@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2014;1(2):20-29

Background
Aging of population is accompanied with the increase in cares and chronic diseases as well as significant increase in healthcare costs. … [1].
Previous Studies
Health promoting self-care behaviors are directly associated with the health in elderly and their quality of life, and it reduces morbidity and mortality rates [2]. … [3-7]. Health Belief Model is based on the assumption that the amount of doing health behaviors such as self-care behaviors are rooted in the people`s health beliefs, and they lead people toward healthy behaviors [8-9]. … [10-11].
Aim(s)
The first aim was investigating the promoting self-care behaviors in the seniors, and the second aim was explaining the relationship between the Health Belief Model constructs with the self-care behaviors.
Research type
This research is descriptive-analytic.
Research society, place and time
The population consisted on the seniors aged 60 and older who had referred to cultural centers in Tehran in 2014.
Sampling method and number
The sample size was calculated at least 386 based on the formula related to descriptive studies and taking to the account the p=0.5, alpha=0.05, and accuracy=0.05. To enhance the accuracy and prevent loss of samples, 465 seniors were enrolled. Inclusion criteria were informed consent, age 60 years and more, the ability of speaking, literacy and writing, lack of cognitive problems, and absence in other research studies. Sampling was based on stratified random sampling. Tehran was divided into five geographic regions, and from each region, one culture center was randomly selected. Then referring to the selected culture centers, seniors were randomly selected.
Used devices&materials
In addition to assessing some demographic information (age, gender, level of education, employment status, marital status, and economic status), in order to collect desired data, three instruments were used including Health Belief Assessment Questionnaire about Health Promoting Self-care Behaviors (Except perceived self-efficacy), Self-rated Abilities for Health Practice Scale, and Health Promoting Behavior Profile II. Each of these questionnaires had 26. 28 and 52 items respectively. Health Belief Assessment Questionnaire about Health Promoting Self-care Behaviors: In order to measure five constructs of Health Belief Model, Antonacci questionnaire [12] was used. This instrument has been used to measure health beliefs about health promotion behaviors (except for perceived self-efficacy). The questionnaire has 26 questions (Perceived susceptibility 6 questions, perceived severity 6 questions, perceive benefits 5 questions, perceived barriers 5 questions, and cues to action, 4 questions). This questionnaire is based on 5-point Likert scale, and is rated from 1 to 5. A part from the structure of perceived barriers, higher scores indicate better condition in other constructs. The results of investigating reliability and validity indicate content validity of 0.73 for the entire questionnaire. Cronbach`s alpha for the total scale was 0.79, and it was varied from 0.69 to 0.83 for its constructs. Coefficient Internal Correlation was obtained 0.74. Self-rated Abilities for Health Practice Scale (SRAHPS): In this study, SRAHPS was used to assess the perceived self-efficacy. Becker et al. [13] first designed this instrument, and it is consisted of 28 questions, which measures the self-efficacy of health promoting behaviors in for dimensions (nutrition, physical activity, taking responsibility for health behaviors, and mental health, each 7 items). The options in each question are based on five-point Likert scale, and it is rated from zero to 4. The higher score indicates the higher perceived self-efficacy. According to the results of investigating reliability and validity, the content validity of the questionnaire and all its dimensions was higher than 0.82. Cronbach`s alpha for the entire questionnaire and its dimensions was ranged between 0.73 and 0.84. ICC value for the entire instrument was 0.76 and it was ranged from 0.76 to 0.84 for its dimensions. Health Promoting Behavior Profile II (HPLP-52): This questionnaire was used to measure health promoting self-care behaviors. Since Zeidi et al. [14] had used HPLP-52 for Iranian adults, and its reliability and validity had been confirmed, during the process of reliability and validity, its translation was skipped. The main version of this questionnaire contains 52 questions that measure health promoting self-care behaviors in six dimensions (nutrition 9 questions, physical activity 8 questions, taking responsibility for health 9 questions, stress management 8 questions, interpersonal information 9 questions, and spiritual growth 9 questions). Options in each question are four-point Likert scale and the rating is between 1 and 4. Generally, the score for health promoting lifestyle and the score for behavioral dimensions are being calculated based on the mean responses for the 52 questions and for the each subscale (8 or 9 questions). Statistical Analysis: Data was entered SPSS software version 22. Descriptive statistics such as mean, percentage, and standard deviation were used to describe the status of subjects. In order to examine the relationship between self-care behaviors and demographic factors, independent t-test and one-way ANOVA were used. To investigate the correlation between self-care behaviors and health beliefs, Pearson correlation test was used, and finally to identify the determinants of self-care behaviors, multiple linear regression and stepwise method were used. The significance level for tests was less than 0.05.
Findings by Text
The total number of subjects was 465 with the mean age 68.24±6.12. Other demographic characteristics of the subjects and the mean score of their self-care behaviors, has been presented in Table 1. The overall mean score of self-care behaviors was 1.79±0.36. The mean score of subscales of HPLP included: taking responsibility of health care 1.64±0.51, physical activity 1.37±0.49, nutrition 1.82±0.42, stress management 1.74±0.29, interpersonal relationship 1.75±0.37 and spiritual growth 2.13±0.39. Independent t-test showed that the overall mean score of health promoting self-care behaviors in the males was significantly more than those of women (p=0.011). ANOVA showed that there was a significant relation between self-care behaviors and the variables of age (p=0.008), lifestyle (p<0.0001), level of education (p<0.0001) and economic status (p<0.0001). One-way ANOVA post-hoc test results indicated that the mean score of health promoting self-care behaviors in the age group 60-69 was significantly higher than other age groups. Seniors with the level of education “diploma and higher” achieved higher score in comparison to the seniors having other level of education. Seniors who were living alone had a weaker mean score; finally, seniors who had reported their economic status as good or moderate, had better scores compared to those who had reported their economic status as “bad” or “very bad” (Table 1). In the analysis of correlation between Health Belief Model constructs with self-care behaviors, Pearson Correlation Coefficient showed that all the constructs of Health Belief Model had significant relation with the self-care behaviors that this correlation was of greater strength in cases of self-efficacy (r=0.44, p<0.001) and perceived barriers (r=-0.52, p<0.001). In order to identify the determinants of self-care behaviors, Health Belief Model constructs were entered the linear regression that according to the results of the regression analysis model, perceived barriers, perceived self-efficacy, and perceived severity were identified as the final determinants of self-care behaviors. These three constructs could predict 37% of the changes in the behavior (R2=0.37) (Table 2).
Main comparison to the similar studies
… [15, 16].Baghianimoghadam[17] in a study on patients with hypertension found that males` self-care actions are more than those of women are. Men`s better self-care actions are probably due to their more self-efficacy and less perceived barriers. Men due to social factors, roles and opportunities have higher self-efficacy. Therefore, their self-care behaviors are more [18].This research showed that the amount of self-care behaviors in seniors having diploma or higher level of education was significantly higher than seniors having lower level of education. Frauman[19] also sees this finding in the study. … [20]. Seniors who had reported their economic statues as good or moderate achieved better score in self-care behaviors than those seniors who had bad or very bad economic status. This finding is in line with the study conducted by Smith [21]. … [22-30]. Many other studies, also, have considered self-efficacy as the most important predictors of physical activities in adults and seniors [31-34].
Suggestions
In future studies, other related factors to self-efficacy behavior should be investigated. Perceived barriers, perceived self-efficacy, and perceived severity as the predictors of self-care behaviors should be studied with more details, and appropriate interventions to improve the predictors should be considered.
Limitations
Illiterateseniors were excluded from the study. In addition, the population of this study was the seniors referring to the culture centers in Tehran. Therefore, seniors who had physical and social limitations were excluded from this study. Therefore, the generalizability of the results of study to the elderly living in the elderly house or living at home has been declined.
Conclusions
Factors such as level of education, economic statues, age and gender have significant relation with self-care behaviors. However, only the constructs of perceived severity, barriers, and self-efficacy are the predictors of behavior that the perceived barriers and self-efficacy have more predicting power.
Acknowledgments
Vice Chancellor of Research and Technology of Tehran University, all senior people who participated in this study, as well as Tehran cultural centers officials are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
Non-declared
Funding Sources
This article is the result of a Master thesis in health education degree in Tehran University of Medical Sciences and Services, and it has been funded by Department of Science and Technology of the university.

TABLES and CHARTS

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