Journal of Education and Health Promotion

Abstract BACKGROUND: Physical changes in high‑risk pregnancy (HRP) can lead to changes in mood and
social relationships and negative effects on women’s well‑being. Individuals in different sociocultural
contexts have different perceptions of well‑being. Yet, there is limited information about perceptions of
well‑being in HRP. This study aimed to explore the Iranian women’s experiences of well‑being in HRP.
MATERIALS AND METHODS: This qualitative study was conducted in 2019–2020 through directed
content analysis based on the conceptual framework of well‑being in HRP. Participants were 26
women with HRP purposively recruited from public and private healthcare settings in Mashhad, Iran.
Face‑to‑face semistructured interviews were held for data collection until data saturation. Data were
analyzed through directed content analysis proposed by Elo and kyngäs (2008) and were managed
using the MAXQDA (v. 10) program.
RESULTS: Well‑being in HRP had seven attributes in the five main dimensions of physical,
mental‑emotional, social, marital, and spiritual well‑being. The seven attributes of well‑being in HRP
were controlled physical conditions, controlled mood, emotions, and affections, perceived threat,
self‑efficacy, and competence for multiple role performance, maintained social relationships, meaning
seeking and relationship with the Creator, and positive marital relationships.
CONCLUSION: The present study provide an in‑depth understanding about well‑being in the Iranian
women with HRP. It is a complex and multidimensional concept with physical, mental‑emotional,
social, marital, and spiritual dimensions. Comprehensive multicomponent interventions are needed to
promote well‑being among women with HRP and designed the guidelines to provide woman‑centered
care.

Abstract BACKGROUND: Couples’ attitudes toward infertility are related to different dimensions of infertility.
Counseling can change attitudes toward infertility in infertile couples. Therefore, this study was
conducted to determine and compare the effect of face‑to‑face counseling and telephone counseling
on infertility attitudes in infertile couples.
MATERIALS AND METHODS: This two‑group intervention study was performed on 34 infertile
couples who were randomly assigned to face‑to‑face and telephone counseling groups. The couple
attended counseling sessions as scheduled by the researcher. An Infertility Attitude Questionnaire
was completed by all participants at the beginning and end of the study. Data were analyzed using
SPSS software version 16.
RESULTS: The results of independent t test showed that after the intervention, the mean score
of attitude toward infertility in the face‑to‑face counseling group was significantly higher than
the telephone counseling group. Based on paired t test, the mean score of infertility attitude in
the face‑to‑face counseling group was significantly increased two weeks after the intervention
compared to before. The mean score of infertility attitude in the telephone counseling group was
significantly increased two weeks after the intervention compared to before. According to the results
of independent t test, the attitude score toward infertility was not statistically significant between
the two groups.
CONCLUSION: The results of the present study showed that with counseling, the mean score of
infertility attitude in infertile couples in both groups had increased. In other words, counseling can
change attitudes toward infertility in infertile people.

Abstract BACKGROUND: The development of any society depends on proper planning in various fields such
as population and birth control. Fertility control is designed to create a level of population growth
appropriate to the resources available and to ensure a good life. Receiving information and education
is one of the basic strategies to change the attitude toward fertility and awareness in most people in
society. Therefore, this study was conducted to determine the effect of education on knowledge of
fertility counseling and attitudes toward fertility control in health workers.
MATERIALS AND METHODS: The present study was a randomized clinical trial with a control
group that was conducted in the presence of 107 health workers of health centers and community
health centers working in Mashhad in 2017. The research units were randomly divided into three
groups (webinar training, group discussion training, and control). Research tools were researcher‑made
questionnaires on attitudes toward fertility and measuring healthy reproductive awareness that all
study participants completed at the beginning of the study and 2 weeks after the intervention. Data
analysis was performed by the Chi‑square, one‑way analysis of variance, and independent t‑test
using the SPSS software version 16.
RESULTS: The results of this study showed that at the beginning of the study, all three groups
were homogeneous in terms of quantitative and qualitative demographic variables including age,
education, work experience, type of employment, and number of family members. The results of
Kruskal–Wallis test showed that before the intervention, the three groups did not have a statistically
significant difference in terms of mean scores of awareness about fertility counseling (P = 0.77) and
attitude toward fertility control (P = 0.523), but this relationship was significant after the interventions.
Furthermore, the results of Mann–Whitney intragroup test showed that the scores before and after
the intervention were significant in both educational groups (P = 0.001).
CONCLUSION: Considering the importance of healthy fertility counseling and the important place
of education in promoting awareness and attitude toward healthy fertility, it is recommended to use
active educational methods to promote the awareness and attitude of health workers to provide
healthy fertility services to couples.

Abstract BACKGROUND: Fertility is always one of the most important functions of the family. Having a
child equals growing up and entering the adult world. Adoption is one of the methods that can be
considered to treat infertility. One of the duties of health professionals, especially midwives, is to
advise and educate infertile people, which helps them in a way beyond medical treatment. Therefore,
this study was conducted to determine the effect of face‑to‑face and telephone counseling on the
desire for adoption in infertile couples.
MATERIALS AND METHODS: The present study was a two‑group counseling intervention study that was
performed on 34 infertile couples referred to Mashhad Infertility Center. Infertile couples were randomly
assigned to face‑to‑face and telephone counseling groups. All participants completed the Adoption
Adoption Questionnaire at the beginning and end of the study. Data were analyzed by spss16 software.
RESULTS: The mean score of propensity to adopt in the face‑to‑face counseling group 2 weeks after
the intervention was significantly higher than before the intervention. Furthermore, the mean score
of desire for adoption in the telephone counseling group increased significantly 2 weeks after the
intervention compared to before (P < 0.001). Adoption scores varied in the face‑to‑face counseling group
at 3.15 and in the telephone counseling group at 3.23. There was no statistically significant difference
between the two groups (P < 0.885). The most common reason for not wanting to adopt was hope
for self‑treatment and having children (70.6% women and 67.6% men). The most common reason for
accepting an adopted child was the strong need to have a child (23.5% in women and 23.5% in men).
CONCLUSION: According to the results of this study, counseling can increase people’s awareness
of the conditions of adoption and thus increase the desire of people to accept the adopted child. For
this reason, considering adoption counseling sessions for infertile couples who have been receiving
infertility treatment for a long time but have not become pregnant can help the couple decide.

Abstract BACKGROUND: Reproductive motivation is a complex issue that has cultural, behavioral, and
ideological roots and changes in the context of population transfer and economic and social
development. Reproductive motivations include positive and negative motivations that can be
influenced by education. Training can be done in different ways. It seems that face‑to‑face training
increases learning. On the other hand, face‑to‑face training increases participants’ cooperation and
desire for educational topics. Therefore, the aim of this study was to compare and determine the
effect of two counseling methods on the fertility motivation of infertile couples.
MATERIALS AND METHODS : This intervention study was performed on 68 men and women
with infertility referring to Milad Infertility Center in Mashhad in 2016–2017. Subjects were randomly
assigned to two methods of counseling. Participants completed written consent to participate in
the study. Infertile couples were included in the study if they met the inclusion criteria. The fertility
motivation questionnaire was completed by the participants at the beginning of the study before
the consultation and 2 weeks after the consultation. The collected data were analyzed by SPSS
Software Version 16.
RESULTS: According to the independent t‑test, there was no statistically significant difference
between the mean scores of positive fertility motivation in the two groups of face‑to‑face and telephone
counseling before the intervention. Independent t‑test showed that 2 weeks after the intervention,
there was no significant difference between the two groups in terms of this variable (P = 0.283). There
was no statistically significant difference between the mean scores of positive fertility motivation in the
face‑to‑face counseling group before and after the intervention. Further, in the telephone counseling
group, there was no significant difference between the mean scores of positive fertility motivation
in the two stages before and after the intervention. According to the independent t‑test, there was a
statistically significant difference between the mean scores of negative fertility motivation in the two
groups of face‑to‑face and telephone counseling before the intervention (P = 0.025). However, this
test showed that there was no significant difference between the two groups in terms of this variable
2 weeks after the intervention.
CONCLUSION: The results of this study showed that face‑to‑face and telephone counseling did not
have a significant effect on fertility motivations of infertile couples. In other words, the mean scores
of positive and negative fertility motivations before and after counseling remained unchanged in both
groups and the two groups did not differ in this regard. In other words, the issue of fertility motivation
in infertile women can be affected by different characteristics such as social, family, cultural, and
economic conditions of individuals. If infertile people do not make having a child a necessity in their
lives and cope with it more easily, no counseling can change their motivation. On the other hand,
if infertile women consider having a child as an essential part of their married life and the health of
their married life, counseling can have the greatest effect on them.

Abstract INTRODUCTION: Many infertile people have heard about adoption, but little is known about the true
meaning of adoption and how it is accepted. Giving the right information about adoption is effective
in making the right decision for couples. As a result, there is a need to intervene and provide training
to improve community attitudes and increase adoption among infertile people. Therefore, the present
study aimed to determine the effect of two counseling methods (face‑to‑face and telephone) on
awareness and attitude toward adoption in infertile couples.
MATERIALS AND METHODS: The present study is a randomized quasi‑experimental study of two
groups in the Milad Infertility Center of Mashhad on 34 (each group of 17 couples) infertile couples
with the criteria to enter the study. Couples were randomly assigned to two telephone and face‑to‑face
counseling groups, and each individual’s awareness and attitudes toward adoption were completed
separately before and after counseling. The average number of face‑to‑face sessions for face‑to‑face
counseling was three 60‑min sessions and six 30‑min sessions for telephone counseling.
RESULTS: Based on the results of t‑test, there was a statistically significant difference between
the average score of awareness of adoption before and after the intervention (2 weeks after the
last counseling session), in infertile couples in face‑to‑face training group and in telephone training
group (P < 0.0001). The score of the attitude toward adoption before counseling in the face‑to‑face
counseling group was 60.55 ± 5.5, which reached 66.76 ± 4.7 after counseling. Based on the results
of the T‑pair test, this difference was significant (P < 0.0001). In addition, in the telephone counseling
group, the score of attitude toward adoption increased from 59.53. 7.4 to 67.73 ± 7.5, which was a
significant difference in terms of t‑pair test. The mean score of attitudes toward adoption was not
statistically significant in the two groups (P = 0.653).
CONCLUSION: The results of this study showed that both counseling methods (face to face and
telephone) increase the level of awareness and attitude of couples about adoption, but neither
method was superior to the other.

Abstract INTRODUCTION: Considering the trend of reducing fertility in recent decades, the level of awareness
and attitude of health workers to fertility has an important role in achieving the country’s demographic
goals. Improving attitudes and improving the scientific level and skills of health workers are the basic
pillars to improve the quality and quantity of health‑care services. Therefore, this study was conducted
with the aim of improving the level of awareness and attitude toward fertility and fertility counseling
skills of health workers with both face‑to‑face and virtual training methods.
MATERIALS AND METHODS: This study was a randomized controlled trial of three groups and
pre‑test‑posttest experiments performed on 108 midwives and health‑care workers working in
Mashhad Health Center and Community Health Centers and Health Centers in 2015. The tools
used in this study were four researcher‑made questionnaires that were validated and reliable. Data
analysis was performed by Chi‑square test, one‑way, and independent t‑analysis of variance using
SPSS software version 16.
RESULTS: The results showed a significant increase in awareness level, attitude toward fertility,
and counseling skills in the studied groups after the implementation of interventions (P < 0.001).
Furthermore, there was a significant inverse relationship between the attitude score of the research
units at the beginning of the study and the demographic variables with only the average work
experience.
CONCLUSION: Training is effective in raising the level of awareness and changing the attitude of
health workers. The use of group discussion methods in person as well as through a webinar in
which learners think, interact, and gain experience in promoting healthy fertility counseling promotes
awareness, attitudes toward fertility, and their counseling skills in providing healthy reproductive
counseling.

Abstract INTRODUCTION: Due to the significant decrease in fertility in recent decades and the important role
of health workers and health‑care providers in providing healthy reproductive counseling, their training
is necessary using effective educational methods. Webinar and group discussion (GD) are effective
in this regard. This study was conducted to determine the most effective method and with the aim
of comparing the effect of two training methods (webinar and GD) on the attitude and performance
of health workers in providing counseling with fertility promotion approach in comprehensive health
centers in Mashhad.
METHODS: In this randomized trial study with a control group, 108 health workers working in health
centers no. 2–3 and 5 of Mashhad entered the study and were randomly divided into three groups of
training by webinar, GD, and control. Intervention groups received healthy fertility counseling skills
in three training sessions. Research tools were demographic information questionnaires, fertility
attitudes, and performance measurement checklists for fertility counseling. The questionnaires were
completed in three groups at the beginning and after the completion of the interventions. Data analysis
was performed by Chi‑square test and one‑way analysis of variance using SPSS software version 16.
RESULTS: The analysis of variance test showed that before the intervention, there was no statistically
significant difference between the three groups in terms of average scores of fertility attitude and
performance scores of fertility counseling. After the interventions, the difference between the fertility
attitude scores (P < 0.001) and the performance scores of fertility counseling (P < 0.001) was significant
in the three groups. There was no significant relationship between demographic characteristics and
attitude and performance.
CONCLUSION: Teaching by webinar and GD promotes the attitude and performance of health
workers in providing counseling with a fertility promotion approach. Therefore, it is recommended to
use new educational methods such as webinar and GD to promote childbearing counseling, which
has been emphasized in the country’s population policies. Since the mean score difference for
the webinar training method was the highest due to the mean scores, this method could be more
effective than the GD method.

Abstract INTRODUCTION: Midwifery screening is one of the duties of midwives according to national
guidelines. It is possible to increase midwives’ knowledge and practice through effective education.
The aim of this study was to compare the effect of standardized patient‑based education and feedback
lecture on midwives’ knowledge and practice in screening counseling for fetal malformations.
METHODS: This quasi‑experimental, two‑group study (standardized patient‑based training and
feedback lecture) was performed on 67 midwives (licensed by the office) in Mashhad in 2018.
Midwives’ knowledge and practice before and 2 weeks after training (a 4‑h training program)
were assessed by the Objective Structured Clinical Examination and a questionnaire. The data
were analyzed by the SPSS software version 16 using Mann–Whitney, Chi‑square, Wilcoxon and
independent t‑test while P < 0.05 considered as a significant level.
RESULTS: Before intervention, the total score of knowledge and practice showed no statistically
significant difference between the two groups (P > 0.05). After intervention, knowledge score
in feedback lecture group was statistically significantly higher than that of standard patient
group (P < 0.001). In addition, there was no statistically significant difference in performance scores
between the two groups after intervention (P = 0.761).
CONCLUSION: Both educational methods can increase midwives’ knowledge and practice in fetal
screening counseling. However, in raising midwives’ awareness, feedback lecture group was more
effective than standard patient group.

Abstract INTRODUCTION: An appropriate exchange of information between the health‑care provider and
the family is an important component of coping with stress following the prenatal diagnosis of fetal
anomalies. Therefore, this study was conducted to explore the informational needs of pregnant
women following a prenatal diagnosis of fetal anomalies in Mashhad, Iran.
SUBJECTS AND METHODS: This qualitative, conventional, content analysis study was designed
through two referral centers for fetal anomaly. The data were collected from April 2017 to January
2018 in Mashhad (Iran) through individual semi‑structured in‑depth interviews, from 25 pregnant
women with a prenatal diagnosis of fetal anomalies.
RESULTS: Three categories and nine subcategories emerged. Category 1, information needed for
clarifying the diagnosed anomaly and making a decision, containing four subcategories: The need to
know the reasons of doing more diagnostic tests; The need to know the facts regarding the anomaly
and its cause; The need for more information to gain control over the situation; and The need to know
about legal permission for therapeutic abortion. Category 2, Information needed for preparing to the
future, containing three subcategories: Practical and economic issues; The delivery and postnatal
situation; and Future mortality and morbidity of especial anomaly. Category 3, the adequacy of the
information provided, containing two subcategories: Information overload and Inadequate information.
CONCLUSIONS: Pregnant women receiving a prenatal diagnosis of fetal anomaly have a variety
of information needs that are not adequately met by the health‑care providers. Further research is
required for finding a means to meeting this information need.

Abstract INTRODUCTION: Motivation is directly involved in women’s childbearing decision. Considering
the lack of information about reproductive‑age women’s childbearing motivations with preferences
and actual child number in Iran, this study was conducted to determine the relationship between
childbearing motivations with the fertility preferences and actual child number of reproductive‑age
women.
MATERIALS AND METHODS: The participants in this descriptive–correlational study were 844
reproductive‑age women (aged 15–49 years) who were married for the first time and came from
a wide range of areas in Mashhad. Multistage and convenience samplings were applied and the
data were collected using Miller’s childbearing motivation and fertility preferences and actual child
number questionnaire.
RESULTS: The results of the study reveal that positive‑ and negative‑childbearing motivation were
correlated with preferences (P < 0.001) but were not correlated with actual child number. Furthermore,
the interactional variable derived by a combination of positive and negative motivations showed a
significant relationship with the ideal and actual child number (P < 0.05).
CONCLUSIONS: Childbearing motivations affect the fertility preferences in reproductive‑age women
but do not appear to have any influence on the actual child number. Furthermore, the interactional
variables affect the ideal and actual child number.

Abstract INTRODUCTION: Preeclampsia is the most common medical complication in pregnancy; along
with bleeding and infection, it is one of the three causes of death in pregnant women. Most of these
deaths were due to delays in the diagnosis and improper midwifery management and care. On
the other hand, the quality of midwifery education has a profound effect on the proper provision of
services. Therefore, the present study has been done to compare the effect of simulation‑, blended‑,
and lecture‑based education on simulated midwife performance in the management of preeclampsia
and eclampsia.
MATERIALS AND METHODS: This three‑group clinical trial study was performed on 90 midwives
of selected hospitals in Mashhad in 2016. Midwives were divided into three groups of simulation‑,
blended‑, and lecture‑based education using the random number table. The simulation group was
trained for 6 h at the Center for Clinical Skills, the blended group was trained for 4 h by lecture, and
6 weeks through the educational website, and the lecture group was trained for 6 h through lecture.
An objective structured clinical test was performed before and 2 weeks after the intervention. Data
were analyzed using SPSS Version 16 software and descriptive statistics, paired t‑test, one‑way
ANOVA, and Wilcoxon and Kruskal–Wallis tests. Significance level was considered to be P < 0.05
in all cases.
RESULTS: The mean score of midwives’ performance was not statistically significant before education
in all three groups (P < 0.05). The mean score of midwives’ performance was significantly increased
in all three groups 2 weeks after education (P < 0.001), and the results of intergroup comparison
showed that the mean score of performance in the simulation group was significantly higher than the
blended group and the lecture group (P < 0.001), and it was higher in the blended group compared
to the lecture group (P < 0.001).
CONCLUSION: Education increased the midwives’ simulated performance in preeclampsia and
eclampsia. The performance of the management of preeclampsia and eclampsia in the simulation
educational group is more than that of the blended and lecture groups, so we can use the simulation
education which is a self‑centered method.

Abstract CONTEXT: Infertility is one of the major stressful events in individual life, especially women.
Self‑efficacy means a person can perceive a potentially threatening and stressful situation as being
amenable to influences of personal control.
AIMS: This study was conducted to determine the acupressure effects on self‑efficacy and pregnancy
rate in infertile women under in vitro fertilization (IVF)/intracytoplasmic sperm injection treatment.
SETTINGS AND DESIGN: This study was a randomized controlled trial in infertile women. It performed
at Milad IVF Center, Mashhad, Iran, from September 2015 to August 2016.
MATERIALS AND METHODS: The sample size was 144 participants. The participants were
randomly divided into three groups: real and sham acupressure and control groups. Acupressure
performed on the H7 and P6 acupoints on both the hands. The infertility self‑efficacy scale was
completed before and after intervention. Beta‑human chorionic gonadotropin hormone assay was
measured to determine pregnancy. Data analysis was done by Chi‑square, Fisher’s exact, paired
sample t, Kruskal–Wallis, and ANOVA test and general linear model and multinomial logistic. Levels
of significance were reported at P < 0.05.
RESULTS: The mean age of women was 30.84 ± 5.34 years. The ovulation factor (P = 0.02) and
spouse’s job (P = 0.05) were statistically significant difference between the groups. The score of
self‑efficacy and frequency of clinical pregnancy were no significant difference among three groups.
Using linear regression, only the score of primary self‑efficacy (before intervention) was in a significant
relationship with self‑efficacy after the intervention (P < 0.001).
CONCLUSION: To our results, we recommend more research for assessing acupressure effects
on self‑efficacy and clinical pregnancy rate in infertile women.