Journal of Education and Health Promotion

Abstract BACKGROUND: Metamemory can be described as an intentional endeavor to guide or control
one’s memory processes. In other words, awareness and knowledge of one’s own memory process
and strategies for using the memories effectively. Planning, allocating cognitive resources, selecting
strategies, assessing understanding, and evaluating performance all rely heavily on metamemorial
information. For efficient learning, good memory abilities are necessary. This study aimed to
understand metamemory functioning and to see if there were any gender differences in metamemory
functioning among medical students.
MATERIALS AND METHODS: This cross‑sectional study was conducted by collecting data from
350 medical students using the Memory Functioning Questionnaire in 2021. The sample group was
selected from medical colleges in South India such as Kerala, Karnataka, Tamil Nadu, Telangana,
and Andhra Pradesh using a purposive sampling technique. This questionnaire focused on the
seriousness of forgetting, the rate at which people recalled things over time, and frequency of use
of mnemonics and techniques that assist memory. Descriptive statistics, independent sample t‑test,
correlation, and regression were used for analysis.
RESULTS: There was a significant difference based on gender among medical students in general
memory functioning and frequency of forgetting (P < 0.001). Similarly, it was also found that gender
was a major predictor of general memory functioning and frequency of forgetting among medical
students (P < 0.001).
CONCLUSION: Most medical students believe they have a minor memory issue. Even if the majority
of medical students forget information, the vast majority of them believe they have an exceptional
memory. Gender acts as a significant predictor of general memory performance and forgetfulness.

Abstract BACKGROUND: Nutrition is essential for schoolchildren to reach their full potential psychologically
and cognitively. Malnutrition, which is prevalent among aboriginal schoolchildren in Malaysia,
can interfere their learning and academic performance. Developing a module to be used during a
school‑based nutritional intervention program is essential to ensuring that students develop healthy
eating habits and lifestyles. Thus, this study aims to develop and validate nutrition education module
focusing on aboriginal schoolchildren for the eat right future bright (ERFB) nutrition education program.
MATERIALS AND METHODS: This cross‑sectional study was conducted in three steps: Step 1:
development of module based on literature reviews, Step 2: content and face validation of the module
by the expert panels, and Step 3: face validation of the module by target users. This study has used
the validation form proposed by de Castro. This form consists of seven aspects, two aspects related
to content validity and another four aspects related to face validity. A content validity index (CVI) was
used to analyze the content validity. Two formulas were used to calculate CVI, which were I‑CVI and
S‑CVI. Meanwhile, the data for module’s face used the level of agreement.
RESULTS: Both I‑CVI and S‑CVI obtained more than 0.78 and 0.80, respectively, which indicate
that the module has good content validity. Moreover, for face validity, the total of agreement from
expert panels and target users was more than 75%, which is considered face validated.
CONCLUSIONS: In conclusion, the module that has been developed has good content validity and can
be used by teachers in teaching appropriate nutrition knowledge to aboriginal primary schoolchildren.

Abstract BACKGROUND: Sexually transmitted diseases are a major health problem in all countries. Human
papillomavirus (HPV) infection is the most common viral sexually transmitted disease in both genders.
High‑risk sexual behaviors (HRSBs) are among the major risk factors for HPV infection. Lack of
knowledge can contribute to HRSBs and hence, education can potentially reduce HRSB risk. This
is a study using theory of reasoned action to reduce the high‑risk sexual behaviors among patients
with HPV.
MATERIALS AND METHODS: This study was a two‑grouped, randomized, controlled trial. The
educational program was developed based on the results of a survey into the most important
components of the theory of reasoned action contributing to HRSBs among 100 patients recruited
from Razi hospital, Tehran, Iran. Then, 110 patients from the same hospital were consecutively
recruited and randomly allocated to a control (n = 55) and an intervention (n = 55) group. Then,
each participant in the intervention group was provided with the developed educational program.
Their counterparts in the control group solely received routine care services. Three months after
the first educational session, HRSBs were reassessed in both groups. Data were analyzed via the
SPSS software (v. 21.0).
RESULTS: After the intervention, the mean score of HRSBs significantly decreased in the intervention
group (P < 0.001) but did not significantly change in the control group (P = 0.70). The post‑test mean
score of HRSBs in the intervention group was significantly less than the control group (P = 0.015).
CONCLUSION: Education based on the theory of reasoned action is effective in significantly reducing
HRSBs. Nurses can develop and use educational interventions based on this theory to reduce
HRSBs and HPV infection.

Abstract BACKGROUND: Job satisfaction is one of the most important issues related to human resources in
the organization which can reduce organizational productivity. In this regard, occupational health is an
important science related to the health of the workforce in any organization, paying attention to it will help
health promotion. The aim of the present study was to determine the relationship between the status of
occupational health management and job satisfaction among farmers with a health promotion approach.
MATERIALS AND METHODS: This cross‑sectional study was conducted in 2020. The number of
209 farmers from all villages of Zabol was included by census method. Data were collected using
a researcher‑made questionnaire that consisting of three sections of demographic information,
occupational safety and health status, and standard job satisfaction questionnaire. At first, the validity
and reliability of the questionnaire were evaluated. In addition, 5–10 staff working in Agricultural Jihad
Organization were asked about the content, clarity, and simplicity of the questionnaire terms. Content
validity index and content validity ratio indexes were calculated as 0.68 and 0.83 for occupational
health management and 0.69 and 0.83 for job satisfaction questionnaires, respectively. Instrument
reliability was also assessed using the Cronbach’s alpha coefficient, which was 0.872. Finally, after
verifying the validity and reliability of the instrument, a questionnaire was used to collect the research
data. Shapiro–Wilk, Wilcoxon, and Spearman correlation tests were used to analyze the findings.
The collected data were analyzed using SPSS software version 19. Armonk; NY, USA: IBM Corp.
RESULTS: The results of the study indicate that occupational health management was at a moderate
to a high level (3.701) and job satisfaction (3.381) was at a moderate to a high level. The standard
regression coefficient between occupational health management and job satisfaction was obtained
as 0.571. With a confidence of 95%, it can be stated that occupational health management in Zabol
city under the supervision of jihad‑e‑agriculture organization has a significant impact on farmers’
job satisfaction. In addition, the research findings confirmed a positive and significant relationship
between occupational health management and job satisfaction of employed farmers and showed that
the implementation of occupational safety and health programs in the jihad‑e‑agriculture organization
can affect the job satisfaction of farmers.
CONCLUSION: According to the evaluation of research findings, job satisfaction and occupational
health management in the Agricultural Jihad Organization are relatively favorable among farmers
in Zabol city. It was argued that there is a relationship between occupational health management
and job satisfaction, that the implementation of programs related to occupational safety and health
management system such as Health and Safety Executive will promote health.

Abstract BACKGROUND: Social networks are integrated in our lives and, amongst other functions, they
are a means of dissemination. There are numerous social network accounts dedicated to health
that could be used as an educational resource. The aim of this study was to evaluate the quality of
accounts dedicated to health in different social networks, assessing their content and didactic and
technological effectiveness and accessibility.
MATERIALS AND METHODS: Observational cross‑sectional descriptive study in which an
analysis of social networks related to health was carried out from April to June 2021 in Spain.
Twenty‑eight accounts were analysed using a mixed qualitative‑quantitative methodology.
Content analysis of the speeches disseminated through the selected accounts was performed.
In addition, the quality of the accounts was assessed with the Instrumento de Evaluación
de Recursos Educativos Digitales (#IE_RED) (Digital Educational Resources Evaluation
Instrument [#IE_RED]).
RESULTS: Four categories were identified according to the content: student‑focused profiles, specific
professionals’ profiles, current health issues and profiles promoting a healthy lifestyle. In addition, the
quality of the accounts obtained a score that indicates they meet the requirements to be validated
as a good educational digital resource but could be improved. Instagram social network accounts
and those managed by nurses scored significantly higher.
CONCLUSIONS: The analysed accounts were revealed as a quality tool for health dissemination,
with varied content and applicable to teaching. Their use could be applied both to the training of
health professionals and to the promotion of the population’s health.

Abstract BACKGROUND: Schools are ideal setting for children’s oral health‑promoting programs. It is an
integrated model for oral health‑promoting schools (OHPS) with the capacities of dental school’s
curriculum and dental students as workforces. In this protocol, the principle of planning and
implementation of the oral health program is described.
MATERIALS AND METHODS: Based on the PRECEDE‑Policy, Regulatory, and Organizational
Constructs in Educational and Environmental Development (PROCEED) planning model, a framework
for determining the potential predisposing, reinforcing, and enabling factors that could be intervening
was diagnosed. To adapt the phases of the planning model for integration of the “OHPS” principles
and the dental students’ curriculum, the following steps are supposed to be considered: Phases
1–5 which are to assess the baseline data will include the assessment of children oral health status
and parents and teachers’ knowledge, attitude, and performance. Phase 6 or implementation phase
will be allocated to oral health education interventions for students, parents, and teachers, professional
screening, prevention, and referral. Phase 7 or the process assessment phase will be to record the
number of screened students, the amount of fissure sealant and fluoride provision, and percentage
of trained parents and teachers. Phase 8 or the impact assessment phase will assess the students’
improvement in knowledge and practice, decayed, missing, and filled teeth scores, teachers and
mothers’ oral health attitudes and behaviors, and brushing and flossing behaviors. At the last, cost
analysis of the program and long‑term monitoring of the interventions is suggested.
CONCLUSION: In case that the effectiveness of this model is proven, it can be implemented by other
dental schools for the primary schools in their regions. Considering the number and distribution of
dental schools in the country, this model is executable as targeted population oral health promotion
approach in 6–12‑year‑old schoolchildren.

Abstract BACKGROUND: Nursing is one of the most stressful occupations. Educational intervention regarding
stress management can play an important role in reducing occupational stress among nurses The
present study aimed to determine the effectiveness of educational intervention on reducing oxidative
stress caused by occupational stress in nurses: A health promotion approach in a hospital in western
Iran.
MATERIALS AND METHODS: The present interventional study was performed in 2019 among
92 nurses working at the Kosar Hospital located in the city of Sanandaj in the country of Iran.
Occupational stress was evaluated using the Osipow Occupational Stress Questionnaire. Oxidative
stress was measured by taking blood samples and measuring the enzymatic activity of superoxide
dismutase (SOD), malondialdehyde, and catalase (CAT) using SOD, malondialdehyde (MDA), and
CAT kits. Educational intervention was carried out in the second stage. Three months after the
intervention, data were taken again.
RESULTS: The results of the present study indicated that there was a significant difference in
occupational stress between before and after the educational intervention (P < 0.05). A significant
reduction in MDA (P = 0.038) and SOD (P = 0.048) was observed after educational intervention, but
this was not the case for CAT (P = 0.592). There was no significant correlation between occupational
stress with oxidative stress parameters before and after the educational intervention (P < 0.05). No
significant difference in occupational stress was observed between men and women. Among the
oxidative stress parameters under evaluation, MDA was higher among men compared to women
and this was statistically significant.
CONCLUSIONS: Educational intervention regarding occupational stress is effective in reducing
oxidative stress among nurses. The group meetings teach stress management to the participants
and enable them to better manage their stress by utilizing their own capabilities. Thus, attention to
this issue is vital in maintaining the mental and physical health of nurses and, in turn, improves the
quality of care rendered.

Abstract Health education is a crucial consideration in the healthcare system and has the potential to improve
global health. Recently, researchers have expressed interest in streamlining health education, utilizing
digital tools and flexible curriculums to make it more accessible, and expanding beyond disease and
substance abuse prevention. They have also expressed interest in promoting global health through
health and safety promotion programs. Amidst the COVID‑19 pandemic, climate change, the refugee
crisis, and overpopulation, healthcare crises are erupting all over the world. A lack of health education
has and will continue to have a profound impact on community healthcare indicators, particularly in
low‑income nations. Current priorities within the health education sector include digitization, equity,
and infectious disease prevention. Studies and data from university journals and other academic
databases were analyzed in a literature review. Health education programs have a significant positive
impact on attitudes and behaviors regarding global health. Improving upon these programs by digitizing
them and expanding upon the scope of health education will help ensure that such interventions and
programs make a significant difference.

Abstract BACKGROUND: Healthy children are the foundation for a healthy and developing nation. Perceived
behavioral control (PBC), comprising control belief and perceived power, is a person’s perception of
the ease or difficulty of performing the behavior of interest. For facilitating regular physical activity and
regular healthy dietary practices among the adolescents, PBC is an important construct to develop
and implement appropriate interventions. The aim is to assess PBC to perform regular physical
activity and regular healthy dietary practices and measure their statistical relationship among the
school‑going adolescents in an urban area in West Bengal.
MATERIALS AND METHODS: A school‑based cross‑sectional study was conducted among 251
adolescents aged 12–16 years after taking consent and assent for participation in the study. Data
were collected with self‑administered questionnaire on sociodemographic variables and the two
domains of PBC, i.e., control beliefs and perceived power, related to regular physical activity and
regular healthy dietary practices. Each PBC total score was calculated by multiplying control belief
score and perceived power score for each respondent. Partial correlation coefficient was calculated
between regular healthy dietary practices and regular physical activity.
RESULTS: Among the total 251 responses analyzed, 34.7% and 27.5% students belonged to age
group 14 and 15, respectively. It was observed that the mean (± standard deviation) score of PBC
regarding regular healthy dietary practices was 100.7 (±27.7) and for regular physical activity was
106.0 (±21.4). The correlation between PBC of regular healthy dietary practices and regular physical
activity was 0.421 and was statistically significant.
CONCLUSION: In case PBC score over any behavior is higher, behavioral intention and ultimately
chances of performing that particular behavior increases. Designing appropriate school‑based health
promotion strategies can lead to healthier children fostering regular healthy dietary practices and
regular physical activity in their homes and communities.

Abstract BACKGROUND: In recent years, among managers and designers of health‑care spaces, there
has been a growing tendency to move toward hospital design by combining patient perceptions
and expectations of the physical environment of the care area. The main idea of this study was
to present a conceptual model of hospital architecture in our country with a patient‑centered
approach based on some factors that were affecting the sense of place. This model determined
the architectural features of treatment spaces from a patient’s lived experience that could have a
positive mental effect on patients as well. The main question of the research was how to adapt the
objective perception to the patient’s mental perception to create a sense of place in the hospital
space?
MATERIALS AND METHODS: This research was qualitative with a phenomenological approach,
conducted between July and December 2020. Purposeful sampling consisted of 23 patients, 13 males
in the male surgery unit and 10 females in the gynecology unit, who were interviewed in‑depth. They
were hospitalized for at least 3 days in two hospitals (Dr. Pirooz in Lahijan and Ghaem in Rasht).
The data were analyzed by the Colaizzi method.
RESULTS: The results consisted of 530 primary codes, 57 subthemes, and 7 main themes. The main
themes were hospital location, access to hospital, hospital identity, hospital dependency, hospital
attachment, human interactions in the hospital, and hospital evaluation.
CONCLUSION: The hospital form guided the patient, and the hospital function directed and obviated
the patient’s needs. The healing environment and human interactions with it caused the patient to
be satisfied with the hospital environment.

Abstract BACKGROUND: Coronary artery bypass graft (CABG) plays an important role in reducing coronary 
heart disease mortality, but patients are still at risk after surgery. Consequences can be avoided if 
threatening behaviors are soon detected and lifestyles are promoted. Therefore, the present study 
aimed to evaluate, follow‑up, and promote a healthy lifestyle in the patients.
MATERIALS AND METHODS: The present research was a quasi‑experimental pre‑ and 
postintervention single‑group study on 35 patients under the CABG at two hospitals affiliated to the 
Baqiyatallah University of Medical Sciences in Tehran from August 2020 to April 2021. The samples 
were selected using the purposive sampling method and the educational content was determined 
by creating an expert panel. We utilized the Health‑promoting Lifestyle Profile II to collect data, and 
SPSS 22 to analyze them.
RESULTS: There was a significant difference between mean total scores of health‑promoting lifestyle 
before and after the intervention and they reached from 138.7 ± 20 to 157.2 ± 18 (P < 0.0001). There 
was also a statistically significant difference between mean scores of nutrition (P < 0.003), physical 
activity (P < 0.0001), health responsibility (P < 0.0001), and stress management (P < 0.0001) before 
and after the intervention, but there was no statistically significant difference between mean scores 
of interpersonal relationships, and spiritual growth before and after the intervention.
CONCLUSIONS: The program had a positive effect on the health‑promoting lifestyle scores of 
patients after CABG. It is possible to increase scores of healthy lifestyles in the patients by combining 
face‑to‑face and virtual training methods as well as involving family members and relatives of patients 
in training and follow‑up programs.

Abstract BACKGROUND: Health‑care workers are exposed to complex types of health and safety hazards. 
A high percentage of hospital staff in Iran are women, who in addition to heavy and stressful hospital 
work, also carry the burden of the family roles. It is in these circumstances that creating a supportive 
environment for women is of particular importance. Accordingly, this study is designed to determine 
the characteristics of a mental supporting work environment in the workplace from the perspective 
of female hospital staff.
MATERIALS AND METHODS: This study was performed by a qualitative method and content 
analysis approach. Sampling was purposive and 26 women working in different wards of this 
hospital were included in the study. In this study, women with maximum diversity in terms of age, 
work experience, and employment ward were selected. The main method of data collection in this 
study was a semi‑structured interview. Interview texts were extracted and divided into meaningful 
units. To validate and confirm the results plus accuracy of the research, the criterion of data validity 
or data credibility, admissibility, data accuracy, verifiability, reliability, and transferability were used.
RESULTS: Through the data analysis, 58 primary concepts with the same features were classified 
into 10 subcategories. Then, based on common features at a more abstract level, they were converted 
into four main categories including job stressors, women’s stress management, providing women’s 
psychological‑job satisfaction, and women’s work‑life balance.
CONCLUSION: Creating supportive work environments for women, especially those operating in 
workplaces such as hospitals, which brings a lot of work pressure and workload for them, can be an 
important policy for organizations and hospital work environments.

Abstract BACKGROUND: Nongovernmental organizations (NGOs) as entities out of the health sector can 
play various roles and functions at different levels of the health systems. The present study was 
conducted to investigate NGOs’ potential and actual functions in Iran’s health system.
MATERIALS AND METHODS: This exploratory study was carried out in two parts from April 2020 
to December 2020 in Tehran, Iran. For the first part, the statute of 65 NGOs was used for document 
review, and in the second part, the required data were collected using semi‑structured interviews 
with 26 key informants from the governmental sector and NGOs. Data were analyzed using the 
framework analysis method and MAXQDA software.
RESULTS: According to data analysis, the results of this study were classified into two sections 
of NGOs’ current functions and expected functions in Iran’s health system. The current functions 
of NGOs in Iran’s health system include service delivery, educational, research, and information 
activities, financing, supportive and facilitation activities, and advocacy. Other functions in which 
NGOs could play a role include health system management, education, and service providing and 
support activities.
CONCLUSION: In this study, the various roles of NGOs in Iran’s health system were explained. 
NGOs can act actively as the consulting and executive hand alongside the public sector in the lowest 
to the highest levels of Iran’s health system. Hence, health sector managers and policymakers must 
facilitate NGOs’ involvement in the health sector and use their capacities and capabilities to improve 
health and increase public access to health‑care services.

Abstract BACKGROUND: Capturing the baseline information on awareness, practices, and prevailing 
myths related to the ongoing coronavirus disease‑19 (COVID‑19) pandemic in rural India will help 
in planning interventions to improve the health literacy on COVID‑19. The aim of the study was to 
assess the level of awareness, practices, and myths regarding COVID‑19 among rural population 
of Kolar district in South India.
MATERIALS AND METHODS: A concurrent mixed‑methods study with a quantitative 
community‑based cross‑sectional analytical design and a qualitative phenomenological design 
was conducted in five randomly selected villages during June 2020. A prevalidated and pretested 
semi‑structured questionnaire was administered to one adult in the households selected using 
systematic random sampling to capture the sociodemographic details and their awareness, practices, 
and myths related to COVID‑19. The supervisors additionally and concurrently used a nonparticipant 
observation technique to record the real‑time behaviors and preventive practices adopted by the 
villagers. Quantitative analysis was done using STATA and included multivariable regression 
analysis, and the association was reported using prevalence rates along with their 95% confidence 
intervals (CIs). Qualitative analysis was done manually as per discussion and concordance among 
supervisors and reported as categories along with supporting statements.
RESULTS: Among the 298 respondents, “poor awareness” was seen in 128 (43.0%, 95% 
CI: 37.5%–48.6%). Among the responders, 89 (29.9%) believed in the myth that “Corona disease is due 
to God’s wrath or curse.” The field observations were categorized under three categories – “avoidance 
of masks,” “nonexistent social distancing,” and “rampant spitting.”
CONCLUSION: About two in five villagers were found to have “poor awareness” to COVID, and 
practices related to COVID were found to be largely unsatisfactory. Lower level of education and 
belonging to nuclear family were associated with “poor awareness.” Various myths were identified 
that has to be debunked on priority basis by the government, especially targeting the people having low level of education in rural India.

Abstract BACKGROUND: Domestic violence against women is a global problem that can lead to many
negative consequences on physical, mental, and social health that various sociocultural causes play
a role in its occurrence in different societies. Therefore, this study was conducted to determine the
causes and type of violence against spouses in married men in Kerman.
MATERIALS AND METHODS: This cross‑sectional study was performed in 2018. The study was
conducted on 400 married men who experienced violence against their wives. Sampling was a
multistage cluster sampling method. The data collection tool was a questionnaire on violence against
women. Data were analyzed using descriptive statistics, one‑way analysis of variance (ANOVA),
and two‑variate analysis.
RESULTS: The results of the data showed that the highest rate of violence in the group of housewives
was related to physical violence and in the group of women living in dormitories and pregnant women
was related to verbal violence. The results of data analysis with a one‑way ANOVA test showed
that between the three groups, all dimensions of violence and the overall score of violence had
significant changes (P < 0.05). The results of the two‑variate analysis test showed that there was a
significant relationship between the variables of age, duration of marriage, male education, spouse
education, type of marriage, male job, and spouse job with the overall score of violence in all three
groups (P < 0.05).
CONCLUSION: According to the results of the present study, it seems that the empowerment of
women in all dimensions to improve and promote health to deal with domestic violence is essential.
As a result, the relevant measures should be taken by the support systems taking into account the
circumstances of the individuals.

Abstract BACKGROUND: Candidiasis vaginitis is an opportunistic and common mucosal infection. Although
Candida albicans is the most common isolated species, other species of Candida such as Candida
glabrata, Candida krusei, Candida parapsilosis, and Candida tropicalis have also increased
significantly in recent years. The aim of this study was to identify Candida species in women with
candidal vaginal infection in order to promote health in women.
MATERIALS AND METHODS: This cross‑sectional descriptive study was performed on nonpregnant
women of childbearing age who referred to health centers in Neyshabur in 2018. At the beginning of
the study, 163 people entered the study and the culture results were positive in 68 of them. In vitro,
culture was performed in subduxtrose agar medium containing chloramphenicol and gentamicin.
Species identification was performed using Candida specific culture medium (Saburo dextrose agar
and chloramphenicol). After culture, 15% of the residual wet slide with potash (KOH) was prepared
and observed with a lens. Finally, the data were analyzed with SPSS software version 24.
RESULTS: The participants in the study were women with a mean age of 35.55 ± 5.47 and the
average number of deliveries was 1.38 ± 1.15. In this study, the prevalence of C. albicans was
59.7%, C. tropicalis was 14.8%, C. krusei was 15%, and C. glabrata was 7.61% and also krusei and
tropicalis were 3% simultaneously. Therefore, C. albicans was the most common species isolated
from clinical specimens.
CONCLUSION: In this study, the most common species after albicans were C. tropicalis and
cruciferous. Considering the role of C. glabrata in the development of resistance to antifungal drugs,
the lower prevalence of this species in the present study can be associated with improved treatment
outcomes in patients.

Abstract BACKGROUND: This study aimed to investigate the effect of educational intervention based on the
Pender’s health promotion model (HPM) on lifestyle and self‑efficacy of the patients with diabetic
foot ulcer.
MATERIALS AND METHODS: In this clinical trial conducted in 2019, 74 patients based on
inclusion criteria were selected through convenience sampling and allocated to two groups of
intervention (n = 37) and control (n = 37) using the randomized permuted block method. In this
study, Demographic characteristics and localized Diabetes Foot Care Self‑Efficacy Scale and
Health‑Promoting Lifestyle Profile Questionnaire for diabetic foot care were completed by two groups.
The obtained data were analyzed using SPSS 16 and through descriptive and comparative statistics,
independent t‑test, paired t‑test, and ANCOVA.
RESULTS: After the intervention, the mean score of the intervention group significantly increased
in all lifestyle dimensions (P < 0.001). Furthermore, the mean score of self‑effcacy increased in the
intervention group after the intervention (P < 0.001). Comparing the change in the mean scores of
lifestyle and self‑efficacy in both the groups 50 days after the intervention, an increase was observed
in the mean scores of self‑efficacy (P < 0.001) as well as those of lifestyle and its dimensions in the
intervention group compared to those in the control group (P < 0.001).
CONCLUSION: Educational intervention based on the Pender’s HPM can promote the self‑efficacy,
lifestyle, and its dimensions in the patients with diabetic foot ulcers. The results of this study can be
used in educational interventions aiming at patients with diabetic foot ulcers to change their lifestyle
and improve their self‑efficacy.

Abstract BACKGROUND: Health literacy is an important variable in the promotion and improvement of the
health of all social groups, especially the elderly people. It indicates cognitive and social skills that
specify the individuals’ motivation and ability to access and perceive information using methods
for health retention and improvement. The present research aimed to study health literacy and its
relevant dimensions in a population over 60 years of age in Farsan city.
MATERIALS AND METHODS: A cross‑sectional study on 384 older people in Farsan city was
conducted, using a standard health literacy questionnaire including 33 items and 5 dimensions on
a 5‑point Likert scale for collecting data. Data analysis was done using descriptive and analytical
statistics, using the multiple linear regression analysis.
RESULTS: Among the dimensions, the highest and lowest scores belonged to decision‑making and
reading skill dimensions, respectively. The multiple linear regression analysis revealed that among
the demographical variables, education level, age, sex, and job were the best predictors of total
scores of health literacy (P < 0.001).
CONCLUSIONS: The health‑related institutions should make effort to improve the elderly people’s
health literacy based on general literacy, using suitable methods with less need to read and paying
attention to personal characteristics.

Abstract Clinical governance is a systematic approach to enhancing the quality of primary health care and
ensuring high clinical standards, responsiveness to performance, and continuous improvement
in service quality. The objective of the current study was to investigate the global experiences
of clinical governance in primary health care. In the present systematic review, relevant articles
from different countries were searched in various databases such as MD PubMed from Medline
portal, Emerald Springer link, ProQuest, Cochrane, Scopus, Web of Science, and Consult until
April 2019. The searched articles were checked through CASP and PRISMA checklists, and their
results were extracted. Of the 17 selected studies, 16 belonged to developed countries, including
England (13), Australia, Italy, and New Zealand, and one was from Turkey. The findings were divided
into three general categories: (1) principles of effectiveness and risk management, (2) deployment
requirements such as structural and organizational needs, resource and communication, and
information management, and (3) barriers of clinical governance toward providing primary health
care. it is recommended that a suitable framework or model be developed and designed adapted
to the local culture and taking into account all effective dimensions for a proper establishment and
implementation of clinical governance in primary health care.

Abstract BACKGROUND: There is a lack of organized effort in the arena of school health promotion, which
has been recognized as an effective approach to combat the growing incidence of communicable
and noncommunicable diseases. With this view, a study was conducted to develop comprehensive
and replicable model for health promotion in schools.
MATERIALS AND METHODS: The Knowledge to Action (KTA) framework recognized by the World
Health Organization as an implementational framework was used in an implementation study in
a school of urban Jodhpur to assess the challenges and gaps associated with health promotion
interventions in the school. Baseline regarding knowledge application and practices was gathered
using interviews with school staff, parents, and group interaction with students. Knowledge synthesis
was done by a thorough search of available literature and the gathered baseline. Resource mapping
was carried out using checklists developed from knowledge synthesis. Tailor‑made tools were
constructed for knowledge implementation for each component of the action cycle. Knowledge of
facts related to health behaviors among students was evaluated using pre‑ and postquestionnaires
and practical application of knowledge was assessed using a checklist of 28 indicators on a 5‑point
Likert scale. Values of tests were gathered and compared with test values 3 and 6 months after the
implementation of tailored interventions using descriptive and inferential statistics.
RESULTS: Increase in correct answers by students (42% to 96%) and average response for
indicators on the Likert scale (3.23–4.86) was seen on repeated interventions over 6 months. Tobacco
consumption by school staff reduced by 20% and an increase in willingness among teachers was
observed on follow‑up interviews.
CONCLUSION: The study thus developed a model for health promotion in a school with the help of
the KTA framework using tailored interventions that could further be evolved in other setups based
on local needs and available resources.

Abstract BACKGROUND: nongovernmental organizations (NGOs( are the hidden system of promoting public
health and the symbol and mediator of people’s participation. The aim of the present research was
to assess the status and recognize the performance of various NGOs in providing health‑oriented
services as opportunities in promoting community health.
MATERIALS AND METHODS: The present study was a descriptive–analytical (cross‑sectional)
study, which was conducted on the position and function of all NGOs in Kerman from February 2014
to the end of January 2015. A researcher‑made checklist was used to collect the data, which was
designed based on the statutes of NGOs. The information was collected from a total of 150 NGOs.
To analyze the data, in addition to descriptive statistical tests (frequency, percentage, mean, and
standard deviation), other tests were also used (Chi‑square test and Fisher’s exact test). Moreover,
all data analysis was done using SPSS (ver. 16).
RESULTS: There was a significant relationship between the levels of prevention and field of activity
and the objectives and methods of implementation of these objectives (P < 0.001). There was a
significant relationship between health prevention levels in the target community of the NGO and
initial assets (P = 0.02), licensing organization (P < 0.001), management type in terms of the board
of trustees or membership availability (P < 0.001), relevance of members’ major with organizational
goals (P = 0.02), and activeness or inactiveness of the organization (P = 0.007).
CONCLUSION: The results showed that there was a relationship between NGO’s target population
in terms of levels of prevention and the studied factors. The relationship between the services of
these organizations and the levels of prevention is a very important and effective role in community
health promotion.

Abstract Community empowerment has been proposed since the 1980s as a way to increase people’s power
to influence social determinants of health. However, community empowerment for health promotion
in urban slums still faces challenges. The present study examined interventions, challenges, actors,
scopes, and the consequences mentioned in various studies and with emphasizing interventions
and executive challenges tried to create a clear understanding of empowerment programs in slums
and improving their health. Narrative review method was used to conduct the study. Databases
including PubMed, Scopus, Embase, Web of Science, and Cochrane were searched. The selection
of studies was done according to the “community empowerment” defined by the World Health
Organization, the concept of bottom–up approach for health promotion of Laverack and Labonte’s
study and definition of slums by UN-HABITAT. Finally, Hare and Noblit’s meta-synthesis was used
to analyze the studies. From 15 selected studies, the most intervention proposed for empowerment
was identified to be “residents’ participation in expressing problems and solutions.” The challenge of
“creating a sense of trust and changing some attitudes among residents” was the greatest challenge
in the studies. Moreover, “improving living conditions and health services” were the most important
outcomes, “slum residents” and “governments” were the most important actors, and “sanitation”
was the most important scope among the studies. Having a comprehensive view to the health and
its determinants and attention to the factors beyond neighborhood and health sector would lead to
fewer implementation challenges and better intervention choices to health promotion of slum dwellers.

Abstract BACKGROUND: Adopting healthy behaviors can lead to better outcomes which can deeply impact
cardiovascular diseases (CVDs) development; consequently, tailoring appropriate theory‑based
interventions may improve various outcomes among patients at CV risks. This study aimed to assess
published researches on the application of health education and promotion of intrapersonal and
interpersonal theories/models’ interventions on patients with CVD.
MATERIALS AND METHODS: In this systematic review, PubMed, Web of Science, Google Scholar,
Scopus, Science Direct, and SID, Magiran databases for English and Persian studies were searched
using relevant keywords, respectively. We searched for interventional studies published with no time
limits until the end of 2020 assessing the application of health education and promotion theories/models
interventions on adult patients with CVDs. Two reviewers individually reviewed abstracts/full‑text
articles to assess inclusion according to predefined criteria. In case of discrepancy between the two
researchers, a third expert was requested to assess papers, and final selection decision was made
based on the agreement among the three evaluators. This systematic review was conducted using
the following data extraction steps and assessing the quality of the studies and results.
RESULTS: From 60 articles, 35 studies met inclusion criteria. Most interventions improved at least
some educational including models constructs (20%), clinical (14.2%), and practical (88.5%) outcome
related to CVDs. It is noted that attention to educational, practical, and clinical outcomes was focused
in published papers, respectively. Furthermore, based on the study categorization using models,
some CVDs and theories/models were more concerned compared to others.
CONCLUSIONS: Health education and promotion theory‑based interventions on patients with CVD
appeared beneficial in the most published paper.

Abstract Pharmacies are a major component of health systems and a major part of health service
provision. This study aimed at identifying and introducing the potentials of pharmacies
in health promotion. This was a systematic review that searched PubMed, Web of Science,
Science Direct, SID, Magiran, and IranMedex from February 1990 to September 2018 for
related materials. The main search keywords were (pharmacy services), (community
pharmacy services), (retail pharmacy services), (pharmacy practice intervention). Inclusion
was limited to those papers that discussed the health‑promoting services provided in
the pharmacies. The quality of included papers was assessed by the Critical Appraisal
Skills Program checklists. The Preferred Reporting Items for Systematic Reviews and
Meta‑Analyses chart was followed in all stages of the study. Of the 4156 papers retrieved,
18 met the inclusion criteria and included in the analysis. Study findings were categorized
into three main categories: Health and prevention services, services related to treatments,
and the awareness about the pharmacies’ functions. The health and prevention category
consisted of education, vaccination, screening and prevention of diseases, family planning,
blood pressure monitoring, quitting smoking, limiting alcohol, and weight management. The
treatment‑related services consisted of adherence to medication, medication consultation,
minor pains, and emergency medical services. Pharmacies can provide a wide variety of
services besides the medications. Purposeful development of the services provided in the
pharmacies and involving them in an extended array of services may accelerate the health
promotion activities of the health system and result in improved quality of life and decreased
costs. To do so, the legal, educational‑skill, and pricing challenges should be resolved.

Abstract BACKGROUND: Benefactors of nongovernmental organizations (NGOs) are the hidden public health
promotion systems. These benefactors are the symbol and intermediary of people participation, which
is one of the main arms of health promotion and reduction of poverty and injustice in the societies.
The present study is aimed to identify the benefactors’ experiences in NGOs in terms of providing
and promoting health‑oriented services.
MATERIALS AND METHODS: This study was conducted with a qualitative approach. The total
number of participants was 32, which consisted of 25 chief executive officers from active and inactive
organizations. Active organizations refer to organizations that submitted their 6‑month report at the
time of the investigation and whose operating license was renewed and in operation and seven
officials of the social deputy of governmental organizations related to NGOs. Data collection was
performed by using semi‑structured interviews and with purposive sampling and then continued until
data saturation. Furthermore, the content analysis method was used for data analysis. MAXQDA
software version 2007 was used to manage quality data.
RESULTS: During the data analysis, the following four subcategories were obtained: “high effort
in empathy with fellow human beings,” “role of merit in the success of donors,” “creating a platform
for social attention for the client’s spontaneity,” and “respect of the client,” which were the results of
experience and dimensions. The performance of non‑governmental organizations is in line with the
confrontation and responsibility of non‑governmental organizations with a focus on health‑oriented
services.
CONCLUSION: Having benevolent motives, benefactors attempt to provide conditions, in which help
seekers have more chance for living through establishing new, sustainable, and future‑reassuring
conditions.