Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 14 3 2026 4 1 The Effect of a Protection Motivation Theory–Based Educational Intervention on Preventive Behaviors against Animal Bites in Elementary School Students 1 12 FA Zahra Khoshkharam MSc Student in Health Education and Promotion, Mashhad University of Medical Sciences, Mashhad, Iran. khoshmaramz4012@mums.ac.ir N Elham Charoghchian-Khorasani Department of Health Education and Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran. echaroghchian@yahoo.com N Bahare Behrozi MSc Student in Health Education and Promotion, Mashhad University of Medical Sciences, Mashhad, Iran. behrouzib4012@mums.ac.ir N Samane Saboori Social Determinants of Health Research Center, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran. SabouriSM@mums.ac.ir N Nooshin Peyman Department of Health Education and Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran peymann@mums.ac.ir Y 10.22034/ijhep.14.3.3 Background and Objective: Animal bites are considered a public health concern worldwide. This study was conducted to determine the effect of an educational intervention based on Protection Motivation Theory on preventive behaviors against animal bites among female elementary school students in the city of Mashhad. Materials and Methods: This quasi-experimental study was conducted on 122 girls aged 7–12 years in Mashhad during the 2024–2025 academic year. Participants were divided into intervention and control groups (61 students in each group) using a multistage random sampling method. The data collection tool was a two-part questionnaire including demographic information and a researcher-made animal bite prevention questionnaire, which was completed in three stages: before, immediately after, and three months following the educational intervention. The educational intervention was conducted in five sessions, each lasting 30 minutes. Data were analyzed using the Mann–Whitney, Friedman, and Chi-square tests in SPSS version 20. A significance level of 0.05 was considered. Results: According to the results, the mean age of the students was 9.59 ± 1.79 years in the intervention group and 9.57 ± 1.63 years in the control group. Immediately after the intervention and also at the three‑month follow‑up, the mean scores of the Protection Motivation Theory constructs in the intervention group were significantly different compared with the control group (p < 0.05). Conclusion: The results of the present study indicated the effectiveness of an educational intervention based on Protection Motivation Theory in improving animal bite preventive behaviors among female elementary school students. Therefore, it is recommended that school educational programs be designed using this theory to enhance students’ awareness and safe behaviors and to prevent consequences such as rabies. 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/ Protection Motivation Theory, Animal Bites, Students, Education http://journal.ihepsa.ir/article-1-3178-en.html http://journal.ihepsa.ir/article-1-3178-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 14 3 2026 4 1 Intersectoral Synergy for Urban Health Promotion: A Qualitative Study of the Interaction Between the Health System and City Councils in Iran 13 26 FA Maryam Paydar Department of Environmental Health Engineering, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran. paydarm1@mums.ac.ir N Najmeh Khodadadi Department of Health, Safety, Environment management, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran. khodadadinj@mums.ac.ir Y Aidin Aryan Khesal University of East Anglia, Norwich, UK. A.Aryankhesal@uea.ac.uk N Ali Vafaee najar Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran. vafaeea@mums.ac.ir N 10.22034/ijhep.14.3.2 Background and Objective: The COVID-19 pandemic has highlighted the critical need for targeted collaboration between the health system and local institutions globally. Successful experiences of various countries in this crisis have shown that effective intersectoral collaboration can greatly improve crisis management. This study aimed to investigate the interaction between the Iranian health system and city councils to promote community health by relying on institutional collaboration in 2004. Materials and Methods: This qualitative research was conducted using semi-structured interviews with key experts from the Ministry of Health, universities of medical sciences, and metropolitan city officials. Purposive sampling using the snowball method was used to select 15 participants to achieve a diversity of perspectives. To ensure the accuracy and validity of the data, the criteria of validity, reliability, transferability, and verifiability were systematically implemented. The interviews were transcribed and analyzed line by line, categorized through thematic content analysis, and codes were organized using MaxQDA 12 software based on common concepts. Results: The analyses revealed two main themes of barriers to participation and partnership solutions, which included seven subthemes, 21 categories, 15 subcategories, and 9 sub-subcategories. The most important barriers to participation included a deterrent attitude, resistance to change, a weak culture of participation, lack of awareness, and parallel work. The suggested solutions included using existing capacities, creating permanent cooperation mechanisms, integrating public policies, improving citizen satisfaction, and facilitating joint planning. Conclusion: The study findings showed that despite the existence of numerous structures and related laws, the partnership between the health system and municipalities still faces many challenges. Therefore, developing a practical framework to strengthen cooperation between health institutions and urban management seems essential. This framework should avoid creating new structures and controversial laws and focus on cultural alignment, utilizing existing resources, and strengthening infrastructure. Such a partnership model can reduce costs, improve population health, and increase the resilience of the country's health system against future crises. 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/ Intersectoral Collaboration , Urban Health, Health Systems , City Councils , Qualitative Research http://journal.ihepsa.ir/article-1-3145-en.html http://journal.ihepsa.ir/article-1-3145-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 14 3 2026 4 1 Investigating the Predictive Factors Affecting Waste Separation Behavior in Northern Iran: A Study Based on the Theory of Planned Behavior (TPB) 27 43 FA Elham Falahati Naghibi Student Research Committee, Babol University of Medical Sciences, Babol, Iran. efn2208@gmail.com N Neda Ahmadzadeh Tori Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Neda.ahmadzade.tori@gmail.com N Hamid Sharif-Nia Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran pegadis@yahoo.com N Fatemeh Soltani Student Research Committee, Babol University of Medical Sciences, Babol, Iran. ghazalsoltani1401@gmail.com N Kimia Palouch Student Research Committee, Babol University of Medical Sciences, Babol, Iran. kimiapalouch@gmail.com N Zahra Abbaszadeh Student Research Committee, Babol University of Medical Sciences, Babol, Iran. zahraabbaszadeh156@gmail.com N Aram Tirgar Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. aramtirgar@yahoo.com N Mohammad Shirmardi Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. shirmardim@yahoo.com Y 10.22034/ijhep.14.3.6 Background and Objective: Source separation is the most critical stage in the waste management hierarchy and requires a thorough understanding of the factors influencing citizens' behavior. This study aimed to investigate the predictors of waste separation behavior among residents of Babol city based on the Theory of Planned Behavior. Materials and Methods: This cross sectional analytical study was conducted in 2024–2025 on 475 citizens of Babol. Convenience sampling was used. Data were collected using a standardized TPB based questionnaire and analyzed with JASP software using simple and multiple linear regression. Results: The final model explained 56.4% of the variance in waste separation behavior. Behavioral intention and perceived behavioral control were the strongest predictors, such that for every one‑unit increase in these variables, the behavior increased on average by 0.39 and 0.22 units, respectively. Attitude (β=0.09) and perceived policy effectiveness (β=0.13) also had significant contributions (p < 0.05). Among the demographic variables, only education level showed a significant relationship with the behavior (p <0.05). Conclusion: The findings indicated that focusing on strengthening behavioral intention and perceived behavioral control through education and providing necessary infrastructure, along with attention to the effective role of policies and education level, can guide the design of effective interventions to improve waste separation behavior in Babol city.   Waste Management, Theory of Planned Behavior, Behavioral Intention, Iran http://journal.ihepsa.ir/article-1-3258-en.html http://journal.ihepsa.ir/article-1-3258-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 14 3 2026 4 1 Examining the Psychometric Properties of the Health Literacy Tool Related to Fatty Liver among Women 44 56 FA Shilan Vakilinejad Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran. shilanvakili98@gmail.com N Azam Rahmani 2. Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran. N Parvaneh Taymoori Department of Public Health, School of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran. parvaneh.tay@gmail.com N Arezo Falahi Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. arezofalahi91@gmail.com Y 10.22034/ijhep.14.3.1 Background and Objective: Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver disorders and a leading cause of liver-related mortality, imposing a significant economic burden on society. This study aimed to design and psychometrically evaluate an instrument for assessing NAFLD-related health literacy in women.  Material and Methods: This psychometric study was conducted in 2024 in Sanandaj. The initial items were developed based on literature review, existing questionnaires, and relevant documents, resulting in a 97-item preliminary version. Face and content validity were assessed by a panel of experts and through interviews with eligible women. After content validation, the number of items was reduced to 33. The questionnaire was then administered to 330 women aged 18–60 years. Finally, reliability and construct validity were evaluated. Results: The face and content validity assessment of the 33 items showed acceptable indices, including an item impact score of 1.5, a content validity ratio  (CVR) of 0.62, and a content validity index  (CVI) of 0.79. Exploratory factor analysis identified six factors—basic skills, decision-making, comprehension, knowledge, analysis, and behavior—with factor loadings greater than 0.4, explaining 61.35% of the total variance. Cronbach’s alpha coefficients ranged from 0.71 to 0.90 for the subscales, and the overall reliability of the instrument was confirmed with an alpha of 0.94. Conclusion: The 33-item NAFLD health literacy questionnaire for Iranian women demonstrates satisfactory validity and reliability and is recommended for use in future studies to assess NAFLD-related health literacy. 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/ Psychometrics, Scale, Health literacy, Fatty liver, Women, Iran http://journal.ihepsa.ir/article-1-2895-en.html http://journal.ihepsa.ir/article-1-2895-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 14 3 2026 4 1 Stress Management in Primgravid Women: A Theory of Planned Behavior-Based Supportive-Educational Intervention 57 74 FA Zeinab Emami Alni Master's degree, Department of Health education and promotion, Faculty of Health, Qom University of Medical Sciences, Qom, Iran. www.zemami.alni@gmail.com N Esmail Soltani Assistant Professor, Department of Clinical Psychology, Faculty of Medical, Shiraz University of Medical Sciences, Shiraz, Iran ssoltani65@gmail.com N Abolfazl Mohammadbeigi Professor, Department of Epidemiology and Biostatistics, Faculty of Health, Qom University of Medical Sciences, Qom, Iran. www.beigi60@gmail.com N Zabihollah Gharlipour Professor, Department of Health education and promotion, Faculty of Health, Qom University of Medical Sciences, Qom, Iran. gharlipourz@yahoo.com Y 10.22034/ijhep.14.3.5 Background and Objective: Many of women describe pregnancy as one of the most stressful periods of their lives, and this phenomenon is more intense among primiparous women. On the other hand, pregnant mothers prefer non-pharmacological treatments for managing mood and anxiety disorders. The aim of this study was to assess the impact of a Supportive-Educational Intervention based on the Theory of Planned Behavior on stress management in primiparous women. Materials and Methods: In this quasi-experimental intervention, of 92 primiparous women from Qom city health centers – Iran spanning from December 2020 to June 2021, was randomly divided into two groups: the intervention group and the control group. Multistage sampling method used in the study. The intervention group participated in a 5-week, 10-session educational program. Data were collected using a set of questionnaires, including those for demographic information, the Zimet Social Support Scale, the Depression Anxiety Stress Scale(DASS-21), and constructs of the Theory of Planned Behavior both before and 6 to 8 weeks after the intervention. Data analysis was conducted using SPSS-23 software and involved a variety of statistical tests, including t-test, paired t-test, chi-square test, and Pearson's correlation coefficient.  Results: The results indicated that, following the intervention, the intervention group demonstrated a significant reduction in stress(P<0.001, Mean± SD:26.08±18.24), anxiety(P=0.03, Mean± SD:17.77±13.09), and depression(P =0.02, Mean± SD: 14.81±15.47) mean scores when compared to the control group. Furthermore, the intervention group exhibited a significant increase in social support   (P<0.001, Mean± SD: 78.25±8.14) and mean scores related to the constructs of the Theory of Planned Behavior  (P< 0.001) following the intervention.    Conclusion: The findings of this study underscore the effectiveness of employing the Theory of Planned Behavior in mental health promotion programs, particularly for Primigravid women. 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/   Primiparous, Stress, Theory of Planned Behavior http://journal.ihepsa.ir/article-1-3247-en.html http://journal.ihepsa.ir/article-1-3247-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 14 3 2026 4 1 Disaster Preparedness among Health Ambassadors in Sabzevar City: An Extended Parallel Process Model 75 86 FA Fahriba Shahraki-Sanavi Associate Professor, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. faribasanavi@gmail.com N Azam Barghamadi Deputy of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran. Barghamadi94@gmail.com N Reza Shahrabadi Associate Professor, Department of Health Education, Faculty of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran sharabadi.reza@yahoo.com N Hamid Jovini Associate Professor, Department of Health Education, Faculty of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran Hamidjoveyni124@gmail.com N Ali Mehri Associate Professor, Department of Health Education, Faculty of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran. hadimehri1386@gmail.com Y Tahereh Kamalikhah Assistant Professor, Department of Public Health, Kashan University of Medical Sciences, Kashan, Iran Tahereh.kamalikhah@yahoo.com N 10.22034/ijhep.14.3.7 Background and Objective: Natural disasters are among the most significant public health threats, particularly in disaster-prone countries such as Iran. Community preparedness plays a critical role in reducing disaster-related mortality and economic losses. Health Ambassadors, as a bridge between the health system and the community, can contribute substantially to improving disaster preparedness. This study aimed to assess disaster preparedness among Health Ambassadors in Sabzevar, Iran, based on the Extended Parallel Process Model (EPPM). Materiah and Methods: This cross-sectional analytical study was conducted in 2017 among 120 Health Ambassadors in Sabzevar, Iran, who were selected through random sampling. Data were collected using a three-part questionnaire comprising demographic characteristics, EPPM constructs (knowledge, perceived susceptibility, perceived severity, perceived response efficacy, self-efficacy, enabling factors, and behavioral intention), and the standardized Disaster Assessment of Readiness and Training (DART) questionnaire. Data were analyzed using descriptive statistics and linear regression analysis in SPSS version 16. Results: The mean age of participants was 37.8 ± 9.11 years. Most participants were married (88.3%) and had a secondary level of education (67%). The mean knowledge score was 11.78 ± 2.01 out of 14, whereas the mean disaster preparedness score was 4.85 ± 4.16 out of 15. Regression analysis revealed that EPPM constructs explained 39.9% of the variance in behavioral intention. Among these constructs, self-efficacy (β=0.534, P<0.001) and perceived response efficacy (β=0.174, P=0.033) were significant predictors of behavioral intention. Furthermore, enabling factors emerged as the only significant predictor of disaster preparedness (β=0.351, P<0.001) and, together with behavioral intention, explained 21.8% of the variance in preparedness. Conclusion: Despite relatively adequate knowledge levels, disaster preparedness among Health Ambassadors was low. Self-efficacy and perceived response efficacy were the strongest predictors of behavioral intention, whereas enabling factors played the most important role in explaining disaster preparedness. These findings suggest that improving preparedness requires more than educational interventions alone. Providing enabling resources, practical skills, equipment, organizational support, and appropriate infrastructure is essential for translating behavioral intention into actual preparedness. Therefore, theory-based interventions that simultaneously strengthen self-efficacy and enabling factors may enhance community disaster preparedness and mitigate the adverse consequences of disasters. 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/ Disasters, Preparedness, Health Ambassadors, Extended Parallel Process Model http://journal.ihepsa.ir/article-1-3275-en.html http://journal.ihepsa.ir/article-1-3275-en.pdf

Iranian Journal of Health Education and Health Promotion Iranian Journal of Health Education and Health Promotion 2345-346X 2345-3265 14 3 2026 4 1 Investigating Exposure Therapy Based on Virtual Reality on Anxiety and Physiological Indicators (Pulse and Blood Pressure) of People Undergoing Outpatient MRI Referring to MRI Centers of Zahedan University of Medical Sciences 87 98 FA Fatemeh Miri 1. Master of Science in Psychiatric Nursing, Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Iran fatemehmiri2143@gmail.com N Ali Navidian 2. Professor, Department of Psychiatric Nursing, Community Nursing Research Center, Zahedan University of Medical Sciences, Iran. alinavidian@gmail.com Y 10.22034/ijhep.14.3.4 Background and Objective: Magnetic resonance imaging is one of the most important diagnostic imaging methods used to evaluate a wide range of diseases. One of its characteristics is the anxiety that people experience before and during this procedure, which has a negative effect on the quality of the images. This study aimed to determine the effect of virtual reality-based exposure therapy on anxiety and physiological indicators of patients undergoing MRI. Materials and Methods: The present quasi-experimental study was conducted with a pre-test-post-test design with the participation of 80 outpatients referring to the MRI department of Zahedan hospitals in 1404. The sampling was selected conveniently and randomly assigned to two intervention and control groups. Patients in the intervention group received two virtual exposure therapy sessions on the previous days and the third session on the scheduled day 30 minutes before the MRI. The control group did not receive any intervention during this period. Data were collected in the form of the Spielberger Anxiety Questionnaire and a pre- and post-intervention data recording form. Data were analyzed using chi-square, Fisher's exact test, paired t-test, independent t-test, analysis of covariance, and analysis of variance with repeated measures in SPSS version 26. The significance level in this study was considered to be less than 0.05. Results: The results showed that the mean and standard deviation of anxiety scores of patients undergoing MRI in the control group were 45.05±7.14, 46.77±7.96, and 46.55±9.91, respectively, and in the intervention group were 45.50±7.37, 40.67±8.87, and 40.12±11.34. The test results showed that the mean and standard deviation of anxiety scores of patients three days before MRI in the two intervention and control groups were not significantly different  (P = 0.88), but just before and after MRI, the mean anxiety score of patients in the intervention group was significantly lower than that of the control group  (P<0.05). Also, the results of covariance analysis showed that the mean of physiological indices in the two groups before and after MRI were not significantly different  (P<0.05). Conclusion: The results showed that although virtual reality-based exposure therapy had no effect on physiological indicators, it had a positive and significant effect on reducing anxiety in patients undergoing MRI. Therefore, nurses and radiology personnel in the imaging department can use this easy, low-cost, and complication-free intervention to reduce patient anxiety. 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/   Anxiety, Blood Prussure, Heart Rate, Magnetic Resonance, Virtual Reality http://journal.ihepsa.ir/article-1-3203-en.html http://journal.ihepsa.ir/article-1-3203-en.pdf