Journal of Education and Health Promotion

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

Abstract BACKGROUND: Caring for a family member with cancer is a challenging issue for families. Family
caregivers often need the help of supportive resources to solve problems in their care role. A deep
understanding of the requirements of caregivers to seek help is an effective step toward their ability
to use supportive resources. This study aimed to identify and describe the requirements for promoting
help‑seeking behaviors in Iranian family caregivers of cancer patients.
MATERIALS AND METHODS: This qualitative study was conducted through in‑depth semi‑structured
interviews with 28 participants selected using purposeful sampling method from 2019 to 2021. An
interview guide with general questions about seeking help was used to maintain coherence in data
collection. The interviews continued until data saturation. All interviews were recorded, transcribed
and analyzed through qualitative content analysis.
RESULTS: The requirements of promoting help‑seeking behaviors in family caregivers
were grouped into four main categories: (1) improving social paths toward seeking help, (2)
spiritual‑psychological‑cognitive empowerment toward seeking help, (3) strengthening the motivations
behind seeking help, and (4) modifying the perception of cultural barriers to seeking help.
CONCLUSION: According to the results of this study, it is expected that by identifying the requirements
of caregivers for seeking help and by health stakeholders designing comprehensive programs to
address these needs, caregivers will be empowered to use supportive resources and provide a
better care role.

Abstract BACKGROUND AND AIM: Given the complexities of the health care system and the importance
of the subject and effects of health literacy in all aspects of care, defining specific health literacy in
this context seems necessary. The purpose of this research was to explain the concept of hospital
health literacy (HHL), its definition, and the related dimensions using the qualitative research method.
MATERIALS AND METHODS: An exploratory qualitative design was used. Exploratory, open‑ended,
and face‑to‑face interviews based on the interview guide were used to elicit participants’ perspectives
between July 2021 and January 2022. By using the content analysis method, researchers coded
transcripts and collated these codes into sub‑categories and then merged them into the main category
and explored the dimensions of the concept.
RESULTS: A total of 23 service providers and 25 service recipients were included in the study.
Analysis of qualitative data led to the identification of 6 categories and 25 sub‑categories including
cognitive literacy, functional (basic) literacy, communicative literacy, behavioral literacy, media
literacy, and emotional literacy.
CONCLUSION: The findings of the present study provide a deep understanding of the concept
of HHL that could be applied to develop valid and reliable measurement tools for assessing HHL
among a variety of populations. Also, it is hoped that the present attempt can be useful to guide
future research and interventions as well as to provide a clear base for planning, implementing, and
evaluating interventions aimed at promoting individuals’ health literacy in health settings.

Abstract BACKGROUND: Heat wave adaptation is a new concept related to experiencing heat. The present
study aims at investigating a conceptual definition, that is, the mental framework of heat wave
adaptation and its strategies.
MATERIALS AND METHODS: A phenomenological study was performed to explain the mental
concept. At the same time with the data collection process, data analysis was also performed using
Colaizzi method. Semi‑structured interview method and purposeful sampling with maximum variety
were used. Interviews were conducted with 23 different subjects in the community. The accuracy of
the data was guaranteed using Lincoln & Guba scientific accuracy criteria.
RESULTS: The two main themes of the adaptation paradigm as well as its strategies were divided
into the main categories of theoretical and operational concepts, as well as personal care measures
and government measures. Under the category of individual measures, we obtained “clothing,
nutrition, building, place of residence and lifestyle,” and under the category of governance actions,
the “managerial, research, health, organizational” subcategories were obtained.
CONCLUSION: According to the results of the conceptual‑operational definition, heat wave adaptation
is an active process and an effort to reduce the adverse effects of heat waves on individual and
social life, and striking a balance that will not only result in individual awareness and actions that
will lead to lifestyle changes, but also mostly requires integrated and comprehensive planning in the
community. On the one hand, heat waves could not only be regarded as a threat or danger, but can
also become an opportunity for the development of a community through identification and smart
measures, and for adaptation, the community must take it as a risk. The community should have a
plan in advance, apply the necessary rules and training, and use the new facilities and rules where
necessary. This practical concept definition includes the main features of heat wave adaptation.

Abstract BACKGROUND: Strategic management of the wastage produced due to earthquakes has faced
many challenges over the recent decade. Thus, the present study seeks to identify and explain the
challenges in earthquake wastage strategic management.
MATERIALS AND METHODS: The present qualitative study has been steered through a content
analysis approach and conducted using semi‑structured interviews and a purposive selection of 17
professors, experts, and managers experienced in the field of waste management in Kermanshah
and Varzaghan‑Ahar earthquakes over 2020‑2021. Besides, the interviews were initially categorized
using MAXQDA18 software.
RESULTS: Analysis of the experiences and perception regarding the changes in strategic
management of wastage produced due to Kermanshah and Varzaghan‑Ahar earthquakes revealed
418 codes, 97 subcategories, 33 categories, and 8 main categories including management and
leadership, organizational culture, planning, organizational learning, employee management, rules
and regulations, resource management, and procedure management.
CONCLUSION: Strategic waste management has not been implemented in a coherent, integrated,
and well‑planned manner in the cases of the Kermanshah and Varzaghan‑Ahar earthquakes. The
challenges of strategic waste management turned out to be due to various reasons which will result
in many issues in achieving the goals and selecting the suitable method for resource and procedure
management should they not be managed well. Hence, policymakers, managers, and executors in
the field of crisis management and waste management in disasters ‑specifically earthquakes‑ must
take the necessary measures to remove these barriers.

Abstract BACKGROUND: Treatment adherence is one of the behaviors associated with type 2 diabetes that
predicts whether it will be successfully treated or develop complications and become uncontrolled.
This study aimed to determine factors affecting nonadherence to treatment among diabetic patients
with limited health literacy from the perspectives of patients, their families, and healthcare providers.
MATERIALS AND METHODS: This qualitative study with a content analysis approach was conducted
on 84 eligible type 2 diabetes patients with limited health literacy and poor adherence to treatment,
as well as their families and healthcare providers using a purposive sampling method, in Kerman city
in 2021. Interviews were conducted using a semistructured interview guide with a broad, open‑ended
question to provide a general history of the disease separately. The interviewer asked participants
to identify the perceived barriers to treatment nonadherence. Each interview lasted 45–60 min.
MAXQDA version 20 and inductive content analysis were used to code and analyze extracted data.
RESULTS: Four major themes emerged from the patients’ perspectives as “financial problems,”
“individual factors,” “problems related to medication availability,” and “healthcare providers’ poor
practices.” Two major themes were classified from the perspective of patients’ families as “financial
problems” and “Individual factors,” and four major themes were identified from the viewpoint of
healthcare providers including “financial problems,” “individual factors,” “scarcity and medication
availability,” and “poor practice of the healthcare provider.” These mentioned barriers were confirmed
regarding treatment nonadherence among study participants.
CONCLUSION: Study findings revealed different factors of treatment nonadherence among diabetic
patients with limited health literacy. Therefore, these factors should be considered in tailoring
promotive educational and supportive interventions. Considering the importance of adherence to
treatment patients, planning empowerment family‑based interventions focusing on health literacy
improvement seems necessary.

Abstract BACKGROUND: Patients with a vegetative state (VS) are completely dependent on caregivers in
all physical aspects of their lives. Caring for such patients comes with a great deal of difficulty for
family caregivers. As a result, family caregivers must be fully trained and prepared for this role. The
present qualitative study was conducted to investigate the educational challenges faced by family
caregivers of VS patients for home care preparedness.
MATERIALS AND METHODS: The present qualitative study was conducted through the conventional
content analysis method from August 2020 to September 2021 in two provinces of Iran (Sistan and
Baluchestan Province; and Razavi Khorasan Province). Fourteen family caregivers of patients in a VS
were included in the study. Semi‑structured and in‑depth interviews were employed to collect data.
The Graneheim and Lundman method was utilized to conduct the data analysis using MAXQDA2020
software. Data collection continued until data saturation and the identification of main categories.
RESULTS: As indicated by the data analysis, three categories of “unmet educational needs,”
“confused caregiver,” and “searching for practical knowledge” which included 19 sub‑categories
described the experiences of family caregivers of patients in a VS concerning challenges they went
through in preparation for patient care at home. Participants’ experiences revealed that despite the
inadequacy of educations provided by health‑care providers on knowledge and skills required by
family caregivers, they were committed to caring for the patient and trying to acquire the required
knowledge.
CONCLUSION: Results indicated that inadequate education and the lack of family caregivers’
contribution to caring for the patient in the VS during their stay in the hospital impedes their acquisition
of adequate knowledge and skill to care for patients at home. Therefore, healthcare system
policymakers should be planning to eliminate the educational barriers faced by family caregivers
and expand the educational activities of hospitals’ homecare centers to provide educational support
of family caregivers after the patient’s discharge.

Abstract BACKGROUND: The ability to interact and communicate effectively is one of the factors affecting the
performance of faculty members, which is considered one of their basic competencies. The purpose
of this study was to identify the factors affecting on interaction of faculty member with student and
colleague, through the synthesis of literature.
MATERIALS AND METHODS: The research method was qualitative with a meta‑synthesis approach.
Meta‑synthesis was performed with Sandelowski and Barroso method. After the research of databases
in the period 1995–2021, 259 studies were collected and finally 48 sources were selected and were
included in the analysis phase. Coding method was used to analyze the data.
RESULTS: Analyzing the findings of previous researchers and synthesizing the results, 155 codes,
18 subcategories, and 6 categories were identified and validated through kappa coefficient. The
categories included “emotional‑cognitive factor,” “sociocultural factor,” “communication factor,”
“professional factor,” “educational factors,” and “management factor.”
CONCLUSION: Based on the findings of this study and the importance of faculty members’
interactions in medical universities, it is recommended that university officials and administrators
use the results of this study to provide a suitable platform for creating and strengthening these
interactions through holding workshops.

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

Abstract BACKGROUND: Technical skills result in the patient’s safety. Psychiatric nurses need to learn and
apply them to provide effective and secure cares. This study explains the technical competency
required for postgraduate psychiatric nursing students.
MATERIALS AND METHODS: This conventional qualitative content analysis study is part of a larger
study on the clinical competency of postgraduate psychiatric nursing students performed in Iran in
2020. A qualitative study was conducted at universities holding master’s degree courses in psychiatric
nursing. Participants were instructors and postgraduate psychiatric nursing students, psychiatric
nurses, psychologists, and psychiatrists selected by purposeful sampling method. Sampling continued
until data saturation was achieved. Data were collected through a semi‑structured individual interview
and were analyzed by conventional qualitative content analysis.
RESULTS: The “technical competency” has two subcategories of “specialized knowledge” (including
general nursing knowledge, psychiatric nursing knowledge, and basic knowledge of psychology)
and “application of knowledge in practice” (including clinical experience, skills of psychiatric nursing
interventions, educational skills, and research and evidence‑based practice skills).
CONCLUSION: The psychiatric nursing student learns and operates knowledge of psychiatric
nursing, psychology, education, and research, besides improving their knowledge of general nursing.

Abstract BACKGROUND: Nurse educators require to exhibit specialized behaviors that demonstrate the beliefs
of the nursing profession. The aim of the study is to explore the factors influencing professionalism
among nurse educators in the selected nursing educational institutes of Indian States.
MATERIALS AND METHODS: Qualitative approach was adopted where multiple focus group
discussions were planned and conducted. The study was carried out among nurse educators from
the Northern Indian states. Thematic analysis, using the argumentative interactions approach was
used. The consolidated criteria for reporting qualitative research (COREQ) guide were followed.
RESULTS: Three types of factors, that is, individual (micro‑level), organizational (meso‑level), and
external professional occupational (macro‑level) were explored, where individual factors emerged as
having a strong positive impact on nurse educators’ professionalism as compared to other factors.
Poor organizational infrastructure, privatization of educational institutions, and other related factors
were reported as having a negative influence on nurse educators’ professionalism.
CONCLUSION: Most of the educational institutions included in the present study, lacked basic
infrastructure/facilities for the professional development of nurse educators and professionalism.

Abstract BACKGROUND: Clinical decision‑making is not only stressful to physicians, but also to patients and
even their companions. Thus, managing uncertainty in clinical decision‑making is essential which
requires knowing its origins. Therefore, this study aimed to understand determinants of uncertainty
in clinical decision‑making from the perspective of clinical physicians.
MATERIALS AND METHODS: This is a qualitative study which is done during October to November
2020. An in‑depth interview is performed with 24 specialists of clinical groups including obstetrics,
surgery, internal medicine, and pediatrics, working in teaching hospitals affiliated to Iran University
of Medical Sciences. All the interviews were recorded, transcribed and analyzed according to the
steps suggested by Graneheim and Lundman. The interviews were analyzed through comparative
method. Then, the interviewer created initial codes, categories, and key concepts and sent them to
fourteen physicians for member check.
RESULTS: According to the participants’ view, determinants of uncertainty in clinical decision‑making
consisted of three themes: individual determinants, dynamics of medical sciences, and diagnostic
and instrumental constraint. Individual determinants can be related to the physician or patient. The
dynamics of medical sciences could be explained in two categories: variation of medical science and
complexity. Diagnostic and instrumental constraint category could be also explained in subcategories
such as lack of efficient diagnostic tests and unknown etiology.
CONCLUSION: To curb uncertainty, the more accessible way is considering interventional programs
with a focus on individual determinants related to physicians, such as strengthening doctor–patient
relationships, and considering related mandatory retraining courses to reduce insufficient knowledge
of physicians.

Abstract BACKGROUND: People living with noncommunicable diseases (PLWNCDs) are often
disproportionately affected due to adverse interaction with socioecological and biological factors.
Hence, it is imperative to learn from their lived experience to gain a greater understanding of
interactions as well as explore their priorities and needs in accessing care and identify areas of
priority action through multistakeholder engagement.
MATERIALS AND METHODS: The qualitative study with grounded theory approach was
conducted between October and December 2020. An online key‑informant interview with the health
policymaker, virtual group discussion with eight PLWNCDs, and in‑depth telephonic interviews
with five PLWNCDs were conducted, after obtaining informed consent using interview guide,
developed, and validated by the experts. Data collection continued till data saturation was achieved.
Transcripts generated from the interview recordings were coded using hand‑code technique and
analyzed thematically.
RESULTS: Challenges faced by PLWNCDs in accessing care were lack of empathy and support
from health‑care professionals, stigma, financial hardship, and hospital overcrowding. Caregivers
emphasized on the felt need to involve civil society organizations (CSOs) in raising awareness toward
noncommunicable diseases (NCDs) at family, community, and policymaking levels. The need for
home‑based NCD care and rehabilitation centers was voiced by the PLWNCDs. Impediments toward
effective implementation of NCD policies were adoption of a “top‑down” approach, poor awareness
about government health insurance schemes, skewed distribution of empanelled hospitals in and
around cities, nonavailability of qualified health‑care professionals in underserved areas, aggravated
allocation‑utilization disparity during COVID‑19 pandemic, and lack of robust information technology
infrastructure to support access to telemedicine services.
CONCLUSION: The collective role of governments, CSOs, and health‑care providers, along with
meaningful involvement of PLWNCDs, would help to create an enabling environment for overcoming
the challenges of access to care and thus achieve universal health coverage.

Abstract BACKGROUND: Male reproductive health is a necessary pillar of childbearing. If a reproductive health
assessment is conducted in the preconception period, the chance of a healthy pregnancy can increase.
This qualitative study aimed to explore men’s reproductive health needs before conception in Iran.
MATERIALS AND METHODS: This research was a qualitative study conducted in Bushehr city, Iran
to explore men’s reproductive health needs from April 2021 to November 2021. 30 semistructured
interviews were conducted with married men, women, healthcare providers, and specialists individually
in the health centers. The sampling method used in this study was purpose‑based with maximum
variety. All interviews were digitally recorded and transcribed verbatim in Persian and analyzed
using directional content analysis. MAXQDA software version 12 was used to facilitate data analysis.
RESULTS: From the data analysis, 2 themes, 15 categories, and 38 subcategories emerged. The
themes included evaluation and health promotion recommendations. It consisted of 10 categories:
reproductive life plan evaluation, medical history evaluation, family and genetic history evaluation,
social history evaluation, sexual health evaluation, medication evaluation, laboratory evaluation,
physical examination, lifestyle evaluation, and mental health evaluation. Health promotion
recommendations included five categories: nutritional recommendations, stress management,
avoiding harmful behaviors, protective measures against harmful exposure, and need for education.
CONCLUSIONS: Our results showed that men need a comprehensive evaluation of reproductive
health and recommendations to improve their health in the preconception period. Our study findings
can inform healthcare providers to increase men’s participation in reproductive health.

Abstract BACKGROUND: Living with children with autism spectrum disorder (ASD) can affect different
aspects of parents’ physical and mental health and quality of life. This study aimed to identify parents’
perceptions of their quality of life and factors influencing such perceptions and investigate how they
cope with difficulties in their daily lives.
MATERIALS AND METHODS: This study was conducted using a qualitative research design to gain
insight into how children with ASD may influence their parents’ quality of life. A total of 31 parents
and school counselors were selected by the snowball sampling method in autism schools in Tehran
in the academic year 2018–2019. Semi‑structured interviews were used to collect the data. Each
interview was held based on a preprepared guideline by the researchers. In‑depth questions were
also asked as needed. Finally, the data were analyzed using the content analysis approach.
RESULTS: The participants reported a variety of difficulties and crises to cope with in their daily
lives. The factors reported to decrease the quality of life were categorized into six main themes and
20 subthemes. The main themes included “family interactions,” “parenting,” “daily living,” “health,”
“financial issues,” and “community‑related.”
CONCLUSIONS: Due to the diversity and multilevel factors affecting the quality of life of parents
having children with ASD, it is essential to adopt a comprehensive approach with the participation
of all stakeholders in the development, design, and implementation of future interventions.

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: The role of medical undergraduates is limited while interacting with the community 
related to issues involving human behavior. Since qualitative research seeks to build a holistic 
understanding of social phenomena, we designed this project to expose them to the basics of 
qualitative research in a real‑world setting of experiential learning. The aim of this study is to sensitize 
the medical undergraduates to the basics of qualitative research and able to apply it in the context 
of experiential learning in the community.
MATERIALS AND METHODS: In this current educational intervention, a structured teaching 
program was designed and applied for the first time, to our students to effectively sensitize them 
to qualitative research in a natural community setting, intended to provide them a solid base for 
experiential learning. A batch of students (n = 50) was selected by convenient sampling method 
who had their clinical postings with us. At first, a “session planning guide” was drawn on the plan of 
conduction of this program. We followed the “facilitators reference manual by research consortium on 
educational outcomes and poverty (RECOUP) for our teaching sessions. The framework of our study 
was executed in the following sequence: sensitization of the learners, exposure to structured quality 
experience, systematic debriefing sessions with evaluation of learner experiences, and the process 
and outcome feedbacks from the learners. The students were monitored by trained facilitators. The 
various study tools used in the structured teaching program included, the teaching sessions using 
the RECOUP manual, didactic lectures and short group interactive sessions to teach qualitative 
research and photographs and video clips to facilitate the sessions, mock demonstrations and role 
plays on interviewing techniques, use of case vignettes on the theme “perception of psychosis” 
for interviewing the community, structured debriefing guide, and various self‑reflective exercises. 
Learners’ perspective of community perception, debriefing sessions, and self‑reflective responses 
were transcribed, and manual content analysis was done to identify the codes and interpret the results.
RESULTS: Majority could appreciate the uniqueness of qualitative research over the quantitative 
counterpart. They could enumerate the attributes of a good qualitative researcher. The debriefing 
exercises made them summarize their experiences and the self‑reflective exercises enabled them 
to identify their abilities and critique their ideas. It was a different experience to our learners as they 
could identify themselves with the sentiments of the community. To them, the facilitating points 
were the interviewing skills and confidence gained in facing the community. However, they felt time 
constraint for exploring the sensitive issues during the fixed posting schedule.
CONCLUSIONS: The experience of learning beyond the boundaries of a classroom setting sensitized 
them to various community perceptions and reactions. The students perceived the qualitative methods 
well and could apply the lessons learnt in the facility. They also felt that this learning exposure gave 
them community orientation and confidence in dealing with community issues.

Abstract BACKGROUND: Patient‑centered care (PCC) is a key component of high‑quality care. Given the 
different effects of cancer on patients, patient‑centeredness is very important in oncology nursing 
care. The aim of this study was to explore nurses’ perceptions of the patient‑centered in oncology 
nursing care.
MATERIALS AND METHODS: This descriptive qualitative study was conducted in 2018–2020, Iran. 
Data collection methods included observation and semi‑structured interviews. Patient, family, and nurse 
behaviors were observed (total: 318 h). In addition, interviews were conducted with nurses and nursing 
managers (12 interviews). Data analysis was performed using Graneheim and Lundman’s approach.
RESULTS: Data analysis resulted in the emergence of four themes: “Organizational structure as 
a barrier to the PCC,” “Lack of institutionalization of PCC in nurses,” “Understanding and paying 
attention to the patient as PCC,” and “Situational PCC.” The final theme of this study is “PCC in the 
shadow of paternalism.”
CONCLUSIONS: The paternalism approach in the context of oncology nursing care has made the 
realization of PCC difficult. The first step to promote PCC is increasing nurses’ awareness of the impact 
of paternalism on patient‑centeredness. Providing patient‑centered oncology nursing care requires 
changing attitudes, values, and behaviors at individual, professional, and organizational levels.

Abstract BACKGROUND: Childbearing is the most important determinant of population fluctuations and its 
studies are more important than other population phenomena. Many factors are associated with 
childbearing, but individual factors associated with it have been less studied in a specific framework. 
The present study aimed to explore and identify the factors related to childbearing based on extended 
theory of planned behavior (ETPB).
MATERIALS AND METHODS: This qualitative study was conducted among married women <35 years 
of age and married men whose spouses were under 35 years of age and lived in the City of Hamadan, 
Iran, in 2019. The data were collected by semistructured and face‑to‑face in‑depth interviews and 
continued until the data saturation was reached. Overall, 15 interviews were conducted with 17 
people. The data were analyzed, using a directed content analysis approach.
RESULTS: The data analysis resulted in the extraction of 28 main codes, 9 subcategories, and 4 
themes, which were correspond to constructs of the theory, consisting of attitudes, subjective norms, 
perceived behavioral control, and social support in the field of childbearing. The main predictors were 
attitude toward childbearing and perceived control.
CONCLUSION: The findings of this study showed that ETPB has a potential to explain the intention 
and behavior of childbearing. The ETPB makes it possible to understand many of the factors 
associated with childbearing. The results of this study could be the basis for designing appropriate 
data collection instrument in quantitative studies and vast surveys.

Abstract BACKGROUND: For any effective vaccination strategy, the willingness of the beneficiaries and its 
contributing factors are important. This study was conducted among the health‑care workers (HCWs) 
and community members to find the perceptions regarding the COVID‑19 vaccine and understand 
the influencers and the barriers of vaccine acceptance.
MATERIALS AND METHODS: A qualitative study was conducted from October 2020 to December 
2020 in two primary care settings in an urban area. Eighteen in‑depth interviews (IDIs) after taking 
consent were conducted with the help of IDI guide developed and validated beforehand by the experts. 
IDIs were done among the ten community members and eight HCWs selected conveniently. Data 
collection were continued till data saturation when no new information yielded from the interviews. 
Thematic analysis was performed.
RESULTS: All the participants were hopeful about availability of the vaccine. The key influencers 
identified for promoting willingness to accept the vaccine among both the groups were opinion of the 
health‑care providers, colleagues’ and other people’s acceptance of the vaccine, effectiveness of 
vaccine on other people, and perceived risk of the disease. Fear of adverse reactions was the most 
important barrier among all the respondents. The prevalent perception was that other preventive 
practices and vaccine together can only be the best solution to prevent COVID‑19 illness. The 
HCWs perceived that acceptance of vaccine among the community members would be good overall 
but apprehended some initial difficulties. Mass campaign to promote COVID‑19 vaccination and 
sensitization events are the need of the hour.
CONCLUSIONS: Since opinion of health‑care personnel emerged as an important influencer of 
vaccine acceptance, mass campaign and sensitization programs spearheaded by the health‑care 
providers can bring about change by increasing the vaccine acceptance among the beneficiaries 
at large. Re‑enforcement regarding practice of preventive measures should be made among the 
population irrespective of the vaccination status.

Abstract INTRODUCTION: In the COVID‑19 crisis, nurses are directly involved in patient care, so they face
many challenges. This study was performed to determine the challenges faced by nurses while
caring for COVID‑19 patients in Iran in 2020.
MATERIALS AND METHODS: This qualitative, content analysis was conducted in Iran on ten nurses
directly involved in the fight against the corona epidemic, selected through a purposeful sampling
strategy. Data were collected through deep interviews consisting of open questions. All the interviews
were recorded, and immediately after each interview, it was transcribed into written form. The data
were analyzed using MAXQDA software.
RESULTS: All the challenges could be classified into three main categories and 17 subcategories.
The main categories were miss‑management in controlling corona conditions, mental and physical
complications and challenges in corona work conditions, and lack of sufficient workforce.
CONCLUSION: Hospital managers and authorities play a significant role in meeting the financial
needs and requirements of nurses, and can minimize the job discrimination prevalent at medical
centers through providing financial and nonfinancial incentives for nurses. Moreover, the findings
of the present study can help hospital managers and authorities to gain a better understanding of
the experiences of nurses, and to take the necessary measures to obviate the challenges faced by
nurses in public health emergencies.

Abstract BACKGROUND: Patients with inflammatory bowel disease (IBD) experience wide range of physical
and psychological problems experience. The use of strategies to improve disease management by
patients is of has special importance in solving these problems. The aim of present study was to
discover the strategies and behaviors of patients to manage their disease.
MATERIALS AND METHODS: The present study was conducted with a qualitative research approach
and a qualitative content analysis method. The research participants included 20 patients with IBD
referred to gastrointestinal wards in 2020 in Mashhad. Data were collected through unstructured
interviews and purposeful sampling method and continued until data saturation. Data analysis was
performed continuously and simultaneously with data collection and comparatively.
RESULTS: Data analysis provided five themes of “Improving self‑efficacy and problem‑solving skills,”
“Coexistence with disease,” “Reviewing and modifying of interactions,” “Adjusting job and professional
conditions” and “Commitment to self‑care.” The combination of these concepts indicated that is the
main theme in disease management for these patients.
CONCLUSIONS: Reconstruction of individual, social, and professional life can improve self‑regulation
and problem‑solving skills in these patients and make them a sense of control on their lives and
disease.

Abstract BACKGROUND: Participation in a student‑run pro bono clinic (SRPBC) provides opportunities for
students to develop professional skills, engage with the community, and provide an often‑underserved
population with needed care.
MATERIALS AND METHODS: This paper describes the results of a mixed‑method analysis of student
experiences in an SRPBC. A survey with both Likert‑type and write‑in elements was administered
to three cohorts of students enrolled in a doctoral program of physical therapy. Students were
prompted to provide their perspective on the value of the clinic experience with respect to professional
development, academic relevancy, and personal growth.
RESULTS: The analysis discovered that perspective value of the clinic in the areas of personal
growth and academic relevancy differed by cohort. Specifically, 1st‑year students reported that they
benefitted immensely by learning from their peers, especially in the use of outcome measures.
Second‑year students did not report the same benefits.
CONCLUSION: The findings suggest that even though students from different cohorts work together
in the same clinic, they may experience the clinic very differently. This observation provided the basis
for changes to the SRPBC to enhance leadership and conflict management skills of the 2nd‑year
students.

Abstract BACKGROUND: Patient‑centered care (PCC) is a cornerstone for health‑care professionals to
improve the quality of care they provide to patients with cardiac disease. However, implementation
of PCC programs has always accompanied with unpredictable challenges and obstacles. Therefore,
the present study was conducted to determine effective strategies for the implementation of PCC
from the perspective of patients and healthcare providers.
MATERIALS AND METHODS: The present research was a qualitative study using conventional content
analysis method in one of the university hospitals of Abadan University of Medical Sciences during
2019–2020. Purposive sampling was performed until data saturation was achieved. Data were collected
through four focused group discussions and 24 in‑depth semi‑structured interviews with 22 health‑care
providers and seven cardiac patients. Depending on the interview process and the responses of each
individual, the sequencing of questions was different from one participant to another. Data analysis was
performed continuously and concurrently with data collection, using a comparative method.
RESULTS: After data analysis, seven subcategories and three main categories were extracted. The
main categories included structural, process, and outcome strategies. The category of structural
strategies included subcategories of nursing care organization, application of appropriate motivational
mechanisms, and expansion of team coordination. Process strategies included three subcategories,
namely, promoting communication, respectful and compassionate care, and the development of
holistic care. Finally, the outcome strategy consisted of the subcategory of patient empowerment.
CONCLUSION: The practical strategies for the implementation of PCC in coronary care unit revealed
in this study were at structural, process, and outcome levels. Health‑care managers and administrators
can avail themselves of the findings of the present study to promote the quality care for cardiac care
unit patients and improve patient satisfaction.

Abstract BACKGROUND: Clinical training during internship is an important part of medical education. The
maternity ward is a clinical environment in which medical students pass their obstetrics and gynecology
internship to obtain competencies in this field. The present study was conducted to explain medical
interns’ manner of learning in the maternity ward.
MATERIAL AND METHODS: The present study was conducted using a qualitative approach with
the inductive content analysis method. This study observed the maternity wards of teaching hospitals
affiliated to medical sciences universities of Isfahan and Shahrekord. Data were collected through
observation and semi‑structured individual interviews.
RESULTS: Two main categories and seven subcategories emerged from the analysis of the data.
Inadequate participation in learning opportunities included the following three subcategories: the
incongruousness of the learning opportunities with the educational goals, inadequate readiness for
participation in learning opportunities, and the overlap between learning opportunities and diminished
autonomous practice. Inadequate formal and structured education included the following four
subcategories: inadequate learning support and direction, subordinate roles and aimless presence,
the pale educational role played by the attendants and senior residents, and learning through the
support of midwifery educators.
CONCLUSION: Participation in and access to learning opportunities in the maternity ward are very
difficult for interns. Interns, therefore, need to attend the maternity ward by a structured program and
in the company of training supervisors or competent educators to obtain the required competencies
in pregnancy and childbirth.