فهرست مطالب hassan mahmoodi

 Current evidence suggests that health literacy (HL) impacts self-care behaviors and quality of life (QOL) in patients with type 2 diabetes mellitus (T2DM). This study aimed to evaluate the impact of a short-time health literacy promotion program (HeLPP) on self-care behaviors and QOL in rural patients with type 2 diabetes.

 Conducted from 2018 to 2019 in Chaldoran county, Iran, this randomized controlled trial followed the Solomon four-group design. Participants included 160 rural individuals with T2DM, who were divided into two intervention (A and C) and two control (B and D) groups. Pre-tests were conducted for intervention group A and control group B, with post-tests administered to all groups at three and six months. Interventions, consisting of five training sessions lasting 45 to 55 minutes, were planned and executed based on pre-test analyses. Primary outcomes were QOL and self-care behaviors, and secondary outcomes were glycated hemoglobin (HbA1c), HL and patients’ awareness of the disease.

 Prior to the intervention, there was no significant difference in awareness, HL, self-care behaviors, HbA1c, and QOL between intervention group A and control group B (P>0.05). However, at three and six months after the educational program, intervention group A exhibited significantly increased average scores in awareness, HL, self-care behaviors, and QOL, along with reduced HbA1c levels (P<0.05) compared to control group B. No interaction was detected between the pre-test and the primary and secondary outcome scores after intervention.

 Implementing intervention programs like HeLPP focusing on enhancing practical HL and empowering T2DM patients seems to be promising in improving patients’ self-care behaviors and QOL, while reducing their HbA1c levels.

 Proper elucidation of medication non-adherence reasoning especially in older adults might pave the way for an auspicious therapeutic outcome. The main aim of this study was to develop and psychometrically test the Medications Non-adherence Reasoning (MedNARS) questionnaire for application in research and probably practice settings.

 A mixed methods design was utilized to develop the MedNARS. The item pool was mainly generated based on a qualitative query and literature review. The expert panel approved version of the MedNARS was psychometrically assessed on a convenience sample of 220 older patients with chronic disease. The internal consistency, test-retest reliability, content and face validity of the scale were appraised and its construct validity was assed using exploratory and confirmatory factor analyses.

 A nine-item version of the MedNARS was drafted based on the classical item analysis procedures and its estimated internal consistency measure of the Cronbach’s alpha (0.85) and test-retest reliability (0.96) were in the vicinity of acceptable range. The exploratory factor analysis (EFA) output revealed a unidimensional structure for the MedNARS and the conducted confirmatory factor analysis (CFA) indicated an acceptable data fit for the extracted one-factor model. The goodness of fit indices were as the followings: χ2 /df=1.63(90% CI: 0.02 to 0.11), root mean squared error of approximation (RMSEA)=(0.07), comparative fit index (CFI)=0.95, Tucker–Lewis index (TLI)=0.93 and standardized root mean squared residual (SRMSR)=(0.05).

 The study findings were indicative of MedNARS’s applicability and feasibility for use in assessment of medication non-adherence reasoning among the elderly patients with chronic diseases. The MedNARS as a brief and elder-friendly instrument can be applied both in research and practice settings to enhance efficiency, safety, and health outcomes of the therapeutic recommendations.

Our objective was to determine the frequency of inadequate functional health literacy (FHL) among adult Kurd population, and infer the contribution index of sociodemographic factors for FHL across gender.  In this cross-sectional study, multistage cluster sampling was employed to recruit 1000 people older than 18 years from 38 urban and 14 rural healthcare centers in Sanandaj, Iran. Data on FHL was collected from May to July 2019, through face-to-face interviews by using the validated Persian version of the Test of functional health literacy in adults (TOFHLA). The concentration index method was used to measure inequality in FHL.  Overall, 869 respondents (response rate: 86.9%) with a mean age of 33.68 (±13.0) completed the TOFHLA questionnaire. The average TOFHLA score was 51.9, which was 52.2 (±0.46) among males and 50.7 (±0.40) among females, p<0.001. Among females, the place of residence, monthly income, age, education level, and being head of the household contributed to 43%, 32%, 13%, 11.5%,  and 11% of FHL inequality, respectively. While, among males, the place of residence (45.2%), household size (15.1%), and monthly income (13.5%) contributed most to inequality in FHL.  FHL has disparities by gender and location. Males and rural people are at particular risk for poor FHL. For ease and better resolution of poor FHL, each population, gender, and area type should be considered as a stand-alone, which may help in identifying tailored interventions for males and females with low levels of FHL.

The World Health Organization has identified health literacy (HL) as one of the most important determinants of people’s health. Therefore, this research aimed to investigate the status of HL and its predictors.

This research was a cross-sectional study that was performed on 600 adults in Bijar County, Iran. Cluster sampling was used to select the samples. Data were collected using the questionnaire of HL for Iranian adults. Data were analyzed using one-way analysis of variance, Student’s t-test, and multiple linear regression in SPSS 21.

The mean score of HL was 3.6 out of 5; 69% and 29% of the samples had a moderate- to-high health status, respectively. Among the dimensions of HL, the highest and the lowest means were perception (3.94) and evaluation (3.21), respectively. Based on the multiple regression results, the variables (gender – B = −0.142, confidence interval [CI]: −0.409 to −0.011, P = 0.39; education level – B = 0.391, CI: 0.149–0.287, P = 0.00; and income level – B = 0.203, CI: 0.00–0.00, P = 0.01) were significantly positively associated with HL.

The results of this study can be applied to educational interventions through media and radio-television to increase public awareness. Education is also strongly recommended in terms of demographic variables and characteristics to promote HL in the society.

Planning to reduce the production and supply of hookah and tobacco can be a positive step to reducing the hookah and tobacco consumption in the community. The aim of the present study was to determine the effectiveness of educational programs on decreasing intention of hookah and tobacco supply among the handlers of public places and food centers in Arak city, Iran based on the theory of planned behavior.

This research is a quasi-experimental study with the pretest-posttest method and the control group. The present research was carried out between 102 handlers of public places and food centers of Arak city, Iran in 2017 which randomly divided into two experimental (n=51) and control groups (n=51). Data were collected using a questionnaire, including the constructs of the planned behavior theory and demographic variables. The intervention program consisted of 4 sessions that were applied to the experimental group during one month. Both groups were followed for two months after the intervention. Data were analyzed using SPSS 16 software through the chi-squared, independent T, paired T and McNemar tests.

After the educational intervention, significant differences were observed in the changes of attitude constructs, subjective norms, perceived behavioral control and behavioral intention between the experimental and control groups in the pretest-posttest steps (p<0.001). Also, the educational intervention resulted in a 25.1% decrease in the intention of hookah and tobacco supply among the experimental group.

The educational interventions based on the theory of planned behavior is effective to reduce the supply of hookah and tobacco among the handlers of public places and food centers.

 Health literacy includes social and cognitive skills determining individuals’ motivation to obtain and understand health information, thus empowers them to promote healthy behaviors. The exact level of health literacy in the Iranian population is unknown, as different Iranian studies have reported different health literacy rates in the Iranian population. Therefore, this study aimed to investigate health literacy in the Iranian population by systematically combining and analyzing findings from the previous studies. A total of 26 articles in Persian and in English, published up to December 2017 were reviewed. Searching for articles with the keywords prevalence, abundance, health literacy, and Iran was conducted in the following national and international databases: Scientific Information Database (SID), Medline, Magiran, Web of Science, ScienceDirect, Google Scholar, PubMed, and Scopus. The data were analyzed using the meta-analysis method and a random effects model. The heterogeneity among the studies was examined using the I2 statistic. All statistical analysis were performed using STATA version 12. The highest levels of health literacy were for the region 1 of Iran, including the following provinces: Alborz, Tehran, Qazvin, Mazandaran, Semnan, Golestan, and Ghom (46.7% with 95% CI: 25.7 - 67.7). Moreover, pregnant women (37.4% with 95% CI: 27 - 53.3) had the highest level of health literacy. In contrast, older people (60.2% with 95% CI: 43.7 - 76.8) and patients with diabetes (55.4% with 95% CI: 35.6 - 75.2) had the lowest health literacy levels. The lowest health literacy level was in older people and patients with diabetes. Therefore, it seems necessary to provide education for communities and groups with inadequate health literacy levels, especially older people and patients with chronic diseases to improve their health.

The Health Promoting Hospitals (HPH) initiative emphasizes on changes in traditional hospitals’ approach in care provision. This study aimed to provide scientific evidence required for successful planning and implementation of the HPH in the country’s educational hospitals. In this descriptive-analytical study, opinions of 300 frontline health professionals working in the ten educational hospitals affiliated to the Tabriz University of Medical Sciences were examined using validated tools in 2016. Descriptive data analysis procedures and logistic regression analysis (using Enter method) were applied by SPSS software version 22. The level of significance was considered less than 0.05. The mean scores and SD for applicability of the HPH standards were 66.06±17.51. Gender (OR=3.19 95%CI: 1.33- 8.40), occupation type (OR= 1.50 95% CI: 0.65- 0.70), hospital type (general vs. specialized) (OR= 1.59 95%CI: 1.10- 1.25), number of active beds (OR=3.84 95% CI: 1.56-9.42) and having prior knowledge about the HPH program (OR=2.81 95% CI: 1.31-4.80) were identified as significant predictors of the HPH standards’ feasibility in the studied hospitals. Given that study findings, at least the baseline subjective inclination to adapt the HPH standards in the educational hospitals do not exist through the Iranian health care providers’ points of view. As the first step in progress towards preparation for implementing the HPH standards, planning of tailor-made educational programs for hospitals’ staff in Iran is recommended.

Heart failure (HF) is a common clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of ventricles to fill with or eject blood.Our aim in this study was to examine the possible direct/indirect effects of health belief model(HBM) constructs on self-care behaviors among HF patients. A secondary analysis was conducted on an HBM-based data set collected from 180 patients with HF who were recruited from a heart hospital in Tehran, Iran, during a prospective experimental study in 2008. A regression-based path analysis was conducted to examine the relationships between HBM constructs (as independent variables) and self-care behaviors (as dependent variable). A conceptual path model was identified for the cognitive determinants of self-care behaviors among HF patients. Knowledge (β = 0.399), perceived barriers (β = 0.315) and susceptibility (β = 0.165) had direct effects on self-care (R2 = 0.512, P < 0.001). Perceived benefits, self-efficacy, severity and threat, locus of control and cues to action had indirect effects on self-care through the first three variables. HBM was found to be helpful in understanding direct and indirect associations between the cognitive determinants and self-care behaviors among HF patients. Based on this challenging path analysis, HF patients’ knowledge and perceived barriers and susceptibility are suggested as the most core categories while designing HF educational programs. Better understanding on such associations may lead nurses and health practitioners in designing properly informed stage-specific educational interventions aiming to foster self-care behaviors among HF patients

As a primary phase of a Health Impact Assessment (HIA) on the Iranian Targeted Subsidy Plan (TSP), this study was conducted to assess the psychometric properties of a newly developed quantitative Health Policy Impact Assessment Tool (HEPIAT).

In 2014, multistage cluster sampling was employed to recruit 509 key informants in Sanandaj, Iran, to participate in this cross-sectional study. A comprehensive literature review was conducted to develop the initial draft of HEPIAT. Content validity was determined by a consensus panel of experts, and construct validity and factor structure of the HEPIAT were assessed using Exploratory Factor Analysis (EFA). Reliability was assessed utilizing the Cronbach’s alpha coefficient and the test– retest reliability coefficient.

Applying EFA, the optimal solution including 35 items and 6 factors was emerged, which accounted for 64.94% of the total variance. The mean items’ relevancy, clarity, simplicity, and their total mean±SD score were 88.3±0.2, 90.1±0.5, 86.1±0.7, and 89.6±0.4, respectively. The scores of intra-class correlation coefficients (ICC) and internal consistency reliability for all the factors were ranged from 0.67 to 0.89. HEPIAT demonstrated an appropriate validity, reliability, functionality, and simplicity.

Although further works in different settings are warranted, HEPIAT may be a practical and useful quantitative instrument in socioeconomic-related HIAs aimed to inform policymakers and stakeholders on the health impacts of their decisions and plans.

The expansion of urbanization and, consequently, the increasing use of personal cars and the limitation of the development of communication networks and the lack of infrastructure and the ability to equip urban spaces have led to traffic congestion in major cities of Iran. The purpose of this study was to explain the causes of traffic congestion in Sanandaj City, focusing on managerial and infrastructural causes, from the perspective of residents and key informants. This study was conducted qualitatively and by using conventional content analysis. The participants in the study were 22 residents of the city and 8 key informants who were interviewed in central interviewing sessions (4 sessions) and via in-depth interviews. A purpose-based sampling method was used. To manage the data, Max Kiddy 10 was used. The causes of urban traffic congestion from the participants' point of view in Sanandaj include infrastructure causes (city physical infrastructure, socioeconomic status and demographic situation), and management causes (macro level decision makers, planning and policies, actions at micro and executive levels, and systems and Public transportation). Considering the structural and management factors associated with urban traffic and urban transportation in Sanandaj is very important in macro and management planning. Actions at trans-provincial and inter-city levels are needed to solve the problems of urban traffic congestion in Sanandaj. Functional measures are proposed to reduce traffic such as the efficiency of the public transportation system.

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Spiritual health is an important aspect of health that can create hope and inner peace in individuals, giving meaning to life. The aim of this study was to evaluate spiritual health of female prisoners and its relation to the type of crime.
This descriptive-analytical study was conducted on 150 female prisoners in 2016. To measure the spiritual health, the Palutzian and Ellison spiritual health questionnaire and a demographic questionnaire including demographic data, type of crime, and sentence length were used. The collected data were analyzed using Chi-square, ANOVA and Scheffe test. In this study, the ethical issues were all considered and the authors declared no conflict of interest.
The results indicated 27 participants (18%) with poor spiritual health, 90 (60%) with moderate spiritual health, and 33 (22%) with high spiritual health. The results also showed that convicts of murder and accomplices in murder and those sentenced to death were at the lowest level of spiritual health. Overall, spiritual health relationship to type of crime and sentence length was statistically significant (P Given the low spiritual health of female prisoners and its relationship to the severity of the offense, it seems necessary that policies promoting spiritual health of the prisoners which are consistent with the evidence be taken so that not only other aspects of prisoner's health are improved but also crimes are prevented from recurring.

Spirituality is taken deeply into consideration as a part of health because of its role in the control of chronic diseases and its importance in determination of life purpose in the elderly. This study aimed to investigate the association between spiritual health and blood sugar control in elderly patients with type 2 diabetes.
This cross-sectional study was conducted on 200 elderly patients with type 2 diabetes from 10 rural health centers of Urmia city, North West of Iran. These patients were selected by cluster random sampling. Data were collected by Spiritual Well-Being Scale of Paloutzian and Ellison. Glycated hemoglobin (HbA1c) was used to measure blood sugar control status of diabetic patients. Data were analyzed using descriptive statistics and chi-square test and Pearson correlation coefficient in SPSS software.
The spiritual health score in 43% of the elderly with diabetes was moderate and 57 % had high spiritual health level. There was statistically significant relationship between Spiritual health and gender, age, education, occupation and economic status. The results also showed that there was no significant correlation between spiritual health and its subdomains with HbA1c (r=0.07).
In this study, there was no statistically significant difference between spiritual health scores in patients with uncontrolled and controlled blood sugar. It is suggested to conduct case-control study with larger sample size on factors affecting blood sugar control.

Today, chronic diseases such as high blood pressure are increasing; this disease is closely associated with lifestyle. Therefore, the current study was conducted to assess the effect of lifestyle modifying educational intervention on blood pressure control in patients with hypertension.
This Quasi-experimental study was conducted on 210 patients with hypertension, referring to health centers of Shabestar County, Iran in 2016. Patients were assigned into two groups of intervention (n = 105) and control (n = 105) using random multi-stage sampling method. The data was collected using standard life style questionnaire (LSQ) in four dimensions of exercise, weight control, nutrition, and mental and spiritual health, before and two months after the educational intervention. Data were analyzed in SPSS-21 using descriptive and inferential statistics, such as chi-squared, paired t-test and independent t-test.
The results showed that the mean scores of exercise, weight control, nutrition and mental health in the intervention group increased significantly after the intervention (P 0.05). Also, the educational intervention had a significant effect on reducing blood pressure in the intervention group compared with the control group (P According to the findings of the study, educational intervention is effective in promoting physical activity, improving weight management, nutrition and mental health in patients with hypertension. In addition, the results indicated that controlled blood pressure can be achieved by improving the lifestyle.

Skin cancer is one of the most common types of cancer in the world and in Iran as well. The incidence of this disease continues to climb. The present study was therefore aimed to investigate the copping with skin cancer among farmers in Chaldoran County in 2015.
Materials and Totally, 238 farmers from the rural areas of Chaldoran County participated in this analytical-descriptive study. They were selected through a multi-stage random sampling process. A reliable and valid questionnaire used by Tazval et.al was exploited for data collection. The gathered data were analyzed by the use of descriptive and analytic statistics in SPSS software (v. 21). A statistically significance level of p≤ 0.05 was considered. Ethical issues such as confidentiality of studied community were all considered.
A statistically significant relationship was observed between the education level of participants (p=0. 001) and their income status (p=0. 025). About 12.2% of respondents showed high perceived self-efficacy towards skin cancer protective behaviors. It was further found that response self-efficacy was low among 45.5% of community. The most of the farmers (61.8%) had moderate response cost towards skin cancer protective behaviors. The assessment of farmers copping status with skin cancer revealed that 182 (76.5%), 8 (3.4%) and 48 20.1%) respondents have an unacceptable, borderline, and acceptable copping appraisal, respectively.
The results of this study indicate that the farmers’ coping appraisal status towards skin cancer was low. Thus, it is necessary to design and implement appropriate interventions in this field.

Adolescence is a critical stage of growth and development. That is associated with changes in body shape and appearance. Issues such as irregular menstrual periods, amenorrhea, and menstrual cycle are major issues in women's health. The purpose of this study was to examine the determinants of physical puberty health based on the Health Belief Model (HBM) among female adolescents.
This analytical cross sectional study was conducted in welfare boarding centers in Tehran, Iran. Data were collected in 2011 by a structured and valid questionnaire. Total 61 female adolescents (age range: 12-19 yrs) participated in this study from welfare boarding centers in Iran, Tehran, by using convenience sampling method. The questionnaire consisted of demographic characteristics, health belief model constructs and physical puberty health behaviors gathered by using interview. A series of univariate general linear models were used to assess the relationship between puberty health and health belief model constructs.
According to the results of this study there were positive significant relationships between perceived susceptibility, perceived benefits, perceived barriers, cues to action and increased puberty health in female adolescents (p Based on the results of the study to improve the physical Puberty health behaviors of female adolescents should make them aware of the benefits of health behaviors, and remove or reform the perceived barriers of health behaviors. Also, the appropriate information resources should be introduced for obtaining information about puberty health.

Focus group discussion is a research methodology in which a small group of participants gather to discuss a specified topic or an issue to generate data. Menstrual prob-lems are a major cause of morbidity for women. This study mainly aims to determine the impact health education based on focus group discussion on promotion Hygienic practices during menstrua-tion of female adolescents welfare boarding centers of Tehran city. This is a quasi-experimental intervention study، conducted Female adoles-cents inhabitant welfare boarding centers of Tehran city. All eligible persons were selected (n=61). Data collection tool was a questionnaire including demographic information، performance regarding pubertal physical health and that completed before training and one month after training by inter-view. Educationalinterventionwasimplementedin3 months. Data was analyzed by statistical methods (Paired T Test and Kalmogorov– Smiranov Test) using SPSS16 software. After educational intervention the mean scores of Hygienic practices during menstruation increased from 12/114/43 to 16/502/79 based on Statistical test was significant (P<0/001). After training through group discussion Increased Hygienic practices during menstrua-tion، so this method can be used in education to girls during puberty.

The health promoting behaviors is an important aspect of health promo-tion for the health of pregnant women and their children. The study aimed to assess the health promot-ing behaviors of pregnant women referred to Imam Khomeini Hospital in in Saqqez. This was a descriptive study using convenience sampling. Altogether, 181 pregnant women were recruited from an in pregnant women’s center. The data collection tools used in the study was (i) a questionnaire that was used to collect sociodemographic data from the participants and (ii) the Health Promoting Lifestyle Profile II (HPLP II). The results obtained from the study showed Health promotion behavior in pregnant women highest scores were obtained on the spiritual growth dimension and the lowest scores on the physical activity dimension. Health promotion behavior total score was moderate. Thus on the basis of t test there was meaningful relationship between job demographic variable (P<0.032). The results indicate that the optimal level of health promoting behaviors in this group of women is ethnicity. It is recommended that in areas such as subscale physical activity, stress manage-ment and health responsibility and other studies in other ethnicity to be done with the more sample size.