Journal of Education and Health Promotion

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: The lack of fundamental knowledge and awareness about the biological process of
reproduction is low worldwide but has reportedly higher incidence rates in under‑developed countries.
Infertility can have a tremendous effect on a woman’s psychological and social well‑being, pushing
her toward mental stress, anxiety, depression self‑blame, self‑isolation, feeling of worthlessness,
and lack of interest in life. The present study was conducted to determine the level of knowledge and
awareness regarding factors affecting fertility and also to ascertain the emotional status of females
visiting the Obstetrics and Gynecology out‑patient department for fertility assistance.
MATERIALS AND METHODS: A cross‑sectional study was performed by using a questionnaire
which had two parts; the first part had questions about awareness and knowledge of the subject
of infertility, and the second part had 12 questions that assessed the psychological and emotional
status of the participants, and it also explored prevailing myths about infertility based on a validated
questionnaire.
RESULTS: There was a significant difference in mean knowledge score; those who were more
educated had better knowledge of various aspects of infertility. The overall adequacy for knowledge
and awareness revealed that only 62 (47.7%) of the participants had adequate knowledge (score >6)
regarding female infertility. The mean score for knowledge among all the respondents was 6.61 ± 1.48.
The overall emotional and psychological score suggested that 30 (23%) of the respondents were
disturbed because of stress because of infertility.
CONCLUSION: Infertility can have a serious impact on the psychological well‑being of females,
and social pressure and stigma associated with childlessness can further worsen the physical and
emotional well‑being of couples, which needs to be addressed before starting treatment of infertility
for a better response to treatment. The limited knowledge and prevailing mis‑conceptions regarding
infertility need to be sincerely dealt with to complement the medical treatment of infertility.

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 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: 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: Despite new anticoagulants’ developments, warfarin is still one of the most
commonly used medicines, particularly in the cardiovascular system. One of the significant challenges
with warfarin is the prevalence of dangerous side effects such as bleeding and drug and food
interactions, which can negatively affect patients if not adequately controlled. As health‑care team
members, nurses have a crucial role in prescribing this medicine and educating patients. In this
regard, this study was conducted to determine the knowledge and practice of nurses working in the
cardiovascular wards regarding warfarin.
MATERIALS AND METHODS: In this cross‑sectional, descriptive study, knowledge and practice
of 239 nurses working in the cardiovascular wards of teaching hospitals affiliated to Iran University
of Medical Sciences have been investigated using European Cardiovascular Nurses Knowledge
questionnaire on anticoagulants and the checklist for high‑risk drugs safety instructions. The sampling
was performed through the stratified sampling method with proportional allocation. Data were analyzed
using the SPSS software version 16 through descriptive and inferential statistics (independent t‑test,
one‑way analysis of variance, and Pearson correlation coefficient) (Inc., Chicago, IL, USA).
RESULTS: The mean scores of knowledge (18.51 ± 3.87) and practice (10.53 ± 2.12) were
slightly higher than the median, and the lowest mean score was related to knowledge on drug
interactions (7.62). The practice had a statistically significant relationship with knowledge (P ˂ 0.001).
Regarding demographic variables, there was a statistically significant relationship between nurses’
knowledge and the education level (P = 0.009) and nurses’ practice and age (P = 0.022), work
experience (P = 0.032), and work experience in cardiovascular wards (P = 0.036).
CONCLUSIONS: Based on the findings of this study, the knowledge of nurses working in the
cardiovascular wards about warfarin was not sufficient, and their practice was of poor quality. Nurses’
lack of knowledge and improper practice can jeopardize drug safety in patients and cause serious
side effects such as bleeding. Proper training of nursing students and nurses about warfarin as a
high‑risk drug, its side effects, and drug‑food interactions, and the emphasis on patient education in
patients receiving this medicine can effectively reduce the incidence of side effects.

Abstract BACKGROUND: Preconception reduces unplanned pregnancies and plays an important role in 
reducing maternal and infant mortality. Considering the importance of these care services, this study 
was conducted to determine the status of preconception care (PCC) model with Structural Equation 
Modeling (SEM).
MATERIALS AND METHODS: This cross-sectional descriptive study was conducted on 394 pregnant 
women referring to Gorgan’s health centers. Samples were selected by multi‑stage stratified sampling 
method. The instrument used in this research was a researcher-made questionnaire by Bayrami. Data 
were analyzed using R software version 4.1.4. Structural equation modeling (SEM) with weighted 
least square mean and variance method was used to fit the conceptual model and the significance 
level of the tests was considered 0.05.
RESULTS: The results showed that PCC model was deemed appropriate as optimum conditions 
indicators of goodness of fit; knowledge with a coefficient of 0.182 leads to self‑efficacy (SE), and 
SE affects the accessibility of facilities with a coefficient of 0.465 and the expected outcome with a 
coefficient of 0.500. After facility structure with a coefficient of 0.500, SE construct with a coefficient 
of 0.215 had the most effect on performing PCC behavior.
CONCLUSIONS: Facilities and SE as a key element of empowerment have an important role in 
promoting PCC. Identifying the factors associated with this care appears to help health policymakers 
to planning for these caregivers more precise and sensitive.

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 Pandemic 2019 is observed in all sectors of the world which had caused a huge disruption in the
education system in India as well as worldwide adding challenges to student’s life. We aimed to
provide an outline on E‑Learning and the difficulties experienced by students of various colleges in
the southern parts of India and to conduct knowledge, attitude and practices (KAP) analysis based
on student’s perception regarding E‑learning by collecting an online survey, 346 valid questionnaires
were retrieved. In order to evaluate the association between the variables of KAP, structural equation
modeling was used for data analysis. The influencing factors of KAP were observed to know the
effect of the pandemic on E‑learning from the model. The result finding moderately fit the collected
data and reveals a good fit of the model in the means of satisfying the threshold values.

Abstract BACKGROUND: Although basic life support (BLS) has been taught in school by a variety
of professionals, it is still unclear that, whether the instructor’s previous cardiopulmonary
resuscitation (CPR) experience is an important factor. This study aimed to compare the effect of
BLS training, based on trainer experience in actual situations, on knowledge and skills of secondary
high school students.
MATERIALS AND METHODS: In this randomized controlled trial, 150 high school students were
selected based on the inclusion criteria and then assigned into two groups, (76 in Group A), and (74
in Group B) randomly. Both groups were trained according to adult BLS: 2020 American Heart
Association guidelines on mannequins in three 60 min in‑person training sessions. The knowledge
and skill scores were measured for both groups before, immediately, and 1 month after intervention
by a questionnaire. Data were analyzed by the SPSS software version 22, using Chi‑square,
Mann–Whitney U, repeated‑measure ANOVA tests, and statistically modeling at a significance
level of 0.05.
RESULTS: There were no significant differences between groups regarding demographic
characteristics. The knowledge and skill scores in both groups increased significantly compared
to baseline immediately and 1 month after the intervention (P = 0.001). However, there was no
significant difference in knowledge scores between groups (P = 0.076(. However, at the immediacy
and 1 month after the intervention, the skill score in “Group A” was significantly higher than the
“Group B” (P = 0.001).
CONCLUSIONS: The trainer’s experience of CPR in the actual setting in the transfer of BLS
knowledge is not important, but it improved Student’s BSL skill acquisition score.

Abstract BACKGROUND: Road traffic accidents (RTAs) are an emerging public health issue of global concern
causing 1.35 million deaths per year. They are the leading cause of death among 5–29 years who
contribute to the future and current productive population of the country. The outcome of mortality
and permanent disability are public health concerns. We determined the factors associated with RTAs
among medical undergraduates and assessed their knowledge of road traffic rules.
MATERIALS AND METHODS: This study had 500 medical undergraduates from a tertiary hospital
located in Chengalpattu district, Tamil Nadu. Data were collected using questions from “Road safety
question bank” issued by Ministry of Road Transport and Highways, Government of India, sent as
Google forms to students. Descriptive statistics were used and multivariate analysis was performed
to identify risk factors associated with RTAs.
RESULTS: The mean age of the students was 21.4 (standard deviation = 1.7) years. About 30.4%
of students suffered from RTAs in the past 2 years. Practice of drunken driving and mobile phone
usage showed significant association with RTA occurrence (P < 0.001). Multiple logistic regression
revealed that students crossing speed limits and jumping signals had 3.19 and 2.04 times more
risk of sustaining RTAs. Seventy‑five percent of students had good knowledge on road traffic rules.
CONCLUSION: Nearly half the subjects have suffered RTA in the past 2 years. Students who over
speed, jumped signals and used mobile phones while driving sustained more RTAs. Overall, road
traffic rules knowledge was satisfactory. Students need education on risky driving behaviors and
aftermath of crashes.

Abstract BACKGROUND: The coronavirus disease (COVID) is predicted to cause serious mental health 
problems among healthcare providers (HCPs) especially dentists. Also understanding the influencing 
factors of the acceptance of COVID‑19 vaccination among HCPs are important aspects in the design 
of effective strategies to improve the vaccine coverage rate. Therefore, this study aimed to assess 
the knowledge, vaccination acceptance, fear, and obsession, as well as the preventive practice 
behaviors of Iranian dentists and dental students in late 2020 toward COVID‑19.
MATERIALS AND METHODS: A descriptive, web‑based cross‑sectional survey was conducted 
among Iranian dental students and dentists (general practitioners and specialists). All Iranian dentists 
and dental students living in the Islamic Republic of Iran regardless of their city and workplace were 
invited to participate in the study. The total number of dentists in Iran was estimated to be 54,927. The 
sample size was calculated 380. The questionnaires used in this study were adapted from previously 
published studies based on the authors’ permission. The questionnaire consisted of four sections 
that sought to collect information on the respondents’ vaccination acceptance, knowledge, preventive 
practice, fear, and obsession toward COVID‑19. The relationship between the study variables was 
assessed using Pearson’s correlation coefficient and also multiple linear regression tests.
RESULTS: Overall, 394 dentists were filled the questionnaire (65 dental students, 151 general 
dentists and 178 specialists). There were no differences in terms of vaccination acceptance, 
knowledge and also fear score in different designation groups. Dentists had significantly higher 
obsession and also preventive practice scores than other designation groups (P < 0.05). The majority 
of respondents had good knowledge (more than 9), acceptable preventive practice (more than 19), 
low fear‑obsession (<2.7), and high acceptance of COVID‑19 vaccination (more than 8.8).
CONCLUSIONS: Although obsession and fear scores were low in all designation groups, dentists 
had higher obsession and also preventive practice scores than other designation groups. More than 
half of respondents preferred imported COVID‑19 vaccines. Finally, organizations such as the World 
Health Organization and the Ministry of Public Health in Iran should increase vaccine convenience 
and accessibility in terms of vaccine importing, distribution, supply, and immunization service.

Abstract BACKGROUND: Many measures have been taken so far to minimize the outbreak of COVID‑19, but 
it is still unclear to what extent people have understood the risk. Public participation plays a vital role 
in better and effective control of the coronavirus, and the importance of risk perception is effective 
in their preventive behavior. The aim of this study was to investigate the pandemic risk perception 
of coronavirus disease after began of pandemic in Iranian society.
MATERIALS AND METHODS: This cross‑sectional study was conducted in Iran in spring 2020. The 
data collection tool was a researcher‑made questionnaire. The questions were extracted through 
interviews with experts and summarizing the opinions of public interviews, etc., The questionnaire 
was made available to the public through social media. The information was collected within 
3 months. Quantitative data were reported as mean ± standard deviation and the qualitative data 
were reported as number and percent. Multiple linear regression and cross were also used to examine 
the demographic factors associated with risk perception. Data Analysis was performed using the 
SPSS version 21 statistical software.
RESULTS: In this study, 402 individuals from 28 provinces (Azarbaijan Gharbi, Azarbaijan Sharghi, 
Alborz, Ardabil, Bushehr, Chaharmahal and Bakhtiari, Esfahan, Fars, Ghazvin, Gilan, Golestan, 
Hamedan, Hormozgan, Ilam, Kerman, Kermanshah, Khorasan Razavi, Khorasan Shomali, Khuzestan, 
Kohgiluyeh and Boyerahmad, Kurdistan, Lorestan, Mazandaran, Semnan, Sistan and Baluchestan, 
Tehran, Yazd, and Zanjan) of Iran participated. The risk perception score obtained from the sum 
of the scores of the questions was classified into quartiles. Accordingly, the risk perception score 
of (22.9) 92 people was very low, (26.6) 107 people low, (26.9) 108 people moderate, and (23.6) 95 
people high. The results of multiple linear regression showed that the variables of gender (P = 0.008) 
and occupation (P = 0.013) had a significant relationship with risk perception. There was no 
significant relationship between risk perception and variables of age, marital status, and level of 
education (P > 0.05).
CONCLUSION: The study showed that the risk perception of the people is more in categories 
of moderate to high. Assessing the risk perception of a pandemic can be helpful for preventive 
measurements and planning, and also, according to the results of the research, can be done 
appropriate educational interventions. Given that 47.5% of respondents were employees, of course, 
it should be noted that in sending a questionnaire virtually, there is usually a lot of loss and this is 
a limitation of the research. The results of this study can be useful in making prevention decisions 
and maintaining safety and health in the workplace.

Abstract BACKGROUND: The prevalence of self‑medication is high in Bangladesh due to easy access 
and poor regulatory controls over these drugs. Our study aimed to assess the attitude of university 
students in Bangladesh toward antibiotic usage, especially their knowledge and awareness about 
antibiotics and their resistance. We also evaluated the determinants behind their attempts at drug 
intake without prescription.
MATERIALS AND METHODS: A cross‑sectional study was conducted in Mawlana Bhashani Science 
and Technology University that included information from randomly selected 200 students from 15 
departments using a structured questionnaire. The statistical analyses were performed by using 
SPSS software (version 21) and R programming.
RESULTS: The study revealed that 61.0% of the students use self‑medication at different times 
or always; 32.5% of the respondents keep antibiotics for future use, and 38% of the students think 
it is right to stop antibiotics when symptoms are improving. Half of the participants (47.5%) use 
antibiotics based on their previous experience. The criteria of antibiotic selection have a significant 
relationship with knowledge about antibiotic resistance (P = 0.017) and altered prescribed medicine 
without doctor’s advice (P < 0.001). The multivariate analysis indicates that respondents who know 
about antibiotic resistance select antibiotics from the community pharmacists with respect to their 
own experience 5.102 times higher than those who do not know about antibiotic resistance.
CONCLUSIONS: The study mainly explored the knowledge gaps of the students on the options that 
are responsible for antibiotic resistance in the community and found that students have mid‑level 
knowledge (66%) about antibiotic resistance.

Abstract BACKGROUND: Teachers’ knowledge and awareness about the signs and symptoms, behavioral 
problems, and treatment are imperative to handling children with attention‑deficit/hyperactivity 
disorder (ADHD) in the school. This study aimed to assess the level of knowledge about ADHD 
among primary schoolteachers in Sharjah, UAE.
MATERIALS AND METHODS: In this cross‑sectional study, a convenient sampling method was used 
to collect data from 239 teachers working in private schools and 25 teachers working at the public 
schools in Sharjah. A self‑administered questionnaire was used to measure the sociodemographic 
characteristics and the Knowledge of Attention‑Deficit Disorders Scale was used to measure the 
knowledge about ADHD. Data were analyzed using both descriptive and inferential methods.
RESULTS: Private schoolteachers have more knowledge about ADHD than public 
Schoolteachers (P = 0.016). Teachers obtain information about ADHD through educational 
workshops (32%), social media (23%), friends and relatives (12%), TV and radio (9%), scientific 
journals (8%), campaigns (7%), and other sources (9%) such as the Internet, lectures, personal 
experience, and reading. Most of the teachers (56.3%) have knowledge about the signs and symptoms 
of ADHD, whereas teachers’ knowledge about the associated features and treatment of ADHD is 
34.4% and 34.1%, respectively.
CONCLUSION: Teachers’ level of knowledge about ADHD‑associated features and treatment was 
inadequate in Sharjah. Hence, enhancing knowledge about ADHD by providing various training 
workshops and conducting social events, and campaigns are warranted to enhance their knowledge 
on ADHD.

Abstract BACKGROUND: There is limited research on sexual and reproductive health (SRH) knowledge level 
among very young adolescents aged between 10 and 14 years. Policy makers and educators are 
unable to address very young adolescents’ SRH needs without proper understanding of their SRH 
knowledge. Thus, the objective of this study is to explore very young adolescents’ SRH knowledge 
level and the influences of demographic variables on the respondents’ SRH knowledge level in 
Malaysian primary schools.
MATERIALS AND METHODS: This cross‑sectional study involved 617 primary five students who were 
recruited through multistage sampling method from the state of Johor, Malaysia. A self‑administered 
questionnaire (Cronbach’s α = 0.81) which comprised of 38 items related to puberty, HIV/AIDS 
and sexually transmitted diseases, prevention of child sexual abuse and reproductive systems 
and reproduction was used. Multivariate logistic regression analysis was applied to examine the 
association between demographic variables and student’s SRH knowledge.
RESULTS: Based on the results, 28.5% of the respondents had unsatisfactory level of SRH 
knowledge. Among the four dimensions, the respondents had more knowledge on prevention of 
child sexual abuse but displayed poorer knowledge on HIV/AIDS and sexually transmitted diseases 
topic. The findings indicated female (odd ratio [OR] = 1.464) and Indian respondents (OR = 3.208) 
are more likely to exhibit poor SRH knowledge which suggested demographic factors exert some 
extent of influence on primary school children’s SRH knowledge.
CONCLUSION: The findings provide useful insights for the policy makers and educators seeking 
to improve the comprehensiveness of culturally accepted sexuality education which are essential in 
promoting young adolescents’ well‑being.

Abstract BACKGROUND: Gamification involving application of elements of game play that provides unique 
opportunities to learners to sail through complex medical concepts is gaining importance in medical 
education. The current study was aimed at assessing the perception of medical students regarding 
checkerboard game in enhancing learning process.
MATERIALS AND METHODS: The present prospective cross‑sectional study was conducted at the 
microbiology department. The fifth-year medical students of the academic year 2018–19 were the 
participants. Pre‑ and post‑test scores and self‑administered questionnaire regarding effectiveness 
of the checkerboard game‑based learning were used as assessing tools. The data were collected, 
tabulated, and statistically analyzed using SPSS version 20. The pre‑ and post‑test scores of students 
were statistically analyzed using paired t test. A descriptive analysis on the 3‑point Likert scale of 
effectiveness survey was measured and expressed in percentages.
RESULTS: In total, 124 fifth-year medical students participated in the study. Majority (89.5%) of them 
liked the game, nearly 86% opined that game was enjoyable and created interest. Approximately 
88% indicated game helped them to understand the topic, enhanced learning, and thus improved the 
knowledge. Most students (79%) also believed that game encouraged critical thinking and problem 
solving, while 75% felt that it improved their communication skills. Around 70% felt that game was 
also useful for exam preparation and nearly 90% recommended to use the game more frequently.
CONCLUSION: From the results of the study, it can be concluded that checkerboard game‑based 
learning method is effective in fostering learning process and cognition of medical students in the 
microbiology course.

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: One of the important challenges faced by health‑care system is to raise the level of 
knowledge of nurses about cerebrovascular accident(CVA) nursing care in the emergency department. 
Therefore, the aim of this study was comparison of two new educational techniques (noninteractive 
multimedia learning and workshop) on knowledge of nurses about CVA nursing care in the emergency 
department.
MATERIALS AND METHODS: This experimental study was conducted with a two‑group design. 
Sixty‑four eligible nurses working in the emergency department in selected hospitals affiliated to 
Isfahan University of Medical Sciences, Isfahan, Iran, were selected as the study participants. Nurses 
were randomly assigned into two groups of noninteractive multimedia (n = 32) and workshop (n = 32) 
using random number table. The data‑gathering tools including a demographic questionnaire (6 items) 
and knowledge questionnaire (24 items) were completed before and 2 weeks after the intervention in 
both the groups. Data were analyzed using SPSS 18 and descriptive (mean and standard deviation) 
and analytical statistics (ANOVA, independent t‑test, and paired t‑test). The level of statistical 
significance was P ≤ 0.05.
RESULTS: The result shows that independent t‑test showed that there was not a significant difference 
between the mean total scores of nurses’ knowledge before intervention in the two groups (P > 0/05). 
Furthermore, the results of paired t‑test showed a significant difference in the knowledge score 
2 weeks after compared to before the education in both the groups (P < 0.005). In addition, the 
results of independent t‑test showed a significant difference in the knowledge score 2 weeks after 
the intervention in the two groups (P < 0.005). The average knowledge score in the workshop group 
was significantly higher than in noninteractive multimedia learning group.
CONCLUSION: According to the result, new educational techniques such as noninteractive 
multimedia learning and workshop could improve knowledge of nurses about CVA nursing care in 
the emergency department.

Abstract BACKGROUND: Coronavirus pandemic puts healthcare workers (HCWs) at high risk and challenges 
the abilities of healthcare systems to respond to the crisis. This study aimed to assess the level of 
knowledge of HCWs and associated factors in West Guji zone public health facilities in southern 
Ethiopia.
MATERIALS AND METHODS: A health facility‑based quantitative cross‑sectional study was 
undertaken from June 10 to July 10, 2020. Two hundred and eighty‑three HCWs were involved in 
the study using a systematic sampling method. The instrument was pretested on 5% of the sample 
in Yabello Hospital. Data were analyzed using bivariate and multivariate logistic regression.
RESULTS: The HCW who had good knowledge was 84.7%. HCWs who had degree holders, 
masters and above holders, work experience of 2–4 years, and >4 years of experiences, had 
training on Coronavirus, and medical diseases were significantly associated with good knowledge 
of Coronavirus.
CONCLUSIONS: This study indicated that HCWs’ knowledge about the Coronavirus was good. 
Improving the educational status of HCWs and giving updated training on the Coronavirus will improve 
HCW’s knowledge of the Coronavirus.

Abstract BACKGROUND: The use of personal protective equipment (especially face masks) has increased in
different communities amid the COVID‑19 pandemic. Therefore, the present study aimed to assess
knowledge and performance of Iranian general population in wearing face masks.
MATERIALS AND METHODS: The present study is a cross‑sectional study conducted using a valid
and reliable questionnaire on 1843 eligible individuals. The questionnaires were shared by Link (www.
porsall.com) in groups and social networks. Data were analyzed using SPSS (Version 24.0, SPSS
Inc., Chicago, IL).
RESULTS: The mean age of the participants was 42.84 years (standard deviation: 16.84). The
majority had inadequate and low knowledge of masks (69.2%), nearly 30% had moderate (30.1%),
and few had adequate and high knowledge of masks. The individuals’ knowledge on when to wear
a mask was also assessed and the results showed poor and low in 42.2%, 46.9% moderate and
high performance in 10.7%. The participants’ performance on how to properly wear a mask was also
assessed and 12% showed poor, 69.3% showed moderate, and 18.7% showed high performance.
Safe removal of masks was also assessed, and the results showed 52% low and poor, 27.6%
moderate, and 20.3% high performance. A significant and direct correlation was found between the
overall score knowledge and performance regarding use of masks (P < 0.001).
CONCLUSION: The results showed poor to moderate knowledge and performance of majority of
Iranian general population regarding the masks. Therefore, further effective training courses and
action plans are needed in Iran given the importance of masks for the prevention of COVID‑19,
especially in public places. Educational package about how to use the mask and its benefits, through
the media and health centers is recommended.

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: The 2019-novel coronavirus (2019-nCoV) started as an epidemic later
transformed into a pandemic causing a threat to public health globally.  Any community to fight
the COVID-19 pandemic requires adequate knowledge, attitude of the people, and practice of the
government-imposed laws and regulations. Based on these factors, we framed the objectives to
find the sociodemographic profile of the study group and to assess their knowledge, attitude, and
practice (KAP) toward COVID-19. These results will help the health planners and administrators in
each state to find out the gap in health education efforts.
MATERIALS AND METHODS: A descriptive, cross-sectional study was conducted on South
Indian population to know KAP toward COVID-19. A convenient sampling technique was used to
collect the data using Google forms, and analysis was done using the SPSS software version 21.
The questionnaire includes sociodemographic information, KAP questions toward COVID-19, and
perception toward national and community responses.
RESULTS: A total of 1644 were participated; the average knowledge score was 17.5 (+1.9).
Most of them (92.9%) respondent’s perceived that early detection will have a better outcome from
COVID-19, whereas the knowledge compared with practice, there is a significant difference Pearson
correlation (0.404) P is < 0.001.
CONCLUSIONS: Although a high level of knowledge on COVID-19 in the public gradually decreasing
the practice of preventive measures, the government should continue the consistent efforts to change
the behavioral communication and motivate the public social responsibility to adhere to the health
protocols, masking, hand hygiene, social distancing, and vaccination to prevent expected COVID-19
subsequent episodes.