Journal of Education and Health Promotion

Understanding the inclination of South Indian nursing graduates in using mobile learning applications

. Cynthia Milton; . Aruna Subramaniam

Volume 13, Issue 2 , February 2023, , Pages 1-9

Abstract

  BACKGROUND: Clinical‑based mobile learning courses have great demand among the nursinggraduates as learners look for possibilities to update skills. The present study explores thefeasibility, ...  Read More BACKGROUND: Clinical‑based mobile learning courses have great demand among the nursinggraduates as learners look for possibilities to update skills. The present study explores thefeasibility, familiarity, utility, and attitude of nursing graduates of South India toward mobile learningapplications (m‑apps).MATERIAL AND METHODS: An online‑based cross‑sectional descriptive survey was conducted inMay 2021 among the South Indian nursing graduates of Tamil Nadu and Kerala, using a questionnaireconsisting 49 items categorized under six sections with items related to socio‑demographicinformation; m‑app usage; online learning experience; preference in using m‑apps for learningpurposes before COVID‑19 and during COVID‑19; students’ engagement through e‑learning; andanxiety 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 learningapplication (m‑learning apps) usage; students of less than 20 years of age used applications morefrequently and possessed more educational applications. Majority of them, 84% (377) of them hadstarted using m‑learning apps only after COVID. 57.7% (249) commonly used m‑learning apps foracquiring nursing knowledge resources, nursing exam preparatory, and drug resources. Studentsrated high for the interactive nature of these m‑learning apps, while abundant learning materialsand usage with ease were rated as other attractive features. Sixty‑six percent (305) had mostlydownloaded these apps from Google Play Store.CONCLUSION: The findings would help the m‑learning application developers to offer customizesolutions to address learning gaps that prevail among the South Indian nursing graduates and helpwith sustainable growth.

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Knowledge, attitude, and practice toward seasonal influenza vaccine during the COVID‑19 pandemic among students at King Saud bin Abdulaziz University for Health Sciences‑Jeddah, Saudi Arabia

. Amir Abushouk; . Mohamed Eldigire Ahmed; . Zaher Althagaf; . Abdulrhman Almehmadi; . Samer Alasmari; . Fares Alenezi; . Muhannad Fallata; . Rayan Alshamrani

Volume 13, Issue 1 , January 2023, , Pages 1-7

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 ...  Read More BACKGROUND: Annual influenza vaccine is recommended among health professionals especially,health science undergraduates; although, studies suggest that there is a low level of vaccine coverageamong health care undergraduates. Thus, the study aimed to investigate students’ knowledge,attitudes, and practices regarding the seasonal influenza vaccine at King Saud bin Abdulaziz Universityfor Health Sciences (KSAU‑HS) in Jeddah, Saudi Arabia.METHODS: A cross‑sectional, unicentral study was carried out during the period of April to November2021. A total of 341 validated questionnaires that included four sections were distributed in all fourdifferent colleges of KSAU‑HS. Data management and analyses were carried out using StatisticalSoftware for Social Sciences (SPSS) version 25.RESULTS: Out of 341 respondents, 336 participants completed the full survey (98.53% completionrate). The majority of participants were males (67.6% and the most participants were from the collegeof medicine (60.4%). The mean knowledge score of students was found to be (11.3 ± 2.0) out of 14points. The most common barrier to vaccination among healthcare students was not having enoughtime to take the vaccine (23.8%), while the second one was the COVID‑19 pandemic (22.32%). Thevaccination rate in 2020 was 103 (30.7%), while 235 (80.4%) students stated that they have receivedthe vaccine previously. School/work requirements and the student’s awareness of the vaccine’simportance were the most common reasons for taking the influenza vaccine.CONCLUSION: Even though students showed a high level of knowledge and a positive attitudetowards the influenza vaccine, they generally had a low level of vaccine uptake. To enhanceimmunization rates, we encourage vaccine campaigns in all healthcare colleges. Further studies areneeded to identify influences on students’ attitudes and practices regarding influenza vaccination.

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Knowledge, attitude, and practice of medical interns and postgraduate residents on American Geriatric Society updated Beers criteria

. Aditi Rathore; . Rishabh Sharma; . Parveen Bansal; . Manik Chhabra; . Malika Arora

Volume 13, Issue 1 , January 2023, , Pages 1-8

Abstract

  BACKGROUND: Potentially inappropriate medication (PIM) prevalence in older adults is increasingday by day due to lack of knowledge among medical students and professionals.OBJECTIVE: ...  Read More BACKGROUND: Potentially inappropriate medication (PIM) prevalence in older adults is increasingday by day due to lack of knowledge among medical students and professionals.OBJECTIVE: To determine the knowledge of medical students toward American GeriatricSociety (AGS) Beers criteria for PIM prescribing.MATERIALS AND METHODS: This cross‑sectional study employed a self‑administered questionnairewhich was validated and designed to assess the knowledge, attitude, and practice of medical internsand postgraduate residents on Beers criteria for PIMs in older adults. The study was conductedin Faridkot region of Punjab in 2019. This study will utilize a purposive sampling strategy and aconvenience sampling of up to 183 participants. Mann–Whitney U or Kruskal–Wallis tests were usedto 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%) hadfilled the survey and were included in the study. 61.3% (n = 95) of the respondents were males. Themean knowledge score of 155 participants was (5.16 ± 1.56), where the highest score was 9 and thelowest score was 2 out of 10. 15.5% (n = 24) of the participant strongly agreed that Beers criteria useis necessary in clinical setting and would be very helpful. While 22.5% (n = 35) of the participantsstrongly agreed that PIMs cause adverse drug event (ADE) and drug‑related problems (DRPs) inolder adults. Age of the participant had a significant effect on the knowledge score (p = 0.009), andparticipant aged between 31 and 40 years had significantly higher knowledge scores compared withparticipants falls under 20–30 years.CONCLUSION: Medical students and postgraduate residents had average knowledge of PIMs andare unaware of the standard guidelines in older adults such as the Beers criteria. Lack of formaleducation or training about Beers guidelines was the main reason responsible for average knowledgeamong participants.

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Sub‑optimal knowledge with positive attitude and belief of frontline health workers toward the use of information technologies: A mixed‑method study from rural Haryana, India

. Ramadass Sathiyamoorthy; . Ankit Chandra; . Sagar Poudel; . Rakesh Kumar; Harshal R. Salve .; . Kapil Yadav; . Shashi Kant; . Ballabgarh Teaching and Research Group

Volume 12, Issue 11 , December 2022, , Pages 1-9

Abstract

  BACKGROUND: Information technology (IT) can be used by frontline health workers (FLWs) toconnect and deliver care to the community. Various studies in India have assessed the beneficialimpact ...  Read More BACKGROUND: Information technology (IT) can be used by frontline health workers (FLWs) toconnect and deliver care to the community. Various studies in India have assessed the beneficialimpact of IT usage by FLWs, but for the long‑term sustainability, the attitude and belief toward ITusage have not been adequately studied. We conducted this study to assess the knowledge andattitude 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 quantitativeapproach) 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 accreditedsocial 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. Theirknowledge about the benefits of IT use, past use of IT applications and devices, and self‑rating ofknowledge regarding computers or laptops were collected. We used 14 attitude statements, each witha 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 (fourFGDs with ASHAs, two FGDs with AWWs, and two FGDs with MPWs). A descriptive analysis wasperformed 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. Amongthe 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 forattitude statements among all the FLWs (n = 144) was 54 [inter‑quartile range – 48–59]. Four themesemerged for beliefs toward IT usage, namely, positive beliefs, negative beliefs, challenges anticipatedin adopting IT use, and facilitation factors. The positive beliefs were related to improvement in workefficiency and social status, less paperwork, timely report generation, and better learning. The negativebeliefs 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 theylacked knowledge regarding laptop/computer use. They had a satisfactory level of confidence inusing smartphones, and most of them were using mobile applications. The majority of the FLWs hada positive attitude and beliefs toward IT use and wanted to use it in the future.

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Investigating the relationship between attitudes toward fertility and childbearing and the value of children with attitudes toward fertility control in married women aged 15‑45 in Isfahan

. Shahnaz Kohan; . Mahboobe Gholami; . Fatemeh Shaghaghi; . Zahra Mohebbi-Dehnavi

Volume 12, Issue 11 , December 2022, , Pages 1-5

Abstract

  BACKGROUND: The family is one of the important social institutions and the function of childbearingis one of the important functions of the family. The decision to have children depends ...  Read More BACKGROUND: The family is one of the important social institutions and the function of childbearingis one of the important functions of the family. The decision to have children depends on theindividual’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 fertilityand childbearing and the value of children with attitudes toward fertility control in married womenaged 15 to 45 years in Isfahan.MATERIALS AND METHODS: This study was a cross‑sectional correlational study that wasperformed on 500 married women with at least one child in health centers affiliated to IsfahanUniversity 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 securityin old age and the area of procrastination had the highest mean values of children and attitudestoward fertility and childbearing, respectively. Analysis of data by Spearman test showed that thereis a significant relationship between all dimensions of child value and attitudes toward fertility andchildbearing with attitudes toward fertility control (P < 0.05).CONCLUSION: A positive attitude toward the child increases the likelihood of having children andbelieving in the negative impact of the child on freedom reduces the likelihood of having a desirefor fertility. Changing attitudes of societies toward childbearing and less desire to have childrenshould not be sought only in material, economic, or social reasons but also cultural factors shouldbe considered in this area.

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Teaching‑learning process and the attitude toward scientific research among midwifery students

. John Barja‑Ore; . Willy Ramos; . Jhony A. De La Cruz Vargas; . Rudi Amalia Loli Ponce

Volume 12, Issue 11 , December 2022, , Pages 1-7

Abstract

  BACKGROUND: Research in universities requires systematic and participatory processes thatintegrate teachers, contents, strategies and tools, and students and their own interests. Therefore,the ...  Read More BACKGROUND: Research in universities requires systematic and participatory processes thatintegrate 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 theteaching‑learning process (TLP) and the attitude toward scientific research among midwifery students.MATERIALS AND METHODS: Descriptive cross‑sectional study, conducted on 250 students fromsecond to fourth year of study selected by convenience sampling. The data were collected with twoself‑administered Likert‑type scales that were validated in content and construct, both with highreliability. Descriptive statistics were carried out; the Spearman correlation test was used prior tothe 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 researchprotocol. 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. Inthe analysis of dimensions, the role of the student had a moderate relationship with the researchdesign (rho = 0.536; P < 0.001), while a weak relationship was demonstrated between media andtechniques with ethical and scientific value (rho = 0.104; P < 0.001).CONCLUSION: The TLP perceived by midwifery students and their attitudes toward scientific researchhad a direct and significant correlation. The proportion of students with favorable perception wasgreater among those with a favorable attitude.

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Knowledge, Anxiety, and practice during the COVID‑19 crisis among HCWs in Saudi Arabia

. Salah Alshagrawi; . Sultan Alhowti

Volume 12, Issue 10 , November 2022, , Pages 1-6

Abstract

  BACKGROUND: The rapid and widespread of COVID‑19 has caused distress and havoc amongpeople in all walks of life. Such impact has been more pronounced among HCWs. We sought toexamine ...  Read More BACKGROUND: The rapid and widespread of COVID‑19 has caused distress and havoc amongpeople in all walks of life. Such impact has been more pronounced among HCWs. We sought toexamine how health care workers (HCWs) knowledge about COVID‑19 and perceived anxiety caninfluence preventive practices.MATERIALS AND METHODS: In this cross‑sectional study a multiple regression analysis wasapplied to examine the relationship between knowledge, anxiety, and preventive practices among267 participants work in different settings in a variety of health care organizations in different regionsin Saudi Arabia. To estimate potential associations, a multiple regression analysis was applied.Standardized beta‑coefficients and their 95% confidence intervals were estimated to examine theoutcome variable and the predictors’ associations.RESULTS: Our findings shows that HCWs had high levels of knowledge about COVID‑19, perceivedanxiety, and preventive practices. In examining the relation between HCWs characteristics and theirknowledge about COVID‑19, older HCWs have been shown to have higher knowledge comparedto younger HCWs. Finally, the model to estimate the impact of knowledge about COVID‑19 andperceived anxiety on preventive practice showed that both have a significant impact.CONCLUSIONS: HCWs tendency to adhere to preventive practices is related to their levels ofknowledge and perceived anxiety. Such a relationship can inform administrators and policymakersin the health care field to design health promotion campaigns to ensure all HCWs are aware of thenature of communicable diseases and the risk they might entail.

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The survey of nursing students’ attitude towards virtual education and its relationship with their satisfaction during the Covid‑19 epidemic: A cross‑sectional study

. Mansooreh Rooeintan; . Niloofar Hajiaraghi; . Seyed Maryam Mousavi; . Behnaz Asadizaker; . Zahra Gorjian

Volume 12, Issue 10 , November 2022, , Pages 1-6

Abstract

  BACKGROUND: Coronavirus disease 2019 (Covid‑19) pandemic has increased virtual educationuse. This study aimed to determine the attitude of nursing students of Ahvaz Jundishapur Universityof ...  Read More BACKGROUND: Coronavirus disease 2019 (Covid‑19) pandemic has increased virtual educationuse. This study aimed to determine the attitude of nursing students of Ahvaz Jundishapur Universityof Medical Sciences towards virtual education and its relationship with their satisfaction during theCovid‑19 pandemic.MATERIALS AND METHODS: This descriptive‑analytical study was conducted during 2020–2021with the participation of 229 nursing students (undergraduate, graduate, and doctoral) who had spentat least one semester virtually at Ahvaz Jundishapur University of Medical Sciences. The samplingmethod 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 includedthe standard questionnaire of individual development and educational assessment to determinestudents’ attitudes toward virtual education and their satisfaction with this type of education. IBMSPSS 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 virtualeducation was 35.1 ± 11.3 and the mean score of students’ satisfaction with this educational methodwas 88.3 ± 30.6, both of which are at the desired level. Also, a direct relationship was found betweenstudents’ attitudes and satisfaction scores (P < 0.001).CONCLUSION: In this study, the attitude of nursing students to virtual education and their satisfactionwith this educational method had been at the desired level. Therefore, the relevant authorities shouldalso consider the necessary planning in the field of using this educational method and improvingstudents’ attitudes towards it under normal conditions.

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Effect of a community‑based multicomponent intervention on cervical cancer behavior among women – A randomized controlled trial

. Jisa George T; . Kiran Batra

Volume 12, Issue 9 , October 2022, , Pages 1-9

Abstract

  BACKGROUND: Cervical cancer is the leading cause of death worldwide, especially in developingcountries. More than one‑fifth of newly diagnosed cervical cancer cases are occurring ...  Read More BACKGROUND: Cervical cancer is the leading cause of death worldwide, especially in developingcountries. More than one‑fifth of newly diagnosed cervical cancer cases are occurring in India. Cervicalcancer is a highly preventable and curable cancer compared with other types of cancer, if detectedat 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 ofwomen.MATERIALS AND METHODS: An experimental randomized controlled trial was carried out byrecruiting 419 women in the age group of 30–60 years (246 in the experimental group and 173 in thecontrol group) residing in a selected rural community (selected tribal settlements) of Idukki district ofKerala, India, using multistage cluster sampling. The intervention comprising small group educationfollowed 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 controlgroup did not receive any intervention. Knowledge, attitude, and screening behavior of women relatedto prevention of cervical cancer were assessed before and twice after the intervention.RESULTS: The experimental and control groups were homogenous in all baseline sociodemographicvariables. 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 cervicalcancer. A significant moderate positive correlation was found between knowledge and screeningbehavior (r = 0.408). Significant association was found between knowledge, attitude, and practiceregarding prevention of cervical cancer with education, age at the time of marriage, and number ofpregnancies.CONCLUSION: The community‑based, multicomponent, nurse‑led intervention program waseffective in improving cervical cancer screening behavior among women. Repeated motivation andreinforcement are needed to bring behavioral change and to increase uptake of screening servicesamong rural women.

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Knowledge, attitudes, and sociodemographic factors related to COVID‑19 among older people living in the community in Malaysia

. Sharifah Munirah Syed Elias; . Nur Rasyidah Rohinmi

Volume 12, Issue 8 , September 2022, , Pages 1-7

Abstract

  BACKGROUND: Although older people are at a higher risk of COVID‑19 infection, there is a lack ofresearch that focuses on COVID‑19 in older people in Malaysia. Therefore, the aim ...  Read More BACKGROUND: Although older people are at a higher risk of COVID‑19 infection, there is a lack ofresearch that focuses on COVID‑19 in older people in Malaysia. Therefore, the aim of this study wasto assess the level of knowledge and attitudes related to COVID‑19, and to identify the association ofsociodemographic background with knowledge and attitudes towards COVID‑19 among older people.MATERIALS AND METHODS: This is a cross‑sectional study involving 382 older people livingin the community in Malaysia. Data was collected using convenience sampling through an onlinequestionnaire that consisted of three parts: sociodemographic details, knowledge, and attituderelated to COVID‑19.RESULTS: The overall correct rate of knowledge was 77.3%, indicating that participants had slightlygood knowledge related to COVID‑19. The participants showed a positive attitude with a meanscore of 26.0 (SD = 5.0). There were significant associations between knowledge and educationlevel (P = 0.00) and marital status (P = 0.02). Marital status was significantly associated withattitude towards COVID‑19 (P = 0.03). A weak positive correlation was found between knowledgeand attitude (r = 0.17, P = 0.00) suggesting that an increase in knowledge will increase the positiveattitude 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 educationlevels and divorced or widowed to improve knowledge and attitudes towards COVID‑19.

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Comparison of the effect of bioterrorism education through two methods of lecture and booklet on the knowledge and attitude of nurses of Shams Al‑Shomus Nezaja Hospital

. Masoud Khoshnudi; . Fahime Ghadamgahi; . Gholamreza Najjarzade; . Farzane Habibi Mud; . Nahid Aghaei; . No’man Arab; . Seyyed‑Javad Hosseini‑Shokouh; . Atabak Nikbakht

Volume 12, Issue 5 , June 2022, , Pages 1-7

Abstract

  BACKGROUND: Today, considering the importance of bioterrorism, it may be time to assess therisk of bioterrorism as an important priority. Nurses, as the broadest group of therapy group, ...  Read More BACKGROUND: Today, considering the importance of bioterrorism, it may be time to assess therisk of bioterrorism as an important priority. Nurses, as the broadest group of therapy group, arevery influential in this regard.General aim: To determine the impact of bioterrorism education throughtwo 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 abefore and after education intervention with the participation of 80 nursing staff of Shams Al-Shomus NezajaHospital affiliated to Health Administration of Islamic Republic of Iran Army Ground Forces. The studypopulation included all hospital nursing staff in 2021. The inclusion criteria included having a willingnessand informed consent to participate in the study and exclusion criteria included unwillingness to continuecooperation and failure to complete more than 10% of the questionnaire by the subject. This study wasperformed 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 theposttest. Both groups then completed the questionnaire again after about 2 weeks. First, all the data weremeasured for normal distribution by the Kolmogorov–Smirnoff test. Statistical description was expressedfor the variables with normal distribution as the ratio of geometric mean ± standard error and for abnormalvariables as mean ± standard error. To compare the means of the studied quantitative variables, t-testand 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 trainingand 2 weeks after training, a significant increase in the average knowledge score of the lecture groupStatistically shows (P < 0.001). However, the analysis of attitude scores was performed between thetwo 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 bioterrorismattacks is useful, effective, correct, and sufficient training. According to the results of the presentstudy,bioterrorism training leads to increasing the level of knowledge and betterment the attitude ofnurses in the field of bioterrorism. Therefore, the inclusion of training courses in medical centers,especially military medical centers, is necessary and sensitive.

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The relationship between health‑related quality of life of students at Tehran University of Medical Sciences and their knowledge, attitudes, and practices regarding COVID‑19 in 2020

. Reza Heidari‑Soureshjani; . Tayeb Mohammadi; . Ali Hashemi‑Shahraki; . Roya Khorrami Estakhri; . Arezoo Rasti

Volume 12, Issue 2 , February 2022, , Pages 1-11

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 ...  Read More 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.

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A survey of nurses, midwives, and physicians attitudes in regard to health reform plan at Jahrom University of Medical Sciences in 2020

. Yasaman Pourfarid; . Mohsen Hojan

Volume 12, Issue 2 , February 2022, , Pages 1-4

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 ...  Read More 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.

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Knowledge and attitude toward professional ethics: A study among Iranian medical and nursing students’

. Poria Hoseinialiabadi; . Ali Omidi; . Mansour Arab; . Zohreh Makarem; . Mojtaba Jafari

Volume 12, Issue 1 , January 2022, , Pages 1-5

Abstract

  BACKGROUND: Professional ethics is a set of principles and standards of human behavior thataffect individual behavior and leads to improve care that provided by medical staff. The presentstudy ...  Read More BACKGROUND: Professional ethics is a set of principles and standards of human behavior thataffect individual behavior and leads to improve care that provided by medical staff. The presentstudy examined the knowledge and attitude of medical and nursing students toward professionalethics in Iran.MATERIALS AND METHODS: This descriptive‑analytic study was carried out on 176 medical andnursing students in Bam University of Medical Science, Iran in 2019. In this study, students wereselected by census sampling. Data collected using two researcher‑made questionnaires related toknowledge 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 studentswas 127.06 (12.45) and 129.9 (11.88), respectively. Results of the Pearson correlation test showed apositive and significant associated between the score of knowledge and attitude nursing and medicalstudents’ (P < 0.001), (r = 0.76) (r = 0.66). Among the demographics characteristics, student agewas associated to their attitude and knowledge significantly (P = 0.03).CONCLUSION: Iranian nursing and medical students have a positive attitude and a high level ofknowledge about professional ethics. A high level of knowledge was related to the most positiveattitude.

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Comparing the effectiveness of motivational interviewing and self‑development education on type II diabetes mellitus patients’ lifestyle

. Javad Kazemi; . Fatemeh Rahmati

Volume 11, Issue 10 , November 2021, , Pages 1-7

Abstract

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

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Promotion of posttraumatic stress disorder following traumatic birth experiences and the influence of maternity religious Attitude: A correlational study

. Sedighe Alipanahpour; . Mahnaz Zarshenas; . Marzieh Akbarzadeh

Volume 11, Issue 9 , October 2021, , Pages 1-8

Abstract

  BACKGROUND: Women who experience stillbirth and preterm delivery are likely to be associatedwith an increased risk of posttraumatic stress disorder (PTSD) compared to women with live ...  Read More BACKGROUND: Women who experience stillbirth and preterm delivery are likely to be associatedwith an increased risk of posttraumatic stress disorder (PTSD) compared to women with live birthsand dose religious attitude related to posttraumatic stress? The aim of the study was promotion PTSDfollowing traumatic birth experiences and the influence of maternity religious Attitude.MATERIALS AND METHODS: A cross‑sectional analytical study was conducted at selected hospitalsof Shiraz University of Medical Sciences on 82 subjects in 2018. The instruments were demographicquestionnaire, Religious Attitude questionnaire, and Mississippi PTSD Scale which were completedafter 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 ofreligious attitude. In the stillbirth group, 90% had high levels of PTSD and in the preterm deliverygroup, 90% had moderate stress, and 10% had high PTSD levels. The correlation between religiousattitude and PTSD after stillbirth was 0.373 with a significance level of 0.018. Therefore, there wasa significant positive relationship between religious attitude and PTSD. However, the relationshipbetween 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 significantrelationship with religious attitude. However, in mothers of preterm infants, the level of stress wasmoderate and did not have a significant relationship with religious attitude. The findings indicate theneed of mothers for interventions to cope better with the physical and psychological problems ofstillbirth and preterm delivery.

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A questionnaire‑based study to develop an instrument measuring poor interest in biostatistics among postgraduate medical students and faculties

. Uttam Kumar Roy; . Pabitra Biswas; . Purnendu Mandal

Volume 11, Issue 9 , October 2021, , Pages 1-5

Abstract

  BACKGROUND: It has been realized by senior researchers that interest in biostatistics is very pooramong medical professionals. Knowledge of biostatistics plays an important role in ...  Read More BACKGROUND: It has been realized by senior researchers that interest in biostatistics is very pooramong medical professionals. Knowledge of biostatistics plays an important role in medical research.Studies conducted about knowledge, attitude toward biostatistics by many researchers, but there wereno 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 focusgroup discussion involving seven experts from different departments of medical colleges. Face validityand content validity and pilot testing were carried out step by step. In estimating reliability, internalconsistency measured after collecting data from 66 study participants. Data were collected throughself‑administered paper‑based questionnaire where response in each item was in five‑point Likertscale. Cronbach’s alpha for reliability analysis was used.RESULTS: In first stage, item generation through FGD, then face validity was assessed by seniorfaculties. Content validity was checked by Aiken’s V index. In initial stages, with six items, Cronbach’salpha was 0.805. Scale mean and variance were 24.24 and 27.26. After final reliability testing, itbecame 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 instatistics 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.

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Comparing the effect of electronic and lecture education of pain management on the knowledge, attitude, and practice of nurses: A randomized‑controlled trial

. Azizeh Farshbaf‑Khalili; . Madine Jasemi; . Atefe Seyyedzavvar

Volume 11, Issue 9 , October 2021, , Pages 1-10

Abstract

  INTRODUCTION: Efficient pain management by nursing staff initially needs accurate knowledgeand proper attitude in this field. The aim of present study was to compare the effects of ...  Read More INTRODUCTION: Efficient pain management by nursing staff initially needs accurate knowledgeand proper attitude in this field. The aim of present study was to compare the effects of lectureand electronic education on the knowledge, attitude, and practice of nursing staff regarding painmanagement.MATERIALS AND METHODS: The present superiority randomized controlled trial with two parallelarms was conducted on 78 occupied nurses of surgery wards of X. The participants were recruitedrandomly and divided into two groups of lecture and electronic education through random blocking (4and 6 blocks). For allocation concealment, coded nontransparent pockets numbered 1–78 containingthe type of intervention were used. Educational material was presented using teacher‑centeredmethod in lecture group, as well as through multimedia program using FLASH software in e‑learninggroup through 1‑h sessions for 4 weeks. Data on nurses were collected before and 4 weeks after thetraining 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, andANCOVA. P < 0.05 was considered statistically significant.RESULTS: Mean ± standard deviation of nurses’ knowledge, attitude, and practice regardingpain management had significant increase in both groups post‑training (P < 0.001). According toANCOVA the mean postintervention knowledge score in e‑learning group by controlling baselinescore 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 ofpost‑intervention attitude and practice in e‑learning group adjusted for baseline score significantlyincreased 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 ofknowledge, attitude, and practice on pain management among nursing staff.

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Knowledge and attitude regarding cervical cancer and its prevention among young female adults in Kuantan, Malaysia

. Munawara Burhan; . Nor Azlina A. Rahman; . Mainul Haque

Volume 11, Issue 8 , September 2021, , Pages 1-9

Abstract

  BACKGROUND: Cervical cancer is the second‑most common female cancer in Malaysia after breastcancer. This study intended to investigate the knowledge and attitude regarding cervical ...  Read More BACKGROUND: Cervical cancer is the second‑most common female cancer in Malaysia after breastcancer. This study intended to investigate the knowledge and attitude regarding cervical cancer andits prevention and its associated factors among young female adults in Kuantan, Malaysia, to gaugethe 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 andconvenience sampling method. Data on the respondents’ knowledge and attitude regarding cervicalcancer 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 SPSSsoftware.RESULTS: From the total of 142 respondents, almost half of them aged between 20 and 24 years oldwith the majority were Malays (85.9%) and single (74.6%). The internet (78.1%) was identified as themain 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’ knowledgeand attitude scores in this study. Age was found to be associated with knowledge scores only, whilemarital status was only significantly associated with the attitude scores regarding cervical cancer andits prevention. Knowledge scores were also found to be positively associated with attitude scores.CONCLUSION: Several socio‑demographic factors were significantly associated with the knowledgeand attitude regarding cervical cancer and its prevention. In view of the positive association betweenknowledge and attitude scores, suitable health promotion activities can be designed and planned toincrease young female adults’ knowledge and attitudes toward cervical cancer and its prevention.

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Student perceptions: Background to a new ethics curriculum in Indian medical colleges

. Shimpa Sharma; . Rakesh Sharma; . Rajesh K. Khyalappa; . Shweta Sharma; . Samin Kandoth

Volume 11, Issue 7 , August 2021, , Pages 1-5

Abstract

  BACKGROUND: Ethic education as a part of medical school curriculum is one which requiresconstant re‑evaluation and re‑emphasis. The medical regulatory body of India has, in recent ...  Read More BACKGROUND: Ethic education as a part of medical school curriculum is one which requiresconstant 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 medicalschools. Medical students’ perception of ethics education is an important variable which will influencethe validity of this module. This study attempts to evaluate the same.MATERIALS AND METHODS: A peer‑validated questionnaire was distributed to 150 undergraduateand postgraduate medical students (response rate: 74.4%) with the aim to evaluate their attitudetoward 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 knowledgeand its positive impact on their career (P < 0.05). They accept material taught as per plannedcurriculum as a source of learning and favor interactive methods of teaching (P < 0.05). Researchprojects 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.” Perceptionshave been identified that need to be addressed. The study reveals a need to further explore thepurpose and contribution of role models in this context and to identify ways of strengthening theirrelated perceptions by students.

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The knowledge of COVID‑19 treatments, behaviors, and attitudes of providing the information on COVID‑19 treatments: Perspectives of pharmacy students

. Dyah Aryani Perwitasari; . Imaniar Noor Faridah; . Haafizah Dania; . Lolita Lolita; . Lalu Muhammad Irham; . Muthia Dewi Marthilia Alim; . Maratun Shoaliha; . Mochammad Junaidy Heriyanto

Volume 11, Issue 5 , June 2021, , Pages 1-6

Abstract

  BACKGROUND: Increasing community awareness about the transmission and treatment ofCOVID‑19 will stop the spread of the virus. Pharmacy students are the potential facilitator to givecommunity ...  Read More BACKGROUND: Increasing community awareness about the transmission and treatment ofCOVID‑19 will stop the spread of the virus. Pharmacy students are the potential facilitator to givecommunity education about COVID‑19 treatment. The objective of this study is to evaluate thepharmacy students’ knowledge of COVID‑19 treatment, behavior, and attitude of providing theinformation about COVID‑19 treatment.MATERIALS AND METHODS: We conducted cross‑sectional study, recruiting 429 pharmacystudents from three schools of pharmacy in Indonesia. The questionnaire about the knowledge ofCOVID‑19 treatment, behavior, and attitude of providing the information on COVID‑19 treatment metthe validity and reliability criteria. We defined the proportion of knowledge, behavior, and attitude ofthe students using SPSS® version 22.RESULTS: Most of the students are in the earlier years (46.63%), female (84.15%), find the informationabout COVID‑19 from many sources of media (85.08%) including scientific articles and knowinformation about COVID‑19 transmission around their life area (76.46%). The students’ knowledgeabout antiviral and plasma convalescent is good (>70%), the positive behaviors are related to theCOVID‑19 treatment information regarding to the antiviral and the provision of Vitamin C (>50%), andthe 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‑19treatment needs to be improved since earlier years. Furthermore, using the good knowledge aboutCOVID‑19 treatment, the positive behavior and attitude of providing information of the students, thecommunity behavior and attitude will be improved. The high year students have a tendency for thegood knowledge and positive behavior and attitude of providing the information.

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The effect of a nutrition education intervention on knowledge, attitude, and intake of foods high in fats in women

. Fatemeh Zeynalzadeh Borjloo; . Tahereh Dehdari; . Jamileh Abolghasemi; . Fatemehsadat Amiri; . Ali Vasheghani‑Farahani

Volume 11, Issue 5 , June 2021, , Pages 1-6

Abstract

  BACKGROUND: Given that many Iranian were interested in the consumption of foods that are highin fats, the present study was done to determine the effect of a nutrition education intervention ...  Read More BACKGROUND: Given that many Iranian were interested in the consumption of foods that are highin fats, the present study was done to determine the effect of a nutrition education intervention onknowledge, 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 healthhouses affiliated to Tehran municipal were selected and assigned to either intervention (n = 46) orcontrol (n = 46) groups. Information (data) regarding women’s knowledge, attitude, and practice interms of foods rich in fat intake was collected by three questionnaires. Then, a nutrition educationintervention included four 40–60 min training sessions over 4 weeks was designed and conductedto the study participants in the intervention group. Two groups were followed up 2 months after theintervention. Finally, all data were analyzed by using the independent‑samples t‑tests, Student’spaired‑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 foodwith high fat content and intake of these foods in the intervention group compared with the controlgroup after the intervention (P < 0.001). Furthermore, following the intervention, the intervention groupreported 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 theconsumption of foods rich in fat in Iranian women.

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Comparison of the effect of training academic honesty using two workshop and virtual training methods on the knowledge and attitude of M. S. students

. Pyam Nikjo; . Fatemeh Vizeshfar; . Nahid Zarifsanayee

Volume 11, Issue 4 , May 2021, , Pages 1-7

Abstract

  BACKGROUND: Nowadays, one of the most important challenges of the universities and highereducation centers is academic dishonesty among students. Academic dishonesty is done throughcheating, ...  Read More BACKGROUND: Nowadays, one of the most important challenges of the universities and highereducation centers is academic dishonesty among students. Academic dishonesty is done throughcheating, deception, and plagiarism, which creates serious educational, studious, and social problemsfor the students and society. The purpose of this study was to compare the effect of virtual andworkshop 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‑experimentaltype having pretest and posttest and the participants of this study included 90 M. S. nursing studentsof 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 comparisonbetween 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 twoworkshop and virtual training methods, both can be used as efficient and effective methods in trainingdimensions depending on the condition and facilities to prevent and reduce plagiarism in students.

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Exploring the knowledge, attitude, and practice of health‑care professionals on coronavirus (COVID‑19) pandemic infection

. Meenu Rani; . Ishan Sharma; . Shivangi Sharma; . Lokendra Sharma; . Susheel Kumar

Volume 11, Issue 3 , March 2021, , Pages 1-7

Abstract

  BACKGROUND: To prevent the rapid spread of infectious COVID‑19 in India, many steps have beentaken. Adherence to the control measures depends on the knowledge, attitude, and practices ...  Read More BACKGROUND: To prevent the rapid spread of infectious COVID‑19 in India, many steps have beentaken. 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 amonghealth‑care professionals in Jaipur. The objective was to evaluate the KAPs about COVID‑19 amonghealth‑care professionals.MATERIALS AND METHODS: A total of 385 participants took part in the study. A self‑designedquestionnaire was filled by the participants online (Google Form). The knowledge of the participantswas assessed using 12 questions. Attitude and practices of the participants were assessed by twoquestions for each.RESULTS: Among the study completers, 52.20% were male, 71.42% of the participants were agedabove 30 years, and 59.22% were nurse. The knowledge score was approximately 90%. The majorityof the participants had a strong conviction that India can overcome this infectious disease in the nearfuture. Multiple regression analysis found that good knowledge score of COVID‑19 was associatedwith lower negative attitudes and less risky practices (P ˂ 0.001).CONCLUSION: Participants of the study were knowledgeable, held positive attitudes, and hadadequate practices for COVID‑19.

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The effect of educational intervention based on theory of planned behavior and self‑regulatory strategies on the social vitality of women employee

. Maryam Bahlgerdi; . Mohammadreza Miri; . Gholamreza Sharifzadeh; . Ensiyeh Norozi; . Tayebeh Hosseini

Volume 11, Issue 3 , March 2021, , Pages 1-7

Abstract

  BACKGROUND: Social vitality is one of the most important social indicators to develop a senseof public satisfaction. The aim of this study was to investigate the effect of educational ...  Read More BACKGROUND: Social vitality is one of the most important social indicators to develop a senseof public satisfaction. The aim of this study was to investigate the effect of educational interventionbased on theory of planned behavior (TPB) and self‑regulatory strategies on the social vitality ofwomen employee.MATERIALS AND METHODS: In this randomized controlled field trial study, 66 women employeesof 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 aresearcher‑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 andself‑regulatory strategies which were to the interventional group. Data analysis was performed usingthe Chi‑square, Fisher’s exact test, independent t‑test, repeated measures ANOVA, and Bonferronipost 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 and36.2 ± 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) hada significant increase in the intervention group. In the control group, only a significant differenceoccurred over time in the happiness rate (P = 0.031).CONCLUSIONS: The results of the present study showed the effectiveness of educational interventionon the social vitality of women employees. Therefore, TPB is recommended to use in interventionsto promote social vitality.

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