Journal of Education and Health Promotion

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: Few women in history were respected by society because of their contributions
to the field of science, arts, politics, and so on, but in general, women are deprived of their rights
and being refrained from decision‑making in major areas of individual and family life. This research
tried to investigate the degree of empowerment and quality of life (QOL) of the women to find out
the relationship between empowerment and QOL of women.
MATERIALS AND METHODS: An exploratory survey was carried out among 210 purposively selected
married women aged between 20 and 49 years in a selected municipality area of West Bengal.
Data were obtained by one‑to‑one interviews using Women Empowerment Interview Schedule and
WHOQOL Scale BREF.
RESULTS: The mean total QOL score of the women was found as 98.59 ± 13.61. The transformed
scores in the physical, psychological, social relation, and environmental domains were 74.92 ± 14.97,
66.58 ± 15.78, 81.00 ± 18.07, and 65.28 ± 17.99, respectively. The degree of empowerment was
calculated as 64.71 ± 6.79. Among the women, 5% had poor, 62% had medium, and 33% had a
high degree of empowerment. A weak positive correlation (r = 0.325, P = 0.001) was found between
QOL and empowerment. Significant associations were established between empowerment and
education (Fisher’s exact = 13.975 [0.007]) and education gap with husband (Fisher’s Exact = 8.68,
P 0.069). Multiple regression analysis between empowerment dimensions and QOL shows that
personal or family dimensions, including health, are a significant predictor for the QOL (P < 0.01).
CONCLUSION: Most of the women had medium degree of empowerment. Increased degree of
empowerment improves their QOL of women. Women should be aware of their rights that can
enhance the empowerment in different dimensions of life.

Abstract BACKGROUND: Burnout is a syndrome of emotional exhaustion, depersonalization, and low 
professional efficacy that health workers, especially nurses, experience the highest rates of this. 
Burnout causes stress and negative attitude towards work and feeling unable to perform tasks in 
the person. The purpose of this study was to investigate the effect of a method called compassion, 
awareness, resilience, and empowerment (CARE) on nurses’ burnout.
MATERIALS AND METHODS: This study was a semi‑experimental study with control group, the 
statistical population in this study was nurses of Kashani Hospital in Isfahan as intervention group and 
nurses of Al‑Zahra Hospital as control group. The samples were selected by stratified sampling. For 
both groups before and after and 3 months after the intervention, the burnout questionnaire (Maslach 
Burnout Inventory) was completed. The intervention was performed in 5 sessions of 90 min 1 day 
a week. Data were analyzed by SPSS version 25 software (IBM Inc., USA) and independent t‑test, 
repeated measures analysis of variance and Chi‑square test and Friedman test, significance level 
was set at P < 0.05.
RESULTS: The comparison of mean and intensity of burnout and two dimensions of emotional 
exhaustion and depersonalization showed a difference between the two groups and this difference 
was statistically significant (P < 0.05). Mean of Individual performance also had a statistically significant 
difference between the two groups (P < 0.05), but its intensity did not change.
CONCLUSION: CARE method can be effective in burnout of nurses and it can be used as a practical 
method. This training program can be implemented both preservice and in‑service for health workers.

Abstract BACKGROUND: Faculty development programs as useful approaches for organizational development
improved competencies in faculty members which assist them to cope with workload and environment
changes. Evaluating organizational development for faculty development programs provides insight
into the impact of these programs on system development. The aim of present study was conducted
to study the organizational development for faculty development programs at Kerman University of
Medical Sciences.
MATERIALS AND METHODS: This analytical and cross‑sectional study was conducted between
October and December 2020. The organizational development for faculty development questionnaire
was sent to a simple random sampling of 100 faculty members who had been participated in the
“Medical Education Fellowship” program. The data were analyzed using descriptive statistics including
independent sample t‑test, one‑way ANOVA, and post hoc, using version 24.0 of SPSS.
RESULTS: The response rate was 82%. Most of the faculty highly agreed that the “Medical Education
Fellowship” program had produced organizational development. The score of the “Development and
sustaining faculty development programs” domain (mean = 3.35, standard deviation [SD] =0.96) was
higher than “Development and innovation in teaching and learning process” (mean = 3.31, SD = 0.74).
CONCLUSIONS: Specific characteristics of the organizational development process for faculty
development programs in health profession education were recognized. The findings emphasized on
the importance of these interventions on creating developments in the broader community system.

Abstract BACKGROUND: Caring for brain dead patients is the heaviest of duties for nurses, and despite
tremendous stress, there are no theories/models to support nurses in this situation. This study
designed a supportive model for nurses to provide care for potential organ donors.
MATERIALS AND METHODS: This qualitative study was conducted in two stages. In the first
stage, semi‑structured interviews with 31 nurses and other stakeholders, observation and field
notes continued until data saturation, (on 2018), were analyzed using continuous and comparative
analysis through Corbin–Strauss method. In the second stage, theory synthesis of Walker and Avant’s
strategies for theory construction (2011) was used to design a supportive model/theory. The theory
synthesis includes three stages: (i) selection of focal concept (the concept of “moral obligation to
provide holistic care until the last minute” was selected); (ii) review of studies to identify the factors
related to focal concept relevant studies (42 articles were reviewed, statements and concepts
related to focal concept were then extracted and classified, and their relations were specified);
and (iii) organization of concepts and statements within a relevant general and effective manifestation
of the phenomenon under study which led to developing of a model.
RESULTS: In this supportive model/theory, “improving psychological security and empowerment”
was conceptualized within the conceptual framework. This supportive model entails three main
components, including (i) informational and educational support, (ii) systematically support,
and (iii) management support.
CONCLUSIONS: According to the results, nurses with moral obligation to provide holistic care
were faced with several challenges. Therefore, it is recommended that the healthcare system take
supportive proceedings for nurses in various fields of the care for brain dead patients to resolve
educational, moral, and legal challenges. This supportive model is essential for maintaining the
nurses’ health, increasing the quality of nursing care and the health of potential transplant organs.

Abstract BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is one of the most suitable methods
for long‑term nutritional support. In this study, the empowerment of intensive care nurses is examined
by a simulation technique to control the short‑term complications of PEG.
METHODS: A two‑group clinical trial study will be conducted on eighty intensive care nurses in
a teaching hospital in Tehran. The study participants will be randomly assigned to one of the two
control and intervention groups based on the inclusion criteria. A pretest will be given to both groups
using a researcher‑made tool. Then, the empowerment package developed by the researcher will
be provided to the intervention group in two stages. Next, a posttest will be administered. After this
stage, patients’ complications with PEG will be observed using a researcher‑made checklist. Nurses’
performances in both control and intervention groups will be evaluated in terms of preventing and
controlling short‑term complications up to 1 week after PEG insertion. All of the data collected in this
research will be analyzed with statistic tests such as independent t‑test, standard deviation, T pair,
ANOVA, and mean based on the SPSS 16 software.
RESULTS: At present, the research team is designing an empowerment package for nurses and
tools needed to evaluate the nurses’ empowerment.
CONCLUSION: This study will attempt to design and evaluate the empowerment package of graduate
nurses with a cognitive empowerment approach and using a simulation technique to care for patients
with PEG and to control their short‑term complications.

Abstract BACKGROUND: Organizational capacity development is an important outcome of faculty
development programs, but there is a lack of an appropriate instrument for its evaluation.
AIMS AND OBJECTIVES: The aim of this study was to develop a questionnaire to evaluate the
organizational capacity development for faculty development programs and to test its psychometrics.
MATERIALS AND METHODS: The initial capacity development for faculty development
questionnaire (CDQ‑FD) of 26 items was developed based on a literature review and opinion
of experts. Content validity ratio (CVR), content validity index (CVI), content validity index for
items (I‑CVI), and the content validity index for scales (S‑CVI) were computed for content validity.
Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were performed for construct
validation.
RESULTS: The score for CVR, CVI, I‑CVI, and S‑CVI was 0.71, 0.83, 0.87, and 0.90, respectively.
EFA resulted in a three‑factor model with total variance extraction of 64%. Cronbach’s alpha and
Spearman Brown coefficient were investigated for reliability assessment. The Cronbach’s alpha of
overall scale was 0.8 and the test‑retest reliability of the overall scale was 0.78. The final CDQ‑FD
contained 21 items and three categories.
CONCLUSIONS: The CDQ‑FD questionnaire appears to be a valid and reliable instrument for the
evaluation of organizational capacity development for faculty development in the medical education.

Abstract INTRODUCTION: Teacher empowerment is thought to improve student learning by fostering teaching
quality. Therefore, the purpose of this study is investigating the relationship between empowerment
and self‑efficacy of Iranian English as Foreign Language teachers.
MATERIALS AND METHODS: The present study is an experimental study; the population of the
study includes all the English language teachers of the universities of Ilam, Iran. Among whom by
random sampling, the sample which was consisted of 60 teachers were selected. Participants in
this study answered the School Participant Empowerment Scale questionnaire (Short and Rinehart,
1992) as the instrument of the study. The Pearson product‑moment correlation was computed to
determine the relationship between teacher empowerment and teacher self‑efficacy.
RESULTS: The results showed that there was a positive correlation between teacher empowerment
and their self‑efficacy (r = 0.55, P <  0.01) and differences among teachers’ self‑efficacy is not
significant according to age (r = −0.14, P = 0.23).
CONCLUSIONS: Based on the results of the study, empowerment and self‑efficacy have interactive
relationships; i.e. self‑efficacy in teachers leads to empowerment and empowerment in teachers
leads to self‑efficacy.

Abstract BACKGROUND: Structural empowerment (SE) is an effective method of advancing work
environments and has previously been widely discussed in Western countries. Due to the lack of
culturally and academically accepted scales in Iran for measuring SE, localization of a foreign scale
in this field is necessary.
OBJECTIVES: This study aimed at investigating the validity and reliability of the Persian Version of
the Conditions of Work Effectiveness Questionnaire‑II (CWEQ‑II‑PV) among Iranian nurses.
METHODS: The present cross‑sectional methodological research was conducted during 2017–2018.
Participants were 230 nurses working in four teaching hospitals affiliated to Kashan University of
Medical Sciences in Kashan, Iran, who were selected using quota sampling. A standard forward–
backward translation procedure according to Wild et al. (2005) was used to translate the English
Version of the CWEQ‑II to Persian. The psychometric evaluation processes were achieved by face,
content, and construct validity (confirmatory factor analysis [CFA]). Reliability was examined using
test–retest and Cronbach’s alpha for internal consistency reliability.
RESULTS: The CWEQ‑II‑PV showed good content validity (the mean content validity scores for
relevancy, clarity, and simplicity were 94%, 96%, and 94%, respectively). In the CFA, the original
six‑factor version with 19 items was confirmed. The original model was presented and incorporated in
the CFA, indicating an acceptable fit for the model (root mean square error of approximation = 0.06,
comparative fit index = 0.92, goodness of fit index (GFI) = 0.94, and adjusted GFI = 0.91). Cronbach’s
alpha coefficient for the total scale was 0.84 and for each component ranged from 0.71 to 0.87,
indicating good internal consistency, and the test–retest Spearman and intraclass correlation
coefficients were 0.93 and 0.87, respectively, showing good test–retest reliability.
CONCLUSIONS: Evidence was found to support the reliability and validity of the CWEQ‑II‑PV scale
that measures the quality of the work environment for nurses from a SE perspective.

Abstract Infertility requires long‑term care and treatments which would influence different aspects of health
including the mental health of infertile women. The present study was conducted to determine
strategies for psychological empowerment of infertile women. This systematic review was performed
on previously conducted clinical trials. To achieve the intended studies, databases of Magiran,
Scientific Information Database, Google Scholar, Scopus, PubMed, ProQuest, ScienceDirect, and
Web of Science and also Iranian Registry of Clinical Trials website were searched using “infertility
and infertile women” as the keywords. The inclusion criteria were being an interventional study
and assessing the psychological status of infertile women. Performed studies in Iran with no time
limitations were evaluated. Based on the Jadad criteria, studies with a score of 3 or more were
enrolled in the systematic review. After assessing the quality of the studies, 21 studies were enrolled
in the review for final evaluation. Reviewing the conducted studies showed that educational and
counseling interventions could be effective in improving the aspects of psychological well‑being of
infertile women. Existing evidence revealed that applying coping strategies is effective in improving
the quality of life in infertile women, which consequently lead to the improvement of psychological
empowerment of infertile women.

Abstract AIM AND BACKGROUND: Mental health and empowerment are two of the women’s essential
needs. These two related concepts play an important role in women’s lives. Therefore, this study
aimed to investigate empowerment of women and its relation with mental health problem prevention
during difficult situations.
METHODS: This qualitative study was conducted through semi‑structured interviews with 33 experts
in the fields of psychology, social sciences, women studies, medicine and crisis management
specialists using snowball sampling in cities of Tehran, Isfahan, Tabriz, and Mashhad during the year
1395 (March 2016–March 2017). Samples were selected heterogeneously. The interview transcripts
and codes were presented to the participants, and structural analysis was used for data evaluation.
RESULTS: The factors related to empowerment of women with consideration to their mental health
were determined based on Longew theory and interviews and include: welfare (primary needs
(biological and security) and developmental needs (social needs and dignity), access (facilities and
values), knowledge (about inequalities and rights), participation (in politics, decision‑making and
society), and control (implementation and institutionalization of the above‑mentioned needs).
CONCLUSIONS: The indicators determined in this study show that empowerment has an important
role in determining women’s real position in society. Since women make up half of the population and
affect society as a whole, the advantages of empowerment of women will be felt in the entire society.

Abstract Type 2 diabetes is one of the most serious health concerns and policy agendas around the
world. Epidemiological evidence suggests that it will likely continue to increase globally.
Diabetes is strongly associated with the patients’ unhealthy lifestyle and behavioral patterns
and socio-economic changes. New model of thinking is required to recognize whether the
patients are in control of and responsible for the daily self-management of diabetes. Such a
new approach should be based on ‘empowerment and involvement’ to be more applicable
to daily activities in diabetic patients. Rapid changes toward patient empowerment and
increasing involvement of patients in their care plan indicate more emphasis on disease
prevention and health promotion and education than on mere disease and its treatment.
Such changes make a step toward pervasive sense of responsibility among patients
about their illness for their daily activities. Using the empowerment approach, healthcare
professionals would help patients make informed decisions in accordance with their particular
circumstances. Patient empowerment implies a patient-centered, collaborative approach
that helps patients determine and develop the inherent capacity to be responsible for their
own life. Empowerment is something more than certain health behaviors. Empowerment
is more than an intervention, technique or strategy. It is rather a vision that helps people
change their behavior and make decisions about their health care. It has the potential to
improve the overall health and well-being of individuals and communities, and to change
the socio-environmental factors that cause poor health conditions. The main concept of this
change is the tendency to change.

Abstract Information Technology (IT) is known as a valuable tool for information dissemination. Today,
information communication technology can be used as a powerful tool to improve employees’
quality and efficiency. The increasing development of technology-based tools and their
adaptation speed with human requirements has led to a new form of the learning environment
and creative, active and inclusive interaction. These days, information is one of the most
important power resources in every organization and accordingly, acquiring information,
especially central or strategic one can help organizations to build a power base and influence
others. The aim of this study was to identify the most important criteria in job empowerment
using IT and also the advantages of assessing empowerment. This study was a narrative review.
The literature was searched on databases and journals of Springer, Proquest, PubMed, science
direct and scientific information database) with keywords including IT, empowerment and
employees in the searching areas of titles, keywords, abstracts and full texts. The preliminary
search resulted in 85 articles, books and conference proceedings in which published between
1983 and 2013 during July 2013. After a careful analysis of the content of each paper, a total
of 40 papers and books were selected based on their relevancy. According to Ardalan Model
IT plays a significant role in the fast data collection, global and fast access to a broad range
of health information, a quick evaluation of information, better communication among health
experts and more awareness through access to various information sources. IT leads to a
better performance accompanied by higher efficiency in service providing all of which will
cause more satisfaction from fast and high-quality services.

Abstract Type 2 diabetes is one of the most life-threatening public health challenges in the world. It
causes a high disease burden including increased disability, reduced life expectancy and everincreasing costs of care in almost every country. The growing burden of diabetes along with
rapid cultural changes, aging population, increasing urbanization, changes in nutritional habits,
reduced physical activity, and improper lifestyle and behavior patterns would inexorably drive
increased health care costs and demands. Several models of education have been proposed
to reduce the complications of chronic diseases including diabetes. However, it is widely known
and acknowledged that adopting self-care and self-management behaviors play a fundamental
role in diabetes control and treatment.A non-systematic (narrative) search strategy was used to
collect necessary data. Several models of diabetes care such as compliance-based or curative
models exist. Neither the curative model nor the compliance/adherence model is rigorously
effective in diabetes care. The model of self-empowerment – based on the three fundamental
aspects of chronic illness care: choices, control, and consequences – is much more applicable
in the management of diabetes. This point to an approach which recognizes that patients are
responsible for their diabetes care. Self-empowerment model has the potential to place diabetes
care into context – a context which is based on active involvement of patients and informed,
proactive healthcare professionals in the process of care.