3. Materials and Methods
3.1. Study Design
In this cross sectional study, 276 moderate-to-severely affected chemical veterans living in Ilam province were recruited between July and November 2014 via census sampling. Veterans more than 25 percent were categorized as moderate and severe based on the medical committee of department of veterans’ affairs (DVA). Ilam province is one of the western provinces of Iran. It covers an area of 20,132.844 square kilometers and its population is 557599 people. The province has temperate climate in the north, and warm and semi-warm climate in the south. The inclusion criteria included having suffered from moderate-to-severe levels of injury and having adequate physical health. However, individuals who did not comply with the study procedures, not satisfied about participating in the study, or without permanent residence in Ilam Province were excluded from the study.
For sampling, first, the complete list of chemicals veterans’ names and phone numbers was obtained from the department of veterans’ affairs (DVA). Then, through telephone contact, explanations regarding the targets, procedures, and confidential rules of the research were presented to potential study participants. Thereafter, if a veteran expressed desire to participate in the investigation, the researcher would visit their home to collect data. The participants were told that all information would bekept secret and anonymous. Then, they were requested to choose the best options as their answers to questions. Of the 276 referred veterans, six died, three were not able to respond to the questions, 15 submitted incomplete questionnaires, and 13 moved out of Ilam. Therefore, finally, 239 veterans (86.6% response rate) entered into the study.
3.2. Instruments and Measures
A self-administered questionnaire, the health-promoting lifestyle profile II (HPLP II) questionnaire, and five standard instruments regarding Pender models’ constructs, including perceived health status, perceived benefits, perceived barriers, social support, and self-efficacy, were used to collect data. All instruments were first translated by the primary investigator and then a bilingual person translated them back to English; all differences were improved. The translated instruments were reviewed by a group of Iranian health education experts, and minor amendments were made to them. Prior to data collection, the questionnaires were tested for reliability in a sample of 50 chemical veterans. In this study, all questionnaires were reliable and the ranges of Cronbach’s alpha coefficients were 0.82 (perceived health status)–0.92 (HPLP II).
The self-administered questionnaire queried age, gender, occupation, disability, type of injury, and militancy type.
The HPLP II included 52 questions, and all items are scored using a Likert scale ranging from 1 (never) to 4 (always). Therefore, the total questionnaire score ranges between 52 and 208. This standard questionnaire for measuring health-promoting behaviors includes six dimensions, namely, health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management. Higher scores indicate more favorable conditions in veterans in terms of health-promoting behaviors. Walker and collogues reported Cronbach’s alpha of 0.94 for this instrument (13-15). In this study, for this instrument, we obtained Cronbach’s alpha of 0.92, and content validity index (CVI) values in terms of simplicity, precision, and specificity were 0.91, 0.97, and 0.91, respectively.
The perceived health status questionnaire is a 12-item scale covering physical and mental health. Response categories for items vary from 2- to 6- point scales, and raw scores for items range from 1 to 6. Physical domain scores range from 6 to 20, and mental domain scores range from 6 to 27. Montazeri et al. reported Cronbach’s alpha of 0.73 for the physical health subscale and 0.72 for the mental health subscale in Iranian people. Furthermore, explanatory factor analysis (16) and confirmatory factor analysis (CFA) indicated good fit validity for this tool (17). Given these previous evaluations of this questionnaire in Iran, we did not validate it in the present study.
The standard multidimensional scale of perceived social support contains 12 items and assesses three subscales, namely, family, friends, and other significant individuals’ support. The items are scored on a 7-point Likert scale ranging from strongly disagree (1 point) to strongly agree (7 points), and the total questionnaire score ranges from 12 to 84. Psychometric studies have indicated good reliability (α = 0.91). Moreover, Cronbach’s alpha coefficient of this scale was 0.94, which indicates good internal consistency (18). In this study, the CVI values for simplicity, precision, and specificity were 0.93, 0.96, 0.91, respectively, and Cronbach’s alpha was 0.87, for this instrument.
The scales regarding perceived benefits