Predicator of Pregnant Women's Self-care Behavior against Air Pollution: An explanation based on the Extended Parallel Process Model (EPPM)

Environmentally vulnerable or sensitive groups exhibiting varying concerns toward air pollution can drive government response to improve air quality

Air pollution seriously threatens human health, and its consequences are particularly prevalent among environmentally vulnerable or sensitive groups. However, whether the concerns among these groups are different and how they affect air pollution governance remain unclear. Here, we extract 3.8 million haze-related posts from China’s Sina Weibo and analyze the concerns raised by these groups by constructing an air pollution notability index. The results show that protection is the key theme for women aged 20–35 years, while elderly individuals are easily influenced by haze-related product ads yet lack awareness of scientific-based protection. Concerns shared by young individuals are more effective in pressuring the government in cities that experience higher levels of pollution. Concerns shared by women are more effective in cities that experience lower levels of pollution. This study evidences the influence of the public concerns conveyed via social media on air pollution governance in China.

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Online haze concerns from environmentally vulnerable groups can drive air clean

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Government response to their concern plays the key role in improving air quality

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When PM2.5 exceeds 200 μg/m³, their concern shifts from self-protection to governance

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Elders are easily drawn by haze-related ads yet lack aware of scientific protection

COVID-19 Prevention Behaviors among Health Staff: Data from a Large Survey in the West of Iran

Background: Hospital staffs are at high risk of Novel Coronavirus (2019-nCoV preventive behaviors play a peculiar role in the reduction of the incidence and mortality of this infection. Therefore, the present study aimed to assess the prevention behaviors of COVID-19 among health staff based on the Extended Parallel Model (EPPM) in western Iran.

Study design: It was a cross-sectional study.

Methods: The present study was performed in the west of Iran in April 2020. In total, 1,664 cases were enrolled in this study via multi-stage sampling. The data were collected using a questionnaire, including the demographic characteristics of participants and EPPM constructs. All analyses were conducted in Stata software (version 14) at a 5% significant level.

Results: As evidenced by the obtained results, 1,523 (91.53%), 1,226 (73.68%), 1,526 (91.71%), 893 (53.67%), and 862 (51.86%) of health staff wear gloves, use masks, avoid contact with others, maintain a good distance from other people, and wash their hands frequently with water and soap, respectively. In terms of using gloves and avoiding contacts with others, participants with high perceived threat had higher odds of observing health behaviors (OR= 3.14, 95% CI: 2.08, 4.73; P<0.001) and (OR= 3.1, 95% CI: 2.04, 4.69; P<0.001), respectively. In all categories of EPPM, the participants with high efficacy had higher odds of exhibiting health behaviors, compared to those with low efficacy (P<0.001).

Conclusion: The results of the present study demonstrated that health workers are expected to be at the highest level of threat and efficiency. Moreover, the findings emphasized the effectiveness of the recommended strategies in the prevention of COVID-19 disease.

Comparing the impact of educational messages based on an extended parallel process model on solid waste separation behaviors in female students: A four-group randomized trial

BACKGROUND

The increase in non-separated solid waste is a threat to environmental health. People may be motivated to reduce the destructive effects of waste accumulation in the environment by receiving educational messages and learning the proper methods of waste separation. This study aimed to determine the effect of educational messages on waste separation in dormitory students based on Extended Parallel Process Model (EPPM).

METHODS

This randomized controlled trial was performed on 320 students categorized into four groups from October to December 2019. After installing waste separation tags on separate containers, three types of messages were presented to encourage and educate waste separation in the following four groups: threat messages; efficacy messages; threat/efficacy messages; and control group. Data were collected prior to and one week after training by a self-reported valid and reliable questionnaire. They were analyzed in SPSS21.

RESULTS

In the efficacy group and threat/efficacy group, not only the mean scores of "perceived threat associated with non-segregation and waste accumulation", "attitude" and "intention" but also the mean score of "efficacy" and "waste separation behavior" were improved (P < 0.05). In both groups, the mean score of "perceived barriers" for waste separation was lower than the other two groups (P < 0.001).

DISCUSSION

Use of efficacy-based massages alone or in combination with the threat component was proposed to promote waste separation. No specific study has documented the effectiveness of messages based on EPPM on solid waste separation behaviors. The current study highlighted the effectiveness of using EPPM to promote waste-separation behavior in practice, not in theory.

Development and psychometric evaluation of waste separation beliefs and behaviors scale among female students of medical sciences university based on the extended parallel process model

Background

The increasing production of un-recycled waste is a great threat to public health. Therefore, assessment and measurement of people’s beliefs and perceptions with regard to these threats can contribute to the development of suitable educational messages promoting waste separation behaviors. This study aimed to carry out the scale development and psychometric evaluation of behaviors and beliefs associated with waste separation among female students.

Method

This methodological research was performed in 2019. The primary questionnaire was developed based on the assessment of waste separation beliefs and behaviors based on the extended parallel process model. Afterwards, to confirm the content and face validity of the research tool, the opinions of 14 faculty members and certain students were asked for, respectively. In order to assess the construct validity of the questionnaire, exploratory factor analysis was performed based on the data collected from 386 female students in Isfahan University of Medical Sciences, Iran. The internal and external reliability of the tool was determined through estimating Cronbach’s alpha and test-retest based on intraclass correlation (ICC) index, respectively.

Results

The mean age and academic semester of the students were 22 ± 1.9 years and 5.58 ± 2.6, respectively. The primary version of the questionnaire was designed with 65 items; one item was omitted during the content validity process. Construct validity with factor analysis technique yielded nine dimensions including 64 items with a factor loading above 0.3. The overall reliability of the research tool was confirmed at Cronbach’s alpha of 0.87. Furthermore, the ICC of the entire questionnaire was 0.89.

Conclusion

According to the results of the study, the final 64-item questionnaire could be used by various researchers to assess waste separation beliefs and behaviors considering suitable psychometric features.

Health literacy, knowledge and self-care behaviors to take care of diabetic foot in low-income individuals: Application of extended parallel process model

AIM

This study has been conducted with the aim of determining the relationship between health literacy, knowledge and self-care behaviors to take care of the diabetic foot in low-income individuals, based on the extended parallel process model (EPPM).

METHODS

This cross-sectional study was conducted on 400 patients with type II diabetes referred to the Diabetes Clinic, using a random sampling method and using standard questionnaires. In this study, the constructs of knowledge, EPPM (perceived sensitivity, perceived severity, response efficacy, self-efficacy), and health literacy were significantly related to self-care behaviors (p < 0.05).

RESULTS

Based on the linear regression results, the constructs of knowledge, health literacy, and constructs of EPPM were able to account for 43% of the variance to perform diabetic foot self-care behaviors. The maximum impact was related to the constructs of health literacy and self-efficacy (p < 0.001).

CONCLUSION

Based on these results, levels of knowledge and health literacy of patients were very poor overall, and the self-care behaviors were not appropriate. On the other hand, considering the great impact of health literacy in performing self-care behaviors, it is suggested that educational courses be held in this regard and proper strategies are employed to enhance the health literacy of diabetic patients.

Cervical Cancer Literacy in Women of Reproductive Age and Its Related Factors

Cancer health literacy, which is the ability to search, understand, and use health information to make appropriate health decisions, plays an important role in the use of preventative and screening information. The present study aims to evaluate cervical cancer health literacy in women of reproductive age and its related factors. In this cross-sectional study, 231 women of reproductive age who referred to health centers of Khuzestan Province, Iran, were selected via convenience sampling. A valid and reliable measure was employed to collect information about various dimensions of cervical cancer health literacy, including having access to, reading, understanding, appraising, using, and communicating it. The data collected were analyzed using SPSS 16. Data analysis was conducted by independent sample t test, one-way ANOVA, Spearman's correlation, chi-square, and linear regression. The participants' average health literacy score was 97.88 ± 12.7 (from 135 points), and 47.2% of the participants had limited health literacy. Health literacy was associated with education, employment, income, searching, mothers' and young friends' counseling, and duration of the study time (p < 0.05). In linear regression model, there was a significant association between income (p = 0.011), searching (p = 0.01), study time (p = 0.009), and young friends' counseling (p = 0.002) and cervical cancer literacy scores. In this study, no significant association was observed between age and health literacy. This study indicated that the cervical cancer literacy in women of reproductive age was not at good levels. Health workers should pay more attention to groups who are at greater risk of having low health literacy. Moreover, targeting and tailoring educational interventions with respect to different levels of cervical cancer literacy might increase cervical cancer screening.

Effectiveness of a theory-based mobile phone text message intervention for improving protective behaviors of pregnant women against air pollution: a randomized controlled trial

Health impact of exposure to air pollution is a public health concern. The aim of this study was to investigate an extended parallel process model (EPPM)-based mobile phone text message intervention for improving protective behaviors against air pollution among pregnant women. In this randomized controlled trial (IRCT2016102810804N8), 130 pregnant women were randomly assigned into either experimental or control groups. A valid and reliable questionnaire was used to collect data. Experimental group received mobile phone intervention on a daily basis for 2 months. Control group received usual care, only. Data were analyzed using SPSS 15 applying t test, chi-square, and Wilcoxon and Mann-Whitney U test. Although before intervention, there were no significant differences between different structures of EPPM (P > 0.05), after intervention, there were statistically significant differences between perceived severity, response efficacy, self-efficacy, and protective behaviors between two groups (P < 0.05). Implementing EPPM based-mobile phone intervention could promote protective behaviors against air pollution among pregnant women. The present study might be used as a framework for evidence-based health promotion regarding air pollution risk communication and self-care behaviors.

TRIAL REGISTRATION

IRCT2016102810804N8.

A behavioral strategy to minimize air pollution exposure in pregnant women: a randomized controlled trial

Background

Pregnant women and their fetus belong to a sensitive group in response to air pollution hazards. The aim of this study was to evaluate the effectiveness of a theory-based educational program to change pollution exposure behavior in pregnant women.

Methods

In this randomized controlled trial, pregnant women attending a prenatal clinic in Tehran, Iran were selected and randomized into the experimental and control groups. The inclusion criteria were age between 18 and 35 years, having a history of pregnancies without adverse outcomes and not suffering from chronic diseases. Data collected at baseline and 2-month follow-up. At baseline face-to-face interviews were conducted using a valid and reliable questionnaire including items on demographic characteristics, stages of change, self-efficacy, decisional balance and practice regarding air pollution preventive behaviors. The intervention composed of three parts: motivational interviewing, a booklet and daily small message service (SMS). The control group received no intervention except receiving usual care. Follow-up data were collected after the intervention. Data were analyzed performing t-test, Mann–Whitney U test, and chi-squared.

Results

In all the data for 104 pregnant women (53 in the intervention and 51 in the control group) were analyzed. The mean age of participants was 27.2 (SD = 4.11) years and it was 22.89 (SD = 8.75) weeks for gestational age. At baseline there were no significant statistical differences between intervention and control groups on the study measures while we found significant group differences in terms of stages of change, self-efficacy, perceived benefits and practice regarding air pollution preventive behaviors at follow-up assessment (P < 0.05).

Conclusion

The findings indicated that the TTM-based intervention was effective in increasing air pollution preventive behaviors among pregnant women. This study provided a framework to modify some psychosocial determinants of air pollution preventive behavior other than knowledge using constructs of Transtheoretical model of behavior change, additionally results suggests the importance of education and makes enlightenment of the air pollution risk knowledge accelerate.

Trial registration

IRCT2012091010804N1