Journal of Education and Health Promotion

Abstract BACKGROUND: Previous studies have shown that psycho‑spiritual state of mothers may have
significant effects on their breastfeeding. The most common cause of nonexclusive breastfeeding is
inadequate breastfeeding; therefore, this study examined the relationship between spiritual health
and perceived stress with breastfeeding adequacy in mothers with infants aged 1–6 months.
MATERIALS AND METHODS: This cross‑sectional, descriptive, correlational study was performed
on 186 mothers with infants aged 1–6 months, who referred to the health centers in Dorud city of
Lorestan province, Iran, in 2021, which were selected based on cluster sampling. Data were collected
through four questionnaires including demographic–fertility, spiritual health, perceived stress, and
breastfeeding adequacy. Data was analyzed by Statistical Package for the Social Sciences (SPSS)
software version 22 using descriptive and analytical statistics.
RESULTS: The mean ± standard deviation (SD) values of spiritual health, perceived stress, and
breastfeeding adequacy were 99.59 ± 12.96, 23.8 ± 72.19, and 55.67 ± 7.67, respectively. There was
a significant positive relationship between spiritual health and breastfeeding adequacy (P < 0.001,
r = 0.268). In addition, there was a significant negative relationship between perceived stress and
breastfeeding adequacy (P = 0.002, r = −0.231).
CONCLUSION: Breastfeeding adequacy has a significant positive relationship with spiritual health and
a significant negative relationship with perceived stress. Since infants are one of the most vulnerable
groups and breastfeeding is the best way to support their health and reduce infant mortality rates,
breastfeeding adequacy can be improved by reducing stress and promoting spiritual health.

Abstract BACKGROUND: Incivility is one of the significant challenges that affect nursing education. Uncivil
behaviors have a significant upward trend compared to the past in nursing education. This study
was conducted to explore academic incivility from the perspective of nursing students and faculty.
MATERIALS AND METHODS: This study was conducted in 2021 using a descriptive qualitative
method. Fifteen baccalaureate nursing students and six faculty were selected using purposeful
sampling method. Data was collected through in‑depth semi‑structured interviews, and a qualitative
content analysis was applied for data analysis.
RESULTS: Data analysis revealed four categories, namely, ineffective teaching–learning, inapposite/
unreasonable requests, behaviors disrupting mutually respectful environment, and academic
dishonesty, and 14 subcategories.
CONCLUSION: To reduce incivility, closer attention needs to be paid to the admission of faculty as
well as training them to use effective communication techniques and interactive teaching methods.
In addition, nursing students must be provided with the training about uncivil behaviors. Furthermore,
clear and precise rules and regulations concerning incivility incidence should be developed and
implemented in the universities.

Abstract BACKGROUND: One of the most important goals of sexual intercourse is to arouse the psychological
effects of intercourse and to increase sexual self‑concept, which changes following sexual behaviors
such as the use of contraception methods. This study was performed to investigate the relationship
between sexual self‑concept and contraception sexual behavior in 15–49‑year‑old women covered
by community health centers.
MATERIALS AND METHODS: The present descriptive correlational study was performed on 297
married women referring to Isfahan community health centers in 2020 who were selected as cluster
that randomly classified. The tools included demographic information and the Snell’s Multidimensional
Sexual Self‑Concept Questionnaire, the data of which were analyzed via SPSS version 22 software
by Mann–Whitney U test and Pearson correlation.
RESULTS: Among a total of 297 women, 5.4% of the samples used hormonal methods and 94.6%
used non‑hormonal methods, which was the most common intermittent method. The results also
showed that the mean score of negative sexual self‑concept in women using the hormonal level
method was significantly higher (P = 0.012). Positive and positive sexual self‑concept score was
significantly higher in women using non‑hormonal methods (P = 0.048 and P = 0.002). Therefore,
there was a significant relationship between sexual self‑concept and contraception method.
CONCLUSION: Due to the relationship between contraception and sexual self‑concept, it is
recommended to pay attention to the aspects of sexual self‑concept and contraception during
reproductive health counselling sessions so that if there is a disorder, useful advice can be provided
or referred, if necessary.

Abstract BACKGROUND: Surrogacy has become an alternative family formation option for women who are
unable to carry a pregnancy. There is no comprehensive care program despite the different nature of
this pregnancy. The present study aimed to develop a reproductive health‑care program for surrogate
mothers within the cultural and social context of Iran.
MATERIALS AND METHODS: In the present sequential exploratory mixed methods study, first
through a qualitative approach surrogate mothers, care providers, and policy makers of reproductive
health services were selected purposefully. Data were collected by using the in‑depth semi‑structured
interviews and analyzed. A care program draft was designed by integrating results of the qualitative
study and reviewing the literature and guidelines, then appropriateness of each proposed care was
assessed by a two‑Rounds Delphi technique (RAM), and the final reproductive health‑care program
for surrogate mothers was developed.
RESULTS: The surrogate mothers’ reproductive health needs were summarized in four main
categories: surrogate mothers’ extra care, educational training, psychological support, and protecting
against surrogacy`s social and familial consequences. The reproductive health‑care program for
surrogate mothers were developed in four sections: prepregnancy health screenings and legal
counseling; special care during embryo transfer until pregnancy confirmation; psychological support
and prenatal care of surrogacy until delivery and follow‑up postpartum care.
CONCLUSION: Women face many challenges in surrogacy and need special care such as legal
counseling, reproductive health care, and psychological support. Implementation of this care program
seems to help improve the reproductive health of these mothers.

Abstract BACKGROUND: Postpartum depression and anxiety is one of the most common complications
that women face and cause many problems for mother, baby, and family. Considering the effect of
self‑efficacy on women’s adaptation to pregnancy and delivery conditions and their mental health
during this period, the present study was designed to investigate the effect of pregnancy training
classes based on Bandura self‑efficacy theory on postpartum depression and anxiety and type of
delivery.
MATERIALS AND METHODS: In this clinical trial study, 64 pregnant women were randomly divided
into intervention and control groups. Mothers in the intervention group received pregnancy training
in eight sessions (each session was 2‑hour) from the 20th week of pregnancy. The classes were run
by a trained midwife and the content of the training was based on Bandura self‑efficacy components.
The mothers in the control group received routine care. The demographic‑reproductive information
form, Beck Depression and Spielberger Anxiety Questionnaire were completed by pregnant women
of both groups at several times, before the program, 1 week and 1 month after delivery.
RESULTS: The results showed that the training program significantly decreased the depression
score in 1 week and 1 month after delivery in the intervention group compared to the control group.
In addition, this training program decreased the mean score of apparent and hidden anxiety in the
intervention group 1 month after delivery, although this decrease was not statistically significant.
Furthermore, 80.55% of the intervention group and 58.33% of the control group had vaginal delivery,
which were significantly different between the two groups in terms of the type of delivery.
CONCLUSION: The findings showed that pregnancy training classes based on Bandura self‑efficacy
theory decrease depression and anxiety and increases vaginal delivery rate.

Abstract BACKGROUND: The positive effect of breastfeeding on health is globally accepted. However,
breastfeeding has not yet practiced at a favorite level. Empowerment of mothers is an important
factor for continuing breastfeeding. This study was conducted to explore women’s perception of
empowerment in breastfeeding.
METHODS: The present qualitative study was conducted in conventional content analysis method.
Thirty‑four semi‑structured deep interviews were conducted with 18 mothers, four key family members,
and 12 other personnel involved in breastfeeding counseling services.
RESULTS: Analysis of participants’ descriptions led to the emergence of five main categories: Enough
knowledge and skill for breastfeeding, feeling adequacy in breastfeeding, overcoming breastfeeding
problems, informed belief in the value of breastfeeding, and perceiving comprehensive support for
breastfeeding.
CONCLUSION: in participants’ point of view, empowerment in breastfeeding can be formed
through an acquisition of “Enough knowledge and skill for breastfeeding” as well as assurance
about the proper quality and quantity of mother’s milk. As well as overcoming breastfeeding
problems will lead to stabilization empowerment in breastfeeding. In addition, data analysis
showed that informed belief in the value of breastfeeding strengthens the empowerment in
breastfeeding and presence of perceived comprehensive support for breastfeeding facilitates
empowerment in breastfeeding continuance. Thus, comprehensive plans should be designing
for promoting breastfeeding.