Journal of Education and Health Promotion

Abstract BACKGROUND: Amniocentesis is one of the methods for diagnosing prenatal abnormalities.
Pregnant women with high‑risk fetal screening results are the candidates for amniocentesis. Most
of these women are afraid of this procedure because they predict that the test will be painful and
worried about its adverse effects on pregnancy, fetal injury, or the risk of maternal death. Therefore,
the aim of this study was to determine the effect of education on the perceived stress of mothers
who are the candidates for amniocentesis.
MATERIALS AND METHODS: The present study was a quasi‑experimental, two‑group clinical trial
with a parallel design. This study was in three stages: pretest (before intervention), posttest (after
intervention), and after amniocentesis. This study was performed on 80 pregnant women who were
the candidates for amniocentesis (15–20 weeks of pregnancy) with high‑risk fetal screening results
referred to the perinatology clinic in Yazd in 2020. The intervention package included training and
using breathing techniques, broadcasting educational animations on how to perform amniocentesis,
expressing experiences by people who had experienced amniocentesis, and finally visiting the
amniocentesis site and getting to know the relevant perinatologist. Data collection tools were
demographic and midwifery profile questionnaires and Cohen perceived stress. SPSS software
version 16 was used for statistical analysis of data.
RESULTS: The results showed that the research units had high stress at the beginning of the
study. The perceived stress score at the beginning of the study in the intervention group was
30.1750 ± 6.53153 and in the control group was 28.2750 ± 8.57841. After the intervention, the
participants’ stress level decreased below the cutting point. In the experimental group, the mean
stresses after the intervention and after amniocentesis were significantly lower than before the
intervention; however, after amniocentesis, it was somewhat higher than the postintervention stage.
In the preintervention stage, the mean stress score between the two groups was not statistically
significant. The difference after the intervention between the two groups was significant (P < 001.0);
however, in the postamniocentesis stage, the difference in stress was not significant. After the
intervention and after amniocentesis, the perceived stress of pregnant mothers in the experimental
group was less than the control group.
CONCLUSION: Considering that the perceived stress in amniocentesis candidate mothers was
high in the present study, so that after performing the method, mothers left the center with high
stress, it is very important to pay attention to its psychological aspects. Therefore, it is suggested
that educational interventions before and during amniocentesis be considered for them along with
psychological support and follow‑up care after amniocentesis.

Abstract BACKGROUND: Quality of relationship marital status affects all aspects of family functioning,
including sustainability of cohabit living, supporting children, and happiness of couples. This study
was conducted to examine the effect of group cognitive‑behavioral counseling on optimism and
self‑esteem of women during the 1st month of marriage that referring to marriage counseling center.
MATERIALS AND METHODS: A semi‑experimental study was designed by a test, posttest, and
follow‑up. Participants consisted of 30 women admitted to premarriage counseling center of Farsan
city in 2018 with using purposive sampling by random numbers’ table into experimental and control
groups. The experimental group participated in eight consecutive 2‑h group counseling sessions.
Data collection tools were demographic questionnaire, Rosenberg’s Self‑Esteem Scale, and optimism
designed by Mir Ahmadi (reliability and validity are calculated and was 0.96) and completed in three
rounds. Women’s self‑esteem retested was done after 1 month. Data were analyzed with independent
t‑test and repeated measures ANOVA (significance level <0.005). Quantitative variables were
analyzed using the Kolmogorov–Smirnov test.
RESULTS: There were no significant differences between optimism scores in the
experimental (M = 150.47, standard deviation [SD] = 22.07) and control groups (M = 149.2,
SD = 21.54) prior to intervention (P = 0.875). The mean optimism score was significantly different in
intervention (M = 169.33, SD = 17.01) and control (M = 147.2, SD = 22.22) groups immediately after
counseling (P = 0.005) and 1 month after counseling (P = 0.002, M = 171.08, SD = 17.98). The mean
self‑esteem scores were statistically significant in both groups immediately after counseling (P = 0.023,
I: M = 37.06, SD = 8.69, C: M = 31.4, SD = 4.83) and 1 month after counseling (P = 0.028, I: M =
34.73, SD = 4.93, C: M = 30.06, SD = 4.8).
CONCLUSION: Cognitive‑behavioral counseling enhances women’s optimism by emphasizing
the training of communication and conflict resolution skills, which leads to positive attitude and life
satisfaction. Therefore, using cognitive‑behavioral counseling in marriage counseling sessions can
improve couples’ relationships.

Abstract BACKGROUND: Pregnant women are classified as one of the vulnerable groups. Physiological and
psychological changes during pregnancy predispose them to serious psychiatric disorders; if not
identified and treated in time, it can have a negative and long‑term impact on mental health. The aim
of this study was to determine the effect of cognitive–behavioral counseling of pregnant women with
the presence of a spouse on the level of stress, anxiety, and postpartum depression.
MATERIALS AND METHODS: The present study is a clinical trial that was performed on 40 pregnant
women with a gestational age of 32–28 weeks (20 in the intervention group, 20 in the control group)
who were randomly assigned to the intervention group and the control group according to the inclusion
criteria. Cognitive–behavioral group counseling in the presence of spouses was performed by the
midwife and under the supervision of a psychologist, in eight sessions, each session lasting 90 min,
once a week for the intervention group. The control group received routine care and a counseling
session. Data collection tools were demographic information questionnaire and Depression–Anxiety–
Stress Scale 21, which were completed before the intervention, immediately after the intervention,
and on the 14th day after delivery in both groups. Data analysis was performed using statistical tests,
independent t‑test, repeated measures test, Bonferroni post hoc test, and Kolmogorov–Smirnov test.
RESULTS: The results of this study showed that the mean scores of stress, anxiety, and depression
in the two groups in the preintervention stage were not significantly different (P < 0.05), but in the
postintervention stage and follow‑up, the mean scores of stress (P < 0.001), depression (P = 0.010),
and anxiety (P = 0.029) in the intervention group were significantly reduced compared to the control
group.
CONCLUSION: According to the research findings, cognitive–behavioral group counseling can be
effective as an approach in improving the symptoms of stress, anxiety, and depression in pregnant
women. Therefore, it is necessary to plan properly to use this counseling approach to manage stress,
anxiety, and depression in women during pregnancy.

Abstract BACKGROUND: Pregnancy alone is associated with many anxieties and worries for many women.
Prenatal diagnosis of fetal malformations is one of the most important anxious events for women.
Increasing knowledge empowers the person to identify the important issues and by increasing
understanding, creates a positive attitude in people. Therefore, the aim of this study was to investigate
the effect of education on the level of anxiety of pregnant mothers before invasive screening for fetal
abnormalities (amniocentesis).
MATERIALS AND METHODS : This is a quasi‑experimental study with two parallel designs in three
stages: Pretest (before intervention), posttest (after intervention), and after amniocentesis. This study
was performed on 80 pregnant women candidates for amniocentesis (40 pregnant women in the
control group and 40 pregnant women in the intervention group) referred to the perinatology clinic in
Yazd in 2020. Data collection tools were demographic and midwifery questionnaires and Spiel Berger
anxiety questionnaires. In the experimental group, the intervention was performed as group training
for 90 min immediately before amniocentesis. In the control group, only routine procedures (brief
description by a perinatologist during amniocentesis) were performed. SPSS software version 16
was used to analyze the data.
RESULTS: The mean age of the research units was 67/5 ± 5/33 years. The results of Mann–Whitney
intergroup test showed that the mean scores of overt anxiety before the intervention between the
control and intervention groups were not significant (P < 0.014) but were significant after training and
after amniocenter (P < 0.001). Furthermore, the results of Mann–Whitney group test showed that
the mean scores of overt anxiety in the intervention group before and after training were significant
(P < 0.001). Furthermore, the results of the control group showed significant results (P < 0.001). The
results of the independent t‑test showed that the mean scores of latent anxiety before the intervention
between the control and intervention groups were not significant (P < 0.194) but were significant
after the training (P < 0.57) but The results were not significant after amniocentesis (P < 0.216).
Furthermore, the results of paired t‑test within the group showed that the mean scores of overt
anxiety in the intervention group before and after training was significant (P < 0.001). Furthermore,
the results of the control group showed significant results (P < 0.001).
CONCLUSION: The findings of the present study indicate the positive effect of education on anxiety of
pregnant women candidates for amniocentesis. The results also show the important role of education
on the psychological dimension of high‑risk pregnant women in relation to the consequences of
pregnancy and childbirth. According to the research results, it seems that education affects the
cognitive system and information processing by increasing people’s awareness of the amniocentesis
process and its consequences.

Abstract BACKGROUND: Given that the need to pay attention to measuring efficiency is considered as
one of the main pillars of improving the level of efficiency in hospitals, so this study was carried
out aimed to determine the mean technical efficiency (The technical efficiency is bound by zero
and one and a score of less than one means that the theatre is inefficient as it could) score in
terms of type and activity of the hospital, input‑oriented and output‑oriented attitude, returns to
scale (In economics, returns to scale and economies of scale are related but different concepts
that describe what happens as the scale of production increases in the long run, when all input
levels including physical capital usage are variable (chosen by the firm). The concept of returns
to scale arises in the context of a firm’s production function. It explains the behavior of the rate
of increase) in hospitals of Iran using data envelopment analysis (DEA) (DEA is a nonparametric
method in operations’ research and economics for the estimation of production frontiers. It is
used to empirically measure productive efficiency of decision‑making units) and stochastic frontier
analysis (SFA) (SFA is a method of economic modeling. It has its starting point in the stochastic
production frontier models simultaneously introduced by Aigner, Lovell and Schmidt[1977] and
Meeusen and Van den Broeck[1977]
MATERIALS AND METHODS: The present study was carried out with a systematic review
of all studies conducted on measuring efficiency of hospitals in Iran from March 21, 2001 to
December 21, 2017 using DEA and SFA. Eleven databases were searched using appropriate
keywords and 470 articles were found and evaluated using a checklist, and finally, 24 articles
were entered into the meta‑analysis process. Meta‑analysis was performed using random effect
model and fixed‑effect model, and study heterogeneity was investigated using Q‑Cochran
test and I
2 index. Furthermore, the main reasons of study heterogeneity were identified due
to meta‑regression.
RESULTS: The average technical efficiency score of hospitals using DEA and SFA method
was obtained equal to 0.885 and 0.809, respectively. Furthermore, with regard to the DEA
method, 0.885, 0.891.0.952 and 0.913 was obtained for input‑oriented and output‑oriented,
general and specialized care hospitals and constant returns respectively. With regard to SFA
method, 0.733, 0.664, 0.641, 0.802, was obtained, and the inputs and outputs affect measuring
the efficiency.
DISCUSSION: In contrast, the DEA method can investigate several input and output simultaneously
and is used as an effective and flexible tool in order to measure the efficiency of the hospital. DEA
can be easily used for calculating efficiency scores based on the proper selection of input and
output indicators. The data envelopment analysis method and different input and output variables
have been used in most studies conducted in Iran, and Stochastic Frontier Analysis has been less
considered. In the present study, the DEA method in governmental educational hospitals showed a
higher efficiency than SFA method in the hospitals under study. But in general, due to lack of optimal
efficiency level in the hospital, it is suggested that policymakers determine the hospital efficiency
indices in order to evaluate their efficiency from different dimensions.  CONCLUSION: The average technical efficiency score of hospitals using DEA and SFA method was obtained equal to 0.885
and 0.809, respectively. Also, the mean technical efficiency score in terms of input-oriented and output-oriented, general and
specialized care hospitals and constant returns to scale using the DEA method was obtained equal to 0.885, 0.891.0.952 and
0.913 and using the SFA method, respectively, it was equal to 0.733, 0.664, 0.641, 0.802, and the inputs and outputs affecting
measuring the efficiency. There is no significant difference between the mean efficiency score between the two methods, but
the data envelopment analysis method is used more. It is suggested that the hospitals efficiency indicators to be determined in
order to more accurately evaluate the hospitals efficiency.