Journal of School of Public Health and

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Background and Aim: Stress during pregnancy can have a lasting effect on the mental health of women after childbirth. Statistics show that about 18% of pregnant women have major or partial depression during pregnancy, but many have not been screened or treated. Lack of treatment can have serious consequences for the mother and her child. The purpose of this study was to determine the mental health status and marital satisfaction of pregnant mothers in Kashan city, Iran in 2015.
Materials and Methods: This was an analytical cross-sectional study. Using the convenience sampling method 202 pregnant women were selected from four urban health centers in Kashan, Iran and entered the study. Data were collected using a Diagnostic Interview, the General Health-28 Questionnaire and the Golombok Rust Inventory of Marital State. Descriptive statistics was used for data analysis, the statistical tests being one-way ANOVA, chi-square test, Pearson correlation test and logistic regression.
Results: The results showed that 26.7% of the pregnant women were suffering from psychiatric disorders, the most and least serious disorders being related to physical activity and depression, respectively. About 80% of the women expressed very good marital satisfaction. Further analysis of the data showed statistically significant associations between depression and age and anxiety, insomnia and duration of marriage, marital satisfaction and delivery type, and mental health and marital satisfaction. Furthermore, marital satisfaction had a negative association with education. (p<0.05).
Conclusion: It seems that it is essential to develop and implement a therapeutic, psychiatric and health care model for women at risk of psychiatric disorders during pregnancy and after childbirth in the health service delivery system in Iran.

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Background and Aim: Orexin is a hormone involved inoverweight and obesity and a regulator of glucose metabolism. The purpose of this study was to determine the effects of a high-intensity interval training (HIIT) on plasma levels of orexin-A (OXA) and insulin resistance in overweight women.
Materials and Methods: In a semi-experimental study, 24 overweight women (aged 20-25 years; body mass index (BMI), 25-30 kg/m²) were divided into 2 groups, namely, a control (n=12) and a training (n=12) group. The training group performed selective HIIT including 6 movements for 6 weeks (3 sessions/week). Initial and final blood markers were measured in blood samples collected 24 hours after the test. The data were analyzed using the paired and independent sample t-tests; a p<0.05 was considered to show statistical significance.
Results: There were no statistically significant differences between body weight, BMI, plasma levels of glucose, insulin and insulin resistance before and after the period in either the training or control group (p>0.05). Neither were there any significant differences between the training and control groups after the 6-week period as regards plasma levels of glucose, insulin, OXA or insulin resistance (p>0.05).
Conclusion: The findings of this study show that a 6-week high-intensity interval training has no influence on plasma OXA or insulin resistance in overweight women.

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Background and Aim: The present study aimed to determine the stages of changes and cognitive and behavioral processes (Transtheorical model) in the use of nutrients in overweight middle-aged women.
Materials and Methods: The present study was a descriptive-analytic. The research sample consisted of 281 middle-aged women with overweight referring to comprehensive health centers in Isfahan. Personal characteristics, stage of change and behavior and cognitive behavioral processes, and FFQ questionnaire (168-item) were completed by Questioning, and then the information entered the N4 and SPSS 18 software, and information was analyzed using descriptive and analytical tests.
Results: 57.7% of the people were inactive (pre-thinking, thinking, preparation) and 42.3% of them were in active phase. There was a significant difference between the different stages of change and the use of behavior change processes (p=0.001) And Benfrown's test shows the increasing use of cognitive and behavioral processes during the stage of change in use of nutrients (p<0.001).
Conclusion: The difference in the mean of changes processes during the stage of change show the impact of these processes on the nutritional individual's behavior, which is recommended to use stage of change and behavioral change processes for education nutrition behavioral.

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Background and Aim: A person is more likely to become a violence victim in his/her family than outside the family. The purpose of this study was to investigate domestic violence, especially violence against women, in families in Herat Province, Afghanistan.         

Materials and Methods: A total of 130 female victims referring to support centers in Herat, Afganistan were selected using the accessible sampling method. A researcher-developed questionnaire was used to collect data.

Results: No woman older than 40 years referred to the centers, and the age of 65.4% of those referring was below 30 years.  The proportions of the women suffering from psychological, physical-plus-sexual and economic violence were 42%, 29% and 26%, respectively.  In addition, 65.4% of them had been married for at most 5 years and only 10% had been married for over 10 years. Further analysis of the data showed that about 60% of the clients were illiterate and only 13.8% had a bachelor's degree; 72.3% of the victims were housewives and only about 21% had freelance or office jobs; more than 70.2% of the victims were at the lowest income level, and about 76.6% had married with their own accord. As regards the victims' spouses, 88.5% were under 40 years of age, 57.7% were illiterate and 29.2% were high school graduates.  In terms of occupation, they were typically non-employed and had private jobs (13.8% workers, 22.3% farmers and 40.8% freelance). Furthermore, 95.4% had been married for the first time and 97.7% had one spouse. Finally, 83% of them (83.8%) were not addicts.

Conclusion: The most frequent complaints were related to psychological violence. Clients were typically under 40 years of age with a marriage history of less than 5 years. A typical victim in this study was a young illiterate woman who was financially weak; had a young, self-employed, low-educated spouse who had been married for the first time; had no other spouse; and was not a drug addict. 

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Background and Aim: Rheumatoid arthritis is the most common and most important type of arthritis caused by interaction of genetic, immunologic, psychological and social factors and is accompanied by chronic pains. The aim of this study was to investigate the effectiveness of treatment based on acceptance and commitment to the perception of pain and functional disability of women with rheumatoid arthritis in Khorramabad, Iran.
Materials and Method: This was a semi-experimental study with a pre- and post-test design with experimental and control groups, the statistical population being all the women with rheumatoid arthritis in Khorramabad, Iran. A sample of 40 women were selected using the available sampling method and randomly assigned to either an experimental (n = 20) or a control (n= 20) group. Under similar circumstances a pre-test was conducted using the pain perception and functional disability questionnaires in both groups. Admission- and commitment-based treatment interventions were then performed in the experimental group in eight 90-minute sessions, but the control group did not receive any intervention. At the end, post-tests were done in both groups.
Results: The multivariate and univariate analysis of covariance showed that the intervention based on acceptance and commitment had a significant effect on reducing the patients' perception of pain and functional disability (P <0.001).
Conclusion: Based on the results of this study, it can be said that treatment based on acceptance and commitment can reduce the perception of pain and functional disability in women with rheumatoid arthritis. Therefore, along with medical treatment, this type of treatment can be used to reduce the perception of pain and functional disability of such patients.
 

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Background and Aim: Individualism is a mental and behavioral tendency that leads to individual autonomy in such a way that the individual's goals and desires are more important to him than the goals and desires of others; such a person considers himself responsible for his successes and failures. The main purpose of this study was to determine the relationship between lifestyle and individualism in women in Shiraz, Iran.
Materials and Methods: This was a cross-sectional correlational study conducted in Shiraz, Iran 2019 on a sample of 564 single women aged 25 to 49 years selected by a combination of appropriate and purposive stratified sampling methods. The data were collected using the horizontal and vertical individualism questionnaire of Triandis et al. and analyzed using the SPSS software version 25 at both the descriptive and analytical levels, the statistical test being the Pearson correlation coefficient test.
Results: The rate of individualism of the respondents was about 69%. Investigating the dimensions of individualism showed that the respondents' tendency to individualism in the dimension of prioritizing the individual activities of the individuals (78.15%) was higher than those of the other two dimensions. The lifestyle score of the respondents was 63.4%. Based on the Pearson correlation coefficient, there was a significant inverse relationship between the women's lifestyle in Shiraz and their individualism, which means that a better lifestyle can lead to a decrease in the women's individualism.
Conclusion: Based on the findings, there is an inverse relationship between lifestyle and the degree of individualism of women in Shiraz, Iran. Therefore, improving the lifestyle by focusing on the family and paying attention to its supportive dimensions can have a positive effect on reducing the individualism of this group.

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Background and Aim: Prostitution is one of the alarming social harms in any population with considerable challenges and concerns. Many prostitutes have been victims of unfavorable social conditions. The purpose of this study was to determine and explain the goals, service patterns, challenges and proposed solutions for the Program of Rehabilitation of Socially Harmed Women in the Iranian Welfare Organization (IWO).
Materials and Methods: A qualitative study was conducted in 2016. The participants included managers and experts of the general departments of the IWO in 31 provinces, 21 members of public mediators and stakeholder organizations, and 5 senior staff managers and senior experts of the IWO Deputy Director’s Office for Social Affairs. Data were collected using document analysis and in-depth individual interviews and focus group discussions and analyzed using the content analysis method.
Results: Based on the data collected, the challenges of the program implementation were found to be as follows: non-acceptance of these women by the society, identity problems of the children borne to them (legally), poor chances of employment, sexual abuse of the women by the employers and mental disorders of the women, as well as poor intersectoral collaboration in IWO and lack of sufficient manpower. Proposed solutions for improvement of the situation included increasing financial credits, creating a national database, informing and sensitizing the people and approving some new judicial laws, as well as reforming some of the existing judicial laws.
Conclusion: Despite the services delivered in this national program, the program faces challenges at the government and public levels. In order to improve the current situation, it is essential to apply the proposed solutions, as well as review and modify the relevant processes.

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Background and Aim: Patients with diabetes need continous support for sustainable self-care behaviors. The use of supportive forces to improve the level of self-management of diabetes is felt. The aim of this study was to compare the effectiveness of direct and indirect virtual educational interventions on the promotion of self-management behaviors and diabetes control in women with type 2 diabetes. The study was conducted in 2019.
Materials and Methods: This clinical trial study included 100 females with type 2 diabetes under the coverage of three health centers affiliated to Tehran University of Medical Sciences, randomly divided into two groups of direct and indirect education (50 subjects in either group). A questionnaire was used as the standard tool of diabetes self-management. The education imparted to the subjects was based on the latest version of Diabetes Self-Management Education (DSME), and the educational sessions were based on the Stanford University's self-management model, including six 90-minute sessions during three weeks. Data were analyzed using SPSS-16 statistical software, the statistical tests being covariance analysis, etc.        
Results: There were no statistically significant differences between the direct and indirect educational groups as regards the self-management scores and HbA1c levels in the first and second pre-tests (p<0.05). However, both the self-management scores and HbA1c levels of the two groups, determined at 3- and 6-month follow-ups, were found to be statistically significantly different (p<0.05).               
Conclusion: The findings of this study indicate the feasibility of using volunteers, after empowering them properly, to implement diabetes self-management educational interventions.              

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Background and Aim: Cardiovascular diseases are the most common cause of death in most countries of the world, hypertension being the most important cause of disability. The aim of this study conducted in 2020-2021 was to determine the effect of educational intervention on the nutritional knowledge, illness perception and dietary adherence in hypertensive middle aged women based on the transtheoretical model (TTM).
Materials and Methods: This was a quasi-experimental study on middle-aged women (30-59 years old) suffering from hypertension referred to the  health centers and health bases in the 21st district of Tehran in 2020-2021. A total of 164 subjects were randomly assigned to the intervention (n=82) or control (n=82) group by randomized quadruple blocks. A multifaceted questionnaire was completed for both the control and intervention groups and their blood pressure measured. This was followed by  a one-month virtual education for the intervention group in the form of a WhatsApp group and designing and developing fifty-six podcasts and educational clips with a maximum duration of four minutes based on the transtheoretical model constructs. After a lapse of one and six months both groups completed the questionnaire again and their blood pressure was measured. Descriptive statistics and general linear model were used for data analysis using the SPSS version 25 (p<0.05).
Results: Before the intervention the mean age of the subjects was 50.16 years and their systolic and diastolic blood pressures were 1.35 and 1.84 mmHg, respectively, and there were no statistically significantly differences between the two groups as regards contextual variables, constructs of nutritional awareness, disease perception, diet adherence, systolic and diastolic blood pressures and body mass index (as an ananthropometric index) and transtheoretical model constructs. Data one month after the intervention revealed significant differences (p<0/001) between the two groups (p <0/001) as regards the constructs of nutritional awareness, disease perception, self-sufficiency construct of the transtheoretical model and systolic blood pressure. Six months after the intervention significant differences were observed between the two groups as regatds  nutritional awareness constructs, disease perception (p<0.007), diet adherence (p<0.001), stages of change constructs (p<0.001) and self-sufficiency (p<0.001) of the transtheoretical model.
Conclusion: The results of this study show that educational intervention based on the transtheoretical model in middle-aged women with hypertension can increase their nutritional knowledge, illness perception, self-sufficiency, self-adequacy and diet adherence.
 

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Background and Aim: Family female heads are one of the most vulnerable groups in the society and empowering them is essential. This research was a systematic study to design and develop a model of educational needs of female heads in the female-headed households.
Materials and Methods: This study was a qualitative applied research of a research synthetic type conducted using content-analysis and meta-analysis. The statistical population included all the relevant works published in Persian or English between 2012 and 2021 available in four reliable databases, namely, ERIC, Science Direct, PubMed and Google Scholar. Using the keywords "education of women-headed households, women's empowerment, women-headed households, and skills of women-headed households" and based on the inclusion criteria, initially 140 scientific articles were identified and finally, based on the exclusion criteria, 47 articles were selected for the final analysis. The Software MAXQDA 18 was used for the qualitative analysis of the articles.
Results: Analysis of the data obtained showed the educational needs of women-headed households as the main theme to consist of four subthemes including "knowledge and skills of desirable sexual orientation", "knowledge and skills of raising children", "knowledge and skills of occupation" and "individual and social development and empowerment”. Based on meta-analysis out of the four main themes 22 themes were extracted and a model was designed for educating female-headed households.  
Conclusion: Considering that the educational needs of female-headed households have been identified, it is recommended that educational courses be designed in accordance with their educational needs.
 

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Background and Aim: Demographic policies are designed and implemented with the aim of creating a better life for individuals in the society as well as protecting national interests. However, whether the implementation of these policies has achieved this goal or has had other, possibly unwanted, consequences that would affect the lives of the citizens, especially vulnerable people, requires careful investigation. These policies have had profound effects on the family and the health of family members, especially women. The purpose of this research was to investigate the understanding and interpretations of women in the southern areas of Tehran who had experienced unwanted pregnancy regarding population increase policies and their effects on women and their family lives.
Materials and Methods: This research was a descriptive qualitative study. Data were collected through semi-structured in-depth interviews with 23 married women with a history of unwanted pregnancy referring to the comprehensive health centers in districts 16, 17 and 19 of South Tehran Health Network. Purposive sampling was continued until a theoretical saturation was reached, and data analysis was performed based on the foundation data theory.
Results: Out of the primary data consisting of a total of 850 open codes, 452 concepts, 15 main categories and 47 sub-categories were extracted. Finally, "dissatisfaction with interventionism" was chosen as the main phenomenon covering the rest of the categories.
Conclusion: The most important factors causing dissatisfaction with government intervention among the participants are imposing costs related to unwanted pregnancies and keeping and raising an unwanted child. The intervening conditions of this phenomenon are "poverty and high cost". The participants' strategies included suppressing their wants, regret and attempts to improve the situation and reducing sexual relations.                

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Background and Aim: Domestic violence against women as a social characteristic can affect women's reproductive behaviors. The present study investigated the relationship between domestic violence against women and their childbearing intention.
Materials and Methods: This study was a survey conducted using a questionnaire in 2022. The statistical population was married women aged 15-49 years living in Sadra city, Iran, out of whom a sample of 379 was selected by the multi-stage cluster technic. Domestic violence against women was measured using a form with 26 items with a Likert scale, the domestic violence score being obtained by the sum of scores of the items. The SPSS software version 20 was used to analyze the data, the statistical tests being descriptive statistics and two-dimensional logistic regression.
Results: The most common types of domestic violence against women were found to be, in descending order, psychological, physical, economic and sexual violence. The duration of marriage and education of women had a statistically significant effect on their childbearing intention. Increasing domestic violence against women was found to reduce their childbearing intention.
Conclusion: Reducing domestic violence can increase the women’s intention to have children. Therefore, reducing domestic violence against women should be on the policy agenda of the relevant decision makers.
 

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Background and Aim: Considering the quality of prenatal care services, indentification of the avoidable and inevitable maternal factors and proper promotion of the knowledge and skills of health care service providers is vital for providing suitable preventive and interventional services with the aim of ensuring a successful pregnancy and proper management in the health care system.  This study was conducted to compare the adverse pregnancy outcomes among women with or without a history of Covid-19 in the pregnancy and postpartum stages covered by the Babol University of Medical Sciences, Babol, Iran.
Materials and Methods: This was a descriptive-analytical cross-sectional study including 4124 women, either pregnant or after a recent childbirth (with or without Covid-19) between 20.2.2020  and  29.3.2022, registered in the Sib electronic system (hereinafter Sib) of Babol University of Medical Sciences, Babol, Iran. Using a checklist developed and validated by an expert panel data were collected on the prevalence of maternal and neonatal outcomes in mothers with or without a history of Covid-19 and compared. The data collected were analyzed with SPSS 24 using descriptive tests such as chi-square and Fisher's exact test and STATA version 22, and the adverse outcomes with high frequencies following Covid-19 were determined.
Results: Analysis of the data showed the following to be the most common outcomes among mothers with a history of Covid-19: 1. obstetric complications and maternal disorders/diseases (hypertension, type-2 diabetes mellitus, at least one case of bleeding during pregnancy, premature/delayed birth and premature rupture of the amniotic sac, n= 457, 27.8%); 2. medical and surgical problems (unhealthy pregnancy weight gain and thromboembolic events, n=206, 12.5%). In addition, there was a statistically significant difference between the two groups of pregnant mothers with and without a Covid-19 infection as regards medical and surgical problems (P=0.001) and obstetric complications and maternal diseases (p=0.002). As regards the adverse neonatal outcomes in pregnant mothers with and without a history of Covid-19, there was a statistically significant difference between the two groups in terms of Apgar score at minutes 1 and 5 (p≥0.001) and exclusive breastfeeding (P=0.001) and the presence of Covid-19 symptoms in the baby (p<0.001).
Conclusion: Based on the findings of this study it seems that Covid-19 infection during pregnancy is associated with a higher risk of some of the undesirable maternal and neonatal outcomes.  Therefore, it is essential to plan and implement programs for health education, creation of a sound attitude towards better management, enhancement of the skills and capabilities of the health-care providers and, finally, promotion of the knowledge of service recipients. 
 

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Background and Aim:  Women referring to health centers are one of the most important groups at risk of disease. Thus, in order to enjoy a high level of health, it is necessary for them to have health literacy. The purpose of this research was to find the demographic predictors of health literacy in women referring to comprehensive health service centers in Zahedan, Iran.
Materials and Methods: This was a descriptive-analytical study including 400 women selected by random cluster sampling from health centers under coverage of Zahedan University of Medical Sciences in 2022. The short form of the HELIA standard questionnaire was used to measure health literacy of the women. Data were analyzed using SPSS-22 software, the statistical tests being ANOVA, Kendall's correlation, and multiple regression.
Results: The subjects were between 18 and 60 years old. They were found to have obtained most of the information related to health and disease by asking doctors and healthcare workers (about 52.25%). The scores of the components of the subjects’ health literacy were as follows: average health literacy 69.91±23.34, reading 72.17±29.80, access 34.73±27.91, understanding 71.41±29.43, assessment 62.10±25.51, and the scope of decision-making and behavior 71.49±20.27. The strongest predictor of health literacy was found to be education, such that with an increase in the level of education, the health literacy of a woman would increase by 0.53 units. In addition, education variables, income level, age and ethnicity would predict 55% of the health literacy of the women.
Conclusion: This study shows that the health literacy score is related to age, education level, marital status, occupation, economic status and ethnicity, the strongest predictor of health literacy being the a high level of education. Therefore, considering the available evidence on the importance of health literacy and factors related to it and the low level of health literacy of women in this study, it is clear that women need to acquire, process and understand the basic information on health and therapeutic services in order to be able to make appropriate decisions. Briefly, women need to receive simple and understandable information and have more time to communicate with the health service personnel to understand health information.