Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 13 2 2025 4 1 The Effect of a Health Promotion Program Based on Longwe\'s Empowerment Framework on Self-efficacy, Perceived Social Support and Health Enablers among Postmenopausal Women: a Randomized Controlled Trial 113 127 FA khadijeh Khademi PhD candidate of Health Promotion, Student Research Committee, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran. khademikhadijeh@gmail.com N Mohammad Hossein Kaveh Professor, Research Center for Health Sciences, Institute of Health, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran. kaveh@sums.ac.ir Y Mahin Nazari Associate Professor, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran. manazar@sums.ac.ir N Abdolrahim Asadollahi Assistant Professor, Department of Gerontology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran. gs21205@gmail.com N 10.22034/13.2.8 Background and Objectives: Menopause is an important stage in a woman's life. Therefore, menopausal women should prioritize maintaining and improving their health and quality of life. Self-efficacy, social support and health enablers are among the most important determinants of health and quality of life for postmenopausal women. The present study examines the effect of an educational program based on Longwe's empowerment framework on self-efficacy, social support, and health enablers of postmenopausal women. Materials and Methods: This study is a randomized controlled trial with simple random sampling. It was conducted on 140 postmenopausal women in Shiraz from November 2023 to May 2024. The intervention group participated in six 120-minute training sessions over 6 weeks. Data were collected using the General Self-Efficacy Belief Scale (GSES), the Multidimensional Scale of Perceived Social Support (MSPSS), and a researcher-made questionnaire about women's health enabling factors before, two weeks, and four months after the intervention. The reliability of these tools were determined using Cronbach’s alpha coefficients of 0.82, 0.84, and 0.70, respectively. Data analysis was performed using Independent t, Chi-square and ANOVA Repeated Measure tests in SPSS 27 software. A p<0.05 was considered statistically significant. Results: The findings demonstrate a significant improvement with a medium effect size in self-efficacy (η² = 0.06, p = 0.01), and perceived social support (η² = 0.07, p = 0.006), as well as a large effect size on women's health enablers (η² = 0.19, p < 0.001). Conclusion: The health promotion program based on Longwe's empowerment framework resulted in a significant improvement in self-efficacy, perceived social support, and health enablers of postmenopausal women. Therefore, it is recommended to implement empowering educational programs based on health theories for postmenopausal women in all health centers. Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ Menopause, Self-Efficacy, Social Support, Empowerment, Women http://journal.ihepsa.ir/article-1-2957-en.html http://journal.ihepsa.ir/article-1-2957-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 13 2 2025 4 1 The Effect of Educational Intervention Based on the Pender’s Health Promotion Model on Fatigue of Patients after Chemotherapy: An Interventional Study 128 142 FA Maryam Bahrami MSc Student, Clinical Care Research Center, Department of Nursing, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran. bahramim7155@gmail.com N Hossein Feizi Instructor, Clinical Care Research Center, Department of Nursing, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran. h_feyzi65@yahoo.com N Alireza Abdi Associate professor of nursing education, nursing and midwifery school, Kermanshah University of Medical Sciences, Kermanshah, Iran. abdialireza@yahoo.com N Yousef Moradi Assistant professor. Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. yosefmoradi@yahoo.com N Mokhtar Mahmoudi Instructor, Clinical Care Research Center, Department of Nursing, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran. mahmodimokhtar85@gmail.com Y 10.22034/13.2.6 Background and Objective: Cancer is a chronic and debilitating disease and one of the prevalent side effects of cancer treatment is fatigue. The aim of this study was to determine the effectiveness of education base on Pender's health promtion model on the level of fatigue and lifestyle of cancer patients. Materials and Methods: The present study is an experimental before-and-after study with a control group. This interventional study involved 78 cancer patients selected through convenience sampling in 2023 and then randomly allocated to intervention and control groups using block randomization. All participants in both groups completed demographic information forms, the Cancer Fatigue Scale to assess demographic characteristics and fatigue levels before and after the intervention. Data were analyzed using independent and paired t-tests, and non-parametric tests including the Mann-Whitney U and Wilcoxon tests. All analyses were conducted using SPSS20 (p=0.05). Results: The intervention and control groups were homogeneous in terms of demographic indices and fatigue level before the intervention (P<0.1). After the intervention, the results indicated an improvement in all dimensions and a reduction in fatigue levels in the intervention group compared to the control group (P<0.05). Conclusion: Education based on Pender's health promotion model has a significant effect on reducing the fatigue of patients undergoing chemotherapy and can help to improve physical and mental conditions and increase the quality of life of these patients along with drug treatments. Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/   Cancer, Pender Model, Health Promotion, Fatigue, Patients http://journal.ihepsa.ir/article-1-2938-en.html http://journal.ihepsa.ir/article-1-2938-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 13 2 2025 4 1 New Strategies needed to Health Promotion governance in the Iranian Health System: Based on the results of a Futures Studies 143 148 FA Fatemeh Saadati Tabriz University of Medical Sciences, East Azarbaijan Province, Tabriz, Iran. fatemee.saadati@gmail.com N Haidar Nadrian Research Center of Social determinants of Health, Tabriz University of Medical Sciences, Tabriz, Iran. haidarnadrian@gmail.com Y Mohammad Hossein Taghdisi Department of Public Health, Faculty of Health and Medical Engineering, Islamic Azad University of Medical Sciences, Tehran, Iran. taghdisi.mh@gmail.com N 10.22034/13.2.4  According to the Ottawa Charter (1986), health promotion is a process that enables people to take control of their health and improve it. In many developed countries, the “health promotion approach” is considered as the governing approach in their health system governance. Taking into account their experiences, it can be inferred that as long as the governing approach to Iran's health system is the “biomedical approach”, the implementation of programs such as the “Family physician plan”, the “Health system reforms”, and the “IRAPENI” can only play a sedative role in overcoming the challenges of Iran's health care system. Therefore, the solution to overcome the challenges of this system seems to be the governance of the “Health promotion approach” in the health system. The results of a futures study conducted by the authors of current paper during the years 2019 to 2023 entitled "Futures study on the governance of “Health promotion approach” in Iran's health system" in the field of health education and promotion revealed three favorable, unfavorable and static scenarios in the Iran's health system governance by the year 2034. In this article, the description of the favorable scenario is presented, and based on that, a set of strategies are proposed at the end of the article. These scientific and evidence-based strategies may be helpful for the Iranian health policy makers and stakeholders in realizing the favorable scenario of the “governance of health promotion approach” within Iran's health care system. Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/   Health Promotion, Health System, Futures Studies, Policy Development http://journal.ihepsa.ir/article-1-2879-en.html http://journal.ihepsa.ir/article-1-2879-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 13 2 2025 4 1 The Effectiveness of an Educational Intervention Based on Self-Efficacy and Social Support on the Mental Health of Families of Persons with Disabilities 149 159 FA Maryam Sadat Hashemi Moghadam Ms Health education. Public Health group, School of Health, Zahedan University of Medical Sciences, Zahedan, Iran. mogadamm939@gmail.com N Fariba Shahraki-Sanavi Assistant Professor, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran faribasanavi@gmail.com Y Iraj Zareban Professor, Health Promotion Research Center, School of Health, Zahedan University of Medical Sciences, Zahedan, Iran. zareban@gmail.com N Mehdi Mohamadi Professor, Health Promotion Research Center, School of Health, Zahedan University of Medical Sciences, Zahedan, Iran. memohammadi@yahoo.com N 10.22034/13.2.2 Background and Objective: Families of persons with disabilities who do not have adequate social support do not have proper mental health, and this puts the health of the community at risk. This study aimed to investigate the effectiveness of an educational intervention based on self-efficacy and social support on the mental health of families of persons with disabilities. Materials and Methods: This semi-experimental study was conducted on 100 families with a child with a disability, with random sampling, in 2022 in Zabol city. The data collection tool, with appropriate validity and reliability, included demographic information, awareness, attitude, self-efficacy, mental health, social support, and a questionnaire on the experiences of received services. The educational intervention was conducted for four weeks and eight educational sessions in the form of question and answer, pamphlet presentation, educational video display, and group discussion. WhatsApp groups were also created to send educational messages. After one month, the post-test was performed. The obtained data were analysed using SPSS23 software and chi-square, t, and logistic regression tests. Results: There was a statistically significant difference between the mean change scores of awareness, attitude, self-efficacy, mental health, and social support score in the intervention and control groups after the educational intervention (p<0.001). The results of the regression test showed that only the social support structure had a significant effect on the mental health of families of persons with disabilities (P<0.05). Conclusions: The educational program based on self-efficacy and social support was effective on the mental health of families with a member with a disability. Therefore, it is recommended to implement educational interventions with an emphasis on social support to promote the mental health of families with a member with a disability. Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ Disability, Self-Efficacy, Mental Health, Social Support http://journal.ihepsa.ir/article-1-2813-en.html http://journal.ihepsa.ir/article-1-2813-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 13 2 2025 4 1 Effect of Educational Intervention Based on Motivational Protection Theory on Colorectal Cancer Screening Behaviors of Middle-aged Adults aged 45 to 55 in Eastern Iran 160 172 FA Mojtaba Hajizadeh Maaster's health education and promotion student, Faculty of Health, Gonabad University of Medical Sciences, Gonabad, Iran. mojtabahajizadh@ymail.com N Mahdi Moshki Professor, Department of Health Education and Health Promotion, Faculty of Health, Social Determinants of Health Research Center, Research Center, Gonabad University of Medical Sciences, Gonabad, Iran. drmoshki@gmail.com N Nasim Khajavian Instructor, Department of Biostatistics and Epidemiology, Faculty of Health, Reproductive Health and Population Research Center, Gonabad University of Medical Sciences, Gonabad, Iran. naja_khajavian@yahoo.com N Mitra Dogonchi Assistant Professor, Department of Health Education and Health Promotion, Faculty of Health, Social Determinants of Health Research Center, Research Center, Gonabad University of Medical Sciences, Gonabad, Iran dogonchi.mitra@yahoo.com Y 10.22034/13.2.1 Background and objectives: Due to the increasing incidence of colon cancer in the world and Iran and the decrease in the age of the disease, people are strongly encouraged to perform available care and screenings, so the present study aims to determine the effect of educational intervention based on the theory of protection motivation on screening. Colon cancer was performed in middle-aged people of Tabas City. Materials and Methods: This research was a randomized controlled trial intervention study. The sample size in this study was 80 middle-aged people aged 45 to 55 years, covered by Tabas Comprehensive Health Service Centers in 2023, who were selected through a two-stage random sampling method. The intervention group participated in six 60-minute training sessions based on protective motivation theory, using videos prepared with artificial intelligence, posters, pamphlets, and infographics. The data was collected using a demographic information questionnaire and, according to the protection motivation theory constructs, analyzed using SPSS version 26 statistical software at a significance level of 0.05. Results: The results of this study showed that the average score of awareness and all constructs of protective motivation theory increased in the intervention group compared to the control group after the educational intervention. A significant difference was observed between the two groups (p < 0.001). Additionally, the colon cancer screening rate among middle-aged individuals aged 45 to 55 increased following the intervention, with fit test participation rising to 18.6% and colonoscopy participation to 8%. Conclusion: The results showed the effectiveness of an educational intervention based on the protective motivation theory in promoting colon cancer screening. Therefore, it is recommended that educational interventions based on this theory using modern and localized media be designed to educate and promote community health. Open Access Policy: This is an open-access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ Screening, Colon Cancer, Protection Motivation Theory, Middle-Aged http://journal.ihepsa.ir/article-1-2802-en.html http://journal.ihepsa.ir/article-1-2802-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 13 2 2025 4 1 The Effect of Educational Intervention Based on Social Cognitive Theory on Self-care Behavior of Patients with Diabetes Referring to Comprehensive Health Service Centers in Fasa 173 188 FA Laleh Hassani Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. 7hassani1969@gmail.com N Asiyeh Yari Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. yariasi98@yahoo.com Y Shokrollah Mohseni Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran mohseni57faryab@gmail.com N 10.22034/13.2.5 Background and objectives: Diabetes is the most common chronic metabolic disease in the world. The present study was conducted with the aim of determining the effect of an educational program based on social cognitive theory on the self-care behaviors of patients with type 2 diabetes in Fasa city. Materials and Methods: This semi-experimental study was conducted in 2018 on 106 patients with type 2 diabetes referring to comprehensive health service centers in Fasa city. The samples were randomly divided into two intervention groups (53 people) and control (53 people). The data was collected by the standard questionnaire of self-care behavior and the researcher-made questionnaire of social cognitive theory, which was completed by both intervention and control groups before and 3 months after the educational intervention. The educational intervention was held during 12 sessions of 60-90 minutes using lecture methods, providing an automatic disk program for the intervention group. The data were analyzed by SPSS software version 23 and descriptive statistical tests, chi-square, independent t and paired t. The significance level (p < 0.05) was considered. Results: The average age of patients in the intervention group was 48.81±8.56 years and the control group was 49.37±8.60 years. After the educational intervention, the average scores of awareness and all constructs of social cognitive theory and self-care behavior in the test group increased significantly compared to the control group (p<0.05). Also, Hemoglobin A1C and Fast Blood Sugar decreased after the intervention in the test group compared to the control group (p<0.05). Conclusion: According to the results of the present study, self-care increased in the patients of the intervention group compared to the control group after the educational intervention, so social cognitive theory can be a suitable framework for designing educational interventions to promote self-care behaviors in patients with diabetes. Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ Education, Social Cognitive Theory, Self-care Behavior, Type 2 Diabetes, Fasa http://journal.ihepsa.ir/article-1-2917-en.html http://journal.ihepsa.ir/article-1-2917-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 13 2 2025 4 1 The Effect of Self-care Training Based on Orem\'s Theory on the Quality of Life of Parents of Children with Celiac Disease 189 199 FA Zahra Khalilzadeh Farsangi Master of Community Health Nursing, Student Research Committee, Zahedan University of Medical Sciences, Zahedan, Iran. zahrakhlilzde@gmail.com N Mahsa Yousefi Master of Internal Surgery Nursing, , Student Research Committee, Zahedan University of Medical Sciences, Zahedan, Iran. Mahsayosefi76@gmail.com N Azizollah Arbabi Sarjou Associate Professor of Nursing Education, Department of Nursing, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran. arbabisarjou207@gmail.com N Samaneh Fallah Karimi Instructor, Department of Nursing, Faculty of Nursing and Midwifery, Torbet Heydarieh University of Medical Sciences, Torbet Heydarieh, Iran. sfallah084@gmail.com Y 10.22034/13.2.7 Background and Objective: Celiac disease has a significant impact on the quality of life of children and their families. Orem’s theory, with its focus on empowerment and self-efficacy, provides an appropriate framework for designing self-care interventions. Therefore, this study aims to investigate the effect of self-care education based on Orem’s theory on the quality of life of parents of children with celiac disease. Materials and Methods: In this semi-experimental study (pre-test–post-test design), 70 parents of children with celiac disease attending educational hospitals in Zahedan in 2024 were selected using a convenience sampling method and randomly assigned into two groups of 35 each (intervention and control) by coin toss. In the intervention group, four in-person self-care education sessions based on Orem’s self-care theory were conducted. Before and one month after the intervention, quality of life was measured using the World Health Organization Quality of Life questionnaire. Data were analyzed using SPSS version 27, employing Chi-square, paired t-test, and independent t-test statistical tests. Results: The mean age of children in the intervention group was 8.65 ± 1.74 years, and in the control group, it was 8 ± 2.07 years. The mean general quality of life score before the intervention in the intervention and control groups was 50.37 ± 5.04 and 49.71 ± 5.51, respectively. After the intervention, in the intervention group, it increased to 56.02 ± 5.01, while in the control group, it was 50.17 ± 5.69. Self-care education based on Orem's model significantly improved the quality of life in all domains for the intervention group (p<0.001). Conclusions: The results indicate that the self-care model based on Orem’s theory is an effective method for improving the quality of life of parents of children with celiac disease, and it is recommended to be included in support programs for these parents. Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ Self-care, Quality of Life, Parents, Celiac http://journal.ihepsa.ir/article-1-2956-en.html http://journal.ihepsa.ir/article-1-2956-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 13 2 2025 4 1 Evaluating the Impact of an Educational Intervention Based on the Adapted Mental Health Literacy Curriculum on Barriers and Help-Seeking Behaviors Among High School Students 200 212 FA Zahra Saboohi Department of Health Services, School of Public Health, Iran University of Medical Sciences, Tehran, Iran saboohizahra2020@gmail.com N Mahsa Nazarnia Department of Health Education and Promotion, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran mhealthliteracy@gmail.com N Avasadat Hoseini Department of Health, Faculty of Medical Sciences, Karaj Branch, Islamic Azad University, Karaj, Iran avasadat.hosseini@yahoo.com N Mahnaz Solhi Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran solhi80@yahoo.com Y 10.22034/13.2.3 Background and Objectives: Mental health disorders are significant public health challenges that impact adolescents. In Iran, the high prevalence of mental health issues and the lack of help-seeking behavior among adolescents highlight the necessity of improving mental health literacy. This study aimed to evaluate the impact of an educational intervention based on the Canadian Mental Health Literacy Curriculum (adapted for Iran) on reducing barriers and improving help-seeking behaviors among high school students. Materials and Methods: This was a quasi-experimental, cluster-based study conducted in 2023 among 200 female high school students in Saveh, Iran. Participants were selected using multistage cluster sampling and were randomly assigned to either the intervention group (n = 100) or the control group (n = 100). Data collection tools included standard questionnaires on "Barriers to Help-Seeking" and "Help-Seeking Behaviors." The intervention group participated in a 6-week educational program. Data were collected at three time points (before, one month after, and three months after the intervention) and analyzed using SPSS version 21 and repeated-measures ANOVA. Results: Results indicated that variables were homogenous between the two groups prior to the intervention. Following the intervention, a significant reduction in perceived barriers to help-seeking was observed in the intervention group (p < 0.05). However, while there was an increase in help-seeking behaviors in the intervention group, the change was not statistically significant (p > 0.05). No significant differences were observed in the control group before and after the intervention (p > 0.05). Conclusion: The findings suggest that the adapted Mental Health Literacy Curriculum effectively reduced perceived barriers and fostered a more positive attitude toward help-seeking. However, these changes did not significantly translate into improved help-seeking behaviors. This study underscores the importance of designing interventions that not only enhance mental health literacy but also improve access to services, strengthen self-efficacy, and address perceived barriers among adolescents. Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ Mental Health Literacy, Barriers, Help-Seeking Behavior, Early Intervention, Educational, Adolescent http://journal.ihepsa.ir/article-1-2837-en.html http://journal.ihepsa.ir/article-1-2837-en.pdf