Journal of Education and Health Promotion

Abstract BACKGROUND: The cancer is uncontrolled growth and spread of cells that affect almost all parts of
the body. One of the most prevalent cancers in the female genital system is cervical cancer. The aim
of present study was to determine the effect of educational intervention using the Precaution Adoption
Process Model (PAPM) on cervical cancer screening behavior (Pap smear test) among women.
MATERIALS AND METHODS: In this interventional study that was done in Karaj health centers (2016),
women (aged 15‑49 years) were in the third stage of behavior change process based on PAPM
randomly assigned to experimental and control groups. The data collection tool was a PAPM‑based
questionnaire whose validity and reliability were confirmed. Gathered data were analyzed using
statistical software SPSS 16 and statistical tests (t‑test, repeated measures analysis of variance,
and Wilcoxon, Chi‑squared, Fisher’s exact, and Mann‑Whitney tests).
RESULTS: The result showed that the stages of the decision‑making process between the two groups
were significantly different at the time immediately and 2 months after the intervention (P > 0.001). Also
the results of the intervention based on the health belief model health belief model (HBM) components,
regarding variables of knowledge, perceived susceptibility, perceived benefits, perceived barriers,
and subjective norms, the mean scores in the experimental group were significantly different between
the three sections before, immediately, and 2 months after the intervention (P > 0.001).
CONCLUSIONS: This study provides hints how persons could be influenced to move from the
“Deciding about action” positions into to the stages of decided to act, adoption, and maintenance
for promoting cervical cancer screening behavior.

Abstract BACKGROUND: Asymptomatic bacteriuria (ASB) is commonly seen during pregnancy due to the
various morphological, hormonal, and physiological changes the body undergoes. If left undiagnosed,
it can lead to conditions such as pyelonephritis and preterm delivery which could culminate in causing
maternal and fetal morbidity and mortality. Therefore, this study aims to determine the prevalence,
risk factors, microbial profile, and antibiotic susceptibility patterns associated with ASB in a tertiary
healthcare center.
MATERIALS AND METHODS: A cross‑sectional study was carried out where 150 urine samples
were obtained from pregnant women within the gestational age of 13–36 weeks. Randomized
stratified sampling was the method of sampling used. A questionnaire was also administered to
them to determine potential risk factors. The samples were cultured and identified using biochemical
tests. Antibiotic susceptibility tests were carried out by Kirby–Bauer disc diffusion method. Statistical
analysis was carried out using Chi‑square test. The graphs and tables were generated using Microsoft
Excel and Word.
RESULTS: Out of the 150 samples that were obtained, 8 samples had significant bacteriuria which
is a prevalence of 5.33%. Escherichia coli was the most frequently isolated organism accounting
to 45% of the isolates. The other organisms that were isolated were Enterococcus, Klebsiella
pneumoniae, Coagulase negative staphylococcus (CONS), Candida albicans, and Group B
Streptococcus which measured to 11% of the total distribution each. In the antibiotic sensitivity
tests, among the gram‑negative isolates, marked resistance to Ampicillin and Amoxycillin along with
sensitivity to Cotrimoxazole and Nitrofurantoin. Of the gram‑positive isolates, there was sensitivity
to Ampicillin and Nitrofurantoin. A positive correlation was seen between the age groups of 23–27
and the prevalence of ASB.
CONCLUSION: The prevalence of ASB in this study shows that ASB is not uncommon in the
population. Despite the World Health Organization (WHO) guidelines and National Health Mission
recommendations to make urine check‑ups a routine, it not carried out, possibly due to cost
implications. However, it poses a risk for severe maternal and fetal outcomes and hence, should be
screened for on a regular basis. Thus, this study emphasizes the importance of screening pregnant
women for ASB for promoting better maternal and fetal health.

Abstract BACKGROUND: One way to reduce the burden of early detection of COVID‑19 disease is in
vulnerable and high‑risk groups. The aim of this study was to diagnose and evaluate the disease in
the homeless in Southern Iran Bandar Abbas.
MATERIALS AND METHODS: The target group of this study was 234 homeless people. Census
sampling included all homeless residents of Isin camp Bandar Abbas. People were individually
examined, and their information was recorded. COVID‑19 sampling was done for all as outpatients
this year.
RESULTS: Eight percent of people were able to answer the questions of awareness about symptoms,
ways of transmission, and ways of prevention of COVID‑19 disease. Nine percent of the homeless
people in the target group stated that they used to wash their hands before settling in the camp. Six
percent of homeless people stated that they used face masks before settling in the camp. Fifteen
participants showed similar symptoms to COVID‑19, yet their test result was negative. However, six
people who were asymptomatic ended up afflicted. The mean duration of time (since the emergence
of symptoms to the sampling date) was 3 days. The minimum duration of time from the emergence
of symptoms to the sampling date was 3 h, and the maximum time was 7 days.
CONCLUSION: Considering the spread of the disease, certain social measures need to be taken in
society to help take care of these people and transfer them from streets to safe places and provide for
their essentials. Diagnostic tests should be done periodically among these people at regular intervals.

Abstract INTRODUCTION: It is universally acknowledged that strengthen the participation rate in breast
cancer (BC) screening can find cancer in its earlier stages. The aim of this study was to determine the
effect of regular visits to the health centers on women’s knowledge and attitude about BC screening.
MATERIALS AND METHODS: In a cross‑sectional study, data were collected from 380 women
identified with Kurdish background, who were registered in health care centers of Islamabad‑e Gharb
during January and February 2017. The subjects were divided into two regular and irregular groups
based on the quantity of presence in health centers. Data on women’s awareness and attitude about
BC screening were collected by a trained interviewer using a structured questionnaire. Bivariate
analysis, analysis of variance, and independent sample t‑test were used to see the mean differences
within the groups. The level of confidence was set at 0.05 significant.
RESULTS: Women were representative of four health‑care centers of the city, mainly ≤39 years
old  (73.9%), married  (96.3%), with high school education  (44.2%) characteristics. The total
mean  ±  standard deviation of awareness score about BC was 6.03  ±  3.90. In total, 19.2% of
participants had poor  (<2.13), 64.2% had an average  (2.13–9.93), and 16.6% had good  (˃9.93)
awareness about BC. The results showed that the level of knowledge and attitude about BC screening
was significantly different between regular and irregular groups (P < 0.05).
CONCLUSION: An important message from this study is the need for improved and coordinated
BC education for all social classes of women. It is necessary to discover ways to encourage women
with academic education to visit health centers regularly during interventional studies.

Abstract BACKGROUND: Breast cancer is the most common type of cancer among women. Mammography
is the most sensitive and important method for screening and early diagnosis of breast cancer.
Considering the importance of using mammography in breast cancer screening, this study was
performed to evaluate mammographic determinants.
MATERIALS AND METHODS: In the cross‑sectional study, we surveyed 985 women over 40 years in
Tehran concerning demographic characteristics: age, socioeconomic status, a problem in the breast,
alcohol use, drug use, and health belief model. Logistic regression was used to identify determinant
factors associated with mammography performance.
RESULTS: The results of this study showed that 42.1% (95% confidence interval [CI]: 38, 45)
participant performed mammography at least once during their lifetime. Age (odds ratio [OR] = 4.252;
95% CI = 2.041–8.857); housing situation (OR = 1.706; 95% CI = 1.178–2.469); having breast
problems (OR = 5.224; 95% CI = 3.501–7.795); socioeconomic status (OR = 1.855; 95%
CI = 1.035–3.325); family income level (OR = 1.998; 95% CI = 1.028–3.884); alcohol
consumption (OR = 2.676; 95% CI = 1.344–5.328); smoking (OR = 2.824; 95% CI = 1.418–5.623);
self‑efficacy (OR = 1.935; 95% CI = 1.242–3.015); perceived barriers (OR = 2.017; 95%
CI = 1.348–3.019); self‑care (OR = 4.901; 95% CI = 3.152–7.620); perceived susceptibility (OR = 1.971;
95% CI = 1.271–3.057) and perceived severity (OR = 1.830; 95% CI = 1.170–2.860) were
mammography behaviors determinants.
CONCLUSION: The findings indicated that the rate of mammography screening among Tehranian
women is low and highlights the need for developing a comprehensive national breast cancer control
program, which should be considered as the priority for health‑care providers. Furthermore, the
identification of these factors can help to design an appropriate educational intervention that focuses
on the benefits of mammography screening.

Abstract BACKGROUND: Breast cancer is a preventable disease, using three secondary preventive methods
of mammography, clinical breast examination (CBE), and breast self‑examination (BSE) that can
lead to early detection of breast cancer. This study was designed to assess breast cancer screening
behavior and its associated factors in females employed in South Khorasan.
MATERIALS AND METHODS: In this analytic‑descriptive study, 2256 female personnel of
governmental organizations were investigated in Birjand city in 2016–2017. The data collection tool
was a three‑part questionnaire: sociodemographic characteristics, knowledge about breast cancer
screening methods plus women’s performance, and stage of change regarding screening behaviors
of mammography, CBE, and BSE. The data were analyzed by SPSS 16 and one‑way analysis
variance, Tukey’s post hoc, and multiple logistic regression model statistical tests.
RESULTS: The mean ± standard deviation score of knowledge of the women was 3.45 ± 1.5. There
was a significant difference of the mean score of knowledge between the single and married (P = 0.03)
and age group (P = 0.04). The stage action of mammography, CBE, and BSE was 6.8%, 12.3%,
and 16.8%, respectively. Logistic regression model showed that variables such as age and family
history of breast cancer were highly significant related to mammography and also CBE. Knowledge
was also highly significant in mammography, CBE, and BSE. Education level in CBE, marital status
in BSE and mammography, and job in BSE were also significant (P < 0.001).
CONCLUSIONS: This study reveals insufficient knowledge of female workers about breast cancer
and the negative influence of low knowledge on the practice of breast cancer screening behavior.
Therefore, the establishment and maintenance of regular educational courses for female employees
is essential.

Abstract BACKGROUND: Pregnancy alone is associated with many anxieties and worries for many women.
Prenatal diagnosis of fetal malformations is one of the most important anxious events for women.
Increasing knowledge empowers the person to identify the important issues and by increasing
understanding, creates a positive attitude in people. Therefore, the aim of this study was to investigate
the effect of education on the level of anxiety of pregnant mothers before invasive screening for fetal
abnormalities (amniocentesis).
MATERIALS AND METHODS : This is a quasi‑experimental study with two parallel designs in three
stages: Pretest (before intervention), posttest (after intervention), and after amniocentesis. This study
was performed on 80 pregnant women candidates for amniocentesis (40 pregnant women in the
control group and 40 pregnant women in the intervention group) referred to the perinatology clinic in
Yazd in 2020. Data collection tools were demographic and midwifery questionnaires and Spiel Berger
anxiety questionnaires. In the experimental group, the intervention was performed as group training
for 90 min immediately before amniocentesis. In the control group, only routine procedures (brief
description by a perinatologist during amniocentesis) were performed. SPSS software version 16
was used to analyze the data.
RESULTS: The mean age of the research units was 67/5 ± 5/33 years. The results of Mann–Whitney
intergroup test showed that the mean scores of overt anxiety before the intervention between the
control and intervention groups were not significant (P < 0.014) but were significant after training and
after amniocenter (P < 0.001). Furthermore, the results of Mann–Whitney group test showed that
the mean scores of overt anxiety in the intervention group before and after training were significant
(P < 0.001). Furthermore, the results of the control group showed significant results (P < 0.001). The
results of the independent t‑test showed that the mean scores of latent anxiety before the intervention
between the control and intervention groups were not significant (P < 0.194) but were significant
after the training (P < 0.57) but The results were not significant after amniocentesis (P < 0.216).
Furthermore, the results of paired t‑test within the group showed that the mean scores of overt
anxiety in the intervention group before and after training was significant (P < 0.001). Furthermore,
the results of the control group showed significant results (P < 0.001).
CONCLUSION: The findings of the present study indicate the positive effect of education on anxiety of
pregnant women candidates for amniocentesis. The results also show the important role of education
on the psychological dimension of high‑risk pregnant women in relation to the consequences of
pregnancy and childbirth. According to the research results, it seems that education affects the
cognitive system and information processing by increasing people’s awareness of the amniocentesis
process and its consequences.

Abstract BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in men and the fourth
most common cancer in women in Iran. Therefore, the aim of this study was to determine the effect
of educational intervention based on the theory of planned behavior (TPB) on the improvement of
CRC screening intention among average‑risk individuals.
MATERIALS AND METHODS: This quasi‑experimental study was performed on the 50–69‑year‑old
individuals referred to Asadabad city clinics in 2020. The individuals were randomly assigned to
multistage cluster sampling in each intervention and control group. The instrument used in this
research was a researcher‑made questionnaire based on TPB. Educational intervention was
conducted for the intervention group, one of their family members, and staff of clinic under intervention.
Finally, the data were entered into SPSS and analyzed utilizing descriptive and analytical statistics.
Results were considered significantly <0.05.
RESULTS: There were no significant differences between two intervention and control groups in the
preintervention phase in terms of the mean scores of attitude (P = 0.58), subjective norms (P = 0.59),
and behavioral intention (P = 0.66). However, in the postintervention phase, these differences were
significant. Furthermore, regarding the mean score of perceived behavioral control, there was a
significant difference between the two groups in the preintervention phase (P < 0.02), while in the
postintervention phase, this difference was not significant (P = 0.29).
CONCLUSION: Educational intervention based on the TPB has been effective in improving the CRC
screening intention among average‑risk individuals. Therefore, using the results of this research
and developing appropriate educational programs at the community level can be increased the
participation of community members in CRC screening programs.

Abstract BACKGROUND: Cancer cervix is caused by human papillomavirus (HPV), oncogenic virus and has
vaccines and screening as its preventive measures. This study analyzes the change in awareness
and attitudes of nonmedical students toward the condition following the use of an educational module.
METHODOLOGY: The study design was quasi‑experimental. The interprofessional (IP) team
implemented an educational module and analyzed the difference in awareness of young individuals
toward the cancer cervix. A pretest and posttest written questionnaire, customized for both genders,
was administered with the intervention of the educational module in between. The module consisted
of a short educational presentation along with a group activity. A follow‑up survey was also done after
2 months to check the attrition of awareness. The statistical analysis was done using MacNemar test
using SPSS 12 IBM software and significance of differences were determined.
RESULTS: There was a significant improvement of knowledge and awareness on linkage between
HPV and cervical cancer (P < 0.001). There was also significant change with regard to attitudes
toward cervical cancer vaccination (P = 0.004). The knowledge of HPV linkage to the malignancy
was maintained after 2 months of gap. The subjects also wished for more future awareness program.
CONCLUSIONS: There is improved awareness in the dental and foundation in science students,
and this improved awareness will ensure favorable attitudes toward cervical cancer vaccines or
will attend regular screening programs. Awareness program must be held at regular intervals at
different locations to enhance the knowledge dissemination of this common yet preventable genital
malignancy of females. The IP collaboration and practices will help in reducing the disease burden
of the society in future.

Abstract BACKGROUND: With an estimation of every two women newly diagnosed with breast cancer,
one dies. It is accounted that 1 in 28 women is likely to develop breast cancer during her lifetime.
Developing a risk prediction tool by assessing the prevalence of known risk factors in the community
will help public health intervention.
METHODOLOGY: A cross‑sectional study was conducted among 18–64‑year‑old women to gather
the prevalence of known breast cancer risk factors, through a community survey (sample survey). In
this multistage random number‑based cluster sampling study, the results were compiled, collated, and
analyzed in rates and proportions. Statistical conclusions were made using spreadsheets (Microsoft)
and the values were converted into ordinal values using modified Likert scale and median was used
to estimate central values. The estimated prevalence of these known risk factors was re‑assorted for
analysis and these re‑assorted data were categorized into range of values across the communities.
The internal validity of the survey questionnaire was measured using Cronbach’s alpha (α).
RESULTS: The analysis of 558 participants was performed for the known risk factors for breast cancer
including participant’s age, age at menarche, marriage, first childbirth, menopause, family history of
breast cancer and benign breast disease, history of abortion, and body mass index. Based on the
estimated prevalence of these risk factors, a community‑based risk prediction tool was developed
with Cronbach’s α score of medium internal validity.
CONCLUSIONS: The risk assessment tool has collated most of the risk factors of breast cancer
that are capable of being measured at community level. The survey findings concluded that the
community under survey was bearing moderate risk for breast cancer for women.

Abstract BACKGROUND: Patients with cancer often delay seeking medical advice in developing
countries. In India, only 20%–30% of cancers are being diagnosed in Stages I and II.
Screening for red flag symptoms of cancer can be used to identify high‑risk individuals in the
community.
METHODOLOGY: A community‑based cross‑sectional study was conducted in February 2017
among 302 participants in one of the service areas of Jawaharlal Institute of Postgraduate Medical
Education and Research urban health center selected by universal sampling. Data on the presence
of red flag symptoms of cancer (persistent cough, persistent change in bowel/bladder habits,
nonhealing ulcer, persistent difficulty in swallowing, unexplained weight loss, unexplained lump,
persistent unexplained pain, unexplained bleeding, and change in the appearance of mole) and
presence of risk factors were collected through interviews. The collected data were entered using
EpiData version 3.0.
RESULTS: The mean (standard deviation) age of the study participants was 44 (11) years and 50.6%
of them were male. At least one red flag symptom of cancer was present in 22 (7.3%) individuals;
9 (2.8%) had unexplained pain, 4 (1.3%) had change in bowel habits, 4 (1.3%) had change in bladder
habits, 3 (1%) had cough, 3 (1%) had nonhealing ulcer, 2 (0.6%) had unexplained bleeding, 1 (0.3%)
had difficulty in swallowing, 1 (0.3%) had weight loss, 1 (0.3%) had lump, and 1 (0.3%) had change
in the appearance of mole.
CONCLUSION: Screening for red flag symptoms of cancer is an easy tool that can be used in the community
to identify high‑risk individuals, which will facilitate early diagnosis of cancer.

Abstract Background: Congenital hypothyroidism and phenylketonuria (PKU) are the most common
cause for preventable mental retardation in infants worldwide. Timely diagnosis and treatment
of these disorders can have lasting effects on the mental development of newborns. However,
there are several problems at different stages of screening programs that along with imposing
heavy costs can reduce the precision of the screening, increasing the chance of undiagnosed
cases which in turn can have damaging consequences for the society. Therefore, given these
problems and the importance of information systems in facilitating the management and
improving the quality of health care the aim of this study was to improve the screening process
of hypothyroidism and PKU in infants with the help of electronic resources. Methods: The
current study is a qualitative, action research designed to improve the quality of screening,
services, performance, implementation effectiveness, and management of hypothyroidism and
PKU screening program in Isfahan province. To this end, web‑based software was designed.
Programming was carried out using Delphi.net software and used SQL Server 2008 for database
management. Findings: Given the weaknesses, problems, and limitations of hypothyroidism
and PKU screening program, and the importance of these diseases in a national scale, this
study resulted in design of hypothyroidism and PKU screening software for infants in Isfahan
province. The inputs and outputs of the software were designed in three levels including
Health Care Centers in charge of the screening program, provincial reference lab, and health
and treatment network of Isfahan province. Immediate registration of sample data at the time
and location of sampling, providing the provincial reference Laboratory and Health Centers of
different eparchies with the ability to instantly observe, monitor, and follow‑up on the samples
at any moment, online verification of samples by reference lab, creating a daily schedule for
reference lab, and receiving of the results from analysis equipment; and entering the results
into the database without the need for user input are among the features of this software.
Conclusion: The implementation of hypothyroidism screening software led to an increase in
the quality and efficiency of the screening program; minimized the risk of human error in the
process and solved many of the previous limitations of the screening program which were
the main goals for implementation of this software. The implementation of this software also
resulted in improvement in precision and quality of services provided for these two diseases
and better accuracy and precision for data
inputs by providing the possibility of entering
the sample data at the place and time of
sampling which then resulted in the possibilityof management based on precise data and also helped develop a comprehensive database
and improved the satisfaction of service recipients.