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Determinants of Oral Health Behavior Among High School Students in Marivan County, Iran Based on the Pender’S Health Promotion Model

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Determinants of Oral Health Behavior Among High School Students in Marivan County, Iran Based on the Pender’S Health Promotion Model ﻣﺠﻠﻪ ﺩﺍﻧﺸﮑﺪﻩ ﺑﻬﺪﺍﺷﺖ ﻭ ﺍﻧﺴﺘﻴﺘﻮ ﺗﺤﻘﻴﻘﺎﺕ ﺑﻬﺪﺍﺷﺘﻲ ﺩﻭﺭﻩ ٩ ﺷﻤﺎﺭﻩ ٢ ﺗﺎﺑﺴﺘﺎﻥ ١٣٩٠ ، ﺻﻔﺤﺎﺕ : ١٠٦ - ۹۳ ﺳﺎزه ﻫﺎي ﻣﺪل ارﺗﻘﺎي ﺳﻼﻣﺖ ﭘﻨﺪر درﺑﺎره ﺑﻬﺪاﺷﺖ دﻫﺎن و دﻧﺪان در داﻧﺶ آﻣﻮزان ﻣﻘﻄﻊ دﺑﻴﺮﺳﺘﺎن ﺷﻬﺮ ﻣﺮﻳﻮان ﻛﺎوه ﺑﻬﻤﻦ ﭘﻮر : ﻛﺎرﺷﻨﺎس ارﺷﺪ ، داﻧﺸﻜﺪه ﭘﺮﺳﺘﺎري و ﻣﺎﻣﺎﻳﻲ، داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ واﺣﺪ ﺳﻨﻨﺪج، ﺳﻨﻨﺪج، اﻳﺮان ر وﻧﻤﺎ ﻧﻮري : ﻛﺎرﺷﻨﺎس ، ﺷﺒﻜﻪ ﺑﻬﺪاﺷﺖ و درﻣﺎن ﺷﻬﺮﺳﺘﺎن ﻣﺮﻳﻮان، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻛﺮدﺳﺘﺎن ، ﺳﻨﻨﺪج، اﻳﺮان ﺣﻴﺪر ﻧﺪرﻳﺎن : ﻛﺎرﺷﻨﺎس ارﺷﺪ ، داﻧﺸﻜﺪه ﭘﺮﺳﺘﺎري و ﻣﺎﻣﺎﻳﻲ، داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ واﺣﺪ ﺳﻨﻨﺪج، ﺳﻨﻨﺪج، اﻳﺮان - ﻧﻮﻳﺴﻨﺪه راﺑﻂ: [email protected] ﺑﻬﺰا د ﺻﺎﻟﺤﻲ : دﻧﺪاﻧﭙﺰﺷﻚ ، ﺳﻨﻨﺪج، اﻳﺮان ﺗﺎرﻳﺦ درﻳﺎﻓﺖ : 27/9/ 1389 ﺗﺎرﻳﺦ ﭘﺬﻳﺮش : 3/31/ 1390 ﭼﻜﻴﺪه زﻣﻴﻨﻪ و ﻫﺪ ف : ﺑﻬﺪاﺷﺖ ﺿﻌﻴﻒ دﻫﺎن و دﻧﺪان ﻣﻲ ﺗﻮاﻧﺪ اﺛﺮات ﻧﺎﻣﻄﻠﻮﺑﻲ ﺑﺮ ﻋﻤ ﻠ ﻜﺮد ﻛﻮدﻛﺎن در ﻣﺪرﺳـﻪ و ﻣﻮﻓﻘﻴﺘـﺸﺎن در ﺳﺮاﺳـﺮ زﻧـﺪﮔﻲ داﺷﺘﻪ ﺑﺎﺷﺪ . ﻣﺸﺨﺺ ﻧﻤﻮدن ﻋﻮاﻣﻞ ﻣﺮﺗﺒﻂ ﺑ ﺎ رﻓﺘﺎرﻫﺎي ﺑﻬﺪاﺷﺖ و دﻧﺪان ﻣﻲ ﺗﻮاﻧﺪ ﺑﻪ ﻋﻨﻮان راﻫﻨﻤﺎﻳﻲ ﺑﺮاي ﻃﺮح رﻳﺰي ﺑﺮﻧﺎﻣﻪﻫﺎي آﻣﻮزﺷـﻲ ﺑﺮاي داﻧﺶ آﻣﻮزان و اﻧﺠﺎم ﻣﺪاﺧﻠﻪ ﻫﺎي ﺻﺤﻴﺢ و ﻣﻨﺎﺳﺐ ﺟﻬﺖ ارﺗﻘﺎي اﻧﺠﺎم اﻳﻦ رﻓﺘﺎرﻫﺎ در آﻧﻬﺎ ﻋﻤﻞ ﻛﻨﺪ . ﻟﺬا اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﻫـﺪف ﺗﻌﻴـﻴﻦ ﻋﻮاﻣﻞ ﻣﺮﺗﺒﻂ ﺑﺎ رﻓﺘﺎرﻫﺎي ﺑﻬﺪاﺷﺖ دﻫﺎن و دﻧﺪان در د اﻧﺶ آﻣﻮزان دﺑﻴﺮﺳﺘﺎﻧﻲ ﺷﻬﺮﺳـﺘﺎن ﻣﺮﻳـﻮان ﺑﺮ اﺳـﺎس اﻟﮕـﻮي ارﺗﻘـﺎي ﺳـﻼﻣﺖ ﭘﻨـﺪر ( Health Promotion Model (HPM در ﺳﺎل 1389 ﻃﺮاﺣﻲ و اﺟﺮا ﮔﺮدﻳﺪ . روش ﻛﺎ ر: اﻳﻦ ﻣﻄﺎﻟ ﻌـﻪ ﺑﺮ روي 403 ﻧﻔﺮ از داﻧﺶ آﻣﻮزان ﻣﻘﺎﻃﻊ دوم و ﺳﻮم دﺑﻴﺮﺳﺘﺎن ﺷﻬﺮﺳﺘﺎن ﻣﺮﻳﻮان ﻛـﻪ ﻃـﻲ ﻧﻤﻮﻧـﻪ ﮔﻴـﺮي ﺗـﺼﺎدﻓﻲ - ﺧﻮﺷﻪاي ﭼﻨﺪ ﻣﺮﺣﻠﻪاي در ﺳﺎل ﺗﺤﺼﻴﻠﻲ 89- 1388 ﺑﺪﺳﺖ آﻣﺪ ،ﻧﺪ اﻧﺠﺎم ﺷﺪ. اﺑﺰار ﺟﻤﻊ آوري اﻃﻼﻋﺎت ﭘﺮﺳﺸﻨﺎﻣﻪ اي اﺳﺘﺎﻧﺪارد ﻣﺒﺘﻨـﻲ ﺑـﺮ ﺳﺎزه ﻫﺎي ﻣﺪل ارﺗﻘﺎي ﺳﻼﻣﺖ ﭘﻨﺪر ﺑﻮد ﻛﻪ ﻣﺸﺘﻤﻞ ﺑﺮ ﺳﺎزه ﻫﺎي ﺧﻮدﻛﺎرآ ﻣﺪي و ﻣﻨﺎﻓﻊ و ﻣﻮاﻧﻊ درك ﺷﺪه، ﺗﻌﻬﺪ ﺑﻪ ﻃﺮح ﻋﻤﻞ، اﺣـﺴﺎﺳﺎت ﻣﺮﺗﺒﻂ ﺑﺎ رﻓﺘﺎر، ﺗﺄﺛﻴﺮﮔﺬارﻧﺪه ﻫﺎي ﺑﻴﻦ ﻓﺮدي و وﺿﻌﻴﺘﻲ ﻫﻤﺮاه ﺑﺎ رﻓﺘﺎرﻫﺎي ﺑﻬﺪاﺷﺖ دﻫﺎن و دﻧﺪان ﺑﻮد و ﺑﺼﻮرت ﺧﻮداﻳﻔﺎء ﺗﻜﻤﻴﻞ ﮔﺮدﻳـﺪ . ﺟﻬﺖ ﺗﺠﺰﻳﻪ وﺗﺤﻠﻴﻞ داده ﻫﺎ از آزﻣﻮنﻫـﺎي Pearson Correlation Coefficient ، T-test ، ANOVA و Linear Regression اﺳﺘﻔﺎده ﺷﺪ . Downloaded from sjsph.tums.ac.ir at 15:20 IRST on Sunday October 3rd 2021 ﻧﺘﺎﻳﺞ : رﻓﺘﺎرﻫﺎي ﺑﻬﺪاﺷﺖ دﻫﺎن و دﻧﺪان در دوﺟﻨﺲ ﺗ ﻔ ﺎوت ﻣﻌﻨﻲ دار داﺷﺖ ﺑﻪ ﻃﻮري ﻛﻪ دﺧﺘﺮان وﺿﻌﻴﺖ ﺑﻬﺘﺮي ﻧﺴﺒﺖ ﺑﻪ ﭘـﺴﺮان داﺷـﺘﻨﺪ (p <0/01 ). ﻫﻤﺒﺴﺘﮕﻲ ﻣﺜﺒﺖ و ﻣﻌﻨﻲ داري ﺑﻴﻦ رﻓﺘﺎرﻫﺎي ﺑﻬﺪاﺷﺖ دﻫﺎن و دﻧﺪان و دﻳﮕﺮ ﻣﺘﻐﻴﺮﻫـﺎي اﻟﮕـﻮي ارﺗﻘـﺎي ﺳـﻼﻣﺖ (p <0/01 ) ) وﺟﻮد داﺷﺖ . درﻣﺠﻤﻮع ﻣﺘﻐﻴﺮﻫﺎي ﻣﺪل ارﺗﻘﺎي ﺳﻼﻣﺖ /2 42 % از وارﻳﺎﻧﺲ رﻓﺘﺎرﻫﺎي ﺑﻬ ﺪاﺷﺖ دﻫﺎن و دﻧﺪان را ﭘﻴﺶ ﺑﻴﻨﻲ ﻧﻤﻮدﻧﺪ و از ﻣﻴﺎن اﻳﻦ ﻋﻮاﻣﻞ، ﺗﻌﻬﺪ ﺑﻪ ﻃﺮح ﻋﻤﻞ و ﺧﻮدﻛﺎرآ ﻣﺪي درك ﺷﺪه ﻗﻮﻳﺘﺮﻳﻦ ﭘﻴﺶ ﺑﻴﻨﻲ ﻛﻨﻨﺪه ﻫﺎ ﺑﻮدﻧﺪ ( β≤ /0 223 ). ). ﻧﺘﻴﺠﻪ ﮔﻴﺮي: ﻛﺎرﺷﻨﺎﺳﺎن ﺑﻬﺪاﺷـ ﺖ ﻣﺪارس ﻣﻲ ﺑﺎﻳﺴﺖ ﺑﺮﻧﺎﻣـﻪ ﻫﺎي ﻣﺪاﺧﻠﻪ اي ﻣﺮﺣـ ﻠﻪ ﺑﻪ ﻣﺮﺣـ ﻠﻪ ﺑﺮ اﺳﺎس ﻣﺪل HPM ﻃﺮحرﻳـﺰ ي ﻧﻤﺎﻳﻨﺪ ﻛﻪ در آن ارﺗﻘـﺎي ﺧﻮدﻛـﺎرآ ﻣﺪي درك ﺷﺪه، ﺗﻌﻬﺪ ﺑﻪ ﻃﺮح ﻋﻤﻞ و ﺗﺄﺛﻴﺮﮔﺬارﻧﺪه ﻫﺎي ﺑﻴﻦ ﻓـ ﺮدي از اوﻟﻮﻳﺖ ﻫﺎي ﺑﺮﻧﺎﻣـ ﻪ ﺑﺎﺷﻨﺪ. ﺑﺎﻳـ ﺪ ﻫﻨﮕـ ﺎم ﺑﺮﻧﺎﻣﻪرﻳﺰي ﺟﻬﺖ ارﺗﻘﺎي ﺑﻬﺪاﺷﺖ دﻫﺎن و دﻧﺪان در داﻧﺶ آﻣـﻮزان، راﻫﺒﺮدﻫﺎﻳﻲ را ﺟﻬﺖ ﻏﻠﺒﻪ ﺑﺮ ﻣﻮا ﻧـﻊ اﻧﺠﺎم رﻓ ﺘـﺎرﻫﺎي ﺑﻬﺪا ﺷـﺖ د ﻫـ ﺎن و دﻧﺪان ﭘﻴﺸﻨ ﻬـ ﺎد داد ﺗﺎ اﻳﻨﻜﻪ ﻣﻨﺎﻓﻊ اﻧﺠﺎم اﻳﻦ رﻓﺘﺎرﻫﺎ را ﺑﺮاي آﻧ ﻬـﺎ ﺑﺎز ﮔـﻮ ﻧﻤﻮد . ﻧﺘﺎﻳﺞ ﻧ ﺸـﺎن دﻫﻨﺪه آن اﺳﺖ ﻛﻪ ﻣﻲ ﺗـﻮان اﻳـﻦ اﻟﮕـﻮ را در ﺷﻬﺮ ﻣﺮﻳﻮان ﺑﻪ ﻋﻨﻮان ﭼﺎرﭼﻮﺑﻲ ﺟـﻬﺖ ﺑﺮﻧﺎﻣﻪ رﻳﺰي ﻣﺪاﺧﻼت در ﺟ ﻬـﺖ ﭘﻴﺶ ﺑﻴﻨﻲ، ﺑﻬﺒﻮد و ارﺗﻘﺎي رﻓ ﺘـﺎرﻫﺎي ﺑﻬﺪاﺷـﺖ دﻫـﺎن و دﻧـﺪان داﻧﺶ آﻣﻮزان ﺑﻜﺎر ﮔﺮﻓﺖ . واژﮔﺎن ﻛﻠﻴﺪي : رﻓﺘﺎرﻫﺎي ﺑﻬﺪاﺷﺖ دﻫﺎن و دﻧﺪان، ﻣﺪل ارﺗﻘﺎي ﺳﻼﻣﺖ ﭘﻨﺪر، داﻧﺶ آﻣﻮزان، ﻣﺮﻳﻮان 94 / ﻛﺎوه ﺑﻬﻤﻦ ﭘﻮر و ﻫﻤﻜﺎران ﻣﻘﺪﻣﻪ ( US General Accounting Office, 2000 ). ﺑﻪ ﻃﻮر ﭘﻮﺳﻴﺪﮔﻲ دﻧﺪان ﻳﻚ ﻣﺸﻜﻞ ﻋﻤﺪه ﺑﻬـ ﺪاﺷﺖ دﻫﺎن و ﻛﻞ، ﺷﻴﻮع ﺑﻴﻤﺎري ﻫﺎي ﻟﺜﻪ در ﻣﻴﺎن ﻛﻮدﻛﺎن و ﻧﻮﺟﻮاﻧﺎن ﺑﺎﻻ دﻧﺪان در ﺑﻴﺸﺘﺮ ﻛﺸﻮرﻫﺎي ﺗﻮﺳﻌﻪ ﻳﺎﻓﺘﻪ اﺳﺖ و ﺑﻴﺸﺘﺮ از اﺳﺖ، ﺑﻪ ﻃﻮري ﻛﻪ 50 ﺗﺎ 100 % ﻛﻮدﻛﺎن 12 ﺳﺎﻟﻪ داراي 60 ﺗﺎ 90 درﺻﺪ ﻛﻮدﻛﺎن و ﻧﻮﺟـ ﻮاﻧﺎن ﺳﻨﻴﻦ ﻣﺪرﺳـ ﻪ و ﻋﻼﺋﻢ اﻟﺘﻬﺎب ﻟﺜﻪ ﻫﺴﺘﻨﺪ ( WHO 2001 ) و اﻳﻦ ﺣﺎﻟﺖ در اﻛﺜﺮﻳﺖ ـﻋﻤ ﺪه اي از ﺑﺰرﮔﺴﺎﻻن را ﺗﺤـ ﺖ ﺗﺄﺛﻴﺮ ﻗـ ﺮار داده ﻣﻴﺎن ﺑﺰرﮔﺴﺎﻻن ﺷﺎﻳﻌﺘﺮ ﻧﻴﺰ اﺳﺖ . اﺳﺖ اﻳـ ﻦ ﺑﻴﻤـ ﺎري ﻫﻤﭽﻨﻴﻦ ﺷـ ﺎﻳﻊ ﺗﺮﻳﻦ ﺑﻴﻤﺎري ﺣﻔﺮه ﻣﻄﺎﻟﻌﺎت در اﻳﺮان ﻧﻴﺰ ﺑﻪ ﻋﻨﻮان ﻳﻚ ﻛﺸﻮر درﺣﺎل دﻫﺎن در ﺑﺴـ ﻴﺎري از ﻛﺸﻮرﻫﺎي آﺳﻴﺎﻳﻲ و آﻣﺮﻳﻜﺎي ﻻﺗﻴﻦ ﺗﻮﺳﻌﻪ ﻧﺸﺎن ﻣﻲ دﻫﺪ ﻛﻪ ﭘﻮﺳﻴﺪﮔﻲ دﻧﺪان در ﻛﻮدﻛﺎن 12 ﺳﺎﻟﻪ ﻣﻲ ﺑﺎﺷﺪ( WHO 2003 ). در ﭼﻨﺪ ﺳﺎل اﺧﻴﺮ ﻣﺸﺨﺺ ﺑﺎ ﺑﻜﺎرﮔﻴﺮي ﺷﺎﺧﺺ D) DMFT = دﻧﺪان ﻫﺎي ﭘﻮﺳﻴﺪه ﻳﺎ ﺷﺪه اﺳﺖ ﻛﻪ ﭘﻮﺳﻴﺪﮔﻲ دﻧﺪان و ﺑﻴﻤﺎري ﻫﺎي ﭘﺮﻳﻮدﻧﺘﺎل در ﭘﻮﺳﻴﺪﮔﻲ ﻫﺎي درﻣﺎن ﻧﺸﺪه؛ M = دﻧﺪان ﻫﺎي ازدﺳﺖ رﻓﺘﻪ؛ ﻛﻮدﻛﺎن در ﺑﻴﺸﺘﺮ ﻛﺸﻮرﻫ ﺎي ﺗﻮﺳﻌﻪ ﻳﺎﻓﺘﻪ ﻛﺎﻫﺶ ﻳﺎﻓﺘﻪ F = دﻧﺪان ﻫﺎي ﭘﺮﺷﺪه؛ T = دﻧﺪان ﻫﺎي داﺋﻢ ) ﻛﺎﻫﺶ اﺳﺖ ( .WHO 2000; Beltran-Aguilar et al ﭼﺸﻤﮕﻴﺮي داﺷﺘﻪ اﺳﺖ . ﺑﺎ اﻳﻦ وﺟﻮد، وﺿﻌﻴﺖ ﻛﻠﻲ 1999 ). در ﻣﻘـ ﺎﺑﻞ، اﻳﻦ روﻧﺪ ﻣﺜﺒﺖ در ﻛﺸـ ﻮرﻫﺎي ﺑﻬﺪاﺷﺖ دﻫﺎن و دﻧﺪان ﻫﻨﻮز رﺿﺎﻳﺖ ﺑﺨﺶ ﻧﻴﺴﺖ؛ ﺑﻪ وﻳﮋه درﺣـ ﺎل ﺗﻮﺳﻌﻪ ﻣﺸﺎﻫﺪه ﻧﺸﺪه اﺳﺖ و ﻣﻴﺰان ﺑﻴﺸﺘﺮي از در ﻣﻴﺎن ﻛﻮدﻛﺎن ( Pakshir 2003 ). در ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﻛﻪ در ﭘﻮﺳﻴﺪﮔﻲ ﻫﺎي دﻧﺪان در ﻣﻴﺎن ﻛﻮدﻛﺎن ﻣﺸﺎﻫﺪه ﺷﺪه ؛ ﺑﻪ ﺳﺎل 81 - 1380 اﻧﺠﺎم ﺷﺪ، ﻣﻘﺪار ﺷﺎﺧﺺ DMFT ﺑﺮاي وﻳﮋه در ﻛﺸﻮرﻫﺎﻳﻲ ﻛﻪ ﺑﺮﻧﺎﻣﻪ ﻫﺎي ﻣﺮاﻗﺒﺖ و ﭘﻴﺸﮕﻴﺮي از اﻓﺮاد -15 19 ﺳﺎﻟﻪ 4/1 ﺑﻮد ( Pakshir 2004 ). در ﻳﻚ ﭘﻮ ﺳﻴﺪﮔﻲ دﻧﺪان ﻣﺒﺘﻨﻲ ﺑﺮ ﺟﺎﻣﻌﻪ در آﻧﻬﺎ اﺟﺮا ﻧﺸﺪه اﺳﺖ ﻣﻄﺎﻟﻌﻪ دﻳﮕﺮ، 50 % ﻛﻮدﻛﺎن 12 ﺳـ ﺎﻟﻪ داراي ﭘﻮﺳﻴﺪﮔﻲ دﻧﺪان ( WHO 2000 ). ﻋﻮاﻣﻞ ﻣﺨﺘﻠﻔﻲ ﺟﻬﺖ ﺗﻮﺻﻴﻒ اﻳﻦ ﺑﺎ ﻣﻴﺎﻧﮕﻴﻦ DMFT ﺑـ ـﺮاﺑ ﺮ ﺑﺎ 2/46 ﺑﻮدﻧـ ﺪ ﻛﻪ اﻳـ ﻦ ﻣﻘـ ﺪار ﺗﻔﺎوت ﻫﺎ در ﺷﻴﻮع و ﺷﺪت ﺑﻴﻤﺎري ﻫﺎي ﭘﺮﻳﻮدﻧﺘﺎل در ﻣﻴﺎن در ﻧـ ـﻮﺟ ﻮاﻧﺎن 15 و 16 ﺳﺎﻟـ ﻪ ﺑﻪ ﺗﺮﺗﻴـ ﺐ 2/66 و ﺑ2/76 ـ ﻮد و ﺑﻴﻦ ﮔﺮوه ﻫﺎي ﺟﻤﻌﻴﺘﻲ ﻋﻨﻮان ﺷﺪه اﺳﺖ . از ﺟﻤﻠﻪ اﻳﻦ ( Hamissi et al. 2008 ﺑ). ـ ﺮ اﺳـ ﺎس ﻧﺘﺎﻳـ ﺞ ﻳﻚ ﻋﻮاﻣﻞ ﻣﻲ ﺗﻮان ﺳﻦ، ﺟﻨﺲ، ﺗﻐﻴﻴﺮات در ﺳﺒﻚ زﻧﺪﮔﻲ و ﻣﻄﺎﻟ ـﻌـ ﻪ اﺧﻴﺮ در ﺗﻬـ ﺮان ( Yazdani et al. 2008 ) ﺑﺮ ﻋﺎدت ﻫﺎي ﻣﺮﺑﻮط ﺑﻪ ﻣﺼﺮ ف ﻣﻮاد ﺧﻮراﻛﻲ، و ﻣﺘﻐﻴﺮﻫﺎي روي داﻧﺶ آﻣﻮزان دﺑﻴﺮﺳﺘﺎﻧﻲ 15 ﺳـ ﺎﻟﻪ، ﻣﻘﺪار ﺷﺎﺧﺺ اﺟﺘﻤﺎﻋﻲ- ﻓﺮﻫﻨﮕﻲ را ﻧﺎم ﺑﺮد ( DMFT Whelton and ﺑﺮاﺑﺮ ﺑﺎ 2/1 ﺑﻮد و ﻧﻴﺰ ﻧﻴﺎز ﺑﻪ درﻣـ ﺎن ﭘﻮﺳﻴﺪﮔﻲ در Downloaded from sjsph.tums.ac.ir at 15:20 IRST on Sunday October 3rd 2021 Mullane 2007;Carranza 2006; Murray and 40 % داﻧﺶ آﻣﻮزان وﺟﻮد داﺷﺖ . ﺑﻪ ﻋﻨﻮان ﻳﻚ ﻣﻘﺎﻳﺴﻪ ﺑﺎ . Pitts 2007; Faisal 2010 ) ﻗﺎﺑﻞ ﺗﻮﺟﻪ اﺳﺖ ﻛﻪ در اﻳﺮان در ﺳﺎل 2006 ، ﻣﻴﺎﻧﮕﻴﻦ DMFT در ﻣ ﻴﺎن اﻓﺮاد 15 15 ﺑﻌﻀﻲ از ﻛﺸﻮرﻫﺎي در ﺣﺎل ﺗﻮﺳﻌﻪ ﻛﻪ اﺟﺮاي ﺑﺮﻧﺎﻣﻪ ﻫﺎي ﺳﺎﻟﻪ در ﭼﻨﺪ ﻛﺸﻮر دﻳﮕﺮ ﺑﺼﻮرت زﻳﺮ ﺑﻮد : ﻟﺒﻨﺎن 5/4= ؛ 4/5= ﺑﻬﺪاﺷﺖ دﻫﺎن ﻣﺒﺘﻨﻲ ﺑﺮ ﻣﺪارس در آﻧﻬﺎ ﺑﻬﺘﺮ ﺷﺪه اﺳﺖ، ﻋﻤﺎن 3/2= ؛ ﭘﺎﻛﺴﺘﺎن 1/9= ؛ آﻟﻤﺎن 1/8= ؛ داﻧﻤﺎرك 8/1= 8/1= ﺑﻬﺪاﺷﺖ د ﻫﺎن و دﻧﺪان در ﻣﻴﺎن ﮔﺮوه ﻫﺎي ﺟﻤﻌﻴﺘﻲ ﺟﻮان و اﻧﺪوﻧﺰي WHO 2006 ) =4/2 ). ). Lam et al. ﺑﻄﻮر ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪ اي ﺑﻬﺒﻮد ﻳﺎﻓﺘﻪ اﺳﺖ ( ﻣﻬـ ﻤﺘﺮﻳﻦ راه ﻣﻘﺎﺑﻠـ ﻪ ﺑﺎ ﭘﻮﺳﻴﺪﮔﻲ دﻧﺪان ﭘﻴﺸﮕﻴـ ﺮي از 2000 ). آن اﺳﺖ و ﻛﻠﻴـ ﺪ ﭘﻴﺸﮕﻴﺮي و ﻣﻮﻓﻘﻴﺖ در درﻣﺎن ﺑﻴﻤﺎري ﻫﺎي ﺑﻬﺪاﺷـ ﺖ ﺿﻌﻴﻒ دﻫـ ﺎن و دﻧـ ﺪان ﻣﻲ ـﺗ ﻮاﻧﺪ اﺛﺮات ﺎـدﻫ ن و دﻧﺪان و ﭘﻴﺸﮕﻴﺮي از ﭘﻮﺳﻴـ ﺪﮔﻲ دﻧـ ﺪان و زود از ﻧﺎﻣﻄﻠـ ﻮﺑﻲ ﺑﺮ ﻋﻤﻠـ ﻜﺮد ﻛﻮدﻛﺎن در ﻣﺪرﺳـ ﻪ و ﻣﻮﻓﻘﻴﺘﺸـ ﺎن دﺳﺖ دادن دﻧـ ﺪان ﻫﺎ، ﺑﻬﺪاﺷـ ﺖ دﻫﺎن و دﻧﺪان ﻣﻲ ﺑﺎﺷﺪ در ﺳـ ـﺮاﺳ ﺮ زﻧﺪﮔﻲ داﺷﺘـ ﻪ ﺑﺎﺷ ﺪـ . اﺣﺘﻤـ ﺎل اﻳﻨﻜ ـ ﻪ ( Morowatisharifabad and Karimzadeh 2007 ). ـﻛ ﻮدﻛﺎن ﺑﺎ ﺑﻬـ ﺪاﺷﺖ دﻫـ ﺎن ﺿﻌﻴﻒ ﻧﺴﺒﺖ ﺑﻪ ﻛﻮدﻛﺎن ﺑﺎ ﺳﺮ ﻣﻨﺸﺎء ﭘﻮﺳﻴﺪﮔﻲ دﻧﺪان و ﻧﺎراﺣﺘﻲ ﻫﺎي ﻟﺜﻪ ﻧﺪاﺷﺘﻦ آﮔﺎﻫﻲ ﺑﻬﺪاﺷﺖ دﻫﺎن ﺧﻮب روزﻫـ ﺎي ﻫﻤﺮاه ﺑﺎ ﻣﺤﺪودﻳﺖ ﺑﻴﺸﺘﺮ ﻛﺎﻓﻲ ﻧﺴﺒﺖ ﺑﻪ ﺑﻬﺪاﺷﺖ دﻫﺎن و دﻧﺪان و در ﻧﺘﻴﺠﻪ رﻓﺘﺎر ـﻣﺎﻧ ﻨﺪ ﻏﻴﺒﺖ از ﻣﺪرﺳﻪ داﺷﺘﻪ ﺑﺎﺷﻨﺪ 12 ﺑﺮاﺑﺮ ﺑﻴﺸﺘﺮ اﺳﺖ ﺳﺎزه ﻫﺎي ﻣﺪل ارﺗﻘﺎي ﺳﻼﻣﺖ ﭘﻨﺪر .../ 95 ﺑﻬﺪاﺷﺘﻲ ﻧﺎدرﺳ ﺖ و ﻧﺎﻛﺎﻓﻲ اﺳﺖ. اﻣﺮوزه ﺗﻮﺟﻪ ﺑﻪ ﻣﻲ ﺷﻮد، اﺣﺴ ﺎس ﻣﺮﺗﺒﻂ ﺑﺎ رﻓﺘﺎر[ ﻣﺜﺒﺖ وﻣﻨﻔﻲ]، ﺣﺎﻟـﺖ ﻫﺎي ﭘﻴﺸﮕﻴﺮي از ﺑﻴﻤﺎري ﻫﺎي دﻫﺎن و دﻧﺪان از ﻃﺮﻳﻖ ارﺗﻘﺎي اﻧﺘﺰاﻋـﻲ اﺣﺴﺎس ﺑﺮ ﭘﺎﻳـﻪ ي ﺗﻨـ ﺎﺳﺐ ﻫﺎ ي ﺗﺤﺮﻳﻜﻲ ﻣﺮﺗﺒﻂ ﺑﺎ آﮔﺎﻫﻲ ﻫﺎ و در دﺳﺘﺮس ﻗﺮار دادن اﻣﻜﺎﻧﺎت اوﻟﻴﻪ ﭘﻴﺸﮕﻴﺮي، ﺣﺎدﺛﻪ رﻓﺘﺎري، ﺗﺄﺛﻴﺮ ﮔﺬارﻧﺪه ﻫﺎي ﺑﻴﻦ ﻓﺮدي، ﺷﻨﺎﺧﺖ ﻫﺎي ﺟﺰء ﻣﻬﻤﺘﺮﻳﻦ اﻫﺪاف ﺳﺎزﻣﺎن ﺑﻬﺪاﺷﺖ ﺟﻬﺎﻧﻲ ( WHO ) ﻣﺮﺗﺒﻂ ﺑﺎ رﻓﺘﺎرﻫﺎ، ﻋﻘﺎﻳﺪ ﻳﺎ ﻧﮕﺮش ﻫﺎي دﻳﮕﺮان، ﺗﺄﺛﻴﺮ اﺳﺖ . از ﻣﺤﻮرﻫﺎي ﻋﻤﺪه ﻛﻨﺘﺮل ﺑﻴﻤﺎري ﻫﺎ، آﻣﻮزش ﮔﺬارﻧﺪه ﻫﺎي وﺿﻌﻴﺘﻲ، ا دراﻛﺎت و ﺷﻨﺎﺧﺖ ﻫﺎي ﻓﺮدي از ﻫﺮ ﺑﻬﺪاﺷﺖ ﺑﻪ ﺟﺎﻣﻌﻪ و آﻣﻮزش ﺑﻬﺪاﺷﺖ ﺑﻪ ﮔﺮوه در ﻣﻌﺮض وﺿﻌﻴﺖ ﻳﺎ زﻣﻴﻨﻪ اي ﻛﻪ ﺑﺘﻮاﻧﺪ رﻓﺘﺎ ر را ﺗﺴﻬﻴﻞ ﻧﻤﻮده و ﻳﺎ ﻣﺎﻧﻊ ﺧﻄﺮ ﻳﺎ ﮔﺮوﻫﻲ ﻛﻪ ﻧﻘﺶ ﻋﻤﺪه اي در ﻛﻨﺘﺮل ﺑﻴﻤﺎري ﻫﺎ ﺷﻮد، ﺗﻌﻬﺪ ﺑﻪ ﻃﺮح، ﺗﻌﻬﺪ ﺑﻪ اﻧﺠﺎم ﻳﻚ ﻋﻤﻞ ﺑﺨﺼﻮص دارﻧﺪ، ﻣﻲ ﺑﺎﺷﺪ ( Rahimloo and Zarei 1999 ). ﺑﺮ ﺑﺪون ﺗﻮﺟﻪ ﺑﻪ ﺗﺮﺟﻴﺤﺎت رﻗﺎﺑﺖ ﻛﻨﻨﺪه ، رﻓﺘﺎر، ﻋﻤﻠﻲ ﻛﻪ در اﺳـ ﺎس ﮔﺰارﺷﺎت ﻣﻮﺟـ ﻮد، آﻣﻮزش ﺑﻬﺪاﺷـ ﺖ ﻣﻲﺗـ ﻮاﻧﺪ ﻳﻚ زﻣﺎن ﻣﺨﺼﻮص اﻧﺠﺎم ﺷﻮد و داراي ﻳﻚ زﻣﻴﻨﻪ و ﻫﺪف ﺑﻬﺘﺮﻳﻦ و ﻣﻮﺛـ ﺮﺗﺮﻳﻦ راه ﺑﺮاي ﺗﺄﻣﻴـ ﻦ ﺳﻼﻣـ ﺖ اﻓﺮاد ﺑﺨﺼﻮص ﺗﻮﺻﻴﻒ ﺷﻮد . ﻣﻄﺎﻟﻌ ﺎت ﻣﺨﺘﻠﻒ ﻧﺸﺎن داد ه اﺳﺖ ﺟﺎﻣﻌـ ﻪ ﺑﺎﺷﺪ، ﭼﻪ از ﻧﻈﺮ ﺗﺄﻣﻴﻦ ﻧﻴﺮوي اﻧﺴﺎﻧﻲ و ﭼﻪ از ﻧﻈﺮ ﻛﻪ اﻳﻦ ﻣﺪل ﻣﻲ ﺗﻮاﻧﺪ ﺑﻪ ﻋﻨﻮان ﭼ ﺎرﭼﻮﺑﻲ ﺟﻬﺖ ﺑﺮﻧﺎﻣﻪ رﻳﺰي ﻫﺰﻳ ﻨﻪ ﻫﺎي ﺳﻨﮕﻴﻦ درﻣﺎﻧﻲ . ﺑﻨﺎﺑﺮاﻳﻦ ﺑﺎﻳﺪ آﻣﻮزش ﺑﻬﺪاﺷﺖ و ﻣﺪاﺧﻼت در راﺳﺘﺎي ﺑﻬﺒﻮد رﻓﺘﺎرﻫﺎي ارﺗﻘﺎي دﻫﻨﺪه ﺳﻼﻣﺖ روش ﻫﺎي ﭘﻴﺸﮕﻴﺮي ﺑﻪ ﻧﺤﻮي اﻧﺠﺎم ﭘﺬﻳﺮد ﺗﺎ ﺑﺘﻮاﻧﺪ ﺑﺎ ﺑﻜﺎر ﺑﺮده ﺷﻮد ( Morowatisharifabad and ﻛﺎرﺑﺮد روش ﻫﺎي ﺟﺪﻳﺪ و در ﻋﻴﻦ ﺣﺎل آﺳﺎن و ﻗﺎﺑﻞ ﻗﺒﻮل Karimzadeh 2007). ﺑﺮاي اﻓﺮاد ﺟﺎﻣﻌﻪ از ﭘﻴﺪاﻳﺶ ﺑﻴﻤﺎري ﻫﺎي ﭘﺮﻳﻮدﻧﺘﺎل ﺑﺴﻴﺎري از ﺻﺎﺣﺒﻨﻈـ ﺮان ﻣﻌﺘﻘﺪﻧﺪ ﻣﺴﺎﺋـ ﻞ و ﻣﺸﻜﻼت ﺟﻠﻮﮔﻴﺮي ﺑﻌﻤﻞ آورد ( Akhawan et al. 2002). ﻧﻮﺟـ ﻮاﻧﺎن ﺑﻴﺸﺘﺮ رﻓﺘـﺎ ري اﺳﺖ .
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