Factors predicting nutrition and physical activity behaviors due to cardiovascular disease in tehran university students: application of health belief model

The effect of a health belief model-based education on nutritional behavior and biochemical factors of patients with myocardial infarction: A line follow-up experimental study

Background and Aim

Myocardial infarction is a common cause of hospitalization, and nutritional behaviors are risk factors in such patients. The present study aimed to determine the effect of education based on the health belief model on nutritional behavior and indices in patients with myocardial infarction.

Methods

The present experimental study examined patients with myocardial infarction in 2021. Seventy-two patients with myocardial infarction were randomly divided into intervention and control groups. The intervention group received educational interventions based on the health belief model in four 60-min sessions for 3 months. The constructs of the health belief model, nutritional behavior, and indices were measured using a valid questionnaire before, 1, and 3 months after the intervention. At the end, the study data was analyzed using SPSS version 22 software.

Results

There was a significant difference between the two groups in the mean scores of knowledge, perceived susceptibility, perceived severity, perceived benefits, self-efficacy, nutritional behaviors, and body mass index after the intervention (p < 0.05); however, no significant difference was found in the field of perceived barriers (p > 0.05). Biochemical factors also had a significant difference after the intervention (p < 0.05).

Conclusion

Educational intervention based on the health belief model is effective for myocardial infarction patients and has a significant impact on the constructs of perceived sensitivity, perceived intensity, perceived benefits, and self-efficacy as well as biochemical factors, so it can be used to improve the nutritional status of patients suffered from a myocardial infarction.

Breaking barriers to rehabilitation: the role of behavior change theories in overcoming the challenge of exercise-related behavior change

BACKGROUND

Promoting exercise-related behavior change in rehabilitation is a challenge. The lack of integration between rehabilitation program prescriptions, behavior change interventions, and behavioral change theories is profound. Using behavior change theories properly is crucial for better adherence and promoting positive outcomes. Therefore, it is essential to bring theories that support the understanding of exercise-related behavioral change to the attention of rehabilitation practitioners.

OBJECTIVE

This masterclass article aims to provide the theoretical background of theories and strategies for exercise behavior change within the physical therapy context based on acknowledged behavioral change theoretical models.

METHODS

This is a narrative review that examines six behavior theories; five of them well-established, and a new (and promising) theory that has exhibited the most favorable outcomes in rehabilitation settings. The development process for this masterclass included conversations between authors, reviewing behavior theories, summarizing and discussing the theories' concepts and strategies for physical therapy.

RESULTS

The included theories were self-determination theory, social-cognitive theory, the transtheoretical model, the theory of planned behavior, the health belief model, and the unifying theory of physical activity. Each theory offers a unique perspective on exercise behavior change within rehabilitation, exploring constructs such as motivation, self-efficacy, stages of change, behavioral intention, perceived threat, and the core elements of physical activity expression.

CONCLUSION

These theoretical models provide a foundation for understanding and developing strategies for promoting exercise behavior change in rehabilitation. Knowing and using these theories is important for respecting the patient's individuality.

Investigation of factors related to healthy eating behavior based on the developed theory of planned behavior in adolescents

BACKGROUND

Adolescence is a complicated and sensitive period, and proper nutrition in this period of life can influence the quality and quantity of growth and maturity. The aim of the present study is to determine the factors associated with healthy eating behavior based on the developed theory of planned behavior in adolescents.

MATERIALS AND METHODS

This is a descriptive-correlational study in which 400 female students of the first grade of high school in Bandar Anzali participated. Among the junior high schools in this city, two schools were randomly selected and sampling was done using census method. Data collection tool was Healthy Eating Behavior questionnaire based on Theory of Planned Behavior, which includes three sections of demographic information, constructs of Theory of Planned Behavior, including attitude toward behavior, subjective norms, perceived behavioral control, and behavioral intention, and food behavior, and food habits questionnaire. The scale was evaluated and confirmed by content validity ratio, content validity index, and alpha coefficient. P value was considered significant at less than 5%. Data analysis was performed using SPSS software 24, through linear regression and Pearson's correlation.

RESULTS

As shown by linear regression analysis, the developed theory of planned behavior is able to predict 26% of the variance of healthy eating behavior, and this predictive power is related to the constructs of behavioral intention, attitude, and habits.

CONCLUSIONS

In the present study, adding the variable of habits to the theory of planned behavior showed that this variable is very effective in predicting healthy eating behavior in adolescents, just like the constructs of behavioral intention and attitude. Therefore, it is suggested to carry out educational interventions based on the developed theory of planned behavior with the focus of the mentioned structures.

Civil servants' physical activity status and its associated factors in Northeast Ethiopia: applying Health Belief Model

Background

Identifying the associated factors of the physical activity of civil servants is necessary to increase the practice of physical activity. However, limited studies addressed associated factors of civil servants' physical activity status in Ethiopia. Hence, this study assessed civil servants' physical activity status and associated factors in Northeast Ethiopia.

Methods

An institution-based cross-sectional study design was conducted from 28 February to 13 March 2020 and measured physical activity using WHO physical activity definition. Four hundred and eight civil servants were interviewed using a systematic random sampling technique. A descriptive statistics and multivariable logistic regression model were used.

Result

The percentage of physical activity for the civil servants of the study was only 2.38, with the prevalence of physical activity status of 64.0% (95% CI 60.4% to 67.61%). Perceived self-efficacy (adjusted OR (AOR)=1.98, 95% CI 1.15 to 4.12), cues to action (AOR=2.12, 95% CI 1.04 to 3.22) and being a health professional (AOR=2.19, 95% CI 1.13, 4.23) were main associated factors of physical activity. However, physical activity was not affected by respondents' sex (AOR=1.01, 95% CI 0.67 to 1.83), educational status (AOR=0.23, 95% CI 0.03 to 1.91), perceived barrier (AOR=0.97, 95% CI 0.91 to 1.04) or perceived benefit (AOR=1.02, 95% CI 0.95 to 1.09).

Conclusion

The health profession, self-efficacy and cues to action were the main associated factors of physical activity. Hence, the Sports Bureau and Health Bureau should pay attention to providing information by focusing on improving self-confidence and creating a positive attitude toward physical activity.

Effect of Education Based on Health Belief Model on the Dietary Intake of Patients with a Myocardial Infarction

INTRODUCTION

Dietary modification significantly impacts reducing myocardial infarction (MI) mortality and its recurrence. This study aimed to investigate the effect of education on the dietary intake of patients with MI based on the health belief model.

METHOD

This quasi-experimental study was conducted on patients with MI from October 2021 to January 2022. A total of 72 MI cases were randomly divided into intervention and control groups. The intervention group received an educational intervention based on the health belief model for three months in four sessions. The structures of the health belief model were measured using a questionnaire before the intervention and one and three months following it. Dietary intake was measured with a three-day dietary record before and after three months of the intervention.

RESULTS

After the educational intervention, a significant difference was observed between the two groups in terms of the average scores of awareness, perceived susceptibility, perceived severity, perceived benefits, and self-efficacy (P<0.01). However, no significant difference was observed concerning the perceived obstacles. Although there were no significant differences between dietary intake at the baseline, the intake of energy, cholesterol, and energy percent from carbohydrate, total fat, and saturated fatty acids were lower, and fiber intake was higher in the intervention group versus the control group after the intervention (all P<0.05).

CONCLUSION

Given the positive effect of the health belief model in this study, it is suggested to use this model for designing education for MI patients focusing on nutrition.

Exercise health belief model mediates the relationship between physical activity and peer support among Chinese college students: A cross-sectional survey

This study explored the influence of the exercise health belief model and peer support on university students' physical activity PA and clarified the related mechanism. Three hundred and thirty-six healthy university students (aged 19.4 ± 1.3 years, 166 male and 170 female) from Sichuan University of Arts and Science in China were evaluated by the peer support scale, the health belief model scale for exercise, and the physical activity scale (short volume). The results showed that the male students' exercise self-efficacy and PA were markedly higher than female university students. Peer support was positively correlated with perceived benefits, exercise self-efficacy, perceived severity, and cues to action, and was adversely associated with perceived objective and subjective barriers. PA was positively correlated with perceived benefits and exercise self-efficacy, and negatively correlated with perceived objective and subjective barriers. Among the components of the exercise health belief model, only exercise self-efficacy was suitable for constructing a structural equation model (SEM) with peer support and PA. The analysis showed that the predictive effect of exercise self-efficacy on PA was more significant than peer support, and exercise self-efficacy played a critical intermediary role. It is worth noting that, in the grouping model, the effect of male college students' exercise self-efficacy on PA was greater than that of female students, and the model fit of male peer support was better than that of female students. Although the impact of peer support on PA was less than that of exercise self-efficacy and the direct effect of peer support was less than the indirect effect, the impact of peer support on the PA of female university students was higher than that of male university students. This study revealed the impact of exercise self-efficacy and peer support on university students' PA and suggested that exercise self-efficacy is the main path to promoting university students' PA, followed by peer support. Peer support could affect university students' PA not only through direct effects but also through indirect effects. This study also suggested that female university students' peer support has a higher impact on PA than male students. Therefore, when formulating physical exercise courses in the future, it is necessary to give more peer support to female university students to compensate for their low exercise self-efficacy.

The Current Health Belief of Exercise Conditions of Chinese College Students and Ways of Improvements: An Analysis Based on the Health Belief Model

The purpose of this study was to discuss the differences in the parameters of exercise health beliefs among college students of different genders, and assess the relationship between demographic factors and parameters of exercise health beliefs, and examine the relationship between exercise self-efficacy and internal components of exercise health beliefs. A total of 313 Chinese college students from the Sichuan University of Arts and Science completed the exercise health belief scale voluntarily under the tutor’s explanation. The results showed that compared with female students, male students have higher perceived benefits and self-efficacy of exercise and lower perceived subjective and objective barriers. Monthly family income has a significant positive correlation with exercise self-efficacy and a negative correlation with perceived subjective barriers to exercise disorder. Exercise self-efficacy has a positively correlated with perceived benefits and perceived severity and a significant negative correlation with perceived subjective and objective barriers. From the structural equation model, we found that family income no longer significantly impacted exercise self-efficacy. Within the exercise health belief items, we found only that there were negative relationship between perceived subjective barriers and exercise self-efficacy. According to the study, our findings provide a new psychological angle for understanding the exercise condition of college students and the restraining factors and provide new insights into increasing exercise self-efficacy to lower the subjective barriers to exercise. Future studies will focus on evaluating the relationship between exercise health belief components and college Students’ physical activity levels and exercise behaviors.

Health information seeking and sharing behavior of young adults on social media in Pakistan

Social media such as Facebook, YouTube, WhatsApp, and Twitter have radically enhanced the public access to health information. Still, studies have unexplored the factors that contribute toward such behaviors especially in developing countries. Therefore, this study identifies the factors that contribute to the likelihood of young adults’ health information seeking and sharing on social media. Specifically, drawing upon health belief model (HBM), the study attempts to understand how health belief and e-Health literacy affects health information seeking and sharing on social media. The study collected data from 413 young adults through Google Forms on a random basis. The results generated applying structural equation modeling confirmed that HBM related factors such as perceived susceptibility, perceived severity and perceived benefits positively while perceived barriers negatively influence young adults’ health information seeking and sharing intentions on social media. Furthermore, e-Health literacy was positively associated with health information seeking and sharing intentions on social media. This study is amongst a first few studies in the context of developing world to investigate the young adults’ intentions of seeking and sharing health information on social media based on HBM.

Perception towards cardiovascular diseases preventive practices among bank workers in Hossana town using the health belief model

BACKGROUND

Cardiovascular diseases (CVD) are becoming a public health problem in Ethiopia, especially among those who have limited physical activity. Although bank workers are at an increased risk of contracting CVD, their participation in CVD preventive activities is not studied in Ethiopia. Therefore, this study aimed to assess the perception of bank workers towards CVD preventive behaviors and associated factors in Hossana town.

METHODS

A cross-sectional study was conducted on a sample of 258 participants from February 11 to 30/2020. A simple random sampling method was used to select study participants from the enumerated list of staff. Data was collected using a self-administered structured questionnaire and the collected data was entered and analyzed using SPSS version 20 software. Descriptive statistics and logistic regression analysis were done. A p-value less than 0.05 with 95% CI was considered to declare an association between independent and dependent variables.

RESULTS

A total of 253 respondents with response rate of 98.0% were participated. The study revealed that the likelihood of performing CVD preventive behaviors is 62.0%. Moreover, the study found that bank workers' exposure to passive smoking [AOR = 0.5; 95% CI: 0.23-0.98], level of alcohol consumed [AOR = 0.5; 95% CI: 0.01-0.54], regularly consuming fruit and vegetable in daily meal [AOR = 0.16; 95% CI: 0.03-0.80], perceived severity[AOR = 0.1;95% CI: 0.01-0.68], and cues to take action [AOR = 0.12;95% CI: 0.02-0.73] were identified as predictors of perception to engage in CVD preventive behaviors.

CONCLUSION

The level of bank workers' perception of engaging in CVD preventive behavior was in a considerable state to design and implement intervention strategies. Behavior change communication should be strengthened to improve their knowledge and perception of the severity of CVD and barriers so as to improve the likelihood of taking action.

Using the Health Belief Model to examine travelers' willingness to vaccinate and support for vaccination requirements prior to travel

Data from a survey of 1478 travelers and multistep group structural equation model analysis revealed that the Health Belief Model constructs of cues to action (trust in third-party information sources), perceived severity of and susceptibility to COVID-19, and beliefs about the protection benefits of a COVID-19 vaccine, subsequently elicited willingness to vaccinate and beliefs that others should vaccinate prior to travel and enhanced support for pre-travel vaccination mandates. Also, significant differences in the perceived protection benefits of the vaccine and willingness to vaccinate were found across groups of travelers who travel more or less frequently and those with and without a prior positive test for COVID-19. The study provides a theoretically informed understanding of the dynamics that may enable the success of important health-related travel policy in the wake of COVID-19 and future pandemics and identifies the communication mechanisms that must be leveraged by governments and travel authorities in enforcing policy.

The effect of patient education based on health belief model on hospital readmission preventive behaviors and readmission rate in patients with a primary diagnosis of acute coronary syndrome: a quasi-experimental study

BACKGROUND

The health belief model is one of the applicable methods of training health preventive behaviors, especially in patients with cardiovascular diseases. Therefore, this study aimed to determine the effect of patient education based on the health belief model on readmission preventive behaviors and readmission rate in patients with a primary diagnosis of acute coronary syndrome.

METHODS

The present quasi-experimental study was conducted in 2020 on patients with a primary diagnosis of acute coronary syndrome who were discharging from Seyed Al-Shohada Hospital, Urmia, Iran. In this study, a total of 70 samples were recruited using convenience sampling and then randomly assigned to two groups of intervention and control (n = 35 in each group). A total of 7 face-to-face group training sessions were held with the participation of the patients and one of their family members during 14 days after hospital discharge. These sessions were conducted along with concentration on the structures of the health belief model. Data were collected at three time points of immediately before, one month, and three months after the intervention using a demographic questionnaire, a researcher-made questionnaire of readmission preventive behaviors in cardiovascular diseases, and a checklist of hospital readmission. Data were analyzed using SPSS Statistics for Windows, version 17.0 (SPSS Inc., Chicago, Ill., USA).

RESULTS

The results showed that there was a statistically significant difference in the mean score of preventive behaviors between the two groups at time points of one month and three months after the intervention (p < .05). However, there was no statistically significant difference in the readmission rate between the two groups after the intervention (p > .05).

CONCLUSION

Health belief model-based education was shown to be effective on readmission preventive behaviors in patients with acute coronary syndrome, although this model had no effect on the readmission rate in these patients. Other factors affecting the readmission rate are recommended to be investigated.

Development and validation of an instrument to measure beliefs in physical activity among (pre)frail older adults: An integration of the Health Belief Model and the Theory of Planned Behavior

OBJECTIVE

To develop and evaluate the psychometric properties of an instrument assessing beliefs in physical activity based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) among (pre)frail older adults.

METHODS

A literature review and semi-structured interviews were conducted to generate the initial item pool of the instrument. A rural sample of 611 (pre)frail older adults was enrolled to examine the validity and reliability of the instrument.

RESULTS

The exploratory factor analysis extracted eight factors for this instrument, explaining 71.3% of the variance in beliefs in physical activity. The confirmatory factor analysis confirmed the eight-factor structure. Linear regression models found that the integrated HBM-TPB constructs explained 65.9% of the variance in physical activity intention and 13.6% in physical activity. The Cronbach's alpha coefficients for the factors ranged from 0.80 to 0.98, and ICCs ranged from 0.71 to 0.85.

CONCLUSION

This instrument has satisfactory construct validity, predictive validity, internal consistency reliability and test-retest reliability, and it can be used in (pre)frail older adults to measure beliefs in physical activity.

PRACTICE IMPLICATIONS

This instrument may help health care providers understand beliefs in physical activity and facilitate targeted interventions among (pre)frail older adults.

Cardiovascular Disease in the Peruvian Andes: Local Perceptions, Barriers, and Paths to Preventing Chronic Diseases in the Cajamarca Region

Objectives: Public health interventions can be improved by understanding peoples' explanatory models of disease. We explore awareness and perceptions of cardiovascular diseases (CVD) and options for preventative actions in young adults living in rural Andean communities. Methods: We used convenience sampling to select 46 men and women from communities in Cajamarca (Peru). Subjects participated in eight focus groups where they discussed their understanding and perceived causes of CVD as well as barriers and pathways to healthy lifestyles. Results: Fresh foods, physical activity, unpleasant emotions, and healthcare access were cited as important determinants of healthy lifestyles. Barriers to healthy diets included lacking nutritional knowledge, fluctuating food prices, and limited access to foodstuffs. Women felt particularly vulnerable to CVD and identified gendered barriers to manage stress and engage in sports. Low health literacy, poor doctor-patient relationships, and long distances prevented participants from fully accessing healthcare. Conclusion: CVD prevention interventions should consider local knowledge of these diseases and of healthy lifestyles, and harness ongoing programmes that have successfully promoted good nutrition in children and pregnant women. In concert with public-private parterships, governments should include disease prevention interventions for the entire family.

Associations between cardiometabolic risks and physical activity in early adulthood: a cross-sectional study

OBJECTIVES

Young adults' physical activity (PA) is a foundation of creating future healthy lifestyles. The purpose of this study was to explore differences in PA, sedentary behaviour, walkability and health beliefs among young adults with different levels of cardiometabolic risks and the influence of moderate-to-vigorous PA.

DESIGN

A cross-sectional study was conducted using a structured questionnaire.

PARTICIPANTS

Totally, 1149 valid responses were received for a response rate of 86.32%. According to the self-reported worst health condition, participants were categorised into healthy adults, and adults at levels 1 (overweight), 2 (obese), 3 (hypertensive, hyperlipidaemic, and/or hyperglycaemic), and 4 (with a diagnosis of cardiometabolic diseases) of cardiometabolic risks.

PRIMARY OUTCOME MEASURES

PA, sedentary time, walkability and health beliefs.

RESULTS

Significant differences in PA (F=3.78, p<0.01) and sedentary time (F=2.39, p<0.05) among groups with various cardiometabolic risk levels were found. Healthy adults and adults at level 1 risk had significantly higher PA than adults at risk levels 2 and 3. Young adults at risk level 3 were less likely to participate in moderate-to-vigorous PA than were healthy adults (OR=0.64 (95% CI 0.41 to 0.99), p<0.05). Individuals who perceived that there were more recreational facilities (OR=1.27 (1.05 to 1.53), p<0.05), who had higher benefits of exercise (OR=1.73 (1.30 to 2.31), p<0.001), and who had lower barriers to exercise (OR=0.42 (0.32 to 0.55), p<0.001) were more likely to participate in moderate-to-vigorous PA.

CONCLUSIONS

Being aware of body weight changes could be a danger sign of a lack of PA. Developing environmental and psychological strategies to promote engaging in PA is necessary to promote the cardiometabolic health of young adults.

Development and validation of a questionnaire measuring knowledge, attitudes, and practices (KAP) to healthy eating and activity patterns in school children (HEAPS)

BACKGROUND

Development of culturally appropriate and psychometrically sound instruments that measure knowledge and health behaviors of children will help to inform appropriate interventions.

AIM

To develop and test the validity and reliability of a questionnaire measuring knowledge, attitudes, and practices to healthy eating and activity patterns in school children in India.

METHODS

Review of literature, focus-group discussions, and theoretical constructs of the Health Belief Model guided the development of an item pool. Face and content validity were assessed by children and a panel of experts and the item content validity, item difficulty, and discrimination indices were calculated. Construct validity was determined using the principal axis method of exploratory factor analysis among a cross-sectional sample of children (n=252). Internal consistency (Cronbach α values >0.7) and test-retest reliability (intraclass correlation coefficient values >0.75) were estimated.

RESULTS

Item content validity index for clarity and relevance were satisfactory (>0.80) and internal consistency for knowledge (Kuder-Richardson 20 = 0.832), attitude (Cronbach's α = 0.912), and practice items (Cronbach's α = 0.769) were good. Four factors (children's eating habits, family dietary practices, and consumption of healthy and unhealthy foods) and two factors (moderate to vigorous activities and sedentary activities) explained 67.7% and 48.2% of the total variance in practice items. Intraclass correlation coefficient estimates ranged from good to excellent (0.72-0.99).

CONCLUSIONS

The results of the validity and reliability of the 84-item knowledge, attitudes, and practices to healthy eating and activity patterns in schoolchildren questionnaire were promising. The detailed description of the methodology employed may prove useful to researchers conducting similar studies in children.

Modelling knowledge, health beliefs, and health-promoting behaviours related to cardiovascular disease prevention among Malaysian university students

Background

Healthy lifestyle habits formed during young adulthood may have a sustaining impact on health across later life. The current study aimed to test the theoretical model of factors (selected demographic variables, knowledge of heart disease, health belief related to cardiovascular disease (CVD), self-efficacy, cues to action, and screening intention) influencing health-promoting behaviours among Malaysian university students.

Methods

In a cross-sectional survey, the undergraduate students in Universiti Sains Malaysia were invited to complete the self-administered questionnaires. Participants were selected using a purposive sampling method. The proposed hypothesised model was analysed using a structural equation modelling with Mplus 7.3 program. A total of 788 (70.7% female) undergraduate students with a mean age of 20.2 (SD = 1.02) participated in the study. The primary outcome of knowledge, health beliefs, and health-promoting behaviours related to CVD were measured by questionnaires namely: Knowledge of Heart Disease, Health Beliefs Related to CVD, and Health Promoting Lifestyle Profiles-II.

Results

The final hypothetical structural model showed a good fit to the data based on several fit indices: with comparative fit index (CFI) at .921, standardised root mean square residual (SRMR) at .037, and root mean square error of approximation (RMSEA) at .044 (90% CI: .032, .054). The final structural model supported 13 significant path estimates. These variables explained 12% of the total variance in health-promoting behaviours. Through perceived benefits, total knowledge had an indirect effect on health-promoting behaviours.

Conclusion

The results suggest that perceived barriers, perceived benefits, family history of CVD, and screening intention enable young adults to engage in health-promoting behaviours.

A Cross-Sectional Survey of Risky Travel and Leisure Behaviors During the COVID-19 Pandemic

PURPOSE

COVID-19 is largely spread through close contact with infected people in indoor spaces. Avoiding these spaces is one of the most effective ways to slow the spread. This study assessed who had engaged in risky travel and leisure behaviors before the availability of vaccines.

DESIGN

National cross-sectional on-line survey collected in November and December 2020. Setting: United States; Participants: 2589 adults representative by gender and race/ethnicity to the US population; Measures: The survey assessed if people had resumed 11 risky behaviors during the pandemic, prior to vaccines. Independent variables included age, race/ethnicity, region of the country, education, income, preexisting conditions, perceived severity and susceptibility, positive COVID diagnosis, and political ideology.

ANALYSIS

Univariate analysis and logistic regressions were used to assess demographic and psychological factors of those resuming these behaviors. Results: Most (60.3%) of people had resumed at least 1 behavior with eating inside of restaurants (33.2%) and visiting family and friends (37.5%) being the most prevalent. In the multivariate analyses, perceived susceptibility was significant across all behaviors. Young people, fiscal conservatives, and people with higher perceived severity were more likely to perform several of the behaviors. Preexisting conditions did not predict any of the behaviors.

CONCLUSIONS

Travel and leisure behaviors vary by type of risk and may need specific tailored, prevention messages to promote risk reduction during future pandemics.

Factors associated with physical activity in elderly nursing home residents: a path analysis

BACKGROUND

Physical activity (PA) is low among elderly residents in nursing homes in China. We aimed to determine the factors that influence PA among elderly nursing home residents and their direct or indirect effects on PA levels.

METHODS

The PA levels of the participants were measured using the International Physical Activity Questionnaire, and their health beliefs were assessed using a self-developed 18-item questionnaire titled the 'Health Beliefs of Nursing Home Residents Regarding Physical Activity' in accordance with Health Belief Model (HBM) constructs. The correlations between HBM constructs and PA levels were analyzed and a regression-based path analysis was conducted to examine the relationships between HBM constructs and PA levels.

RESULTS

A total of 180 residents with a mean age of 82.5 years (standard deviation = 5.76) were recruited. Linear regression analysis revealed that self-efficacy (p < 0.001), perceived severity (p < 0.01), and cues to action (p < 0.01) were associated with the level of PA among nursing home residents. In the conceptual path model, self-efficacy, perceived severity, and cues to action had positive direct effects on the PA level, while perceived benefits and perceived barriers had indirect effects on the PA level.

CONCLUSION

The residents' self-efficacy, perceived severity, and cues to action were found to be important factors that can affect the design and implementation of educational programs for PA. A better understanding of such associations may help healthcare providers design informed educational interventions to increase PA levels among nursing home residents.

Development and evaluation of the health belief model scale for exercise

Objectives

This study was aimed to develop a health belief model scale for exercise among Chinese residents to describe the relationships between health beliefs and exercise for promoting residents to adopt or maintain exercise programs.

Methods

Participants were from two projects, Project 1 with 3833 participants and Project 2 with 7319 participants. A pool of 21 items was developed based on a small-scale qualitative study about health beliefs of exercise and literature. Internal consistency and construct validity of the scale were evaluated with Cronbach's α coefficient, exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and second-order confirmatory factor analysis.

Results

A final version of 18 items loaded on six factors which could explain 60.30-% of variance was observed after EFA. The internal consistency of the final version with 18 items performed in Project 1 was acceptable (0.609). The reliability of the six subscales was good with Cronbach's α coefficient of 0.628, 0.713, 0.628, 0.801, 0.676 and 0.838 for perceived benefits, perceived objective barriers, perceived subjective barriers, self-efficacy, perceived severity and cues to action, respectively. CFA and second-order CFA indicated a good fit to data.

Conclusions

The Health Belief Model Scale for Exercise(HBMS-E) is a valid and reliable instrument to assess health beliefs of exercise among residents in China. Understanding the health beliefs of exercise will help health professionals to develop effective interventions for health and evaluate the effectiveness.

Development and validation of the Oral health behavior questionnaire for adolescents based on the health belief model (OHBQAHBM)

BACKGROUND

Oral health belief is a prerequisite of changing oral health behaviors especially during adolescence. However, there is a paucity of well-established questionnaire for use among adolescents. This study aimed to develop and validate an instrument to evaluate adolescents' beliefs about oral health behaviors using health belief model.

METHODS

A preliminary 43-item questionnaire was developed by an expert panel. Then the questionnaire was finalized by decreasing the number of items to 35 by analyzing the results from face validity and factor analysis from 421 Hong Kong secondary school students. The content validity were evaluated by a panel of 2 behavioral scientists, 2 dentists, 2 schoolteachers and 10 adolescents. The construct validity of the questionnaire was assessed by performing exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Cronbach's alpha coefficient, item-total correlation and intraclass coefficient were used to test its reliability. In addition, to confirm its applicability, multiple regression analysis and path analysis were used to evaluate the possibility of HBM as predictors for oral health behaviors and oral hygiene status.

RESULTS

The initial analysis extracted six factors that jointly accounted for 62.47% of the variance observed. Based on CFA, the final version of the questionnaire consisted of 35 items and the data of the final version fitted the model well. The Cronbach's alpha coefficient for the subscale (> 0.7), item-total correlations (0.47-0.91) and the intraclass coefficient (0.82-0.91) were all above acceptable thresholds. The results of multiple regression analysis and path analysis confirmed its ability to predict oral health behaviors and status.

CONCLUSIONS

The present findings indicate satisfactory validity, reliability and applicability of the proposed Oral Health Behavior Questionnaire for Adolescents based on the Health Belief Model (OHBQAHBM) for measuring oral health beliefs of adolescents. This questionnaire can be used as an instrument to measure oral health beliefs and predict oral health behavior and oral hygiene status of adolescents.

A priority oriented nutrition education program to improve nutritional and cardiometabolic status in the workplace: a randomized field trial

Background

Workplace nutrition has been identified as a priority setting that can significantly reduce cardiovascular diseases (CVD) risk factors. This study was conducted as a part of the workplace education program to improve nutritional practices and cardiometabolic status in industrial personnel.

Methods

The present research was a randomized controlled field trial conducted on employees of a regional petrochemical company. The health-related priorities of the program were defined and addressed in the study in which 104 employees with dyslipidemia were randomly divided into two groups of education and control. Data were collected pre- and post-intervention, using valid and reliable multi-session questionnaires on demographic data, nutritional knowledge, and nutritional intake. Anthropometric measures, serum FBS, HbA1C, hs-CRP and homocysteine (Hcy) were assessed in both groups. In the education group, the nutrition program included five educational workshops about healthy nutrition and regular exercise along with educational messages over a 3-month period. The controls did not receive any education during the study.

Results

There were no statistically significant differences between the two groups regarding the baseline variables. The education group significantly improved their nutritional knowledge (p < 0.001), dietary intakes (p < 0.005), serum FBS (p < 0.001) and Hcy levels (p < 0.001) and anthropometric indices.

Conclusion

Workplace nutrition education programs can improve knowledge and reduce important CVD risk factors.

Determinants of physical activity: A path model based on an ecological model of active living

Maintaining physical activity is necessary to promote health in our daily lives. The Ecological Model of Active Living was proposed to examine whether individuals participate in active living. The purpose of this study was to understand the determinants of physical activity and create a predictive path model of the intrapersonal, perceived environment, behavior settings, and policy environment domains. Data were obtained from open government data and questionnaires, including the International Physical Activity Questionnaire, Health Belief Model Inventory, Physical Activity Neighborhood Environment Survey, and Accessibility of Open Spaces. Participants comprised 1085 healthy adults who completed a self-reported internet survey. An analysis of the intrapersonal domain revealed that the variables of female, an older age, and a low educational level, and individuals with obesity or cardiometabolic diseases presented lower odds ratios for active living. We found significant statistical support for our path model (The Ecological Model of Active Living), with a predictive power of 23.1%. The predictive path model is a good approach to quantitatively measure the impacts of various determinants on active living that suggests further lines of research in approaches for modeling relationships.

Predictors of Oral Health Behaviors in Female Students: An Application of the Health Belief Model

BACKGROUND

Oral and dental health diseases can affect the general health of students.

OBJECTIVES

The aim of this study was to identify the predictors of oral and dental health behavior using the health belief model (HBM) in female students in Teheran, Iran.

PATIENTS AND METHODS

This was a cross-sectional study framed by the HBM, including 400 female students living in district 5 of Tehran, Iran. The sampling technique used in this study was multi-stage stratified random sampling. The data on the HBM constructs (perceived severity, perceived susceptibility, perceived benefits, perceived barriers, cues to action, and self-efficacy) and demographic characteristics were collected using a self-administered questionnaire. Descriptive statistics, bivariate correlations, and linear regression were performed to analyze the data, using the SPSS software, version 18.

RESULTS

The results showed that there were relationships between the knowledge, perceived barriers, cues to action, and mother's education with oral health behaviors. A multivariate hierarchical regression analysis was conducted with the barrier entered at step one, knowledge at step two, and cues to action at step three. Finally, the three variables accounted for 17% of the total variance in the oral and dental health behavior.

CONCLUSIONS

The current study provided evidence for the utility of the belief-based model in the prediction of oral health behaviors. It could be suggested that oral health behavior can be promoted by reducing the perceived barriers and enhancing the students' knowledge of oral and dental hygiene.

Efficacy of HBM-Based Dietary Education Intervention on Knowledge, Attitude, and Behavior in Medical Students

Background

Using various models of behavior change, a number of studies in the area of nutrition education have confirmed that nutrition habits and behaviors can be improved.

Objectives

This study sought to determine the effects of education on patterns of dietary consumption among medical students at the military university of Tehran, with a view to correcting those patterns.

Methods

In this quasi-experimental study, 242 medical students from the Military University of Tehran were chosen by convenience sampling and then divided into control (n = 107) and intervention groups (n = 135) by block randomization. The self-administered questionnaire involving six categories of item (knowledge, perceived benefits, perceived barriers, perceived threats, self-efficacy and behavior) has been validated (Cronbach alpha > 0.7 for each).

Results

Following the educational intervention, the mean score of knowledge, health belief model (HBM) structure, and behavior of students in relation to healthy patterns of food intake increased significantly (P < 0.05). The mean pre-intervention knowledge score was 6.76 (1.452), referring to threats to HBM constructs including perceived threat 2.93 (1.147), perceived benefits 7.28 (1.07), perceived barriers 5.44 (1.831), self- efficacy 4.28 (1.479), and behavior 8.84 (2.527). The post-intervention scores all improved as follows: knowledge 8.3 (1.503), perceived threats 3.29 (1.196), perceived benefits 7.71 (0.762), perceived barriers 5.9 (1.719), self- efficacy 4.6 (1.472), and behavior 9.45 (2.324). This difference in mean scores for knowledge, health belief structures and employee behavior before and after educational intervention was significant (P ≤ 0.05).

Conclusions

The significant improvement in the experimental group’s mean knowledge, HBM structures , and behavior scores indicates the positive effect of the intervention.

Radiation Protection Knowledge, Attitude and Practice (RP-KAP) as Predictors of Job Stress Among Radiation Workers in Tehran Province, Iran

Background

In recent years, much attention has been paid to occupational stress, but relatively little or no research has been conducted on the influence of knowledge, attitude, and practice of radiation protection (RP-KAP) on job stress among radiation workers

Objectives

This study aims to assess job stress among health care workers in Iran who are occupationally exposed to radiation in order to determine the effects of KAP on self-protection against radiation on their job stress.

Materials and Methods

The population in this descriptive cross-sectional study comprised 670 healthcare workers, including 428 staff with a degree in radiology and 242 other medical personnel who were working in 16 hospitals affiliated with Tehran University of Medical Sciences (TUMS) in Tehran, Iran. The census method was used to sample the workers. In total, 264 staff with a degree in radiology and 149 other medical personnel completed the job content questionnaire (JCQ) and the RP-KAP questionnaire from May to November 2014.

Results

The prevalence rate of job stress was 22.5% based on calculation formulas and possible scores on the JCQ. Sex, RP-knowledge, attitude, practice, and in-service training predicted 41.8% of the variance in job stress. According to the results of the binary logistic regression, workers with higher scores on knowledge (OR = 0.82, 95% CI: 0.75 - 0.90), attitude (OR = 0.71, 95% CI: 0.63 - 0.82), and practice (OR = 0.78, 95% CI: 0.72 - 0.86) and those who had participated in training programs had significantly lower rates of job stress (OR = 0.51, 95% CI: 0.28 - 0.93).

Conclusions

The effects of RP knowledge, attitude, and practice on job stress were significant. In order to reduce job stress in radiation environments, ongoing training programs related to self-care and protection principles are recommended.

Effective Factors on Health-Promoting Lifestyle Among Iranian Chemical Veterans in 2014 Based on Health Promotion Model: A Path Analysis

Background

Health-promoting behaviors can enhance physical and mental health among individuals with disability, particularly veterans.

Objectives

The current study aimed to examine both one-way direct and indirect effects of the factors of the Health Promotion Model (HPM) on health-promoting behaviors in chemical veterans from Ilam province in Iran.

Materials and Methods

This cross-sectional study was conducted in 2014. In this study, 239 moderate-to-severe chemical veterans from Illam province supported by the veterans’ affairs department of Ilam were evaluated via census sampling. Data including health-promoting behaviors, perceived self-efficacy, perceived barriers and benefits, perceived social support, and perceived health status were collected using standard questionnaires.

Results

The results show that the HPM is a poor predictor of the health-promoting lifestyles of chemical veterans (R² = 15%). Social support (factor loading = 0.38) is the strongest predictor of health-promoting behaviors and it influences such behaviors directly, while perceived barriers (factor loading = -0.11) and perceived self-efficacy (factor loading = 0.02) indirectly predict behavior through social support.

Conclusions

Perceived social support is the most important factor that influences health-promoting behaviors. Increasing social support by enhancing self-efficacy and decreasing perceived barriers can improve health-promoting behaviors among veterans.

Relationship between observational learning and health belief with physical activity among adolescents girl in Isfahan, Iran

Background:

Physical activities among adolescents affects health during pubescence and adolescence and decrease in physical activities among adolescents has become a global challenge. The aim of the present study was to define the relation between the level of physical activity among adolescent girls and their health beliefs as personal factor and level of observational learning as environmental factor.

Materials and Methods:

The present study was a cross-sectional study that was conducted on 400 students aged from 11 to 19 years in Isfahan, Iran. Information regarding the duration of physical activity with moderate/severe intensity was measured in four dimensions of leisure time (exercising and hiking), daily activities, and transportation-related activities using the International Physical Activity questionnaire. Health belief structures included perceived sensitivity, intensity of perceived threat, perceived benefits, and barriers and self-efficacy; observational learning was measured using a researcher-made questionnaire.

Results:

Results showed that perceived barriers, observational learning, and level of self-efficacy were related to the level of physical activity in all dimensions. In addition, the level of physical activity at leisure time, transportation, and total physical activity were dependent on the intensity of perceived threats (P < 0.05).

Conclusions:

This study showed that the intensity of perceived threats, perceived barriers and self-efficacy structures, and observational learning are some of the factors related to physical activity among adolescent girls, and it is possible that by focusing on improving these variables through interventional programs physical activity among adolescent girls can be improved.

Effect of Patient-Focused Clinical Pathway on Anxiety, Depression and Satisfaction of Patients With Coronary Artery Disease: A Quasi-Experimental Study

Background:

Coronary artery diseases (CAD) are associated with psychological problems such as anxiety and depression in patients. Thus, management of these problems can consider as an important intervention by health care workers, especially nurses.

Objectives:

The purpose of this study was to investigate the effectiveness of patient-focused clinical pathway on anxiety, depression and satisfaction of patients with CAD.

Patients and Methods:

In this quasi-experimental study, 138 patients suffering from CAD in a coronary care unit of a referral teaching hospital affiliated to Semnan University of Medical Sciences in Semnan, Iran, were recruited using a convenience sampling method. The participants were assigned to two groups: Clinical pathway (CP) and routine (RUT) care. The level of anxiety and depression of patients were measured in admission and discharge in both groups. Also, the level of patients’ satisfaction was measured at the time of discharge. Data were analyzed using descriptive and inferential statistics.

Results:

Prevalence rates of anxiety and depression in total of patients were 7.2% and 8.7%, respectively. In terms of anxiety, the mean of difference between pretest and posttest scores in the CP group (0.52 ± 1.39) was higher compared to the RUT group (-0.17 ± 1.69) and there was a significant difference between the two group (P = 0.009). In terms of depression, the mean of this difference in the CP group (0.75 ± 2.05) was higher compared to the RUT group (0.00 ± 1.08), as there was a significant difference between the two group (P = 0.024). Also, the mean of patients’ satisfaction scores in the CP group (3.69 ± 0.39) was higher compared to the RUT group (3.45 ± 0.47) and there was a significant difference between the two groups (P = 0.002).

Conclusions:

According to the positive effects of CP on patients with CADs, it can be considered as a useful, safe and simple instrument for the improvement of patients’ outcomes. Thus, the findings of this study can provide a new insight in patient care for clinical nurses.