• Journal of muscle and joint health
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• v.22 no.3
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• pp.245-257
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• 2015

Purpose: The purpose of this study was to apply intervention mapping (IM) to develop a community-based disease self-management support program for patients with osteoarthritis. Methods: IM was applied as follows: i) a needs assessment has been carried out by a literature review, survey and interview with osteoarthritis patients; ii) on the basis of the needs assessment, identification of expected outcomes and change objectives for the target population; iii) selection of theory-based methods and practical applications to influence self-management and the determinants of behavior; iv) design of the intervention by developing activities and materials such as osteoarthritis self-management guide and smart patient pocket book. The activities were integrated into an existing healthcare activities; v) implementation and evaluation plan has been developed. Results: The program is aimed at improving health status through activating patients by a patient-centered and tailored intervention for patients with osteoarthritis; consists of 8 sessions with coaching and cognitive emotional psychological skills; includes smart patient, communication, osteoarthritis, medication adherence, pain control, depressive mood control, physical activity and healthy diet. Conclusion: The IM is a systematic and feasible method for developing the program. The next step is to evaluate the impact of the intervention on activation, and health status.

• Journal of Korean Academy of Nursing
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• v.49 no.4
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• pp.472-485
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• 2019

Purpose: This study aimed to develop and evaluate the effectiveness of an adapted health literacy self-management intervention for elderly cancer patients undergoing chemotherapy. Methods: The intervention in this study was systematically developed through the six stages of Intervention Mapping Protocol and was based on Fransen et al's causal pathway model. A quasi-experimental trial was conducted on a total of 52 elderly patients (26 in an experimental group and 26 in a control group) undergoing chemotherapy in Korea. The intervention consisted of seven sessions over 5 weeks. The experimental tool for this study was an adapted health literacy self-management intervention, which was designed to promote a reduction in the symptom experience and distress of elderly cancer patients through the promotion of self-management behavior. To develop efficient educational materials, the participants' health literacy was measured. To educate participants, clear communication and the teach-back method were used. In addition, for the improvement of self-efficacy, four sources were utilized. For the promotion of self-management behavior, five self-management skills were strengthened. Data were collected before and after the intervention from June 4 to September 14, 2018. The data were analyzed with SPSS/WIN 21.0. Results: Following the intervention, self-management knowledge and behavior and, self-efficacy significantly improved in experimental group. Symptom experience and distress decreased in the experimental group compared to the control group. Conclusion: The self-management intervention presented in this study was found to be effective in increasing self-management knowledge and behavior and, self-efficacy, and ultimately in reducing symptom experience and distress for elderly patients undergoing chemotherapy.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.17
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• pp.7309-7316
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• 2014

Background: While many researchers often use a theoretical framework for mammogram repeat interventions, it seems they do not apply an identified mediation analysis method. The aim of this study was to determine the mediators of mammogram replication behavior in two tailored interventions for non-adherent Iranian women. Materials and Methods: A sample population of 184 women over 50 years old in Sanandaj, Iran, was selected for an experiment. Participants were randomly allocated into one of the three conditions: 1) an intervention based on the Health Belief Model (HBM) 2) an intervention based on an integration of the HBM and selected constructs from the Theory of Planned Behavior (TPB), and 3) a control group. Constructs were measured before the intervention, and after a 6-month follow-up. Results: Perceived self-efficacy, behavioral control, and subjective norms were recognized as mediators in the HBM and selected constructs from the TPB intervention. Perceived susceptibility, severity, barriers, self-efficacy and behavioral control met the criteria for mediation in the HBM intervention. Conclusions: This study was successful in establishing mediation in a sample of women. Our findings enrich the literature on mammography repeat, indicating key intervention factors, and relegating redundant ones in the Iranian populations. The use of strategies to increase mammography repeat, such HBM and TPB constructs is suggested to be important for maintaining a screening behavior, once the behavior has been adopted.

• Research in Community and Public Health Nursing
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• v.22 no.3
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• pp.342-354
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• 2011

Purpose: This study was to estimate the effectiveness of an intervention program using the trans-theoretical model on the stages of change, the process of change, decisional balance, self-efficacy, the levels of medication adherence, and blood pressure difference. Methods: A similar experiment was conducted using a nonequivalent control group pre- and post-test design. The study subjects were 108 hypertensive patients. The program was administered to the experimental group while educational materials were given to the control group. Descriptive analysis, 2-test, t-test, and repeated measures ANOVA were used with SPSS 17.0 to analyze collected data. Results: After treatment with this program, the experimental group showed stage of change ($x^2=52.917$, p<.001), cognitive (F=13,528, p<.001), behavioral process of change (F=10.808, p<.001), benefits (F=5.569, p=.012), loss of medication adherence (F=15.661, p<.001), self-efficacy (F=5.407, p=.011), levels of medication adherence (F=51.442, p<.001). Conclusion: There was a significant improvement in the experimental group who participated in the TTM medication adherence intervention program. Given that this intervention program motivated and stimulated hypertensive patients to adhere to the prescribed medications, the TTM medication adherence intervention program is expected to be an effective and practical intervention method for health improvement.

• Korean Journal of Health Education and Promotion
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• v.34 no.1
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• pp.35-45
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• 2017

Objectives: This study thus set out to examine the health literacy and self-care behaviors of community-dwelling elderly patients with hypertension and investigate their relations and influential factors, thus providing basic data to develop a nursing intervention program to promote self-care behaviors among hypertension patients. Methods: The subjects include 180 hypertension patients using community health centers, public senior centers, and welfare centers in Jeju. Results: The subjects scored a mean of 49.8 (${\pm}12.4$) points on health literacy and 55.8 (${\pm}6.7$) points on self-care behaviors. In the results of hierarchical regression analysis, health literacy independently predicted self-care behaviors (${\beta}=.12$, p=.050) after controlling for general characteristics, hypertension-related knowledge and self-efficacy. Conclusions: These results suggest that interventions for improving health literacy are important to enhance elder's ability of self-care behaviors. It is necessary to understand the health literacy of elderly patients with hypertension before providing them with educational intervention and information and to develop appropriate educational materials and intervention programs.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.8
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• pp.3849-3854
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• 2016

Background: Breast cancer is the most prevalent malignancy in women worldwide; lack of awareness of symptoms and delay on diagnosis of breast cancer are the main causes of mortality among women. This study was conducted with the purpose of assessing the effect of educational consulting for breast self-examination (BSE) based on the health belief model (HBM) on the knowledge and performance of women over 40 years attending health care centers in Hamadan, Iran. Materials and Methods: In this quasi-experimental study, eligible women admitted to health centers in Hamadan city in 2015 were randomly assigned to intervention and control groups (n=75 in each group). The intervention group received 4 weekly sessions of breast cancer screening consulting based on the HBM. Control group received only routine care. Knowledge, HBM constructs, and BSE practice were compared between the groups before, immediately after and three months after the consultation. Results: Before the intervention, no significant differences were observed in knowledge, health belief and practice between two groups. However, after the intervention a significant difference was observed between two groups in mean scores of perceived benefits, perceived barriers, self-efficacy and the health motivations (p <0.05). Significant differences were also observed in terms of knowledge and BSE practice (p <0.01). Conclusions: The results indicate the importance of consultation on knowledge and beliefs to improve BSE performance and prevention of breast cancer in Iranian women.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.2
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• pp.609-614
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• 2016

Background: Although breast cancer is the most common cancer in women, economic evaluation of breast cancer screening is not fully addressed in developing countries. The main objective of the present study was to analyze the cost-effectiveness of breast cancer screening using mammography in 35-69 year old women in an Iranian setting. Materials and Methods: This was an economic evaluation study assessing the cost-effectiveness of a population-based screening program in 35-69 year old women residing in rural areas of South east Iran. The study was conducted from the perspective of policy-makers of insurance. The study population consisted of 35- to 69-year old women in rural areas of Kerman with a population of about 19,651 in 2013. The decision tree modeling and economic evaluation software were used for cost-effectiveness and sensitivity analyses of the interventions. Results: The total cost of the screening program was 7,067.69 US$ and the total effectiveness for screening and no-screening interventions was 0.06171 and 0.00864 disability adjusted life years averted, respectively. The average cost-effectiveness ratio DALY averted US$ for screening intervention was 7,7082.5 US$ per DALY averted and 589,027 US $ for no-screening intervention. The incremental cost-effectiveness ratio DALY averted was 6,264 US$ per DALY averted for screening intervention compared with no-screening intervention. Conclusions: Although the screening intervention is more cost-effective than the alternative (noscreening) strategy, it seems that including breast cancer screening program in health insurance package may not be recommended as long as the target group has a low participation rate.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.16
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• pp.6981-6986
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• 2015

Background: Breast cancer is the most common cancer in women. One way to decrease the burden of this cancer is early detection through mammography. This study compared the effectiveness of two different educational methods for teachers' uptake of mammography based on the Health Belief Model. Materials and Methods: The current study was a randomised trial of 120 teachers over 40 years old in two groups receiving multimedia or group education, both based on the Health Belief Model. Participants completed questionnaires before, immediately and three months after educational intervention. Mammography was evaluated before and after educational intervention. Results: The participants in the two groups were demographically similar. Comparison showed no difference noted in the scores of knowledge, perceived barriers, susceptibility, and severity constructs between two groups (p > 0.05). Health motivation and benefit were perceived to be higher in the group education compared to the multimedia group. There was a significant difference in mammography between two groups after the intervention (p= 0.003). Conclusions: Planning and implementation of educational program based on the Health Belief Model can raise knowledge and increase participation in mammography especially with group education.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.5
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• pp.2891-2896
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• 2013

Background: To illustrate multiple approaches and to assess participation rates adopted for a community based smoking cessation intervention programme in rural Kerala. Materials and Methods: Resident males in the age group 18-60 years who were 'current daily smokers' from 4 randomly allocated community development blocks of rural Thiruvananthapuram district, Kerala (2 intervention and 2 control groups) were selected. Smoking status was assessed through house-to-house survey using trained volunteers. Multiple approaches included awareness on tobacco hazards during baseline survey and distribution of multicolour anti-tobacco leaflets for intervention and control groups. Further, the intervention group received a tobacco cessation booklet and four sessions of counselling which included a one-time group counselling cum medical camp, followed by proactive counselling through face-to-face (FTF) interview and mobile phone. In the second and fourth session, motivational counselling was conducted. Results: Among 928 smokers identified, smokers in intervention and control groups numbered 474 (mean age: 44.6 years, SD: 9.66 years) and 454 respectively (44.5 years, SD: 10.30 years). Among the 474 subjects, 75 (16%) had attended the group counselling cum medical camp after completion of baseline survey in the intervention group, Among the remaining subjects (n=399), 88% were contacted through FTF and mobile phone (8.5%). In the second session (4-6 weeks time period), the response rate for individual counselling was 94% (78% through FTF and 16% through mobile phone). At 3 months, 70.4% were contacted by their mobile phone and further, 19.6% through FTF (total 90%) while at 6 months (fourth session), the response rate was 74% and 16.4% for FTF and mobile phone respectively, covering 90.4% of the total subjects. Overall, in the intervention group, 97.4% of subjects were being contacted at least once and individual counselling given. Conclusion: Proactive community centred intervention programmes using multiple approaches were found to be successful to increase the participation rate for intervention.

• Quality Improvement in Health Care
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• v.12 no.2
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• pp.93-112
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• 2006

This study reviewed published studies on interventions used by hospitals, health insurance programs, or governments to improve use of medicines in foreign countries. Interventions to improve use of medicines are classified into two categories: 1) information strategies-dissemination of educational materials, group education, one-to-one educational outreach, drug utilization review, and feedback; 2) managerial strategies- formularies, prior authorization, and financial incentives. Dissemination of educational materials, which is a common intervention, was unsuccessful in changing physicians' prescribing behaviors. Problem-based small group education was more likely to change behaviors than didactic large group education. One-to-one educational outreach(academic detailing) was among the most effective strategies used to change prescribing behaviors. Prospective drug utilization review (DUR) program was more successful in improving use of medicines than retrospective DUR program. Feedback intervention has been reported to be ineffective to change behaviors. Formularies are frequently used to control medication use by most health insurance programs. Financial incentives provide physicians economic incentives according to appropriateness of prescribing. However, few published studies have assessed the efficacy of formularies or financial incentives. Prior authorization requires physicians to get authorization from health insurers before prescribing a certain group of drugs which is usually of high costs or risk. There is no magic bullet for quality use of medicines. Multifaceted interventions that help to predispose, enable, and reinforce desired behaviors are more likely to be successful.