Journal of Preventive Medicine

Introduction
Lifestyle includes a variety of patterns, methods and activities of daily life, and is formed as a result of the interactions of their personal, environmental, economic and social characteristics. The reason for the importance of lifestyle in health is its role in the change of the nature of diseases from communicable to non-communicable or chronic. Chronic diseases, especially cardiovascular diseases, cancers, diabetes, obesity, etc. are often caused by unhealthy living conditions. Some of the most common modifiable risk factors for chronic disease include poor diet, physical inactivity, obesity, smoking, and alcohol consumption. Focusing on changing these behaviors may significantly enhance non-communicable disease prevention and control. According to the results of various studies, educational interventions based on lifestyle modification can improve people’s psychological well-being and health behaviors. Considering that no study has been conducted on improving the healthy lifestyle of people in Yazd, this study aims to determine the effect of an educational intervention on improving the healthy lifestyle of people in Yazd, Iran.

Methods
This is a quasi-experimental study that was conducted on 140 people aged 18-40 years referred to health centers in Yazd city in two intervention (n=69) and control (n=71) groups. The sampling method was a multi-stage random method. The data collection tool was a lifestyle questionnaire designed based on Amiri et al.’s study. First, the questionnaires were completed. Based on the results of the pre-test phase, the educational intervention was designed and implemented for the intervention group, while no intervention was done for the control group during this period. The educational intervention was implemented at three sessions of 45-60 minutes. To adjust the subjective norms, one of the family members of the samples was invited to discuss and exchange opinions about the importance of adopting health-promoting behaviors. To adjust the enabling factors in the field of physical activity, a physical education instructor was invited to teach to increase physical activity behavior. In addition, vegetable seeds and pots were put near the participants and planting of vegetables was taught and some of the seeds were planted in the same session. Immediately and three months after the completion of the educational intervention, the questionnaires were completed again by both groups. The collected data were entered into the SPSS software, version 18 and analyzed using descriptive and statistical tests.

Results
The mean age of participants in the intervention and control groups were 30.57±4.29 and 30.31±5.6 years, respectively, which were not significantly different. The educational level of most people was a high school diploma (33.8%). Also, about 60% were female, 39.6% were housekeepers, and 86.3% were married. Moreover, 82.7% had a household size ≤4 and 13% had a household size >4.
The results of the independent t-test showed that before the educational intervention, there was no significant difference in the mean score of knowledge, enabling factors, and health-promoting behaviors between the intervention group and the control group. In the post-test and follow-up phases, this difference was significant. Also, the results of repeated measures ANOVA showed a statistically significant difference in the mean score of knowledge, attitude, enabling factors, and health-promoting behaviors in the intervention group among three time points of pre-test, post-test, and follow-up (P<0.0001). However, this difference was not significant in the control group. The results for subjective norms in three time points showed that the person and her/his family had the greatest influence on having or not having healthy behavior.
According to hookah smokers in both groups, the lack of healthy recreational centers to spend their free time was the most important reason for making it difficult to quit hookah. According to smokers in both groups, the lack of necessary skills to quit and easy access to cigarettes made it difficult for them to quit smoking.

Conclusion
Implementing educational intervention and increasing knowledge, changing attitudes, social norms and enabling factors can promote healthy lifestyle behaviors of people in Yazd. Therefore, it is recommended to hold educational programs related to healthy lifestyle behaviors of people.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Rafsanjan University of Medical Sciences (Code: IR.RUMS.REC.1395.41) and was approved as a master's thesis by the Research Council of Rafsanjan University of Medical Sciences (Dated: 26/6/2016). 

Funding
This paper was extracted form the master's thesis of Fahimeh Zarezadeh, approved by Department of Health Education and Health Promotion, School of Public Health, Rafsanjan University of Medical Sciences, and was financially supported by the Research Vice-Chancellor of the Rafsanjan University of Medical Sciences and Shahid Sadoughi University of Medical Sciences.

Authors' contributions
Study design: Mohammad Asadpour, Seyed Saeed Mazloomy Mahmoodabad; Implementation and data collection: Fahima Zarezadeh; Writing the original draft: Seyedeh Shirin Lotfipur Rafsanjani and Fahima Zarezadeh; Review & editing: Mohammad Asadpour.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors hereby express their gratitude for the support of all those who helped the research group in some way in conducting the study. It is hoped that by applying the results of this research, a big step will be taken in the direction of improving women's health.


References

1. Kieny MP, Bekedam H, Dovlo D, Fitzgerald J, Habicht J, Harrison G, et al. Strengthening health systems for universal health coverage and sustainable development. Bull World Health Organ. 2017; 95(7):537-9. [DOI:10.2471/BLT.16.187476] [PMID] [PMCID]
2. Solhi M, Fard Azar FE, Abolghasemi J, Maheri M, Irandoost SF, Khalili S. The effect of educational intervention on health-promoting lifestyle: Intervention mapping approach. J Educ Health Promot. 2020; 9:196. [DOI:10.4103/jehp.jehp_768_19] [PMID] [PMCID]
3. Darsareh F, Aghamolaei T, Ghanbarnejad A. [Prediction of physical activity based on BASNEF model constructs among female teachers in schools of Bandar Abbas (Persian)]. J Prev Med. 2015; 2(1):1-9. [Link]
4. Estebsari F, Bakhshi F, Nemati S, Kazemnejad Leili E, Ramezani H, Sadeghi R. Determinants of health promoting lifestyle behaviors in hospital staff of Guilan University of Medical Sciences. Health Educ Health Promot. 2019; 7(2):71-6. [DOI:10.29252/HEHP.7.2.71]
5. Mousavi RS, Soleimani MA, Bahrami N, Ranjbaran M. [Effect of health promoting lifestyle education on health promoting behaviors of postmenopausal women: A clinical trial study (Persian)]. Koomesh. 2021; 23(2):192-202. [DOI:10.52547/koomesh.23.2.192]
6. Jahani Eftekhari M, Peyman N, Doosti H. The effect of educational intervention based on the self efficacy and health literacy theory on health promoting lifestyles among female health volunteers of Neyshabur, Iran. Health Dev J. 2018; 6(4):302-13. [DOI:10.22062/JHAD.2018.91267]
7. Budreviciute A, Damiati S, Sabir DK, Onder K, Schuller-Goetzburg P, Plakys G, et al. Management and prevention strategies for non-communicable diseases (NCDs) and their risk factors. Front Public Health. 2020; 8:574111. [DOI:10.3389/fpubh.2020.574111] [PMID] [PMCID]
8. Frost H, Campbell P, Maxwell M, O'Carroll RE, Dombrowski SU, Williams B, et al. Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. Plos One. 2018; 13(10):e0204890. [DOI:10.1371/journal.pone.0204890] [PMID] [PMCID]
9. Zabaleta-Del-Olmo E, Casajuana-Closas M, López-Jiménez T, Pombo H, Pons-Vigués M, Pujol-Ribera E, et al. Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): A hybrid effectiveness-implementation cluster randomised trial. BMC Public Health. 2021; 21(1):2208. [DOI:10.1186/s12889-021-11982-4] [PMID] [PMCID]
10. Wolfenden L, Goldman S, Stacey FG, Grady A, Kingsland M, Williams CM, et al. Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity. Cochrane Database Syst Rev. 2018; 11(11):CD012439. [DOI:10.1002/14651858.CD012439.pub2] [PMID] [PMCID]
11. Azadnajafabad S, Mohammadi E, Aminorroaya A, Fattahi N, Rezaei S, Haghshenas R, et al. Non-communicable diseases' risk factors in Iran; a review of the present status and action plans. J Diabetes Metab Disord. 2021; 1-9. [DOI:10.1007/s40200-020-00709-8] [PMID] [PMCID]
12. Mirzaei M, Mirzaei M, Sarsangi AR, Bagheri N. Prevalence of modifiable cardiovascular risk factors in Yazd inner-city municipalities. BMC Public Health. 2020; 20(1):134. [DOI:10.1186/s12889-020-8217-8] [PMID] [PMCID]
13. Sedighi M, Cheraghi M, Hashemzadeh P. [Study of lifestyle and its effects on cardiovascular diseases (Persian)]. Paramed Sci Mil Health. 2021; 16(1):56-46. [Link]
14. Blok AC, Valley TS, Abbott P. Gamification for family engagement in lifestyle interventions: A systematic review. Prev Sci. 2021; 22(7):831-44. [DOI:10.1007/s11121-021-01214-x] [PMID] [PMCID]
15. Blumenthal JA, Hinderliter AL, Smith PJ, Mabe S, Watkins LL, Craighead L, et al. Effects of lifestyle modification on patients with resistant hypertension: Results of the TRIUMPH randomized clinical trial. Circulation. 2021; 144(15):1212-26. [DOI:10.1161/CIRCULATIONAHA.121.055329] [PMID] [PMCID]
16. Tahmasebi H, Baqer Maddah Sadat S, Dalvandi A, Ghasemi S, Rahgozar M. [The effect of educational program on health promotion behaviors on elderly life style (Persian)]. Iran J Rehabil Res Nurs. 2019; 5(2):47-54. [Link]
17. Amiri A, Rkhshany F, Farmanbar R. [The effect of educational program based on basnef model on healthy lifestyle of taxi drivers in Langroud (Persian)]. J Torbat Heydariyeh Univ Med Sci. 2014; 1(4):45-54. [Link]
18. Fraticelli F, Marchetti D, Polcini F, Mohn AA, Chiarelli F, Fulcheri M, et al. Technology-based intervention for healthy lifestyle promotion in Italian adolescents. Ann Ist Super Sanita. 2016; 52(1):123-7. [DOI:10.4415/ANN_16_01_20] [PMID]
19. Oli N, Vaidya A, Eiben G, Krettek A. Effectiveness of health promotion regarding diet and physical activity among Nepalese mothers and their young children: The heart-health associated research, dissemination, and intervention in the community (HARDIC) trial. Glob Health Action. 2019; 12(1):1670033. [DOI:10.1080/16549716.2019.1670033] [PMID] [PMCID]
20. Laar RA, Shi S, Ashraf MA, Khan MN, Bibi J, Liu Y. Impact of physical activity on challenging obesity in Pakistan: A knowledge, attitude, and practice (KAP) study. Int J Environ Res Public Health. 2020; 17(21):7802. [DOI:10.3390/ijerph17217802] [PMID] [PMCID]
21. Xu X, Chen C, Abdullah AS, Liu L, Sharma M, Li Y, et al. Smoking related attitudes, motives, and behaviors of male secondary school students in an urban setting of China. Springerplus. 2016; 5(1):2021. [DOI:10.1186/s40064-016-3694-z] [PMID] [PMCID]
22. Hatami H, Dehkordi AH, Tali SS, Lotfizadeh M, Ganji H. The effect of educational program (based on BASNEF model) on quality of life and adherence to treatment in patients with myocardial infarction in Shahrekord, Iran. Journal of education and health promotion. 2022;11:39. [DOI:10.4103/jehp.jehp_588_21] [PMID] [PMCID]
23. Jadgal K, Alizade Seiouki H, Lotfi Mayen Boulagh B, Zareban I. [The effectiveness of educational program based on basnef model on the urban taxi drivers healthy lifestyle (Persian)]. Iran J Health Educ Health Promot. 2016; 4(2):110-9. [DOI:10.18869/acadpub.ihepsaj.4.2.110]
24. Jalili Z, Hosseini ZS, Shojaei Zade D. [The application of the theory of planned behavior in preventing osteoporosis in women referring to comprehensive health service center in Tehran City, 2019-2020 (Persian)]. Tolooebehdasht. 2022; 21(1):14-27. [DOI:10.18502/tbj.v21i1.9930]
25. Khani Jeihooni A, Jormand H, Saadat N, Hatami M, Abdul Manaf R, Afzali Harsini P. The application of the theory of planned behavior to nutritional behaviors related to cardiovascular disease among the women. BMC Cardiovasc Disord. 2021; 21(1):589. [DOI:10.1186/s12872-021-02399-3] [PMID] [PMCID]
26. Shahnazi H, Bee Koon P, Abd Talib R, Lubis SH, Ganjali Dashti M, Khatooni E, et al. Can the BASNEF model help to develop self-administered healthy behavior in Iranian youth? Iran Red Crescent Med J. 2016; 18(3):e23847. [DOI:10.5812/ircmj.23847]
27. Jaras M, Mansoorian MR, Delshad Noghabi A, Nezami H. [Comparison of effectiveness self-care returns two methods of focus group discussions and teach-back on lifestyle of pregnant women (Persian)]. Int Med Today. 2019; 26(1):94-107. [DOI:10.32598/hms.26.1.2761]
28. Zhang X, Lu J, Wu C, Cui J, Wu Y, Hu A, et al. Healthy lifestyle behaviours and all-cause and cardiovascular mortality among 0.9 million Chinese adults. Int J Behav Nutr Phys Act. 202; 18(1):162. [DOI:10.1186/s12966-021-01234-4] [PMID] [PMCID]