Health Promotion Lifestyles and Associated Factors Among Clinical Nurses in Iran: A Cross-Sectional Study

Health Promotion Lifestyles and Associated Factors Among Clinical Nurses in Iran: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Health Promotion Lifestyles and Associated Factors Among Clinical Nurses in Iran: A Cross-Sectional Study Sumayya Sani, Mohammad Javad Ahmadzadeh-Zeidi, Esmaeil Mohammadnejad, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6483607/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background & Aims: Each person's lifestyle affects their health, and health-promoting behaviors and a healthy lifestyle are key strategies for facilitating and protecting health. Health-promoting lifestyle behaviors is an important determinant of health status in nurses, and nurses' health affects patients' health. The present study aims to determine health promotion lifestyles and associated factors among clinical nurses in Iran. Materials & Methods: This cross-sectional descriptive-analytical study was conducted on 303 nurses working in Imam Khomeini Hospital Complex (IKHC) affiliated with Tehran University of Medical Sciences from October 2022 to August 2023. The research population included all nurses working in Imam Khomeini Hospital Complex. The research samples were included in the study by available sampling method after obtaining organizational permits, ethical approval and informed consent. Data collection was done using two questionnaires including: Demographic information form, Health-Promoting Lifestyle Profile II Questionnaire. The collected data was analyzed in SPSS software, version 25. Results: The Mean ± SD score of nurses’ Health-Promoting Lifestyle Behaviors was at upper moderate level (124.85 ± 19.89). the highest score of the Health-Promoting Lifestyle Behaviors dimension is related to "Interpersonal support (2.56 ± 0.48)" and " Self-Actualization (2.55 ± 0.54)" and the lowest score related to "Physical activity (2.12 ± 0.55)" and "stress management (2.26 ± 0.47)". The results showed that nurses who were divorced (p< 0.01) and those who had sufficient income (p< 0.05), never used tobacco (p< 0.01), and those who worked according to their legal working hours (p0.05). Conclusion: Due to low scores related to stress management and physical activity healthcare providers and nursing managers are advised to include physical activity programs and stress management courses in their training plans. Self-perceived health Health-promoting lifestyle Health promoting behaviors Nurse Background Non-communicable diseases (NCDs) are on the rise worldwide and cause major problems in developing countries ( 1 ). In 2024 The World Health Organization (WHO) reports that 60% of global deaths and 80% of deaths in developing countries are attributable to unhealthy lifestyle and behavior choices. This statistic is expected to reach 75% of global deaths by 2030 ( 2 ). Due to the unhealthy lifestyle, the prevalence and occurrence of many chronic diseases, including obesity, arteriosclerosis, and coronary heart disease, has increased significantly ( 1 ). The WHO considers lifestyle as specific and definable behavioral patterns that result from the interaction between personal characteristics, social relationships, environmental conditions and socio-economic situations ( 3 ). These behaviors are under the control of individuals and include activities that positively or negatively affect their health, which then becomes as a routine in their lives ( 4 ). A holistic approach suggests that health-protective behaviors (risk reduction and prevention) and health-promoting behaviors may be considered as two components of a healthy lifestyle ( 5 ). A health-promoting lifestyle behaviors (HPLB) includes behaviors that enable people to increase control over their health, which ultimately leads to improved health for individuals and communities ( 6 ). These behaviors affect different levels of health promotion, including self-actualization, physical activities, health responsibility, food choices, interpersonal support to increase or maintain the level of well-being or reduce the incidence of illness ( 7 ). The concept of a HPLB involves six dimensions including: Health responsibility, physical activity, nutrition, spiritual growth, interpersonal relationships, and stress management ( 8 ). Factors affecting HPLB can be divided into cognitive-perceptual factors and modifying factors. Meanwhile, cognitive-perceptual factors refer to the main motivations for adopting or maintaining health-promoting lifestyles, including health perception and perceived health status. Modifying factors indirectly affect the health-promoting lifestyle by affecting cognitive-perceptual factors, including demographic characteristics and behavioral factors ( 9 ). Nowadays, due to the high cost of providing health care, it is emphasized to change the treatment approach to their prevention ( 5 ). To achieve these health goals, nurses play an important and vital role and constitute the main workforce in health care systems. According to the WHO, there are 43.5 million health workers worldwide, of which more than 20 million are nurses ( 7 ). In this regard, nurses play an important role in healthcare delivery, providing essential care, supporting patients ( 10 ), creating a supportive environment for health, strengthening community action ( 5 ) and directly or indirectly influencing the beliefs or attitudes of their clients about health promotion ( 7 ). Nursing is a high-pressure profession, and the pressure on healthcare workers comes not only from the work itself, but also from patients, colleagues, and hospital systems. For these reasons nurses tend to adopt unhealthy lifestyles, including low levels of physical activity and poor nutritional behaviors which can ultimately increase the risk of developing adverse health conditions ( 11 ). In this regard, Chiang et al. suggested that adopting a health-promoting lifestyle among nurses can lead to positive health outcomes that affect job satisfaction, mental health, and overall quality of life ( 12 ). One of the main goals of the WHO program is to strengthen the capacity of individuals and communities to choose a healthier life and follow health-promoting lifestyle patterns ( 3 ). Nurses are an essential part of the health care system, and their health-promoting lifestyle can influence societies beliefs or attitudes towards their health promotion ( 10 ). Additionally, identifying at-risk nurses and providing programs to improve their lifestyle behaviors helps prevent chronic diseases and increase their resilience in the workplace, which is an important key to maintaining an efficient workforce ( 13 ). Therefore, during this study, health promotion lifestyles and associated factors among clinical nurses in Iran was investigated. Methods Design and aim This is a descriptive cross-sectional study, which was conducted with the aim of determination health promotion lifestyles and associated factors among clinical nurses working in Imam Khomeini Hospital Complex (IKHC) affiliated to Tehran University of Medical Sciences. This study was carried out from October 2022 to August 2023. Study setting and participants In the present study, the research population included all nurses working in Imam Khomeini Hospital Complex (IKHC) affiliated with Tehran University of Medical Sciences. This hospital had chosen purposefully as the research environment due to its alignment with the aim of this study as well as laws and guidelines used. It should be noted that IKHC has about 1,300 active beds and approximately 1,400 nursing staff. The inclusion criteria were; willing to participate in the study, being a nurse with a bachelor’s degree or higher education level. Exclusion criteria included incomplete answers to the questionnaires. Sample size and power To determine the sample size at the confidence level of 95% and the test power of 90%, the sample size calculated 293 according to following Cochran's formula: $$\:n=\frac{N{z}^{2}pq}{N{d}^{2}+{z}^{2}pq}\:n=\frac{1400\times\:{\left(1.96\right)}^{2}\times\:0.5\times\:0.5}{1400\times\:{\left(0.05\right)}^{2}+{\left(1.96\right)}^{2}\times\:0.5\times\:0.5}=301$$ A total of 303 nursing staff, including nurses with bachelor’s degree, master’s degree working as clinical nurses were selected by available sampling method. Instruments Before conducting the research, permission was obtained from both creators of the localized version and original version of these two questionnaires, and then the researchers began to conduct this study. The data collection in this study was based on the self-reporting method via two following questionnaires: Demographic and Anthropometric Information Questionnaire was used to collect information such as age, gender, marital status, education level, type of shift, weight and height which were transformed into body mass index (BMI) (kg/m2). BMI is an important indicator for obesity prevalence among large populations and generally, reflects the degree of fatness among individuals. It is a statistical measure of the weight of a person scaled according to his/her height. Four categories of BMI included being underweight (≤ 18.5); having normal weight (18.6–24.9); being overweight (25–29.9); and being obese (≥ 30) ( 1 ). Health-Promoting Lifestyle Profile II Questionnaire (HPLP II) : This questionnaire was originally designed by Walker et al. in 1987 ( 14 ). This questionnaire consists of 52 items divided into six dimensions including: Nutrition (e.g. having a food pattern and choosing food, 9 items), physical activity (e.g. following a regular exercise pattern, 8 items), health responsibility (e.g. discuss my health concerns with health professionals, 9 items), stress management (e.g. take some time for relaxation each day, 8 items), interpersonal support (e.g. maintaining relationships with a sense of closeness, 9 items), and self-actualization (e.g. having a sense of purpose, seeking personal development, and experiencing self-awareness and satisfaction, 9 items) ( 2 ). The answer to each item of this questionnaire is on a 4-point Likert scale from never (1 point) to always (4 points). In this way, points obtained from this questionnaire varies between 52 and 208. The total score is further categorized into four groups: poor (52–90), moderate (91–129), good (130–168), and excellent (169–208). Higher scores on each subscale indicate more frequent health-promoting behaviors ( 15 ). This questionnaire is without reverse score questions and the validity of original version of this questionnaire, calculated as 0.91 ( 16 ). The Persian translation and psychometric properties of this questionnaire, which is used in Iran, was firstly done by Aghamolaei et al. and its’ validity and internal consistency was measured 0.92 ( 4 ). The reliability of this questionnaire was calculated as 0.90 using Cronbach's alpha coefficient during this research. Data collection After obtaining the approval of the ethics committee and the necessary permits from the relevant authorities of the Faculty of Nursing and Midwifery of Tehran University of Medical Sciences, a well-trained researcher introduced herself to the directorates of IKHC hospital. Then, after attending in each ward, the samples were entered into the study using the convenience sampling method at each time in the morning, evening and night according to inclusion criteria. Then the researcher explained the study objectives to the nurses at the appropriate place and time and took written consent from them. Then, these two questionnaires were distributed among them. The samples were then given 2 days to fill them out so that the nurses could complete the questionnaires when they felt free and relaxed. Statistical analysis Data were analyzed in SPSS software version 25. First, the Kolmogorov-Smirnov test was used to determine the normality of total score of the questionnaire and its dimensions. After the data distribution was measured normal, data evaluation was done using descriptive statistics such as frequency and percentage, mean and standard deviation as well as inferential statistics such as independent t-test and ANOVA. The significance level of the data was considered as p < 0.05. Ethical considerations This study was conducted by obtaining the code of ethics from ethical committee of the Vice-Chancellor in Research Affairs- Tehran University of Medical Sciences (TUMS) (IR. TUMS. FNM. REC. 1401.018). After obtaining the approval of ethics committee and the necessary permits from the relevant officials, a well-trained researcher introduced herself to the directorates of IKHC hospital. The researcher explained to nurses about the study objectives and told them that their participation was voluntary and that there would be no negative consequences for refusing to participate. All participants were assured of the confidentiality of all research information and only the researchers have access to the data. Then informed consent was obtained from all study participants. Finally, the results of the study were provided to the hospital under study. Results After distributing about 350 questionnaires, 303 participants who had completed these two questionnaires were participated in the study. The majority of this nurses were female (61.4%) and 54.8% were married. The Mean ± SD of age was 35.47 ± 8.84 and the Mean ± SD of working hour per month was 246.83 ± 13.36. 258 (85.1%) had a bachelor's degree and more than 235 (77.5%) never used Tabaco. The mean of BMI of male nurse was 25.32 ± 3.76 kg/m2 and 24.41 ± 3.41 kg/m2 for female nurses. The BMI for 53.5% of the sample was being in normal range, 3.0% was being underweight, and 34.3% was being overweight and 9.2% was being obese. Other demographic information is given in Table 1 . Table 1 Demographic characteristics of the nurses participating in the study (n = 303) Variables Number (%) Iran Age ≤ 29 86 (28.4) 30–39 129 (42.6) ≥ 40 88 ( 29 ) mean 35.47 ± 8.84 Gender Male 117 (38.6) female 186 (61.4) Marital status Single 122 (40.2) married 166 (54.8) Divorced 15 ( 5 ) Education level Bachelor 258 (85.1) Master 45 (14.9) Type of shift Fix 74 (24.4) Rotational 229 (75.6) Income adequacy Adequate 60 (19.8) Inadequate 243 (80.2) Range of BMI ≤ 18.5 9 (3.0) 18.6–24.9 162 (53.5) 25–29.9 104 (34.3) ≥ 30 28 (9.2) BMI, Mean ± SD Male 25.32 ± 3.76 female 24.41 ± 3.41 Tabaco use Frequent 25 (8.3) Occasionally 23 (7.1) Never 255 (84.6) Working hour per month ≤ 180 38 (12.5) 180–240 169 (55.7) ≥ 240 96 (31.6) mean 246.83 ± 13.36 Working in another organization Yes 66 (22.8) No 224 (77.2) Number of children, Mean ± SD 1.60 ± 0.96 Work experience (year), Mean ± SD 10.49 ± 7.71 The Mean ± SD score of nurses’ Health-Promoting Lifestyle Behaviors was 124.85 ± 19.89, which indicates moderate Health-Promoting Lifestyle Behaviors. The results showed that the highest score of the Health-Promoting Lifestyle Behaviors dimension is related to " Interpersonal support" with a Mean ± SD score of 23.06 ± 4.33 (range 9–36) and the lowest score related to "Physical activity" with a Mean ± SD score of 16.97 ± 4.46 (range 8–32). Other information is given in Table 2 . Table 2 Comparison of Health Promotion Lifestyle Behaviors subscales in Iran (n = 303) Health-Promoting Lifestyle Behaviors Possible scores range (min-max) Iran (min-max) Mean ± SD On 1–4 basis Nutrition (9–36) 17–36 21.39 ± 3.96 2.38 ± 0.44 Physical activity ( 8 – 32 ) 16–32 16.97 ± 4.46 2.12 ± 0.55 Health responsibility (9–36) 13–30 22.36 ± 4.02 2.48 ± 0.44 Stress management ( 8 – 32 ) 10–23 18.07 ± 3.81 2.26 ± 0.47 Interpersonal support (9–36) 13–32 23.06 ± 4.33 2.56 ± 0.48 Self-Actualization (9–36) 14–32 22.99 ± 4.89 2.55 ± 0.54 The overall score of Health-Promoting Lifestyle (52–208) 90–205 124.85 ± 19.89 2.40 ± 0.38 The results of ANOVA and independent t-test showed that nurses who were divorced and those who had sufficient income, never used tobacco, and those who worked according to their legal working hours had higher health-promoting lifestyle behaviors. No more relationship was observed between other demographic variables with Health-Promoting Lifestyle Behaviors (Table 3 ). Table 3 The relationship between demographic characteristics of participants with Health Promotion Lifestyle Behaviors. Health Promotion Lifestyle Behaviors Demographic Characteristics Nutrition (9–36) Physical activity ( 8 – 32 ) Health responsibility (9–36) Stress management ( 8 – 32 ) Interpersonal support (9–36) Self-Actualization (9–36) Overall Health Promotion Lifestyle Behaviors (52–208) Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Age ① ≤ 29 21.15 ± 3.96 16.34 ± 4.51 22.34 ± 3.51 17.56 ± 3.60 23.15 ± 3.76 22.27 ± 4.54 122.80 ± 17.79 30–39 21.57 ± 3.96 17.17 ± 4.40 22.68 ± 3.92 18.27 ± 3.90 23.17 ± 4.44 23.26 ± 4.99 126.12 ± 19.87 ≥ 40 21.38 ± 3.98 17.31 ± 4.50 21.91 ± 4.52 18.03 ± 3.85 23.06 ± 4.33 23.31 ± 5.07 125.00 ± 21.84 Test result *F = 0.28 *F = 1.24 *F = 0.96 *F = 1.09 *F = 0.19 *F = 1.31 *F = 0.71 Gender ② Male 21.34 ± 4.11 17.16 ± 4.84 22.06 ± 4.02 18.03 ± 4.05 23.09 ± 4.73 22.73 ± 4.95 124.40 ± 21.79 Female 21.42 ± 3.87 16.85 ± 4.22 22.55 ± 4.01 18.10 ± 3.66 23.05 ± 4.07 23.16 ± 4.86 125.13 ± 18.65 Test result *t=-0.77 df = 301 *t = 0.58 df = 301 *t=-1.03 df = 301 *t=-0.17 df = 301 *t=-0.07 df = 301 *t=-0.74 df = 301 *t=-0.30 df = 301 Marital status ① Single 21.01 ± 21.61 16.89 ± 4.37 22.24 ± 3.92 17.70 ± 3.63 22.61 ± 4.29 21.94 ± 4.97 122.39 ± 19.74 Married 21.61 ± 3.87 16.73 ± 4.46 22.32 ± 4.08 18.20 ± 3.88 23.48 ± 4.27 23.66 ± 4.77 126.01 ± 19.72 Divorced 22.07 ± 4.30 20.40 ± 3.96 23.80 ± 4.14 19.67 ± 4.04 22.07 ± 4.99 24.07 ± 4.28 132.07 ± 21.32 Test result *F = 1.05 ***F = 4.80 *F = 1.02 *F = 2.02 *F = 1.83 ***F = 4.83 ***F = 3.59 Working hour per month ① ≤ 180 20.94 ± 3.68 16.53 ± 4.45 22.31 ± 3.53 18.94 ± 3.50 22.89 ± 4.07 24.23 ± 4.38 127.44 ± 21.32 180–240 21.50 ± 4.50 17.85 ± 4.35 22.43 ± 4.07 18.56 ± 4.15 23.28 ± 4.58 23.83 ± 5.21 125.44 ± 21.32 ≥ 240 21.67 ± 3.93 17.10 ± 4.36 23.33 ± 3.61 16.32 ± 3.39 23.00 ± 4.48 20.20 ± 4.98 122.27 ± 18.75 Test result *F = 1.13 *F = 1.23 *F = 1.02 **F = 3.89 *F = 0.86 **F = 4.56 ***F = 3.23 Number of children ① 0 21.36 ± 3.97 17.16 ± 4.50 22.40 ± 22.10 18.05 ± 3.78 23.16 ± 4.26 22.98 ± 4.98 125.11 ± 19.81 1 21.04 ± 4.44 16.80 ± 4.76 22.38 ± 3.52 17.74 ± 4.38 22.70 ± 4.78 22.68 ± 5.06 123.06 ± 22.72 2 21.79 ± 3.50 15.79 ± 4.01 22.10 ± 4.97 18.17 ± 3.55 22.83 ± 4.13 22.81 ± 4.43 123.76 ± 17.46 3 and above 21.39 ± 3.96 18.57 ± 3.50 22.64 ± 4.30 19.29 ± 2.70 23.71 ± 4.46 24.71 ± 4.44 130.86 ± 17.53 Test result *F = 0.35 *F = 1.73 *F = 0.09 *F = 0.60 *F = 0.29 *F = 0.66 *F = 0.61 Income adequacy ② Adequate 21.70 ± 3.22 17.98 ± 3.43 22.47 ± 3.75 19.05 ± 3.18 23.40 ± 4.21 25.10 ± 4.02 129.70 ± 15.88 Inadequate 21.32 ± 4.12 16.72 ± 4.65 22.33 ± 4.09 17.83 ± 3.91 22.98 ± 4.36 22.98 ± 4.36 123.65 ± 20.61 Test result *t = 0.77 df = 301 **t = 2.35 df = 301 *t = 0.23 df = 301 **t = 2.23 df = 301 *t = 0.67 df = 301 ***t = 3.80 df = 301 **t = 2.47 df = 301 Tabaco use ① Frequent 20.56 ± 2.89 17.48 ± 3.89 20.53 ± 3.25 16.70 ± 3.12 22.54 ± 3.76 20.33 ± 3.66 122.41 ± 20.71 Occasionally 21.83 ± 4.50 16.83 ± 3.99 22.13 ± 4.27 18.06 ± 3.89 23.12 ± 4.43 23.83 ± 5.25 124.64 ± 21.02 Never 21.79 ± 3.83 17.03 ± 4.20 23.54 ± 3.19 18.42 ± 3.64 23.07 ± 4.84 23.63 ± 4.43 126.31 ± 18.49 Test result *F = 1.28 *F = 1.03 **F = 2.61 **F = 3.25 *F = 1.43 ***F = 5.07 ***F = 3.06 Education level ② Bachelor 21.43 ± 4.01 16.79 ± 4.56 22.55 ± 4.00 18.07 ± 3.84 23.25 ± 21.98 22.92 ± 4.83 125.05 ± 20.14 Master 21.02 ± 3.65 18.00 ± 3.71 21.24 ± 3.96 18.07 ± 3.62 21.98 ± 4.45 23.40 ± 5.28 123.71 ± 18.52 Test result *t = 0.67 df = 301 **t=-1.93 df = 301 **t = 2.02 df = 301 *t = 0.11 df = 301 *t = 1.82 df = 301 *t=-0.68 df = 301 *t = 0.41 df = 301 Discussion In recent years, researchers' attention to the topic of health-promoting behaviors has been increasing. Despite nurses being in a unique position in the healthcare system, there is limited evidence regarding HPLB in clinical nurses. Therefore, this study was conducted with the aim of determining health-promoting lifestyles behaviors and factors affecting them in clinical nurses. The results of the present study showed that most nurses in the study had upper moderate health-promoting lifestyles behaviors. In the searches conducted by the researcher, few studies regarding health-promoting lifestyles behaviors in Iranian nurses related to recent years were found, which shows the necessity of examining this important issue in nurses. Consistent with our findings the mean scores of HPLB was reported at a moderate level in Iran ( 17 , 18 ), Hong Kong ( 19 ), China ( 20 ), India ( 21 ) and Iraq ( 22 ). While in other studies in Iran ( 13 , 23 ) and Egypt ( 24 ), the mean scores of HPLB was at good level. It seems that the use of the standard questionnaire of HPLB and the same target group had an effect on achieving similar results. Despite the differences in the cultural context of the above study samples, relatively similar results have been obtained, which could suggest professional commonalities that have led to such results. Furthermore, the results of the present study showed that the mean scores of the physical activity and stress management obtained the lowest score among the all HPLB dimensions which is in line with the study of Moghimi et al. ( 13 ), Budury et al. ( 10 ) and Bagheri Saveh et. al ( 17 ). While in the study of Wang et al. ( 11 ) and Chao ( 9 ), Health Responsibility along with physical activity had lowest score. The reason for the decrease in physical activity among nurses could be due to the lack of a sports culture in Iranian society, having multiple jobs due to insufficient income for nurses, and their multiple and long shifts ( 17 ). It seems that lack of proper physical activity is one of the consequences of today's life, where people are increasingly using electronic devices such as smart phones and computers and are less likely to engage in physical activities ( 25 ). The problem of physical inactivity is a health issue with cultural and social origins. Participation in sports activities depends on various factors, including nurses' perception of physical activity, self-confidence, social support, and sufficient motivation ( 26 ). Also, in Iranian society, due to economic issues and forced overtime, most nurses have limited opportunities to engage in regular physical activities, which in the long run can have an adverse effect on staff efficiency and their useful working life ( 27 ). In addition, irregular rotating shifts and high workload in the nursing profession make it difficult to participate in leisure-time physical activities because nurses are forced to spend more time recovering from such condition ( 7 ). It was shown that the majority of the nurses studied had poor stress management behaviors. The presence of high burnout, coupled with poor organizational support and the lack of planned training programs for stress management, has led to low scores in this dimension ( 27 ). Comprehensive and coordinated stress management programs that include ways to identify coping strategies and foster resilience should be incorporated into undergraduate nursing programs to prevent psychological health threats and increase nurses' resolve to face new challenges ( 19 ). Nursing managers should consider that reduced physical activity and poor stress management have an undeniable negative impact on nurses' performance and will reduce their efficiency. Consistent with our findings with the study of Chao ( 9 ), Ifroh et al. ( 28 ) and Nekoei et al. ( 29 ), the mean scores of Interpersonal support and Self-Actualization had higher scores compared to other dimensions. While in the study of Nejat et al. ( 30 ) and Mahmoud et al. highest scores was related to Nutrition ( 24 ). The reason for this may be the nature of the nursing profession and its spiritual state in caring for patients. And that professional nursing is based on communication with patients and colleagues, which requires a high level of establishing relationships with others and helping them ( 3 ). Pender believes that spiritual growth is something beyond a person's religious practices. This concept relates to the exploration of a person's beliefs about life, love, hope, life after death, connection to self and others, and the purpose of life ( 31 ). The role of demographic factors in health-promoting behaviors has not been reported in the same way in different studies. According to our finding, no relationship was observed between age, gender educational level and number of children, which is in line with study of Mahmoodi et al ( 32 ) and Nejat et al. ( 30 ). Contrary with studies of Moghimi et al., Zeng et al. and Wang et al., it was shown that as nurses' age increased, total HPLB also increased. Furthermore, it was stated that women nurses and who had higher educational level had better stress management and had higher health promoting behavior. But in current study no differences were observed between different groups ( 7 , 11 , 13 ). This difference in health-promoting behaviors among male and female nurses could be due to the level of awareness and education, the availability of appropriate conditions for activity, and the prevailing culture of that society regarding health-promoting behaviors among both genders ( 32 ). It seems that nurses have sufficient and appropriate awareness of health-promoting behaviors due to the nature of their profession, but due to the hard work, shift work, and lack of a regular hospital program to develop these behaviors, etc., they do not have enough time to perform health-promoting behaviors ( 26 ). It has been found that HPLB is lower among nurses who work longer hours. It has also been found that there is a statistically significant relationship between longer working hours and reduced stress management and reduced self-actualization. In the present explanation, it can be noted that when a person is involved in continuous job activities, his life becomes unbalanced and he may not be able to effectively control the stresses that enter his life ( 33 ). In addition, in Iran, nurses have suffered a lot of stress due to back-to-back shifts, forced overtime, lack of resilience, and sleep deprivation caused by irregular shifts, which has made it difficult to control and manage stress and self-actualization in this profession ( 34 ). As it turned out, smoking among nurses led to a significant decrease in health responsibility, stress management, self-actualization and ultimately HPLB. Smokers often say that smoking reduces stress, so it is difficult to quit (35). While, Yadegar et al. suggested that there is a bidirectional relationship between smoking and stress. Stress causes cravings for cigarettes for smokers, leading to the belief that smoking reduces stress, and that acute stress causes cravings for cigarettes and negative effects (36). This is why Brotons et al. reported that the possible reason for the gap between the knowledge and practice of health care workers in preventing tobacco use and promoting their own health is the lack of skills, beliefs to change these behaviors (37). Based on the results of the present study and other similar studies, health-promoting behaviors among healthcare professionals have an important impact on individuals' health, such that it can be viewed as a preventive method. The results of this study can help nursing managers to pay more attention to controlling individual and occupational variables that affect health-promoting lifestyle behaviors. Research limitations include the psychological condition of the participants which is beyond the researcher's control and using the data collection method based on the participants' self-report. Also, despite ensuring the confidentiality of the information, the fear of revealing the information may cause the participants to respond unrealistically. Moreover, this study used a cross-sectional design, which means the study results are limited to reflecting only those conditions experienced during the data collection process. Conclusions The present study showed that the nurses in the study were at an average level in their assessment of health behaviors, and the most health-promoting behaviors were related to self-actualization and interpersonal support, and the least health-promoting behaviors were related to stress management and physical activity. According to our finding, no relationship was observed between age, gender educational level and number of children. Also, HPLB had a significant relationship with working hours, marital status, working hour, income adequacy and Tabaco use variables. Based on the findings of this study, healthcare providers and nursing managers are advised to set aside hours for regular physical activity for nurses and plan programs for them to better manage stress. Declarations Acknowledgements The authors would like to express their gratitude to the Deputy for Research of Tehran University of Medical Sciences and all the nurses participated in this study for their support and cooperation. Authors’ contributions Data collection: Sumayya Sani, Esmaeil Mohammadnejad Data analysis: Mohammad Javad Ahmadzadeh-Zeidi, Zahra Rooddehghan Manuscript writing: Mohammad Javad Ahmadzadeh-Zeidi, Zahra Rooddehghan Final approval: All authors. Funding This study was funded by Tehran University of Medical Sciences. Availability of data and materials The datasets are available from the corresponding author on reasonable request. Ethics approval and consent to participate This study was conducted by obtaining the code of ethics (IR.TUMS.FNM.REC.1401.018) from the ethical committees of the Nursing & Midwifery Faculty of Tehran University of Medical Sciences. After obtaining the approval of ethics committee and the necessary permits from the relevant officials, the researcher presented himself to the directorates of selected hospitals. A well-trained and experienced research assistant explained to nurses about the study objectives and their participation was voluntary and refusal to participate would not result in any negative consequences. All the participants were assured of the confidentiality of all the information of the research and only the researchers have access to the data. Then informed consent was obtained from all of the participants in the study. Finally, the results of the study were given to the hospitals under research. Consent for publication Not applicable. Conflict of interests The authors declare no conflict of interests. References Mehri A, Solhi M, Garmaroudi G, Nadrian H, Sighaldeh SS. Health promoting lifestyle and its determinants among university students in Sabzevar. Iran Int J Prev Med. 2016;7(1):65. Nekoei M, Behroozi N, Ghanbari S, Abbaspoor Z. Effectiveness of mindfulness-based counseling on the health promoting lifestyle in Iranian middle-aged women: an experimental study. Mod Care J. 2024;21(1). Ebadi B-N, Dehghani F, Barkhordari-Sharifabad MJN, Journal M. The relationship between health-promoting lifestyle and achievement motivation in nursing students. Nurs Midwifery J. 2022;20(2):102–11. Aghamolaei T, Ghanbarnejad A, Health. Validity and reliablity of the Persian health-promoting lifestyle profile II questionnaire. J Res. 2015;5(3):358–65. Mohammadi Zeidi I, Pakpour Hajiagha A, Mohammadi Zeidi B. Reliability and validity of Persian version of the health-promoting lifestyle profile. J Mazandaran Univ Med Sci. 2011;20(1):102–13. SolaimaniMoghaddam R, Mohammadian Zirjan B. Health-promoting Lifestyle and its Relationship with Examining Self-efficacy among Students of GONABAD University of Medical Sciences in 2019: a Descriptive Study. J Jiroft Univ Med Sci. 2023;9(4):1097–108. Zeng W, Shang S, Fang Q, He S, Li J, Yao Y. Health promoting lifestyle behaviors and associated predictors among clinical nurses in China: a cross-sectional study. BMC Nurs. 2021;20:1–11. Torabi Chafjiri R, Sum S, Shirinkam F. The effect of health promoting lifestyle training on elderly happiness. J Gerontol. 2020;5(2):10–2. Chao D-P. Health-promoting lifestyle and its predictors among health-related and non-health-related university students in Taiwan: a cross-sectional quantitative study. BMC Public Health. 2023;23(1):827. Budury S, Sharoni SKA, Gusmantara P, Purwanti N, Hidaayah N. Health Promoting Lifestyle among Nurses in Indonesia. Revista de Gestão Social e Ambiental. 2024;18(5):1–9. Wang K-Y, Chien C-M, Lee H-F, Yobelina Y. The mediation of health-promoting lifestyle on self-perceived health status and quality of life among nurses: a cross-sectional study. BMC Nurs. 2023;22(1):447. Chiang Y-C, Lee H-C, Chu T-L, Wu C-L, Hsiao Y-C. The relationship between spiritual health, health-promoting behaviors, depression and resilience: A longitudinal study of new nurses. Nurse Educ Pract. 2021;56:103219. Moghimi A, Saberi Isfeedvajani M, Javanbakht M, Khedmat L. Health-promoting lifestyle behaviors and its association with sociodemographic characteristics in hospital clinical staff. Front Public Health. 2024;12:1391094. Walker SN, Sechrist KR, Pender NJ. The health-promoting lifestyle profile: development and psychometric characteristics. Nurs Res. 1987;36(2):76–81. Budury S, Sharoni SKA, Gusmantara P, Purwanti N. Hidaayah NJRdGSeA. Health Promoting Lifestyle among Nurses in Indonesia. Revista de Gestão Social e Ambiental. 2024;18(5):1–9. Gómez-Acosta A, Escobar-Velásquez K, Barajas-Lizarazo M. Dimensionality and internal consistency of the Health-Promoting Lifestyle Profile (HPLP-II) in university students. articles Sci technological Res. 2024;24(1):50–61. Bagheri Saveh MI, Fereydoni P, Khaleghverdi M, Mardokhian P, Yarahmadi F. Evaluation of Health Promoting Behaviors and Related Factors in Nurses. Military Caring Sci. 2023;10(2):199–208. Najafabadi M, Rezaei B. The health promotion behaviors and its correlation with selected professional factors in nurses. J Health Promotion Manage. 2017;6(3):28–35. Chow SKY, Lam K-M, Lie S-H, Mak K-C, Mong K-C, So C-M, et al. Do demographic factors and a health-promoting lifestyle influence the self-rated health of college nursing students? BMC Nurs. 2018;17:1–9. Mak YW, Kao AH, Tam LW, Virginia W, Don T, Leung DY. Health-promoting lifestyle and quality of life among Chinese nursing students. Prim health care Res Dev. 2018;19(6):629–36. Sahu M, Gandhi S, Sharma MK, Marimuthu P. Social media use and health promoting lifestyle: an exploration among Indian nursing students. Investigacion y Educ en enfermeria. 2020;38(2). Hussein AA, Younis NM, Ahmed MM. Health Promoting Lifestyle profile Among Nursing Students in Mosul University. Int J Psychosocial Rehabilitation. 2020;24(09):1916–20. Hossein Abbasi N, Aghaamiri M. Relationship Between Health-Promoting Lifestyle and Body Mass Index in Male Nurses Based on Demographic Variables. Am J Men's Health. 2020;14(6):1557988320966519. Mahmoud RI, Yousef F, Ali RAE. Health Promoting Lifestyle Behaviors and Associated Factors among Sohag University Students. Sohag Med J. 2024;28(2):1–11. Mohammadian Zirjan B. Health-promoting Lifestyle and its Relationship with Examining Self-efficacy among Students of GONABAD University of Medical Sciences in 2019: a Descriptive Study. J Jiroft Univ Med Sci. 2023;9(4):1097–108. Khademi Z, Banaei M, Mahdavifar M, Imani E, Tayari N. Health promotion behaviors in Iranian nurses: A review study. J Prev Med. 2018;5(1):64–73. Ahmadzadeh-Zeidi MJ, Rooddehghan Z, Haghani S. The relationship between work-family conflict and missed nursing care; a cross-sectional study in Iran. BMC Nurs. 2024;23(1):869. Ifroh RH, Imamah IN, Rizal AAF. The health-promoting lifestyle assessment among nursing students in East Kalimantan. Jurnal Ilmu Kesehatan Masyarakat. 2022;13(2):168–79. Nekoei M, Behroozi N, Ghanbari S, Abbaspoor Z. Effectiveness of mindfulness-based counseling on the health promoting lifestyle in Iranian middle-aged women: an experimental study. Mod Care J. 2024;21(1):e138180. Nejat K, Abedi H. Evaluation of health promotion activities in nurses. Appl Sci. 2015;4(6):715–20. Kalroozi F, Pishgooie A, Taheriyan A. Health-promoting behaviours in employed nurses in selected military hospitals. 2015. Mahmoodi H, Hasanpoor E, Zareipour M, Housaenpour H, SHARIFI SP, Babazadeh T. Compare the health promoting behaviors among nurses, health and administrative staff. Iran J Nurs. 2016;29:99–100. Khoshnoodian K, Norouzi K, Rahgoi A. Correlation between work-family conflict and happiness in the nursing staff of the selected Social Security Hospital. J Health Promotion Manage. 2020;9(6):37–47. Ebrahimi B, Faraji O, Nouri B, Valiee S. Relationship between work-family conflict and perceived organizational support among nurses of Kurdistan University of Medical Sciences. Casp J Health Res. 2021;6(4):137–46. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6483607","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":457998672,"identity":"974ad4ec-42db-471a-96d7-a110f4c53a93","order_by":0,"name":"Sumayya Sani","email":"","orcid":"","institution":"Tehran University Of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Sumayya","middleName":"","lastName":"Sani","suffix":""},{"id":457998673,"identity":"c6f8e11b-0278-412a-bafe-357699b93918","order_by":1,"name":"Mohammad Javad Ahmadzadeh-Zeidi","email":"","orcid":"","institution":"Tehran University Of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Javad","lastName":"Ahmadzadeh-Zeidi","suffix":""},{"id":457998674,"identity":"12a6d48b-b35f-4533-a185-fb4a02aefc85","order_by":2,"name":"Esmaeil Mohammadnejad","email":"","orcid":"","institution":"Tehran University Of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Esmaeil","middleName":"","lastName":"Mohammadnejad","suffix":""},{"id":457998675,"identity":"1370cd90-10d0-4785-bd1a-450fa985e055","order_by":3,"name":"Zahra Rooddehghan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYLACHjaGBAYJIOMDA5BBkhbGGSRrYeYhRov87MMHH7wps8mTj25+9ti2zS6Pn72B8cPHHNxaGPvSkg3nnEsrNrxzzNw4ty25WLLnALPkzG24tTDz8JhJ87YdTtw4I8FMOreNOXHDjQQ2Zl48WtggWv4DtaR/k7ZsqyeshQei5UDifIkcM2lGoHUEtUjwsIH8kpy4QSKnTLLn3PHEmT0Hm/H6Rb6HGRRidonzZ6Rvk/hRVp3Yz9588MNHPFrgwOAAkGBkAzEZG4hQD7IOrO4PcYpHwSgYBaNgZAEAxyFQYvALqNcAAAAASUVORK5CYII=","orcid":"","institution":"Tehran University Of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Rooddehghan","suffix":""}],"badges":[],"createdAt":"2025-04-19 08:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6483607/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6483607/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83033508,"identity":"36576bc8-c9aa-4deb-8f51-667204e48a95","added_by":"auto","created_at":"2025-05-19 09:30:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":920780,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6483607/v1/28f4a56e-037b-4d5f-9f14-34027407d3b8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Health Promotion Lifestyles and Associated Factors Among Clinical Nurses in Iran: A Cross-Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003eNon-communicable diseases (NCDs) are on the rise worldwide and cause major problems in developing countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In 2024 The World Health Organization (WHO) reports that 60% of global deaths and 80% of deaths in developing countries are attributable to unhealthy lifestyle and behavior choices. This statistic is expected to reach 75% of global deaths by 2030 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Due to the unhealthy lifestyle, the prevalence and occurrence of many chronic diseases, including obesity, arteriosclerosis, and coronary heart disease, has increased significantly (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe WHO considers lifestyle as specific and definable behavioral patterns that result from the interaction between personal characteristics, social relationships, environmental conditions and socio-economic situations (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These behaviors are under the control of individuals and include activities that positively or negatively affect their health, which then becomes as a routine in their lives (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). A holistic approach suggests that health-protective behaviors (risk reduction and prevention) and health-promoting behaviors may be considered as two components of a healthy lifestyle (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA health-promoting lifestyle behaviors (HPLB) includes behaviors that enable people to increase control over their health, which ultimately leads to improved health for individuals and communities (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). These behaviors affect different levels of health promotion, including self-actualization, physical activities, health responsibility, food choices, interpersonal support to increase or maintain the level of well-being or reduce the incidence of illness (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe concept of a HPLB involves six dimensions including: Health responsibility, physical activity, nutrition, spiritual growth, interpersonal relationships, and stress management (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Factors affecting HPLB can be divided into cognitive-perceptual factors and modifying factors. Meanwhile, cognitive-perceptual factors refer to the main motivations for adopting or maintaining health-promoting lifestyles, including health perception and perceived health status. Modifying factors indirectly affect the health-promoting lifestyle by affecting cognitive-perceptual factors, including demographic characteristics and behavioral factors (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNowadays, due to the high cost of providing health care, it is emphasized to change the treatment approach to their prevention (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). To achieve these health goals, nurses play an important and vital role and constitute the main workforce in health care systems. According to the WHO, there are 43.5\u0026nbsp;million health workers worldwide, of which more than 20\u0026nbsp;million are nurses (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In this regard, nurses play an important role in healthcare delivery, providing essential care, supporting patients (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), creating a supportive environment for health, strengthening community action (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and directly or indirectly influencing the beliefs or attitudes of their clients about health promotion (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNursing is a high-pressure profession, and the pressure on healthcare workers comes not only from the work itself, but also from patients, colleagues, and hospital systems. For these reasons nurses tend to adopt unhealthy lifestyles, including low levels of physical activity and poor nutritional behaviors which can ultimately increase the risk of developing adverse health conditions (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In this regard, Chiang et al. suggested that adopting a health-promoting lifestyle among nurses can lead to positive health outcomes that affect job satisfaction, mental health, and overall quality of life (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne of the main goals of the WHO program is to strengthen the capacity of individuals and communities to choose a healthier life and follow health-promoting lifestyle patterns (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Nurses are an essential part of the health care system, and their health-promoting lifestyle can influence societies beliefs or attitudes towards their health promotion (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Additionally, identifying at-risk nurses and providing programs to improve their lifestyle behaviors helps prevent chronic diseases and increase their resilience in the workplace, which is an important key to maintaining an efficient workforce (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Therefore, during this study, health promotion lifestyles and associated factors among clinical nurses in Iran was investigated.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eDesign and aim\u003c/p\u003e \u003cp\u003eThis is a descriptive cross-sectional study, which was conducted with the aim of determination health promotion lifestyles and associated factors among clinical nurses working in Imam Khomeini Hospital Complex (IKHC) affiliated to Tehran University of Medical Sciences. This study was carried out from October 2022 to August 2023.\u003c/p\u003e \u003cp\u003eStudy setting and participants\u003c/p\u003e \u003cp\u003eIn the present study, the research population included all nurses working in Imam Khomeini Hospital Complex (IKHC) affiliated with Tehran University of Medical Sciences. This hospital had chosen purposefully as the research environment due to its alignment with the aim of this study as well as laws and guidelines used. It should be noted that IKHC has about 1,300 active beds and approximately 1,400 nursing staff.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were; willing to participate in the study, being a nurse with a bachelor\u0026rsquo;s degree or higher education level. Exclusion criteria included incomplete answers to the questionnaires.\u003c/p\u003e \u003cp\u003eSample size and power\u003c/p\u003e \u003cp\u003eTo determine the sample size at the confidence level of 95% and the test power of 90%, the sample size calculated 293 according to following Cochran's formula:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=\\frac{N{z}^{2}pq}{N{d}^{2}+{z}^{2}pq}\\:n=\\frac{1400\\times\\:{\\left(1.96\\right)}^{2}\\times\\:0.5\\times\\:0.5}{1400\\times\\:{\\left(0.05\\right)}^{2}+{\\left(1.96\\right)}^{2}\\times\\:0.5\\times\\:0.5}=301$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eA total of 303 nursing staff, including nurses with bachelor\u0026rsquo;s degree, master\u0026rsquo;s degree working as clinical nurses were selected by available sampling method.\u003c/p\u003e \u003cp\u003eInstruments\u003c/p\u003e \u003cp\u003eBefore conducting the research, permission was obtained from both creators of the localized version and original version of these two questionnaires, and then the researchers began to conduct this study. The data collection in this study was based on the self-reporting method via two following questionnaires:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDemographic and Anthropometric Information Questionnaire\u003c/strong\u003e \u003cp\u003ewas used to collect information such as age, gender, marital status, education level, type of shift, weight and height which were transformed into body mass index (BMI) (kg/m2). BMI is an important indicator for obesity prevalence among large populations and generally, reflects the degree of fatness among individuals. It is a statistical measure of the weight of a person scaled according to his/her height. Four categories of BMI included being underweight (\u0026le;\u0026thinsp;18.5); having normal weight (18.6\u0026ndash;24.9); being overweight (25\u0026ndash;29.9); and being obese (\u0026ge;\u0026thinsp;30) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eHealth-Promoting Lifestyle Profile II Questionnaire (HPLP II)\u003c/b\u003e: This questionnaire was originally designed by Walker et al. in 1987 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This questionnaire consists of 52 items divided into six dimensions including: Nutrition (e.g. having a food pattern and choosing food, 9 items), physical activity (e.g. following a regular exercise pattern, 8 items), health responsibility (e.g. discuss my health concerns with health professionals, 9 items), stress management (e.g. take some time for relaxation each day, 8 items), interpersonal support (e.g. maintaining relationships with a sense of closeness, 9 items), and self-actualization (e.g. having a sense of purpose, seeking personal development, and experiencing self-awareness and satisfaction, 9 items) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The answer to each item of this questionnaire is on a 4-point Likert scale from never (1 point) to always (4 points). In this way, points obtained from this questionnaire varies between 52 and 208. The total score is further categorized into four groups: poor (52\u0026ndash;90), moderate (91\u0026ndash;129), good (130\u0026ndash;168), and excellent (169\u0026ndash;208). Higher scores on each subscale indicate more frequent health-promoting behaviors (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). This questionnaire is without reverse score questions and the validity of original version of this questionnaire, calculated as 0.91 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The Persian translation and psychometric properties of this questionnaire, which is used in Iran, was firstly done by Aghamolaei et al. and its\u0026rsquo; validity and internal consistency was measured 0.92 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The reliability of this questionnaire was calculated as 0.90 using Cronbach's alpha coefficient during this research.\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003e After obtaining the approval of the ethics committee and the necessary permits from the relevant authorities of the Faculty of Nursing and Midwifery of Tehran University of Medical Sciences, a well-trained researcher introduced herself to the directorates of IKHC hospital. Then, after attending in each ward, the samples were entered into the study using the convenience sampling method at each time in the morning, evening and night according to inclusion criteria. Then the researcher explained the study objectives to the nurses at the appropriate place and time and took written consent from them. Then, these two questionnaires were distributed among them. The samples were then given 2 days to fill them out so that the nurses could complete the questionnaires when they felt free and relaxed.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed in SPSS software version 25. First, the Kolmogorov-Smirnov test was used to determine the normality of total score of the questionnaire and its dimensions. After the data distribution was measured normal, data evaluation was done using descriptive statistics such as frequency and percentage, mean and standard deviation as well as inferential statistics such as independent t-test and ANOVA. The significance level of the data was considered as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eEthical considerations\u003c/p\u003e \u003cp\u003e This study was conducted by obtaining the code of ethics from ethical committee of the Vice-Chancellor in Research Affairs- Tehran University of Medical Sciences (TUMS) (IR. TUMS. FNM. REC. 1401.018). After obtaining the approval of ethics committee and the necessary permits from the relevant officials, a well-trained researcher introduced herself to the directorates of IKHC hospital. The researcher explained to nurses about the study objectives and told them that their participation was voluntary and that there would be no negative consequences for refusing to participate. All participants were assured of the confidentiality of all research information and only the researchers have access to the data. Then informed consent was obtained from all study participants. Finally, the results of the study were provided to the hospital under study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAfter distributing about 350 questionnaires, 303 participants who had completed these two questionnaires were participated in the study. The majority of this nurses were female (61.4%) and 54.8% were married. The Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of age was 35.47\u0026thinsp;\u0026plusmn;\u0026thinsp;8.84 and the Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of working hour per month was 246.83\u0026thinsp;\u0026plusmn;\u0026thinsp;13.36. 258 (85.1%) had a bachelor's degree and more than 235 (77.5%) never used Tabaco.\u003c/p\u003e \u003cp\u003eThe mean of BMI of male nurse was 25.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.76 kg/m2 and 24.41\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41 kg/m2 for female nurses. The BMI for 53.5% of the sample was being in normal range, 3.0% was being underweight, and 34.3% was being overweight and 9.2% was being obese. Other demographic information is given in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the nurses participating in the study (n\u0026thinsp;=\u0026thinsp;303)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (28.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129 (42.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.47\u0026thinsp;\u0026plusmn;\u0026thinsp;8.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117 (38.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e186 (61.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122 (40.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e166 (54.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e258 (85.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (14.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of shift\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (24.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRotational\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229 (75.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIncome adequacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (19.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e243 (80.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eRange of BMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (3.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.6\u0026ndash;24.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162 (53.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;29.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104 (34.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (9.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBMI, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.41\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTabaco use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (8.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e255 (84.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eWorking hour per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180\u0026ndash;240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169 (55.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96 (31.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e246.83\u0026thinsp;\u0026plusmn;\u0026thinsp;13.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWorking in another organization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (22.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e224 (77.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNumber of children, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWork experience (year), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.49\u0026thinsp;\u0026plusmn;\u0026thinsp;7.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD score of nurses\u0026rsquo; Health-Promoting Lifestyle Behaviors was 124.85\u0026thinsp;\u0026plusmn;\u0026thinsp;19.89, which indicates moderate Health-Promoting Lifestyle Behaviors. The results showed that the highest score of the Health-Promoting Lifestyle Behaviors dimension is related to \" Interpersonal support\" with a Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD score of 23.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33 (range 9\u0026ndash;36) and the lowest score related to \"Physical activity\" with a Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD score of 16.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46 (range 8\u0026ndash;32). Other information is given in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Health Promotion Lifestyle Behaviors subscales in Iran (n\u0026thinsp;=\u0026thinsp;303)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHealth-Promoting Lifestyle Behaviors\u003c/p\u003e \u003cp\u003ePossible scores range (min-max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(min-max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOn 1\u0026ndash;4 basis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutrition (9\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u0026ndash;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.39\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical activity (\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026ndash;32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth responsibility (9\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.36\u0026thinsp;\u0026plusmn;\u0026thinsp;4.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress management (\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterpersonal support (9\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026ndash;32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-Actualization (9\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u0026ndash;32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.99\u0026thinsp;\u0026plusmn;\u0026thinsp;4.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe overall score of Health-Promoting Lifestyle (52\u0026ndash;208)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u0026ndash;205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124.85\u0026thinsp;\u0026plusmn;\u0026thinsp;19.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of ANOVA and independent t-test showed that nurses who were divorced and those who had sufficient income, never used tobacco, and those who worked according to their legal working hours had higher health-promoting lifestyle behaviors. No more relationship was observed between other demographic variables with Health-Promoting Lifestyle Behaviors (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe relationship between demographic characteristics of participants with Health Promotion Lifestyle Behaviors.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c9\" namest=\"c3\"\u003e \u003cp\u003eHealth Promotion Lifestyle Behaviors\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDemographic Characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNutrition\u003c/p\u003e \u003cp\u003e(9\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhysical activity\u003c/p\u003e \u003cp\u003e(\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHealth responsibility\u003c/p\u003e \u003cp\u003e(9\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStress management\u003c/p\u003e \u003cp\u003e(\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInterpersonal support\u003c/p\u003e \u003cp\u003e(9\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSelf-Actualization\u003c/p\u003e \u003cp\u003e(9\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOverall Health Promotion Lifestyle Behaviors\u003c/p\u003e \u003cp\u003e(52\u0026ndash;208)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.34 \u0026plusmn; 3.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22.27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e122.80\u0026thinsp;\u0026plusmn;\u0026thinsp;17.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.27\u0026thinsp;\u0026plusmn;\u0026thinsp;3.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.26\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e126.12\u0026thinsp;\u0026plusmn;\u0026thinsp;19.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.31\u0026thinsp;\u0026plusmn;\u0026thinsp;4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.31\u0026thinsp;\u0026plusmn;\u0026thinsp;5.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e125.00\u0026thinsp;\u0026plusmn;\u0026thinsp;21.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTest result\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGender\u003csup\u003e②\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.06\u0026thinsp;\u0026plusmn;\u0026thinsp;4.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.09\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22.73\u0026thinsp;\u0026plusmn;\u0026thinsp;4.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e124.40\u0026thinsp;\u0026plusmn;\u0026thinsp;21.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.42\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.85\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.55\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.10\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.05\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e125.13\u0026thinsp;\u0026plusmn;\u0026thinsp;18.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTest result\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*t=-0.77\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*t\u0026thinsp;=\u0026thinsp;0.58\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*t=-1.03\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*t=-0.17\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*t=-0.07\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e*t=-0.74\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*t=-0.30\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMarital status\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.01\u0026thinsp;\u0026plusmn;\u0026thinsp;21.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.89\u0026thinsp;\u0026plusmn;\u0026thinsp;4.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.24\u0026thinsp;\u0026plusmn;\u0026thinsp;3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.70\u0026thinsp;\u0026plusmn;\u0026thinsp;3.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.61\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21.94\u0026thinsp;\u0026plusmn;\u0026thinsp;4.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e122.39\u0026thinsp;\u0026plusmn;\u0026thinsp;19.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.61\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.73\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.32\u0026thinsp;\u0026plusmn;\u0026thinsp;4.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.48\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.66\u0026thinsp;\u0026plusmn;\u0026thinsp;4.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e126.01\u0026thinsp;\u0026plusmn;\u0026thinsp;19.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.07\u0026thinsp;\u0026plusmn;\u0026thinsp;4.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.67\u0026thinsp;\u0026plusmn;\u0026thinsp;4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.07\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24.07\u0026thinsp;\u0026plusmn;\u0026thinsp;4.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e132.07\u0026thinsp;\u0026plusmn;\u0026thinsp;21.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTest result\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e***F\u0026thinsp;=\u0026thinsp;4.80\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;2.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e***F\u0026thinsp;=\u0026thinsp;4.83\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e***F\u0026thinsp;=\u0026thinsp;3.59\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eWorking hour per month\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.89\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e127.44\u0026thinsp;\u0026plusmn;\u0026thinsp;21.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180\u0026ndash;240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.85\u0026thinsp;\u0026plusmn;\u0026thinsp;4.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.56\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.28\u0026thinsp;\u0026plusmn;\u0026thinsp;4.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.83\u0026thinsp;\u0026plusmn;\u0026thinsp;5.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e125.44\u0026thinsp;\u0026plusmn;\u0026thinsp;21.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.10\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.32\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e122.27\u0026thinsp;\u0026plusmn;\u0026thinsp;18.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTest result\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e**F\u0026thinsp;=\u0026thinsp;3.89\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e**F\u0026thinsp;=\u0026thinsp;4.56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e***F\u0026thinsp;=\u0026thinsp;3.23\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eNumber of children\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.40\u0026thinsp;\u0026plusmn;\u0026thinsp;22.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e125.11\u0026thinsp;\u0026plusmn;\u0026thinsp;19.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.04\u0026thinsp;\u0026plusmn;\u0026thinsp;4.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.74\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.70\u0026thinsp;\u0026plusmn;\u0026thinsp;4.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22.68\u0026thinsp;\u0026plusmn;\u0026thinsp;5.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e123.06\u0026thinsp;\u0026plusmn;\u0026thinsp;22.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.79\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.79\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.10\u0026thinsp;\u0026plusmn;\u0026thinsp;4.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.17\u0026thinsp;\u0026plusmn;\u0026thinsp;3.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22.81\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e123.76\u0026thinsp;\u0026plusmn;\u0026thinsp;17.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.39\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e130.86\u0026thinsp;\u0026plusmn;\u0026thinsp;17.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTest result\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIncome adequacy\u003csup\u003e②\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.70\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.40\u0026thinsp;\u0026plusmn;\u0026thinsp;4.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25.10\u0026thinsp;\u0026plusmn;\u0026thinsp;4.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e129.70\u0026thinsp;\u0026plusmn;\u0026thinsp;15.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.32\u0026thinsp;\u0026plusmn;\u0026thinsp;4.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.72\u0026thinsp;\u0026plusmn;\u0026thinsp;4.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.83\u0026thinsp;\u0026plusmn;\u0026thinsp;3.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e123.65\u0026thinsp;\u0026plusmn;\u0026thinsp;20.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTest result\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*t\u0026thinsp;=\u0026thinsp;0.77\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e**t\u0026thinsp;=\u0026thinsp;2.35\u003c/b\u003e\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e*t\u0026thinsp;=\u0026thinsp;0.23\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e**t\u0026thinsp;=\u0026thinsp;2.23\u003c/b\u003e\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*t\u0026thinsp;=\u0026thinsp;0.67\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e***t\u0026thinsp;=\u0026thinsp;3.80\u003c/b\u003e\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e**t\u0026thinsp;=\u0026thinsp;2.47\u003c/b\u003e\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eTabaco use\u003csup\u003e①\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.70\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.54\u0026thinsp;\u0026plusmn;\u0026thinsp;3.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e122.41\u0026thinsp;\u0026plusmn;\u0026thinsp;20.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.83\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.12\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.83\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e124.64\u0026thinsp;\u0026plusmn;\u0026thinsp;21.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.79\u0026thinsp;\u0026plusmn;\u0026thinsp;3.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.54\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.42\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.07\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.63\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e126.31\u0026thinsp;\u0026plusmn;\u0026thinsp;18.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTest result\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e**F\u0026thinsp;=\u0026thinsp;2.61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e**F\u0026thinsp;=\u0026thinsp;3.25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*F\u0026thinsp;=\u0026thinsp;1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e***F\u0026thinsp;=\u0026thinsp;5.07\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e***F\u0026thinsp;=\u0026thinsp;3.06\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducation level\u003csup\u003e②\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.79\u0026thinsp;\u0026plusmn;\u0026thinsp;4.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.55\u0026thinsp;\u0026plusmn;\u0026thinsp;4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.25\u0026thinsp;\u0026plusmn;\u0026thinsp;21.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e22.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e125.05\u0026thinsp;\u0026plusmn;\u0026thinsp;20.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.24\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.40\u0026thinsp;\u0026plusmn;\u0026thinsp;5.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e123.71\u0026thinsp;\u0026plusmn;\u0026thinsp;18.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTest result\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e*t\u0026thinsp;=\u0026thinsp;0.67\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e**t=-1.93\u003c/b\u003e\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e**t\u0026thinsp;=\u0026thinsp;2.02\u003c/b\u003e\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*t\u0026thinsp;=\u0026thinsp;0.11\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*t\u0026thinsp;=\u0026thinsp;1.82\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e*t=-0.68\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e*t\u0026thinsp;=\u0026thinsp;0.41\u003c/p\u003e \u003cp\u003edf\u0026thinsp;=\u0026thinsp;301\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn recent years, researchers' attention to the topic of health-promoting behaviors has been increasing. Despite nurses being in a unique position in the healthcare system, there is limited evidence regarding HPLB in clinical nurses. Therefore, this study was conducted with the aim of determining health-promoting lifestyles behaviors and factors affecting them in clinical nurses. The results of the present study showed that most nurses in the study had upper moderate health-promoting lifestyles behaviors. In the searches conducted by the researcher, few studies regarding health-promoting lifestyles behaviors in Iranian nurses related to recent years were found, which shows the necessity of examining this important issue in nurses.\u003c/p\u003e \u003cp\u003eConsistent with our findings the mean scores of HPLB was reported at a moderate level in Iran (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), Hong Kong (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), China (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), India (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and Iraq (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). While in other studies in Iran (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and Egypt (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), the mean scores of HPLB was at good level. It seems that the use of the standard questionnaire of HPLB and the same target group had an effect on achieving similar results. Despite the differences in the cultural context of the above study samples, relatively similar results have been obtained, which could suggest professional commonalities that have led to such results.\u003c/p\u003e \u003cp\u003eFurthermore, the results of the present study showed that the mean scores of the physical activity and stress management obtained the lowest score among the all HPLB dimensions which is in line with the study of Moghimi et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), Budury et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) and Bagheri Saveh et. al (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). While in the study of Wang et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and Chao (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), Health Responsibility along with physical activity had lowest score. The reason for the decrease in physical activity among nurses could be due to the lack of a sports culture in Iranian society, having multiple jobs due to insufficient income for nurses, and their multiple and long shifts (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt seems that lack of proper physical activity is one of the consequences of today's life, where people are increasingly using electronic devices such as smart phones and computers and are less likely to engage in physical activities (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The problem of physical inactivity is a health issue with cultural and social origins. Participation in sports activities depends on various factors, including nurses' perception of physical activity, self-confidence, social support, and sufficient motivation (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Also, in Iranian society, due to economic issues and forced overtime, most nurses have limited opportunities to engage in regular physical activities, which in the long run can have an adverse effect on staff efficiency and their useful working life (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In addition, irregular rotating shifts and high workload in the nursing profession make it difficult to participate in leisure-time physical activities because nurses are forced to spend more time recovering from such condition (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt was shown that the majority of the nurses studied had poor stress management behaviors. The presence of high burnout, coupled with poor organizational support and the lack of planned training programs for stress management, has led to low scores in this dimension (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Comprehensive and coordinated stress management programs that include ways to identify coping strategies and foster resilience should be incorporated into undergraduate nursing programs to prevent psychological health threats and increase nurses' resolve to face new challenges (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Nursing managers should consider that reduced physical activity and poor stress management have an undeniable negative impact on nurses' performance and will reduce their efficiency.\u003c/p\u003e \u003cp\u003eConsistent with our findings with the study of Chao (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), Ifroh et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and Nekoei et al. (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), the mean scores of Interpersonal support and Self-Actualization had higher scores compared to other dimensions. While in the study of Nejat et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) and Mahmoud et al. highest scores was related to Nutrition (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The reason for this may be the nature of the nursing profession and its spiritual state in caring for patients. And that professional nursing is based on communication with patients and colleagues, which requires a high level of establishing relationships with others and helping them (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Pender believes that spiritual growth is something beyond a person's religious practices. This concept relates to the exploration of a person's beliefs about life, love, hope, life after death, connection to self and others, and the purpose of life (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe role of demographic factors in health-promoting behaviors has not been reported in the same way in different studies. According to our finding, no relationship was observed between age, gender educational level and number of children, which is in line with study of Mahmoodi et al (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) and Nejat et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Contrary with studies of Moghimi et al., Zeng et al. and Wang et al., it was shown that as nurses' age increased, total HPLB also increased. Furthermore, it was stated that women nurses and who had higher educational level had better stress management and had higher health promoting behavior. But in current study no differences were observed between different groups (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). This difference in health-promoting behaviors among male and female nurses could be due to the level of awareness and education, the availability of appropriate conditions for activity, and the prevailing culture of that society regarding health-promoting behaviors among both genders (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). It seems that nurses have sufficient and appropriate awareness of health-promoting behaviors due to the nature of their profession, but due to the hard work, shift work, and lack of a regular hospital program to develop these behaviors, etc., they do not have enough time to perform health-promoting behaviors (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt has been found that HPLB is lower among nurses who work longer hours. It has also been found that there is a statistically significant relationship between longer working hours and reduced stress management and reduced self-actualization. In the present explanation, it can be noted that when a person is involved in continuous job activities, his life becomes unbalanced and he may not be able to effectively control the stresses that enter his life (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In addition, in Iran, nurses have suffered a lot of stress due to back-to-back shifts, forced overtime, lack of resilience, and sleep deprivation caused by irregular shifts, which has made it difficult to control and manage stress and self-actualization in this profession (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs it turned out, smoking among nurses led to a significant decrease in health responsibility, stress management, self-actualization and ultimately HPLB. Smokers often say that smoking reduces stress, so it is difficult to quit (35). While, Yadegar et al. suggested that there is a bidirectional relationship between smoking and stress. Stress causes cravings for cigarettes for smokers, leading to the belief that smoking reduces stress, and that acute stress causes cravings for cigarettes and negative effects (36). This is why Brotons et al. reported that the possible reason for the gap between the knowledge and practice of health care workers in preventing tobacco use and promoting their own health is the lack of skills, beliefs to change these behaviors (37).\u003c/p\u003e \u003cp\u003eBased on the results of the present study and other similar studies, health-promoting behaviors among healthcare professionals have an important impact on individuals' health, such that it can be viewed as a preventive method. The results of this study can help nursing managers to pay more attention to controlling individual and occupational variables that affect health-promoting lifestyle behaviors.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eResearch limitations include\u003c/strong\u003e \u003cp\u003ethe psychological condition of the participants which is beyond the researcher's control and using the data collection method based on the participants' self-report. Also, despite ensuring the confidentiality of the information, the fear of revealing the information may cause the participants to respond unrealistically. Moreover, this study used a cross-sectional design, which means the study results are limited to reflecting only those conditions experienced during the data collection process.\u003c/p\u003e \u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe present study showed that the nurses in the study were at an average level in their assessment of health behaviors, and the most health-promoting behaviors were related to self-actualization and interpersonal support, and the least health-promoting behaviors were related to stress management and physical activity. According to our finding, no relationship was observed between age, gender educational level and number of children. Also, HPLB had a significant relationship with working hours, marital status, working hour, income adequacy and Tabaco use variables. Based on the findings of this study, healthcare providers and nursing managers are advised to set aside hours for regular physical activity for nurses and plan programs for them to better manage stress.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to the Deputy for Research of Tehran University of Medical Sciences and all the nurses participated in this study for their support and cooperation.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eData collection: Sumayya Sani, Esmaeil Mohammadnejad\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData analysis: Mohammad Javad Ahmadzadeh-Zeidi, Zahra Rooddehghan\u003c/p\u003e\n\u003cp\u003eManuscript writing: Mohammad Javad Ahmadzadeh-Zeidi, Zahra Rooddehghan\u003c/p\u003e\n\u003cp\u003eFinal approval: All authors.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was funded by Tehran University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted by obtaining the code of ethics (IR.TUMS.FNM.REC.1401.018) from the ethical committees of the Nursing \u0026amp; Midwifery Faculty of Tehran University of Medical Sciences. After obtaining the approval of ethics committee and the necessary permits from the relevant officials, the researcher presented himself to the directorates of selected hospitals. A well-trained and experienced research assistant explained to nurses about the study objectives and their participation was voluntary and refusal to participate would not result in any negative consequences.\u0026nbsp;All the participants were assured of the confidentiality of all the information of the research and only the researchers have access to the data. Then informed consent was obtained from all of the participants in the study. Finally, the results of the study were given to the hospitals under research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMehri A, Solhi M, Garmaroudi G, Nadrian H, Sighaldeh SS. Health promoting lifestyle and its determinants among university students in Sabzevar. Iran Int J Prev Med. 2016;7(1):65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNekoei M, Behroozi N, Ghanbari S, Abbaspoor Z. Effectiveness of mindfulness-based counseling on the health promoting lifestyle in Iranian middle-aged women: an experimental study. 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Dimensionality and internal consistency of the Health-Promoting Lifestyle Profile (HPLP-II) in university students. articles Sci technological Res. 2024;24(1):50\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBagheri Saveh MI, Fereydoni P, Khaleghverdi M, Mardokhian P, Yarahmadi F. Evaluation of Health Promoting Behaviors and Related Factors in Nurses. Military Caring Sci. 2023;10(2):199\u0026ndash;208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNajafabadi M, Rezaei B. The health promotion behaviors and its correlation with selected professional factors in nurses. J Health Promotion Manage. 2017;6(3):28\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChow SKY, Lam K-M, Lie S-H, Mak K-C, Mong K-C, So C-M, et al. Do demographic factors and a health-promoting lifestyle influence the self-rated health of college nursing students? BMC Nurs. 2018;17:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMak YW, Kao AH, Tam LW, Virginia W, Don T, Leung DY. Health-promoting lifestyle and quality of life among Chinese nursing students. Prim health care Res Dev. 2018;19(6):629\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahu M, Gandhi S, Sharma MK, Marimuthu P. Social media use and health promoting lifestyle: an exploration among Indian nursing students. Investigacion y Educ en enfermeria. 2020;38(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHussein AA, Younis NM, Ahmed MM. Health Promoting Lifestyle profile Among Nursing Students in Mosul University. Int J Psychosocial Rehabilitation. 2020;24(09):1916\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHossein Abbasi N, Aghaamiri M. Relationship Between Health-Promoting Lifestyle and Body Mass Index in Male Nurses Based on Demographic Variables. Am J Men's Health. 2020;14(6):1557988320966519.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahmoud RI, Yousef F, Ali RAE. Health Promoting Lifestyle Behaviors and Associated Factors among Sohag University Students. Sohag Med J. 2024;28(2):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohammadian Zirjan B. Health-promoting Lifestyle and its Relationship with Examining Self-efficacy among Students of GONABAD University of Medical Sciences in 2019: a Descriptive Study. J Jiroft Univ Med Sci. 2023;9(4):1097\u0026ndash;108.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhademi Z, Banaei M, Mahdavifar M, Imani E, Tayari N. Health promotion behaviors in Iranian nurses: A review study. J Prev Med. 2018;5(1):64\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmadzadeh-Zeidi MJ, Rooddehghan Z, Haghani S. The relationship between work-family conflict and missed nursing care; a cross-sectional study in Iran. BMC Nurs. 2024;23(1):869.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIfroh RH, Imamah IN, Rizal AAF. The health-promoting lifestyle assessment among nursing students in East Kalimantan. Jurnal Ilmu Kesehatan Masyarakat. 2022;13(2):168\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNekoei M, Behroozi N, Ghanbari S, Abbaspoor Z. Effectiveness of mindfulness-based counseling on the health promoting lifestyle in Iranian middle-aged women: an experimental study. Mod Care J. 2024;21(1):e138180.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNejat K, Abedi H. Evaluation of health promotion activities in nurses. Appl Sci. 2015;4(6):715\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalroozi F, Pishgooie A, Taheriyan A. Health-promoting behaviours in employed nurses in selected military hospitals. 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahmoodi H, Hasanpoor E, Zareipour M, Housaenpour H, SHARIFI SP, Babazadeh T. Compare the health promoting behaviors among nurses, health and administrative staff. Iran J Nurs. 2016;29:99\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhoshnoodian K, Norouzi K, Rahgoi A. Correlation between work-family conflict and happiness in the nursing staff of the selected Social Security Hospital. J Health Promotion Manage. 2020;9(6):37\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEbrahimi B, Faraji O, Nouri B, Valiee S. Relationship between work-family conflict and perceived organizational support among nurses of Kurdistan University of Medical Sciences. Casp J Health Res. 2021;6(4):137\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Self-perceived health, Health-promoting lifestyle, Health promoting behaviors, Nurse","lastPublishedDoi":"10.21203/rs.3.rs-6483607/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6483607/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u0026amp; Aims:\u003c/strong\u003e Each person's lifestyle affects their health, and health-promoting behaviors and a healthy lifestyle are key strategies for facilitating and protecting health. Health-promoting lifestyle behaviors is an important determinant of health status in nurses, and nurses' health affects patients' health. The present study aims to determine health promotion lifestyles and associated factors among clinical nurses in Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials \u0026amp; Methods:\u003c/strong\u003e This cross-sectional descriptive-analytical study was conducted on 303 nurses working in Imam Khomeini Hospital Complex (IKHC) affiliated with Tehran University of Medical Sciences from October 2022 to August 2023. The research population included all nurses working in Imam Khomeini Hospital Complex. The research samples were included in the study by available sampling method after obtaining organizational permits, ethical approval and informed consent. Data collection was done using two questionnaires including: Demographic information form, Health-Promoting Lifestyle Profile II Questionnaire. The collected data was analyzed in SPSS software, version 25.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The Mean ± SD score of nurses’ Health-Promoting Lifestyle Behaviors was at upper moderate level (124.85 ± 19.89). the highest score of the Health-Promoting Lifestyle Behaviors dimension is related to \"Interpersonal support (2.56 ± 0.48)\" and \" Self-Actualization (2.55 ± 0.54)\" and the lowest score related to \"Physical activity (2.12 ± 0.55)\" and \"stress management (2.26 ± 0.47)\". The results showed that nurses who were divorced (p\u0026lt; 0.01) and those who had sufficient income (p\u0026lt; 0.05), never used tobacco (p\u0026lt; 0.01), and those who worked according to their legal working hours (p\u0026lt; 0.01) had higher health-promoting lifestyle behaviors. No more relationship was observed between other demographic variables with health-promoting lifestyle behaviors (p\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eDue to low scores related to stress management and physical activity healthcare providers and nursing managers are advised to include physical activity programs and stress management courses in their training plans.\u003c/p\u003e","manuscriptTitle":"Health Promotion Lifestyles and Associated Factors Among Clinical Nurses in Iran: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-19 09:14:47","doi":"10.21203/rs.3.rs-6483607/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-06-01T08:06:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-20T17:18:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-20T15:14:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281893614150760834895196376914853508640","date":"2025-05-20T14:41:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176080752633091792454031482616861253333","date":"2025-05-17T12:26:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138888011845053131502908040346833195297","date":"2025-05-15T05:39:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-15T04:05:21+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-24T06:57:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-23T11:39:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-23T11:37:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-04-19T08:49:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f4d394d3-65d9-42be-a085-46763faa732a","owner":[],"postedDate":"May 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-19T09:14:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-19 09:14:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6483607","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6483607","identity":"rs-6483607","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}