The Study on Effect of Health Maintenance Principles Based on Iranian Traditional Medicine on Health Workers’ Quality of Life
2 Health Metric Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
3 School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
4 Persian Medicine Office of Ministry of Health and Medical Education, Iran
Citation: Rohani Z, et al. The Study on Effect of Health Maintenance Principles Based on Iranian Traditional Medicine on Health Workersâ Quality of Life. Ann Med Health Sci Res. 2019;9: 644-648
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Background: Iranian traditional medicine prioritizes the health maintenance and its promotion rather than diseases treatment and has also expressed some logical principles for maintaining health. Given the health workers’ healthiness promotion, as one of the most efficacious forces in health care domains which has considerable importance and it is extensively beneficial and practical in health assessment and evaluating the quality of life, the recent study with the purpose of examining the effect of instructing the principles of maintain health based on health workers’ quality of life has conducted in Kashan.
Methods: This research is semi experimental which has conducted in 2017 and during this process, 54 health workers in Kashan were selected and were studied. SF36 survey was the medium for assessing the quality of life in the research questionnaire. Moreover, the information germane to individual peculiarities (age, gender, education) was assembled. Then educational intervention within 5 weeks and 25 hours was implemented in this course. The foundations of traditional medicine and six principles pertinent to health maintenance have been instructed to health workers. The data was compiled before educational intervention and 3 months after educational one using written questionnaire.
Results: The results indicated that instructing the principles of health care based on traditional medicine has enhanced the score of health workers’ quality of life in all aspects of questionnaire. In addition, in terms of physical function, physical pain and exhilaration, these alterations had been meaningful. In terms of instructing, there weren’t any remarkable and meaningful alterations in data.
Conclusion: The study represented that instructing the principles of health maintenance based on Iranian traditional medicine is able to ameliorate the health workers’ quality of life. It seems that embedding instructions of traditional medicine in health organization employees’ curricula can promote healthiness and ameliorate the quality of life.
Health workers’; Quality of life; Questionnaire; Kashan
Promoting and providing individuals’ health are significant elements in progressing communities.  World Health Organization (WHO), introduces the promotion of health as a process of empowering people in order to control influential factors on health. Furthermore, it defines health as a full physical, mental, social and spiritual well-being, not only lack of illness and disability. 
According to conducted research in USA 53% (percent) of causes of illnesses pertain to lifestyle.  Increase in cardiovascular diseases is affected by industrialization of life, urbanization and unhealthy lifestyle particularly in developing countries. [4-6]
Health specialists who previously concentrated on treating diseases, their attention has presently been focused on preventing and providing health by improving lifestyle including nutrition, physical activities, health responsibility and spiritual growth and also eliminating the factors which somehow negatively affect human health. 
According to this, we can perceive that one of the most effective ways for advancing hygienic purposes and global health promotion is to enhance people’s awareness concerning factors causing and maintaining health and also the ones causing risk and disease. It will not be realized unless with correct instruction of these principles according to the accurate educational patterns.
Iranian Traditional medicine great scholars have made many efforts in maintaining individual and society health, and also they have developed and promoted simple and meticulous hygienic instructions and regulations. These instructions called the “Six Essential principles” also known as “seteh zaroriah” in Persian are regarding 1) Climatic conditions and environment 2) Physical activities and rest 3) Sleep and wakefulness 4) Food and drinks 5) Psychiatric conditions (including that of sadness, happiness, depression, and stress) 6) Absorbing key nutrients and ridding body from waste materials.
Regular behaviors based on these six principles can guarantee health and the lack of balance among these six principles can cause illness. The importance of health from Iranian traditional medicine perspective is to such an extent that in the definition of medicine in the beginning, maintaining health and well-being were considered as physicians’ and doctors’ main duties. After that they highlighted the role of a physician in curing diseases.  However, we need to do a lot regarding security research, efficiency and quality of research related to traditional and complementary medicine.  Research pertaining to traditional and complementary medicine need to be done based on scientific and acceptable approaches including comparative studies of effectiveness. 
Dr. Margaret Chan remarks on combination of two therapeutic systems:
There is no need for contrast between traditional and western medicine. We are capable of achieving great purposes of health using the best features of each system and compensating special weak points of each one in a useful harmony with framework of primary health care. The success is not achieved spontaneously. It requires major decisions and politics. 
One of the main dynamic peculiarities of the system is to have appropriate mediums for developing. Also, instructing working staff that as a scientific term called “training”, is one of the most important developmental mediums for any organizations. Not only, is our country’s health care system not an exception, but also by virtue of the various services which offers, and also the rapidly changeable requirements, it doesn’t have any capabilities of providing diverse arenas for teaching dexterity to its own staff. 
The vast majority of critics and practitioners in health domain of the country, believed that health workers’ presence as the front line of health in deprived and rural areas has been one of the most important activities and achievement of the country in health care domain. 
Paying attention to health workers’ physical and mental healthiness and offering suitable educational services by promoting health workers’ well-being definitely cause amelioration of the quality of their life. Moreover, this will cause the better function by promoting community health. Since in the recent decades “health” is regarded as a remarkable concept, therefore considering the multiple dimensions and its quality in assessing health have been taken into consideration more than ever. That is why; today assessing the quality of life related to health has been widely used as a consequence of health status of community in health sciences domains. 
Given the above, the study has been conducted with the purpose of examining the effect of instructing the principles of health maintenance based on Iranian traditional medicine on health workers’ quality of life. Accordingly, the proper curriculums in order to promote the community health are designed and implemented by assessing the health workers’ quality of life.
The current study in terms of purpose and the applied result is of type of interventional semi-experimental one and in terms of method of doing, is the one with a test group, in which the effects of instructing the principles of maintaining health based on Iranian traditional medicine on the health workers’ quality of life are studied with the pretest and the post test. The population of this study consisted of all health workers in Kashan which according to Kashan University of Medical Sciences, are 54 people. The program of holding the course of instructing the principles of maintaining health based on traditional medicine was informed to them through the SIB system of health department. After receiving their informed consent for attending the course, the curriculum was sent to them. The exclusion criterion from the research was the time that somebody could not participate in training sessions.
Questionnaire was the medium used in the research which comprises 2 parts. 1) Demographic information that has been achieved by studying health workers’ file and 2) Short form health survey (SF36) questionnaire of quality of life. This questionnaire contains 36 questions which measures 8dimensions. These dimensions include physical functioning, role-physical, bodily pain, mental health, role-emotional, social functioning, vitality and general health perception. Each of these scales is a combination of 2 to 10 questions. Overall, every one of these 8 health dimensions gets the score of 0 to 100.
The higher scores illustrate the better health status. This questionnaire is one of the general mediums for assessing the quality of life pertinent to health and moreover it is useful in some cases such as clinical work, assessment of hygienic politics and studies on population. The concepts which are measured by this questionnaire are not restricted to age, group or specified disease. The purpose of designing this questionnaire is to assess both physical and mental health status. Reliability and validity of Iranian version have been determined in a study by Montazari et al. The reliability using statistical analysis (internal consistency) and the validity using the method of comparing identified groups and convergence validity have been demonstrated. 
Analyzing the questionnaire data has been conducted by SPSS13 software. In order to analyze the data, the test and one-way variance analysis have been utilized.
In this process, health workers were asked to fill in the questionnaires. The research was conducted by the coordination and presence of the health center manager and the authorities of health (working) house at the first training session. Furthermore, they were assured that the personal information will be confidential and will not exert an influence over their annual assessment. The educational content of this course is the book “acquaintance with foundations of Iranian medicine and healthy living principles” which in (2016) has been published by traditional medicine office of the health ministry in country. 
The content was taught to health workers in 5 weeks and 25 hours from the date 96/4/31. Health workers were divided into two groups for instructing by virtue of a plethora of health workers and the impossibility of closing health houses on one day. The health workers played an important role in the process of instructing. In addition, per week they controverted the previous instruction and communicated with the learners via social media during the course. They used the potentials of these social media for questioning, answering and group discussion [Table 1].
|The position of Traditional Medicine in Iran and the World||Acquaintance with health workers with the increasing position of traditional medicine in Iran and the world|
|The key role of health workers in developing traditional medicine||The importance of health workers as a front line for rural health care and improving villagers’ knowledge about maintaining health and lifestyle based on traditional medicine.|
|The foundations of traditional medicine and temperaments||Definition of temperament, description of different temperaments and the key role of it in lifestyle|
|The Six Principles of Health, climatic conditions and environment||The importance of healthy air for being health and planning for exposure to various conditions of weather including cold, hot and polluted air|
|sleep and wakefulness||Acquaintance with right conditions for sleeping and the effects of sleep on health|
|Physical activities and rest||Getting acquainted with the right exercises and exercise conditions in different seasons and ages and various temperaments|
|Food and drinks||The importance of eating and drinking as the most controllable way to maintaining health and proper nutrition for any temperaments.|
|Absorbing key nutrients and ridding body from waste materials||Understanding the importance of cleaning the body and ways for excreting waste materials such as excretion, urine, perspiring and bath.|
|Psychiatric conditions||Types of mental states and their significance based on each temperament and strategies for controlling them and their important role in maintaining health and the development of diseases.|
Table 1: A summary of the educational content.
Among 54 health workers in the city, one person was excluded from research due to illness and one was omitted due to pregnancy leave. Among 52 health workers who were left in the study, 21 people were men (40.4%) and 31 were women (59.6%). 50 people are married (96.2%), one is widowed (1.9%) and one is single (1.9%).
In terms of education, one person (1.9%) has elementary school certificate, 45 people (86.6) have high school certificate and six health workers (11.5%) have university degrees. The average age of health workers is 42.1+ 6.37 [Table 2].
Table 2: Frequency distribution of demographic variables of research population.
In Table 3, the mean scores of the studied group are presented in different dimensions of the SF-36 questionnaire. As shown in Table 3, the mean scores of all sub-scales of quality of life questionnaire (SF36) increased in the post-test stage and there was a significant and considerable difference in the sub-scales of physical functioning, bodily pain and vitality
|Eight Dimensions||Before intervention||After intervention||P-value|
|Mean (standard deviation)||Mean (standard deviation)|
|General Health Perception||52.8||56||0.112|
Table 3: Comparison of mean and standard deviation of scores in the eight dimensions of quality of life of health workers before and after interventional training.
According to the results, health workers’ quality of life has increased in all of its subscales after instructing the principles of health maintenance based on Iranian traditional medicine, so that these differences were significant in the scales of physical function, physical pain and exhilaration.
Although a study has not been conducted to examine the effect of instructing the principles of health maintenance based on traditional medicine on the quality of life, but plenty of studies illustrate that increasing people’s and patients’ awareness regarding a true lifestyle will lead to amelioration of quality of their life and health.
In a study conducted by Ma’sumah Jahani Eftekhari et al., it was found that curriculum implementation based on the theory of self-efficacy and health literacy can ameliorate women’s lifestyle.  In a study, Fatemeh Samiee et al., suggested that instructing lifestyle correction can improve the control of anxiety, stress and depression in people with high blood pressure. 
A review study by Nego et al. have observed a significant relationship between low health literacy, low level of health, lack of following the diet, drug errors along with increasing drug expenses and also increasing hospitalization. In 2004, Rana et al. conducted a study entitled “Assessing the effect of instructing health on rural elderly people’s quality of life in Bangladesh”. In this process, by instructing healthy nutrition and physical activity and also encouraging them to do these behaviors and confronting challenges of aging, they noticed that these instructions and trainings amend the elderly’s quality of life.  In 2005, Jarsma and et al. by examining previous studies entitled “The Key Role of Instructing in Cardiac Patients.” concluded that, in order to amend the quality of life, patients need to learn self-care behaviors.  In a study Mes Zaras et al. in Tajikistan in 2003 showed that instructing health and self-care exert a positive influence over asthmatical patients’ quality of life.  In a study conducted by Corman in 2012, it was specified that using the complementary and traditional medicine for patients with health care services provided by trained general physicians were effective in reducing treatment expenses and also patients’ mortality.  Iman Navidi et al. conducted a study in Arak in 1394 revealed that morning exercise had an effective role in ameliorating staff’s quality of life in health centers.  In a study done by Zahra Motheghad et al. in 2014 on seventy health workers in Semnan, it was found that curriculums enhance interpersonal communicative dexterities in health workers.  A study was also done in 2014 in Ilam, on 60 health workers in two groups of 30 people, test and control groups. During the process Mojtaba Hosseini et al. suggested that skills confronting stress are able to improve health workers’ job performance. 
The present study showed that instructing the principles of health maintenance based on Iranian traditional medicine can have significant effects on ameliorating health workers’ quality of life as a group of society. Traditional and complementary medicine is extensively utilized in many countries of the world. Therefore, simultaneously interest in traditional and complementary medicine has expanded among physicians society. The administrator of the World Health Organization (WHO), Dr Margaret Chan, expresses that traditional medicine is helpful in terms of quality, security and efficacy for achieving the motto and reaching all the people to health cares. Traditional medicine is also considered as a way for confronting increase in the chronic non-communicable diseases.
Due to the increasing development of traditional medicine in the international community, our studies are still limited to confirm the quality, security and effectiveness of traditional medicine services. Moreover, reliable evidence is necessary so that traditional and complementary medicine is considered as a part of a common health care system. This evidence can be accessible through research and innovation, by focusing on knowledge management and attention to spiritual property rights that can lead to encouragement of innovation and support traditional knowledge. 
The instructions of health maintenance based on Iranian traditional medicine ameliorate the quality of life. Considering the community’s welcome to traditional medicine services, and also in order to provide incontrovertible and reliable evidence to affirm the quality, security and effectiveness of the instructions of traditional medicine, it is recommended that this study can be implemented by more copious groups and for the other community members in other ecological circumstances.
The authors declare that they have no competing interests.
- Raiyat A, Nourani N, Samiei Siboni F, Sadeghi T, Alimoradi Z. Health Improving Behaviors in students of Qazvin Secondary Schools in 2011. Journal of Health. 2012;3:46-53.
- Mohamadi Keshavarz N, Zarei F, Parsi Nia S. Health education and health promotion in Iran, past, presently and future. Iran-J-Health-Educ-Health-Promot. 2013;1:5-8
- Fowkes FGR, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010. The Lancet. 2013;382:1329-1340.
- Gulliksson M, Burell G, Vessby B, Lundin L, Toss H, Svärdsudd K. Randomized controlled trial of cognitive behavioral therapy vs. standard treatment to prevent recurrent cardiovascular events in patients with coronary heart disease: Secondary prevention in Uppsala Primary Health Care Project (SUPRIM). Arch Intern Med. 2011;171:134-140.
- Rahmati-Najarkolaei F, Tavafian SS, Gholami Fesharaki M, Jafari MR. Factors predicting nutrition and physical activity behaviors due to cardiovascular disease in Tehran university students: application of health belief model. Iranian Red Crescent medical journal. 2015;17:e18879.
- Rahmati Najarkolaei F, Ghaffarpasand E, Gholami Fesharaki M, Jonaidi Jafari N. Nutrition and physical activity educational intervention on CHD risk factors: A systematic review study. Archives of Iranian Medicine. 2015;18:51-57.
- Paulik E, Boka F, Kertesz A, Balogh S, Nagymajtenyi L. Determinants of health promoting lifestyle behaviour in the rural areas of Hungary. Health Promotion International .2010 25:277-288
- Naseri M, Jafari F, Ali Zadeh M. Maintaining principles in Iranian Traditional medicine. Journal of Islamic and Iranian Traditional Medicine. 2010;1:39-44.
- World Health Organization. Programme on Traditional Medicine. General guidelines for methodologies on research and evaluation of traditional medicine, 2000.
- World Health Organization. World Health Organization strategy for traditional medicine 2014-2023;46.
- Rezayizadeh H, Compilation, translated and summarized by World Healt Organization strategy for traditional medicine 2014-2023. Alma`i Publication, 2015.
- Ansaripour S, Soleimani B, Sadri GH, Bahonar A. The effect of acute respiratory infection education by rural health technicians and Behvarz Training Center Instructors on Knowledge and Practice of Behvarzes. Iranian Journal of Medical Education. 2005;5:33-39.
- Hosseini S, Nasiripor A, Pournajaf A. A study upon the effect of training the skills of coping with stress in occupation function of health care providers (BEHVARZAN) in Ilam Township, 2014. Journal of Ilam University of Medical Sciences. 2016;24:92-102.
- Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The short form health survey (SF36): translation and validation stody of the Iranian version Quality of Life Research 2005;14: 875-882
- Persian Medicine Office of Ministry of Health and Medical Education, Familiarity with the rudiments of Persian medicine and healthy living principles. Alma`a Publication, 2017.
- Jahani Eftekhari M, Peyman N, Doosti H. The effect of educational intervention based on the self-efficacy and health literacy theory on health promoting lifestyles among female health volunteers of Neyshabur, Iran. Health and Development Journal. 2017;6:302-313.
- Samiei Siboni F, Alimoradi Z, Sadegi T. Impact of corrective life style educational program on controlling stress, anxiety and depression in hypertensives. Journal of Birjand University of Medical Sciences. 2013;19:1-9.
- Rana AK, Wahlin A, Lundborg CS, Kabir ZN. Impact of health education on health-related quality of life among elderly persons: Results from a community-based intervention study in rural Bangladesh. Health Promotion International. 2009;24:36-45.
- Stromberg A. The crucial role of patient education in heart failure. European journal of heart failure. 2005;7:363-369.
- Meszaros A, Orosz M, Magyar P, Mesko A, Vincze Z. Evaluation of asthma knowledge and quality of life in Hungarian asthmatics. Allergy. 2003;58:624-628.
- Kooreman P, Baars EW. Patients whose GP knows complementary medicine tend to have lower costs and live longer. Eur J Health Econ. 2012;13:769-776.
- Navidi I, Ghofranipour F, Taheri Z, Khorsandi M. The effect of morning exercise on quality of life among health Center staff in Arak City: A short report. Journal of Rafsanjan University of Medical Sciences. 2015;14:161-166.
- Motaghed Larijani Z, Vakili MM, Gofranipour F, Mirmohammadkhani M. Effects of health education program on Behvarz's interpersonal communication skills in Semnan University of Medical Sciences. Koomesh. 2015;16:229-238.