BackgroundPhysical activity (PA) rates decline precipitously during the high school years and are consistently lower among adolescent girls than adolescent boys. Due to cultural barriers, this problem might be exacerbated in female Iranian adolescents. However, little intervention research has been conducted to try to increase PA participation rates with this population. Because PA interventions in schools have the potential to reach many children and adolescents, this study reports on PA intervention research conducted in all-female Iranian high schools.MethodsA randomized controlled trial was conducted to examine the effects of two six-month tailored interventions on potential determinants of PA and PA behavior. Students (N = 161) were randomly allocated to one of three conditions: an intervention based on Pender's Health Promotion model (HP), an intervention based on an integration of the health promotion model and selected constructs from the Transtheoretical model (THP), and a control group (CON). Measures were administered prior to the intervention, at post-intervention and at a six-month follow-up.ResultsRepeated measure ANOVAs showed a significant interaction between group and time for perceived benefits, self efficacy, interpersonal norms, social support, behavioral processes, and PA behavior, indicating that both intervention groups significantly improved across the 24-week intervention, whereas the control group did not. Participants in the THP group showed greater use of counter conditioning and stimulus control at post-intervention and at follow-up. While there were no significant differences in PA between the HP and CON groups at follow-up, a significant difference was still found between the THP and the CON group.ConclusionThis study provides the first evidence of the effectiveness of a PA intervention based on Pender's HP model combined with selected aspects of the TTM on potential determinants to increase PA among Iranian high school girls.

We explored the role of religiosity and spirituality on (i) feelings and attitudes about breast cancer, (ii) strategies for coping with breast cancer, and (iii) health care seeking behaviors among breast cancer survivors in Iran. We conducted in-depth semistructured interviews with 39 breast cancer survivors. We found that spirituality is the primary source of psychological support among participants. Almost all participants attributed their cancer to the will of God. Despite this, they actively have been engaged with their medical treatment. This is in surprising contrast to Western cultures in which a belief in an external health locus of control diminishes participation in cancer screening, detection, and treatment. These findings can help researchers to provide a framework for the development of appropriate and effective culturally sensitive health interventions.

BackgroundPeople living with HIV (PLHIV) sometimes experience discrimination. There is little understanding of the causes, forms and consequences of this stigma in Islamic countries. This qualitative study explored perceptions and experiences of PLHIV regarding both the quality of healthcare and the attitudes and behaviours of their healthcare providers in the Islamic Republic of Iran.MethodsIn-depth, semi-structured interviews were held with a purposively selected group of 69 PLHIV recruited from two HIV care clinics in Tehran. Data were analyzed using the content analysis approach.Results and discussionNearly all participants reported experiencing stigma and discrimination by their healthcare providers in a variety of contexts. Participants perceived that their healthcare providers' fear of being infected with HIV, coupled with religious and negative value-based assumptions about PLHIV, led to high levels of stigma. Participants mentioned at least four major forms of stigma: (1) refusal of care; (2) sub-optimal care; (3) excessive precautions and physical distancing; and (4) humiliation and blaming. The participants' healthcare-seeking behavioural reactions to perceived stigma and discrimination included avoiding or delaying seeking care, not disclosing HIV status when seeking healthcare, and using spiritual healing. In addition, emotional responses to perceived acts of stigma included feeling undeserving of care, diminished motivation to stay healthy, feeling angry and vengeful, and experiencing emotional stress.ConclusionsWhile previous studies demonstrate that most Iranian healthcare providers report fairly positive attitudes towards PLHIV, our participants' experiences tell a different story. Therefore, it is imperative to engage both healthcare providers and PLHIV in designing interventions targeting stigma in healthcare settings. Additionally, specialized training programmes in universal precautions for health providers will lead to stigma reduction. National policies to strengthen medical training and to provide funding for stigma-reduction programming are strongly recommended. Investigating Islamic literature and instruction, as well as requesting official public statements from religious leaders regarding stigma and discrimination in healthcare settings, should be used in educational intervention programmes targeting healthcare providers. Finally, further studies are needed to investigate the role of the physician and religion in the local context.

Physical activity (PA) helps to prevent osteoporosis, but older women are often sedentary. This study used a pre-post randomized controlled design to evaluate a 12-week exercise education intervention program based on the stages of change (SoC) and processes of change from the transtheoretical change model (TTM) to improve adherence with strength and balance training recommendations at levels sufficient to prevent osteoporosis in Iranian women aged 40-65 years. The home-based exercise prescription consisted of strength and balance training that was progressive, individually tailored and included a walking program. Individuals in the training group (n=61) had a positive, significant progression in psychological SoC (P<0.001), whereas no progression in stages occurred in the control group (n=55). After the intervention, the training group demonstrated significant improvements in PA, lower body muscle strength, static and dynamic balance, with no significant changes in the control group. These results support the applicability of the TTM for a PA intervention and indicate that this training program is very effective in improving balance and lower body strength in older women.

Background: It is believed that smoking is the gateway to use substances and illicit drugs. Due to an increase in smoking among students, we thought there is a need for more efficient ways to prevent smoking among the young and adolescents. Objectives: This study aimed to develop an extended version of the Health Belief Model (HBM) with elements of Health Literacy (HL) to assess whether an educational intervention could be effective in smoking prevention based on this new development in 2016. Methods: This was a quasi-experimental study performed on 130 students living in dormitories of Shahid Beheshti University of Medical Sciences in Tehran, Iran, who were recruited and assigned to experimental and control groups (each containing 65 students). The experimental group received 6 electronic educational sessions via telegram application while the control group received no intervention. The data were collected using a questionnaire containing items on HBM, smoking preventive behaviors, and a measure of HL (the HL inventory for adults-HELIA). The questionnaire was completed at three time-points: before, immediately and three months after the intervention. The significance level was set at 0.05. Results: Before the intervention, there was no significant difference in the demographic and background variables, the underlying level of knowledge, preventive behaviors, HL, and all the constructs of the model between the groups (P > 0.05). After the intervention, comparing two groups showed that the mean scores of knowledge, preventive behaviors, HL, and all components of the model changed significantly in the experimental group compared to the control group (P < 0.05). The mean and standard deviation of adoption of smoking preventive behaviors at the beginning of the study in smoking and non-smoking students in the

Women play the most important role in Iranian families. Therefore, it is necessary to pay attention to efforts to maintain and promote their health. The diagnosis and treatment of breast cancer have significant physical and psycho-social impacts on patients, families and friends. This qualitative study was designed to analyze the role of several social and cultural factors and their relationship to health-related quality of life among Iranian breast cancer survivors. In-depth semi-structured and unstructured faceto-face interviews were conducted with 39 breast cancer survivors. The results of the present study revealed that most prevalent physical problems that were reported by Iranian breast cancer survivors were fatigue, pain and lymphedema related to the adverse effects of mastectomy. We found that most participants have a strong sense of spirituality and used this as a source of psychological support to help them accept their disease. Spirituality has been found to be a strong source of psychological support among Iranian breast cancer survivors. Religious faith has provided this community the strength and motivation to seek medical treatment and to be patient and relax. These findings can help researchers to provide a framework for the development of appropriate and effective culturally sensitive health interventions.

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BackgroundThis study carried out to develop a scale for assessing diabetic patients' perceptions about physical activity and to test its psychometric properties (The Physical Activity Questionnaire for Diabetic Patients-PAQ-DP).MethodsAn item pool extracted from the Theory of Planned Behavior literature was generated. Then an expert panel evaluated the items by assessing content validity index and content validity ratio. Consequently exploratory factor analysis (EFA) was performed to indicate the scale constructs. In addition reliability analyses including internal consistency and test-retest analysis were carried out.ResultsIn all a sample of 127 women with diabetes participated in the study. Twenty-two items were initially extracted from the literature. A six-factor solution (containing 19 items) emerged as a result of an exploratory factor analysis namely: instrumental attitude, subjective norm, perceived behavioral control, affective attitude, self-identity, and intention explaining 60.30% of the variance observed. Additional analyses indicated satisfactory results for internal consistency (Cronbach's alpha ranging from 0.54 to 0.8) and intraclass correlation coefficients (ranging from 0.40 to 0.92).ConclusionsThe Physical Activity Questionnaire for Diabetic Patients (PAQ-DP) is the first instrument that applies the Theory of Planned Behavior in its constructs. The findings indicated that the PAQ-DP is a reliable and valid measure for assessing physical activity perceptions and now is available and can be used in future studies.