Document Type : Original Article


1 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, IranIranian Heart Foundation (IHF), Iran

2 Iranian Heart Foundation (IHF), Iran

3 Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

4 Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

5 Department of Epidemiology and Biostatistics, Health School, Isfahan University of Medical Sciences, Iran

6 Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran

7 Hormozgan Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandarabbas, Iran

8 Cardiovascular Disease Research Center, Birjand University of Medical Sciences, Birjand, Iran

9 Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran

10 Department of Psychiatry, Shahrekord University of Medical Sciences, Shahrekord, Iran

11 Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

12 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

13 Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

14 Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran


BACKGROUND: To investigate the effects of comprehensive, integrated interventions on dyslipidemia Knowledge and Practices (LIPOKAP) using population and high-risk approaches.
METHODS: The baseline of this national, multicentric community trial was conducted on three groups: the general population (adults over the age of 18 and their children aged 6-18), patients with dyslipidemia and their caregivers, and health professionals (physicians, nurses, health providers, and health workers). The general population was selected using multi-stage random sampling, while patients and health professionals were recruited using the consecutive sampling method. The research was carried out in urban and rural areas of five Iranian counties. The sampling method and sample size were similar in baseline and post-intervention surveys. Approximately 8-month intervention programs were carried out on the target groups, which generally included educational strategies. The intervention activities addressed the management, prevention, and control and were tailored to each target group, focusing on lifestyle and self-care. 
RESULTS: All questionnaires’ content validity ratio, content validity index, and Cronbach’s alpha were over 0.68, 0.83, and 0.73, respectively. We enrolled 2456 adults and 850 of their children, 3331 dyslipidemia patients, 1699 caregivers, and 1800 health professionals.
CONCLUSIONS: The validity and reliability of all developed questionnaires that can examine knowledgeand practice  changes as a result of intervention activities were acceptable.


1. Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol 2017; 70(1): 1-25.
2. Sarrafzadegan N, Mohammmadifard N. Cardiovascular Disease in Iran in the Last 40 Years: Prevalence, Mortality, Morbidity, Challenges and Strategies for Cardiovascular Prevention. Arch Iran Med 2019; 22(4): 204-10.
3. Organization. WH. WHO/Europe International Conference on Cardiovascular Diseases. Saint Petersburg, Russian Federation . 2015.
4. Hedayatnia M, Asadi Z, Zare-Feyzabadi R, Yaghooti-Khorasani M, Ghazizadeh H, Ghaffarian-Zirak R, Nosrati-Tirkani A, Mohammadi-Bajgiran M, Rohban M, Sadabadi F, Rahimi HR. Dyslipidemia and cardiovascular disease risk among the MASHAD study population. Lipids in health and disease. 2020; 19(1): 1-11.
 5. Silverman MG, Ference BA, Im K, Wiviott SD, Giugliano RP, Grundy SM, et al. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis. JAMA 2016; 316(12): 1289-97.
6. Jamé S, Wittenberg E, Potter MB, Fleischmann KE. The new lipid guidelines: what do primary care clinicians think? Am J Med 2015; 128(8): 914.e5-.e10.
7. Ai AL, Carretta H, Beitsch LM, Watson L, Munn J, Mehriary S. Medication therapy management programs: promises and pitfalls. J Manag Care Spec Pharm.2014; 20(12): 1162-82.
8. Fernandez-Lazaro CI, García-González JM, Adams DP, Fernandez-Lazaro D, Ayuso J, Caballero-Garcia A, Moreno Racionero F, et al. Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC Fam Pract. 2019; 20(1): 132.
9. Kelishadi R, Mohammadifard N, Sarrazadegan N, Nouri F, Pashmi R, Bahonar A, et al. The effects of a comprehensive community trial on cardiometabolic risk factors in adolescents: Isfahan Healthy Heart Program. ARYA atheroscler 2012; 7(4): 184-90.
10. Sarrafzadegan N, Kelishadi R, Sadri G, Malekafzali H, Pourmoghaddas M, Heidari K, et al. Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: the Isfahan Healthy Heart Program. Arch Iran Med 2013; 16(1): 4-11.
11. Shirani S, Kelishadi R, Sarrafzadegan N, Khosravi A, Sadri G, Amani A, et al. Awareness, treatment and control of hypertension, dyslipidaemia and diabetes mellitus in an Iranian population: the IHHP study. East Mediterr Health J 2009; 15(6): 1455-63.
12. Sarrafzadegan N, Laatikainen T, Mohammadifard N, Fadhel I, Yach D, Puska P. “Isfahan Healthy Heart Program”: A practical model of implementation in a developing country. Prog Prev Med 2018; 3(3): e0014.
13. Ayre C, Scally A. Critical values for Lawshe’s content validity ratio. Measurement and Evaluation in Counseling and Development. 2013; 47: 79-86.
14. Mohammadifard N, Haghighatdust F, Kelishadi R, Bahonar A, Dianatkhah M, Heidari H, et al. Validity and reproducibility of a semi-quantitative food frequency questionnaire for Iranian adults. Nutr Diet. 2021;78(3):305314.
15. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35(8): 1381-95.
16. Global Adult Tobacco Survey Collaborative Group. Global adult tobacco survey (GATS): core questionnaire with optional questions, version 2.0; 2010.
17. Anisi J, Bahadori MH, Jahanbakhsh M. Developing and validation of identifying people in risk of addiction questionnaire (I.p.R.a). Int J High Risk Behav Addict 2013; 1(4): 183-91.
18. Liang N, Zhao Q, He Y, Li J, Yang L. Development and Validity of a Questionnaire on Dyslipidemia Dietary Knowledge. BioMed Res Inter 2019; 2019: 5382130.
19. Ameh PO, Yakubu K, Miima M, Popoola O, Mohamoud G, Von Pressentin KB. Lifestyle, cardiovascular risk knowledge and patient counselling among selected sub-Saharan African family physicians and trainees. Afr J Prim Health Care Fam Med. 2019; 11(1): e1-e15.
20. Taber KS. The Use of Cronbach’s Alpha When Developing and Reporting Research Instruments in Science Education. Res Sci Educ 2018; 48(6): 1273-96.
21. Mazloomy SS, Baghianimoghadam MH, Ehrampoush MH, Baghianimoghadam B, Mazidi M, Mozayan MR. A study of the knowledge, attitudes, and practices (KAP) of the women referred to health centers for cardiovascular disease (CVDs) and their risk factors. Health Care Women Inter 2014; 35(1): 50-9.
22. Rashidi Y, Manaflouyan H, Pournaghi Azar F, Nikniaz Z, Nikniaz L, Ghaffari S. Knowledge, attitude and practice of Iranian hypertensive patients regarding hypertension J Cardiovasc Thorac Res  2018; 10(1): 14-9.
23. Saeidlou SN, Babaei F, Ayremlou P. Nutritional Knowledge, Attitude and Practice of North West Households in Iran: Is Knowledge likely to Become Practice? Maedica 2016; 11(4): 286-95.
24. Karbalaeifar R, Kazempour-Ardebili S, Amiri P, Ghannadi S, Tahmasebinejad Z, Amouzegar A. Evaluating the effect of knowledge, attitude and practice on self-management in patients with type 2 diabetes. Acta diabetol 2016; 53(6): 1015-23.
25. Niroomand M, Ghasemi SN, Karimi-Sari H, Kazempour-Ardebili S, Amiri P, Khosravi MH. Diabetes knowledge, attitude and practice (KAP) study among Iranian in-patients with type-2 diabetes: A cross-sectional study. Diabetol Metab Syndr 2016; 10(1 Suppl 1): S114-9.
26. Niroomand M, Ghasemi SN, Karimi-Sari H, Khosravi MH. Knowledge, Attitude, and Practice of Iranian Internists Regarding Diabetes: A Cross Sectional Study. Diabetes Metab 2017; 41(3): 179-86.
27. Farshidi H, Nikparvar M, Rostami-Qeshmi I, Ezzati-Rad R, Piroozan A, Boushehri E. Physicians’ knowledge, attitudes, and practice for hypertension management: A cross-sectional study in Hormozgan province, Iran. ARYA atheroscl 2018; 14(3): 132-8.
28. Sabouhi F, Babaee S, Naji H, Zadeh AH. Knowledge, awareness, attitudes and practice about hypertension in hypertensive patients referring to public health care centers in Khoor & Biabanak. Iran J nursing and midwifery research. 2011; 16(1): 34-40.
29. Correction to: 2018 AHA/ ACC/ AACVPR/ AAPA/ ABC/ ACPM/ ADA/ AGS/ APhA/ ASPC/ NLA/ PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 139(25): e1178-e81.
30. Del Castillo JA, del Castillo-López ÁG, Dias PC, García-Castillo F. Social networks as tools for the prevention and promotion of health among youth. Psicologia: Reflexão e Crítica. 2020; 33(1): 13.
31. Neiderud CJ. How urbanization affects the epidemiology of emerging infectious diseases. Infect Ecol Epidemiol. 2015; 5(1): 27060.
32. Khosravi A, Mehr GK, Kelishadi R, Shirani S, Gharipour M, Tavassoli A, et al. The impact of a 6-year comprehensive community trial on the awareness, treatment and control rates of hypertension in Iran: experiences from the Isfahan healthy heart program. BMC Cardiovasc Disord 2010; 10(1): 1-8.
33. Doğan V, Başaran Ö, Özlek B, Çelik O, Özlek E, Mert KU, Rencüzoğulları İ, Mert GÖ, Doğan MM, Biteker M, Kayıkçıoğlu M. Rationale, design, and methodology of the Evaluation of Perceptions, Knowledge, and Compliance with the Guidelines in Real Life Practice: A Survey on the Under-treatment of Hypercholesterolemia. Turk Kardiyol Dern Ars. 2018; 46(1): 47-53.