Iran Journal of Nursing

Introduction
Health-promoting behaviors are among the main determinants of health. People need self-efficacy to be successful in changing their bad behaviors and improving their health. Adolescence is a period in which individuals are at risk of several health-threatening behaviors such as an increase in food intake, reduction in physical activity, and increase in developmental vulnerability. Thus, improvement in health-promoting behaviors of adolescents may prevent many health problems in them. Differences in health-promoting behaviors may be due to the effects of health components or  several personal, socio-economic, and environmental factors. This study aims to determine the relationship between mothers' self-efficacy and health-promoting behaviors of their adolescent girls in Shiraz, Iran.

Materials and Methods
This is a descriptive-correlational study with a cross-sectional design. The study population consists of all high school female students (second term) and their mothers in Shiraz city in 2018 (n=51234). Using Cochran's formula, the sample size was calculated 384. The inclusion criterion were the informed consent of mothers and their girls. The samples were selected using a random multi-stage cluster sampling method from four girls’ high schools in each four districts of the city. Mothers completed Sherer’s General Self-efficacy Scale and their girls completed Walker's Health-Promoting Lifestyle Profile II (HPLP II) questionnaire. The collected data were analyzed using descriptive and inferential statistics. Among inferential statistics, Pearson or Spearman correlation test, t-test, and Eta squared coefficient were used. The significance level was set at 0.05. Statistical calculations were performed in SPSS software, verision 22.

Results
Among girls, 31.5% were grade 10 students, 33.3% were grade 11, and 35.2% were grade 12. Moreover, 38.5% of mothers were 31-40 years old, 5% had age 41-50 years, and 11.5% aged >50 years. About 11.5% of mothers were self-employed, 18.2% were employed, and 70.3% were housewives. About 28.9% of mothers held a high school diploma or lower education, 65.9% had a bachelor's degree, and 5.2% had a master's degree or higher. The mean HPLP II score of girls was 169.29± 15.97. In terms of subscales, the highest score was related to nutrition (3.53±0.45) and the lowest score was related to interpersonal relationships (2.79±0.56). The mothers' mean self-efficacy score was 46.66±5.77. The results of Pearson's correlation test showed the direct and significant correlation of mothers' self-efficacy scores with health-promoting behaviors of girls and its domains (r=0.556, P<0.05). This means that with the increase of mothers' self-efficacy, health-promoting behaviors of their girls can be improved. In terms of HPLP II domains, the highest correlation was with the interpersonal relationships (r=0.875) and the lowest correlation was with the physical activity (r=0.113). The results of analysis of variance showed no significant difference in the scores of HPLP II among girls in terms of educational grade (P>0.05). The scores of girls' health-promoting behaviors and mothers' self-efficacy had a statistically significant relationship with the number of siblings, mother's age, mother's occupation, and mother's educational level (P<0.05).

Conclusion
The obtained results revealed a direct significant relationship between mothers' self-efficacy and health-promoting behaviors of their daughters. Considering the importance of health-promoting behaviors and the effect of self-efficacy and living conditions on these behaviors, it is needed to develop strategies to improve people's lifestyle and healthy behaviors. Policy makers in the health system are recommended to promote self-efficacy of mothers by using cultural and educational programs. The high school girls in Shiraz have favorable health-promoting behaviors; however, it is recommended that their health-related behaviors should be periodically monitored, and group training sessions, conferences, and online educational programs be used for them, if needed. It is also recommended that mothers with lower self-efficacy should be identified and their self-efficacy be improved by counseling programs and attending psychological clinics.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Islamic Azad University, Isfahan (Khorasgan) Branch (Code: IR.IAU.KHUISF.REC.1398.007).

Funding
This study was extracted from the master’s thesis of Niloufar Zare in nursing, funded by Islamic Azad University of Isfahan (Khorasgan) Branch.

Authors' contributions
Conceptualization, methodology, validation, investigation, data analysis, initial draft preparation, resources, and funding acquisition: Niloufar Zare; Visualization, supervision, and project administration: Niloufar Zare and Narges Sadeghi; Editing & review: All authors.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the Islamic Azad University of Isfahan (Khorasgan) Branch, and all participants for their support and cooperation.

 References

1. Tol A, mohebbi B, Yekaninejad M, Sabouri M. [Influential factors on health promoting behaviors and happiness among women (Persian)]. Razi J Med Sci. 2018; 25(4):11-22. [Link]
2. Cappa C, Wardlaw T, Langevin-Falcon C, Diers J. Progress for children: A report card on adolescents. Lancet (London, England). 2012; 379(9834):2323-5. [DOI:10.1016/S0140-6736(12)60531-5] [PMID]
3. Piri N, Garmaroudi G, Noori K, Azadbakht M, Hashemi S. [Health-promoting behaviors among female students in primary and secondary high school levels in Poldokhtar In 2014 (Persian)]. Yafteh. 2015; 17(3):47-56. [Link]
4. Moghadam R, Tabibi J, Riahi, Hajinabi K. [A comparative study of adolescent and youth health status: A systematic review (Persian)]. Journal of Health Promotion Management. 2019; 8(6):67-75. [Link]
5. Ahangrzadeh Rezaei S, Khalilzadeh H. [Enhancing management of mothers during adolescence of their daughters in guidance schools of Urmia (Persian)]. Nurs Midwifery J. 2012; 9(6):1-7. [Link]
6. Mostafaei MR, Bashirian S. [Comparative survey of depression among chronic disease and healthy adolescences of Hamadan City (Persian)]. Avicenna J Nurs Midwifery Care. 2015; 20(2):65-75. [Link]
7. Abdolkarimy M, Zareipour M, Mahmoodi H, Dashti S, Faryabi R, Movahed E. [Health promoting behaviors and their relationship with self-efficacy of health workers (Persian)]. Iran J Nurs. 2017; 30(105):68-79. [DOI:10.29252/ijn.30.105.68]
8. Kalroozi F, Pishgooie SAH, Taheriyan A, Khayat S, Faraz R. [Health-promoting behaviours and related factors among nurses in selected military hospitals (Persian)]. Mil Caring Sci J. 2015;  1(2):73-80. [DOI:10.18869/acadpub.mcs.1.2.73]
9. Danesh E, Nikoomanesh N, Shamshiri M,  Saliminia N. [Predicting self-efficacy of female high school students based on their mother's personality traits (Persian)]. Knowl Res Appl Psychol. 2015; 16(3):79-89. [Link]
10. Hasking P, Boyes M, Greves S. Self-efficacy and emotionally dysregulated behaviour: An exploratory test of the role of emotion regulatory and behaviourspecific beliefs. Psychiatry Res. 2018; 270:335-340. [DOI:10.1016/j.psychres.2018.09.045] [PMID]
11. Bussey K, Luo A, Fitzpatrick S, Allison K. Defending victims of cyberbullying: The role of self-efficacy and moral disengagement. J Sch Psychol. 2020; 78:1-12. [DOI:10.1016/j.jsp.2019.11.006] [PMID]
12. D'Souza MS, Karkada SN, Parahoo K, Venkatesaperumal R, Achora S, Cayaban ARR. Self-efficacy and self-care behaviours among adults with type 2 diabetes. Appl Nurs Res. 2017; 36:25-32. [DOI:10.1016/j.apnr.2017.05.004] [PMID]
13. Razi T, Shamsi M, Khorsandi M, Roozbahani N, Ranjbaran M. [Education and self-efficacy of mothers regarding alerting signs in children less than five years in Arak, Iran (Persian)]. Avicenna J Nurs Midwifery Care. 2016; 24(1):1-8. [DOI:10.20286/nmj-24015]
14. Kokolaki S, Kouli O, Bebetsos E, Goudas M. Mothers' self-efficacy regarding dietary behaviour and physical activity of preschool children. Int J Pediatr. 2018; 6(1):6843-50. [Link]
15. Roosta F, Ahmadi A. [Self-Efficacy and health promoting behaviors among women of reproductive ages in Shiraz during 2013 (Persian)]. J Ilam Univ Med Sci. 2016;  24(2):90-100. [DOI:10.18869/acadpub.sjimu.24.2.90]
16. Nilsson K, Engström I, Hägglöf B. Family climate and recovery in adolescent onset eating disorders: A prospective study. Eur Eat Disord Rev. 2012; 20(1):e96–102. [DOI:10.1002/erv.1127]
17. Fass MN, Khoury-Kassabri M, Koot HM. 2018. Associations between Arab mothers' self-efficacy and parenting attitudes and their children's externalizing and internalizing behaviors: Gender differences and the mediating role of corporal punishment. Child Ind Res. 2018; 11:1369-87. [Link]
18. Sadeh-Sharvit S, Arnow KD, Osipov L, Lock JD, Jo B, Pajarito S, et al. Are parental self-efficacy and family flexibility mediators of treatment for anorexia nervosa? Int J Eat Disord. 2018; 51(3):275–80. [PMID]
19. Arabian A, Khodapanahi M, Heydari M , Saleh S. [Relationships between self efficacy beliefs, mental health and academic achievement in colleagues (Persian)]. J Psychol. 2004; 8(4):360-71. [Link]  
20. Mohammadi N, Takarli F, Khodaveisi M, Soltanian A. [The effect of peer educational program on the self-efficacy of multiple sclerosis patients: A randomized-controlled trial (Persian)]. Avicenna J Nurs Midwifery Care. 2017; 25(2):36-44. [DOI:10.21859/nmj-25025]
21. Walker SN, Kerr MJ, Pender NJ, Sechrist KR. A Spanish language version of the health-promoting lifestyle profile. Nurs Res. 1990; 39(5):268-73. [DOI:10.1097/00006199-199009000-00003] [PMID]
22. Mohammadi Zeidi I, Pakpour Hajiagha A, Mohammadi Zeidi B. [Reliability and validity of Persian version of the health-promoting lifestyle profile (Persian)]. J Mazandaran Univ Med Sci. 2011; 20(1):102-13. [Link]
23. Anari G R, Ghasmi H, Farahani A. [The role of media consumption on physical activity based on health pattern in Iranian students by Pender's Model (Persian)]. Iran J Health Educ HealthPromot. 2020; 8 (2):172-86. [DOI:10.29252/ijhehp.8.2.172]
24. Shahhosseini Z, Simbar M, Ramezankhani A. [Female adolescents'health needs: The role of family (Persian)]. Payesh. 2012; 11(3):351-9. [Link]
25. Kirag N, Ocaktan EM. Analysis of health promoting lifestyle behaviors and associated factors among nurses at a university hospital in Turkey. Saudi Med J. 2013; 34(10):1062-7. [PMID]
26. Lee H. Barriers and facilitators to engaging in health promoting behaviors among nurses in an urban setting: A mixed-method study [PhD dissertation]. Baltimore: Johns Hopkins University. [Link]
27. Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Tavananezhad N, Karkhaneh M. [Health promoting lifestyles and self-efficacy in adolescent boys (Persian)]. J Mazandaran Univ Med Sci. 2014; 23(109):152-62. [Link]