Journal of Education and Health Promotion

Abstract BACKGROUND: Mothers need the necessary skills to be empowered in successful breastfeeding.
This study aimed to investigate effectiveness of the distance education program on the mothers’
empowerment in exclusive breastfeeding.
MATERIALS AND METHODS: A randomized clinical trial study was done on 72 nulliparous pregnant
women 28–32 weeks with normal pregnancy. The qualified women were randomly assigned to the
intervention and control groups based on the random‑number table. The breastfeeding training
packages were sent to women in the intervention group via Telegram every week from 32 until
37 weeks of gestation. The mothers’ empowerment in breastfeeding (primary outcome) and the
exclusive breastfeeding rate (secondary outcome) were assessed by questionnaires.
RESULTS: Based on the repeated measured tests, although scores for all domains and also the
total score of the mothers’ empowerment in breastfeeding between two groups had increased
during the study period, there was a significant difference between the increasing trends of the
maternal empowerment domains in two groups (interaction P value ‹0.001). Also, the prevalence of
exclusive breastfeeding (secondary outcome) at 6 months was significantly higher in the intervention
group (81.8% and 57.1% in the intervention and control groups, respectively) (P = 0.028).
CONCLUSION: Distance education could increase all domains of the mothers’ empowerment in
breastfeeding after delivery. Also, exclusive breastfeeding at 6 months after delivery was significantly
higher in mothers who were receiving the distance education packages.

Abstract BACKGROUND: Infertility is one of the main concerns in women’s lives that may lead to psychological
imbalance and disrupt their sexual relationship. The study was conducted with the aim of evaluating
role of mental health in prediction of sexual function in infertile women.
MATERIALS AND METHODS: This analytic‑descriptive study was conducted in 2015–2016 in
424 infertile women referring to Fatemeh Zahraa Infertility and Reproductive Health Center, Babol,
Iran. The participants filled out the Female Sexual Function Index (α = 0.72–0.90), General Health
Questionnaire (GHQ‑28, α = 0.86), and demographics questionnaires. Linear regression used to
analyze the data.
RESULTS: The mean of total GHQ was 23.57 ± 12.06. The highest mean of GHQ subscales was
social dysfunction (8.68 ± 3.69). There was a negative association between GHQ with the overall
sexual function of infertile women (r = −0.397, P < 0.0001). The higher mental health disorder was
associated with lower sexual function. Furthermore, there was an inverse significant association
between all the subscales of mental health and sexual function. Based on the multiple linear regression
analysis, the variables of anxiety and sleep disorder (β = −0.143, P < 0.035), social dysfunction
(β= −0.139, P < 0.003), depression symptoms (β = −0.121, P < 0.046), sexual intercourse frequency
(β = 0.272, P < 0.0001), and educational level (β = −0.110, P < 0.016) were the significant predictors
of perceived sexual dysfunction after adjusting for other variables. The strongest predictor of the
GHQ subscale was anxiety and sleep disorder.
CONCLUSIONS: Undesirable conditions of mental health and its adverse effects on sexual function
and also other predictors emphasize the need to develop more effective screening and supportive
strategies with the help of the psychologists.

Abstract BACKGROUND: Postpartum period and recurrent abortion are stressful conditions that affect
women’s mental health. Stress and depression lead to the release of stress biomarkers that may
be dangerous for the mother and fetus. The aim of this study was to determine stress in the after
recurrent pregnancy loss (RPL) and normal vaginal delivery (NVD) in the north of Iran.
MATERIALS AND METHODS: This case–control study was done on forty women with NVD and
forty women with RPL. Stress was measured through measuring serum cortisol, Perceived Stress
Scale‑14 (PSS‑14), and the revised version of the Symptom Checklist‑90 (SCL‑90‑R). Data were
analyzed using the Statistical Package for the Social Sciences (SPSS) 22.0 software. Chi‑square
test, independent‑samples t‑test, Mann–Whitney U‑test, and Pearson correlation were used to
analyze the data.
RESULTS: Findings showed that nonpregnant healthy women had significantly higher
cortisol level than RPL women (mean ± standard deviation [SD]: 155.80 ± 84.97 ng/ml and
126.02 ± 50.44 ng/ml, P < 0.011), respectively. Furthermore, they had higher PSS‑14 and
SCL‑90 scores than PRL women (mean ± SD: 25.87 ± 7.48 and 25.5 ± 9.19, P = 0.745, and
mean ± SD: 1.27±0.63 and 1.20 ± 0.53, P = 0.624), respectively.
CONCLUSION: High levels of cortisol reflect the acute stress caused by the care of the baby in
women. Therefore, social support for the pregnant woman by the health‑care team is an essential
factor for reducing postpartum depression.