Better evaluation of the contribution of the main diseases, injuries, and risk factors for mortality and life expectancy is crucial for more efficient policy making at the national and subnational levels in Iran. The aim of this study is to assess the effect of emerging causes of mortality on health, specifically COVID-19, which can help policy makers implement preventive measures in similar situations. In this systematic analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we present estimates of cause-specific mortality at the national and subnational levels in Iran from 1990 to 2023. New to this iteration of GBD, we present a decomposition analysis of the contribution of specific causes of death to net gain or loss in life expectancy across 31 provinces of Iran. We used an array of data sources including censuses, vital registration, and surveys for national and subnational estimates. The two leading causes of death in Iran were ischaemic heart disease and stroke in both 1990 and 2019. However, in 2020 and 2021, the COVID-19 pandemic displaced the leading causes of death, ranking first with age-standardised mortality rates of 286·2 deaths (95% uncertainty interval 267·9-310·5) per 100 000 in 2020 and 250·0 deaths (233·2-272·5) per 100 000 in 2021. COVID-19 ranked second and tenth in 2022 and 2023, respectively. Life expectancy at birth for both sexes combined declined from 78·0 years (77·7-78·1) in 2019 to 74·3 years (74·0-74·4) in 2020. It steadily recovered to 78·8 years (78·5-79·2) in 2023. COVID-19 was the main cause of loss in life expectancy, by 4·19 years, between 2019 and 2020. There was a net gain of 12·4 years in life expectancy in Iran from 1990 to 2023. The net gain at the national level can be mostly attributed to reduced mortality from ischaemic heart disease (2·61 years), stroke (1·63 years), neonatal disorders (1·26 years), transport injuries (0·88 years), and neoplasms (0·64 years). The decline in mortality rates of major causes continued to 2023 despite the pandemic. An exception was Alzheimer's disease, which showed a 4·0% increase in rate between 2019 and 2023 and led to a net loss of 0·04 years in life expectancy since 1990. Diabetes led to a net loss of 0·09 years since 1990. There were variations between provinces in terms of age-standardised rates and the net change in life expectancy before and after the COVID-19 pandemic. The COVID-19 pandemic disrupted the rising trend of life expectancy in Iran, varying across provinces. Findings show that the health-care infrastructure and policies in Iran were not efficient in controlling the pandemic in 2020 and 2021, mainly due to inadequate vaccination coverage and timeliness, specifically for vulnerable subgroups. Sanctions may have aggravated the effect of COVID-19 on loss in life expectancy of Iranians. Despite the pandemic, the declining trend in age-standardised rates for top causes of mortality has continued to 2023, leading to a full recovery of life expectancy and underscoring the ultimate resilience of Iran's health system. Gates Foundation.
Unhealthy lifestyle behaviors such as poor diet, physical inactivity, smoking, and substance use significantly increase the burden of disease and mortality in Iran. These behaviors pose serious challenges to public health and healthcare systems, making it essential to quantify their impact to guide effective health policies and allocate resources efficiently. This study estimates and compares the health burden of unhealthy behaviors in Iran using quality-adjusted life year (QALY) loss. A cross-sectional study was conducted in 2024-2025 involving 3,518 individuals aged 18 and older, selected through multistage sampling across nine provinces in Iran. Data collection included face-to-face interviews using a self-administered questionnaire alongside the Iranian version of the EQ-5D-5 L and EQ-VAS tools to assess health-related quality of life (HRQoL). Generalize linear model (GLM) with gamma distribution and a log link analyzed the impact of each unhealthy behavior including smoking, physical activity, sleep quantity and quality, oral health practices (such as brushing and flossing), breakfast skipping, and dairy consumption on health utility scores. Annual QALY loss per 100,000 individuals was calculated by combining behavior prevalence and health utility data. All data analyses were performed using Stata/MP version 17. In this study, we assessed eight unhealthy lifestyle behaviors among participants: physical activity, smoking status, regular tooth brushing, regular dental flossing, sleep duration, sleep quality, breakfast skipping, and dairy consumption. The prevalence of these behaviors was as follows: 41.79% of participants reported poor physical activity, 25.85% were smokers, 13.19% did not brush their teeth regularly, and 39.57% did not floss regularly. Additionally, 84.22% had insufficient sleep duration (≤ 7 h), 12.48% reported poor sleep quality, 49.81% skipped breakfast, and 25.42% had unsuitable dairy consumption. The study also found that all the unhealthy behaviors were significantly associated with lower EQ-5D-5 L and EQ-VAS scores, with poor sleep quality exhibiting the most substantial negative effect, showing a coefficient of -0.2373 (p < 0.001) for the EQ-5D-5 L score and - 0.1838 (p < 0.001) for the EQ-VAS score. Poor sleep quality also had the largest annual QALY loss per 100,000 individuals at -2961.50 (95% CI: -3407.50 to -2586.52), followed by insufficient sleep duration at -2787.68 (95% CI: -4978.37 to -56.81), breakfast skipping at -2216.55 (95% CI: -3414.74 to -1173.60), and poor physical activity at -2102.04 (95% CI: -3094.81 to -1251.11). Unhealthy behaviors significantly reduce HRQoL in Iran, with these findings highlighting the high health burden of sleep-related behaviors. These results emphasize the urgent need for targeted public health interventions and prevention strategies to address these behaviors and improve population health.
Family caregivers of stroke patients play a critical role in post-stroke recovery, yet they often face significant challenges, including physical and emotional stress, lack of knowledge, and limited access to resources. Mobile health (mHealth) apps offer a promising solution to support caregivers by providing education, task management, and mental health resources. However, gaps remain in understanding the effectiveness, functionalities, and limitations of these apps. This study aimed to 1) identify and categorize existing mHealth apps for family caregivers of stroke patients, 2) evaluate the effectiveness of these apps in supporting caregivers, and 3) analyze the gaps in current mHealth offerings to inform future app development. A systematic literature review was conducted, analyzing 30 studies published between 2014 and 2024 from databases such as IEEE Xplore, Scopus, Web of Science, and PubMed. The studies were evaluated based on app functionality and effectiveness in caregiver support, and limitations were identified. The findings revealed a diverse range of mHealth apps offering functionalities such as caregiver education, rehabilitation guidance, task management, communication tools, and health monitoring. However, notable gaps were identified, including limited multi-functionality, insufficient support for caregiver well-being, a lack of customization for diverse needs, and minimal validation through rigorous trials. While mHealth apps provide valuable tools for family caregivers of stroke patients, addressing the identified gaps is essential to maximize their impact. Future Development should focus on creating comprehensive, user-centered, and evidence-based apps that integrate education, mental health support, and task management.
This study aims to determine the validity and reliability instrument of the health literacy for school-age children (HLSAC) in Iranian adolescents (HLSAC-IA). Cross-sectional study. This study was conducted on 487 adolescents in Khorasan, in east of Iran. Data were collected using the health literacy instrument for school-aged children. The English version of the instrument was translated into Persian using forward and backward translation methods and adapted to the Iranian culture. Content validity ratio (CVR) and content validity index (CVI) were used to calculate content validity. TLI, CFI, χ2/df, and RMSEA indices were calculated for construct validity and model fit. Intra-class correlation coefficient (ICC) and Cronbach's α were used to determine reliability. The mean age of adolescents was 14.92 ± 46 years. Most were girls (73.1 %) and students (88.1 %). The CVR and CVI were 0.925 and 0.810, respectively. The results of the confirmatory factor analysis showed that the loadings of the confirmatory factor were between 0.616 and 0.741. The indices (TLI = 0.966, CFI = 0.981, RMSEA = 0.050, and (χ2/df = 2.222)) showed a good fit of the model in confirmatory factor analysis. ICC and Cronbach's α were 0.881 and 0.91, respectively. The Persian version of the health literacy questionnaire for school-aged children comprising 5 components and 10 items demonstrates good validity and reliability and is suitable for evaluating health literacy interventions and adolescent health literacy.
The PRECEDE-PROCEED Model (PPM) is a theoretical tool for comprehensively assessing population health priorities and practically guiding the planning, implementation, and evaluation of interventions. We aimed to analyze systematically the extent of PPM utilization in the development and evaluation of public health interventions and to appraise the effectiveness of PPM-based interventions. PUBMED, Web of Science, ELSEVIER, EBSCO, and SCOPUS were systematically searched to identify relevant peer-reviewed studies from inception to June 2024. Data were extracted on study objectives, design, population, PPM utilization, interventions, and outcomes. Qualitative synthesis was performed to analyze how PPM was applied, to identify recurring themes, and to assess intervention effectiveness. A total of 54 studies were included, of which 51 reported effective outcomes. These studies spanned 11 domains including disease prevention and control, healthy behaviors, preventing domestic violence, and so on. Education and ecological assessment was most frequently adopted (96%) in the PRECEDE stage, and outcome assessment was most commonly adopted (94%) in the PROCEED phase. All studied interventions incorporated health education. Nine key intervention elements were identified including sustained implementation, adequate duration, multiple educational topics, diverse formats, social support, providing educational materials, participant interaction, intervention monitoring, and practice support. Participant interaction was most frequently utilized (85%), whereas practice support was least frequently used (54%). Our findings highlight the importance of educational and ecological assessment in the PRECEDE stage and outcome evaluation in the PROCEDE phase for effective intervention design and assessment. Future PPM-based interventions should consider the nine identified core elements, with emphasis tailored to the specific health domain.
Exposure to third-hand smoke (THS) is hazardous for human health, especially for pregnant women. This study aimed at psychometric evaluation of the Iranian version of "Beliefs about Third-Hand Smoke Scale" (BATHS-T) in pregnant women. The data collected from 364 pregnant women referring to Yazd health centers. The BATHS scale was translated into Persian, and the stages of adaptation of the BATHS scale in Persian were evaluated with CVR=0.87 and CVI=0.88. Confirmatory factor analysis (CFA) was performed to analyze the construct validity of the scale. Besides, the correlation test was used to evaluate the correlation of categories and subcategories of the scale. The BATHS structural equation model showed a favorable fit as RMSEA value was less than 0.05 and X2/df varied between 2 to 5. Moreover, other indices such as CFI and NFI were more than 90%, indicating the optimal fit of the present model. The correlation between the overall scale of BATHS and its two subcategories was 0.843 (p < 0.001) and the correlation between health and stability subcategories was 0.886 (p < 0.001). Since there was a positive and highly significant correlation, the fitted BATHS scale was considered to be structurally consistent with its subcategories. The reliability of the whole scale was 0.86 using Cronbach's alpha coefficient. The Iranian version of the BATHS scale is reliable and valid. This scale provides the required prerequisites for further research and education on third hand smoke exposure. It can also be possibly used in similar studies. The BATHS scale has innovative aspects based on the real beliefs of participants concerning third-hand smoke. The favorable validity and reliability of the scale makes it possible to use it in similar studies. Hence, a reliable scale of THS beliefs may be a criterion for measuring the desire to reduce exposure to SHS and THS at homes or other private spaces such as cars. Additionally, examining the results among different populations may be useful in identifying high-risk groups to ward off exposure to THS, and groups that are likely to respond positively to interventions that emphasize THS damage.
Human papillomavirus (HPV) is a common sexually transmitted infection (STI) and the main cause of precancerous changes in the cervix. Despite the undeniable role of HPV vaccines in preventing cervical cancer, the vaccination rate has remained low. The perception of a disease can predict preventive behaviors such as vaccination. This qualitative study aimed to explore women's perceptions of HPV and its vaccine. In-depth, semi-structured interviews were conducted in four focus groups (FG) with 23 eligible women (aged 15-45), who had no prior history of cervical cancer, HPV infection, and vaccination. Interviews were recorded, transcribed verbatim, and analyzed using a directed content analysis approach based on the Health Belief Model (HBM). Perceived sensitivity, the risk of HPV infection, benefits and barriers of HPV vaccination, cue to action, self-care, and new category named social support were the main categories that emerged. Two main concerns for women included worries about the virus leading to cancer as well as marital and sexual relationship tension in case the husband contracts an infection. Main barriers to vaccination included informational, psychological, socio-cultural, and economic barriers. Self-protection acts, stress management, and medical care were the women's main perceptions of self-care and they expressed a need for informational, emotional, and financial support. The results of our study indicate that educating women and their families, improving people's sexual health awareness, integrating the vaccine into the national vaccination program, and establishing sexual health counselling units at healthcare centers are essential actions for encouraging women to get vaccinated and preventing HPV infection and its related adverse outcomes such as cancers.
Menopause is a natural biological transition in a woman's life, often accompanied by various physical and emotional challenges. Enhancing postmenopausal women's health and quality of life requires empowerment, particularly through self-care strategies. The present study aimed to evaluate the effectiveness of a training programme based on Longwe's Empowerment Framework and a Community-Based Participatory Research approach. A randomised controlled trial was conducted involving 140 postmenopausal Iranian women, with 70 women in each control and intervention group. The intervention group received a 6-week training programme, with weekly 120-min sessions, designed using Longwe's framework in combination with the PRECEDE-PROCEED model. Data were collected at three time points: baseline, 2 weeks post-intervention and 4 months post-intervention, using validated questionnaires. Statistical analyses were performed using SPSS version 27, with significance set at p < 0.05. The training intervention significantly improved participants' quality of life (η² = 0.23, p < 0.001) and overall health (η² = 0.12, p < 0.001), with large and moderate effect sizes, respectively. Notably, the programme had a large effect on menopausal self-care behaviours (η² = 0.42, p < 0.001) and a small but significant effect on internal health locus of control (η² = 0.05, p < 0.001). This study demonstrates that a structured self-care training programme, based on empowerment theory and community engagement, can effectively enhance the health outcomes and quality of life of postmenopausal women. The findings indicate that integrating participatory and empowerment-based educational interventions into public health initiatives for midlife women is advantageous. This study employed a community-based participatory research approach, actively engaging postmenopausal women as collaborators throughout the intervention process. Participants were involved in the initial needs assessment, where they shared their self-care priorities and preferences. They also provided input on the structure, scheduling, and delivery format of the educational sessions. Furthermore, they collaborated to develop and participate in weekly group activities that promoted self-care behaviours. Ongoing feedback from participants was incorporated into refining of the intervention, improving its cultural relevance, feasibility and alignment with the lived experiences of the target population.
This scoping review aimed to identify intermediary Social Determinants of Health (SDH) affecting access to reproductive health services among Afghan migrant women, emphasizing the challenges in achieving equitable health service access for this vulnerable population. To ensure methodological rigor, the PRISMA checklist was followed. The inclusion criteria comprised quantitative studies addressing access to reproductive health services among Afghan migrants. Articles were retrieved from SCOPUS, Web of Science, and PubMed databases, as well as through manual reference checks, covering the period from Jan 2000 to Mar 2025. Data extraction was guided by the World Health Organization's SDH framework, with a specific focus on intermediary determinants such as healthcare quality, behavioral and psychosocial factors, and social networks. From an initial pool of 628 articles, 18 met the eligibility criteria. The most frequently reported intermediary SDH was the quality and condition of healthcare services. Other common factors included behavioral aspects, social capital and cohesion, and psychological well-being. These determinants were consistently linked to disparities in access to reproductive health services. Effective access to reproductive health services among Afghan migrant women hinges on addressing both structural and intermediary SDH. The influence of these factors is context-specific, and tailored interventions are needed. Notably, the supportive role of non-governmental organizations and community-based social support systems should be prioritized to enhance reproductive health outcomes in migrant population.
This study aims to explore the impact of transformational, transactional and servant leadership on organizational success, with specific attention to the moderating role of technology adaptation and potential mediating role of organizational culture in the Iranian healthcare system. A quantitative, cross-sectional survey was conducted with 340 healthcare professionals across public and private sector, using judgmental sampling and analyzing the data using correlation, regression analysis and PROCESS MACRO to test mediation and moderation. Results confirm that leadership strategies, when considered as a composite construct have a statistically significant positive impact on organizational success, encompassing patient care quality, operational performance and employee engagement. Contrary to the theoretical expectations, the mediating role of organizational culture in this relationship was not supported, suggesting that cultural change may be less responsive to leadership efforts in bureaucratic healthcare systems. However, the study revealed that technological adaptation moderates the relationship between leadership and success, amplifying the effectiveness of leadership strategies in technologically adaptive environments. By extending leadership theory to a non-Western, resource-constrained healthcare setting, this research contributes to the global discourse on healthcare leadership and highlights the importance external contextual enablers in enhancing leadership effectiveness. It also challenges the assumed universality of cultural mediation models in leadership theory.
The migration of nurses has become a critical concern for Iran's healthcare system. However, the roots of this challenge may emerge early-during nursing education-when students begin forming attitudes toward working abroad. This study aimed to identify key predictors of Iranian nursing students' attitudes toward brain drain using a validated multivariate approach. In this cross-sectional study, a total of 296 bachelor's and master's nursing students from two nursing schools were recruited through convenience sampling between April and June 2025. Data were collected via an online questionnaire, which included demographic information, educational characteristics, life-related variables, migration-related factors, and the Attitudes toward brain drain scale. Multiple linear regression analysis was performed to examine the predictors of attitudes toward brain drain. Data were analyzed using IBM SPSS Statistics v.26. The average age of students was 22.7 years. Half of the students reported a moderate level of interest in the profession. Canada was the most frequently chosen destination country (33.5%). The average attitude score toward brain drain was 59.25 ± 11.97. In addition, language proficiency (β = 0.498, p < .001) positively predicted attitudes toward brain drain, whereas life satisfaction (β = -0.192, p < .001) and family connectedness (β = -0.125, p = .014) were negative predictors. These findings highlight the role of both personal and contextual factors in shaping migration attitudes among nursing students. Academic institutions should enhance educational experiences and support students' psychological well-being to foster more positive professional engagement within the country.
Early Childhood Caries (ECC) is a common oral health problem that negatively affects their quality of life and everyday function. The Early Childhood Oral Health Impact Scale (ECOHIS) is a validated tool for measuring Oral Health-Related Quality of Life (OHRQoL) in preschoolers. Although the Persian version of ECOHIS exists, the relationship between dental caries and OHRQoL has not been sufficiently investigated in Iranian preschool populations. This study aimed to examine the association between ECC and OHRQoL in children aged 2 to 6 years within the PERSIAN birth cohort in Isfahan, Iran. A cross-sectional study was conducted between April and October 2023 on a subset of the PERSIAN birth cohort-Isfahan. A total of 350 children aged 2-6 years were initially recruited, of whom 347 were included in the final analysis. Clinical examinations were performed to record decayed, missing, and filled primary teeth (dmft) and parents completed the ECOHIS questionnaire. Children received oral health education and fluoride varnish. The association between dmft and OHRQoL was analyzed using chi-square tests, independent t-tests, and multivariate logistic regression, with adjustments made for confounding variables. Higher dmft scores were significantly associated with lower OHRQoL in both child and parent sections of the ECOHIS questionnaire (p < .001). According to multivariate logistic regression, each unit increase in dmft was associated with greater odds of low child OHRQoL (OR = 1.23, 95% CI: 1.16-1.31), low parent OHRQoL (OR = 1.32, 95% CI: 1.23-1.41), and lower parental satisfaction (OR = 1.35, 95% CI: 1.26-1.45). Household income was significantly associated with parent-reported OHRQoL (OR = 0.27, 95% CI: 0.12-0.61). Dental caries were associated with lower OHRQoL of preschool children and their families. These findings emphasize the need for early detection, preventive strategies, and targeted oral health education, especially among low-income households. However, the results should be interpreted with caution due to the limited sample size, particularly within the moderate-income subgroup. Enhancement of public health initiatives and considering oral health in early childhood care programs may help reduce the burden of ECC and improve quality of life in this vulnerable population.
Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
Background: Research has shown that disordered eating behaviors-including binge eating, night eating syndrome, and food addiction-contribute to the heterogeneity of obesity and assist in phenotyping patients for more tailored interventions. The Eating Behavior Assessment for Obesity (EBA-O) is a recently developed 18-item questionnaire that assesses five pathological eating-behavior domains among individuals with obesity (night eating, food addiction, sweet eating, hyperphagia, and binge eating). The present study aimed to translate, culturally adapt, and validate the Persian (Farsi) version of the EBA-O. Methods: The original English EBA-O was translated into Persian following a standardized forward-backward translation procedure, with cultural adaptations implemented to ensure linguistic accuracy and conceptual clarity. A cross-sectional sample of 278 Iranian adults with overweight or obesity (body mass index [BMI] ≥ 25 kg/m2) completed the Persian EBA-O. Confirmatory factor analysis (CFA) was conducted to verify the five-factor model in the Persian sample. Internal consistency was evaluated using Cronbach's alpha and composite reliability (CR). Convergent validity was assessed using the average variance extracted (AVE), and discriminant validity was examined with the Heterotrait-Monotrait ratio (HTMT). Model fit indices, including the Comparative Fit Index [CFI], Tucker-Lewis Index [TLI], Normed Fit Index [NFI], Goodness-of-Fit Index [GFI], the Standardized Root Mean Square Residual [SRMR] and relative chi-square value [χ2/df] were used to determine the adequacy of the factor structure. Results: The Persian EBA-O demonstrated a clear and stable five-factor structure consistent with the original instrument. CFA indicated good model fit (CFI = 0.95, TLI = 0.94, NFI = 0.91, GFI = 0.92, SRMR = 0.05, χ2/df = 1.94), confirming the presence of the intended domains. Internal consistency was acceptable to high across all subscales (Cronbach's α = 0.78-0.86; CR > 0.70), and the total scale showed strong reliability. Three of the five factors demonstrated acceptable convergent validity (AVE = 0.54-0.68), while Food Addiction (AVE = 0.46) and Night Eating (AVE = 0.43) fell slightly below the 0.50 threshold; however, their adequate CR and α values indicate that these constructs remain coherent and psychometrically sound. All inter-factor correlations satisfied discriminant validity criteria (HTMT < 0.90), with the highest association observed between the Binge Eating and Hyperphagia factors. Overall, the psychometric properties of the Persian EBA-O were comparable to those reported in the original validation and subsequent translations. Conclusions: The Persian version of the EBA-O is a valid and reliable instrument for assessing pathological eating behaviors among individuals with obesity. It preserves the original questionnaire's five-factor structure and demonstrates acceptable internal consistency and construct validity in a Persian-speaking population. This validated tool will support both clinical assessment and research on eating-behavior phenotypes and may contribute to the development of more personalized and effective obesity-management strategies among Persian-speaking individuals.
Parental phubbing, the experience of children perceiving parental inattentiveness due to smartphone use, can signal emotional unavailability, perceived rejection, and model maladaptive behaviors. Theoretically, Risky Families Model highlights how emotionally unavailable parenting disrupts children's emotional and social development, PAR theory explains children's psychological responses to perceived parental neglect, and Social Learning Theory describes how children may adopt parents' smartphone habits. Despite these theoretical foundations, most research has been conducted in Chinese populations, limiting cross-cultural generalizability, and no validated Persian-language instrument exists. This study aimed to translate, culturally adapt, and validate the Persian Perceived Parental Phubbing Scale (PPPS) among Iranian university students, and to examine its psychosocial and sociodemographic correlates. A cross-sectional online survey was conducted with 428 Iranian university students (70.8% female; M = 28.03, SD = 8.67). The participants completed the adapted 9-item PPPS alongside validated measures of smartphone addiction (SABAS), loneliness (ULS-8), and fear of missing out (FoMOs). Confirmatory factor analysis (CFA) was used to evaluate structural validity, whereas Cronbach's alpha (α), McDonald's omega (ω), and Guttman's lambda (λ) were used to assess reliability. Group differences were analysed via t tests and ANOVA. Confirmatory factor analysis supported a unidimensional structure with acceptable model fit (RMSEA = 0.076, CFI = 0.98), and the PPPS showed high internal consistency (α = 0.90, ω = 0.901). The PPPS score was positively correlated with smartphone addiction (r = .29), loneliness (r = .27), and FoMO (r = .42). Higher scores were found among students with psychological disorders and those in romantic relationships. No significant differences emerged in terms of gender, residence, educational level, or family history of psychological disorders. The Persian PPPS is a valid and reliable tool for assessing perceived parental phubbing among Iranian students. The lack of gender differences suggests cultural or developmental nuances in how such behaviors are interpreted. The findings highlight the role of psychological vulnerability and relational context, offering a foundation for future cross-cultural research and culturally responsive interventions promoting mindful smartphone use in families.
Nursing is a high-stress profession frequently marked by demanding workplace conditions. Pregnant nurses, in particular, face heightened pressure to balance work and family responsibilities while maintaining their professional obligations throughout pregnancy. Adjusting to the physical, emotional, and occupational challenges of pregnancy is a complex process with important implications for both maternal well-being and fetal development. This study aims to explore the factors that influence how pregnant nurses adjust to continuing to deliver nursing care during this critical period. This study utilized the qualitative content analysis method proposed by Graneheim and Lundman. Eighteen participants were selected between May 2023 and August 2024 from healthcare centers affiliated with Semnan University of Medical Sciences, Iran, including fourteen pregnant nurses and four nursing managers (two head nurses and two supervisors). Based on the study's central research question, data collection tools included in-depth semi-structured interviews, field observations, and field notes. To ensure rich and comprehensive data, the study aimed to achieve maximum variation in age, educational level, work departments, and different stages of pregnancy. Data management was conducted using MAXQDA software, version 2020. Data analysis yielded three themes, including "Health Concerns," "Thoughts and Past Experiences," and "Workplace Tensions in the Nursing Profession," comprising seven categories and twenty-two subcategories. Pregnant nurses' adjustment is influenced not only by pregnancy-related factors such as workplace conditions, fetal health, and the physical and mental well-being of the mother, but also by past personal experiences. Identifying and understanding the factors affecting pregnant nurses' adjustment and designing a mandatory training for all managers on Iranian pregnancy labor laws enables nursing managers to reduce occupational stressors. These programs could be directed toward creating a system of non-reciprocal behaviors, voluntary shift swaps for pregnant staff, and the reassignment of high-risk nurses with physical and psychological problems. Such initiatives may improve nurses' adjustment during pregnancy, the quality of patient care, and the health of both mother and fetus.
Pelvic organ prolapse (POP) is a public health problem that affects individuals' psychosocial quality of life (QOL). However, affected women are often hesitant to seek care and treatment. Access to treatment and self-management for this condition can be supported through self-care applications. This study aimed to determine the effect of a self-care application on the quality of life of women with pelvic organ prolapse. This RCT was conducted at Imam Reza Hospital and private women's clinics in Mashhad, Iran, from February 2024 to August 2024. 64 women were randomly assigned to either the application group or the control group via block randomization, and 56 women completed the study. The control group received pamphlets and face-to-face education, whereas the intervention group used self-care applications alongside routine education. The participants completed a demographic questionnaire and the Pelvic Organ Prolapse Quality of Life questionnaire (P-QOL) before and immediately after two months of intervention. A lower score reflects a higher quality of life. For the secondary outcome, participants' knowledge was assessed before and after the intervention using the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). In addition, the prolapse stage was assessed by the Pelvic Organ Prolapse Quantification (POP-Q). The data were analyzed via SPSS Version 16. Before the intervention, the median quality-of-life score in the intervention group and in the control group was not statistically significant (P = 0.501). However, the median change in quality of life scores from pre- to post-intervention was - 14.58 (IQR:-20.73 to -11.14) in the intervention group and - 7.49 (IQR:-11.10 to -3.34) in the control group (P < 0.001). After intervention, the proportion of participants with an improvement of one or more POP-Q stages showed no difference between the groups (P = 0.880). After the intervention, the median knowledge score in the intervention group was significantly higher than the control group (P < 0.001). The application was effective in improving the quality of life of women with symptomatic stage I-II pelvic organ prolapse. In situations where self-care is appropriate, a self-care application can be a suitable alternative to other treatments or other conservative management approaches. This trial was registered in the Iranian clinical trials database (irct.behdasht.gov.ir) under the code IRCT20230923059497N1. Date of first registration was: 02/12/2023.
Aedes-borne diseases pose escalating public health challenges globally, influenced not only by ecological and biological factors but critically by social determinants of health (SDH). In Iran, emerging local transmission of dengue highlights these diseases as effective proxies to examine the impact of social and environmental factors on health equity. However, evidence on context-specific drivers and effective responses remains scarce. This study aimed to identify key SDH and propose prioritized interventions to inform evidence-based policymaking. This mixed-method study included a two scoping review on SDH of Aedes-Borne Diseases and SDH-focused interventions, complemented by qualitative data from in-depth interviews with 21 national and provincial health experts in Iran. Data were analyzed using an inductive content analysis approach and MAXQDA 25 software was used throughout the analysis. The identified interventions were prioritized through a multi-criteria decision analysis, incorporating expert input via an online checklist and digital platform, based on four key criteria: effectiveness, feasibility, social acceptability, and political support. Findings reveal that socioeconomic inequalities, weak community awareness, and limited health system capacity substantially drive disease risk. Notably, the local emergence and spread of dengue serve as a sensitive indicator reflecting broader social vulnerabilities affecting health outcomes. Integrated multisectoral strategies-encompassing health education, environmental management, digital surveillance, and cross-sector collaboration-are vital for effective control. Priority actions include healthcare worker training, embedding disease prevention within educational curricula, and tailored communication leveraging native languages and trusted community leaders. The study underscores that Aedes-borne diseases are not only biological threats but also reflections of underlying social and structural inequities. By framing dengue and related diseases as sentinel indicators of SDH, policymakers can better design integrated and equity-oriented strategies. Controlling Aedes-borne diseases requires a shift from disease-centric approaches toward comprehensive, SDH-informed strategies that strengthen community engagement, improve environmental and health infrastructure, and enhance cross-sector coordination. The prioritized interventions identified in this study provide a practical roadmap for strengthening preparedness and response in Iran and similar settings.
Digital health technologies are pivotal in delivering the WHO-recommended healthy lifestyle messages to reduce premature mortality associated with noncommunicable diseases (NCDs). However, evidence on effective strategies to promote healthy lifestyle behaviours among patients with limited health literacy remains insufficient. This review explores current digital health communication strategies that support healthy lifestyles in adults with NCDs and low health literacy. A scoping review was conducted using Arksey and O'Malley's framework, focusing on adults with NCDs and limited health literacy, digital health communication strategies, and healthy lifestyle behaviours. Searches were performed across 14 electronic databases and bibliographies of relevant studies from Jan 2012 to Nov 2022. Only primary studies published in English were included. Findings were reported following the PRISMA Extension for Scoping Reviews guidelines. Overall, 12 studies involving 15,175 participants, predominantly from high-income countries, met the inclusion criteria. Five digital health communication strategies were identified: telecommunication-based coaching, mobile applications, text messaging programs, eHealth and web-based tools, and bundled or multimodal interventions. These strategies demonstrated positive impacts on supporting healthy lifestyle behaviours. This review highlights the potential of diverse digital health communication strategies to enhance healthy lifestyle behaviours in adults with NCDs and limited health literacy. Tailoring these strategies to individual preferences is critical for optimizing outcomes. Further research is required to validate these findings, particularly in low- and middle-income countries.
Recently, along with the increase of the older adult population, the necessity of health management in daily life is emerging, and interest in the traditional oriental health management method, Yangsaeng, is increasing. This study was to provide a basis for future oriental health promotion intervention research by analyzing previous studies related to the Yangsaeng (oriental health management) of the older adults. This study was a systematic review on older adults' Yangsaeng. The databases used for literature search for data collection include PubMed, Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library (CDSR), Research Information Sharing Service (RISS), Oasis, Korean Studies Information Service System (KISS), and DataBase Periodical Information Academic (DBpia). Analysis of the status by year, subject characteristics, study types, research design methods, and variables related to older adults' Yangsaeng among previous studies related to older adults' Yangsaeng published in academic journals from 1990 to 2021 was performed. Eighteen quantitative studies related to the older adults' Yangsaeng have been published so far, and all of them were descriptive research studies using Yangsaeng measurement tool. The variables related to the older adults' Yangsaeng identified in this study were activities of daily living, self-efficacy, instrumental activities of daily living, perceived health state, self-esteem, empowerment, life satisfaction, physical function, quality of life, social support, anxiety, and depression. The study will be helpful in the development of integrative and complementary interventions for health promotion of the older adults.