Journal of Education and Health Promotion

Abstract BACKGROUND: Due to the COVID‑19 pandemic, online learning has become the main method of
instruction. This study aimed to evaluate Moroccan medical students’ perceptions of medical online
learning experience and to list its probable related advantages and barriers.
MATERIALS AND METHODS: A cross‑sectional study on 400 medical students randomly selected
from the different national medical institutions was conducted. A questionnaire evaluating the online
learning experience during the pandemic was distributed via institutional e‑mails. Statistical analyses
were carried out using Statistical Package for the Social Sciences (SPSS).
RESULTS: 51.2% of students were satisfied with the online learning experience and reported several
benefits including no need to travel (35.8%), cost savings (20.7%), and flexibility of home studying
(32.3%). Technical issues related to the use of platforms or internet connection, limited interaction
between students and their instructors, and lack of motivation were the major barriers to online learning.
Moreover, results also showed a significant difference when comparing the attendance frequency between
presential classes and online learning (i.e., before vs. during the COVID‑19 pandemic) (P < 0.001).
CONCLUSIONS: The experience of medical online learning was reported in our study to be associated
to several advantages and disadvantages. Hence, students’ perceptions should be considered
to evaluate and improve the quality of this instructional method for a successful and more active
approaches implementation.

Abstract BACKGROUND: The aim of this study was to investigate the living experience of coronary patients
in Shiraz and the peak prevalence of the second stage in summer. This study could further examine
these experiences in broader groups in subsequent studies. Identifying the psychological causes
and effects of this disease with the help of patients involved in some countries has been considered.
MATERIALS AND METHODS: The method, which was used in this study, was a qualitative method
and content analysis. Participants in this study were 13 patients with COVID‑19, some of whom
were members of the medical staff. The participants were selected purposefully. The semi‑organized
interview with the participants continued until the theoretical saturation was reached.
RESULTS: After extracting the codes, researchers classify them, and then the results were examined
in more depth and categorized. About 120 extracted codes were classified into seven general
categories; three of them were directly related to psychological issues. The other four of them were
related to the subject of psychological effects and consequences.
CONCLUSION: In general, during the interview process, it was proved that the more severe the
symptoms of the disease, the psychological experiences of confronting the disease because of its
outbreak, and the processes of coping with it were deeper.

Abstract BACKGROUND: Because of the spread of coronavirus disease 2019 (COVID‑19), the preventive
measures have increased, such as focusing on the use of medicinal plants in most communities,
including Iran. The purpose of this study was to identify the knowledge, attitude, and performance of
individuals toward the use of medicinal plants and to identify the predictors of the use of medicinal
plants in the prevention of COVID‑19.
MATERIALS AND METHODS: This descriptive‑analytical study (February–April 2021) was performed
on 3840 Iranian men and women aged 20–70 years selected as a multi‑stage cluster study. At the
first stage, all provinces were divided into five regions: North, South, East, West, and Center. In the
second stage, a provincial center and a city were randomly selected from each region (North: Sari,
Babol; South: Bushehr, Bandar Genaveh; East: Mashhad, Sabzevar; West: Hamedan, Toisarkan;
Center: Yazd, Ardakan). Data were collected by a researcher‑made scale based on the Health
Belief Model (HBM). Data analysis was performed applying Pearson correlation coefficient, logistic
regression, and linear regression.
RESULTS: The results showed that people have relatively high knowledge and positive attitude toward
the use of medicinal plants in prevention of COVID‑19. The most important reason for positive attitude
was the perceived benefits with the mean of 75.06%. Also, half of the people had poor performance.
Correlation coefficient showed that the use of medicinal plants with perceived sensitivity (p = 0.000,
r = 0.3), perceived benefits (p = 0.012, r = 0.126), perceived barriers (p = 0.000, r = 0.179), and
perceived self‑efficacy (p = 0.000, r = 0.305) had a significant correlation. The strongest correlation
between perceived self‑efficacy was observed with the use of herbs in prevention of COVID‑19. The
HBM constructs can predict 26% of the variance for the use of medicinal plants in the prevention
of COVID‑19, among which perceived self‑efficacy (β = 0.230) was the most powerful predictor.
CONCLUSION: Based on the results, the predictive role of self‑efficacy constructs for the use of
medicinal plants in prevention of COVID‑19 has been confirmed according to the HBM. Therefore,
methods of increasing self‑efficacy such as training programs and providing appropriate intervention
models can be used not only as promoters of using medicinal plants in prevention of COVID‑19 but
also for improving people’s performance in the proper use of medicinal plants.

Abstract BACKGROUND: Since the outbreak of the pandemic, the release of the COVID (Corona Virus
Disease)‑19 vaccine was highly anticipated. Nevertheless, vaccine availability does not symbolize the
end of pandemic due to ongoing vaccine hesitancy and anti‑vaccination movements. The objective
of this study is to evaluate COVID‑19 vaccine acceptance among pregnant and lactating individuals
in Maharashtra state, India.
MATERIALS AND METHODS: A descriptive cross‑sectional study was conducted via a hybrid
approach using various digital portals such as Whatsapp, telegram, and physical distribution to those
who did not have access to smartphone devices. A probability proportional sampling strategy was
deployed. A pre‑validated structured self‑administered questionnaire tool designed by Freeman et al.
2020 (Oxford COVID‑19 vaccine hesitancy scale) was used, which consisted of seven close‑ended
targeted and focused questions. Analysis of several survey items and vaccine acceptance was
conducted using the Chi‑square test.
RESULTS: Analysis revealed that 58% of individuals were willing to take vaccines after government
approval and 26% of individuals showed hesitancy toward vaccination. When compared, lactating
individuals showed less vaccine hesitancy (22%) than pregnant individuals (27%). The maximum
vaccine hesitancy was observed in the third trimester of pregnancy (29.5%).
CONCLUSIONS: Trust in vaccines is a crucial factor and is dependent on the ability of the government
in promoting vaccines through effective communication; this can be one of the reasons for the high
level of acceptance and awareness toward COVID‑19 vaccination in this study.

Abstract During the COVID‑19 pandemic, people are using social media more than usual routine because they
rely on online sources to seek health information for themselves and their loved ones. The spread of
inaccurate and misleading information via social media has a number of detrimental psychological
effects on members of society. The aim of this systematic review was to describe the impact of social
media on the mental health of the general population. An extensive systematic search was done till the
last month of 2021 for collecting the evidence using the PRISMA technique. The search was mainly
focused on the article leading with keywords and search engines used during the course of the study
were Pubmed, Semantic Scholar, Mendeley, and Science direct. Articles for this study were selected
based on the predetermined eligibility criteria and performed quality assessment by using the NHLBI
quality assessment tool. Most of the studies included in this review are found fair (score between
9 and 12) quality. Out of 866 publications, 533 articles were included in the initial screening, after
duplication removal 46 full‑text articles were assessed for eligibility and 14 studies were selected for
systematic review. In most of the studies, maximum participants used social media as a primary source
of information. Relatively high rates of symptoms of depression (14.14% to 48.3%), anxiety (7.4% to
47.82%), and prevalence of stress increased to 37.67% are reported after exposure to social media
for coverage of COVID‑19 news in the general population. Risk factors of psychological distress are
associated with female gender, younger age group, marital status, staying alone, and duration of
exposure to mass media. Increased exposure to COVID‑19 information through mass/social media
is associated with highly significant levels of psychological health issues; mitigating the hazardous
effect of social media exposure during the COVID‑19 pandemic on the psychological health of the
general population is an international public health priority.

Abstract BACKGROUND: Accurately predicting the intubation risk in COVID‑19 patients at the admission
time is critical to optimal use of limited hospital resources, providing customized and evidence‑based
treatments, and improving the quality of delivered medical care services. This study aimed to design
a statistical algorithm to select the best features influencing intubation prediction in coronavirus
disease 2019 (COVID‑19) hospitalized patients. Then, using selected features, multiple artificial
neural network (ANN) configurations were developed to predict intubation risk.
MATERIAL AND METHODS: In this retrospective single‑center study, a dataset containing 482
COVID‑19 patients who were hospitalized between February 9, 2020 and July 20, 2021 was used. First,
the Phi correlation coefficient method was performed for selecting the most important features affecting
COVID‑19 patients’ intubation. Then, the different configurations of ANN were developed. Finally,
the performance of ANN configurations was assessed using several evaluation metrics, and the best
structure was determined for predicting intubation requirements among hospitalized COVID‑19 patients.
RESULTS: The ANN models were developed based on 18 validated features. The results indicated
that the best performance belongs to the 18‑20‑1 ANN configuration with positive predictive value
(PPV) = 0.907, negative predictive value (NPV) = 0.941, sensitivity = 0.898, specificity = 0.951, and
area under curve (AUC) = 0.906.
CONCLUSIONS: The results demonstrate the effectiveness of the ANN models for timely and reliable
prediction of intubation risk in COVID‑19 hospitalized patients. Our models can inform clinicians and
those involved in policymaking and decision making for prioritizing restricted mechanical ventilation
and other related resources for critically COVID‑19 patients.

Abstract BACKGROUND: COVID‑19 (Coronavirus disease‑19) is an ongoing pandemic. COVID vaccine
administration in adults has provided some degree of protection from infection but children are still
susceptible So, we have to be prepared to handle COVID‑19 infection in children by training our
healthcare workers by updating both their knowledge and skills. We developed a training module to
train our healthcare workers in all domains of learning and also planned related assessment methods
to know the effectiveness of the module.
MATERIALS AND METHODS: This was a quasi‑experimental study with pre‑ and post‑intervention
conducted at a tertiary‑level teaching medical college in southern India from July to September 2021.
The training module was developed as per the “ADDIE” model of the development process module.
It was further validated by five experts before implementation. In addition to the quasi‑experimental
method of evaluation like pre‑ and post‑test, Observed Skill clinical examination (OSCE) had been
also used as an assessment tool at the completion of training. A total of 92 participants have been
trained as per this module in our tertiary‑level care hospital. The association between continuous
and categorical variables was assessed using an independent t‑test and ANOVA, and paired t‑test
was used for comparing the difference between pre‑ and post‑test scores.
RESULTS: Pre‑test scores had no association with years of experience (P = 0.803) and previous
training status of participants (P = 0.350). The mean difference of pre‑ and post‑test scores was 3.8
and it was statistically significant (P value < 0.001) A weak positive correlation between pre‑ and
post‑test was present by the Spearmen correlation test (r = 0.337). The correlation between post‑test
score and OSCE score does not have a significant correlation.
CONCLUSION: Structured training module was effective in training the participants. Multimode
assessment method (Pre‑test, Post‑test, and OSCE) is an important step to evaluate any training
program as compared to only the pre‑ and post‑test methods of evaluation.

Abstract BACKGROUND: Psychological disorders, such as depression and anxiety, are common among
individuals who have experienced coronavirus disease 2019 (COVID‑19); however, diagnosis may
be challenging and subjected to invalidity. This study aimed to examine agreement between online
self‑assessment and psychiatric telephone interview among COVID‑19 survivors.
MATERIALS AND METHODS: This cross‑sectional descriptive study was carried out from March
to June 2021 in Afzalipour Hospital, Kerman, Iran. The inpatients confirmed with COVID‑19 were
contacted within the first week after discharge and were asked to fill the Hospital Anxiety and
Depression scale (HADS) and socio‑demography questionnaire. They were later interviewed using
Hamilton Depression Rating Scale (HAM‑D) and Hamilton Anxiety Rating Scale (HAM‑A). Agreement
between the data extracted from self‑report and telephone interview was analyzed using Cohen’s
kappa coefficient, sensitivity, and specificity.
RESULTS: Out of 200 post‑COVID patients, 60 participants completed all assessments. Prevalence
of depression was observed to be 88% via telephone interview and 45% via self‑assessment.
Moreover, 83% of the participants were diagnosed with anxiety according to the telephone interview,
in comparison to 31% diagnosed with anxiety using self‑report questionnaire. The agreement between
online self‑assessment and telephone interview for depression and anxiety was not significant
(κ = 0.08 and κ = 0.1, respectively).
CONCLUSION: The discordance between online self‑report and clinician’s assessment via phone
contact interview indicates that using self‑report evaluations is not sufficient as the single assessment
tool for mental health monitoring and reflects the need to employ multiple assessments for diagnosis
of psychiatric problems in pandemics.

Abstract BACKGROUND: Video‑based teaching has become rapidly popular during the coronavirus disease
2019 (COVID‑19) pandemic. The current study aimed to assess the efficacy of a hybrid video‑based
teaching module of oxygen therapy and critical care troubleshooting in nursing professionals managing
COVID‑19 patients in our institute.
MATERIALS AND METHODS: A retrospective analytical study (pretest and posttest design) was
conducted in our medical education department in March 2022 using the data from a workshop
conducted on oxygen therapy and critical care area troubleshooting during COVID‑19 patient
management for 296 nursing professionals. A hybrid video‑based teaching module was used. Pretest
and posttest data were compared along with subgroup analysis. P value <0.05 was considered
significant.
RESULTS: Posttest scores were significantly higher than the baseline scores in the overall group
as well as in all subgroups (P < 0.001). Subgroup comparisons revealed no significant difference
in mean baseline pretest and posttest scores in male versus female participants. Baseline pretest
scores (P = 0.02) and posttest scores (P = 0.08) were lower in the nurses of the noncritical areas
compared to critical area nurses. Mean improvement in posttest score compared to baseline score
was similar between all groups.
CONCLUSION: Hybrid technique involving both video aspects and in‑person teacher presence
for demonstration or troubleshooting improves perceived knowledge in nursing professionals with
some prior formal training and may be superior to the conventional only didactic/lecture‑based
demonstrations, especially in the context of imparting rapid training during pandemics or similar
urgent situations.

Abstract BACKGROUND: As the core of a health‑care team, nurses play a key role in promoting community
health, and their job involves witnessing human suffering and pain in health‑care settings. The present
study aimed to evaluate the correlations between resilience coping strategies, and the underlying
factors in the nurses working in COVID‑19 hospitals.
MATERIALS AND METHODS: This descriptive, cross‑sectional study was conducted on 320 nurses
working in COVID‑19 wards for a minimum of 6 months in 2021. The participants were selected
via multistage sampling. Data were collected using demographic, resilience, and coping strategy
instruments. Data analysis was performed in SPSS version 20.
RESULTS: The mean resilience score was 76.94 ± 11.33. The mean scores of emotion‑focused
and problem‑focused strategies were 59.65 ± 4.40 and 96.08 ± 5.38, respectively. The assessment
of the correlation between resilience with the emotion‑focused and problem‑focused strategies
showed a positive significant correlation (r = 0.25; P < 0.001 and r = 0.33; P < 0.001, respectively).
CONCLUSION: According to the results, the nurses working in COVID‑19 wards mostly adopted
problem‑focused strategies in difficult work conditions depending on the required care provision.
Both coping strategies significantly affected the subscales of resilience in the nurses. Therefore, it is
recommended that special attention be paid to teaching strategies to cope with anxiety and resilience
and develop problem‑solving skills in nursing personnel during the emergence and outbreak of new
diseases in order to reduce their anxiety.

Abstract In 2019, the COVID‑19 pandemic posed a major challenge to the world. Since the world is constantly
exposed to communicable diseases, comprehensive preparedness of countries is required. Therefore,
the present systematic review is aimed at identifying the preparedness components in COVID‑19. In
this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Science Direct, Iran
Medex, Magiran, and Scientific Information Database were searched from 2019 to 2021 to identify
preparedness components in COVID‑19. Thematic content analysis method was employed for data
analysis. Out of 11,126 journals retrieved from searches, 45 studies were included for data analysis.
Based on the findings, the components of COVID‑19 preparedness were identified and discussed in
three categories: governance with three subcategories of characteristics, responsibilities, and rules
and regulations; society with two subcategories of culture and resilience; and services with three
subcategories of managed services, advanced technology, and prepared health services. Among
these, the governance and its subcategories had the highest frequency in studies. Considering the
need to prepare for the next pandemic, countries should create clear and coherent structures and
responsibilities for crisis preparedness through legal mechanisms, strengthening the infrastructure
of the health system, coordination between organizations through analysis and identification of
stakeholders, culture building and attracting social participation, and service management for an
effective response.

Abstract BACKGROUND: The COVID‑19 pandemic has become a major problem for education systems. This
study was conducted to investigate the effect of educational intervention based on the self‑efficacy
theory of high‑school students in adopting preventive behaviors of COVID‑19.
MATERIAL AND METHODS: This quasi‑experimental study was performed on Hazrat Zahra and
Shahed high‑school students in Jahrom (southern Iran) in 2021. In total, 160 students (80 each in
the intervention group and the control group) were selected by multistage random sampling. Data
collection tools included a demographic information questionnaire and self‑efficacy in adopting
preventive behaviors from COVID‑19 researcher‑made questionnaire. Questionnaires were completed
by all participants before and 3 months after the educational intervention. The educational intervention
was performed for 6 weeks by using an educational program based on Bandura self‑efficacy theory.
The intervention was performed during 12 sessions of face‑to‑face training in the classroom (two 1‑h
sessions per week), distributing educational packages and sending educational videos through
cyberspace. Data were analyzed using Chi‑square test, independent t test, paired t test, and linear
regression.
RESULTS: After the educational intervention, a significant difference was observed in the intervention
group before and after the educational intervention (P = 0.018) and between the intervention and the
control groups (P = 0.001) in the self‑efficacy in adopting preventive behaviors from COVID‑19 score.
Also, the average self‑efficacy score of students increased with an increase in parental education
level and a history of COVID‑19 in family members.
CONCLUSION: Educational intervention based on self‑efficacy theory was shown as an effective
method to improve students’ self‑efficacy in adopting preventive behaviors from COVID‑19.

Abstract The COVID‑19 pandemic has disordered the lives of millions in an unprecedented way. A state of
mental health crisis has emerged across the globe. The lifestyle and well‑being of the individual and
social integrity have been adversely affected. One‑third of US citizens and one in five Indian citizens
suffer from depression due to this pandemic. This scoping review aimed to estimate the mental health
challenges and their possible solutions in the recent two years (2020–2021). Our search strategy
used search engines such as Medline, Google Scholar and PubMed. The search strategy used the
MeSH keywords “Mental Health AND Covid‑19”. The findings emerged in the following key points:
anxiety and depression, social isolation and quarantine, and vulnerable or high‑risk groups. Out
of 216 articles screened, 20 were found eligible to meet the inclusion criteria. Most of the studies
focused on psychological anxiety, stress and mental disorder during the pandemic. Psychosocial
assessment and monitoring in the context of COVID‑19 should include inquiries about stressors
related to COVID‑19, like exposure to infected sources, infected family members, loss of loved ones,
physical distance; secondary adverse events like economic loss, psychosocial effects like depression,
anxiety, psychosomatic preoccupations, insomnia, increased substance use, domestic violence; and
indicators of vulnerability like pre‑existing physical or psychological conditions.

Abstract BACKGROUND: The COVID‑19 pandemic has led to numerous psychological consequences and a
drastic increase in the workload of nurses. The present study aimed to investigate the correlation of the
job turnover intention of Iranian nurses with job satisfaction and burnout in the COVID‑19 pandemic.
MATERIALS AND METHODS: This cross‑sectional descriptive study was conducted on 300 nurses
working in the hospitals in Sabzevar, Iran from October 2020 to January 2021. Data were collected
using the questionnaires of turnover intention, Spector job satisfaction, and Maslach burnout in a
self‑report manner. Correlation analysis was used. Then, for assessing a predictive model used a
simple linear regression and multiple linear regression analyses. Data analysis was performed using
SPSS version 24.
RESULTS: The results showed that the variables of burnout and job satisfaction are effective on
nurses’ willingness to job turnover. Furthermore, among the background variable, the findings
showed that the economic status of nurses and the male gender of patients under their care can
be effective on nurses “job turnover intention and can be used as predictor variables of nurses” job
turnover intention.
CONCLUSION: According to the results, special attention must be paid to the job satisfaction, burnout,
and the economic situation (as a mediator variable) of nurses to prevent their job turnover in the
COVID‑19 pandemic. Therefore, it is recommended that health managers prevent the job turnover
intention of nurses in the COVID‑19 pandemic by taking psycho‑socio‑economic support measures.

Abstract BACKGROUND: Coronavirus disease 2019 (COVID‑19) constrained the regular teaching in
educational institutions and hampered the teaching–learning process across the globe. E‑learning
method is widely used in higher education in the current situation. the objective is to assess the beliefs
and expectations of the students on e‑learning among adult learners of a tertiary level health‑care
institution.
MATERIALS AND METHODS: A single group pre‑post design was adopted. Microsoft Go two‑in‑one
devices were used to find the effectiveness of e‑learning, including digital exam solution. Depending
on the availability of device, 25 participants were selected for the study from three different steams.
A 5‑point Likert scale was used for assessing the quality, adoptability, and acceptance of digital
education developed by the researchers. Chi‑square/Fisher’s exact or McNemar’s test was used to
test the association between independent or related categorical variables. Comparison of the average
score between different courses was performed using the Kruskal–Wallis test.
RESULTS: Twenty‑two participants who completed the final assessment were retained for the
analysis. Majority of the participants believed that e‑learning helps to achieve personal learning
goals or objectives and bridge skill or knowledge gaps and caters to learning preferences.
However, the overall quality score across the study groups was found to be statistically insignificant
(Kruskal–Wallis statistic: 1.26; P value: 0.533).
CONCLUSION: The findings show that the adult learners in higher education, irrespective of their
age differences, believe that intense e‑learning support with Microsoft Go two‑in‑one device has a
complementary effect on their learning outcome.

Abstract Abstract:
The coronavirus disease 2019 (COVID‑19) pandemic has negatively affected the medical services,
particularly cancer diagnosis and treatment, for vulnerable cancer patients. Although lung cancer
has a high mortality rate, monitoring and following up of these patients can help to improve disease
management during the pandemic. Telemedicine has proven to be an effective method of providing
health care to these patients. As a result, the purpose of this study was to identify telemedicine
applications in the management of lung cancer patients during the COVID‑19 pandemic. In this scoping
review, studies published in online scientific databases such as Web of Science, Scopus, and PubMed
between January 1, 2020 and September 1, 2021 were systematically searched and screened. The
studies were chosen using predetermined inclusion and exclusion criteria. The bibliometric information
and technological aspects of included studies were collected using a data extraction form and the
data was analyzed using the content analysis approach. A total of 68 articles were found, from which
four articles were finally selected based on specific inclusion/exclusion criteria. Real‑time consultation
was one of the most common applications of telemedicine to deliver health‑care services to cancer
patients. Health‑care providers used applications such as Zoom, Facetime, WeChat, and e‑mail,
as well as devices including PCs, phones, and smartphones to provide real‑time consultation to
patients via videoconferencing, phone calls, and messaging, as well as store and forward consultation
via e‑mail. Telemedicine in the COVID‑19 pandemic provides health‑care services to lung cancer
patients at their homes by enabling physicians and patients to communicate in real time. Several
telemedicine services are still unavailable for patients with lung cancer. As a result, health experts,
politicians, and entrepreneurs must pay special attention to this issue.

Abstract BACKGROUND: Linking anatomy with the clinical approach for creating an inquisitive mind for
a millennium via the digital platform is the need of the hour. Traditional lecturing makes students
have rote memorization of the human anatomy. The inquiry‑based project will allow undergraduate
medical students to have a deeper understanding of human anatomy along with team building and
interpersonal skill development. This approach of teaching would allow students to link the content
taught for human anatomy with its clinical applicability and probably generate inquisitiveness for
further exploring the course content. The study aimed to appraise and assess the perception of
medical students and faculty about the inquiry‑based digitalized project presentation.
MATERIALS AND METHODS: A descriptive cross‑sectional study was conducted for inquiry‑based
project presentation where students were divided into 15 groups with 15 inquiries, which were
presented as projects on a digital platform under the guidance of the facilitator. The perception
of students and faculty for the inquiry‑based approach was collected using a validated survey
questionnaire. The quantitative data were analyzed by SPSS‑version 15, using descriptive statistics,
Friedman’s rank, and thematic analysis for qualitative data.
RESULT: In total, 117 students participated in the pre‑test and 129 in the post‑test part of the study.
Also, 79.1% of students appreciated that the inquiry‑based project presentation approach allowed
them to link anatomy with different courses; 73.6% agreed that this approach has a positive impact
on their attitude toward learning anatomy. Then, 75.2% students appreciated of learning new skills
using the digital platform. They agreed to have developed leadership (65.1%) and team‑building
skills (83.7%) and self‑directed learning (SDL) improvement (71.3%). However, some students (9.3%)
and faculty (16.7%) had been ostracized for presenting their inquiry‑based projects on a digital
platform, whereas 65.1% of students appreciated this approach.
CONCLUSION: Inquiry‑based learning approach would allow students to have a deeper
understanding of the subject knowledge and skills for the SDL and learn strategies for the usage of
virtual technology for literature search.

Abstract BACKGROUND: Learning helps acquire knowledge or skills. COVID‑19 outbreak severely affected
the progress of education all across the globe. Pandemic‑induced alternative methods of teaching
promoted the progress of online education. Hence, this study is undertaken to assess an overview
of teaching learning strategies in the COVID‑19 pandemic so as to explore the direction of medical
education and help perk up the teaching learning methods in medical education.
MATERIAL AND METHODS: The cross‑sectional study involves first year medical undergraduate
students of 2020–2021 batch studying at Dr.VMGMC, Solapur. It involves complete enumeration of
students of 2020-2021 batch. Due to the second wave of COVID‑19 pandemic hematology, classes
were continued and completed by the same faculty by online live teaching using Microsoft teams.
As this being an online survey, it was ethically exempted. A comparison of questionnaires between
offline and online classes was done by using χ2
 test and a P value less than 0.05 was considered
as significant. Quantitative data generated by the dichotomous question and five‑point Likert scale
questions were analyzed using descriptive statistics and frequency analysis. Out of 189 respondents,
majority of students preferred traditional offline classes over online classes. Self‑directed learning
was feasible in both methods of teaching.
DISCUSSION: Traditional offline classes were more interactive and enthusiastic than online classes.
Offline classes helped students to revise, recollect, and reproduce necessary information as their
attention span was better in offline teaching than online teaching.
CONCLUSION: Holistic understanding and better learning were experienced through traditional
offline classes. Although teachers take double efforts for online teaching, the overall learning effect
and impact of traditional offline classes were much better than online classes. It definitely motivates
andrgaogy and helps understand the concept on their own.

Abstract BACKGROUND: Crises are often unavoidable events that occur around the world. Hospitals play
an important role in treating patients and preventing extensive injuries in times of crisis, requiring
adequate preparedness. In order to design a proper planning system, it is essential to be aware of
the challenges of hospitals during a crisis. The purpose of this study was to explain the challenges
of hospitals admitting COVID‑19 patients in the city of Mashhad, Iran, from the perspective of their
managers.
MATERIALS AND METHODS: This study employed a qualitative approach, using the method of
conventional content analysis and was conducted from May to July 2020. A purposive sampling
method was used to recruit the senior managers of hospitals admitting COVID‑19 patients in Mashhad.
The interviews were conducted face to face, with open‑ended questions following an interview guide
based on semi‑structured questions, and continued until data saturation was reached. Data were
analyzed using Atlas Ti software.
RESULTS: After the implementation of the interviews, first 665 initial codes were extracted from
the data, and after removing the overlapping sequences, a total of 115 codes were obtained. Three
categories (organizational challenges, extra organizational challenges, and challenges related to
information domain), 13 sub‑categories, and 33 codes were extracted from the content analysis of
the interviews. The main themes propounded in the field of challenges of COVID‑19 referral hospitals
in Mashhad were organizational challenges, extra organizational challenges, and information domain
challenges.
DISCUSSION: The results of this study showed that the hospitals admitting COVID‑19 patients in
Mashhad faced many challenges. To improve the quality of services in postcrisis phase, replacing
hospitals’ equipment, revising curriculums at medical universities, staff retraining, recruiting skilled
human resources, and creating a supportive community context are necessary.
CONCLUSION: For sure, the COVID‑19 crisis will not be the last one, we have to be prepared for
the bigger health crisis.

Abstract BACKGROUND: Congenital heart disease (CHD) is one of the underlying medical conditions that
put children at increased risk for coronavirus. This study aimed to predict preventive behaviors of
COVID‑19 among children with CHD based on the protection motivation theory (PMT).
MATERIALS AND METHODS: This cross‑sectional study was conducted from March 2021 to April
2021, on 240 children 3–7 years with CHD whose data had been registered in Persian Registry of
Cardiovascular Disease/CHD (PROVE/CHD) System in Isfahan, Iran. The research variables were
measured using an online researcher‑made questionnaire that was based on PMT constructs. The
collected data were analyzed using statistical tests (e.g., Pearson correlation coefficient and linear
regression analysis).
RESULTS: From a total of 240 participants (mean age of 4.81 ± 1.50) in the present study, 122 (50.8%)
were girls. The most common types of CHD among children participating in this study were related
to atrial septal defect (ASD) (29.2%, n = 70) and ventricular septal defect (VSD) (26.7%, n = 64),
respectively. Protective behaviors showed a significant correlation with all constructs of PMT. The
PMT constructs explained 41.0% of the variances in protective behavior, in which the perceived
reward (β = 0.325) and perceived self‑efficacy (β = 0.192) was the most important, respectively.
CONCLUSION: The results of this study showed well the effectiveness of PMT on the preventive
behaviors of COVID‑19 in children with CHD. This theory can be used to teach preventive behaviors
of COVID‑19 to children with CHD in education programs.

Abstract BACKGROUND: Coronavirus disease (COVID‑19) causes significant psychological distress among
nursing students. College‑bound nursing students might have preferred different types of coping
strategies to deal with psychological distress. This study aims to measure the psychological distress
and role of coping styles to mediate the stress level among the baccalaureate nursing students amid
the COVID‑19 pandemic.
MATERIAL AND METHODS: A cross‑sectional online survey was conducted in December 2020 at
a nursing college attached to a tertiary care teaching hospital, North India. Nearly 251 baccalaureate
nursing students completed the Impact of Event Scale‑Revised (IES‑R) and Coping Orientation to
Problems Experienced Inventory (Brief‑COPE) scale to report their psychological distress and coping
styles, respectively. Chi‑square test, independent sample t‑test followed by binary and multivariable
regression were used to identify the factors associated with distress in students during the pandemic.
RESULTS: Students’ mean age was 22.22 ± 1.24 years. The mean IES‑R was 19.59 ± 12.45 in
nursing students. Psychological distress found a significant association with age (P = 0.022), academic
class (P = 0.016), travel history (P = 0.034), and being positive reverse transcription–polymerase
chain reaction (RT‑PCR) for COVID‑19 status of self (P = 0.018) and family members in the medical
profession (P = 0.013). In binary logistic regression, stress level found a significant association with
first‑year academic level (OR: 3.250, 95% CI: 1.429–7.390, P = 0.005) and family members in the
medical profession (OR: 4.44, 95% CI: 1.019–19.382, P = 0.047). Adaptive coping styles were more
frequently preferred than maladaptive coping styles (54% vs 41%). Adaptive (r = 0.295, P < 0.001)
and maladaptive coping (r = 0.403, P < 0.001) shows a significant positive relationship with stress
in students, respectively.
CONCLUSIONS: Coronavirus pandemic causes significant distress among nursing students. Students
were able to manage stress using acceptance and religious/spiritual coping strategies. During the
pandemic, stress management to support mental health is highly recommended.

Abstract BACKGROUND: This study was designed to evaluate the impact of the COVID‑19 pandemic on
the learning status of students from different educational boards and universities of Nepal. An online
survey was conducted from tenth to twentieth of September 2020 to record the data.
MATERIAL AND METHODS: A self‑designed questionnaire link, using “Google form” was sent to
the students via social networks. A total of 589 participants shared their complete information. The
simple percentage distribution was employed to evaluate the learning status of the students.
RESULTS: During the lockdown period, >70% of the students were engaged in online classes, most
commonly by using the Zoom app. The majority of the students were using WIFI as an internet source
to attend online classes. Students have been suffering from various problems related to anxiety,
stress, economic crises, poor internet connectivity, deprivation of study materials, required e‑learning
accessories, and an unsuitable study environment. Mainly, students from remote areas and middle
income families suffered enormously. Among those participants, who were able to attend the online
classes, the majority of students (70%) were dissatisfied with the ongoing online classes. Only 23.3%
of the participants suggested the feasibility of online classes in the near future.
CONCLUSION: Our study recommended that training teachers and students about online classes
might create effectiveness toward e‑learning. The government needs to provide free internet
services to the remote areas and the poor students since in the current scenario, huge numbers of
the population are struggling with the economic burden.

Abstract BACKGROUND: Education and assessment have changed during the COVID‑19 pandemic so that
online courses replaced face‑to‑face classes to observe the social distance. The quality of online
assessments conducted during the pandemic is an important subject to be addressed. In this study,
the quality of online assessments held in two consecutive semesters was investigated.
MATERIALS AND METHODS: One thousand two hundred and sixty‑nine multiple‑choice online
examinations held in the first (n = 535) and second (n = 734) semesters in Birjand University of
Medical Sciences during 2020–2021 were examined. Mean, standard deviation, number of questions,
skewness, kurtosis, difficulty, and discrimination index of tests were calculated. Data mining was
applied using the k‑means clustering approach to classify the tests.
RESULTS: The mean percentage of answers to all tests was 69.97 ± 19.16, and the number of
questions was 34.48 ± 18.75. In two semesters, there was no significant difference between the
difficulty of examinations (P = 0.84). However, there was a significant difference in the discrimination
index, skewness, and kurtosis of tests (P < 0.001). Moreover, according to the results of the clustering
analysis in the first semester, 43% of the tests were very hard, 16% hard, and 7% moderate. In the
second semester, 43% were hard, 16% moderate, and 41% easy.
CONCLUSION: To evaluate the tests’ quality, calculating difficulty and discrimination indices is
not sufficient; many factors can affect the quality of tests. Furthermore, the experience of the first
semester had changed characteristics of the second‑semester examinations. To enhance the quality
of online tests, establishing appropriate rules to hold the examinations and using questions with
higher taxonomy are recommended.

Abstract BACKGROUND: All health care workers including nurses are working in the frontline against
coronavirus disease 2019 (Covid‑19), which keeps them at high risk of getting infected. This study
was conducted to identify risk factors for Covid‑19 infection and compliance to Covid appropriate
behavior among nurses.
MATERIAL AND METHODS: A cross‑sectional study was conducted on 150 nurses in a tertiary
care hospital attached to a medical college in Mumbai, from April 2020 to December 2020. Data
were collected telephonically using an interviewer‑administered pre‑validated, semi‑structured
questionnaire. Data entry and analysis were performed using SPSS version 21.0.
RESULTS: The mean age of the nurses was 38.19 ± 12.14 years. The majority (80.7%) were exposed
to Covid‑19 while taking active care of Covid patients; a total of 108 (72%) were symptomatic at
the time of testing; dietary modifications because of fear of Covid were performed by 121 (80.2%);
92.77% used the appropriate personal protective equipment (PPE) category according to the
workplace; 121 (80.77%) followed all steps of donning and doffing at all times, and 19 (12.77%)
reported a breach in PPE. A greater proportion of nurses working in Covid duties opted for hospital
isolation than home isolation (p = 0.003). Risk factors such as sleep, shift duty, shift pattern, food
timing, mode of travel, and type of PPE during travel were also found to be significantly associated
with work type – Covid versus non‑Covid (p < 0.05).
CONCLUSIONS: Use of workplace appropriate PPE, proper donning and doffing facilities, duty shifts
with a fixed duration, adequate hand hygiene practices, and regular food intake with adequate sleep
can prevent Covid‑19 infection at the workplace among nurses.

Abstract BACKGROUND: The impact of Coronavirus Disease‑19 on peoples’ life has become evident.
Recently, sport activities are important in improving individual health and their well‑being. The aim of
this study is to investigate the effect of using mobile phone fitness applications on some characteristics
of physical fitness and psychological well‑being of female university students.
MATERIALS AND METHODS: A descriptive study design was implemented using a survey which
was adapted to collect data from a sample of 50 female participants within the age of 18 to 19 years.
As for the results, the participants indicated that they used physical fitness application by smart
phone regularly during COVID‑19.
RESULTS: The results also illustrate that there was a significant difference on the study variables
based on the study groups and test time. The study results extend literature concerning sport activities
participation and promoting positive well‑being during COVID‑19 pandemic.
CONCLUSION: The study indicated a significant difference of the application on physical fitness
and psychological well‑being among the participants. Based on the results, the study recommended
to organize several sport activities among students and encourage them to use smart phones for
positive purposes. Finally, practical implications are outlined.