Journal of Preventive Medicine

Introduction
Psychosomatic disorders are conditions that appear physically, but their cause is psychological factors that affect the functioning of the automatic nervous system, endocrine glands and physiological flows of the body. One of these disorders is asthma which is a periodic and chronic inflammatory disease of the airways that is caused by increased sensitivity to environmental allergens. Recently, the role of “illness perception” on the quality of life of people with chronic diseases has received attention. Illness perception refers to a person’s cognitive and emotional beliefs about the disease and its treatment, as well as how the person reacts emotionally to the symptoms of the disease [5]. Health-promoting lifestyle is a model that consists of people’s perceptions and behaviors for the promotion of health status and achieve well-being [14]. Today, the health of the people is ensured through the promotion of lifestyle and the elimination of factors that have a negative impact on the health status. Health-promoting lifestyle education can be used for improving healthy lifestyle [21]. The present study aims to determine the effectiveness of health-promoting lifestyle education on physical symptoms and illness perception in patients with asthma.

Methods
This is a quasi-experimental study that was conducted in 2020 on 30 people with asthma Referred to Shahid Fayazbakhsh Hospital in Tehran, Iran, who were selected using a purposive sampling method and randomly divided into two groups of intervention and control. The criteria for entering the study include not receiving psychological intervention at the same time and willingness to participate in the study. Exclusion criteria were any chronic diseases, retardation, lack of cooperation, and the absence from more than two intervention sessions. In order to collect information, the following tools were used: Demographic form, Illness Perception Questionnaire with 9 items, and St. George’s Respiratory Questionnaire developed by Jones et al. [24] with 50 items rated on a Likert scale from 0 to 100 and three subscales of symptoms, activity, and impact. The health-promoting lifestyle education was presented based on the protocol proposed by Walker et al. [14] at 6 weekly sessions each for 90 minutes. The questionnaires were completed before, immediately after, and 3 months after the intervention. To describe the data, mean and standard deviation were used, and to analyze the data, chi-square test and repeated measures analysis of variance (ANOVA) were used. To test the assumptions of ANOVA, Shapiro-Wilk test, Levene’s test, Box’ M test, Mauchly’s sphericity test, and Bonferroni post hoc test were used. The significance level was set at 0.05. Data were analyzed in SPSS software, version 24.

Results
The results showed that the two groups were similar in terms of age, gender, education, occupation, and marital status. The mean age of participants was 39.97±9.38 years in the intervention group and 39.17±7.46 years in the control group. The results of the normality check by the Shapiro-Wilk test, showed that the data had a normal distribution, and the assumption of normality was therefore confirmed. Levene’s test statistic was not significant for any of the research variables; therefore, the assumption of homogeneity of variance was confirmed. The results of the sphericity test showed that the assumption of sphericity was confirmed. The results in Table 1 showed that the effect of group, time and the interaction effect of time*groups were significant for the illness perception variable. Therefore, the health-promoting lifestyle education was effective in improving the illness perception of asthma patients.



Discussion
The present study aimed to determine the effectiveness of health-promoting lifestyle education on physical symptoms and illness perception in patients with asthma. Health-promoting education is an approach that is commonly used to teach and create healthy behaviors. health-promoting lifestyle focuses on activities that improve the level of well-being and potential health of individuals, families, and society. According to Walker et al. [14], these behaviors have an effect on maintaining or promoting the level of well-being and improving the life of the self and others. The normal and routine daily activities that the patients with asthma accepted in their lives during the educational intervention had an effect on their illness perception. By choosing a lifestyle, these people took effective measures to maintain or promote their health and prevent disease. One of the limitations of this study was the use of a self-report tool to measure the illness perception of the disease, where the responses may be biased.

Ethical Considerations

Compliance with ethical guidelines
This article is taken from the doctoral thesis in the field of health psychology, Islamic Azad University, Kish International Branch (Code : IR.HUMS.REC.1398.321).

Funding
This research did not receive any financial aid from government, private or non-profit organizations and the expenses were covered by the first author.

Authors' contributions
Implementation, analysis and interpretation of data: Leila Asani; Design, project management, conceptualization and drafting: Mehrdad Sabet; Revising, correcting, editing and finalizing the article: Amin Rafieipour.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
We thank and appreciate all the patients of Shahid Fayaz Bakhsh Hospital who participated in this research, as well as the officials of Islamic Azad University, Kish International Branch, who made this research possible with their cooperation.
 

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