Journal of Education and Health Promotion

Abstract BACKGROUND: Following the global emergency of coronavirus disease 2019 (COVID‑19),
health‑care workers, especially nurses were encountered with an increasing workload. Therefore, due
to the importance of this issue, the present study aimed to examine stress, anxiety, and depression
levels among nurses during the COVID‑19 pandemic in Iran.
MATERIALS AND METHODS: This cross‑sectional study was conducted in four educational hospitals
affiliated to Kerman University of Medical Sciences in 2020. The standard Depression, Anxiety and
Stress Scale‑21 questionnaire was applied to assess the levels of stress, anxiety, and depression
in nurse personnel with a census method (n = 403). Data were analyzed using descriptive statistics
and analytic statistics such as Kolmogorov–Smirnov, Mann–Whitney, Kruskal–Wallis, and multiple
linear regression tests through the version 20, SPSS Inc., Chicago, IL, USA, Software at the level
of P < 0.05.
RESULTS: The results of the study showed that the mean scores of depressions (9.18 ± 4.45),
stress (9.62 ± 4.94), and anxiety (10.32 ± 4.85) in nurses were at moderate level. A significant
relationship was observed between stressed, anxious, and depressed participants in the gender,
marital status, level of education, and working hours per month. No statistically significant relationship
was found between other demographic variables including age, work experience, and employment
status with anxiety, depression, and stress categories.
CONCLUSION: The results of this study can increase the awareness of health system managers,
especially hospitals, about the level of stress, anxiety, and depression and can help in order to provide
psychological support programs for improving the mental health of nurses during the COVID‑19
pandemic.

Abstract BACKGROUND: The coronavirus disease 2019 (COVID‑19) pandemic has prompted the further
virtualization of medical education. The satisfaction level of specific users such as cardiology residents
with virtual education can augment its quality; hence, the significance of a valid and reliable questionnaire
to obtain feedback is needed. This study aimed to design and measure validity and reliability of a
satisfaction questionnaire for virtual education of cardiology residents during COVID‑19 pandemic.
MATERIALS AND METHODS: In this cross‑sectional study, a self‑administered questionnaire
was developed by the faculty members of Rajaie Cardiovascular Medical and Research Center.
Reliability was tested utilizing Cronbach’s alpha  and intercorrelation which was tested using Pearson’s
correlation coefficient test (ICC). Factor analysis was done by the Kaiser–Meyer–Olkin measure of
sampling adequacy and Bartlett’s sphericity test. The statistical analyses were performed with the
SPSS software version 22.
RESULTS: The face validity index was determined via an assessment of the relevance, clarity, and
simplicity of each item, and values >0.79 were accepted. The total Cronbach’s alpha coefficient was
calculated 0.93. Concerning test–retest reliability, the correlation between two rounds of evaluation
was >80 (P > 0.001) and ICC was 0.99 (P = 0.001). The content validity evaluation yielded an index of
0.95 and a ratio of 0.91. The principal component factor analysis, conducted to investigate construct
validity, generated four domains.
CONCLUSIONS: The study results confirmed the validity and reliability of the designed questionnaire
to evaluate the level of satisfaction of cardiology residents with virtual learning in COVID‑19 pandemic.