The effect of educational text message based on health belief model on osteoporosis preventive behaviors in women: a randomized controlled clinical trial

The Use of Mobile Technologies to Promote Physical Activity and Reduce Sedentary Behaviors in the Middle East and North Africa Region: Systematic Review and Meta-Analysis

BACKGROUND

The Middle East and North Africa (MENA) region faces unique challenges in promoting physical activity and reducing sedentary behaviors, as the prevalence of insufficient physical activity is higher than the global average. Mobile technologies present a promising approach to delivering behavioral interventions; however, little is known about the effectiveness and user perspectives on these technologies in the MENA region.

OBJECTIVE

This study aims to evaluate the effectiveness of mobile interventions targeting physical activity and sedentary behaviors in the MENA region and explore users' perspectives on these interventions as well as any other outcomes that might influence users' adoption and use of mobile technologies (eg, appropriateness and cultural fit).

METHODS

A systematic search of 5 databases (MEDLINE, Embase, CINAHL, Scopus, and Global Index Medicus) was performed. Any primary studies (participants of all ages regardless of medical condition) conducted in the MENA region that investigated the use of mobile technologies and reported any measures of physical activity, sedentary behaviors, or user perceptions were included. We conducted a narrative synthesis of all studies and a meta-analysis of randomized controlled trials (RCTs). The Cochrane risk-of-bias tool was used to assess the quality of the included RCTs; quality assessment of the rest of the included studies was completed using the relevant Joanna Briggs Institute critical appraisal tools.

RESULTS

In total, 27 articles describing 22 interventions (n=10, 37% RCTs) and 4 (15%) nonexperimental studies were included (n=6141, 46% women). Half (11/22, 50%) of the interventions included mobile apps, whereas the other half examined SMS. The main app functions were goal setting and self-monitoring of activity, whereas SMS interventions were primarily used to deliver educational content. Users in experimental studies described several benefits of the interventions (eg, gaining knowledge and receiving reminders to be active). Engagement with the interventions was poorly reported; few studies (8/27, 30%) examined users' perspectives on the appropriateness or cultural fit of the interventions. Nonexperimental studies examined users' perspectives on mobile apps and fitness trackers, reporting several barriers to their use, such as perceived lack of usefulness, loss of interest, and technical issues. The meta-analysis of RCTs showed a positive effect of mobile interventions on physical activity outcomes (standardized mean difference=0.45, 95% CI 0.17-0.73); several sensitivity analyses showed similar results. The trim-and-fill method showed possible publication bias. Only 20% (2/10) of the RCTs measured sedentary behaviors; both reported positive changes.

CONCLUSIONS

The use of mobile interventions for physical activity and sedentary behaviors in the MENA region is in its early stages, with preliminary evidence of effectiveness. Policy makers and researchers should invest in high-quality studies to evaluate long-term effectiveness, intervention engagement, and implementation outcomes, which can inform the design of culturally and socially appropriate interventions for countries in the MENA region.

TRIAL REGISTRATION

PROSPERO CRD42023392699; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392699.

A Theory-Based, Technology-Assisted Intervention in a Hybrid Cardiac Rehabilitation Program for Patients with Coronary Heart Disease: A Feasibility Study

PURPOSE

To assess the feasibility of a technology-assisted intervention in a hybrid cardiac rehabilitation program among patients with coronary heart disease.

METHODS

This study was a two-arm parallel randomized controlled trial. Twenty-eight patients with coronary heart disease were randomly assigned to either the intervention group, receiving a 12-week technology-assisted intervention (n = 14), or the control group (n = 14), receiving usual care. Guided by the Health Belief Model, the intervention group received three center-based, supervised exercise training sessions, a fitness watch that served as a cue to action, six educational videos, and a weekly video call. The Self-efficacy for Exercise, exercise capacity, and Health Promoting Lifestyle Profile II were assessed at baseline and immediately post-intervention (12-weeks).

RESULTS

Among the 28 patients who participated in this study, 85.7% completed the program, with a relatively low attrition rate (14.3%). The number of exercise training sessions accomplished by the participants in the intervention group was 51.27 ± 19.41 out of 60 sessions (85.5%) compared to 36.46 ± 23.05 (60.8%) in the control group. No cardiac adverse events or hospitalizations were reported throughout the study. Participants in the intervention group showed greater improvement in health-promoting behaviors when compared with the control group at 12 weeks. Within-group effects demonstrated improvement in exercise self-efficacy and exercise capacity among participants in the intervention group. A participant satisfaction survey conducted immediately post-intervention revealed that participants were "very satisfied" (23.1%) and "satisfied" (76.9%) with the technology-assisted intervention.

CONCLUSIONS

The findings demonstrated that technology-assisted intervention in a hybrid cardiac rehabilitation program was feasible and suggested to be beneficial in improving exercise self-efficacy, exercise capacity, and health promoting behavior among patients with coronary heart disease. A full-scale study is needed to determine its effectiveness in the long term.

TRIAL AND PROTOCOL REGISTRATION

ClinicalTrials.gov NCT04862351. https://clinicaltrials.gov/ct2/show/NCT04862351.

A health communication campaign for prevention of osteoporosis in rural elderly women

BACKGROUND

Osteoporosis, as the most common metabolic disease and the leading cause of death among older people, affects more than 200 million women throughout the world. This study aimed to evaluate the effect of a health communication campaign on knowledge, attitude, and practice of older women towards prevention and control of osteoporosis.

METHODS

In this multi-stage mixed methods study, 30 days' health communication campaign for prevention of osteoporosis was conducted on 60- 75-year-old women, in rural areas of Fasa, Iran. Subjects were divided into two groups, control (n = 103) and intervention (n = 98). Data were collected using a researcher-made questionnaire and analyzed by SPSS 25.0. The significance level was set at < 0.05.

RESULTS

Inter-group group analysis revealed that the mean scores of knowledge, attitude, and practice were not significantly different between the two groups before the intervention, but after the intervention, unlike the behavior (P = 0.569), mean scores of knowledge (p < 0.001) and attitude (p < 0.001) of the intervention group were significantly more than the control group. Intra-group comparisons showed that, unlike the control group, the mean scores of knowledge (p < 0.001), attitudes (p < 0.001), and behavior (P < 0.001) increased significantly in the intervention group.

CONCLUSIONS

Health communication campaign is an effective way to change the knowledge and attitude and to a lesser extent the practice of the eldery toward prevention and control of osteoporosis.

Promoting the adoption of behaviors to prevent osteoporosis using the health belief model integrated with health literacy: quasi-experimental intervention study

BACKGROUND

The health belief model (HBM) is effective in preventing osteoporosis and promoting health literacy (HL). In this regard, there are some critical points such as the role of HL in preventing osteoporosis, adoption of preventive behaviors, adoption of behaviors, including physical activity, and the role of health volunteers in transmitting health messages to the community. Considering the aforesaid points this study was performed among the health volunteers aimed to determine the effect of educational intervention based on integrated HBM with HL on walking and nutrition behaviors to prevent osteoporosis.

MATERIALS AND METHODS

In this quasi-experimental intervention study, 140 health volunteers (70 people in each of the two intervention and control groups) were enrolled in the study using multi-stage random sampling, in 2020. The members of the intervention group received e-learning through social media software, 4 times during 4 weeks (once a week) and were provided with educational booklets and pamphlets. Data collection tools included demographic and background questionnaires; standard questionnaire based on the HBM, awareness, and walking and nutrition behaviors to prevent osteoporosis; and HELIA questionnaire to measure HL. These questionnaires were completed in two stages, before and 3 months after the intervention. The educational intervention in this study was sent to the intervention group in 4 stages. The collected data were analyzed using proportional tests (paired t-test, Wilcoxon test, independent t-test, Mann-Whitney test) and SPSS software version 23.

RESULTS

The mean and standard deviation related to the score of adoption of nutrition behaviors at the beginning of the study in the intervention group was 5.398 ± 1.447, which changed to 8.446 ± 1.244 after 3 months, indicating a significant increase in the adoption of such behaviors (P = 0.009). In the control group, the mean and standard deviation of the scores of adoption of nutrition behaviors changed from 5.451 ± 1.222 to 6.003 ± 1.005, which was not statistically significant (P = 0.351). Also, the mean and standard deviation related to the scores of adoption of walking behavior at the beginning of the study in the intervention group was 8.956 ± 0.261, which changed to 13.457 ± 0.587 after 3 months, indicating a significant increase in the adoption of such behaviors (P < 0.001). In the control group, the mean and standard deviation related to the scores of the adoption of walking behavior changed from 8.848 ± 0.353 to 9.025 ± 0.545, which was not statistically significant (P = 0.211). Prior to the intervention, there was no significant difference between two groups regarding the variables of demographic and background, knowledge, all constructs of the model, HL, and adoption of walking and nutrition behaviors (P > 0.05). After the intervention, the comparison of the two groups showed that there was a significant change in the mean scores of awareness, all constructs of the model, HL, and adoption of preventive behaviors in the intervention group than the control group (P < 0.05).

CONCLUSION

The educational intervention based on an HBM integrated with HL was effective and acceptable in correcting and promoting walking and nutrition behaviors to prevent osteoporosis among health volunteers. Therefore, it can be said that the intervention implemented was in line with the developed model used.

Trends in the Number of Behavioural Theory-Based Healthy Eating Interventions Inclusive of Dietitians/Nutritionists in 2000-2020

Nutrition interventions developed using behaviour theory may be more effective than those without theoretical underpinnings. This study aimed to document the number of theory-based healthy eating interventions, the involvement of dietitians/nutritionists and the behaviour theories employed from 2000 to 2020. We conducted a review of publications related to healthy eating interventions that used behaviour change theories. Interventional studies published in English between 2000 and 2020 were retrieved from searching Medline, Cinahl, Embase, Psycinfo and Cochrane Central. Citation, country of origin, presence or absence of dietitian/nutritionist authors, participants, dietary behaviours, outcomes, theories and any behaviour change techniques (BCTs) stated were extracted. The publication trends on a yearly basis were recorded. A total of 266 articles were included. The number of theory-based interventions increased over the two decades. The number of studies conducted by dietitians/nutritionists increased, but since 2012, increases have been driven by other researchers. Social cognitive theory was the most used behaviour theory. Dietitians/nutritionists contributed to growth in publication of theory-based healthy eating interventions, but the proportion of researchers from other professions engaged in this field increased markedly. The reasons for this growth in publications from other professions is unknown but conjectured to result from greater prominence of dietary behaviours within the context of an obesity epidemic.

The Determinants of Panic Buying during COVID-19

The COVID-19 pandemic has seen an unmatched level of panic buying globally, a type of herd behavior whereby consumers buy an uncommonly huge amount of products because of a perception of scarcity. Drawing on the health belief model, perceived scarcity, and anticipated regret theories, this paper formulated a theoretical model that linked the determinants of panic buying and analyzed their interrelationships. Subsequently, data were collated from 508 consumers through an online survey questionnaire in Singapore that was conducted during the early stage of the pandemic, before the onset of the circuit breaker in April 2020. Next, an analysis of the results was done through structural equation modeling. It showed that the effect of the health belief model dimensions (i.e., perceived susceptibility, perceived severity, outcome expectation, cues to action, and self-efficacy) on panic buying is partially mediated by the consumers' perceived scarcity of products. Furthermore, the effect of perceived scarcity on panic buying is partially mediated by consumers' anticipation of regret. This paper expands on the current theoretical understanding of panic buying behavior, giving insights into the possible measures and solutions that policymakers and relevant stakeholders can uptake to manage panic buying in future a pandemic or health crisis.

Promoting sustainable physical activity among middle-aged Iranian women: a conceptual model-based interventional study

Background

Physical inactivity enhances the risk of adverse health conditions such as non-communicable diseases, morbidity, and mortality among middle- and older-aged population. This study is aimed to design, implement, and evaluate a conceptual model of physical activity (PA) promotion among middle-aged Iranian women (MAIW).

Methods

An interventional study was conducted with 80 women aged between 30 and 59 years in intervention and control groups during 2018–2019. The subjects referred to health centers were selected by the available convenience sampling method. Data collection tools to assess the MAIW' PA level (metabolic equivalent tasks (MET)-min/week) included face-to-face interviews, body mass index (BMI) measurements, the four-question form of PA vital signs in the framework of Iran's Package of Essential Non-communicable (IraPEN) program, and the questionnaire is based on the Health Belief Model (HBM) constructs.

Results

The intervention led to a three-fold increase in the average PA (from 280.63 to 927.70 MET-min/week) of the intervention group. Although no significant difference in the BMI between both groups was found before the intervention, this educational program decreased the mean BMI from 30.36 to 28.83 kg/m² (p = 0.01). After the intervention, the values of HBM-based perceived sensitivity/severity and self-efficacy were increased from 62.09 to 71.03% and from 27.01 to 83.15%, respectively (p < 0.0001). There were no significant differences in the cue to action and perceived benefits and barriers after the intervention.

Conclusion

The developed model by increasing the motivation of MAIW could remarkably improve the PA level with a decrease in their BMI.

Trial register Iranian Registry of Clinical Trials (IRCT): IRCT20200717048124N1 at 2020-08-05, retrospectively registered.

Parental-oriented educational mobile messages to aid in the control of early childhood caries in low socioeconomic children: A randomized controlled trial

OBJECTIVES

To evaluate the effectiveness of educational messages as an aid in the control of early childhood caries (ECC) in low socioeconomic children.

METHODS

A single-blinded, randomized, and parallel-group study was conducted with 104 dyads of parents and children aged between 36-60 months, recruited in preschools from Bauru, Brazil. The participants were randomly allocated into control and intervention groups (1:1), stratified by parental eHealth literacy scores (eHEALS) and children's caries experience. Every 2 weeks, text messages were sent to parents of intervention group via WhatsApp. Visible plaque index (VPI) and the International Caries Detection and Assessment System (ICDAS) were assessed at baseline, 3- and 6-month follow-ups, while eHEALS and dietary habits were determined at baseline and 6-month follow-up. Statistical analysis was performed to intra and intergroup comparisons through Fischer's exact and McNemar tests, and Mann-Whitney U and Friedman tests, respectively (P < 0.05).

RESULTS

Despite similarities between groups, intervention increased parental eHEALS scores, influencing the reports about the children's consumption of sugar-free sweets and controlling the severity of ECC.

CONCLUSION

Therefore, mobile text messages were effective to control the severity of ECC in low socioeconomic preschoolers, improving parental eHealth literacy and changing children's dietary patterns.

CLINICAL SIGNIFICANCE

These findings demonstrate that parental-oriented WhatsApp messages can contribute to oral health education of socioeconomic vulnerable parents towards risk behavior changes to control ECC.

Educational Intervention Based on the Health Belief Model to Modify Risk Factors of Cardiovascular Disease in Police Officers in Iran: A Quasi-experimental Study

Objectives:

Police officers may be at a greater risk for cardiovascular disease (CVD) than the general population due to their highstress occupation. This study evaluated how an educational program based on the health belief model (HBM) may protect police officers from developing CVD.

Methods:

In this single-group experimental study, 58 police officers in Iran participated in a 5-week intervention based on HBM principles. Outcomes included changes in scores on an HBM scale, time spent on moderate to vigorous physical activity (International Physical Activity Questionnaire), body mass index (BMI), blood lipid profile, blood glucose, and blood pressure. The intervention consisted of 5 HBM-based educational sessions. Follow-up was conducted at 3 months post-intervention. The paired t-test was used to examine differences between baseline and follow-up scores.

Results:

All aspects of the HBM scale improved between baseline and follow-up (p<0.05), except the cues to action subscale. Self-efficacy and preventive behaviors improved the most. BMI decreased from 26.7±2.9 kg/m² at baseline to 25.8±2.4 kg/m² at follow-up. All components of the lipid profile, including triglycerides, cholesterol, high-density lipoprotein, and low-density lipoprotein, showed significant improvements post-intervention. Blood glucose and blood pressure also decreased, but not significantly. Nearly 25% of participants who were not physically active at baseline increased their physical activity above or beyond the healthy threshold.

Conclusions:

A relatively brief educational intervention based on HBM principles led to a significant improvement in CVD risk factors among police officers. Further research is needed to corroborate the effectiveness of this intervention.

Promoting drug abuse preventive behaviors in adolescent students based on the health belief model

Background Nowadays, drug abuse is one of the most important health problems that can affect the quality of life of people in mental, psychological, physical, and social dimensions. Theory-based education can help the adolescents to promote their drug abuse preventive behaviors. Objectives The aim of this study was to determine the effectiveness of education based on the health belief model (HBM) on drug abuse preventive behaviors in adolescent students. Methods This study was an interventional quasi-experimental study with a pre-test/post-test design conducted in two high schools in the southeast of Iran. A two-step cluster sampling method was used and 120 students were randomly selected and categorized into the control (n = 60) and intervention (n = 60) groups. The intervention group participated in an education program based on the HBM in four 75-min sessions. Data were collected using demographic and drug abuse preventive behavior questionnaires based on the HBM. Results In the pre-test stage, the mean scores of drug abuse preventive behaviors and its dimensions were not significantly different between the intervention and control groups (t = -2.597 p = 0.641). In the post-test stage, the mean scores of the intervention and control groups were significantly different; the drug abuse preventive behaviors and its dimensions improved in the intervention group (t = 14.57, p < 0.001). Conclusion The findings showed that education based on the HBM had a significant effect on drug abuse preventive behaviors and its dimensions. Therefore, educational packages based on the HBM are recommended to improve these behaviors in adolescents.