{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T22:40:23Z","timestamp":1791326423690,"version":"4.3.1"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T00:00:00Z","timestamp":1695340800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The IraPEN program is an adapted version of the WHO-PEN program designed to prevent four major non-communicable diseases in Iran. This study aimed to determine the rate of compliance and related factors among individuals participating in the IraPEN program for the prevention of cardiovascular disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>In this study, compliance was defined as timely referral to the health center as scheduled, and the researchers approached four pilot sites of IraPEN from March 2016 to March 2018. Sex-stratified logistic regressions were applied to investigate factors related to compliance. However, it is important to note that in this study, compliance was defined as compliance to revisit, not compliance to taking prescribed medications or behavioral lifestyle changes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The total compliance rate, including timely compliance and early and late compliance, was 16.5% in men and 23.3% in women. The study found that cardiovascular risk factors such as diabetes, hypertension, hypercholesterolemia, and being underweight were associated with lower compliance. The higher calculated risk of CVD was associated with higher compliance, but after adjusting for cardiovascular risk factors, high-risk individuals showed lower compliance. There was negligible interaction between sex and other factors for compliance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The compliance rate with scheduled programs for cardiovascular preventive strategies was very low, and high-risk individuals were less compliant, regardless of their high level of risk factors. The study recommends further training to increase awareness and knowledge regarding the IraPEN program and the prevention of non-communicable diseases among high-risk populations.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1098312","type":"journal-article","created":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T09:35:17Z","timestamp":1695375317000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Timely referral to health centers for the prevention of cardiovascular diseases: IraPEN national program"],"prefix":"10.3389","volume":"11","author":[{"given":"Fatemeh","family":"Hadavandsiri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davood","family":"Khalili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Mahdavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi","family":"Afkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afshin","family":"Ostovar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyed-Saeed","family":"Hashemi-Nazari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somayeh","family":"Derakhshan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1224","DOI":"10.1016\/S0140-6736(17)32471-6","article-title":"Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition","volume":"391","author":"Prabhakaran","year":"2018","journal-title":"Lancet (London, England)."},{"key":"B2","unstructured":"Data and Tools2017"},{"key":"B3","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1016\/S2213-8587(19)30179-2","article-title":"Metabolic health in the Middle East and north Africa","volume":"7","author":"Azizi","year":"2019","journal-title":"Lancet Diabetes Endocrinol."},{"key":"B4","unstructured":"Tools for Implementing WHO PEN (Package of Essential Noncommunicable Disease Interventions)2018"},{"key":"B5","unstructured":"Islamic Republic of Iran on a Fast-Track to Beating Noncommunicable Diseases2017"},{"key":"B6","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/1471-2261-7-32","article-title":"Prevalence of coronary artery disease risk factors in Iran: a population based survey","volume":"7","author":"Hatmi","year":"2007","journal-title":"BMC Cardiovasc Disord."},{"key":"B7","doi-asserted-by":"publisher","first-page":"35","DOI":"10.2147\/RMHP.S19801","article-title":"Adherence and health care costs","volume":"7","author":"Iuga","year":"2014","journal-title":"Risk Manag Healthc Policy"},{"key":"B8","doi-asserted-by":"publisher","first-page":"785","DOI":"10.7326\/0003-4819-157-11-201212040-00538","article-title":"Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review","volume":"157","author":"Viswanathan","year":"2012","journal-title":"Ann Intern Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1097\/01.mlr.0000163641.86870.af","article-title":"Impact of medication adherence on hospitalization risk and healthcare cost","volume":"43","author":"Sokol","year":"2005","journal-title":"Med Care"},{"key":"B10","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/j.amepre.2015.08.021","article-title":"Medication adherence and incident preventable hospitalizations for hypertension","volume":"50","author":"Will","year":"2016","journal-title":"Am J Prev Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"4","DOI":"10.7812\/TPP\/09-090","article-title":"Patients' perspectives on nonadherence to statin therapy: a focus-group study","volume":"14","author":"Fung","year":"2010","journal-title":"Perm J."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11883-012-0291-7","article-title":"How do we improve patient compliance and adherence to long-term statin therapy?","volume":"15","author":"Maningat","year":"2013","journal-title":"Curr Atheroscler Rep."},{"key":"B13","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.ypmed.2016.07.006","article-title":"Systematic review of interventions to improve adherence to statin medication: What do we know about what works?","volume":"90","author":"Rash","year":"2016","journal-title":"Prevent Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1517\/14740338.2011.583915","article-title":"Clinical impact and drivers of non-adherence to maintenance medication for inflammatory bowel disease","volume":"10","author":"Selinger","year":"2011","journal-title":"Expert Opin Drug Saf."},{"key":"B15","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1093\/ecco-jcc\/jjw002","article-title":"Non-adherence to Anti-TNF therapy is associated with illness perceptions and clinical outcomes in outpatients with inflammatory bowel disease: results from a prospective multicentre study","volume":"10","author":"van der Have","year":"2016","journal-title":"J Crohn's & Colitis."},{"key":"B16","volume-title":"Package of Essential Non-Communicable (PEN) Disease Interventions for Primary Health Care in Iran (IraPEN). (Implementation Tools for General Practitioner).","author":"Koosha","year":"2017"},{"key":"B17","volume-title":"Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care in Low-Resource Settings","year":"2010"},{"key":"B18","unstructured":"International Society of Hypertension (WH0\/ISH) Risk Prediction Charts for 14 WHO Epidemiological Sub-Regions. Eri\u015fim adresi2007"},{"key":"B19","first-page":"116","article-title":"Adherence to Iran's package of essential noncommunicable diseases (IraPEN) program for regular follow-up to reduce the risk of cardiovascular disease in healthcare centers","volume":"22","author":"Hadavand Siri","year":"2020","journal-title":"Iran J Endocrinol Metab."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e006056","DOI":"10.1161\/JAHA.117.006056","article-title":"Antihypertensive medication adherence and risk of cardiovascular disease among older adults: a population-based cohort study","volume":"6","author":"Yang","year":"2017","journal-title":"J Am Heart Assoc."},{"key":"B21","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1016\/S0022-3999(99)00057-4","article-title":"Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness","volume":"47","author":"Horne","year":"1999","journal-title":"J Psychosom Res."},{"key":"B22","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1093\/fampra\/19.5.476","article-title":"Patient trust in the physician: relationship to patient requests","volume":"19","author":"Thom","year":"2002","journal-title":"Fam Pract."},{"key":"B23","doi-asserted-by":"publisher","first-page":"18","DOI":"10.5365\/wpsar.2015.6.3.HYN_024","article-title":"Use of the WHO package of essential noncommunicable disease interventions after Typhoon Haiyan","volume":"6","author":"Martinez","year":"2015","journal-title":"WPSAR."},{"key":"B24","doi-asserted-by":"publisher","first-page":"CD006887","DOI":"10.1002\/14651858.CD006887.pub4","article-title":"Risk scoring for the primary prevention of cardiovascular disease","volume":"3","author":"Karmali","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"B25","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1186\/s12875-019-1019-3","article-title":"Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study","volume":"20","author":"Fernandez-Lazaro","year":"2019","journal-title":"BMC Fam Pract."},{"key":"B26","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1016\/j.ahj.2011.06.007","article-title":"Medication adherence: a call for action","volume":"162","author":"Bosworth","year":"2011","journal-title":"Am Heart J."},{"key":"B27","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s13031-017-0115-z","article-title":"Cardiovascular disease risk and prevention amongst Syrian refugees: mixed methods study of Medecins Sans Frontieres programme in Jordan","volume":"11","author":"Collins","year":"2017","journal-title":"Confl Health."},{"key":"B28","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1089\/jwh.2012.3972","article-title":"Influence of patient sex and gender on medication use, adherence, and prescribing alignment with guidelines","volume":"23","author":"Manteuffel","year":"2014","journal-title":"J Women's Health."},{"key":"B29","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/1475-2840-12-78","article-title":"Sex-specific-differences in cardiometabolic risk in type 1 diabetes: a cross-sectional study","volume":"12","author":"Kautzky-Willer","year":"2013","journal-title":"Cardiovasc Diabetol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"107","DOI":"10.3389\/fendo.2019.00107","article-title":"The sex-specific detrimental effect of diabetes and gender-related factors on pre-admission medication adherence among patients hospitalized for ischemic heart disease: insights from EVA study","volume":"10","author":"Raparelli","year":"2019","journal-title":"Front Endocrinol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"2535","DOI":"10.1111\/bcp.13706","article-title":"Therapeutic drug monitoring-guided definition of adherence profiles in resistant hypertension and identification of predictors of poor adherence","volume":"84","author":"Avataneo","year":"2018","journal-title":"Br J Clin Pharmacol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e023995","DOI":"10.1136\/bmjopen-2018-023995","article-title":"Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study","volume":"9","author":"Kimani","year":"2019","journal-title":"BMJ Open."},{"key":"B33","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1111\/jgs.12171","article-title":"Sex differences in barriers to antihypertensive medication adherence: findings from the cohort study of medication adherence among older adults","volume":"61","author":"Holt","year":"2013","journal-title":"J Am Geriatr Soc."},{"key":"B34","first-page":"568","article-title":"Antihypertensive medication adherence and subsequent healthcare utilization and costs","volume":"16","author":"Pittman","year":"2010","journal-title":"Am J Manag Care."},{"key":"B35","doi-asserted-by":"publisher","first-page":"910","DOI":"10.2337\/dc18-0575","article-title":"Long-term association of depression symptoms and antidepressant medication use with incident cardiovascular events in the look AHEAD (Action for Health in Diabetes) clinical trial of weight loss in type 2 diabetes","volume":"42","author":"Hazuda","year":"2019","journal-title":"Diabetes Care."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.2147\/PPA.S136639","article-title":"Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review","volume":"11","author":"Kennedy-Martin","year":"2017","journal-title":"Patient Prefer Adherence."},{"key":"B37","doi-asserted-by":"publisher","first-page":"e025477","DOI":"10.1136\/bmjopen-2018-025477","article-title":"Association between family history of diabetes and clusters of adherence to healthy behaviors: cross-sectional results from the Health Examinees-Gem (HEXA-G) study","volume":"9","author":"Choi","year":"2019","journal-title":"BMJ Open"},{"key":"B38","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.copsyc.2015.03.012","article-title":"Risk perceptions and health behavior","volume":"5","author":"Ferrer","year":"2015","journal-title":"Curr Opin Psychol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1093\/fampra\/cml006","article-title":"Perceptions of family history across common diseases: a qualitative study in primary care","volume":"23","author":"Walter","year":"2006","journal-title":"Fam Pract."},{"key":"B40","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1097\/JCN.0b013e31827db5eb","article-title":"Family history of cardiovascular disease (CVD), perceived CVD risk, and health-related behavior: a review of the literature","volume":"29","author":"Imes","year":"2014","journal-title":"J Cardiovasc Nurs."},{"key":"B41","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1016\/S0002-8703(98)70318-7","article-title":"Risk factors in the offspring of women with premature coronary heart disease","volume":"135","author":"Allen","year":"1998","journal-title":"Am Heart J."},{"key":"B42","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.jtumed.2019.01.006","article-title":"Factors associated with adherence to Mediterranean diet among Saudi non-diabetic patients attending primary health care centers: a cross-sectional study","volume":"14","author":"Aljabri","year":"2019","journal-title":"J Taibah Univ Medical Sci."},{"key":"B43","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1161\/ATVBAHA.113.300156","article-title":"Smoking and cardiovascular disease: mechanisms of endothelial dysfunction and early atherogenesis","volume":"34","author":"Messner","year":"2014","journal-title":"Arterioscler Thromb Vasc Biol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"759","DOI":"10.3390\/nu12030759","article-title":"Gender-related determinants of adherence to the mediterranean diet in adults with ischemic heart disease","volume":"12","author":"Raparelli","year":"2020","journal-title":"Nutrients."},{"key":"B45","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.rmr.2015.08.005","article-title":"Smoking and adherence to anti-tuberculosis treatment","volume":"33","author":"Underner","year":"2016","journal-title":"Rev Mal Respir."},{"key":"B46","doi-asserted-by":"publisher","first-page":"278","DOI":"10.4278\/ajhp.150205-QUAN-709","article-title":"Health behaviors and medication adherence in elderly patients","volume":"31","author":"Han","year":"2017","journal-title":"Am J Health Promot."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1002\/pds.3526","article-title":"Factors influencing adherence in long-term use of statins","volume":"22","author":"Warren","year":"2013","journal-title":"Pharmacoepidemiol Drug Saf."},{"key":"B48","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1161\/01.HYP.0000035855.44620.DA","article-title":"Treatment and control of hypertension in the community: a prospective analysis","volume":"40","author":"Lloyd-Jones","year":"2002","journal-title":"Hypertension"},{"key":"B49","doi-asserted-by":"publisher","first-page":"3","DOI":"10.5812\/ijem.101612","article-title":"Knowledge, attitude, and practice regarding cardiovascular diseases in adults attending health care centers in Tehran, Iran","volume":"18","author":"Koohi","year":"2020","journal-title":"Int J Endocrinol Metabol"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1098312\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T09:35:24Z","timestamp":1695375324000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1098312\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,22]]},"references-count":49,"alternative-id":["10.3389\/fpubh.2023.1098312"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1098312","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,22]]},"article-number":"1098312"}}