Journal of Education and Health Promotion

ORIGINAL ARTICLE
Year
: 2017  |  Volume : 6  |  Issue : 1  |  Page : 26-

Determinants of physical activity in middle-aged woman in Isfahan using the health belief model


Habibollah Hosseini1, Razieh Moradi2, Ashraf Kazemi3, Maryam Sadat Shahshahani4,  
1 Department Health Nursing, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Reproductive Health, School of Nursing and Midwifery, Nursing and Midwifery Research Care Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Nursing Health, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Correspondence Address:
Razieh Moradi
Department of Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan
Iran

Abstract

Introduction: Nowadays with respect to the automation of the lifestyle, immobility statistics in middle-aged women has increased and they are at risk for complications of immobility. One of the models used to identify factors associated with physical activity is Health Belief Model utilized in different age and different cultural backgrounds and different results have been obtained from those studies. The purpose of this study was to investigate the factors affecting on physical activity in middle-aged women using Health Belief Model. Materials and Methods: This descriptive-correlation study was conducted on 224 middle-aged women referring to health centers in Isfahan. Health Belief Model structures including perceived susceptibility and severity, perceived barriers and benefits, and self-efficacy were measured by questionnaire and physical activity was assessed using the international physical activity questionnaire. Collected data were analyzed using descriptive statistics and Pearson correlation coefficient test and regression analysis. Results: There wasn't significant correlation between perceived susceptibility (P = 0.263, r = 0.075) and perceived severity with physical activity duration (P = 0.127, r = 0.058) but there was positive and weak correlation between physical activity duration with perceived benefits (P = 0.001 and r = 0.26) and perceived self-efficacy (P = 0.001, r = 0.54) and had weak and inverse correlation with perceived barriers (P = 0.001, r = -0.25). Regression analysis also showed that from among all the Health Belief Model structures just self-efficacy structure has influenced on behavior independently and other structures are affected by it. Conclusion: The obtained results implied on a correlation between benefits, barriers and perceived self-efficacy with and moderate physical activity. Therefore it is necessary to develop appropriate educational programs with emphasis on structures of Health Belief Model that has the maximum impact on physical activity in middle-aged women.



How to cite this article:
Hosseini H, Moradi R, Kazemi A, Shahshahani MS. Determinants of physical activity in middle-aged woman in Isfahan using the health belief model.J Edu Health Promot 2017;6:26-26


How to cite this URL:
Hosseini H, Moradi R, Kazemi A, Shahshahani MS. Determinants of physical activity in middle-aged woman in Isfahan using the health belief model. J Edu Health Promot [serial online] 2017 [cited 2021 Oct 19 ];6:26-26
Available from: https://www.jehp.net/text.asp?2017/6/1/26/205740


Full Text

 Introduction



According to the World Health Organization report, immobility is 1 of the 10 major causes of death and disability in the world.[1] In Iran immobility life has been recognized as a serious problem too.[2] Studies show that the prevalence of immobility among the population 22–65 years during the 4 years has increased from 15% (1385) to 21.5% (1390) and the rate of immobility in work, travel and traffic, and recreation and leisure time have been 56.4%, 39.2% and 78.7%, respectively.[3] Moreover, evidences show that 70–80% of Iranians do not have enough mobility [4],[5] that its statistics in Iranian women is far higher than Iranian men.[6] In a study conducted in Tehran, 69.8% of the study population was inactive; in other words, only 3.30% of the women were doing physical activity.[2] In another study conducted in Isfahan on average, 71.6% of women working at Isfahan University and Isfahan University of Medical Sciences had an immobility life.[7] Despite the emphasis of health centers to exercise and physical activity, a quarter of women never participate in regular physical activity [8] and in Iran 77% of women are inactive.[2] Immobility life is associated with the risk of many chronic diseases [1] so that yearly 2 million deaths in the world occur due to immobility life.[9] In the meantime, midlife often is considered as a sign of reduced health in women and this group compared to younger ages is more susceptible to disease.[10] In this course, people encounter with different physiological, physical, cognitive, and social changes and experience the first symptoms of chronic diseases such as hypertension, arthritis, cardiovascular disease, and diabetes in this period and with the occurrence of menopause are susceptible to changes that affect on their health condition.[11] And while appropriate physical activity has protective effects against chronic diseases and premature death and several studies have confirmed its benefits.[12] Doing physical activity causes the postponement of aging and disability, increased physical stamina, reduced risk of falling in the elderly,[13] reduced vasomotor symptoms arising from menopause,[14] reduced risk of cardiovascular diseases, diabetes, osteoporosis, cancer, and obesity.[15],[16],[17]

In this regard, one of the developed goals of the World Health Organization up to 2025 is to promote people's healthy style of life and reduce immobility as much as 10% that based on it all countries should actively put in their agenda strategies that are effective in improving their individual and social life and reduce factors damage to human health.[1] Encouraging people to change behavior and choose healthy behavior is a complex process that under the worst conditions is still very difficult.[18] Physical activity pattern is affected by environmental, social factors,[19] and biological structure of body [20] and psychological factors [21] that during different periods of life undergoes changes.[19] Diversity of various sociocultural fields has made complex the effect of the factors associated with physical activity.[22] Since the people's ability level as well as barriers and benefits can be considered as important variables in doing physical activity; hence, health belief pattern can be used as one of the models studying behavior.[23] Health belief model tries to explain that why some people utilize health behaviors and some do not do it.[24] Based on this pattern adopting health behavior depends on the two subjects: first, person's perceptions of the danger that threatens him; second, person assessment of the barriers and benefits of health action. Perceived threat means that person's feelings are subjected to the disease and so adopts preventive behavior that itself is influenced by two factors: perceived severity and susceptibility. In perceived susceptibility, person knows himself sensitive to a particular disease so in this respect, does measures already and in perceived severity, the person estimates intensity and deterioration of disease and feels the threat. Person's assessment of the benefits and barriers of healthy behavior is also effective in the probability of doing behavior. The person follows behavior that is feasible, useful, and effective. But, on the other hand, negative and potential aspects of a health behavior also may act as a barrier for adapting a health behavior. The other important structure of this model is self-efficacy that is the result of this subject that the person has the ability to follow a behavior. Self-efficacy is related to the specific behavior and in the present time and is not related to the past or the future.[23],[24] In several studies, the correlation between health belief model structures and doing behavior has been examined.

Shojaeezadeh et al. in their study reported that the mean score of perceived severity and susceptibility of women has been moderate, but their perceived benefits for doing exercise has been too low.[25] In other studies, lack of time, lack of social support, feeling laziness, indifference, lack of belief in the benefits of exercise, low self-efficacy, work and academic concerns, and lack of access to sport place have been mentioned as the main perceived barriers for doing exercise.[26],[27],[28],[29] These studies in different cultural and age fields around the world have been conducted. But still the relationship between this model and physical activity behavior in middle-aged women of Isfahan has not been examined. Accordingly, in the present study, we identified the factors associated with physical activity of middle-aged women in Isfahan-based on health belief model in order to put available its results for planning and necessary measures for health professionals.

 Materials and Methods



This was a descriptive-correlation study conducted for a month (Ordibehesht) on middle-aged women referring to the Health Centers in Isfahan in 1394. The number of samples based on previous studies [30] using statistical formula [INSIDE:1] have been calculated at least 200 people. Considering the 20% fall, sample size was considered 240 people (Z: Confidence coefficient 95% and d = 0.14 S). In this study, two health networks 1 and 2 of Isfahan were considered as clusters and of the 46 centers affiliated to these two networks eight centers including Khaju, Nawab Safavi, Pol Shahrestan, Rostamian, Feiz, Shahidfadayii, Moataned, and Amir Hamze were randomly selected and for each center 30 samples equally were considered. Then, all the 40–60 years women referring to the centers were interviewed. Criteria for entering the study were Iranian citizenship and residence in Isfahan, lack of any disease and conditions that limit movement and lack of infecting to mental and psychological illness examined through medical history, and according to the patient. Moreover, exclusion criteria were a lack of completing, at least, one item from each section of the questionnaire and lack of intention to continue during completing questionnaire. All women who had inclusion criteria for the study were invited. Of the 320 people who were eligible for entering the study, 240 people were ready to participate in research. The data were collected through a three-part questionnaire including.

Field variables questions and demographic section

This section was examined with four questions regarding age, marital status, menopausal status, and education level.

Questions related to the health belief model structures section

It consisted of perceived barriers of physical activity and perceived benefits of physical activity and perceived severity and susceptibility of immobility that statements of all parts of health belief model measurement were scored based on 5-point Likert scale from 0 for strongly disagree to 4 for strongly agree. And then, resulting score was calculated of 100. In cases that the samples were illiterate, the questionnaires were completed by questioning and in other cases were completed as self-reporting. In order to determine content validity and face validity, after correction and approval by the supervisor and counselor, questionnaires were given to ten faculty members who had sufficient expertise and experience in the field of health education, healthy behaviors and physical activity, and their comments regarding the questionnaire were applied. To determine the reliability of internal consistency of the questionnaire, Cronbach's alpha coefficient was used and the limit higher than the 0/7 was considered acceptable. Then assessment of the reliability of the consistency of the results was performed by test-retest method, and the questionnaire was given to 20 middle-aged women who were eligible for inclusion in the study to be completed; then with an interval of 10–14 days the questionnaires were completed by them again. In this study, the Cronbach's alpha coefficient for each section “perceived severity,” “perceived benefits,” “perceived barriers,” and “self-efficacy” was obtained 0.76, 0.75, 0.78, 0.77, and 0.82, respectively. In addition, the correlation of each mentioned sections was determined 0.77, 0.76, 0.76, 0.72, and 0.73, respectively.

Perceived barriers and perceived benefits

In order to investigate these structures a researcher made questionnaire was used designed according to the results of previous researches and available questionnaires.[31] Perceived barriers included eight questions and perceived benefits included nine questions. In section perceived barriers, the middle-aged women's beliefs about the barriers considered as a deterrent and disruptive factor for adapting physical activity were investigated, including “physical activity makes me tired” and/or “I don't have time for physical activity.” And in section perceived benefits, we assessed the attitude of middle-aged women about profits and benefits that they get off physical activity (in individual and social aspects). For example, “physical activity gives me self-confidence” and “physical activity causes to do my daily activities without fatigue.”

Perceived severity and susceptibility complications of physical inactivity

These structures were investigated using a researcher made questionnaire designed based on the results of previous studies and available questionnaires. Section perceived severity included five questions and section perceived susceptibility included five questions too. Perceived susceptibility was the perceptions and attitudes of middle-aged women about this matter that how much they feel are exposure to the risk of immobility complications. Items can be studied in this questionnaire are physical and psychological complications resulting from immobility and disorder in individual and social performance, for example, “immobility during menopause is dangerous” and/or “immobility in middle-age threatens my health.” And perceived severity assessed the attitude of middle-aged women about injuries and problems can be created as a result of the immobility, for example, “if I'm immobility during middle-age it is possible to infect to a disease” and “I'm immobility during middle-age it is possible to infect to depression and anxiety.”

Perceived self-efficacy

Perceived self-efficacy in this study is a degree of middle-aged women's belief in their ability in doing physical activity. This structure was assessed using researcher made questionnaire. This section was examined by seven questions and included items such as “I can do physical activity, even if I'm tired” and “I can do physical activity, even if I feel depression and upset.”

International physical activity questionnaire

The questions assess the physical activity performance in 7 past days.[32] Accordingly, measures activities with weak, moderate, and severe intensity. Moderate intensity activities like carrying light loads, average speed cycling or volleyball, and walking and intense activities like aerobics and aerobic exercises, fast cycling, and running meanwhile any activity that its duration is [33] Reliability and validity of this questionnaire have been confirmed in Kelishadi et al. study in 1380.[34] Furthermore, questionnaire's correlation coefficient in Vahedian-Shahroodi et al. study has been stated 0.86.[35] Collected data were analyzed with the help of statistical program SPSS 16 (SPSS Inc.: Chicago, IL) and using descriptive statistics (absolute and relative frequency, mean and standard deviation) and Pearson correlation coefficient test and linear regression and the significant level of data was considered equal to 0.5. It should be noted that ethical issues were considered in the study. Researcher after obtaining official permission from the Nursing and Midwifery Faculty of Isfahan referred to the Province and City Health Center and began his/her research by providing the necessary explanations to the relevant authorities. Also besides explaining the purpose of research, oral and written consent was obtained from all subjects. Then questionnaires were completed at the right place in the health center.

Findings

After finishing sampling, data were entered into SPSS 16. A total of 224 subjects asked to the questionnaires completely. The mean age of surveyed subjects was 48.96 ± 5.84 years that most were married and housekeeper [Table 1]. Seventy-five percentage of the samples did physical activity less than the standard 150 min/week, and the mean and standard deviation of the duration of moderate and intense physical activity were 137 and 114 min, respectively. The mean score of health belief model structures has been shown in [Table 2]. Calculating Pearson correlation coefficient, there was an inverse relationship between age and duration of intense and moderate physical activity, and also there was a direct relationship between education level and duration of intense and moderate physical activity. Also, there was a positive and weak correlation between physical activity duration and perceived benefits, and there was a positive and strong correlation between moderate intensity between perceived self-efficacy and physical activity behavior and there was a weak and inverse correlation between perceived barriers and physical activity behavior. But there was not significant correlation between perceived susceptibility and severity with physical activity behavior [Table 3]. Moreover, the linear regression analysis between duration of moderate and intense physical activity in terms of health belief model structures with multiple coefficients (R2 = 0.33) showed that there is a significant linear relationship between duration of moderate and intense physical activity and score of health belief model structures (P < 0.05). The most correlation was between duration of moderate and intense physical activity and perceived self-efficacy [Table 4].{Table 1}{Table 2}{Table 3}{Table 4}

 Discussion



The purpose of this study was to investigate the factors affecting on physical activity in middle-aged women of Isfahan-based on health belief model. In this study, 75% of samples were inactive and did not do the minimum amount recommended by the World Health Organization (150 min moderate physical activity per week). Therefore, the results of this study shows that the surveyed subjects do not do necessary physical activity as much as is useful for their health. In other studies conducted in Iran, similar results have been achieved.[4],[5],[6] Hence, designing educational interventions in order to promote physical activity in middle-aged women seems necessary. In this study, perceived benefits and barriers had direct but weak correlation with duration of physical activity which is consistent with a study conducted by Solimanian et al. on middle-aged women in Tehran.[30] The results of a study conducted on menopausal women in Texas [36] and the study of King et al. also support the results of this study indicating that there is a correlation between perceived benefits and barriers with duration of intense and moderate physical activity. In the study of Shin et al., perceived benefits and barriers were as the factors affecting on subject's commitment to participate in sports activities, and perceived barriers had shown a negative correlation with participating in sports activities.[37] But in the study of Gharlipour et al. conducted on personnel of medical emergencies, there was not significant correlation between perceived benefits and barriers and physical activity.[38] Also in the study of Aghamolayi et al., a significant correlation between perceived benefits and doing behavior was not observed.[39] It seems that in middle-aged women of Isfahan, benefits and barriers structures perceived of health belief model are effective components for strengthening physical activity. Perhaps we can say that the statements of the present questionnaire which has been used to measure perceived benefits and barriers can examine this structure well by including different dimensions of perceived benefits and barriers of physical activity. But, on the other hand, the important thing is that why despite high mean score of perceived benefits (85.8%) in studied samples, physical activity is undesirable? Accordingly, it seems necessary to do more comprehensive studies with a holistic view and/or identify other relevant and determinant factors in this group. In this study, despite the favorable score in perceived susceptibility and severity (acquisition 95–99%) of the obtainable mean score by perceived susceptibility and severity duration of moderate and intense physical activity and in other words perceived susceptibility and severity were not able to predict behavior. In line with our findings other studies such as the studies of Baghianimoghadam et al. which had investigated the role of health beliefs in performing preventive behavior of cardiovascular diseases in people at risk showed that perceived susceptibility and severity are not predicting factors for adopting preventive behavior.[40] In Edmonds study in 2009,[41] Keating et al. in 2005,[42] and Solimanian et al. in 2014[30] there was not statistical significant correlation between perceived severity and behaviors preventing of osteoporosis, but there was a direct correlation between perceived susceptibility and behavior. In other studies like study of Mazloomy et al. there was a direct correlation between perceived susceptibility and behavior preventing of diabetes including physical activity, but it did not have a significant correlation with perceived severity.[43] It seems that only understanding the threat and feeling vulnerable against immobility complications are not sufficient for changing or promoting behavior, but since the perceived susceptibility and severity is affected by medical knowledge and information it seems that the reason of difference in the results of different studies, is the difference in awareness level of the risks and disabilities following unhealthy behavior. Given that in various studies, different results from the relationship between perceived susceptibility and severity with physical activity behavior have been obtained, it is needed that still more studies are done in this field to explain the relationship between these two structures with behavior more than ever. One of the other factors examined in this study was perceived self-efficacy which showed a strong association with physical activity that this result is consistent with several studies. For example, a study conducted on Korean middle-aged women in 2006 showed that self-efficacy causes to people are put in the more advanced stages of changing physical activity and have more preparation for change.[44] Also in the study of Daniali et al., there was a statistical significant correlation between self-efficacy and physical activity in women working at Isfahan University and Isfahan University of Medical Sciences.[7] The results of studies such as Dlugonski and Motl in 2014,[45] and Peyman et al. in 2013[46] and Solimanian et al. in 2014[30] were consistent with our results. With regard to the results of this study and previous studies, it seems that self-efficacy is one of the important structures in predicting physical activity behavior and strengthening this structure has a high effect on the promotion of physical activity. Accordingly, it is necessary that planners and practitioners, in their short-term and long-term planning, with appropriate methods promote self-efficacy in this group of people.

 Conclusion



The findings of this study showed that surveyed subjects do not need physical activity as much as is useful for health and there is a need to design educational interventions of community health nurse in his/her educational role, to promote level of intense and moderate physical activity in middle-aged women of Isfahan. Default underlying the health belief model about role of perceived susceptibility and severity in increasing probability of behavior incidence was not confirmed. It seems that only risk perception and sense of vulnerability about immobility complications is not sufficient for creating health behavior. In educational curricula of community health nurse based on the health belief model, emphasis on self-efficacy, perceived susceptibility and severity, and raising it can lead to promotion of physical activity level of middle-aged women in Isfahan. On the one hand, people's recognition of the benefits of regular physical activity and on the other hand, reducing barriers in order to achieve this, is necessary. Self-efficacy as the most effective structure in this study should be taken into consideration because self-efficacy affects on person's emotions, thoughts, and actions and if someone believes that he can do anything, the likelihood of his success in that task will increase.

Limitations of the study

One of the limitations of this study is that this study is sectional and has weakness than longitudinal studies in providing behavior predictors.

Acknowledgments

This study as a Master's thesis research project under the contract number 394152. Researchers express their thanks and appreciation to the Center of Nursing Research of Isfahan Medical University for their financial support. They also appreciate Mr. Hassan Zadeh for his help in statistical consultation.

Financial support and sponsorship

Isfahan University of Medical Sciences; our article has been derived from a thesis research project. Approval code of project: 394152.

Conflicts of interest

There are no conflicts of interest.

References

1World Health Organization 2015, Physical Activity Fact Sheet; 2015. Available from: http://www.who.int/mediacentre/factsheets/fs385/en/. [Last accessed on 2015 May 24].
2Momenan AA, Delshad M, Mirmiran P, Ghanbarian A, Azizi F. Leisure time physical activity and its determinants among adults in Tehran: Tehran lipid and glucose study. Int J Prev Med 2011;2:243-51.
3Koohpayehzadeh J, Etemad K, Abbasi M, Meysamie A, Sheikhbahaei S, Asgari F, et al. Gender-specific changes in physical activity pattern in Iran: National surveillance of risk factors of non-communicable diseases (2007-2011). Int J Public Health 2014;59:231-41.
4Solhi M, Ahmadi L, Taghdisi MH, Haghani H. The effect of trans theoretical model (TTM) on exercise behavior in pregnant women referred to Dehaghan Rural Health Center. Iran J Med Educ 2012;11:942-50.
5Hashemi SZ, Rakhshani F, Navidian A, Mosani SR. Effectiveness of educational program based on transtheoretical model on rate of physical activity among household women in Zahedan, Iran. J Health Syst Res 2013;9:144-52.
6Esteghamati A, Khalilzadeh O, Rashidi A, Kamgar M, Meysamie A, Abbasi M. Physical activity in Iran: Results of the third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007). J Phys Act Health 2011;8:27-35.
7Daniali SS, Azadbakht L, Mostafavi Darani F. The relationship between body image, self-efficacy and physical activity in female employees of Isfahan University of Medical Sciences and Isfahan University. Health Syst Res 2012;6:991-1001.
8Adachi-Mejia AM, Drake KM, MacKenzie TA, Titus-Ernstoff L, Longacre MR, Hendricks KM, et al. Perceived intrinsic barriers to physical activity among rural mothers. J Womens Health (Larchmt) 2010;19:2197-202.
9World Health Organization. WHO Tools to Prevent and Control Noncommunicable Diseases. Available from: http://www.who.int/nmh/publications/ncd-infographic-2014.pdf?ua=1. [Last accessed on 2014 Oct 24].
10Chareonsanti J, Tiansawad S, Chanprasit C, Newburn-Cook CV, Eastlick Kushner K. Health meanings and practices among midlife professional Thai women. Thai J Nurs Res 2009;13:55-67.
11Pérez JA, Garcia FC, Palacios S, Pérez M. Epidemiology of risk factors and symptoms associated with menopause in Spanish women. Maturitas 2009;62:30-6.
12US. Department of Health and Human Services. Physical Activity. In the Healthy People 2020. December 25, 2015. Available from: http://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity?topicid=33.
13Pahor M, Guralnik JM, Ambrosius WT, Blair S, Bonds DE, Church TS, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: The LIFE study randomized clinical trial. JAMA 2014;311:2387-96.
14Moilanen J, Aalto AM, Hemminki E, Aro AR, Raitanen J, Luoto R. Prevalence of menopause symptoms and their association with lifestyle among Finnish middle-aged women. Maturitas 2010;67:368-74.
15World Health Organization. A Global Brief on Hypertension, Silent Killer, Global Public Health Crisis; 2013. Available from: http://www.apps.who.int/iris/bitstream/10665/79059/1/WHO_DCO_WHD_2013.2_eng.pdf. [Last accessed on 2015 Apr 18].
16Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT; Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. Lancet 2012;380:219-29.
17Singh MA. “Exercise and Bone Health.” Nutrition and Bone Health. New York: Springer; 2015. p. 505-42.
18Mohammadi N, Rafie Far SH. Health Education (Basic Concepts). Tehran: Mehr Ravesh Publication; 2006;75-8.
19Thøgersen-Ntoumani C. An ecological model of predictors of stages of change for physical activity in Greek older adults. Scand J Med Sci Sports 2009;19:286-96.
20Martin KR, Schoster B, Shreffler JH, Meier A, Callahan LF. Perceived barriers to physical activity among North Carolinians with arthritis: Findings from a mixed-methodology approach. N C Med J 2007;68:404-12.
21Ball K, Salmon J, Giles-Corti B, Crawford D. How can socio-economic differences in physical activity among women be explained? A qualitative study. Women Health 2006;43:93-113.
22Lowenstein A, Foord-May L, Romano J, editors. Teaching Strategies for Health Education and Health Promotion: Working with Patients, Families, and Communities. Massachusetts: Jones and Bartlett Publishers; 2009.
23Glanz K, Rimer BK, Viswanath K, editors. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco: John Wiley and Sons; 2008.
24Sharma M, Romas JA. Theoretical Foundations of Health Education and Health Promotion. Sudbury: Jones and Bartlett Publishers; 2011.
25Shojaeezadeh D, MehrabBeik A, Mahmoodi M, Salehi L. The effect of education on knowledge, attitude and practice of women clients Imam Khomeini Relief Foundation about preventing osteoporosis using the health belief model. Iran J Epidemiol 2011;7:30-7.
26Pirasteh A, Davati A, Jouhari Z, Mohamadi L. Predicting physical activity behavior among Iranian medical college students using the transtheoretical model. Daneshvar (Shahed Univ Med Sci) 2012;19:1-11.
27Gómez-López M, Gallegos AG, Extremera AB. Perceived barriers by university students in the practice of physical activities. J Sports Sci Med 2010;9:374-81.
28Taymoori P, Falhahi A, Esmailnasab N. Application of the health promotion model in studying physical activity behavior of students in Sanandij, Iran. Sci J Sch Public Health 2011;9:35-46.
29Kamaradin K, Omar-Fauzee MS. Attitude toward physical activities among college students. Pak J Psychol Res 2007;22:43-54.
30Solimanian A, Niknami S, Hajizadeh I, Shojaeezadeh D, Tavousi M. Predictors of physical activity to prevent osteoporosis based on extended health belief model. Journal of the Institute for Health Sciences 2014;13:313-20.
31Sechrist KR, Walker SN, Pender NJ. Development and psychometric evaluation of the exercise benefits/barriers scale. Res Nurs Health 1987;10:357-65.
32International Physical Activity Questionnaire (IPAQ). Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire; November, 2005. Available from: http://www.ipaq.ki.se/scoring.pdf. [Last cited on 2014 Jan 27].
33King KA, Vidourek RA, English L, Merianos AL. Vigorous physical activity among college students: Using the health belief model to assess involvement and social support. Arch Exerc Health Dis 2014;4:267-79.
34Kelishadi R, Rubaie K, Khosravi AR, Famoory F, Sadeghi M, Roohafza H, et al. Patterns of physical activity among adolescents in Isfahan. Shahrekord Univ Med Sci 2001;2:55-66.
35Vahedian-Shahroodi M, Lael-monfared E, Esmaily H, Tehrani H, Mohaddes-Hakkak HR. Prediction of osteoporosis preventive behaviors using the health belief model. Iran J Health Educ Health Promot 2014;2:199-207.
36Swaim RA, Barner JC, Brown CM. The relationship of calcium intake and exercise to osteoporosis health beliefs in postmenopausal women. Res Social Adm Pharm 2008;4:153-63.
37Shin YH, Hur HK, Pender NJ, Jang HJ, Kim MS. Exercise self-efficacy, exercise benefits and barriers, and commitment to a plan for exercise among Korean women with osteoporosis and osteoarthritis. Int J Nurs Stud 2006;43:3-10.
38Gharlipour Gharghani Z, Sayarpour SM, Moeini B. Associated factors with regular physical activity among emergency medical personnel in hamadan: Applying health belief model. J Health Syst Res. 2012;7:710–7.
39Aghamolayi T, Tavafian SS, Hasani L. Perceived self-efficacy, barriers and benefits within regular physical activity among students of Hormozgan University of Medical Science. Iran J Epidemiol Spec 2008;4:4-15.
40Baghianimoghadam MH, Mirzaei M, Rahimdel T. Role of health beliefs in preventive behaviors of individuals at risk of cardiovascular diseases. J Health Syst Res 2013;8:1151-8.
41Edmonds E. Osteoporosis Knowledge, Beliefs, Behaviors of the College Students: Utilization of Health Belief Model, Doctorate Degree of Philosophy, Alabama University; 2009. p. 1-40.
42Keating XD, Guan J, Piñero JC, Bridges DM. A meta-analysis of college students' physical activity behaviors. J Am Coll Health 2005;54:116-25.
43Mazloomy S, Mirzaei A, Afkhami M, Baghianimoghadam M, Falahzadeh H. The role of health belief model in preventive behaviors of individuals high – Risk of type 2 diabets mellitus. J Shaheed Sadoughi Univ Med Sci 2010;18:24-31.
44Kim Y, Cardinal BJ, Lee J. Understanding exercise behavior among Korean adults: A test of the transtheoretical model. Int J Behav Med 2006;13:295-303.
45Dlugonski D, Motl RW. Social cognitive correlates of physical activity among single mothers with young children. Psychol Sport Exerc 2014;15:637-41.
46Peyman N, Esmaily H, Taghipour A, Mahdizadeh M. Using of social cognitive theory: Predictors of physical activity among women with diabetes type 2. Health 2013;3:345-54.