Journal of Education and Health Promotion

Abstract BACKGROUND: Clinical‑based mobile learning courses have great demand among the nursing
graduates as learners look for possibilities to update skills. The present study explores the
feasibility, familiarity, utility, and attitude of nursing graduates of South India toward mobile learning
applications (m‑apps).
MATERIAL AND METHODS: An online‑based cross‑sectional descriptive survey was conducted in
May 2021 among the South Indian nursing graduates of Tamil Nadu and Kerala, using a questionnaire
consisting 49 items categorized under six sections with items related to socio‑demographic
information; m‑app usage; online learning experience; preference in using m‑apps for learning
purposes before COVID‑19 and during COVID‑19; students’ engagement through e‑learning; and
anxiety related to online assessment. Descriptive and inferential (ANOVA, Chi‑square, and t test)
statistical data analysis were done using SPSS version 23.
RESULTS: A total of 447 student nurses responded. The result shows that most of them, 96% (432)
used android phones and 94% (422) owned a mobile. Age was highly influencing mobile learning
application (m‑learning apps) usage; students of less than 20 years of age used applications more
frequently and possessed more educational applications. Majority of them, 84% (377) of them had
started using m‑learning apps only after COVID. 57.7% (249) commonly used m‑learning apps for
acquiring nursing knowledge resources, nursing exam preparatory, and drug resources. Students
rated high for the interactive nature of these m‑learning apps, while abundant learning materials
and usage with ease were rated as other attractive features. Sixty‑six percent (305) had mostly
downloaded these apps from Google Play Store.
CONCLUSION: The findings would help the m‑learning application developers to offer customize
solutions to address learning gaps that prevail among the South Indian nursing graduates and help
with sustainable growth.

Abstract BACKGROUND: Annual influenza vaccine is recommended among health professionals especially,
health science undergraduates; although, studies suggest that there is a low level of vaccine coverage
among health care undergraduates. Thus, the study aimed to investigate students’ knowledge,
attitudes, and practices regarding the seasonal influenza vaccine at King Saud bin Abdulaziz University
for Health Sciences (KSAU‑HS) in Jeddah, Saudi Arabia.
METHODS: A cross‑sectional, unicentral study was carried out during the period of April to November
2021. A total of 341 validated questionnaires that included four sections were distributed in all four
different colleges of KSAU‑HS. Data management and analyses were carried out using Statistical
Software for Social Sciences (SPSS) version 25.
RESULTS: Out of 341 respondents, 336 participants completed the full survey (98.53% completion
rate). The majority of participants were males (67.6% and the most participants were from the college
of medicine (60.4%). The mean knowledge score of students was found to be (11.3 ± 2.0) out of 14
points. The most common barrier to vaccination among healthcare students was not having enough
time to take the vaccine (23.8%), while the second one was the COVID‑19 pandemic (22.32%). The
vaccination rate in 2020 was 103 (30.7%), while 235 (80.4%) students stated that they have received
the vaccine previously. School/work requirements and the student’s awareness of the vaccine’s
importance were the most common reasons for taking the influenza vaccine.
CONCLUSION: Even though students showed a high level of knowledge and a positive attitude
towards the influenza vaccine, they generally had a low level of vaccine uptake. To enhance
immunization rates, we encourage vaccine campaigns in all healthcare colleges. Further studies are
needed to identify influences on students’ attitudes and practices regarding influenza vaccination.

Abstract BACKGROUND: Potentially inappropriate medication (PIM) prevalence in older adults is increasing
day by day due to lack of knowledge among medical students and professionals.
OBJECTIVE: To determine the knowledge of medical students toward American Geriatric
Society (AGS) Beers criteria for PIM prescribing.
MATERIALS AND METHODS: This cross‑sectional study employed a self‑administered questionnaire
which was validated and designed to assess the knowledge, attitude, and practice of medical interns
and postgraduate residents on Beers criteria for PIMs in older adults. The study was conducted
in Faridkot region of Punjab in 2019. This study will utilize a purposive sampling strategy and a
convenience sampling of up to 183 participants. Mann–Whitney U or Kruskal–Wallis tests were used
to compare different issues as appropriate. P values of <0.05 were considered significant.
RESULTS: Out of 183 questionnaires distributed, only 155 participants (response rate 84.6%) had
filled the survey and were included in the study. 61.3% (n = 95) of the respondents were males. The
mean knowledge score of 155 participants was (5.16 ± 1.56), where the highest score was 9 and the
lowest score was 2 out of 10. 15.5% (n = 24) of the participant strongly agreed that Beers criteria use
is necessary in clinical setting and would be very helpful. While 22.5% (n = 35) of the participants
strongly agreed that PIMs cause adverse drug event (ADE) and drug‑related problems (DRPs) in
older adults. Age of the participant had a significant effect on the knowledge score (p = 0.009), and
participant aged between 31 and 40 years had significantly higher knowledge scores compared with
participants falls under 20–30 years.
CONCLUSION: Medical students and postgraduate residents had average knowledge of PIMs and
are unaware of the standard guidelines in older adults such as the Beers criteria. Lack of formal
education or training about Beers guidelines was the main reason responsible for average knowledge
among participants.

Abstract BACKGROUND: Information technology (IT) can be used by frontline health workers (FLWs) to
connect and deliver care to the community. Various studies in India have assessed the beneficial
impact of IT usage by FLWs, but for the long‑term sustainability, the attitude and belief toward IT
usage have not been adequately studied. We conducted this study to assess the knowledge and
attitude and to explore the beliefs of FLWs toward the use of IT in a rural area of Haryana.
MATERIALS AND METHODS: We conducted a mixed‑method study (qualitative and quantitative
approach) in a rural setting of Haryana, India. We included FLWs of two primary health centers (PHCs).
Data were collected from October 19, 2020 to December 31, 2020. We collected data from 75 accredited
social health activists (ASHAs), 37 Anganwadi workers (AWWs), 28 multi‑purpose workers (MPWs),
two information assistants, and two medical officers using a semi‑structured interview schedule. Their
knowledge about the benefits of IT use, past use of IT applications and devices, and self‑rating of
knowledge regarding computers or laptops were collected. We used 14 attitude statements, each with
a five‑point Likert scale to assess the attitude; a total score ≥35 was considered a positive attitude.
We conducted eight focus group discussions (FGDs) to explore the beliefs regarding IT usage (four
FGDs with ASHAs, two FGDs with AWWs, and two FGDs with MPWs). A descriptive analysis was
performed for the quantitative data, and a thematic analysis was performed for qualitative data.
RESULTS: Knowledge about the benefits of IT use was present among 77.8% of FLWs. Among
the FLWs, 79.2% self‑rated their knowledge of computers/laptops as ‘do not have knowledge’, 16%
self‑rated as ‘low knowledge’, and 4.8% self‑rated as ‘good knowledge’. The median total score for
attitude statements among all the FLWs (n = 144) was 54 [inter‑quartile range – 48–59]. Four themes
emerged for beliefs toward IT usage, namely, positive beliefs, negative beliefs, challenges anticipated
in adopting IT use, and facilitation factors. The positive beliefs were related to improvement in work
efficiency and social status, less paperwork, timely report generation, and better learning. The negative
beliefs were related to an increase in working hours, close monitoring, and feeling over‑burdened.
CONCLUSION: We found that FLWs had knowledge regarding the benefits of IT use, but they
lacked knowledge regarding laptop/computer use. They had a satisfactory level of confidence in
using smartphones, and most of them were using mobile applications. The majority of the FLWs had
a positive attitude and beliefs toward IT use and wanted to use it in the future.

Abstract BACKGROUND: The family is one of the important social institutions and the function of childbearing
is one of the important functions of the family. The decision to have children depends on the
individual’s attitude about the consequences of having another child and their perceived norms.
Therefore, this study was conducted to determine the relationship between attitudes toward fertility
and childbearing and the value of children with attitudes toward fertility control in married women
aged 15 to 45 years in Isfahan.
MATERIALS AND METHODS: This study was a cross‑sectional correlational study that was
performed on 500 married women with at least one child in health centers affiliated to Isfahan
University of Medical Sciences. Data collection tools in this study were standard questionnaires.
The data were analyzed by SPSS software version 22.
RESULTS: The mean score of attitude toward fertility control was 40.43 ± 9.03. The area of security
in old age and the area of procrastination had the highest mean values of children and attitudes
toward fertility and childbearing, respectively. Analysis of data by Spearman test showed that there
is a significant relationship between all dimensions of child value and attitudes toward fertility and
childbearing with attitudes toward fertility control (P < 0.05).
CONCLUSION: A positive attitude toward the child increases the likelihood of having children and
believing in the negative impact of the child on freedom reduces the likelihood of having a desire
for fertility. Changing attitudes of societies toward childbearing and less desire to have children
should not be sought only in material, economic, or social reasons but also cultural factors should
be considered in this area.

Abstract BACKGROUND: Research in universities requires systematic and participatory processes that
integrate teachers, contents, strategies and tools, and students and their own interests. Therefore,
the main objective of this study was to establish the relationship between the perception of the
teaching‑learning process (TLP) and the attitude toward scientific research among midwifery students.
MATERIALS AND METHODS: Descriptive cross‑sectional study, conducted on 250 students from
second to fourth year of study selected by convenience sampling. The data were collected with two
self‑administered Likert‑type scales that were validated in content and construct, both with high
reliability. Descriptive statistics were carried out; the Spearman correlation test was used prior to
the application of the Kolmogorov–Smirnov test and Kendall’s tau‑b test.
RESULTS: The favorable perception of the TLP was greater among second‑year students (42.6%),
in addition, 15.2% agreed that the advice of teachers contributes to the elaboration of the research
protocol. The attitude of indifference toward research was more frequent in third‑year students (58.2%)
and 28.4% were deemed in disagreement to be able to identify and operationalize the variables. In
the analysis of dimensions, the role of the student had a moderate relationship with the research
design (rho = 0.536; P < 0.001), while a weak relationship was demonstrated between media and
techniques with ethical and scientific value (rho = 0.104; P < 0.001).
CONCLUSION: The TLP perceived by midwifery students and their attitudes toward scientific research
had a direct and significant correlation. The proportion of students with favorable perception was
greater among those with a favorable attitude.

Abstract BACKGROUND: The rapid and widespread of COVID‑19 has caused distress and havoc among
people in all walks of life. Such impact has been more pronounced among HCWs. We sought to
examine how health care workers (HCWs) knowledge about COVID‑19 and perceived anxiety can
influence preventive practices.
MATERIALS AND METHODS: In this cross‑sectional study a multiple regression analysis was
applied to examine the relationship between knowledge, anxiety, and preventive practices among
267 participants work in different settings in a variety of health care organizations in different regions
in Saudi Arabia. To estimate potential associations, a multiple regression analysis was applied.
Standardized beta‑coefficients and their 95% confidence intervals were estimated to examine the
outcome variable and the predictors’ associations.
RESULTS: Our findings shows that HCWs had high levels of knowledge about COVID‑19, perceived
anxiety, and preventive practices. In examining the relation between HCWs characteristics and their
knowledge about COVID‑19, older HCWs have been shown to have higher knowledge compared
to younger HCWs. Finally, the model to estimate the impact of knowledge about COVID‑19 and
perceived anxiety on preventive practice showed that both have a significant impact.
CONCLUSIONS: HCWs tendency to adhere to preventive practices is related to their levels of
knowledge and perceived anxiety. Such a relationship can inform administrators and policymakers
in the health care field to design health promotion campaigns to ensure all HCWs are aware of the
nature of communicable diseases and the risk they might entail.

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

Abstract BACKGROUND: Cervical cancer is the leading cause of death worldwide, especially in developing
countries. More than one‑fifth of newly diagnosed cervical cancer cases are occurring in India. Cervical
cancer is a highly preventable and curable cancer compared with other types of cancer, if detected
at an early stage. The present study has been carried out to assess whether a community‑based,
multicomponent, nurse‑led intervention program improves cervical cancer screening behavior of
women.
MATERIALS AND METHODS: An experimental randomized controlled trial was carried out by
recruiting 419 women in the age group of 30–60 years (246 in the experimental group and 173 in the
control group) residing in a selected rural community (selected tribal settlements) of Idukki district of
Kerala, India, using multistage cluster sampling. The intervention comprising small group education
followed by reinforcement session, telephonic reminders, navigation and guidance for Pap smear,
and follow‑up visit by the investigator was administered to the experimental group, and the control
group did not receive any intervention. Knowledge, attitude, and screening behavior of women related
to prevention of cervical cancer were assessed before and twice after the intervention.
RESULTS: The experimental and control groups were homogenous in all baseline sociodemographic
variables. The community‑based intervention program was effective in improving knowledge(P< 0.001),
attitude (P < 0.001), and screening behavior (P < 0.001) of women regarding the prevention of cervical
cancer. A significant moderate positive correlation was found between knowledge and screening
behavior (r = 0.408). Significant association was found between knowledge, attitude, and practice
regarding prevention of cervical cancer with education, age at the time of marriage, and number of
pregnancies.
CONCLUSION: The community‑based, multicomponent, nurse‑led intervention program was
effective in improving cervical cancer screening behavior among women. Repeated motivation and
reinforcement are needed to bring behavioral change and to increase uptake of screening services
among rural women.

Abstract BACKGROUND: Although older people are at a higher risk of COVID‑19 infection, there is a lack of
research that focuses on COVID‑19 in older people in Malaysia. Therefore, the aim of this study was
to assess the level of knowledge and attitudes related to COVID‑19, and to identify the association of
sociodemographic background with knowledge and attitudes towards COVID‑19 among older people.
MATERIALS AND METHODS: This is a cross‑sectional study involving 382 older people living
in the community in Malaysia. Data was collected using convenience sampling through an online
questionnaire that consisted of three parts: sociodemographic details, knowledge, and attitude
related to COVID‑19.
RESULTS: The overall correct rate of knowledge was 77.3%, indicating that participants had slightly
good knowledge related to COVID‑19. The participants showed a positive attitude with a mean
score of 26.0 (SD = 5.0). There were significant associations between knowledge and education
level (P = 0.00) and marital status (P = 0.02). Marital status was significantly associated with
attitude towards COVID‑19 (P = 0.03). A weak positive correlation was found between knowledge
and attitude (r = 0.17, P = 0.00) suggesting that an increase in knowledge will increase the positive
attitude among older people.
CONCLUSION: Older people reported good knowledge and positive attitudes towards COVID‑19.
The Malaysian government should provide relevant health education for those with lower education
levels and divorced or widowed to improve knowledge and attitudes towards COVID‑19.

Abstract BACKGROUND: Today, considering the importance of bioterrorism, it may be time to assess the
risk of bioterrorism as an important priority. Nurses, as the broadest group of therapy group, are
very influential in this regard.General aim: To determine the impact of bioterrorism education through
two methods of lectures and booklets on the knowledge and attitude of nursing staff. Practical Aim:
Minimizing the damage caused by bioterrorism attacks by empowering nursing staff.
MATERIALS AND METHODS: This two-group semiexperimental intervention study was performed as a
before and after education intervention with the participation of 80 nursing staff of Shams Al-Shomus Nezaja
Hospital affiliated to Health Administration of Islamic Republic of Iran Army Ground Forces. The study
population included all hospital nursing staff in 2021. The inclusion criteria included having a willingness
and informed consent to participate in the study and exclusion criteria included unwillingness to continue
cooperation and failure to complete more than 10% of the questionnaire by the subject. This study was
performed on 77 nurses in 2021. The nurses were divided into two groups: lecture and booklet. First,
the pretest was completed by the nurses. After the educational intervention, both groups completed the
posttest. Both groups then completed the questionnaire again after about 2 weeks. First, all the data were
measured for normal distribution by the Kolmogorov–Smirnoff test. Statistical description was expressed
for the variables with normal distribution as the ratio of geometric mean ± standard error and for abnormal
variables as mean ± standard error. To compare the means of the studied quantitative variables, t-test
and Wilcoxon matched-paired statistical tests were used. The significance level was considered <0.05.
SPSS.16 and Graph Pad Prism 8.0.1 softwares were used to analyze the statistical data.
RESULTS: Using both methods is effective in improving the level of knowledge and betterment attitude,
but according to the paired t-test in comparison of the two groups, at intervals immediately after training
and 2 weeks after training, a significant increase in the average knowledge score of the lecture group
Statistically shows (P < 0.001). However, the analysis of attitude scores was performed between the
two groups of lectures and booklets, which did not show statistically significant changes between them.
CONCLUSIONS: One of the most important issues in the performance of medical staff in bioterrorism
attacks is useful, effective, correct, and sufficient training. According to the results of the present
study,bioterrorism training leads to increasing the level of knowledge and betterment the attitude of
nurses in the field of bioterrorism. Therefore, the inclusion of training courses in medical centers,
especially military medical centers, is necessary and sensitive.

Abstract BACKGROUND: Present study attempts to investigate health‑related quality of life (HRQoL) and its 
relation with knowledge, attitudes, and practices (KAP) of students of Tehran University of Medical 
Sciences (TUMS) during this pandemic.
MATERIALS AND METHODS: In this cross‑sectional study which was conducted between 23 may 
to 21 June 2020, 470 students in different levels of TUMS were included to the study randomly. 
participants completed validate, designed online questionnaire which assessed KAP towards 
coronavirus disease 2019 (COVID‑19) and HRQoL. All statistical tests were applied, including 
Chi‑square and Fisher’s exact test, Partial correlation, analysis of variance, multiple linear regression, 
multiple binary and multinomial logistic regression models (P < 0.05) and were performed in SPSS 
16, R 4.0.2, and GraphPad Prism 6.0 softwares.
RESULTS: A total of 470 students were included in the study. The overall correct answer rate of the 
COVID‑19 knowledge questionnaire was 74.43% and total score of the HRQoL was 72.50 (14.85). 
61.7% of the students were agreed that COVID‑19 will finally be successfully controlled, 44.3% had 
confidence that Iran can win the battle against the COVID‑19, and 92.6% agreed that Quarantine will 
reduce the prevalence of COVID‑19. Most of them adhered to health protocols and about a relation 
between HRQoL and knowledge we have a weak positive and unsignificant correlation between 
them (r = 0.05, P = 0.27).
CONCLUSIONS: TUMS students showed expected levels of knowledge, proper attitudes, and 
preemptive practices regarding COVID‑19, whereas COVID‑19 outbreak substantially affected 
the physical and mental health but, the students were in a way better physical health rather than 
mental. Therefore, motivational planning and other related intervention to improve mental health 
can be noticeable.

Abstract BACKGROUND: The health reform plan (HRP) is a plan to improve Iran’s health systems that began 
in 2014. The three main approaches of this plan include financial protection of the people, creating 
justice in access to health services, and improving the quality of services. It predicted that the level 
of health system responsiveness would increase. Achieving this goal is possible only with the correct 
implementation. The best people to measure the correct implementation are nurses, midwives, 
and physicians. Hence, this study was conducted to assess the attitude of nurses, midwives, and 
physicians about the implementation of the HRP.
MATERIALS AND METHODS: This cross‑sectional descriptive study was conducted in educational 
hospitals of Jahrom University of Medical Sciences in 2020. By convenience sampling method, 325 
nurses, midwives, and physicians participated in this study. Sampling was done in all work shifts, and 
in all wards. A researcher‑making questionnaire was used to collect data. The scoring did by the Likert 
scale from (completely agree = 4 to completely disagree = 1). Quantitative and qualitative face and 
content validity was calculated (IS: 0.84, CVI: 0.92, CVR: 0.87), and its reliability was calculated by 
Cronbach’s alpha method (0.78). The data were analyzed by SPSS software version 16. Descriptive 
statistics, Mann–Whitney U‑test, and Kruskal–Wallis test were used for the data analysis (P ≤ 0.05).
RESULTS: In the study, 90.15% agreed with the implementation of the HRP. There was no significant 
difference between the male and female (P = 0.063). There was a significant difference between the 
educational degree (P = 0.006), married and the single participants’ attitude (P = 0.003), the nurses, 
midwives, and physicians (P = 0.001).
CONCLUSION: HRP is more successful in the field of financial protection, so policymakers should 
pay more attention to justice in access to health services and improving the quality of services fields.

Abstract BACKGROUND: Professional ethics is a set of principles and standards of human behavior that
affect individual behavior and leads to improve care that provided by medical staff. The present
study examined the knowledge and attitude of medical and nursing students toward professional
ethics in Iran.
MATERIALS AND METHODS: This descriptive‑analytic study was carried out on 176 medical and
nursing students in Bam University of Medical Science, Iran in 2019. In this study, students were
selected by census sampling. Data collected using two researcher‑made questionnaires related to
knowledge and attitude toward professional ethics. Data were analyzed in SPSS software.
RESULTS: The mean scores of knowledge among nursing and medical students were 86.56 (8.76)
and 85.10 (12.19), respectively. The mean score of attitude among nursing and medical students
was 127.06 (12.45) and 129.9 (11.88), respectively. Results of the Pearson correlation test showed a
positive and significant associated between the score of knowledge and attitude nursing and medical
students’ (P < 0.001), (r = 0.76) (r = 0.66). Among the demographics characteristics, student age
was associated to their attitude and knowledge significantly (P = 0.03).
CONCLUSION: Iranian nursing and medical students have a positive attitude and a high level of
knowledge about professional ethics. A high level of knowledge was related to the most positive
attitude.

Abstract BACKGROUND: Lifestyle can play an important role in controlling type II diabetes (T2D), and a
high‑risk lifestyle can exacerbate its effects. The aim of this study was to compare the effectiveness
of motivational interviewing with self‑development education on T2D patients’ lifestyle.
MATERIALS AND METHODS: This was a quasi‑experimental study in 2017–2018. The design was
pretest–posttest with an active comparison group. The population of this study was T2D patients of
Firouzgar and Imam Reza Hospitals in Tehran. Using targeted sampling, 80 patients were selected and
randomly assigned into experimental and comparison groups. The instrument was a tool for assessing
lifestyle determinants in T2D patients (determinants of lifestyle behavior questionnaire) based on the
theory of planned behavior. Intervention program was initially performed, and motivational interviewing
was conducted on Firouzgar Hospital’s patients for 10 sessions while self‑development education
was conducted on Imam Reza Hospital’s patients for 10 sessions (active comparison group). To
analyze the data, independent t‑test and Chi‑square test were used.
RESULTS: The results showed that the patients who received motivational interviewing had significant
improvement in their lifestyles with a 95% confidence level at P = 0.042, compared to the patients
who had been trained with self‑development education.
CONCLUSION: Motivational interviewing improves the lifestyle of T2D patients compared to
self‑development education. It is recommended that motivational interviewing be used to help the
rehabilitation of these patients. This method helps patients control their blood sugar while improving
their lifestyle.

Abstract BACKGROUND: Women who experience stillbirth and preterm delivery are likely to be associated
with an increased risk of posttraumatic stress disorder (PTSD) compared to women with live births
and dose religious attitude related to posttraumatic stress? The aim of the study was promotion PTSD
following traumatic birth experiences and the influence of maternity religious Attitude.
MATERIALS AND METHODS: A cross‑sectional analytical study was conducted at selected hospitals
of Shiraz University of Medical Sciences on 82 subjects in 2018. The instruments were demographic
questionnaire, Religious Attitude questionnaire, and Mississippi PTSD Scale which were completed
after delivery. Data were analyzed using SPSS software, version 22, using the Pearson correlation test.
RESULTS: About 75% stillbirth group and 65% of the preterm delivery group had a high level of
religious attitude. In the stillbirth group, 90% had high levels of PTSD and in the preterm delivery
group, 90% had moderate stress, and 10% had high PTSD levels. The correlation between religious
attitude and PTSD after stillbirth was 0.373 with a significance level of 0.018. Therefore, there was
a significant positive relationship between religious attitude and PTSD. However, the relationship
between religious attitude and PTSD after preterm delivery was not statistically significant (P = 0.158).
CONCLUSION: PTSD was significantly higher in mothers with stillbirth and had a significant
relationship with religious attitude. However, in mothers of preterm infants, the level of stress was
moderate and did not have a significant relationship with religious attitude. The findings indicate the
need of mothers for interventions to cope better with the physical and psychological problems of
stillbirth and preterm delivery.

Abstract BACKGROUND: It has been realized by senior researchers that interest in biostatistics is very poor
among medical professionals. Knowledge of biostatistics plays an important role in medical research.
Studies conducted about knowledge, attitude toward biostatistics by many researchers, but there were
no works about factors in relation to it. Considering this gap, we tried to develop a new instrument.
MATERIALS AND METHODS: Item generation and questionnaire formation were done using focus
group discussion involving seven experts from different departments of medical colleges. Face validity
and content validity and pilot testing were carried out step by step. In estimating reliability, internal
consistency measured after collecting data from 66 study participants. Data were collected through
self‑administered paper‑based questionnaire where response in each item was in five‑point Likert
scale. Cronbach’s alpha for reliability analysis was used.
RESULTS: In first stage, item generation through FGD, then face validity was assessed by senior
faculties. Content validity was checked by Aiken’s V index. In initial stages, with six items, Cronbach’s
alpha was 0.805. Scale mean and variance were 24.24 and 27.26. After final reliability testing, it
became 0.866 with four items where scale mean and variance came to 15.85 and 16.38.
CONCLUSION: All the six items were important factors. Reliability improved when knowledge in
statistics in higher secondary level and biostatistics classes in PG course were eliminated as factors.
More qualitative research is needed for better understanding of this concept.

Abstract INTRODUCTION: Efficient pain management by nursing staff initially needs accurate knowledge
and proper attitude in this field. The aim of present study was to compare the effects of lecture
and electronic education on the knowledge, attitude, and practice of nursing staff regarding pain
management.
MATERIALS AND METHODS: The present superiority randomized controlled trial with two parallel
arms was conducted on 78 occupied nurses of surgery wards of X. The participants were recruited
randomly and divided into two groups of lecture and electronic education through random blocking (4
and 6 blocks). For allocation concealment, coded nontransparent pockets numbered 1–78 containing
the type of intervention were used. Educational material was presented using teacher‑centered
method in lecture group, as well as through multimedia program using FLASH software in e‑learning
group through 1‑h sessions for 4 weeks. Data on nurses were collected before and 4 weeks after the
training using demographic questionnaire, Pain Management Principles Assessment Tool, Nurses’
Attitude Survey, and nursing practice checklist. Data were analyzed using SPSS software (version 24)
utilizing descriptive and analytic statistical test such as Chi‑square, Fisher, independent t‑test, and
ANCOVA. P < 0.05 was considered statistically significant.
RESULTS: Mean ± standard deviation of nurses’ knowledge, attitude, and practice regarding
pain management had significant increase in both groups post‑training (P < 0.001). According to
ANCOVA the mean postintervention knowledge score in e‑learning group by controlling baseline
score had significant increase compared to the lecture group (adjusted mean difference [aMD] =
1.8: 95% confidence interval [CI] = 1.5–2.1, P < 0.001). Furthermore, the mean of total scores of
post‑intervention attitude and practice in e‑learning group adjusted for baseline score significantly
increased compared to lecture group (aMD = 1.8: 95% CI = 1.5–2.1, P < 0.001) and (aMD = 3.2:
95% CI = 2.7–3.6, P < 0.001).
CONCLUSION: Electronic education was more efficient than lecture education in increasing of
knowledge, attitude, and practice on pain management among nursing staff.

Abstract BACKGROUND: Cervical cancer is the second‑most common female cancer in Malaysia after breast
cancer. This study intended to investigate the knowledge and attitude regarding cervical cancer and
its prevention and its associated factors among young female adults in Kuantan, Malaysia, to gauge
the community’s understanding and idea about this issue.
MATERIALS AND METHODS: The study was conducted in attractive places in Kuantan, Malaysia,
such as shopping malls and Urban Transformation Centre, using a cross‑sectional study design and
convenience sampling method. Data on the respondents’ knowledge and attitude regarding cervical
cancer and its prevention were collected using a questionnaire. Kruskal–Wallis, Independent t‑,
and Pearson correlation tests were used to investigate the study variables’ association using SPSS
software.
RESULTS: From the total of 142 respondents, almost half of them aged between 20 and 24 years old
with the majority were Malays (85.9%) and single (74.6%). The internet (78.1%) was identified as the
main medium to gain information regarding cervical cancer. The results show that levels of education,
races, and occupation types were statistically significantly associated with the respondents’ knowledge
and attitude scores in this study. Age was found to be associated with knowledge scores only, while
marital status was only significantly associated with the attitude scores regarding cervical cancer and
its prevention. Knowledge scores were also found to be positively associated with attitude scores.
CONCLUSION: Several socio‑demographic factors were significantly associated with the knowledge
and attitude regarding cervical cancer and its prevention. In view of the positive association between
knowledge and attitude scores, suitable health promotion activities can be designed and planned to
increase young female adults’ knowledge and attitudes toward cervical cancer and its prevention.

Abstract BACKGROUND: Ethic education as a part of medical school curriculum is one which requires
constant re‑evaluation and re‑emphasis. The medical regulatory body of India has, in recent times,
introduced a revised module of the same, which is implemented across the country in all medical
schools. Medical students’ perception of ethics education is an important variable which will influence
the validity of this module. This study attempts to evaluate the same.
MATERIALS AND METHODS: A peer‑validated questionnaire was distributed to 150 undergraduate
and postgraduate medical students (response rate: 74.4%) with the aim to evaluate their attitude
toward knowledge of ethics, and their perceptions of contents and methods of learning ethics.
RESULTS: A significant number of students recognize the importance of medical ethics knowledge
and its positive impact on their career (P < 0.05). They accept material taught as per planned
curriculum as a source of learning and favor interactive methods of teaching (P < 0.05). Research
projects and didactic lectures were rejected as learning methods (P < 0.05).
CONCLUSION: “Deliberate teaching” has been accepted as a source of learning ethics by all students,
though undergraduate students also favored learning about ethics “during practice.” Perceptions
have been identified that need to be addressed. The study reveals a need to further explore the
purpose and contribution of role models in this context and to identify ways of strengthening their
related perceptions by students.

Abstract BACKGROUND: Increasing community awareness about the transmission and treatment of
COVID‑19 will stop the spread of the virus. Pharmacy students are the potential facilitator to give
community education about COVID‑19 treatment. The objective of this study is to evaluate the
pharmacy students’ knowledge of COVID‑19 treatment, behavior, and attitude of providing the
information about COVID‑19 treatment.
MATERIALS AND METHODS: We conducted cross‑sectional study, recruiting 429 pharmacy
students from three schools of pharmacy in Indonesia. The questionnaire about the knowledge of
COVID‑19 treatment, behavior, and attitude of providing the information on COVID‑19 treatment met
the validity and reliability criteria. We defined the proportion of knowledge, behavior, and attitude of
the students using SPSS® version 22.
RESULTS: Most of the students are in the earlier years (46.63%), female (84.15%), find the information
about COVID‑19 from many sources of media (85.08%) including scientific articles and know
information about COVID‑19 transmission around their life area (76.46%). The students’ knowledge
about antiviral and plasma convalescent is good (>70%), the positive behaviors are related to the
COVID‑19 treatment information regarding to the antiviral and the provision of Vitamin C (>50%), and
the positive attitude are related to giving information about the use of avigan®, plasma convalescent,
chloroquine, hydroxychloroquine, and immunomodulator (>50%).
CONCLUSIONS: As a future pharmacist, the knowledge of pharmacy students about COVID‑19
treatment needs to be improved since earlier years. Furthermore, using the good knowledge about
COVID‑19 treatment, the positive behavior and attitude of providing information of the students, the
community behavior and attitude will be improved. The high year students have a tendency for the
good knowledge and positive behavior and attitude of providing the information.

Abstract BACKGROUND: Given that many Iranian were interested in the consumption of foods that are high
in fats, the present study was done to determine the effect of a nutrition education intervention on
knowledge, attitude, and intake of foods high in fat among a sample of women in Tehran.
MATERIALS AND METHODS: In this quasi‑experimental study, 92 female referrals to the health
houses affiliated to Tehran municipal were selected and assigned to either intervention (n = 46) or
control (n = 46) groups. Information (data) regarding women’s knowledge, attitude, and practice in
terms of foods rich in fat intake was collected by three questionnaires. Then, a nutrition education
intervention included four 40–60 min training sessions over 4 weeks was designed and conducted
to the study participants in the intervention group. Two groups were followed up 2 months after the
intervention. Finally, all data were analyzed by using the independent‑samples t‑tests, Student’s
paired‑samples t‑test, and Pearson correlation analysis on the R software (version 6.3.2).
RESULTS: The results showed that there were significant reductions in a positive attitude  towards food
with high fat content and intake of these foods in the intervention group compared with the control
group after the intervention (P < 0.001). Furthermore, following the intervention, the intervention group
reported a significant increase in dietary fat nutrition knowledge than the control group (P < 0.001).
Conclusion: Developing nutrition education interventions is an effective strategy for reducing the
consumption of foods rich in fat in Iranian women.

Abstract BACKGROUND: Nowadays, one of the most important challenges of the universities and higher
education centers is academic dishonesty among students. Academic dishonesty is done through
cheating, deception, and plagiarism, which creates serious educational, studious, and social problems
for the students and society. The purpose of this study was to compare the effect of virtual and
workshop training on the knowledge and attitude of M. S. students in terms of plagiarism.
MATERIALS AND METHODS: This research was an applied interventional study of quasi‑experimental
type having pretest and posttest and the participants of this study included 90 M. S. nursing students
of Medical Science University of Shiraz in the southwestern part of Iran.
RESULTS: The comparison of the three groups indicated that virtual and workshop training, both,
developed the knowledge and attitude of students regarding plagiarism; however, the comparison
between two methods did not indicate a statistically significant difference.
CONCLUSION: Both virtual and workshop training methods had an effect on increasing students’
knowledge and attitude. Regarding the positive effect of training academic dishonesty using two
workshop and virtual training methods, both can be used as efficient and effective methods in training
dimensions depending on the condition and facilities to prevent and reduce plagiarism in students.

Abstract BACKGROUND: To prevent the rapid spread of infectious COVID‑19 in India, many steps have been
taken. Adherence to the control measures depends on the knowledge, attitude, and practices (KAPs)
toward COVID‑19 disease in health‑care professionals. The present study was conducted among
health‑care professionals in Jaipur. The objective was to evaluate the KAPs about COVID‑19 among
health‑care professionals.
MATERIALS AND METHODS: A total of 385 participants took part in the study. A self‑designed
questionnaire was filled by the participants online (Google Form). The knowledge of the participants
was assessed using 12 questions. Attitude and practices of the participants were assessed by two
questions for each.
RESULTS: Among the study completers, 52.20% were male, 71.42% of the participants were aged
above 30 years, and 59.22% were nurse. The knowledge score was approximately 90%. The majority
of the participants had a strong conviction that India can overcome this infectious disease in the near
future. Multiple regression analysis found that good knowledge score of COVID‑19 was associated
with lower negative attitudes and less risky practices (P ˂ 0.001).
CONCLUSION: Participants of the study were knowledgeable, held positive attitudes, and had
adequate practices for COVID‑19.

Abstract BACKGROUND: Social vitality is one of the most important social indicators to develop a sense
of public satisfaction. The aim of this study was to investigate the effect of educational intervention
based on theory of planned behavior (TPB) and self‑regulatory strategies on the social vitality of
women employee.
MATERIALS AND METHODS: In this randomized controlled field trial study, 66 women employees
of Birjand University of Medical Sciences (Iran) were selected including intervention (n = 31)
and control (n = 35). Data were collected by standard Oxford Happiness Questionnaire and a
researcher‑made questionnaire based on TPB which its the validity and reliability were confirmed.
The educational intervention consisted of 5 sessions based on the constructs of the TPB and
self‑regulatory strategies which were to the interventional group. Data analysis was performed using
the Chi‑square, Fisher’s exact test, independent t‑test, repeated measures ANOVA, and Bonferroni
post hoc test at a significance level of <0.05.
RESULTS: The mean age of women in the intervention and control group was 37.1 ± 9.3 and
36.2 ± 7.6 years (P = 0.67). Model constructs and happiness scores were homogeneous (P > 0.05)
before the intervention, in two group of study, but after attitude (P = 0.016), subjective norm (P = 0.029),
perceived behavior control (P = 0.01), intention (P = 0.006), and happiness score (P < 0.001) had
a significant increase in the intervention group. In the control group, only a significant difference
occurred over time in the happiness rate (P = 0.031).
CONCLUSIONS: The results of the present study showed the effectiveness of educational intervention
on the social vitality of women employees. Therefore, TPB is recommended to use in interventions
to promote social vitality.