@2024 Afarand., IRAN

---

ISSN: 2383-2150    Journal of Education and Community Health 2019;6(2):79-85

Background
Iron deficiency anemia is one of the most common nutritional disorders in developing countries and the most important cause of anemia in children and women of reproductive age [1].
Previous Studies
... [2]. The prevalence of anemia according to the Mozaffari et al. study reported 13.5% in high school girls in Yazd, 9.3% of whom had iron deficiency anemia and 34.7% of all participants had iron deficiency [3]. Several studies have shown the same efficacy of weekly and daily iron supplementation in adolescents and the results of these weekly iron supplementation studies have been suggested for these groups [4, 5]. ... [6, 7]. In this regard, a study by Nabizadeh Asl et al. showed that 17.6% of Yazidi women who had iron deficiency anemia did not take iron supplementation during treatment [8]. Although studies have shown the efficacy of iron supplementation in schools [4, 5], some studies have also shown that iron supplements are not properly consumed for reasons, such as poor nutritional awareness [8, 9]. The study of iron supplementation and its related factors in girls in Semnan city showed that only 53.9% of secondary school girls and 16.5% of high school girls used supplements completely and by increasing the grade in secondary school girls, iron supplementation was reduced [10]. ... [10]. The Health Promotion Model (HPM) is one of the comprehensive and predictive models of health promoting behaviors and quality of life that is used to discover the factors that influence health promoting behaviors [11]. ... [12, 13].
Aim(s)
The aim of the present study was to determine the predictors of iron supplementation in high school girls using HPM
Research type
This research was carried out on female students from high schools of Meybod city, Yazd province, Iran in 2017
Research society, place and time
This research was carried out on female students from high schools of Meybod city, Yazd province, Iran in 2017
Sampling method and number
The random stratified sampling was done. Sample size was calculated 202 individuals based on the Tabanchnick & Fidell formula to calculate sample size in multiple regression and considering a 15% possible fall, finally 230 subjects were studied. Inclusion criteria were being students participation in school iron supplementation and the consent to participate in the study and incomplete answers to the questionnaire was considered as the exclusion criterion.
Used devices&materials
Data collection tool was a researcher-made questionnaire based on HPM. After designing the items, its face and content validity was evaluated and approved by 4 experts in health education and nutrition. To determine the items clarification, the questionnaire was provided to 20 students and based on their feedback, necessary corrections were made. The internal stability of the instrument was evaluated by comparing the Cronbach's alpha coefficient of primary and final studies and the cut-off point was set above 0.65 for acceptance of Cronbach's alpha coefficient in the final stage [15]. The questionnaire was developed in two parts: demographic characteristics and constructs of HPM. Questionnaires were provided to students and completed by self-report. The data were analyzed by SPSS 16 software using descriptive statistics and Spearman correlation coefficient and linear regression analysis.
Findings by Text
The participants were 230 high school girls, 59.5% of whom were in secondary school and 40.5% were in the second grade of high school. The mean age of subjects was 15.70 ± 1.78 years and the mean age of their mothers was 39.85 ±5.08 years. Fathers' education in 50.4% of the subjects and mothers' education in 44.7% of the subjects was bachelor and above. 36.1% of fathers were employed and 60.4% of mothers were housewives. 57.4% of the students had supplemental insurance and 27.4% had no insurance. 59.1% of them assessed their family's economic status as good and 36.5% rated it as poor and average. Given the achievable score of HPM constructs, girls showed a high perceived barrier in iron supplementation and considered themselves to be effective in iron supplementation. The barriers to iron supplementation at school were relatively high. The mean score of social support indicated relatively good support for iron supplementation. Participants achieved approximately half of the achievable score of situational influencers. In terms of iron supplementation behavior, girls consumed on average half of the 16 iron supplements at school (Table 1). All constructs had a significant correlation with the iron supplementation behavior by students. In this regard, the most positive and significant correlation was between perceived self-efficacy and positive emotions with iron supplementation behavior, respectively. There was also a significant negative correlation between perceived barriers and iron supplementation behavior (Table 1). Overall, 19.1% of the changes in iron supplementation behavior were explained by perceived self-efficacy and perceived barriers, among which self-efficacy was the strongest significant predictor of iron supplementation behavior in high school girls (Table 2).
Main comparison to the similar studies
In Karimi et al. research, the complete iron supplementation was 53.9% and 16.5% in the secondary school students and high-school students, respectively [10]. In the Mohammadalizadeh Charandabi et al. study, 40.3% of students always used iron supplements at school [13]. Consistent with the present study, in the Mohammadalizadeh Charandabi et al. study, 77.2% of subjects were aware of the benefits of iron supplementation, but only 40.3% of them were always taking iron supplementation at school [13]. ... [16, 17]. … [19]. ... [20, 21]. In a study by Bahmanpour et al. study, HPM predicted 42.2% of the variance in oral health behaviors of students in Marivan and commitment to action and self-efficacy were the strongest constructs [19]. In addition, in the Banaye Jeddi et al. study HPM predicted 43.6% of variance of oral health behavior and in line with this study, it was the strongest predictor of self-efficacy behavior [22]. In the Khodaveisi et al. study, HPM constructs were able to predict 82% of women's nutritional behavior, and as the mean perceived self-efficacy was low in that study, it was one of the influential constructs in predicting behavior [18].
Suggestions
Intervention-based studies to remove the barriers mentioned in this study can evaluate the impact of such interventions.
Limitations
Lack of adjustment for other variables, such as parents' education and occupation and self-assessment of family economic status along with the variables of HPM in regression analysis can be other limitations of this study.
Conclusions
Increasing the self-efficacy and decreasing perceived barriers can increase the iron supplementation by high school girls.
Acknowledgments
The authors are thankful to the Meybod City education administration and the principals, teachers and health educators of the girls' high schools and also the students who helped the researchers to perform this research and collect data.
Conflict of interest
None declared.
Ethical Permissions
This study was conducted after obtaining the Ethics Code (IR.SSU.SPH.REC.1396.43) from the Ethics Committee of Shahid Sadoughi University of Medical Sciences.
Funding Sources
This study is extracted from a master's thesis in health education from the Yazd Shahid Sadoughi University of Medical Sciences.

TABLES and CHARTS

Show attach file