The Open Public Health Journal




ISSN: 1874-9445 ― Volume 13, 2020
RESEARCH ARTICLE

The Effect of an Educational Intervention Performed by Volunteers on Knowledge, Attitude and Modification of Dietary Habits among Women



Esmat Rezabeigi Davarani1, Mohabbat Mohseni2, Narges Khanjani3, Farahnaz Yazdanpanah4, Salman Daneshi5, *, Kiavash Hushmandi6, Mehdi Raei7
1 Health Services Management Research Center, Kerman University of Medical Sciences, Kerman, Iran
2 Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
3 Research Center for Environmental Health Engineering, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
4 Health Center of Kerman City, Kerman University of Medical Sciences, Kerman, Iran
5 Department of Public Health, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran
6 Department of Food Hygiene and Quality Control, Division of Epidemiology and Zoonoses, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
7 Department of Biostatistics, Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran

Abstract

Background:

Unhealthy eating habits are an important cause of Non-communicable Diseases (NCDs). One of the most effective methods to prevent these diseases is the use of health education interventions. The aim of this study was to evaluate the effect of educational intervention performed by Women Health Volunteers (WHV) on knowledge, attitude, and modification of dietary habits among women in Kerman.

Methods:

This research was a quasi-experimental study performed on 400 women in Kerman. Participants were selected using multistage cluster sampling. Data were collected immediately before and 6 weeks after the intervention by a questionnaire, including demographic information and questions related to knowledge, attitude, and dietary habits. Data were analyzed using Pearson and Spearman correlation, paired t-test, and Wilcoxon-test in SPSS 24.

Results:

The average age of women was 41.91±12.87 years. Before the intervention, a positive and significant correlation was observed between knowledge and dietary habit (r=0.249) (p<0.001), knowledge and attitude (r=0.249) (p<0.001), and attitude and dietary habits (r=0.264) (P<0.0001). After the intervention, the mean scores of knowledge (p<0.001), attitude (p=0.017) and dietary habits (p<0.001) significantly increased.

Conclusion:

Education provided by WHV was effective in promoting knowledge, and attitude, and in modifying the dietary habits of women. Therefore, the use of local human resources can help improve public health.

Keywords: Education, Volunteers, Knowledge, Attitude, Dietary habits, Non-communicable diseases.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 13
First Page: 611
Last Page: 616
Publisher Id: TOPHJ-13-611
DOI: 10.2174/1874944502013010611

Article History:

Received Date: 16/5/2020
Revision Received Date: 5/9/2020
Acceptance Date: 13/9/2020
Electronic publication date: 13/11/2020
Collection year: 2020

© 2020 Davarani et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of Public Health, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran; Tel: 03443310916; E-mail: salmandaneshi008@gmail.com





1. INTRODUCTION

In recent decades, most low- and middle-income countries are rapidly moving from traditional diets towards a diet rich in saturated fat, sugars, salt, animal, and processed products, and low in carbohydrates, fibers, fruits, and vegetables [1Popkin BM. Nutrition transition and the global diabetes epidemic. Curr Diab Rep 2015; 15(9): 64.
[http://dx.doi.org/10.1007/s11892-015-0631-4] [PMID: 26209940]
]. The rapid changes in lifestyle and dietary patterns have contributed to the increasing prevalence of obesity and Non-communicable diseases (NCDs) such as type 2 diabetes, hypertension, cardiovascular diseases, and some cancers [2Bishwajit G. Nutrition transition in South Asia: The emergence of non-communicable chronic diseases. F1000 Res 2015; 4: 8.
[http://dx.doi.org/10.12688/f1000research.5732.2] [PMID: 26834976]
, 3Swinburn B, Sacks G, Vandevijvere S, et al. INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): Overview and key principles. Obes Rev 2013; 14(Suppl. 1): 1-12.
[http://dx.doi.org/10.1111/obr.12087] [PMID: 24074206]
]. NCDs are responsible for 63% of all deaths globally [4Kazemi T, Hajihosseini M, Moossavi M, Hemmati M, Ziaee M. Cardiovascular risk factors and Atherogenic indices in an Iranian population: Birjand east of Iran. Clin Med Insights Cardiol 2018; 12: 1179546818759286.
[http://dx.doi.org/10.1177/1179546818759286] [PMID: 29497341]
], and the main cause for 76% of deaths in Iran [5Poustchi H, Eghtesad S, Kamangar F, et al. Prospective epidemiological research studies in Iran (the PERSIAN Cohort Study): Rationale, objectives, and design. Am J Epidemiol 2018; 187(4): 647-55.
[http://dx.doi.org/10.1093/aje/kwx314] [PMID: 29145581]
]. NCDs are the major cause of mortality and disability in Iran. An unhealthy diet is one of the most important risk factors of NCDs in Iran [6Peykari N, Hashemi H, Dinarvand R, et al. National action plan for non-communicable diseases prevention and control in Iran; a response to emerging epidemic. J Diabetes Metab Disord 2017; 16(1): 3.
[http://dx.doi.org/10.1186/s40200-017-0288-4] [PMID: 28127543]
].

The results of a review study showed that the per capita consumption of calories in Iran is more than the recommended daily amount and the per capita consumption of oil is 20% and sugar 38% more than the recommended amounts in the desired food basket. Also, the consumption of vegetables and fruits is 25% less than the recommended amounts [7Abdi F, Atarodikashani Z, Mirmiran P, Esteki T. Surveying global and Iranian food consumption patterns: A review of the literature Journal of Fasa University of Medical Sciences 2015; 5(2): 159-67.].

Educational programs play a key role in reducing risk factors for these diseases [8Arena R, Guazzi M, Lianov L, et al. Healthy lifestyle interventions to combat noncommunicable disease-a novel nonhierarchical connectivity model for key stakeholders: A policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Eur Heart J 2015; 36(31): 2097-109.
[http://dx.doi.org/10.1093/eurheartj/ehv207] [PMID: 26138925]
]. Several studies have shown the positive impact of nutrition education on reducing risk factors and a healthy diet [9Azizi F, Ghanbarian A, Momenan AA, et al. Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II. Trials 2009; 10(1): 5.
[http://dx.doi.org/10.1186/1745-6215-10-5] [PMID: 19166627]
-12Mirbazegh SF, Rahnavard Z, Rajabi F. The effect of education on dietary behaviors to prevent cancer in mothers. J Research & Health 2012; 2: 108-17.].

Community participation is one of the key elements of health promotion [13Alami A, Nedjat S, Majdzadeh R, Foroushani AR, Hoseini S, Malekafzali H. Factors influencing women's willingness to volunteer in the healthcare system: evidence from the Islamic Republic of Iran 2013; 19(4): 348-55.
[http://dx.doi.org/10.26719/2013.19.4.348]
]. The most successful community participation program in Iran has been the Health Volunteers Plan [14Sahbaei F, Niksadat N, Keshavarz N, Toohidi M. Practice of the health volunteers in Iran. J Med Counc Iran 2016; 34(2): 157-62.]. Recruiting local women health volunteers (WHV) is an excellent investment for community education, especially in developing country societies with shortages of resources [15Kok MC, Kane SS, Tulloch O, et al. How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature. Health Res Policy Syst 2015; 13(1): 13.
[http://dx.doi.org/10.1186/s12961-015-0001-3] [PMID: 25890229]
, 16Mishra SR, Neupane D, Preen D, Kallestrup P, Perry HB. Mitigation of non-communicable diseases in developing countries with community health workers. Global Health 2015; 11(1): 43.
[http://dx.doi.org/10.1186/s12992-015-0129-5] [PMID: 26555199]
].

Employing WHV is one of the most effective strategies for educating households because they are familiar with the culture and customs of the community, and their contributions to health service delivery are accepted by households [17Damari B, Riazi-Isfahani S. Evaluating the Women Health Volunteers Program in Iran- a Quarter Century Experience (1992-2016). Arch Iran Med 2018; 21(12): 566-71. [AIM].
[PMID: 30634853]
, 18Sommanustweechai A, Putthasri W, Nwe ML, et al. Community health worker in hard-to-reach rural areas of Myanmar: Filling primary health care service gaps. Hum Resour Health 2016; 14(1): 64.
[http://dx.doi.org/10.1186/s12960-016-0161-4] [PMID: 27769312]
].

In Iran, the WHV Plan was accomplished according to the Declaration of Alma-Ata for community participation in the planning and implementation of health care [19Fazeli N, Moradi M, Khadivzadeh T, Esmaily H. Effect of preconception care education by health volunteers on knowledge and attitudes of women: Application of the health belief model. Evidence Based Care 2018; 8(1): 76-81.]. The WHV program started in 1990 in the capital of Iran, Tehran, since 1993, this program has been implemented throughout the country [20Miri M-R, Ramazani AA, Moodi M, Mirkarimi K. The effects of suburban villages’ health volunteer plan on women’s health knowledge and attitude. J Educ Health Promot 2012; 1: 12.
[http://dx.doi.org/10.4103/2277-9531.98570] [PMID: 23555115]
]. Currently, there are more than 200 thousand health volunteers in Iran [17Damari B, Riazi-Isfahani S. Evaluating the Women Health Volunteers Program in Iran- a Quarter Century Experience (1992-2016). Arch Iran Med 2018; 21(12): 566-71. [AIM].
[PMID: 30634853]
]. Each volunteer usually covers an average of 50 households from her neighborhood [19Fazeli N, Moradi M, Khadivzadeh T, Esmaily H. Effect of preconception care education by health volunteers on knowledge and attitudes of women: Application of the health belief model. Evidence Based Care 2018; 8(1): 76-81.]. WHV are women who live in the urban regions covered by health centers who are interested in helping people to improve their health status. They are involved in the delivery of health services to the community without receiving wages [21Vizeshfar F, Momennasab M, Yektatalab S, Iman MT. Challenges faced by health volunteers in comprehensive health centers in the southwest of Iran: A qualitative content analysis. J Med Life 2018; 11(1): 62-8.
[PMID: 29696067]
].

The most important activities of WHV include:educating and delivering health messages and distributing educational materials, collecting demographic and statistical data of vital events, defining health-related issues and trying to solve such problems through community participation and cooperation, encouraging and persuading people to receive health care and following-up on individuals who visit health centers especially:children, pregnant women, and people with chronic diseases, and contributing to the control of infectious diseases such as HIV, malaria, and tuberculosis [17Damari B, Riazi-Isfahani S. Evaluating the Women Health Volunteers Program in Iran- a Quarter Century Experience (1992-2016). Arch Iran Med 2018; 21(12): 566-71. [AIM].
[PMID: 30634853]
, 22Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: An overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health 2014; 35: 399-421.
[http://dx.doi.org/10.1146/annurev-publhealth-032013-182354] [PMID: 24387091]
].

The findings of a study in Iran show that the WHV had an appropriate attitude towards a healthy diet [23Rezabeigi Davarani E, Mahmoodi M, Khanjani N, Fadakar Davarani M. Application of planned behavior theory in predicting factors influencing nutritional behaviors related to cardiovascular diseases among health volunteers in Kerman. Journal of Health 2018; 8(5): 518-29.
[PMID: 30580628]
]. In another study, the attitude of WHV was acceptable regarding family education [24Heshmati H, Rahaei Z, Hazavehei S, Dehnadi A, Hasanzadeh A. Related factors to educational behaviors of health volunteers about cutaneous leishmaniasis on the basis of BASNEF model in Yazd. Journal of Health 2010; 1(3): 48-56.]. Therefore, this made them suitable for educating households.

The participation of health volunteers in education, in addition to improving their capabilities, also, the strengths and weaknesses and the effectiveness of this program are identified and the interventions can be designed to improve the WHV program.

Considering that so far, no study has been conducted on the effect of Kerman WHVon behaviors related to community health; therefore, the aim of this study was to determine the effect of education by health volunteers on the knowledge, attitude, and dietary habits of women in Kerman.

2. METHODS

The current quasi-experimental study was performed on 400 women covered by health centers who were selected by cluster sampling in Kerman in 2017. The city of Kerman was divided into 4 regions and a health center was selected from each region randomly. Then, from each health center, 10 active volunteers (A total of 40 volunteers) were selected. Each volunteer was responsible for educating 10 women. The volunteers cooperated with the selected health centers and routinely participated in various training sessions of that center. The list of active volunteers was obtained from the relevant center. The volunteers selected for training had already received the necessary training, the results of which were published in a separate study [25Rezabeigi Davarani E, Mahmoodi MR, Khanjani N, Fadakar MM. The Effect of Educational Intervention based on the theory of planned behavior on Nutritional Behavior with Regard to Cardiovascular Diseases among Health Volunteers. J Nutr Food Sec 2019; 4(2): 93-100.].

The women who participated in the study were randomly selected from the health center registry system.

The inclusion criteria were being literate, and able to participate in group discussions and respond to the questions. Informed consent was inquired from all participants before the intervention. In order to ensure confidentiality, information was encoded and kept anonymous.

Educational content, a collection of materials related to the role of nutrition in the prevention of chronic non-communicable diseases, including limiting the consumption of salt, fat and oil, simple sugars, processed meats and increasing fiber intake (whole grains, legumes, fruits and vegetables), low dairy fat and fish, an avoidance of overeating and obesity, was prepared by the researcher and provided to the volunteers. For more information, educational booklets published by the Ministry of Health were also used.

In these sessions, in order to increase general awareness about nutrition, the role of nutrition in the prevention of non-communicable diseases was taught through lectures and educational materials were distributed. Questions were answered at the end of each session.

Also, in order to create a positive attitude and correct misconceptions about nutrition and cooking, a group discussion for idea-sharing was organized and the personal experiences of the participants were recounted.

During the training sessions, an attempt was made to actively involve all participants in the discussions by facilitating appropriate communication in order to motivate them enough to learn, reconsider their thoughts, attitudes and past actions, and ultimately change their behavior.

Data were collected before the intervention using questionnaires. The educational content and material were used according to the results of the analysis, and of the fields about which participants were needed to be educated.

The educational sessions were conducted by group discussions held by health volunteers at the health centers for 8 weeks (2 hours a week) and educational materials such as tracts and pamphlets were provided. Six weeks after the last session, participants completed the questionnaire for a second time (post-test).

2.1. Instruments

Data were collected by a questionnaire consisting of demographic information (age, weight, height, level of education, and financial status satisfaction), knowledge (13 items), attitude (14 items), and dietary habits (10 items).

Knowledge was assessed by 13 questions with three answer options: (correct, wrong, and I don't know). Each correct answer was scored 1, and the wrong and “I don’t know” answers were scored zero. The attitude was measured on a five-point Likert scale ranging from ‘completely disagree’ (scored 1) to ‘completely agree’ (scored 5). Dietary habits were also measured on a five-point Likert scale ranging from 1 (never) to 5 (always).

Inverse questions were assessed based on the Likert scale with a range of 5 (strongly disagree) to 1 (strongly agree) and eating habits from 5 (never) to 1 (always).

The validity and reliability of this questionnaire were confirmed in a previous study [25Rezabeigi Davarani E, Mahmoodi MR, Khanjani N, Fadakar MM. The Effect of Educational Intervention based on the theory of planned behavior on Nutritional Behavior with Regard to Cardiovascular Diseases among Health Volunteers. J Nutr Food Sec 2019; 4(2): 93-100.].

2.2. Anthropometric Measures

The height of the participants was measured by a tape meter fixed on the wall, in the standing position and without shoes. Weight was measured with a digital scale with minimum clothing, and no shoes . Body Mass Index (BMI) was calculated by dividing weight in kilograms by the square of height in meters. These analyses were performed by SPSS version 21. BMI <18.5, 18.5-24.9, 25-29.9, and 30 or more were considered as underweight, normal, overweight and, obese, respectively [26James PT. Obesity: The worldwide epidemic. Clin Dermatol 2004; 22(4): 276-80.
[http://dx.doi.org/10.1016/j.clindermatol.2004.01.010] [PMID: 15475226]
].

2.3. Statistical Analyses

Central and dispersion indices (mean, standard deviation, percent, and frequency) were calculated. Data analysis was performed using SPSS version 24. Statistical analyses were performed using Pearson correlation, paired t-test, independent t-test, one- way ANOVA, and linear regression. The significance level was considered p<0.05.

3. RESULTS

Fourteen participants decided to leave the study, and therefore the data of 386 participants were analyzed. The mean age of the participants was 41.91±12.87 and the range of age participants was from 20 to 75 . Moreover, 10.10% were obese and 38.60% were overweight and the mean body mass index was 25.17±4.14. Other demographic characteristics of the study group are presented in Table 1.

Before the educational intervention, a positive and significant correlation was observed between knowledge and dietary habit (r=0.249) (p<0.001), knowledge, and attitude (r=0.249) (p<0.001), and attitude and dietary habits (r=0.264) (P<0.001). This means that higher knowledge and a positive attitude led to better dietary habits.

The results of linear regression analysis between socio-demographic and other variables showed that before the educational intervention, there was a significant relationship between education and income variables and health status with dietary habits and attitude (P = 0.00), But there was no significant relationship with marital status (P = 0.08). In the dimension of knowledge, there was a significant relationship with the level of education alone (P = 0.01). Also, the results of linear regression analysis of socio demographic and other variables showed that after the educational intervention, there was a significant relationship between the level of education and knowledge and attitudes and behaviors (P <0.05).

Table 1
The distribution of demographic characteristics of the participants.


Table 2
Comparison of Mean±SD of scores before and after the intervention.



Table 2 shows the mean values of knowledge, attitude and dietary habits of women which significantly increased after the intervention.

Before the intervention, there was a statistically significant difference between the level of education with the average level of knowledge (p = 0.008), attitude (P <0.0001) and dietary habits (P <0.0001) (Table 3).

There was a statistically significant difference between the mean of healthy dietary habits in people who received previous training with the group who had no training history (p = 0.046).

There was a statistically significant difference between the level of satisfaction with the economic situation with the mean of eating habits (P <0.0001) and attitude (p = 0.004). This difference between awareness and satisfaction with the economic situation was not significant (p = 0.895)

There was a statistically significant difference between the assessment of health status with the mean of dietary habits (P <0.0001) and knowledge (p = 0.006) and attitude (p = 0.003).

4. DISCUSSION

The present study was conducted with the aim of determining the impact of education provided by health volunteers on knowledge, attitude, and modification of dietary habits among women.

In this study, before the intervention, most of the participants had an appropriate level of knowledge. This can be related to training health volunteers and health care staff after integrating diabetes and blood pressure screening programs in Iran, as well as to women's access to various educational resources.

The results of this study showed that there were significant positive correlations between knowledge, attitude, and dietary habits. A systematic review showed that the majority of previous studies reported significant positive relations between nutrition knowledge and dietary intake [27Spronk I, Kullen C, Burdon C, O’Connor H. Relationship between nutrition knowledge and dietary intake. Br J Nutr 2014; 111(10): 1713-26.
[http://dx.doi.org/10.1017/S0007114514000087] [PMID: 24621991]
].

In this study, the level of knowledge, attitude and healthy dietary habits were higher in people with higher education. Also, people who reported receiving training had healthier dietary habits, which indicates the effect of education on the promotion of health-related behaviors. In the studies by Hendrie et al., in Australia [28Hendrie GA, Coveney J, Cox D. Exploring nutrition knowledge and the demographic variation in knowledge levels in an Australian community sample. Public Health Nutr 2008; 11(12): 1365-71.
[http://dx.doi.org/10.1017/S1368980008003042] [PMID: 18671887]
] and Vriendt et al., in Belgium [29De Vriendt T, Matthys C, Verbeke W, Pynaert I, De Henauw S. Determinants of nutrition knowledge in young and middle-aged Belgian women and the association with their dietary behaviour. Appetite 2009; 52(3): 788-92.
[http://dx.doi.org/10.1016/j.appet.2009.02.014] [PMID: 19501783]
], people with higher education had more nutritional knowledge.

The findings of this study showed that the mean score of knowledge, attitude, and dietary habits improved after the intervention, and this can show the effectiveness of the educational intervention performed by health volunteers.

In Iran, several studies reported some evidence for the effectiveness of health volunteer programs on promoting health-related behaviors. For example, in a study conducted in the city of Yazd, knowledge, attitude, and behavior about cardiovascular health and nutrition among women significantly increased after receiving education from health volunteers [30Mazloomy Mahmoudabad S, Khani H, Kaseb F, Fallahzadeh H. The effect of nutrition and health heart instruction of health volunteers on knowledge, attitude and performance of mothers. Tolooebehdasht 2013; 11(4): 81-90.].

A study about evaluating the WHV program in Iran showed that this program had made many great achievements including increasing public participation, particularly of women, increasing health literacy, and increasing the coverage and utilization of health services [17Damari B, Riazi-Isfahani S. Evaluating the Women Health Volunteers Program in Iran- a Quarter Century Experience (1992-2016). Arch Iran Med 2018; 21(12): 566-71. [AIM].
[PMID: 30634853]
].

In a study, Neupane et al., showed that health education provided by community health volunteers resulted in significant reductions in high blood pressure cases in individuals with hypertension [31Neupane D, McLachlan CS, Mishra SR, et al. Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN): An open-label, cluster-randomised trial. Lancet Glob Health 2018; 6(1): e66-73.
[http://dx.doi.org/10.1016/S2214-109X(17)30411-4] [PMID: 29241617]
]. In another study, health education provided by community health volunteers,\ made significant improvements in patients with type 2 diabetes [32Spencer MS, Rosland A-M, Kieffer EC, et al. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: A randomized controlled trial. Am J Public Health 2011; 101(12): 2253-60.
[http://dx.doi.org/10.2105/AJPH.2010.300106] [PMID: 21680932]
].

In this study, a change in the eating habits like less consumption of salt, separating excess fats from meat and boiling food and consumption of fruits and vegetables occurred by providing training by volunteers and a significant difference was observed in the mean of these items compared to before the intervention. In a study in Chabahar, after the implementation of the training program by local volunteers, salt consumption during cooking and the use of table salt in the intervention group reduced [33Agh Atabay R, Zareban I, Shahrakipoor M, Montazerifar F. Application of planned behaviour theory to predict salt consumption in the rural women of chabahar. Health Education & Health Promotion 2015; 2(1): 3-15.].

The results of a study by Luger et al., in Austria showed that volunteer training intervention resulted in a significant reduction of dietary disorders in the study group [34Luger E, Dorner TE, Haider S, Kapan A, Lackinger C, Schindler K. Effects of a home-based and volunteer-administered physical training, nutritional, and social support program on malnutrition and frailty in older persons: A randomized controlled trial. J Am Med Dir Assoc 2016; 17(7): e9-e16.
[http://dx.doi.org/10.1016/j.jamda.2016.04.018]
].

Table 3
Mean±SD of scores and frequency of dietary habits before and after the intervention.



The results of this study showed that despite the increase in the average daily consumption of nuts and white meat and the decrease in the consumption of fast food and solid vegetable oil, the difference was not significant compared to that observed before the intervention. Given that the group who were not satisfied with their economic situation had lower average healthy dietary habits and most of the people were dissatisfied with their financial situation or were somewhat satisfied, this can affect the preparation of healthy food. In the Acheampong and Haldeman study, the most common barrier to healthy eating reported by the women in the study was the cost of healthy foods [35Acheampong I, Haldeman L. Are nutrition knowledge, attitudes, and beliefs associated with obesity among low-income Hispanic and African American women caretakers? Journal of obesity 2013.
[http://dx.doi.org/10.1155/2013/123901]
].

However, despite the success of the health volunteers' program in some research, in a study carried out in Lenjan city, Iran did not show a significant change in any health indicators [36Mohammad zadeh Z. Compares health care in health centers have no health volunteers and health communicators in Lenjan city. TebvaTazkiyeh 2003; 45: 41-7.]. Various factors, such as inadequate training of volunteers, being unknown to the community, the lack of cooperation of some households with volunteers, weakness in monitoring and evaluation of the program, and inefficient maintenance are reasons that may have affected the success of these programs [17Damari B, Riazi-Isfahani S. Evaluating the Women Health Volunteers Program in Iran- a Quarter Century Experience (1992-2016). Arch Iran Med 2018; 21(12): 566-71. [AIM].
[PMID: 30634853]
, 21Vizeshfar F, Momennasab M, Yektatalab S, Iman MT. Challenges faced by health volunteers in comprehensive health centers in the southwest of Iran: A qualitative content analysis. J Med Life 2018; 11(1): 62-8.
[PMID: 29696067]
].

5. LIMITATIONS

Due to the fact that health volunteers have a close relationship with the population covered, despite the anonymity of the questionnaires, the participants might not get their real attitudes and performance registered in the questionnaire. Also, due to time constraints, the evaluation period of the results in this study was considered 6 weeks after the educational intervention. In future researches, in order to better evaluate the training outcomes, the follow-up period can be extended.

CONCLUSION

The results of the study showed that the education provided by WHV has been effective in promoting knowledge, attitude and the dietary habits of women. The use of local human resources due to low cost is affordable in societies with limited resources. Therefore, it is recommended that health policymakers promote and empower community participation.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

This study was approved by the Ethics Committee of University of Medical Sciences, Iran. Ethics code: K/94/20.

HUMAN AND ANIMAL RIGHTS

Not applicable.

CONSENT FOR PUBLICATION

Written informed consent was obtained from each participant prior to the study.

AVAILABILITY OF DATA AND MATERIALS

The raw data and materials used to support the findings of this study are with the the corresponding author [S.D] and can be made available upon request.

FUNDING

This research project was approved and financially supported by the Kerman University of Medical Sciences (K/94/20).

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

The authors thank the Kerman Health Centers, the health volunteers and all of the women who participated in this study.

REFERENCES

[1] Popkin BM. Nutrition transition and the global diabetes epidemic. Curr Diab Rep 2015; 15(9): 64.
[http://dx.doi.org/10.1007/s11892-015-0631-4] [PMID: 26209940]
[2] Bishwajit G. Nutrition transition in South Asia: The emergence of non-communicable chronic diseases. F1000 Res 2015; 4: 8.
[http://dx.doi.org/10.12688/f1000research.5732.2] [PMID: 26834976]
[3] Swinburn B, Sacks G, Vandevijvere S, et al. INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): Overview and key principles. Obes Rev 2013; 14(Suppl. 1): 1-12.
[http://dx.doi.org/10.1111/obr.12087] [PMID: 24074206]
[4] Kazemi T, Hajihosseini M, Moossavi M, Hemmati M, Ziaee M. Cardiovascular risk factors and Atherogenic indices in an Iranian population: Birjand east of Iran. Clin Med Insights Cardiol 2018; 12: 1179546818759286.
[http://dx.doi.org/10.1177/1179546818759286] [PMID: 29497341]
[5] Poustchi H, Eghtesad S, Kamangar F, et al. Prospective epidemiological research studies in Iran (the PERSIAN Cohort Study): Rationale, objectives, and design. Am J Epidemiol 2018; 187(4): 647-55.
[http://dx.doi.org/10.1093/aje/kwx314] [PMID: 29145581]
[6] Peykari N, Hashemi H, Dinarvand R, et al. National action plan for non-communicable diseases prevention and control in Iran; a response to emerging epidemic. J Diabetes Metab Disord 2017; 16(1): 3.
[http://dx.doi.org/10.1186/s40200-017-0288-4] [PMID: 28127543]
[7] Abdi F, Atarodikashani Z, Mirmiran P, Esteki T. Surveying global and Iranian food consumption patterns: A review of the literature Journal of Fasa University of Medical Sciences 2015; 5(2): 159-67.
[8] Arena R, Guazzi M, Lianov L, et al. Healthy lifestyle interventions to combat noncommunicable disease-a novel nonhierarchical connectivity model for key stakeholders: A policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Eur Heart J 2015; 36(31): 2097-109.
[http://dx.doi.org/10.1093/eurheartj/ehv207] [PMID: 26138925]
[9] Azizi F, Ghanbarian A, Momenan AA, et al. Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II. Trials 2009; 10(1): 5.
[http://dx.doi.org/10.1186/1745-6215-10-5] [PMID: 19166627]
[10] Ritchie LD, Whaley SE, Spector P, Gomez J, Crawford PB. Favorable impact of nutrition education on California WIC families. J Nutr Educ Behav 2010; 42(3)(Suppl.): S2-S10.
[http://dx.doi.org/10.1016/j.jneb.2010.02.014] [PMID: 20399405]
[11] Kang J-S, Kim H-S. A study on the evaluation of a nutritional education program for the middle aged obese women. Korean Journal of Food and Nutrition 2004; 17(4): 356-67.
[12] Mirbazegh SF, Rahnavard Z, Rajabi F. The effect of education on dietary behaviors to prevent cancer in mothers. J Research & Health 2012; 2: 108-17.
[13] Alami A, Nedjat S, Majdzadeh R, Foroushani AR, Hoseini S, Malekafzali H. Factors influencing women's willingness to volunteer in the healthcare system: evidence from the Islamic Republic of Iran 2013; 19(4): 348-55.
[http://dx.doi.org/10.26719/2013.19.4.348]
[14] Sahbaei F, Niksadat N, Keshavarz N, Toohidi M. Practice of the health volunteers in Iran. J Med Counc Iran 2016; 34(2): 157-62.
[15] Kok MC, Kane SS, Tulloch O, et al. How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature. Health Res Policy Syst 2015; 13(1): 13.
[http://dx.doi.org/10.1186/s12961-015-0001-3] [PMID: 25890229]
[16] Mishra SR, Neupane D, Preen D, Kallestrup P, Perry HB. Mitigation of non-communicable diseases in developing countries with community health workers. Global Health 2015; 11(1): 43.
[http://dx.doi.org/10.1186/s12992-015-0129-5] [PMID: 26555199]
[17] Damari B, Riazi-Isfahani S. Evaluating the Women Health Volunteers Program in Iran- a Quarter Century Experience (1992-2016). Arch Iran Med 2018; 21(12): 566-71. [AIM].
[PMID: 30634853]
[18] Sommanustweechai A, Putthasri W, Nwe ML, et al. Community health worker in hard-to-reach rural areas of Myanmar: Filling primary health care service gaps. Hum Resour Health 2016; 14(1): 64.
[http://dx.doi.org/10.1186/s12960-016-0161-4] [PMID: 27769312]
[19] Fazeli N, Moradi M, Khadivzadeh T, Esmaily H. Effect of preconception care education by health volunteers on knowledge and attitudes of women: Application of the health belief model. Evidence Based Care 2018; 8(1): 76-81.
[20] Miri M-R, Ramazani AA, Moodi M, Mirkarimi K. The effects of suburban villages’ health volunteer plan on women’s health knowledge and attitude. J Educ Health Promot 2012; 1: 12.
[http://dx.doi.org/10.4103/2277-9531.98570] [PMID: 23555115]
[21] Vizeshfar F, Momennasab M, Yektatalab S, Iman MT. Challenges faced by health volunteers in comprehensive health centers in the southwest of Iran: A qualitative content analysis. J Med Life 2018; 11(1): 62-8.
[PMID: 29696067]
[22] Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: An overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health 2014; 35: 399-421.
[http://dx.doi.org/10.1146/annurev-publhealth-032013-182354] [PMID: 24387091]
[23] Rezabeigi Davarani E, Mahmoodi M, Khanjani N, Fadakar Davarani M. Application of planned behavior theory in predicting factors influencing nutritional behaviors related to cardiovascular diseases among health volunteers in Kerman. Journal of Health 2018; 8(5): 518-29.
[PMID: 30580628]
[24] Heshmati H, Rahaei Z, Hazavehei S, Dehnadi A, Hasanzadeh A. Related factors to educational behaviors of health volunteers about cutaneous leishmaniasis on the basis of BASNEF model in Yazd. Journal of Health 2010; 1(3): 48-56.
[25] Rezabeigi Davarani E, Mahmoodi MR, Khanjani N, Fadakar MM. The Effect of Educational Intervention based on the theory of planned behavior on Nutritional Behavior with Regard to Cardiovascular Diseases among Health Volunteers. J Nutr Food Sec 2019; 4(2): 93-100.
[26] James PT. Obesity: The worldwide epidemic. Clin Dermatol 2004; 22(4): 276-80.
[http://dx.doi.org/10.1016/j.clindermatol.2004.01.010] [PMID: 15475226]
[27] Spronk I, Kullen C, Burdon C, O’Connor H. Relationship between nutrition knowledge and dietary intake. Br J Nutr 2014; 111(10): 1713-26.
[http://dx.doi.org/10.1017/S0007114514000087] [PMID: 24621991]
[28] Hendrie GA, Coveney J, Cox D. Exploring nutrition knowledge and the demographic variation in knowledge levels in an Australian community sample. Public Health Nutr 2008; 11(12): 1365-71.
[http://dx.doi.org/10.1017/S1368980008003042] [PMID: 18671887]
[29] De Vriendt T, Matthys C, Verbeke W, Pynaert I, De Henauw S. Determinants of nutrition knowledge in young and middle-aged Belgian women and the association with their dietary behaviour. Appetite 2009; 52(3): 788-92.
[http://dx.doi.org/10.1016/j.appet.2009.02.014] [PMID: 19501783]
[30] Mazloomy Mahmoudabad S, Khani H, Kaseb F, Fallahzadeh H. The effect of nutrition and health heart instruction of health volunteers on knowledge, attitude and performance of mothers. Tolooebehdasht 2013; 11(4): 81-90.
[31] Neupane D, McLachlan CS, Mishra SR, et al. Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN): An open-label, cluster-randomised trial. Lancet Glob Health 2018; 6(1): e66-73.
[http://dx.doi.org/10.1016/S2214-109X(17)30411-4] [PMID: 29241617]
[32] Spencer MS, Rosland A-M, Kieffer EC, et al. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: A randomized controlled trial. Am J Public Health 2011; 101(12): 2253-60.
[http://dx.doi.org/10.2105/AJPH.2010.300106] [PMID: 21680932]
[33] Agh Atabay R, Zareban I, Shahrakipoor M, Montazerifar F. Application of planned behaviour theory to predict salt consumption in the rural women of chabahar. Health Education & Health Promotion 2015; 2(1): 3-15.
[34] Luger E, Dorner TE, Haider S, Kapan A, Lackinger C, Schindler K. Effects of a home-based and volunteer-administered physical training, nutritional, and social support program on malnutrition and frailty in older persons: A randomized controlled trial. J Am Med Dir Assoc 2016; 17(7): e9-e16.
[http://dx.doi.org/10.1016/j.jamda.2016.04.018]
[35] Acheampong I, Haldeman L. Are nutrition knowledge, attitudes, and beliefs associated with obesity among low-income Hispanic and African American women caretakers? Journal of obesity 2013.
[http://dx.doi.org/10.1155/2013/123901]
[36] Mohammad zadeh Z. Compares health care in health centers have no health volunteers and health communicators in Lenjan city. TebvaTazkiyeh 2003; 45: 41-7.
Track Your Manuscript:


Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents




Webmaster Contact: info@benthamopen.net
Copyright © 2020 Bentham Open