Healthcare-delivered lifestyle recommendations and their association with health behaviors in Iran

Background Non-communicable diseases (NCDs) are the leading cause of mortality in Iran, driven largely by modifiable lifestyle risk factors. Healthcare providers play a pivotal role in delivering preventive lifestyle recommendations, yet the extent and effectiveness of these efforts remain unclear. This study aimed to assess the distribution of lifestyle counseling across sociodemographic and clinical subgroups and its association with health behavior status in Iran using data from the 2021 WHO STEPS survey. Methods We conducted a cross-sectional analysis of 27,704 included adults participating in the nationally representative 2021 STEPS survey in Iran. Data on delivery of ten specific lifestyle recommendations within the past 12 months, covering diet, physical activity, weight management, and tobacco non-initiation/cessation, were collected. Associations between recommendation delivery and health behaviors were analyzed using logistic regression models. Results Only 33.4% (95% Confidence Interval (CI): 32.8–34.0) of participants received all ten lifestyle recommendations, while 10.7% (10.2–11.1) received no recommendations. Recommendations were more frequently delivered to females, rural residents, and individuals with multiple comorbidities, indicating a risk-based response by healthcare providers. Notably, tobacco non-initiation/cessation advice was not more commonly offered to patients with multiple chronic conditions. Delivery of lifestyle counseling was associated with positive behavior status: individuals who received weight loss/ maintaining normal weight and physical activity advice were more likely to engage in sufficient physical activity (adjusted odds ratio 1.21(1.13–1.29)), and among current smokers, receiving tobacco cessation recommendation was associated with a higher likelihood of attempting tobacco cessation (aOR: 1.83(1.49–2.24)). A dose-response relationship was observed between the number of nutritional recommendations received and better diet quality (aOR for 6 vs. ≤ 2 recommendations: 1.32 (1.24–1.41)). Geographical disparities were evident, with eastern provinces receiving the least comprehensive counseling. Conclusion Delivery of lifestyle recommendations by healthcare providers in Iran shows variation by sociodemographic and clinical factors and is positively associated with behavior status. Given the cross-sectional design, causal or temporal relationships cannot be inferred. These findings suggest opportunities for more equitable and consistent delivery of preventive counseling within national NCD prevention efforts.