 5.53±2.19. There was a significant correlation between awareness, attitude, self-efficacy, and performance. There was also a significant relationship between parents' awareness and education and the mother's job (p<0.05).
Conclusions: The mothers' awareness and performance are at a moderate level. Therefore, in the Health Service Centers, it is necessary to consider mothers' awareness and performance with infants from 6 months to one-year-old, when the baby's first teeth grew.

Abstract Aim: Cardiovascular diseases (CVDs) are the main contributor to disability and the leading cause of death in Iran and worldwide. This study was done to determine the effect of education on behaviors related to CVDs among Yazd city restaurants` chefs.
Method: In an experimental study, the intervention factor for case group was education through lectures, pamphlets, and videos. All the restaurant and hotel chefs of Yazd were divided into two groups: intervention and control (each group 39). Data were gathered through a researcher-made questionnaire with confirmed validity and reliability. All registered data were transformed to the SPSS program and analyzed under Mann-Whitney's U, Wilcoxon's, McNemar's, Marginal homogeneity, Spearman's correlation, and Chi-square tests.
Findings: Before training, the average scores of knowledge, attitude and practice had no significant differences between the case and control groups (p≥0/05), but this difference was significant immediately and three months after education (p>0/05). Significant differences were observed in the scores of the knowledge and attitude of the intervention group between prior and immediately and three months after education (p>0/05). Also three months after the intervention, the mean score of practice was increased in the intervention group. The main information source of the subjects was media (63.5%) with physicians being their preferred source (62.2%).
Conclusion: According to the average knowledge of chefs before the intervention and significant role of chefs on cardiovascular health, improving their information through regular training programs (in consultation and health education centers), posters, pamphlets, and media is suggested.

Abstract Aim: Recently, prevention of osteoporosis has become the goal of many health professionals. Behavior change is one of the most powerful strategies for osteoporosis prevention. This study aimed to determine calcium intake in order to identify osteoporosis preventive behavior in women aged 30-50 years in Khorramabad city, Iran. Methods: This descriptive cross-sectional study included 269 women aged 30-50 years who were selected from all the health centers of Khorramabad city according to the inclusion criteria of the study and by cluster and systematic sampling. The tools for data collection were valid and reliable questionnaires of demographic information, stages of change, decisional balance, self-efficacy, and calcium intake. Chi-square test and logistic regression were applied to analyze the data. Findings: The mean age of the subjects was 38.72±7.003, and the mean total calcium weekly intake was 3191.03±3869.24. The results also showed that self-efficacy among the constructs of the Trans-theoretical Model (TTM) was a significant predictive of dietary calcium intake for the behavior. Conclusion: The results showed that the weekly intake calcium in women was low. Self-efficacy among the constructs of the TTM was the only significant predictive for osteoporosis prevention behavior. Therefore, the findings of this study can be considered when designing educational interventions for prevention of osteoporosis by health authorities.

Abstract Aims: Drug abuse among college students continues as a major public-health concern. Theory-driven research is necessary to address and find causes. The current research investigates the utility of Theory of Planned Behavior (TPB) in designing and implementing a drug abuse educational prevention program among medical college students. Methods: This quasi-experimental study was conducted among 120 college students in two groups: experimental and control, who were randomly enrolled at the baseline survey. We used a questionnaire, which included three sections of background data (11 questions), knowledge about the side effects of drug abuse questionnaire (16 questions), and TPB-based questionnaire (20 questions). Educational planning was based on active learning with using group discussion, printed leaflet, and audio-visual CD. The participants were followed up after 2-month intervention. Data were analyzed by the SPSS software version 16 using appropriate statistical tests such as stepwise multiple logistic regressions and t-test. Findings: Almost 6.7% of the participants had a history of drug abuse. The three predictors of 1) attitude, 2) subjective norms, and 3) perceived behavioral control accounted for 48 % of the variation in the outcome measure of the intention to drug abuse. There was a significant improvement in average response for knowledge about the side effects of drug abuse and TPB variables among the students who were under intervention (P < 0.05). Conclusions: Designing intervention to reduce positive attitude and subjective norms toward drug abuse among college students could be useful to substance abuse prevention.