Journal of Education and Health Promotion

Abstract BACKGROUND: Cardiovascular diseases are the most common causes of death in the world.
Because of the rate of emergencies and disasters in the country, this study was conducted to
investigate the challenges of providing health services to cardiovascular patients in emergencies
and disasters in Iran.
MATERIALS AND METHODS: This conventional content analysis study was conducted in 2020.
Subjects were selected from among 16 Iranian experts) epidemiologists, cardiologists, PhD in Disaster
Health, and PhD in Nursing (using purposeful and snowball sampling methods. Data were collected
using semi‑structured interviews and were analyzed by the content analysis.
RESULTS: The results were obtained after analyzing the data in the pre‑emergency phase (lack
of training on medication and nutrition, lack of training vulnerable groups, lack of databases of
cardiovascular patients, and lack of identification of patients before disasters), the emergency
response phase (lack of sleep and rest patterns, lack of health forces, lack of blood pressure control,
lack of proper nutrition, increased medication needs, and lack of mental health interventions), and
the post‑emergency phase (lack of planning, lack of management of patients’ mental problems).
CONCLUSION: Developing strategies for planning, training, providing resources, and mental
health during the three phases of the emergency management cycle for specific groups such as
cardiovascular patients together with empowering these patients in the event of disasters is one of
the key strategies which can be used after curbed emergencies and disasters to reduce the rate of
mortality.

Abstract BACKGROUND: Since the field of health professions education (HPE) is an emerging trend in the
country, educationists face considerable challenges in their workplaces while proposing any changes
in the existing systems of academic institutions. The challenges affect the quality of work, hinder
innovation, and create a dysfunctional work environment, non‑conducive for both personal and
professional progress. The study was conducted to explore the various kinds of challenges faced
by educationists while bringing changes to the existing systems of academic institutions in Pakistan.
MATERIALS AND METHODS: A qualitative exploratory research design was used to explore the
challenges faced by health professions educationists in Pakistan during their efforts to bring about
changes in the existing systems and structures. Thirteen health professions educationists working
in various academic institutions of Pakistan were interviewed through one‑to‑one semi‑structured
interviews from March to May 2022. The data obtained were analyzed through manual thematic
analysis, and themes and subthemes were identified.
RESULTS: Four themes emerged after qualitative data analysis explaining the predominant
challenges faced by educationists. These included challenges related to faculty and staff, institutional
constraints, challenges from leadership, and stakeholders’ apprehension.
CONCLUSION: Challenges are inevitable at every workplace but the field of health professions
education in Pakistan faces significant challenges in institutions, leading to hindrance in positive
developments and innovations in the field. Educationists should be skilled at recognizing the
predominant challenges in the workplace and be equipped with strategies to manage conflicts to
achieve productive results and to promote the long‑overdue reforms in the field.

Abstract BACKGROUNDS: Due to the severity of the earthquake, it may need immediate treatment and
transfer of the injured people to advanced medical centers, as well as dispatch of the expert team
and specialized health equipment to the accident‑affected area. Aerial emergency is an important
responsibility of the health care system in this situation. The study aimed to extract the prehospital
emergency challenges of Iran aerial operations emergency in response to the earthquake.
MATERIALS AND METHODS: The study was qualitative content analysis with conventional
approach. Sampling was done in a purposive method and data were collected through semi‑structured
interview. The panel involved consists of 26 health professionals in medical emergencies. Recorded
interviews were transcribed into written and then conventional content analysis was used to derive
coding categories directly from the text data.
RESULTS: Content analysis is provided 97 initial codes, 20 subcategories and 4 main categories
including challenges of “response assessment,” “support,” ”pre‑hospital staff‑management,” and
“response operation,” respectively.
CONCLUSIONS: The results showed that the necessity to assess the affected area, staffing, and
management actions, including integrated operations command and the development of a dedicated
response plan, as well as the use of strategies inter‑organizational coordination in the response
phase to earthquake. This study also emphasized that providing standard equipment, support actions,
and strengthening communication infrastructure, and updating the aerial emergency system should
be considered as one of the priorities of the emergency organization of Iran to provide a desired
response to the earthquake.

Abstract BACKGROUND: Nowadays, various strategies are applied by governments to control costs and 
finance hospitals and the health sector. Public‑private partnership (PPP) option is one of these 
strategies. Considering the growing importance of hospitals in different communities and their 
problems, this study aimed to identify PPP challenges, opportunities and solutions in hospitals. This 
study aimed to identify the challenges and opportunities of PPP in the country’s hospitals and then 
offered an appropriate solution to overcome these challenges.
MATERIALS AND METHODS: This is a qualitative study and content analysis approach is 
undertaken. The participants were selected through purposive sampling and data were collected using 
a semi‑structured interview with experts in the public and private health sector until the saturation 
point achieved. Data analysis was performed through the thematic analysis of expert’s statements 
using MAXQDA. 10 software in this sector.
RESULTS: According to the study results, 3 main themes (challenges, opportunities, and solutions), 
10 sub‑themes, and 32 codes were identified in relation to the public and private partnership. 4 
sub‑themes on challenges of PPP, 3 sub‑themes on partnership opportunities and 3 sub‑themes 
on challenges solutions were identified.
CONCLUSION: The results of this study revealed that given the discussed challenges the most 
important challenge seems to be not evaluated outsourcings, incorrect usage of participatory models, 
and inadequate and inappropriate postoutsourcing supervision, however, it appears evaluated 
outsourcing backed with adequate supervision could solve many current hospitals’ problems.

Abstract BACKGROUND: The human coronavirus was first identified in 1965, belongs to the same family 
of Viruses as SARS, MERS‑Co. The current virus that affected worldwide came into existence 
in late 2019, recently found in Wuhan, China, and caused a global pandemic called coronavirus 
disease‑2019 (COVID‑19). This disease became a quick global pandemic due to the rapid 
transmission of the virus from one human to another. In the history of humankind, people were inside 
the four walls for more than a month. The COVID‑19 pandemic has posed significant problems in a 
variety of fields. The current pandemic created many changes that are seen as challenges worldwide. 
However, it created opportunities and benefits for many, extend a helping hand towards the people 
in need, in the society, community, and the nation. This paper focuses on challenges, opportunities, 
and benefits during the (COVID‑19) pandemic in India.
MATERIALS AND METHODS: Online search engines like PubMed and Google Scholar were used to 
conduct the research. The review article’s dates were not restricted in any way. A total of 48 articles 
were chosen. The data was tabulated based on the kind of study and the outcomes. There are just 
a few papers available that demonstrate the necessity for more study.
RESULTS: COVID‑19 caused unforeseen changes in the health care industry, unequal distribution of 
health care, and consequences on mental health, according to the review studies. Teleconsultation, 
Internet use, and E‑learning have all become more accessible. A period of transitory economic 
collapse and an increase in the number of migrants left many despondent. Improvement in family 
bonding, use of a face mask, and hygiene measures to adapt to the current scenario. There was also 
an impact on water sources, waste management systems, and environmental resource conservation.
CONCLUSION: Difficult conditions can provide both problems and opportunities and advantages to 
the people during a pandemic outbreak.

Abstract INTRODUCTION: The qualification of managers in terms of management skills is one of the most
important factors in the continuous success of each organization, and utilizing such skills can have
a positive contribution in the effectiveness of the organization while improving the performance of
the employees in line with the objectives and goals of the organization. The study's primary objective
was to examine the necessary skills of the hospital managers and their capabilities to manage the
challenges in providing health care facilities to their patients and employees.
MATERIALS AND METHODS: This study is a qualitative that deep interviews were performed with
22 managers (senior and middle managers) of educational hospitals of Kermanshah city, and the
sample size was 22 individuals. The interviews were analyzed by a MAXQDA software application
after transcription.
RESULTS: This study includes 8 themes and 23 subthemes. The strategic skill, the perceptive
skill, the human relations skill, work experience, and personal characteristics were among the skills
necessary for hospital managers. Some of the challenges facing the hospital managers included
rapid changes in the policies, the limitations of financial resources, and lack of proportion between
the educational and occupational spheres.
CONCLUSION: Because of their existential philosophy and differences with other service sectors,
managing hospitals poses a particular sensitivity. In this regard, the role of the hospital manager is very
important. Therefore, in order to meet the satisfaction of those receiving services, decision‑makers
and policy‑makers must think twice when selecting and appointing hospital managers and evaluate
and appraise this group in terms of abilities and skills necessary for managing such an important
service section.

Abstract BACKGROUND: Sexual health education, especially in adolescents, faces excess challenges in
many cultures. Iranian adolescents, especially boys, have many educational needs in the field of
sexual health that have not been met due to various obstacles. The main purpose of this qualitative
study was to explore the challenges of sexual health education for Iranian adolescent boys.
MATERIALS AND METHODS: This qualitative content analysis study was conducted through
individual semi‑structured in‑depth interviews from 45 participants (20 adolescents and 25 key
adults). Data were analyzed using inductive conventional content analysis based on the Graneheim
and Lundman’s approach via MAXQDA software (version 2010) by VERBI GmbH Company, Berlin,
Germany.
RESULTS: In total, 2 categories and 11 subcategories emerged; including, “extrapersonal barriers
to sexual health education for adolescent boys” containing seven subcategories of lack of clear
policies, family inadequacy, social barriers, cultural heterogeneity, school inadequacy, cyber threats,
and educational process inadequacy concerning adolescent sexual health education as well as
“intrapersonal barriers to sexual health education for adolescent boys” comprised four subcategories
of uncontrolled emotions of adolescence, adolescent rebellion, information and communication
weaknesses, and adolescents’ concerns about being judged by others.
CONCLUSION: The findings clarify some barriers to sexual health education for adolescent boys.
Therefore, it was recommended to develop community‑based educational programs to change
attitudes of families and society toward addressing the challenges of providing sexual health
education to adolescent boys. Moreover, it was suggested to utilize an educational program specific
to adolescent boys, tailored to the Iranian culture, using the potential of religion.

Abstract INTRODUCTION: The healthcare program has opponents and supporters with its multiple policies
and also its difficult implementation, which requires that its barriers and problems be addressed
comprehensively and extensively. This study was conducted aimed to determine the service
provision challenges by healthcare providers, from their point of view, in selected comprehensive
health centers of Isfahan.
MATERIALS AND METHODS: The present study is a descriptive‑analytic one. One‑hundred
and ninety‑seven healthcare providers were selected by census sampling method from the
population of female healthcare providers in Isfahan comprehensive health centers in 2017. The
data collection tool was a researcher‑made questionnaire in the field of individual–professional,
managerial–organizational, and executive challenges. Data analysis was done by repeated measures
ANOVA and post hoc test.
RESULTS: The findings indicated that there was a significant difference between the mean score
of individual–professional, managerial–organizational, and executive challenges (P < 0.001) from
the point of view of healthcare providers. According to least significant difference post hoc test, the
mean score of individual challenges was significantly lower than that of managerial and executive
challenges (P < 0.001). However, there was no significant difference between the mean score of
managerial–organizational and executive challenges (P = 0.46).
CONCLUSION: Based on the results, healthcare providers have put forward several challenges during
the implementation of the healthcare program. Meanwhile, executive and managerial challenges
have been considered more than individual challenges. Considering that this could lead to improper
service provision to the clients, the role of policymakers in this program to remove obstacles and to
provide satisfaction to healthcare providers is emphasized.

Abstract BACKGROUND: The patient handover process is in fact a valuable and essential part of the care
processes in the hospitals. This can be a factor in increasing the quality and effectiveness of medical
care. Incorrect and incomplete handover can increase the percentage of errors and cause serious
problems for patients. The aim of this study was to identify the handover challenges concerning
safety and quality of health services.
MATERIALS AND METHODS: A systematic review was conducted according to the Preferred
Reporting Item for Systematic Reviews and Meta‑analyses guideline. The key words “challenges
of patient handover” or “challenges of patient handoff” were used in combination with the Boolean
operators OR and AND. The ProQuest, Ovid, Doaj, Magiran, SID, Scopus, Science Direct, PubMed,
and ISI were searched.
RESULTS: A total of 263 articles were extracted, and 20 articles were selected for final review.
The results of selected articles indicated that there are various challenges such as communication,
noncoordination, nonuse of checklist, poor management, time management, and other things. These
studies reported that communication was the main challenge of handover process.
CONCLUSIONS: Hospitals try to provide a lot of services to the patients and other customers in a
safe and healthy environment. Lack of communication among the incoming and outgoing nurses in
handover process is one of the main causes of reduced safety and quality of services and patient
dissatisfaction.

Abstract BACKGROUND AND AIM: Considering that the Qom University of Medical Sciences was a pioneer
to implement the health system reform (HSR) in the domain of health services and the lack of a
study that has addressed the challenges and strategies to promote the HSR in the health domain,
this study was designed to explain the structural challenges and its solutions in the health domain
of the HSR in the city of Qom, Iran, 2017.
MATERIALS AND METHODS: This study was a qualitative research. The health managers, the
health‑care providers, and the recipients of health services referring to the health centers in Qom were
the participants in this study who were selected using the convenience sampling method. The data
were collected using individual interviews and with the guidance of a semi‑structured questionnaire.
Collected data were analyzed by the qualitative content analysis method with an inductive approach.
After extracting the challenges of the HSR in the health domain through a qualitative approach, these
challenges were prioritized through Delphi’s technique in terms of relevance and resolving strategies.
RESULTS: From the perspective of the study participants, the structural challenges of HSR in the
health domain in order of importance and priority included problems due to the SIB system, defects in
the instructions, the disruptions caused by multitasking, poor service coverage, incomplete health‑care
packages, and the shortage of resources.
CONCLUSION: According to the findings of this study, we hoped that the HSR in the health area
can be improved to increase its success by modifying the guidelines and the coverage of services,
modifying the SIB system, providing requires resources, completing the service packages, and
solving the multitasking problem.

Abstract INTRODUCTION: Given the importance of feedback to improve teachers’ educational performance,
the current study aimed to identify the challenges and problems involved in providing feedback to
clinical teachers on their educational performance.
MATERIALS AND METHODS: In the first phase of this mixed‑methods study, the clinical teachers,
students, and university officials were interviewed on feedback problems and challenges. After
an inductive content analysis, and based on the problems enlisted, a ten‑item questionnaire was
developed. Subsequently, 25 clinical teachers completed the questionnaire by scoring the importance
and urgency of each problem.
RESULTS: Overall, 18 individual and group interviews were conducted with 24 people. A total
of ten themes and five categories emerged, including “lack of transparency of feedback system,”
“absence of criticizability culture,” “lack of motivation to improve performance,” “failure to consider
factors affecting teacher’s performance,” “lack of formative evaluation,” “inappropriate data obtained
on teacher’s performance,” “inappropriate feedback providers,” “inappropriate feedback recipients,”
“inappropriate feedback provision,” and “no feedback follow‑up.” Three items of priority involved
“inappropriate feedback providers,” “inappropriate data,” and “failure to consider factors affecting
the teacher’s performance.”
CONCLUSIONS: All the raised problems obtained high scores; nevertheless, the interviewees had
more problems with the feedback provider, the data collected on the performance, and inattention
of university officials to the factors influencing performance than feedback presentation methods.
Hence, gaining the trust of teachers on the collected data, providing feedback by their trustworthy
individuals, and paying attention to the factors influencing teachers' performance are associated with
an increased possibility of feedback acceptance.

Abstract INTRODUCTION: The development of information technology (IT) in education has led to the
expansion of new teaching and learning methods at universities. Implementation of E‑learning
programs at Iran’s universities as well as assessing the prerequisites and level of preparation of
learners to attend E-learning environments require extensive study. Therefore, this study examined
to investigate the challenges of E‑learning system at Tehran University of Medical Sciences.
METHODOLOGY: This study was a descriptive and cross‑sectional one that conducted in 2016_2017.
The statistical populations were all of the students that have an E‑learning course in Tehran University
of Medical Sciences, from whom, 300 were selected to participate in the study using a stratified
random sampling method. The tool of the study was a researcher‑made questionnaire. The data
were analyzed through SPSS software.
RESULTS: According to the findings of this study, about half of the participants (40%) had problems
accessing the technology, and only 26.4% of the participants had good preparation for the use of
E‑learning system. Furthermore, a significant difference was found between the challenges of skill
and culture of the participants (P value = 0.01).
CONCLUSION: Success in the implementation of E‑learning educational system as one of the main
approaches in managing knowledge and educational needs of higher education organization will not
be achieved without identifying the different skill, technical and cultural challenges. To overcome this
challenge, establishing IT infrastructure and standards, using experiences of the leading countries
in the field of E‑learning, creating proper culture, and familiarizing learners and teachers to the
development and use of E‑learning materials are necessary.

Abstract OBJECTIVE: Cancer is one of the most preventable and common chronic diseases that have
economic, social and psychological burden for patients, families, and the society. Cancer can be
monitored by new information technology. Digital games as a uniquely powerful interaction tool
support optimal care management program operation in all dimensions. The aim of this review article
is to describe opportunities and challenges of this new modern technology on the delivery of cancer
care services in cancer management domains for cancer care improvement.
METHODS: This study was un‑systematic (narrative) review article. In this research, 50 full‑text
papers and reports had been retrieved, studied exactly, and arranged based on study aims. We
searched papers based on specific and relevant keywords in research databases including PubMed,
ScienceDirect, Scopus, and Google scholar.
CONCLUSION: In cancer management domain, digital games are as an effective medium for
health education and intervention, disease self‑management training, attention distraction to relieve
pain, enhance clinical outcomes, improvements in lifestyles, and physical and psychosocial activity
promotion when active participation and behavior rehearsal are required for cancer patient. In spite
of potential benefits of new technology, sometimes people confront various challenges such as
social isolation, unusual anxiety, and disorder in physiological times of body, low physical activities,
decrease academic performance, increase aggressive behavior, and physical pain. These problems
can be partly overcome by proper planning, good design, and usage of suitable and continuous
monitoring.