Authors
Soghra Nikpour,
Aghil Habibi Sola,
Mahnaz Seiedoshohadaei,
Hamid Haghani,
Eftekharalsadat Hadjikazemi

Soghra Nikpour, Msc in society health nursing, member of scientific board of faculty of nursing and midwifery, Iran University of Medical Sciences and Health Services, Tehran, Iran
Aghil Habibi Sola MSc in Medical surgical nursing
Mahnaz Seiedoshohadaei MSc in medical surgical nursing
Hamid Haghani Msc in biostastistics
Eftekharalsadat Hadjikazemi Msc in society health nursing

Correspondence:
Soghra Nikpour
Collage of nursing & midwifery,
Iran University of Medical Science Health Services,
Rashid Yasami St. Vali ASR Ave.
Tehran-Iran.
Email: nikiniki_s@yahoo.com

With the aging of the world population, more than One-quarter of the world's population will be over the age of 60 by the year 2100⁽¹⁾. As in most other countries, the proportion of elderly people is increasing every year in Iran due to decreased birth rates and increased longevity. The proportion of those 60 years and older in Iran was approximately 12 % in 2004 and is expected to rise 15% in 2020⁽²⁾. As individuals live longer, health promotion behaviors become even more important, particularly with Regard to correlated factors ^(3-4-5). Issues in health promotion for older persons are related to their independence in every day life, high cognitive and physical function, and active engagement with life ⁽⁶⁾. On health promotion and aging highlighted regular exercise, smoking cessation, avoiding excessive alcohol use, Nutrition, and having age-appropriate immunization. These behaviors are encouraged with the intention of reducing the potential years of life lost in premature mortality and ensuring better quality of remaining life⁽⁷⁾. There is considerable evidence that health-promoting behaviors of older adults offer the potential for improving health status for reducing the cost of health care ^(8-9-10-11). Especially, culturally sensitive guidelines are becoming more important because of the rapid growth of the older population and the growing awareness of the importance of cultural differences.

Therefore, this study examined the degree of health Promotion behaviors and the relationship between health promotion behaviors and correlated factors in the Iranian elderly who live in the west area in Tehran-Iran. This study will elucidate the health promotion behaviors that Iranian elderly engage in. This investigation of the relationship between health promotion behaviors and correlated factors will help health care professionals to develop evidence-based health promotion strategies in the community to facilitate healthy and active life for the elderly population. Ultimately, this will help these individuals achieve their highest level of Health promotion behaviors.

This study was a descriptive-correlational study to understand health promotion behaviors and their correlated factors in Iranian elderly living in west area in Tehran-Iran. The sample included 410 community residents who were over 60years old, cognitively intact Participants were conveniently selected from 6 regions in west of Tehran. Subjects who consented to participate in the study were interviewed by trained interviewers with a structured questionnaire at the time of consent, or a subsequent interview was scheduled that was more convenient for the participants.

This study was approved by the Institutional Review Boards of the senior centers and public health centers. Health promotion behavior checklist Participants were asked about smoking cessation, alcohol abstinence, exercise and low salt diet, low fat diet, drinking milk, consumption of dairy and meat, consumption fresh vegetables and fruits. Participants were also asked whether or not they had had a recent blood pressure (BP) check-up, flu vaccination (within the past year), and health check-up (within the past 1-2 years). The criteria for specific health behaviors are shown in Table 1. If the criteria were met, for example, if the individual engaged in exercise for 20 min at least three times per week, then an affirmative ''yes'' was marked for exercise behavior.

Data analysis
Descriptive statistics were used to consider health promotion behaviors, perceived health status, number of chronic illnesses. T-test and ANOVA were used to explore the differences in quality of care by the status of specific health promotion behaviors, and socio-demographic variables

Table 1 Criteria for health promotion behaviors Behavior Criteria

The majority of the participants was male (55.6%), 60-74 years old (77.3%), with no schooling (30.5%), and married (80%). The mean age was 69.71±6.84 years old with a range of 60-86. Examining the living arrangement of the elderly, 55.1% of the elderly lived with spouse, and with their family (30%), followed by alone 12.9 % (Table 2).
On average, these participants had 2.18 chronic illnesses. Arthritis (60%) was the most common health Problem, followed by hypertension (36%), cataract (34.9%) and gastrointestinal disorder (26.8%).In terms of perceived health status, 32.9% of the participants indicated that their health was poorer compared to their peer group of elderly.

Table 2 Socio-demographic characteristics of the study sample (N = 410)

The mean score of health promotion behaviors was 7.08± 1.59, range 3-9, indicating that the study participants engaged in approximately 7 health promotion behaviors. Approximately 85.9% and 94.6 of the participants neither smoked nor drank alcohol. 69.3% and 69.8, 64.6% of the elderly engaged in low salt diet and low fat diet and exercise, respectively.76.8% and 75.6% consumed milk and dairy and meat, fresh vegetables and fruits respectively. Only 0.7% received flu shots. There were statistically significant differences in the mean score of Health promotion behaviors with regard to gender, age group, and education, economic status, Perceived health status to the peer group of elderly, Living arrangement, number of chronic diseases.

In terms of gender, there were significant differences of the participation rates for smoking and alcohol drinking: the smoking rate for male was 45% compared to13% for females, while the alcohol drinking rate was 8.8% for males compared to 1.1% for females. On the other hand, 89.8% and 0.7% of the elderly had had a BP check-up at least once and the flu vaccination in the last year, respectively. About 81.7% of the elderly had had a health check-up within the last 1-2 years (Table 3).

Table 3 Participation rate of health promotion behaviors (N = 410)

The two goals of Healthy People 2010 focus on increasing the quality and years of healthy life for each individual and eliminating health disparities⁽¹²⁾. Caring for older people in the community can be a challenging task for public health nurses. This study investigated the relationship between health promotion behaviors and correlated factors among in Iranian elderly living in west area in Tehran-Iran.

The goals of health promotion behaviors are to maintain function and independence, and improve quality of life⁽⁴⁾. There is some literature to suggest that adults aged 60 years and over benefit just as much from health promotion behaviors, as those the middle-aged^(4-7-13). Resnick (2000) categorized health promotion behaviors into two groups: primary health promoting behaviors, for the prevention of disease before it occurs; and secondary health promoting behaviors, for the detection of disease at an early stage ⁽¹⁴⁾.

Based on the current research findings, Iranian elderly engaged in approximately three health promotion behaviors, and participation in such behavior was higher for males, younger elderly, and those with higher educational status, independent economic status, who lived with their spouses, who had better Perceived health status to the peer group of elderly and who had more than three chronic diseases. However, the findings about the relations with socioeconomic status are still controversial. The participants of this study engaged in primary and secondary health-promoting behaviors such as smoking cessation (85.9%), alcohol abstinence (94.6%), and BP check-up (89.8%). The smoking rate in this sample was consistent with that reported for the elderly living in the community^{(15-16-17-18)}. The prevalence of alcohol drinking in this sample was less than that commonly reported for elderly in Western countries, but was consistent with that data of Korean studies^{(17-18-19-20)}. The findings of this study suggest a more objective Perspective on elderly health promotion issues in Iran.

A picture of elderly population in terms of the degree of health promotion practices in this study can be used as the basis for guiding important directions and planning health promotion activities in the community. Certain health promotion activities, such as engaging in regular exercise, moderate use of alcohol, and flu vaccination, are clearly recommended for all Iranian older adults. The first step toward promoting healthy behaviors among the elderly is to set priorities and to encourage older persons to make an informed decision abut his or her own health care practices. In the second step, differentiated health promotion programs that consider gender, age, and education should be developed and implemented. Finally, health care professionals should assess the orderly's own perception of their health and identify interventions to improve their health perception. Educational programs that enhance the patient's ability to manage the disease have been found to be effective in fulfilling this purpose⁽²¹⁾.On the other hand, this study had several limitations. First, a cross-sectional design was used to identify the relationship between health promotion behaviors and correlated factors, thereby precluding causality. Future research should use a longitudinal design to understand better the impact of health promotion behaviors on correlated factors. Second, since the instruments used in this study were developed in line with Iranian culture or were based on revised Western ones, it was not easy to compare directly the results of this study with those of previous western studies. In addition, one possible reason for the absence of strong evidence for significant relationships between correlated factors and other health promotion behaviors is that the measures used may not have been sensitive enough to detect the modest difference of health promotion behaviors in the elderly. Caution should be exercised in generalizing these results to the entire population of Iranian elderly because of the convenient sampling method through senior centers and public health centers. The current study focused only on health promotion behaviors and correlated factors of Iranian elderly. In conclusion, health promotion is an important outcome that is intricately linked to the goals of nursing. The literature Abounds with references to health promotion behaviors, whereas there is little research on the correlates with health promotion behaviors of elderly populations. The current study contributes to the expansion of the coherent body of knowledge about health promotion behaviors, which is essential for health care professionals and others who work with older populations. Health care professionals should further facilitate health promotion behaviors through formal health Promotion programs which focus on regular diet, exercise, and regular physical check-ups to enhance the health promotion behaviors of individual elderly and to improve the overall health among community.

We kindly acknowledge the research assistant of IUMS and all research units and individuals participating in this study.