Journal of Education and Health Promotion

Abstract CONTEXT: Mass gatherings (MGs) are established for different religious, social, political, cultural,
and sport motivations. Many risks threaten the participants` health in MGs for different reasons. One
duty of health‑care system is to identify the risks and manage them to reduce the participants` injuries
in MGs. This study aimed to identify and classify the risks threatening the health of participants in
MGs and review related articles systematically.
SUBJECTS AND METHODS: In this study, we investigated electronic databases including Science
Direct, PubMed, Ovid, ProQuest, Web of Science, Scopus, and Google Scholar. This systematic
review investigated those health articles which studied MGs published after 2000. Keywords that were
searched included (Mass gathering OR Crowd) AND (Assessment OR Evaluation) AND (Disaster
OR Emergencies) AND (Injuries OR Stamped). The final full text articles were assessed qualitatively
by STROBE article assessment checklist, and then the data extracted from the results of the articles
were analyzed and reported.
RESULTS: Initially, a total of 1874 articles were found, qualitative exclusion and inclusion
criteria were applied, and finally 29 full‑text articles were selected for the analysis. More than
forty health‑related risks were recognized. In order to better understand the risks and use of the
results more efficiently, the risks were classified and reported into the following five domains:
environmental risks, individual risks, psychological risks, public health risks, and management
risks.
CONCLUSION: Many risks threaten the health of participants in MGs. Recognizing and managing
the risks are considered the primary and basic essentials of health sector for the better management
of MGs.

Abstract BACKGROUND AND AIM: Customer’s satisfaction is one of the main goals of the health system
because it is effective on the desire of external customers for using the services of the health system
and also the quality and quantity of the provided care for the internal customers and eventually the
health of the society. Considering the importance of the subject, the present study was designed
to determine the customers’ satisfaction with the health system reform plan in the field of health.
MATERIALS AND METHODS: Participants in the present content analysis qualitative study were 22
technical and operational managers and 118 health‑care providers, and 15 recipients of health services
referring to the health centers in Qom; who individually answered the questions of the interview
guide. The gathered qualitative data were analyzed using conventional qualitative content analysis.
RESULTS: Customers’ satisfaction with the health system reform plan was categorized into six
themes of decreased trust of the caregivers, wasting caregivers’ time in the health units, increased
provision of services to the caregivers, decreased motivation for work, occupational burnout, and a
sense of petition in the care providers.
CONCLUSIONS: Although external customers were satisfied with some services of the health
system reform such as providing various free services, follow‑up the patients, and beautification
the environment of the health centers; but there are multiple weaknesses in this plan that would
cause dissatisfaction in the external and internal customers. More studies seem necessary to better
determine the different aspects of the satisfaction in the caregivers and care.

Abstract INTRODUCTION: The identification of health education needs through the community results
in targeted services and health promotion. Prioritizing these needs, in addition to identifying the
desired health system based on the needs of the community, is required for the optimal allocation
of resources. Therefore, this study was conducted with the aim prioritizing the health educational
needs of Sabzevar‑Iran community.
MATERIALS AND METHODS: This study was a two‑step mix study. In the first stage, the qualitative
method of the main themes of health educational needs of Sabzevar society was determined. Then,
the questionnaire was prepared by a paired scale (36 questions) and quantitative method was used
to prioritize the main themes with Analytic Hierarchy Process (AHP) software. The random sampling
method was used in this study and data analysis was performed using Expert Choice software using
AHP method.
RESULTS: Social problems with 0.206, contagious diseases with 0.205, nutrition with 0.161, and
public health with 0.132 were in the first to fourth grades of health educational needs in Sabzevar city
and environmental health, health management, noncontagion diseases, elderly, and occupational
health were in the fifth to ninth grades. The consistency index in this study was 0.08, although the
adjustment index is <0.1 good and acceptable.
CONCLUSION: Social problems are the first priority of Sabzevar society, which require appropriate
training.

Abstract INTRODUCTION: A sharp increase in expenditure is one of the challenges of the health system
in Iran. Every macroeconomic variable affects health, and if it is disregarded, it will lead to higher
macrobudgets. Physical and mental health as well as the use of health services change according
to the macroeconomic conditions and business cycles (boom and recession). The present study
aimed to determine the effect of macroeconomic indicators on health expenditure.
METHODS: This study was descriptive analytical. The required data related to macroeconomic
indicators and health expenditure in public and private sectors were collected during 1995–2014.
The data were analyzed using the time series models in econometrics, Vector Auto Regression,
and Granger causality technique.
RESULTS: The results of this study indicated that health expenditure has a positive bilateral
relationship with gross domestic production (GDP), gross national production, national income,
and national consumption. On the contrary, expenditure has a negative bilateral relationship with
liquidity rate and inflation rate. In addition, budget deficit has a negative unilateral relationship with
health expenditure while population rate has a positive unilateral relationship with health expenditure.
CONCLUSION: The results of this study indicated the increase of health expenditure in Iran that
GDP is the most critical determining factor of health expenditure. In general, the total expenditure in
the health sector in the world increases when the countries become richer. In line with the increase
of resources, innovative financing methods and efficiency improvement are required for providing
basic health services in low‑income countries.

Abstract BACKGROUND: Nurses are often faced with the variety of work‑related stress which could affect
their physical and mental health. Coping strategies play an important role in reducing stress and
consequently increasing the health and well‑being. This study was conducted to investigate the role
of stress and coping strategies to predict the general health of nursing staff.
SUBJECTS AND METHODS: An analytical cross‑sectional design was carried out on 318 nurses
working in governmental health centers of Guilan University of Medical Sciences, the North of Iran, in
2017. Data were collected through multistage cluster sampling using self‑report questionnaires and
demographic characteristics. The study instruments included Hospital Job Stress, Coping Strategies,
and General Health Questionnaires. For analysis of data, descriptive statistics and regression test
were applied using SPSS software version 19.
RESULTS: The results revealed that the highest mean score (47.71 ± 7.88) of different dimensions of
coping strategies was related to task‑oriented strategy. Furthermore, the results indicated that stress
and coping strategies together could explain around 2.5% of variance of general health (ΔR2 = 0.025).
However, based on the statistically significant level, the results revealed the coping strategies as the
predictor of general health (P = 0.002, beta = 0.094).
CONCLUSIONS: The results highlight the importance of considering coping strategies for predicting
general health in nurses. Regarding the inevitability of some stressors in the nursing profession and
the need to prevent stressful effects, workshops as an effective training method to reduce staff stress
should be on the agenda of managers.

Abstract CONTEXT: There are numerous factors which affect the health status in different ways, including
financing mechanisms, health‑care expenditures, socioeconomic characteristics, and health‑care
resources. One of the most important factors which contribute to the health status of a population
is health‑care resource which includes number of beds or health‑care professionals for instance.
AIMS: The objectives of this study were as follows: to examine the regression of the life expectancy
and health‑care inputs and also to investigate the regression of death rate and health‑care inputs.
SETTINGS AND DESIGN: This study was a panel dataset analysis of OECD countries.
MATERIALS AND METHODS: A generalized method of moment (GMM) regression models with
country‑level health outcomes (death rate and life expectancy) as dependent variables were estimated.
A panel dataset with n = 26 (the number of countries) and T = 12 (the number of time periods) was
used. The GMM regression model was used to estimate the effect of health‑care resources on
health outcomes.
RESULTS: Findings showed that there are strong reverse correlations between immunization rate and
number of physicians with crude rate of death (−2.64 [P < 001] and −76.50 [P < 001], respectively).
There were also positive correlations between immunization rate and number of physicians with
life expectancy at birth (0.01 [P < 001] and 1.03 [P < 001], respectively). Moreover, there were
negative correlations between inpatient rate and beds with life expectancy (−0.00003 [P < 001]
and −0.12 [P < 001], respectively).
CONCLUSIONS: It is essential for policymakers to consider the optimal level of health resource to
achieve better health outcomes. Oversupply of hospital beds and specialist doctors could lead to
induced demand and put the patients at risk of unnecessary procedures.

Abstract CONTEXT: Individuals with social well‑being can cope more successfully with major problems of
social roles. Due to the social nature of human life, it cannot be ignored to pay attention the social
aspect of health.
AIMS: The purpose of this study was to identify variables that predict the social well‑being of medical
students.
SETTINGS AND DESIGN: A descriptive‑analytical study was conducted on 489 medical science
students of Gilan Province, the North of Iran, during May to September 2016.
SUBJECTS AND METHODS: The samples were selected using quota sampling method. Research
instrument was a questionnaire consisting of two parts: demographic section and Keyes social
well‑being questionnaire.
STATISTICAL ANALYSIS USED: Data analysis was done using SPSS software version 19 and
with descriptive and inferential statistics (t‑test, ANOVA, and linear regression).
RESULTS: The results showed that majority of the students had average social well‑being.
Furthermore, a significant relationship between the academic degree (P = 0.009),
major (P = 0.0001), the interest and field’s satisfaction (P = 0.0001), and social well‑being was
seen. The results of linear regression model showed that four variables (academic degree, major,
group membership, and the interest and field’s satisfaction) were significantly associated with
the social well‑being (P < 0.05).
CONCLUSIONS: The findings demonstrate that the different effects of the demographic factors on
social well‑being and the need for further consideration of these factors are obvious. Thus, health
and education authorities are advised to pay attention students’ academic degree, major, group
membership, and the interest and field’s satisfaction to upgrade and maintain the level of their social
well‑being.

Abstract OBJECTIVE: Exercise evaluation is one of the most important steps and sometimes neglected in
designing and taking exercises, in this stage of exercise, it systematically identifying, gathering, and
interpreting related information to indicate how an exercise has fulfilled its objectives. The present
study aimed to assess the most important evaluation techniques applied in evaluating health exercises
for emergencies and disasters.
METHODS: This was meta-evaluation study through a systematic review. In this research, we
searched papers based on specific and relevant keywords in research databases including ISI web
of science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, Google Scholar, and Persian
database such as ISC and SID. The search keywords and strategies are followed; “simulation,”
“practice,” “drill,” “exercise,” “instrument,” “tool,” “questionnaire,” “ measurement,” “checklist,” “scale,”
“test,” “inventory,” “battery,” “evaluation,” “assessment,” “appraisal,” “emergency,” “disaster,” “cricise,”
“hazard,” “catastrophe,: “hospital”, “prehospital,” “health centers,” “treatment centers,” were used in
combination with Boolean operators OR and AND.
RESULTS: The research findings indicate that there are different techniques and methods for data
collection to evaluate performance exercises of health centers and affiliated organizations in disasters
and emergencies including debriefing inventories, self‑report, questionnaire, interview, observation,
shooting video, and photographing, electronic equipment which can be individually or collectively
used depending on exercise objectives or purposes.
CONCLUSION: Taking exercise in the health sector is one of the important steps in preparation and
implementation of disaster risk management programs. This study can be thus utilized to improve
preparedness of different sectors of health system according to the latest available evaluation
techniques and methods for better implementation of disaster exercise evaluation stages.

Abstract INTRODUCTION: Adolescence is a period of life that is a bridge between childhood and adulthood.
India has the world’s largest adolescent girl’s population, and adolescent girls are an important
vulnerable group of population. Perceived health is a predictor of morbidity and mortality in adults
and has been an important marker of the health status in population health studies for decades. The
aim of the study was to describe adolescent’s perception of health and association between some
factors such as nutrition status, socioeconomic status (SES), and health status. As their perception
of health discomfort affects their health behavior and self‑care, therefore, their health status is an
important matter to discuss.
MATERIALS AND METHODS: A cross‑sectional study was conducted in urban areas from a major
city in South India. Six hundred and fifty adolescent female students aged 10–19 years formed the
study population. Standardized self‑reporting questionnaires were used to obtain relevant data
regarding demographic features, SES, and health status. BMI calculated for each individual. The
data were analyzed using SPSS version 16.
RESULTS: About 83.3% of participants ranked their health status as good to excellent. A majority
of the girls had one or more problems related to their menstrual cycles. The most common occurring
problem was headache (45.3%). 47.8% of participants exhibited symptoms of mild insomnia.
Strong significant association between nutritional status and SES was found. Higher percentage of
undernourished adolescents belonged to low SES.
CONCLUSION: Adolescents are expected to enjoy good health, but this does not seem to be the case
in the developing countries like India, where poverty, malnutrition, and repeated infection are rampant.
Majority of the problems such as healthy nutrition and self‑care can be solved by community‑based
programs, health education, and food fortification.

Abstract BACKGROUND: Cancer and its treatments have been shown to have a negative psychological
effect on many cancer patients. One of these effects is often described as body image disturbance.
Due to the limited number of studies in this area, this study was performed to assess body image in
cancer patients and its association with clinical variables.
MATERIALS AND METHODS: This was a descriptive and correlational research that was designed
in Sayyed‑Al‑Shohda Hospital affiliated to Isfahan University of Medical Sciences, Iran in 2013. Two
hundred and ten adult patients who had been suffering from cancer were selected and completed
the personal/demographic/illness questionnaire and the multi‑dimensional body‑self relations
questionnaire that contained 64‑items with appearance orientation, appearance evaluation, fitness
evaluation, fitness orientation, health evaluation, health orientation, illness orientation, body areas
satisfaction, self‑classified weight and overweight preoccupation sub‑scales. Data were analyzed
by ANOVA and Pearson correlation with a significance level of P < 0.05.
RESULTS: The mean (standard deviation (scores of body image in cancer patients was 184.40 (43.68)
indicating that 58.3% of them had negative body image. In addition, most of patients had negative health
evaluation (60.2%), negative appearance evaluation(63%), negative illness orientation(61%), and negative
fitness orientation(56%). Furthermore, there were no significant correlations between type of cancer (P=0.5,
f = 0.3), kind of treatment (P = 0.8, f = 5.2) and duration of illness with body image (P = 0.6, r = −0.2).
CONCLUSION: In this study most of the cancer patients had body image disturbances. Also, body image in
this group wasn’t associated with the type of cancer, kind of treatment and duration of illness. Totally, these
results underscore the importance of assessing and treating body image disturbance in cancer patients.

Abstract Background: Quality of life (QOL) is one of the health indexes for which many efforts have been
made to define and measure during the last four decades of the 20th century in many countries.
This paper is aimed at studying the QOL in relation to socioeconomic status of the general
population of Isfahan in 1390. Materials and Methods: We applied a descriptive‑analytical and
sectional method. In this research, 385 women and men over 15 years of age from 14 regions of
Isfahan’s municipality were studied using multi‑stage quota sampling. We examined QOL using
the SF‑36 standard questionnaire, along with two domains of mental and physical health and
eight subscales within the validity domain of 65–90%. Social (81%) and economical (70%) status
was also measured by the questionnaire instrument in both objective and subjective domains
after confirming the validity and reliability of the instruments. The given data were analyzed by
SPSS 17 software and using descriptive and statistical tests. Results: The indicators of QOL
showed that a score deviation of the SF‑36 questionnaire in physical health (SD = 2.31) and
mental health (SD = 3.22) domains was obtained from the population. Of the eight subscales,
bodily pains and limitations on functioning as physical and mental had an inverse relationship
with socioeconomic status. However, physical health, mental health, social activities, public
health, and vitality had a significant positive relationship, including different strengths and
weaknesses, with socioeconomic status. Also, sexuality and housing status had no relationship
with QOL. Conclusion: There is a direct and significant relationship between quality of life and
socioeconomic status variables in Isfahan.

Abstract Introduction: Health and healthy human being as a core concept of nursing have attracted
considerable attention in the Western literature but have received less attention in the context
of Eastern philosophy contexts. Methods: This study was done based on philosophical inquiry;
this method could be accomplished by means of different approaches like philosophical analysis
through concept analysis. There are different methods for concept analysis. Mors’s method
was employed to analyze the concept of health and healthy human being, we sought to clarify
them according to ideas deriving from the Islamic thought. To achieve the research objective,
Islamic texts were studied and analyzed based on the criteria of concept analysis (definition,
attributes/characteristics, and beaneries). Results: Our analysis revealed in the Islamic
thought human being is an integrated entity. Therefore, his health not only consists of each
single dimension, but also the full health together with the health of society gets meaning in
a balanced and coordinated set. Conclusion: Based on the results, in this study, there are
a series of similarities and differences with the perspectives of health in Islamic thought and
holism paradigm available in nursing.

Abstract Background: Puberty is one of the most critical periods in a female adolescents’ life. This
intervening study aimed to evaluate the effect of educational program for puberty health
on improving intermediate and high school female students’ knowledge in Birjand, Iran.
Materials and Methods: In this quasi‑experimental study, 325 female intermediate and high
school students were selected through randomized cluster sampling during several stages.
Then, researcher‑made questionnaire including 20 questions, each having one point regarding
puberty health, was distributed. After completion of the questionnaires were gathered. Following
this, under a systemic educational plan all intermediate and high school selected students were
given the same instruction by trained instructors. Instruction time for each meeting was estimated
1.5 hours. One month after the educational program and handing out the pamphlets in schools,
the previous questionnaires were again distributed among the students to fill out. At the end,
302 students who had filled out the questionnaires before and after intervention were studied.
Results: Out of 302 students, 151 were intermediate and 151 high school students. Knowledge
level among intermediate students was 5.03 ± 3.7 before intervention and was 10.8 ± 4.8 after
intervention. Among high school students, the scores were 4.1±2.3 and 8.7±3.8, respectively. There
was a significant difference between pre and post intervention stages in both groups (P < 0.001).
Furthermore, mean knowledge grade in all the students increased from 4.6 ± 3.1 before intervention
to 9.7 ± 4.4 after intervention (P < 0.001). Conclusion: Performing educational programs during
puberty has a crucial role in young girls’ knowledge increase. Since young girls often do not share
their problems with their parents and their peers during the period, instructional classes in schools
provide a good opportunity for them to present their problems and finding solutions.

Abstract Background: Family health is one of the World Health Organization’s (WHO) programs
concerning individuals’ and families’ health and development. If properly implemented, family health may ensure the health of human beings and support their self-fulfillment; and may
pave the way for bringing up a healthier and better generation by achieving two important
and specific quantitative and qualitative results. This study aims at establishing the existing
problems in the medical education system with respect to family health, which may be managed by the family health professional if a Masters’ course educational program is developed.
Materials and Methods: In this cross-sectional, descriptive study, five Type-1 and four Type-2 and
Type-3 universities were randomly selected. Then, the faculty members of health services/public
health departments, health managers, health and treatment networks managers, personnel of
provincial health centers in family health units, and also public health B. S. students were surveyed
on the existing problems in the national health system which can be solved by family health professional. A questionnaire containing one open-ended and several demographic questions was sent
by mail for some and personally handed over to some others. Since the data were of a qualitative
nature, first the categories were specified through content analysis and then the opinions of each
category of individuals were differentiated based on the relevant categories. Results: Results obtained from the comments of the study population led to specification of problems in health system,
which could be solved by the family health senior expert. Such problems were categorized into six
groups as: Planning and implementation, research, education, management, service-providing, and
cultural problems. Conclusion: Given the problems in our nation concerning various family health
issues, the field of family health in the levels of associate and bachelor degrees cannot respond to
all public requirements, and health personnel in these levels do not possess various professional,
planning, research, and educational skills required to analyze family health problems. Therefore,
it is suggested that a Masters’ course educational program be developed.