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: Recent findings show that a longer breastfeeding duration and proper dietary
management could lower the risk of postnatal diabetes. An excellent and interactive education
module on breastfeeding and diet may effectively improve breastfeeding practices and dietary
knowledge among women with gestational diabetes mellitus (GDM). Therefore, this study delves
into developing and validating the content of Breastfeeding and Dietary Education Package (BFDEP)
for women with GDM.
METHOD: The development of the module involved three phases: need assessment, module
development, and validation. Six experts deployed a content validity index (CVI) to evaluate three
areas of the module, including objectives, structure or presentation, and relevance. Sixteen women
with GDM were involved in the face validation process by assessing the “literacy presentation,”
“illustrations,” “material is sufficiently specific,” and “quality of information.”
RESULTS: Generally, I‑CVI, S‑CVI/Ave, and S‑CVI/UA of the objectives, structure or presentation,
and relevance revealed an excellent level of content validity. No alteration was needed for the
domains of objective and relevance (S‑CVI/Ave: 1.0, S‑CVI/UA: 1.0). However, a minor revision was
required in the structure or presentation domain (S‑CVI/Ave: 0.98, S‑CVI/UA: 0.90). The experts
also thought that some module pages were wordy, and a change of font color was needed. The
module was thus modified accordingly. For face validation, “literacy presentation” and “material is
sufficiently specific” had a 99% positive response, while “illustrations” and “quality of information”
had 100% positive feedback.
CONCLUSION: A BFDEP with excellent content validity was developed and can be implemented to
improve breastfeeding practices and dietary knowledge among women with GDM.

Abstract BACKGROUND: Family caregivers of hemodialysis patients experience various physical,
psychological, social, economic, and spiritual problems that reduce their quality of life. The present
study aimed to determine the effect of a family‑centered education program on the quality of life of
family caregivers of patients undergoing hemodialysis.
MATERIALS AND METHODS: This was a randomized controlled trial that was performed on 70
caregivers of patients undergoing hemodialysis in the medical centers of Hazrate Ali Asghar and
Hazrate Zahraye Marzieh in Isfahan. Caregivers were randomly divided into experimental and control
groups, and the experimental group received an eight‑session family‑centered education program.
Data were collected using the Quality of Life Scale (QOLS)‑short form immediately after and 1 month
after the intervention. Data analysis was performed using the Statistical Package for the Social
Sciences (SPSS) software version 18 and analysis of variance and covariance.
RESULTS: The results showed that both experimental and control groups were homogeneous in
terms of demographic information and there was no significant difference between them in this regard.
Analysis of data on quality of life and its four domains showed that the mean scores of quality of
life (P = 0.089) and its four domains including physical health (P = 0.367), mental health (P = 0.429),
community relations (P = 0.132), and environmental health (P = 0.232) increased significantly
immediately after and 1 month after the intervention (P < 0.001 in all cases).
CONCLUSION: Educational programs can improve the quality of life of family caregivers of
hemodialysis patients. Therefore, it is recommended that programs be developed and evaluated in
various studies in the future.

Abstract BACKGROUND: The birth of a pre‑mature infant and subsequent hospitalization and separation
from the family can impair maternal and neonatal attachment and quality of maternal care. This
study aimed to assess the effect of instructing mothers in attachment behaviors on short‑term health
outcomes of pre‑mature infants admitted to neonatal intensive care units (NICUs).
MATERIAL AND METHODS: In this quasi experimental study, 80 mothers of pre‑mature infants who
were admitted to NICUs at two referral health centers in northern Iran were studied in two groups in
2018. Attachment behaviors were taught to mothers in the test group during four consecutive sessions.
Mother–infant attachment behaviors were evaluated at both the beginning and the end of this study
using a checklist derived from Avant’s Maternal Attachment Assessment Strategy. Moreover, infants’
short‑term health consequences were investigated in two groups. SPSS 18 statistical software was
used for data analysis.
RESULTS: On average, it took respectively 34.90 ± 12/65 and 31/15 ± 14/35 days for the infants in
the control and the intervention group to reach full oral feeding and 38/5 (38/4–42/11) and 37 (31/85–
42/14) days to gain the minimum weight required for discharge. Moreover, the mean length of stay
for the infants in the control and the intervention group was 41/80 ± 13/86 and 39/02 ± 16/01 days,
respectively (P > 0/05).
CONCLUSION: Instructing mothers in attachment behaviors clinically improved short‑term
health‑related outcomes. Hence, this intervention is recommended to be incorporated in the care
program for mothers with pre‑mature infants.

Abstract Emotions are universal in academic and clinical settings. A student is likely to hope for success,
maybe be worried about failure, or may feel comfortable after an exam. These feelings undoubtedly
affect his/her motivation, effort, academic performance, and progress. This study aimed to investigate
the role of emotion in the learning and performance of medical students and its mechanism. This
study was a scoping review conducted in 2022 to examine the role of emotions in medical education.
The three databases PubMed, ERIC, and Science Direct and the search engine Google Scholar
were searched using the following keywords: “emotion,” “medical student,” “teaching,” “learning,”
and “medical education.” English articles published from 2010 to 2022 were reviewed, and finally,
34 articles that met the inclusion criteria were reviewed. Review of the selected articles showed that
there was a significant relationship between the cognitive system and emotions in the brain. The
conceptual framework of the relationship between cognition and emotion can be explained in the
form of dimensional and discrete views of emotions and based on cognitive load theory. Emotions
affect cognition with the four mechanisms of memory, cognitive resources, cognitive strategies,
and motivation and can be effective in learning self‑regulation, clinical reasoning, and academic
achievement of medical students. Emotions in medical education is a double‑edged sword. In other
words, it is highly recommended to divide emotions into activating and inactivating, instead of dividing
them into positive and negative ones. In this context, medical educators can use the positive aspects
of nearly all emotions to improve the quality of their teaching.

Abstract Educational policymaking is a kind of public policy that is done in order to achieve the goals of the
educational system in fields areas such as education and students’ health. The purpose of this study
was to determine the components of educational policymaking model in education. The method of
the present study is systematic review. This is done using the SPIDER framework. The statistical
population of the study included all related Persian and English articles published in the years
2010–2021 consisting of 98 articles that are indexed in ScienceDirect, Sage, Springer, Wiley, Eric,
and PMC English language databases and SID, Irandoc, and Magiran Persian language databases.
The research sample included 52 articles selected in the article screening stage. The number of
Persian language references was 12 and English language references was 40. Sterberg thematic
analysis was used for coding the selected texts of articles. Results of coding the selected texts of
the articles showed that the components of the educational policymaking model are included in 11
themes: quiddity of policy and public policy, educational policy’s necessity, quiddity of educational
policy, process of educational policy, consequences, factors, obstacles, stakeholders, evaluation
criteria, and change in educational policies. Paying attention to all the dimensions and factors
interacting in educational policy can lead to better education and improve the quality of education in
all dimensions, especially in the field of health education.

Abstract BACKGROUND: Human survival requires the ability to communicate. Today’s students’ use of
social media has opened up a slew of new possibilities; nevertheless, it is hard to say how many
more may emerge in the future. As the years have gone by, the use of social networking sites has
grown in popularity among teenagers. This research investigates both the ways in which social
media draws in users and the ways in which it hooks users by revealing the gimmicky worlds that
they inhabit. Depending more on social media than on oneself causes a tremendous problem. It is
quite challenging to separate human beings from their many electronic devices in today’s world. The
use of devices gradually began to take over the world.
MATERIALS AND METHODS: Qualitative research approaches were used in this research. The
qualitative study’s findings were gathered from a variety of secondary sources, including media
articles, academic journal articles, and past theses. Throughout the course of this study, a discourse
analysis method was employed, and several case studies were gathered from news articles and
journals.
RESULTS: According to the results of the research, addiction to the Internet has been defined as
a decrease in an individual’s ability to exercise self‑control within the context of the social‑cognitive
framework. The research is based on true events that occurred in and around India. This research
article focuses on the various positive and negative effects that social media may have on education
and students. It is critical to figure out how to tackle this issue.
CONCLUSION: One effective strategy is to restrict their access to social media. The bulk of the
disadvantages may be mitigated by reducing the amount of time spent on social media sites. Keeping
track of their academic progress and dealing with any problems early on can help them avoid the
negative effects of social media on their education.

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: Due to the role of education in improving anxiety and essential skills of mothers
for caring for their infants, this study aimed to investigate the effect of education based on the health
belief model (HBM) on anxiety among mothers of infants with retinopathy of prematurity (ROP).
MATERIALS AND METHODS: This randomized controlled clinical trial was performed on 67 mothers
with premature infants admitted to the ROP unit of Khatam Al Anbia Eye Hospital in Mashhad,
Iran from 2019 to 2020. Participants were randomly allocated to intervention and control groups.
Intervention was designed based on HBM during six sessions, each of 45–60 minutes duration. The
control group received routine educations according to the hospital policies. The maternal anxiety,
adherence with follow‑up examinations and the rate of neonatal retinal vascularization were evaluated
using an HBM‑ based questionnaire and State‑Trait Anxiety Inventory questionnaire and checklists,
respectively. Data was analyzed by using SPSS software, version 16, using Chi‑squared test, Fisher’s
exact test, independent t test, and Mann–Whitney U test.
RESULTS: Based on our findings, no significant difference was observed between the two groups
before the intervention regarding the mean score of maternal anxiety (P = 0.141). However, after
intervention, the mean score of maternal anxiety decreased significantly from 67.0 ± 6.3 to 38.5 ± 6.6
in the intervention group and increased from 69.8 ± 3.1 to 68.3 ± 3.4 in the control group (P < 0.001).
In the intervention group, the mean scores of model constructs (perceived susceptibility and
severity, perceived benefits, barriers, self‑efficacy and cue to action) increased significantly after
intervention (P < 0.001).
CONCLUSIONS: Education based on HBM appear to be an efficient method to improve maternal
anxiety among mothers of infants with retinopathy of prematurity. Accordingly, nurses and treatment
staff can provide interventions in the NICU based on the HBM to the parents of hospitalized and
premature infants.

Abstract BACKGROUND: Mothers need the necessary skills to be empowered in successful breastfeeding.
This study aimed to investigate effectiveness of the distance education program on the mothers’
empowerment in exclusive breastfeeding.
MATERIALS AND METHODS: A randomized clinical trial study was done on 72 nulliparous pregnant
women 28–32 weeks with normal pregnancy. The qualified women were randomly assigned to the
intervention and control groups based on the random‑number table. The breastfeeding training
packages were sent to women in the intervention group via Telegram every week from 32 until
37 weeks of gestation. The mothers’ empowerment in breastfeeding (primary outcome) and the
exclusive breastfeeding rate (secondary outcome) were assessed by questionnaires.
RESULTS: Based on the repeated measured tests, although scores for all domains and also the
total score of the mothers’ empowerment in breastfeeding between two groups had increased
during the study period, there was a significant difference between the increasing trends of the
maternal empowerment domains in two groups (interaction P value ‹0.001). Also, the prevalence of
exclusive breastfeeding (secondary outcome) at 6 months was significantly higher in the intervention
group (81.8% and 57.1% in the intervention and control groups, respectively) (P = 0.028).
CONCLUSION: Distance education could increase all domains of the mothers’ empowerment in
breastfeeding after delivery. Also, exclusive breastfeeding at 6 months after delivery was significantly
higher in mothers who were receiving the distance education packages.

Abstract BACKGROUND: Couples’ attitudes toward infertility are related to different dimensions of infertility.
Counseling can change attitudes toward infertility in infertile couples. Therefore, this study was
conducted to determine and compare the effect of face‑to‑face counseling and telephone counseling
on infertility attitudes in infertile couples.
MATERIALS AND METHODS: This two‑group intervention study was performed on 34 infertile
couples who were randomly assigned to face‑to‑face and telephone counseling groups. The couple
attended counseling sessions as scheduled by the researcher. An Infertility Attitude Questionnaire
was completed by all participants at the beginning and end of the study. Data were analyzed using
SPSS software version 16.
RESULTS: The results of independent t test showed that after the intervention, the mean score
of attitude toward infertility in the face‑to‑face counseling group was significantly higher than
the telephone counseling group. Based on paired t test, the mean score of infertility attitude in
the face‑to‑face counseling group was significantly increased two weeks after the intervention
compared to before. The mean score of infertility attitude in the telephone counseling group was
significantly increased two weeks after the intervention compared to before. According to the results
of independent t test, the attitude score toward infertility was not statistically significant between
the two groups.
CONCLUSION: The results of the present study showed that with counseling, the mean score of
infertility attitude in infertile couples in both groups had increased. In other words, counseling can
change attitudes toward infertility in infertile people.

Abstract BACKGROUND: Access to online patient education information can lead to more effective self‑care
and disease management. However, the large amount of online information provided through
unknown or unreliable sources can challenge patients to trust and use this information. This study
was designed to examine the opinions of Iranian gastrointestinal patients about the quality of online
information used.
MATERIALS AND METHODS: A qualitative study was conducted using thematic analysis. Data
were gathered via a semi‑structured interview with 29 gastrointestinal patients, and data analysis
was performed by qualitative content analysis using open coding with MAXQDA 2018 software.
RESULTS: Based on the study, 22 codes were extracted in nine subcategories named as: “Emphasis
on the identity of providers,” “Nature of online information,” “Distrust on online information,” “Poor
quality of information,” “Giving misinformation,” “False impact,” “Improve communication,” “Positive
effect on the patient,” “Better Diagnosis.”
CONCLUSIONS: In the current situation, Iranian patients are not confident enough about the quality
of available online information. They believe that the use of current poor‑quality information has
negative consequences. However, they tend to use online patient education materials are produced in
Persian by reputable scientific authorities. Using online information can increase patients’ knowledge
and lead to better communication with medical staff and other similar patients. They can use this
information for self‑care with more confidence, and such an approach can also have significant
benefits for the national health system.

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 BACKGROUND: The high prevalence of coronavirus disease‑2019 (COVID‑19) has a lot of stress on
medical students. This study was conducted to investigating the adaptation strategy with COVID‑19
health anxiety in nursing students
MATERIALS AND METHODS: This study was designed as a cross‑sectional study. Participants
of the study were 431 students of the Nursing and Midwifery Faculty of Shahid Beheshti University
of Medical Sciences. Inclusion criteria were studying at the time of the outbreak of COVID‑19 and
willingness to participate in the study. Data collection tools included participated in the study. Data
collection tools included a demographic questionnaire, Health Anxiety and Coping Inventory for
Stressful Situations (Short Form). Reliability of tools was assessed and confirmed with Cronbach’s
alpha coefficient. Cronbach’s alpha coefficient of health anxiety was 0.76 and Cronbach’s alpha
coefficient of Coping Inventory for Stressful Situations was 0.79. Data were collected between July
2020 and September 2020. Pearson’s correlation coefficient was used to examine the relationship
between the data. Data were analyzed with SPSS 26.
RESULTS: Findings indicated that most of the participants were female, single, 22–28 years old, and
undergraduate students. The mean of COVID‑19 health anxiety was 5.59 ± 17.04. Results showed
that 19.58 ± 5.05 of the participants used avoidance‑focused adaptation strategies, 25.12 ± 3.88
problem‑focused adaptation strategies, and 19.32 ± 5.13 emotion‑focused adaptation strategies.
CONCLUSION: The COVID‑19 health anxiety was higher in female, young, and married students.
The problem‑focused adaptation strategy should be further taught so that students can better coping
with COVID‑19 health anxiety.

Abstract BACKGROUND: Coronavirus disease 2019 (Covid‑19) pandemic has increased virtual education
use. This study aimed to determine the attitude of nursing students of Ahvaz Jundishapur University
of Medical Sciences towards virtual education and its relationship with their satisfaction during the
Covid‑19 pandemic.
MATERIALS AND METHODS: This descriptive‑analytical study was conducted during 2020–2021
with the participation of 229 nursing students (undergraduate, graduate, and doctoral) who had spent
at least one semester virtually at Ahvaz Jundishapur University of Medical Sciences. The sampling
method was convenience. The data collection tool was a questionnaire consisting of three parts.
The first part included students’ demographic information and the second and third parts included
the standard questionnaire of individual development and educational assessment to determine
students’ attitudes toward virtual education and their satisfaction with this type of education. IBM
SPSS statistics 22 software and descriptive and analytical statistical tests were used for data analysis.
RESULTS: According to the study results, the mean score of students’ attitudes toward virtual
education was 35.1 ± 11.3 and the mean score of students’ satisfaction with this educational method
was 88.3 ± 30.6, both of which are at the desired level. Also, a direct relationship was found between
students’ attitudes and satisfaction scores (P < 0.001).
CONCLUSION: In this study, the attitude of nursing students to virtual education and their satisfaction
with this educational method had been at the desired level. Therefore, the relevant authorities should
also consider the necessary planning in the field of using this educational method and improving
students’ attitudes towards it under normal conditions.

Abstract BACKGROUND: Complications of chronic liver disease (CLD) in children play an important role in mortality
and disability. This disease is one of the health problems of the country and due to its chronic and irreversible
disease, it needs care and treatment education programs. Therefore, this study was performed to determine
the effect of nutrition adjustment training program on anthropometric indices in children with CLD.
MATERIALS AND METHODS: This clinical trial study was performed on 75 children
(45 in the intervention group and 30 in the control group) with CLD in the nutrition clinic of Ghaem
Educational‑Research Center in Mashhad. Children and caregivers with inclusion criteria entered
the study after completing written consent. Anthropometric indices (abdominal circumference, body
water level, body fat, height, weight, body mass index, arm circumference) were measured and
recorded in children at the beginning of the study. Children and their caregivers were randomly
divided into control and intervention groups. The intervention group underwent nutritional adjustment
(calculation of energy and carbohydrates, lipids and proteins, vitamins and minerals, calculation
and selection of diet) training (face to face) for 6 sessions (each session 90–120 min, three times
a week for 2 weeks). Twelve weeks after the start of the study, children in both intervention and
control groups were evaluated for anthropometric indices. The collected data were analyzed by SPSS
software version 16 and descriptive and analytical statistical tests (Mann–Whitney and Wilcoxon).
RESULTS: The results of Wilcoxon statistical test showed that children in the intervention group at
the end of the study compared to the beginning of the study had significant changes in scores around
the abdomen (P = 0.001), total body water (P = 0.009), total fat (0.001 > P), height (P = 0.001),
weight (P < 0.001), body mass index (P < 0.001), arm circumference (P < 0.001). The mean scores
at the end of the study increased compared to the beginning of the study, but the mean scores of
the studied indices in the control group did not change significantly.
CONCLUSION: The results of this study showed that diet adjustment training program can be effective
on anthropometric indices of children with CLD. For this purpose, the use of this educational method
is recommended to improve the anthropometric indices of these children.

Abstract BACKGROUND: Improving self‑care in adolescent pregnancy leads to improved maternal and
neonatal outcomes of pregnancy. However, self‑care in adolescent pregnancy is less than other
women. The aim of this study was to compare the effect of face‑to‑face training and telemedicine
on self‑care in adolescent pregnant women.
MATERIALS AND METHODS: The present study is a quasi‑experimental study that was conducted
in Zahedan in 2021 and 120 adolescent pregnant women with a gestational age of 15–20 weeks
participated in it. The sampling was done in multistage, and the samples were divided into three groups:
Face‑to‑face training, telemedicine, and control. Face‑to‑face training was presented in five sessions
and the telemedicine group received the similar educational content through the mobile applications.
The samples completed a researcher‑made self‑care questionnaire before the intervention and at
28 weeks of gestation. SPSS software version 21 was used for the analysis, and data were analyzed
by ANOVA, Tukey post hoc, Kruskal–Wallis, and Mann–Whitney tests.
RESULTS: There was no significant difference in face‑to‑face and telemedicine training in improving
the scores of nutritional performance, smoking and narcotics use, personal hygiene, and routine
pregnancy care (P > 0.05), but face‑to‑face training caused more improvement in the scores of
sports and physical activity as compared to telemedicine group (P = 0.04). Face‑to‑face training
and telemedicine training in all domains led to a significant improvement in scores as compared to
the control group (P < 0.05).
CONCLUSION: The results of this study showed that the face‑to‑face training and telemedicine
methods were proper methods for self‑care education in pregnant adolescent women. It is
recommended to use these methods in promoting self‑care in pregnant adolescent women.

Abstract BACKGROUND: Role of multimedia training materials on Mini-CEX scores of internal medicine
residents. We aimed to assess the effect of multi multimedia training materials on Mini-CEX scores
of internal medicine residents of Isfahan University of Medical Sciences.
SETTINGS AND DESIGN: A quasi-experimental action research study on 1st, 2nd, and 3rd-year
internal medicine residents were implemented.
MATERIALS AND METHODS: The Mini-CEX test measures students’ performance in six core skills
necessary for medical practice. Mini-CEX scores of 135 internal medicine residents in 2017–2018
were compared before and after the training with prepared multimedia materials. We used repeated
measured ANOVA and Mann–Whitney U test to compare the distribution of Mini-CEX scores across
corresponding groups. Analysis was done using the SPSS software version 23 (IBM SPSS Statistics
for Windows. Armonk, NY, USA: IBM Corp).
RESULTS: The median Mini-CEX score (IQR) of students in preintervention and postintervention
groups were 16.14 (5.19) and 19.62 (3.13), respectively. Findings of this study showed a significant
increase in mini-CEX scores of the groups who used the multimedia learning material compared to
those who did not use it (P < 0.001).
CONCLUSIONS: Multimedia learning resources demonstrated a promising influence on internal
residents’ mini‑CEX scores in this study. They demonstrate significantly greater performance after
using multimedia learning materials compared to their same‑year residents who did not benefit from
it. This demonstrates the favorable effect of multimedia on the acquisition of practical skills such as
obtaining a history or performing a physical examination.

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 BACKGROUND: Case‑based learning is a modern learning approach, aims to prepare students
for practical skills. In the present study, we aimed to determine the effectiveness of case‑based
e‑learning (CBEL) on the academic performance and problem‑solving ability of nursing students.
MATERIALS AND METHODS: In this pre‑ and post‑test study, census sampling method was used
to select 128 nursing students who had nutrition courses during 2015–2017 at (blinded). Before and
after the educational intervention, the students completed the problem‑solving inventory including
problem‑solving confidence (PSC), approach‑avoidance style (AA), and personal control (PC) and a
scientific test for evaluating academic function. Continuous variables before and after the intervention
and categorical variables were analyzed using paired t‑test and Chi‑square test, respectively.
RESULTS: The mean scores of PSC, AA, and PC decreased after the intervention (P < 0.001). The
mean scientific score of the students improved after the intervention (P < 0.001).
CONCLUSION: This study showed that the CBEL method had a positive effect on the ability to solve
the learning problems and the academic performance of the students and can be used to train nurses
to improve their ability to confront clinical problems in the future.

Abstract BACKGROUND: Midwifery services help maintain and improve the health of the community. However,
a comprehensive examination reduces students’ psychological well‑being by creating anxiety. For this
purpose, the present study was conducted to determine and compare the effect of two educational
methods based on mindfulness and cognitive emotion strategies on psychological well‑being and
anxiety of eighth‑semester midwifery students before the final clinical trial.
MATERIALS AND METHODS: This study was a quasi‑experimental three‑group study with available
sampling method that was performed on 30 eighth‑semester midwifery students of the School of
Nursing and Midwifery of Isfahan University of Medical Sciences in 2020–2021. Data collection tools
were psychological well‑being and Test Anxiety Questionnaire. Two intervention groups were trained
for eight sessions. The control group did not receive any training program. The data collected by
SPSS version 22 software were analyzed by analytical statistical tests of ANOVA and least significant
difference post hoc test.
RESULTS: The results showed that there was a statistically significant difference between the three
groups in terms of components of test anxiety and psychological well‑being. Furthermore, emotion
regulation training and mindfulness‑based training reduced test anxiety and increased students’
psychological well‑being before the comprehensive test (P = 0.001).
CONCLUSION: It is recommended that educational programs be considered before the comprehensive
examination to promote the mental health and success of these students.

Abstract Osteoporosis is a systemic skeletal disease that is associated with negative physical and psychosocial
consequences, so understanding the effective strategies that can be used in the prevention of
osteoporosis is especially important. The aim of this study was to integrative review the published
interventional of nonpharmacological studies regarding the prevention and treatment of osteoporosis
among menopausal women. In this systematic review, databases such as PubMed, PsycInfo, Web
of Science (ISI), Scopus, ScienceDirect, EmBase, Cochrane library, Google scholar, and Iranian
databases, such as Scientific Information Database and Magiran, were searched. The latest search
was performed between “November 2020 and December 2020” separately by two researchers and
then double‑checked by them. The quality of the included studies was assessed using the Jadad
score calculation tool. Twenty eight randomized controlled trials and quasi‑experimental studies were
included in this current study. The quality assessment indicated that 19 studies had acceptable (good)
methodological quality and also 9 studies had weak methodological quality. The main results of this
study were classified in three main categories such as exercise or physical activity training (n = 15),
educational sessions (n = 11), and other interventions (n = 2). The results of most included studies
showed that nonpharmacological strategies such as physical activity and educational interventions
are considered as the appropriate actions to prevention of osteoporosis among menopausal women
so implementing these strategies can be a good alternative for women with contraindication of
hormone therapy or therapeutic treatment.

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: In the COVID‑19 outbreak, women with a history of miscarriage need more mental
health. Anxiety and meta‑worry as consequences of miscarriage, besides concerns due to pregnancy
during coronavirus, show the necessity of appropriate online and face‑to‑face educational counseling.
This study aimed to evaluate the effectiveness of online metacognitive educational counseling versus
face‑to‑face method on anxiety and meta‑worry in these women.
MATERIALS AND METHODS: In this randomized clinical trial, 80 women with a history of
miscarriage, anxiety, and meta‑worry referred to Imam Jafar Sadegh hospital (labor, women ward
and women clinic), Meybod, Iran, were selected conveniently and randomly assigned into two
groups (n = 20/each). The participants received 8‑session metacognitive educational counseling
package online or face‑to‑face. Data were collected by Beck Anxiety Inventory, Wellz meta‑worry
questionnaire at baseline, week eight, and follow up as primary outcomes and analyzed via SPSS
software (Anova and Repeated measure statistic tests).
RESULTS: Anxiety in the 12th week (online group 13.75 ± 3.59 vs. face to face 18.25 ± 5.91,
P = 0.04) was statistical significantly less than baseline (respectively 22.15 ± 5.67 vs. 22.35 ± 4.93,
P =  0.56); with fewer anxiety scores in the online group. Meta‑worry in the 12th week (online
group 11.90 ± 2.59 vs. face to face 15.70 ± 4.06, P = 0.03) was statistically significant compared to
baseline (respectively 17.15 ± 2.70 vs. 18.50 ± 3.47, P = 0.36); with fewer meta‑worry scores in the
online group. Belief about worry in 12th week (online group 66.50 ± 14.60 vs. face to face 78.45 ± 9.27,
P = 0.01) was statistical significantly less than baseline (respectively 85.50 ± 8.87 vs. 86.05 ± 8.85,
P = 0.96); with less score of belief about worry in the online group.
CONCLUSION: Online and face‑to‑face metacognitive educational counseling methods decreased
anxiety, meta‑worry, and belief about worry in women with miscarriage. But online educational
counseling was more effective. Distance online counseling in COVID‑19 can help the mental health
of women with miscarriage.

Abstract BACKGROUND: Financial literacy is a person’s capability to manage their own monetary matters. 
There was no information available on financial literacy status of healthcare professionals (HCPs) of 
India. So, the current research was formulated to assess the financial literacy status and its correlates 
among HCPs of India.
MATERIALS AND METHODS: It was an observational study, cross‑sectionally designed, conducted 
among 524 HCPs of India using a structured Google form during July 2020. For data analysis, 
SPSS (version 22) was used.
RESULTS: Among the study participants, 68.3% were found to be financially literate. Among the 
various subdomains of the total financial literacy, knowledge regarding general domain was observed 
to be the best (69.3%) followed by savings (63.7%) and investment (58.0%) domains, respectively. 
The total financial literacy score was found to be positively correlated with higher age [spearman 
rho correlation co‑efficient (ρ) = 0.25; P =< 0.01], qualification [(medical postgraduate) (ρ = 0.16;
P =< 0.01); (medical super speciality) (ρ = 0.14; P =< 0.01)], and annual family income (ρ = 0.29;
P =< 0.01). Moreover, males (ρ = 0.23; P =< 0.01)], currently married (ρ = 0.19; P =< 0.01), and 
surgeons (ρ = 0.12; P =< 0.01) were found to be more financially literate compared with others. 
Positive financial attitude (ρ = 0.26; P =< 0.01) and regular maintenance of financial record (ρ = 0.21;
P =< 0.01) were the other enabling factors of financial literacy observed in the study.
CONCLUSIONS: Financial literacy was found to be quite low in the surveyed HCPs as every third 
study participant were found to be deficient in knowledge regarding one or more financial attributes. 
Incorporation of finance management in curriculum of the healthcare allied courses and repeated 
sensitization of the graduated HCPs are warranted to enable them to take effective financial decisions 
to meet their personal and organizational financial goals.