Journal of Education and Health Promotion

Abstract BACKGROUND: Patient relationship management (PRM), in addition to saving costs, increases
patient loyalty and creates a satisfactory environment for the patient and the service provider. This
study aimed to design a model of PRM in general hospitals using the combination of the analytic
hierarchy process and interpretive structural modeling (ISM).
METHODS: This was an applied and cross‑sectional study conducted in 2020 at three stages. At
the first stage, using a systematic review, factors affecting PRM were identified. In the second stage,
these factors were prioritized based on the pair‑wise comparisons. In the third stage, the interaction
levels of the factors were modeled for the general hospitals using ISM through the use of the MICMAC
technique and Excel 2007 software.
RESULTS: The results showed that “integrated information system,” “registration of the patient’s
essential information,” and “right data at the correct time” were the first to third priority in implementing
PRM in the general hospitals. In the final model of ISM, three levels of effective factors were extracted,
and 10, 4, and 6 factors were identified in the first, second, and third levels, respectively.
CONCLUSION: Establishing the PRM strategy in the hospital, in addition to executive and managerial
requirements, depends on the existence of an electronic customer relationship management system,
and the choice of new technology, as well as the integration of information systems and technology
culture, should be given special attention by managers.

Abstract BACKGROUND: Although a certain amount of stress is essential, excessive stress can adversely
influence the physiological and mental health. Hence, this study aims to assess common stressors
and coping strategies among university students.
MATERIALS AND METHODS: This qualitative study was conducted from October to November
2019 in Iran. Twelve students were recruited based on purposeful sampling to participate focus group
discussions (FGD). Transcripts of three sessions of FGD were analyzed applying Graneheim and
Lundman (2004) approach, and a thematic network was applied to illustrate the findings.
RESULTS: The finding emerged 78 codes, 14 subthemes, and 4 main themes. Stressors were
classified in two main themes, including individual stressors and the social ones. Behavioral strategies
and the cognitive ones were among two categories of coping strategies. According to the thematic
network, a full stress student affecting the precious stressors and the social, cultural, and the economic
context may manage his/her stress applying the coping strategies.
CONCLUSION: The findings revealed that university students experienced different kinds of stress,
and usually, they do not apply right coping strategies. It is important to establish stress counseling
programs for university students. Besides, it is proposing to provide 1st year university students with
workshops about the cause of stress and effective coping strategies.

Abstract CONTEXT: The success of the health system research and technology management in the 21st century
can play an important role in advancing the country toward becoming a scientific power.
AIMS: The study aimed to increase knowledge and identify factors affecting the health system
research and technology, as well as to provide solutions for improving the status of health science
and technology.
MATERIALS AND METHODS: This was an applied and descriptive study conducted in 2018 using
cross‑impact analysis. The factors affecting the Iranian Health System Research and Technology
Management and their influences on each other were identified using an expert panel. The key‑driven
factors were determined using the MICMAC software.
RESULTS: The input, stake, target, resultant, excluded, and regulating factors were identified. The
degree of fill rate the matrix was 58.9%. Financial annex of the health scientific map (S = 206),
roadmap (S = 206), governmental laws and regulations (S = 198), and sufficient governmental budget
allocation (S = 194) earned the highest potential influence scores by 2025. Furthermore, scientific
authority (S = 216), international communication (187), university relationship with industries (S = 187),
and competitive infrastructure (S = 178) obtained the highest potential dependence scores by 2025.
CONCLUSIONS: The success of the Iranian Health System Research and Technology Management
by 2025 requires the development of the financial annex of the comprehensive scientific health map,
the development of the road map, and the allocation of sufficient governmental budget for health
research. Policy‑making in health system research and technology management requires more
attention to these factors and the dynamics of relationships among factors in the model.

Abstract BACKGROUND: Today, the scope of dental activities is a broad range from the needs assessment
for epidemiological studies to the implementation of comprehensive programs for the prevention of
oral diseases at various levels of the society. This study aimed to identify and prioritize the need
researches in the field of oral and dental health in a dental hospital in Tehran, Iran.
METHODS: This applied research was a mixed methods study carried out in Tehran, Iran, in
2018. The data gathering tool included a data collection form used for reviewing the documents,
a semi‑structured interview, and an open questionnaire. MAXQDA 10.0, Expert Choice 11.0, and
Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) software were used for
analyzing the collected data.
RESULTS: After analyzing the results of the qualitative phase, 171 research topics in 6 areas
were obtained, including 44 topics in “dental clinical care and treatment,” 37 topics in “health and
prevention,” 19 topics in “education and health promotion,” 37 topics in “management of dental care
delivery,” 16 topics in “policy and its requirements,” and 18 topics in “dentistry materials, equipment
and technologies.”
CONCLUSION: According to the results, it can be recommended that the research resources should
be allocated based on the priorities identified by the present study so that the studied hospital has
the highest dynamic performance in achieving its goals and objectives.

Abstract Background: The expansion of outpatient services and the desire to provide more outpatient
care than inpatient care create some problems such as the overcrowding in the outpatient
clinics. Given the importance of overcrowding in the outpatient clinics, this qualitative study
aimed to determine the factors influencing the overcrowding in the specialty and subspecialty
clinic of a teaching hospital. Materials and Methods: This was a qualitative study conducted in
the specialty and subspecialty clinic of a hospital using content analysis method in the period
of January to March 2014. The study population was all managers and heads of the outpatient
wards. The studied sample consisted of 22 managers of the clinic wards who were selected
using the purposive sampling method. The required data was collected using semi‑structured
interviews. The collected data was analyzed using conventional content analysis and the
MAXQDA 10.0 software. Results: Three themes were identified as the main factors affecting
the overcrowding including the internal positive factors, internal negative factors, and external
factors. Conclusions: Despite the efforts made to eliminate overcrowding, and reduce waiting
times and increase access to the services for patients, the problem of overcrowding still has
remained unresolved. In addition, the use of some strategies such as clarifying the working
processes of the clinic for staff and patients and the relationships between the clinic and
other wards especially emergency department, as well as using a simple triage system on the
patients’ arrival at the clinic are recommended.

Abstract Background: The application of the nursing research findings is one of the most important
indicators of development in the nursing profession, which leads to providing efficient and
effective patient care and improving the quality of nursing care. According the result of some
studies, transferring the evidence‑based findings to the nurses’ practice and education in
the world has been slow and sometimes unsuccessful. This study aimed to investigate the
most important barriers to the application of research findings from the nurses’ perspective.
Materials and Methods: This cross‑sectional study conducted on a sample of 210 nurses
in a teaching hospital in Tehran in 2013. The data were collected using a researcher‑made
questionnaire consisted of two parts, including items about nurses’ demographic characteristics
and 30 items to identify the most important barriers to the application of research findings from
the studied nurses’ perspective. Results: “The lack of sufficient time for reading the studies,”
“the lack of sufficient time to implement the new ideas,” “the lack of adequate facilities to
implement the ideas,” “nurses’ little interest in conducting studies,” and “the lack of authority
to change the methods and patterns of care” with, respectively, 85%, 84.6%, 83.8%, 83.4%,
and 80.5% agreement with the existence of barriers were the most barriers to application of
research findings from the studied nurses’ perspective. Conclusion: The lack of time was the
most important barrier to the use of research findings from the perspective of studied nurses.
Therefore, some effective strategies should be used by hospital managers and health policy
makers to overcome this barrier. Some of these strategies can be employing new personnel
and hiring skilled and efficient human resources in order to decrease the workload of nurses,
organizing the nurses’ work shifts, providing right balance between patients and nurses in the
wards, etc.

Abstract Background: Hemodialysis patients have lower quality of life and one of the ways to improve
their quality of life is providing self‑care education to them using some models including self‑care
model. This study aimed to determine and evaluate the effects of using self‑care model on
health and quality of life outcomes in hemodialysis patients. Materials and Methods: This was
a quasi‑experimental study conducted in 2012 on the patients who were referred to a military
hospital in Tehran, Iran to be treated with hemodialysis. All 32 patients referred to this hospital in
2012 were selected and studied. Required data were collected using the Short Form‑36 (SF‑36)
standard questionnaire and a researcher‑made questionnaire. The educational intervention was
implemented using self‑care model. Collected data were analyzed using SPSS for Windows
version 18.0 and some statistical tests including paired samples t‑test, Wilcoxon and McNemar
tests. Results: The results showed that the mean and standard deviation (SD) of patients’
parameters including weight and blood pressure improved significantly after the educational
intervention compared to before the intervention (P < 0.001). Also, all dimensions of the quality
of life of hemodialysis patients, including physical function, role physical, bodily pain, general
health, vitality, social function, mental health, and role emotional improved compared to those
before the intervention (P < 0.001). Conclusion: Implementing the self‑care model increased
the quality of life of hemodialysis patients. Therefore, the use of this model in hemodialysis
patients is recommended.

Abstract Background: Military hospitals are responsible for preserving, restoring and improving the health of
not only armed forces, but also other people. According to the military organizations strategy, which
is being a leader and pioneer in all areas, providing quality health services is one of the main goals of
the military health care organizations. This study was aimed to evaluate the service quality of selected
military hospitals in Iran based on the Joint Commission International(JCI) standards and comparing
these hospitals with each other and ranking them using the analytic hierarchy process (AHP)
technique in 2013. Materials and Methods: This was a cross‑sectional and descriptive study
conducted on five military hospitals, selected using the purposive sampling method, in 2013.
Required data collected using checklists of accreditation standards and nominal group technique.
AHP technique was used for prioritizing. Furthermore, Expert Choice 11.0 was used to analyze the
collected data. Results: Among JCI standards, the standards of access to care and continuity of
care (weight = 0.122), quality improvement and patient safety (weight = 0.121) and leadership
and management (weight = 0.117) had the greatest importance, respectively. Furthermore, in
the overall ranking, BGT (weight = 0.369), IHM (0.238), SAU (0.202), IHK (weight = 0.125) and
SAB(weight = 0.066) ranked first to fifth, respectively. Conclusion: AHP is an appropriate technique
for measuring the overall performance of hospitals and their quality of services. It is a holistic
approach that takes all hospital processes into consideration. The results of the present study can
be used to improve hospitals performance through identifying areas, which are in need of focus
for quality improvement and selecting strategies to improve service quality.