Journal of Education and Health Promotion

Abstract INTRODUCTION: Spiritual health is one of the four dimensions of health in humans, and the others
are physical, psychological, and social dimensions. This dimension is essential to increase the
adaptation to the disease. Therefore, this study was aimed to determine spiritual health in women
with multiple sclerosis (MS) and its association with self‑esteem.
METHODS: This is a descriptive cross‑sectional study, and 210 women with MS referring to Ayatollah
Kashani Hospital affiliated to Isfahan University of Medical Sciences were selected using convenience
sampling method. The data were collected by questionnaires of demographic characteristic
questionnaire (6 items), Rosenberg Self‑esteem Scale (10 items), and Ellison and Paloutzian Spiritual
Well‑being Questionnaire (20 items). Data were analyzed using descriptive statistics, Pearson’s
correlation coefficient, and multiple regression analysis at a significance level of 0.05.
RESULTS: The mean and standard deviation of spiritual health  (including religious health and
existential health) and self‑esteem in MS patients were 48.8 ± 6.80, 44.7 ± 6.70, and 3.21 ± 2.5,
respectively. The results showed that 95.2% of the research units had moderate‑to‑high
spiritual (religious and existential) health and 57.7% had high self‑esteem. Pearson’s correlation
coefficient also showed a significant positive correlation between religious health and existential
with self‑esteem (r = 0.22, P = 0.03 and r = 0.24, P = 0.01, respectively).
CONCLUSIONS: In this study, most of the women with MS had high levels of spiritual health and
self‑esteem. This can be used as a coping strategy and has a protective effect against stress‑induced
illness and even against complications of the treatment. In addition, in some cases, it is effective in
alleviating frustration in these patients.

Abstract Background: Multiple sclerosis (MS) occurs with a variety of physical and psychological
symptoms, yet there is not a conclusive cure for this disease. Complementary medicine is a
current treatment which seems is effective in relieving symptoms of patients with MS. Therefore,
this study is aimed to determine and compare the effects of reflexology and relaxation on anxiety,
stress, and depression in women with MS. Subjects and Methods: This study is a randomized
clinical trial that is done on 75 women with MS referred to MS Clinic of Kashani Hospital. After
simple non random sampling, participants were randomly assigned by minimization method to
three groups: reflexology, relaxation and control (25 patients in each group). In the experimental
groups were performed reflexology and relaxation interventions within 4 weeks, twice a week for
40 min and the control group were received only routine treatment as directed by a doctor. Data
were collected through depression anxiety and stress scale questionnaire, before, immediately
after and 2 months after interventions in all three groups. Chi‑square, Kruskal–Wallis, repeated
measures analysis of variance and one‑way analysis of variance and least significant difference
post hoc test via SPSS version 18 were used to analyze the data (P < 0.05) was considered as
significant level. Results: The results showed a significant reduction in the severity of anxiety,
stress and depression during the different times in the reflexology and relaxation groups as
compared with the control group (P < 0.05). Conclusion: The results showed that reflexology
and relaxation in relieving anxiety, stress and depression are effective in women with MS. Hence,
these two methods, as effective techniques, can be recommended.

Abstract Background: Multiple sclerosis (MS) could be considered as one of the most common chronic
disorders of the central nervous system. However, patient education tasks in this group are
a challenge for health care provider team but due to increase in the incidence of MS, a new
category of contact, care, and education seems to be useful. Hence, the aim of this study
was to compare the effect of electronic education and illustrated booklet on knowledge of
patients with MS. Methods: This was a quasi‑experimental research was carried out on
120 patients with MS from January 2013 to July 2013. All patients attended MS clinic located at
the Ayatollah Kashani Hospital conducted to Isfahan Neurosciences Research Center (INRC).
Patients were divided randomly into two equal groups: (1) Electronic education (n = 60)
and (2) illustrated booklet (n = 60). Participants’ knowledge score was collected according
to the researcher‑made questionnaire with 40 questions. Data were analyzed using Student’s
t‑test and paired t‑test through SPSS (version 11.5) with a significance level of P < 0.05.
Results: Although there was not any significant difference between the knowledge score
of electronic education and illustrated booklet group before intervention (18 ± 2.2 vs.
17.01 ± 3.4(, (P = 0.434, t = −5.64), but there was a significant difference after 2 weeks
intervention (35.74 ± 1.4 vs. 33.74 ± 3.4), (P = 0.021, t = −6.64). Paired t‑test showed a
statistically significant difference in the knowledge level in both groups after intervention as
follow: (1) Electronic education (18 ± 2.2 vs. 35.74 ± 1.4), (P = 0.024, t = −7.55) and illustrated
booklet (17.01 ± 3.4 vs. 33.74 ± 3.4), (P = 0.003, t = −8.55). Conclusion: The electronic
educational program applied in this study appears increased knowledge of patients with MS.
Therefore, the conveyance of this program to earn time for patient and healthcare provider
team is suggested as a valuable and appropriate teaching method.

Abstract Background: Mindfulness may be conceptualized as a dispositional trait which differs
across individuals, so this study was, therefore, designed to determine the survey of
mindfulness in multiple sclerosis (MS) patients and its association with attachment style.
Materials and Methods: This was a cross‑sectional study which was conducted in Kashani
Hospital affiliated to Isfahan University of Medical Sciences, Iran, in 2013. Samples were 210
adult patients who suffered from MS completed demographic and disease characteristics
questionnaire, Five Factor Mindfulness Questionnaire and adult attachment style. The SPSS
version 16 software was used to conduct statistical tests including t‑test, NOVA, and Pearson
correlation. Results: The means of age and duration of illness were (33/96 ± 9/5) years
and (24/3 ± 6/3) month, respectively. Most patients were married (66/1%), without university
education (62/8%) and with incomes suffice (63%). The majority of the patients had received
beta‑interferon (55/4%) as their main treatment. The mean ± standard deviation attachment
style and mindfulness were 25/6 ± 11/6 and 79/8 ± 25/6, respectively. Furthermore, there
was a significant negative correlation between the attachment style score and mindfulness
score (P = 0.001, r = −0.32). Conclusion: The result shows that stronger association between
mindfulness and attachment can reflect the beneficial effects of mindfulness interventions
on both mindfulness and attachment and it can provide some evidence that mindfulness
interventions may enhance secure attachment.