@2024 Afarand., IRAN

---

ISSN: 2383-2150    Journal of Education and Community Health 2014;1(2):1-9

Background
… [1] In 2030, more than 60 countries will have 2 millions people over 65 years old [2]. By getting older, seniors will face more disabilities and chronic diseases and long-term care for elderly makes a great challenge for physicians and caretakers [3].
Previous Studies
… [4-10] PRECEDE has been introduced as a successful model in health education programs. The main target of this model is to use organized theories and concepts in order to plan and evaluate the behavior-changes programs. PRECEDE model was designed by Green et al. in 1970 decade. PRECEDE is acronyms of components: Predisposing, Enabling and Reinforcing in recognition of Educational and Evaluation. This model is based on the assumption that educational recognition is prior to intervention program and accordingly in PRECEDE model planning process is based on the problems which are priority and changeable [11].
Aim(s)
This study was performed with the purpose of determining the effect of educational intervention based on PRECEDE model in order to promote the elderly`s quality of life.
Research type
This study was a pre and post quasi-experimental intervention
Research society, place and time
This research was conducted on seniors who referred to health centers in Shabestar city.
Sampling method and number
80 seniors who referred to the health center were entered the study according to the convenience sampling and by using the table of random numbers, they were divided into two groups of intervention and control. The criteria for entering the study was to be over 60s, and to have personal satisfaction; and the criteria for exiting the study were death, specific diseases that avoid continuing the activity of that person and lack of willingness to cooperate in each level of research performance.
Used devices&materials
... [12]. In this research the instrument for collecting information were the questionnaires adjusted in 3 sections: First section consisted of WHO Quality of Life Standard Questionnaire (WHO-BREF) with the score range between 26 and 130 that has been standardized by Montazeri et al. in Iran. The psychometrical properties of this questionnaire have been shown that this instrument can also be used in Iran [13]. Second section was Social Support Questionnaire [14] that the amount of its Cronbach Alpha was 84% in the current research. Third section was researcher-made questionnaire that contained series of questions related to predisposing factors ( knowledge, attitude, and efficacy), and enabling and reinforcing factors of doing physical activities in old age. It was considered 20 questions for knowledge, 6 questions for attitude, 5 questions for efficacy, 7 questions for enabling factors and 3 questions for reinforcing factors. The qualitative content validity method was used for studying the validity of questionnaire. For this aim, the questionnaire was sent to 10 professors who were expert on health education and after collecting their comments, necessary changes were applied to the questionnaire content. Questionnaire reliability was evaluated by two methods of internal consistency (Cronbach Alpha) and test-retest (ICC) that the calculated amount for each component was as following respectively: knowledge (0.69, 0.74), Attitude (0.72, 0.79), Enabling factors (0.85, 0.87), Reinforcing factors (0.88, 0.93). There were self-efficacy questions based on Physical Exercise Self-Efficacy Scale [15] with the amount of 72% of Cronbach Alpha in the current research. Educational program was planned and conducted for intervention group during 3 sessions (1 session per a week) according to the results from self-made questionnaire. This program included 3 parts: Warm-Up exercises (muscular stretching and endurance movements), basic sports (explosive movements) and Cool-Down exercises. Duration of each session was about 45-60 minutes. The educational methods of short speeches, discussion in large and small groups, questions and responses and practical performance have been used in the classes (enabling) in order to change the knowledge, attitude, self-efficacy (predisposing) and each of the participants was asked to do exercises that had learnt, in front of the coach that could cause pleasant feelings in that person because the exercises were encouraged (reinforcing) by the physicians of the center who had attended in the session. The senior participants in instructional sessions have been given the instructional flip chart (enabling) at the end of third session for continuity of trained behavior here of and in order to improve family social support and its influence on starting and continuity of doing regular physical activities in seniors, the family of the intervention group was given educational pamphlet for seniors support to do physical activities regularly in order to indirect instruction. After receiving intended intervention by the intervention group, considering the studies which had used PRECEDE model for improving the quality of life in target group [16-17], both groups filled out the related questionnaires one month after intervention for studying the changes in predisposing, enabling, reinforcing, social support factors, and finally the life quality. Statistical Analysis:Collected data was statistically analyzed using SPSS version 21 software, paired and independent T tests, Chi-square test, One-Way Analysis Of Variance (ANOVA), and Analysis of Covariance (ANCOVA) in significant level of 0.05.
Findings by Text
In this study, the mean of participants' age was 68.81 years old with the standard deviation of 6.09 years. Two groups of intervention and control did not have significant differences in gender combination (p=0.34). Most of the studied seniors had elementary educational level. Table 1 represents distribution of the frequency of the age, gender and education in intervention and control groups. The results of the Chi-square test and One-way Analysis of Variance showed that there was insignificant difference between two groups in terms of demographic variables before intervention (p>0.05). According to the results of paired t-test, total score of life quality and its dimensions had insignificant differences in control group before and after instruction. However, there were significant statistical differences in intervention group before and after instruction (Table 2).Table 3 represents the comparison between mean and standard deviation of the scores of knowledge, attitude, self-efficacy and social support in two groups of intervention and control before and after instruction. The studied variables based on components of PRECEDE model ( knowledge, attitude, self-efficacy, enabling and reinforcing factors), effective at doing the regular physical activities in old age, had insignificant differences in intervention and control group before instruction (p>0.05). However, the mean score increased after instruction in intervention group, and paired t-test showed significant difference before and after instruction in this group. However, the difference was not significant in the control group.
Main comparison to the similar studies
Dehdari`s study on the influence of education based on PRECEDE-PROCEED model on improving life quality of patients after coronary artery bypass surgery is in line with the current study [16]. A study conducted by Afkari confirms influence of PRECEDE model usage on improving the quality of seniors' life [17]. … [18]. In current study, the intervention occurred according to results of the primary study on the target population and their needs. In the same line, the study conducted by Salehi and et al. in terms of improving nutritional behaviors associated with cardiovascular diseases in rural community confirms this issue [19]. Results of current study indicate the increase in the quality of elderly people due to the effect of education based on PRECEDE Model. Successful usage of this model is seen in Ransdell study for the purpose of increasing efficiency of universities [20] and Jimba study for providing solutions for Taenia solium infection control in Nepal [21]. Formal and informal supports should be main aim of regulation and laws enacted for the elderly [22]. … [23]. Chong, also, in his research has shown the role of social support in overcoming the health issues [24]. Herderson, based on the results of his studies, writes that the family, spouse or any other relative's social supports cause improvement in physical activity level [25]. … [26-31].
Suggestions
In our country it is necessary to emphasize on educational planning and design based on educational patterns and theories, social and behavioral sciences for seniors with various health issues.
Limitations
Statistical community of this research was chosen according to convenience sampling and the possibility of selection for all seniors in the society was not the same, hence there was not the possibility of result generalization to the other seniors.
Conclusions
Training according to the PRECEDE model can be affective on empowering seniors in order to improve the quality of their life.
Acknowledgments
All participants and especially Shabestar City health center that helped us for conducting this research are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
This article is research project (code No. 90-03-27-15103) that was approved by School of Health, Tehran University of Medical Sciences.
Funding Sources
Non-declared

TABLES and CHARTS

Show attach file