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Volume 10, Issue 4 (1-2024)                   J Prevent Med 2024, 10(4): 412-425 | Back to browse issues page

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Pazandeh F, Banihashem F, Mohseni S, Mohseni M, Firouzi H. Social Determinants of Health and Health-promoting Lifestyle of Pregnant Women in Hormozgan Province, Southern Iran. J Prevent Med 2024; 10 (4) :412-425
URL: http://jpm.hums.ac.ir/article-1-741-en.html
Social Determinants of Health and Health-promoting Lifestyle of Pregnant Women in Hormozgan Province, Southern Iran
Farzaneh Pazandeh1 , Farzaneh Banihashem *1 , Shokroallah Mohseni2 , Masoumeh Mohseni2 , Hamdan Firouzi3
1- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
3- Mother and Child Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Keywords: Health-promoting lifestyle, Social determinants of health, Pregnant women
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Introduction
In line with the sustainable development goals, Iran has aimed to reduce maternal mortality in deprived areas. A woman’s living conditions have a significant impact on her own health and her child’s health. One of the most important issues affecting maternal mortality is the involvement of social determinants of health, including income, race, age, literacy level, gender, culture, education, etc. which cause differences in lifestyle and access to health services among different communities. Therefore, it is necessary to know about the social determinants of health and lifestyle of pregnant women. The health-promoting lifestyle is defined as the control of the behaviors that affect health and arrange them by choosing health-promoting behaviors. It has 6 dimensions of spiritual growth, health responsibility, interpersonal relations, stress management, nutrition, and physical activity. The health-promoting lifestyle leads to the reduction of maternal and fetal death and to the control of non-communicable diseases. It helps with controlling blood pressure, obesity, diabetes, stress, and depression, and as a result, improves maternal and fetal health. Hormozgan Province is located in the south of Iran, and according to the World Bank report in 2018, it is a poor and very deprived province in Iran, which has an unfavorable situation compared to the national indicators and goals of the World Health Organization (WHO). This study investigates the health-promoting lifestyle of pregnant women and social-structural determinants of their health in Hormozgan Province.

Methods
This is a descriptive cross-sectional study on 800 pregnant women in the second and third trimesters of pregnancy referred to urban and rural health centers in Hormozgan Province in 2016 to receive prenatal care services. Sampling was done by a cluster sampling method from 12 healthcare centers as clusters. From each city, the clusters were randomly selected proportional to the number of health centers. The selection of samples from each center was done using a convenience sampling method. Data were collected by a researcher-made form surveying demographic/socio-economic information and the health-promoting lifestyle profile (HPLP-II). In this questionnaire, the items are rated on a Likert scale as 1=never, 2=sometimes, 3=often, and 4=always. SPSS software, version 21 was used to analyze the data. Descriptive statistics (frequency, percentage, Mean±SD) were used to describe the variables, and t-test, analysis of variance, multiple linear regression, and Pearson’s correlation test were used to analyze and find the relationship between the variables.

Results
The overall score of HPLP-II was 139.94±22.52 (71.39%), which indicates a moderate level. The lowest score was related to the women from the eastern part of the province (138.78±19.73). Regarding lifestyle dimensions, women had the highest score in spiritual health and the lowest score in physical activity and stress management. A multiple regression model was used to study the effect of intervening variables (age of women, educational level of women and their husbands, occupation of women and their husbands, socio-economic status of household, body mass index of women, receiving prenatal care, receiving pregnancy care, and number of pregnancies) on the health-promoting lifestyle. The HPLP-II score of women with university education was higher than that of other educational groups by 3.11. The HPLP-II score of women working outside the home was lower than that of other occupation groups by 2.96. The HPLP-II score of women with normal BMI was higher than that of other BMI groups by 5.52. The HPLP-II score of women who received prenatal care was higher than that of those with no prenatal care by 11.19.

Conclusion
Overall, pregnant women in Hormozgan Province have a health-promoting lifestyle status lower than the average level. They have the highest score in spiritual health and the lowest score in physical activity and stress management. It seems that the women’s low awareness of the importance of physical activity and stress management, as well as the lack of attention to these dimensions in prenatal care visits, have a role in reducing the score of these domains. Improving the health-promoting lifestyle of pregnant women can lead to a decrease in their stress and, subsequently, mortality caused by pregnancy complications. On the other hand, having physical activity can increase women’s physical readiness for childbirth, reduce their stress, and help with their physical recovery after delivery. The social determinants of health, including educational level, occupation, and socio-economic status, have a significant relationship with having a health-promoting lifestyle in pregnant women. Therefore, it is possible to improve the health of pregnant women by raising their awareness, educating them about having a healthy lifestyle, and providing them with any intervention that can increase their physical activity and stress management.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by Shahid Beheshti University of Medical Sciences (Code: IR.SBMUPHNM.1395.435). 

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors' contributions
Study design: Farzaneh Pazandeh and Farzaneh Banihashem; Statistical analysis: Shokroallah Mohseni; Review and editing: Masoumeh Mohseni; Final approval: All authors.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors appreciate the support of Hormozgan University of Medical Sciences.




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Type of Study: Orginal | Subject: Midwifery
Received: 2023/11/15 | Accepted: 2023/11/5 | Published: 2024/01/1
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