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November 2017 -
Volume 15, Issue 9

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From the Editor

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Original contribution/Clinical Investigation
Diabetes Mellitus - Knowledge, Management and Complications: Survey report from Faisalabad-Pakistan
Ijaz Anwer, Ahmad Shahzad, Kashmira Nanji, Farah Haider, Muhammad Masood Ahmad

Alanine aminotransferase indicates excess weight and dyslipidemia
Mehmet Rami Helvaci, Orhan Ayyildiz* Mustafa Cem Algin, Yusuf Aydin, Abdulrazak Abyad, Lesley Pocock

Comparative Analysis of Antimicrobial Peptides Gene Expression in Susceptible/Resistant Mice Macrophages to Leishmania major Infection

Hamid Daneshvar, Iraj Sharifi, Alireza Kyhani, Amir Tavakoli Kareshk, Arash Asadi

Does socio-economic status of the patients have effect on clinical outcomes after coronary artery bypass grafting surgery?
Forough Razmjooei, Afshin Mansourian, Saeed Kouhpyma

Comparison of the uterine artery Doppler indices during pregnancy between gestational diabetes and diabetes mellitus and healthy pregnant women
Nazanin Farshchian, Farhad Naleini, Amir Masoud Jaafarnejhad,
Parisa Bahrami Kamangar

Survey single dose Gentamicin in treatment of UTI in children with range of 1 month to 13 years old in Jahrom during 2015
Ehsan Rahmanian, Farideh Mogharab,
Vahid Mogharab

Evaluation of control of bleeding by electro cauterization of bleeding points of amplatz sheath tract after percutaneous nephrolithotomy (PCNL) in Jahrom Peymanieh hospital during year 2015-2016
Ali Reza Yousefi , Reza Inaloo

Comparison of the three-finger tracheal palpation technique with triple ID formula to determine endotracheal tube depth in children 2-8 years in 2016-2017
Anahid Maleki, Alireza Ebrahim Soltani, Alireza Takzare, Ebrahim Espahbodi,
Mehrdad Goodarzi , Roya Noori

Effect of Sevoflurane and Propofol on pulmonary arterial pressure during cardiac catheterization in children with congenital heart diseases
Faranak Behnaz, Mahshid Ghasemi , Gholamreza Mohseni, Azim Zaraki
Population and Community Studies

Prevalence and risk factors of obesity in children aged 2-12 years in the Abu Dhabi Islands
Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal Darwish

Study and comparison of psychological disorders in normal students and students with multiple sclerosis in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Comparative study of self-concept, physical self-concept, and time perspective between the students with multiple sclerosis and healthy students in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Relationship between Coping Styles and Religious Orientation with Mental Health in the Students of the Nursing-Midwifery Faculty of Zabol
Nasim Dastras, Mohsen Heidari Mokarrar, Majid Dastras, Shirzad Arianmehr

Tuberculosis in Abadan, Iran (2012-2016): An Epidemiological Study
Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi, Rahil Hojjati,
Parvin Gholizadeh

Family Stability and Conflict of Spiritual Beliefs and Superstitions among Yazdi People in Iran: A Qualitative Study
Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad ; Hassan Zareei Mahmoodabadi ; Hossein Tavangar ; Seyed Mojtaba Yassini Ardekani ; Ali Akbar Vaezi

A comparative study of the self-actualization in psychology and Islam
Simin Afrasibi, Zakieh Fattahi

The effectiveness of cognitive - behavioral therapy in reducing the post-traumatic stress symptoms in male students survivors of earthquake in the central district of Varzeghan
Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh

Reviews

Effects and mechanisms of medicinal plants on stress hormone (cortisol): A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley Pocock

Comparing Traditional and medical treatments for constipation : A Review Article
Mohammad Yaqub Rajput

A review of anti-measles and anti-rubella antibodies in 15- 25 year old women in Jahrom City in 2011
Ehsan Rahmania , Farideh Mogharab, Vahid Mogharab

Review of percutaneous nephrolithotomy in children below 12 years old in Jahrom hospital, during 2010-2014
Ali Reza Yousefi , Reza Inaloo

Physical and mental health in Islam
Bahador Mehraki, Abdollah Gholami

International Health Affairs

The Challenges of Implementation of Professional Ethics Standards in Clinical Care from the viewpoint of Nursing Students and Nurses
Saeedeh Elhami, Kambiz Saberi, Maryam Ban, Sajedeh Mousaviasl, Nasim Hatefi Moadab, Marzieh Ghassemi

Cognitive Determinants of Physical Activity Intention among Iranian Nurses: An Application of Integrative Model of Behavior Prediction
Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki, Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi

Effect of resilience-based intervention on occupational stress among nurses
Hossein Jafarizadeh, Ebrahim Zhiyani, Nader Aghakhani, Vahid Alinejad, Yaser Moradi

Education and Training

Calculation of Salaries and Benefits of Faculty Members in the Ministry of Health and Medical Education of Iran
Abdolreza Gilavand

The effect of education on self-care behaviors of gastrointestinal side effects on patients undergoing chemotherapy
Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram Razie, Lila Nezam Abadi Farahani

Creating and Validating the Faith Inventory for Students at Islamic Azad University of Ahvaz
Solmaz Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Creating and Validating the Adjustment Inventory for the Students of Islamic Azad University of Ahvaz
Homa Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Evaluating the Quality of Educational Services from the Viewpoints of Radiology Students of Ahvaz Jundishapur University of Medical Sciences
Abdolreza Gilavand, Jafar Fatahiasl

An Investigation of Psychosocial aspect of Iranian Nursing Students' Clinical Setting
Mahsa Boozaripour , Zanyar Karimi, Sima Zohari Anbohi, Amir Almasi-Hashiani, Fariba Borhani

Clinical Research and Methods

Comparison of the Antibacterial Effects of Chlorhexidine Mouth washes with Jaftex Mouth wash on Some Common Oral Microorganisms (An in Vitro Study)
Ebrahim Babadi, Zahra Bamzadeh, Fatemeh Babadi

Study of the effect of plasma jet on Fusarium isolates with ability to produce DON toxins
Elham Galin Abbasian, Mansour Bayat, Arash chaichi Nosrati, Seyed Jamal Hashemi, Mahmood Ghoranneviss

The comparison of anti-inflammatory effect in two methods of topical dexamethasone injection and topical application of ginger alcoholic extract after removing mandibular wisdom teeth
Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran Mirzaie, Ramin Seyedian, Narges Aria, Saman Jokar

The effect of curcumin on growth and adherence of major microorganisms causing tooth decay
Leila Helalat, Ahmad Zarejavid, Alireza Ekrami, Mohammd Hosein Haghighizadeh, Mehdi Shiri Nasab


Middle East Quality Improvement Program
(MEQUIP QI&CPD)

Chief Editor -
Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE

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November 2017 - Volume 15, Issue 9

Cognitive Determinants of Physical Activity Intention among Iranian Nurses: An Application of Integrative Model of Behavior Prediction


Arsalan Ghaderi (1)
Firoozeh Mostafavi
(2)
Behzad Mahaki
(3)
Abdorrahim Afkhamzadeh
(4)
Yadolah Zarezadeh
(5)
Erfan Sadeghi
(6)

(1) Student Research center, school of health, Isfahan University of medical science, Isfahan, Iran
(2) Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
(3) Department of Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
(4) Department of Community Medicine, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
(5) Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
(6) Non-communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran

Corresponding Author:
Firoozeh Mostafavi,
Department of Health Education and Promotion,
School of Health, Isfahan University of Medical Sciences,
Isfahan, IR Iran.
Tel: +98-3137922710,
Email: f_mostafavi@yahoo.com

Abstract

Introduction:
Sedentary lifestyle and physical inactivity is recognized as a risk factor for various diseases. Nurses have a special place among healthcare team members, and their numerous roles require nurses to have good physical fitness. The present study aimed to determine cognitive factors related to doing regular physical activity among a sample of Iranian nurses based on the integrative model of behavior prediction (IMBP).

Methods: This cross-sectional study was conducted in 2016 on a sample of 418 nurses who were working in medical teaching hospitals in Isfahan and Sanandaj in Iran. Participants were randomly selected proportionally to staff size among different hospitals. A structured questionnaire was applied for collecting data and data were analyzed by SPSS version 16 using correlations, linear and logistic regression statistical tests.

Results: Mean age of the subjects was 33.1 years (range, 21-53 years). 66.6%, 25.4%, and 8% had low, moderate, and severe physical activity, respectively. The best predictors for doing regular physical activity were skills with OR of 1.203 [95% CI: 1.093, 1.324], and attitude with OR of 1.023 [95% CI: 1.023, 1.034]. The IMBP variable, accounted for 34% of the variation in the outcome measure of the intention to do physical activity.

Conclusion: Based on our result, it seems that designing and implementation of educational programs to increase attitude and skills regarding doing physical activity may be useful in the promotion of physical activity.

Key words: Cognitive Determinants, Physical Activity, Intention, Nurses, IMBP


INTRODUCTION

Nowadays one of the health problems is sedentary lifestyle. In this regard, studies have shown that more than 80 percent of people do not have enough regular physical activity (1). The prevalence of inactivity in urban and rural areas of Iran, with an emphasis on leisure physical activities between men and women in the age group of 15-64 years, was 76.3% and 55.8% respectively, with the overall percentage of 67.6 percent (2). Sedentary lifestyle and physical inactivity is recognized as a risk factor for various diseases. It is also raised as one of the main modifiable risk factors for cardiovascular diseases and plays an important role in the development of other diseases (3). Researchers have shown that adequate physical activity has a beneficial effect on blood pressure, obesity and serum lipids. So that, regular exercise is proven to reduce total cholesterol, increase high-density lipoprotein, reduce low-density lipoprotein, and improve the general health of the body (4). As a significant health promoting behavior, regular physical activity can prevent or delay the occurrence of chronic diseases and early mortality (5). Nurses have a special place among healthcare team members, and their numerous roles require nurses to have good physical activity (6). Nurses cannot meet the needs of patients unless they pay great attention to the ways of promoting their own lives and health (7). Therefore, paying more attention to their health condition and determining risk factors of nurses, is very important (8). Studies have shown that the most effective programs are theory-based, rooted in social psychology (9, 10). Previous research has also shown that psychological studies and social psychology theories play an important role in creating programs that impact on health promotion. (11-17). The theories that examine the role of these factors in predicting behavior include the theory of rational action and the theory of planned behavior (10). By developing the theory of rational action and the theory of planned behavior, Fishbein has proposed an integrative model of behavior prediction in which several factors such as attitude, subjective norms, self-efficacy or perceived behavior control, behavioral intention, skill, and environmental constraints have been considered effective (18). This research aims to find cognitive determinants of physical activity intention among Iranian nurses based on application of integrative model of behavior prediction.

METHODS

Participants and procedure
This cross sectional study was a part of a project conducted among Iranian nurses during 2016, with the goal of providing knowledge for the promotion of physical activity. The sample size was calculated at 95% significant level according to the results of a study by Tofighi et al (19) which reported that about half of Iranian nurses were lower than the Average levels of physical activity and considering the 20% attrition rate (rate of drop-out among participants), a sample of 418 was estimated. The study population included all nurses working in teaching hospitals in Isfahan and Sanandaj. In this study, a major teaching hospital in the aforementioned cities was randomly selected and then specifically-designed questionnaires were distributed among nurses who volunteered for this research and the required information was collected. It is worth mentioning that all the participants were informed about the project and confidentiality of the information, as well as the purpose of the project, and entered the study with consent. All questionnaires were anonymous and incomplete questionnaires were excluded from the study. The study protocol was approved by the institutional review board and ethics committee of the Isfahan University of Medical Sciences, Isfahan, Iran.

Measures
The participants were instructed about how to fill out the designed self-report questionnaire before gathering the required information. The questionnaire used here included three sections including demographic information questions, integrative model of behavioral prediction constructs, and the short form of the international physical activity questionnaire (IPAQ).

A: Demographic Characteristics
Background data inquired about included age, gender, marital status, education, weight, height, waist circumference, record of membership in the sports club, duration of membership in the sports club, current sport club membership status, and job history.

B: IMBP Variables
IMBP items were designed based on standard questionnaires applied to physical activity (20, 21). Before data collection, its reliability was evaluated using the alpha coefficient method through a preliminary study on 30 cases in the control group. This questionnaire consisted of the constructs of attitude (10 questions), subjective norms (5 questions), and self-efficacy (18 questions - Bandura’s standard physical activity self-efficacy questionnaire (22), environmental constraints (10 questions), skills (4 questions) and behavioral intention (4 questions). In order to measure the score of each construct, the mean of the total score of that construct was considered. Furthermore, at least 10 faculty members and qualified individuals were consulted to determine the validity of the questionnaire and face and content validity were determined. In order to determine content validity, CVR and CVI were calculated according to the opinion of experts.

C: Short form of the International Physical Activity Questionnaire (IPAQ)
This questionnaire asks questions about the amount of intense and moderate physical activity, walking, and the average duration of sitting over the last week (7 days). Questionnaire score is reported according to the IPAQ protocol. The total physical activity of an individual per week is measured in minute/week –MET format. The term MET refers to the expression metabolic equivalent. MET is a unit used to estimate the metabolic cost of physical activity. One MET is approximately equal to the amount of resting energy expenditure for an individual (23). All physical activity can be classified with multiples of resting energy expenditure.

The questionnaire includes questions about the physical activity of participants. This section can be finally used to classify physical activity into three categories: Weak or low, moderate, and severe. This questionnaire has been used by the World Health Organization to evaluate the level of physical activity. It has also been used in several domestic studies and its validity and reliability have been confirmed. The intensity of energy expenditure for all of the activities during the past 7 days was calculated according to IPAQ instructions; if the total calculated energy during the week is 600 to 3000 Met/Cal/Week, the intensity of the activity of the relevant questionnaire is moderate and if more than 3000 Met/Cal/Week, the intensity of the activity of the relevant questionnaire is severe. Moreover, if the amount of consumed energy is less than 600, the person is classified as: with no regular physical activity (24).

Statistical Analysis
Data were analyzed by SPSS version 16 using appropriate statistical tests including bivariate correlations, linear and logistic regression statistical tests at 95% significant level.

RESULTS

Mean age of the subjects was 33.1 years (range, 21-53 years). Among the participants, 73.2% were female, respectively, among whom 88 were single, 268 married, and 63 did not answer the marital status question. Regarding education, 90.9% had bachelor’s degrees and 9.1% had master’s degree. The results of the present study showed that 66.6%, 25.4%, and 8% had low, moderate, and severe physical activity, respectively.

Table 1 shows the Zero-order correlations. Statistical significance was calculated at 0.01 and 0.05. The results showed intention was correlated with the attitude (r=0.159), subjective norms (r=0.222), self-efficacy (r=0.198), skills (r=0.553), and environmental constraints (r=0.128). Environmental constraints was significantly correlated with self-efficacy (r=0.130), and skills (r=0.196). In addition, skills was correlated with the attitude (r=0.143), subjective norms (r=0.218), and self-efficacy (r=0.147). Furthermore, self-efficacy was significantly correlated with attitude (r=0.133). Finally, subjective norms was significantly correlated with attitude (r=0.136).

Click here for Table 1: Correlation between different components of IMBP

Linear regression analysis was performed to explain the variation of physical activity intention. As can be seen in Table 2, Collectively, IMBP variables accounted for 34% of the variation of physical activity intention.

Table 2: Predictors of the intention to physical activity

Adjusted R squared = 0.34, F: 80.190, and P <0.001

However, in Table 3, by dividing physical activity behavior into two groups of people without physical activity (people with poor physical activity) and those with physical activity (people with moderate and severe physical activity) and using logistic regression, it was observed that the constructs of attitude and skill were more important regarding physical activity behavior.

Table 3: Multiple logistic regression analysis for IMBP components related to physical activity


DISCUSSION

The aim of this study was to determine the factors related to physical activity among a sample of Iranian nurses, based on integrative model of behavior prediction. Determined factors related to physical activity among nurses is important for implementing physical activity promotion programs. The results of the present study indicated that attitude and skill were the most effective predictors of regular physical activity.

According to the results, 66.6% of nurses had a sedentary life style. The results of a study by Jalilian et al. showed that about 65% of women working at Hamedan University did not have physical activity (25). A study of physical activity of employees living in Yazd, Mazloomi et al. also showed that about 73.6% of employees did not have physical activity (26). The results of a study by Skaal et al. on the employees of a public hospital in South Africa showed that about 75.5% of the employees in this hospital had no physical activity (27). These statistics are consistent with the results of this study. These results indicated that status of physical activity is low among nurses. This warns health policy makers in Iran that it requres special attention to design physical activity promotion programs.

Our findings indicated, IMBP variables accounted for 34% of the variation of physical activity intention. In this regards, Araújo-Soares et al., carried out research on adolescents and reported that behavioral intention was a strong predictor of physical activity (28). On the other hand, a review study carried out by Sheeran suggests that intention in 82,107 study samples can only be responsible for an average of 28% of behavior variance (29). Therefore, there is a gap between intention and action. Despite the importance of factors influencing behavioral intention, there are several important controlling factors which determine how intention to adopt the behavior is interpreted.

The findings revealed that among an integrative model of behavior prediction constructs, attitude and skills were the main factors predicting physical activity among nurses. In