Journal of Education and Health Promotion

Abstract BACKGROUND: All policies and decisions need evidence examined by scientific methods. Moving
toward evidence‑based decision‑making (EBDM) as a change in organizations, especially health
systems (HSs), is inevitable. This study was conducted to identify the factors affecting EBDM in HSs
from two approaches and to score them.
MATERIALS AND METHODS: A mixed‑method study was carried out using the force field analysis
regarding the change toward EBDM in HS in 2020. This study included six steps to identify and
score the key driving forces (DFs) and restraining forces (RFs) to change toward the EBDM in
HS: first, finding forces from literature; second, selecting key DFs and RFs through focus group
discussion; third, scoring the first group of DFs and RFs by the experts through electronic forms;
fourth, determining key DFs and RFs from the managers’ perspective using qualitative interviews;
fifth, scoring the second group of DFs and RFs by the experts; and sixth, comparison between forces
resulted from two approaches.
RESULTS: According to the literature and experts’ opinions, “relevant, reliable, interpretable, and
understandable evidence” and “interaction between researchers and decision‑makers” were the
strongest forces to change, and “lack of organizational commitment and support” and “lack of relevant/
high‑quality evidence” were the strongest forces against the change toward EBDM in HS. Further,
based on managers’ perspective and scores by the experts, “suitable supervision and control” and
“reforming the planning and decision‑making system” were the strongest forces to change, and
“inadequate knowledge of the managers and staff about the principles and contents of EBDM” and
“issues beyond the authorities of managers” were the strongest forces against the change toward
EBDM in HS.
CONCLUSIONS: Based on the findings, HSs’ managers can focus to reduce RFs and promote DFs
for implementing EBDM strategies, so they can provide better services by making more efficient
decisions.

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 BACKGROUND: Oral health practitioners are at the frontline of infection, particularly with respiratory
viruses such as the novel coronavirus. Knowledge, awareness, and attitude of these workers are
considered important in preventing and controlling the outbreak. This study aims to review the
literature to provide a better understanding of the status of dentists and other oral health practitioners’
knowledge, attitude, and awareness about COVID‑19.
METHODS: A systematic review was conducted through Web of Science, PubMed, Scopus, and
ProQuest up to May 6, 2020. All the knowledge, attitude, and practice studies on oral health workers
about respiratory contagious outbreak the same as severe acute respiratory syndrome, Middle East
respiratory syndrome, and COVID‑19 were included in the meta‑analysis.
RESULTS: A total of eleven studies were included in the meta‑analysis. 85.5% of the dentists and oral
health practitioners had a high level of awareness about virus transmission modes (95% confidence
interval [CI]: 78.6%–92.4%; P < 0.001). 80.7% of the oral health practitioners gave right answers to the
questions related to virus transmission modes (95% CI: 69.9%–91.4%; P < 0.001), and 79.9% of the
dentists had a positive attitude about virus transmission modes (95% CI: 66.4%–93.4%; P < 0.001).
CONCLUSION: This meta‑analysis shows that the level of dentists and oral health practitioners’
knowledge, awareness, and attitude was relatively high about the respiratory contagious diseases
as well as COVID‑19. The present results can shed further light for policymakers to support the
best evidence medical education for all health‑care workers the same as oral health practitioners.
Preventing the dissemination of misinformation along with preparing comprehensive guidelines can
be considered by the oral health policymakers, particularly in the more infected regions.