Journal of Education and Health Promotion

Abstract BACKGROUND: Prenatal education provides opportunities for health promotion of healthy behaviors
and risk reduction. Quality and coherence with prenatal health promotion best practices depend on
an individual class instructor. The objective of our study was to document the experiences, practices,
and perceptions of our diverse Ottawa, Canada community of prenatal educators.
MATERIALS AND METHODS: In this quantitative, mixed methods e‑survey conducted in Ottawa,
Canada, prenatal educators were asked to describe their prenatal class settings, delivery formats,
content, perceptions of pregnant women, and recommendations. Data were analyzed by descriptive
statistics and thematic content analysis.
RESULTS: Respondents included public health nurses and a diverse group of “allied childbirth
educators” (ACE). Topics related to pregnancy, labor, and postpartum issues were well addressed;
however, established and emerging risks to pregnancy were omitted. Nurses were more likely to
discuss lifestyle risks to pregnancy and general prenatal health promotion, whereas ACE respondents
emphasized informed consent and individualized counseling. Women marginalized by social exclusion
including Indigenous women, immigrants, and women with disabilities were perceived as missing
from prenatal educational settings.
CONCLUSIONS: Heterogeneity of prenatal education provides opportunities for collaboration;
however, established and emerging risk factors to pregnancy are neglected topics. Addressing the
needs of diverse communities of pregnant women requires timely, evidence‑based, inclusive, and
culturally safe delivery of prenatal health promotion.

Abstract The objective was to identify the existing links between the conceptual proposal of the movement of
health-promoting universities (HPU) and the activities carried out to increase the health of workers
in higher education institutions. An integrative literature review was conducted in October 2020 in
the following databases: LILACS, Scientific Electronic Library Online, Web of Science, and CINAHL
and with the Boolean phrase citing, University AND “health promotion.” In the initial review, 5351
studies were found, and after removing the repetitions, applying the inclusion criteria, and making the
qualitative analysis, a sample of 9 articles was obtained. For the construction of the flowchart with the
representation of the eligibility and inclusion of the articles, the PRISMA model was use .The findings
were analyzed with the theoretical and conceptual support of the movement of HPU, which made it
possible to establish the construction of three categories, to quote: full provision of social, medical,
and health services; creating a favorable health environment on campus; and development of health
education actions. The movement of HPU is relevant to the contemporary world; however, initiatives
to incorporate these practices are still scarce, creating a gap between expectations and reality.

Abstract BACKGROUND: Limited research has been conducted in the field of diabetes educator’s competency.
However, no comprehensive and integrated explanations of educator’s competence requirements
in treatment centers exist in Iran. The aim of this study is to explain the components of diabetes
educator’s competence in diabetes self‑management education in Iran.
MATERIALS AND METHODS: This was a qualitative descriptive‑exploratory study. The data were
collected through semi‑structured and in‑depth interviews and using purposeful sampling method
in Isfahan University of medical science from April to October 2018. Sampling continued until data
saturation. Participants included 20 people who were selected by purposive and snowball sampling
method. The interviews were analyzed using content analysis method of Graneheim, Lundman.
RESULTS: Data analysis resulted in the emergence of three main categories including (1) Patient and
family centered education, (2) process‑based education, and (3) continuous progress in profession
and also seven subcategories (patient and family activation, empower), facilitating educational
process, comprehensive education assessment, development, implementation and evaluation of
educational plans, developing educators’ educational knowledge and skills, development of creativity
and innovation, promote inter‑professional cooperation in education.
CONCLUSION: The evaluation of facilitation factors for participation and empowerment patient and
family along with creativity and interprofessional collaboration for comprehensive evaluation of patients
in designing, implementation of educational programs were mentioned as important competencies
of diabetes educators, which can have a significant impact on patients’ recovery, treatment, and the
promotion of society’s health.

Abstract BACKGROUND: Paying attention to students’ opinions and suggestions on existing evaluation
methods and new methods of evaluation is an essential and important part of clinical education, so
this study aimed at determining the effectiveness of two evaluation techniques satisfaction among
undergraduate nursing students.
MATERIALS AND METHODS: This was a quasi‑experimental study conducted on 60 undergraduate
nursing students of Isfahan University of Medical Sciences in 2019. There were 30 samples in each
group (logbook and e‑logbook) that were selected by convenience sampling method. the Android
application (e‑logbook) was used in the intervention group to evaluate the clinical skills of students.
The User Satisfaction Questionnaire was conducted by undergraduate nursing students. Data were
analyzed using SPSS software version 14 and descriptive statistical tests.
RESULTS: The results showed that the mean (standard deviation) overall score of satisfaction
from both evaluation methods including logbook and e‑logbook was 39.7 (9.4) and 47.7 (12.2),
respectively. Also satisfaction score of the evaluation method was significantly different between
the two groups (P = 0.03).
CONCLUSION: According to the results of the present study, the use of new and active methods of
evaluation, including the application of e‑logbook, can be useful in evaluating nursing students and
cause student satisfaction, so using the application is useful.

Abstract BACKGROUND: Involving medical undergraduate students in patients’ health education will not only
help in improving students’ learning as well as professional and communication skills but also plays
an important role in achieving better health outcome of patients. The aim of the study was to assess
the impact of students led educational intervention regarding tuberculosis (TB) on their learning and
on the patients’ knowledge and attitude towards the disease.
MATERIALS AND METHODS: One hundred medical undergraduates were included in the study. An
integrated lecture on TB was given to all participants followed by preintervention test on TB. One group
was then subjected to interactive traditional lecture. Whereas the videos reflecting the experiences
of TB patients were shown to the other group and was given an assignment to prepare educational
leaflets for TB patients followed by postintervention test for both groups. The patients’ satisfaction
level with the information given via educational leaflet and the overall perceived benefits of this
activity by the students were assessed. Data analysis done using SPSS version 23.0. Independent
and paired t‑test were used to calculate difference of means for quantitative variables.
RESULTS: Two groups were comparable preintervention however postintervention there was
significant improvement in knowledge in the study group (P0.000). Overall 74.2% of the patients
were satisfied with the information provided through leaflets. Students’ feedback highlighted that
majority of the them felt benefitted from this activity.
CONCLUSION: It can be concluded that such type of educational interventions have dual benefits,
i.e., learning for the students as well as providing health education to patients which in turn will
improve their clinical outcome.

Abstract Fibromyalgia has been increasing worldwide and is considered a public health problem.
Nonpharmacological treatment through exercise and education is recommended for
fibromyalgia management. In this sense, there is a need for interdisciplinary programs to
promote health and improve symptoms in fibromyalgia. The purpose of this study was
to verify the effectiveness of interdisciplinary health education programs for individuals
with fibromyalgia. This is a systematic review that followed the Preferred Reporting
Items for Systematic Reviews and Meta‑Analyses recommendations and was registered
at Prospective Register of Systematic Reviews (CRD4201913228). A search was conducted
in the following databases: Scientific Electronic Library Online, Lilacs, Medical Literature
Analysis and Retrieval System Online, Scopus, Web of Knowledge ISI, Physiotherapy
Evidence Database, Excerpta Medica Database, Cumulative Index to Nursing and Allied
Health Literature, Cochrane Library, and SPORTDiscus. The descriptors used were
“Fibromyalgia” and “Health Education.” Clinical trials published between 1990 and 2019
were selected. The Jadad Quality Scale and the Cochrane Risk‑of‑Bias Tool were used to
evaluate the risk of bias and the methodological quality of the clinical trials. The search
found 2887 articles, and only two studies were included in the analysis. Both studies
conducted the interventions through lectures and group activities. In particular, the
topics most frequently approached at the interdisciplinary health education programs
were general information about fibromyalgia, body practices, physical activities, and
pharmacological approaches. An interdisciplinary health education program can improve
pain and quality of life in people with fibromyalgia; however, evidence shows low
methodological quality. This systematic review indicates that studies are of low quality,
interfering with the effectiveness of interdisciplinary health education programs.

Abstract INTRODUCTION: We know that risk communication is equally important as risk identification, which
is usually not communicated properly to the patients and resulting in poor outcomes, especially in
hypertensive patients.
OBJECTIVE: Our study objective was to evolve and test a colour coded client segmentation based
public health approach to educate the community to deal with problem of hypertension.
METHODOLOGY: This cross‑sectional pilot study was done in March 2020 among purposively approached
in a primary health centre to 100 people aged above 18 years, among them 41 gave written consent for the
study and their demographic information was noted. They were given colour coded cards as per the current
blood pressure level and previous history of hypertension. On each colour coded card, specific advice
was written for that category. For all the participants, blood pressure and treatment seeking behaviour was
noted. For hypertensive patients, adherence to medication and non‑pharmacological measures was noted.
RESULTS: Mean age of the participants was 46.5 ± 13.06 years. Mean systolic blood pressure (SBP)
and diastolic blood pressure (DBP) of the participants were 135 ± 16.85 mm Hg and 86 ± 11.42
mm Hg, respectively. Among the participants, 10 (24.39%) had a known history of hypertension.
Among them, as per the blood pressure levels measured on the day of the study 50% (5) had their
blood pressure levels under control. Interestingly 16 (39%) participants were found hypertensive
incidentally.
DISCUSSION: It is evident from the studies that colour coded approach is used in multiple ways, in
multiple settings, for multiple diseases. To our knowledge, little focus has been given for hypertensive
disorders in the community level. We merely bother about making their risk profiling, even in the
digital age. Sometimes physicians in emergency become puzzled whenever patients collapsed in front
of them and we missed the “Golden Hour” for the treatment by searching patients’ medical details.
CONCLUSION AND RECOMMENDATIONS: The above problem can be solved by risk profiling of
chronic patients by colour coded OPD/Health cards.

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.

Abstract INTRODUCTION: Health promotion is one of the most important aspects in pregnancy, and
health‑promoting behaviors are one of the major determinants of health under the influence of various
factors. This study aimed to determine the association between social support and psychological
factors with health‑promoting behaviors in pregnant women.
MATERIALS AND METHODS: This cross‑sectional was performed on 375 pregnant women when
they had 24–28 weeks in Ilam, October 2018 to May 2019. Two‑stage cluster sampling was performed
after checking the inclusion criteria. Data collection tools consisted of four questionnaires that were
completed in self‑report form. The collected data were analyzed by the descriptive and inferential
tests with the SPSS software version 19.
RESULTS: The mean score of health‑promoting behaviors was 139.87 (21.26) and self‑healing and
physical activity had the highest and the lowest mean 27.67 (4.84) and 16.29 (4.84), respectively.
Linear regression analysis showed a significant difference between different level of stress, anxiety,
depression, and social support with health‑promoting behaviors (P < 0.001). The results showed
that one‑point increase in the score of stress, anxiety, and depression led to the 2.2%, 6.1%, and
24.1% reduction of health‑promoting behaviors, respectively, and one‑point score increase in social
support resulted in 40% increase in health‑promoting behaviors (P < 0.001).
CONCLUSION: A negative association was found between psychological factors and a positive
relationship with health‑promoting behaviors. Although perceived moderate health promotion
behaviors and perceived social support were moderate, they did not have a good status in terms of
psychological factors. Given awareness of the issues under study in each region is essential and
planning to improve stress, anxiety, and depression, as well as promoting and correcting inappropriate
behaviors through planned interventions are required.

Abstract OBJECTIVES: Involving the patients in health‑related decisions requires high health literacy. Health
literacy is related to the concept of information literacy through its emphasis on information skills.
Hence, the aim of this study was to investigate the relationship between information literacy and
health literacy.
STUDY DESIGN: We carried out an original research.
MATERIALS AND METHODS: This is an applied research that is carried out in a survey method.
The statistical population of this study is MSc and PhD students at School of Health Management
and Information Science in Iran University of Medical Sciences who were selected by stratified
random sampling. A standard health literacy questionnaire including access dimensions, reading
skills, comprehension, evaluation, decision‑making, and application of health information was used to
assess the health literacy status of the students. To measure information literacy, the questionnaire
includes identifying information needs, locating information, organizing information, and evaluating
information were used. The data were analyzed by tests of one‑sample t‑test, Pearson correlation,
and simple linear regression with spss software version 18 produced by IBM located at New York.
RESULTS: The results showed that the level of information literacy among students was higher
than the average level. The average of information literacy rate in the sample is 49.09. In this
regard, the most frequent information is gained from the internet, interacting with friends, and asking
practitioners and health workers. In addition, there is a positive and significant relationship between
all dimensions of information literacy with health literacy and information literacy affects 35.4% of
health literacy changes.
CONCLUSIONS: It can be said that information literacy is a predictor of health literacy. Furthermore,
the pattern of people’s health information has moved to new information environments and to improve
health having sufficient information seeking and information literacy skills are essential.

Abstract INTRODUCTION: One of the most thought‑provoking problems in the world is child marriage that is
affected by various factors. Therefore, the purpose of this study is to identify the social determinants
of child marriage in Kurdish regions of Iran.
MATERIALS AND METHODS: This qualitative study was conducted using conventional content
analysis approach. The participants of the study were 30 Iranian‑Kurdish women married under the
age of 18 who were selected through purposeful and snowballing sampling. Data collection was
conducted through semi‑structured interviews and face‑to‑face interviews and continued until the
saturation of concepts was achieved. Graneheim and Lundman method was used to analyze the
data, and Guba and Lincoln criteria were used to strengthen the research.
RESULTS: In general, findings include 5 categories and 17 subcategories: 1 – economic
factors  (financial problems and economic benefits); 2  –  sociocultural factors  (social customs,
cultural beliefs, community encouragement, social learning, gaining prestige, and social support);
3 – individual factors (physical characteristics, personality traits, lack of awareness of the damaging
consequences of early marriage, and fear of the future); 4 – family factors  (dysfunctional family,
weak awareness of parents, and harm prevention); and 5 – structural factors (high demand, limited
access to educational services, and the lack of supportive social and legal structures).
CONCLUSION: By raising the level of awareness and attitude of girls and their families about
the consequences of early marriage, creating the culture of correcting cultural beliefs and social
misconceptions, passing appropriate laws, and the use of local and national media to prevent child
marriage, this social harm can be reduced.

Abstract BACKGROUND: Osteoporosis is one of the major problems associated with aging and is more
common among women than men. This study was designed to modify osteoporosis‑related behaviors
in female students based on the transtheoretical model (TTM).
MATERIALS AND METHODS: This quasi‑experimental study was conducted on female
secondary school students. The sample size was determined 100 by using Altman’s nomogram,
including 50 cases and 50 controls. Participants were completed the Demographic Information and
Osteoporosis‑Related Behavior Questionnaire based on TTM. Evaluation of the data showed that
each participant was at what stage of change in physical activity and preventive dietary behavior
of osteoporosis. The content of the training package was designed, and for the intervention group,
2‑h training sessions were held weekly by the instructor in accordance with the stage of change
for 2 months, and the booklet was provided with the appropriate contents of the stage of change.
Three months after the completion of training, the questionnaires were completed by intervention
and control groups. Statistical analysis was performed using SPSS 23 software.
RESULTS: Concerning the stages of change in physical activity and nutrition, a significant difference
was before and after the intervention in the intervention group (P < 0.001), while no significant
difference was observed in the control group. After the intervention, there was a significant difference
in the self‑efficacy and some subconstruct of processes of change, but there wasnot a significant
difference in the decisional balance.
CONCLUSION: Educational intervention based on TTM has been successful in achieving the goal of
modifying osteoporosis‑related behaviors in female students. The results of this study can be used
by health planners to plan and implement health promotion interventions that will undoubtedly help
reduce the burden of disease.

Abstract BACKGROUND: Recently, the Iranian Ministry of Health estimated about 750,000 deaths are
attributed smoking complications. The aim of this study was to apply the transtheoretical model
(TTM) on general population of Mashhad city to evaluate the stages of change and possible cultural
factors regarding smoking cessation.
METHODS: This descriptive, cross-sectional population-based study was conducted in Mashhad, Iran.
A total number of 562 participants selected by multistage sampling. They were asked about stages of
change for smoking cessation for both hookah and cigarette smoking. Stages of change refer to an
orderly sequence of changes in smoking behavior that people progress through according to the TTM.
Its six stages are as follows: precontemplation (PC) (no intention to quit smoking within 6 months),
contemplation (planning to quit smoking in the following 6 months), preparation (planning to stop
smoking within 1 month), action (quit smoking for <6 months), maintenance (stopped smoking for
6 months or more), and termination (will never smoke again). Data were analyzed using tests such
as Chi-square, Kruskal–Wallis, and logistic regression by SPSS 11.5.
RESULTS: About 18% and 19% of people in this study were regular hookah and cigarette smokers,
respectively. There was significant difference between cigarette smoking and sex (P < 0.001) and
marital status (P = 0.01). There was a statistically significant difference between stages of change
in men and women from the point of cigarette smoking (P < 0.001). Male sex, hookah smoking,
and alcohol abuse were predictors of PC, and age was the only predictor of termination stage for
cigarette smoking. Sex did not have any role in hookah smoking.
CONCLUSION: Targeted education based on gender and marital status warrant attention.
Community-wide education and interventions such as increasing the price of cigarettes are desired.

Abstract BACKGROUND: Better preventive care is a prerequisite to foster community health and in reducing
the unnecessary burden on the health‑care system. The Unani System of Medicine has given due
emphasis on preventive care. This article aims to discuss the health promotion and disease prevention
approaches in Unani Medicine.
MATERIALS AND METHODS: A manual literature survey of classical Unani texts such as
Firdaus‑al‑hikmat, Al Qanoon‑fit‑tib, Kitab‑al‑mansoori, Kitab‑al‑kulliyat, and Kitab‑al‑taisir was
conducted to collect the information available on the strategic approaches of health promotion and
disease prevention in Unani Medicine. To obtain the appropriate English equivalent words for Unani
terms and the scientific name of the drugs, “Standard Unani Medical Terminology” and “Classification
of Unani Drugs” were consulted, respectively.
RESULTS: The findings of the literature survey revealed that Unani physicians have advocated the
personalized and predictive approaches for maintaining health and preventing diseases. Personalized
approach mainly centers on the temperament of an individual. By determining an individual’s
temperament, Unani physician can tell what is adequate or not adequate for the individual. While in
the predictive approach, correct knowledge of prodromal symptoms is a prerequisite to predict the
future developments in the human body and recommending the appropriate preventive measures
accordingly.
CONCLUSION: These approaches present interesting perspectives in the field of promotive and
preventive care and are of much relevance in the present scenario. Unfortunately, the lack of efficacy
studies is a limiting factor in their application. Hence, effective protocol must be developed to provide
evidence‑based data and to give grounds for their widespread usage.

Abstract INTRODUCTION: Social media is becoming a new tool for developing health knowledge management.
However, despite the rapid growth of research in this area, few attempts have been made to review
previous research. This study tried to summarize the opportunities and challenges of using social
media to managing health knowledge.
METHODOLOGY: This article used a narrative approach to collect and review studies. In this
review, published documents during 2010–2019 were retrieved by search in the following three
electronic scientific databases: Web of Knowledge, PubMed, and Google Scholar search engine
using keywords including social media, public health, health knowledge, knowledge management,
and health promotion.
RESULTS: Social media by overcoming geographical barriers, developing health promotion,
facilitating decision‑making, and providing public health education has been able to enhancing health
awareness and improving health behavior. Doctors’ unwillingness to interact with the public, lack of
compliance with the principles of medical ethics, users’ privacy concerns, and difficulty of managing
negative comments are the four challenges to health knowledge management in social media.
CONCLUSION: Social media can be a suitable tool for developing health knowledge management
processes if medical professional ethics and users’ privacy managed properly.

Abstract BACKGROUND: Improving the learning process in education will empower medical students, and
also formative assessment helps improve the teaching–learning process by providing ongoing
reflective information about learning gaps.
OBJECTIVE: The aim of this study was to explore the effect of student‑centered formative assessment
by weekly reflective self‑correction quizzes on medical laboratory students’ performance on the final
examination of hematology course in 2018.
MATERIALS AND METHODS: A semi‑experimental study was conducted on fifty students divided
randomly into intervention (n = 25) and control groups (n = 25) using convenience sampling in 2018
from Torbat Heydariyeh University of Medical Sciences, Iran. Data analysis was performed using
SPSS software version 16, two‑sample t‑test, Chi‑square test, and analysis of covariance.
RESULTS: The intervention had positive effects on students’ mean test scores in hematology
II so that the intervention and control groups managed to obtain 18.45 ± 1.46 and 14.57 ± 2.64,
respectively (P < 0.01).
CONCLUSIONS: The results suggested that weekly formative assessments along with reflective
self‑correction activity and active participation of students in the learning process by designing
questions could improve student learning.

Abstract INTRODUCTION: School teachers play an important role in instilling positive behavior changes
among school children. School children at an early age group of 2–7 years face challenges and need
extra support. Utilization of psychological interventions via school teachers for oral health promotion
is minimal. The present study was done to determine the impact of counseling and reinforcement by
school teachers on children for a follow‑up period of 1 year.
MATERIALS AND METHODS: A quantitative research on 58 randomly selected children for a
follow‑up of one year was conducted to determine the prevalence of preoperational characteristics
in school children. The tools to determine characters in preoperational children consisted of classical
cognitive experiments followed by behavior counseling intervention. The interventional group received
reinforcement with school teachers for a follow‑up of one year.
RESULTS: The assessment of the three characteristics revealed a prevalence of ego centralism,
centration, and lack of conservation and reversibility in 84.4%, 89.6%, and 89.6% children,
respectively. A significant difference in behavior change was seen in children who received behavior
counseling and reinforcement.
CONCLUSION: The present study concluded that Piaget’s characteristics were consistent for a
follow‑up period of one year.

Abstract BACKGROUND: Social media platforms are progressively developing as a rich source of mass
communication. Increasing mental health awareness with the help of social media can be a good
initiative to reach out to a large number of people in a short time frame. This study was conducted
to understand the usefulness of social media platforms for health promotion.
MATERIALS AND METHODS: It was a qualitative study to evaluate the effectiveness of social
media platforms in hosting health promotion campaigns in the field of mental health, which was
observed over 5 months from May to September 2019 to reach more people for effective information
dissemination. The campaigns were as follows (1) The Buddies for Suicide Prevention: an online
campaign to create awareness about suicide prevention. The campaign included script writing,
slogan writing, poster making, and short films making, organized for the general public who were
interested to take part; (2) The #Iquitobacco was a 21‑day campaign with an idea of tobacco cessation
in the community, conducted among social media viewers who were willing to participate; and (3)
#Migrainethepainfultruth was yet another campaign conducted among the social media viewers who
were interested to participate. All the campaigns were conducted using two famous social media
platforms commonly used by young adults. Descriptive statistics such as frequency and proportions
were computed for the number of likes and shares.
RESULTS: The Facebook and Instagram posts concerning all the campaigns brought about a
considerable amount of reach to the targeted population. After the campaigns, the page reached to
around 10.3 k people (both fans and nonfans).
CONCLUSIONS: Use of social media to conduct mental health campaigns is an effective initiative
as one can reach out to several people over a short time period. There is an increasing trend in the
awareness of mental health with the effective use of digital media as a platform for disseminating
information.

Abstract INTRODUCTION: Smoking is a significant health problem among Indonesian adolescents and adults.
The Indonesian government had issued several policies to alleviate this problem, including placement
of pictorial health warning (PHW) on cigarette package. There had been several evaluation studies
regarding the effectivity of PHW in urban areas but none in rural areas. This study aims to evaluate
the effectivity of PHW in motivating smoking cessation in a rural area in Indonesia.
MATERIALS AND METHODS: This was a descriptive cross‑sectional study conducted in August
2017 in Losari village, Indonesia. Respondents of this study were villagers aged 18–60 years who
were active smokers and purchased cigarette with PHW on the package. The research instruments
for this study were questionnaire and printout pictures of each PHW approved by the Indonesian
government.
RESULTS: There were 94 respondents recruited in this study. Among them, only 26 (27.7%) stated
that PHW motivated them to stop smoking. From the five figures of PHW, a picture of lung cancer
was the most effective PHW to motivate smoking cessation. Eighty‑one of 94 respondents affirm
that there are other factors besides PHW that might motivate them to stop smoking. Most of them
agreed that an increase in cigarette price will force them to stop smoking.
CONCLUSIONS: Current PHW used on cigarette package might be ineffective in motivating smoking
cessation at Losari village. Further study with larger samples needs to be done to confirm this finding.

Abstract CONTEXT: Health promotion (HP) and clinical risk management (CRM) topics are seldom discussed
during medical school lessons. Peer‑assisted learning (PAL) has long occurred informally in medical
education, and interest in this method has recently grown, as it is considered a valuable technique
for both tutors and tutees.
AIMS: The aim was to evaluate the impact of HP and CRM PAL intervention on medical
students’ (tutees) knowledge level.
SETTINGS AND DESIGN: A PAL intervention has been implemented at Udine University medical
school during 2017. It was composed of lectures and practical activities conducted by ten near‑peer
tutors.
METHODS: The effectiveness has been evaluated by giving tutees: (1) a knowledge multiple‑choice
questionnaire, before and after the intervention; (2) a satisfaction questionnaire; and evaluating (3)
tutees’ group assignments.
STATISTICAL ANALYSIS USED: We performed descriptive analysis; then McNemar, Wilcoxon
signed rank, Wilcoxon Mann–Whitney, and t‑tests were applied.
RESULTS: The number of students addressed by PAL intervention was 62. Difference in total
correct answers among pre‑ and post‑intervention questionnaires showed a statistically significant
improvement  (P  <  0.0001), both when analyzing it globally and by area  (HP/CRM). Students’
satisfaction for CRM was greater than for HP area (P = 0.0041).
CONCLUSIONS: This educational intervention based on PAL showed its effectiveness producing
a statistically significant improvement in students’ knowledge. Our findings confirm that PAL could
be a feasible method for HP and CRM topics.

Abstract INTRODUCTION: Stroke causes physiologic functional changes such as vascular resistance and
arterial remodeling. This study aimed to explore the effects of 3‑month regular home‑based exercise
rehabilitation on brachial flow‑mediated dilation (FMD), daily physical activity, and upper and lower
extremity sensorimotor of the acute ischemic stroke patients.
MATERIALS AND METHODS: This randomized control trial was done from August 2017 to September
2018. Patients with unilateral ischemic stroke were recruited from inpatient wards at an educational
hospital. Patients were randomly assigned to the home‑based rehabilitation program (intervention
group) or usual care (control group). Fugl‑Meyer upper and lower extremity sensorimotor score and
Barthel score were evaluated in both the groups before and 3 months after baseline assessment.
Furthermore, brachial artery vasomotor reactivity (FMD) hemiparetic arm assessed vascular health.
The intervention group received home‑based rehabilitation exercise program for 3 months. The
control group did not receive home‑based rehabilitation program and incentive telephone call. All
data were collected and analyzed by SPSS software (version 20) and appropriate statistical tests.
RESULTS: Forty ischemic stroke patients (twenty in the intervention group and twenty in the control
group) were examined. Results showed that Barthel score and Fugl‑Meyer upper and lower extremity
score and FMD in the intervention group were significantly higher than the control group after 3‑month
home‑based exercise rehabilitation (P < 0/001).
CONCLUSION: Twelve‑week regular home‑based exercise training was well tolerated by the
intervention group. After this period, improvements were reported in brachial FMD as well as daily
physical activity and upper and lower extremity functional capacity.

Abstract BACKGROUND: The vulnerability of the youth to acquired immune deficiency syndrome (AIDS) and
smoking is one of the most important public health issues around the world. Adequate knowledge
about AIDS and smoking is a powerful tool for promoting positive attitudes and safe behaviors.
OBJECTIVE: This study aimed to determine the effect of self‑care education on AIDS and smoking
on the level of adolescents’ knowledge and health attitude.
MATERIALS AND METHODS: This experimental study was conducted in the academic year of
2017–2018, and the participants were selected using randomized cluster sampling. These participants
included 220 female students of the third grade of middle school in Isfahan (105 in the intervention
group and 115 in the control group). Data were collected using a demographic questionnaire; a
researcher‑made questionnaire on knowledge about AIDS, knowledge about smoking, and attitudes
toward smoking; and a standard questionnaire on students’ attitude toward AIDS. After completing the
pretest, the intervention group performed two training sessions and completed the posttest 1 month
later. One month after completing the pretest, the control group completed the posttest and did not
receive an intervention. Finally, the data were analyzed using descriptive statistics, statistical tests,
and statistical software SPSS version 22.
RESULTS: The results showed that despite the similarity between the two groups at the beginning
of the study, after self‑care education, the knowledge level of AIDS (P < 0.001) and attitude
toward AIDS (P < 0.001) and the knowledge level of smoking (P < 0.001) and attitude toward
smoking (P < 0.001) in the intervention group were significantly higher than the control group. In
intragroup analysis, it was also observed that the difference between the scores before and after
was only significant in the intervention group.
CONCLUSION: It seems that education can promote the level of knowledge and attitude of
adolescents toward AIDS.

Abstract INTRODUCTION: Smoking is one of the leading factors of mortality in Malaysia. Most youngsters start
at adolescence, fascinated by the concept of smoking. Interventions that harness the broad availability
of mobile phones, as well as adolescents’ interest in their appearance, may be an innovative way
to advance school‑based prevention. This study aims to determine the perceptions of facial‑aging
apps among secondary school students.
METHODOLOGY: For this research, descriptive cross‑sectional study using simple random sampling
method was used. Population sampling was targeted toward three government schools. The total
number of respondents is 383, with all of them aged between 13 and‑ 16 years of age. Legal
considerations were taken to maintain the confidentiality of respondents. The specific objectives
are: 1. To determine the level of change of intention on smoking, 2. To know the perceived reactions
of the peer groups on the appearances of students as nonsmokers, 3. To determine whether the
students learned new benefits of nonsmokingand, 4. To measure the impact of a facial‑aging app
among students.
RESULTS: The number of respondents who smoke was 40 (10.4%), while the number of respondents
who do not smoke was 343 (89.6%). About 89% of the respondents agree that their three‑dimensional
selfie image motivates them not to smoke. In addition, 87.8% of respondents admit that the perceived
reactions of their classmates make them think that they look better as nonsmokers. After learning
the effects of smoking, about 86.4% of the respondents acknowledged that they would educate
their peer groups. Furthermore, 85.9% of the respondents found this “Smokerface” app enjoyable.
CONCLUSION: The facial‑aging intervention was effective in motivating Malaysian pupils to stay
away from tobacco use. Thus, the analysis on the study of facial app usage in smoking prevention
among youngsters concludes that most of the adolescents concur that the “Smokerface” app helps
in the prevention of smoking among youths.

Abstract INTRODUCTION: Various programs are implemented internationally to promote the mental and social
health of the students in schools. This study systematically reviewed and categorized all resources,
indicators, and criteria for evaluating mental and social programs of schools.
MATERIALS AND METHODS: This systematic review was conducted by collecting data
from the PubMed, Google Scholar, Scopus, ProQuest, and Web of Science databases
using the keywords of “evaluation, mental health program, social health program, behavioral
and emotional program.” In the initial review, 4295 studies were found, which reduced to 75 after
removing the repetitions and evaluating the studies’ quality. The articles were selected using the
PRISMA chart.
RESULTS: The findings resulted in three main categories of structure, process, and
outcome; 16 subcategories; and 166 codes. The category of structure included the subcategories of
human resources, physical space, facilities, training, needed committees and teams, financing, and
implementing mental and social programs. The subcategories of process category were functional
indicators, guidelines and protocols, communication, documentation, planning/coordination, time
management, and monitoring. The subcategories of behavioral‑therapeutic, satisfaction, and
educational outcomes were associated with the outcome category.
CONCLUSION: Application of the structure, process, and outcome indicators, derived from the
findings of this study, will greatly improve evaluation of the international mental health programs in
schools.

Abstract INTRODUCTION: It is essential to provide key information and support to every woman regarding
pregnancy and childbirth to enable all women to make a fully informed decision regarding their choice
of reproduction. The study aimed to find the impact of an educational program based on the Theory
of Planned Behavior (TPB) on health promotion and childbearing of minor thalassemia couples.
SUBJECTS AND METHODS: This study was quasi‑experimental. A total of 70 women with minor
thalassemia held in Minudasht health center were classified into two groups: study and control. The
study group received the educational program based on TPB, and the control group only received
the routine program. The data were collected using the TPB‑based questionnaire at baseline and
3 months after the intervention. They were analyzed by Chi‑square, Student’s t‑test, Wilcoxon test,
and regression analysis through SPSS version 16.
RESULTS: The mean (standard deviation) ages of the participants in the control and study group
were 30.69 (6.20) and 31.08 (6.66), respectively. There were significant differences between
the two groups (study vs. control) in terms of perceived behavioral control, intention, attitude, or
childbearing behavior (P < 0.001). The change in fertility behaviors had a significant increase in the
study group (62.8%) compared to the control group (2.9%) (P < 0.001).
CONCLUSION: Based on the results, the TPB is an effective model to explain fertility intentions
and behaviors in Iranian women with minor thalassemia; however, further researches are needed
to generalize our findings to other people including healthy women.