Journal of Education and Health Promotion

Abstract BACKGROUND: Preclinical students often fail to appreciate the clinical relevance of basic sciences
during the first year of undergraduate medical training, leading them to lose interest in the subject,
and preventing them from achieving the desired goals. In order to rectify this gap in the curriculum,
Medical Council of India (MCI) in 2011 published a document announcing curricular strategies
including Early Clinical Exposure (ECE) to effectively modify the Indian system of education. Lack
of proper guidance prevented many institutions from implementing ECE. Since our institution had
run a similar program of “Clinical Observership” as early as 2001, we were able to implement ECE
in an efficient way.
MATERIALS AND METHODS: Early clinical exposure was implemented as a structured program,
with the participation of 10 clinical departments since 2013. Feedback from the students, soon after
ECE and also from the batch of CRRIs, who had undergone this program while they were preclinical
students amply support the effectiveness of ECE in its contents and methods of implementation.
Manual content analysis was performed on open comments. After reading the responses, they were
broken down to meaning units, and these were then condensed. The condensed meaning units
were labeled with codes. The codes were grouped into categories. Themes were derived from the
categories.
RESULTS: Out of the 70 CRRIs, 52 responded to the questionnaire. All the CRRIs except one said
that ECE was very helpful during their clinical postings and internship period. They suggested that
the number of hours of posting should be increased and also reiterated the fact that a greater number
of clinical departments could be included in the program. Though the beneficial effects were felt in
all the domains of learning, the most remarkable impact was felt in the affective domain, wherein
changes are not easy to come by.
DISCUSSION: Recently, National Medical Council has come out with plans of including ECE in
the syllabus with strict time schedule. It is felt that the faculty will find our experience of running the
program for the past five years helpful in implementing this program, for the fullest benefit of the
preclinical students.

Abstract BACKGROUND: The behavioral aspects of human beings influence the incidences of cancer cases
directly and indirectly. The factors like positive thinking and motivation were found to change the
behavior toward knowledge and awareness of cancer. The main objective of the study is to assess
the knowledge and awareness of select Indians about reproductive cancer.
MATERIALS AND METHODS: The online survey method assessed various components of
knowledge and awareness about reproductive cancer. A Google Form has been distributed through
social media platforms such as e‑mail, Instagram, Facebook, and WhatsApp. The coded data has
been computed in SPSS (version 25) by IBM (USA) for the analysis. Univariate and bivariate data
analysis has been drawn to justify the objective.
RESULTS: Nearly 68 percent of the respondents were aware of reproductive cancer. Among them,
17 percent know about cervical cancer, and 12.5 percent have awareness about breast cancer.
Electronic and print media (41.2 percent) were major sources of information about reproductive
cancer. Nearly 48 percent of respondents reported that multiple sexual partners and poor sexual
hygiene were risk factors for reproductive cancer. Around 57 percent of respondents reported
reproductive cancer is preventable, 59 percent knew about cancer screening, and 63.5 percent
knew the treatment process. The gender of the respondents was associated (p‑value = 0.002) with
awareness of reproductive cancer. It has been found that there is a significant association between
knowledge of screening tests and the treatment process of reproductive cancer. The marital status
of respondents is strongly associated (p‑value = 0.000) with the awareness of reproductive cancer.
CONCLUSION: The factors like knowledge of reproductive cancer and awareness proceed as
an important role in cancer prevention. A gender‑neutral cancer awareness program is needed to
increase cancer awareness irrespective of marital status.

Abstract BACKGROUND: Many academicians suggested the supplementary use of 3D‑printed models
reconstructed from radiological images for optimal anatomy education. 3D‑printed model is newer
technology available to us. The purpose of this systematic review was to capture the usefulness or
effectiveness of this newer technology in anatomy education.
MATERIALS AND METHODS: Twenty‑two studies met the inclusion and exclusion criteria for
quantitative synthesis. The included studies were sub‑grouped according to the interventions and
participants. No restrictions were applied based on geographical location, language and publication
years. Randomized, controlled trial, cross‑sectional and cross‑over designs were included. The effect
size of each intervention in both participants was computed as a standardized mean difference (SMD).
RESULTS: Twenty‑two randomized, controlled trials were included for quantitative estimation of effect
size of knowledge acquisition as standardized mean difference in 1435 participants. The pooled effect
size for 3D‑printed model was 0.77 (0.45–1.09, 95% CI, P < 0.0001) with 86% heterogeneity. The
accuracy score was measured in only three studies and estimated effect size was 2.81 (1.08–4.54,
95% CI, P = 0.001) with 92% heterogeneity. The satisfaction score was examined by questionnaire in 6
studies. The estimated effect size was 2.00 (0.69–3.32, 95% CI, P= 0.003) with significant heterogeneity.
CONCLUSION: The participants exposed to the 3D‑printed model performed better than participants
who used traditional methodologies. Thus, the 3D‑printed model is a potential tool for anatomy
education.

Abstract BACKGROUND: This study aimed to investigate how medical students perceive their educational
environment, as well as the implications of motivation, learning strategies, and the factor of emotional
intelligence on academic achievement.
MATERIALS AND METHODS: In a cross‑sectional study, 3384 undergraduate students were
recruited from randomly selected Egyptian medical colleges. Students from second to final year, taking
fundamental and clinical courses and, at a minimum, three professional exams, were enrolled and
subjected to the Dundee Ready Educational Environment Measure scale, the Motivated Strategies
for Learning Questionnaire, and Emotional intelligence questionnaire.
RESULTS: The overall mean age of the studied students was 21.42 ± 1.61 years. Females
represented 63.5%, rural residents were 52.2% and students with enough income represented 88.0%.
The traditional system adopted 28.4% of the students versus 71.6% in the integrated system. Linear
regression using path analysis was conducted to study the predictors of academic achievement, and
it revealed that motivation was the highly significant predictor of academic achievement (β = 2.68,
CI95%:2.35–3.05, P < 0.001), followed by learning (β = 1.09, CI95%:0.80–1.41, P < 0.001), emotional
intelligence (β = 0.92, CI95%:0.87–0.97, P < 0.001), and the educational environment (β = 0.14,
CI95%:0.13–0.15, P < 0.001).
CONCLUSION: The study’s findings have implications for medical educators trying to understand the
personal factors that influence learning and performance in medical school. Students’ motivation was
the highly significant predictor of academic achievement followed by learning, emotional intelligence,
and educational environment. Perception of the learning environment had improved because of
the integrated student‑centered system, which fosters motivation and emotional intelligence. To
improve learners’ EI, optimal learning, and educational outcomes, the EI components can be taught
and fostered.

Abstract BACKGROUND: Metamotivation is a process that students use to monitor their motivational states
to reach their academic goals. To date, few studies have addressed the ways that medical students
manage their motivational states. This study aim to identify the motivational strategies of medical
students as they use the metamotivational process to monitor and control their motivational states.
MATERIALS AND METHODS: This qualitative study uses directed content analysis of the narrative
responses of 18 medical students to draft an in‑depth and semistructured interview protocol which were
conducted through WhatsApp due to social distance restrictions of COVID‑19. Data were collected,
encoded, and analyzed using deductive content analysis approach descripted by Elo and Kyngäs.
RESULTS: Seven main themes were extracted as the motivational strategies of medical students
including “regulation of value,” “regulation of situational interest,” “self‑consequating,” “environmental
structuring,” “efficacy management,” “regulation of relatedness,” and “regulation of situational
awareness.” In this study by identifying new strategies, we provide a broader framework of
metamotivational strategies in the field of the progression of learners in medical education.
CONCLUSION: Medical students use a variety of strategies to regulate their academic motivation. To
sustain and improve the motivation of medical students, identifying and strengthening metamotivational
strategies is the first step.

Abstract BACKGROUND: Self‑regulated learning (SRL) is a critical skill for medical students to reach their
learning goals in the bedside clinical rotations. This study was performed with the aim of comparing
SRL and motivation of 4th year medical students who are in their educational transition between
students with mentors and those without mentors.
MATERIALS AND METHODS: This study was cross‑sectional. A total of 196 medical students
were invited to complete a form consisting the motivation and SRL questionnaire through Google
form during their 1st year of clinical clerkship, while some of them had participated in the mentoring
program beforehand. data correlation and regression analysis were employed.
RESULTS: Comparing SRL and motivational beliefs scores between students with mentors and
without mentors indicated that motivational beliefs mean score in students with mentors (87.5 ± 8.44)
was significantly higher compared to the others (83.49 ± 7.36) (P = 0.005). Among SRL subscales,
planning and examination stress were significantly different between two groups with higher
scores for mentees (P = 0.033 and 0.021). Having a mentor predicted motivational beliefs with
OR = 7.974 (1.391–45.719) and P = 0.020.
CONCLUSION: Considering a significant correlation between mentor possession and the scale of
motivation beliefs, future longitudinal and interventional research besides the customized mentoring
program is required to understand the role of mentoring programs on SRL as a cause‑and‑effect
relationship to recommend the peer mentoring program to enhance SRL skills in the medical students
especially during their transition to the new clinical environment.

Abstract BACKGROUND: Demanding careers like medicine requires a lot of motivation and the Academic
Motivation Scale (AMS) developed by Vallerand et al. (1992) is an instrument to measure motivation.
This study evaluated the validity and reliability of AMS among medical students in the Middle East.
MATERIALS AND METHODS: This was a methodological research utilizing a convenient sampling
technique. AMS scale comprising 28 items subdivided into seven subscales was administered to 900
students (281 students returned the filled AMS). Data were analyzed using the descriptive statistics,
one‑way ANOVA, and t‑tests. Exploratory factor analysis and Cronbach’s alpha were used to evaluate
the validity and reliability of the scale, respectively.
RESULTS: There was a statistically significant difference between both genders in overall
scores (P = 0.015*), two subscales, namely “Identified Regulation” (P =0.017*) and “Stimulating
Experience” (P = 0.015*), with females showing higher value. Second‑year students (n = 91) had
significantly higher score (10.9 ± 4.1) for “Amotivation” (P =.001*) and first‑year students (n = 48)
had significantly higher score (16.2 ± 3.0) for “Achievement” subscale (P =.014*). P < 0.05
was considered statistically significant with 95% confidence interval. No statistically significant
difference was observed between the groups based on nationality or age. Bartlett’s test of
sphericity was significant (Chi‑square: 2988.010; df = 278; P < 0.001). Kaiser–Meyer–Olkin
was 0.890. Principal component analysis with varimax rotation extracted seven factors
corresponding to the original items of AMS questionnaire. All subscales correlated positively
except “amotivation.” Structural equation modeling revealed the relation between observed
and unobserved variables.
DISCUSSION: This study demonstrated that AMS is valid and reliable for application among Middle
East medical students, without needing any modification. AMS has widespread application in medical
education as it impacts learning outcomes.
CONCLUSION: This study demonstrated that AMS is valid and reliable for application among the
Middle East students without needing any modification.

Abstract Motivation is one of the key factors in educational achievement. Like any other field of study, motivation
in nursing is highly critical. The instructor’s knowledge about the teaching methods that are effective
in academic motivation of students enables them to adopt proper measures to improve the teaching
efficiency. The present paper is a systemic review of the efficiency of instructional interventions in
improvement of academic motivation in nursing students. The published papers related to the study
from 2000 to February 2020 were searched at different databases such as PubMed, Scopus, Web
of Science, PsycInfo, and ERIC. To examine the quality of the articles, critical appraisal instrument
for reports of educational interventions was used. Totally, 18 articles entered the study for structured
review. The majority of the articles reported that educational interventions improved academic
motivation in nursing students. The effective teaching methods described in the reviewed articles
that led to an improvement in academic motivation were simulation, case‑based learning, cooperative
learning, learning contract, peer assessment, and self‑assessment using video typing. As the findings
showed, implementation of applied and participatory methods in teaching process improved the
academic motivation of nursing students. Therefore, using such methods, nursing instructors can
improve the academic motivation of their students.

Abstract BACKGROUND: Absenteeism is a situation whereby students absence themselves from clinical
posting without good reason, this incidence among student nurses contributed a significant problem
that if not addressed will adversely affect the quality of nursing care; therefore, motivation of student
during clinical posting found to be an important ingredient needed in eradicating absenteeism.
Consequently, this study aims to determine the reasons why student nurses absenting themselves
from clinical posting, its effect and how clinical instructor can motivate student nurses since they are
the first role models and have a significant impact in their skill development.
MATERIALS AND METHODS: A descriptive, quantitative design was used to elicit the information
from a sample of 80 nurses and 80 students’ nurses. Nurses: 25 medical surgical ward, 23 surgical
ward, 17 obstetrics and gynecology ward, 15 theaters, and 80 student nurses, statistically drawn
through a stratified sampling technique across the wards and school of nursing. Data collected were
analyzed using tables, percentages, means, and standard deviation at 0.05 level of significance
through the Statistical Package for the Social Sciences software.
RESULTS: The student participants reported that non conducive working environment, working
in infectious ward without adequate protection, noncooperation from clinical instructor, excessive
number of clinical hours, embarrassment faced in front of patients and other medical personnel, lack
of prompt medical treatment and care when sick, too much workload, and other number of clinical
assignments as a major reason why they absenting themselves from clinical posting. The effect of
student absenteeism and how students can be motivated is identified in this study.
CONCLUSION: Reported factors leading to absenteeism among nursing students and identified
motivating care should be handled carefully by the hospital managers to produce better health-care
delivery’ nurses in future.

Abstract BACKGROUND: The rate of reporting medication errors is lower than the actual rate. The role of
education, encouragement, and promotion of reporting culture can contribute to the increase of errors
reporting. This study was to investigate the effect of motivational program on reporting of medication
errors in the pediatric units.
MATERIALS AND METHODS: A quasi‑experimental study with pre‑ and post‑test design was done
through 60 nurses working in the pediatric wards of the selected hospital in Isfahan, Iran in 2018–2019.
Nurses participated in the study through the census sampling method. Data were collected using
a questionnaire based on eight medication principles completed by the nurses before and after the
intervention. The intervention was conducted through a motivational program in two parts of training
and positive reinforcement. Data were analyzed through the descriptive statistics (frequency, mean,
and standard deviation [SD]) as well as inferential statistics (Wilcoxon test and paired t‑test).
RESULTS: After the intervention, the most medication error reports (60%) were in the principle
of right medication (similar name). Furthermore, the total score (SD) of medication error reporting
was significantly increased from 7.35 (2.43) before the intervention to 17.04 (5.59) after the
intervention (t = 8.03, P < 0.001).
CONCLUSIONS: Motivational program increased medication error reports. Therefore, the
managers can improve medication care and the safety of children through continuous education
and encouragement in the hospitals.

Abstract BACKGROUND: Short‑term academic procrastination may be accompanied by negative outcomes
such as anxiety, stress, and depression. The current study aims to evaluate the two parameters of
procrastination and test anxiety in physiotherapy students and explore whether a relationship exists
between them.
MATERIALS AND METHODS: A descriptive, cross‑sectional survey with a prospective study design
was carried out over a period of 6 months. The study used a two‑staged cluster sampling method:
220 undergraduate and postgraduate physiotherapy students from colleges in Mumbai and Navi
Mumbai participated in the study, ensuring participation of students from each year of the course.
The Westside Test Anxiety Scale was administered to evaluate test anxiety, and the Academic
Procrastination Scale was used to evaluate procrastination. To illustrate the basic demographics
of the participants, descriptive statistics were used. A correlation matrix was used to analyze the
correlation between the two parameters.
RESULTS: The mean procrastination score of the physiotherapy students was 74.1. Amongst
undergraduates, the highest procrastination was seen in the 3rd Bachelor of Physiotherapy
students (mean = 76.7), whereas among postgraduates, the highest procrastination was seen in
Master of Physiotherapy 1 students (mean = 75.7). The mean test anxiety score was 3, indicating
moderately high test anxiety among students. There was a statistically significant, positive correlation
between test anxiety score and procrastination score (P value = 0.000, Pearson’s correlation
co‑efficient = 0.383).
CONCLUSION: Both test anxiety and the tendency to procrastinate were present among
undergraduate and postgraduate physiotherapy students, in varying degrees. There was a positive
correlation between the two factors.

Abstract BACKGROUND: Game‑based education is fast becoming an innovative teaching approach in the field
of medical education. Traditional review sessions (tutorials) are mainly focused on instructor‑based
learning and they help to review concepts previously taught in the lecture class. The primary objective
was to evaluate the cognitive learning of students in game based learning (GBL) as compared to the
conventional review sessions. The secondary objectives were to assess the perception and feedback
of students regarding GBL and conventional review sessions.
MATERIALS AND METHODS: An interventional GBL study was designed for 2nd year MBBS
students. The enrolled students were randomly assigned to either tutorial (Group A) or GBL (Group
B), and informed consent was obtained. Group B students were further divided into smaller groups,
and for Group A, the traditional tutorial method was followed. For both the groups, a multiple choice
question (MCQ) pre‑test and post‑test was conducted on the selected topics. A total of 15 MCQs with
gradually increasing difficulty were used in the GBL. For each group of students, one student would
be on hot seat by answering the questions and then continued the game. Lifelines were provided.
RESULTS: From the pretest and posttest scores, students performed better in Group B (39.53%)
than Group A (18.43%) with respect to the knowledge score, and the difference was statistically
significant. Students’ perception and feedback regarding GBL were very enthusiastic and promising
than the tutorial group. Largely, students commented that GBL was unique, active participation, fun,
and novel learning style.
CONCLUSIONS: GBL is a student‑centered learning and showed more effective than the traditional
tutorials in understanding the topic and was more enjoyable by students.

Abstract BACKGROUND: In Iran, community health workers (CHWs) are native and are only employed in
the health‑care system. Therefore, the training and empowerment of these staff are essential. The
present study was aimed to develop cooperative learning techniques in CHWs to improve both
cognitive and noncognitive aspects such as accountability and other social skills in learners.
METHODOLOGY: This study employed a quasi‑experimental pre‑ and post‑test design with a control
group that was conducted in Kangavar City, Iran, in 2019. Forty‑four CHWs were selected using a
two‑stage cluster sampling, of whom 22 were randomly assigned to the experimental group where
the jigsaw technique was applied and the rest to the control group where the lecture method was
applied. The aim was to identify job performance and motivation among the CHWs after instruction
and compare the two groups. Pre‑ and posttests were applied to the groups before and after an
in‑service training course using valid questionnaires. Data analysis was performed on both descriptive
and inferential statistics such as mean and standard deviation, paired t‑test, and covariance analysis
with the confidence level of 95%.
RESULTS: The findings showed that the intervention significantly increased the mean score of
motivation and performance in the experimental group. Covariance analysis with the removal of the
pretest effect was also statistically significant (P = 0.01). Moreover, the MANCOVA test showed the
jigsaw technique effect considering motivation and performance with a confidence level of 95%.
CONCLUSION: Given the well‑known effect of cooperative learning techniques and since CHWs
have multi roles and tasks, it is necessary to use such techniques so that they can be accountable
for developing health indicators in local areas.

Abstract BACKGROUND: Human immunodeficiency virus (HIV) is a kind of behavioral disease in that
adopting behavioral changes is the only way to control and stop the epidemic. The aim of this study
is to investigate the effect of education base on the health belief model (HBM) on health‑seeking
behavior among HIV‑positive women.
MATERIALS AND METHODS: This study is a paralleled, randomized controlled clinical trial done
with control group among HIV‑positive women who were registered at the voluntary and counseling
testing center of Imam Khomeini hospital in Tehran. Data were gathered by using information obtained
from the Motivation‑Skill‑Behavior questionnaire and demographic data. The women were divided by
permuted block and were randomized into two groups. Interventional group participated in six HBM
educational classes and used routine counseling guidelines, but the control group used only routine
counseling protocol. Data were collected before, immediately after, and 3 weeks after interference
among all participants. Data were analyzed by using SPSS software version 16.
RESULTS: According to the results and statistical test, before intervention, the mean score of
knowledge was not significantly different in the two groups, but after intervention in the interventional
group, test result and follow‑up increased statistically significantly (P = 0.000). Both groups had
increased mean score of knowledge, and there is significant trend in level of knowledge(interventional
group 20.79 ± 1.88, control group: 17.36 ±2.44) and there was a significant increase in mean attitude
follow‑up score (P < 0.001).
CONCLUSION: According to the result of the present study, counseling base on HBM by trained
educator can increase information‑motivation‑skill‑behavior among women living with HIV.

Abstract BACKGROUND: HIV‑infected patients with poor antiretroviral therapy (ART) adherence are prone
to depression, and depression can exacerbate the disease condition. This study was conducted to
determine ART Adherence based on Information, Motivation, and Behavioral Skills (IMB) Model and
its association with depression among HIV‑positive patients.
MATERIALS AND METHODS: This descriptive–correlational study was carried out on people over
the age of 18 years with HIV/AIDS, who referred to the Behavioral Diseases Counseling Center in
Kerman City, Iran, in 2017. In this regard, 119 patients were selected using the table of random
numbers. To collect the data, we used the Beck’s depressioninventory‑II and the IMB researcher
made questionnaire to evaluate the ART adherence.
RESULTS: The results of the study reveal that a significant association was observed between the
total adherence and all constructs of the IMB model (P < 0.001). Risk perception and self‑efficacy had
the highest mean scores regarding the ART adherence. The prevalence of depression was 71.5%
among patients. Information, personal motivation, and total adherence had a significant association
with depression.
CONCLUSIONS: IMB model was an appropriate and practical strategy with regard to the ART
adherence among people living with HIV who are prone to depression and drug consumption is crucial
for them to achieve the 90‑90‑90 target. This article created a questionnaire to assist policy‑makers
and health professionals designing interventions to improve adherence and health outcomes of ART.

Abstract BACKGROUND: Academic motivation is highly important in nursing education. Providing high‑quality
nursing care requires students who have motivation to acquire information and skills. However, nursing
students lose their motivation gradually during their program. Thus, the present study is aimed at
elaborating on the strategies to improve academic motivation in nursing students.
MATERIALS AND METHODS: A qualitative study was conducted in Saveh University of Medical
Sciences. The data were collected through focus groups and individual semi‑structured interviews
with forty nursing students, professors, and lecturers of nursing and midwifery school. The participants
were selected through purposeful sampling method. This method is used for the selection of people
who have had experience with or are part of the culture or phenomenon of interest. Data analysis
was done as a continuous process through conventional qualitative content analysis.
RESULTS: The strategies to promote academic motivation of nursing students were categorized
into four main categories including strategies pertinent to professors (empowering and motivating
to improve the quality of teaching), strategies pertinent to students (creating positive attitude toward
nursing, empowering, and encouraging academic achievement), strategies pertinent to clinical
education (improvement of the quality of clinical training and optimization of the academic and
clinical relationships), and strategies pertinent to faculty (providing extracurricular activities, proper
curriculum programming, and educational and welfare facilities).
CONCLUSIONS: The strategies to improve academic motivation are available in different areas
including professors, students, faculty, and clinical education. In general, improving the quality of
education and creating positive attitude in nursing students increase their academic motivation.

Abstract Background: Despite their ascribed intellectual ability and achieved academic pursuits,
medical students’ academic achievement is influenced by motivation. This study is an endeavor to examine the role of motivation in the academic achievement of medical students.
Materials and Methods: In this cross-sectional correlational study, out of the total 422 medical
students, from 4th to final year during the academic year 2007–2008, at School of Medicine,
Isfahan University of Medical Sciences, 344 participated in completion of the Inventory of
School Motivation (ISM), comprising 43 items and measuring eight aspects of motivation. The
gold standard for academic achievement was their average academic marks at pre-clinical and
clinical levels. Data were computer analyzed by running a couple of descriptive and analytical tests including Pearson Correlation and Student’s t-student. Results: Higher motivation
scores in areas of competition, effort, social concern, and task were accompanied by higher
average marks at pre-clinical as well as clinical levels. However, the latter ones showed greater
motivation for social power as compared to the former group. Task and competition motivation
for boys was higher than for girls. Conclusion: In view of our observations, students’ academic
achievement requires coordination and interaction between different aspects of motivation.