Journal of Education and Health Promotion

Abstract BACKGROUND: As shown in previous persons that used the effective coping strategies are more
aware to recent stressful life events in their live, this study conducted to investigate the main stressful
life events and common coping styles in adult’s population.
MATERIALS AND METHODS: This cross‑sectional study was conducted in 2018. In overall, 345
persons aged 18 years and more by stratified cluster sampling were enrolled in the study. The valid
questionnaires including the coping inventory for stressful situations‑21, the Holmes‑Rahe Stress
Inventory, and 28‑item General Health Questionnaire (GHQ‑28) were used to interview. The analysis
of variance and t‑student (t‑test) was used to determine the association between the two variables.
The statistical significance level was considered <0.05.
RESULTS: The top three importance events among 43 stressful items in our study were change
in financial state, gain of a new family member, and death of close family member. We found that
task‑oriented coping (P < 0.001) and avoidance‑oriented coping (P = 0.021) significantly more used
in males compered to females. According to Holmes‑Rahe life stress inventory instructions only 4.7%
of participants are prone to getting ill in next 2 years.
CONCLUSION: The results of this study showed a positive relationship between coping styles and
lower risk of mental health problems and stressful life events. Hence, activities and training programs
aiming to enhance personal approach coping skills is important to reduce of side effects of stressful
life events especially those recently exposed to negative life events and stresses.

Abstract BACKGROUND: Mindfulness as an intervention approach in mental health has been increasingly
used to promote health in young people. The aim of this study was to investigate the effectiveness of
mindfulness training on coping with stress, test anxiety, and happiness to promote health in female
high school students.
MATERIALS AND METHODS: The design of this study was quasi‑experimental with control
group, with pretest and posttest. The statistical population of the study included all the female
students studying in the secondary high school in the city of Sanandaj in Iran with 2890 students,
40 of whom were selected by simple random sampling method and were randomly assigned to the
experimental (20 individuals) and control groups (20 individuals). Participants completed the Oxford
Happiness (0.79), Sarason Exam Anxiety (0.87), and Andler and Parker Stress Management (0.81)
Questionnaires. The method of intervention was training based on mindfulness. Data were analyzed
using covariance analysis.
RESULTS: The results showed that in the posttest, a significant difference was seen between
the mean scores of the participants of the experimental and control groups in the variables of
problem‑oriented, emotion‑oriented, and avoidant coping variables (P < 0.05). In addition, the
results showed that in the posttest, there was a significant difference between the mean scores of
test anxiety; happiness; and happiness components including life satisfaction, self‑esteem, active
well‑being, satisfaction, and positive mood (P < 0.05).
CONCLUSIONS: Based on the results of the present study, it can be said that mindfulness training
is an effective intervention to improve coping styles, test anxiety, and happiness in students.

Abstract BACKGROUND: Internet addiction (IA) currently is the major public health concern, especially
in adolescents, although the results of previous reports are not generally uniform. This study was
conducted to determine IA in adolescents and to examine the correlation of IA with mental health
in adolescents.
METHODS: This cross‑sectional study was conducted in 2019 in Ilam city. In this study, 362 persons
were included using stratified cluster sampling; clusters were geographical area and schools. The valid
questionnaires including Internet Addiction Test and 28‑item General Health Questionnaire (GHQ‑28)
were used to interview. The correlation statistical technique was used to determine the association
between the two variables. The significance level was considered <0.05.
RESULTS: The mean ± standard deviation age of the responders was 16.40 ± 2.47 years; the total
score of IA and mental health was 43.02 ± 16.50 and 19.27 ± 9.72, respectively. We found that
5.5% of the adolescents had a severe level of IA. The lack of control with anxiety, neglect work and
social dysfunction, and neglect social life and severe depression in internet users were found to be
statistically significant: r (365) = 0.151, P < 0.033; r (365) = 0.126, P < 0.021; and r (365) = 0.125,
P < 0.033, two‑tailed, respectively.
CONCLUSION: According to the results, the excessive use of internet, lack of control, and neglect
social life are significantly correlated with mental health in adolescents; these results could be
contribute to improve the theoretical models for IA in adolescents.

Abstract BACKGROUND: Nurses in their workplace, for a variety of reasons, always face moral distress that
is an underlying issue in the nursing profession, which can lead to problems such as reduced quality
and quantity of care and sleep disorder. Besides, given the increased privatization of hospitals, this
study aimed to explore the association between nurses’ moral distress and sleep quality and its
comparison among nurses in private and public hospitals.
MATERIALS AND METHODS: This was a descriptive‑analytical study involving 150 nurses working
in Ilam Province hospitals. Sampling conducted using a multistage random sampling method. Data
were collected through the questionnaire of sociodemographic characteristics, the Corley’s Moral
Distress Scale, and the Pittsburgh Sleep Quality Index. Data were analyzed using SPSS software
version 22. Descriptive statistics such as frequency, mean, ANOVA, independent t‑test, multiple linear
regression, and Pearson correlation coefficient at the significant level of P < 0.05 were calculated.
RESULTS: The analysis revealed that moral distress was positively associated with sleep quality.
Furthermore, the scores of nurses’ moral distress and sleep quality were different in private and
public hospitals, so that the level of moral distress in the public hospital and sleep quality in the
private hospital was higher and lower, respectively, but the difference was not statistically significant.
Moreover, sleep quality, and the type of employment was the most important predicting variables of
moral stress (B = 1.86) and sleep quality (B = 2.39), respectively.
CONCLUSION: According to the study results, a positive and significant association was found
between moral distress and nurses’ sleep quality. It is recommended that appropriate strategies
and training program be formulated by the health‑care system to increase nurses’ ability to combat
moral distress adverse effects.

Abstract INTRODUCTION: Sexual problems in elder people are considered as a public health concern and
can affect their overall health and quality of life. This study aimed to investigate the sexual quality of
life and its relationship with general health in older men in the west of Iran.
METHODS: This was a cross‑sectional study among 362 older men aged 60 years or older attending
Comprehensive Health Care Centers in Ilam, Iran. Samples selected through Quota sampling method
and simple random sampling. Data were collected using the Sexual Quality of Life Questionnaire‑Male
and General Health Questionnaire‑28.
RESULTS: The mean ± standard deviation (SD) of age was 69.9 ± 8.1 years. The mean ± SD
score of sexual quality of life and general health of older men was 46.6 ± 14.6 and 19.2 ± 9.7,
respectively. A positive and significant association was found between sexual quality of life and
general health (P < 0.001, r = −0.41). Moreover, general health, age, sleep problems, and the level
of education were the important predictors for sexual quality of life in elder men (P < 0.05).
CONCLUSION: According to the results, the sexual quality of life of participants was at a moderate
level. Since only some factors influencing the sexual quality of life were ascertained, further studies
are required to investigate all factors influencing older men’s sexual quality of life.

Abstract INTRODUCTION: Majority of critical care nurses do not have desirable skills in performing
endotracheal tube suctioning (ETS) despite related training taught in the curricula. This study aimed
to investigate and compare the effect of education through video and performance feedback (PF)
on nurses’ skills in performing ETS.
METHODS: This was a quasi‑experimental study. The sample size comprised of all nurses (n = 49)
working in the intensive care unit of one of the educational hospital located in one of the western
cities of Iran. Nurses were assigned to either one of educational video (EV) and PF groups. Data
were collected using a 25‑item structured best practices information sheet. Data were analyzed using
SPSS software version 20 (SPSS Inc., Chicago, IL, USA).
RESULTS: After the interventions, no significant difference was found in the total mean score of
nurses’ practice in ETS between those who received education through EV and those who received
through PF (16.3 vs. 15.1) (P > 0.05). Before and after the intervention, a significant improvement
was observed in the total mean score and other dimensions of nurses’ practice in endotracheal
suctioning (P < 0.0001).
CONCLUSIONS: The results showed that both of methods through feedback and EV are useful
in improving nurses’ ETS practice. However, further studies are required to examine the effects of
such interventions in the long term.

Abstract INTRODUCTION: Teacher empowerment is thought to improve student learning by fostering teaching
quality. Therefore, the purpose of this study is investigating the relationship between empowerment
and self‑efficacy of Iranian English as Foreign Language teachers.
MATERIALS AND METHODS: The present study is an experimental study; the population of the
study includes all the English language teachers of the universities of Ilam, Iran. Among whom by
random sampling, the sample which was consisted of 60 teachers were selected. Participants in
this study answered the School Participant Empowerment Scale questionnaire (Short and Rinehart,
1992) as the instrument of the study. The Pearson product‑moment correlation was computed to
determine the relationship between teacher empowerment and teacher self‑efficacy.
RESULTS: The results showed that there was a positive correlation between teacher empowerment
and their self‑efficacy (r = 0.55, P <  0.01) and differences among teachers’ self‑efficacy is not
significant according to age (r = −0.14, P = 0.23).
CONCLUSIONS: Based on the results of the study, empowerment and self‑efficacy have interactive
relationships; i.e. self‑efficacy in teachers leads to empowerment and empowerment in teachers
leads to self‑efficacy.

Abstract BACKGROUND: The importance of spirituality and spiritual growth in humans has been increasingly
taken to attention by psychologists and mental health professionals. In this study, we aimed to
investigate the relationship between the tendency to aggression and individual resilience also
considering the role of mediator of spirituality in academic students by path analysis.
MATERIALS AND METHODS: A cross‑sectional study was conducted using structural equation
method (SEM). The target population consisted all of undergraduate academic students in Ilam, Iran
University of Applied Sciences, in 2018. Participants included 200 people whom were selected by
stratified random sampling. Data collection tools were demographic, Buss and Perry aggression,
spirituality assessment, and resiliency of Connor and Davidson questionnaire. In this study, bivariate
analysis was used to determine the directionality correlation between the study variables.
RESULTS: The results showed that there was a significant and positive correlation between
spirituality and resilience (r = 154% r = 83%). Furthermore, there was a negative and nonsignificant
relationship between aggression with resiliency (r = −122% P = 101). In addition, there was no
significant correlation between the aggression and spirituality (r = 0.05%, P = 0.942). The results of
SEM showed that spirituality and aggression can predict about 20% of the variations in the degree
of resilience in academic students. Accordingly, the results of SEM spirituality in an indirect path
reduce the aggression and thus increase the resilience (r = 0.102).
CONCLUSION: The results of this study showed the effect of spirituality on increasing the level of
resilience and also positive mediator role of spirituality between aggression and resiliency.

Abstract BACKGROUND: Internet is one of the most advanced modern communication technologies. Despite
the positive uses of internet, the existence of extreme behaviors and its harmful consequences has
attracted the attention of all. The aim of this study was to determine the relationship between internet
addiction with anxiety and educational performance.
MATERIALS AND METHODS: This research is a descriptive correlative study. The statistical
population of the study includes a total number of 4401 female students in the high school in the city
of Ilam‑Iran in the academic year of 2017–2018. The sample size includes353 students estimated
using Cochran’s formula. They were selected by random cluster sampling. For data collection, the
Young’s Internet Dependency Questionnaire, Academic Performance Inventory, and Marc et al.,
anxiety Scale were used. Data were analyzed at the significant level of α = 0.05.
RESULTS: The results showed a positive and significant correlation between internet dependency
and students’ anxiety (P < 0.01). There is also a negative and significant correlation between internet
dependency and academic performance of students (P < 0.01), and also a negative and significant
correlation between anxiety and educational performance of students (P < 0.01).
CONCLUSION: On the one hand, the results indicate a high prevalence of internet dependency and
its significant relationship with anxiety and academic performance in students, and on the other hand,
the negative effect of internet dependency on the students’ educational performance. Therefore, it is
necessary to design some intervention programs to prevent harm to students who are increasingly
interacting with internet. In addition, raising the level of the students’ awareness on the complications
of internet addiction and the proper use of the internet seems to be necessary.

Abstract BACKGROUND: Difficulty with reading fluency has been increasingly acknowledged as a significant
aspect of reading disabilities which is called dyslexia. To investigate this important issue, this
research aims to examine the impact of an intervention program on reading fluency of dyslexic
students.
MATERIALS AND METHODS: The research is an experimental one. The population of the study
included all the second‑ and third‑grade male and female students in the city of Ilam, Iran, among whom
68 students were recognized to be dyslexic using a screening inventory reading test (IRT) developed
by Shafiei et al., in 2009, they were selected using purposeful sampling method. The students were
equally divided and assigned into a control and an experimental group. The experimental group
received the Barton intervention program for 10 weeks. The reading fluency test was administered
for the measurement of reading fluency in pre‑ and post‑tests. Data were analyzed using descriptive
statistics (mean and standard deviation) and paired t‑test.
RESULTS: The analysis of the finding through t‑test found a statistically significant difference between
the control and experimental groups after the intervention program at P < 0.01.
CONCLUSIONS: The results revealed that the students who received the intervention program of
the experimental group were improved in terms of their reading fluency.

Abstract BACKGROUND: Marital satisfaction, conscientiousness, and self‑compassion are necessary
for successful and lasting marriages. Therefore, the purpose of this study was to investigate the
relationship between marital satisfaction, conscientiousness, and self‑compassion among married
employees of Shahid Mostafa Khomeini Hospital in the city of Ilam in 2017.
METHODOLOGY: This study is a descriptive research with a correlation design. The research
population included all 260 married employees of Mostafa Khomeini (I) Hospital in the city of Ilam,
among which 150 were selected using simple random sampling. Data were collected using three
questionnaires of conscientiousness, self‑compassions, and marital satisfaction. Data were analyzed
using Pearson correlation and multivariate regression.
RESULTS: The research results revealed a positive and significant relationship between
conscientiousness and marital satisfaction (P = 0.028 and r = 0.187) and a positive and significant
relationship between self‑compassion and marital satisfaction (P = 0.000 and r = 0.185). Both
conscientiousness and self‑compassion variables could predict 51% of the variance of marital
satisfaction among married employees.
CONCLUSIONS: Given the research results, it could be stated that people who have self‑compassion
and have a high level of conscientiousness make much effort for their improvement and resolving
their committed mistakes. For this reason, they have high motivation to maintain marital relationships.

Abstract BACKGROUND: Studies have found that nearly 90% of the first use of tobacco takes place before
high school graduation (teenagers) and training discussion due to prevention can be useful, therefore,
here, we aimed to determine the effects of training on awareness of cigarette outcomes (physical
and psychological) in male teenagers.
MATERIALS AND METHODS: We conducted an interventional study using Solomon’s four‑group
plan, which used a two‑stage cluster sampling in four groups (two experimental groups and two
control groups). The three sessions of at least 2 h of education intervention including visual displaying
using photo, film, and short scientific texts were held for the interventional group. After 1 month, all
four groups took posttest, and research groups were followed up after 8 months of intervention. All
data were analyzed using one‑way analysis of variance and covariance in SPSS.
RESULTS: According to the results, the mean of posttest scores had increased rather than pretest
scores, and generally, a significant difference was observed (P ≤ 0.001). These results were
significant in the aspect of both physical and psychological outcomes awareness. The difference
between the mean of scores in follow‑up period and posttest was not statistically significant, and it
shows training retention after 8 months (P < 0.666).
CONCLUSIONS: It can be concluded that through the training, it is possible to increase the awareness
of teenagers about physical and psychological outcomes of cigarette smoking that this can have an
important role in smoking prevention.