Title : Application of Behavioral Analysis phase of PRECEDE Model for Quality of Life Survey in Postmenopausal women in Birjand By: Mohammad Reza Miri

Background Today, health systems have found their most important programs on family health basis. Women have a key role in family health and are the main model of education and promotion of healthy lifestyle to the next generation. Women have a greater population and their average age and life expectancy is more than men but their imperfection and disability is higher and they face special issues resulting from their natural and physiological conditions. one of these issues is the menopausal transition period.

Background The average age of menopause onset is 51 years (from 47 to 53 years), but in Iran menopausal age is lower and is about 47.8 years. Regarding life expectancy in Iran, women spend about one-third of their life in this period. During the menopause women experience certain physical and psychological changes and face various problems such as urogenital, psycho–social, cardiovascular and neurological problems that having a considerable impact on women’s health-related quality of life.

Background Since one of the goals of HFA Policy for the twenty ‑ first century is improving the quality of life, the use of a model as a framework to identify the factors that lowered the quality of life in postmenopausal women appears to be essential. Reviewing resources indicates the efficiency of PRECEDE model in the prediction of quality of life of different groups of people The aim of the present study was to investigate factors associated with quality of life in Postmenopausal women based on Behavioral Analysis phase of PRECEDE Model.

Methods This cross-sectional study was conducted through stratified sampling on 200 healthy postmenopausal women in Birjand in The included participants were women between 1 to 10 years of menopause. Meanwhile, women who had a history of hormone therapy during the past 6 months, hysterectomy, non ‑ Iranian nationality, and severe physical and psychological disorders were excluded.

Methods Necessary data was collected by means of two validated and reliable questionnaires, i.e. quality of life questionnaire(MENQOL) and a questionnaire for assessing factors based on Behavioral Analysis phase of PRECEDE Model. Data were analyzed using SPSS software (version 18), descriptive statistics, independent t ‑ test, Spearman and Pearson correlation tests.

Results Mean age of respondents was 54.26±5.26 years and mean age at menopause was 48.89±2.86. More than one third (38.5 %) of menopausal women were illiterate and 7% had University education. Pearson's correlation coefficient indicated a positive relationship between quality of life and attitude toward menopause, enabling, and reinforcing factors; but there was a negative relationship between quality of life and knowledge about menopause and women's perceived self-efficacy (P<0/01). The final point to mention is that quality of life was significantly associated with education level, health condition, and economical status.

Results Correlation coefficients between the scores of quality of life in postmenopausal women and behavioral analysis phase of PRECEDE model factors *All significant correlation coefficients are at 0.01 level Reinforcing Factors score Enabling factors score Perceived self ‑ efficacy score Attitude score Knowledge score variable 0.186*0.188*-0.368*0.417*-0.273*Quality of life score

Conclusion Based on the present study attitude had strongest association with quality of life in postmenopausal women. attention to this issues is essential to women’s health planning. Providing more access to enabling factors, which creates a positive attitude and helping to establish supporting groups is necessary to promote women's health during menopause.