Health Education and Health Promotion

Abstract Aims: This study aimed to translate and determine the psychometric properties of the Gerontopole Frailty Screening Tool in the elderly in Tehran.
Instrument & Methods: This cross-sectional study assessed the validity and reliability of the translated Gerontopole Frailty Screening Tool. Eleven experts evaluated the content validity of tool in the elderly after re-translation into Persian. With 214 elderly participants, we assessed convergent validity and concurrent validity. A receiver operating characteristic curve was used to determine sensitivity, specificity, and the cutoff point. Cohen’s Kappa was used to assess the external consistency of the tool, and Cronbach’s alpha was used to assess its internal consistency.
Findings: The participants included 44.9% women and 55.1% men. The overall kappa coefficient between the two evaluators was 0.826, and the Cronbach’s alpha coefficient for the tool was estimated at 0.757. To determine convergent validity and concurrent validity, the correlations between the Gerontopole Frailty Screening Tool and the Stanford Questionnaire were 0.519, with Abbreviated Mental Test Score 0.247, with Mini Nutritional Assessment 0.214, and with Geriatric Depression Scale 0.258 (p<0.05). The known-groups validity was not significant based on age. Also, the sensitivity and specificity based on the receiver operating characteristic curve at cutoff point 3 were 75% and 65.8%, respectively. The area under the receiver operating characteristic curve was estimated to be 0.785.
Conclusion: The Persian version of the Gerontopole Frailty Screening Tool is a valid and reliable instrument to determine frailty in Iranian elderly at the level of primary care.

Abstract Aims: Individuals with schizophrenia frequently experience impaired social functioning and reduced relationship satisfaction. This study investigated the psychometric properties of the Persian version of the Social Effort and Conscientiousness Scale in individuals with schizophrenia.
Instrument & Methods: This study examined the psychometric properties of the Persian Social Effort and Conscientiousness Scale in 83 Iranian individuals with schizophrenia (55 men, 28 women, aged 18-65). Participants, recruited via purposive sampling from Ahvaz medical centers, completed the translated Social Effort and Conscientiousness Scale, the Social Functioning Questionnaire, the Positive and Negative Syndrome Scale, and the Calgary Depression Scale for Schizophrenia. The Social Effort and Conscientiousness Scale translation followed a forward-backward method. Data analysis, conducted using SPSS 27 and SmartPLS 3, included confirmatory factor analysis, assessment of convergent validity, discriminant validity (HTMT and Fornell-Larcker), and reliability analysis.
Findings: Confirmatory factor analysis confirmed the Social Effort and Conscientiousness Scale's two-factor structure, with all 12 items loading above 0.4. Model fit was acceptable (SRMR=0.067; CFI=0.94). High internal consistency was observed (α=0.92 overall; 0.93 for social effort; 0.77 for conscientiousness), as was composite reliability (0.92 overall; 0.94 and 0.77 for subscales). Convergent validity was established (AVE>0.5). Discriminant validity was supported by both HTMT (<0.9) and Fornell-Larcker criteria.
Conclusion: The Persian version of the Social Effort and Conscientiousness Scale demonstrates satisfactory psychometric properties in individuals with schizophrenia. This culturally adapted tool can be used in research and clinical settings to assess social effort and conscientiousness in this population.

Abstract Aims: Measuring health literacy through metaphors can enhance the understanding of metaphorical concepts in the health field. Therefore, the purpose of this study was to design, construct, and evaluate the psychometric characteristics of a metaphorical health literacy questionnaire.
Instrument & Methods: This descriptive research used survey and psychometric studies. Based on the four areas of knowledge, services, strategies, and interventions derived from the content analysis of the Metaphorical Health Literacy Questionnaire, 15 Likert items were designed for the most common source domains of object, force, and product. The content validity of the questionnaire was assessed by three cognitive linguists, two health psychologists, two health experts, two physicians, and one psychometric expert. Finally, the questionnaire was completed voluntarily by 150 Persian-speaking university students in Tehran in 2024. The data were analyzed using SPSS 26, and AMOS 14 software was employed for modeling.
Findings: Exploratory factor analysis indicated that four factors (object, force, product, and human) explained 38.21% of the total variance of the questionnaire. The reliability of the questionnaire was obtained using Cronbach’s alpha method, with a value of 0.79, indicating high reliability. Furthermore, confirmatory factor analysis was performed to assess the factorial validity of the questionnaire, which demonstrated an appropriate fit of the model to determine the factors.
Conclusion: The Metaphorical Health Literacy Questionnaire for Persian speakers is both valid and reliable.

Abstract Aims: How people react to stressful and painful situations, such as suffering from a chronic disease like multiple sclerosis, is influenced by various factors, one of which is self-compassion. Self-compassion has a psychological nature and significant efficiency in the care and treatment of chronic patients. Existing tools have not paid attention to the characteristics of people suffering from chronic diseases such as MS in using self-compassion for managing the disease. Therefore, the present study aimed to design a questionnaire to measure self-compassion in patients with MS.
Instrument & Methods: The present study is methodological research that was conducted in qualitative and quantitative parts. The items were designed based on the qualitative part of the study and review of texts. The validation characteristics of the questionnaire were performed using face validity, content, and structure. The reliability was assessed by internal consistency and stability methods.
Findings: In the qualitative phase, 78 initial items were extracted. After calculating the item impact score index with values higher than 1.5, content validity ratio higher than 0.51, and content validity index higher than 0.79, 73 items were selected. Confirmatory and then exploratory factor analysis was performed. The internal consistency of the questionnaire was 0.813, and the stability of the questionnaire was 0.778.
Conclusion: Self-compassion scale in patients with MS is a valid and reliable tool in Iranian society. Since Neff theory was used as a guiding framework in this study, the tool can also be used for non-Iranian patients to understand their perception and experiences.

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: 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: This research aimed at designing and psychometric properties of a questionnaire for health-worker skills evaluation to obtain a self-care program for pre-diabetic patients.
Instrument & Methods: The questionnaire's psychometric properties were evaluated utilizing face validity by 15 health workers, content validity was evaluated by ten experts (5 health education and health promotion experts, three diabetes experts, and two general practitioners), and construct validity, internal consistency, and stability were assessed by 400 health workers who were randomly selected.
Findings: Due to the results of investigating the texts and interviews, the initial questionnaire, including 54 phrases, was presented. In the face validity section, eight expressions were removed quantitatively. Then, in identifying content validity, three other words were deleted, and the questionnaire was reduced to 43 phrases in general. This questionnaire's exploratory factor analysis revealed four factors: self-efficacy, attitude, reinforcing factors, and enabling factors. These four factors explained 57.51% of the total variance of the test. The confirmatory factor analysis results also confirmed the factors of the PRECEDE-PROCEED model. Cronbach's alpha and intra-cluster correlation index for questionnaire structures ranged from 0.87-0.88 and 0.87-0.88, respectively.
Conclusion: The designed questionnaire has good validity and reliability.

Abstract Aims: The growing prevalence of fatty liver is a major threat to health. This study aimed to design and measure a psychometric scale on the fatty liver disease-related health beliefs in middle-aged Iranian people.
Instrument & Methods: This qualitative descriptive study was performed on middle-aged people referring to the Comprehensive Health Service Centers of Qorveh, Kurdistan Province, Iran, in 2020. An extensive literature review was performed, and interviews were done with people with fatty liver disease and experts in the field. The interviews were analyzed through a directed content analysis approach. The researchers applied an existing theory (health belief model) and designed and compiled 90 items.
Findings: Following evaluation of the face and content validity and obtaining item impact mora than 1.5, CVI more than 0.62, and validity mora than 0.79, a research scale with 57 items was designed. After exploratory factor analysis, 49 items with factor loading mora than 0.5 were confirmed, covering seven factors with a predictive power of 57.5. The reliability of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cue to internal action, cue to external action, and self-efficacy were 0.90, 0.89, 0.85, 0.81, 0.91, 0.86, and 0.88, respectively. The total reliability of the scale was also confirmed (Cronbach's alpha=0.92).
Conclusion: The designed scale has appropriate validity and reliability for measuring the health belief constructs associated with fatty liver in middle-aged people.

Abstract Aim: The goal of this study was to investigate the effect of Gottman's theory-based training on the reduction of couples' marital conflict and marital instability.
Methods: The research method was quasi-experimental with the pretest-posttest control-group design, and the population of this study was comprised of all the married couples in Shiraz, Iran in 2015-16. They were selected by the convenience sampling method, and after the interview, and were randomly assigned into two (28) groups. To collect the data, descriptive statistics such as mean, standard deviation, frequency and frequency percentage, as well as inferential statistics including analysis of covariance (MANCOVA) and (ANCOVA) were used to test the hypotheses. Subsequently, the experimental group was given the considered training during 7 sessions, and the questionnaires were, finally, completed again by both groups.
Findings: Based on the findings of this study, Gottman's theory-based training has had a significant effect (α=0.05) on the reduction of marital conflict and marital instability of married couples.
Conclusion: It was concluded that Gottman's theory-based intervention is able to reduce the level of marital conflict and its components and marital instability significantly in the experimental group.

Abstract Aim: The present study was conducted to validate the international version of the resilience scale (CYRM-28) among adolescent youth students.
Methods: The first original scale was translated into Persian language by two experts. Then an integrated version of the two was translated to the language of the original version again; then it was ensured that the content of the Persian and English versions' was matched. The Persian version scale was filled in by 412 high school students (270 males and 142 females) in Tehran, who were selected as a random cluster. Regarding the clear scale structure to assess the validity, construct validity was used (confirmatory factor analysis) using the LISREL software version 8.8. In addition, scale reliability was examined using the two methods of internal correlation coefficient and test-retest.
Findings: Fit Index confirmed the resilience scales' fit ness in confirmatory factor analysis. In examining the reliability using the internal correlation calculation method (Cranach’s alpha), the value of each sub-scale item, as well as that of total questions was higher than the standard value of 0.7 to confirm the tool's reliability. In examining the reliability using test-retest method, correlation coefficient of each sub-scale in two steps was at an acceptable level and significant.
Conclusion: The present study confirmed the three-factor structure of CYRM-28 scale, including the individual sub-scale's relationship with the primary caregiver and contextual factors in the Persian version of the scale. This study showed that the reliability and validity of the Persian version of CYRM-28 was suitable for measuring the resilience of Iranian children and youth.

Abstract Aim: The aim of this study was to design a tool and to assess its validity and reliability based on native culture characterization to evaluate the health belief model (HBF) constructs about prenatal care.
Methods: 215 pregnant women covered by the health centers of Iranshahr in the age group of 18-35 years and the least ability of reading and writing participated in this cross-sectional study. After reviewing the literature, the tool was designed, and its validity and reliability were approved based on psychometric data of the target group and the view of a panel of experts through calculating the content validity ratio, content validity index, exploratory factor analysis, and internal consistency.
Findings: The validity of 42 items was assessed through calculating the index score of the item effect above 1.5, content validity ratio more than 0.80, and content validity index higher than 0.79. By using exploratory factor analysis with a special value greater than 1, six factors and 35 items remained that were classified into six categories based on the literature review and content items, which were able to predict 77.095 % of the total variance of the tool. The reliability of the research tool was calculated using Cronbach’s alpha equal to 0.816.
Conclusion: The results of this study provide proper evidence about the strength of structural factors and the reliability of the assessment tool for the structures of HBM about prenatal care. It can be considered by the researchers in developing a tool for research, education and action.

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.