Health Promotion Perspectives
Volume:1 Issue: 2, Dec 2011

‘Hard-to-reach’ is a term used to describe those sub-groups of the population that may be difficult to reach or involve in research or public health programmes. Application of a single term to call these sub-sections of populations implies a homogeneity within distinct groups, which does not necessarily exist. Different sampling techniques were introduced so far to recruit hard-to-reach populations. In this article, we have reviewed a range of ap-proaches that have been used to widen participation in studies. We performed a Pubmed and Google search for relevant English language articles using the keywords and phrases: (hard-to-reach AND population* OR sampl*), (hidden AND population* OR sample*) and (“hard to reach” AND population* OR sample*) and a consul-tation of the retrieved articles’ bibliographies to extract empirical evidence from publications that discussed or examined the use of sampling techniques to recruit hidden or hard-to-reach populations in health studies. Reviewing the literature has identified a range of techniques to recruit hard-to-reach populations, including snowball sampling, respondent-driven sampling (RDS), indigenous field worker sampling (IFWS), facility-based sampling (FBS), targeted sampling (TS), time-location (space) sampling (TLS), conventional cluster sampling (CCS) and capture re-capture sampling (CR). The degree of compliance with a study by a certain ‘hard-to-reach’ group de-pends on the characteristics of that group, recruitment technique used and the subject of inter-est. Irrespective of potential advantages or limitations of the recruitment techniques reviewed, their successful use depends mainly upon our knowledge about specific characteristics of the target populations. Thus in line with attempts to expand the current boundaries of our know-ledge about recruitment techniques in health studies and their applications in varying situa-tions, we should also focus on possibly all contributing factors which may have an impact on participation rate within a defined population group.

Osteoporosis is an important public health problem. The aim of this study was to investigate food habits and some factors related to osteoporosis in women in Iran. This cross-sectional study was conducted on 399 childbearing age women who were attending health centers and 200 healthcare providers in 2007. Food habits and dietary calcium intake was evaluated by food frequency questionnaire and 24-hour recall method.Weight and height of subjects were also measured. Independent t-test, Mann-withney U test, Pearson, Spearman and Partial correlation coefficient tests were used for analyzing of data. Two groups of women had calcium intake deficiency. Daily frequency of milk, cheese, fruit and coffee consumptions in healthcare providers (0.82±0.82, 0.94±0.49,2.01±1.28 and 0.84±2.05, P<0.02) were significantly higher than those of women attending health centers(0.58±0.72, 0.84±0.32, 1.50±0.99 and 0.48±1.25). Mean frequency use of dark vegetables, cola and pickles were significantly (P<0.004) higher in women who attending health centers (0.67±0.50, 1.55±2.36 and 1.92±2.03) than those of the other group (0.50±0.44, 1.09±2.65 and 1.49±1.72). In women who were attending health centers, negative and positive significant relationship was found between daily calcium intake with age (P<0.04) and educational level (P<0.001). No significant relationship was found between body mass index with studied variables. Women of health care providers had healthier food habits compared to women who attending health centers. Educational programs are suggested to improve food habits among women to prevent osteoporosis in later life.

In order to help rheumatoid arthritis (RA) patients in carrying out and attaining relevant self-care behaviors and adaptation to the physical limitations of this disease and, consequently, promoting their level of health status, an education program based on the PRECEDE component of the PRECEDE–PROCEED model targeting patients with RA was developed. This paper describes the planning of a RA Patient Education Program (RAPEP) designed to promote their quality of life. The development of the program began with a comprehensive review of the literature. This included a review of the signs and symptoms of RA, accompanying functional disabilities, previous educational programs and the effect of the disease on the patient’s quality of life. Besides, in order to help inform RAPEP program development, and organize the survey according to the factors identified in the PRECEDE model a cross-sectional survey was applied on a non-probability sample of 181 outpatients in Yazd, center of Iran. The quality of life (QOL) problem identified was the considerable low role functioning, health perception and physical functioning due to chronic pain. One of the most significant modifiable behavioral factors impacting pain and functional limitations was self-care behaviors in RA patients. Higher level of knowledge, attitude, self-efficacy, enabling factors and social support is associated with better self-care behavior. The PRECEDE component of the PRECEDE–PROCEED model provided a comprehensive conceptual framework for the development of RAPEP aiming at RA patients in Yazd. Further research to evaluate this educational program is suggested.

Road accidents are a social phenomenon in different communities that its infrastructural dimensions of which as well as technologic failures such as road quality, and technical faults of automobiles, need to be assessed in detail. Iran has the first order in the world for deadly road accidents. This study was designed to assess the association between aberrant behaviors of truck drivers and the incidence of road accidents in Yazd, center of Iran, in 2010. This cross-sectional descriptive-analytic study was conducted on 300 truck drivers in Yazd. We used 3 questionnaires, including one for demographic data, Driver Behavior Questionnaire (DBQ), and one for driver's self-evaluation of the of their driving. Five types of the behavior had the highest frequency: Misjudge speed of oncoming vehicle when overtaking.; Deliberately disregard the speed limits late at night or very early in the morning.; Ignore 'give way' signs, and narrowly avoid colliding with traffic having right of way.; Stuck behind a slow-moving vehicle on a two-lane highway, you are driven by frustration to try to overtake in risky circumstances.; Drive with only 'half-an-eye' on the road while looking at a map, changing a cassette or radio channel, etc. The more the driver's driving was influenced by emotional and mental states the more deliberate violations and slips. Among truck drivers, safety has not developed sufficiently, and because of the dangers of road accidents both for the drivers and other people and its economic losses, the importance of the presenting some solutions is completely obvious.

As breast milk micronutrients content are essential for health and growth of the infants, this study was conducted to determine the breast milk zinc, copper and iron concentrations and their possible correlations with maternal nutritional status, dietary intakes as well as socioeconomic status. Breast milk samples and information on maternal anthropometric characteristics and dietary intake were collected from 90 Iranian lactating women with 3 different socioeconomic status who exclusively breastfed their infants. Concentrations of trace elements were analyzed using atomic absorption spectrophotometry. Nutritionist III program, Multiple Regression and ANOVA test were used for data analyses. The mean milk zinc, copper, and iron concentrations were 1.93 ± 0.71, 0.58 ± 0.32, and 0.81 ± 0.2 mg/l, respectively. In all three SES groups only zinc mean level was lower than the recommended range. A significant difference was observed in breast milk zinc, copper and iron concentration between high and low SES groups (Zn (P<0.001), Cu (P<0.001) and Fe (P<0.044)) and also moderate and low SES groups (Zn (P<0.03), Cu (P<0.001) and Fe (P<0.049)). After adjusting for maternal body mass index (BMI), socioeconomic status, mean dietary energy, zinc, copper, and iron intakes, there was a negative and significant association between maternal age and breast milk zinc (β=-0.28, P<0.034), copper (β=-0.18, P<0.048), and iron (β=-0.22, P<0.04) concentrations. In low socioeconomic group with lower mean age, breast milk mineral levels were higher than others and there was no significant correlation between mineral levels and dietary intake. Hence it is supposed that maternal age may be better predictor of breast milk mineral levels.

Prevalence of non-alcoholic fatty liver disease (NAFLD) is more common worldwide and no certain treatment apart from lifestyle modification has been established yet. Available data consistently show that energy intake is significantly higher in patients with NAFLD than in individuals with no evidence of fatty liver. Changing nutritional behaviors seems to be the primary approach for treatment, simultaneously addressing all the clinical and biochemical defects. This study was aimed to examine the effects of two different composition of low energy diet (diet I vs. diet II) on non-alcoholic fatty liver disease patients. In this double-blind randomized controlled trial, 44 ultrasonography-proven overweight non-alcoholic fatty liver disease patients were divided into two groups and received two low-energy diets (-500 kcal less than energy requirement individually) inc. diet I (Carbohydrate: Fat: Protein: 55:25:20) and diet II (Carbohydrate: Fat: Protein: 40:40:20) for six weeks. Anthropometric and biochemical measures as well as liver enzymes were assessed after 12 hours fasting. After diet I and diet II, weight decreased significantly (%1.82 and %2.45, respectively). Liver enzymes and echogenicity decreased significantly by both diet I and diet II. Mean of triglyceride concentration decreased (%18.09) after diet II (P=0.023), while there was no significant change after diet I. Significant correlations were found between changes in aspartate aminotransferase with triglyceride and LDL-C diet I. Low energy diets can decrease liver enzymes regardless of their composition, while diet II seems to be more effective than diet I in reduction of weight and triglyceridelevel.