Breakfast consumption determinants among female high school students of Yazd Province based on Pender's Health Promotion Model

Psychometrics properties of type 2 diabetes treatment adherence questionnaire (DTAQ): a study based on Pender's health promotion model

BACKGROUND

Management of type 2 diabetes (T2D) as a chronic disease requires treatment adherence such as controlling the blood glucose level and adopting a healthy lifestyle. The present study aimed to develop and psychometrically evaluate a questionnaire based on the Pender's Health Promotion Model (HPM) to measure treatment adherence and the associated factors among T2D patients.

METHODS

The present study was conducted in qualitative and the quantitative phases between March 2022 and March 2023. The participants were T2D patients visiting Shahid Mohammadi hospital Diabetes Clinic in Bandar Abbas in the south of Iran. The first draft of items was extracted from the qualitative phase. The present study used interviews with T2D patients, item construction, validity and reliability evaluation of the instrument, and the relevant statistical analyses. It emphasized the significance of content, face, and construct validity, along with reliability testing using Cronbach's alpha and test-retest method. Data were analyzed using SPSS software, V16 and AMOS, V23.

RESULTS

A 97-item questionnaire was developed through the qualitative phase and, after content validity, it was reduced to 86 items. Five items were removed in face validation, and after the test-retest method, 79 items were retained. The confirmatory factors analysis confirmed a 65-item model with appropriate fitness of data. Cronbach's alpha coefficient showed an acceptable reliability of the diabetes treatment adherence questionnaire (α = 0.92).

CONCLUSION

The questionnaire developed based on the HPM model provides a standard and comprehensive measurement of the degree of adherence to treatment and the associated factors among Iranian T2D patients. This is especially valuable in the Iranian healthcare context, where effective management of chronic diseases such as diabetes is of a top priority. Questionnaires can help identify barriers and facilitators of treatment adherence to inform systematic and goal-oriented interventions. The proposed questionnaire had good psychometric properties, and can be used as a valid and practical instrument to measure the factors related to treatment adherence behaviors.

A health promotion model-based intervention to enhance treatment adherence in patients with type 2 diabetes

BACKGROUND

The present study aimed to determine the effect of an intervention based on Pender's health promotion model (HPM) on treatment adherence in patients with type 2 diabetes (T2D).

METHODS

The present quasi-experimental study with a 3-month follow-up was conducted in Bandar Abbas, a city in the south of Iran in 2023. The intervention group (IG) with a total number of 95 T2D patients was selected from Hormuz diabetes clinic and the control group (CG) with 95 T2D patients was selected from comprehensive health centers through a clustering sampling method. The educational intervention was implemented in 10 sessions to improve patients' treatment adherence. The teaching methods in training sessions were lectures, joint discussions, Q&A, role-play and peer training. The participants were evaluated using a researcher-made questionnaire including the constructs of Pender's HPM about T2D treatment adherence, hemoglobin A1C (HbA1C), and BMI. Independent-samples t-test, paired-samples t-test, covariance analysis and stepwise regression analysis were used. Data analysis was done in SPSS 26.

FINDINGS

Three months after the intervention, in comparison to the CG, the mean and standard deviation of treatment adherence benefits (p = 0.002), treatment adherence self-efficacy (p = 0.010), treatment adherence related affect (p = 0.001), interpersonal influences (p = 0.012), commitment to plan of action (p < 0.001), treatment adherence behavior (p = 0.022), treatment adherence experiences (p = 0.001) was higher in the IG. The mean and standard deviation of situational influences (p < 0.001), immediate competing demands and preferences (p = 0.018) were lower than the CG. The results obtained from the analysis of covariance proved the effectiveness of the intervention in the constructs of Pender's HPM and HbA1C in participants of the IG (p < 0.001). The regression analysis showed, after the intervention, for every 1 unit of change in commitment to behavior planning, action related affect and perceived self-efficacy, compared to before the intervention, there were 0.22 units, 0.16 units and 0.26 units of change in the behavior score in the IG.

CONCLUSION

The findings proved the effectiveness of the educational intervention in improving the constructs in Pender's HPM and the blood sugar level of T2D patients. As the results of the educational intervention showed, the use of a suitable educational approach as well as the development of appropriate educational content for the target population can significantly improve the treatment adherence behavior.

TRIAL REGISTRATION

This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741 ) and first release date of 17th March 2022.

Application of Pender's health promotion model for type 2 diabetes treatment adherence: protocol for a mixed methods study in southern Iran

BACKGROUND

Type 2 diabetes (T2D) mellitus treatment as a chronic disease requires adequate adherence to treatment including controlling blood glucose levels and lifestyle management. The aim of this study is to investigate the factors affecting of adherence to T2D treatment from the perspective of patients and design an intervention program based on Pender's health promotion model (HPM) to increase T2D treatment adherence in Bandar Abbas, a city located in the south of Iran.

METHODS

This mixed method study will consist of qualitative stage, questionnaire design and a randomized, open-label, parallel-group interventional study based on HPM in southern Iran. Sampling for qualitative stage will continue until reaching the saturation. In the intervention stage, participants will be 166 T2D patients referring to the Bandar Abbas Diabetes Clinic will be randomized into intervention and control groups (allocation 1:1). After identifying the factors affecting adherence to treatment in T2D patients by qualitative study and literature review, a questionnaire based on HPM will be designed. In the next stage, 10 sessions of intervention for the intervention group will be designed. To evaluate the effect of the intervention, intervention and control groups will be tested for hemoglobin A1c (HbA1c) before and 3 months after the intervention.

DISCUSSION

This designed study is a program for improving treatment adherence in T2D based on the HPM model and contributes to a better understanding of effective factors in adherence to treatment in T2D patients. The results of this project can be used for macro-diabetic planning.

TRIAL REGISTRATION

This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741 ) and first release date of 17th March 2022.

Adolescent health in the Covid-19 pandemic: a construction through Nola Pender's model

OBJECTIVE

To construct perspectives of adolescent health in the face of the Covid-19 pandemic, through emancipatory dialogues guided by Nola Pender's Model.

METHOD

This is a participatory research based on the methodology of Psychodramatic Pedagogy of María Alicia Romaña. The action was carried out with 17 school-aged adolescents from a city in the Center-West Region of Brazil. The theoretical-analytical framework used was Nola Pender's Health Promotion Model, and the data collected were discussed based on Paulo Freire's dialogical framework.

RESULTS

The workshop allowed the sharing of individual characteristics and experiences of adolescents regarding the reality experienced in the pandemic, highlighting mental health as a main theme for health promotion.

FINAL CONSIDERATIONS

It was construct, along with the adolescents, important knowledge about health in the pandemic, supporting the thematic reflection and the elaboration of timely health promotion interventions.

Saúde do adolescente na pandemia de Covid-19: uma construção através do modelo de Nola Pender

RESUMO Objetivo: Construir perspectivas de saúde dos adolescentes em face à pandemia de Covid-19, a partir dos diálogos emancipatórios, orientados pelo modelo de Nola Pender. Método: Trata-se de uma pesquisa participativa, metodologicamente estruturada com a Pedagogia Psicodramática de María Alicia Romaña, realizada com 17 adolescentes escolares de um município na região Centro-Oeste do Brasil. Utilizou-se como referencial teórico-analítico o Modelo de Promoção da Saúde de Nola Pender, sendo os dados discutidos com base no referencial dialógico de Paulo Freire. Resultados: A oficina propiciou o compartilhamento de características e experiências individuais dos adolescentes sobre a realidade vivenciada na pandemia, evidenciando a saúde mental como tema protagônico para a promoção da saúde. Considerações finais: Foi possível elaborar com os adolescentes um conhecimento sobre a saúde na pandemia, fundamentando a reflexão temática e a construção de intervenções oportunas de promoção da saúde.

Breakfast characteristics, perception, and reasons of skipping among 8th and 9th-grade students at governmental schools, Jenin governance, West Bank

BACKGROUND

There is growing recognition of the important role of breakfast in children's nutrition, and the potential harms related to skipping breakfast, including its contribution to obesity and non-communicable diseases. The patterns associated with skipping breakfast may be related to the nutrition transition. This study aimed at exploring the composition of breakfast consumed by Palestinian school children and their perceptions toward this meal. It also aimed at exploring skipping breakfast prevalence, reasons, and its association with selected schoolchildren's sociodemographic variables and behavioral patterns.

METHODS

A cross-sectional online survey was conducted among 12- to 14-year-old schoolchildren from 4 governmental schools in urban and rural areas of the Jenin district in Palestine. The questionnaire included information about children and parents sociodemographic and behaviours, breakfast patterns and composition, reasons for skipping breakfast, and items on schoolchildren's perception toward breakfast. Statistical analysis of the relevant factors was undertaken using SPSS software.

RESULTS

In a sample of 193 schoolchildren, only 32% reported consuming breakfast all year round. The main reasons reported for skipping breakfast were not feeling hungry, not having the time, and lack of appetite. The vast majority (79%) believed breakfast was beneficial for general health. Sleeping before 10 pm, regular exercise (p value < 0.05). and shorter screen time were all significantly associated with a higher level of breakfast consumption (p value < 0.01).

CONCLUSION

Understanding the reasons for missing or skipping breakfast factors which make skipping it more likely, should inform public health strategies to promote breakfast consumption. For example, our findings suggest that awareness of the importance of breakfast was not a significant contributor to skipping breakfast, compared to other structural and cultural factors.

Effect of a nutritional education intervention on breakfast consumption among preparatory school students in Egypt

OBJECTIVES

The current study evaluates the effect of nutritional education based on Pender's health promotion model on breakfast consumption behavior among Egyptian school students.

METHODS

A pre-posttest intervention study through a nutritional education message based on Pender's health promotion model was carried on 244 preparatory school students. Data were collected using questionnaires and measuring weight, height and blood pressure before and after educational intervention was conducted to the intervention group.

RESULTS

The educational intervention was having a significant positive effect on all components of the model in the intervention group, the mean breakfast consumption, frequency of non-skipping and healthy breakfast per week (p ≤ 0.05). Overweight and obesity and higher blood pressure were significantly present among breakfast skippers.

CONCLUSIONS

The nutritional educational intervention based on Pender's health promotion model was effective in increasing the frequency of healthy breakfast among the school students. There is a need to develop evidence-based policies, community, family, and school-based interventions to promote healthy lifestyle and nutritional behavior among adolescents for a better quality of life.