The Effectiveness of Health-promoting lifestyle training on psychological well-being, hopefulness, and quality of life in patients with diabetes

Document Type : Original Article


1 Department of psychology, Kish International Branch, Islamic Azad University, Kish Island, Iran.

2 Assistant Professor, Department of Clinical Psychology, Kharazmi University, Tehran, Iran.

3 Professor, Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran.


Background: It is necessary to help people with diabetes to solve the problems related to diabetes, recognizing the factors affecting their psychological well-being, hope, and quality of life that can be improved by using different approaches.
Objectives: This study aimed to determine health-promoting lifestyle education on psychological well-being, hope, and quality of life in patients with diabetes.
Methods: The present study was quasi-experimental research was pre-test-post-test and follow-up with the control group. The statistical population of the study includes patients with type 2 diabetes referred to medical centers and diabetes associations in Tehran. The participants were selected by convenience sampling method and assigned to two groups of health-promoting lifestyle training (n=15) and control group (n=15) using simple randomization method. Data were obtained using the Ryff Psychological Well-Being Scale (RSPWB), World Health Organization Quality of Life Questionnaire, Snyder Hope Scale (SHS). The health-promoting lifestyle training was performed in 10 sessions (one session per week) for 90 minutes. Data were analyzed using the repeated measurement method and SPSS.22 software.
Results: The results showed that health-promoting lifestyle education is effective on psychological well-being (p<0.001), hope (p<0.001), and quality of life (p<0.001) in patients with diabetes.
Conclusion: Based on the findings of this study, it can be said that health-promoting lifestyle education is effective on psychological well-being, hope, and quality of life in patients with diabetes.


 1.American Diabetes Association. Executive summary:
standards of medical care in diabetes—2014.
2.Domingueti CP, Dusse LM, das Graças Carvalho M,
de Sousa LP, Gomes KB, Fernandes AP. Diabetes
mellitus: the linkage between oxidative stress,
inflammation, hypercoagulability and vascular
complications. Journal of Diabetes and its
Complications. 2016 May 1;30(4):738-45.
3.Nathan HJ, Poulin P, Wozny D, Taljaard M, Smyth C,
Gilron I, Sorisky A, Lochnan H, Shergill Y. Randomized
trial of the effect of mindfulness-based stress reduction
on pain-related disability, pain intensity, health-related
quality of life, and A1C in patients with painful diabetic
peripheral neuropathy. Clinical Diabetes. 2017 Dec
4.Rook KS, August KJ, Choi S, Franks MM, Stephens
MA. Emotional reactivity to daily stress, spousal
emotional support, and fasting blood glucose among
patients with type 2 diabetes. Journal of health
psychology. 2016 Nov;21(11):2538-49.
5.Verma SK, Luo N, Subramaniam M, Sum CF, Stahl D,
Liow PH, Chong SA. Impact of depression on health
related quality of life in patients with diabetes. Annals
Academy of Medicine Singapore. 2010 Dec
6.Tomas-Carus P, Ortega-Alonso A, Pietilainen KH,
Santos V, Goncalves H, Ramos J, Raimundo A. A
randomized controlled trial on the effects of combined
aerobic-resistance exercise on muscle strength and
fatigue, glycemic control and health-related quality of
life of type 2 diabetes patients. The Journal of sports
medicine and physical fitness. 2016 May 1;56(5):572-8.
7.Anderson BJ, Laffel LM, Domenger C, Danne T,
Phillip M, Mazza C, Hanas R, Waldron S, Beck RW,
Calvi-Gries F, Mathieu C. Factors associated with
diabetes-specific health-related quality of life in youth
with type 1 diabetes: the Global TEENs Study. Diabetes
Care. 2017 Aug 1;40(8):1002-9.
8.Livingstone SJ, Levin D, Looker HC, Lindsay RS,
Wild SH, Joss N, Leese G, Leslie P, McCrimmon RJ,
Metcalfe W, McKnight JA. Estimated life expectancy in
a Scottish cohort with type 1 diabetes, 2008-2010. Jama.
2015 Jan 6;313(1):37-44.
9.Walker J, Colhoun H, Livingstone S, McCrimmon R,
Petrie J, Sattar N, Wild S, Scottish Diabetes Research
Network Epidemiology Group. Type 2 diabetes,
socioeconomic status and life expectancy in Scotland
(2012–2014): a population-based observational study.
Diabetologia. 2018 Jan 1;61(1):108-16.
10.Sussman JB, Kerr EA, Saini SD, Holleman RG,
Klamerus ML, Min LC, Vijan S, Hofer TP. Rates of
deintensification of blood pressure and glycemic
medication treatment based on levels of control and life
expectancy in older patients with diabetes mellitus.
JAMA internal medicine. 2015 Dec 1;175(12):1942-9.
11.Boehm JK, Trudel-Fitzgerald C, Kivimaki M,
Kubzansky LD. The prospective association between
positive psychological well-being and diabetes. Health
Psychology. 2015 Oct;34(10):1013.
12.Hofmann M, Dack C, Barker C, Murray E. The
impact of an internet-based self-management
intervention (HeLP-diabetes) on the psychological wellbeing of adults with type 2 diabetes: a mixed-method
cohort study. Journal of diabetes research. 2016 Jan
13.Huijg JM, Gebhardt WA, Verheijden MW, van der
Zouwe N, de Vries JD, Middelkoop BJ, Crone MR.
Factors influencing primary health care professionals’
physical activity promotion behaviors: a systematic
review. International journal of behavioral medicine.
2015 Feb 1;22(1):32-50.
14.Neville K, Cole DA. The relationships among health
promotion behaviors, compassion fatigue, burnout, and
compassion satisfaction in nurses practicing in a
community medical center. JONA: The Journal of
Nursing Administration. 2013 Jun 1;43(6):348-54.
15.Golden SD, Earp JA. Social ecological approaches to
individuals and their contexts: twenty years of health
education & behavior health promotion interventions.
Health education & behavior. 2012 Jun;39(3):364-72.
16.Khalaila R, Litwin H. Changes in health behaviors
and their associations with depressive symptoms among
Israelis aged 50+. Journal of aging and health. 2014
17.Ryff CD, Keyes CL. The structure of psychological
well-being revisited. Journal of personality and social
psychology. 1995 Oct;69(4):719.

Ghorbani M et al.
96 Razavi Int J Med. 2022; 10(2):e1109.
18.Dadfar M, Momeni Safarabad N, Asgharnejad Farid
AA, Nemati Shirzy M, Ghazie pour Abarghouie F.
Reliability, validity, and factorial structure of the World
Health Organization-5 Well-Being Index (WHO-5) in
Iranian psychiatric outpatients. Trends in psychiatry and
psychotherapy. 2018 Apr;40(2):79-84.
19.Whoqol Group. Development of the World Health
Organization WHOQOL-BREF quality of life
assessment. Psychological medicine. 1998
20.Nedjat S, Montazeri A, Holakouie K, Mohammad K,
Majdzadeh R. Psychometric properties of the Iranian
interview-administered version of the World Health
Organization's Quality of Life Questionnaire
(WHOQOL-BREF): a population-based study. BMC
health services research. 2008 Dec;8(1):1-7.
21.Snyder CR, Harris C, Anderson JR, Holleran SA,
Irving LM, Sigmon ST, Yoshinobu L, Gibb J, Langelle
C, Harney P. The will and the ways: development and
validation of an individual-differences measure of hope.
Journal of personality and social psychology. 1991
22.Shahidi E, Aliakbari M, Yavari M. The Role of
Personality traits in Prediction of Hope in Men with
Cardiovascular Disease. Journal of Research & Health.
2019; 9(7):699-705.
23.Hua Y, Wang B, Wallen GR, Shao P, Ni C, Hua Q.
Health-promoting lifestyles and depression in urban
elderly Chinese. PloS one. 2015 Mar 17;10(3):e0117998.
24.nilsaz M, tavasoli E, mazaheri M, sohrabi F, khezeli
M, ghazanfari Z. Study of Health-promotion behaviors
and Life Style among students of Dezful universities.
scientific journal of ilam university of medical sciences.
2013 Mar 1;20(5):168-75.
25.Mak YW, Kao AH, Tam LW, Virginia WC, Don TH,
Leung DY. Health-promoting lifestyle and quality of life
among Chinese nursing students. Primary health care
research & development. 2018 Nov;19(6):629-36.
26.Kim HJ, Choi‐Kwon S, Kim H, Park YH, Koh CK.
Health‐promoting lifestyle behaviors and psychological
status among Arabs and Koreans in the United Arab
Emirates. Research in nursing & health. 2015
27.Fincham SM, Roomaney R, Kagee A. The
relationship between worldview, self-efficacy,
psychological distress, and a health-promoting lifestyle
among a South African undergraduate university sample.
South African Journal of Psychology. 2015
28.Chuang SP, Wu JY, Wang CS, Pan LH. Healthpromoting lifestyles and psychological distress
associated with well-being in community adults.
American Journal of Health Behavior. 2017 Jul
29.Han KS, Yang CH. Relationship between HealthPromoting lifestyle and psychological Well-Being in
obese Middle-Aged people. Indian Journal of Public
Health Research & Development. 2018;9(9):1098-106.
30.Cheng J, Wang T, Li F, Xiao Y, Bi J, Chen J, Sun X,
Wu L, Wu S, Liu Y, Luo R. Self-rated health status and
subjective health complaints associated with healthpromoting lifestyles among urban Chinese women: a
cross-sectional study. PloS one. 2015 Feb
31.Chen MF, Wang RH, Hung SL. Predicting healthpromoting self-care behaviors in people with prediabetes by applying Bandura social learning theory.
Applied Nursing Research. 2015 Nov 1;28(4):299-304.
32.Vahedi H, Khosravi A, Sadeghi Z, Aliyari R,
Shabankhamseh A, Mahdavian M, Binesh E, Amiri M.
Health-promoting lifestyle in patients with and without
diabetes in Iran. Health Scope. 2017 May;6(2).